Category Archives: Blog

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.

Looking at Iowa’s Child Welfare Data to Inform Policy Choices

Looking at Iowa’s Child Welfare Data to Inform Policy Choices

This blog’s new publication, Looking at Iowa’s Child Welfare Data to Inform Policy Choicesis now available. The publication uses data from Iowa Department of Human Services sources to analyze reports and assessments of child abuse, the number of types of abuse, county-specific figures, and child welfare services and costs. Several of the tables linked in the report are posted below.

 

The report concludes that recent increases in service levels and drug-related cases, along with variation in abuse rates among Iowa’s counties, raise concerns about the state’s ability to respond adequately. This concern is heightened with the widely reported increased service demands in 2017 and lack of additional state revenue to meet the demand.

 

The report also raises questions about how well Iowa is preventing child abuse before it occurs. Are there sufficient resources to support families earlier, and are those resources used most effectively? Will those resources be reduced to meet child welfare service demands?

 

Linked tables:

Child Abuse 2016

Iowa abuse 2014-16

DCC and drugs 2014-16

Sexual and physical abuse 2014-16

Iowa average abuse type 2014-16

Changes in Types of Abuse 2010-16

Increases in Abuse

 

 

Summary of Government Oversight Hearing on Child Welfare, June 5, 2017

Summary of Government Oversight Hearing on Child Welfare, June 5, 2017

DHS Management Discussion 

 

Reaction: Administrator Wendy Rickman and Operations Manager Vern Armstrong shared their reactions to the two deaths. Rickman said they were unusual and different from her past experience and described herself as “flummoxed.” She said Armstrong told her the Finn case was “the worst I have ever seen.”

 

Response. At the recommendation of Casey Family Programs, DHS just contracted with the Child Welfare Policy and Practice Group (Alabama), a longstanding consulting firm, to conduct six onsite visits to review overarching policies and practices and engage with key stakeholders. DHS will be consulting with “the usual groups” during this process. The Alabama group will produce an assessment with possible recommendation for further reviews, and DHS will then decide where to go next. Legislators asked to be included in this process and questioned whether this expenditure was sufficient. Rickman reiterated that the group’s consultation was an initial one, with possibly more to follow.

 

Staffing and Caseloads. In response to concerns about caseload growth, DHS insisted that its child protection staff numbers are not declining. Over the five years, DHS has had 200-210 SW3 and 340-350 SW2 workers. SW3 workers do child abuse assessments and CINA investigations, and SW2s are the ongoing case managers. Turnover has been 12 percent a year, with the average SW2 staying 11 years and SW3 14. DHS said the workloads are in the range of 12-14 and have not been increasing until now, when DHS is accepting more cases. Senator Matt McCoy questioned these figures, saying that many DHS staff have told him their caseloads are much higher. Senator Petersen asked about the percentage of DHS child protection staff who are licensed social workers, and Rickman agreed that her figure of 17 percent was likely correctRep. Thede asked about the training for social workers. Armstrong said SW2s receive 160 hours and SW3s receive 152 hours.

 

Foster care. Rickman insisted that foster care in Iowa was very safe, with 99.7 percent of children remaining safe. This figure is calculated as set forth in a federal review process. DHS discussed its recent $6.8 million statewide contracts for recruitment, training, and support for foster and adoptive parents. Four Oaks is providing services in four regions and LSI in the West. Rep. Heaton asked about the typical profile of a foster child and wondered if it is getting harder to recruit foster parents and if foster children are getting more difficult. He also expressed concern that some parents were fostering too many children. Rickman said recruitment was harder and that foster children varied greatly in their ages and behaviors. Senator Petersen asked whether DHS monitored the practices of the private agencies to make sure they were doing the required home studies. DHS insisted it does.

 

Subsidized adoption oversight. Rickman reported that, after adoptions are completed, adoptive parents are treated like any other parent, even if they are receiving state subsidies. In other words, they are left alone and not monitored. DHS will only learn of problems in care through abuse reports. Some legislators questioned whether there should not be check-ins, at least where subsidies were involved. Rep. Breitbach asked if a code change would be needed for instituting follow-ups in subsidized adoption cases. Rickman said she thought legislation would be needed.

 

 Court System and Law Enforcement

 

County attorney involvement. Assistant county attorneys from Polk and Linn described how they handle DHS referrals and serve as a check on DHS actions. County attorneys receive information on all rejected and accepted cases and final assessment reports. They do not hear anything after family assessments.The Polk County attorney reported that her office does not look at the rejected reports. Legislators expressed concern about this review not occurring, saying an important check on the system was missing. The Polk County attorney expressed concern over funding levels and insisted caseloads were increasing.

 

Juvenile Court Judge. Polk County judge Colin Witt described his court’s practices, which include providing a guardian ad litem and attorney for each child. He described the notice parents receive. There are provisions for a child to give testimony without the parents being present. Legislators asked about out-of-state placements with relatives that might make it harder for parents to connect. DHS usually prefers an Iowa foster provider, even if not a relative, to assist with reunification.

 

Sheriffs. Sheriffs from Marshall and Dickinson counties described their collaboration with DHS. One expressed his concern over DHS caseloads and the amount of travel involved.

 

 Home Schooling

 

At several points in the hearing, legislators and DHS expressed concerns that home schooling takes away an important safety net for children, schools, whose employees submit the most reports of suspected abuse of any group. Scott Woodruff, an attorney with the Home School Legal Defense Association, testified. He insisted that, despite the three cases (and a fourth to be reported on soon), there really was no pattern of abuse related to home schooling. He insisted home schooling was safe for children and that restrictions on it do not make children safer or better educated. He argued that the best way to protect children would be to have a more “muscular” approach to repeat abuse. Senator McCoy asked about his organization’s opposition to court laws prohibiting parents with recent abuse cases from home schooling and requiring annual medical check-ins. Woodruff insisted there was no need for these requirements. McCoy expressed his opposition to the 2013 Iowa law that removed almost all requirements for home schoolers.

 

Future Actions

 

At the hearing’s conclusion, co-chair Rep. Kauffman said that he needed time to review documents and confer with committee members. As a result, he did not set a next meeting time. The other co-chair, Senator Breitbach, said that he has not been contacted by DHS or other sources and would like to hear from them. The consultation from the Child Welfare group will also be important over the next few months, as it may provide answers to a lot of the points of disagreement or uncertainty. Advocates on these issues will likely focus much of their efforts on engaging these experts. Despite their differences, legislators showed some openness to changes in these areas:

 

Requiring some ongoing contact or reporting from subsidized adoptive parents

 

Imposing minimal controls on homeschooling by parents where there has been a recent confirmed child abuse case; there seems less interest in requiring an annual medical check-up (which PA does)

 

Considering a stronger response (whatever that would be) in cases of repeat abuse or neglect

 

Looming above all these issues, of course, are the Iowa budget woes, which will make improving caseloads and practice more difficult.

Session-End Review of Legislation

Session-End Review of Legislation

The Iowa-AAP registered on almost two dozen policy bills filed this legislative session, which ended on April 22.  Following is a summary of legislative action on several bills that Iowa-AAP supported, opposed, or registered undecided — along with links to earlier related blog posts. A table with a list of action on all Iowa-AAP policy bills of interest is available.

 

Bills That Passed

 

HF 543 expands drug-related caregiver actions that can be subject to a Child in Need of Assistance proceeding and/or a founded child abuse case. The bill also expands reporting requirements for mandatory reporters suspecting that infants are suffering the effects of drugs or alcohol. More. Iowa-AAP SUPPORTED.

 

SF 51 expands education about congenital cytomegalovirus and requires testing for the virus if a newborn fails the required hearing test. MoreIowa-AAP REGISTERED UNDECIDED.

 

HF 517 is an omnibus gun rights bill that removes the former requirement that a child be at least 14 years old to possess a handgun. A parent or other adult must provide direct supervision of the child and is strictly liable for any resulting injuries. More. Iowa-AAP OPPOSED.

 

HF 215 expands insurance coverage for applied behavior analysis to treat autism spectrum disorder. The bill requires that certain individual and group health insurance policies for public employees who are not state employees cover this treatment for children under 19 years old. MoreIowa-AAP SUPPORTED.

 

HF 625 removes the requirement that the Iowa Department of Revenue advise low-income taxpayers with dependent children without insurance of potential eligibility for Medicaid or hawk-i. Iowa-AAP OPPOSED.

 

SF 489 permits sales of fireworks in Iowa, including in open tents, during times around July 4 and January 1. More.  Iowa-AAP OPPOSED.

 

Bills That Failed to Pass

 

HF 7 allows an exemption from compulsory immunization based on someone’s “personal conviction.” MoreIowa-AAP OPPOSED.

 

SF 254 makes it a criminal offense for a licensed health professional to inquire about a patient’s possession or ownership of firearms. MoreIowa-AAP OPPOSED.

 

SF 360 expands “safe haven” options for a parent to abandon a newborn without being subject to criminal prosecution. Iowa-AAP REGISTERED UNDECIDED.

 

SF 11 requires Iowa DHS to assist new mothers receiving pregnancy-related Medicaid to secure private or public health insurance. MoreIowa-AAP SUPPORTED.

 

 

 

Senate Passes Legislation Impacting Autism and Congenital Cytomegalovirus

During the week of March 20-23, the Iowa Senate acted on bills impacting autism and congenital cytomegalovirus (CMV). The autism legislation now goes to the Governor for his signature, and the CMV bill moves onto the Iowa House for its consideration. Here’s a summary of the two bills.

 

Insurance coverage for applied behavior analysis. The Senate unanimously approved House legislation, HF 215, that expands insurance coverage for applied behavior analysis to treat autism spectrum disorder. The bill requires that certain individual and group health insurance policies for public employees who are not state employees cover this treatment for children under 19 years old. The treatment must be provided by a board-certified behavior analyst or by a licensed physician or psychologist. The bill allows insurers to set annual maximum benefits that are not less than $30,000 for a child through age 6, $25,000 for a child 7 through 13, and $12,500 for a youth 14 through 18. Insurers may also impose deductibles and coinsurance charges. The bill becomes effective on January 1, 2018.

 

Cytomegalovirus education and testing.  The Senate unanimously approved legislation (SF 51) to expand education about and testing for congenital CMV, which is a virus infecting individuals of all ages. While infected adults usually have no signs or symptoms, the virus can have profound and long-term effects on newborns born with the virus, acquired by transmission from their mothers. The CDC estimates that one in 150 newborns are born with congenital CMV.  Most showing no signs or effects, but some do and suffer any of several health effects, including vision and hearing loss, intellectual disability, muscle weakness, small head size, seizures, and death.

 

Determining the existence of congenital CMV presents challenges. Testing for congenital CMV must occur with the newborn’s first three weeks and can be done from the newborn’s saliva or urine. In the absence of a clear indicator of the disease,  SF 51 requires testing if a hospital’s initial newborn hearing screening indicates the newborn a hearing loss – which is a potential, but not certain, indicator of congenital CMV.

 

The Iowa-AAP registered undecided on SF 51 and, after consultation with state and national experts, issued a statement expressing support for and concern over provisions in the legislation. In the absence of statewide standardized testing, the Iowa-AAP statement recommends offering, but not mandating, congenital CMV testing to parents of infants who fail the newborn hearing screen, with the medical provider determining the test based on available resources. Iowa-AAP also recommends that, “Targeted testing should be done in such a manner that the medical community can gather safety, incidence, efficacy and cost effectiveness data to improve diagnosis and treatment.”

 

The bill has an education component, which Iowa-AAP supports. The bill requires the Iowa Department of Public Health to collaborate with health organizations to approve and publish information on congenital CMV, to be distributed to pregnant women, attending health care providers, and child care organizations. SF 51 also provides that health professionals who conduct the mandated test provide information to a newborn’s parents regarding congenital CMV, early intervention, and treatment resources and service.

 

The House has referred the legislation to its Commerce Committee.

 

Update: The Governor signed the autism bill on March 30. House approved the CMV bill on April 6, and the Governor signed it into law on April 20.