Senate Children and Youth Committee and House Aging, Children and Youth

Chair sees a quarter if you would take your seats please. Good morning thank you for being here today first thing i'd like to do is just apologize for missing the last meeting. I think you'll excuse me I was at the southern regional education board legislative advisory council meeting yes that's a mouthful as was senator english and so I wasn't just sitting home eat and cookies while you had your meeting too so you know. This morning our first order business is to adopt the september twenty second meeting minutes and I need a motion thank you have a motion in the second thank you. First on our oh i'm sorry although I guess I could let you vote on it all those in favor opposed. Thank you now we have adopted the minutes first on our personnel's list is david cook. The. Good morning if you would identify yourself and who you're with you may begin your report. Thank you madame chair and thank you members my name is david cook on the director of government affairs and public policy at the alzheimer's association today i'd like to just give you an update on the implementation of the ultimate state plan and just give you our annual report that you have in your packets but to to get into that I thought of the level set a little bit just about the nature of our disease what makes all time as unique from other chronic conditions is prevention researches is evolving an evidence is strong that there are some steps we can take to reduce our risk of developing dementia or also one of the things that we we we say the kind of simplify that is what we know is what's good for the heart is also good for the brain diagnosis there's not a single diagnostic test here in arkansas really the process for forgetting a diagnosis positions primarily use cognitive screening but to test for some of the bio markers that exist in also one of the biomarks is amaloy plack you actually need an amaloi pet scan are consoled as not how the amaloid pet scan we have the technology to do a scan like that but we don't have access to the tracer die that's used for that test acquiring that die is a very complicated maze that we're still trying to unpack and figure out some positions here usually refer their patience out to other states like missouri texas and nashville intonacy to receive one of these specialized email boy pet scans if they don't you utilize the petski and physicians have the capability of pulling spinal fluid and testing for the bill marker of amazed which of course is very invasive to the patient treatment or there is no cure for all simers or dimension there are several medications that help manage. The behaviors associated with those diseases but we're still far away from the cure of what we are excited about is that for the first time in twenty years we do have a viable treatment that's out on the market this drug is performed very well and received after approval earlier this year we do have another drug in the pipeline that we expect to receive FDA approval sometime in december and january and those are some things that are very exciting for the research community and also physicians having an extra tool in their tool box to treat their patience and on these drugs have actually showed promise and slowing the progression of emiloy place which is though the place that builds up in the brain that keeps them around from firing and one of the buyer markers of all time was disease I do want to go back to diagnosis there is some encouraging trends in the research community that indicate that we are probably around three years away depending on which research you talk to to being able to detect some of these bio markers with a simple blood test and if we can ever get to that point in the research community that will change to the game in terms of detection and diagnoses but would you like to say that we are in an error treatment because we do have viable treatments and because of that it is imperative that we make sure that there is equitable access to these treatments regardless of the payer type and so that's something that we are working on at the also must association. Of course the burfer syndicates were respect or surrendered system indicates that many other chronic people with credit conditions also have dementia I know individuals with all summers to mention about eighty percent of those also have other co mobilities that are going on my my dad is example of that who has advanced diabetes also has some heart um uh some heart issues as well along with his dementia and there is very limited funding for all simers at the federal level you know there's a you know extra federal funding for cancer and other drug diseases like that but very limited funding in terms of federal kickback funny to the states arkansas was awarded a bull grant the bold act was passed in twenty sixteen and it stands for building our largest dimension infrastructure act and then in twenty twenty two are consultant awarded are sorry twenty twenty one arkansas was awarded a core capacity funding and that funding was used to strengthen our infrastructure to be in respond to the great need that we see here and arkansas as prevalence continues to increase just on prevalence we we know here in arkansas that over fifty eight thousand or cancels over the age of sixty five or currently living with all similars and in two short years we expect that number to climbed over sixty seven thousand there's quite a few variables that are driving prevalence here in the state we also believe because of the other chronic conditions that exist in the state we have high levels of heart disease diabetes and obesity all of those things elevate your risk forward developing dementia and for that reason we think our numbers are conservative and soft um their translates to care givers typically when someone receives an alternatives or dimension diagnosis the care giving duties immediately fall to the family and twenty twenty two we estimated there's a hundred and fifty four thousand of those family care. For fighting here for someone with osimers or dimension they provided an estimated two hundred and sixty eight million hours of unpaid care and the car savings of that care to the status over four point four billion dollars so the impact of family care givers is great. Um we also learned through the birth that in arkansas nearly twelve percent of individuals over the age of forty five are reported self reported that they have begin experiencing confusion or memory loss of that's twelve percent sixty percent of those patients for those surveyed reported that that memory loss has gotten to the point where it's beginning to interfere with their activities of day the living but what's concerning to us is that of that number over half have not discussed this in these memory issues with their providers and what we do know in the space as that providers because of just the patient volume in the limited time they have with their patience and for several other reasons or not initiating these discussions around come to decline impatience or not self advocating for that as well there are some steps that we are taking in partnership with the help department to try to encourage more conversation around early detection and diagnosis and this kind of goes back to the treatments the treatments that are available currently are only viable for people in the very early stages of mile kind of impairment or also and because of that early detection and diagnosis is critical and that's going to take a public health mindset set or mine shift of shift mindset shift that's what I was looking for because typically when we've talked about all times the mention we've only talked about in the context of older populations but research is indicative of that also which can be present twenty years before symptoms you know begin to present itself and with the available treatments were now encouraging younger populations to begin these conversations their physicians i'm i'm forty four and because of my family history you know i'm that's one of the things that I have what my list of. The things to do with so that my position could actually begin an establishment baseline from my cognition and then continue to track it as time passes and so we need to have those conversations earlier rather than later now that we can have treatment options that are available. I'm just kind of thinking about domension care givers and generally over sixty percent of care givers are are women twenty twenty six percent or sixty five and older and emerging trend that we're seeing now is an increase in what we call say much caregivers and those are care givers who are providing care for children who live in the home but also having to provide care for an aging adult or at aging parents and because of that that has a huge impact on our work force people having to make something some cases retire early so they can provide that care so their level and can age in place at the home and there and they're preferred setting what what's also arming is is over forty percent of those households make less than fifty thousand a year annually so the need for intervention and support is great. Just kind of thinking about the impact of family care givers again as I mentioned approx my two thirds or over the age are are women eighty three percent of those that eighty three percent of those that help provide care for over adults that usually comes from family members as I mentioned earlier as well and compare with care givers of people without dimension twice as many gives of those with the mention indicate a emotional financial and physical stream so carrying for individual dimensions specially as that disease progresses the need for more direct interventions as needed which causes not only just you know emotional stress but also physical stress and what we also know is these caregivers because of a time constraints of being a here give her less likely to care for themselves as well which lead to ultimate more medical issues as well. I know when I turn to the also measure advisory council in your reports kind of walk through that these are our coach years of for this year at senator pinzo was appointed to service co chair taking the place to serve a ricky hill who previously held that position because of his obligations and the senate he stepped aside and certainly pinso is our co chair along with representative julie maybe kind of see our state agency partners there and here's a comprehensive list of the other organizations that are around the table the advisory council was established through act three ninety one and twenty twenty one in this advisory council continues to work on updating the also state plan I mentioned before two bodies like this that alzheimer's the ultimate state play arkansas want the first dates in the country to establish a state plan in two thousand eleven but a majority of that state plan went unimplemented on recommendations that did was implemented was a silver alert that's with the so world war came from here in arkansas but we did realize that the state plan a lot has changed since two thousand eleven and the state plan was in direct of an update and so we produced our update to the state player in twenty twenty two. The the categories that the working group and the advisory council focused on where public awareness in an education making sure that providers were educated on the importance of our detection diagnosis a risk reduction but also that consumers were as well about the importance of those things but also the available support services. We also focused on access quality of care making sure that we had the infrastructure needed to care for the silver tsunami that is coming which is one of those things driving prevalence but not just access to care when I make sure there was quality care as well and so we looked at to match a training standard just i'll talk about just a few moments and then also the the council carved out seeing the great need to support our family care givers car got a priority that focused specifically on supporting our family caregivers and then finally just dimension training standards across health care settings to ensure that our providers are equipped with the tools they need to care for the unique needs of individuals with all simers or other forms of dimension on these were not just you know it's not something we just you know through it was a lot stuck these were actually informed by the healthy break initiative which is a project that's been going on for quite some time it's from the cdc and we did that with four site because we knew that the CDC who dictates where bold phones go we're looking for states to have priorities consistent with their priorities and so we modeled our state plan after the cdc to ensure that the state was adequately prepared to receive a federal funding when those speed things became available. During twenty twenty three were quickly just go through the legislator priorities that we implemented all of these were consistent with the recommendations included in the also mistake plan our first legislated piece of legislation was to strengthen our advisory council by adding the arkansas home based services association that home care providers were were under representative on the council so we added them we also added the arkansas residential assisted living association as a members of the council as well one of I think the most critical pieces are legislation that was enacted was establishing a dimension services coordinator within an apartment of human services it's our understanding that that position has been posted and so they're they're actively looking to higher for that position as well DHS was a great partner in crafting and helping us I have support that legislation as well and we certainly appreciate the support from legislative body because that is a critical agency staff personnel that will help again coordinate the government response to all servers to mention but also within the agency making sure that our waivers and support systems are there to help families who are now beginning the challenges of all signers and mention. Um again about the the building support for family caregivers in twenty twenty two uh the legislative body approved a funding for the establishment of an also and dimension respect grant program the great program provides two hundred thousand dollars of funding that is funded through a federal block grant to DHS in this provides dimension care givers with five hundred dollars worth of grants to secure respite services or eligibility for that is you have to be a caregiver of someone with them all simers or a confirmed demential diagnosis we also have put in there that they can access the funds twice annually but they have to wait six months in between awards periods for that as well and if you are going to hire someone they must live outside the home and be over the age of eighteen so those will only restrictions that we placed are on the great program in your one we did set a twenty five percent rural threshold during twenty twenty two we want to make sure that those funds were actually reaching the royal communities where we are starting to see emerging needs and the reason for that is the existing programs that we have that fun respect whether it be to the waiver or child or three funding most of those ones were saying isolated in the metros and not getting out and so that's why that that rural threshold was placed and i'll report on the how that's performed in a few slides as well. Again imagined just the importance of dimension training for our health care providers one of the first things we did as a advisory council was to look at the existing damage of training settings across a care settings and we identified efficiencies and we attempted to address those divisions he's the legislation this past year act seventy arkansas became the one of the first states in the country to actually enact an also must be mentioned training standards for home care providers as well so I certainly proud of that legislative accomplishment i'm actually o two arkansas became one of only twelve states in the country to acquire dimension training for first responders particularly our municipal officers and so that uh training program is being implemented at a leader and of course the inacmin date of that is january one to give the agency time to prepare for that as well because we we do know that or so much the mitch have frequent interactions with first responders and we want to make sure they're propo- prepared to communicate to the escalate but also in the unfortunate cases of a loadment when someone goes wondering how to approach and support the family as well and the resources that are available for families who are going to that challenge. Yeah. And i'm gonna fall this chair some point at three thirty five require some four hours of initial dimension training for all direct care staff and assisted living and two hours of continuing education that act also prompted the agency to begin the process of updating the rules and regulations that govern assisted livings that is work that is ongoing and we have put out some of the rule changes out for public comments more specifically we looked at the dimension training requirements for facilities who have either all summer special care unit or memory here units and we we look at that section of the rules and we increase the match a trading standard since or now those with an and ask you or a memory care units must have an additional fifteen hours of dimension specific training that that goes a little bit more in detailed in the basic training that we require all facilities to have. Ah just wanted to kind of look forward about where we we feel like the priorities are where we need to go next we know that also says not slowing down and sold the need for more interventions is certainly great and so I always this committee to to dream with me for a little bit and think about the importance of a risk reduction this projected prevalence you can kind of see over the next thirty years it takes a huge jump but what's what's important to note about this the scraft in this this projection is that these these prevalence numbers were based on previous uh generational cohorts so you know the greatest generation the baby boomers and if you look at those generation lifestyles there's less access to process foods more people worked outside the remore active and now if you look at the pressing public health concerns that we see that are present in the state for for current generations in future generations there is reason to be alarmed at these prevalent summers can be much greater than this do that there's there's more risk factors with these current generations in there were in previous ones also that has to do with diet exercise and and several other variables as well. But what would happen if we can get ahead of the curve and we could focus on early interventions and invest in in risk reduction because we do know the science is there that there are steps we can take to decrease our risk what what would happen in the public health space you're in arkansas we live in that area and we're able to get a head of the curve and begin driving risk reduction this this past year in order to inform public health strategies we for the first time ever had a county level prevalence presented at the also associations international conference this allowed us to get it out a very granular look at counties and what's happening here in the states this was a combined effort with rush university in chicago and and they identified the countings that had the highest prevalence and also the lowest prevails that we have access to that again these are forecast numbers based on data uhm and I might kind of share with you here in arkansas what that looks like some of our higher prevalence counties are are lee chico and phillips and then of course our lower or our newton marion and carol I will share with you that and maybe around december time frame we hope to produce a reports the health apartment has actually used some of these county level data and begin to analyze it a little bit and how it has a project it's gonna try to talk about some of the social vulnerability index and how that compares to county level prevalence but with this county regular data the parking palestine implications are great because because we know where the hot spots are we can have an informed public health strategy we we can drive risk reduction of communities also promote the importance of early detection and diagnosis improve access to those diagnostics as well. But also just making sure we have support services in place with a families who are impacted one of our greatest needs that we see of course is public awareness not only on the consumer level but the commissioner level as well so as we go into the fiscal session there's several priorities for identified one of those we want to insure that the state i'm aging program are the aging plan is inclusive of the priority of or detection diagnosis uh of all simers actually get a scan of the aging plan earlier this weekend and found that all simultaneously mentioned five times in the plan which was concerning but also our health improvement plan that expires in twenty twenty five so as they begin working on the process of updating that we we feel very strongly we need to include messaging around the importance of early detection diagnosis and education. So we are gonna ask the legislature for some specific funding for public awareness campaign not only on the physician cyber so the consumer side specific to early detection and diagnosis because again that's so important because now we have treatments. Uhm in terms of access and quality of care one things that we are we are monitoring closely not not just public payers but also private players to ensure that there's equitable access to fda approved troop message they become available specifically cause we know that there are more drugs in the pipeline that have shown very strong promise in their clinical trials so we're continuing to monitor to that but we also want to make sure that we improve access to considered screening because you can't qualify for a treatment unless you have the cognition that early detection diagnosis piece that I feel like i've said fifty times today but also ensuring that there's coordination of these services and and resources and so more specifically a cms issued several years ago a billing code that reimburses providers for continued screening services and care planning services we are are asking that the state medical program provide a reimbursement for that for individuals who are not medicare eligible so you're non I don't eligible folks but civilly for the medicaid population it's one step that we can take to against shift the public health mindset to not focus on the disease with just aging adults but looking earlier for early detection diagnosis and of course and center vice providers to have those conversations as well so the billing could all already exist medicaid is not assigned a reimbursement for that so we are working to try to get that established here at the state level as well. Briefly oh I want to go back just to the impact of of the family care give her space here in arkansas as I mentioned earlier a hundred fifty four thousand care givers again there's reason to believe that numbers is soft already kind of went through the statistics of that but just can I think about the impact of care giving on the work force based on self reported surveys fifty percent had to leave work early some had a retirement sixteen percent take a lead leave of athens seven percent lost job benefits some close to ten percent had to quit work entirely and so as you take on these caregiver roles it has a significant impact on our work force so ensuring that employees have adequate access to to pay time leave also something that we need to look at in the future as well. Um when it comes to zero in again on the dimension of a response program and just report how it is performing in your one it served over four hundred fan or four hundred families and I mentioned that the world threshold was twenty five percent or grant distributor exceeded that in hit thirty two percent but funds are in your one expired in and march twenty twenty three um and here too so far these funds were released in july so far they have reached two hundred and twenty eight families there's real threshold performance rate as of last week was thirty nine percent and also we found out that over it's a hundred and fourteen thousand as a last friday of of the two hundred thousand has already been distributed out to arkansas families so the need is great as word has spread about this so we are looking for some additional funding to fund this program as well so just kind of the the recommendations recommendation summary just the things that we we are I have identified as prep priorities for the fiscal session as again that that funding for a specific targeted public awareness campaigns more public health education are around the importance of early detection diagnosis and risk reduction and our ask for that we identify the three hundred thousand again I mentioned we we would like to see medicaid pick up the billing code for care planning and contact screening and then we are asking that we increase funding for the domestic care give her program by two hundred thousand so the total amount be four hundred thousand and if we find two hundred thousand through the block we're asking the state to match that through gsr so those are the things that we have identified as priorities in the fiscal session. I'm happy to take any questions you might have. Thank you thank you for your report and represent a fight your recognized thank you madam chair and thank you for this excellent report and for the work that you were doing throughout the state and I specially appreciate your social media presence with getting people facts in and tips and help in and recognizing this and with the chairs indulgence. Could we ask that everyone here who has a family member who is dealing with this would raise their handerstand sure would you raise your hand pla. Pretty widespread. Thank you. Maybe you're recognized hate that thank you madame chair and thank you david cook i'm sorry I was light I was at a doctor's appointment with my daughter I apologize but II just wanted to add to anybody on this committee anybody watching we are next altimer's disease and dimension by zero committee meeting is monday you know this coming monday at twelve thirty in any legislator I encourage you to come or watch online and be a part of it the last two meetings we've spent quite a bit of time looking at new old timers medications and the fda recently approved one medication the quinby end july and we were trying to find out white insurance companies are going to cover that and that's opened a whole canner worms make insurer that this new medication is actually accessible to our cancers we've had a lot of conversation about that are can some medicaid will be covering it but our state employee benefits package will not be blue cross will not be sent will be so I mean it just kind of depends there is another medication that probably will be approved here very soon and david feel free to chime enter any of theirs but we will be talking about that one and whether it's once it's approved by the fda what insurance companies are going to cover it and night the key to it is early a detection though um and and so I encourage you to be engaged in that conversation at this coming meeting um we will also be I just got a note that you did talk about that so I apologize I listened as I would as I was driving in and I didn't hear that so I apologize about that we're also talking about a personal needs allowance that's a a monthly amount that each person in the nursing home and medicaid has. It's forty dollars a month that they can use for their personal needs and that would be you know if if they want to buy a book to read if they want to perhaps buy a a cookie effect is there are there favorite soda or whatever it might be that's just their own personal thing that's not supplied by the nursing home we're gonna be talking about um that as well for the for more than two decades it's been set at forty dollars and i've heard many people comment that it needs to be raised so anyway I encourage you to be a part of those meetings always helpful to have everybody at the table who cares about this issue. Present if pilkington your recognized they get a river thank for the presentation on the two questions in some resident maybe it could already answer for me but I was curious on some the treatment medications are any of those on the three forty b less or there is there a payment issue with getting payment for these drugs so the can be that she referenced is is on the three hundred but there is some concern we were not sure how the supply chain is going to work in terms of getting it access to to arkansas one thing that we have been working armers and pilkington is evaluating or infrastructure these are infusion drugs so you have to have an infusion certain available deliver that needs to be done a clinical setting and we've kind of looked in the identified several different health systems that have that capability so we do have technology or I guess infrastructure to be able to disseminate the drugs I think what what concerns us is that the diagnostic tools are limited because of that these are these first generation of treatments their anti amaloid drugs at the specifically target amaloid which is just one piece of the alzheimer's puzzle and so you have to detect the the that there is the presence of amaloid and of course the spinal fluid is what they use to do that because we don't have the imaging and so we've worked on that the access piece the diagnostics but answered question yellow can be is the nanomab is the other one that it should be approved in january it's it's really outperformed can be and it's it's clinical face three trials and so we're I think there's a lot of excitements from positions that we talk to not only about the kimby but also the future drugs as well fantastic it just what are the real quick I saw on the **** the provide reimbursement for a medicare providers for a nine nine four eight three is there a cost on that do you know how much estimated there would be. Sure so on the I think cms cms is set the reimbursement to seventy five and but but the problem with that is like what we're what we're seeing is that. You know about one or two percent of positions are actually accessing the code there's a lot of billing billing codes out there so more clinician education but also working with a hell system to how they are very far reached to equipped like practitioners do those continue screenings and being able to refer those out to specialists that you can get the that detection piece I think I answer your question we are doubt there but yes so two seventy five is the federal reimbursement rate why does it matter I was curious for it just like the state portion like that we're going to pay. If we provide a reimbursement to that code did I total total amount of a year. Estimation I mean because I could just say people aren't used to the code so it's kind of hard to say like. Yeah it's going to be and I get it's fine I mean that's income a normal amount to get paid i'm going to try to answer your question this way is that the way that we're the reason why ask the medicare to pick it up it would only be for people who have who are not also eligible for medicare because medicare would cover that like I said this would be targeted to people who might be experiencing memory loss in their forties so so younger populations to qualify for medicaid and we're going in for like health screenings and things like that so III mean any number I gave you would just be an estimation on on use yeah that we would be pretty small yeah I would I would think I guess that's kind of my question I fear to be pretty small amount so it would be it's not you're not asking as the pump and extra ten million dollars into medicaid no II guess that's kind of what I it's it's a pretty small amount you appreciate thanks for that clarification. Are there any other questions. Okay I have an eighty oh thank you senator hammer you're recognized thank you i'm just curious the resistance has been shown outside of medicaid toward pain for this what's the reasoning that they're given is that unknown cost is because the drugs not banned approved by fda which what's the reasoning they're giving that's a great question we we the association are initial battle was actually would see ms because the drug had not received traditional fda approval it actually was approved through the accelerated pathway once it received traditional approval cms picked up coverage of it but most of the the resistance that we're hearing has to do with cost are argument is that you know we we do cover higher higher price drugs for other diseases like cancer and but we we also fighting a two front battle with the drug companies about the cost issue as well I think one of the other arguments is transparency in the interest transparency is there some argument around the efficiency of the efficient of the drug is it is it really effective in and what we say to those arguments is that if you can delay progression of emiloy and with this drug in some cases it's removed the plato from the brain but decreased it significantly you're also going to alleviate some of the other problems that the mature patients have increased fall risk hospitalizations you're able to to carefully manage the mentioned behaviors of associated with dimension also you're delaying placement in in higher care settings like long term care and you're giving people more time and so II think we're going to need. More more data to to clearly identify like what is the overall fiscal impact of this in terms of like the cost benefit because it's only been on the market since july right so we we need a little more down to study the impact and in what it can make but that's the majority of the the the resistance again has to do with the cost but fda hands approved it for use of treatment correct fda has approved its your boss to be accelerated pathway in the traditional pathway and you like lily who has denied a map they did not pursue the accelerator pathway they are going to the traditional pathway and as I mentioned that that drug is is shown even more promised in the candy do you know what they're testing time is for the trial to be completely by they just release their face three trials last month we we do expect december january is what they're saying that that we we might get full approval for that drug as well okay cause I was camera under the impression of fifty a approved then it became a recognized drug that was able to be used for a treatment and that would eliminate some of that argument I was kind of under that impression with fda's involvement i'm glad you brought that out because for every other drug that is the case also homers is the only drug that we've we've got to see this the prejudicial response if you will give me liberty using that term but yeah this has been a struggle from day one for us as well okay be curious to manch out no member to me thanks for lead to get medicated here maybe to respond her given put it thank you medicaid has already agreed to to cover that for our patience. Thank you seeing no other questions we thank you i'd like to echo representative fight we thank you not just for your report but all of your excellent work on behalf of so many thank you committee and thank you members while the work you do to serve the receipt of work and saw. Members next on our agenda is director right she has several dhs reports for us. Your recognize yourself you may begin. Hey good morning i'm tiffany right and i'm the director for the division of children and family services so you have in front of you several reports today that i'm presenting and so I first wanted to ask the committee permission of the committee to not review the quarterly report because we have the annual report card which is the information just for the for the whole year is that a approved by the committee we think that's wonderful thank you so then I am gonna go to the annual report card and walk through walk this through with your. So if you go to page one of the in your report card in state fiscal year two thousand and twenty three and there were thirty four thousand one hundred and sixty two mile treatment reports except it at the hotline I wanted to make a specific point to note that those numbers are that number is almost bringing us back to prepain democ numbers because in two thousand and nineteen there were three thirty four thousand two hundred and twenty six reports called into the child of you satline. Have the reports that came through twenty seven thousand eight hundred and seventy seven were assigned to dcfs. I'm going to page two. Erm findings of champ childman treatment investigations I wanted to just point out that. In state fiscal year two thousand and twenty three um thirty two percent first uhm CACD found true and twenty percent for dcfs with the combined total of thirty four percent. The types of allegations for two investigations will be at the bottom of page two five thousand seven hundred and forty two of those are sixty eight percent or for neglect and followed by set twenty percent of those were for sexual abuse. Moving to page four the timelines of investigations for dcfs only priority ones was eighty one percent and priority two reports were seventy six percent with a combined total of seventy seven percent. Going on to pay. Seven at the top of page seven in protective services are in home services we served a approximately four thousand eight hundred and ninety seven children through protective services cases in a state fiscal year two thousand and twenty three. He end and we also served and we also had three hundred and fifty six supportive services case in cases opened in two thousand and twenty three. Moving to page eight you will see on the bottom of page the required monthly visits in home cases at the end of state fiscal year we were at approximately seventy two percent which isn't increased from the year prior of sixty seven percent. Going on to page ten they as you can see at the top of page send the at the end of state fiscal year dcfs had four thousand and twenty three children in foster care. And then on the bottom of page ten you would also know i'd also like to point out that are dish charges from foster care were higher and won't i'm sorry we're at two thousand seven hundred and ninety five compared to our injury so we discharge more children from foster care than we had entries which means we were moving children to permanency. And then on the bottom of page eleven there's a specific breakdown related to those discharges so forty two percent of children and foster care reunified with their parent or care giver and twenty nine percent of those were adoption. And then there's also another chart at the bottom of page twelve that reflects the permanent current permanency goals for children in foster care and currently we do have a forty eight percent shop children that their current goal is for reunification and twenty percent percent with the goal of adaption. On the top of page thirteen we have a required monthly visits by caseworkers at seventy seven percent and then kid children in foster care who are having any contact with the dcfs caseworkers the chart right below that and that's at eighty eight percent. In that eighty eight percent is regardless of their position so that is someone from dcfairs seeing those children. I am moving to page sixteen i'm gonna point out specifically the number of children available for adoption and that number for the end of state fiscal year shows three hundred and forty two however if you note on the side and the blue ribbon there is a percentage out we place because we know a certain percentage of children would be adopted by a relative or fictive can and when you take out that twenty percent it's actually at two hundred and seventy four children that we are truly doing recruitment for with our partner project zero and we're actually we have worked to do but that is the lowest number we have we have seen in our state. And that is all I have for the annual report card. Ready for questions unless you want me to go through all the reports or we can do one at a time it's up to you let's do one at a time so we can. Attach the questions that belong to each one okay that sounds great and represented fight your recognized thank you madame chair we have a lot of new members on this committee would you mind just briefly having us understand how a call comes in where it goes in how it's assignedyes me and so you can make a report to the child abuse hotline and we also have the mandated reporter portal now as well where you can do online reporting the report comes in the heartline uses a tool to determine the route of the report and so if the report is accepted it would either go to the crimes against children division or be assigned to dcfs based on classification of and the alleged mouth treatment once the reports accept it out while say it's assigned to dcfs. It's classified as a priority one or a priority to and we have that is the numbers of hours that we have to respond to that report so a party won is for twenty four hour response rate a priority to is seventy two hour response rate and then and it's assigned to our staff dc staff and we go out and initiate within those time frames. Your recogn. Understand I sort of start again could you help us all to understand where their heartline is physically located yes ma'am their child abuse hotline is physically located at arkansas state police headquarters thank you. Representative shepherd recognized. Thank you thank you for being here this morning if if I really correctly want out of three findings are true. That's great is there a particular area or program in this state that has an unusually hard. So I actually can show you that in another report and I can go over that with you and but also if you'll go to the appendix in the back of this but starts on page twenty three it breaks it down by county end at will tell you the true rate. I'm page twenty three later numbers off tap do you know which county has to hire i'm sorry are not off the top of my head i'm sorry. Representative water into your recognized thinking about him to a director thanks for being here I was interesting was interesting to me to see that you said around two hundred and seventy four children that are available for that adoption and you can see through your graph that that's trending downward over the last three or four years my question would be are there less kids that are needing adoption that are entering the system or is the state doing a better job with ground zero getting those kids quickly through the system and into a safe homes I think you are it's a mixed answer a blending answer I think we're doing a better job of getting children in place with relatives who are adopting I think we are working hard on reunification in timely permanency and then also focusing in on the children and you then foster her that I call essentially long stairs you have been in our system for a substantial amount of time and we are really trying to focus in on how we move those children to permanency wonderful thank you for your work they could benefit repetitive painter you're recognized. Right here director it's good to see you this morning thank you again for all the work you do and appreciate these reports. You said a beginning at page one I think you know this fly thirty four thousand hundred sixty two and you said something about was this number and increased before the pandemic or whatever the pandemic results before so I was referencing back to twenty nineteen just sharing that if I should have I should have bright state fiscal you're twenty two but that reports are now turning back up which I think means we are getting back to a place of normal sea kids where you seen kids kids are out in communities and reports are coming into the hotline also contributing that to having the online reporting option vs a call in option and in just to clarify too so during the pandemic we sold it kind of go down a little bit just we'll make sure that's correct for the record yes people were at home and children were at home and so the reports can you know weren't they his kids were not connected to communities and seen teachers and been involved with what was happening out in the community appreciate a mountain thank you. Senator hammer you recognized thank you the family first act at winning in a few years ago can you just having been on watches lines you bank can you tell you your perception you're impression about how it has affected placement here in arkansas you know foster care or you know the the homes that take foster kids any any impression that you can give us on that. I think that family first impact it us in relation to putting more emphasis in value on family but also ensuring that children who enter our system are placed in a family setting should they can't have to be in our system and there's not an appropriate relative or effective can and then also you know it had I suggest the system so children were not sitting in emergency shelters for an extended period of time and really made us have that family approach which is what our children need to succeed. Follow up manager. It recognized thank you with regards to in in the event where they are not enough foster parents and with regards to home set of kind of restructured their model so is to be more of a home environment it was with house parents etc do you see that plane evidence role to help plug the gap between when you don't have the home was to place the kids in and the kids not having to stay in the DHS office overnight that kind of thing or can you give us your perception on that please yeah so we had several providers in the state who did a transform their way of work to be fart true foster families but in but could take large sibling groups because they had homes large enough to take those sibling groups in we are grateful that they have adjusted to walk alongside us in general and we can use them what we call family like settings and they take the large sibling groups for us or you know more complex our children in yours thank you thank you. Thank you saying no other questions before you got your next report I will tell you that if you'll get the information and any further like that representative shepherd asked to blake he will disseminate it to the. The committee yes me. Okay next i'm moving to family preservation it's the thicker of the all the reports I wanted to just remind you that this report does talk about specific areas of the state and so you can always if you're like what area of the state is she talking about go back to the front of the annual report card in it will tell you what area that i'm referencing. So I am going to go to. And I also wanted to give it a reminder i'm sorry and this report is by calendar year not state fiscal year so if you look at it in your like weight wire the number why do the numbers not look the same that's why because it's how it's captured in reporting for this specific report and also I wanted to point out that the appendix has a breakdown of the counties as well in the backs of you want to know about your specific county they at information is all in the back and it starts on page. Right after page twenty three it becomes a one. Okay. The. So i'm gonna go I am add so as you flip through each section is broken down in the first section is around safety and if you scroll if you go to the back on to page very sorry I thought i'd have this. On page ten there is a discussion about safety and that is where i'm going to direct you to in night on each of the charts but I really wanted to point out a couple of strings as well as there are areas for improvement that are reference in this report and so overall and it talk this section regarding safety which is our differential response or tomorrow treatment reports initiations. In the rear couriers of maltreatment dcfs actually has done well i'm preventing the reoccurrence of maltreatment within the last or twelve months of substantiated reports which is better than the national standard of nine point one percent for each of the last three years and all ten of our areas meant that standard for two thousand and twenty two and nearly almost all of our counties did as well in relation to a reoccurrence of mount treatment. And then also as I wanted to just point out there is a specific discussion in the strength section about the rollout of received you organize practice in decision making around safety and using am evidence based programs including team decision making. And then at areas for improvement because we always can continue to strive for to be better continuing to work on our initiation rates as well as insuring that we are assessing safety at each point in the maltreamer report and in seen children sooner depending upon the information that's coming through the heartline. The. Okay I am looking also then next moving into the permanency section which starts on page eleven but if you go to page nineteen specifically again a whole discussion on the strength and the weaknesses but I just want to point out several points of this report and this isn't really good information so again we have shown an arkansas that placement with relatives active kin is better and our children are achieving greater outcomes as well as an increase that increases in supports reunification we we have continued to perform. I'm moving children to permanency through adoption of necessary and in calendar year twenty two we finalised eight hundred and sixty one adoptions um and then areas for improvement i'll just want to point out placement stability is noted and that is a route moving children to placement to placement in them not being stable in those placements which is going to be a huge impact of the work that every child are considered doing it is a huge focus on all retaining foster repairs but recruitment of foster parents and supporting them while they're carrying for our children that are in foster care and so just continuing to target them as well as focusing on honest strategic plan on how we get children closer to their home counties instead of moving them for counties away where they're not connected to their communities but again i'm continuing to focus on finding appropriate safe inappropriate relatives as well as victim can and really honey then on school teachers counselors coaches. Mentors in the community that we can utilize will also help come back plate a placement instability. And then there is another section around well being start on page twenty one with a smaller section for discussion on page twenty three e and we again areas for improvement just be continuing to be consistent on reaching its in home visitation go area ten is one of our areas that does well they continue to show in this report that they are going and really doing the work and i'm seeing those children and families but we have areas of the state though we need to continue to focus on in support the work related to getting those on visits done in things completed. That's what I got for this report. And you are ready for questions yes ma'am ok senator live your recognized thank you man sheer even in order to draw your attention to page four. And I was just looking through this report and one of the things that was concerned and was the timelineness of completing investigations in the you know halfway down the purchases for the second consecutive year less than sixty percent of the investigations for each of areas three form five were completed on town. And so i'm looking at these percentages so what is really going on in areas three four and five were where the town minus with the investigation is so long. So as you know we struggle with a work for when we experience turnover what happens is work gets behind and we have what what we're calling is overdue investigations and we actually have been working diligently since february to clean those up and they are all clean we will never be in a place where we have no overdo investigations just because of the complexity of investigations but to be in a place where at one point in this we had five hundred overdue investigations we were diligently as a state to clean those up but work force is a significant factor in that with the turnover because they then have to move those investigations and then move them to and then if that person quotes we move them again in all while the work is still coming in your the work is that reports don't stop just because someone quits a dcfs and so continuing to just manage that and work together as the team is what we have to do and really focus in and pay attention to that okay so so I don't want to get into the the micromanagement of dhs but it here's an it is it's a leadership in these areas still the same or is that turning over as well. This. So we have had leadership turnover within dcfs not on i'm seeing in these specific areas for me okay so in areas and we have had even our area director level has turned over so we have I don't know the I don't know the complete history but for the first time ever I have area brand new area directors and areas one three I am filling a vacancy in area five have a renewal director in area six I have a newary director in area eight i'm filling a vacancy in area oh well it was it's just a little concerned and when we started saying it seemed investigations there are delayed I will say so okay thank you for the work that you do we are focused I just want to re insure we are focused on it keeping children safe is our priority and we have been hyper focused on insuring that we know where these children in youth are in that they are safe as we were through this clean up area thank you thank you madam chair representative painter to recognize. I'm trying. I am approving you it's just rejecting them there and go. Thank you madame chair and I just want to kind of follow up on senator loves lot of questioning. Out of the ten areas what is what is the area what area you having the most problems with his forest turnover getting folks hired. Area six which is pulasky county and I mean honestly at right now I have to I have vacancies all over all over the state I mean they're it is. And I can I think i'm sure that committee last time I came I think it was in may or june I can't remember what I can share the vacancies by area but we are we are focus on we just have turnover almost across the board across the state but we have higher levels of vacancies in areas six area wine which would be northwest arkansas those are are too highest gadget okay. I appreciate it manager. Senator hammer you're recognized like ma'am chair and I realize you know you're leadership at the helmets just can a new but what I wanted to do is your ideas. Or your plans for developing the leadership that are in key roles and no you know the the pay is always an issue but also I understand leadership is also an issue so i've just curious your thoughts if you're free to share at this time about developing that that middle management leadership and and how to retain those because to me the one thing I hear is that if that middle man in which meant is not stable the instructions are given everybody below them is is not consistent or accurate and that that could attribute to some of the challenges so i'm just curious as to what your vision is for building that out please yeah so obviously we are supporting them from our central office level and coaching and ensuring that they have the appropriate coaching and mentoring going on we are we you know we bring all of those leaders in every month and work through and topics like hot topics conversations and continuing to guide them and ensure they have good practice not all of them are brand new some of them have been within dcfs but you know stepping into a leadership role is a different challenge right and so just continuing to make sure that we have the right levels of support for them but giving them also the tools that they need to make good decisions and ensure that practice remains aligned in that the were being values based and keeping children in a families you know safe and stable so it's a lot of coaching and a lot of conversations but i'm also I would be open to ideas and suggestions as well but a lot of it is just working through each situation in and supporting them but also making sure that they are appropriately trained there's not a specific training to be in area director there is for a supervisor and they do go through that supervisor. Follow up motor. You recognized thank you very much the number of vacant positions that you have is it in this report or are could you provide that as far as number of they can positions and. I cannot remember so I may ask you not but I just can't remember are you when it comes to the hiring freeze are you having any resistance as far as filling the vacancies or are you at liberty to fill what you need in order to get those vacancies up. Occupied. Yes II have the number of vacancy used by area but i'm happy to email that so everyone has it in their email and we are able to fill our positions we can fell off the service where goods program assistance family service workers supervisor so those are the critical positions and we are able to fill those and are you getting applicants that are applying to mean is are you are you like getting a good response for you you're struggling even to get a response for people to want to apply for those. It depends on the location what the position is a end. Yeah the location in really the position what the position is I would say it's a it's a makes if the applications are good or not and not consistently across the state it's different where you're at. Okay are they comment you. Reps in if bringer you're recognized. Good morning hang a manner happy to have here i've been on this committee for the past couple of years then this seems to be a reoccurring concern with respect to staffing and I believe that the last director indicated that you all have a plan that you've developed to digit plan in order to address this have you do you all have a written plan in place to address the concerns with respect to staff and that sort of thing it was value standard that you all had one in that you were following such a plan is that is that understanding so we have done several things related written I guess is my question do you have a ridden plan not necessarily not necessarily a written plan we have done several things that we've implemented several things and the most recent actually is because one of the supervisors who are carrying a caseload because of turnover we actually recently received approval to be able to pay them over time for doing that front line case works like that was part of one of the things we've been asking for and that was approved recently but I don't have like a written plan you know we've been using our comprehensive organizational health assessment to guide our decision making around the work force. Follow up manager recognized i'm not trying to tell you how to do your jaw but i've been in management and business and so in order for to address concerns there needs to be some time type of document in order for you to know what the concerns are the problems or to identify the areas and then follow up and monitor those and that would be something that you as the direct of the version in your supervisors could come together and discuss those things in order to come up with some type of solution so and that trying to tell you what to do but i'd think a writing would assist in europe developing you know filling the vacancies in address now the concerns that you have within your department so that we won't be in the same position because i've been here in the same things for the last two years and seemed like me there are to be some type of resolution and i'm at fault in any particular person but i'm just saying it has to be what men your management is of italy were fall on the shoulders of the directors and you know you at your level as to what's taken place and even the secretary so hopefully you are will develop a plan that you can review and monitor it on the regular base is in order to ensure that you are addressing the concerns within your deviation thank you so very much for being here thank you for that feedback. Senator hammer you're recognized they come out here two things one on that subject direct there i'm under the impression that DHS is supposed to be implementing a plan similar to like a three sixty valuation where you'll do some internal things and I think that was being implemented i'm not sure within your division or another one is that in your division that that's being exporter do you know I haven't heard we have we have been talking about positions and we have been talking about having the right positions and structure of positions as DHS o there are conversations about that happening i'm not i've not heard the term a three sixty plane now okay i'll follow up on that one in and the other question was we approved and maybe this is what you were alluding to while ago we approved several months your funding for like a pilot program that would be intense to I think it was placed county like forty positions that would be hired to counter in in your kind of reshuffle the deck as far as responsibilities inspectors out the field versus gain paperwork done can you give us a status update on there you for me with very familiar with that first of all II do know a whole you said several months ago do you mean like maybe two years ago it may have been to your time flies around here when you have done I don't know it does we do have those positions and those are some of the positions that were currently working to fill so that then do you know how much I think we approved forty didn't we or do you remember I don't remember the exact number but I could follow up with you after related to where those positions are in which ones have been filled in which ones have not okay because I knew that was supposed to be a model that was if it's successful here was going to be duplicated cost state so maybe a follow up would be good if you will do I will follow up with you thank you thank you. Seeing no other questions are you moving to the overturned investigations report am i. Okay so this is the overturned investigations report in I had to learn some history on this report myself so this report was from act a ten twenty five from two thousand and seventeen related to concerns around through findings and though the appeals of those true findings and so what you have in front of you is a breakdown by county by area by county from across the state on the number of investigations and the true findings and so i'm just going to pick the top county in walk it through with us who you understand each of the. Parts of this report so if i'm in bitten county erm they received four thousand nine hundred and fifty seven calls to the heartline. Two thousand two hundred and twenty seven were accepted three hundred and ninety six of those were found true. Which is approximately seventeen point eight percent of the number of true reports which was the three ninety six. The number of true investigations appealed was thirty five. The percentage of the true investigations appealed was eight point eight percent and the number of appealed investigations are overturned was three of the thirty five percentage. I think I have the button i'm sorry percentage of appealed investigations overturned was eight point six percent and percentage of true investigations over turned was and then percentage of all investigations overturned was one. And that's that is the breakdown of this report. Are there any questions by committee. Representative may bearing a recognized thank you I guess I just have a question because this this information is mandated by law to have this and i'm seeing it and i'm learning a lot in a from it but do you see it as helpful how what does this tell you is an agency when you look at this is the spent a helpful law. Cause it does seem like a lot of work but it might just be plugging in numbers that are already there and it's really no big deal and you might find it very helpful so when I look at this for me it does give me a perspective by the county of just like what is happening right like we are out investigating families what happens on their foundry and how many of them are being appealed just so we have a clear understanding erm I mean it's a great snapshot of the state of like what's happening at appeals and hearings and so I do like I feel like this is helpful I don't know if you are finding helpful but for me it does give a just gives me a quick glance I can see what's happened in that county around through finding or heartland calls accepted reports and then those true findings that are going on across the state. Any other questions. Seeing number four you moved to the garage law report that we remove into the summary yes i'd like to recognize someone in our audience today and we have with a time wilderage who has not only the great honor of being the father of representative germing will do it but it also served in the house and the senate and rather appropriately for today was part of the legislature that actually passed gear its law initially so if you'll stand we will recognize you and thank you for your service thank you for indulging you may proceed. Okay so you have two garets law essentially reports one you have a thick breakdown of all the girls all reports the data that is not what I am reviewing today I am moving to the summary of the garage law reports and I am going to go to though the page with the summary now as you go through this there are charts that you can look breaking down from twenty twenty all the way to twenty twenty three for state fiscal year to look at more specifically if you would like but I am going to. Move to the summary page which for me is page eight it should be helpfully page maybe. Okay so during a state fiscal year twenty three there were one thousand five hundred and twenty five reports that were accepted for investigation which is a slight decrease from the previous year of one thousand five hundred and fifty two mirror wanna was the most commonly mentioned illegal substance i'm using its law and first date fiscal year twenty three started at seventy eight percent and about and then if you look a little further and federals and method federal means were at twenty three percent in combination with the mirror wanna as well as opiates and then bins of disappearance were cited four percent of their reports in cocaine was so excited and cited for two percent. Um the rate at which dcfs case workers opened a protective services case was eighty four percent for state fiscal year and then them a level of removal and was eleven percent of new borns will remove from parents custody in response to the girls are report in twenty twenty three. And then nineteen percent of those children removed from a substantiated report were either returned home or discharged to a relative within twelve months. Are you right for questions yes. Okay sender to get more you recognize thank you mountain or thank you for bringing this report. And for all those who work to pass this law earned former center boards thank you for your efforts in that. Looking through this it's it's pretty disturbing quite frankly to to see all these cases so one thing that just sort of jumps out obviously marijuana as you point it out was the number one on list which is disturbing obviously but. More I guess to drill down into that are you all tracking delta a delta nine obviously that's a derivative of the or has the in it is there any way to track that in all does it shortly can you test for that in some way other than just the amount of the we are not we are not testing for delta eight or delta nine day is that something that we should consider again i'm not all that familiar other than I know that it has thc innocent maybe that would just show up as dhc. I would need to ask more questions about that in then they could come back to you with an answer related to that but I probably need to ask more questions as well okay if you would follow up on that place thank you. Represent it maybe you recognize thank you is there any way to clarify his marijuana listed on there for example twenty twenty three seventy eight percent some people are using marijuana because they're legally allowed to in the state of arkansas and some might be using it. Illegally sir anyway to know the difference. We we do not differentiate whether they're well let me clarify in the course of an investigation we may be asking those questions about do you have a medical marijuana card that kind of thing but in reporting we do not have a way to know you know that's part of the conversation and the assessment with the period. So there is no way in the future to have that differentiation i'm not saying not in the future I was I thought you might right now i'm just saying is that even a possible thing that could be added does that require the wall to add that or is that just something that you are can do can III don't know cause I think there's. That that would be interesting to know okay i'd like to explore that and have conversations with our dad a management team and you know we have a we have a serious system were also in the process of building a new serious system so is this something that we could add into and that whenever and we get there so I would like to have some conversations and I can fall back up with you on that thank you. The. Thank you london discussion marijuana. If recorational marijuana became legal. How would that affect your ability to protect children if it is a problem now under medical marijuana because they're either using it under the medical marijuana or they're using it illegally do you have an opinion or something you would care to expresses to the challenges it would create them because if it becomes recorrational that it's going to enhance the number of people that would have it and if that is a side of problem in the report how do you think that's going to affect your ability to protect children. I do think it will make it more difficult just because you know it would. I mean they could use it right recreationally but I think we as an agency would still have a do diligence to ensure that those children are safe and understand the impact of what is what's happening when they're using it recreationally where they're using that kind of thing so I think we would still have a due diligence to ensure safety whether it was recreational or not and understand how it's impacting their ability to parent supervise and care for those children. And have you looked at other states that have legalized recreational mayor wanted to see that at the point that the marijuana was. Legal eyes that the number of cases that DHS had to get involved in either increase decreased receipt I have not would you mind looking into that because i'd suspect that it'll be interesting to find out if in the states where they've legalized recreational marana what that has done to the case load of dhs and specifically house affected children I would hope that conscientiously if it shows that it's increased that people would take that and consideration that legalizing recreational marijuana if it increases the case load of dhs that's only because it's increasing problems in the home the taxpayers are having to pay for so i'd appreciate if you get look at that and send that to me if you don't mind what how other states are being affected through DHS thank you thank matter. Senator gilmore you're recognized. Thank you just just looking through this data um. I know we're tracking obviously the listed drugs are we are we also tracking alcohol and and tobacco we need any other sort of substances as well we're not we don't have a tracking making ism for alcohol or tobacco okay cause I mean obviously that leads to potential side effects as well and in pregnancies and. The. Well I may come back for another question in the second thank you mountain. Representative duke you're recognized thank you madam chair I have a couple of questions if you if that's okay thank you I am so one is for myself and maybe any other freshman in a few people online can you give the specifics on the gear it slight self i've tried to read through the summary and I haven't quite been able. To. To get a great understanding of what how it supplied and when the test now gets takes occurs and the second question I have and i'm really thinking we have people that are listening to this committee online is what however this is triggered white help and support it does is triggered for these mothers when they do test positive i'm assuming there is some so that they probably can keep their children so could you elaborate on that if you're able to thank you yeah so I think the first question if I don't enter it ask me again but you're asking well how do we get involved with gear it's law so typically that is that's at the birth of the child so normally those reports you know a medical provider is involved in so we are assessing a child at birth so sometimes are in the hospital or usually their stolen hospital and we're out working with the team that's carrying for their infant and assessing talking to the mother figuring out what's been going on if there's a father president talking with the father of their family members so I don't know if that's what you minute. Sorry. I think you madam chair I guess on what i'm asking is what triggers this to take place I mean my youngest was two thousand four so i'm not exactly sure what triggers this but this testing to take place on on the child and so that's. And then what happens once at a curse. So it. They're the hospital is doing a drug screen and so they have some level of information or concern about them parent using drugs the mother using drugs and so that's how you know their drug screening right then. Erm at the hospital so that would that would trigger the report and then we would become involved with the family as far as weren't once we're involved yes we do provide services to the family the mother and. And that could look different depending on what's happening in so I am obviously if they're leaving the hospital with the child and we're involved then we're probably we're going to do some referrals for services so and we might involve a safe care or we might do intensive in home services making sure that they're connected to the local health department for week and that kind of thing as well as continuing to monitor the substance use issue and it might be that they are asking them to get a drug assessment and go from there around what they might need further. Um. Thank you thank you for your leniency i'm just triggered another question so are you finding with these young mothers particularly when it comes to their marijuana do they understand. The significance of their decisions they're making on their child they're on their child or do they seem. Unaware so i'm not there but in my history and the work that i've done with dcfs it's definitely a case by case with the period you know some of them some of them know and they're using michael wanna some of them are using as a coping mechanism it just have been on what's going on in their life and that's why we really have to ask questions and really assess determined what what's happening. The. Representative may very recognize. Thank you. I was just looking at page for where it says no health problems twenty twenty three seventy eight percent and I just find that just. Remarkable but keep in mind that I guess this is right at birth maybe there's no help problems and we need to keep that in mind that that doesn't mean that there's not going to be health problems or developmental delays I can't imagine that three six even you know a year down the road that there are some type of medical or cognitive delays going on so I guess my question is. Is there no way to follow up a year later with. Can that be a next step in garet's law can that be something that we could do and how would that be done. So. I mean I don't want to say no but you know typically were providing services right then been trying to support that family because you know when I while let me just let me say two things if it's a case where it's an in home case and we're serving the family you know we're not meant to be there forever we're connecting them to services and supports and getting them in their community and making sure they have everything they need and then once you know we're ready to close the case the case would close so that could but again that's dependent on the family right in the assessment of what's happening with that family and assessment of safety each time so I would say it depends now if they're in foster care you know we are assessing and we would have them in front of her and we would be working the case and so we would probably see along the way what was what was happening so an. I think it's. It's hard to say yeah we could keep it open for a year and come back in an assessor and see what those children need because I also think you know we've brought kids in foster care where we learn and. That they had been exposed to drugs and in it there are three or four in so you know sometimes you don't know till they start school or that kind of thing like what they've experienced in what their developmental needs are going to be especially when you're with the families that were serving rate so I guess I don't really have a yes or a no to that question. Senator gilmore you're recognized. Thank you and final question from me so I appreciate your indulgence just following back on this data and see where prescription drugs are mentioned I think I and one of the data summary pages so is that elizate use of prescription drugs or that actual script from a physician. So that would again be the assessment if they tell us that they're using drugs. You know that are not prescribed to them than that would be you know a listen use but if they had prescriptions along the way during their pregnancy then again that you know the medical provider was providing them those drugs so that's just prescription drugs that we know they were using prescription drugs because we have a test positive the child tested positive interesting cause cause I know and I mean obviously works prescription drugs have their side effects antibodics for instance can have major side effects on on unborn and children so I just it would be interesting to have that data break broken out if possible so that we could know and it'll be interesting to to make sure I mean there's obviously all kinds of reasons that a physician would prescribe medicine but making sure that you know we're tracking that knowing what's been prescribed and wire physicians my bees prescribing things that have very negative consequences but anyway thank you thank you senator love you recognize thank you man you're just a follow up on representative merriers of question misright so she raised out the no health problems issue when you have a I guess when the state takes a chat in the classic through gear sla is that shell not a sign medicaid if there are any health problems or any additional health problems children who enter foster here do receive medicaid okay so you've ever charge if a health problem does actually I guess they they see a health problem in six months or a year or whatever then medicaid would actually. They would actually have medicaid so the dent health problem will be taken care of that not correct yes because they're in foster care okay thank you thank you madam chair. Yeah. Seeing no other questions thank you also for all of your work and for your reports today thank you as a so much I this is my first presentation to your so thank you you did a good job and you got quite a few questions so it was no light feet there thank you committee we have no other business but our next meeting will be november twentieth just for your calendar schedule and we are journal. The. Right now.