Shelby Disease Control

Data Are Rolling In Regarding the Effectiveness of Mitigation in Schools

WHAT ARE THE RESULTS?

A CDC MMWR released last week found that mitigation measures like masks and distancing were quite effective at slowing the spread of COVID-19 in schools. A new MMWR entitled Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools found that rates of COVID-19 were 37% lower in elementary schools that required teachers and staff to use masks, and 39% lower in schools that took steps to improve ventilation.

In schools that improved ventilation alone (e.g. open windows, fans), COVID-19 incidence was 35% lower. Schools that combined opening windows with filtration had a 48% reduction.

Another article in the journal Science entitled Household COVID-19 risk and in-person schooling found even more striking results.

Researchers found that school-based mitigation measures (when done properly and in tandem) reduce the spread of COVID-19 so much that it is statistically the same as going to distance learning. Here’s an excerpt from the article:

School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extracurricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed.

Teachers working in schools had an increased risk of COVID-19, but in schools implementing effective interventions, the risk was similar to that in other in-person occupations (e.g., health care or office work). Although in-person schooling was associated with household COVID-19 risk, the risk can likely be controlled with properly implemented school-based mitigation measures.

The most important school interventions were daily symptom checks, teacher masking, and closure of extracurricular activities.

This and future research regarding the effectiveness of school-based mitigation measures provides valuable information for school districts and parents this fall, especially for grades K-5 (right now the Pfizer vaccine is only authorized for kids 12 years old and up). The evidence in these articles suggest that implementing and adhering to targeted interventions can allow schools to safely stay in-person.

Shelby Uncategorized

June 2021 Arizona Screenings and Panel Discussion ERNIE & JOE: CRISIS COPS

Diverting community members away from jail and into mental health treatment, one 911 call at a time. That’s the focus of the Emmy-award winning documentary Ernie & Joe: Crisis Cops.

Vitalyst Health Foundation, The David & Lura Lovell Foundation, and The NARBHA Institute have partnered to bring this powerful film back to Arizona in June for a series of screenings.

Leaders and individuals from law enforcement, the fire service, emergency medical services, emergency dispatch, behavioral health services, and community members are invited to register now for a free regional screening.

HBO has captured the San Antonio Police Department’s pioneering crisis intervention approach in an Emmy Award-winning documentary, and Vitalyst is pleased to be offering free virtual screenings.

By region, the Zoom-based “Ernie & Joe Crisis Cops” events will span the month of June, starting with Maricopa County’s screening on June 3. The screenings are open to leaders and individuals from law enforcement, the fire service, emergency medical services, emergency dispatch, and behavioral health services. The abridged, 35-minute screening will be followed by a live panel Q&A.

As communities reckon with the behavioral health impacts of the pandemic and more, the work modeled by Ernie and Joe in this documentary is more important than ever. All Arizonans are encouraged to view the full documentary via HBO, and our first responders are urged to click here to register today for their free regional screening events. See below for more information about the upcoming screenings and to register:

Contact: hello@kominote.org with any questions.

Shelby Behavioral Health, Opioids, Prevention, Public Health

Syringe Services & Fentanyl Test Strips Finally Legalized

The opioid epidemic is one of the greatest public health crises of our time. The causes of are deep and the public health interventions needed to ease the crisis are many. Those interventions include changes to prescribing practices, distribution of naloxone, more robust treatment options including Medically Assisted Treatment, and harm reduction and engagement strategies like Syringe Services.

We need all those tools working together to mount an effective response. Arizona’s Opioid Epidemic Act was an important law that is addressed many of those factors- but not all. Things that weren’t included in the Act (despite strident advocacy by numerous organizations including AzPHA) include decriminalizing syringe service programs and legalizing fentanyl testing strips.

As this 2019 report by Stephanie Innes in the Arizona Republic shows, needle exchange efforts in Arizona have been impaired because some of the things that syringe service programs do had been felonies under state law.

Syringe services programs are community-based prevention efforts that offer a range of interventions. They provide access to and disposal of sterile syringes and injection equipment, linkage to substance use disorder treatment, and naloxone distribution. People who use syringe service programs gain access to other vital services including vaccination, testing, and linkage to care and treatment for infectious diseases including viral hepatitis and HIV.

Nearly 30 years of research shows that comprehensive syringe service programs are safe, effective, and reduce overall health costs. They play an important role in reducing the transmission of viral hepatitis, HIV, and other infections and are a major component of the Ending the HIV Epidemic: A Plan for America initiative.

The U.S. Surgeon General determined that syringe service programs don’t increase the illegal use of drugs by injection. Studies also show that they protect the public and first responders by providing safe needle disposal.

Sadly, syringe service and fentanyl test strips have been considered drug paraphernalia under Arizona law (a class 6 felony). While arrests, indictments and convictions of workers that operate syringe service programs have been rare, the fact that syringe service programs are illegal has had a chilling effect on the ability of organizations and individuals to operate and fund these important programs.

After all- it’s pretty hard to get a grant award if you need to disclose to the funder that you intend to commit felonies with the money! A cohort of public health organizations led by Sonoran Prevention Works have been trying for the last 4 years to simply decriminalize syringe service programs & legalize fentanyl test strips.

This year those efforts were finally successful.

The governor signed SB1250 overdose prevention which makes it legal for cities, towns, counties, and NGOs to implement a syringe service programs. While the state still can’t technically operate a syringe exchange program, there’s no restriction on the state funding syringe service programs with the copious money on the way from the American Rescue Act Plan.

The governor also signed SB1486 drug paraphernalia, testing equipment sponsored by Senator Marsh. This bill (once it becomes law 90 days after the end of session) will make it possible for folks to buy fentanyl test strips to make sure that any drug they have is free from fentanyl. Fentanyl has become the dominant cause of opioid deaths in the last few years and is rapidly increasing (see Figure 14 in our landmark (opioid epidemiology report).

NEW OPPORTUNITIES

Making syringe service and fentanyl test strips legal provides a big opportunity for AHCCCS, ADHS and the county health departments to fund syringe service and fentanyl test strip programs.

Because of the American Rescue Plan Act, there are more resources than ever to implement these programs. SAHMSA’s Community Mental Health Services Block Grant Program and Substance Abuse Prevention and Treatment Block Grant Program will be dispersing $1.5B to states in the next 2 years.

These supplemental funding awards are in addition to the usual $2.5B award. Here’s a press release and information on the supplemental awards. Arizona’s share of the pie is about $80M!

Back in the day, these SAHMSA substance abuse funds were managed by the ADHS. These days they’re managed by AHCCCS’ Substance Abuse Prevention and Treatment Block Grant.: FY 2021 Substance Abuse Prevention and Treatment Block Grant Program American Rescue Plan Supplemental Awards.

The combination of the passage of these important new laws and the substantial increase in funding from the American Rescue Plan Act provide a terrific opportunity to implement both of these evidence based best practices in a big way.

Shelby Community Health Workers, Medicaid, Prevention, Social Determinants, Vaccination

UA Mobile Health Units Provide Great Partnering Opportunity for County Health Departments

The UA’s Mel & Enid Zuckerman College of Public Health has Primary Prevention Mobile Health Units that have been administering vaccine and doing preventive health screenings in rural & underserved Arizona communities in partnership with local health departments and organizations.

The mobile health units have served Arizona communities since 2016 and maintain close relationships with local communities. They’re  currently collaborating with Cochise, Santa Cruz, and Maricopa County health departments, Sunlife, and Chicanos por la Causa to distribute COVID-19 vaccine and are enthusiastic to expand partnerships to additional local health departments, FQHCs, other community based organizations.

Their teams are flexible, bilingual, and driven by local health department and community priorities. The units can arrive at a site anytime – e.g. early in the morning, weekends, evenings. Team members are trained to address vaccine hesitancy by tailoring conversations to address individual concerns.

The Team collaborates with health department and community partners to host mobile vaccine events in farming communities, senior housing complexes, community centers, schools, long-term care facilities, and other locations.

The teams are comprised of health sciences staff, students and volunteers with faculty oversight. Many staff, students and volunteers have strong ties to rural communities and are eager to work in partnership with their local health departments to expand vaccine access throughout rural Arizona.

There’s no cost to the county health department. This is a major win for health departments in the continued critical effort to get our most vulnerable vaccinated!

If your health department has not already, contact Dr. Cecilia Rosales at crosales@arizona.edu and her team will work with you to get the mobile health units out to your county quickly!

Shelby Public Health, Return on Investment, Suicide Prevention

Governor Vetoes $15M in Funding for Research & Public Health Prevention

INVESTMENTS WOULD HAVE COME FROM EXCESS MONEY IN THE MEDICAL MARIJUANA FUND

Actions speak volumes, don’t they? Well, the Governor showed his true colors when it comes to investing in public health when he vetoed more than $15M in public health prevention programs for things like suicide prevention, health issues and communities affected by drug addiction and incarceration, and medical student loans with a focus on psychiatry.

All of the money would have come from excess funds in the Medical Marijuana Fund that are there because of my mistake.

When the Arizona Medical Marijuana Act passed back in 2010 I set the card fee at $150/year ($75/year for folks that qualify for SNAP) which turned out to be way too high. I anticipated that we’d have about 40,000 card holders, not hundreds of thousands. As a result, the Medical Marijuana Fund now has almost $100,000,000 in it, far more than is needed to administer the program.

The governor’s veto of SB1408 stopped more than $15M from going to various public health and research programs. Governor Ducey’s veto scuttled a golden opportunity to use some of the excess money in the fund for worthy causes. Instead, the Fund will continue to lie dormant and important public health interventions unaddressed.

The bill would have required ADHS to provide grant monies from the Fund for a host of good causes, including:

  • $5,000,000 to the county public health departments to address public health issues related to drug addiction and incarceration;

  • $2,000,000 to the Institute for Mental Health Research for research to improve mental health services, research and education;

  • $2,000,000 to the Primary Care Provider Loan Repayment Program & the Rural Private Primary Care Provider Loan Repayment Program (prioritizing providers in behavioral health);

  • $2,000,000 to the Board of Medical Student Loans with a focus on psychiatry or other areas of practice;

  • $1,250,000 to ADHS for suicide prevention;

  • $1,250,000 to the AHCCCS for suicide prevention;

  • $1,000,000 for the health care directives registry; and

  • $250,000 to the ADHS’ Arizona Biomedical Research Commission for research the correlation between marijuana use and mental illness.

Sadly, none of these research and intervention opportunities will be happening now that the governor vetoed the bill.

Shelby Community Health Workers

An Open Letter from AzPHA’s Community Health Justice Committee

The JAMA podcast and its aftermath raise questions of the knowledge and attitude of physicians, public health practitioners and institutions regarding health disparities and racism in healthcare. Being unaware or ignoring the social, political and historical factors that impact health outcomes today is malefic to improving health equity.

In advertising the podcast, JAMA’s former editor said, “No physician is racist, so how can there be structural racism in healthcare?” This uninformed and biased viewpoint negates the lived experiences of many consumers of healthcare.

JAMA’s podcast (now removed from the site) further suggested that pointing to systemic racism as the root cause of health disparities is divisive. This ignores the scientific basis laid out in the body of research on health disparities.

Furthermore, to maintain that mentioning the role of racism in health disparities could be disruptive or divisive is bound to stifle the speech of those working in public health who strive to highlight the scientific knowledge and advocate for justice.

Comprehending systemic racism as a root cause of health disparities is a rich paradigm that can lead to more integrated public policy solutions. Policy solutions should be evidence-based, culturally responsive and rely on the existing research.

We call upon all health institutions and personnel, especially those who serve marginalized communities, to:

  1. Educate themselves and their staff comprehensively on the issue of structural racism and health disparities,

  2. Ensure their staff can discuss the evidence basis openly and without fear of reprisals, and

  3. Institute cultural humility advocacy learning beyond cultural competency and unconscious bias training.

Learn more here.

– AzPHA’s Community Health Justice Committee

Shelby Behavioral Health

Ducey Whimsically Vetoes Important Governance Bills

In other irresponsible actions, the governor also vetoed two bills that would have helped governance of important state government functions. Both bills are low profile but important. Both got unanimous support from the legislature.

Vetoed: Better Oversight at the Arizona State Hospital

SB1716 would have provided for some badly needed additional oversight at the Arizona State Hospital (ASH). The ADHS both runs and regulates ASH. That lack of check and balance creates a ‘fox watching the henhouse’ situation in which the ADHS Director can send the message to her or his licensing team to ‘go easy’ on ASH or send in rookie inspectors that are unlikely to find deficiencies or substantiate complaints.

The bill that he vetoed would have made some modest reform that would have helped with oversight some (although far less reform than is needed).

The bill would have required the ADHS to add information in their reports about certain patient information and information on admission by civil commitment.  It would have also forced the ADHS to buy a surveillance system at ASH that has audio and visual capability and adequate storage.

The original bill would have created a badly needed independent Governing Board, but pressure from the ADHS resulted in an amendment that removed that provision.

I think Director Christ and Governor Ducey like things just the way they are…  a status quo scenario in which there is little accountability because the ADHS both runs and ‘regulates’ ASH.

Vetoed: Needed Reform of the Psychiatric Security Review Board

For the last 25 years persons that have been determined by the courts to be ‘guilty except insane’ (GEI) of a crime are placed under the jurisdiction of the Psychiatric Security Review Board housed at the ADHS. The PSRB maintains jurisdiction for the length of their presumptive sentence while they are committed at the Arizona State Hospital’s Forensic Unit (operated by the Arizona Department of Health Services).

The PSRB decides whether to release any person determined to be GEI person from ASH to the community if the they meets statutory release criteria (A.R.S. § 13-502). A big problem has been that the PSRB doesn’t have nearly enough resources to properly carry out their function and as a result due process suffers.

SB 1030 (which the governor vetoed last week) would have moved the PSRB responsibilities to the superior court in 2023, which is in a MUCH better position to make these decisions. The bill also makes important reforms of practices and the procedures of the PSRB.

This is a complex issue and many people spent countless hours working out the details of how to provide better governance of GEI system. The bill passed with unanimous support.

Nevertheless, the bill fell victim to a whimsical governor who is more interested in posturing than good public policy.

Shelby Marijuana, Social Determinants

Ground Rules for “Social Equity” Adult Use Marijuana Stores Set

SEE OUR POWERPOINT SUMMARIZING THE FINAL REGULATIONS

The authors of the Smart and Safe Arizona Act (aka Adult Use Marijuana) included an opportunity for persons “ from communities disproportionately impacted by the enforcement of previous marijuana laws” to be able to compete for 26 new licenses to own and operate a “marijuana establishment”.

Today the ADHS released the final criteria that they’ll use to decide who qualifies to apply for these new coveted licenses. In a nutshell, the new rules require that applicants meet 3 of the 4 following criteria in order to apply for one of these potentially lucrative licenses:

  1. Had a household income of less than 400% of the federal (HHS) poverty level in 3 of the last 5 years;

  2. Convicted of and eligible for expungement of eligible for possession of marijuana under A.R.S 36-2862 (less than 2.5 oz of Cannabis);

  3. Have a spouse, surviving spouse, parent, child, sibling or legal guardian who was convicted of a violation of federal or state laws related to marijuana or marijuana paraphernalia;

  4. Have lived in a “community that has been disproportionately affected by the enforcement of Arizona’s previous marijuana laws” in 3 of the last 5 years. (These criteria have yet to be developed and will be added in a subsequent iteration of the rules).

Principal officers & board member applicants cannot have an “A.R.S. § 36-2801 felony offense (with some exceptions – see the PowerPoint).

Applications would be accepted during the first 2 weeks of this December and would be awarded by the end of the year.

In addition to complying with all other requirements for operating a marijuana establishment, social equity licensees must show how they’ll help communities disproportionately affected by Arizona’s marijuana laws through either specific hiring or interning practices or by donating some of their profits to community organizations that focus on social or health inequities in the community.

The Marijuana Industry Trade Association will be holding a webinar this Friday from 3-5pm to explain the latest draft regulations. It’s free and you can join here.

SEE OUR POWERPOINT SUMMARIZING THE FINAL REGULATIONS

Editorial Note: Many states have attempted to put together social equity license programs as part of adult use marijuana laws. Most attempts have been largely unsuccessful and subject to intense criticism by the very communities that were supposed to be helping. Many of those programs were overly complex and relied on subjective qualifying criteria.

In my opinion, the ADHS rules have a decent chance at being successful where other programs have failed. The selection criteria are thoughtful, relevant, objective and verifiable. Well done in my opinion. It’s important to give credit where credit is due.

Shelby Vaccination

Updated Pfizer-BioNTech COVID-19 Vaccine Storage Guidelines

FDA has authorized undiluted, thawed Pfizer-BioNTech COVID-19 vaccine vials to be stored in the refrigerator at 2°C to 8°C (35°F to 46°F) for up to one month. This is a change from previous guidance which stated that thawed, undiluted vaccine vials could be stored in the refrigerator for up to five days. See the factsheet for healthcare providers administering vaccine for more information. This will make it easier for doctors offices to order and administer the Pfizer vaccine.

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New MMWR: The ACIP’ Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine in Adolescents Aged 12–15 Years Weekly / May 21, 2021 / 70(20);749–752

Shelby Public Health

2021 AzPHA Annual Conference Looking to the Future: Arizona’s Public Health & Healthcare Workforce

REGISTER TODAY!

ARIZONA PUBLIC HEALTH ASSOCIATION 2021 ANNUAL CONFERENCE

IN PERSON: DESERT WILLOW CONFERENCE CENTER

4340 E Cotton Center Blvd, Phoenix, AZ 85040

Thursday, August 26, 2021

8:30am – 5pm

VIEW OUR AGENDA

REGISTER HERE

 SPONSORSHIP OPPORTUNITIES

The COVID-19 pandemic has created an upheaval in Arizona’s public health and healthcare systems. Amid the pandemic, healthcare workers struggled to provide an optimal standard of care for their patients. Public health workers at the state, county and community level worked tirelessly to implement evidence-based interventions amid resource constraints and occasional resistance from elected and appointed officials.

Disruptions to the public health and healthcare systems also resulted in new and creative approaches to respond to this unprecedented public health crisis. County health departments and community-based organizations found new ways to leverage community health workers.

Telehealth was unleashed as a key intervention to safely provide care. Creative solutions to new problems were identified and implemented on an almost daily basis.

The pandemic also posed new challenges that still need to be met. Children missed out on well-child visits and fell behind on immunizations. Pre-existing health equity problems became more acute. Exhausted workers in both sectors sometimes began exploring alternative career paths.

As we emerge from the COVID-19 crisis in Arizona, there is room for optimism. Unprecedented funding from the American Rescue Plan Act will infuse funding across a host of sectors that can be used to improve the social determinants of health.

More than $43M will be arriving in Arizona over the next two years to recruit, train and hire public health workers. Plans are underway to improve clinical rotation opportunities and training center locations. New efforts are underway to build more under-represented populations into the healthcare workforce.

Join us on Thursday, August 26, 2021 in person at the Desert Willow Conference Center in Phoenix as we explore these topics and more including updates from county health officials about their post-pandemic workforce needs and hear from our state and regional Area Health Education Centers as they develop plans to meet Arizona’s post-pandemic public health and healthcare system needs!

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