| Meeting 12 Notes|
Welcome to the Governor's Child Health Advisory Committee Meeting!
Attendees: Mim Wilkey (phone), Doug Vance (phone), Dick Morrissey, Jason Eberhart-Phillips, Dennis Cooley, Mary Ann Shorman, Mary Baskett, Gerard Lozada, Katy Belot (guest from SRS), Leadell Ediger, Mary Ann Shorman, Mandy Cawby, Paul Getto, Gary Brunk, Rand O'Donnell (phone)
Remarks from Jason Eberhart-Phillips:
- Last worked as local county health official in CA.
- Delighted to find out body like this had already been created, with people with expertise like you, saw some of the good work you've done.
- Great to come to a place with such capacity and dedication to public health.
- Thank you for what you are doing.
Reading emails about this group and its future. Is there a purpose in continuing?
Thought to myself, yes, I hope there is! I need your help, I need the perspectives you bring and the backing you can give to advocate addressing problems that concern all of us related to children and families. I hope you do continue.
I have already run a couple of things by Dennis. Would love to ignite your interest in these things, hope you would be excited to renew your commitment to these things.
*** Katy Belot, SRS
It is a tough time for the agency.
$1.3 billion is starting budget.
For FY09 4.25% reduction to that.
For 2010, may be almost 10% cut.
Right now, House has agreed to 5% cut across the board.
Senate agreed to 2.5%, that is a little more reasonable.
SRS serves the state's most vulnerable systems. State hospitals are budgeted like a separate agency. Secretary has tried to do as little cuts as possible to hospitals. Haven't been funded as much as they've needed to in past. Further cuts would be staff in harm's way and not allow us to give care they need.
With the ARRA funds and stimulus money and maintenance of efforts, have a very short list of what we can cut. e.g., Cuts that don't have big federal match, don't require statuatory change, etc. Not many cuts that fall into this category.
3 items on reduced resource package that directly affect KS kids and their well-being:
- 2 changes to KS code for children in need of care.
(1) would not take kids into Sec custody other than those in harms way (e.g., no truancy). Net savings is $2.2 million that will come from renegotiating foster care contracts. Feel like contractors can work with families and kids in the home who have these issues. use respite care, counseling, etc. Important to include kids and not necessarily remove kids. When introduced, judges had problems, did not pass. Went back, came up with language judges were okay with. If judges can't provide parental support, can come into care. Judgest don't want to be boxed in. All of the judges came back as proponents. Not just nuetral.
(2) End custody at age 18. This garners $1.5 million. The 18 year-olds to us, in most cases, are not as vulnerable. Maybe the best of hard choices. Again, judges didn't like, went back to drawing board, inserted that judges must approve transition plan. Put in clause that covers individuals with disability.
- 3rd piece for KS kids in foster care. Grandparents as caregivers program has not been as utilized as we had hoped. Can't afford to fund, but think it is useful. Had an option to transfer program into temporary assistance for needy families. Program now is state-funded. When grandparents care for kids, don't have to comply with child-support requirements. Moving program into TANF, fund by TANF. No age requirement for caregiver. No custody requirement. Must cooperate with child support enforcement.
A lot of interest and will to expand autism waiver. Very costly. No money for this. Anticipate, as revenues recover, this will be something that will continue to be of interest. Could fund additional waivers.
Budget cuts in next round:
- Could potentially have to close children's beds at Larned State Hospital
- Child care assistance going from 185 to 150
- Cuts to community mental health centers - no one wants to do, but...
- cuts to community developmental disability organizations (CDDOs)
Disproportionate minority contact. Looking at counties where larger proportion of minority kids taken into care.
Closure committee - went to school for blind, school for deaf.
Waivers - developmental disability waivers. Big waiting list. Now using 2 go off, 1 go on.
These decisions are very hard. None are easy. Trying to manage with few resources.
Can answer questions.
Gary: Child care assistance - my understanding is we could put at risk the $18 million in federal $.
Katy: Yes, question about supplanting. Agency would never do anything to jeopardize the $18 million, just telling you some of the things that have come up on the list.
*** Gary Brunk - Kansas Action for children. Gary passed around document with legislative priorities.
Talk about a couple of them:
(1) Expansion of HealthWave eligibility from 200% to 250% poverty. Has been some support for this. Fairly optimistic. Would get phased in over 2 years. Will cover 8,000 or more kids that not currently covered. When looked at data in KS about kids not covered, growing group of kids uninsured were the group between 200 - 250%
(2) Graduated drivers license. Finally passed. Governor signed. 1. extends learning period to 12 months. Once have regular license - 2. restrictions on nightime driving after 9 p.m 3. Can only be driving with one unrelated young person in the car. Finally we can say no longer one of 3 state that doesn't have GDL. Teen and child death rates in KS look pretty bad compared to other states, motor vehicle accidents contribute to this.
- Autism. Additional waivers. Pretty hard sell this year. Last year 45 kids covered. 205 kids were eligible.
- Children's Initiative Fund. Last year, made some important progress for early childhood new education. Particularly, creation of new $11 million block grant to help build early childhood system for KS. With budget requirements, concerned about what could happen to this. So far, these $ seem to be protected.
Mary: No, on the House side 32% of budget was cut. Not on the Senate side. Effort passed in House to take $3.2 million out. We were all very surprised because went specifically to block grant. Did pass on House side and not on Senate side. Within the block grant, there are several programs that definitley impact childrens health. Early Head Start. Mental Health component. Cut to block grant would definitely impact children's health.
*** Paul Getto. Kansas Association of school Boards.
Did change military impact aid on school districts. Helps schools that have kids moving in and out.
KanEd technolgoy, still hoping they can get more $ into that, links many of the different agencies. Way to get information to people together than doesn't involve travel.
Autism - We continue to argue against mandates that would require schools to provide more services, just because we are already doing more than we can do.
Book - Thinking in Pictures - professor at Colorado State. Was autistic (still is), fascinating story, has redesigned most of cattle industry in the country. Fascinating story.
$11 million from tobacco $, putting into early childhood education.
Epi pens. Work on zero tolerance. (e.g., story from back east of young lady who saved a child's life with an epi pen then was expelled the next day due to no meds zero tolerance rule).
Financial literacy: we lobbied against because no evidence this will work and will take away from things already doing and already overextended.
Comprehensive sex ed emphasizing abstinence. Discussion on this.
***KDHE Updates - Dick.
See handouts on web.
Quick overview of stimulus funding that we know about. (See spreadsheet posted online.)
Prevention and Wellness funds
- Immunization (fairly firm figure)
- Chronic Disease (competitive, no guidance yet)
- Infection prevention - aimed at state's addressing health care-associated infections. All state's required to develop plan to address health-care associated infections.
- Child Care Development Block Grant.
- Electronic Health Record
- State Loan Replayment Program
- Increased Demand for Services is for Community Health Centers. Virtually all community health centers in the state are received additional funding under separate grants
- IDEA - Infant Toddler Program.
- WIC. Competitive.
Health Policy updates (See handout online.)
- Bill to revoke sunset provision on child lead program. Passed. Lead program will continue.
- Highest priority - Clean Indoor Air. Got through Senate but not House, not expected to make it through the session.
- Tobacco User Fee Increase was apparently dead on arrival.
- Bill with American Heart Association...
- 4 child care bills that were a package. 4 subjects combined into 3 bills. Agreed to hear one, our choice. House passed increasing public information bill. Because vehicle for CIA in Senate, so did not survive. Still some chance it may get revived before session is over, but probably not.
- Perinatal HIV prevention act. To convert HIV testing for pregnant women to opt-out versus opt-in. Passed Senate but not House. Added provision to require women to sign form saying they had been giving option to opt-out. Doctors thought the added provision may actually have a negative effect. Could not reach agreement on language that chair would accept.
- Graduated drivers license.
- Quarantine and isolation statutes.
Dr. Lozada: When discussing lead, how is it that something we would all agree on get tied up in a sunset provision?
Dick: It was 10 years ago. It was a long fight to get the program established. Due to liability concerns. Testimony - virtually no opposition now. Environment has changed. In general, a way to create an automatic check. For that particular bill, no sunset clause. Also no state funding. All federally funded.
*** Dr. Cooley: Get Dr. Jason E-P thoughts on topics, then will take a short break, then continue our discusion.
Passed out information on infant mortality from annual summary.
Secretary has asked that our Division take a look at infant mortality and pay particular attention to racial disparity.
IM rate in nation and KS has been steadily going down and improving. Has always been a gap between the black rate and the white rate. Gap has not been getting any narrower. In some states actually widening. Our rate as a nation has gone from 12th in the world in 1960 to 29th in the world in 2008.
Black rates as low as any developing country.
KS as a state has also declined in its relative position. Low 20s, 20 yrs ago, is now 33. Can bounce around a little due to relatively small numbers. But we do seem to be slipping.
Gap has been getting larger in the last few years.
Clearly something good was happening at the end of the 1990s.
Looking at avg 1998-2000, and 2002-2004, found that during this time, black IM rate increased in 10 states.
Even the white rate is higher than many of the European nations.
What kind of a role could this group play in working on this?
What is behind it?
Too many preterm births, too many low weight births.
What is behind that?
If we designed some type of improved focus on prenatal care, would that help?
Or, do we need to see what the root causes are in the communities?
If your committee wants to take hold of this, it would be great for me. Could use what you have discovered and the advocacy you have to take this issue on.
For example, in Wyandotte, rate is 10 vs. 5 in Johnson Co.
I'm asking if this is something you would like to examine.
Might be a working group that grows out of this Committee because you might not have all the expertise you need.
Leadell: Where does health insurance play into this?
You would need to examine that.
Rates of prenatal care have actually increased.
Dick: Have a 1-person office of health disparities. Could bring epidemiological expertise from Linda's office.
Mary: What approaches are other states taking on this issue?
Dick: I don't think we are familiar with current activities. Are states that have a long-term different history (trends), and this would be another research issue.
Dennis: Talking 0-12 months, need to look at different age ranges. So many factors. When lump group together...
About 2/3 of infant deaths occur in neonatal period through day 28. About 1/2 of total occur in first week of life.
May also want to look at effective strategies in other countries.
Other issue that may be of interest to group is childhood immunization. Are in need of advisory body for immunization group.
This state last year undertook major collaborative examination called Immunize Kansas Kids to look at immunization rates. IKK coaltion recommended,and secretary accepted, that there should be standing committee of 10-15 members who have some understanding of child health and the role that immunization plays in this. Goal is that body would be convening group. appoint members and have them report to you. Secretary is reluctant to see independent advisory group formed. Another headline public health issue.
* Break *
Want to throw open the discussion for thoughts on where this committee goes. Any thoughts or comments?
Gerard: When we first began, we had a very set agenda, so we had a clear idea of what we were going to do. The priorities that the Gov saw but wanted additional information, that was us. That was a fantastic idea, in my opinion. Wondering if, on the govt level, and now with the budget, think we have gone to the side. Don't think there will be any problem with us tackling it.
Dr. Cooley: When we first came together, had 3-4 issues, and we did it. Then, it was you can look at and advise on whatever you want, got a little lost. With a group like this, think it is helpful to have some suggestions on how we can be helpful.
Regarding infant mortality, suggested we may want to have workgroups, use resources KDHE has, some may want to be involved in some of the workgroups, others may not. Maybe a little like the Obesity workgroup. Think this woudl be a good way to do it.
- do we have to meet every quarter?
- Do we meet more often sometimes? Not so often other times?
If we have workgroups, probably need to have quarterly meetings.
Vicki: One of difficulties with quarterly meetings, have a conflict in Oct. If you miss one, then you missed out, and the perception may be disinterest when that is not the case.
Mary Ann: I think quarterly is good.
Gerard: Would other timing be better for legislative session? Maybe we could meet 4 x/year but not necessarily every 3 months.
What about Sept, Nov, then a winter/spring. Maybe Sept, Nov, late Jan/early Feb, late April/early May.
Mandy: My experience has been is that if there are big initiatives, best timing would be to roll those out in Nov, because then you have good 6 weeks before legislative ssions start. If you wait until Jan, generally too late for them to plug into your issue because others have talked with them first.
Could also have workgroups meeting inbetween times as often as you need.
Gary: Could we go back to the idea of something about infant death rates? As an organization, we would be very interested in this. Would be interested in being part of workgroup.
Workgroup meeting over the summer time, then come back to committee in Sept.
Dennis: Dick, had mentioned that you may have suggestions about who can participate in workgroups.
Dick: Yes, don't right now have a timeline. Would need to do a literature review...
Dennis: Is this something the group would like to have as a main issue?
Everyone seemed to agree.
Leadell: Also seems like the last spring meeting every year would identify the topic for the next year, and start the process again. Think child death rate - looking at various issues, would be good to categorize some of these #.
Dennis: Each year, find out what the key issue is, then look at that. Never felt like we looked at our issues very closely.
Dick: There is an Office of Health Disparities and an Advisory Group for this office. Similar sized to CHAC.
Leadell: Would it be advantageous to bring the two groups together?
Dick: Could be fine, not sure what their schedule is like, but entirely doable.
Dennis: Next step?
Dick: We can get staff activity going to produce some of the background research. Can get back quickly to health disparities program and sort out...are their other experts that you want to get involved? Think the answer is yes, then start thinking through who that might be.
Don't have a budget for this, but can tap federal and other resources.
Who is interested in being in workgroup: Gary, Mary, Gerard, Leadell, Vicki - have an interest.
Others can email Dr. Cooley, if interested.
Leadell: Also interested in immunization issue. Is there some preliminary work we could help with?
Dick: System is set up pretty well....
Leadell: Waht is the purpose? What do we need to know about the situation?
Dennis: advisory group would make recommendations.. history is there have been adhoc advisory groups, they make recommendations, rates go down, then rates come back up... this would be a constant group.
Dick: Haven't gotten close to the Healthy People 2010 goal. Supposed to have an advisory group anyway, related to federal grants.
IKK became very large.
Would be an ongoing group.
Intrested in immunization: Mary Ann Shorman
(Others in CHAC have others in their organization on IKK.)
Next steps: KDHE will come back to CHAC with who would add to people interested in this group.
Group as a whole will be more active with infant mortality.
Dennis: Look at 2 main areas in the future:
(1) infant mortality - form workgroup to look at this. See who is interested from this committee in joining workgroup. Give recommendations to CHAC.
(2) immunizations: a little different. advisory group. Will come from IKK group, probably, and be made up of represenatives of those organizations that are also related to CHAC.
Notify Dennis or Connie if interested.
Future dates - move July meeting to Sept and Oct to Nov.
Can keep Friday afternoons.
Send out meeting options.
Any other items or topics?
Mary: Think this was helpful. Feels more focused now.
Leadell: Had written down obesity topic again. Wonder if, in perhaps 2 years, revisit. Not necessarily dismiss topics just because we've already done them, may want to bring them up again.