Call for Oral Presentations: AZPHA Annual Conference | “Addressing the Opioid Crisis in Arizona”

 Desert Willow Conference Center |  Leap Day: 2/29/2024

Thank you for your interest in presenting your work at the 2024 – Arizona Public Health Association Annual Conference, which will take place on February 29, 2024, at Desert Willow Conference Center in Phoenix, Arizona: “Addressing the Opioid Crisis in Arizona

We are seeking proposals presenting cross-sector collaboration initiatives relating to the opioid crisis addressing prevention, intervention, treatment, and harm reduction through various lens of service, support, and collaboration.

Presentations may highlight interventions using OneArizona opioid settlement funding, community  coalition efforts, initiatives based on best practices (i.e. Strategic Prevention Framework)/promising practices, municipal engagement, and other relevant efforts.

Submit Your Proposal Here

You may propose a solo presenter or as a team. The breakout sessions will be 45 minutes, there will be a morning and an afternoon session. We will be able to confirm your session time once we have finalized all the breakout sessions. Plan on attending the full conference. Depending on your selection, you may be asked to present twice.

Presenting teams: Please identify the primary presenter for your team presentation. This individual will communicate conference-related information with the rest of the team.

If you are submitting this proposal as part of a team, please confirm the following before applying:

  • Proposed speakers have agreed to participate.
  • Proposed speakers will be available on Thursday, February 29, 2024
Deadline for submission is January 2, 2024

We look forward to reviewing your proposal for the 2023 AZPHA Annual Conference!

Submit Your Proposal!

Dr. Marcy Flanagan Tapped as Deputy Maricopa County Manager; Jeanene Fowler to Serve as Interim Maricopa County Public Health Department Director

Congrats to AzPHA member Dr. Marcy Flanagan who has been appointed as a Deputy County Manager for Maricopa County government. For the last several years Dr. Flanagan has been serving as the director for the Maricopa County Department of Public Health. Marcy also served as the director of the Pima County Health Department for several years.

Marcy is a veteran public health practitioner with more than 23 years of public health work behind her.  She’s been a champion for the thousands of Pima and Maricopa County residents her agencies have served.

In addition to being a member of AzPHA, she’s a member of the APHA and serves on the Metropolitan Education Commission and National Association of City and County Health Officials. She has also been the President of the Arizona Association of Local Health Officers Association.

Marcy grew up in a small farm town in Michigan and came to Arizona for her freshman year of high school. After graduating from Paradise Valley High School, she moved to Tucson to attend the U of A. She fell in love with Arizona and has lived here ever since.

Outside of spending time with her family, she loves reading, going to the movies, walking in Reid Park, golfing, and taking girl trips with her friends. Marcy earned a BS in Sociology from the U of A and a master’s in administration from NAU. She also earned a Ph.D. in Business Administration Leadership from Walden University.

AzPHA is delighted to have Marcy in her important leadership position within Arizona’s public health system!

Jeanene Fowler will now serve as the Interim Director of Maricopa County Department of Public Health. Jeanene is a household name in Arizona’s public health world, a nearly 20-year veteran of Maricopa County Department of Public Health, the 3rd largest health jurisdiction in the U.S.  With a background in marketing & communications, she started her service in 2005 as the Public Information Officer.

This position laid a solid foundation in learning public health programming as well as the principles of risk communications allowing her to flourish into a true public health practitioner. Since then, she has served in roles that included Public Information Supervisor, Program Operation Administrator and most recently, Assistant Director.

Throughout the years, Jeanene has held leadership roles in MCDPH’s response to numerous emergencies such as H1N1 and COVID 19. She has had the opportunity to help the agency in becoming an accredited health department and also growing its capacity by completing numerous county-wide community health needs assessments. Over the last few years, much of her work has been focused on leading the department’s effort with developing and implementing a strategic plan focused on combatting the issue of substance use and misuse.

A native of Massachusetts, Jeanene has called Arizona home for more than 25 years. She is a proud graduate of Syracuse University with a degree in marketing and public relations. Please join us in welcoming Jeanene in her new interim role as Maricopa County’s Director of Public Health…  a role that she has earned after more than two decades in public health in leadership positions!

Solid choices by the Maricopa County Board of Supervisors & County Manager Jen Pokorski!

Valleywise Turns the Key on ‘First Episode’ Centers

What is the First Episode Center?

An innovative treatment and support program that serves adolescents and young adults who are experiencing psychosis.   Research shows that seeking treatment early will improve life overall and help the young person achieve their life goals.  The sooner care is sought, the sooner a person will feel better.

Adolescent and Teen Psychosis | Valleywise Health

How does the First Episode Center work?

The FEC uses evidence-based practices to provide a comprehensive array of recovery-oriented services over a period of about 5 years from the onset of symptoms. 

They use a team approach to assist a person and their family in a time efficient manner, eliminating long delays between onset of experiences and engagement in effective treatment.

Who is the First Episode Center for?

  • Adolescents and young adults age 15-25
  • People who experience:
    • unusual thoughts or behaviors that seem strange to themselves or others
    • becoming fearful or suspicious
    • hearing voices or seeing things others don’t
    • withdrawing from family and friends
  • People who want help to recovery from psychosis to help achieve their life goals for school, work, family, and relationships

What services are provided at the First Episode Center?

  • Recovery Coaching and Peer Support
  • Individualized Goal Setting
  • School and Employment Support
  • Family Education and Support
  • Individual, Group, and Family Therapy, including Cognitive Enhancement Therapy, Cognitive Behavioral Therapy
  • Medication Treatment if a person and their doctor decides it is needed.

Recovery

Recovery is different for each person and can vary depending on many factors.  The First Episode Center believes everyone can and will recover to lead a full and meaningful life.  

  • Movement toward important personal life goals
  • Building connections in the community, including school, work, social activities, hobbies, volunteer work, and fun
  • Improved relationships with family, friends, and any significant supports in one’s life
  • Reduction in experiences and roadblocks that prevent pursuing life goals
  • Feeling more hopeful about the future

This center has an Valleywise Health primary care and dental clinic, where preventative and regular medical care are available.  There is also a First Things First Family Resource Center, to support parents and families to learn, grow, and thrive.

Adolescent and Teen Psychosis | Valleywise Health

Arizona Supreme Court to Decide the Fate of Abortion Care in AZ: Oral Arguments Tuesday, December 12

Now that the U.S. Supreme Court removed constitutional protections for abortion rights the question becomes… what’s the law of the land in Arizona?

The answer to that question hinged on whether SB1164 (restricting abortions to the first 15 weeks’ gestation) is the law of the land or whether the territorial-era law [ARS 13-3603] takes precedence as well as whether ARS 13-3603 is found to be unconstitutional on grounds other than those covered in the Dobbs decision.

During the summer of 2022 Attorney General Brnovich moved to begin implementation of the abortion ban in ARS 13-3603 by filing a motion in Pima County Superior Court to remove the injunction from the Nelson v. Planned Parenthood Center of Tucson case.

On September 22, 2022, Pima County Superior Court Judge Kellie Johnson ordered the lifting of the injunction in the Nelson v. PP case. In her decision she dismissed the relevance of the new law limiting abortions to those at less than 15 weeks of gestation because the state legislature included in the session law that the 15-week gestation age limitation does not “… repeal by implication or otherwise Section 13-3603 or any other applicable state law regulating or restricting abortion.”

By lifting the injunction, Judge Johnson turned the clock back to January 1973 when abortions were illegal to perform “… unless it is necessary to save her (the patient’s) life.”

From September 23 to December 30, 2022, any clinician in Arizona who performed an abortion (whether medication or surgical) that is not necessary to save the life of the patient could have been an be charged with and convicted of a violation of ARS 13-3603 and if found guilty, punished with between 2 and 5 years in the state penitentiary.

Planned Parenthood appealed to the Superior Court ruling, and on December 30, 2022, held that doctors can’t be prosecuted for performing abortions because other Arizona laws passed over the years allow them to perform the procedure. See the appellate court ruling.

The ruling from the three-member Court of Appeals panel temporarily cleared up two months of controversy, and abortion care providers were again allowed to provide abortion care up to 15 weeks of gestation (beginning December 30, 2022).

The intervening plaintiffs in the case (the Alliance Defending Freedom & Yavapai County Attorney Dennis McGrane) appealed the appellate court ruling to the Arizona Supreme Court, who agreed to hear the case, with oral arguments on December 12, 2023. Meet The Justices who will decide the case (note that Justice Montgomery has recused himself because of his historic actions and statements opposing abortion care).

Note: Attorney General Mayes and Pima County Attorney Conover are not defending the territorial-era ban, which is why the Alliance Defending Freedom and McGrane are called ‘intervenor plaintiffs.

A decision by the Arizona Supreme Court could take weeks or even months.

The AZ Supreme Court could uphold the Court of Appeals ruling that abortion is legal up to 15 weeks, they could agree with the Superior Court ruling that abortion is illegal except when the mother’s life is in danger, or they could come up with some other hybrid ruling.

In the meantime, a voter initiative changing the Arizona Constitution guaranteeing the right to abortion services is gathering signatures for the 2024 ballot. The signature gathering effort is being organized by Arizona for Abortion Access. The campaign must collect 383,923 valid signatures from Arizona voters by July 3, 2024. If the organizers are able to collect the required valid signatures, and if the initiative survives the inevitable legal challenges to keep it off the ballot, Arizona voters would have an opportunity make abortion care (up to the point of viability) a constitutional right in Arizona regardless of how the Arizona Supreme Court rules in the coming weeks.

Note: The Arizona Supreme Court may decide abortion is illegal except to save the life of the mother in the coming weeks. If that were to happen, Arizona women would again be forced to seek abortion care in neighboring states like California, Nevada, New Mexico, or Colorado, all of which allow abortion services.

See Our Comprehensive Report:

Women’s Reproductive Rights in Arizona: 1864-2023

Is the Rural Physician Workforce Production Act of 2023 A Policy Answer to Arizona’s Physician Shortage?

Rural Arizonans face challenges accessing that care, including getting routine check-ups or seeing a specialist, and the problem has been getting worse year after year.

We’ve written several blogs about the policy interventions that would help improve access to care such as building more residency programs in rural Arizona – especially those in primary care and family medicine. Ideal locations for those are at the many Federally Qualified Health Centers in AZ in association with their local hospitals.

But providing financial incentives remains a key…  and has yet to be addressed. A shovel ready bill is sitting in the hopper in Congress called the Rural Physician Workforce Production Act of 2023.

The Rural Physician Workforce Production Act lifts the current cap on Medicare reimbursement payments to rural hospitals that cover the cost of taking on residents, helping to alleviate the serious disadvantage that rural hospitals face when recruiting new medical professionals.

The bill would also allow Medicare to reimburse urban hospitals that send residents to train at rural health care facilities during a resident rotation, and it would set up a per resident payment initiative to ensure rural hospitals have the resources to bring on added residents.

Last week Representative Ruben Gallego announced his support for the Rural Physician Workforce Production Act of 2023. Let’s hope thew rest of Arizona’s delegation gets on board too!

AZ Grant Opportunity Update

Nonprofits have a unique ability to engage in developing meaningful public policy that builds healthier communities. This can range from sharing of information to conducting research to grassroots or direct lobbying.

Vitalyst keeps running tabs on lots of grant opportunities to help nonprofits etc. stay informed about the possibilities. Below is their latest compiled list:

NEW Due December 5th: WITH Grant

Due December 7th: Agriculture and Food Research Initiative Competitive Grants Program Education and Workforce Development

Due December 7th: Seventh Generation Fund for Indigenous People

NEW Due December 12th: State of Housing Trust Fund NOFA – 4% Projects without prior ADOH gap financing

Due December 12th: Teaching Health Center Planning and Development Program

Due December 13th: State Primary Care Offices

Due December 14th: Eliminating Disparities in Perinatal Health

Due December 15th: Sundt Foundation Grant

Due December 15th: Nonprofit Security Grant Program (NSGP)

Due December 16th: Nina Mason Pulliam Charitable Trust funds – Helping People in Need, Protecting Animals and Nature, & Enriching Community Life

Due December 17th: Justice Reinvestment Grants for Maricopa County

Due December 17th: Resident Opportunity and Self-Sufficiency (ROSS) Service Coordinator Program

Due December 19th: State of Housing Trust Fund NOFA – 4% LIHTC Projects seeking additional gap financing for cost overruns

Due December 21st: Suicide Prevention Capacity Building

Due December 31st: Yavapai County – Industrial Development Authority Grant

Due December 31st: Honor the Earth

Schools Offered Free COVID Tests

The U.S. Department of Education & HHS have a program in which school districts can get rapid antigen COVID-19 self-tests free of charge for their students.  Interested school districts should choose a Primary Contact who will oversee determining the number of self-test kits to order, how frequently, and where the self-test kits should be delivered.  

Primary Contacts should populate the fields below using information from the Department’s National Center for Educational Statistics (NCES) website – https://nces.ed.gov/ccd/districtsearch/.

AHCCCS Requests Federal Authority To Expand Eligibility for KidsCare

Nearly 10,000 More Children Could Become Eligible for Coverage

In 2023, the Arizona Legislature passed, and Governor Hobbs signed, a bill to increase the income limit for KidsCare eligibility to 225% of the federal poverty level. If approved by CMS, Arizona could enroll nearly 10,000 more children in KidsCare. The current income limit is capped at 200% of the federal poverty level.

The Federal Comment Period which is open through Dec. 20. While waiver approval can be a lengthy and complex process, AHCCCS and CMS are committed to working as quickly as possible to implement the new income limit in early 2024.

AHCCCS included the public comments it had received on the proposal in the waiver amendment submission package and will continue to accept comments through Dec. 27, 2023.

Interested stakeholders can submit public comments to AHCCCS by email at waiverpublicinput@azahcccs.gov or to CMS through the Federal Public Comment Register.

Read the proposal and additional details on the KidsCare Expansion web page.

Are We Finally Turning the Corner on Arizona’s Decaying Childhood Vaccination Network?

A recent report from the CDC found Arizona has among the lowest childhood vaccination rates in the U.S. (as measured by school vaccine exemption rates). There are many reasons why vaccination rates can be poor. Part of it can be attributed to parental vaccine hesitancy & the anti-vax movement. 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 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, leaving parents scrambling to get their kids vaccinated.

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 have anecdotally said they quit because of the administrative hassles imposed on them by the state over the last 8 years. At the top of the list of grievances is ADHS’ punitive practice of financially punishing providers who have discrepancies in their vaccine inventories.

Stakeholders from several organizations including AZPHA had been pressing ADHS’ Vaccine for Children program to make policy, regulation, and tone adjustments over the last several years, to no avail.

Finally, the Maricopa County Department of Public Health contracted with The Arizona Partnership for Immunizations to study this issue and prepare a report describing the facilitators and challenges to participating in the VFC program from healthcare providers’ perspectives, as well as recommendations for reversing this course. TAPI hired OMNI Institute, a social sciences non-profit consultancy to conduct this assessment.

That report, entitled An Assessment of the Facilitators & Challenges Providing-Vaccine in Arizona was released Monday evening. The 96-page report has many findings. A common theme as presented in the Executive Summary:

“Respondents expressed frustration with the complexity surrounding ordering and returning vaccines, the challenges integrating practice electronic medical record systems with the Arizona State Immunization Information System and the administrative burdens regarding compliance and reconciliation.”

“When asked about the significant challenges/barriers to their continued participation in the VFC program, a common theme respondents raised was an adversarial tone in the enforcement of VFC policies and communications, with administrative errors (some of which stemmed from ASIIS) often being met with accusations of fraud and/or wastage. Many non-VFC providers pointed to administrative burdens, expensive charges to rectify incorrect dose counts, and a generally punitive tone from the VFC program as rationales for their non-participation.”

Read the Report

The response from MCDPH Director, Marcy Flanagan, painted an optimistic assessment of the chances that ADHS will implement some of the recommendations in the report:

“The results of this assessment help to paint a picture of opportunity. Opportunity to look at each spoke in this very complicated vaccine delivery system and address how it could be done more efficiently and effectively for all parties involved. With so many of the spokes leading to federal and state regulation, it made sense that many of the recommendations cited in the report looked at system improvements.

“In the spirit of continuous quality improvement, MCDPH leadership sat down and talked with the Arizona Department of Health Services leadership about this assessment and potential areas of improvement. ADHS listened intently and asked questions as we explained concerns cited in the report. They agreed that a deeper dive into the system and the policies that make up the system made sense. In fact, an immediate response from ADHS was to host a working group made up of providers and partners to dig into some of the challenges brought forth in this report. This is a great first step.”

The next several weeks will be critical. ADHS is in the process of hiring a new leader for their Immunizations program. The quality and professional outlook of the candidate they hire will be critical to implementing the recommendations in the report.

The ADHS Director/CEO has also promised to “… convene a workgroup of providers and partners to review current policies and practices and collaboratively determine changes to improve the provider experience within the program.” Interested parties can contact the Director’s Office at andrea.schoenecker@azdhs.gov.

As for the dose-for-dose restitution policy at the core of many of the findings in the report…  ADHS says they don’t intend to enforce the policy while they: ”…work with partners on the best approach to vaccine management.” The policy will nevertheless stay on the books while it’s enforcement will be ‘paused’ – even though CDC’s official Operational Guide DOES NOT require states to have a vaccine restitution policy.  See Page 80-86 of CDC’ VFC Operations Guide 2023 

As for me…  I’m reminded of the old proverb: “Trust, but verify.”

 

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

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

Arizona Nursing Home COVID Booster Vaccination Rates Lowest in the U.S.

CDC recently updated their dashboard of COVID vax booster rates among nursing home staff & residents: Nursing Home COVID-19 Vaccination Data Dashboard | NHSN | CDC (arguably the most important population groups to be vaccinated). 

Arizona has the lowest nursing home resident COVID booster vaccination rate in the entire country (8.3%) – much lower than even the deep south and West Virginia. Same goes for nursing home staff (1.2%) – although the vax rates for staff are bad throughout the whole country.

The intervention? The ADHS licensing rules we published in 2014 require nursing homes to offer in house influenza and pneumonia vaccines to their residents/patients at least once per year [AAC R9-10-413(5)] – however ADHS never updated their licensing rules to require facilities offer the COVID vaccine or its boosters annually.

BTW: that could have been (and could still be) fixed by a licensing rule change – wouldn’t need legislation.