Will Humble Behavioral Health, Medicaid, Wills Blog

New Facility on AZ State Hospital Grounds to Provide Bridge Housing for Persons Experiencing Homelessness with Mental Health Needs

The Arizona Department of Administration will be breaking ground in the next few weeks on a new facility on the grounds of the AZ State Hospital that will provide ‘bridge housing” for persons with behavioral health needs. The facility will have a separate (physically attached) outpatient behavioral health service setting. When completed, it’ll have capacity for approximately 70 persons (w/privacy).

Residents will not be required to be in treatment to access housing services. According to a PowerPoint from AHCCCS, it’ll have 24/7 shelter staff for supervision & security. Housing & services will be available by referral only (no walk-up services).

There will be common areas for reception, food service (no food preparation on site), laundry, conference/group activity rooms, patio; personal storage; private space for delivery of wrap-around supportive services and home-based services. I’m told COPA Arizona Behavioral & Mental Health Services and Central Arizona Shelter Services will be operating the facility, which will be located on ‘Bower Park’ part of the ASH Campus (NE corner of 24th Street and Van Buren).

Editorial Note: You may recall my blog from last month where I urged ADHS and ADOA to clean up the terrible dead landscaping in this area of the State Hospital: Call to Action: Clean Up the AZ State Hospital Grounds. There are acres and acres of very large dead trees (some falling over) creating a community eyesore that’s disrespectful to patients, families, and the community.

The acres of dead grass and weeds have since been trimmed (reducing the fire risk) but there are still dozens of dead, falling trees on campus. My source assures me that the dead vegetation will be addressed when groundbreaking actually starts in the next few weeks (I actually saw some prep equipment when I drove by this afternoon).

Will Humble Firearm Safety, Prevention, Public Health, Social Determinants, Wills Blog

30th Annual Child Fatality Review Report Recommends Key Interventions that Would Save Children’s Lives if Implemented

Back in the mid 1990’s the AZ State Legislature established the Arizona Child Fatality Review Program to evaluate every child death and provide evidence-based policy recommendations to prevent child deaths.

Over the years many policy and operational interventions came out of these reports, from safe sleep to new seat belt laws for kids. The goal of each year’s report by conducting a comprehensive review of all child deaths and make policy recommendations to prevent as many as possible.

The report 2 years ago found that firearm deaths increased 41% over the previous year, while child death rates were 250% higher than the national average (likely due to the lack of mitigation measures implemented by the previous administration).

View this year’s 30th Annual Child Fatality Review Report

The Arizona Child Fatality Review Program’s goal is to reduce child deaths in Arizona by conducting a comprehensive review of all child deaths to figure out what steps could have been taken, if any, to prevent each child’s death.

The leading causes of preventable deaths were: 1) car crashes [21%]; 2) suffocation [16%]; 3) firearm injury [15%]; 4) poisoning [11%]; and 5) drowning [8%].

Local review teams found that 100% of accidental injury deaths (n=215), suicides (n=46), and homicides (n=49) were preventable.

The most important part of the Child Fatality Review Report is the policy recommendation part, which starts on page 98. The research team goes to great lengths to find evidence-based recommendations to prevent child deaths.

Highlighted recommendations are from this year’s report include:

  • Require proper storage of all firearms by making adult owners legally civilly & criminally responsible for keeping the firearm unloaded and locked in a safe with the ammunition stored separately.
  • Require children younger than 13 to be in the rear seats of vehicles, continue promoting the importance of safety seats for children and provide parents with education and information on the locations of certified seat installers, increasing awareness about proper vehicle restraint use and the risks associated with driving under the influence, and ensuring that helmets are worn when required.
  • Expand of the DCS Workforce Resilience Experiences and home visiting programs through the state, increasing awareness of Adverse Childhood Experiences and increasing awareness and support for the All-Babies Cry Program.
  • Prevent prematurity (a leading cause of death among neonates) focus on maternal behavioral health: 1) policies to encourage pregnant women to avoid using substances such as drugs or alcohol during pregnancy; 2) increasing the availability of affordable health insurance; and 3) awareness of AHCCCS coverage up to one year postpartum; and increasing availability of home visiting programs.
  • Continue to educate parents on safe sleeping environments and the dangers associated with the use of products for sleep that are not specifically marketed for infant sleep and recalled items.

The recommendations in this year’s report can be implemented in various ways. Some, like passing Child Firearm Access Prevention laws require legislative action, while others can be implemented by AHCCCS, ADHS, ADES and DCS without additional statutory authority. Others can be adopted as best practices by nonprofits working in this sector.

I expect this year’s Child Fatality Review Program report to be more influential in informing public policy as Governor Hobbs and her appointees are generally more receptive to prioritizing evidence-based public health policy & practice than the former administration.

Will Humble Professional Development, Wills Blog

Public Health Journalism this Week

Dr. Peter Hotez: Anti-science rhetoric is threatening lives worldwide (azcentral.com)

EPA announces $30M grant for PFAS treatment in Tucson (azcentral.com)

US Surgeon General Vivek Murthy talks mental health with ASU students (azcentral.com)

Arizona mobile health teams bring medication, services to patients (azcentral.com)

Hobbs takes action that’s expected to lead to increased childcare subsidies | Arizona Capitol Times (azcapitoltimes.com)

Will Humble Disease Control, Wills Blog

Updated Data Continue to Reveal Arizona Led the Nation in Excess Deaths During Pandemic

Guest Blog via AzPHA Member Allan Williams, MPH, PhD

CDC data as of 11/09/23 indicated that nearly 1.2 million COVID deaths (underlying or contributing cause) have occurred in the U.S since the start of the pandemic. In Arizona, 33,788 COVID deaths have occurred according to the COVID dashboard at ADHS as of 10/04/23. 

Many COVID deaths could have been prevented had more individuals and public officials followed recommended public health prevention guidelines or had officials not been prevented by legislators from implementing preventative measures or even providing accurate information on vaccines, treatments, and other measures. 

As previously noted in the 08/27/23 AZPHA Policy Update, COVID deaths do not reflect the full impact of the pandemic on mortality.

Many other causes of death have also been elevated during the pandemic due in part to delayed or denied access to healthcare, unemployment, and many other factors.

For example, a comparison of just the 15 leading causes of death during 2018-2019 to those causes during 2020-2021 showed significantly increased rates of death for nine of the 15 causes in the U.S .and 8 of the 15 causes in Arizona, including heart disease, accidents, strokes, diabetes, liver disease, hypertension, Parkinson’s disease, and homicides. Other causes such as firearm deaths and opioid overdose deaths also increased.

As has been widely reported, the increased pandemic-related deaths have had a dramatic effect on life expectancy (which assumes current mortality rates were to continue though life).  In 2020, life expectancy at birth declined by 1.8 years in the US and by 2.5 years in Arizona compared to 2019. In 2021, life expectancy declined by 2.4 years in the US and 2.8 years in Arizona compared to 2019.

The CDC has tracked overall excess deaths (Table 1) for the U.S. and for each state by week, month, and year. For each time period (week, month, or year) the observed deaths from all causes are compared to the estimated expected number of total deaths had the pandemic not occurred.

Those estimates are based on weekly death data during 2017-2019. It’s important to note that estimates of expected deaths (and the percent excess) are much more accurate for time periods closer to the 2017-2019 comparison period.  Thus, the estimated excess would be most accurate for 2020 and least accurate for 2022.

In previous Policy Updates we compared the percent of excess deaths among the states for specific pandemic years. In 2020, the 29% excess of total deaths in Arizona was the highest among the states. In 2021, Arizona tied with Alaska with a 38% excess based on still provisional data.

Final 2021 data, however, indicated that Alaska had a 39% excess, barely exceeding Arizona’s 38% excess. In 2022, provisional data indicate Alaska again narrowly exceeded Arizona with a 27% excess vs a 25% excess for Arizona.

For an overall perspective, CDC data was used to aggregate total observed deaths and expected deaths during 2020-2022 to calculate the overall percent of excess deaths for each state.

As shown in the map above, Arizona led all states with an overall 31% excess deaths in 2020-22. Alaska and New Mexico followed with 27%. Vermont, Hawaii, and Massachusetts had the smallest excesses at 10%.

Based on the CDC estimates of excess deaths, Arizona experienced an excess of 55,000 deaths (including COVID) during 2020-2022.

However, using a slightly different approach for estimating the “expected” number of deaths based on extrapolation of the linear increase in total deaths during 2015-2019 (R² = 0.975, p = 0.002) and on slightly newer provisional data for 2022 yields a higher number of expected deaths and therefore a lower number of excess deaths, approximately 41,000. Wherever the true value lies, both estimates represent a tragic and largely avoidable mortality toll among Arizona residents.

The portion of the excess due to COVID varied widely by state, ranging from 45% to 100+%. For Arizona, COVID represented 53% of excess deaths, while for the U.S. COVID accounted for 68% of the excess.

Will Humble Opioids, Wills Blog

Promising Strategies to Prevent Opioid Overdoses

Strategy to Action: Incorporating CDC’s 10 Evidence-Based Strategies to Prevent Opioid Overdoses: Journal of Public Health Management and Practice

CDC found 10 strategies by scanning scientific literature to examine interventions that have been successfully implemented in at least one jurisdiction and have proven effective at reducing overdose deaths as well as the risk factors that contribute to overdose.6 These strategies include the following:

  • Targeted naloxone distribution;
  • Medication-assisted treatment;
  • Academic detailing;
  • Eliminating prior authorization requirements for medications for opioid use disorder;
  • Screening for fentanyl in routine clinical toxicology testing;
  • 911 Good Samaritan laws;
  • Naloxone distribution in treatment centers and criminal justice settings;
  • MAT in criminal justice settings and on release;
  • Initiating buprenorphine-based MAT in emergency departments; and
  • Syringe service programs.

Our 2024 AZPHA Conference will be focusing on public health responses to the continuing opioid epidemic with a focus on how to effectively use resources from the various opioid settlements to fund evidence-based interventions like those found by CDC above.

Will Humble Opioids, Wills Blog

Promising Strategies to Prevent Opioid Overdoses

Incorporating CDC’s 10 Evidence-Based Strategies to Prevent Opioid Overdoses: Journal of Public Health Management & Practice

CDC found 10 strategies by scanning scientific literature to examine interventions that have been successfully implemented in at least one jurisdiction and have proven effective at reducing overdose deaths as well as the risk factors that contribute to overdose.6 These strategies include the following:

  • Targeted naloxone distribution;
  • Medication-assisted treatment;
  • Academic detailing;
  • Eliminating prior authorization requirements for medications for opioid use disorder;
  • Screening for fentanyl in routine clinical toxicology testing;
  • 911 Good Samaritan laws;
  • Naloxone distribution in treatment centers and criminal justice settings;
  • MAT in criminal justice settings and on release;
  • Initiating buprenorphine-based MAT in emergency departments; and
  • Syringe service programs.

Our 2024 AZPHA Conference will be focusing on public health responses to the continuing opioid epidemic with a focus on how to effectively use resources from the various opioid settlements to fund evidence-based interventions like those found by CDC above.

Will Humble Medicaid, Wills Blog

AHCCCS Gets Extension of Federal Approval for Providing Direct Care for Minor Kids Enrolled in ALTCS

CMS granted the temporary extension of the State’s existing COVID-19 Appendix K authority to allow the State and CMS to continue negotiations over the demonstration amendment application submitted on September 27, 2023 that proposes to allow AHCCCS to continue the program permanently. The COVID-19 Appendix K authority will now expire March 29, 2024 or once the proposal is approved, whichever may come first.

The letter from CMS, and more information and documents, are posted on the Parents as Paid Caregivers web page.

Will Humble Assurance & Licensure, Maternal Health, Wills Blog

‘Birthing-Friendly’ Designation on Web-Based Care Compare Tool

Centers for Medicare & Medicaid Services (CMS) will begin displaying the ‘Birthing-Friendly’ designation icon on CMS’s Care Compare online tool.

CMS created the new designation to find hospitals and health systems that take part in a statewide or national perinatal quality improvement collaborative program and that implement evidence-based care to improve maternal health. The public can use the Care Compare tool — along with a complementary interactive map to find a hospital or health system with the ‘Birthing-Friendly’ designation in their area.

Will Humble Assurance & Licensure, Wills Blog

HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes

HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes

Last week CMS issued a proposed rule that seeks to set up comprehensive staffing requirements for nursing homes including national minimum nurse staffing standards.

Under CMS’s proposal, nursing homes taking part in Medicare and Medicaid would have to meet specific nurse staffing levels that promote safe, high-quality care for residents. 

CMS also proposes to require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities

CMS estimates approximately three quarters (75%) of nursing homes would have to strengthen staffing in their facilities.

Federal Register :: Federal Register Documents Currently on Public Inspection

Will Humble Professional Development, Wills Blog

Free Webinar: How do Ideas and Evidence Become Real Laws and Policies?

Wednesday, November 15 | 4:00pm – 5:00pm MST

Translational research is critical to ensuring that our work actually improves public health. But this type of work often requires skillsets in more than one field, work that does not fit neatly into a traditional job category, and relationships.

Moreover, laws and employer policies limit permissible political activities, government systems are confusing, and the adversarial nature of politics is downright intimidating.

During this free webinar presenters will highlight the skills, activities, and methods necessary to transform evidence or abstract ideas into sound policies.


Learning Objectives: 

  1. Define translational research and its importance in public health.
  2. Explore the gaps and unmet needs of current systems and why those systems can make it difficult to operationalize academic ideas.
  3. Find the ways various professionals can contribute within a specific job role.
  4. Discuss the skills, methods, and relationships needed for successful translational research.

Translational Research Webinar

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