Meeting 10 Notes
Note: Please contact Connie Satzler at (785) 587-0151 or csatzler@kansas.net with edits or corrections to the meeting notes.
Members present: Dennis Cooley, Betsy Hineman, Paul Getto, Rand O'Donnell (phone), Mim Wilkey (phone), Vicki Hoffman (phone), Tom Ostrander (phone)
Staff present: Richard 'Dick' Morrissey, Linda Kenney, Connie Satzler, Mandy Cawby, Sue Bowden
Guests present: Linda Williams, Lori Haskett, Brenda Nickel, Laura Tate, Martha Hagen
*** Meeting Summary ***
I. Updates
a. KDHE Updates: Dick Morrissey, Director of Health, provided updates from KDHE.
b. Immunize Kansas Kids: Dennis Cooley, Chair, reviewed the immunization handout and provided updates on Immunize Kansas Kids.
c. Kansas Breastfeeding Coalition: Martha Hagen, with Bureau of Family Health Nutrition and WIC Services, reviewed handout and provided update on the Kansas Breastfeeding Coalition.
i. The state does not yet have any breastfeeding-friendly hospital certifications, but Stormont Vail is applying.
ii. The new data show that Kansas met the 75% goal for initiation, but did not meet the 50% goal for duration (breastfeeding at 6 months).
iii. They are working with local coalitions and hope to continue to work with the Child Health Advisory Committee (CHAC) to encourage adoption of your recommendations.
d. Expanded Newborn Screening: Linda Williams, Bureau of Family Health Newborn Screening Coordinator, reviewed the expanded newborn screening handout and provided updates on the program.
i. The program has already picked up four asymptomatic diagnoses.
ii. Paul Getto suggested sending a letter from the Committee regarding the success of this program.
II. Emergency Medical Services for Children. Lori Haskett, Injury Program Director, provided an update on Emergency Medical Services for Children.
a. The CHAC recommendations related to Emergency Medical Services for Children were sent to Secretary Bremby on June 6th.
b. Have hired Sarah House, a paramedic, as the Emergency Medical Services for Children Coordinator.
c. Surveyed all EMS Services. Once HRSA approves the data, they will send out fact sheets.
d. All recommendations are to be implemented by 2011, but there are no penalties if not implemented. Awareness of this needs to be raised.
e. Discussed rural/urban disparities, Western Kansas challenges, issue of volunteer providers and training of volunteers.
III. Child Care Health Consultation, presentation by Brenda Nickel, Bureau of Family Health Child Health Consultant.
a. See presentation for details.
b. Brenda stressed that child care health consultation is a voluntary request for services and is separate from regulation.
c. As a pilot project, they will be training public health nurses starting in January. The training will be completed by May 31.
d. Brenda answered questions from the group.
IV. Early Childhood Mental Health, presentation by Nancy Crago, Clinical Social Worker.
a. Kansas Association of Infant and Early Childhood Mental Health has been working the past several months to develop a plan for children age 0-5.
b. Nancy reviewed plan. See presentation and draft plan online.
c. Nancy answered questions from group.
d. Discussion included how to address needs of children through age 18, rural and Western Kansas challenges, and school system challenges.
V. Next Steps. Committee suggested the following for the next meeting, Friday, October 24th:
a. Discussion on Early Childhood Mental Health.
b. Jim Redmon or other representative from Children’s Cabinet to explain work and how $11.1 million will be spent.
c. Presentation from Rachel Berroth on Child Care death data (information is posted online).
d. BEST team is working on set of child care recommendations; report on this.
e. Committee will plan to meet Friday afternoons, quarterly.
*** Discussion Notes ***
Note: Discussion notes here include some of the comments made by members, speakers and guests. This is not a transcript of all comments. Although every effort was made to capture key comments accurately, some comments may have been misrepresented, and others were missed entirely. Send corrections to Connie Satzler at csatzler@kansas.net or (785) 587-0151.
* KDHE Updates
Dick Morrissey: Provided brief KDHE updates, including update on lab/mold situation [sorry, did not catch all due to phone/computer problems.]
* Immunization Updates
Dennis Cooley: Provided immunization updates. Reviewed handout; see handout for more detail.
Dick Morrissey: Implementation of immunization recommendations... Steering Committee is reviewing, delayed the roll-out. Will be implementing.
Paul Getto: Good for schools to keep [immunization records] because people call to ask about it.
Sue Bowden: Happy to report that the pilot project is working in several districts.
* Newborn Screening Update
Linda Williams. Update on Expanded Newborn Screening. See handout in packet.
Dennis Cooley: It is very exciting that we picked up four asymptotic diagnoses. Signs that this is up and running and successful. This was one of the first issues that the committee addressed.
Paul: Seems like this would be a good time to send a letter or note about the success of this.
Linda Williams: We do need to do more education with both the public and providers so we don't meet with resistance.
* Kansas Breastfeeding Coalition
Update by Martha Hagen.
Logo is in packet.
Martha is passing out a handout (was emailed.)
See handout (passed out and emailed for those joining by phone.)
Martha reviewed handout, provided update.
Any questions?
Linda Kinney: Are there any breastfeeding-friendly hospitals yet?
Martha Hagen: Not yet. Stormont-Vail is applying.
The new data came out. Kansas has met the 75% goal for breastfeeding initiation. But, we have not met the goal for duration (goal is 50% for 6 months).
We are developing much better data from WIC; we should have some updated data come out soon.
Dennis Cooley: How does the recommendation that this committee made fit with the Kansas Coalition? Duration rates are a problem because women often stop when they go back to work. Could see the coalition go out and push this.
Martha: Yes, we are working with local coalitions. We are getting additional materials from Health and Human Services about breastfeeding in the workplace. As soon as we get the website in place, we will try to get something accomplished that we can build on. Hoping the grassroots-coalitions can work from the bottom up, this group from the top down, and hopefully will make some progress.
** Emergency Medical Services for Children Update by Lori Haskett **
Thanks to Dr. Cooley, Dr. Colvin, and the AAP - KS chapter for noticing and looking into EMS for Children needs. Dr. Colvin presented last time. This group made recommendations, which were sent to Secretary Bremby on June 6th.
To give you an update, when Dr. Colvin presented, I was without an EMS for Children Coordinator. Since then, we have hired Sarah House, who is a paramedic. She has started working with Board of EMS. As part of the program, we send a survey to all EMS services. Data were compiled, analyzed, and submitted to HRSA August 1st. Once they approve our data, we will send out fact sheets.
To give you a preview, of the BLS services (Basic Life Support). (There are also ALS - Advanced Life Support services.) For BLS services, 51% have online medical direction, 58% of ALS have online medical direction, 57% of BLS have offline med direction, and 70% of ALS have offline medical direction. There is a wide variety of services and a wide variety of direction available.
See handout for more info.
Dr. Cooley & I spent Mon and Tues with trauma program.
Any questions? A lot of information.
All of these recommendations are to be implemented by 2011, but they won't be penalized if aren't implemented by 2011. Kansas isn't alone in this picture. We need to raise awareness of this.
Dennis Cooley: Think it is hard to realize that a lot of this is at the local level. And it is as though we have two states (Eastern and Western). Very difficult problem. Not an easy fix.
Many of the EMS providers (especially rural and western KS) are not even paid for their time. They are volunteer. To require volunteers to take extra training, then require them to pay for it is a challenge.
Dick Morrissey: EMS - along with small hospitals - being able to focus on pediatrics is a concern, but it's not the first concern. Can they get a BLS service at all? Can they keep the doors open? Not that there is not an interest, but it's that they have to solve other very basic problems first. If we talk about mental health, there are probably very similar issues.
Paul Getto: This is a problem for small communities, in general.
* Brenda Nickel presented on Child Care Health Consultation.
See handouts and presentation online.
Brenda walked through presentation.
Brenda stressed that the Child Care Health consultation is SEPARATE from regulation. It is a voluntary request for services.
We are planning to do this as a pilot project with local public health nurses. Training takes about 4 months. We will follow the same information as the national curriculum. It provides 144 contact hours. The intent is that the course will begin in January and be completed by May 31.
The training plans are in the presentation.
Reviewed resources, including rating scales.
Questions?
Dick Morrissey: Brenda, think you have clarified, but in small LHD, if they participate, would it be through a nurse that is other than the nurse who's doing the [regulatory] surveys?
Brenda: No, because we don't want to create a hardship for the local health department. However, if a nurse is invited into a home, if they happen to see something, they may address it, but NOT in a regulatory way.
Dick: Is it the same person?
Brenda: Yes, it probably would be the same person, because health departments do not have resources for additional staff.
Brenda: This is not something new. They are already providing this information, in some cases. The training gives them great resources. Thanks, good question.
Dennis Cooley: Can you explain a little more about what the health nurse will do when they go there? What would they do for infectious diseases, for example?
Brenda: Say there is a case of chicken pox, it would be an opportunity for the nurse to go in, direct resources to the family, then use that as an opportunity to see how the child care facility or home is controlling infectious diseases and what policies they have in place.
The nurses are getting almost $500 of printed resources.
Linda Kenney: Comment. After one national training, attendees went back and essentially started businesses in their state sharing this information. It's kind of a business practice, working with child care facilities before their regulatory visits. Kind of interesting. Think, in Kansas, have such good local public health, that it is possible to get this information and training out through the Kansas public health system.
Brenda: Families with children with special health care needs have a need for – but difficulty finding – child care. This can help train child care providers to be able to serve this child with special needs.
Dennis Cooley: Because the terminology overlaps other areas, it may confuse providers. For example, we [medical providers] use the term “child health consultation” – it may be confusing to some. Just a comment.
Brenda: Yes, we have discussed this some. In other states, there are pediatricians who fill this role. Also, assume nurses will refer back to pediatricians, as needed. This is outreach. How do you help child care providers utilize the resources in their communities? Provide resources, linkages.
Dennis: Only potential problem... when you start having referrals to mental health, for example, without involving medical home, tend to have fragmented care.
Brenda: This is where the Kansas early childhood medical system is needed.
Dick Morrissey: Isn't it an important distinction that the focus of this is consultation for the PROVIDER [versus the child] in the child care setting, though there is potential for some overlap.
Yes.
** Early Childhood Mental Health, presentation by Nancy Crago, Clinical Social Worker.
Past year and a half, advisory group has been meeting.
See presentation and handout for more detail.
Your copy of the plan is labeled 'pre-release' because we are waiting for the Governor to sign off, but it is probably in its final form.
Early Childhood Advisory Council – there are about 50 of us. Part of what we did when starting out was to get organized. We found there were a lot of good things going on in little pockets of the state, but no one knew what others were doing.
This group addressed Goal 2: Mental health and social/emotional
Model is based on 3-tier pyramid. It is the Oregon model for supporting young children (see diagram in report and presentation.)
Recreated the Kansas Association of Infant and Early Childhood Mental Health. It had originally been established by the Menninger foundation and had been very active. It is up and running again. Would invite any of you to be a member. Follows the model of a lot of states. Any state that has an early childhood mental health program has an organization similar to this.
Dr. Cooley's comment about there being two different states in KS is absolutely true. What is available in the Western half of the state is very different that what is available in Eastern Kansas. There is an inequality to what is offered across the state.
Natural environments...the best practice for most early childhood mental health is to have visits in home and child care facilities, rather than pulling children out and bringing them into an office.
State has received funding ($7 million); this is very exciting.
Reviewed goals in detail (see presentation)
Tiffany Smith-Birk has been excellent in setting up training, wonderful training and wonderful opportunities. We are head and shoulders above where we were two years ago.
Research on brain development the last few years – very exciting – has revolutionized the way we approach early childhood mental health.
Next, Nancy reviewed priorities by year.
Discussed therapeutic preschools and the report that more preschoolers are being expelled because of behavioral problems.
Therapeutic preschools - in 2001, partnered with HeadStart in Topeka. 300 preschoolers in HeadStart, if assume about 20% have problems...[did not catch all of these comments].
By June 2008, all therapeutic preschools were supposed to be self-sustaining, and they were. Shifted funding to early childhood mental health consultation.
Reviewed statistics from their [Nancy’s] center as an example.
Reviewed the endorsement process.
One of the things that has been a process in the state, no way to organize all of the people that work with early childhood mental health. Other states have adopted an endorsement process, which is essentially a credentialing process. There are four levels: associate para (early childhood MH worker), bachelor’s level, master's level, then mentor who can supervise other people. Would adopt this endorsement process so would have common language about how to organize ourselves. We did go ahead and purchase the model (Michigan model of endorsement). At least 5 other states are using this. It is all ready to go.
Linda Kenney: My thinking is that a lot of this came about because so many kids were getting expelled from preschools.
Nancy Crago: I think this info was very alarming to people. At any time, we have 40-50 kids in our program in Topeka. All have been kicked out of multiple preschools.
Linda Kenney: My understanding is that consultation is to help the providers as much or more than the kids.
Nancy: Yes, absolutely, we do educate child care providers.
Paul Getto: Assume these children will end up with an IEP in public school kindergarten? How do you coordinate?
Nancy: We have good relationships with Part A and Part B IEP programs. We have very good working relationships here in Topeka. There are two groups [of children] here - one group stays with us all day, the other group goes to HeadStart or public school preschool the other half of the day. We can't do this in isolation. Every year in January, we go through the list to see who will need help in kindergarten next year and work with the public schools. There are very few territorial battles. We work together well.
Paul: Do you know anything about the rest of the state?
Nancy: I think there are pockets that don't do as well. There is one city that has no early childhood mental health in their mental health center. Some places do it very well. Some need work. Pittsburg has a great program, Wellington has a great program.
Paul: Any discussions on integrating what you are doing with early childhood licensing?
Nancy: Yes, have more work to do in this area, but we are working on it.
Paul: Think will probably see more and more kids with these issues. Is that true?
Nancy: Unfortunately, think that is true. Sit on drug child endangerment task force (don't know if I have the name quite right). Hospital here report up to 50% of babies that show some type of issue.
Dennis Cooley: Couple of comments. When you say fragmentation, this pretty well covers it. This covers age 0-5. What about age 0-18? Where are we going to go with this? Here [in Topeka], I can refer my kids down the street to you. Not everyone in the state has that kind of resource. Not only fragmentation of treatment, fragmentation of groups, problems with feedback loops (e.g., medical home doesn't get information). And it may not be your fault, may be because parents don't want me to get info. All boils down to the fact that mental health is separate from the rest of the medical system. Until that changes so can look at it more holistically, will continue to have problems. Endorsement approach is great. Another problem from provider perspective, no list of resources. Almost has to be geographical. And who will deal with kids up to 18?
Large problem.
Two main areas of children getting treatment for MH is private provider offices and schools.
Paul Getto: That's my concern. Don't have a way to get a grip on this. Once in school, even if in special education, very underfunded.
Dennis: This is great if you can get them into system, but what if you can't? From 0-5, a lot of it is getting them into the system, getting the access point. Once they get into school, will access through the school or through the provider.
Nancy:
- Need to do a better job of coordinating. I believe that my center tries to do this, and we still have problems.
- Western Kansas can't find a child psychologist to buy.
- Short on resources, short on funds, but not an excuse not to try.
- You're right, we are not addressing kids beyond 5. My opinion is, early childhood people cooperate better than anyone else. My hope is, through this initiative, we could create a model that could be expanded to older ages.
- We are going to try to do universal home visits. May not get funded, may not pull off, but are trying.
Linda Kenney: And the only way we're going to pull that off is to pool all resources.
Dennis: One thing that would be nice, United Way's 212 info system. Making sure it is on the list.
Need to get the word out on what resources we do have.
Linda Kenney: Thinking about the 50% of babies who are potentially drug-affected...who is supporting the parents? What is the next step? What can we do for parents?
Betsy, what is your perspective, on Western Kansas issues, in particular?
Betsy: Usually, taken to other parts of the state, I think. Transport to KC, Wichita.
- School age, transport to Dodge City; don't have anything locally. We don't have a very good system.
- And, often, those families are transient. May be there short term, then gone.
- Birth to age 5, do have the transportation piece, I feel like. This is a good thing.
Paul: If doing something west of Salina, need to try to work with the school.
Yes.
Dennis Cooley: We are seeing some providers trying to incorporate social workers in their practices, in their office. Working with the schools, as you suggested, is good. Almost like you need to look at other models, other approaches.
Nancy: Wonderful that you transport people, but not really best practice because supposed to meet them where they are.
Betsy: No, not best practice...
Dennis: One advantage of having services in family practice doctor’s office, it gets rid of the stigma society unfortunately associates with going to a mental health provider.
Paul: Will have to figure out how to integrate services in rural counties (medical, dental, education, law, etc.) Will have buildings because many of them will be empty. Think 50 years from now, rural will still be there, but will only be county seats. Need to get back to idea of integration and block grants.
Linda Kenney: And we have so many counties. This creates a lot of difficulties for us.
Betsy: Have been in discussions about combining counties. Also have county AND city government that uses a lot of resources. There is one county by us that is combining county and city government; people are watching to see how it goes.
Dennis: Not sure where we are going to go with this, except maybe to revisit this. Think there is a lot going on. Know of a couple of initiatives with the KS AAP chapter looking into this, too. Think there will be more information coming out.
Nancy: By October, will know what grants will be awarded in the state. Might be interesting to know how $7 mil will be spent. (Someone from Children's Cabinet would know this.) Report official released.
Dick: Would be good to know how entire $11.1 million will be spent.
Dr. Cooley: Maybe we get an update on this.
Jim Redmond was suggested to provide an update.
Dr. Cooley: Other business?
Next meeting, will have presentation from Rachel Berroth.
Review information on web before meet next time.
Dick: BEST team is working on whole set of child care recommendations before this year's session. Think everyone expects will continue to have active discussion in coming session on what will be fundamental changes in regulatory structure.
Certain day for meeting?
Friday is fine.
Dick: In next meeting, Chris Ross-Baze could do an update to see what they are considering.
Consider meeting every 4th Friday, quarterly.
| Meeting 10 Discussion Board is now closed.
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