Meeting 3 Notes
November 2, 2006
Welcome to Child Health Advisory Committee Discussion Group!
Mary Baskett, Dennis Cooley (chair), Shannon Cotsoradis, Leadell Ediger, Paul Getto (phone), Betsy Hineman, Vicki Hoffman, Gerard Lozada, Tom Ostrander, Nick Rogers, Mary Ann Shorman, Doug Vance, Mim Wilkey (phone)
Staff and guests present: Gail Hansen, Linda Kenney, Paula Marmet, Howard Rodenberg, Michael Runau
Michael Runau Immunization update: Kansas 5th in U.S. for 4:3:1:3:3, with varicella (4:3:1:3:3:1), was a 6.3% increase from previous year. We were 43rd in the nation in 2004! We are above the national average now.
Dr. Rodenberg: Michael isn't giving himself and his staff enough credit. It takes a lot of work to increase the rate!
1. Publicity
2. Web IZ is having effect
3. Other programs like Immunize and win a price
4. Haven't immunization RNs in WIC clinics, the WIC linkage, probably made the biggest difference. 5 counties, including Wyandotte, Ford and Finney (1st 3 counties to try)
2007 Leg.: Have budget proposal before the governor to put 10 more WIC nurses out there in high risk counties.
Gail Hansen - Head lice
Head lice causes much consternation for the fact that it does not cause disease.
Children must stay away from schools and child care until they have been treated AND been nit-free. But, this is not consistent with science. If you have people, you will have lice.
Looking to change so kids have to be treated, but remove the no-nits clause. To have this as a statewide law when no way to enforce, would be good to get rid of this law.
Lots of information in the handout (we will try to get this handout to those joining by phone. Information is similar to website address posted.)
Dennis Cooley: As a provider, yes, we are with you on this.
Paul: We would like to see that loosen up for practical reasons. Rarely hear in high school, grade school problem. Probably older kids have, but we don't look for them! We don't want to exclude them from school for head lice. Want them in school as quickly as possible.
Anecdotally, hear that students may be out of school for 2-3 weeks at a time.
Handouts, Harvard school of public health, Kansas State extension also has information.
Gail Hansen: We have started the process.
Dennis Cooley: Wonder if the problems we're having with [public, parent, teacher] resistance is due to the fact we used to over-treat.
Tom Ostrander: From school setting, we want the kids in school, too, but the no-nits situation makes it a pretty clean decision. Do you see this as being a potential problem determining whether or not they've been treated? Who decides this?
Gail Hansen: It really shouldn't be only a school issue, it's a family and community issue too.
Pretty easy to tell if it’s been treated (if one day, see 25 lice, next day see 1 in comb, it’s been treated)
Leadell Ediger: What about in child care?
Gail Hansen: I do know child care and quarantine regulation does talk about child care and schools.
Dennis Cooley: Other questions or comments?
Gail Hansen: We just wanted to find out if there were objections or concerns so we could address, but not hearing those.
Linda Kenney: Isn't the big issue parent education?
Gail Hansen: Combination of parents, teachers, and principals, trying to educate so there is not so much consternation.
We have been trying to get information out to parents and parent teacher groups.
What kind of push-back are you getting?
Setting aside the no-nits policy has caused concern, these little bugs cause concern for parents and teachers.
Betsy Hineman: What is the transmission rate?
Gail Hansen: If children share combs, caps, or work head to head. Not so much ear phones. Lice won't spend a lot of time on a cap. It doesn't take very many lice (all you need is one pregnant female) to get an infestation. Biggest thing - people seem to place an excess of concern on this little insect. (e.g., chiggers, misquito bites don't cause problems.) Social concerns and stigma are an issue. [Committee discussion about social concerns and stigma.]
** Newborn Screening
Dr. Rodenberg reviewed comments received by group.
Question #1 about core group of conditions (29) versus 49. Not a huge cost difference - only a $1/test (per newborn *staff note: check with Willie Craft to verify) difference. Do you test for something if you can't treat it? Does this provide useful clinical or family planning information? Most states are doing core group, because there is broad support for that.
Mary Baskett: Parent who spoke to the group had a compelling argument about how this would have helped their family to know. To me, there are ethnical issues, I think we would be remiss not to address this and discuss as a group possibility of expanding to 49.
Dennis Cooley: Even though we can't treat...actually can treat in a sense. Don't put in hospitals and run many unnecessary tests, don't put strain of not-knowing on families, doctors...costs. Think this hasn't been considered as much as it should have. What if a treatment becomes available?
Nick Rogers: Would we be jeopardizing the core group (or strengthening) by adding tests?
Dennis Cooley: How did we choose $30? Well, costs of doing the tests. Hospitals had strong feelings that they were willing to charge for services they provided, but not wiling to charge for services they didn't provide.
Dr. Rodenberg: As long as we got buy-off from Medicaid on this, tell them that the Child Health Advisory Committee is for expanding. I don’t see this is a big political hurdle. If it is the consensus of the group to expand, I would have no problem taking this back.
Tom Ostrander: If information is available and if we can provide the information for the parents, then it’s short-sighted of us not to consider.
Dr. Rodenberg: Linda, other considerations?
Linda Kenney: Wish Willie were here, not sure how long it will take us to get up-to-speed on the others. It's certainly possible. Might take us an extra year to do the additional tests.
Dennis Cooley: Yes, it's done.
Dr. Rodenberg: Wonder if one approach that might be acceptable...a staged approach. 29 first, then move to 49.
Linda Kenney: It is a big deal, even for the 29. Think staged approach would be good.
Comments supporting this approach.
Dennis Cooley: Then CHAC will recommend starting with 29, but recommend moving towards all 49.
Yes, in agreement.
Dr. Rodenberg discussed Comment #2 (was also addressed earlier.)
Comment #3: Is this for sure?
It's as for sure as it can be for this process right now. There are other budget initiatives we submitted that I can tell you will probably not go. This is not one of them.
Comment #4: wording revised (?)
Comment #5: 2.b. - chances of non-birth hospital being billed are insignificant. Charge will go to hospital where delivery took place. Charge will be rolled into birth charge; non-birth facility would never be filled.
3. Good to know that Children's Mercy is another resource for us. It’s good to know they are willing to be a partner. Expect Children's Mercy to get Medicaid contract for [?]
3.b. Repeat screenings - no specific mention, but this is a routine part of what we do. Do people want to see this in writing?
Mary Baskett: How often are repeat screenings needed?
Linda Kenney: For all presumptive positives. Rand provided for Missouri in has comments.
Vicki Hoffman: If it will happen, it makes sense to include language to clarify.
Dr. Rodenberg: Yes, we can put the language in for this.
4.c. Start-up costs. May be because Missouri is bigger. May be difference in leasing versus buying equipment. We are leasing equipment. Without looking at Missouri numbers, I can't comment specifically on their costs versus ours.
Comment #7, Linda: Discussed difference in our list versus ACMG Uniform Panel (handout). Difference is G6PD and hearing. Think we need to resolve the difference.
Dr. Rodenberg: Go to #30?
Linda: Yes, this is standard. We do the hearing screening.
Dennis Cooley: Difference...is this different because hearing is billed separately? Do we need to add a note or language to explain?
Linda Kenney: Yes, we should probably add some language or disclaimer to explain differences.
Dr. Rodenberg: Do 3 tests for hemoglobinopathy (sp?). Some people count as 1. Some count as 3.
Linda Kenney: What we want to say is that we follow the national recommendations, be very clear we are following national recommendations.
Dennis Cooley: We should finalize and forward to Secretary?
Dr. Rodenberg: Yes, finalize and forward to Secretary and to working group, some may need to go back to advocacy groups.
Dennis Cooley: Went over changes, decided as we went. We should probably propose to accept document as amended.
Tom Ostrander moved, Mary Baskett seconded.
Anyone opposed? No.
Shannon Cotsoradis: KAC is joining forces with March of Dimes and sent out trifold related to newborn screening issue. There is a post card recipients can send out to policy makers. We also have an electronic version. Shannon will send to Connie, and it will be forwarded to the group.
**Break**
Physician give-away examples from Dr. Rodenberg!
*Summary of Childhood Obesity Work Group Recommendations
Front page are recommendations. 2nd page - didn't focus much attention here. Areas of interest that we might focus on in the future.
Dennis Cooley: Three recommendations:
1. Population-based surveillance
2. Increase physical activity in schools
3. Insure all competitive foods in schools are healthy and regulated
Dennis Cooley reviewed Childhood Obesity recommendations from group.
Paula Marmet: Governor's Council on Fitness update
Fitness council was excited about recommendations, endorsed rec.
Meeting they had was focused on strategic planning, fairly new council. Took to heart their role in being policy-recommending type of body, be in a position to demonstrate leadership. In a position to engage honorary members/chairs to provide leadership.
They selected 3 areas they would like to develop more. Formed subcommittees
1. Surveillance - BMI, etc. (Kathy Ermler will chair)
2. Focus on increase physical activity in schools in immediate future, though group is concerned with the entire lifespan. Some discussion on adding requirements to QPA #5. Rhonda Holt will be heading up this committee.
3. Fitness standards - how and what to communicate. Looking to develop promote-able standards. (10,000 steps a day, concept of METs, messaging) Dr. Doug Iliff will head.
On to discussion. Dennis Cooley: Will have short-term and long-term goals. Can't cure short-term. I look at this as first steps. These are first steps on an issue that will take a lot of work.
What about recommendation #1?
Gerard Lozada: Mentioned BMI being strongly supported. Why is that key number?
Dennis Cooley: BMI is a tool. Has some limitations (e.g., doesn't work for high school football players) tends to be standardized # nationwide. Easy to do…being used enough right now, can use to...it does work.
Mary Ann Shoreman: Starting using in my school. Gave sheet to students...
Dennis Cooley: Are some problems with providers using BMI. We have a group working on getting a laminated handout.
Mary Ann Shoreman: Blue Cross Blue Shield has grant... our nurses have written a grant, trying to put together displays. Talking about nutrition and diabetes. One thing we are looking at...
[Missed discussion on BMI, pros and cons, by Dennis Cooley, Paula Marmet]
Linda Kenney: WIC - we get 50-55% of population. We do have that data for surveillance purposes. Below 185% poverty, but it is a substantial portion.
Paula Marmet: WIC data is good, but it does cover a portion.
In HK2010, talked about putting field for height and weight in immunization registry [for broader population surveillance].
Dennis Cooley: BMI is only height and weight, then you calculate. It is very quick.
Gerard Lozada: Looks like a great way to do.
Paula Marmet: Schools are doing, but not collected.
Tom Ostrander: With new kids system we have to do now, data can be there pretty easily.
Paula Marmet: Unique ID database?
Yes. Currently don't have field for height and weight, but could add easily.
Nick Rogers: Some short term, some long-term. Is the committee that far?
Dennis Cooley: Think this would be both short-term and long-term. It’s important that we have data, get a baseline. Do get some immediate benefit from the school systems if they do it.
Vicki Hoffman: To me, strength is identifying interventions. Are they worthwhile? Should someone else duplicate?
Dennis Cooley: Obesity is 'flavor of the month' now - lots of activity. would be nice to coordinate.
Betsy Hineman: Wondered about a preventative measure. Early education, preventive dollars are less costly than later. WIC, HeadStart. Nutrition education program, preventive measures?
Dennis Cooley: Vast majority of committee time was spent on school-aged discussion. I thought that this was something that could be done quickly.
Betsy Hineman: Having programs in place (WIC, head start), should also be able to move quickly on this. Would need to be evaluated.
Tom Ostrander: #3 fits in with what schools are doing, what they actually adopt depends on culture of school.
Parent education is important. (example of bringing treats for child's birthday)
Vicki Hoffman: We work so hard on connection with parents. If you tell them, treat from parent is no good, you hurt your relationship with the parent.
Concern: Have to implement wellness policy to get reimbursement, if school climate doesn't support wellness policy, only part of school that bears the brunt is food service program. Food service bears brunt of flack if school policy and procedure opposes Kansas Model Wellness guidelines.
Tom Ostrander: QPA - brings some force. Back to #2... [didn't catch]
Vicki Hoffman: If have BMI, surveillance data, could evaluate if kid has 15 minutes or more of activity. Maybe this enhances achievement versus 15 more minutes studying.
Paul Getto: [see comment on discussion board]
Dennis Cooley: Will schools be able to do? Are we putting to much on them?
Paul Getto: Physical activity is not the same as physical education.
Dennis Cooley: Other thoughts on #2?
Mary Baskett: My understanding of what we needed to do, come up with impact on state policy, what state could do, which is why I think we didn't come up with recommendation on early childhood - much is outside of state control (some is in). If we have something that will receive resistance...is there a way, as a policy recommendation that we can address parent education?
Nick Rogers: Is it parent education or parent compliance?
Betsy Hineman & Mary Baskett: I think it's both.
Betsy Hineman: Program teaching family about nutrition, modeling for family. How to buy in supermarket to read labels, how to take favorite recipes and make healthy? It's a family model. I think education is a piece that is necessary.
Doug Vance: Ties into general public awareness campaign.
Leadell Ediger: I think this is what Kansas Health Foundation, their media campaign is about, should help.
Tom Ostrander: Think 2 is a toss-up. Think not all students need additional physical education. All students do need to be active.
Vicki Hoffman: Think a big component would be showing teachers how to incorporate activity into our classrooms. As adults, we need to be more active.
Doug Vance: Are you saying that the school isn't way to fight?
Vicki Hoffman: I think the school is definitely place to fight this.
Mary Ann Shoreman: But I think we need to start BEFORE schools.
Betsy Hineman: Described family - parent education program.
Mary Baskett: Success stories about programs initiatives in schools (e.g., walking school bus)...could we encourage these, look at what works.
We could find sites where things are being done, success stories, get people excited, added benefit of community involvement)
There are community activities (YMCA, parks & rec) - sometimes hard to get people enrolled.
Dennis Cooley: How could we do this? How could we get funding to look at innovative programs? What do we need to do, as a state policy, to get funding to look at innovative programs?
Doug Vance: Don't want to give up on school policy.
Dennis Cooley: Could we lump it together?
Put nutrition with physical activity.
Betsy Hineman: PAT program is through schools.
Gerard Lozada: Talking about BMI/CDC website, get the printout - what do you do? Can you tag it on to that? include community programs. we recommend that you sign your child up and participate in this program. I like this idea very much, maybe tie into something else.
Dennis Cooley: Yes, need to emphasize nutrition standpoint, too, maybe even a little more than physical activity.
Doug Vance: I think that KAC is part of advocacy program for after-school programs. Another place for activity.
Tom Ostrander: Great idea! School-age - could encompass through school, after school programs instead of “in schools” “in school age children”.
Mary Baskett: Don't want to eliminate younger children. this is important.
Include information for parents. Tie in nutrition and BMI information.
Should we talk about preschool kids separately, in a separate recommendation?
Yes.
Vicki Hoffman: Greater challenge with pre-K group in terms of finding kids.
Add early childhood to incorporate parent education, childcare, WIC.
Leadell Ediger: Through child care resources and referral agencies, have curr for nutrition piece and curr for PA. evaluating curr. think 6-9 months will have data that will show, in early childhood, we can make a difference.
What are recommendations? What is state policy?
Can't recommend a uniform mandate because many programs., but maybe like #2 - encourage, promote.
Encourage parent and provider education on benefits on benefits of PA ad good nutrition for children 0-5.
Add how-to's in addition to benefits.
#2 change to school-aged
Subtext: Encourage funding for innovative program in schools and communities
Add a venues point to #2: WIC, Head start, PAT, etc.
Is the point to #2 that the state should provide a funding stream for this? Think we need a stronger recommendation. What do we really hope to get? Think language needs to be stronger. Looking for competitive RFP process where schools could compete for innovative program.
Yes.
Maybe school and pre-K. going for pool of money to do community-based innovation, then split between school and pre-K.
Leadell Ediger: Was the Department of Education active in this discussion?
Yes (in work group)
This could be similar to wellness policies.
Tom Ostrander: Funding for nutrition programs and school/community childhood programs
Vicki Hoffman: Can we really make a difference with limited funding? In bigger districts, need more funding, or maybe a little change that impacts everyone. You need a certain level for it to make a difference, especially in the larger districts.
Nick Rogers: To take this concern to the next level, what kind of money are we talking about?
Dennis Cooley: I don't think we know - we're talking about changing people's behavior. hard to do! I think we're talking about looking at innovative programs, see what works, then see if we can apply across Kansas.
Leadell Ediger: this is an issue receiving a lot of attention now. Let's go to the foundations.
Dennis Cooley: Maybe we identify need only and don't identify funding source.
Mary Baskett: I think pretty clearly we are NOT recommending physical education requirements.
Vicki Hoffman: This will come from fitness group, probably...
3rd recommendation comments?
Shannon Cotsoradis: I think that we should turn vending machines off during school day.
Nick Rogers: Do schools need to change what they are serving?
Vicki Hoffman: I will defend, we have to meet many, many requirements, most regulated part of the school. You don't get the money unless you meet the requirements.
Nick Rogers: Seems like foods are high on starch and salt...
Vicki Hoffman: Have you talked with schools to see nutrient analysis? We all have to have this.
Tom Ostrander: This concern has been our history, but this new wellness policy hits this head-on. We have made major changes on breakfast, lunch, and vending due to Wellness policy.
Vicki Hoffman: State law - all foods within school must be addressed.
Shannon Cotsoradis: Wellness policy - limited enforcement.
Vicki Hoffman: School food service is funded by sales to students and by reimbursements. Free and reduced lunches, student revenue, small amount of federal funding, small amount of general fund. Designed to be self-supporting - some are, some aren't. Not enough federal reimbursement to provide fruits, vegetables, and whole grains. Look to other sources of revenue. Not allowed to do catering. Look at a la carte - can sell food to students. No federal regulations that say what you can/can't value EXCEPT foods of minimal nutritional value (gum, candy, carbonated beverages) - can't sell those in cafeteria. Wellness policies are an attempt to address a la carte.
[Discussion on vending, a la carte, choices...]
Vast majority is middle school and high school.
Recent research showed that some elementary schools do have access to vending machines because they are adjacent to a high school.
Would not want to lose sight of other sales besides vending - e.g., student groups setting up tables in hallways that are totally unrestricted.
Can't they be restricted by school policy?
They could, get back to how you are going to fund groups.
What about if they have a football or volleyball game that starts at 5? Do you turn vending machine back on?
What do we do with #3?
School food service doesn't have any control over other foods in schools.
Mary Baskett: Complex, what about a group, task force. It’s a very complex issue! Nothing I would feel comfortable recommending today.
Paula Marmet: No incentive for schools to be above 'Basic' unless schools want to move beyond basic.
Vicki Hoffman: Problem I have, the school administration doesn't want to buy into model language - do you know whose funding is at risk?
Linda Kenney: Why not have an awards system? Ask governor to make awards for exemplary status? Go with positive reinforcement vs. negative.
Also public relations aspect. Create a little external pressure.
Dennis Cooley:
1. Implement surveillance with h&w, BMI
2. Increase min & quality of PA in school age children through school & community programs
- funding innovative programs
- same thing with 0-5
3. Not sure yet.
Paula Marmet - Governor's Awards
Healthy Schools award - but requirements are pretty minimal
Hometown Health Hero -
Healthy Restaurant Award - relies mostly on publicity, low cost, low budget
Vending machine - is this something we can pass along as a recommendation.
One of interesting pieces of information shared at Childhood Obesity groups, relatively small percentage said there would be significant cutbacks if no vending.
Tried to introduce a law. Agreement with beverage company. Reality is - not changing how they actual function.
No law that aware of.
Gerard Lozada: What are problems with vending machines?
Motion to eliminate vending.
Vicki Hoffman: All competitive foods.
What about healthy options?
Shannon Cotsoradis: I think it's harder to be compliant with healthy foods than shut the vending machines off.
Are there kids in schools who need something before go to school?
They are on before the school day.
Not all kids arrive to school on time.
Doug Vance: Defer to you to be an expert. If parents know they can get it at school...
Paula Marmet: What is your recommendation to address a la carte?
Vicki Hoffman: People hate mandates, but sometimes you have to say, this is the way it's going to be.
Tom Ostrander: That's the black & white way, but I can't forget about the revenue part. What I will lose if I can't fund….can't buy soccer uniforms…so don't have soccer.
Kids don't go to debate tournaments, they don't go to concerts because that's how they are funded.
Vicki Hoffman: Tried to be ahead of the curve. Board was supportive until it affected (1) funding and (2) parent connection.
It is cultural. e.g., fried tacos.
Vending is not the issue! What good does it do if you have all of this other stuff going on.
Maybe one small step in the right direction.
Move towards competitive foods being healthy.
Read bill 2738. http://www.kslegislature.org/bills/2006/2738.pdf
Maybe we should use that language for other competitive foods. Use 50%. Maybe this is our recommendation. Half of schools outside food service program be healthy choices?
How do you ever evaluate?
Nick Rogers: Though not sure how much good it will do, Eliminating vending machines does send the right message.
Doug Vance: I like the awards system, too.
Motion: Restrict food and beverage vending machine access during school hours. Motion passed.
Awards? Healthy School awards for schools that achieve exemplary status of school
Dennis Cooley motioned. Shannon Cotsoradis seconded. Motion passed with no opposition.
Next meeting? Legislative issues.
How to address competitive foods in schools.
Is there another group that could meet, how would you address loss of funding, vending issues?
Mary: could this be addressed through coordinated school health?
Paula: Yes, coordinated school health has supported dev of well guidelines, supporting, school health index, etc. identifying areas where environmental changes can be made...correlates nicely...certainly CSH staff would be a good resources.
Dennis Cooley: Yes, if staff could look at that, would be good.
Nick Rogers: Is childhood obesity work group ongoing?
No.
| Meeting 3 Discussion Board is now closed.
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