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

AI recap

Transcript

You You You You Okay, we have several things on our agenda today, so we're going to start with a report presentation from Alzheimer's Association and David Cook. Oh, I was like, I know he's here. If you will introduce yourself for the records or then you are recognized. Thank you, Madam Chair and members for this opportunity. My name is David Cook. I'm the Director of Government Affairs at the Alzheimer's Association. We certainly appreciate the opportunity to be able to present some of the recent updates to the state plan, but also wanted to talk just a little bit today about how Alzheimer's really disproportionately has a significant impact on women across our state and what that means going forward. For those of you unfamiliar, the Alzheimer's Association leads the way to end Alzheimer's in all the forms of dementia, and we do that by driving global research, maximizing or driving risk reduction, and early detection and maximizing quality care and support. And often tell people, this is the first job I've had that every day I show up hoping that's my last day because we've ended this disease. Alzheimer's and dementia is having a significant impact across our country and impact just about every aspect of our lives. More 7 million Americans are currently living with Alzheimer's disease, and if you think about the scope, if we do not get ahead of the curve and drive more risk reduction by 2050, that number is going to look closer to about 15 million. When someone receives a diagnosis of Alzheimer's and dementia, the first line of care typically are family caregivers, and here in our country we have over 13 million Americans who provide unpaid care for people living with this disease. It is one of the most expensive diseases to treat, costing our state tax dollars, $409 billion, and again, as prevalence continues to increase by 2050, that number is going to look closer to 1 trillion. Over the last 25 years, we've seen significant decreases in chronic condition deaths, like heart disease, drop like 3.8 percent, while deaths from Alzheimer's and dementia has increased by 134 percent. The Arkansas numbers are not any favorable. Currently here in Arkansas, we're 60,000 arcansons over the age of 65 are currently living with Alzheimer's disease. That number does not include those individuals who may be living with another form of dementia. An umbrella term and Alzheimer's is a degenerative brain disease, and it's the leading cause of dementia, but there are several different types of dementia. My father has frontal temporal dementia. That number doesn't include those individuals living with that type of dementia, or those under the age of 65 being diagnosed. In one clinic last weekend, I heard there was someone age 35 in our state diagnosed with mild cognitive impairment due to Alzheimer's disease. Other people are getting diagnosed with this disease every day. There's over 175,000 caregivers that in 2025, we estimated they provided 268 million hours of unpaid care. The value of the care they provide is $5.1 billion in cost savings to the state. So unpaid family care, again, is the state's largest safety net, so the more that we can do to support family caregivers by investing in things like respite, the more we can save money and delay placement and more costly care settings like long-term care. Again, in terms of the workforce, Arkansas needs a 60% increase in geriatricians just to meet the 2050 demand, and we need a 22% increase in home care and direct care workers just to meet a 2032 demand, and so prevalence is on the rise here across the state. Real quickly, I'll go through some of the state physical numbers, and 25, it costs the state $514 million in Medicaid spend to care for people with Alzheimer's, and then we have some other statistics about readmissions, but the Medicare cost per person with dementia and 2025 was $30,000. Also wanted to, all right, talked about that the next time. Just the impact on women across the country, over 13 million women across our country are either living with Alzheimer's disease or they are caring for someone with a diagnosis. This disproportionately impacts women, nearly 60% of Alzheimer's and dementia caregivers are women, and one in three are emerging as a new class of caregivers, we call sandwich caregivers, which means they're caring for an aging parent, but they also have children at home, and we're seeing that increase as well. I am one of those caregivers, my dad's in long-term care, but I kids at home and so had to manage both of that. In their 60s, our twice as likely to develop Alzheimer's disease, then they are breast cancer, and nearly 20% of Alzheimer's caregivers had to quit work either to become caregiver or because the caregiver duties became too burdensome. And also, we know that caregivers who are women might experience higher levels of burden, depression, feelings of isolation, compared to their male counterparts. Alzheimer's disease also disproportionately impacts people of color. Black Americans are about twice as likely as their white counterparts, develop Alzheimer's or another form of dementia, and Hispanic Americans are nearly one and a half likely to develop this disease compared to their white counterparts. When you think about just the impact this disease has specifically on families, we know that family caregivers who care for someone with dementia have higher levels of stress, physical, emotional stress, and also financial stress, compared to those families who may be caring with someone with a different type of chronic condition. Again, I mentioned two-thirds of caregivers are women and the one in three percentage of those being daughters. Also, family caregivers provide 83% of the help provided to older adults are coming from family caregivers. So when you think about that, Alzheimer's dementia has a dual toll on family caregivers. Again, I mentioned at the onset that unpaid family caregivers is the state's largest safety net. In my particular story, my father was able to stay at home a little longer because we had some support services. We didn't quite have enough to keep him at home, and so because of that, we live in a rural part of the state. We had to place my father in long-term care earlier this year just for lack of just the community services and support services that we needed in Van Buren County. And so, again, caregiver respite is one of those things we've continued to advocate for across the state. We have not secured SGR for a respite program. Other states have made investments, and Arkansas has really relied on a social services block grant to fund our program the last four years. That currently was funded at $200,000, but we knew ahead of time once the SSBG went away, so does the program. And without a state investment, we're afraid this program will go away. So I would expect us to present some legislation around creating a permanent dementia respite program. Other states have invested in things like this. Kansas annual SGR is $850,000 across the river in Tennessee. They had a million for five years. Mississippi had $350,000 of their SGR dedicated to dementia respite, and Arkansas is yet to invest in something like this, so we've kind of used the federal funds to drive this program. Family caregivers also are impacted by their workforce. Many of them have to leave the workforce early, which means it's an impact on tax dollars. It's also an impact on family income, and some of those may have to transition to state assistance, which we've heard stories about that as well. And again, just the chronic health told the additional burden that dementia caregivers face. It's just a heavier burden, more complicated disease to treat, the behaviors are a little bit exaggerated, and so those became difficult, and as the disease progressed at another burden, that exasperates just the need for more intense care, and so a lot of caregivers in the pavement back issues are other health conditions. I know my mom's case, she delayed getting health care because caring for my father, and when I tell you she's a different person now that she has that freedom and that space to care for herself, now that he's in long-term care, it's just really changed the way. She's existed as a person, she's able to have a social life again, and as painful the decision was, it was the right one for our family as well. So what does all mean for Arkansas women, if you take the national average and apply it to our state statistics, we would say 60% of dementia caregivers are women here in the state. That certainly is consistent with some of the data we collected, as we've done this pilot dementia respite program, majority of our participants are women, and if I could tell just a quick story, it's a very rare in my space where we pass legislation and you're able to see an immediate impact. But when this body approved this SSBG dedication to a dementia respite program, about three months into the program, I was at my office one day and a lady in her early 80s came in with her husband who was obviously in the late stages of Alzheimer's in dementia. And with tears in her eyes, she said, this is the first girl's trip I've been able to take with my daughter in over five years because of this respite grant program. So it's making a significant impact on families like that across the state. We do estimate 37,000 women over the age of 65 are currently living with this disease. And again, more than 32% of Arkansas dementia caregivers are also sandwich caregivers providing someone, maybe have a child at home. So there are some things that have happened. We passed our first state plan in 2020, 2022, and so now it was due for an update. But in the last four years, we've seen quite a bit of advancements in Alzheimer's and dementia research. We now know more about risk and brain health. Alzheimer's and dementia still carries a lot of stigma, that word, that phrasing, and so we are now changing to be more proactive around brain health. It's a less intimidating conversation. Now that we know that there are some things that we can do to increase our brain health, some modifiable risk factors that we have in life, the things that we can change, that again, decrease our risk of developing dementia as we age. This is backed by a five year study that was conducted by the Alzheimer's Association called the US Pointer Study. And during the US Pointer Study, we studied four different areas. We looked at physical exercise, aerobic activity, things to get the heart rate up, cognitive exercises and engagement, social engagement, diet, of course, nutrition and health monitoring as a four areas of testing. And what we learned through this experiment is it mirrored the results we saw on the European study called the five finger study. And what we saw that there are some things that we can do in our life to actually improve our cognition, our dementia scores. And so we saw this across the study in both the guidance and the self-guided group. When they were tested, when their cognition was tested at the conclusion of the study, the majority of participants aged or scored as if they were about five years younger than their actual age. And so cognition improved throughout the study. We also know more, we're able to treat the disease for the very first time in history clinicians across the state are actually treating some of the underlying biology. We're associated with Alzheimer's disease. There are two treatments out on the market being prescribed here in Arkansas. Both of them remove one of the proteins associated with a disease called amyloid plaque. And last year, we finally released some clinical data that suggests by removing amyloid from the brain, you actually improve cognition scores. So we know that the treatments are effective. And I know that's kind of been a topic of debate as well. But the treatments are changing every single day. There's more treatments in the pipeline. Also I'd like to mention to the body, the Kim B which is of course being readily prescribed is now going to be prescribed as a sub-Q. And so it will be an injection that people can do at home, which will of course decrease the cost of the treatment as well. And so with the changing landscape, we acknowledge in the state plan that research was moving fast. We believe nationwide or worldwide we can reduce or decrease the cases of dementia by 45% just by introducing modifiable risk factors. The science suggests that what is good for the heart is good for the brain. And so cardiovascular disease, the same things that your doctor tell you to do to improve your heart health, also improve brain health. And so we're trying to latch onto that messaging in our space and also work with the health department to again, just inserting messaging into some of our existing campaigns, like tobacco cessation for example. We know quitting, smoking decreases your chance of developing cancer, but we also know it will improve your brain health. And so if we can insert that messaging, we might be able to change the public opinion and normalize the conversation around brain health in ways we haven't been able to do in the dementia Alzheimer's space. Again diagnostics and treatments are changing literally every day. Clinicians are using blood-based biomarker testing now to triage patients and fast track them onto treatment. But having these treatments doesn't solve some of our access issues. You still have about an eight month to six month wait, six to eight month wait to get into a specialist. And so the more we can do to strengthen primary care's response to this and maybe triage patients and then change the way we deliver health care, the better it's going to be. So there's a variety of things that we're looking at in that space. How do we integrate cognitive health into every day primary care practice? Well, the 222 build a foundation and this plan intends to build on that. And so out of the 222 plan, the state actually accomplished a lot, increasing dementia training standards across clinical spaces. Again, the pilot program, the funding for the dementia-respect grant pilot that we've had the last four years. The state also secured a full time employee inside the Department of Human Services. We now have a dementia services coordinator, which again is going to coordinate some of the state agency work. And then we've done a variety. We were the first state in the country to actually pass dementia training standards for home care providers, so the state should be proud of that. And we were only the 12th state in the country to actually mandate training for law enforcement personnel. We did a few years ago. So again, the Alzheimer's state plan was first authorized by Act 391 in 2021. And what's new in this plan is again, it represents some of the changes that we've seen in research. This is always shaped by a group of stakeholders, state agencies. We've come together as the advisory council to make recommendations. And then out of those recommendations, it's meant to be a guide for legislative action and funding over the next four years. And we'll continue to monitor that as a council and make sure that the plan is not only drafted, but it's implemented, and the majority of our 222 plan was implemented, only a few carryovers. So the priorities that we're focused on for the next four years, I'm not going to go into all the objectives, but just making sure that we advance risk reduction. We talk more about brain health. Again, early detection and diagnosis has always been a priority of the association. But now that treatments are on the horizon, we're in an error treatments. Those treatments are only available to people in the very early stages. So early detection and diagnosis is critical. Just enhancing and improving family caregiver support, also ensuring that there's access to diagnostics and treatment. So that goes into the insurance space, making sure that insurance coverage is adequate. Not only does it cover the cost of treatment, but also should cover the wraparound services needed for treatment. So that's additional MRIs, cognitive testing, monitoring, cognitive assessments. And then continuing to support access to care, but also making sure that that care is quality. And so that's where we kind of think about dementia training standards and looking at different spaces where we can improve dementia training for our clinicians. And the impact that this would have on women again, risk reduction or detection is critical because the majority of Alzheimer's and dementia disproportionately impacts women, timely assessments and care planning as essential. Family caregiver support, again, as a women's health issue, seeing that this disproportionately impacts women across our state. Again, access to diagnostics and treatment with women making up most of the diagnostic space, just making sure we take care of the coverage gaps that we see in the insurance space. And just ensuring that we strengthen our infrastructure to continue to provide HCBS services so that families are empowered to make decisions that are best for them. And that people are allowed, they're able to live in community for as long as possible so we can delay placement in those more costly care settings. Some of our policy recommendations for next year, again, we want to look at how can we expand access to cognitive assessments. More specifically, we are looking at the Medicaid space where while Medicaid covers treatment for individuals, it does not cover the cognitive assessments. There's a billing code that exists, and so getting the Department of Human Services to attach a reimbursement to that is certainly a priority of ours that will carry over into the session. Improving access to caregiver respite services, so we would really like to see a state investment in respite, just to make sure that we can continue to serve those families who are struggling who kind of fall through the gaps. They don't make enough to qualify for Medicaid, but they make too much qualify for Medicaid, but not quite enough to be able to afford the cost of in-home services. Strength and dementia training across healthcare settings. We've had some thoughts around that as well. And again, looking at consumer protections and home care, just making sure that licensure standards are universal. And also, we want to make sure that there's access to some of the FDA-approved therapies, because no matter your income is part of the state that you live in, you deserve a healthy brain. You deserve access to preventative care, and you also deserve access to treatment, so we'll continue to fight for that as well. I didn't want to leave you with just a few resources that the association provides. All of our resources, our community education programs, our support groups, our help line, our care consultations we do are all offered for your charge. We don't charge for any of our services. We do have paid products and full transparency for professionals, but the association, again, one of our most underused, but most important resources is our help line. And that's on the screen there for you to pass to your constituents. I can also get you some little cards with the help line on it. The help lines open 24 hours a day. It never closes even on Christmas. It's open. And when someone calls there, they are able to talk to a master's-level clinician that can help them, even if they're under crisis, at two o'clock in the morning. And so we try to spread the word about this as well. That concludes my presentation, but I did leave my contact information on the screen, and I'm happy to take any questions authority. Thank you, David. Are there questions by committee? Representative Gonzalez, more than you're recognized. You're not recognized. You're attempting to be okay there. Thank you, Madam Chair. Thank you for your presentation. And I just wanted to have a couple of questions. I lost my dad two years ago with Louis body dementia with Louis bodies. And so I know very well what all of that entails and help having been a caregiver, one of the caregivers at home. And I was just curious as to when you were talking about respite care and consumer protections. Can you elaborate a little bit on both of those topics, or is there somewhere I could read more about what that entails? Yeah, so thank you for your question, and I'm sorry to hear about your father and your journey. The respite side, again, more specifically, we've operated this dementia respite grant program as a pilot the last four years. We've collected a lot of data. We would be advocating specifically for a state investment for a permanent dementia respite program. That's not dependent on that social services block grant, because eventually that's been challenging. It's reduced. I think this past year we were only awarded 122 of the 200,000 because of the cut to the block grant. So that just diminishes access to it. I do have some data on the respite specifically that I'm happy to share with you at another time. On the consumer protection side of it, I think there's multiple issues that are concerned to us. One of them is we require Medicaid participant providers who provide home care to have a license to provide home care. We do not require those who have private pay. You know, who are private pay providers, they don't have to have a license to do business so you can put a bumper sticker on your car and you're basically in business. And, you know, I am the dementia populations extremely vulnerable and consumers should have an expectation that when they hire someone they have been properly vetted. They have training and they're capable to take care of their loved ones. Thank you. Any further questions by committee representative Berks, you're recognized. Thank you Madam Chair and thank you very much for your presentation, sir. So I'm just curious, what are the causes of these increase in Alzheimer's cases? Is it a result of an aging population, or is it also environmental factors that we need to think about? Yeah, thank you for your question. I think we know more about some of the risks than we've known before. So one of that that drives, when you have improvements in detection and diagnosis and you're able to diagnose early, that's going to drive some of your prevalence, right? But also, I think especially in our country, we have a higher prevalence because we have so much dependence on processed foods. Our diet has a lot to do with it. Age is your greatest risk factor. We know that what in three seniors will die with some form of dementia. But I think we also know there's data that suggests exposure to wildfires, arson and environmental components that are driving prevalence. But when we look across the state specifically, we have a high rate of diabetes, cardiovascular disease, obesity. And in counties where those numbers are highly prevalent, that's always going to drive dementia risk. You know, I think another component that concerns my life in a town of about 300 in mammary and county. And you know, the aging population in my city, they go to the corner store, which is a gas station to get hot food, and it's all fried. It's all, you know, you can get a pizza. But they have to drive about 15 or 20 minutes to get to a grocery store where they have access to natural food. So again, healthy foods, education, the more we can do around that, I think all those things are kind of driving prevalence. And it's not slowing down, it's increasing. Yeah, okay, thank you. Any other questions back, committee? Seeing none, thank you, David, for your presentation. And you and the council and the association for the work that you're doing. Thank you all so much. I appreciate the time today. Okay, next on our agenda, we have a CACD quarterly report. And as Commander Drew is coming forward, Blake would like to give you some information. Members, I was asked before the mean of day just to give an update. The materials in front of your desk, the Manila envelope, symbolic booklets, if you were not here this morning. Those are just budget materials. They're going to be kind of in this room throughout October. Just pay them no mind. I was just asked to make a statement about that. And what he's not saying kindly is don't take them with you, please. Okay, Commander Drew, if you will introduce yourself, you'll be recognized. Major Jeff Drew, Arkansas State Police Crimes Against Children Division. I'll be giving you the quarterly report for April through June. We'll start on page two with the hotline volume. We had 17,071 calls taken. 9,699 of those were accepted for investigation. And CACD received 1,899 of those with 6,068 going to DCFS. And 1,742 were for differential responses. On page three, you'll see what reflects the allegations by type of investigation at CACD monthly breakdown. Page four, you'll see the reports that came in through the mandated reporters. If I'm going too fast, just slow me down. Page five. We'll show the monthly breakdown of the cases open and closed. In the last three months, there were 1,839 cases that were open. We closed 1,897. Of that 1,897, we found 581 of those to be true with a substantiation rate of 30%. There are 3954 cases that were active and 389 of those remained open over the 45 days. On page six and seven, we have the county breakdown where you can see where it's affected in your areas. On page nine, reflects reported allegations by types and the victim age groups. Pages 10 through 20 will show the relationship between the alleged offender and the alleged victim with the age groups of the alleged offenders. Page 21 through 29 will reflect the judicial districts with prosecuting attorneys and the cases that were submitted and the ones that were declined filed and that are still pending. Page 29 will show where there were 685 submitted. Out of those 351 were filed. We're still showing a pending of 202 with 132 of those declined. Are there any questions? Representative Torres, you're ranking us. Thank you Madam Chair. I'm looking at the report towards the end under the different charges and you know there's rape, sexual assault, neglect, and other. There's zero neglect charges filed in any of these counties. Is that typically put under other or is it not prosecuted at all? It could be under other. The majority of the neglect will be taken care of through DCFS but the portion that we take care of it would fall under the other. Okay. And then that being said, other of course has the majority of the cases. What is that in tell? Those are other things that you will see listed within the allegations. We felt that we needed to list the ones that were more prevalent, the ones that happened the most, what the ones that we wanted to make sure that we had listed here. Okay. All right. Thank you. Vice Chair Bentley, you're recognized. Thank you, Chairman. Thank you Major Drew for being here today. Just looking on page five. I just never heard that before. So do you have law enforcement officers that local jurisdictions that don't react when they get a call? Or is it always followed up? Because you know we have priority ones. I would hope that they're always followed up. Says it always followed up by either you or local law enforcement that's just had me concerned with your statement there. I'm sorry. What was the statement? So it says that local authorities declined to investigate. So do we, do you guys always follow up the local police officers don't go out there for me? Oh, your friend, the 29 where they were declined? Yeah. And I was looking on page five. Just at the bottom there where you were saying that, um, similar declines. If it's, if one of our hotline operates, labels this as a priority one, I would hope that somebody would go out there. So. Right. What would take place in the field if I understand you correctly? Yeah. Have law enforcement is contacted on the front end once we receive those. And they'll have the opportunity to decide if they want to respond or not. In some cases, if we won't have enough when we initially start with it. And then as we go pursuing the investigation, we'll make contact back with that local law enforcement agency. Not only have a detective assigned to it. And we'll let them know what we've discovered so far. And at that time they'll decide if they want to pursue criminal or or not. So the decision is left up to the local law enforcement, not to your department. And whether we're going to pursue criminal. Yes, ma'am. Okay. Okay. Thank you. So that's my question. Are there other questions about committee? Seeing none. Thank you for your work and for your report today. Thank you, ma'am. Okay. Next on our agenda, we have a presentation from Immersed Arkansas. Mr. Gilmore. If you will introduce yourself for the record who you are and who you're with, then you will be recognized. Thank you. You got it there. Good afternoon. Eric Gilmore, founder and CEO of Immersed Arkansas. All right. Thank you so much for the chance to share today. Thank you for what you do. I believe that I have an opportunity to introduce what I think is a really significant idea for a state specifically for our teens in foster care. Okay. So I know you are deeply aware of our foster care system. But a lot of times our teens kind of get pushed to the back burner and have a really hard time as they enter adulthood. Over the past nine months, there's a task force of about 13 different community providers that gathered at the invitation of director right to have a conversation. How can we make the experience of teens in our foster care system? And as they trends out, a really good thing, something that gets them ready for life. And so I'm going to share those recommendations with you today. I would have you note is that I'm going to get my slides to the beginning here. And then we'll get rolling. But just in this process, you know, there's a there's a room that we had maybe 20 different individuals in there who had different very very levels of child welfare experience. And we're all working hard to make sure that individual youth succeed. I just went around the room and said, hey, how many years have you been working at this? And among those 20 individuals, we added up 300 years of working with teens in and around the foster care system. And we just said, and we really need to pause and say how do we go to advocating for one young person to succeed at a time to considering what can we change at a six systemic level to make success normal across the board. And so that's that's what I'm sharing with you today. First real quick. So if you're not aware of a nurse, our big goal is to build a broad reliable pathway to healing available to every youth from crisis around the state of Arkansas. What that means is we're working with 14 to 24 year olds in and around the foster care system. Want to see them enter adulthood resilient healing and ready for life. Just on that immersive, we're serving about 500 young people currently in central Arkansas. That's little rock and Conway and then working to open our doors in northwest Arkansas right now. And then we've been going since about 2010 working to see young people succeed as a transition to adulthood. Potentially one of the most exciting things are able to do recently is open Arkansas's first shelter specifically for young adults. So up until this point, if you're in 18 to 24 year old in our state, you don't have anywhere to go a safe place to go. You're going to couch serve. You're going to get sucked into chronic homelessness potentially be exploited. But just sharing a highlight of something good that our state has been able to take to make progress in recently. And I said that to say the entry point for this for my wife and I was really around one specific young person that had a really tough entrance into adulthood coming out of foster care. And her name was Megan. My wife and I were house parents for teens in foster care. And we met Megan and she kind of she just grabbed our hearts. But during the ages of 12 to 18 while she was in foster care, she was in 50 different foster care placements. So you imagine that for a second she bounced around facility a facility home to home. It never really built any deep roots. And then the day after her 18th birthday, she called us. She said, hey, I'm going to be an adult tomorrow come, come wish me well. She told us to meet her at the Greyhound bus station that used to be in downtown north of Iraq. And we got there, Megan had one bag of clothes, one night's worth of her bipolar medications and her case worker pulled up and bought our one way bus ticket to go to Fort Smith to go back to some family members that she hadn't seen since she came into foster care. And that was her entrance into adulthood. And my wife and I were standing there. We are very dumbfounded and confused. Questions that started going through our minds were, man, why isn't somebody doing something about this followed by this voice of, hey, why don't you do something? And then this question as a person of faith, where is the church in this followed by, oh, hey, you are the church. That set us on a course to really understand the experience of teens in our state, which led to open the doors of a nurse in 2010. I share this to say Megan is still truly the animating story and person as we work to build something so that young people in our state don't have to experience what she experienced. Well, we are but one of 13 amazing providers who gathered who are doing great work around the state to say, okay, what can we do to truly make a meaningful difference for youth as their teens in foster care? They're exiting the system. I want to acknowledge director Tiffany Wright pulled us together at the end of last year and just said, hey, let's have a conversation about how we can serve teens better. And we started to name things like extending amount of time in this program or bigger benefits for this. And as we were talking, we're like, man, I think we've had some of these ideas before him. What's the biggest most ambitious question that we could ask? And we landed on this question of, hey, how does if we're going to do this, we know it's a horrible thing to be a teen in foster care. What could we do to make Arkansas the absolute best place in the nation to be a teen in care or age out? And that has spurred a lot of great ideas and we did a full landscape analysis. You've got a long report. You can go to the end of that and click on an even deeper report. But what we found is we're not talking about just fixing the system. We're not talking about some kind of band-aid approach, but a full reimagination of what it means to walk alongside teens and young adults in our system. I'm just kind of giving you the recommendations right up and then I'll back these up a little bit here. But just so you understand the core recommendations are around the who and the what is doing the work of preparing our teens for adulthood. We're proposing that the who shifts from the government, preparing young people for adulthood to community-based providers, walking alongside these young people. And the actual what the work that's happening transitioning from what's a very small amount of support for young people to really deep in the trenches support through the work of a base coach establishing a backbone training and technical assistance organization that can really uphold a working model around the state for everybody that's working with these young people. It's just foster homes and placements for young people that need this help and then wrap around supports. I'll impact these as we go. You should know if you didn't know and I didn't this didn't hit me until you know within the past few years but Arkansas has a significant density of teens in our foster care system. Okay, so I know when you think about foster care, we think about younger youth but one out of every three young people in our state's foster care system are age 14 or older. So we know that if they all stay alive they're going to become adults for sure 100% likelihood in the next five years. And so with that knowledge we know we need to we need to do something. If we look at what we found as the task forces we dug in what's what's the experience of these young people. The average teen in our foster care system is moving placements about every five months. Okay, so you think about trying to build a foundation of a life. We hear all these stories about backpacks and trash bags and suitcases. And you imagine a new placement, a new family, a new school, a new community every five months and then trying to all of a sudden 18 to step into adulthood and succeed. It just it doesn't work. Our foster youth are falling behind academically and we've had close to a thousand that have aged out in the past five years. If we zoom out nationally what happens to these teens about one in three are going to experience homelessness before their 21st birthday. Very unlikely to get a college degree, high likelihood of mental health challenges and then only half employed at 21. All right, here's the challenge. These are not new statistics. This is not a new phenomenon. This is well documented. This is kind of a predictable failure. But what's happening is we've gotten okay. I would say as a state and as a nation with these outcomes. I think I've got four children of my own three that are teenagers. If you were to come to me today and say hey Eric, if you keep parenting the way that you're parenting. At least one maybe two of your kids are going to be homeless when they leave your household. Maybe one will get a college degree. Mostly all of them are going to have mental health challenges and only two are going to be employed. I would immediately stop what I'm doing. Change my approach. Go grab some experts and say hey, what do we need to do here? That's really the opportunity and challenge before us as a state to say, okay, maybe enough is enough. We know we can say, hey, do we let this continue in other 10, 20 years or maybe this is a time to make some structural changes. If it's not compelling at the heart level, Casey Family Foundation said, okay, what's this actually cost if a young person ages out of foster care support? This is back in 2013, so there's been a little inflation since then. But on average, it's going to cost society through public benefits, heavy use of the ER, go into prison, all those things, about $300,000 over the course of a lifetime of each young person that ages out of foster care. So for Arkansas, over the last five years, that's about a quarter of a billion dollars of economic burden that has been put on the state as these young people go on and carry out their lives with the little support and resources that they've been given. All right, so just a little more about the need for the shift to a community-based provider. Right now, I'm not pointing fingers at anybody I'm involved in this as anyone else. I'm just saying that structurally, it's not working. Right now, the system is doing what it's designed to do in terms of a transitionally service coordinator, developing a transitional plan, a life skills assessment, documenting progress in court, but it's not enough. We surveyed a bunch of young people, only half were meeting with their coordinator on a regular basis. Two thirds of 17 to 21-year-olds didn't have a driver's license, and then about only a third told us that they weren't enrolled in Medicaid, even though they're eligible up until age 26 as a foster child. As we dug in, as we heard back from young people, again at the request of Director Wright, she wanted to hear directly from our young people, we got to survey out, heard back from 350 young people. One thing that they requested, that they said they didn't have access to was the ability to work. They wanted jobs, but the complexity of the bureaucracy, the moves, the various factors just made it too challenging to do that. They said they needed help with housing. You think about a mentor of mine once said that a transitional living program without housing is like a driver's ed program without a vehicle, without a car. People need places to live, and they wanted help with education, and then across the board, we just heard they wanted connection and belonging, reinforcing the need for community-based providers. So again, the opportunity before us is to go from predictable failure, and getting young people truly what we're doing is where we've created a pipeline to poverty, to predictable success, and getting young people ready for life. Again, looking at these core recommendations, I want to dig in specifically on this base coach, and why this is so important coming from a community provider. The work that the task force has done, when you think about how does a young person enter adulthood, you can think of 100 different things that they might need to do. And I, one time I had somebody come to my office and bring me a book that had written this about this stick, and it listed out everything a teenager aging out of foster care might need to know about life, and one, you know, wanted to sell these books to our young people as a manual to go to adulthood. I'm not sure he sold very many, all right, so there's a lot to do there. But through the task force, we boiled it down to, here's these four key things that if a young person can focus on these, if they can build up their well-being, get connected to the right therapist, start that healing journey, if they can build a network of support through one caring adult, if they can have a safe and stable placement, an exit to safe and stable housing, and then build their earning potential, that they've got a really strong base foundation of growing into life. So the key recommendations from the committee here that they really wanted to make sure I communicated is we'd love to find a way to make sure that every team coming about out of our foster care system has a fully funded college education at state schools, as we think about what do these young people need and how might they succeed? The one kind of baseline comparison, I just want to make sure that the difference in what we're proposing is clear. Currently, when we think about transitional youth services, we think about the state delivering the support preparing these young people for adulthood, it's a compliance-based system. So it's truly about accountability to a checklist, and what we're proposing is accountability to outcomes for each young person's future, which is a massive paradigm shift. DCFS still has a key role to play, if we were to externalize and privatize the support for youth in terms of custody, court reporting, permanency. And then that day in, day out work of helping a young person transition to adulthood would be carried out by community providers. One of the things I'm especially excited about in here is rather than teens just going to whatever home is open, you would have this coach who would be able to look and know one young person at a time and say, okay, what type of family do you need? Or who might you know that would be open to helping you as you step and prepare for adulthood? So rather than just putting a kid in kind of any family or some real target approach to recruiting and supporting foster and adoptive families. It's really one of the most kind of important or accelerating piece of this of this that we would like to do is create a statewide scoreboard that lets us see how our youth are performing. Let's us look at those outcomes altogether so we know how to make things better and improve things. At a very basic level, we'd love to see our youth graduate on par with their non-foster peers, be employed on par with their non-foster peers. No more homelessness for youth transitioning out of our system and then see a really significant reduction in incarceration for youth coming out of Arkansas's foster care system. We're recommending a phased pilot approach here. So starting with one to three counties to test it, to prove it, to see what works, we're hopeful and confident that it would work and then we'd hope to roll it out statewide from there. Phase one would really be that base coaching and backbone support organization that I mentioned and then to working into the specialized homes. Before I let that video play, I'm just aware this can all seem sometimes philosophical or just kind of out there, but I think it's I want to bring you into the real world experience of our teens and our foster care system. And so I want to play this video of Sam. It's a brief video. He's he grew up in Arkansas's foster care system, which you'll hear about. And then over the course of time was met with significant support and I just would love for you to hear how that how that assisted him and his journey to adulthood. One of my earliest memories is when I was four years old, I was picked up by cops while I was walking down the highway. So they immediately took all the children out of the home. I went through 13 different foster homes in between the age of four and six. I was then adopted up until I was 14 and went to duty and was in a duty where I started thinking about my future and really saw how I was passionate about becoming a chef. And that's why when I turned 18, I came up here to go to class and attend their culinary program. My most important tool is the chefs and I visit the one when I use 95% of the time. I came to a nurse for housing, but they have helped me explore other areas of my life that I wasn't able to explore. In addition to cooking, my second biggest passion is the outdoors. As a child, I was extremely contented in my acting, I had a nurse overcoming rock climbing colleges, training to run 5K, really explore all my different areas of passion. I have a really great therapist provided by a nurse that's been helping me work through PTSD. I've also learned that stronger and can truly move on. I'm not the scared for your role that's walking on the highway. I'm a 19-year-old who's gotten further in life than anyone would have imagined. Just don't get up and reach your role. Just learn from that role, block learn from that lessons. And just always realize that you have people in your life that's behind you. Just pat down the back and move on and shoot you home and to me to get to that spin as well, since they go well. So, Sam is a, he would represent one of about 1700 teens who will come through our foster care system in a given year. And you think about the difference it would make in our state if each one of those young people were met with that level of support and intentionality around their life. So we know that what that would look like, the vision here is a bunch of young people who are counted out with secure jobs, get a higher education, try and stay safe and stable housing and heal from trauma. We know that would lead to future generations that would experience permanently broken cycles of family or I'm sorry, poverty and trauma where their children are not going back into the child welfare system. And then our communities would be made stronger through the lives of these restored young people and their families. You may be wondering what this would all cost and so are we. Okay, so really today I'm just here asking for your support in carrying out these recommendations and continuing forward in the work that we're doing. The next step would be to work with DCFS to truly understand and do a full cost analysis of what this would look like. We'll start to do some of the implementation planning and the work behind that. But today I'm just simply asking in your capacity as a legislator and your capacity as a leader in your community and in your capacity as someone who knows other people who might care and want to be a part of something like this to support the task force to support our young people and work to this end. I want to share on October 22nd. We're going to have lunch at our immersive youth center where we'll pull this task force together to get again. We'll have young people who poured into this report there who will share will have some others who will share. But we're going to release this report to the community at this time and would love for you to be there. We'd love for you to bring anybody that you think should hear about this or be there as well. Thank you for listening today. Thank you for your work. I'm happy to take any questions if there are any. Thank you for your presentation. Are there questions? Did someone? Okay, no, I'm looking at the representative Eaton is not thank you very much for that ghost question. Okay, representative Torres, you are recognized. Thank you, Madam Chair. Quick question. Thanks for your report. You know, if they need jobs, right, and that's really what they want. Would incentivizing employers in some way to hire foster children for jobs like this? Would that look like help? Yeah, I think that's a great idea. It's not something we've discussed or thought of. I'll say another piece is we've seen employers who have stepped forward to say they really want to do this without incentives as well. Who want to be a part of helping these young people enter adulthood. But I can see that being truly powerful. Yeah, I mean, to me, it would be a self-sufficiency element that they would have versus being dependent on public assistance. Right. And employers can be involved in that ministry, so to speak, of helping them with a job and a career. So anyway, just a thought. Thank you. I'll just reinforce what you're saying. Once a young person gets employed, especially if it's a business that has some understanding of what that young person is doing and their journey that they're on, it's a really powerful thing in that young person's life. Thank you. Thank you so much for your presentation and your work behind us. One quick question. It's been my observation in this space that a lot of these kids are coming from a generational top of situation. And also that the kids that are coming out that the challenges are not addressed are very prone to repeat that life cycle. Has there been any reference to that? I noticed you had the brilliant number of what it's going to cost the state. Long-term have you thought about measuring the recidivism right on the kids that are not coming through this versus the kids that are? I think that would be a great thing to measure and compare. And I think that speaks to where we are. I mean, part of this is we need the data. We need the information. We need these are things that we should be tracking so we know how to improve things. But then also the impact of what this kind of support has. Thank you for what you're doing. Thank you. Senator Hester, you're recognized. How long have you been doing this program right now and how many young people have gone through it? We opened the doors to immerse in 2010. We've probably had about a couple thousand young people come through over that course of time. So do you track their outcomes as well? I mean, maybe it was on one of these stats here, but what's the difference been? Sure. Yeah. For immerse, when we look at that, you know, it's a transitional living program with the coach and the things that we talked about. Typically, the outcomes around well-being, at least one caring adult, safe and stable housing and improving their earning potential hangs out in the 80% range for youth that are coming through there. So significantly higher than no intervention. You've got a long time and a great track record. And so the ask of us is what? I mean, you said you found people that are interested in coming along inside you. Like what is what? Sure. How can we be helpful? Sure. I appreciate that. Yeah. The ask would be to help spread the word, help build momentum. So that could be through private funders that you think might want to get involved. It could be people that you know of that would want to participate in the effort, really just helping us get the word out, spread the work that's happening. I think it's also be very meaningful to the task force if you were to say in your personal or professional capacity, hey, we really want you guys to keep going and running down this track with DCFS to do the full cost analysis to put together an implementation plan. And then come back and tell us what you've heard. That would be meaningful from this group. Thank you. Any other questions by committee? Seeing none. Thank you very much for the work you're doing for that vulnerable age group. That important age group. And thank you for your presentation today. Okay, next on our agenda, we have a presentation from Evident Change from Dr. Diana Coupsick. I'm thinking I might have said her name right. I had some coaching, so. If you and your chamber, whoever comes with you will just introduce themselves, then you are recognized to start your presentation. Hi, Angie Wolf, Evident Change. Diana Coupsick, Evident Change. Thank you so much, Representative Barker, for inviting us to be here today. We really appreciate the opportunity to talk about the work that Evident Change has been doing with the state on improving your child welfare practices. Before I turn it over to my colleague to focus on the CQI reports that we've been producing for the state, I did want to say that for me personally, this is a real full circle moment in my career. My aunt was a social worker here in Little Rock with the state for a number of years, and it's nice to be able to come back in this capacity and be able to work to improve not only the lives of kids and families in Arkansas, but for the social workers as well. So thank you again for this opportunity. This is one body of work of several that we have at Evident Change that focuses on child welfare. You may have heard or be familiar with our project Safe Measures, which is a data dashboard and analytics tool that provides case workers, supervisors and administrators, the data that they need to do their work on a regular basis. It provides a to-do list for case workers, it allows us to aggregate the work that's being done across area, across district, across any number of variables that this state is interested in, and it provides real time information that supervisors can use to direct their resources. One of them, the other one is structured decision making tools. We have a decision making tool process that we use and we have adapted here in Arkansas to state legislation and to the department practices that allows for there to be consistency and accuracy in decision making at various points of the system. In doing this work in Arkansas since I think I started in 2018 and some of this work live went live and right before COVID in 2019. And with that I'll turn it over to my colleague to focus on the more qualitative aspects of this quality assurance work. Thank you Madam Chair and members of the committee. How's this? And I don't even have my own. Could you pull that a little closer? Thank you. Thank you Madam Chair and members of the committee for allowing me to be here today to present. My name is Dr. Diana Coupesk and I'm a senior researcher at Evident Change. And I will be talking today about the most up-to-date data from our continuous quality improvement reports for the hotline and investigations. Continuous quality improvement or CQI is a structured ongoing and data driven process that is used to improve practice at a systems level. So I think it's helpful to think about CQI not as a one point in time assessment of compliance but rather ongoing assessment and reassessment of what parts of practice are going well and where there are opportunities to focus efforts to keep improving practice. Today I will share data from two review periods that have already been conducted as part of our CQI efforts. We provide these data reports and these CQI reviews on a quarterly basis to DCFS. And we use a mixed methods approach so that we can learn from the most comprehensive forms of data to provide the most comprehensive information back about how practice is going. So today you'll hear me talk about administrative data as well as our case record reviews where we go in and review narrative that's provided about practice as well as data that comes from interviews and observations throughout the case review periods. Each of our CQI periods of review are followed by a feedback loop. This is an opportunity for us to bring back data to staff to leadership at the department so that they can use this data on an ongoing basis to think about how to support their staff and practice. So here on this slide you'll see just the scope of what the first two review periods that we've conducted conducted looks like and this is the data from which I'll be sharing today. The really large numbers, the 27,000 and 12,000 reflect administrative data that we are able to look at and analyze as part of our reviews. We've also looked at 125 case records from hotline, 100 from investigations conducted three days of observation at hotline and interviewed completed 72 interviews with staff who have worked on the investigations that we are reporting on. So in some this data comes from again those two periods of review and that reflects practice that occurred between October of 2025 and March of 2026. The second review period January to March of 2026 was just released in a new report on September 30 and we are already kicking off the next cycle of reviews. So this is an ongoing practice. I will start by sharing some key findings from the hotline reports and then move into investigations for each of these I'll share some of the key data points from important steps in the process of both hotline and investigations. The screening process has a few key elements that occur between the time that a referral comes in and a screening decision is made. The first of which is to ensure that there's sufficient information gathering and a check of history to have that information available for the decision making process. Our data show that there is a high level of accurate and accurate documentation of those history checks. And this is an example of where relying on multiple forms of data can really be helpful. So the charts that you see on the right hand side are pulled from the administrative data system. They are a quantitative look at how often staff are indicating that they have completed a history search. On the left hand side you see comparable rates and this comes from our case record review. This is an opportunity for us to affirm what the administrative data is saying by looking at what operators are documenting that they have done in regards to accurate history searches. And so as you can see for both those rates are high and we saw an increase in that documentation of history searches between our first review period and the second one. We've additionally seen an increase between the first review period and the second for documentation in the case records of operators making efforts to contact other individuals who may have information about the reported concerns in order to get a fuller picture of those concerns and family circumstances. So you can see that jump up to 96% in our second review period. As operators gather information and work towards making a decision about screening, they are equipped with the SDM hotline assessment. This is an assessment tool that's designed to support the decision making process and ensure that it is grounding decisions in policy. Between our two review periods we saw an increase in the accurate completion of those assessments. When our reviewers look at the completed hotline assessments, what they are looking for is an alignment between what operators document they heard about concerns that are being called and are reported and what is selected on the assessment that then guides them through the decision making process. In our first review period we saw six hotline assessments that had errors. That was about a 12% rate and that went down to 4% in our most recent review period where we only found three assessments with errors. To help illustrate the impact of such errors when they are found, I have eight couple examples on the next two slides. One way that the errors or the misalignment between the narrative and the selections can happen is if there are items that are selected on the assessment for which our reviewers do not find corresponding narrative that's documented in the case record. So in one instance we saw an assessment that had a selection of medical neglect but there was no documentation of medical concerns in the report that came in. When we looked further we saw that there was an additional assessment that was completed that was that had different allegations selections that did align with the narrative. And so in this example even though both assessments would have led to a screening in of the concerns there were duplicate efforts that came out out of the additional assessment that was completed with the inaccurate allegations selected. The other type of error that we look for is when there is documentation or narrative that describes concerns that would warrant a selection on the assessment but that selection isn't made on the assessment. So one example of this from our first review period was an assessment that screened in a concern for neglect concerns but the narrative that was documented in the case record indicated that there may be potential sexual abuse that should have been selected on that assessment that we did not see selected. In this instance again the screening decision didn't change the assessment was still screened in for that neglect concern. But if the sexual abuse allegation had been selected a supervisory review would have been triggered and that may have the supervisory review may have caught any additional errors in that assessment. It may also impact the agency that's assigned to respond to that concern so concerns of neglect will often go to DCFS concerns of sexual abuse would most likely be assigned for a CACD response. So again the concern was still screened in but there were these other practice implications that had that could have occurred in the decisions that followed the completion of that assessment. I do want to note that we are able to provide referral IDs to the hotline when we do find these errors and that is a practice that we have been using as a review team. We did see an increase in the documentation of supervisory review between the two review periods. So in our second review period every case record that we reviewed had some form of documentation that supervisors reviewed the decisions that were getting made when appropriate. Based on these data we had a few recommendations that we made to help continue strengthening completion of the SDM hotline assessment. One of these is to make sure that the policies and procedures of the assessment are updated to reflect most current policy and practice. We also made the recommendation that staff be appropriately trained or retrained on completion of the hotline assessment including how to better integrate that assessment into their information gathering process. The definitions that are provided in that assessment can help guide operators to know what information is necessary for determining whether a threshold for selecting an allegation is met or not. In addition to this we had three of those errors that I described did relate to potential allegations of sexual abuse. So one of our recommendations was to focus on training or support specifically around making sure that staff are prepared to screen those types of allegations when they come in. And finally documentation support so making sure that staff are aware of the expectations around what should or shouldn't be documented in the narrative. That is both a benefit to agencies that are interested in going back and reviewing those case records as well as for our reviewers and ongoing quarterly reviews. Once the assessment is completed and a decision is ready to be made we expect that that decision happens timely to when the referral is made. We identified this as an area of opportunity that has remained consistent between our two review periods. So here you see that in the first review period 73% and in the second 69% of the referrals received a decision in the same day but about a quarter to 26 to 29% were completed in the next day. This is an example where the feedback loops that I talked about at the beginning can be really impactful when we brought these data back between the first and second review period we learned that in some instances there are screening decisions that get sort of cute up to be put into the assessment and the data system at a later time, especially when they come through the mandated reporter portal. And those would receive a timestamp of a next day decision if they're keyed in after midnight. And so our recommendation around this practice when we learned of it was to ensure that the assessment is getting completed when the decision is getting made to make sure that the assessment is supporting the decision making process as intended rather than being decoupled from the decision that gets made and then the entry of that data into the system. Finally, this sort of will transition us into the investigation data that I have to share. But once a concern is screened in priority response is assigned this helps determine how quickly an investigation should begin depending on the concern and the circumstances. And we see a high level of timely initiation of those investigations for screened and reports. And we've seen comparable rates between our two report review periods as well. I will now move into sharing a little bit more about the investigation data that we have. So once an investigation is initiated, the first step of that process is for workers to make initial contact with the alleged victims. So we saw an improvement between our first review period and the second review period in that timely initiation of contact with alleged victims. We also saw a 10% decrease in the investigations that had no documentation of initial contact with alleged victims. So that increased documentation is a strength that was identified from the first review period to the second. One contact is made it is expected that interviews happen with all relevant individuals in a timely way. We saw stability in the timeliness of interviews with alleged victims. And we also saw an increase in the timely interviews with caregivers in the home between the first review period and the second review period. There remains an opportunity to continue increasing the timeliness of interviews with siblings and caregivers outside of the home. As the investigation progresses, workers, as the investigation continues, workers are constantly working to gather information about the family circumstances and ensure that they are assessing safety. Safety can happen in two ways. Informal safety assessment should be happening at all times at any point of contact with the alleged victim and the family. This can happen through interview conversation observation of the physical space. In addition to completion of a formal safety assessment, which is the assessment that is used to help determine if a child can remain safely in the home or if a safety plan is needed to help them do so. In extreme circumstances, that safety assessment may recommend a removal if there are no other pathways to safely keep the child in the home. We saw there is an expectation that there is at least one SEM safety assessment that is completed, ideally at the beginning of that investigation. So the first time that you are going out and seeing the child and the family, you want to document that that formal safety assessment has happened. We saw an increase between our first review period and the second of investigations with at least one SEM safety assessment completed. And we also saw an increase in the second review period of the initial safety assessment occurring within the first five days of an investigation. In addition to the increased completion of the SEM assessments, we also want to pay attention to the accuracy of the assessments that are completed. This is another example of where the reliance on both administrative data and case record review and other qualitative data efforts can help paint a more comprehensive picture of not just the quantity of the work that's happening but the quality of the work as well. We did see an increase in the accuracy of safety threat selection on that safety assessment between the two review periods. We also saw an increase. There was in fact no case records in our second review period that lacked narrative regarding safety. So that was an improvement from that first quarter of reviews, but we did see an increase in errors in the safety concerns that were documented. And again, those errors are reflective of misalignment between what is documented in the narrative and the items that are selected on the assessment. So this is something that we identified both as a strength and something the fact that they're getting completed and completed sooner and that we see as an area of opportunity for CQI to continue tracking given the fact that the outcomes of the safety assessment can indicate whether the child can safely remain in the home or not. In the documentation of the investigation process, we saw that about half of the case records that we reviewed had documentation of workers developing support networks with the families that they were working with. This is an important practice because it allows families to lean on and leverage the resources that they have in their own lives to help maintain safety. So here on the bar charts that you see, these groups are not mutually exclusive. In fact, it is a benefit for families to have several different types of resources that they can lean on. And so this just shows the rate of different support network members that we saw documented in the efforts that workers were making to develop these support networks with families that were investigated for whose records we reviewed. At the end of the investigation process, there is an expectation that investigations will close within a 45 day time frame. We saw that about a third of investigations are closing outside of that 45 day window. This was pretty stable between our review periods. And we did note that CACD completes investigations within that 45 day window at a slightly higher rate than DCFS. Similar to trends in the hotline that I shared, we did see an increase in the supervisory support that was documented in the case records that we reviewed indicating that staff are working with their supervisors in relying on that support as they work the investigations. Those are all the data slides that I brought to share. I know there was a report as well attached so we're happy to answer any questions if there are any. There are some, so thank you so much for bringing here today and we'll start with Representative Springer. Thank you, Madam Chair. Good afternoon. And thank you so very much for this report. I am very pleased with seeing how you've disaggregated the data. And I just want to make a statement. It seems to me that basically what you've done here is you've captured the information from the time that the call is made into the hotline through the Arkansas State Police all the way up until is handled by the Department of Children and Family Services. And you determined that they are all doing I would just say satisfactory job. Is that correct? Yeah, I think one of the goals of CQI is to lift up both what's working well and where it may benefit more focus. And so we try to really balance that out as we present the data. Yes, all right. Thank you. Thank you very much. And thank you to the Arkansas State Police, the Office of Crimes Against Children and also the Department of Human Services for the work that you're doing. Thank you so very much. Thank you, Representative Duke. Thank you, Madam Chair. Thank you for this information. I do have a quick question on page six on my notes. I'm not sure what it is on you on the selecting items without supporting documentation, the screening impact and what I was wondering on that example is whenever you say that there was a second, a second hotline assessment with documented medical concerns, are you saying in that that that initial phone call that was made? There was another review to it or was there a second phone call made on that same child? There were two assessments that were associated with that referral that we reviewed. So it would have been from a single call. I would need to go back and double check if there were any other associated calls that were made, but we really review for the for the referral IDs that get selected for our sample only. The reason why I asked that just because that wording oftentimes I hear that they make a call and it gets unsustain shaded. And another employee who have witnessed something or something will make a second call now. Unfortunately, often I get told it's unsustain shaded again. And there's a frustration there. So that's why I was wondering clarification on whether this was one call. So they just reviewed or analyzed it differently and came up with a different determination or whatever it was here, how you worded it versus a second call came in. Yeah, so I can't speak to whether the the history searches that I talked about should help ideally with connecting any multiple calls that happen for a single concern. I we would only review one call that came in. So there were two assessments that were linked to that one call. Okay, two assessments linked to the one call, but not two different phone calls. Okay, and so when you're reviewing this and I may be going down a different direction a little bit with this, but say it wasn't the exact same injury or whatever it is that's being court record, but it's the same child on another similar. And do those can you see those linked together the history of that with that one child that there is unsustain shaded and then another one comes in. We would see that there was a history search that flagged a duplicative call, but we only review the IDs that are selected for the sample. So we would not be reviewing different calls on the same concern or family for the purpose of the review. Thank you. Thank you. Senator Hester. Over here. Thank you. You eloquently said and you're you're going through this areas of opportunity a few times. I I interpret that as areas of concern. Like you your data driven. You don't make recommendations. But do you so I'm worried about staffing right so like when we see areas of opportunity meaning we're not meeting the metrics that we want. Do you know do you have data that shows the amount of staffing we have in the state of Arkansas or the amount of funding compared to you know a state comparable to us or another state. We do not look at that we do provide for some of the data that we share we disaggregate by area across the state and can do that for different data points if requested and our hope would be that that information is valuable for the department and leadership who are more familiar with things like the staffing. We do determine if there's maybe specific areas that might need to focus on a particular practice more so than others. Yeah I mean when I look at these areas of opportunity I don't believe we have one employee in DCFS that say it's 4.59 I'm going home. Yet month after month after month we're not we're not getting it doesn't just it doesn't mean we're just short on staffing. Anyway this information is very helpful for us to hopefully make staffing changes that I believe are necessary anyway thank you. Thank you sir representative Torres. Yes thank you madam chair I'm piggybacking on Senator Hester's question because I was looking on the hotline report on page 23 and it said from the reviewed referrals 59% of the applicable referrals had documented supervisor. Supervisor approval but 41% did not have supervisor approval. Is that a is that a documentation problem or is it staffing in the first quarter of the reviews that 59% that would have been related to documentation. So what our reviewers have access to in the narrative is what they have to base their selection on. There are policies or instances where the supervisor review is not required and so what we're looking for is in those instances where a supervisory review would be expected. Did we see that documented if it's not documented we can't speak to it or quantify it in any kind of way. Thank you. Okay I was waiting to ask a couple of questions. Did you do any between the first quarter and the second quarter when you were doing your report and doing your audit. Did you do any training at all with staff here in Arkansas. Did you do any training with them or go over the responses from the first quarter before you do the second one. We did do presentations with the with both CACD and DCFS. We also went out our CQI manager and director right talked to different areas about the findings and we are hope is that the findings are used for such efforts. But those would be at the discretion of the departments. We also visit with CACD with their department as well on the findings. To present the findings yeah. I know I was trying to look through your data and see here I guess this from an over report that we see it was concerned that there was a party one call put out there. I have data to you guys have data to show that that this is going to follow up to see that individual. Do you guys have that awareness to see that your dad is trying to find that in your data to see how many times were they not. Was there not a follow up on the you know so they sent the call to the state police or to the to the local police office department. I'm saying and we know that that person was seen and do we have any of that in your data. It was seen for investigations or investigations. Yeah do we have way to say there was report my investigation did not follow. So I think the most relevant piece from that from the data that we have available would be that initial contact. So we did see that there was in our first quarter that 11% did not have documentation of contact with the alleged victim and we saw that reduced by 10% between quarters. When it decreased quite a bit in the second one. Okay. I was trying to find some data on that. Yeah. And there might be more in the fuller report. I can take a closer look after and provide additional information if we have more. Okay. We did just finish the second report. Correct. All right. Will it get results on that when I'm sorry. Yes. It is. It was shared with the directorate on September 30th. And so I believe that should be making its way out. Okay. Any other questions from the committee at all. All right. Thank you so much for being here today. I truly appreciate it. Sure Senator Hester. Go ahead. Sure. No mind. I would like to ask a director out a few questions. Certainly. Do you mind? No. That's fine. We've got time. She's right here. As long as Betty won't have any follow-ups. Good afternoon, Tiffany Wright, director for the Division of Children and Family Services. Hey, thank you, director. Right. So normal process in government. I want to make sure that you follow the same process. Employee gives you a two week notice, 30 day notice, probably not that long. They give you two week notice. You they have to quit before you can start the process of advertising for the next person. Is that right? Yes, sir. And so like in the absolute fastest scenario. How fast can you get someone hired in a perfect seamless world? In a seamless world with a list full of qualified candidates with no with not a lot of other crisis going on. I would hope in 60 days or less in a seamless, like in a perfect world. Right. So yeah, it's not 60. So it's 90 or 100, but like if they gave you a two week notice, which maybe is that typical? Do you get two week notices? Sometimes. Sometimes. Okay. So every time someone quits, we're absent a social worker for 70, 80, 90, 100 days. Yes, sir. The load goes up. Do you have currently today? Do you have enough positions where you're hiring 365 days a year in our counties that? Need it like bit bit. I'll talk about Benton County because I understand it more than others. People are always quitting, right? Like that's the nature of the job. It's so hard. Like are you always hiring? Do we have we given you enough positions? I'm saying it's because you've got budget hearings coming up. I want to be more prepared for that. Like do you have the amount of positions you need to always be hiring in Benton County? So when there's always a vacancy, then I always have the ability to be hiring. It's just how long it takes to get all of the paperwork done to get the position advertised to keep it going. We had at one point tried to do the evergreen process to have continuous advertisements. But we had, there were some hook hiccups with that and my staff were very frustrated. And so we stopped that and went back to just advertising every single position. Because it felt like the evergreen was making it more complicated for DCFS. So it's hard to answer that question given that we always have vacancies. But what we know is when we get an office that is stabilized. And then there's just one vacancy and we can quickly fill that position. You might not feel an interruption or crisis around what's going on in the day-to-day work of DCFS. So it's hard because when we are looking at workloads, we're looking at what we currently have. And then trying to predict what we might need. And then moving positions around to cover the gaps is something that always happens. So one county loses could lose a position to move it to another county that needs it more. So we're always, I call it playing puzzle pieces with positions. Yeah, and that's, that's hopefully, you know, you're doing a great job managing that. My question, this is an uneducated statement. But if we come to budget hearings and I say I want to add 10 or 20 or 30 or 50 positions. And I get my colleagues to agree to this. I also understand that then comes with like funding. I've got to back that up with funding. Then do I see these reports change? Do I see like we're not having a, you know, these metrics start being met? Is that, is that the issue that I need to focus on from my position to see that metrics change? Yes and no. I say yes because we know in the county, we know like area 10 is the Delta. Area 10 is the Delta. For us, the service region area 10 is the Delta. They, they say pretty staffed up very rule, but they have great outcomes because they have staffing stability. They don't have a lot of turnover. They don't have easy workloads. And they have to drive a lot more all over that part of the region of the state and to different regions to get access to different services. And so I want to say yes. But then I want to say no because when we get into hiring, when we get into the turnover and the positions are vacated. And usually what happens and you know this, you've been around one person quits and someone's like, oh, they quit. I can do it too. And then the next person and then we get into this vicious cycle. And those numbers impact everything we have going on. And so what you all are seeing today is a statewide, that's statewide. And we don't, we do drill in in the reports that you all have down to the area. And then I have data that drills down into the counties. And so I can see my counties that are hot like I call them hot spots where we need to focus and put some attention. And so how do we keep doing that while supporting the rest of the state? Because what we focus on gets improved as you all can see. So how do we keep that momentum to improve every part of the system? Yeah, I've seen you guys have been on a hiring campaign. How's that going? We actually had a lot of, I'm actually very hopeful. We've had a lot of momentum on Monday. We are set to onboard 26 new positions, new people. Wow. 26 all across the state. We are very excited about that. Everyone is hyper focused on hiring. More hyper focus. We are, we did one webinar had a great turnout planning another webinar just to talk to people about what it means to work for us. And I hope we can keep this momentum as we just go in the new year. I would also say sorry if you don't mind just adding to that of like, you know, we just stood up a new staff training in July. At, and we have the learning lab, which is an actual house where they're getting hands on and simulation training and learning more what it's like. And we're protecting those staff. So we're not dumping 50 cases on them on their first day. We're not giving them any cases until they finish training. So we're hoping all of those things will impact what we have going on to retain staff, because we can have positions, but we have to also retain people. Thank you. You're welcome. Thank you, sir. Representative Beatty. Thank you, Madam Chair. My, my question's not, not for director. Right. It's back on page 23 with kind of following up on Representative Torres question. Mine, mine's more on table 10 that you have in, in the report. Where's the time between referral and the completed SDM hotline assessment? Where 73% of these assessments are completed on the same day. I understand the, the volume that's coming in and, and want to clear a cue and move things out. Is that same day completion of the referral leading to some of the mistakes and the errors? You know, just trying to try to get through the work and get to the next case. Has that led to some of some of the issues? I can't be certain of that. What we do know is that using the assessment to help guide the decision making process can reduce some of the room for human error. So anecdotally, some of what we hear or see when folks try, and this is not necessarily an Arkansas specifically, but when folks rely on their best memory of what a policy says or what a threshold is, there's opportunities to make some of that human error. There may also be additional opportunities for human error in the documentation on the assessment. If it's, if the information isn't fresh and an inaccurate, and an inaccurate selection on the assessment could lead to an outcome or a decision that would not reflect the most accurate information if it was input that way. That's why we really try to encourage integration of the assessment, both in the information gathering part of the process, as well as in the process of making the decision. Just looking at, I mean, looking at that number, you would think that that's a great statistic to have 73% of those referrals, but I just had the question, is that also leading to some of the other problems that we have? So I appreciate your answer. Thank you for being the director right where you're sitting. I'm going to put you on the spot on one of the things. Just as we have evidence changed here, do you see this as a valuable tool for you guys? You see it as improving our outcomes and because it's so very, all of us are so very concerned about our kids. Nothing more important than we do than take care of our abused children in the state. So I know we're hitting budgets. I want to ask you if you think this is a valuable tool for us to continue. I know we're putting on the spot with them here, but we'd like to hear your response. Yes. I find this very valuable to receive the reports and then be able to dig in and hear from them what they're seeing during the reviews and then how we take that back as a DCFS team and implement it into our day-to-day practice. And I mean, I have some things that we've done that we've from the reviews like making a more intentional effort for documentation time. We're very excited about an opportunity to do some technology for our staff that we've heard about documentation barriers that will hopefully be coming at the beginning of the year. We were able to get practice coaches for all of our new investigators. So while they're in their first 18 weeks of employment, they're getting practice coaches to walk alongside them and investigations. So I thought I think I brought them, but we implemented a quick reference desk guides for them around different parts of the system laminated them. They're all getting them across the state. They all got the current staff all got them new staff are getting them. So we're using it, the information and putting it into our day-to-day work and then continuing to figure out how do we refine what we're working on and keep refining to continue to make improvements for kids in our state. And so we're just going to keep we get a report we keep trying and so like we saw some different things in the next report that I'll get to you all. And just keep using it to leverage and have conversations and coach our staff to remember what's important, which is kids. And then move remove system barriers advocate to you all when there's things we something we need that we need support on. And so just being able to do that. Thank you. Thank you for your arms. Okay. Any other questions in the committee? I appreciate everybody's time on a Friday. Enjoy your weekend. Thank you.