Good afternoon everyone. Happy Thursday. We're just afternoon. So I said good afternoon
I hope you have a good lunch. I'm Andy Josephson from House District 13 and
I am the sponsor of today's lunch and learn with the good folks from
Volunteers of America. This is Julia Louie. She's the director executive director of
VOA and I've been working with her for
Several years, but but a couple successful years
on expansion of the state's participation in the Continuum of Care grant.
And my memory of this is not what it was a year ago, but
I know that it allows you to have on-site psychiatric providers.
And we are thankful to the Governor for twice really allowing these funds to go through.
And with that, I'm going to go ahead and turn it over to Julia and she can introduce her folks.
Hi, good afternoon, everyone.
Again, my name is Julia Louie, and I serve as the president and CEO of VOA Alaska.
And I am joined by one of my team members, Alyssa Bish.
She's up here helping run the tech.
And then we were here a couple of years ago.
We facilitated a lunch and learned, but this one is super, super special because we have
one the youth that we serve that went through our programs.
And so you'll hear directly from Brianna, who's also joined us here today.
So thank you so much for coming.
to be here with you all.
So, VOA Alaska, yes, we are volunteers of America.
Our organization is a national entity.
Started 125 years ago back when volunteer
meant to serve as a vocation.
We are not volunteers.
We're a collective group of professionals
who provide behavioral health services
to youth, young people, and their families.
We have a mission to empower Alaskans and uplift the human spirit and help them realize their
potential and stand and walk alongside them every step of the way. We
have our mission, our vision, and our core values, but really why we exist is to eliminate the
suffering that so many of our young people experience that has been exacerbated by substance use and
mental health challenges.
So, we have here a map that shares a little bit about who we serve.
We are primarily based in Anchorage, but several of our programs have a statewide reach, and
so you'll see here 91% in South Central Alaska, kind of two to three percent in other regions
of the state.
And you can see just who you served, how many services that we provided.
to youth, young people with treatment services.
you'll see that only 417 assessments were completed.
And so someone might ask, why is that?
Why did you only provide assessments?
That's usually kind of the indicator
to get someone into care.
And that is because the state with their 1115 waiver service,
they create a service called home-based family treatment.
A VOA, we kind call that early intervention
because it's an opportunity to support youth in families
without that formal assessment
and that very long process
intervention services to kids before a more severe problem exists and so I
love to point that out because that is a really beautiful evolution of the
behavioral health system of care here in Alaska.
Here we have our continuum of care.
We strongly believe in providing the right level of
care at the time for the young people that we serve.
Most people really know us for
the residential program that
we provide and that you will see
on the higher side of the continuum.
But over on the earlier side, we provide coalition, statewide coalitions to eliminate
suicide and substance use.
We also provide prevention and education.
We provide a class called Own Your Path to usually high school students who have had
some type of substance-use infraction.
And so providing early intervention to support kids before maybe that problem continues to
escalate.
And then our level of services and intensity kind of go up from there.
And so we have a school-based mental health program.
We're in 13 schools across the school district,
providing integrated mental-health services to students.
We provide outpatient, intensive outpatient and
then partial hospitalization program
So that includes anywhere from one hour a week, all the way to 40 hours a
week. It really depends on the level of need and severity of the young person
that we're serving. The partial hospitalization program for kids, it's called
day treatment. And this has been a critical piece of behavioral health
system that, we did not have here in Alaska before the 1115 waiver, and it
has that missing puzzle piece that since we've been able to integrate it.
has really improved our ability to support kids where they are
before placement into a residential setting, but also supports kids coming out of a
residential settings so that they can continue with their school
and their support network and then once they move into lower level of care
then they're ready to go back into their homeschool and so
it just helps provide some continuity of
care as kids are moving through those various stages.
We used to call it reality whiplash like kids would go through our residential
well and then they leave and that support system is not there like it was the day
before and so that day treatment model really is and has been a critical piece.
Our residential program that we'll talk the most about today is just the heart and soul of VOA.
It has been in operation for over 40 years, and this program is the only substance use treatment facility serving youth across Alaska.
We provide integrated psychiatric, mental health and substance-use services.
And this is where we see the most youth from all across the state engage in this program
in addition to our kinship, family care, or family services program.
And I would say our outpatient telehealth program too.
Our rapid response program is relatively new.
Well, maybe not so new anymore, but we developed this program when we started to see some of the
challenges coming with COVID and we just wanted to be available and accessible to families and
young people who might be struggling. And so this is similar to kind of a kind
of warm line if people are struggling and not sure where to go or what to do or how to
do the paperwork. VOA will help you navigate those steps every step of
So, I wanted to share a little bit and not kind of drown you in statistics, but I think
it's important to recognize just how...
Just the the climate of youth mental health here in Alaska, and I will say to you that we knew
Before COVID that needs of you experiencing mental-health challenges
Was increasing, but then it was like covid kind of put pedal on the metal and it has been steady ever since
We, the way Alaska has expanded by 300% over the last five years out of a direct response
to the increased mental health and substance use needs that we were seeing.
One of the things I wanted to highlight here is the YRBS data that you see 19% of students,
Alaska students reporting attempting suicide in the past year.
When I first read that, I thought it had to be a mistake.
Maybe they felt hopelessness or a sense of sadness for an extended period of time.
And no, this was 19 percent of Alaska's students about one in five kids.
who are reporting that they attempted suicide.
And this is from a survey where students themselves
are filling it out.
And so I sometimes think when you get those kinds of surveys,
you're getting a little bit more sense of the truth
of what's really going on in a young person's life.
And that really highlights the reality
of where we're up against here in Alaska
and the need that we have facing us.
We have seen this arrive at our doorstep, especially in our residential program,
because oftentimes across the state of Alaska, we don't have the most appropriate
or accessible community-based services across this state in every region.
And so when you don t have outpatient, an intensive outpatient or partial hospitalization,
if you do not have those community based services, then an emergency arises and you are going into the hospital.
You're going into a higher level of care and then those systems are incredibly overwhelmed
and we're not sure where to send them.
And we saw that at Arch 2 and kids showing up on our doorstep actively suicidal or going
through intense severe overdose symptoms.
This is another slide that I wanted to highlight that the systems are working the best that
they can.
We know that children who are discharged from psychiatric hospitalization, that 74% did
not receive a follow-up mental health visit within seven days, and 56% didn't receive
And the limitations that we have, one, with crisis triage and support for kids who are
experiencing that crisis, but also just the limitation that
we had in community-based services where kids live.
Children in office of children services, we
have one in four children in OCS custody who did not have their behavioral health needs
And then 25% of children's behavioral health needs are not being met,
just underscoring the lack of, again, adequate community-based accessible services.
Oftentimes we hear of extensive wait lists or it's challenging to get in with insurance
and co-pays and the list goes on and on.
One of the things, it's back up one more slide,
one of things that I always like to reinforce
when I talk about behavioral health,
especially for youth services is, in my opinion,
I do believe that behavioral hall services
is the safety net where a lot of kids
who fall through the cracks of overburden systems fall.
And so we have OCS, we
have hospitals,
we
have overburden schools.
And we also have family
systems that are really
struggling to sometimes
provide adequate support
and healthy living
environment for kids to
excel in.
And that behavioral
health system is the safety
net, but those of us who are
providing youth services
in the behavioral health
A part of being an adolescent youth provider and a provider who provides residential services,
I wanted to take the opportunity to highlight one very significant challenge and that is
how we are reimbursed for the level of care that we offer.
And so, just this week, there have been conversations here at the Capitol about Medicaid rates
and the re-basement effort that is going on, which is overdue and well-needed, and we are
super, super grateful for the opportunity and conversations that are being had at this
level.
And our residential program previously only build an ASAM 3.5 program.
And you can see at the adult level, it's a little bit lower than the adolescent.
But with the new proposed rates,
it is being proposed to decrease those rates a bit.
And then you'll see the ASam 3 .7 rate is the same as adolescents.
And I would say that whenever you see a rate that is exactly the same for an adolescent
as it is for adult, that's a red flag.
For adolescent services, especially in residential settings, we have twice as much staff that
we operate that program.
We're required to provide education and safe staffing ratios, and it's is a completely
And the reason why we're kind of lumped into this is because the substance use kind
of side of the house within behavioral health, it was developed through the lens
of adult services.
And so there's an opportunity to continue evolving our system to be inclusive of
the youth who struggle with substance abuse and co-occurring mental health
challenges.
I wanted to share a couple of years ago, VOA Alaska was only providing that ASAM 3.5 level of care.
and we came to the legislature sounding the alarms and saying we are going to have to close our
doors if we don't get any help here and so I have been so appreciative of Representative Josephson's
advocacy and just being a nice friend kind of through that turmoil and recognized just the dire
need that we had to get some funding in the door and increase safety and help us integrate a new
And we were successful in that and it was a catalyst for incredible change and not only
kept the doors open to arch, but it also helped improve outcomes with us integrating a new
level of care in.
that ASAM 3.7 and bringing in in-house psychiatrists.
We now have two psychiatrists,
increased nursing staff,
and then some much-needed facility renovations
that you guys will see a little video of.
And so this session we really wanted to come through
and say thank you for your support
and for investing in youth
and seeing the potential that they have
by supporting systems that serve them.
So we have a littl video.
to share. We'll move into that.
It felt like my first home ever. Like with the staff, they feel very much
welcoming and inviting. And then just having a bunch of kids around makes it feel almost like
a family in a way. That's what I'd say artists to me. It's just a place for change.
Arch is a residential treatment facility for youth with co-occurring disorders, so substance use and mental health concerns.
It's a place where we encourage them to heal and to be in their safety.
It's a three to six month long program for a 13 year olds through 18 year old's.
We take up to 18 kids at a time and we have about 35 staff members to support them.
Yes, it's the treatment center and it is a professional service that we provide youth,
but it.
It's their home and oftentimes the behavioral health system, especially
residential treatment centers, are capturing kids that are falling through
different gaps, whether that's within their family systems or
OCS or Division of Juvenile Justice or just when there aren't the right levels
of care for youth, oftentimes residential
treatment centres is that safety net for them
and that is an honour for us to be a part of that process with them.
I think the acuity of who we're seeing come into our door nowadays is a lot more
intense in their substance use and using substances like vetinol that are fatal paired with
really intense mental health symptoms and challenges, struggling with self-harm behavior,
suicidal ideation, suicide attempts.
That acuity level has been a huge change and a
huge shift that we've seen coming through our doors in the last couple of years especially.
ARCH recently advanced from a level 3.5 to a
level three point seven residential treatment facility,
meaning it can now serve youth with more acute needs,
including those experiencing withdrawal, thanks to
on-site nursing and daily psychiatric care.
It allows us to bring a more
acute patient.
into ARGE because we have a lot more support, being a psychiatrist every day,
being nursing, and peer support too. So we
have alot more resources to support the children as they're transitioning in.
My mom and my aunt were both addicts.
They were like my parents, alcohol, drugs,
all kinds of stuff.
They always fought in front of me.
It was like every night.
My mama died when I was 14.
And it was just how life was.
I basically was...
Sleep, do drugs, sleep,
do drugs.
And then I came to arch and I learned just how much things
it started to affect me.
But I was able to make that turn around.
When I got to Arch, just kind of realizing my potential
and realizing who I am as a person
and that my past and define what my future could look like.
And I knew that I had to
make a difference.
and it had to stop work with me.
Her potential is absolutely limitless,
and her ability to really own this role of youth advocate
has been so inspiring.
We just got back from DC, she went to DC with
me and a couple of my colleagues,
and just seeing her own that space,
Senator Sullivan, Senator Murkowski,
everybody can be efficient and do their job comfortably as my goal and in the
process of achieving my goals receive grants to make the building more
efficient our main highlight would be our basketball court which is just
completely awesome.
Rich is the only non-tribal residential treatment center operating in
the state of Alaska right now and five years ago that wasn't the case there was
So, ARCH today would not have its doors open if it wasn't for our individual donors, corporate
donors major funding partners. There are so many partners that have walked alongside us in this
journey recognizing the disparity in rates and the lack of grant funding supporting this population.
and came through, and not just came
through to maintain, but helped us
really enhance to make sure that this
is a level of care that's going to
have the greatest impact.
Honestly, you can't put a price on
stuff like this.
The Alaskan saying of it takes a village
to raise a child, like, is very,
like is, very true. Every single kid
I've seen come through this program
could have used more,
you know,
and we're always thinking about
better ways to serve them,
you now,
and if anybody deserves it, it's them.
hard video to follow. But I wanted to just share a little bit more data as far as what
we're seeing from that investment. We are seeing quicker access to psychiatric and medical
care through the integration of the ACM 3.7 services, but we are also seeing a reduction
And so I just I want to share this to say when we come together in a common
purpose and a line on a strategy to support kids this is us helping you know
save lives earlier on and so that they don't continue suffering later in life
initiative that says when we come together and fight for our kids and prioritize them,
we can make that difference together.
And so I thank you for supporting the appropriation and for all of our funding partners who showed
up to walk this journey with us.
You will hear directly from Miss Brie and like I shared a little bit earlier we have grown
exponentially over the last couple of years but has really always maintained as our north star
at our organizations just this mutual belief that we all have and the limitless potential of those
that serve and so we are incredibly honored to be able to continue supporting kids after they
and advocate for systems change and so you heard from Zoe on the video she went
with to DC with me and I'm super excited for you all to hear it directly from
Brianna either or this is a little bit about like my story, you know, and
Shawn kind of just give you all a glimpse of like what has brought me to this point in my life
that I'm able to come on this amazing trip and really just help make a difference
for the organization that helped me make my lives successful.
When I was born my father was a dealer and my mom was
a prostitute.
They were broke, my dad got sent to jail
almost as soon as I were born.
My mom, she didn't have money,
and the money that she did have,
she spent it on drugs.
So I starved a lot as a kid.
not because they like hated me or like was trying to left me it's just like I was a newborn and
she couldn't like breastfeed and formula is expensive so I
was starved a lot um and ocs took me from her uh and then she kidnapped me essentially
because she didn't want the state to take me. She loved me dearly, she did what she could,
she just wasn't set to be a mom. So it was about a week that she took me on the hiatus,
I was starved, I wasn t like she had diapers or anything, so like I
wasn s just really neglected. And so after like,
like newborn, after she got found she fled to Texas and she was found dead in a hotel
room naked October 2016.
So I never got to have her in my life and my dad was still in jail so when I was three
my mom's parents wouldn't take me.
So that's kind of where I lived.
They fed me, it's amazing.
Like I am so thankful that I was able
to get out of the system.
Cause I wasn't in there for a long time.
I'm very fortunate and I've been able
to have like a healthy, loving home.
During COVID.
my grandpa. He was basically my only father figure. I mean, he raised me, you know.
He diagnosed with cancer. It was in his spine and it was like going all through his body.
And that was my father, like that's the only dad figure I had growing up really. So watching
knowing that he was dying and not being able to say goodbye at all because it was
COVID and they wouldn't let kids into the hospitals or anything. I never got to
see like my dad's last moments and I was super like I've never been good at
was not rational and when I could notice the signs that he was getting more sick,
I distanced myself from him so that it would not impact me as much when he died
because it was my way of keeping myself safe, which was really selfish because...
Apparently, when he's on my deathbed, he told my grandma that he thought I didn't love him
because of how much I distanced myself, and that is a guilt that I carried this day because
I was selfish. I'm a selfish a lot. When I wasn't at it, I think, um,
anyone I didn't know how to handle my emotions cuz living with like just my
grandma at the time now um the age gap she didn t know really how
She was grieving of like her husband's loss,
who she was married to for 50 years.
And I was screaming loss in my father.
So it was just a really dark time in that house.
And instead of being there and showing up
for my grandma, who is going through it,
I went to drug use.
I fell deep into a bad friend group.
I'm hanging out with.
people who were way older than me in horrible influences.
And I was getting into a lot of high risk behaviors,
because it was my way of coping.
It was not dealing with reality.
And the more I used, the the better I fell in love,
which is like the emptiness of my mind, you know?
It started out with just weed, like any.
Troubled 12-year-old and then I
Started doing as I got older. I lost those friends and I just gained a new friend group of bad influences
We were all struggling together all of my friends like they weren't
My best interest wasn't in mind, you know, because it was basically a friendship surrounded by drug use.
It's the only thing we had in common and the fact that we were all struggling.
But it wasn my sense of community. It was my way of fitting in,
because I also got bullied a lot as a kid, and I was like,
hey, all of these kids, they're misfits just like me,
and this is how they bond, so I'm just going to, plus I like the way the drugs feel,
a sense of belonging. It gave me like a pact to fit in with and then I started
doing like shrooms and got like plenty of bad trips so I was done with that and
Became like a really bad alcoholic. There was this one time where I fell down like my flight of stairs
Which is like 20 stairs and there's it's not carpeted. It's all just hard wood.
There were lots of bruises. I was sent to
Yarn my poor grandma. She thought that I wasn't getting alcohol poisoning. Um, I put my
family through so much hardships because of my selfishness and it's all
just regrets. I landed up in the hospital for unrelated reasons I cut
myself really badly and I had to go get stitches and then it was basically my
If I didn't get help during that time, I would not still be standing here.
I'd have drunkened myself to death just to escape my own issues that I had.
Um, so they kept me for a while and then I went to the CRC program in Providence.
And the counselor there, she was like, yeah, you probably need substance.
help and I didn't I was ready to get out of there and continue using so I
was like yeah probably and then I don't expect that to go anywhere but then
next thing I knew she was, like, you're going to residential at this place called
Arch and i was great I'm gonna live at rehab fun I
was 14 at the time and yeah it was it that's when I finally got my life in
Started working the program. I mean it took me like a month of just suggesting and then I really started to like take in
What they had through the groups there were?
like, a lot of groups it was
One for two hours a day every day and there was it
And then I had therapy sessions, too.
And there was substance use counselors.
They have an amazing clinical team there.
And I really just started to take in the information
that I was getting.
And realized how selfish and how just horrible
all of my actions had affected people around me.
And decided I needed change.
And, I started working the program.
They started a new thing called MRT,
and I was the first person to complete M R T in arch,
and that group really helped me.
And it's half of the reason why I have the ability to stand up
and do this because it taught me a lot about public speaking, too.
It really let me like
Afflecked on why I was doing the things that I
Was and it helped me change them and put in a plan to change
them
um
so
Yeah, I graduated through that um and then after I
started
That's when they started implementing the 3.7.
I was there while they were integrating, and before it, I witnessed a lot of stuff that
happened behind the arch.
Because every kid there was struggling with their own stuff.
And like Julia said, there's a lot of kids
that do have suicidal tendencies.
Nobody died.
There's been no deaths there, trust.
But there I did.
There was an attempt that happened.
And that's when they started implementing more furniture
that would help, like, that make.
all of attempts like not possible in the future and that's when they upped the security cameras
because there was like a fire in
the um washer we think it was just like grease rags that got caught in
the dryer but it's a possibility someone tried to arson so that when
they were like okay we need we needed security
cameras so those got implements and i could just see like
everything changed. It became a much more surveillance thing and kids really started to act in order
and I know that kids were a lot safer. They were always safe but with the anti-legature furniture
it just it was a nice little blanket of safety. And I got to see change happen before I left
there are multiple people that come and go while you are there and just seeing all the
different kids that I got to grow close to and seeing them become more successful,
that inspired me to become successful too. It's a sense of community, it's
a family there, and all this staff with all their encouragement,
A beautiful program and so I want to thank you all for funding such an amazing important thing because it really does change lives and it makes a difference in Alaska.
And yeah that's all I have for you guys today.
All right.
Well, that wraps up our presentation.
And so I want to go ahead and open it up
and see if anyone has any questions.
Juliet, are you relying on the basement to support?
Is that important for the Basement of Medicaid funds
to the program moving forward, or are
you level at this point?
Yeah, so the question is are you relying for the rebasement that's currently happening with the Medicaid program?
We're keeping a close eye on it
One of the slides that I shared before can you go back to it?
Shares the previous rates adult at a lesson and then the proposed rates that guide house the contractor
Is making for those rate rebassments?
And we are concerned that they aren't much different than either the they
aren t much
different
than the adult services when they are similar. It's indicative that the
adolescent uniqueness is not being applied to that specific methodology. We
have been in close contact with deputy commissioner Ricci and the guide
house team about those concerns. They've been receptive to it and we're
hopeful that that will move in the right direction. I think.
The rest of their recommendations, it is moving in the right direction.
But what I'm hopeful for is that, recognizing what a huge need this is in Alaska, that we
show where we want these kids to be going, which is more community-based services, and
beefing those reimbursements up so that more providers come to the table to provide those
levels of care, because right now they don't exist very much across the state.
Other questions for Julie?
Yes.
How much do you work with other organizations,
like, for instance, my house out in Mozilla?
Is that fairly fair lot of crossover, I guess?
Yeah.
The question is, how often do
you partner with the other organization, such as My House?
My house is a close partner.
We are actually planning on expanding into the valley
next year in partnership with them in the new Carson Coddle
building.
close partners there. We also have just the youth serving per divider network is kind
of a small intimate group in Alaska. And so we have close partnerships there, but we
especially with Covenant House in Alaska, we have clinician and staff who who are there. And so
we definitely recognize that we cannot do this alone. Um, and so we partner closely with others
who provide housing or shelters or other services that We might not provide directly, but they're
in need of that behavioral health support for their kiddos. Yes.
I was going to piggyback off that last question. What kind of work and collaboration are you guys
seeing and your own individual success stories and how they might be applied to some of our
rural regions of the state that may have these services being provided under a larger health
Yeah, I don't know if I can repeat that question, but the question is more so how can you kind of
take what's working in more urban areas and extend those and apply those into more rural settings?
I think the what works is having a continuum of care that meets kids and families where
they're at in the healing process. And when you don t have that, that's when they are escalating
to higher levels of the care and then they get stuck there because there's nowhere to send them
My belief is that the way to build those is incentivize them through the rate structure
by paying for it differently than you would for, say, adult services.
So if you take individual psychotherapy, for example, we get reimbursed the same amount as if
it was an adult or an adolescent, that right there would help.
Providers across the state build out their continuum of care for for kiddos because it is more expensive
To provide care to kids than than it. Is the adult population
My opinion
Yes
Thank you so much for sharing your story very remarkable, and I'm so impressed by you
And I just you know wish you all the best whatever you do
My question is, you talked about the continuity of care
and from partial hospitalization to inpatient and what have you.
I wanted to get a little bit more insights as to the family,
you know, integration into whatever kind of step you're at.
You know, how do you integrate the family in there?
Because oftentimes, you know there's chalice
or you're getting support they need,
but then they're going back to the
family dynamic, and there may be issues
that need to address there as well.
So, do we speak then?
Do you want to talk about it?
Okay.
The question is about how to integrate the family into the therapeutic process kind of spread
throughout the continuum of care. And it's our philosophy that we're not just serving the kiddo
who's walking through our doors. If we aren't wrapping around their whole family then...
What are we doing?
And so it is important to wrap around them.
We, a couple of years ago, even expanded our family services programs
so that we could provide individual services to the families that
we serve so we have
you know, a kiddo at arch, well their clinicians are the ones in the building
and they can provide family therapy which is a requirement of the program
and necessary but it's also really important that that adult
seeks their own support and it is important to have some separation
of that too and so we've seen some success by being able to offer
parents their own services and like simultaneously as their kids are going
through their journey as well but I think that is rooted in just philosophy
too. I will say it's really tough and we have some providers who
who are really challenged in working with some families
who might not be super interested in engaging
in the therapeutic process.
And so it's a different skill level to be able to work
with one's family who may not want to engage very much
with you, and you're working
with a kiddo who desperately needs that.
And it is a gift, it has talent,
and really good quality supervision to do that, yeah.
Great question.
Any last minute questions?
I want to thank Julia, Alyssa, and Brianna for being here
and sharing, particularly you, Briana, no offense to you.
No, all her.
For sharing your story and showing such courage.
And we hope you continue down that path.
You all are going to be in town for a day or so.
Are you heading home tonight?
We're heading on tonight.
OK.
Yeah, well, I look forward to meeting with you this afternoon to talk about these funding issues for sure
With that, let's give them a round of applause
Are you encouraging people to take pizza to go? Okay, okay
Great, thank you so much