Aging, Children and Youth, Legislative & Military Affairs- House

Chair calls this meeting to order. Thank you all for being here this afternoon. I know it's a, a busy time of year for many of you. So I do appreciate your presence at our meeting this afternoon. Um, we're gonna jump right in. First, we have a presentation by Teen Challenge. From their CEO Justin Smith and their team, whomever you'd like to bring, when you get to the table, if you will introduce yourself, tell us who you're with, then you may begin your presentation. If you'll, I'm sorry, excuse me, if you'll turn your mic on for me. You see it? Yes. How about that? I'm a rookie. At this for sure. As my name's Justin Smith. I'm the CEO at Teen Challenge Adventure Ranch. I'll let you introduce my team here. My name is Marissa Snyder. I do marketing and development. Richie Swearingen, the director of clinical operations. Again, I want to say thank you for that's opportunity, uh. I'll tell a little more about myself in a minute, but I've been a part of Teen Challenge for 28 years, and this is the first time we've ever had an opportunity like this, so I just want to say thank you. This is all new to us, so we got a great tour, Miss Charlene fight has been incredibly uh accommodating, hospitable to us. We we appreciate her and letting us be here. Uh, first, I just wanna say, uh. I want to backtrack a little as we were thinking about teen challenge. I know some of you may be aware of team challenges a name throughout the the the the country, uh, so I want to clarify a little bit about that just real quick. Teen Challenge was established uh over 65 years ago by a man named David Wilkerson, and there's a great book called Crossing the Switchblade, that if you want a great little awesome inspirational story, read that book about a man, a preacher who went to New York City to to uh to help the gangs that were on trial for murder the gang members. So anyway, crazy story. miraculous story, uh, of intervention and that led to the establishment of Teen Challenge as a, as a organization. Uh, it is now called Adult and Teen Challenge USA, uh, but what I want to say about that is we we're uh we're very unique. We're, we're a standalone, uh, center, a 501 C3 on our own, uh, but we, we have a basically like a franchise with Teen Challenge, you know, so we, we meet their standards and we definitely believe in their mission and vision, uh, but what we are very unique. So I hope today you'll like uh for sure, uh, I think you'll see that as we present, uh, we have, um, we've gone from those days to, you know, fully licensed accredited treatment center that is absolutely Christ-centered and faith-based, just like the Teen Challenge original model. So we're we're excited to share that with you today. So that, that's just a little context, um, to the overall picture of team challenge. Uh You see on the screen here, you know, we are a substance abuse facility, mental health facility, uh, we deal with maladaptive behaviors, you know, we, uh, of course like to say at this point we're dual diagnosis facility, uh, I started at Teen Challenge 28 years ago and we, we dealt with kids in rebellion and substance abuse. Mental health was a foreign idea, uh, but that has changed dramatically um over those years. We, I, I know, I see heads nodding in the room. I think you'll understand what we've seen in our world. So we've had to embrace that. And I believe we've done an amazing job doing that, and you'll, you'll hear more about that today. We, uh, Or 40 bed facility, uh, we've been in existence for 50 years. So why you haven't heard about us until now, I don't know. But, but we're here to make sure you know, you know, that we, we have been here, we've been serving in Arkansas for over 50 years. We believe uh our numbers show we don't have records exactly of the numbers back in the early days, but uh over 2000 families have been served at our center. We, uh, uh, we strongly believe our numbers show that we have a 70 to 80%, and we, we 78% long term recovery rate. That's, that's phenomenal in what we do. We're very proud of that. We, we, we definitely believe that's a part of a higher power. That's part of what the Lord can do, but we also believe in all the tools we give our students and their families. Uh, to make that number that high, uh, an amazing number. uh, we, we looked back at our past 5 years of satisfaction surveys, and we can honestly say that 99% of our students and their parents report that they believe they have um That that's their satisfaction of the treatment and how they've uh benefited by their time at teen at Teen Challenge Adventure Ranch. So I, I know that looks almost impossible, um, of course, that doesn't mean every life is perfect, but that means they learn something and they believe they, they benefited from their time, and so that's just a powerful statistic that that keeps us going every day. We Uh Sorry, let me back up. Thank you, Marissa. So I do want you to notice on the screen there, we, we put our three seals up there. I think something we want to make sure it's clear today is, uh, we, I'll jump ahead here a little. I know there's, there's a little bit of, uh, there's definitely attack. There's definitely a bad reputation on residential treatment in a lot of realms right now in the world, in our country, in our state, even, and uh we wanted to show, you know, we've achieved accreditation with the state. In fact, we joked, we got a call today that we had one of the state. You show up today for a surprise inspection while we were here, so who planned that is what I wanna know. But uh, but we're not scared of that. We have, in fact, I, I wanna say we've had a great relationship with the state overall, very blessed to be in the state of Arkansas and and and be allowed the freedom to run the center that that we've been able to run, uh, so we're also accredited with CAF and that's our medical accreditation that that is uh that is no easy task. I don't know if you know the ones in the room would be familiar with that. It's either go with Jaco or Carf and uh and we've gone the car fraud and we've been accredited for 7 years now, uh, and, uh, so we, we abide by. those standards and that is definitely made us a better facility and uh then of course our accreditation with Adult and Teen Challenge. So we have 3 agencies that we answer to that keeps us hopping, I promise, uh, but that does, I believe, set us apart and hopefully builds confidence in uh. And the safety of our center and and the treatment that we offer. Uh OK, so you see up here we just kind of got an overview of our model. I know that's just it's an amazing graphic that our Marissa here helped develop and it just gives you just the picture of the, the how we treat the whole person. You know, if this isn't, there's all aspects going on at our center and uh. Um I want to touch on those in in just a minute. Just a To back backtrack just for a minute like I said, I, I've been the CEO. I've been the CEO for 4 years at Teen Challenge Adventure ranch, but I've been there for 28 years. I was for 24 years I worked alongside of our previous executive director and uh you know, it's just been quite a journey, um, I just, I just wanna put, we have such an amazing team, staff, the time that I've had, the experiences, you know, you can, so you can only learn so much through a book and in college, but hands-on experience, 28 years, uh, ah, I'd like to tell you I've learned it all. have not, uh, each, each and every day, it's, it's a new challenge, but, but I do believe, you know, our tenure there, uh, our leadership team there, uh, I estimated we had 75 years of experience together in the industry and uh so that's just, I hope that's that's a powerful encouragement for you all to know that there's a team like that in Arkansas doing the work that we do. So just to give you an overview of Of our campus Uh, just in case you wondered, you know, we're not just some little uh house in the middle of nowhere. I don't know if you can just see that picture there, but we have amazing facilities over the past 7 years, especially, we've been able to just make some phenomenal improvements. There's been multiple uh buildings added, uh. And probably one of the most, the funnest pieces recently was we, we added a 20,000 square foot equestrian center covered area, so we use horses as part of our treatment and so that that was an amazing piece to that. Uh, we specialize in all different areas, of course, peer support. You can see that picture there, uh. That's the key, you know, we have to have a place where students can feel comfortable, where they can be supported by their peers. And no matter what these students tell their parents, they do smile, they do laugh. They do. So you can see that in that picture. Uh, we're very blessed to have an amazing academic support team. Now, I wouldn't tell you that that academics is our number one priority, because the first thing we always tell the family, you know, academics can come later, but we need stabilization. We need mental, spiritual, uh, physical health to come first, right? Then, then they can start to adapt and and realize they can learn, they can still learn, they don't have to give up. So we have an amazing team, uh, in the classroom that's staffed by licensed teachers. We have an accredited school. We Um, last year we brought in more than 62 clients at our program, and the number I got from my academic director was 26 of them received their uh high school diploma or GED while they were in our facility. And these are students that aren't supposed to succeed. They have been kicked out of every school. They've dropped out, they've been in alternative schools. They've been passed around. And uh they've given up. But we were able to restore that in them and so that uh we do have a GED testing center on site as long as, as well as ACT, so we have such amazing tools, um, at our fingertips and and it's work. We, like I said, have amazing facilities. There, there's a picture of the outside and the inside of our equestrian center that we just finished and is now open. We just hosted an event to open that and uh Anyway, that's just a phenomenal, uh, facility. We had estimated that out of 300 days of of services we're trying to offer to students 100 were affected by weather. And so having a facility like that allows us to, you know, utilize the horses at a level that's Uh, second to none, really. And guess what? a horse can be the best therapist ever. I don't know if you've ever been around animals or horses, but uh and I and I'm not, I'm not the one who runs that part of the program, but I know when I walk out there, if I'm, if I'm anxious, that horse is anxious. If I'm stressed, if I'm angry, the horse is a little angry. Uh, so the immediate feedback you get from a horse, uh, is, is, is, is life changing, you know, for many of the students, and they develop relationships with those horses. Uh, it's very common for our students to on graduation day from our program, say, I want to thank my horse, uh, what was the recent one, McFly. I wanna, I wanna, that the name of all the horses, he said, I want to thank, and that was the first thing he, he was very serious. I mean, he, he thanked his therapists and some of the staff, but he thanks his horse, uh, and so, uh, so it's a powerful tool. that we're able to offer. Uh, at our center. We also specialize in outdoor adventure activities and spiritual experiential learning. I, I was able to pioneer that years ago. We found some backpacks in a closet and uh I asked my director if we could go on a hike, uh, that turned into a fully fledged component of our program, uh, going to the outdoors, the Buffalo River. I would hope you all know about our beautiful Buffalo River in the in in Arkansas, we spend uh many days out there. We even have some property located in that area that we can take the students to, but we've We canoe, we backpack, we rock climb with the students, um, all the students go on a, on a, we call a hall trip, a dorm trip once a month and, and get to get outdoors and experience nature on our campus, we have uh the uh challenge course you see there that's a climbing tower. There's two zip lines that come off of that. So there's just again, another tool that just helps the student uh start to become self-aware, start to deal with his, his, uh. Uh, you know, anxieties, fears, and, you know, just an amazing tool. On top of that, like I said, we don't, we don't want to shy away from who we are at our core and, and we are a Christ-centered organization, so we do give uh students all the opportunities we can to experience that. Uh, that is not forced, uh, or coerced or at least it's surely not our heart to do that, but we surely give them uh freedom to experience that on our campus. We have chapels and and classes that are that are uh involved with the Bible and teaching. Um, of course, our therapy is a safe, a safe place where they can talk about anything and it doesn't have to be anything to do with Christian values, but we surely take every opportunity to to help them experience that while they're at Teen Challenge. Help me out. Let me, uh, yeah, we'd like to just show a quick clip here if it works. So. A couple of years before team challenge, uh. I started getting into drugs. Um, it started with just vaping, uh, honestly I wanted friends and that's kind of why I did it, uh, but I started vaping and then I started selling vapes because I wanted people to like me and stuff after that I started smoking weed, selling weed, um, getting into drugs and getting into this drinking alcohol and all that stuff. Um I was really depressed and had a lot of anxiety and the more I did drugs like it was kind of like a a temporary fix, like a temporary fix to the problem of depression and anxiety but when I would be off of it, it would just be exponentially worse, so I started having suicidal thoughts, um, I started just thinking I was worthless thinking that everything was over, um, and I wish that my life would have been over. So, uh, my parents started send me to mental hospital, um, and while I was there they put me on medicine and stuff and I'd just come out and abuse that medicine, um, got to the point where I truly just was suicidal, didn't care if I was gonna be alive anymore, um, so you know, alcohol, weed, pills, I just started doing it all at the same time and you know if I die I die. It didn't really matter to me, um, so the spiral just kept getting worse, uh, my family and I wasn't good. Go screaming matches with my dad, um. What have angry bursts, uh, with my mom. One time I punched the dashboard over of her car and I broke my hand doing it. Um, scared her half to death, and she's honestly scared of me, uh, and so that just, you know, the spiral of everything just got worse and worse. Eli is a very typical example of a percentage of our clients that we get. You heard his story. You know, bullying, anxiety, depression. Ex experimenting with. With vaping To marijuana. I'll just pause there. I hope everybody in this room, we agree vaping marijuana, they are gateways for these young men. I encourage us all to fight to keep that out of their hands, cause his, you know, you can see the pattern. And then, uh, anyway, led to just disasters in his life. Um, you look at these statistics up here, this, this describes him overall greatly, you know, 1 in 4 teams abuse drugs and alcohol, 1 in 5 teens have been a victim of physical or sexual violence, 1 in 3, say they have experienced poor mental health, 1 in 3, you know, that's, that's terrible. Kids shouldn't feel that, right? Uh, 1 in 5 teams have seriously considered attempting suicide. We'll mention later that, you know, the second leading cause of suicide and in boys is, I mean, 2nd leading cause of death in teenage boys' suicide. You know, we, we, we, I believe we're making a difference in that, at Teen Challenge, but we, we want to make more, you know, so, so that need is huge. What I can tell you, About Eli today. In fact, I just had breakfast with Eli two days ago. He asked me to mentor him in his life. He's a young man now. He's married. Uh, he's, he, he finished his college degree. His wife just, he, he's got married. She just finished her pre-med degree. Um, he's uh now a missionary at the Chi Alpha campus on the University of Arkansas. He's raised all his own support. He goes out daily just to to share the hope. Uh, that he's discovered and hope that, you know, find some, you know, we all know on those campuses they need some hope, um, so he's doing amazing things. Like I said, he asked me to have breakfast with him and he just, you know, he asked me all kinds of things about leadership and life and, and ministry and different things, so, uh, it's just a privilege, first of all, you can only imagine. I, I can backtrack on that. I was there the day Eli was dropped off. He had ran away from his family that morning. The police had to go find him cause he was, he said, no way, I'll I'll die first before I go to team challenge. Luckily, the police es stored into our campus and his parents were able to admit him. Uh, we take the students on a quick, a quick, a short day, 3 days we go hiking with them. That's, that's when they get there, that's what we do, either canoeing or hiking something away from all the distractions and I walked on a trail with him, and he was manic. He was dangerous. Um, you know, I mean, to the point, I mean, his mind was not healthy, and I was able to just to to walk and talk with him and not sit in a therapy office and uh Through consistency, love, horses, he'll talk about his horse, uh. it. He's sitting here, you know, you see where he's at today, so that's, that's what drives us. I assume that's what would drive all of us in this room to want to make sure we do it, do something to make a difference in these young men's lives. Uh, so yeah, he's doing amazing. I mean, Eli should not be alive today. I mean, that's just the bottom line. I, I don't believe he would be if he had not gotten intervention. He was at a serious place when he entered, you know, a dark, dark place, and that was combined with drugs and mental health. So, like I said we had to treat both. Uh So, and uh that that, you know, that's been part of our evolution and getting to where we're at today as far as all the licensers we carry now that we are, we do consider ourselves, you know, a fully clinical treatment center and uh I want you to hear just a little more about that from uh my amazing uh director of clinical over here, Richie. Thank you, sir. Um, again, I'm Richie Swarrington, the director of clinical operations. I've been a, uh, registered psychiatric nurse since 2008, uh, worked in many different areas of psychiatry inpatient, outpatient day treatment, home health. It's, there were two places that I, I told the Lord I, I would like to never have to work in the psych field and that was substance abuse and adolescent males. So now I work at an adolescent male substance abuse treatment facility. He has a great sense of humor. Um, I did want to, um, Bring up again some of the um statistics uh and share some that that are so easily um. Locatable online, 58.7 million Americans had a diagnosable mental health issue in the year 2023. To break that down a little more, 4.5 million adolescents met criteria for a major depressive episode last year and of those 4.5 million, 1 in 5 of those adolescents had a co-occurring substance use disorder as we're in a, this is an it's a pandemic, it's an epidemic, it's, it's terrible. So thankful that we are in the state that we're in, state of Arkansas. getting to work with these young men. The freedom we have here is Justin has said it already, but I wanted to thank you personally for, for continuing to allow us that freedom to treat that. So many factors influence um some of the, of the. The illnesses that these young men face, uh, these could include anything from genetics, whether it be hereditary, um, some of it could be trauma or abuse, but also it could be learned behavior. It can be generational. Dad, grandpa did it. Dad did it. I'm going to do it. My kids are going to do it. That's what's seen. That's what's repeated. Uh, we've got to break that cycle. If these patterns are not stopped, it becomes systemic and cyclical, uh, these systemic issues lead to increased healthcare costs over or a decrease. overall productivity and quality of life increases in chances of incarcerations and psychiatric and and uh medical hospitalizations, uh, as well as an increase, greatly increased chance of homelessness and, and, uh, uh, continued problems that occur with that. What we try to do at Teen Challenge Adventure Ranch is focus on the whole family. Our desire is to find the root of that issue for these young men, so often we see that when the parents admit their sons there, and they get this extended treatment, they get this continual, uh, long term treatment, the the families, the parents, the, the siblings are much more likely to, uh, admit their own. Uh, issues that they're having. So focusing on the whole family and treating the family unit as the patient is critical. Um, Justin did mention we're fully accredited. Um, I wanted you to, to hear all these acronyms, right? So we're, we, we provide CBD, uh, CBT DBT individual therapy, family therapy, group therapy, accelerated resolution therapy. We have access to EMDR, you know, those are two of the most state of the art trauma therapies that are, that are available and we have 4 certified therapists there, they're providing these, uh, trauma focused therapies to these young men. We have the equine component, uh, we have hiking, fishing, swimming, camping, CrossFit, med management. Uh, we offer mission trips, uh, we can meet their spiritual needs, uh, we want them to know by the time that they leave, that they have worth, value, and purpose, and we support them as they develop their identity. We strive to get them sober and stable, get them involved, get them focused on their purpose, and then they don't have time to mess it up. If we can get them focused, if we can get them plugged in. It, it's a, it's a great factor and motivator to stay on track and on target. Um, I've heard all my life, uh, the, uh, idle hands and an idle mind are the devil's playground. If we can't get them focused on a purpose and, and, and on a path to recovery and on a path to their future, the outcomes are, are much worse. We also offer a robust aftercare. It sets us apart from so many of the other programs when, when a client completes our program, we do 6 months of what we call aftercare services, and that is weekly contact with them, and then currently we're actually going to their home 3 months after they've completed the program and helping them put back together anything that's falling apart in their aftercare plan. So we make trips all over the state, all over the country helping these young men put this back together if it's anything that's Anything that's come loose. Our outcomes, it's so difficult to really put To quantify and qualify an outcome for these young men. Success is, is very subjective. It's subjective to the family, it's subjective to the student. We can comfortably and confidently say that we have a 60% to 70% success rate at one year after completion of the program. Um, recidivism, I would say between 10 and 15% of the young men that, that go through the program end up back in another program after they leave ours within one year. Phenomenal rates, they almost seem too good to be true. We're continually collecting data to support that because sometimes we feel like we have to pinch ourselves, that, that this is reality that we're really making this much of a difference, but we are. I'll give it a few quick examples. I'll try to be very uh respectful of your time today. Um, I wanted to, to bring up a young man we'll call Mason, a 15 year old male came into our, our, uh, program. His mother was absolutely terrified. He was disappearing for days at a time. She knew he was using drugs, didn't realize the extent until he was in the program. Not only was he, uh, using drugs. He was selling drugs and wanted to be, uh, a very successful drug dealer. So he was actually obtaining and mixing bath salts into the cartridges that he was making, hoping to get a return customers 15 years old. 15. Um, He had done so many of those drugs, tried so many of those different things that he, um, He really burned a lot of the receptors in his brain. It took us a few months to even really get him stabilized to the point that we understood, uh, how unstable he was. We, we actually went and got additional testing that we've, I don't know that we've ever done before, had a special testing done on him. pulled out all the stops, got as many resources involved as we could, um. Unfortunately, his, his mother had to pull him early. She ran out of resources to be able to keep him in the program. We did everything we could do for to set him up for success in his aftercare journey and, uh, checked on him a month or so after he left and we said, we just apologized and said, I'm sorry, I wish there was more we could do. She stopped me and said, You don't understand. Thank you, my son is alive, Lucas, uh, we'll call another young man, Lucas, um, this young man came in, um, one of the angriest young men that I've ever seen, um, after being in therapy for a few months. He did share with his therapist that he was glad he came to our program because he had actively been planning on how to kill his father. He, um, his, he was from a broken home. His parents didn't get along. They argued all the time. They couldn't commit on his, uh, upbringing and his, uh, punishments, his, uh, Where he would live even, um, his dad was a, a terrible alcoholic and would Lucas did not have a a a good home life. And he was actively planning that. We were able to, um, to stabilize him. We got him on a great medication regimen and with a phenomenal therapist that we have on staff. And um we're able to. Help him through his journey on forgiveness for both of them. Lucas came back last summer and was actually an intern in our program, and, uh, was able to work with some of the young men, um, to help them and encourage them on their journey. He also shared with us that he had been working with his father and his father was 2 months sober as of July, and they have restored their relationship. Lucas is also part, uh, is in the 2nd year of his college education at a, a college in Iowa and is on a championship wrestling team. Holding his, uh, place there. Um, so restoration of his family restoration to his future, and he no longer thinks about killing his dad, so that's always a bonus, right? Uh, the last one I'll give you, I'm sorry to take so much of your time. I appreciate it so much. Uh, we'll call this young man Avery. Um, he came in actively, uh, manic and psychotic. The, the day his parents dropped him off, they were not Completely honest on his application, um, but when he got there, we knew that we had to help. We were able to stabilize him quickly. We have a psychiatric APRN that we keep on staff. We contacted her, got him medicated, he stabilized so quickly, uh, we were able to recognize many other issues that we have worked through them, get him on a phenomenal education plan. He dropped by last week on his way through to let us know that he had just completed a class. He's on his way to becoming a stuntman in Hollywood. So he's completed the course and he's end. Ready to go into the training. We've got these, um, my hope is that, um, as I close this, I hope that, um, that you'll be proud to know that in the state of Arkansas, in a tiny town called Morrow, we have a residential adolescent male treatment program with 4 full-time licensed mental health therapist, 2 full-time equine staff, 4 full-time case managers, 8 full-time education staff, a psychiatric APRN available 24/7, 20 direct care staff that are restoring families redeeming young men and reaching communities within the state of Arkansas and all across the United States. I wrap this up as well. I know we took way too long, forgive us. Oh. Put that back on. I'll wrap this up, uh. And skip a few of the things. I think you get the point. The need is, I, I think you all know, but I hope it just brings it to your to your minds. The need is huge. We have to invest in the next generation. And uh to do that, we need your support. I just want to remind you all that we're like, we're blessed in Arkansas right now, but there are legislative trends throughout other states right now that where they're deterring families from utilizing residential treatment. They're saying, in fact, they're there, there, there's some places they're talking about banning it. Um, now I will, I will agree. Let's fix families. Let's fix schools, let's make sure kids don't have to come to residential treatment, but that will never. negate the need. And so, you know, we, we urge you all to continue that fight with us and, and of course to allow us the freedoms of of our Christian faith as well, um, in this, in this realm, because we believe when you combine those two things together, it's the most powerful weapon ever against the epidemic that we just described. And uh, so, so I just want to say that if we, if we could have any kind of voice or any kind of uh, you know, be, be able to share what's happening. We want to be able to do that going forward. So this opportunities is huge, I believe for us, because again, we have, I think we have more experience probably than any center in the state, um, and so I, I hope and an amazing reputation. Uh, I will add that. I, I don't believe there's one news article out there. We've never been in a scandal. We have not been accused of abuse. Um, now I'm not gonna tell you we're about perfect, and we deal with humans. But I will say we have it as stellar reputation and uh we don't take that lightly. We work hard every day to make sure we have an amazing safe place for these young men and their families. Not to be So that that is the first thing I would just say at the end of this, you know, please, uh, um, ask questions, you know, but I hope you will, you will support, uh, what we do and make sure we always can keep doing it in this state. Uh, secondly, of course, any resources, uh, we can glean would be amazing. Um, the cost of what we do is astronomical. Um, we estimate it's $500 a day just to keep our doors open. I'm per bed. Uh, and that is. We have, I haven't met another center like us that's doing it for less than 1000. So I do believe we are using every dollar in the most wise ways possible. Uh, I, I, I know that I'm there every day. I know where it's going, but I see what what our staff team does and the sacrifices we make, the calling that they serve, and uh and I also know the incredible cost to the families. So, you know, we are obviously desperate for resources. The insurance industry is, is not as helpful as we'd like them to be, believe it or not, they don't want to pay a whole lot. So, uh, I don't know, boy, if you could pull those strings for me, please, please. Please, uh, let, let me know uh that there should be rules that they have to compensate, you know, cause we're we're preventing a life of hospitalizations of overdoses, of care. So, so the need is huge in that in those two areas. And uh again, we just want to say thank you for this opportunity, uh, to be here. Thank you for letting me go over in my time. Thank you. Are you ready for questions? Representative Springer, you're recognized. Good afternoon. Thank you, Madam Chair. Madam Chair, I have about 2 or 3 questions to answer if that's OK. Well, you're not the only one in the queue, so if you'll do them one at a time, we'll circle back. How's that? OK, well, the fir I guess the first one then is follow up with respect to funding, uh, you indicated that DHS was one of your partners. My question is, uh, does DHS actually provide any type of resources to you. Um, is there appropriation that is provided to you, ma'am, we've never received any, any money from the state. Um, now that could be part of ignorance on our part. We haven't known what we could ask for, um, uh, for years, of course, there was always the fear or the or the thought that because you were a Christian organization, you couldn't get state funding, um, but that again, that was probably ignorance, um, so anyway, the answer is no, we, we currently don't receive any any funding. I, I'll get back in the queue. I have several others. Thank you. Um, representative Watson, you recognize. Thank you for your presentation, uh, Justin and Richie, uh, out of curiosity, is this voluntary and voluntary or court ordered. A, B, or C, just curious or a little bit of all three. Sure. Well, being a private placement, uh, the court can agree, a family can petition the court to say, you know, we would like to, would you let us put our son in team challenge instead of Youth challenge or somewhere else, right, that may have been available, um, so they could work in agreement, but the court can't order them to be there, but they can. Order them back to court if they don't complete it. Does that make sense? So that, you know, that's part of that. Other than that, it's a private placement, individual families, uh, that, that place their sons in the program, um, of course, the young men don't all come voluntarily. So, uh, you know, they're not uh they don't make the call. Thank you. Appreciate. Keep, keep at the word. Thank you. Representative Shepherd, you're recognized. Thank you so much, Madam Chair, and thank you all for being here today, and I think Representative may have just asked my question, but my question was one of them, do you take DYS kids. No, not, not currently. OK. And the other question would be, uh, and I'm sorry, Madam Chair, follow up, um, are there any clinical diagnosis that will be excluded from the program. I'm gonna let Richie answer that one. As far as like an Axis one diagnosis. I haven't run across one yet. We do run into some intellectual disabilities that do interfere with their success in our program, um, so some of the intellectual delays, uh, the, the type of therapy that we provide is not as effective or impactful, and the length of our program sometimes is a barrier, uh, to them doing well. We have some, have some with some low IQs that have come through and done very well. We've had some come through with, uh, many. come through with autism and, uh, at different degrees and do relatively well. Uh, we've had some with autism, especially the higher functioning that do incredibly well due to the structure and the nature of, of our programming. Um, as far as a severe mental illness, we are very capable of managing those. Uh, we handle individuals that are actively suicidal. Uh, we keep them as long as is safely possible. Those with mood and thought disorders, 100% we're willing and able to take them. Psychotic disorders, bipolar disorder, very, very, uh, well equipped and your ratio between staff and students varies throughout the day because of our different licengers were at, at the low. where 1 to 8. Lowest ratio is 1 to 8, um, during the day where we nearly outnumber them with staff, to be honest. We have a team of over 60 staff for 40 clients. Um, so, as we often feel still very overwhelmed. I, I don't think there's a better ratio of, of, you know, of supervision and in any place that I that I've ever visited, so. Representative Mayberry, you recognized. up here. I'm sorry. I know it's hard to know where's that voice coming from. Um, Representative Springer was asking, you have received no state funding, so I, I assume that means no Medicaid funding, so does private insurance pay for this, or is it only private pay like an individual family having to pay for it. Uh, it's, so we, we, it is, there's a private pay rate, um, and then yes, we do bill insurances, it's all out of network billing at this point, um. because in network, you know, rates are not, uh, will not run the program. It's not enough. So it's a very challenging. We're still, you know, we've been 7 years, uh, problem solving the funding, especially with insurance companies, because we want that to be the case. We definitely want to be able to make sure it's a family with insurance can, can afford to to put their, their child in placement, uh, but when it comes to uh state funding or Medicaid, uh, you know, the honest truth is there's no way we could, we could pay the bills with the. funding that comes through that and, and unfortunately the huge amount of red tape and that comes with that. Representative Springer, you're up again. Thank you, Madam Chair. I just wanted to inquire how many, how many uh students do you believe that your program can accommodate. A number of my questions have already been asked, but students, can you come right now you have, you say you have 4040 rooms, our campus is set up with every student has their own room, so we have 4 we're licensed for 40 currently. Um, if we had the funding and there was access for, you know, the need is massive. I missed one stat in here. We, we estimate we received 10,000 calls a year for help. Now, of course, they don't all need residential treatment once you talk to them, but I would say the vast majority that we, you know, we could fill every bed. Every day if if funding wasn't an issue, you know, uh, so the cost. So, uh, so 40 beds at a time and the stay is between 90 days and 9 months, so 3 to 9 month program, they have options of what. Level they want. We have a 90 day stabilization component. So we don't do a 30 day, we don't do the 7 day, you know, we don't personally believe that's our, our, our place and we, I don't believe the success is there, you know, the longer the better, uh, but the funding is, is again the challenge for long term care. Madam Chair, I just want to ask uh one additional. Oh is this program only confined to just males only or do you receive Yeah we, so our we do, we've been male. Um, we have, um, just put, we have a strategy and a campaign campaign in place for Genesis Ranch, um, a place of new beginnings for teenage girls. We want to open a campus uh within 10 to 20 mile radius of our current campus, so we can utilize the equestrian facility, but also have a campus for girls, uh, so yes, we have a full campaign or going, I have a core team of uh women leaders that want to open that center that are, they're ready, but we need a million dollars. If anybody's got it, let me know. Representative Duke, you recognized. OK. Thank you, Madam Chair, over here, um, thank you all for being here and I appreciate your work and service that you all do. How do, um, How do families become aware of your program, and do you have a relationship with schools, um, in the area, so that they may be able to share that information as well. Thank you. So primarily the Internet, web searches, of course, traditionally it was through um the the the team challenge name, which also is team challenge comes under the assemblies of God, uh, denomination, so through churches and and and and that word of mouth, but really for our center, it is an it it's um it's an internet search, uh. So it's a marketing campaign, um, of course we are working on referrals. Well, that's kind of a whole new uh campaign of ours to make sure we, we have our literature and our names and every, every clinic or treatments, you know, short term treatment in the state, hospitals, places like that, um, courts potentially. So we we need to work on that and that's something we're we haven't done real well in the past. But overall it's word of mouth or or internet based. Follow up, please. You recognize. Thank you. Um, what do you all partner with churches and outside organizations as well? Yes, I mean, uh, we travel to churches, uh, of course, our students even on Sundays, the ones that have gotten so far out of the treatment stabilization component that they attend some of the local churches. So yes, we definitely travel um. At times throughout the state in different places, but especially our region of the state, Northwest Arkansas. Representative Brooks you recognize. Thank you, Madam Chair. uh, just to follow up on Representative Springer's question, line of questioning relative to the need and the amount of kids. Do you have an active waiting list? You've got 40 on campus, 40 spaces, is there an active waiting list that you are working through as, as one teen graduates out successfully. Uh, at times we do, uh, there's several reasons we don't. One is because if your students in crisis, you can't wait. So if they, if their bed is full or it's close, you know, or, you know, they're probably gonna look for something that they can get in immediately. But the second is, again, uh, because of the cost and the challenges out there of of marketing, uh, we, we get those calls, but again, accessibility is tough. So, um, So that limits, uh, you know, it's been tough to get families to place. We now we we're averaging, our average census is above 34 out of 40 beds, that's a good average census. It's not that we're not staying full, but I wouldn't say there's a a true waiting list most weeks. We usually have a couple beds open each week. So every Monday we take in new students. So like this coming Monday, I know I just got confirmation we have 2 new students coming in. We had 1 come in this past Monday. Representative McClure, you're recognized. Thank you, Madam Chair, uh, thank y'all for being here. I enjoyed talking to you before we got started. Also want to thank the committee for asking all the questions on my list, so I'm down to just one combo question. Uh, back to academics, what curriculum do you use and do y'all administer a GED test or do you have a graduation program? Yes, yes, and yes, I think is the answer to that, uh, name of our curriculum, I always say it wrong. Ignatia, uh, it's online curriculum, we have 5, well, I think we have 3 licensed teachers, several, uh, tutors in the classroom, so total, I think we have an academic team of 6 staff, so there, they're tutoring individually. We, uh, let me back up, we do have the only funding we receive is a small amount for Title I funding for our education, for tutoring in the classroom. So we have always been able to tap into a little bit of resource from the, uh, I believe that's through the Lincoln School District. Uh, again, uh, uh, the program is big enough that I do not run the academics, so I have, I have an awesome academic director that's been there for 13 years. In fact, she's the one that is ready to pioneer the Girls Center. Um, so let's see, what I didn't answer part of your question though, uh. For, yeah, so we have a GED testing center like we've been able to get the state to license us to have that on our campus. We have a room that, you know, we can't use for anything but testing, uh, so that's available, uh, as needed. And so we have, I mean we have high school graduations every month and then when the parents come on campus, we do, we didn't talk a whole lot about our parent involvement. We have a ton of parent involvement. Parents come out every 8 weeks for a whole day on our campus, full day of events, therapy, chapel, uh, and celebration of graduations. And so that takes place. So yeah, it's a very accessible and yes, we can give high school diplomas and GEDs and we award those immediately on our campus. Representative Pierce, you recognized. Thank you, Madam Chair, and thank you for your serving hearts and in your vision to do this. And my question is, how many children or how many young people do y'all have to turn down due to finances, their personal finances a year in your facility. I, I, I, I'm just gonna throw a rough guesstimate. I mean a lot, a lot, right, uh, 10, 10,000 calls, 50% of those probably would qualify for our, our center. I'm just gonna, this is a rough gauge. I mean, really it's thousands. I mean it's thousands and thousands, you know. a private pay, I don't want to shy away from this for a private pay to come in our program out of their own funding if if we don't have financial assistance available that day, which we try, but it's $15,000 it's $500 a day, so it's $15,000 a month for them to receive the treatment. Now, in the realm of treatment, if you know, that's really cheap. I mean, I hate to say that, but incredibly cheap. I can tell you about another uh program in, in the state that charges 30 35,000 a month. It's not, it's 105,000 for 90 days of treatment. So, so it's incredibly hard to staff what we do, to provide all the care we're talking about. We, we do have opened a separate foundation. We have a separate 501c3 called New Adventure Foundation. We've just launched this year and we're trying to, you know, the dream is to have an endowment and financial assistance that comes from that fund for those families in need, you know, on a sliding scale. So we still give a lot of scholarships, uh, but. We, you know, but it's, it's, it's hard. That's it's a lot of money. Follow up, Madam Chair. There's about, thank you. So what I come up with around 5000 a year. With 10,000 calls, we have to turn down that we cannot reach we just can't reach them because of finances on even on the personal side of, of things or their insurance policy, you know, it doesn't, it gets denied, you know, I. I don't know if I should pick Blue Cross, you know, Blue Shield of Arkansas, you know, we'd go broke because they don't pay any money, you know, that's the biggest provider. You know, and, and that's from other states as well. So I mean, you know, it's really hard. It's, it's just, and we don't want to ever turn somebody says I have insurance, we want it, we wanna be able to accept them, but that, uh, it doesn't always mean we can. It's just we can't keep the doors open if we do that. follow up. You, I'm sorry. So my, my last question, have we come up with a solution? Obviously we have not, to get these children that we can't reach that are just as important as our children. Absolutely. OK. Uh, I mean, one at a time. That's the only solution I have is, you know, for the view of the scholarships that we can give to those families in need. You know, I could tell you about the client from Arkansas right now that the the family adopted him, um, from the Little Rock area. And, uh, I couldn't say no. I mean, you know, on paper, the finances we knew they had all they need in the world, so we are, we're, we're basically giving, you know, a full financial assistance to that family, which is amazing to them, but that means that bed's not bringing any money in for us, you know, and, and you're talking. 15,000 a month times 9 months, you know, so we just gave a massive scholarship to that family. And we, we want to do that, but we gotta have the, you know, funding to do that cause I, you know, I'm gonna Poke now if if that young man was from California, they have a funding for, for adoption that would pay for all of his care. You know, for, for families that have adopted a a young man who needs help, you know, so we, we would love to see Arkansas do something in that realm. cause we get up, we haven't talked about that. I, I would estimate 30% of our clients come from adopted. They, they've been adopted. Thank you and thank you for the grace, Madam Chair. Represented Brooke you recognized. Thank you, Madam Chair. Uh, one quick follow up to something that another question was asked, keeps like representing McClure, most of I get asked, but creates more questions, uh, relative to the, the education support that they get. Is there a percentage of, of teens that come with a specific diagnosed learning disability. I, I can't think of one any more than another. Um, we, Maybe, maybe a better way to state the question is, is what percentage of your kids have a specific learning disability would say the 30% is very close to it, 30 to 30 to 35% of, of them have some sort of diagnosed learning disability, mostly, um, Well, I, I said no, there's not one in particular, but the reading is very common, uh, a reading, uh, disability is very common. Uh, we were able to accommodate that because of our staff ratios. Um, there was a point that just slipped out of my head. I wanted to answer for you. gone. So sorry. Very good. Thank you. OK, see, no other questions from committee. Thank you for your presentation today and on behalf of all of us, uh, thank you even more for what you're doing for. So many in need. We appreciate you very much. Thank you. Next on our agenda. Is the report, um, let me get it right. The 2024 Annual report of the Alzheimer's and Dementia Advisory Council. By Mr. David Cook. And I know you know the drill, but if you'll introduce yourself, then you may begin your report. Thank you, Madam Chair, um, David Cook, the director of government affairs for the Alzheimer's Association. Um, this is the right presentation I told Blake before I forgot to put 2024, so, um. I have an appointment next week for some cognitive screening on that one. Um, I just wanted to, uh, begin, um, some of the questions that I often get from members in, um, the state house is what is the key difference between Alzheimer's and dementia. Um, of course, dementia is a collection of symptoms that are most um often related to cognitive decline, um, and so just kind of think of dementia as we do cancer, dementia is the umbrella, of course there are various types of dementia, um, but Alzheimer's is a uh. The leading cause of dementia, Alzheimer's is a degenerative brain disease, um, and it is not a normal part of aging, so we, I just wanted to level set, um, kind of explain that there are again, other forms of dementia, um, and, uh, the advisory council, um, is, is working actively to just make sure families who are impacted by these various types of dementia, um, have the support and the services that they need, uh, so it's not just specific to Alzheimer's. I wanted to make that point. Um, it's also helpful as we go into uh the statistics, um, we know here in Arkansas as of the 2020 census, um, over 60,000 Arkansans over the age of 65 are currently living with Alzheimer's and of course that number is not inclusive of those families who may be living with another form of dementia or those individuals who may be living with a younger onset diagnosis, um, and so the number, um, on the screen is, um, extremely conservative in our view, uh, because the number of our cases go undiagnos. um, and so we continue to see prevalence numbers grow in the state. Um, we are an aging state, uh, with multiple chronic conditions that, of course, increase your risk of developing dementia, um, and so we think the numbers are continuing going to be on the rise in the years ahead. Um, when someone receives a diagnosis, of course, family, uh, caregivers are typically the first line of defense, um, and here in Arkansas that represents over 155,000 Arkansans who in 2022, uh, provided over 270 million hours of unpaid care, um, and the value of the care our family caregivers provide, um, is $4.448 billion in cost savings to the state. So family caregivers play a critical role in providing care and support, uh, for their family members. who have been diagnosed um with this horrible disease. Um, you do have a copy of the Alzheimer's and dementia advisory councils, um, report. I'm not going to read through all of that, um, so as we go through today just wanna hit some of the highlights in each of the priority areas, uh, what has been achieved in the state plan, um, but also some of the pending recommendations, um, and then, uh, towards the end of the presentation, I'll give you a summary of where we think the legislation will lie in 2025 and where we need your support. Um, we're briefly, this is, um, uh, our co-chairs of the advisory council Representative Julie Mayberry, um, and Senator Penzo, um, from the Senate side are co-chairs, uh, state agency partners, Department of Human Services, um, the Department of Health, and, and of course the Arkansas minority Health Commission, um, this is a list of, um, the other members of the council, so inclusive of many stakeholders who are working in the aging space, uh, providing services for this population. The state plan is um separated into four main categories, um, just so briefly, um, public awareness and education, we know that is uh critical um that patients and consumers understand the importance of early detection and diagnosis, um, but also that they understand that there are some certain things that we can do to help diminish our risk of developing dementia and risk reduction, uh, certainly is a priority at the Alzheimer's Association, um, and certainly other states have taken that. as well, uh, just to help promote brain health, um, so that we can get ahead of the curve because if prevalence continues to rise at the rate that we anticipate, um, the healthcare system is just not sustainable to meet those needs, um, so risk reduction is essential and also emphasizing brain health, um, access and quality of care. We wanna make sure that there is access points, um, regardless of your zip code that you have access to timely diagnosis, um, but also access to support services and that those Um, care providers are adequately trained, um, to meet the unique needs of the dementia population as well. So we've done a lot in that area. Uh, of course I mentioned family caregiver support is huge, um, and then dementia training and workforce development. Again, that's that quality of care, uh, uh, point. We just want to make sure that the dementia training standards across care settings, um, are inclusive of the unique needs of the dementia population as we know that our clinicians are seeing more and more patients who have, uh, cognitive decline, uh, MCI or, uh, a form of dementia, um, and that is not going to slow anytime soon. So on, uh, the public awareness, uh, piece, there have been several advances, um, most of those have been driven in the nonprofit space. I know that the Alzheimer's Association, the UMS Centers on Aging, um, and Alzheimer's Arkansas have all seen increases in the number of lives that we've touched over the last few years, um, the need continues to be great. Um, we do that in a variety of ways to community education, um, the association has a catalog of programs that we provide in community. Um, that touched on a variety of topics, um, including risk reduction and brain health, um, but enacted recommendations, uh, specific to this, uh, of course, authorizing the Alzheimer's and dementia advisory Council in 2021, um, was very essential and elevating the profile of the disease and also ensured that we had an active Alzheimer's state plan, as well as an active task force or coalition working on implementing that, that state plan as well. Um, uh, in 2023, uh, we advanced legislation, um, Arkansas joined about 20 different other states, um, establishing an Alzheimer's and dementia services coordinator position at the Department of Human Services, um, and so that was, uh, enacted in 2023. Um, there's also been great strides by the health department to improve data collection, um, the health department will now run the cognitive decline module and the caregiver modules and alternating years as a part of their behavioral risk factor. surveillance system, um, with the commitment to at least run one of those modules every 6 years so that we can contract, uh, we can continue to track, uh, the caregiver needs, but also the rates of decline, um, those who self report, um, struggles with cognitive decline, um, very important modules to be, um, established into the burus. Um, as part of our work with the advisory council and working on the state plan, um, that's, uh, elevated the states and allowed them to qualify for funding under the bold grant. Um, what is unique about Alzheimer's and unlike other chronic conditions, there is not a dedicated federal funding stream that comes back to the states to help them work in the public health space. So bold was passed in 2017. It's called Building our large, the acronym stands for building our largest dementia infrastructure Act, um, and that allows. uh states to apply for federal funds, um, Arkansas did receive a core capacity grants under bold, um, in 2022, um, with those funds, they had a grant funded position uh that was a grant manager administering the grants, um, they also made great strides to update, um, the state's website, um, establishing a statewide, um, Alzheimer's and related dementia coalition, um, that works on these issues as well, uh, the health department did reapply for funding under the BOT Act in. 023, to get an enhanced level of funding, um, but unfortunately, um, their application, um, was denied, um, and we were the only states in the country that did not have their bold funding renewed and so that's something that we continue to work with the health department to make sure that we can position the state to qualify for other federal funds that would help us advance some of the programmatic work that's still needed. Public health has um a role to play across the course of the disease, um, Alzheimer's happens on a continuum, um, so in the early stages, uh, it's important to note that Alzheimer's can be present in the body up to 20 years before symptoms start to appear, um, and so in the, in the asymptomatic or the healthy cognitive functioning functioning stage. We believe that public health has a primary role to play in risk reduction and prevention, um, and the secondary phase. Um, there's still some diet and lifestyle interventions that you can introduce, help slow the progression of that disease based on some of the science and research that we're seeing and as the disease progresses, ensuring that families know, uh, some of their options, um, where to access diagnostics, um, where to get care, and now in an age of treatments, the FDA has approved 2 treatments for Alzheimer's, making sure patients know that there are treatments out on the market, um, and some clinical benefits, uh, to those as well. Um, just want to mention real briefly, um, because we always get this question, um, you know. The health department does a really great job and, and try to mitigate risk of developing heart disease, uh, cancer, a lot of awareness campaigns, uh, in that vein. Some of the same things that your doctor tells you to do for, to promote cardiovascular health is also good for the brain, um, and so there is uh a strategy that many states are employing to just incorporate brain messaging into some of the existing public health campaigns. That's certainly something that we'd like to see Arkansas adopt, um, and that Arkansas will get into the fight to. uh, share the information with consumers about some of the things and steps you can take to promote brain health, but also diminish your risk of developing dementia, um, we know that responsibility doesn't only lie with the health department, so we'd like to see the Department of Human Services and those state agencies cooperate to establish a public health campaign, um, to get more information and more awareness around brain health, um, that is very helpful in a variety of ways, but it does also help us primarily to reduce the stigma still attached to. um, Alzheimer's and related dementias, um, we would like at the association to normalize the conversation around brain health and dementia in the same way that we have done in the mental health space, um, 5 years ago, we didn't talk about mental health and now we have normalized that conversation and people are able to get the help and the support services that they need, um, Alzheimer's still has that stigma, um, and so we need more engagement, um, because the nonprofit community just cannot reach the state. in the ways that the state agencies can. So we certainly want to rely and be partners um to the state agencies just continue to educate the public, um, about the steps they can take to promote brain health. In that vein, uh, some of our pending recommendations. This is a policy recommendation, um, more public health messaging around brain health, um, risk reduction, um, and the importance of early detection and diagnosis, uh, not only for consumers, but for clinicians as well, uh, clinicians need to understand that it, it is essential to do cognitive screening, regular cognitive screening, um, but also promote risk reduction in brain health for their patients as well to make sure that clinicians have, um, the late just information, some of the latest research around risk reduction and some of the steps you can do, of course, to diminish your risk, um. Uh, just as a brief example, um, CMS, um, issued, um, a Medicare billing code that allows individuals over the age of 65 during their Medicare annual wellness visit, uh, to ask the physician to perform a cognitive screening. Uh, what we have learned in the years that it's been out, um, is that code is only accessed about 1 to 2% of the time, uh, physicians are not initiating those conversations with their patients, uh, and patients don't know the self-advocate for that. Let's part of our work in communities, especially among aging adults to encourage them, uh, to advocate for that cognitive screening so that your physician can establish a baseline, uh, certainly public health can, um, help advance that messaging and, uh, to be fair, the health department has done quite a bit of clinician outreach, making them aware of the Medicare code. Uh, there's also opportunities for us to improve data collection. One of the recommendations that does live in the state plan, um, that we have yet to address is the establishment of an Alzheimer's and dementia registry that would be voluntary. Uh, we certainly have seen the success in other disease spaces, um, establishing those registries here in Arkansas there has been a lot of success, um, in stroke and utilizing the stroke registry, um, so we'd like to follow that model to establish again, a voluntary registry to help us understand Um, you know, what's happening, particularly in the younger populations, um, are we seeing more and more people under the age of 65 diagnosed with disease because that is a, a number that's very difficult for us to, uh, to get a hold of because again, those cases for a variety of reasons, um, but, uh. Established in this registry would certainly help in, in terms of data collection and helping us get more of a granular look at what's happening here in the. Um, we continue to advocate for access to care, um, on the HCBS side, uh, one of our recommendations was to just to ensure that our Medicaid waivers for home and community-based services, um, are inclusive of individuals who may be living with the dementia diagnosis. Um, I will say the Department of Human Services has been a great partner in helping us, uh, make some changes, uh, to some of those waiver services, uh, but also in future 1915C waivers just ensuring that there's inclusive language. of the dementia population, so individuals who may be eligible for Medicaid under the age of 65 can get access to the services that they, uh, they need, um, the older Americans Act was recently amended in Congress, um, which then opened up the gates for people under the age of 65 to qualify for some of those services such as Meals on Wheels and those essential support services that families need that they, um, travel this difficult journey. Um, we also, uh, need to continue to research and support innovative approaches to expand access to, uh, dementia education, um, we have done that with no fiscal impact to the states again, the nonprofit community has come together to partner, uh, to ensure that we can increase access to our education, um, all of our services are offered free of charge. Um, we offer those in communities, um, I've been in Rogers, I've been in Benton, and Jonesboro, uh, the last two weeks, uh, doing. some of these presentations, um, and all of our support staff is doing the same thing, uh, again, I will mention that, um, all of the agencies, the nonprofits, um, have seen an increase in their, uh, clientele volume, um, the need continues to be great, um, and, um, it's going to continue to be, uh, a need here and some of the uh pending recommendations, um, other states have taken attempts, um, Wisconsin is one that I point to has had a lot of success. And establishing dementia resource centers, um, we, uh, believe that this could happen, uh, very limited cost to the state, uh, particularly by looking at some of our existing infrastructure points, so whether we establish those within the centers on aging through UAMS or the area agencies on aging, um, this would have again, a limited fiscal impact to the state just to expand access to resources, so families who visit those centers naturally, um, have access to dementia education, uh. Support groups and some of the wraparound services that are, again, um, very much needed by people who are living with this, uh, disease. Um, in an area of treatments, we want to make sure that there's equitable access, um, to FDA approved treatments for Alzheimer's. Uh, I did mention that the FDA, um, has, um, approved two treatments for people in the early stages of this disease, um, so we wanna make sure that people can access that drug regardless of their payer type, um, and that's certainly a policy recommendation, um, more specifically, we want to make sure that the state has a transparent process when they make coverage determinations specifically for, um, the employee benefits program as well. Um I did mention that Medicare has established a billing code, um, that would um allow providers and uh. To to bill Medicare, uh, for individuals over the age of 65 during their annual wellness visit, um, for cognitive screening and care planning services. This is a benefit that the Arkansas Medicaid program has not yet established a reimbursement for. It is available to them, uh, so certainly this is a policy recommendation just to make sure that those individuals who are not dual eligible, um, but only eligible for Medicaid under the age of 65 have access to, um, the same care planning services. Many states Medicaid programs have picked up this billing code, um, we've seen very limited, um, fiscal impacts in those states, uh, because the target population for this building code in the Medicaid market would be those individuals aged 55 to 64 who may have a risk of developing Alzheimer's and dementia. So again, we don't expect this to be, uh, having a massive fiscal impact on the state, very minimal, uh, but it's certainly essential, uh, for the Medicaid. to have access to cognitive screening and detection and diagnosis, um, particularly in those early ages because they may be diagnosed with Alzheimer's, um, and if they don't have a diagnostic process or coverage for diagnostics, um, they cannot have access to the treatments that, um, Medicaid does pay for. Um, I did mention that support for family caregivers needs to continue, uh, to grow, um, currently Alzheimer's, uh, excuse me, the Department of Human Services, um, provides $200,000 annually to fund a pilot program called the Dementia respite grant program. Um, it is in its 3rd year of operation, um, those funds were released, uh, to us in July July 1st of this year, uh, just as of last week's report, 110,000 of that $200,000 has already gone out the door, um, and those funds are intended to last, um, to June, um, and so, uh, again, the need is great as um word has spread uh about this program the last few years, uh, we've seen more and more volume come in, uh, families are able to access this grant, um, twice a year, but must wait 6 months in between award periods and can receive that $500 grant to be used for respite, um, but, uh, again, um, the $200,000 grants what we appreciate it, um, it's just not enough funding to help us meet the need, uh, what is also encouraging about this program and its 1st 3 years, um, we internally established a rural threshold to ensure that those funds don't stay into the metros that they get out to the rural communities. Um, we have a 30% threshold just to ensure that 30% of those funds are allocated, uh, to rural parts of the state. And in the first two years, um, they've exceeded that threshold, uh, I think in year one it was 32% last year. It was 34, 35%, um, and it's trending that direction this year as well. Uh, again, the great, the need is great that I already talked about some of the um. The, uh, the role that caregivers play here in Arkansas, particularly family caregivers and the burden that they, uh, carry, um, I'm not only an advocate, I'm also a family caregiver, so I certainly feel this personally, uh, providing care for my father, um, this is, these are national statistics, but, um, we do know that, you know, 2/3 of caregivers are, are women. um, there is an emerging demographic of caregivers, um, that will have a massive impact. On Arkansas's workforce, and those are the sandwich caregivers, um, individuals who have, uh, children at home, but are also providing care for an aging parent, um, of those sandwich caregivers, there are some who have to leave the workforce and go on state assistance, um, to fill that role, uh, we've seen, uh, families here in the state have to retire early, um, to be able to provide care for an aging parent, um, with this diagnosis, um, so that need is going to continue, um, to rise. nationally over 40% of caregivers, um, self-report making $50,000 or less annually. Um, so the need is great and that $500 respite grants of being able to be accessed twice a year is essential, but certainly, uh, just a drop in the bucket when you think about um the, the, the cost of hiring someone to come and provide that respite care, um, We believe that the association, um, there is national trends, um, it is essential for states to support family caregivers, um, and if you invest in respite services, um, you're able to delay placement and more costly care settings. Um, our point and our talking point has always been, you were going to pay for it one way or the other. You can invest in it early or you'll pay for it down the road, um, in costly care settings as well through the Medicaid budget, uh, which in 2022 it costs Medicaid 390. $6 million to care for individuals living with Alzheimer's or another form of dementia, um, and you can imagine as prevalence climbs, um, those costs are gonna continue to rise, um, and it's not really sustainable. Other states have made more aggressive investments in in respite, um, most recently this year, Kansas allocated $650,000 for a program, uh, that is apples to apples, so it's just, uh, similar, it's, it's modeled after our program here in Arkansas, um, Tennessee made a 5-year investment of a million dollars, um, and Mississippi, um, allocated 350,000, um, I just want to be transparent, uh, that allocation was not fun. has not been funded yet, but it is allocated at 350,000, um, and I just kind of pulled those numbers to compare it, uh, to what Arkansas's investing right now at 200,000. We would like to see this respite grant program, um, become more permanent, uh, with more investment, uh, to ensure people have the support services that they need, um, because if you support family caregivers, people are able to age in place in the home, and what we're seeing is more and more families are opting for that. They want to age in place. I know my dad does. Um, he wants to stay at home as long as he can, um, it's gonna be my mom's decision as a caregiver she carries a lot of the brunt, um, but more and more families are choosing that we need to make sure that their support services in place, so families have options, um, uh, in their care as people age. Uh, the state has done quite a bit, um, and in some respects has actually set a trend nationally, um, Arkansas joined, um, only one of 12 states, um, in 2023 establishing, um, dementia training for law enforcement personnel, um, I will tell you that that legislation has served as a model and other states, um, most recently, it'll be a model in Tennessee, um, we were also the first state to establish a mandated training for dementia training. for the home health space as well, um, and then we also made great strides, um, establishing, uh, stricter dementia training guidelines for assisted living, uh, communities as well as strengthening the dementia training standards for those facilities who opt to provide memory care or seek this, the designation of an Alzheimer's special care unit. Um, so those, um, uh, continue, uh, to grow here. uh, there are more that we need to do, um, here in the state that we're looking at, um. This is not a statutory change or a rule change inside the agency. Um, DHS is a willing participant, um, so we have partnered with the Department of Human Services to ensure their personnel like the Adult Protective Services units, um, long term care investigators and some of those support staff, um, are adequately trained, uh, to meet the unique needs of people who are living with dementia. Um, we think that's very essential for APS personnel as they make investigations so they can understand certain communication strategies, uh, we. Again, provide that to the states at no cost, um, and we continue to provide that to DHS personnel, um, whenever we're at, um, we need to continue this track here in Arkansas to establish, uh, dementia-specific training requirements across care settings, um, that is certainly one of our policy recommendations, um, here in 2025 we're specifically looking at, um, perhaps, uh, strengthening some of the continuing education, uh, requirements for a dance practice. Registered nurses, uh, APRNs are sometimes our patient's first touch, so it's very important that they have training, um, and understanding some of the warning signs of dementia, when to perform a cognitive screening, um, but also when to refer that out for specialists for further testing, uh, so that is something that we are exploring here in Arkansas. Just as uh a recap of some of our 2025, uh, policy recommendations again these recommendations, uh, were adopted by the Alzheimer's dementia advisory Council, um, one of our primary recommendations is to ensure that we establish a public health strategy, uh, to advance risk reduction, uh, brain health and also emphasize the importance of early detection and diagnosis, um, established Medicaid coverage, uh, for cognitive screening, um, ensure that there's adequate. Access equitable access, uh, to FDA approved treatments for Alzheimer's and individuals living in the early stages of Alzheimer's, um, and I think one of the recommendations that um we are exploring is to figure out a way we haven't figured out what the policy ask would look like, but physicians should be encouraged to conduct assessments on individuals who may be at risk, uh, for cognitive screening. Uh, during last session, the state, um, passed legislation, uh, mandating post um partum uh screenings for depression for new mothers, um, maybe there's something there that we can borrow for the dementia space, uh, that's something that we are continuing to have conversations about, uh, to figure out what that policy might look like. Uh, dementia training and workforce development, um, just continue to strengthen dementia training amongst, um, healthcare professionals across care settings, um, and in the family care caregiver supports, um, I would anticipate legislation that would make this grant program a permanent program here in the state of Arkansas. That is the conclusion I'm happy to take any questions from the. Thank you for your report and for your work on this, Representative Shepherd, you're recognized. Thank you, Madam Chair, and thank you for being here today. This, this was a great presentation. Can you share with me possible diagnosis that may be um increase the likelihood of an individual developing dementia. I I don't know if it's factual, so this would be for learning purposes for me, but say um individuals with hearing loss, um, it was shared that they're more likely to do well. There's an increase in the likelihood of them developing dementia because they close themselves off to the world. Is there any truth in that? Thank you for that question, Reverend Shepherd, um, we are seeing, um, research was released, um, earlier this year that, that indicated that there is a connection between loss of hearing and enhanced risk of developing dementia, which almost makes sense because if you can't hear you're not absorbing information and you likewise cannot process that information, um, and the brain is a muscle, so if it's not working, um, it gets weak. Uh, so there is some clinical trials, some research that. does support um that that hypothesis that there might be a connection between hearing loss and enhanced risk of dementia, um, I will say that there is more research that needs to be done to, um, figure out if that's causation or correlation, um, what that link is, but there is research happening in that space, um, that has found a definite link between, um, that and also perhaps vision loss as well, right? Thank you for sharing that. Thank you for that question. Mhm Represented Myr, you're recognized. Thank you for all the presentation, you know, we've been there for all those different meetings, and I just wanted to highlight a few things, um, you talked about a bunch of stuff, but I want to make sure legislators hear some of the things that you said were just kind of kind of repeat. One of them was that we did pass last session, um, to have a dementia services coordinator and we still don't have. That coordinator. Um, and I realized that's not your decision, that's DHS, um, but do you mind sharing with the committee some of the things that's been shared with us by DHS as to the troubles, as to why we have, you know, legislatively and, and by law, we should have a dementia services coordinator, but we still do not have one hired. Can, do you mind just sharing some of that conversation. Certainly Representative Mayberry and thank you for the question. Um, so, uh, DHS has, uh, committed in the advisory council meeting, um, where we approved this report that they would have someone on um hired by the November deadline, um, there's some, uh, support services available through the association free of charge for that coordinator, whoever it is, but DHS has not yet made that higher, um, we, we, uh, see a variety of challenges they've had, um, the. first challenge they indicated was um the salary range, um, was not at a level, uh, that could attract a qualified candidate, um, in their defense. I did appreciate that the association, they were being very deliberate and ensuring that they had a qualified candidate to fill that role. Um, I did, uh, I do understand that there are some conversations about placing that role at the University of Arkansas for Medical Sciences inside of their centers on aging, um, those conversations are still happening. Some of those have happened. um, that I'm not privy to, so that's more of a question for the agency. Um, we keep being told that they are close, um, but we are anxiously awaiting, um, that higher, uh, because we do believe it's foundational to make sure that the state has this critical piece of infrastructure. Other states have seen great success by having this position on board. It's very essential we get it hired, um, certainly been a, uh, source of confusion and frustration that it has taken so long to get someone in place. OK, and, and that might be something as we discuss budget, you know, if we do not have a person qualified for this position that's willing to apply and be paid the amount that's allocated, maybe we need to consider also raising that um that level up a little bit. Um, the other thing that I just want to make sure it's really clear. So, um, because you, you talked about a whole bunch of things, but some, some big highlights that are again make sure legislators here is that we have medications for the first time. That can treat Alzheimer's disease, but the, the biggest key of that is to make sure that the person gets treatment right away and very early stages. And not all insurance is covering it. So Medicaid and Medicare, they're, they are covering it, but our, um, employee benefits program is not. And um we also have some private insurance. Again, there's some that are and some that are not, and I, you know, I just want to make sure that we understand that someone on Medicaid and Medicare can receive these treatments, but if you have our state employee plan, you can't receive that treatment, and they are expensive and they're not going to be able to pay for it out of pocket. So do you, do you mind just kind of reiterating and sharing that key highlight. Sure, I'm gonna try my best, um, if I, if I don't address it specifically, please follow up, um, we are seeing more payers come on board, um, but it is, uh, very essential that you understand that these treatments do not offer a cure, um, but they have, uh, through clinical trials shown a lot of promise and slowing the progression of the disease. Uh, I will say that there are patients in Arkansas and we're seeing more and more providers come online to offer these treatment options. uh, to their patients, um, earlier this week, UAMS, um, publicly appeared on KTV, I believe, to talk about one of those patients success stories, um, where they're seeing a lot of, um, hope in delaying that progression of the disease still far away from the cure, uh, but it's also important to note that these treatments are only viable for people in the very early stages of the disease process. So early detection and diagnosis is, is so key, um, there was a stat. stick that was based on evidence and research, um, that estimated every day 2000 people across the country age out of eligibility for these treatments. So, timely diagnosis, uh, timely access is critical, um, as more payers come on board, uh, that will fuel health systems to come on board and offer the treatments, um, and so we are seeing a slow pick up on the private pay market because of cost. Um, there's also some misinformation in the community about the risk, um. Associated with the disease and also some outdated information they're relying on, um, to make their coverage determinations, uh, about the role that amyloid plays in, um, Alzheimer's and development of Alzheimer's. That's probably more information than you need, but that, that is, does that help, does that answer the question? That was great. I probably can talk more, but I'll, I'll let others chime in. I appreciate the discussion, you know, this is near and dear to my heart, so thank you. Representative Springerger recognize. Good afternoon. Thank you, Madam Chair, and I would like to echo the fact that this subject is near and dear to my heart. My mom suffered from Alzheimer's and in fact, she lived for more than 15 years with it and UAMS was part of that process, and I'm sure that your organization helped contribute to that, so I thank you very much for your continued work with respect to this terrible disease. I, I just want to say that and thank you for being here. Thank you. So very much. Representative Springer, thank you for sharing your story. Um, I know we've had some other conversations, um, I know you feel that. I also know many of our members, um, in the statehouse also feel it personally, um, I will tell you that the association and our advocates are relentless, and we're not going to stop until we end this thing, um, and I would do my job for free, um, just don't tell my executive director that, um, but I, but it's because of stories like that that fuel me, um, because I know. many people feel this, um, and we, we fight relentlessly just to make sure families have the support they need because nobody should have to travel this disease journey alone. Representative Shepherd, you recognized. Thank you, Madam Chair, and, and I'll ask my question to the, the Madam Vice Chair, so I don't put Mr. Cook on the spot. But so my question is, if I heard you correctly, state employees, this, this medication is not covered under the pay plan for state employees. That is correct. Blue Cross Blue Shield also is one of the private, um, Providers that does not cover it. OK. Thank you. Sure go ahead. What, what we did learn, uh, and Shepherd is, you know, the blues are different in every state, um, you know, Blue Cross Blue Shield and Illinois covers it, um, but every state has their own, um, coverage, uh, policy, uh, we're seeing blues in other state pick it up, um, but, um, here in Arkansas they're, they're slow right now. Thank you. Thank you, seeing no other questions from committee. Thank you again for your report today, but also for your passion on this, on this work, and we won't tell your executive director. Thank you. Thank you all for being here. We are adjourned.