Will Humble Public Health, Wills Blog

APHA Webinar: Advocacy in the Current Political Climate: Know the Rules and Get Involved

This free webinar is designed to help new and advocates understand the general ethics and legalities related to lobbying and advocacy. The presentation will address common advocacy and lobbying restrictions for employees in non-profit organizations and government agencies and the activities that public health advocates can participate in regardless of their employer and/or profession (yes, even you, state employees!).

The webinar will be held at 3 p.m. ET/noon PT on Monday, February 3. Those who RSVP will receive an emailed link before the event. You can RSVP here. 

APHA will cap this at 100 attendees, but we will make a recording available, as well. Please let me know if you have any questions! 

Will Humble Behavioral Health, Early Childhood, Injury Prevention, Marijuana, Maternal Health, Medicaid, Opioids, Oral Health, Prevention, Public Health, State Legislature, Vaccination, Wills Blog

Governor’s Budget Request Summary

Every mid-January Arizona Governor’s propose their budgets for the upcoming fiscal year. Those budgets set the governor’s priorities and can be influential in what ultimately comes out in the budget. The extent to which the governor’s budget drives the ultimate outcome depends a lot on the relationship between the governor and the majority party in the legislature chambers.

The relationship between the current governor and the majority party in the legislature is cozy and so in the era that we’re in right now- the content of the gov’s budget will likely closely resemble what ultimately comes out this session.

The governor released his budget last Friday and there were some good things in it but also some disappointments. Here goes a summary of his proposal.

Good Things in the Proposed Budget

Newborn Screening Expansion

Arizona’s newborn screening program is run out of the ADHS public health laboratory.  The team tests newborns for a series on metabolic and other disorders and gets the information back to doctors and parents fast so that they can make quick interventions that are critical to good outcomes.  The program is funded by a fee that hospitals and health plans (and AHCCCS) pay for the services which include testing blood spots immediately after birth and again with a new blood spot after a few days.

The program currently bills $36 for the first test (the blood spot test that’s collected right after birth) and $65 for the second test which is collected several days later. The governor’s budget proposes combining the fees into one and boosting the total from $101 to $113.

More revenue would come to the program because of the higher fee ($12 total) and because collections would increase because there would only be one bill.  The extra money would cover the deficit that the program is currently running and allow them to  do 2 additional tests now recommended by HHS:

1) spinal muscular atrophy, a genetic disorder that affects motor nerves; and

2) X-linked Adrenoleukodystrophy, which causes deterioration of myelin, reduces the ability of nerves to communicate with the brain.

Childcare Help for Working Families

The Child Care Development Fund provides subsidies that help low-income working families and foster parents afford childcare. The proposed budget increases funding for the Development Fund by $55M which would go toward boosting rates to childcare providers that participate in the program (which should hopefully build the network and perhaps even get rid of the waiting list).

Some of the money would also go toward providing incentive bonuses to quality childcare facilities ranked by First Things First and help unranked facilities achieve certification.

The folks that can participate in the program include low-income parents who are working; teen parents in school and residents of homeless or domestic violence shelters.

Assistance to Kinship Families

The governor’s budget proposes increasing what is called “kinship assistance funding” which is financial assistance for family members who are caregivers for children that’s called “kinship care.”

Last year Arizona extended the eligibility to all caregivers, regardless of income levels, without filing an application. This year, the proposal is to double the “Grandmother Stipend”.

Suicide Prevention

There have been some solid interventions in the last year to help reduce suicides in Arizona enhancing crisis-response teams, expanding suicide-prevention resources, initiating a campaign to address social isolation, and establishing a Suicide Mortality Review Team. I reviewed some of that in last week’s policy update.

The governor’s budget proposes a general fund appropriation of $400K to help with the work at the Suicide Mortality Review Team. We expect additional evidence-based policy interventions to result from the surveillance work that the Team will undertake using this appropriation.

Protecting Vulnerable Adults and the Elderly

The governor’s proposed budget proposes increasing some (targeted) reimbursement rates to providers of therapy and respite and habilitation care (hopefully stabilizing and improving the availability of those serves for folks that qualify).  The proposal is to increase state funding by $5M which would bring in an additional $11.7M in federal matching funds.

The budget also proposes reimbursement rate increases for providers of aging and adult services for vulnerable and homebound adults and seniors. That increase is $1.5M plus the federal match.

Interestingly, he also proposes tapping the Medical Marijuana Fund to the tune of $6M to provide health care services to 18,000 uninsured or underinsured Arizonans who need treatment for substance abuse. No match or general fund impact with that one.

Disappointments in the Proposed Budget

Adult Protective Services

We had hoped that the governor would have recognized (as did the vulnerable adult task force did) that ADES’ Adult Protective Services needs additional funds and technology to better follow up on neglect and abuse complaints of vulnerable adults. No additional resources were proposed by the governor for this important need. 

Hopefully legislators will recognize the performance shortcomings in the Adult Protective Services program and determine whether additional funds are needed or whether processes and/or personnel and leadership need to change to improve performance. Look for an upcoming series from Stephanie Innes in the Arizona Republic for more on APS.

Abuse & Neglect Investigations in Nursing Homes

We’re disappointed that the governor’s budget proposal fails to address the fact that the ADHS licensing program needs additional funding to be able to adequately follow up on complaints filed by families about nursing home neglect. 

A recent Auditor General’s Report showed that many important complaints are not currently being followed up on.  The agency acknowledged in their response that they don’t have adequate resources to follow up on complaints.

Editorial Note: I’m partly responsible for the lack of resources in the program.  Back during the Recession, the licensing general fund was swept and we were given the ability to charge fees to nursing homes to support our inspections. When we did the math to calculate those fees, we neglected to include Indirect costs which shortchanged the program by 25%.  My bad.

The Senate’s proposed budget includes additional funds (I don’t know if that’s general fund or a fee increase) to help do a better job following up on nursing home complaints.

State Loan Repayment Program

Last year the state’s health care provider loan repayment program which places practitioners in rural and underserved areas that have a dearth of health care providers received a $750K increase. We had hoped that this would be continued for future years, but alas the governor’s budget proposes not funding that increase again.

Oral Health Coverage for Pregnant Medicaid Members

We had hoped to see a proposal to make the small appropriation that would be needed to begin providing oral health coverage for pregnant Medicaid members.  Here’s a blog post from back in March that lays out the case for this important intervention.

State Employee Salaries

We had hoped that there would be a proposal to increase the salaries of public health workers in state government.  Nope.  Again, no increase for hard working state employees (except at DCS etc).

Salaries aren’t the only thing that slows turnover- employees also need to know that their efforts are valued and that they have the ability to make decisions and participate in the development of agency priorities- but salary is part of the equation and state employees have not seen raises in many years.

Will Humble Federal Budget, Federal Public Health Bud, Wills Blog

Final FY 2020 Federal Budget

Federal elected officials finalized the federal budget just before Christmas.  The federal budget included a $4.4B increase for the U.S. Department of HHS including decent increases for CDC and HRSA, including $50M in new CDC funding to improve public health data systems at CDC and state, local, tribal public health departments and an increase of $75 million for CDC’s global disease detection programs.

AzPHA is pleased that the final bill provides both CDC and the NIH each with $12.5M to study gun violence prevention.

Will Humble Affordable Care Act, Wills Blog

Quick ACA Lawsuit Update

The Supreme Court will decide soon whether to grant an expedited appeal in the Texas v. Azar case. Defenders of the Affordable Care Act have asked the court to grant an exception and hear the case in 2020 (before the election). SCOTUS has asked the plaintiffs (who are trying to overturn the ACA) to respond to the request for an appeal last week.

The 5th Circuit Court of Appeals ruled in late 2019 that the ACA’s Individual Mandate is unconstitutional but pushed the case back to the lower court to determine which elements of the law are tied to the individual mandate. If an expedited appeal is granted, the Supreme Court would hear the case before the term ends in June of this year. More info here and don’t forget about the ACA Social Media Toolkit.

Will Humble Early Childhood, Injury Prevention, Prevention, Public Health Law, State Legislature, Wills Blog

Child Fatality Review Report Sets Off Suicide Alarm Bells

The death of any child is a tragedy – for the family and for the community. Everybody wants to prevent childhood deaths. Making policy interventions to prevent childhood deaths requires information in order to develop effective policy interventions.  That’s where the Arizona Child Fatality Review State Team comes in.

More than 25 years ago the state legislature passed a law establishing the Arizona Child Fatality Review Program (A.R.S. § 36-342, 36-3501-4).  It’s a great example of establishing public policy designed to build data and evidence so policy makers can use evidence to build future interventions.

The State Team includes representatives from the Academy of Pediatrics and from the ADES Divisions of Developmental Disabilities and Children and Family Services, as well as from law enforcement and the ADHS. The team’s role is to review all childhood deaths in AZ and produce an annual report to the Governor and legislature with a summary of findings and recommendations based on promising and proven strategies regarding the prevention of child deaths.

The 2019 report was published last week- and as usual it provides a host of data and recommendations that are directly tied to evidence.

In past years this focus has raised the awareness about child drowning and the importance of putting babies to sleep on their backs or making sure all children are always secured in car seats.  Those interventions have made a real difference- and Sudden Unexpected Infant Deaths (SUID) decreased 29% from 2017 (n=84) to 2018 (n=60) and accounted for 7% of all child deaths in Arizona.

The 2019 report sets off the public health alarm bells when it comes to child suicide.

There was a 28% increase in suicide deaths from the previous year (which itself had a 32% increase over the year previous)… so child suicide deaths have gone up about 50% in the last 2 years.  64 kids died by suicide in 2018.  About 40% of the suicides were from a firearm.  Over the last six years, the child suicide mortality rate has gone up more than 100% going from 1.5/100,000 in 2012 to 3.9/100,000 in 2018.

Here are the Suicide Prevention Recommendations from the Report

  • Support funding and training to schools, communities, clinical and behavioral health services providers on the prevention of suicide.  

  • Educate parents, teachers, and caregivers on the risk factors for suicide. These factors include substance use, delinquency, depression and poor impulse control.

  • Provide information for educators, parents and caregivers on how to seek help for children at risk after the first red flag.

  • Continue to expand and enforce anti-bullying policies in schools.

  • Expand resources for teens that are likely to be mourning the suicide death of a friend or family member.

  • Strengthen services available to children and adolescents that address adverse childhood experiences and practice trauma informed care.

  • Completely remove firearms from homes where individuals are experiencing mental health problems such as, depression, substance use, or suicidal ideation.

  • Urge parents to monitor their child’s social media for any talk about suicide and take immediate action if there is evidence of suicidal ideation. 

  • Encourage social media organizations to develop opportunities to flag information that might indicate suicidal thinking and respond with crisis information resources. 

  • Support funding and access for quality behavioral health and substance use assessment and treatment services for youth and their families, especially in rural communities.

  • Promote and expand universal screening for suicide risk by all health care providers at each visit.

  • Store all medications in a locked cabinet and discard unused medications safely and properly when they are no longer being taken.

Here are some of the results in the other categories of child fatalities:

  • Sudden Unexpected Infant Deaths (SUID) decreased 29% from 2017 (n=84) to 2018 (n=60) and accounted for 7% of all child deaths in Arizona.

  • Deaths from prematurity increased 24% from 2017 (n=180) to 2018 (n=224).

  • Accidental injury deaths decreased 9% from 2017 (n=187) to 2018 (n=170) and comprised 20% of all child deaths.

  • The number of firearm deaths was unchanged from 2017 (n=43) to 2018 (n=43) and accounted for 5% of all child deaths.

  • Child fatalities due to abuse/neglect decreased 5% from 2017 (n=79) to 2018 (n=75) and accounted for 9% of all child deaths in Arizona.

  • Motor vehicle crash (MVC) deaths increased 13% from 2017 (n= 65) to 2018 (n= 74) and accounted for 9% of all child deaths in 2018.

  • Homicides decreased 18% from 2017 (n=38) to 2018 (n=31) and accounted for 4% of all child deaths.

  • Drowning deaths decreased 20% from 2017 (n=35) to 2018 (n=28) and accounted for 3% of all child deaths.

The full report covers each of these areas including some recommendations for policy and program interventions in each area.  Sometimes the recommendations are more related to increasing awareness but many are more policy based.

Lots of work went into this report- so if you’re somebody in a position to influence either lawmakers or agency officials to implement preventative policies in these areas- please get familiar with this   important research product – it will really help inform your advocacy efforts.

Will Humble Behavioral Health, Injury Prevention, Wills Blog

Suicide Prevention Training for Schools

In 2019, the Arizona State legislature passed Senate Bill 1468 mandating all public school staff who interact with students in grades 6 through 12 be trained in an evidence-based, best practice suicide prevention training at least once every three years.  The statute tasks AHCCCS with picking evidence-based, best practice suicide prevention training materials.  AzPHA Board member and Treasurer Kelli Donley Williams is the point person at AHCCCS that’s been working on this.

The law takes effect in the 2020-2021 school year and school districts are being encouraged to write policies describing how they will implement and track the training.

AHCCCS and the Arizona Department of Education have already selected the school suicide prevention training options. School administrators can choose from among these materials as they work toward meeting the statute’s requirements.  Here’s a list of the evidence-based programs:

  • Question, Persuade, Refer (QPR).

  • Applied Suicide Intervention Skills Training (ASIST).

  • At-Risk for High School Educators (available online).

  • Youth Mental Health First Aid.

  • Suicide Alertness for Everyone (safeTALK).

  • ACT on FACTS (available online).

  • More than Sad – Suicide Prevention Education for Teachers and other School Personnel.

  • Be a Link! Suicide Prevention Gatekeeper Training.

The qualifying programs were selected using the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Suicide Prevention Toolkit for High Schools, the Suicide Prevention Resource Center for additional gateway trainings, and peer-reviewed articles addressing cultural considerations, particularly for tribal nations, in suicide prevention.

Will Humble Behavioral Health, Wills Blog

Behavioral Health Services in Schools

One of the evidence-based strategies to prevent suicide among children is to provide easily accessible behavioral health services for students in the school setting.

Schools in Arizona have historically been approved settings for Medicaid-covered behavioral health services… but Arizona has recently been moving forward to make it more robust.  

Last legislative session, an additional $3M was appropriated to expand behavioral health services in schools with $1M going to a partnership with the Arizona Department of Education to provide mental health training to schools and school districts.  

The remaining funds are being matched with Federal Funds to generate $10M in Medicaid funding to AHCCCS health plans to bring behavioral health providers into the school setting and pay for Medicaid-covered behavioral health services in schools.  Examples of some of these projects include:

  • Project AWARE: In collaboration with the Arizona Department of Education, AHCCCS is working with three school districts to implement Mental Health First Aid training.

  • The Safe Arizona Schools Plan which pays for in mental and behavioral health resources at schools. With $1M in funding, the Arizona Department of Education and AHCCCS signed an agreement to partner efforts in expanding access to behavioral health training in schools statewide. 

  • Arizona Medicaid School-Based Claiming Program: Arizona participates in two Medicaid reimbursement programs for school-based services, the Direct Service Claiming program and the Medicaid Administrative Claiming program both of which help certain school districts by reimbursing them for their costs to provide Medicaid covered services to eligible students.

At this week’s  State Medicaid Advisory Committee (SMAC) meeting, Director Snyder confirmed that AHCCCS is planning to file a state plan amendment later this year which would allow schools to bill for eligible services provided to AHCCCS participants. More info on this opportunity here and here.  

Will Humble Injury Prevention, Prevention, Wills Blog

Are More Suicide Prevention Interventions on the Way this Legislative Session?

There’s talk at the Legislature of creating a Suicide Fatality Review Board (much like the child fatality review board).  The idea is to review all suicides in Arizona and find trends and brainstorm prevention programming (interventions in AZ are difficult because the trends often depend on geography).  

Yavapai County has the highest rate of suicide, but this is among those 65 and older. Native American youth are most at risk for suicide, but prevention resources are often harder to access in Arizona’s rural and frontier counties where most Native Americans live.

I’ve also heard rumors that there will be a bill that will enhance the existing behavioral health services in schools- but I haven’t heard any details about what the initiative is or what it would do yet.  Stay tuned.

Will Humble State Legislature, Wills Blog

Our Legislative Session Advocacy Approach

This week marks the beginning of the 2020 legislative session.  The kickoff will be the Governor’s address to the legislature where he’ll outline what he sees as priorities.

Our Advocacy Approach

AzPHA will follow the session closely and express our support or opposition to bills based on a simple core principle…  we support bills that will have a positive impact on public health especially when they are evidence-based or evidence-informed.  We will oppose bills that are likely to have a negative impact on public health.  Our support or opposition to bills is located on the https://www.azleg.gov/ site under RTS Current Bill Positions (a summary of the system went out in last week’s update).

We have a host of Resolutions that also guide our advocacy which are posted on the members only website.  The fact that we have Resolutions on so many core public health priorities make it easy for us to be swift with our support or opposition. Our Resolutions go all the way back to the 1930s.  They are initiated by either the Board or our members and all resolutions have been voted on and approved by our members.

Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy.  Let me know if you’d like to sign up for that Basecamp site at willhumble@azpha.org. Our policy committee also has conference calls every other Monday starting tomorrow at 11 am.  The call-in number is 641.715.3580 and the Code is 389388.

Harmful Reproductive Health Education Bill

We haven’t started our full review of bills as most have not yet been proposed.  We have, however, signed up in opposition to SB1082 which would make it more difficult for schools to provide evidence-based and age appropriate reproductive health education. The bill proposes to prohibit age appropriate reproductive health education before 8th grade and would place additional administrative barriers on schools that will discourage them providing this important curriculum topic.

Here’s our statement in the RTS system on the Bill:

Teen births are the number one cause of inter-generational poverty resulting in poor health outcomes and avoidable reliance on public benefits. Evidence-based and age appropriate reproductive health education in schools reduces teen births- and is an important tool to reduce teen births and inter-generational poverty. 

This bill includes burdensome administrative requirements that will discourage school districts from providing reproductive health education and will increase teen births and the resulting poverty, poor health outcomes and reliance on public benefits.  

For example, Texas has a very restrictive reproductive health school requirement (similar to those in this Bill) and also has among the country’s highest teen birth rate.

Will Humble Prevention, Public Health, Wills Blog

US Preventive Health Services Task Force Accepting Applications to Serve

In the last 10 years a prevention model of health has woven its way into the fabric of traditional models of care. With the passage of the Affordable Care Act, the role preventive services has expanded significantly in the US health care delivery system.  Preventive health care services prevent diseases and illnesses from happening in the first place rather than treating them after they happen.

“Category A & B” preventive services recommended by the US Preventive Services Task Force are now included (at no cost to consumers) in all Qualified Health Plans offered on the marketplace. In addition, many employer-based and government-sponsored health plans have included Category A & B preventive services in the health insurance plans they offer to their respective members.

Currently, the United States Preventive Services Task Force recommends more than 50 Category A or B preventive health services.  Category A services are those that “…  there is high certainty that the net benefit is substantial”.  Category B services are those that: “… the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial”.

The Task Force operates within the Agency for Healthcare Research and Quality.  The Task Force consists of a panel of experts representing public health, primary care, family medicine, and academia.  They update the list of recommended services by reviewing best practices research conducted across a wide range of disciplines.

The Preventive Health Services Task Force is currently accepting applications to serve on the Task Force.

This is a terrific opportunity for a mid to late career public health professional to serve the public health community, improve outcomes in the US, develop further professionally, and to increase your professional network connections.

DATES:

Nominations must be received in writing or electronically by March 15th to be considered for appointment (to begin in January 2021).

NOMINATION SUBMISSIONS:

Nominations must be submitted electronically or in writing, and should include:

  • The applicant’s current curriculum vitae and contact information, including mailing address, and email address; and

  • A letter explaining how this individual meets the qualification requirements and how he or she would contribute to the USPSTF. The letter should also attest to the nominee’s willingness to serve as a member of the USPSTF.

AHRQ will later ask people under serious consideration for USPSTF membership to provide detailed information that will permit evaluation of possible significant conflicts of interest. 

Interested individuals can nominate themselves. Organizations and individuals may nominate one or more people qualified for membership on the USPSTF at any time. 

ADDRESSES:

Submit your responses either electronically or in writing to: https://uspstfnominations.ahrq.gov/register, Lydia Hill, ATTN: USPSTF Nominations, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Mailstop: 06E53A, Rockville, Maryland 20857.

SUPPLEMENTAL INFORMATION:

USPSTF members currently meet three times a year for two days in the Washington, DC area. A significant portion of the USPSTF’s work occurs between meetings during conference calls and via email discussions.

Member duties include prioritizing topics, designing research plans, reviewing and commenting on systematic evidence reviews of evidence, discussing and making recommendations on preventive services, reviewing stakeholder comments, drafting final recommendation documents, and participating in workgroups on specific topics and methods.

Members can expect to receive frequent emails, can expect to participate in multiple conference calls each month, and can expect to have periodic interaction with stakeholders. AHRQ estimates that members devote approximately 200 hours a year outside of in-person meetings to their USPSTF duties. The members are all volunteers and do not receive any compensation beyond support for travel to in person meetings.

FOR FURTHER INFORMATION CONTACT:Lydia Hill at coordinator@uspstf.net.

For more information, including nominee selection, qualification requirements, and additional background information: https://www.federalregister.gov/documents/2020/01/07/2020-00019/solicitation-for-nominations-for-members-of-the-us-preventive-services-task-force-uspstf

1 … 30 31 32 33