Meeting 7 Notes
October 19, 2007
Welcome to Child Health Advisory Committee Discussion Group!
Present: Dennis Cooley (Chair), Mary Baskett, Shannon Cotsoradis, Paul Getto, Vicki Hoffman, Gerard Lozada, Tom Ostrander, Nick Rogers, Penney Schwab, Mary Ann Shorman (web), Mim Wilkey (phone)
KDHE Personnel and Staff: Rod Bremby, Linda Kenney, Connie Satzler
Visitors: Gary Robbins, Brenda Nickel, Martha Hagen, Dale Dennis, Marti Macchi, Gale Hansen
***MEETING SUMMARY***
1. Secretary Bremby provided a briefing on Healthy Kansas and explained how CHAC fits into the Healthy Kansas initiative. Secretary Bremby explained that CHAC has wide latitude and wide support to do whatever it takes to study the issues it thinks are most important and to give advice to Secretary Bremby and the Governor.
2. Breastfeeding Support in the Workplace Policy. Three action items were passed by the Committee.
a. CHAC approved the “Breastfeeding Support in the Workplace” document.
b. CHAC recommended all State of Kansas agencies to adopt the “Breastfeeding Support in the Workplace” policy.
c. CHAC urged that the “Breastfeeding Support in the Workplace” policy be used as a model policy and adopted by all Kansas business.
3. An immunization update was provided. The Committee discussed current immunization rates and challenges with immunization. No actions were taken. The Committee will wait to review the immunization plan that will be released in a couple of months.
4. Vision Problems Among Preschools. Gary Robbins, Executive Director of the Kansas Optometric Association, presented. The benefits and challenges of greater participation in the SEE TO LEARN program and the need to diagnose and correct vision problems in children were discussed. The Committee decided to discuss this again next time and make recommendations.
5. Headlice. Gale Hansen reviewed the updated headlice regulations, which were changed to say the children do not need to be nit-free, only treated for lice infestation, before coming back to school.
6. Governor’s Council on Fitness. Update provided by Marti Macchi on current activities and recommendations sent to Governor.
7. Department of Education. Dale Dennis from the Department of Education provided an update on health issues in schools, focusing on nutrition and fitness.
8. Kansas Action for Children. Shannon Cotsoradis provided an update on their support of a federal bill on updating school nutrition standards.
9. Kansas Association of School Boards. Report by Paul Getto. The KASB is supportive of improving child health, but cannot officially support any unfunded mandates.
10. Discussion on Future Topics. Suggestions by CHAC members included the following, some of which are interrelated:
a. Children’s access to health coverage, including current status of SCHIP
b. Report from Marci Neilson of the Kansas Health Policy Authority on child access to health care and other child health-related topics
c. Emergency Preparedness and Children
d. Safe Schools
e. Rural Health Issues
f. Drug and Alcohol
g. Violence
h. Tobacco
i. EMS for Children
j. Foster Care
k. Mental Health
Related to future topics, staff will put together a list and send it out to Committee members for prioritization.
11. Next meeting: Friday, January 25th.
***PRESENTATION AND DISCUSSION NOTES***
* 1. Secretary Bremby: Overview of Healthy Kansas
See PowerPoint presentation, available under meeting materials.
Mission: To create a culture change toward practicing healthy habits resulting in improved health through community coalition building and private sector partnerships
Want culture change – want people treated for fewer conditions.
Health Factors - where health status is most effective. Access to Care is only about 10%. How we behave and how we live accounts for 50% of health status.
Bad genes... “Genes are like a loaded gun, but behavior pulls the trigger.”
Looking at these three modifiable behaviors:
- Tobacco use
- Physical inactivity
- Poor nutrition
1/3 of all deaths annually are attributable to these three modifiable health-damaging behaviors.
Tobacco use costs Kansas about $1 billion per year.
Poor nutrition and physical activity (obesity) combined cost Kansas over $650 Million per year.
Likelihood of developing coronary heart disease, diabetes, or stroke by age 65:
- Non smoker, normal weight, active: 11%
- Smoker, heavy, inactive: 58%
Focusing on 3 market channels (place-based strategy):
- Children in Schools
- Adults in workplace
- KS seniors in community – healthy aging
Using structures already in place, when possible:
- Coordinated School Health Initiative
- School Nutrition and Physical Activity Committees
- Voluntary Body Mass Index (BMI) Testing
- Child Health Advisory Committee
Adults in the Workplace...
- Formalize workplace wellness program
- TA to other state agencies - HRA program
- Pilot business workplace wellness programs with toolkits and website support
Seniors in community
- with KS Department on Aging, provide TA for local wellness programs for seniors
- KDOA STEPS program (Seniors Together Enjoy Physical Success)
- Expansion of senior farmer's market
- Encourage community gardens
Status:
- Media Campaign
- Reactivate Gov's Council on Fitness
- Create Child Health Advisory Committee
- Governor’s/Secretary’s Awards
- Fitness Awards (youth/senior focused)
- Local Community Health Heroes – 4
- Healthy Schools Designation – 106
- Healthy Community Designations
- Model Workplace Wellness Sites
- Website: www.healthykansas.org
Review
Measures of Success - Short-term - a process measure
- Short-term: Number of Kansans taking the pledge
- Intermediate markers: BRFSS data
- Long-term: improved health status
Reviewed online tool 'CheckUp'
Status
Reviewed data...
- Cigarette smoking rates
- Physical activity
- Nutrition
Map options:
- Brand all Cabinet agency prevention related activities with logo to foster identification and recognition
- Develop key partner relationships for co-branding opportunities (Ys, athletic clubs, restaurants, fitness events/activities, grocery stores)
- Approach key foundations for consideration of support
- Reach out to stakeholders for collaborative opportunities
- Procure and distribute specialty items
Interested parties (YMCA, Kansas State Extension Offices, SRS tobacco outreach coordinators)
Additional potential partners (Local partners/organizations, Chambers of commerce, senior centers, health insurers, grocery stores, Kansas wheat commission, fitness organizations, medical societies, hospitals and clinics, faith community, workplace wellness associations)
CHAC Focus Areas
- expanded newborn screening
- childhood obesity
- childhood immunizations (immunize Kansas kids initiative)
Sec Bremby will be back in a couple of months to ask this group if they will be willing to oversee implementation of immunization plan.
Governor will probably not direct this group to any specific study area in the future. This group will identify any key health issues in the future.
In summary - this group has wide latitude, wide support, to do whatever it takes to study the issues you think are most important child health issues and to give advice to me and the Governor.
Each of you, please consider signing a pledge card.
*** Martha Hagen & Linda Kenney - Breastfeeding in the Workplace
Provided information about contacting committee chair for bill in committee related to breastfeeding in the workplace.
Linda: Typically, breastfeeding is assessed at hospital discharge and at 6 months.
Compared with national data, Kansas data shows a “cross-over” effect. At hospital discharge, our rate is higher than the U.S. rate. However, at 6 months, U.S. does better than KS. What we are hearing repeatedly is the breaking point is return to work. While there are some forward-looking businesses, it is difficult for women to continue breastfeeding at work in many situations.
Some states have very forward-thinking policies.
Every state agency does its own thing. If we can get the largest employer (State of KS) to adopt a model policy, then we can serve as model for other private businesses who don't have a policy.
Hoping that this group can go beyond an adoption of it and recommend action steps. Hoping that people could recommend this to Sec Bremby as one that could be adopted by State of Kansas for a policy. It’s a very low-cost way to improve health of Kansas children.
Dennis: Open for discussion.
Shannon: Recommended for state agencies to adopt, but if wanted to, could recommend making it a statewide policy?
Linda: Think this would be up to Committee. Think most people are not opposed to a policy, just are not aware of it as a public health policy.
Other questions/comments?
Paul: Have done board training for 20 years. We talk a lot about school improvement, have added this recently, that breastfeeding is the first school improvement act. This could help kids be more 'ready' for schools. Interesting...you get some skeptical looks.
Linda: It is part of a cultural change. At one time it was accepted, but we have somewhat gotten away from it.
Martha: It also helps with childhood obesity and breast milk is like the child’s first immunization (relating back to Healthy Kansas points)
Penney: Think it is also good from standpoint of general public awareness. Recently got a grant to promote rate of women who BF exclusively for 6 months. Used to be…everyone did, but now everyone doesn't.
Dr. Cooley: Reviewed historical trends of BF...most mothers, as was pointed out by Linda, are BF when in the hospital. There are some cultural factors involved. Get other family members telling mothers they need to add cereal, etc.
Paul: Concurred that WWII, women in workforce contributed to trend against BF.
Vicki: Also very aggressive marketing by formula companies.
Penney: Baby-friendly communities, baby-friendly hospitals. We don't have one hospital in Kansas because they have to agree to not accept free formulas.
Brenda: AAP website has great information on women BF in disasters. Example of contaminated water - if women are BF, they are fine in these times of stress.
Dennis: It seems a motion would be appropriate. First, a motion to approve document, then maybe motion to adopt?
Vicki: Move to approve document
Tom: 2nd
Passed with no opposition
Vicki moved to recommend it be adopted by all State agencies
Penney 2nd
Passed with no opposition
Rand: Moved to use as a model and encourage ALL Kansas employers to adopt
Gerard 2nd
Passed with no opposition
*** Immunization update
- Handout, page 2. 2006 rates less than 2005. Have to look at how much variation and whether this is statistically significant.
Overall, long-term trend is gradually improving.
2004 or 2005 started asking for Varicella, so these rates will continue to improve.
Reviewed information in handout, including…
Total VFC (Vaccine for Children) providers – these are federally-bought vaccines.
Kansas has one of the lowest rates of VFC providers.
Haven't had a big increase - but have made some headway.
Paul: Need to learn more from folks in this room about immunization and the requirement for enrollment. Lower income, low socioeconomic, non-English speaking have more problems with immunization. Don't want to lose those that need into education system the most.
They are not required to start school until age 7. Need to intervene, nurture, correct, and fix, not scare them away from starting school.
Penney: I am in an area with high proportion of non-English speaking. We have wonderful school nurses who work with the population. Everything goes out in multiple languages; we have immunization at Kindergarten Round-Up.
Paul: I'm proud of what you are saying, but I know of children who are being excluded, getting threatening letters.
Vicki: People do take the threatening letters at their word and not come.
Dennis: Think bigger problem will be vaccines required at school entry, then end up having vaccine shortages... (We had this problem with varicella.) This is something that, in the future, could happen more often.
Penney: I have read several articles lately about religious exemptions from people who are really just using as an excuse. Is this a problem in KS?
Dennis: Don't find so much overall, but people don't want certain vaccines. Then, they say it is against their religion. Think in other areas of country, it is much worse.
Paul: Think this is one area [religious exemptions] that could be pushed a little.
Rand: The idea that autism is caused by immunizations is really starting to take hold. We need to better respond to this.
Shannon: Autism – The CDC statement was not as definitive as we hoped it would have been.
Gerard: WIC linkage was something that made the numbers come up a few years ago. How would we approach this? Would a school registration linkage be of benefit?
Dennis: We tend to do well at school entry. Our rates are lower at the 2-year old benchmark. In the past, this was due to the DPT4.
Dennis: One of things we might want to do is wait and see what IKK comes up with. Go from there.
Brenda: We do have the electronic immunization registry - WebIZ. There is a pilot program starting this year where school nurses will have access to WebIZ. Right now, they have to be in county where web IZ exists.
Linda: For any child coming in for WIC services, the WIC staff will be able to look up child's immunizations and do interventions at that point. WIC is seeing over 50% of all live births in the state now, so there’s a high participation rate.
*** Vision Update
Gerard: Didn't see anything about vision in the notes last time related to school health.
Have been involved with Healthy People 2010.
Gary has 25 year history in Kansas.
Gary: Exec Director of KS Opt Association.
(See handouts online.)
25 years ago, became director of KS Opt. Association.
Reviewed screening guidelines.
Discovered that screenings are very helpful...but they are not always enough.
To paint the picture, provided some examples:
- Phone call with optometrist - just finished examining a child in high school. The student had significant vision problems that were never caught.
- Juvenile correction facilities - 60-70% have vision problems. Prison pop - 80% have some type of vision problem. Start looking at social problems.
- A number of vision problems cut across all economic lines. Started SEE TO LEARN program to serve everyone.
We had to do extensive training to get doctors comfortable seeing children. We want parents, educators, all settings to be familiar with the warning signs of vision problems. We want everyone to be aware that there is a free vision assessment for any 3-year old in state. At that age, the eye is fully developed. This is the appropriate entry point for the child to be screened. We have data on 38,000 children. 14% has been fairly consistent proportion of those with problems. This number doubles to 30% by high school. 60% to 70% of special education children have vision problems. People learning to read - 60% of adults have vision problems. NOT everything is a vision problem - but it is important to do vision exam to make sure children are ready to go to school.
Looking at a number of vision problems.
We have really tried to make an effort to remove vision problems as a learning barrier.
Even when a child fails a school screening, many parents do not take the child in to be examined. We are not tracking how many kids fail that are not taken in.
Many optometrists had personal experience themselves with untreated vision problems.
Some problems - if you treat early, they are okay. Otherwise, they have life-long vision problems.
'We are making career choices for children before they ever get into school.' Lazy eye - if child (person) does not have a certain level of vision in one eye, there are certain things they can never do (e.g., pilot, law enforcement, etc.)
Consistently seeing 30-50% of kids in SEE TO LEARN. This year, it looks like we will only see about 25% of kids. (It’s too bad with the amount of work we are doing.) This year, we are probably missing 3,500-4,000 Kansas kids who have vision problems.
We are offering to do free eye exams...but 30,000 kids are not seen. $2 million in free care not delivered, represents children who could have been seen.
Turnover in school nurses, there is a continual process to keep awareness up.
This week, Congress passed children's vision bill. Hoping, if this becomes law, we may come to you to be in a better position to do a better job in screening.
There are a number of tools in the folders we passed out. We also put a copy of vision law currently have in place.
We are working with a number of districts to try to implement.
This is an area that is neglected, and that we take for granted.
What is our main method of informing parents of 3-year olds? How do we reach those parents?
We have done a limited amount of radio promotion... We are pleased with how the Parents As Teachers folks have promoted.
Do most of physicians give this to parents?
Very difficult to get the word out...
Paul: How much of the literature is in Spanish?
Gary: Probably about half of the materials are available in Spanish.
Paul: Some of this reminds me of conversations we have had previously - we need universal health insurance. One of ongoing frustrations - fact that...vision is diminished to point that if the child is wearing glasses and they are having a meeting to work on IEP – say it can't be a vision problem, since the child is already wearing glasses.
One of the things we are seeing - re-do screening with school nurse, optometrist probably needs to see.
With SEE TO LEARN, there is no charge, even if they have insurance at any time.
Tom: Turnover in school nursing... are they doing an adequate job?
Yes, but the children with problems need a more thorough assessment or exam by professional.
Department of Education representative told a story with kids in summer school. The optometrist screened every child. 90% had vision problems.
Don't have time to look at this in detail in this meeting. Will look at this in the future.
Gary: Our compliance was so much better when this went out with immunization.
Wonder if immunization could go out with Immunization registry
Let's look at this again next time and discuss recommendations for further action.
*** Break***
*** Headlice. Gale Hansen provided on update on the headlice regulations. Isolation and quarantine regulations. Changed regulations in middle of July, saying the children do not need to be nit-free, only treated for lice infestation, before coming back to school.
Some other changes in regulations.
Do have some people upset that are allowing children in school with nits.
Paul: I have had conversations with some principals who want to follow the old regulation. Told them they need to follow the new regulation. They are denying a child’s education for no good reason.
Dennis: Looking at isolation requirements...
Looking at staph infection, which seems to be hot issue... also don't see anything about influenza.
Gale: It is a bigger issue... didn't tackle the issue as MRSA, specifically. What do you do as a regulation that works over the whole state?
The other item we changed was to give some latitude to Secretary and to the Local Health Officer. If there's an issue, they have some latitude to respond to an outbreak or a new disease.
Part of the reasoning - if science gets ahead of the regulation, the health officer can have the latitude to address.
Immunizations - parents' fears related to immunizations.
Thiomersal has not been in vaccines for several years. Also lots of literature that discounts it as a risk. Really a non issue (to me).
Dennis: Physicians should explain this when parents come in.
Tom: Do you anticipate recommendations coming out?
Gale: This is an issue...there are recommendations - how to track – we don’t have an answer on this yet.
*** Update on Governor’s Council on Fitness by Marti Macchi.
Sent BMI recommendations and fitness recommendations to the Governor. Encouraged her to put forth regulations.
Last Monday, Dr. Rodenberg and Marci Neilson on KHPA testified to KHPA, pushing legislation related to obesity, physical fitness in schools.
Gearing up for Legislative Fitness Day at the Capitol in March.
Will be having displays at KAHPERD (Kansas Association of Health, Physical Education, Recreation, and Dance) in November.
Promoting President's Challenge
*** Kansas Dept of Education. Update by Dale Dennis.
We provide school breakfasts and school lunches. One of the big issues... in high poverty areas, the students get free breakfast and lunch at schools, then mom & dad take out to MacDonald's or Burger King for dinner. How do you deal with this? Can't control the home. How do you make sure parents understand what is going on?
Trends are encouraging. The pop machines are coming out. Machines with juice and water going in. Schools are adjusting.
Have a school up at Leavenworth. Expanding to school at Ft. Scott. Poor test scores, poor attendance. Discipline was mediocre.
A grant changed many things. School fitness during day. Provide vitamins. Teachers eat with students. Now have some of the highest test scores. Some students have a parent in Leavenworth or Lansing. The results have been great. Principal can give a great report on this. Now, trying this out in Ft. Scott. A school in Tulsa will also pilot. And one elementary in Wichita.
You may want to have them share with you what they did.
They did go through some challenges with this. But, after a while, parents all accepted. It’s working great.
Prevention education, more physical education, more data collected on BMI. One thing we probably need to figure out - how do you give more physical education without eating up a lot of time and spending so much money.
Most districts are trying to promote a more healthy school environment. The culture is changing. But we have not figured out what to do when they go home. How can we involve parents?
Making progress, but not very rapid.
Don't think they [legislature] will mandate [increase physical education in high school] - costs a lot of money, and they don't want to pay for it. It is a lot easier to solve PE problems in elementary than in high schools.
Pressure will continue to be there to promote a healthier lifestyle.
These are all important issues. Back to vision issue - think the same thing is true for dental. It's the follow-up that is needed the most.
Rand: Think you need to give yourself credit for what you’ve accomplished. The piece that's missing - if you teach healthy lifestyles - you are educating children, you have the opportunity for them to grow up and promote healthy lifestyle. At what point and where do you enter in parenting skills?
We do some of that in the Family Consumer Science Program AND through the Parents As Teachers.
Not uncommon for lower elementary child to go home and tell parents not to smoke, etc. point out healthy behaviors to parents.
*** Shannon Cotsoradis – Update on their efforts supporting an initiative at the federal level.
KAC has worked for last several years on state level on competitive foods. Last session, their bill was referred to as the 'crazy bill'. Refocusing a bit, working at federal level, trying to apply same nutritional standards to competitive foods as are applied to school meals, so competitive foods are not undermining nutrition.
The standards for competitive foods have not been updated since 1970s, so they are very antiquated.
*** Perspectives on School and Child Health Initiatives, provided by Paul Getto, Kansas Association of School Boards
Doing better than we ever have. Kansas is within top 5 or top 10 in most measures.
Believe healthy kids are going to learn better.
But, we will officially oppose anything mandated at state level that is not paid for. We are already underfunded, and we have a staff shortage.
Not enough $ to fund what needs to be done. Will take outreach, education, parent involvement.
Thrilled to be part of this type of endeavor/involvement.
But will officially oppose anything unfunded - doesn't matter how good of an idea it is - and there are many good ideas.
We are with you; will continue to engage in the process.
Have to make sure we are coordinated, and work as a unit in the state to deal with this.
Linda: Across all child-serving systems, hearing there is a basic resource problem. Workforce problems are challenging everyone.
Nick: also hearing there are a lot of free services that people are not using. There are opportunities for people to have these services, but they are not taking advantage of it.
Dennis: Echo Paul that coordination is very important.
Most of the time - groups do not know what each other is doing. For example, how many people know what the Child and Adolescent Health group is doing?
We need to coordinate everything better!
Nick: I agree. How many things are we talking about that have already been addressed?
Children's issues - everyone is for them, but there's not a lot of $ for them.
*** Discussion: Future topics.
Now - what do we want to look at?
Children’s access to health coverage, including current status of SCHIP. Think this is something we need to revisit. Would be great to hear from Marci Nielson.
Rand: Encouraged that we've had more discussion on child health coverage. ...through all of this, SCHIP for kids may improve. But we have to take advantage of this.
Think Shannon's idea of Marci coming is good.
Recommendation for children's health coverage - Shannon reviewed.
KHPA Policy Options will be posted online - FYI.
Dennis: One item tied in - emergency preparedness and children. Probably most emergency preparedness programs are not preparing for children's needs. Woefully behind. 69% of services reported they did not have a specific plan for mass casualty events for a school. Response to mass casualty events...have not looked at this adequately.
Would be appropriate to have presentation on pediatric emergency preparedness.
Nick: Would like to go down dental path – Oral Health needs for children.
Brenda: The Attorney General's office is addressing safe and healthy schools. A Governor’s Commission has been appointed to look at healthy and prepared schools.
Paul: As a subset of this, sometimes we forget - rural America. The only ambulance is in the county seat.
Dennis: Yes, this is part of what I'm talking about. Rural Kansas may have EMT services that have training, but do they have pediatric equipment? What will they do? We need to have referral systems. Only two pediatric intensive care units in the state.
Paul: There are counties who don't have an MD.
Rand: Connections with the hospital. We've gone to great lengths since serve all counties in KS now. Have blue telephones in hospitals that they pick up and it puts them in touch with specialists in Kansas City. May have everything all set in hospitals - but what about schools?
Dennis: Really, disaster preparedness plans are all local. What will you do when you have children separated from parents? If disaster occurs, how do you connect with parents? How do you prevent predators?
Gerard; Stories of families separated during Katrina, children separated from parents.
Gerard: Also hitting on rural health care. Maybe we should have a rural health care meeting. Maybe also a meeting that would deal only with inner city. We also have not talked about issues like drug and alcohol, crime.
Dennis: Also tobacco. Would have biggest bang for our buck addressing tobacco use in Kansas children.
EMS for children - committee chaired by Jeanette Shipley - have just issued a booklet about how to deal with children in emergency medical association.
Other ideas?
Tom: Not sure if ties in, but the area of foster care, foster care needs.
Dennis: Also mental health services for children in the state.
Mental health: Report that main two places children receive mental health support are private primary care provider offices and schools
Regarding future topics: Put a list together and prioritize via email.
Next meeting?
One of Fridays in January?
Legislature begins 2nd Monday in January
January 18th? Holiday weekend.
January 25th? Yes, this should work.
*** Adjourned ***
| Meeting 7 Discussion Board is now closed.
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