Meeting 6 Notes
July 12, 2007
Welcome to Child Health Advisory Committee Discussion Group!
Members Present: Dennis Cooley, Mary Baskett, Shannon Cotsoradis, Leadell Ediger, Paul Getto, Betsy Hineman, Vicki Hoffman, Rand O’Donnell (phone), Tom Ostrander (phone), Nick Rogers, Mary Ann Shorman, Doug Vance, Mim Wilkey
Guests and Staff Present: Cindy Galemore, Martha Hagen, Kathy Hubka, Marti Macchi, Sarah Maier, Brenda Nickel, Sandy Perkins, Marilyn Pruitt, Ghazala Perveen, George Vega, Sandy Weeks
**** Summary of Meeting ****
1. George Vega, Director of Personnel Services, Department of Administration, discussed Infant at Work and breastfeeding in the workplace practices for the state of Kansas.
Action Item: The Committee recommended that staff draft a model policy for breastfeeding in the workplace.
2. Brenda Nickel, with Cindy Galemore, Kathy Hubka, and Marilyn Pruitt provided a detailed overview of School Health Services in Kansas.
Action Item: Continue discussion on school health issues. Items for possible staff research and future discussions include, but are not limited to the following:
- Review all school health screening practices and statutes in other states. Recommend appropriate updates for out-of-date statutes.
- Research model comprehensive school health statutes, if available.
- Review model school health programs.
- Provide health education to schools, administrators, students. Determine how to increase/improve health education.
- Research options for increasing access to services (school health and other health services) to children in rural areas.
3. Updates from Dr. Rodenberg:
- Legislative update (not much has changed since the April meeting).
- Some interim legislative committees this year.
- Secretary asking this group to integrate more with Healthy Kansas program to maximize influence. Specifically, school health is a key issue for continued/future focus.
4. Next meeting: Friday, October 19th, 1:00 pm - 4:00 pm, Crumbine Room.
**** Meeting Notes ****
No Announcements.
George Vega, guest speaker: Explained State of Kansas Infants at Work program. The program varies by agency. Programs are required to have a room to breastfeed or pump milk. Not every agency has a designated room. Have lactation stations at some agencies, generally part of the restroom - but outside of toilets and sinks in a lounge area. Other than that...when contacted other agencies (contacted cabinet-level agencies), not doing much more than that. Smaller agencies have problems providing place to breastfeed. Have about 104 agencies in state government. More of a practice versus a policy.
Paul: Is it pretty-well accepted? Any grumblings?
George: Only aware of a few grumblings. In those cases, the baby cried a lot. Feedback is overwhelmingly in favor of the program. People say it has a very positive effect on the work place. ...shared an anecdote about people not wanting the policy, then tried it for a person who had a newborn in a key position and were completely sold. Very good program. Would recommend it to anyone.
Dennis: What other obstacles do you see about bringing this program?
George: Some women, if they don’t have a room to go to for privacy, they can create a room with a curtain for privacy. Only problem is some cubicles are 5 foot.
Shannon: Are agencies encouraged to adopt an infant at work program and lactation station?
George: No one is pushing, but most cabinet-level agencies are participating. The Governor led the program. Coming - not from the top - but from women who are asking about it.
Paul: You describe as a benefit, but in 20-30 years, hopefully not a benefit, hopefully this is just something we can do.
Mim: Said it was a practice not a policy. Do you have anything in writing?
George: Yes, we have plenty of those.
Leadell: We know, across the state, infant care is hard to secure...it is a great benefit.
George: Has been such a success, just had a 1-year old and a 2-year old for a birthday party. Everyone brought gifts!
Dennis: Discussion about model policy.
Paul: Still want to encourage, inform, rather than have model policy, rather than force to use. We would recommend not sending out a policy you MUST use, but - here, if you are interested, here is a model policy.
Shannon: Think there would be a benefit to having a model policy, encouraging agency to adopt. There's a difference between mandating, and encouraging, and just seeing who wants to take it on.
Paul: Yes, encourage,...
Shannon: Policy panel at the next meeting?
Reviewed that information was presented at last meeting.
Paul and Dennis: Testimonials would be helpful.
Vicki: Office workers were mentioned as ideal, but what about other types of jobs? In doctors offices, etc.
Nick: We need to have list of components. It should have, at least, list of components the policy should contain.
Sandy: Part of our infants at work policy (and it is a policy), the person bringing a baby to the workplace must designate 2 alternate care providers. We do have field inspectors who have to go in the field, care providers watch during that time. Also, things like, don't bring infant to work if sick, or move to another place if disruptive. Tried to anticipate anything that could be a problem and include in policy. Limited age to 4 months. As the babies get beyond that age, they get more mobile and more vocal, so also concerned about safety of infant. ...best way to promote the policy – it helps with worker retention. Also have alternative work schedule, this has really worked well.
Paul: Want this in the background of the educational material. Replacing almost anyone is thousands of dollars.
Oregon has pamphlet on internet, why this is a benefit to employer, what the components are.
Sandy: Also have women that take advantage of lactation room that are not bringing infant to work.
Dennis: How do we want to proceed? Do we need to revisit? What to encourage state agencies to have enlightened policy? Have some type of model policy that can use...
Nick: Can we instruct a staff member to develop a model policy? I don't think we, as a group, can do... Check in with different policies. Then present to us at the next meeting. Email out ahead of time and comment online.
Vicki: Do we put the two together - Infants at Work & Breastfeeding - or are these two separate policies?
CDC has booklet similar to that they put out.
Dennis: Plenty of background material.
Nick: Would think pamphlet could have both, but as two separate sections?
Dennis: Hope we can tie together, too. Would like to encourage both. Think infant in workplace is great idea.
Leadell: Was he implying they allow pets, or was this an example?
Just an example.
Decision: At the next meeting, present example model policy and example material.
Next topic: School health issues.
Dennis introduced topic.
Brenda gave an overview and introduced panel.
Each panelist provided background on their schools and part of the state. Very diverse!
Panelists: Brenda Nickel, Cindy Galemore, Kathy Hubka, Marilyn Pruitt
**See presentation online**
Brenda walked through presentation.
Cindy passed around health indicator sheets. Chart to help visualize health needs in children. All of these conditions have an impact on learning. Not intended to say that every child has a health condition, but in 100 students, these are health needs. Would be happy to obtain more.
Many health needs of children!
School nursing is specialty practice area of public health.
Services in hospital or ER - these are same types of services provided in school setting. Also may address needs of other family members.
Panel is reviewing presentation.
Highlighted emerging needs, which include broad range of mental health concerns, specialized pediatric nursing concerns (one possible reason for increase: saving more preemie babies), chronic disease services, medication needs at school.
Marilyn: One concern - with contracted school care, cannot provide as prompt and timely care as possible. Frustrating for those in the school (e.g., school secretaries) that have to assess and address school health issues. Ambulance service may be several minutes away from some schools; concern for crisis situation.
Discussed policies (see presentation).
Continued through presentation…(may be a few slides missing from the online version; an updated presentation will be posted soon)
Referenced national data.
Vermont has 1:298 ratio for nurses (best ratio), but recently talked with a nurse from Vermont and she has 1,000 students, so there is a disparity.
Kansas ranks 10th in U.S. for student/school nurse ratio, 1:594. But there is a disparity between districts and schools. Example, in Wichita, one school has approx 250, one has about 2200 students.
Utah had highest ratio. 1:5,539.
But Utah did recently pass legislation to move more in this direction. Iowa just passed law where there will be a school nurse in every school.
Continued through presentation...
Explained challenges.
**On break**
Q&A on School Nursing
Regarding question on discussion board: Q: What is the liability for those in the school setting for undertaking the duties as assigned and trained by the school nurse, even if they followed the directions and something negative occurs? A: Liability is not too great. Gave an example of error in medication dosage. Immediately recognized the mistake, contacted school nurse, then contacted parents, physician, and pharmacist. Went well. Person that made the error handled the mistake very well. Liability would still fall back on health professional. Would have to demonstrate that they taught the person, what they taught the person, that competency was demonstrated.
Mary: Regarding dental health...if funding were available, what you would LIKE to see related to oral health?
Brenda: Oral health isn't just screening. If person hasn't had good care all along, by the time they reach school age, they can have a significant problem. Health education is very important, but really needs to be in the community.
Cindy: Health professional does not like to screen and identify if don't have a means to solve problem. …If screenings could be performed in Title I school... have tried a variety of things. Used to participate in the card program. Okay, but all you really knew was who WAS going. Have done some unique things like contracting with companies to come into school and provide care, but only insured OR self-pay. Writing a grant, trying to obtain funding where can work in Title I elementary schools.
Would like to target Title I and elementary level. Has been very hard for us, even with all the resources we have.
Nick: Would agree... Problem with school screenings, all dentists split up schools…many times gave a false sense of security. Parents didn't take in for true check-up. Even when we did screenings, the follow-up was poor. Finding children a dental home by age of 1 and the prevention aspect in younger children is very important. Also, access to care is a problem - who do you refer the children to? Who will take them to the dentist? In smaller communities like ours, we can usually make it work. Not sure how you do this in larger community. ...in our community, do use cards...but not sure this is the best way.
Kathy: In our district ...usually school nurse will ask personal dentist to help if problems are identified. Also refer to safety net clinics in Wichita. (Gave much more detail on their process. Did not catch everything.)
Mary: How would you recommend revising statutes?
Kathy: I think we need dental education, starting when they are babies.
Brenda: Dental statute is very specific about who does screening. ...also have to be able to have a referral source. Usually, have school nurses working hard to get other people in the school to assist.
Nick: School nurses in our district are very good about getting help from dentists within our community.
Marilyn: Referral source IS a challenge. I WISH we had a handful of dentists to refer to. We don't HAVE a dentist to refer to in our community. We have to send children to Manhattan or Salina.
Cindy: Need some way to provide insurance for all children in Kansas. Maybe require dental screening for part of Kindergarten and early childhood students - that exam is required on entrance to school. Then, maybe looking at kids who need it most.
Kathy: Our district does not exclude kids if they don't have exam (because of health insurance).
Nick: Didn't we hear about the number who qualify for HealthWave but don't apply?
Shannon: Yes, was about 40,000 uninsured . An estimated 70% of those would qualify.
Brenda: School nurses do often help with promoting HealthWave/Medicaid enrollment.
Dennis: Have done some work on increasing enrollment in HealthWave.
Shannon: Pilot project, matched (with parents' permission) free/reduced lunch with HealthWave/Medicaid for potential eligibles that were not enrolled.
Brenda: Must apply annually.
Shannon: Other states have more mechanisms in place for renewal.
Paul: Regarding exclusion...if they exclude, deny education. ...problems with ESL students...intimidate them by sending packet of government documents. Big problem. Head lice - should be changing that statute - good news.
Brenda: When have health care professional, can assist with policies sent out to schools. ... Still have some children not compliant with immunizations. (more discussion)
Paul: Do need to continue to educate about immunization.
Brenda: With preschool program, children may be compliant for their age, but may be at risk in the event of an outbreak.
Kathy: Grant from KHF translating all forms to Spanish and Vietnamese.
...parent literacy is also a problem...
Kathy: In our district, we do all we can. Compliance rates are better in schools with full-time nurses.
Paul: We are missing a lot of things. We would like to see a principal, a qualified high school math teacher, etc. in every building - in addition to a school nurse. There are a lot of things our school needs.
Brenda: Passed out information on school health conference.
*** Dr. Rodenberg gave update ***
Special legislative committee looking into Greensburg tornado response. (The response went fairly well).
Legislative sessions is officially complete. Not much new since April. To review...
- State funding for newborn screening (not public/private partner model), have $800K this year to set up the program, $1.2 million in future years.
- At one time had $500K for WIC immunization partnership. Ended up with $200K. Won't be able to do everything had hoped for, but will be able to have this program in some communities.
- Childhood obesity - didn't get money, but were charged to look for funding.
We are in the process of forming legislative/budget issues for next year. Putting together our initiatives now because has to go through Governor’s office first.
Do have some interim committees this year. (Have these in odd years.) A total of 7 or 8 committees, not all of which affect health.
- 3 days of hearings regarding regulating amusement park rides
- 3 days of hearings scheduled related to abortion
- clean indoor air - 1 day of hearings
- graduated driver's license
No other big ticket items that he is aware of.
Originally, Secretary Bremby scheduled to talk. Would have addressed the Governor’s Healthy Kansas program.
Governor’s Healthy Kansas program – Governor’s wellness program. 3 populations:
- adults in the workplace
- seniors in the community
- children in the schools
Think Secretary was going to ask this group to integrate more with Healthy Kansas because more political punch to this.
Not that this committee hasn't been doing exactly what it should have - it has. This committee has had real impact, whether you've seen it or not.
School health is a key issue will be focusing on more.
In this increasingly fractured society, school health is the last common denominator left. Vast majority of kids are in this captive environment. School setting has biggest potential to do long-term health.
Governor is interested in schools. Think she is looking at this group to support policy recommendations about what can happen in school setting.
Would ask this committee, as you think about what we can do for school health, to cast the net as widely as possible.
Dennis: Discussion on future topics.
Dennis: Rather than just dental screening, it is all the screening. Starting with screening issues would be a good place to start.
Dr. Rodenberg: Like the idea of trying to make school enrollment an opportunity pass out information, enroll kids in other programs. Not sure how you do that policy wise. Especially, don't want to impair schools. Would be interested in what recommendations we can do to affect that.
Dennis: What about some of the health education issues? Substance abuse, STDs?
Brenda: In the school setting, those are topics that are a little challenging for educators to present, so not uncommon that they ask a school or county health nurse to present. They are turning to, who is the health professional in this community?
Linda: Is there such a thing as model school health statutes?
Kathy will be getting us more information on what they just legislated in Iowa. Vermont and Deleware...
Around 20 states have some type of mandate about school nurses.
Was that the question?
Not really, talking about comprehensive school health statutes/policies.
National Association of School Nurse - does collect some data on requirements by state, so they would be able to provide information on trends, which statutes are for various issues.
Coordinated School Health has 8 components, school team, including school nursing, sometimes some of those pieces are missing.
Paul: Health is first step on ladder. If we say we need to do more, how will it be paid for? ESPECIALLY in the rural areas. Hard to get all the services in the rural area.
Can't keep dreaming up things that no one will pay for...
Bullying is essentially a health issue. More mental than physical.
To incorporate some of the ideas... social services coordinator... to some degree, Head Start has done this. Is it possible to pattern this after a completely different model?
Maybe should look at delivery of this whole thing differently.
We don't have to try to do everything at once. Can do pilots, maybe have better chance to implement.
Don't want to think about this as something that is bigger than we can do. Can do smaller pieces and increase feasibility.
Brenda: We do have some model programs.
Betsy: Early childhood field. Early childhood programs have been successful.
Dighton has very strong early childhood program. All children can go. Really a comprehensive package. School board is paying for this. School superintendent thinks it is affecting AYP.
Brenda: Will have preschoolers come in with chronic health problems, even harder to get…
Tom: Level of certification - RN - ...
Brenda: ...licensure requirements are very specific. Do try to have school officials trying to meet the health needs of students without.
1. Information and education for schools, for superintendents across the state.
2. How do we address true shortage of care that needs to be provided across the state?
Also go back to nutrition and physical education in schools.
Mim - if we are going to focus on school health, State Department of Education should be here to hear these comments. Don't think we can go on without them being here.
Yes, agree.
Next meeting: October 19th, 1-4.
Adjourned.
| Meeting 6 Discussion Board is now closed.
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