Category Archives: Blog

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. 

Iowa House Advances Child Safety and Health Legislation

On March 14 and 15, the Iowa House unanimously passed three bills to improve child safety and provide access to health care. The bills, all of which Iowa-AAP supports, will proceed to the Iowa Senate. Here are brief summaries of the legislation:

 

Children exposed to dangerous drugs. HF 543 provides that a parent, guardian, custodian, or other household member who unlawfully uses, possesses, manufactures, cultivates, or distributes a dangerous drug in the presence of a child can be subject to a Child in Need of Assistance proceeding and/or a founded child abuse report. The bill defines “dangerous drug” to include amphetamine, methamphetamine, cocaine, heroin, and opium or opiates. “In the presence of a child” means in the child’s “physical presence” or “occurring under other circumstances in which a reasonably prudent person would know that the use, possession, manufacture, cultivation, or distribution may be seen, smelled, ingested, or heard by a child.”

 

The bill also requires a health practitioner involved in the delivery or care of a newborn or infant to report to the Iowa Department of Human Services if he or she discovers “physical or behavioral symptoms that are consistent with the effects of prenatal drug exposure or a fetal alcohol spectrum disorder.”

 

Insurance coverage for applied behavior analysis. HF 215 requires that certain individual and group health insurance policies for public employees who are not state employees cover applied behavior analysis for the treatment of autism spectrum disorder for children 18 years old or younger. 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. The bill allows a plan to impose deductibles and coinsurance charges. The bill becomes effective on January 1, 2018.

 

Youth athlete concussion. HF 563 requires coaches to have training in CPR and the use of an automated defibrillator by July 2018. The bill states findings on concussions, their frequency in sports and recreational activities, and potential consequences. The bill requires the state’s athletic associations to work together to develop training materials, guidelines, and protocols on concussions and distribute information sheets on concussions to parents and guardians. The bill further mandates removing an athlete from a contest if he or she shows signs, symptoms, or behaviors consistent with a concussion or brain injury.

 

Under legislative rules, the bills must pass out of a Senate Committee by March 31 to remain eligible for final passage. Since a companion bill on autism coverage has already passed a Senate committee, HF 215 is not subject to this deadline.

 

Update: The Iowa Legislature approved the drugs and autism bills, which the Governor has signed.The Senate Human Resources Committee approved the concussion bill, but the full Senate did not vote on it before session’s end.  

Divided Senate Subcommittee Advances Gun Bill

Divided Senate Subcommittee Advances Gun Bill

After an hour of public testimony from supporters and opponents, a subcommittee advanced an omnibus gun bill (HF 517) to the Senate Judiciary Committee by a 2-1 vote. Senators Dan Dawson (R-Council Bluffs) and Brad Zaun (R-Urbandale) supported the bill, which Janet Petersen (D-Des Moines) opposed – while raising multiple questions about its meaning and consequences.

 

The Des Moines Register reported on the competing testimony. Bill proponents Included a father and two young daughters, who have lobbied for removing Iowa’s minimum age of 14 for possessing a pistol or revolver. Others stressed the primacy of the rights to bear arms and to act in self-defense, with one speaker maintaining that “self-defense is the most basic of human rights.”

 

Opponents argued the bill would increase the risk of deaths and injuries because of expanded “stand your ground” rights, more gun carrying in public spaces, and removal of the 14-year-old minimum age limit. Several speakers urged legislators to err on the side of public safety in balancing competing rights.

 

Representing Iowa-AAP, Steve Scott warned in his testimony that removing the 14-year minimum age would lead to more accidental injuries and deaths. He cited an October 2016 study by the Associated Press and USA Today finding at least one child being accidentally killed by a firearm every two days from January 1 to June 30, 2016.

 

While recognizing many parents will provide the hands-on supervision required by HF 517, Scott insisted others will not. He cited the fatal consequences of parental failure to protect children in Iowa Child Death Review Team’s most recent report. The report found dozens of preventable child deaths resulting from unsupervised swimming, unsafe sleep positions, failure to use car seats, absence of smoke alarms, and unsecured firearms. Scott noted that the difficulty for anyone in supervising children handling firearms due to their physical and emotional immaturity, the inherent danger of firearms, and potential harm during only a few distracted seconds.

 

The Senate Judiciary Committee is scheduled to vote on HF 517 on Thursday, March 16 at 11 a.m.

 

Update: Both chambers approved the gun bill, which the Governor signed on April 13. 

Vaccine Exemption Bill Dies in Committee

Vaccine Exemption Bill Dies in Committee

March 2 is the end of the Iowa Legislature’s first “funnel”: the date by which most policy bills must advance through committee in order to receive further consideration. One of the casualties of the funnel deadline is HF 7, which would allow an exemption from compulsory immunization based on someone’s “personal conviction.” (For more information on this legislation, visit here).

 

By a 2-1 vote, a House Human Resources subcommittee approved the legislation after a hearing on January 24. The subcommittee acted despite organizational opposition and statements against it, including testimony by Dr. Nathan Boonstra, a UnityPoint infectious disease expert and an Iowa-AAP board member. Dr. Boonstra warned that adding unvaccinated children to a classroom dramatically increases the risk of disease for others around them who might not be able to be vaccinated — particularly children with special medical needs like congenital heart disease or severe asthma.

 

HF 7 reportedly faced bipartisan opposition from a significant majority of the House Human Resources Committee. As a result, the committee chair, Rep. Joel Fry (pictured), did not bring the bill up for a vote — leading it to its demise at funnel’s end.

U.S. and Iowa Legislators Support Immunization Efforts

U.S. and Iowa Legislators Support Immunization Efforts

Iowa immunization advocates have recently received support from  federal and  state legislators. In a February 21 letter to members of Congress, U.S. Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Washington) and four House members highlighted the importance of immunizations. At the same time, members of the Iowa House Human Resources Committee have resisted efforts to weaken Iowa’s compulsory immunization law.

 

Federal letter. The federal letter notes progress from 1963, when four million people were infected with measles to 2000, when the CDC declared the disease eliminated. In a step backward, however, there were 667 measles cases in 27 states in 2014 – an outbreak tied to lower vaccination rates in some communities. Cases of pertussis (“whooping cough”) also continue to occur despite a vaccine to prevent the disease.

 

The federal letter stresses the importance of widespread vaccination to create “herd immunity,” which protects children – particularly those who cannot be vaccinated — from disease through the vaccination of those around them. The letter concludes, “The science is clear: FDA-licensed vaccines are proven to be safe and effective, and save the lives both of those who receive them and vulnerable individuals around them. . . . Simply put, vaccines save lives.”

 

 

Iowa legislation. Because of bipartisan opposition, the Iowa House Human Resources Committee has not held a vote on legislation (HF 7) that would allow a “personal conviction” exemption to the state’s compulsory immunization law. By this week’s end, the bill will be officially dead for this year. By a 2-1 vote, a subcommittee had advanced the bill despite widespread opposition in a January 24 public hearing. An Iowa-AAP board member, Dr. Nathan Boonstra, spoke against the bill at the hearing.

Divided Iowa House Panel Advances Gun Bill

Divided Iowa House Panel Advances Gun Bill

Despite widespread opposition in a hearing on February 23, by a 2-1 vote, a subcommittee advanced to the House Judiciary Committee legislation, HSB 133, that vastly expands gun rights.  Almost two dozen spoke against the bill, criticizing many of its provisions, including those:

 

  •  Removing a minimum age for possessing a revolver or pistol
  • Expanding “stand your ground” rights
  • Increasing risks from expanding the right to carry firearms in public spaces, like schools, hospitals, and the Capitol
  • Creating a lifetime permit to carry weapons
  • Removing the obligation to obtain a permit to acquire a firearm
  • Making records of permit holders confidential

The bill’s provision expanding the right to use lethal force drew the most criticism, with warnings of increased deaths and risk to people of color. Two opponents of this provision are quoted in a Des Moines Register article.

 

The Iowa-AAP has registered against the bill, objecting to a provision allowing a child of any age to possess a pistol or revolver. Opposing this provision on behalf of Iowa-AAP and Blank Hospital, pediatrician Dr. Amy Shriver (pictured) noted how 18,000 children are killed by firearms annually in the United States. Citing her clinical experience, Dr. Shriver contended that most children under the current limit of 14 years old lacked the maturity to safely use handguns.

 

The American Academy of Pediatrics believes that, “The absence of guns in homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.” The Iowa-AAP will continue its opposition to the bill, including at a March 2 legislative breakfast co-hosted with Blank Hospital.

 

Update: Both chambers approved the gun bill, which the Governor signed on April 13. 

Iowa-AAP Opposes Bill Restricting Communication About Firearms

The Iowa-AAP has registered against new legislation (SF 254) restricting a health professional’s communications with patients about firearms. The legislation provides that a licensed health professional “shall not inquire about or otherwise request information about a patient’s or client’s ownership or possession of firearms.” A health professional violating this proscription could be guilty of a serious misdemeanor – punishable by up to a one-year sentence and fine of $1,875.

 

If enacted, SF 254 would be only the second state law imposing such a constraint on health professional communications with patients. The law disregards research showing the important role pediatricians and other physicians can play in protecting children from firearm injury or death. According to the American Academy of Pediatrics, “asking a parent a question about gun ownership can open up an opportunity to educate parents about potential dangers to which their child is exposed.” Such “anticipatory guidance” is a “major component” of pediatric care helping patients and their families “know what to watch for in the future.”

 

Further, the Iowa bill likely violates the First Amendment Right to free speech – as Florida just learned after six costly years of unsuccessful litigation defending a similar law. A 2011 Florida law proscribed medical professionals from inquiring about a patient or family member’s ownership of a firearm or ammunition unless relevant to personal safety. It also directed that medical professionals refrain from “unnecessarily harassing” patients about firearms.

 

Soon after the law’s enactment, doctors and medical groups secured a federal court order enjoining its enforcement. Subsequent court and appellate actions led to a February 16 decision by the 11th Circuit Court of Appeals  finding that the Florida law violated the First Amendment’s guarantee of free speech.  In a 10-1 decision and 90-page decision, the court also declared the “unnecessary harassment” provision unconstitutionally vague under the Fourteenth Amendment.

 

The court decision is a landmark one, with implications beyond Florida — as noted in a New York Times article. In a statement expressing delight with the court decision, the American Academy of Pediatrics president Fernando Stein, M.D. declares,  “Pediatricians routinely counsel families about firearm safety just as they offer guidance on seat belt use, helmets and parental tobacco use to reduce the risk of injury to children where they live and play. These are all topics that families should feel very comfortable talking about with their pediatrician.”

 

As of February 18, Blank Hospital, the Iowa Medical Society, and the Iowa Psychological Association have also registered against SF 254, which has been referred to the Senate Human Resources Committee. A subcommittee has not been appointed.

 

Update: This legislation did not advance.