Will Humble Health Equity, Professional Development, Wills Blog

Public Health Career Opportunity with Special Olympics AZ

Special Olympics Arizona is looking for a full-time Research Coordinator to coordinate the first phase of a longitudinal evaluation that examines the impact of Special Olympics participation on physical, mental, and socio-emotional health.

Over the last several years, Special Olympics has expanded their mission to include a host of programming that includes mental and social-emotional health.  The funding for the position is secure. Learn much more about the position and how to apply: Longituidnal Evaluation Research Coordinator

Will Humble Vaccination, Wills Blog

New CDC Report: Arizona Has Among the Lowest Childhood Immunization Rates in the U.S.

States (including Arizona) have vaccination requirements for school attendance. States report data to CDC on the number of children in kindergarten who are exempt from their state’s vaccine requirements. That data provides the best proxy we have for actual childhood immunization rates. CDC just released their latest analysis on national immunization rates (as measured by exemptions) this week… and it’s not a pretty picture for Arizona. Nationally, 2-dose MMR coverage was 93.1% while it is only 89.9% in Arizona. In fact, Arizona has among the lowest childhood vaccination rates in the U.S.

See: Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten — United States, 2022–23 School Year | MMWR

There are many reasons why vaccination rates can be poor. Part of it can be attributed to parental vaccine hesitancy and even politics (these days). Some are related to policy decisions. For example, states that only allow medical exemptions to school attendance requirements (no ‘personal exemptions’) have higher vaccination rates than those that allow for personal exemptions (like Arizona).

But much of it can be attributed to how easy or difficult it is for parents to vaccinate their kids. The more difficult/inconvenient it is to get your child vaccinated the more likely it is that they’ll remain unvaccinated.

Sadly. it’s has been getting harder and harder for parents to get their kids vaccinated in Arizona because so many doctor’s offices dropped out of the Vaccines for Children program.

The Vaccines for Children Program exists to make it convenient for families to get their kids vaccinated and to make sure kids whose parents don’t have health insurance can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States distribute them to physicians’ offices & clinics that take part in the VFC program. ADHS manages the VFC program in our state.

So how good of a job has Arizona been doing implementing the VFC program? Not very good. Arizona lost 50% of its VFC providers during the Ducey administration – going from 1,200 to 600… reducing access to vaccine and lowering childhood vaccination rates.

Arizona now only has 6 VFC providers per 10,000 Medicaid eligible kids, while the national average is 24 providers per 10,000 Medicaid kids… meaning Arizona only has 25% of the number of VFC providers per Medicaid enrolled kid compared with the national average.

Why the decline?

Providers who left VFC over the last few years say they quit because of the administrative hassles imposed on them by the state over the last 8 years (ADHS not AHCCCS). At the top of the list of grievances is ADHS’ punitive practice of financially punishing providers who have vaccine wastage rates over 5% making participation financially difficult (see this letter to AZAAP members regarding ADHS’ policy).

While it’ll be very difficult to bring back providers who’ve left the VFC program, there are immediate interventions that ADHS should take to stop the exodus more providers from the VFC program like immediately suspending vaccine restitution penalties for wastage rates over 5% pending the development of a new ADHS Restitution Policy and making sure remaining VFC providers know about the suspension of their punitive restitution penalties.

There will be many other recommendations coming out shortly in a report from the Arizona Partnership for Immunizations, but immediately suspending ADHS’ punishments is needed right now to stop even more providers from fleeing the coop.

November 27, 2023 Update: In the last couple of weeks, I’ve talked with a few persons in leadership at managed care and network plans who have reported that their network providers are no longer meeting AHCCCS’ quality metrics for childhood vaccinations.
They report that because many of their network providers have quit the VFC program and no longer vaccinate their child patients they are now sending parents to county health departments or WIC clinics. This increase in inconvenience for families is clearly damaging their HEDIS performance measures for vaccines, providing another metric point highlighting the erosion in VFC provider network because of punitive over-regulation is damaging childhood vaccination rates at the clinical and Plan level.
See AHCCCS Quality Metrics Report that demonstrates this phenomenon here: Immunization Metrics & Chart Showing AHCCCS’ Declining Kids Vaccination Rates
pecial Note: CDC DOES NOT require states to have a restitution policy regarding vaccine spoilage. ADHS elected to implement the restitution policy punishing practices.  See Page 80-86 of CDC’ VFC Operations Guide 2023 
AZ Vaccine Congress Meets RE Plummeting Provider Participation in the Vaccines for Children Program 
AZ Childhood Vaccination Rates Declined During the Ducey Administration: Is it Bad Luck or Bad Policy & Management?
Righting Arizona’s ‘Vaccines for Children’ Ship
Will Humble Assurance & Licensure, Wills Blog

House Committee on Abuse & Neglect of Vulnerable Adults Meets: Urges Policy & Operational Changes to Protect Vulnerable Adults

Once the formal legislative session ends, it’s generally pretty quiet down at the legislature. But from time to time there are various important hearings and meetings. For example, the House Committee on Abuse and Neglect of Vulnerable Adults met Wednesday to hear about the latest audit of the system that’s supposed to protect vulnerable adults.

It’s no secret that the system that’s supposed to protect vulnerable adults broke down during the previous administration…  as several reports from the Arizona Auditor General found large gaps in the performance of that safety net:

Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era

ADES’ Adult Protective Services Failed to Protect Vulnerable Adults During the Ducey Administration

Those first audits prompted the legislature to do an additional investigation into how state agencies ADES, ADHS & AHCCCS) handle and respond to reports of abuse and neglect.

I was unable to attend the meeting but watched the recorded hearing on the state legislature’s website.

The Committee heard first-hand about the findings of the most recent auditor general’s report including recommendations. The report outlines three main gaps in Arizona’s care system: a lack of strategic direction, an unclear case management process and the need to better engage patients and families. 

See the Report: Arizona Auditor General APS Audit

Three state agencies each play a role (and have a statutory duty) to protect vulnerable adults (ADES, ADHS & AHCCCS).

The report found AZ’s system “lacked direction” and conducts lengthy investigations that result in rates of substantiating abuse, neglect and exploitation that are “well below” national levels. 

For example, during the study period (during the Ducey Administration) APS substantiated less than 1% of reports of abuse and neglect compared with national substantiation rates of between 29% and 33%.

The report suggests it’s not just poor leadership and a lack of accountability that led to the scathing results in the report. Staffing levels appear to be one of the root causes. APS caseworkers managed an average of 58 cases per caseworker in fiscal year 2022 compared with best-practice standards of 25/caseworker.

I was encouraged to see ADES agree with the audit’s findings and submitted a detailed response agreeing to implement the auditor’s recommendations. Standard practice during the earlier administration was to dispute findings and ignore recommendations.

Tragedies at Arizona assisted living centers stir outrage (azcentral.com)

Heritage Village: Injuries, death at Mesa senior living center (azcentral.com)

Arizona senior living facilities are understaffed, endangering workers (azcentral.com)

Will Humble Public Health Law, Wills Blog

ASU Center for Public Health Law & Policy Updates Public Health Law Analysis

AzPHA member Jen Piatt and Senior Legal Researchers, Lauren Krumholz and Mary Saxon recently published a new SCOTUS Public Health Law Update which is available on the ASU Center for Public Health Law and Policy Website.

The document provides select synopses of cases, petitions, oral arguments, and other news before the U.S. Supreme Court with repercussions in public health law and policy. They’ll continue to post new editions each month through the end of the Court’s current term in June 2024, and summarize major SCOTUS public health law decisions in our annual review set for mid-July 2024. 

Will Humble Health Equity, Wills Blog

Benson Hospital Celebrates One-Year Anniversary of Groundbreaking Telehealth Cardiac Rehab Program

Benson Hospital marked the one-year anniversary of their Telehealth Cardiac Rehabilitation Program last week.

Rural Arizona faces challenges because of workforce shortages of healthcare providers of all kinds, including cardiology.  With many patients unable or unwilling to travel more than 30 miles to participate in rehabilitation, the Benson Hospital Telehealth Cardiac Rehab Program has been transformative. For those recovering from cardiac events, the burden of driving over 100 miles, twice a week for 16 weeks, has been eliminated, offering a lifeline to recovery and well-being.

In its inaugural year of operation, Benson Hospital’s Telehealth Cardiac Rehab Program, in collaboration with Tucson Medical Center, has provided an impressive 601 hours of cardiac rehab care, saving 60,000 patient travel miles and eliminating 1,200 hours of commute time (preventing 2,100 metric tons of carbon emissions).

AzPHA member Jason Zibart, Community Connected Health Manager at Benson Hospital says “The importance of this program cannot be overstated. By providing high-quality cardiac rehab close to home, we are not only enhancing patient care but also significantly reducing transportation insecurity issues, mileage, and missed work hours for our patients and their caregivers. It’s a game-changer in terms of access to vital cardiac rehabilitation services.”

Will Humble Uncategorized

Laws from 2023 Legislative Session Finally Take Effect

Arizona’s constitution says state laws don’t go into effect until 90 days after the end of a legislative session – unless the law contains an emergency clause and is approved by a supermajority of the legislature.

One of the reasons for the delay is to allow for a time period for voters to gather signatures to stop implementation of a law and refer it to the ballot.

For example, voters referred a universal school voucher bill to the ballot where it was resoundingly defeated. In 2022, the Legislature passed it again, but the referral effort failed to gather enough signatures to make it to the ballot, and we now have a universal voucher program that will be a primary reason why the upcoming legislative session will be so challenging (the voucher program is way over budget and has pushed Arizona into a deficit).

Hundreds of policy changes became law in Arizona last Monday.  Here’s where you can See the Slide Deck summarizing bills related to public health.

Will Humble Tobacco, Wills Blog

Tempe to Enforce Tobacco Age Requirement: Require Tobacco Vendor Licenses

Last week the Tempe City Council voted to implement a new policy that requires tobacco retailers to get a license from the city and comply with basic requirements to stay in good standing. An enforcement provision in the new law will allow the city to suspend or revoke the privilege license for noncompliance with basic standards including limiting sales to people 21 and up.

Tempe joins Tucson and Flagstaff – who already have licensing requirements for tobacco sales. The new law will take effect in May 2024.

Some on the Council wanted a ban on selling flavored tobacco products, but that provision was left out of the motion.  

Tempe votes to raise age to buy tobacco products (azcentral.com)

Will Humble Professional Development, Wills Blog

AzPHA Annual Members Meeting: Thursday, November 30

Thursday, November 30, 2023
12:00am – 1:30pm (Zoom)

Agenda

  • Welcome & Introductions
  • Approval of 2022 Business Meeting Minutes
  • Treasurer’s Report
  • Public Health Policy Committee Report
  • Professional Development Committee Report
  • Membership Committee Report
  • Community Health Justice Committee Report & Resolution: 
  • New AZPHA By-laws
  • Executive Director’s Report
  • Recognize Outgoing Board Members
  • Recognize New Incoming Board Members
  • Passing the Gavel & Remarks by Incoming President

Register Here

Meeting Zoom Link: https://us06web.zoom.us/j/83659992969 

Will Humble Behavioral Health, Wills Blog

Call to Action: Clean Up the AZ State Hospital Grounds

As I passed by the Arizona State Hospital this week, I again observed acres & acres of dead trees on the Hospital grounds. Hospital leadership apparently elected to stop watering the vegetation on the entire southern part of the hospital grounds some time ago, a reasonable decision.

But… leaving acres and acres of very large dead trees, some falling over & creating a community eyesore is disrespectful to patients, families and the community. It sends a message that they simply don’t care about the property, community or their patients. The Cemetary at the North end of the Hospital grounds also has many dead trees. Not very respectful to the families of the more than 2000 families with family members buried there.

See: Raising Phoenix: Buried Secrets at the Arizona State Hospital
History of ASH Cemetary Records by Paul Strickland March 1960

I urge ADHS & Arizona State Hospital leadership to clean up the property. Failure to do so reinforces a message that they simply don’t care about the hospital grounds or their patients.

Below are photos of the southern end of the property – which is located between 24th & 28th Streets along Van Buren – and the cemetery.

ASH: Several Dead Trees

ASH: Dead Large Tree Canopy

ASH: Dead Tree Falling Over

ASH Dead Trees in the Cemetary

ASH Cemetary Debris & Trash

PS: It shouldn’t take me to point this blight out & intervene – that’s the job of agency leadership
Note: City of Phoenix Neighborhood Preservation Ordinances require property owners to maintain their property free from dead vegetation which presents a blight upon the area. [Sec. 39-7(D): Exterior Premises and Vacant Land] See the Code Here: Chapter 39 Art. II Maintenance Standards | Phoenix City Code
Sec. 39-7(D): Weeds, Bushes, Trees and Other Vegetation
All exterior property areas shall be kept free from dry vegetation, tumbleweeds, weeds, bushes and tall grass and trees which present a visual blight upon the area, which may harbor insect or rodent infestations and dry vegetation, or which may likely become a fire hazard or result in a condition which may threaten the health and safety or the economic welfare of adjacent property owners or occupants.
The premises shall be free from visual blight; potential fire hazards; dead trees and branches; dead palm fronds within ten feet of the ground, a structure, a fence or wall, or of any combustible other than the tree from which the fronds have grown; lawn grass higher than six inches; tumbleweeds; or weeds higher than six inches tall.
Complaints can be filed with the City of Phoenix at: City of Phoenix Customer Service
Will Humble Behavioral Health, Wills Blog

Featured Editorial: Arizona’s Behavioral Health System and State Hospital Need Reform. Here’s How We Intend to Fix It

Democratic and Republican lawmaker are focusing on three reforms to address glaring problems in the state’s behavioral health system.

Senators Catherine Miranda and T.J. Shope:

The Arizona State Hospital provides critically important inpatient psychiatric care to people with mental illnesses who are under court order for treatment. 

Treatment at our state hospital is considered “the highest and most restrictive” level of care. Patients are admitted because of an inability to be treated in a community facility.

Over the last couple of years we’ve become increasingly concerned about shortcomings in Arizona’s behavioral health system, especially the system of care for folks with a serious mental illness.

Arizona State Hospital needs reform. Here’s how to do it.

After studying the problems and examining best practices, we’ve concluded that there are three major areas that need to be fixed during the upcoming legislative session:

  • Better oversight and governance of the Arizona State Hospital.
  • Improved community reintegration resources.
  • More secure residential treatment options.

State hospital needs better oversight

As we pointed out in an opinion piece back in July, we need to fix oversight of our Arizona State Hospital. A lack of independent oversight is putting lives at stake.

A root cause of the poor oversight (and resultant substandard care) is that the same agency runs and “regulates” the hospital — the Arizona Department of Health Services.

That’s a classic example of the fox watching the henhouse.

A top priority for us this upcoming legislative session will be to permanently fix this flawed oversight model by separating the state hospital from ADHS.

Under our bipartisan plan, the superintendent of the facility would report to an independent, appointed governing body composed of people with experience overseeing complex psychiatric facilities. ADHS would then be free to regulate the facility without the conflict of interest that has compromised oversight and care.

Hospital patients need better transitions

The state hospital doesn’t have a way to successfully discharge many patients, meaning many patients get stuck at the hospital even though they really should be transitioning to live more independently.

We propose developing a small “community reintegration” unit to serve as a transitional unit for patients who are approaching discharge from the state hospital but who still need structured care.

How a 1981 lawsuit: Changed mental health care in Arizona

This unit would be similar to the hospital but would offer more of a community-based treatment environment with physical and psychosocial health services and substance use disorder treatment.

We applaud the state hospital for highlighting this critical gap in its recent legislatively-mandated Clinical Improvement Plan.

Secured facilities must be built, staffed

Another critical gap is the lack of secure facilities where folks can receive more intensive care than they can get in Arizona’s existing residential behavioral group homes.

Some persons with a serious mental illness need a safe place to receive treatment but with more structure and better qualified staff than are available in existing residential behavioral health group homes.

The bipartisan budget that former Gov. Doug Ducey signed in 2022 included funds to build three such secure residential treatment facilities, including funding to staff them.

Sadly, those funds were swept out of the current budget.

We believe these facilities are critical and will insist that the funding is restored in next year’s budget.

We look forward to the Joint Legislative Psychiatric Hospital Review Council meetings this fall. We’re eager to share what we’ve learned about the shortcomings in Arizona’s health care system — and the importance of these three key interventions.

We hope the council meetings will serve as a springboard for bipartisan support to do right by folks with a serious mental illness, and their families.

Let’s do this.

Sen. Catherine Miranda is a Democrat representing Arizona Legislative District 11 in central and south Phoenix, and is a member of the Joint Legislative Psychiatric Hospital Review Council. Sen. T.J. Shope is a Republican representing Arizona Legislative District 16 in Pinal County and is chair of the Senate Health and Human Services Committee. On X, formerly Twitter: @CatherineSenate and @TJShope.

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