Category Archives: Blog

Moving on from Lobbying to Expanded Nonprofit Consulting Services

Moving on from Lobbying to Expanded Nonprofit Consulting Services

After 22 years of state legislative advocacy, I will be absent as a lobbyist in the 2019 Iowa Legislative session. In its stead, I will be available full-time to provide nonprofits with advice and support through my business Scott Advocacy and Consulting, LLC, which I established in Fall 2016. Besides lobbying, my past nonprofit services have included grant writing, organizational planning, advocacy training, and policy research and development.

 

My lobbying efforts included one short and one very long experiences. In the 2017 and 2018 legislative sessions, I had the pleasure of being a contract lobbyist for the Iowa Chapter of the American Academy of Pediatrics. Together with Iowa-AAP members, I advocated for improvements in children’s physical and mental health, childhood vaccinations, child obesity prevention initiatives, gun safety, and reducing the effects of childhood trauma.

 

From 1997 to 2016, as executive director for Prevent Child Abuse Iowa, I lobbied for legislation and funding to enhance Iowa’s child abuse prevention efforts. During that time, our advocacy led to creation of a statewide shaken baby syndrome prevention program, a child sexual abuse prevention task force and initiative, creation of an income tax checkoff for child abuse prevention, increased appropriations for the Iowa Child Abuse Prevention Program, and laws to address the dangers of meth manufacturing.

 

I described my approach to lobbying in a March 2018 blog post for Mid-Iowa Health Foundation, titled “Long-haul Advocacy: Adopting a long-term, sustained advocacy approach to effective child health systems change.” The post highlighted the importance of building partnerships and relationships, honesty, and having a long-term perspective and recommended that aspiring long-term advocates:

  • Approach long-haul advocacy humbly – recognizing the limits of your expertise, the wisdom of others, and the inevitability of mis-steps along the way
  • Identify individuals and organizations with which to build constructive relationships and deepen your subject matter expertise
  • Read more broadly to better understand the larger context impacting the specific change you seek
  • Become familiar with a broad range of research and opinion, including resources that may question or challenge your policy goals
  • Grow your policy advocacy expertise by taking advantage of the myriad toolkits that organizations offer
  • Identify the key decisionmakers with which to engage, how to follow their activities, and potential points of connection

 

Reducing ACEs Through Prenatal Strategies

Reducing ACEs Through Prenatal Strategies

With support from United Way of Central Iowa and Central Iowa ACEs 360, I have authored a report highlighting the need for en­hanced prenatal programs and strategies to reduce early childhood trauma and prevent intergenerational effects of parental adverse childhood experiences. Reducing ACEs Through Prenatal Strategies examines the research supporting these strategies, describes current programs in the Central Iowa area, and identifies opportunities for growth.

 

In expanding prenatal efforts, Central Iowa can build on three major program activities. First, area hospitals offer childbirth education classes – either in core instruction or separate modules – that address infant care, parental stress, the risk of physical injury, and parent support needs. Second, home visiting programs engage parents prenatally to build positive relationships, grow social support, and lay the groundwork for strong parent-child attachments. Third, area group and individual support programs for pregnant young mothers provide peer support, strengthen mothers’ support, reduce the risk of violence, and meet concrete needs.

 

While these efforts are positive, many opportunities exist to strengthen prenatal engagement to reduce childhood trauma. As outlined in the report, they include, at a minimum:

  • Increasing public/private support for prenatal engagement
  • Ensuring continued support for home visiting programs
  • Expanding childbirth education instruction and support
  • Improving and enhancing MCO case management
  • Advocating for prenatal engagement in Families First implementation
  • Securing Medicaid funding for doulas
  • Supporting lactation services
2017 Sees Surge in Iowa Child Abuse Cases

2017 Sees Surge in Iowa Child Abuse Cases

Iowa Department of Human Services (DHS) figures released in mid-May show a striking increase in accepted child abuse reports and confirmed/founded abuse cases — leading to the largest single-year increase in abused children in at least two decades. The increases follow criticism of DHS officials over two high-profile teen deaths and a 2017 change in Iowa law expanding the scope of child protection to include more drug-related cases.

 

Table 1 (below) sets forth figures on how DHS handled child abuse reports from 2014-17. In 2017, DHS accepted 33,418 reports for assessment — a 30 percent increase from the 25,707 reports accepted in 2016.  DHS assigned 21.4 percent (7,136) of accepted reports to the family assessment track — much below the 29 percent assigned to this track in 2016.  (DHS assigns to the family assessment track those denial of critical care cases where it sees less risk of harm to children; those cases do not result in a determination whether abuse occurred.)

 

The remaining 26,282 child abuse reports (78.8%) received a traditional assessment, where DHS decides whether abuse occurred. In 2017, DHS found abuse in 32.6% (8,858) of its traditional assessments — a slightly lower percentage than the previous three years, when 35-36 percent of cases resulted in determinations that abuse occurred. The number of confirmed/founded cases in 2017 was almost one-third more than in 2016.

 

Table 1

DHS Reports, Assessments, and Confirmed Abuse, 2014-17

All told, DHS found that 11,236 children were abused in 2017 — a 27 percent increase from the 8,892 children abused in 2016. (There are more abused children than confirmed/founded cases because some cases involve more than one child as the subject of an abuse assessment.) This increase in abused children is the largest in the last two decades (see Table 2) — exceeding even the 2001 increase following the high-profile death of Shelby Duis, which led to major changes in the handling of abuse reports. A spreadsheet, Child Abuse in Iowa, 2017, has county-specific data on all of these categories. 

 

Table 2

Number of Iowa Children Abused, 1997-2017

Table 3 lists the number and types of abuse that DHS confirmed in 2017. Most common (64.6 percent) were instances of denial of critical care – where a parent or caretaker failed to provide adequate supervision, food, shelter, clothing, or other care necessary for a child’s well-being. Next most common (1,992 cases) were cases where someone possessed, distributed, manufactured, used, or cultivated cocaine, meth, heroin, or opium/opiates near a child. (Prior to 2017 legislation, this category included only cases involving meth manufacturing near a child; 33 instances of this type of abuse were found in 2016).

 

Other categories of abuse involved illegal drugs in a child’s body because of caretaker action or inaction (8.9 percent of all abuse), intentional physical injury (8.6 percent), sexual abuse (5.5 percent), and a parent or caretaker knowingly allowing a sex offender access to a child (1.0 percent).  Only 0.2 percent of cases involved mental injury to a child. A spreadsheet, Types of Child Abuse, 2017, has county-specific figures on types of abuse for  2017. 

 

Table 3

Number and Types of Child Abuse, 2017

 

Increases in the number of abused children was widespread, with 79 of Iowa’s 99 counties having more abused children in 2017 than in 2016. In five counties (Polk, Woodbury, Linn, Black Hawk, and Scott), the number of abused children rose in 2017 by 100 or more. In 13 counties, the number increased by more than half. Table 4 (below) lists those counties with the highest numeric and percentage increases. A spreadsheet, Child Abuse in Iowa, 2014-17, list the changes over the last four years for all Iowa counties. 

 

Table 4

Counties with the Largest Increases in Child Abuse, 2016-17

 

Summary

 

Changes in agency practice and child protection laws clearly had a significant impact in 2017 on Iowa’s child protection system. Unfortunately, this surge in demand for protection and services came during a time when state resources did not — no doubt putting greater strain on DHS and community providers. The need to increase resources to meet this demand is clear. Whether Iowa’s policymakers will meet that need in 2019 is uncertain.

 

Resources

A downloadable PowerPoint PDF contains data and notes expanding upon what

is in this report. There are the tables available for download:

Child Abuse in Iowa, 2017

Types of Child Abuse, 2017

Child Abuse in Iowa, 2014-17

Sexual and Physical Abuse, 2014-17

Denial of Critical Care and Presence of Illegal Drugs, 2014-17

 

 

 

 

 

 

 

 

 

 

 

 

 

Session-End Review of Legislation

Session-End Review of Legislation

On May 5, the Iowa Legislature completed its work for the 2018 session — well beyond the scheduled completion date of April 17. The session featured largely party-line votes on many policy bills and deep partisan divisions on State Fiscal Year (SFY) 2018 de-appropriations, SFY 2019 agency appropriations, and tax cut legislation.

 

The Iowa-AAP was active throughout the 2018 session supporting legislation to ensure the healthy physical and mental development of children. Following is a summary of legislative action on some of the 30-plus bills that Iowa-AAP supported, opposed, or registered undecided — along with links to blog posts and other resources.

 

Bills That Passed

 

Abuse of Opioid Prescription Drugs: On May 2, the Iowa House gave final approval to legislation (HF 2377) to enhance Iowa’s Prescription Monitoring Program as a means to curtail physician or pharmacy shopping in opioids. The bill also encourages the reporting of drug overdoses through a “Good Samaritan” provision. For more on this bill, see this blog post or a summary in the Des Moines Register. Iowa-AAP supported.  

Safe Haven: On March 29, Governor Reynolds signed into law  SF 360, which expands options for parents to legally abandon their newborns without being charged for abandonment. For more on Iowa’s Safe Haven law and this bill, see this blog post. Iowa-AAP was undecided.

Pharmacy immunizations and Vaccinations: On May 2, the Iowa House approved legislation (SF 2322) allowing pharmacies, after state adoption of protocols, to begin administering certain vaccinations or immunizations. For adults, pharmacies can administer naloxone, Tdap, nicotine replacement products, and other immunization or vaccinations recommended by the CDC for travel or as part of an approved schedule for adults. For those 12 and older, pharmacies can administer the second and third doses of the HPV vaccine. The Iowa-AAP expressed opposition to expanded pharmacy vaccinations of youth because of the potential adverse impact on their seeking health care.

Student Athlete Concussions: On April 26, the Governor signed legislation (HF 2442) to reduce the effects and recurrence of concussions in school sports, including: developing training materials for coaches and guidelines for school personnel and families; establishing rules governing returning to play following a concussion; and providing protective gear to students. Iowa-AAP supported.

School Tracking of Student Health Care: On April 17, the Governor signed into law a lengthy education bill, (SF 475), that creates a student health working group to re-examine how schools track whether students have received dental or vision screenings or immunizations. Iowa-AAP opposed this legislation because of its potential to weaken how schools track student health events.

 

Bills That Did Not Pass

 

Mandatory Reporter Training and Child Welfare ReformThe Iowa-AAP supported separate bills calling for DHS work groups to (a) identify how to improve training for mandatory reporters of child or dependent adult abuse (SF 2300) and (b) examine policies and protocols in multiple features of Iowa’s child protection system (HF 2353). Neither bill passed, but the health and human services appropriations bill (SF 2418) included a provision establishing a mandatory reporter training work group.

Coverage for Hearing Aids: The Iowa-AAP supported legislation requiring health insurers to pay for hearing aids for children at least every three years (HF 2178). This bill but not advance, but the Legislature appropriated $156,482 to provide audiological services and hearing aids for children. 

Cigarette Tax Increase. Along with 31 other organizations, Iowa-AAP supported legislation (HF 2339) increasing Iowa’s cigarette taxes by $1.50 a pack in order to reduce teen and adult smoking and raise revenue for health promotion and treatment services. This bill did not receive a hearing.

Public Health ProtectionsThe Iowa-AAP opposed separate bills weakening public health efforts — none of which advanced for a committee vote. The bills sought to: (a) abolish the Iowa Department of Public Health (HF 2017), (b) expand distribution of raw milk (HF 2055), and (c) widen exemptions to Iowa’s compulsory immunization law (HF 7). (For more on the immunization law, see this  blog post.)

Recipient Work Requirements: Iowa-AAP opposed House (HF 2428) and Senate (SF 2370) legislation imposing work requirements on Medicaid recipients. The more punitive Senate bill imposed additional non-work requirements on Medicaid recipients and expanded them to people receiving SNAP (Food Stamps) and Family Investment Program (FIP) benefits. Both bills received committee approval but no chamber vote.

Expanding Access to Care. The Iowa-AAP supported legislation to expand health care by: (a) helping mothers receiving pregnancy-related Medicaid to access health insurance post-partum (SF 11) and (b) restoring three-month retroactive eligibility for Medicaid (SF 2075). The Senate did not hold subcommittee meetings on these bills.

Iowa AAP Board Statement on Gun Safety and March for Our Lives

Iowa AAP Board Statement on Gun Safety and March for Our Lives

The recent horrific school shootings and the powerful response by students from Marjory Stoneman Douglas High School have forced us to confront, once again, the impact of gun violence. Although mass shootings command our attention, children in the United States and Iowa remain at risk daily for becoming victims of gun violence.  The Iowa Chapter American Academy of Pediatrics lends its support to those young people, their families and all those who are exposed to the threat of gun violence.

 

The American Academy of Pediatrics continues to take a strong stance advocating against gun violence and supporting children, youth and families.  As announced on March 16, 2018, the organization has launched the American Academy of Pediatrics Gun Safety and Injury Prevention Research Initiative. This initiative will create a collaboration of experts from across the country to study and implement evidence-based solutions to address the epidemic of gun violence and develop plans for prevention.

 

The epidemic of gun violence against children is a threat to public health. In addition to endangering children’s lives, gun violence adds significantly to the toxic stress load on children, which has been shown to impact their physical and mental well-being. Iowa AAP is committed to advocating for improved access to mental health services to meet the needs of those affected by gun violence and by the threat of gun violence in their schools and communities.

 

This Saturday, March 24, 2018, the courageous students from Marjory Stoneman Douglas High School in Parkland, Florida are channeling their grief and anger into action, joined by students across the country in peaceful protest. March for Our Lives events will be held at the State Capitol and many other locations in Iowa. The Iowa AAP supports the goals of these events: promotion of gun safety and violence prevention.

 

Tackling any epidemic requires comprehensive, common-sense solutions at every level and the partnership of all of us who care for children to come together to ensure the safety of children and adolescents in Iowa.

 

Board of Directors, Iowa Chapter – American Academy of Pediatrics

March 22, 2018

Health Legislation at the Second Funnel

Health Legislation at the Second Funnel

March 15 marks the end of the Iowa Legislature’s second funnel: the deadline for policy bills to pass through one legislative chamber and a committee in the second one. Tax and appropriation bills are exempt from the funnel, as are leadership bills. Here is the status of health and/or safety legislation on which the Iowa-AAP registered a position.

 

Bills That Advanced

 

Safe Haven: On March 12, the Iowa House gave final approval and sent to the Governor SF 360, which expands options for parents to legally abandon their newborns without being charged for abandonment. The Governor is expected to sign this legislation. For more on Iowa’s Safe Haven law and this bill, see this blog post.

 

Abuse of opioid prescription drugs: Legislation to curtail prescription shopping in opioids and enhance Iowa’s Prescription Monitoring Program (HF 2377) now awaits final Senate passage.  See this blog post for more on this bill.

 

Pharmacy immunizations and Vaccinations: Under SF 2322, which awaits final House action,after the development of statewide protocols, pharmacies can begin administering certain vaccinations or immunizations, including:

 

(1) For adults: naloxone, Tdap, nicotine replacement products, and other immunization or vaccinations recommended by the CDC for travel or as part of an approved schedule for adults

(2) For those 12 and older: the second and third doses of the HPV vaccine.

 

In a statement shared at its February 28 legislative breakfast, the Iowa-AAP expressed concerns over expanded pharmacy vaccination of youth because of the potential adverse impact on youth seeking health care and problems with tracking pharmacy administration of vaccines.

 

Student athlete concussions: Awaiting final Senate action, HF 2442 calls for several actions to reduce the effects and recurrence of concussions in school sports, including: developing training materials for coaches and guidelines for school personnel and families; establishing rules governing returning to play following a concussion; and providing protective gear to students.

 

 Bills That Failed to Advance

 

Mandatory reporter training and child welfare reform: Separate bills sought to establish work groups to improve Iowa’s child welfare system failed to advance beyond the funnel. SF 2300 called for a work group to identify how to improve training for mandatory reporters of child or dependent adult abuse. HF 2353 asked for one to examine policies and protocols in multiple features of Iowa’s child protection system.

 

Recipient work requirements: Separate House (HF 2428) and Senate (SF 2370) bills conditioning Medicaid eligibility on meeting work requirements failed to advance beyond the committee level. The more punitive Senate bill also imposed work and other requirements on those receiving SNAP (Food Stamps) and Family Investment Program (FIP) benefits. Iowa-AAP expressed its disapproval of both bills to legislators attending its Feb. 28 breakfast. 

House Gives Final Approval to Safe Haven Legislation

House Gives Final Approval to Safe Haven Legislation

On March 12, the Iowa House unanimously passed legislation (SF 360) amending Iowa’s Safe Haven law. This law allows a parent – or someone at a parent’s request – to abandon an infant anonymously, under limited circumstances, without being charged with neglect.The Iowa Senate unanimously approved the bill in 2017, so it now goes to Governor Reynolds for her expected signature.

 

SF 360 makes two major changes to Iowa’s current Safe Haven law, which was passed in 2017. First, the legislation expands the places where a parent may lawfully leave an infant. Current law provides limits places where a newborn infant can only be left to an institutional health facility, which includes a hospital, residential care facility, nursing home, or intermediate care facility. SF 360 offers additional options of leaving a newborn infant with first responders,  including:

 

** An emergency medical care provider

** A registered nurse or physician assistant

** A firefighter or peace officer

 

The legislation also permits the parent to make telephone contact with a 911 service and relinquish physical custody to a first responder who responds to the call.

 

Second, SF 360 allows the lawful abandonment of an infant who is or appears to be 30 days old; current law limits lawful abandonment to infants 14 days or younger. According to the federal Children’s Bureau, approximately 19 state Safe Haven laws allow abandonment of infants up to a month old. Only six states allow an infant older than a month to be left under their Safe Haven laws; by contrast, 18 states limit protections to infants no more than either three or seven days old.

 

As of September 2017, 30 infants have been abandoned pursuant to the Iowa’s Safe Haven law, according to an Iowa DHS press release. Iowa passed its legislation in response to the tragic 2001 death of a newborn at the hands of her 17-year-old mother.

 

Iowa House Passes Anti-Opioid Legislation

Iowa House Passes Anti-Opioid Legislation

Provisional Iowa Public Health data notes 301 opioid overdose and related deaths in 2017 – an increase from 266 such deaths in 2016 and 222 in 2015. On February 26, the Iowa House unanimously passed HF 2377, this session’s first major legislation addressing the opioid crisis. The bill focuses on the abuse of prescription opioids, while seeking to improve the response to some drug overdoses. The bill does not address the need to expand drug abuse treatment.

 

Enhancing Iowa’s prescription monitoring program (PMP) is a central feature of the legislation. This program collects information from pharmacies on dispensing  controlled substances, including opioids. The PMP can be used to determine whether prescribing or dispensing might contribute to a patient’s abuse of or dependence on addictive drugs or diversion of those drugs to illicit use. The PMP’s current utility is limited, however, by a lack of funding, inconsistent utilization, and delays in posting information.

 

HF 2377 increases funding for the PMP by authorizing the Board of Pharmacy to impose a surtax on businesses dispensing or distributing controlled substances. This funding will enhance the PMP’s capacity and usability and enable it to advise physicians and pharmacists of suspected overuse of opioids.

 

The legislation improves the program’s utility in several ways. The bill requires all prescribing practitioners to register for the program and submit all prescriptions electronically by January 1, 2020. All pharmacies and prescribing practitioners who dispense a controlled substance must report their activity within 24 hours.The Board of Pharmacy must annually issue a prescribing practitioner activity report of PMP activity and establish criteria for identifying patients who may be potentially misusing or abusing prescription-controlled substances and share the board’s concern with pharmacists and prescribing practitioners involved in those patients’ care.

 

The legislation requires licensing boards to establish penalties for practitioners who prescribe in dosage amounts exceeding what would be prescribed by a reasonably prudent prescribing practitioner. The bill  provides additional sanctioning authority for the Board of Pharmacy for violations of Iowa’s Controlled Substance Act by those dispensing controlled substances.

 

HF 2377 encourages prompter responses to drug overdose situations by creating a   “Good Samaritan” protection. This provision ensures that a person seeking medical treatment for someone experiencing a drug-related overdose is not arrested or prosecuted for controlled substance-related violations based on information collected or derived from the person’s actions in seeking medical assistance. To qualify for immunity, the “Good Samaritan” must have acted in good faith,been the first to do so, left a name and contact information, remained on the scene until assistance arrives, and cooperated with authorities. The assistance must not have been provided during the execution of an arrest or search warrant.

 

The legislation now goes to the Iowa Senate for its consideration. The Senate Human Resources Committee has already approved less comprehensive anti-opioid legislation, SF 2198.

House Committee Approves Changes to Iowa’s Safe Haven Law

House Committee Approves Changes to Iowa’s Safe Haven Law

On January 17, the House Human Resources Committee unanimously passed legislation (SF 360) amending Iowa’s Safe Haven law. Passed in 2001,Iowa’s law allows a parent – or someone at a parent’s request – to leave a newborn infant up to 14 days old at an institutional health care facility without facing prosecution for abandonment. In relinquishing physical custody of the newborn, the parent or designee need not provide identification or medical information.

 

According to a federal Children’s Bureau’s report, all 50 states have Safe Haven laws, though with varying provisions. States created Safe Haven programs to protect newborns by providing an alternative for parents to prosecution for abandonment. Iowa passed its legislation following the tragic 2001 death of a newborn at the hands of her 17-year-old mother. As of September 2017, 30 infants have been abandoned pursuant to the Safe Haven law, according to an Iowa DHS press release.

 

SF 360 makes two major changes to Iowa’s Safe Haven law. First, it redefines who is a “newborn infant” under the Safe Haven law to include an infant who is or appears to be 30 days old, instead of only 14. According to the Children’s Bureau, approximately 19 state Safe Haven laws cover infants up to a month old. Only six states allow an infant older than a month to be left under their Safe Haven laws; by contrast, 18 states limit protections to infants no more than either three or seven days old.

 

Second, SF 360 expands relinquishment placement options for parents. Current law provides that a newborn infant can only be left at an institutional health facility, which includes a hospital, residential care facility, nursing home, or intermediate care facility. SF 360 provides that a parent can also leave a newborn infant with a list of first responders,  which includes:

 

** An emergency medical care provider

** A registered nurse or physician assistant

** A firefighter or peace officer

 

The legislation also permits the parent make telephone contact with a 911 service and relinquish physical custody to a first responder who responds to the 911 call.

 

The full House will now consider the legislation, which passed the Senate unanimously in 2017. If the House approves the bill without amendment, the legislation will go to the Governor for her signature.

Iowa-AAP 2018 Policy Agenda

Iowa-AAP 2018 Policy Agenda

In its 2018 Policy Agenda,the Iowa Chapter of the American Academy of Pediatrics  urges Iowa policymakers to act in five areas to ensure the healthy physical and mental development of children:

 

Children’s Mental Health: Create a comprehensive children’s mental health system with greater access to crisis services and enhanced early intervention and prevention efforts

 

Child Health: Ensure children’s access to health care, support EPSDT, reduce the incidence of childhood obesity, and limit youth access to tobacco

 

Child Safety: Reduce childhood injuries and accidental deaths by supporting the Poison Control Center, limiting risks from firearms, and reducing school sports concussions

 

Childhood Trauma: Support Iowa’s Child Protection Centers, expand medical services for traumatized children, and increase physician involvement in child protection services

 

Childhood Immunization: Improve Iowa immunization rates through ready access to childhood vaccines, education about their safety and effectiveness, and strengthened school vaccination policies

 

The Iowa-AAP will have a consistent presence at the Capitol to support this agenda. If you would like to receive updates on its activities, contact its lobbyist at steve@scottadvconsult.com.