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Department of Health and Social Services
Department of Health and Social Services
Results Summary | Details | Questions/Comments
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| | To promote and protect the health and well being of Alaskans.
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| | - Provide the highest quality of life in a safe home environment for older Alaskans and Veterans.
- Manage an integrated and comprehensive behavioral health system based on sound policy, effective practices, and open partnerships.
- Promote stronger families, safer children.
- Manage health care coverage for Alaskans in need.
- Hold juvenile offenders accountable for their behavior, promote the safety and restoration of victims and communities, and assist offenders and their families in developing skills to prevent crime.
- Provide self-sufficiency and basic living expenses to Alaskans in need.
- Protect and promote the health of Alaskans.
- Promote the independence of Alaskan seniors and persons with physical and developmental disabilities.
- Provide quality administrative services in support of the Department's mission.
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 End Result: |
Strategies to Achieve End Result
| | A: Eligible Alaskans and Veterans will live in a safe environment. Details > |
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| A1: Improve the medication dispensing and administration system. Details > | |
| A2: Reduce the number of residents' serious injuries from falls. Details > | |
| | End Result: |
Strategies to Achieve End Result
| | B: The quality of life for Alaskans with serious behavioral health problems is enhanced. Details > |
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| B1: Provide enhancements to prevention and early intervention services. Details > |
| | End Result: |
Strategies to Achieve End Result
| | C: Children who come to the attention of the Office of Children's Services are, first and foremost, protected from maltreatment.
Details > |
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| C1: Implementation of a new practice model to provide front line workers with a better tool to identify safety and risk issues in the home. Details > |
| C2: Children placed outside of the home are protected from further maltreatment. Details > |
| C3: Retain an effective and efficient workforce. Details > |
| | End Result: |
Strategies to Achieve End Result
| | D: Quality management of health care coverage services to providers and clients
Details > |
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| D1: Continue to develop new Medicaid Management Information System (MMIS). Details > |
| | End Result: |
Strategies to Achieve End Result
| | E: Juvenile offenders' success in the community following completion of services is improved, resulting in higher levels of accountability and public safety. Details > |
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| E1: Implement and review information from research-based assessment tools, and incorporate practices proven to reduce recidivism and criminal behavior among youth. Details > |
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Strategies to Achieve End Result
| | F: Low income families and individuals become economically self-sufficient. Details > |
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| F1: 90% of temporary assistance families leave with earnings and do not return for six months.
Details > |
| F2: Increase the percentage of temporary assistance families with earnings.
Details > |
| F3: Increase the percentage of temporary assistance families meeting federal work participation rates. Details > |
| F4: Improve timeliness of benefit delivery. Details > |
| F5: Improve accuracy of benefit delivery. Details > |
| F6: Increase the percentage of subsidy children in licensed care. Details > |
| | End Result: |
Strategies to Achieve End Result
| | G: Healthy people in healthy communities Details > |
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| G1: Strengthen public health in strategic areas. Details > |
| | End Result: |
Strategies to Achieve End Result
| | H: Senior and physically and/or developmentally disabled Alaskans live independently as long as possible. Details > |
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| H1: Promote independent living and provide preadmission screening to nursing homes. Details > |
| | End Result: |
Strategies to Achieve End Result
| | I: Administrative services are delivered efficiently and effectively. Details > |
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| A:
Result - Eligible Alaskans and Veterans will live in a safe environment. |
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Target #1: Reduce resident serious injury rate
Status #1: In FY09, the medication error rate decreased to .13% while medications administered increased to an average of 499,366 per fiscal quarter, up from 434,464 in FY06.
In FY09, our sentinel event injury rate from falls decreased to 2.7%, down from 2.9% in FY07.
Analysis of results and challenges: Increasing age and acuity levels of Pioneer Homes residents creates a challenge in reducing adverse events that result in serious injury. By properly utilizing the strength of trending and tracking information available in the division's risk analysis program, the Homes are able to identify times, places, individual staff and conditions that hold inherent risk. Action plans to address risk help the Homes prevent errors, reduce the number of serious injury events, and reduce the severity of injury.
Related links:
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| A1:
Strategy - Improve the medication dispensing and administration system. |
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Target #1: Less than one percent medication error rate, which is one-half the low end of the national standard range
Status #1: In FY09, the medication error rate decreased to .13% comparing favorably with the target medication error rate of less than one percent.
Fiscal Year Medication Error Rate
| Year |
Qtr 1 |
Qtr 2 |
Qtr 3 |
Qtr 4 |
YTD Total |
| 2010 |
0.13%
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0
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0
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0
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0
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| 2009 |
0.15%
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0.10%
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0.13%
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0.14%
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0.13%
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| 2008 |
0.16%
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0.13%
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0.15%
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0.12%
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0.14%
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| 2007 |
0.19%
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0.22%
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0.15%
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0.14%
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0.18%
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| 2006 |
0.19%
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0.15%
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0.16%
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0.12%
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0.17%
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| 2005 |
0.08%
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0.09%
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0.09%
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0.14%
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0.10%
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| 2004 |
0.07%
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0.11%
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0.06%
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0.07%
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0.08%
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| 2003 |
0.10%
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0.11%
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0.09%
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0.15%
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0.11%
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| 2002 |
0.07%
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0.08%
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0.04%
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0.05%
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0.06%
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Methodology: The medication error rate is calculated by taking the number of medication errors per quarter divided by the total number of medications taken by all Pioneer Home residents in the same quarter.
Analysis of results and challenges: The Centers for Medicare and Medicaid Services, which licenses nursing facilities throughout the United States, considers a five percent medication error rate acceptable.
The Pioneer Home system collects medication information at the individual Pioneer Home level and aggregates the numbers for reporting at the division level. In 2008, Pioneer Home staff administered an average of 488,184 individual medications each quarter.
All care processes are vulnerable to error, yet several studies have found that medication-related activities are the most frequent type of adverse event. Medication administration errors are the traditional focus of incident reporting programs because they are often the types of events that identify a failure in other processes in the system. A wrong medication may be administered because it was prescribed, transcribed, or dispensed incorrectly. The division uses a system-wide risk reporting program that tracks medication errors, and allows the collected data to be reported and trended for use in identifying risks. Trending the cause of the error tends to provide the most useful information in designing strategies for preventing future errors.
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| A2:
Strategy - Reduce the number of residents' serious injuries from falls. |
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Target #1: Less than two percent injury rate, which is the low end of the National Safety Council's range of two to six percent
Status #1: In FY09, the rate of Pioneer Homes resident falls resulting in a major injury (sentinel event injury rate) was 2.7%, exceeding the 2% target rate, but in line with past performance on this measure.
Fiscal Year Sentinel Event Injury Rate
| Year |
Qtr 1 |
Qtr 2 |
Qtr 3 |
Qtr 4 |
YTD Total |
| 2010 |
2.3%
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0
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0
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0
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0
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| 2009 |
1.3%
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2.3%
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3.4%
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3.8%
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2.7%
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| 2008 |
1.5%
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1.3%
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2.0%
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2.1%
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1.73%
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| 2007 |
3.5%
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1.2%
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2.0%
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4.9%
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2.9%
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| 2006 |
0.6%
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2.7%
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1.3%
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1.1%
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1.43%
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| 2005 |
2.6%
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2.4%
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1.5%
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2.3%
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2.2%
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| 2004 |
1.96%
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1.26%
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0.97%
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1.47%
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1.45%
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| 2003 |
1.1%
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0.04%
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1.79%
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1.5%
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1.1%
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| 2002 |
2.9%
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0.7%
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0.0%
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0.37%
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0.99%
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Methodology: The Sentinel Event Injury rate reports the percentage of falls that result in a major injury. The rate is calculated by dividing the number of Sentinel Event injuries to Pioneer Homes residents by the total number of falls reported for the same quarter.
Analysis of results and challenges: Seventy-five percent of elderly deaths result from falls.
Despite remarkable advances in almost every field of medicine, the age-old problem of health-care errors continues to haunt health care professionals. When such errors lead to "sentinel events," those with serious and undesirable occurrences, the problems are even more disturbing. The event is called sentinel because it sends a signal or warning that requires immediate attention. One in three people age 65 and older, and 50 percent of those 80 and older, fall each year. The National Safety Council lists falls in older adults as five times more likely to lead to hospitalization than other injuries. One estimate suggests that direct medical costs for fall-related injuries will rise to $32.4 billion by 2020. Falls can have devastating outcomes, including decreased mobility, function, independence, and in some cases, death.
The average age of Pioneer Homes residents is 85.5, putting them in the highest risk category for suffering a serious injury from a fall that could lead to death.
The Pioneer Homes respond to serious injuries with root cause analysis investigations and corrective action plans to address underlying causes.
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| B:
Result - The quality of life for Alaskans with serious behavioral health problems is enhanced. |
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Target #1: Reduce the number of children in out-of-state residential psychiatric treatment centers (RPTCs) by 10% each year.
Status #1: From FY07 to FY08, there was a 19.8% decrease in the number of distinct out-of-state RPTC recipients of care.
Methodology: Data is presented in the "Bring the Kids Home: Indicators for SFY08" publication (see link below), as provided by the Division of Behavioral Health, Policy and Planning Section (data source: MMIS). The In-State and Out-of-State RPTC recipient counts are each unduplicated; the Total RPTC recipient count is duplicated between In-State and Out-of-State.
* Data for the "Bring the Kids Home: Indicators for SFY09" are not yet available.
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Distinct Counts of Medicaid RPTC Recipients
| Fiscal Year |
Out-of-State |
In-State |
Total |
| FY 2008 |
478
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369
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847
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| FY 2007 |
596
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388
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984
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| FY 2006 |
743
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290
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1033
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| FY 2005 |
711
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291
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1002
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| FY 2004 |
749
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216
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965
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| FY 2003 |
637
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215
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852
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| FY 2002 |
536
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208
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744
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Analysis of results and challenges: The Bring the Kids Home (BTKH) Project was initiated during FY04. This project is a collaboration of the Division of Behavioral Health, Division of Juvenile Justice, and Office of Children's Services, in partnership with the Alaska Mental Health Trust Authority. Positive changes are apparent as shown by the significant reduction, since FY04, in the number of youth experiencing serious emotional disorders receiving care in out-of-state RPTCs.
From FY04 to FY08, there was a 36.2% decrease in the number of out-of-state RPTC recipients of care (749 in FY04; 478 in FY08) and a 70.8% increase in the number of in-state RPTC recipients of care (216 in FY04; 369 in FY08). In addition, for the same time period, the total RPTC recipient count decreased by 12.2% (965 in FY04; 847 in FY08). The total RPTC recipient count peaked in FY06. Since then, there has been an 18% decrease in the total RPTC recipient count (1,033 in FY06; 847 in FY08). These shifts reflect a number of capital projects initiated to increase the number of beds in-state, some of which became available in FY07. In addition, there have been capacity expansion grants to community providers to enhance the service continuum for children and families that provide services at the least restrictive level within a client's home community. As more new beds and other programs become available, it is anticipated that there will be further impact on the number of out-of-state RPTC recipients of care.
Annual comparisons from FY06 to FY08:
From FY07 to FY08 there was a:
• 19.8% decrease in the number of distinct out-of-state RPTC recipients of care.
• 4.9% decrease in the number of distinct in-state RPTC recipients of care.
• 13.9% decrease in the total RPTC recipient count.
From FY06 to FY07 there was a:
• 19.8% decrease in the number of distinct out-of-state RPTC recipients of care.
• 33.8% increase in the number of distinct in-state RPTC recipients of care.
• 4.7% decrease in the total RPTC recipient count.
From FY98 to FY04, the number of distinct out-of-state RPTC recipients of care steadily increased – on average, 46.7% per year. Also, for the same time period, the total RPTC recipient count steadily increased - on average 24.8% per year.
AS47.07.032 requires that the department may not grant assistance for out-of-state inpatient psychiatric care if the services are available in the state. To that end, the department has developed and implemented "diversion" activities, including aggressive case management services that discharge and return children to less restrictive levels of care; utilization review staff implementing gate-keeping protocols with a "level of care" instrument that ensures appropriate placements; and assertive case management with Individualized Service Agreements which direct funding to community-based providers who augment services at the least restrictive level within a client's home community.
Related links:
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Target #2: To reduce the rate of suicides in Alaska to 10.6 deaths per 100,000 population.
Status #2: Preliminary data for 2008 indicates an Alaska suicide death rate of 24.6 suicides for all ages per 100,000 population. This rate is more than double the stated target of 10.6.
Methodology: Rates are age-adjusted per 100,000 population.
* The 2008 Alaska suicide rate and number of lives lost are based on preliminary data.
* The 2008 US suicide rate is not yet available.
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Rate of Suicides 1998-2008
| Year |
Alaska Rate |
Lives Lost |
US Rate |
Target |
| 2008 |
24.6
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165
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0
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10.6
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| 2007 |
23.1
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149
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10.8
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10.6
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| 2006 |
20.1
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132
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10.9
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10.6
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| 2005 |
19.6
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127
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10.9
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10.6
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| 2004 |
23.4
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154
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10.9
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10.6
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| 2003 |
20.5
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123
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10.8
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10.6
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| 2002 |
20.9
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131
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10.9
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10.6
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| 2001 |
16.5
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103
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10.7
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10.6
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| 2000 |
21.1
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135
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10.4
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10.6
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| 1999 |
17.3
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96
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10.5
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10.6
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| 1998 |
22.7
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131
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11.1
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10.6
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Analysis of results and challenges: Alaska averages 125 suicides per year and has a suicide rate of double the national average. The Healthy Alaskan 2010 target is to reduce Alaska's suicide rate to 10.6 per 100,000. The age adjusted suicide rate for Alaska in 2008 was 24.6 per 100,000, with 165 deaths reported (2008 data is provisional and subject to change). Although Alaska experienced a dip in rates in 2005, there has been a slight increase in the suicide rate over the past four years. It is difficult to determine if these figures represent a trend or if suicide deaths occur randomly based on a variety of factors and life circumstances among those at risk of suicide. The rates have consistently risen and fallen incrementally over the past ten years. However, 2008 has shown to be one of the highest suicide rates on record. These measures reflect the need to improve Alaska's ability to provide a comprehensive and coordinated response between state agencies, Tribal entities, community providers, primary health and emergency response systems, school districts and faith-based organizations.
The State Suicide Prevention Council, in close working partnership with the Division of Behavioral Health, recently developed a strategic plan, implementing several strategies targeting suicide prevention awareness, outreach, and community advocacy work. The council is also working closely with the Department of Health and Social Services in an attempt to better understand the complex nature of suicide, the underlying causes, and learning prevention-based strategies that support successful outcomes in order to begin to turn the curve away from the problem. The Division of Behavioral Health, Prevention and Early Intervention Services administers grants for comprehensive suicide prevention programs and services and provides technical training and assistance. Training topics include the Alaska Suicide Prevention Plan; community-based planning methods including identification of need, resources, readiness and capacity to provide services; understanding risk and protective factors associated with suicide in their respective community; and how to effectively collaborate with state and local partners to create a long term impact that is both sustainable and culturally competent. The Division of Behavioral Health has recently been awarded the Garrett Lee Smith Memorial Act youth suicide prevention grant and also coordinates the Alaska Gatekeeper Suicide Prevention Training program designed and targeted specifically for Alaska in order to educate and train individuals on the topic of suicide, how to respond to a suicidal person and how to direct resources to reduce risk, promote well being and improve our systems of care. These programs will be the focus of the state’s efforts to combat suicide over the next few years.
Related links:
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Target #3: Reduce 30-day readmission rate for API to 10%.
Status #3: API's admission rate decreased 7.6% from 1,270 patients in FY08 to 1,173 in FY09 and the readmission rate decreased 1.00%, from 14.29% in FY08 to 13.29% in FY09.
Methodology: * Readmission rate is based on the discharge cohort.
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Alaska Psychiatric Institute 30-Day Readmission Rate
| Fiscal Year |
API Readmission Rate |
Target |
| FY 2009 |
13.29
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10.0
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| FY 2008 |
14.29
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10.0
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| FY 2007 |
13.94
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10.0
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| FY 2006 |
13.39
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10.0
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| FY 2005 |
15.09
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10.0
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| FY 2004 |
16.47
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10.0
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| FY 2003 |
13.54
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10.0
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Analysis of results and challenges: This measure tracks the percent of admissions to the facility that occurred within 30 days of a previous discharge of the same client from the same facility. For example, a rate of 8.0 means that 8 percent of all admissions were readmissions. This measure is an outcome indicator of continuity of care between the acute care hospital (API) and the behavioral health provider system. The ultimate goal is to have Alaska's rate fall below ten percent.
API and the 'system' continue to demonstrate unsatisfactory outcomes. API relocated to a new hospital in July 2005. The success of a 'downsized' state psychiatric hospital was predicated on increased funding for community providers and establishing 18 designated evaluation and treatment beds in Anchorage. These initiatives did not receive planning or funding. As a result, API has come under increasing pressure to shorten length of stays for acutely ill psychiatric patients who ultimately return to the hospital due to lack of adequate supportive housing and case management options.
In FY08, API discharged 1,259 patients of whom 180 had been admitted within 30 days of a previous discharge for a 14.29% readmission rate. In FY09, API discharged 1,188 patients with 158 of them admitted within 30 days of a previous discharge, decreasing the rate of readmission within 30 days to 13.29%.
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| B1:
Strategy - Provide enhancements to prevention and early intervention services. |
| C:
Result - Children who come to the attention of the Office of Children's Services are, first and foremost, protected from maltreatment.
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Target #1: Decrease the rate of substantiated allegations of child maltreatment in Alaska.
Status #1: The target to decrease the rate of substantiated allegations of child maltreatment in Alaska was not met in FY09, as there was a 1.6% increase in the rate of maltreatment per 1,000 children from FY08 to FY09.
Methodology: The victim rate per 1,000 is the count of unique substantiated victims for the quarter multiplied by 4 and 1,000, divided by the Alaska population aged 0 - 17 years.
The Office of Children’s Services is bringing state performance measures in line with federal measures and methodologies. Therefore, this chart contains newly calculated measures back to Quarter 1 of 2007, and will in many cases include adjustments to numbers previously submitted. These adjustments do not represent major changes in outcomes.
Atypical spikes in rates may occur as a result of periodic data cleanup required in the Online Resources for the Children of Alaska (ORCA) data system and are not representative of increases in victim rates. These rate increases are manually flattened using averages as has been done with FY 2009 Quarter 1.
Source of Current Target of 10.6 - United States Department of Health and Human Services Administration for Children and Families, Child Maltreatment, 2007.
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Substantiated Victim Rate (per 1,000)
| Fiscal Year |
Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
National Rate |
| FY 2010 |
21.2
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0
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0
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0
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10.6
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| FY 2009 |
17.3
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14.9
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13.9
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23.1
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10.6
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| FY 2008 |
14.9
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14.1
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15.1
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18.6
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10.6
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| FY 2007 |
21.0
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16.8
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14.4
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16.6
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10.6
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Analysis of results and challenges: An important goal of the Office of Children's Services is to protect children from maltreatment. Measuring the success of children's services agencies can be done, in part, through the number of substantiated child protective services reports received per 1,000 children under the age of 18 in the state.
In FY04, national levels of substantiated maltreatment per 1,000 children, as determined by the Administration for Children and Families, was 12. New data released for 2007 indicates national levels at 12.1. This increase represents approximately 20,000 victims nationwide.
Alaska's rate averaged 15.7% in FY08 down from 17.2% in FY07. The victim rate peaked during the 4th quarter of FY09, but as noted in the chart, the number decreased in the fist quarter of FY10.
The Office of Children's Services is continuing to perfect a new practice model. The new model has proven to be more of a paradigm shift than was previously anticipated; therefore the implementation efforts of new practice standards is taking dedicated staff time and training. The new model of working with families will lead to improved outcomes for the children and families needing OCS intervention. New practice standards have revealed that additional specialized training is necessary and is being provided through the University of Alaska and technical assistance from the federal government.
One of the fundamental differences in the new model requires workers to do an assessment of the entire family and their overall functioning and to look beyond whether the abuse or neglect is substantiated or not substantiated. In the past, workers focused just on the maltreatment itself and did not address other issues going on in the home. This resulted in missed opportunities to engage families in remedial services to avoid subsequent abuse and neglect to the child. Further, the new model helps workers to understand the essential differences in whether the child is unsafe or at risk. Unsafe determinations require OCS intervention, while risk factors may necessitate a referral to community resources. This will result in better identification of families that must be served by the child protective services system versus those that can be served by other resources.
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Target #2: To decrease the recurrence of maltreatment to meet or exceed the national standard of 5.4%.
Status #2: Average recurrence rates decreased by .5% from FY08 to FY09. Alaska's recurrence maltreatment rate reported for the first quarter of FY10 is the lowest since 2007.
Methodology: The rate of recurrence of maltreatment is calculated using the federal measurement of recurrence for a year long period ending the last day of the last quarter measured. The calculation measures the number of victims of substantiated or indicated abuse or neglect during the first 6 months of the reporting year that experienced another incident of substantiated or indicated abuse or neglect within a 6 month period.
The Office of Children’s Services is bringing state performance measures in line with federal measures and methodologies. Therefore, this chart contains newly calculated measures back to Quarter 1 of 2007, and will in many cases include adjustments to numbers previously submitted. These adjustments do not represent major changes in outcomes
Data Source: National Child Abuse and Neglect Data System and Alaska's Online Resources for the Children of Alaska (ORCA).
Target: National standards set by the Administration for Children an Families of 5.4% provided in the 2007 Child Maltreatment annual report.
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Recurrence of Maltreatment - Calendar Year
| Year |
Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
Target |
| 2010 |
10.8%
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0
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0
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0
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5.4%
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| 2009 |
12.0%
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13.9%
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12.4%
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11.1%
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5.4%
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| 2008 |
13.1%
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14.2%
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12.5%
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11.6%
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5.4%
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| 2007 |
10.6%
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8.9%
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9.5%
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11.7%
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5.4%
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Analysis of results and challenges: Alaska's FY08 average rate of recurring maltreatment is 12.9%, an increase from the FY07 average rate of 10.2%. For FY09 the average rate of recurrence dropped to 12.35%.
Recurrence is defined as the percent of victims with substantiated or indicated maltreatment during the first 6 months of the reporting year that experience another incident with substantiated or indicated maltreatment within a 6 month period.
Alaska's rate of repeat maltreatment, while improving slightly during the first quarter of FY10, is still high. A protocol has been developed to more closely examine past assessments that resulted in a substantiated finding of maltreatment. If there have been past substantiated assessments, the OCS worker will review the previous record to ascertain whether the newly reported allegations are against the same child by the same maltreater. If so, the worker and his/her supervisor will devise a strategy for intervention for the current assessment acknowledging that there may be a pattern of maltreatment that needs to be recognized. The supervisor will closely monitor the progress of the assessment and ensure the appropriate actions are taken to protect the child from further maltreatment.
The OCS is working for continued improvements in the number of recurring maltreatment cases through updated business practices. The OCS is receiving technical assistance from the Administration for Children and Families to improve the approach to foster care.
In addition, the OCS has implemented restructuring the administration of foster care and adoptions by moving all of the work to one section and moving the supervision and decision making from the field up through state office to alleviate any conflicts of interest.
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Target #3: Decrease the rate of substantiated maltreatment by out-of-home providers.
Status #3: The rate of maltreatment in out-of-home care improved from an annual average of 1.8% in FY08 to .9% in FY09.
Methodology: The vicitimization by provider rate is the percentage of substantiated victims with a provider perpetrator over all substantiated victims for the quarter.
The Office of Children's Services is bringing state performance measures in line with federal measures and methodologies. Therefore, this chart contains newly calculated measures back to Quarter 1 of 2007, and will in many cases include adjustments to numbers previously submitted. These adjustments align and do not represent major changes in outcomes.
Source: Online Resources for the Children of Alaska (ORCA) data system for the National Child Abuse and Neglect Data System (NCANDS) and federal Adoption and Foster Care Analysis and Reporting System (AFCARS).
Source: Target of .32% - United States Department of Health and Human Services Administration for Children and Families, Child Maltreatment, 2007.
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Percentage of Children Maltreated by an Out-of-Home Care Provider
| Fiscal Year |
Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
National Rate |
| FFY 2010 |
2.1%
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0
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0
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0
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.32%
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| FFY 2009 |
.3%
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1.0%
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1.2%
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.9%
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.32%
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| FFY 2008 |
2.0%
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2.6%
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1.7%
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.9%
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.32%
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| FFY 2007 |
.5%
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.1%
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1.3%
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1.0%
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.32%
|
Analysis of results and challenges: The percentages of maltreatment have averaged 1.26% for the past 2 full years. Some improvement was noted in FY07 but the percentage increased by 1.08% in FY08. FY09 shows improvements at an average of .9%, but the first quarter of FY10 indicates an increased rate.
Maltreatment rates high above national standards in out-of-home care are believed to be an indicator that there are not enough foster homes. The pool of resources from which to make the best possible match for children needing placement and foster parents best able to meet the needs of a particular child is too small. The Office of Children's Services has increased its efforts to obtain and license foster homes across the state with particular efforts in the rural areas.
OCS continues to work toward improved business practices through the use of technical assistance and increased foster and child care rates to assure foster parents will not need to continue to absorb the cost of care for foster children.
|
| |
Target #4: Reduce the rate of staff turnover and increase the number of workers providing direct services at any given time.
Status #4: The Office of Children's Services frontline worker vacancy rates have increased by 2.4% from FY08 to FY09. Turnover rates have decreased 1% during that same time period.
Methodology: Vacancy and turnover analyses are based on vacancies in the Children's Services Specialist I, II, and III and the Social Worker (CS) I, II, III, and IV job class series. Data is collected from the State of Alaska Payroll System. This analysis compiles complete fiscal year data.
Turnover rate represents the number of times a position becomes vacant in the Social Worker and Children's Services Specialist job classes due to an incumbent leaving the position. Reasons for leaving include, but are not limited to transfers, resignation, separation, termination, voluntary demotion, promotion, retirement, or non-retention.
Vacancy rate represents the average rate determined by the number of positions vacant at a point in time quarterly.
|
Office of Children's Services Vacancy /Turnover Rates
| Fiscal Year |
Vacancy Rate |
Turnover Rate |
| FY 2009 |
9.75%
|
34%
|
| FY 2008 |
7.32%
|
35%
|
| FY 2007 |
9.5%
|
33%
|
| FY 2006 |
11.35%
|
30%
|
| FY 2005 |
10.44%
|
38%
|
| FY 2004 |
6.28%
|
32%
|
Analysis of results and challenges: Children's Services frontline worker turnover rates are still extremely high and disruptive. It should be noted that rates presented in this measure include transfers within the division, department, or state. Of the 93 positions that became vacant in FY09, 25 employees transferred into other positions, 17 within OCS.
Vacancy rates have increased by 2.4% from FY08 to FY09 - an average increase of 7 positions.
Since May of 2006 when the Office of Children's Services received the final Hornsby Zeller Associates, Inc. workload study the OCS had been engaged in gradual, incremental changes to personnel that include transferring positions from overstaffed offices to understaffed offices until such time as data regarding caseload and workload trends could be established.
OCS has received all postion recommended by the study as of FY10.
Work on a comprehensive plan to address retention, recruitment and selection of front line staff continues. OCS has not yet realized the kind of success needed from retention and recruitment efforts. There are a number of efforts currently underway and the plan is constantly evaluated and revised as new ideas and efforts are explored. In addition, the Governor's Executive Order 287 has shored up OCS efforts with the involvement of state human resource staff.
|
| C1:
Strategy - Implementation of a new practice model to provide front line workers with a better tool to identify safety and risk issues in the home. |
| C2:
Strategy - Children placed outside of the home are protected from further maltreatment. |
| C3:
Strategy - Retain an effective and efficient workforce. |
| D:
Result - Quality management of health care coverage services to providers and clients
|
| |
Target #1: Decrease average response time from receiving a claim to paying a claim.
Status #1: The division has decreased the average time to pay a claim from 18 days to 11 days from FY07 to FY08. This represents a 39% reduction.
Operation Performance Summary-Annual Average Days /Entry Date to Claims Paid Date
| Fiscal Year |
Medicaid Claims |
Avg Days |
Days Changed |
| FY 2009 |
2,047,064
|
2
|
-9
|
| FY 2008 |
7,293,304
|
11
|
-7
|
| FY 2007 |
7,263,956
|
18
|
6
|
| FY 2006 |
7,721,709
|
12
|
-1
|
| FY 2005 |
7,903,523
|
13
|
3
|
| FY 2004 |
6,690,344
|
10
|
0
|
| FY 2003 |
5,615,072
|
10
|
-2
|
| FY 2002 |
4,959,864
|
12
|
0
|
| FY 2001 |
4,409,121
|
12
|
2
|
| FY 2000 |
3,720,254
|
10
|
0
|
Methodology: Chart Notes
1. Between FY02 and FY03 reports were based on six months of data. Since FY04 reports are based on annual data.
2.A word of caution. FY09 numbers are for first quarter only while all other years are based on 12 months of data
Source: MARS MR-0-08-T.
No national average available.
Analysis of results and challenges: Average days to pay between FY07 and FY08 decreased from 18 days to 11 days.
Three new initiatives, two in the second half of FY06 and the other in first quarter 2007 may provide explanations for the increase of average days. The Personal Care Program instituted a prior authorization process during the third quarter 2006. As part of this new initiative, claims became subject to prior authorization editing. Additionally, regulatory changes for certain Durable Medical Equipment (DME) high-volume supplies occurred during the second half of FY06. This resulted in additional claims pending for evaluation and pricing. Lastly, during the first quarter 2007, several new home and community-based waiver program edits were initiated.
Adding to the hindrance, the Department of Health and Social Services' (HSS) contractor experienced a data entry backlog as they converted from outsourced data entry services to in-house data entry. The decease from FY07 to third quarter FY08 is a result of completion of training and increased staff proficiecy.
All of the above would have had impact on processing time.
|
| |
Target #2: Increase the percentage of adjudicated claims paid with no provider errors.
Status #2: The percentage of claims without error and paid within ten days decreased to 70% in FY08 compared to 72% in FY07.
Error Distribution Analysis-Change in the percentage of adjudicated claims paid with no provider errors
| Fiscal Year |
Medicaid Claims Pd |
% No Errors |
% Change |
| FY 2009 |
1,538,356
|
68%
|
-2%
|
| FY 2008 |
5,562,537
|
70%
|
-2%
|
| FY 2007 |
5,606,347
|
72%
|
-2%
|
| FY 2006 |
6,082,318
|
74%
|
2%
|
| FY 2005 |
6,150,027
|
72%
|
-4%
|
| FY 2004 |
5,106,692
|
76%
|
3%
|
| FY 2003 |
4,776,730
|
73%
|
-1%
|
| FY 2002 |
4,202,677
|
74%
|
1%
|
| FY 2001 |
3,670,331
|
73%
|
1%
|
| FY 2000 |
3,076,978
|
72%
|
0
|
Methodology: Chart Notes
1. Between FY01 and FY03 reports were based on six months of data. Since FY04 reports are based on annual data.
2. This measure was updated annually through FY 2005; beginning with FY 2006, it is being updated quarterly.
3. FY09 numbers are for first quarter of FY09
4. Source: MARS MR-0-11-T.
Analysis of results and challenges: Error distribution analysis is designed to capture the percentage of adjudicated claims paid with no provider errors. To ensure correct claim submission from providers, Health Care Services works with providers to resolve problem areas and to get claims paid. First Health, Medicaid's fiscal agent, provides training to providers on billing procedures, publishes billing manuals, and has a website for providers with information tailored to each provider type.
During FY06, the Department of Health and Social Services (HSS) had two major initiatives that impacted pharmacy: Pharmacy Cost Avoidance and Medicare Part D.
Prior to Pharmacy Cost Avoidance, HSS, as the State Medicaid Agency, paid the pharmacy claims for recipients who had insurance primary to Medicaid and then attempted to recover the costs from liable third parties. The Pharmacy Cost Avoidance initiative changed this practice and therefore the number of claims denied because of other insurance coverage is significant.
Additionally, Medicare Part D required HSS to deny pharmacy claims for Medicare-covered drugs for those recipients of both Medicaid and Medicare. Previously, Medicaid paid for this same population. This results in a significant denial of claims.
These major changes to the Pharmacy program were surely noteworthy enough to result in the decrease of claims paid, and as such, claims paid without error.
|
| |
Target #3: Reduce the rate of Medicaid payment errors.
Status #3: Since payment errors are frequently related to lack of appropriate documentation of services, improved provider training and outreach on required documentation for Medicaid payment is underway.
Error Analysis - Percent Claims Paid with No Errors
| Year |
Total Claims Paid (FY) |
% Paid with no Errors |
| 2008 |
4,127,303
|
70%
|
| 2007 |
1,363,276
|
72%
|
| 2006 |
6,082,318
|
74%
|
| 2005 |
6,150,027
|
72%
|
| 2004 |
5,106,692
|
76%
|
| 2003 |
4,776,730
|
73%
|
Methodology: FY03 reports were based on six months of data.
Since FY04, reports have been based on annual data.
FY08 numbers are based on claims paid through third quarter of FY2008.
Analysis of results and challenges: The Improper Payments Information Act of 2002 (Public Law 107-300) requires Federal agencies to annually review and identify those programs and activities that may be susceptible to significant erroneous payments, estimate the amount of improper payments and report those estimates to the Congress, and if necessary, submit a report on actions the agency is taking to reduce erroneous payments. The effect of this rule is that states are now to be required to produce improper payment estimates for their Medicaid and SCHIP programs and to identify existing and emerging vulnerabilities.
The PERM program commenced nationally on July 1, 2005 with Phase I and one-third of the states participated. Alaska is a year 3 state and will be required to participate during calendar year 2007. There will be an impact on the resources in each division managing Medicaid Services to assist the PERM staff with access to policies, procedures and data. Division staff may be called upon to assist in the interpretation of medical records pertaining to claims associated with services that division manages. The PERM process includes expectations for corrective actions. Divisions will need resources to implement corrective actions resulting from PERM findings.
|
| D1:
Strategy - Continue to develop new Medicaid Management Information System (MMIS). |
| E:
Result - Juvenile offenders' success in the community following completion of services is improved, resulting in higher levels of accountability and public safety. |
| |
Target #1: Reduce percentage of juveniles who reoffend following release from institutional treatment facilities to less than 33%.
Status #1: The defined recidivism rate for juveniles released from secure treatment in FY07 and followed up in FY09 was 45.1%.
Juvenile Institution Recidivism
| Fiscal Year |
YTD Total |
| FY 2009 |
45.1%
|
| FY 2008 |
40.7%
|
| FY 2007 |
34%
|
| FY 2006 |
27.8%
|
Analysis of results and challenges: This measure examines recidivism for youth who have been committed to and released from the Division’s four juvenile treatment facilities. These youth typically have the most intensive needs and are the state’s more chronic and serious juvenile offenders compared with youth who receive only probation supervision. Recidivism rates for these two populations are considered separately because of the distinctively different levels of risk and need presented, and the different types of interventions and programming received.
The recidivism rate for juveniles released from Alaska’s secure treatment institutions has increased over the past few years. (The definitions and procedures for measuring recidivism were set by the Division in 2006.) The increase may not be significant given that the percentage changes in recidivism in fact represent small numbers of youth. (In FY07, a total of 113 juveniles were released from secure treatment institutions.) Nevertheless, the gradual increase in recidivism among this population is enough cause for concern that the Division has formed a work group to closely examine the factors that contribute to recidivism and make recommendations for change. The Division is devoting particular attention to the high rate of recidivism noted among Alaska Native juveniles, and is working to improve its understanding of and practices with these youths.
Differences in the way states manage juvenile delinquency referrals make it challenging to compare Alaska’s recidivism rate with that of other states. Sixteen of the 32 states that track recidivism do so on a 12-month basis. Among the eight states (including Alaska) that measure recidivism based on a 12-month follow-up period, and that consider offenses “recidivism” if they result in a conviction or adjudication in the juvenile or adult systems, the average recidivism rate was 33% (Source: Juvenile Offenders and Victims: 2006 National Report,” National Center for Juvenile Justice, Pittsburgh, page 234). This number serves as the baseline goal from which Alaska works to improve its recidivism rate. This “national” recidivism rate of 33% is very similar to the average recidivism rate over the three prior years in Alaska. (In FY09, this average was 34%, based on institutional recidivism rates of 40.7% in FY08; 34.0% in FY07; and 27.8% in FY06).
Reoffenses, like the original offenses that brought the juveniles to the Division’s attention, may be felonies, misdemeanors, drug offenses, weapons crimes, crimes against persons, crimes against property, and other state crimes. Often these crimes are committed while the juvenile is under the influence of alcohol or other drugs, or in the context of domestic violence. The Division has adopted assessment tools both for juveniles and the facilities that house them to address the root causes of their law-breaking behavior, and will continue to review institutional treatment components and research-based practices as it seeks to improve its outcomes for youths leaving institutions.
Note: Reoffenses by juveniles released from Alaska's treatment institutions are determined through analysis of entries in the Division of Juvenile Justice's Juvenile Offender Management Information System (JOMIS) database and the Alaska Public Safety Information Network (APSIN). Juveniles are included in this measure if the reason for their release from the treatment facility is marked in JOMIS as “Completion of Treatment,” “Court-Ordered Release,” “Order Expired,” “Sentence Served,” “Transfer (Transitional Services Step Down),” or “Transfer to a Non-DJJ Facility.” Reoffenses are defined as: any offenses that occurred within 12 months of release and that resulted in a new juvenile adjudication or adult conviction, or a probation violation resulting in a new juvenile institutionalization order. For this FY09 report, adjudication and conviction information on offenses that were committed 12 months after release by juveniles must have been entered in JOMIS or APSIN by August 1, 2009. Adjudications and convictions for motor vehicle, Fish & Game, non-habitual Minor in Possession/Consuming Alcohol, and misdemeanor-level Driving While Intoxicated offenses are excluded. Adjudication and convictions received outside Alaska also are excluded from analysis.
|
| |
Target #2: Reduce percentage of juveniles who reoffend following completion of formal court-ordered probation supervision to less than the average rate in the three prior years (27.9%).
Status #2: The defined recidivism rate for the probation population was 30.28%, a percentage similar to that identified in the previous two years.
Juvenile Probation Recidivism
| Fiscal Year |
YTD Total |
| FY 2009 |
30.28%
|
| FY 2008 |
27.8%
|
| FY 2007 |
28%
|
| FY 2006 |
27.8%
|
Analysis of results and challenges: This measure examines reoffense rates for juveniles who received probation supervision while either remaining at home or in a nonsecure custodial placement. These youths typically have committed less serious offenses and have demonstrated less chronic criminal behavior than youth who have been institutionalized. (Recidivism rates for institutionalized youth are analyzed in a separate performance measure [above], and are considered separately because of the distinctively different levels of risk and need presented, and the different types of interventions and programming received.)
The recidivism rate among the population of juveniles released from formal supervision in FY07 appears similar to the rates identified in previous years. Nevertheless, the Division is exploring the reasons that some juveniles in Alaska recidivate and will continue to work toward implementing evidence-based practices that will reduce the recidivism rate for the youth released from Division probation supervision.
Differences in the way states manage juvenile delinquency referrals make it challenging to compare Alaska’s recidivism rate with that of other states. Sixteen of the 32 states reported to track recidivism do so on a 12-month basis. Among the eight states (including Alaska) states that measure recidivism based on a 12-month follow-up period, and that consider offenses “recidivism” if they result in a conviction or adjudication in the juvenile or adult systems, the average recidivism rate was 33%. (Source: Juvenile Offenders and Victims: 2006 National Report, National Center for Juvenile Justice, Pittsburgh, 2006, page 234.) In Alaska, the three-year average recidivism rate for youth released from formal probation was 27.9% (27.8% in FY08; 28.0% in FY07; 27.8% in FY06). This number serves as the goal for this year’s probation recidivism study.
Reoffenses, like the original offenses that brought the juveniles to the Division’s attention, may be felonies, misdemeanors, drug offenses, weapons crimes, crimes against persons, crimes against property, and other state crimes. Often these crimes are committed while the juvenile is under the influence of alcohol or other drugs, or in the context of domestic violence. The Division has received technical assistance in FY09-FY10 to assist in understanding its needs for juvenile probation needs more clearly; this information will ultimately be used to improve the Division’s ability to incorporate research-based practices into probation work and ultimately improve outcomes for youth on probation supervision.
Note: Reoffenses for juveniles released from formal probation are determined by checking for entries in the Division's Juvenile Offender Management Information System (JOMIS) and the Alaska Public Safety Information Network (APSIN). This table reports the number of youth for whom court-ordered probation episodes closed during the fiscal year for one of the following reasons: “Completed Successfully,” “Order Expired,” “Court Termination,” “Non-compliant Closed,” or “Waived to Adult Status.” Youth whose formal probation ends because of “Court Termination Resulting in a new Supervision,” “Modified,” “Revoked,” “Supervision Transfer,” “Declared Incompetent,” or “Deceased” are not included. Recidivism for this measure is defined as re-offenses that occurred within 12 months from the time offenders were released from formal probation, and that resulted in a conviction or adjudication. (For example, the FY09 study is represented in the graph above by youth who were released from formal probation in FY07, and who re-offended within FY08. For this FY09 report, adjudication and conviction information on offenses that occurred within 12 months of release must have been entered in APSIN or JOMIS by August 1, 2009.) Youth are not included who have been reassigned to a formal probation order (with or without custody) within 7 days of release, as this typically reflects a modification of probation status or custodial placement rather than true completion of supervision. This analysis also excludes youth who were ordered to an Alaska treatment institution any time prior to their supervision end date, as these youth are included in the analysis for our institutional recidivism performance measure, above. Adjudications and convictions for Motor Vehicle, Fish & Game, non-habitual violations of Minor in Possession/Consuming Alcohol, and misdemeanor-level Driving While Intoxicated offenses are excluded. Adjudications and convictions received outside Alaska are excluded from analysis.
|
| |
Target #3: Alaska's juvenile offense rate will be reduced by 5% over a two-year period.
Status #3: The number of juvenile referrals (reports of juvenile offenses from law enforcement) made to the Division of Juvenile Justice declined 13.7% between FY08 and FY09 and declined 17.7% between FY07 and FY09.
Juvenile Delinquency Referrals in Alaska, FY2002-FY2009
| Fiscal Year |
YTD Total |
| FY 2009 |
4697
-13.71%
|
| FY 2008 |
5443
-4.66%
|
| FY 2007 |
5709
-0.07%
|
| FY 2006 |
5713
-2.53%
|
| FY 2005 |
5861
-6.03%
|
| FY 2004 |
6237
-16.46%
|
| FY 2003 |
7466
+7.7%
|
| FY 2002 |
6932
|
Analysis of results and challenges: Both the raw number of referrals and the percentage of these referrals per 100,000 youth population declined dramatically in FY09 compared with FY08 and FY07. The decline in referrals surpassed the target of a 5% drop in referrals over a two-year period, reflecting a continued trend of decreased juvenile delinquent activity that has been noted nationally as well as statewide over the past several years. Definitive reasons for changes in referral levels are unknown. Possible causes could include changes in economic conditions, changes in prevention and intervention techniques, changes in law enforcement practices or resources, or a combination of some or all of these.
Note: Population data for youth aged 10-17 during the years 2002-2007 is provided by the Alaska Department of Labor and Workforce Development. The population estimate for the year 2008 and 2009 was derived from the 2007 estimate and the 2010 projection from the report Alaska Population Projections 2007-2030, published by the same Department. Juvenile referral data was extracted from the Division of Juvenile Justice's Juvenile Offender Management Information System (JOMIS) database by on August 21, 2009 and includes referrals for youth who are under 10 years old (these referrals make up less than 1% of the total). This data is continually refined and corrected and numbers in future reports may change slightly.
|
| |
Target #4: Divert at least 70% of youth referred to the Division away from formal court processes as appropriate given their risks, needs, and the seriousness of their offenses.
Status #4: The proportion of juveniles with at least one offense (a criminal charge in a report from law enforcement alleging a juvenile perpetrator) diverted from the formal court process matched the goal of 70%.
Percentage of Juveniles with at Least one Case Diverted from the Formal Justice System, FY2006-FY2009
| Fiscal Year |
YTD Total |
| FY 2009 |
70%
|
| FY 2008 |
78%
|
| FY 2007 |
75%
|
| FY 2006 |
71%
|
Analysis of results and challenges: “Diversion” refers to the process of managing juveniles cases through non-court processes, such as non-court adjustments; informal probation; referral to community panels such as youth court; or dismissals due to legal insufficiency. Diversion serves a number of important, valuable purposes. It helps low-risk juveniles who are unlikely to re-offend avoid the stigma and needless harm that can result from delinquency adjudication. Diversion provides opportunities for community partners and victims to take more active roles in handling low-risk juvenile offenders. Diversion processes reduce burdens on the court system, which otherwise would find it impossible to adjudicate every offender referred to it. Diversion also is considerably less expensive and faster than the formal adversarial process. Diversion processes reduce probation caseloads as well, enabling the Division to better allocate resources and staff time to more serious offenders.
In FY09, 2,273 (70%) of 3,233 juveniles referred to the Division had at least one of their offenses managed through non-formal-court processes. This percentage was lower than the percentage identified in previous years, but this difference may not be significant. The decrease may be due as much to refinements in record-keeping and data-gathering and analysis as real change in the patterns of managing juveniles. The Division will monitor this measure in the future to determine whether the decrease in FY09 represents the beginning of a trend.
Note: For this measure, youth are considered to have been diverted away from the formal court system if the intake decision for their delinquency referrals resulted in at least one offense within the referral being adjusted, dismissed, placed on informal probation, or forwarded to a community justice panel such as youth court. Referrals that are screened and referred elsewhere, such as back to law enforcement for further information, and those that were still in process at the time this data was collected are excluded from consideration.
|
| E1:
Strategy - Implement and review information from research-based assessment tools, and incorporate practices proven to reduce recidivism and criminal behavior among youth. |
| F:
Result - Low income families and individuals become economically self-sufficient. |
| |
Target #1: Increase self-sufficient individuals and families by 10%.
Status #1: In FY09, the Alaska Temporary Assistance Program showed a 5% decline in the number of families receiving benefits.
Changes in Self Sufficiency
| Fiscal Year |
September |
December |
March |
June |
YTD Total |
| FY 2010 |
10%
|
0
|
0
|
0
|
10%
|
| FY 2009 |
-10%
|
-6%
|
-2%
|
-5%
|
-5%
|
| FY 2008 |
-7%
|
-7%
|
-5%
|
-6%
|
-6%
|
| FY 2007 |
-5%
|
-11%
|
-13%
|
-10%
|
-9%
|
| FY 2006 |
-23%
|
-22%
|
-19%
|
-20%
|
-22%
|
| FY 2005 |
-6%
|
-7%
|
-8%
|
-6%
|
-7%
|
| FY 2004 |
-12%
|
-7%
|
-6%
|
-9%
|
-9%
|
| FY 2003 |
-1%
|
-11%
|
-14%
|
-13%
|
-9%
|
| FY 2002 |
-16%
|
6%
|
4%
|
3%
|
-2%
|
Analysis of results and challenges: Overall, there has been a 61% decline in the caseload since FY96.
The goal is for clients to move off Temporary Assistance with more income than they received while on the program, and for those clients to stay employed with sufficient earnings to stay off the program. As the caseload declines, families with more significant challenges to employment make up a higher percentage of the caseload. Therefore, with a declining caseload, it becomes more difficult to achieve higher percentages of families becoming self-sufficient.
The other four monthly columns show a snapshot of caseload rate change compared to the previous year's month. (Note: The YTD Total column represents the average annual monthly caseload rate change.)
|
| F1:
Strategy - 90% of temporary assistance families leave with earnings and do not return for six months.
|
| F2:
Strategy - Increase the percentage of temporary assistance families with earnings.
|
| F3:
Strategy - Increase the percentage of temporary assistance families meeting federal work participation rates. |
| F4:
Strategy - Improve timeliness of benefit delivery. |
| F5:
Strategy - Improve accuracy of benefit delivery. |
| F6:
Strategy - Increase the percentage of subsidy children in licensed care. |
| G:
Result - Healthy people in healthy communities |
| |
Target #1: 80% of all 2 year olds are fully immunized.
Status #1: In 2007, 70% of two year olds were fully immunized, which was below the 80% target rate, but slightly above the 67% in FY06. Alaska ranked 45th in the country for fully immunized two year olds.
Vaccination Coverage Among Children 19-35 Months of Age, Alaska and US
| Year |
US % |
Alaska % |
AK US Rank |
| 2007 |
77.4
|
70.1*
|
45
|
| 2006 |
77.0
|
67.3*
|
47
|
| 2005 |
76.1
|
68.1*
|
41
|
| 2004 |
80.9
|
75.3
|
45
|
| 2003 |
79.4
|
79.7
|
27
|
| 2002 |
74.8
|
75.3
|
30
|
| 2001 |
73.7
|
71.2
|
35
|
| 2000 |
72.8
|
70.6
|
41
|
| 1999 |
73.2
|
74.5
|
27
|
Methodology: In 2005, CDC began using a new six-dose standard for its recommended basic immunization series.
Analysis of results and challenges: Chart Note: Source - National Immunization Survey, Centers for Disease Control and Prevention. Annual percentages are based on CDC recommendations at the time, which have changed over the years as vaccines have been added to the "basic immunization series."
* In 2005, the CDC increased its recommendation to a new, six-dose series of vaccinations. As a result, the national rate of fully immunized two year olds dropped considerably, as did Alaska's rate. These results continue to illustrate the need for renewed emphasis on the importance of timely immunizations for young children.
Data for 2008 should be available in late July or August 2009.
|
| |
Target #2: Reduce post-neonatal death rate to 2.3 per 1,000 live births by Healthy Alaskans 2010.
Status #2: The post-neonatal death rate for 2008 was 3.0 per 1,000 live births, above the target of 2.3 per 1,000 live births, but below the rate of 3.3 per 1,000 in 2007.
Post-Neonatal Death Rate - AK and US
| Year |
Alaska |
US |
| 2008 |
3.0
|
0
|
| 2007 |
3.3
|
NA
|
| 2006 |
3.2
|
2.3
|
| 2005 |
2.8
|
2.3
|
| 2004 |
3.2
|
2.3
|
| 2003 |
3.8
|
2.2
|
| 2002 |
3.6
|
2.3
|
| 2001 |
4.5
|
2.3
|
| 2000 |
3.2
|
2.3
|
| 1999 |
3.0
|
2.3
|
Analysis of results and challenges: Chart Note: Rate per 1,000 live births reflects three-year rate, i.e. 2008 represents 2006-2008.
Post-neonatal mortality is more often caused by environmental conditions than problems with pregnancy and childbirth. Nationally, the three leading causes of death during the post-neonatal period (28 through 364 days) in 2005 were birth defects, short gestation/low birthweight, and Sudden Infant Death Syndrome (SIDS) , In Alaska, SIDS/asphyxia is a contributing factor in half of all post-neonatal deaths. Other primary causes are birth defects and infection. The post-neonatal mortality rate in Alaska is higher than the national target of 2.3 per 1,000 live births (Healthy People 2010) and has remained relatively static over time. While not shown graphically, over the last decade Alaska Native infants were twice as likely to die during the post-neonatal period than non-Native infants.
Work by DHSS is underway with the Indian Health Service on a rural initiative to prevent Sudden Infant Death Syndrome (SIDS). Cessation efforts involving tobacco, alcohol and other drugs are being targeted on the pre-conception and prenatal periods. DHSS is launching a statewide Infant Safe Sleep Project to reduce infant death, and a task force will convene in Fall 2009. Finally, work has begun with health providers and community partners to establish a model program of early prevention and chronic disease management for prenatal patients.
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Target #3: Decrease diabetes in Alaskans.
Status #3: 6.1% adult diabetes prevalence for 2006-2008; prevalence has increased 80% since 1998-2000.
Est. Annual Prevalence of Diabetes among Adults (18+) in Alaska Based upon Midpoints of Three-Year Averages
| Year |
Alaska |
US |
| 2007 |
6.1%
|
7.8%
|
| 2006 |
5.7%
|
7.8%
|
| 2005 |
5.3%
|
7.4%
|
| 2004 |
4.8%
|
7.0%
|
| 2003 |
4.4%
|
6.6%
|
| 2002 |
4.2%
|
6.5%
|
| 2001 |
3.8%
|
6.4%
|
| 2000 |
3.8%
|
5.9%
|
| 1999 |
3.4%
|
5.4%
|
Methodology: Note: Alaska data are 3-year averages (2007 number is for 2006-2008); U.S. data are single-year values from the National Health Interview Survey
Analysis of results and challenges: Chart Note: Sources - Alaska Behavioral Risk Factor Surveillance System (AK); National Health Interview Survey (U.S.); both are crude rates.
Diabetes is a chronic disease affecting approximately 27,000 adult Alaskans. Over the past decade, an increasing percentage of Alaskan adults have reported being told by a health professional that they have diabetes.
Type 2 diabetes accounts for 90 to 95 percent of all diagnosed cases and typically occurs in adults, but is increasingly being diagnosed in children and adolescents. Risk factors for Type 2 diabetes include older age (40-plus years), obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. Diabetes prevalence increases with age, and the prevalence of diabetes in Alaska is expected to increase as the population ages.
The DHSS Division of Public Health works to reduce the health burden and economic costs of diabetes in Alaska through an integrated program of prevention and disease management that supports our community partners. To slow or halt the upward trend of diabetes, a comprehensive approach is needed to make healthy behaviors the norm. The major modifiable risk factors contributing to diabetes and other chronic diseases are tobacco use, physical inactivity, unhealthy eating habits, and resulting obesity. The Division will address all of these factors by providing the information and tools needed to make healthier choices, while also assuring that healthy behaviors are reinforced in schools, worksites and other community settings.
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Target #4: Decrease Alaska's adult obesity rate to less than 18%.
Status #4: The adult obesity rate was 27.9% in 2008, below the 28.2% in 2007. However, this was higher than the 26.6% national average and did not meet the 18% target rate.
Prevalence of Obesity: Alaska & US
| Year |
Alaska |
US |
| 2008 |
27.9%
|
26.6%
|
| 2007 |
28.2%
|
26.3%
|
| 2006 |
26.2%
|
25.1%
|
| 2005 |
27.4%
|
24.4%
|
| 2004 |
23.7%
|
23.2%
|
| 2003 |
23.6%
|
22.8%
|
| 2002 |
23.4%
|
22.1%
|
| 2001 |
22.1%
|
21%
|
| 2000 |
21.0%
|
20.1%
|
| 1999 |
20.4%
|
19.7%
|
Analysis of results and challenges: Chart Note: Sources – Alaska and U.S. Behavioral Risk Factor Surveillance System; crude rates.
The trends in Alaska continue to show growing numbers of overweight and obese adults, with an obesity prevalence at 27.9% in 2008 - an alarming 30% higher than the 1999 Alaska prevalence level and 55% higher than the Healthy Alaskans 2010 target.
Premature death and disability, increased heath care costs, and lost productivity are all associated with overweight and obesity. Unhealthy dietary habits combined with inactivity are primary factors in increasing body fat levels. Overweight and obesity are estimated to be responsible for approximately 300,000 deaths per year in the United States. Alaskans annually spend $477 million on obesity-related direct medical expenditures.
Overweight and obesity are directly associated with at least four of the top ten leading causes of death. Obesity is a health threat to all generations of Alaskans, and threatens to make this generation the first to live shorter lives than their parents. It increases the risks of chronic diseases and conditions such as heart disease, diabetes, stroke, hypertension, some cancers, and premature death. Mortality due to unintentional injury, suicide, chronic obstructive pulmonary disease (COPD), pneumonia, and liver disease may also be influenced by obesity to some extent.
A comprehensive approach, as identified in Alaska in Action: the Statewide Physical Activity and Nutrition Plan, is needed to decrease obesity in Alaska. Through educational, programmatic, policy, and environmental strategies, the department works to reduce the percentage of Alaskans classified as overweight or obese.
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| G1:
Strategy - Strengthen public health in strategic areas. |
| H:
Result - Senior and physically and/or developmentally disabled Alaskans live independently as long as possible. |
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Target #1: Increase the number of DD waiver recipients receiving Supported Employment Services.
Status #1: There is a slight increase to utilization of the supported employment Medicaid waiver service in recent years. SDS will encourage increased usage in future years as appropriate.
Developmentally Disabled Recipients Receiving Supported Employment
| Fiscal Year |
Recipients |
| FY 2008 |
336
|
| FY 2007 |
328
|
| FY 2006 |
321
|
| FY 2005 |
320
|
| FY 2004 |
319
|
| FY 2003 |
328
|
| FY 2002 |
320
|
| FY 2001 |
277
|
Analysis of results and challenges: Supported Employment Services is one of the best resources available to developmentally disabled beneficiaries to help them live independently by providing them with the opportunity to work. The Division of Senior and Disabilities Services has determined that the reason the number of DD waiver beneficiaries receiving supported employment has reached a plateau in recent years is because only the highest-functioning clients without behavioral issues can be easily employed. In FY07 and beyond, the division will be working with the Governor's Council on Disabilities and Special Education to increase participation in supported employment as outlined in the Alaska Works Initiative 2006-2010 Strategic Plan.
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| H1:
Strategy - Promote independent living and provide preadmission screening to nursing homes. |
| I:
Result - Administrative services are delivered efficiently and effectively. |
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Target #1: Reduce the average response time for complaints/inquiries to 14 days.
Status #1: In FY08, the HSS Commissioner's office succeeded in meeting the goal of responding within 14 days of receiving a complaint or inquiry.
# of Inquiries/Complaints
| Fiscal Year |
Opened |
Closed |
Avg Days to Close |
| FY 2008 |
1367
|
1772
|
20.06
|
| FY 2007 |
1495
|
1224
|
24.52
|
| FY 2006 |
1590
|
1408
|
25.78
|
| FY 2005 |
552
|
503
|
15.18
|
Methodology: This is only done on a yearly basis.
Analysis of results and challenges: The response log "HSS Track" originally included only inquiries or complaints received by the DHSS Commissioner's Office (i.e., public or legislative complaints, legislative questions, press inquires, etc). However, in the last few years, other divisions have begun utilizing the HSS Track system for other purposes. For example, SDS tracks for case managment purposes. Different employees may enter data on the same client and the log may be left open for longer periods depending on the situation. OCS uses the tracking system to log complaints. First Health, the Medicaid contractor, tracks complaints from Medicaid recipients. Due to the complexity of those issues, the response time has increased overall.
Response time for inquiries and complaints to the Commissioner's Office only (the original intent of this measure), met the response goal with an average of 10 days, half the overall total.
The IT section is working on improvements to the system for tracking and reporting.
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Target #2: Reduce by 5% per year processing time for key indicators.
Status #2: In FY08 the department reduced processing days for grant awards and legislative inquiries. Processing time for purchase requisitions and invoices increased. Capital Grant Awards remained the same.
Timeliness and Accuracy (Days to Process)
| Fiscal Year |
Purchase Requisitions |
Operating Grant Awards |
DHSS Invoices |
Capital Grant Awards |
Legislative Logs |
| FY 2008 |
6.3
+8.62%
|
18.8
-10.35%
|
16.58
+80.81%
|
1.5
0%
|
3.9
-6.25%
|
| FY 2007 |
5.8
-17.14%
|
20.97
+9.68%
|
9.17
-1.71%
|
1.5
-55.36%
|
4.16
+18.18%
|
| FY 2006 |
7.00
|
19.12
|
9.33
|
3.36
|
3.52
|
Analysis of results and challenges: This measure was initiated in FY06 and is updated on an annual basis after year end.
In FY08 "DHSS invoices" processing time increased significantly. This may be a side effect of turnover in positions in the FMS division and fiscal section but is also impacted by other divisions within the department. If invoices are not promptly submitted or approved, the lag in time counts against this measure as it is calculated based on the invoice date as opposed to the date it was submitted to fiscal. In the coming year, fiscal will encourage divisions to reduce their turnover time.
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Current as of Nov 18 2009 14:08:08 |
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