Category Archives: Child & Youth Health

WIC services in Washington given 30-day reprieve during federal shutdown

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WIC WashingtonOLYMPIA – Despite the federal government shutdown, Washington’s Women, Infants, and Children food and nutrition program has funding to continue service through October. The United States Department of Agriculture (USDA) reallocated funding to cover the costs for the month.

The reprieve comes just in time for Washington’s WIC Nutrition Program, which had only enough remaining funds to operate the program statewide until Oct. 9.

WIC provides important nutrition assistance and health referrals along with breastfeeding support to pregnant and breastfeeding women and their children up to age five, whose family income is at or below 185 percent poverty level.

The state Department of Health contracts with local health organizations and tribes to provide WIC services in all 39 counties in Washington. The program also authorizes certain grocery stores to accept WIC vouchers for the purchase of approved healthy foods.

If the federal government shutdown continues through this month, USDA will not have funding to re-allocate for services in November, and Washington WIC may not have funding to continue operations.

The Department of Health had been working on contingency plans in the event that WIC services had to end in October when reallocation was announced. Agency officials now have more time to develop a strategy in the event the shutdown does not end by Nov.1.

“WIC helps low-income families feed their children. We hope a budget will be passed and this important program can continue beyond October 31,” said Janet Jackson Charles, director of Nutrition Services at the Washington State Department of Health.

  • For questions about local WIC services call the state WIC office, 1-800-841-1410.
  • The Washington WIC Nutrition Program website has information about local WIC clinics
  • Related services around the state can be found at ParentHelp123.org or by calling the Family Health Hotline at 1-800-322-2588.
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Take concussions out of play: Learn to prevent, recognize and respond to concussions

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From the Centers for Disease Control and Prevention

BrainCDC estimates 173,285 sports- and recreation-related traumatic brain injuries (TBIs)including concussions, among children and adolescents are treated in U.S. emergency departments each year.

A bump, blow, or jolt to the head can cause a concussion, a type of TBI. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.

Concussions can occur in any sport or recreation activity. So, all coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.

CDC’s “Heads Up: Concussion in High School” and “Heads Up: Concussion in Youth Sports” initiatives include materials and information to help coaches of all sports to help identify concussions and take immediate steps to respond when one is suspected.

Prevention and Preparation

Check with your league or school about concussion policies.Concussion policy statements can be developed to include the league or school’s commitment to safety, a brief description about concussion, and information on when athletes can safely return to play. Parents and athletes should sign the concussion policy statement before the first practice.

Insist that safety comes first. No one technique or safety equipment is 100 percent effective in preventing concussion, but there are things you can do to help minimize the risks for concussion and other injuries.

For example, to help prevent injuries:

  • Enforce no hits to the head or other types of dangerous play.
  • Practice safe playing techniques and encourage athletes to follow the rules of play.
  • Make sure players wear approved and properly-fitted protective equipment. Protective equipment should be well-maintained and be worn consistently and correctly.

Learn about concussion. Before the first practice, talk your athlete(s) and others about the dangers of concussion and potential long-term consequences of concussion. Review the signs and symptoms of concussion and keep the four-step action plan with you at games and practices.

More Information

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What options do parents have to get coverage for their kids?

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An umbrella sheltering medicines - credit MicrosoftBy Michelle Andrews

As the October launch of the state health insurance marketplaces approaches, parents have many questions about covering their children.

Q. Why is it that the adult children of retired members of the military cannot stay on their parents’ insurance? My husband served for 22 years in the Marine Corps. My adult children are still in college, but they have been dropped from our insurance, Tricare Prime.

A. The Affordable Care Act allows adult children to stay on their parents’ health plan until they reach age 26 in most cases.

But Tricare, the health plan for military service members, is governed by a different set of statutes, and the ACA’s provisions that expand young adult coverage don’t apply to it.

Tricare allows dependent children to remain on their parents’ plan until they turn 21, or until they turn 23 if they’re full-time students who are supported financially by their parents, according to Austin Camacho, chief of the benefit information and outreach branch of Tricare Management Activity.

Once adult children are no longer eligible for regular Tricare, they can enroll in the Tricare Young Adult program, which provides coverage for children up to age 26 who are unmarried and don’t have employer coverage available to them, says Camacho.

Unlike regular Tricare, however, the young adult program is a premium-based plan that costs up to $180 per month.

Q. I am a divorced dad who has responsibility for maintaining my 15-year-old daughter’s health insurance. It was easy when I was working and had a corporate health plan. Now that I am retired and in the Medicare program, I am looking for alternatives when the new exchanges open in October. Can I buy health insurance for just my underage daughter on these new exchanges?

A. Yes, you can. The new health insurance marketplaces, also called exchanges, are required to sell child-only policies for children up to age 21.

If you claim your daughter as a dependent on your tax return and your income is less than 400 percent of the federal poverty level ($62,040 for a family of two in 2013), you may qualify for a premium tax credit to reduce the cost of coverage.

If your ex-wife claims your daughter as a dependent, however, in order to receive the tax credit she would have to apply for it based on her household income, says Brian Haile, a senior vice president for health policy at Jackson Hewitt Tax Service in Nashville.

Depending on your income, your daughter might qualify for health insurance through your state’s Medicaid or CHIP programs for lower income people.

As of January 2013, all but four states covered children in families with incomes up to at least 200 percent of the federal poverty level ($31,020 for a family of two in 2013) through one of those programs, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Q. My 21-year-old son is a college student, and I know the Affordable Care Act has made him eligible to remain on my employer-based insurance plan until age 26. However, if it’s cheaper for him to get subsidized coverage through the health insurance marketplace, can he do so?

A. It depends. Almost anyone can shop for coverage on the health insurance marketplace. But your son will only be eligible for subsidies to reduce the cost of coverage under certain circumstances.

If you don’t claim him as a dependent on your tax return and his own income is between 100 and 400 percent of the federal poverty level ($11,490 and $45,960 in 2013), he could be eligible for premium tax credits on the exchange.

But if you do claim him as a dependent, his eligibility for subsidies will be based on your family’s income, not just his own.

It’s also worth looking into Medicaid eligibility for your son. Roughly half of states have decided to expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013) as provided for under the Affordable Care Act. Medicaid would be even less expensive than a private plan on an exchange.

But if you claim your son as a dependent on your tax return, your family’s income would have to be no more than 138 percent of poverty in order for him to qualify, says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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The $13 Test That Saved My Baby’s Life. Why Isn’t it Required For Every Newborn?

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by Michael Grabell
ProPublica

On July 10, my wife gave birth to a seemingly healthy baby boy with slate-blue eyes and peach-fuzz hair. The pregnancy was without complications. The delivery itself lasted all of 12 minutes. After a couple of days at Greenwich Hospital in Connecticut, we were packing up when a pediatric cardiologist came into the room.

We would not be going home, she told us. Our son had a narrowing of the aorta and would have to be transferred to the neonatal intensive care unit at NewYork-Presbyterian Hospital at Columbia, where he would need heart surgery.

It turned out that our son was among the first in Connecticut whose lives may have been saved by a new state law that requires all newborns to be screened for congenital heart defects.

It was just by chance that we were in Connecticut to begin with. We live in New York, where such tests will not be required until next year. But our doctors were affiliated with a hospital just over the border, where the law took effect Jan. 1.

As we later learned, congenital heart problems are the most common type of birth defect in the United States. The Centers for Disease Control and Prevention estimate that about one in 555 newborns have a critical congenital heart defect that usually requires surgery in the first year of life.

Many cases are caught in prenatal ultrasounds or routine newborn exams. But as many as 1,500 babies leave American hospitals each year with undetected critical congenital heart defects, the C.D.C. has estimated.

Typically, these babies turn blue and struggle to breathe within the first few weeks of life. They are taken to hospitals, often in poor condition, making it harder to operate on them.

By then, they may have suffered significant damage to the heart or brain. Researchers estimate that dozens of babies die each year because of undiagnosed heart problems.

The new screening is recommended by the United States Department of Health and Human Services, the American Heart Association and the American Academy of Pediatrics. Yet more than a dozen states — including populous ones like Massachusetts, Pennsylvania, Florida, Georgia, Wisconsin and Washington — do not yet require it.

The patchy adoption of the heart screening, known as the pulse oximetry test, highlights larger questions about public health and why good ideas in medicine take so long to spread and when we should legislate clinical practice.

Newborns are already screened for hearing loss and dozens of disorders using blood drawn from the heel. The heart test is even less invasive: light sensors attached to the hand and foot measure oxygen levels in the baby’s blood. This can cost as little as 52 cents per child.

Our son’s heart defect was a coarctation of the aorta, a narrowing of the body’s largest artery. This made it difficult for blood to reach the lower part of his body, which meant that the left side of his heart had to pump harder.

A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:main pulmonary artery, 10:Aorta.

A: Coarctation (narrowing) of the aorta. 1: inferior caval vein, 2: right pulmonary veins, 3: right pulmonary artery, 4: superior caval vein, 5: left pulmonary artery, 6:left pulmonary veins, 7: right ventricle, 8: left ventricle, 9: main pulmonary artery, 10: aorta. – Source: Wikipedia

In the hospital, though, he appeared completely healthy and normal because of an extra vessel that newborns have to help blood flow in utero. But that vessel closes shortly after birth, sometimes revealing hidden heart problems only after parents bring their babies home.

Depending on the heart defect, the onset of symptoms can be sudden.

This is what happened to Samantha Lyn Stone, who was born in Suffern, N.Y., in 2002. A photograph taken the day before she died shows a wide-eyed baby girl lying next to a stuffed giraffe. The next morning, her mother, Patti, told me, she was wiping Samantha’s face when she heard a gurgle from the baby’s chest.

Before her eyes, Samantha was turning blue. Blood began to spill from her mouth. Ms. Stone dialed 911, and minutes later, a doctor who heard the call over a radio was there performing CPR. Samantha went to one hospital and was flown to another.

But the damage was irreparable. Samantha had gone 45 minutes without oxygen: She lapsed into a coma and died six days later.

It wasn’t until several years later that Ms. Stone learned about the pulse oximetry test. “This could have saved my daughter,” she told me. “There is no parent that should ever have to go through what I went through.”

Pulse oximetry is not a costly, exotic procedure. Most hospitals already have oximeters and use them to monitor infants who suffer complications. You can buy one at Walmart for $29.88.

A recent study in New Jersey, the first state to implement the screening, estimated that the test cost $13.50 in equipment costs and nursing time. If hospitals use reusable sensors similar to those found on blood-pressure cuffs, the test could cost roughly fifty cents.

As medical technology advances, few screenings will be so cheap or simple. Recent years have seen controversy over prostate cancer and mammography screenings. Medical ethicists have to weigh the costs of each program and the agony caused by a false positive against the lives saved.

But with pulse oximetry, the false positive rate is less than 0.2 percent — lower than is seen for screenings newborns already get. The follow-up test is usually a noninvasive echocardiogram, or an ultrasound of the heart. A federal advisory committee came down in favor — three years ago.

“There’s really no question, scientifically, this is a good idea,” said Darshak Sanghavi, a pediatric cardiologist and a fellow at the Brookings Institution. “The issue is, how do we change culture?”

Opposition has taken two forms. One is from doctors who believe policy makers shouldn’t interfere with how medical professionals do their jobs. The other is from smaller hospitals, which worry about access to echocardiograms and the costs of unnecessary transfers.

These concerns can be addressed fairly easily. Nurses in New Jersey and elsewhere have been able to work the test into their normal routines. A rural hospital should already have a protocol to transfer a newborn in serious condition. If Alaska can do it, less remote states can, too.

But this is not simply a rural health care problem. Cardiologists and neonatologists I’ve spoken with said they knew of hospitals in New York City, Boston and metropolitan Atlanta that weren’t screening newborns for heart defects.

“It’s completely the luck of the draw of where you deliver,” said Annamarie Saarinen, who has pushed for the screening since her daughter narrowly avoided leaving the hospital with an undetected heart defect.

Fortunately, our son’s condition was also caught and corrected. The only lasting effects are a three-inch scar on his side and checkups with a cardiologist. He will live a normal life. He will be able to play sports and climb things he’s not supposed to.

Shouldn’t every baby have that chance?

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Health reform’s ‘Family Glitch’ could hurt families who need CHIP

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By Christine Vestal
Stateline Staff Writer

The Affordable Care Act is primarily aimed at insuring more adults, including parents. In the process, a substantial number of uninsured children may also get coverage as their parents learn more about federal and state subsidies.

Just how many will depend on whether states maintain their existing Children’s Health Insurance Program (CHIP).

“Now, more than ever, it is crucial that states continue or expand coverage of children,” said Bruce Lesley, president of the children’s advocacy group First Focus. Without CHIP, the federal-state health care program for kids, he and others worry about potential harm the ACA may do to children.

A main concern is a provision known as the “family glitch” that could make employer-sponsored insurance too costly for low-income workers.

09_20_top_story_VIZ

According to a study by the Urban Institute, Obamacare could result in new coverage for as many as 3.2 million uninsured children because of tax credits on health insurance exchanges and overall outreach efforts.

But if CHIP is not reauthorized by Congress when it expires in 2015, or states decide not to continue it, the ACA could result in fewer children covered by insurance.

Children could fall through the cracks as the massive health care law is rolled out, said Catherine Hess of the National Academy for State Health Policy. The 15-year-old CHIP program, Hess wrote in a recent report, “has been exceedingly successful in finding uninsured children and providing them with quality, affordable coverage.”

She and other advocates for children insist that the program should continue well after the ACA is fully implemented.

What Is the Family Glitch?

An apparent mistake in the ACA makes the future of CHIP particularly important.

The so-called family glitch in the health law requires employers to provide “affordable” insurance only for the workers themselves – not for their families.

Premiums for individual coverage must not exceed 9.5 percent of a worker’s income. But there is no limit on the employee’s share of premiums for family coverage, which typically costs close to three times as much as individual coverage.

In addition, federal subsidies for people with incomes below 400 percent of the federal poverty level ($45,600 for an individual) will be unavailable for anyone who receives an affordable offer of insurance from an employer.

That means workers who can’t afford employer-offered premiums for family coverage will have nowhere to go except the Children’s Health Insurance Programs (CHIP) or Medicaid, if they qualify.

At least two states preparing for the ACA have already discontinued their CHIP programs and more may follow as a way to reduce administrative costs and make enrollment simpler for families. “Looking ahead,” said Joan Alker of Georgetown University’s Center for Children and Families, “the ACA does raise questions about the future of the CHIP program.”

The CHIP Provision

Although most of the ACA focuses on adults, one provision requires states to shift children ages 6 to 19 in families with incomes between the poverty level ($11,490 for an individual and $23,550 for a family of four) and 138 percent of poverty ($15,860 and $32,499) out of CHIP and into Medicaid by Jan. 1.

Children under 6 in families in this income bracket will stay under Medicaid. Those 6 to 19 are covered by Medicaid only if their family income is at or below poverty level.

The CHIP program was started in 1997 to cover these older children in families slightly over the poverty level, as well as kids of all ages in families with incomes too high to qualify for Medicaid but who can’t afford private insurance.

The federal government gave states a higher federal match for CHIP than Medicaid to encourage them to sign up as many children as possible.

Total federal and state spending on CHIP in 2009 – the most recent numbers from the Kaiser Family Foundation   – is $10.6 billion. State expenditures range from Vermont, which spends the least at $7 million, to California’s $1.8 billion.

When it was created, critics said it would result in socialized medicine. But it is now viewed as widely successful and has bipartisan support. Since enactment, CHIP has reduced the uninsured rate among low-income children from 23 percent to 10 percent.

Today, CHIP covers 8 million children and Medicaid covers nearly 36 million. Together, the programs insure more than half of all children in the country. According to the U.S. Census Bureau’s latest data, only 8.9 percent of all children remain uninsured, compared to 15.7 percent of people of all ages.

When CHIP was launched, 21 states chose to create separate CHIP programs. The remaining states opted to cover children under an expanded Medicaid program. The new federal health law requires states with separate programs to shift nearly 30 percent of CHIP kids into Medicaid.

An important difference between CHIP and Medicaid is that CHIP is a block grant, not an entitlement. That means states can create waiting lists for the program when state revenues run short.

Medicaid, on the other hand, must be offered to all comers no matter what the cost. For this reason, Republican governors tend to favor CHIP over Medicaid. Many states have a great deal of pride in their CHIP programs.

For example, Pennsylvania Gov. Tom Corbett, a Republican, has asked the federal government for an exemption to the transfer requirement. He also added state funding to cover 9,300 more children this year, a 3.4 percent increase, according to Kaiser.

The ACA says states will continue to get a higher federal match for former CHIP kids who are moved to Medicaid, averaging about 71 percent nationwide compared to 57 percent for Medicaid.

“Stairstep” Kids

The rationale for the ACA transfer was that parents and children would be best served if they were covered by the same insurance plan, with the same doctors and hospitals and the same enrollment rules.

Since the federal health law assumed that all states would expand Medicaid to adults with incomes up to 138 percent of poverty level, it made sense to cover their children under the same program.

Otherwise, parents would have to deal with separate enrollment and renewal rules for what is known as “stairstep” children who have grown out of Medicaid. When the Supreme Court made the Medicaid expansion optional for states, the justices made clear that the provision requiring states to transfer children to Medicaid was not affected.

The requirement spurred California and New Hampshire to stop running separate CHIP programs, and instead move all low-income children to Medicaid. New York and Colorado chose to make the transfer ahead of the deadline because of projected cost savings.

Nationwide, the transition from CHIP to Medicaid will affect more than 1.5 million low-income children. In California alone, nearly 900,000 kids are moving under Medicaid. New Hampshire will shift about 9,000 children.

In states that are transferring only the required number of children – those older than 6 in families whose incomes range from poverty to 138 percent of poverty – the reduction in CHIP enrollment will be nearly 30 percent.

CHIP vs. Medicaid

There’s no consensus on whether kids and families would be better off if states maintained a separate CHIP program, Alker of the Georgetown center said. Medicaid generally has a stronger benefits package and lower cost-sharing for families.

But it may be easier to get an appointment with CHIP doctors, because Medicaid tends to pay pediatricians and hospitals lower fees.

“Integrating CHIP into Medicaid is tricky,” Lesley of First Focus said. “Kids could be left worse off unless you pay attention to a variety of issues, including benefits and services, out-of-pocket costs, access to care and quality of care.”

California Gov. Jerry Brown’s decision to end the state’s CHIP program was largely fiscal. A legislative analysis showed the state will save $43 million in 2014, primarily due to Medicaid’s lower reimbursement rates.

Florida, which will transfer about 71,000 kids into Medicaid by the end of the year, expects to save $18 million in 2014. A few states have reported small increases in costs due to higher benefits costs under Medicaid, according to a new report from Kaiser. But most expect to see some savings.

Although advocates are not certain whether kids would be better off in CHIP or Medicaid, they are clear about one thing. Any move to shut down a state CHIP program should not be undertaken hastily. According to Hess of the National Academy for State Health Policy, “it makes sense to get all the new ACA systems up and running and see how it goes first.”

Children’s advocate Kristen Golden Testa said California moved way too fast in shutting down CHIP. She and other advocates in the state had nothing against the Medicaid program, but they worried that kids, especially those in treatment, would lose access to their doctors.

In addition to a series of mishaps and confusion during the transition, the state met with a storm of protests when parents of kids with autism found that Medicaid – renowned for its rich benefits package – did not cover the same autism treatments as CHIP did.

Brown, a Democrat, rejected demands to add autism coverage to Medicaid, because it would have cost as much as $50 million, more than the state estimated it would save by ending CHIP.
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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Sequester hits special education like ‘Ton of Bricks’

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Photo of Vierdrie

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By Adrienne Lu
Staff Writer

Since the first day of class for most schools in Michigan last week, Marcie Lipsitt’s phone has been ringing nonstop with parents distraught about cuts to their children’s special education services.

A new round of special education cuts were taking hold, prompted by a 5 percent reduction in federal funding of the Individuals with Disabilities Education Act (IDEA), said Lipsitt, a longtime advocate for disabled children and co-chair of the Michigan Alliance for Special Education.

Lipsitt said it means that many schools have eliminated resource rooms where children can go to get help in areas such as math, reading, writing and organizational skills.

Many schools will have fewer speech, occupational or physical therapists, along with social workers and school psychologists, which means students who previously received speech therapy twice a week might only receive it once week, for example.

And in some general education classrooms that had two teachers – one for the whole class and one specifically to support students with special needs – the special education teacher has been eliminated.

Estimated reductions in dollars in federal funding to the states in fiscal year 2013 for Individuals with Disabilities Education Act Part B Grants, following 5 percent sequestration cuts.

US

$578,892,762

AL

8,915,770

AK

1,919,022

AZ 

10,040,553

AR

5,633,069

CA

62,855,318

CO

8,108,108

CT

6,314,489

DE

1,839,638

FL

31,092,117

GA

17,458,448 

HI

2,035,593

ID

2,865,332

IL

24,657,563

IN

12,376,969

IA

5,770,827

KS

5,251,785

KY

7,688,909

LA

9,752,289

ME

2,586,535

MD

9,719,363

MA

13,418,282

MI

20,279,289

MN

9,199,308

MS

6,123,987

MO

10,762,593

MT

1,919,022

NE

3,529,607

NV

3,775,945

NH

2,247,666

NJ

17,085,902

NM

4,354,823

NY

36,378,359

NC

16,776,161

ND

1,493,764

OH

22,008,413

OK

7,300,677

OR

6,372,225

PA

21,381,079

RI

2,067,098

SC

8,583,510

SD

1,779,462

TN

11,706,600

TX

51,026,919

UT

5,672,990

VT

1,440,274

VA

13,878,260

WA

11,251,352

WV

3,589,871

WI

10,097,151

WY

  1,510,990

DC

924,976

Source: U.S. Department of Education

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“For Michigan, it hit like a ton of bricks,” Lipsitt said. “Conditions are eroding and children are not being allowed to become taxpayers. They’re not being given access to independence, being productive, being ready for a global workforce.”

Across the country, advocates for children with disabilities are grappling with the impact of sequestration, the automatic budget cuts that kicked in when Congress failed to reach an agreement to reduce the federal budget. Although the cuts took effect March 1, the impact did not reach schools until the start of the current school year because of the way many education programs are funded.

Experts agree there is little hard data on the impact of the budget cuts on special education. The U.S. Department of Education estimates the sequester cut about $579 million in federal funding for IDEA Part B, which supports students age 3-21 with specific learning disabilities, speech or language impairments, intellectual disabilities, autism or emotional disturbances.

The National Education Association estimates that if states and local school systems did not replace any of the funds lost through sequestration, nearly 300,000 students receiving special education services would be affected. The union estimated up to 7,800 jobs could be lost as a result of the federal budget cuts.

All told, 6.5 million disabled children from ages 3-21 received services funded by the IDEA in the fall of 2011, the most recent number available.

Tricky Funding Formulas

It is unknown how many states or schools districts will replace some or all of that money from other sources, such as new tax revenues or cuts to other programs. But they may hesitate to replace federal funding even if they have the resources.

That’s because by law, states and school districts that raise their funding for special education and then later reduce it, after adjusting for enrollment and other factors, can see their funding from the federal government cut.

That requirement, known as maintenance of effort, means that even if the federal government eventually replaces the money cut through the sequester, school districts will be on the hook to spend more than they did before the automatic federal budget cuts.

Because of the maintenance of effort requirement many school districts have worked hard even through several years of state budget cuts to preserve special education funding to avoid risking their federal special education funding.

Noelle Ellerson, associate executive director of public policy and advocacy for AASA, the School Superintendents Association, said that as a result, “Over the course of the recession, the cuts in a school district’s budget have disproportionately been on general education students,” although disabled students are often affected along with everybody else by reductions in services to general education students, such as larger class size.

But in a survey by AASA earlier this year on the impact of the recession on schools, more superintendents indicated that special education spending would decline for the first time in the nearly five years the survey has been conducted.

Ellerson said that in previous years, school systems were able to cover the cuts in federal funding, but superintendents indicated this year they can no longer do so because of continuing recessionary pressures and the depth of the sequestration cuts.

Those cuts further exacerbate the federal government’s chronic underfunding of its contribution toward the education of students with disabilities.

Under the IDEA, the federal government committed to giving states funding for up to 40 percent of the difference between the cost of educating a disabled student and a general student.

The most the federal government has ever given the states is 18.5 percent in 2005 (aside from a one-time infusion of economic stimulus funding in fiscal year 2009), and the figure has been declining since, according to Joel Packer, executive director of the Committee for Education Funding, a coalition of education organizations. Under the sequester, the federal share fell to 14.9 percent, the lowest federal contribution by percent dating to 2001.

Federal funding aside, local school systems are obligated by law to provide children with disabilities with a free appropriate education.

“It doesn’t matter what the feds send down to the locals and the states in federal support, the law requires that states and local school districts identify and serve every student that they deem to be eligible and in need of special education,” said Candace Cortiella, director of The Advocacy Institute. The institute is a nonprofit that provides training for special education advocates and runs the web site IDEA Money Watch, which tracks federal funding for special education.

“There can be no consideration given to how much money there is to spend. That really puts the states and the local districts in quite a precarious situation,” Cortiella said.

What States Are Doing

The impact of the sequester on special education varies from state to state and even district to district.

In Virginia, most school districts have been able to weather the special education funding cuts so far by not replacing teachers who leave, according to John Eisenberg, assistant superintendent for special education and student services. Many school systems have also reduced or eliminated staff development, which is critical in special education.

“There’s constant change in the field in terms of making sure folks are up to speed and are using research-based practices for students,” Eisenberg said. “As we have learned more and more about things like autism, the field has changed. Getting teachers trained in the most recent research-based practices is critical.”

Virginia schools have also reported big cuts in budgets for materials and technologies to support students with disabilities, which can include electronic devices to help nonverbal students communicate, technology to help students who are hearing-impaired and computers to enlarge text, for example.

In Florida, Miami-Dade and Palm Beach counties found the money to keep their special education programming intact. But nearby Broward County this year eliminated five of 11 behavior specialists, 10 program specialists and an assistive technology position, according to Mark Halpert, director of the Florida Advocacy Coalition for Learning Disabilities.

Halpert worries about the damage a second year of sequestration could inflict.

“These kids are smart – they learn differently, have challenges and can be enormously successful,” Halpert said. “We owe it as a society to help them succeed.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Washington teens getting their whooping cough immunizations; HPV vaccinations lag

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From the Washington State Department of Health

Vaccination_of_girlImmunization rates for Washington teens improved for some vaccines, while holding steady for others, according to a new national study.

In 2012, 86 percent of teens aged 13–17 in our state got a Tdap booster, according to the National Immunization Survey. That’s up from 75 percent in 2011 and tops the national goal of 80 percent.

Tdap is the vaccine that protects against tetanus, diphtheria and whooping cough (pertussis). The increase is welcome news following the recent whooping cough epidemic in Washington.

“We’re delighted that more teens in our state are protected against whooping cough,” said State Health Officer Dr. Maxine Hayes. “Older kids and teens often spread the disease to babies without knowing it. That’s why it’s so important for teens to get a dose of the Tdap vaccine.”

Over the last couple years, more teen girls are getting all three doses of the HPV vaccine, but fewer are getting the initial shot. About 43.5 percent of Washington girls 13 to 17 received the recommended three doses of the vaccine, up 3.5 percent from 2011.

Yet, only 64.5 percent of girls in the same age group got one dose of the HPV vaccine, a 2 percent decrease over the same time.

In 2012, nearly 15 percent of Washington boys aged 13–17 got the first HPV vaccine dose, up 6 percent from 2011. HPV vaccine was originally licensed only for girls and was made available to boys in October 2011.

This, plus a lack of knowledge by health care professionals and parents on the need and recommendation to vaccinate boys, may be why the rate for boys is lower than girls.

HPV vaccinations are recommended for girls and boys to protect against cervical cancer, genital warts and other types of oral and anal cancers.

Health care professionals should talk with parents about the importance of all kids getting HPV vaccinations starting at age 11 and 12. Kids in this age group have a stronger immune response compared to older kids.

“Parents want what’s best for their kids and want them to live happy, healthy lives,” Hayes said. “They can lower their children’s risk for HPV or cancer by getting them vaccinated.”

Nearly all sexually-active men and women will get at least one type of HPV at some point in their lives. HPV is most common in people in their teens and early 20s. That’s why it’s important for kids to get vaccinated before they start having sex. The vaccine doesn’t protect against any HPV strains someone already has.

Our state’s vaccination rate for two or more doses of chickenpox vaccine rose 8 percent in 2012. The rate for one dose of meningococcal vaccine rose slightly, from 69.4 percent in 2012 to 71.2 percent in 2011.

No-cost vaccines are available to kids up to 19-years-old through health care providers who participate in the state’s Childhood Vaccine Program.

Participating health care providers may charge for the office visit and an administration fee to give the vaccine. People who can’t afford the administration fee can ask for it to be waived.

For help finding a health care provider or an immunization clinic, call your local health agency or the WithinReach Family Health Hotline at 1-800-322-2588.

 

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Schools Are Getting Healthier, says CDC

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school-busBy Marissa Evans

Nowadays, the hub for developing healthy habits isn’t just the gym or home. For kids, at least, it’s increasingly their schools, according to a study released this week by the Centers for Disease Control and Prevention.

School districts across the country are demonstrating a range of improvements in terms of nutrition, exercise and tobacco policies.

For instance, after years of efforts to phase out junk food like candy and chips, the percentage of school districts that prohibited such food in vending machines increased from 29.8 percent in 2006 to 43.4 percent in 2012, according to the CDC’s 2012 School Health Policies and Practices Study.

Also, slightly more than half of school districts – up from about 35 percent in 2000 — made information available to families on the nutrition and caloric content of foods available to students.

“Schools play a critical role in the health and well-being of our youth,” said CDC Director Tom Frieden, in the news release. “Good news for students and parents — more students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free.”

Since 2000, the number of school districts that require elementary schools to teach physical education increased. In addition, the number of districts entering into agreements with local YMCAs, Boys & Girls Clubs or local parks and recreation departments went up, according to the study.

Meanwhile, the percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

The CDC study is a periodic, national survey that examines key components of school health at the state, district, school, and classroom level, including health education; physical education and activity; health services; mental health and social services; nutrition services; healthy and safe school environment; faculty and staff health promotion; and family and community involvement.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Kids with costly medical issues get help, but not enough

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Katie Doderer, with dad, Mark, and mom, Marcy (Photo by Jenny Gold/KHN).

By Jenny Gold
KHN Staff Writer

This story was produced in collaboration with NPR

Katie Doderer is a very poised 15-year-old with short blond hair and a wide smile.

She’s a straight A student who loves singing, dancing and performing in musicals.

This could be considered something of a miracle.

“I have a complex medical condition known as congenital central hypoventilation – blah — syndrome. CCHS,” Katie explains, stumbling on the full name of her malady. “Basically my brain doesn’t tell me to breathe. So I am reliant on a mechanical ventilator.”

She also has a pacemaker to control her heart rate, and she has lupus. And though CCHS is very rare – Katie is one of only 700 children in the world diagnosed with it – she is part of a growing segment of the population that the health care industry calls “medically complex children.”

Katie Doderer, with dad, Mark, and mom, Marcy, has a rare medical condition that requires 24-hour use of a ventilator (Photo by Jenny Gold/KHN).

More than 2 million kids in the US are born with multiple chronic illnesses that often require frequent trips to the hospital. Problems include cystic fibrosis, muscular dystrophy and cerebral palsy, among many other diseases. As medicine has advanced, more very sick children survive past infancy, and even thrive.

The number of medically complex kids is growing at a rate of about 6 percent a year, according to the Children’s Hospital Association. And that comes with a heavy price tag for state and federal budgets.

Million Dollar Baby

Katie’s care has been expensive, but her family is in a better position to deal with the challenges than most: Her mom is the CEO of Arkansas Children’s Hospital.

“Katie hit a million [dollars] in her first year of life,” says Marcy Doderer, Katie’s mother. Katie used to require 24-hour nursing; now the nurse only comes at night, but it still costs almost $75,000 a year, by Marcy’s estimate. It’s a service that most private insurance doesn’t cover. It is, however, paid for by Katie’s Medicaid coverage—even though the family is well off.

“The stereotypical image that comes to mind is a very poor family with a child on Medicaid,” says Marcy. “But it is important to know that in most states there’s some sort of program that is there to supplement private health insurance for a truly medically complex child.”

The sickest 2 million kids account for about 40 percent of Medicaid’s total spending on children. Many of these children have a combination of private insurance and Medicaid, and it can be challenging to coordinate care and coverage. Marcy Doderer, who until recently was the CEO of the children’s hospital in San Antonio, Texas, acknowledges that her job gives her family an advantage.

“I know how to navigate the system,” she says. “I know how to find ways to get what my child needs that the average family would never know how to do.”

Still, Marcy has seen first hand all the ways that the medical system can fall short for patients like Katie. She says Katie’s care is often scattershot.

“In our current health system in San Antonio there are no links between the medical records of the different specialists,” Marcy says. “There is not a single person other than my husband really who is paying attention to how care is coordinated for a kid like Katie.”

‘What A Waste’

Katie’s dad, Mark Doderer, is her main caregiver. He has traveled with her more than 20 times to Chicago to see the doctors who specialize in Katie’s rare disease.

But Katie’s Medicaid doesn’t travel with them: The hospital in Chicago doesn’t accept the Medicaid Katie got from Texas. And that care isn’t coordinated. Mark says the doctors in San Antonio and Chicago often want to do the same test twice, like an EKG.

“They’ll just repeat it, because they want the EKG done according to their rules and that it’s in their records,” he says. “What a waste.”

Mark remembers a mix up between doctors that ended with Katie being prescribed a medication that interfered with another she was already on. The result could have been fatal. Marcy Doderer says hospitals can do better.

At the Children’s Hospital San Antonio, Doderer says she tried to use her experience as a mom to improve things by focusing on a child-centered team approach, even hiring special care coordinators in charge of managing care for each of the sickest kids.

The Children’s Hospital Association has been lobbying Congress to help create a special network within Medicaid to coordinate care between hospitals, too.

“Our hope is to create legislation that would identify these kids in a separate bucket, so to speak, so you can build bridges between the state Medicaid problems to make care more seamless for kids who have to cross state lines,” Doderer says.

Improving the communication between doctors and hospitals to limit repeat tests and unnecessary procedures for medically complex children could save Medicaid $13 billion over 10 years, according to a recent study by CHA.

But Matt Salo, who runs the National Association of Medicaid Directors, worries that while making care more efficient is a worthy goal, it could come at a price.

“It’s important to think about health care spending not as competing for infinite dollars where everyone gets everything they want,” says Salo. “Health care is, unfortunately, a limited pool of funds.

So carving out additional dollars for one group may well mean that another group gets less—low-income frail seniors or individuals with physical disabilities.”

In her new role running the children’s hospital in Little Rock, Doderer says she’ll continue her push for better care. For Katie, it means a new school, new friends and a new set of doctors.

“She has challenging days,” Marcy says of Katie. “It’s not easy walking around with a ventilator, and you don’t get to go swimming or have normal sleepovers with your friends. But she has traveled internationally, she snow-skis, she plays the harp.”

Up next? Learning to ride a bicycle, ventilator and all.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Health reform law leaves autism coverage decisions to the states

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By Christine Vestal
Stateline Staff Writer

Autism advocates celebrated what they thought was a major victory when President Barack Obama signed the Affordable Care Act in 2010:  They expected the law to require all insurance companies to cover pricey, potentially lifelong treatments for those with the incurable condition.

But instead of creating a national standard for autism coverage, the administration bowed to political pressure from states and insurers and left it to states to define, within certain parameters, the “essential benefits” that insurance companies must provide.

Coverage requirements for autism treatments, such as behavioral counseling and speech and occupational therapy, already vary from state to state.  Far from smoothing out those differences, critics say the ACA will add a new layer of complexity.

The U.S. Department of Health and Human Services (HHS) says it will consider setting a national standard in 2016. Until then, states will decide what autism treatments insurance companies must cover.

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What is autism, how is it treated and at what cost?

Autism is a mental disorder affecting more than 2 million Americans and tens of millions of people worldwide. According to the U.S. Centers for Disease Control, one in every 88 children in the U.S has the condition, and the number is rising. Paying for treatment can be financially catastrophic to families.

Symptoms of autism first appear from birth to early childhood, and include mild to severe social, communication and behavioral challenges as well as repetitive behaviors. Treatments include counseling, speech and physical therapy and medications.

Advocates say applied behavior analysis (ABA), in which a therapist reinforces positive behaviors in the patient, is essential to helping children with autism reach their full potential.

ABA, developed in the 1960s, has become the most widely used autism treatment. But it requires hours of intensive, one-on-one therapy, and costs as much as $60,000 a year.

Depending on the severity of symptoms, a trained therapist using ABA may spend as many as 40 hours a week with a child. A new study by researchers at the University of Pennsylvania and the London School of Economics estimates the cost of treating a person with autism during his or her lifetime is $2.3 million. Autism costs Americans an estimated $126 billion annually, a number that has more than tripled since 2006.

Who opposes broad coverage of autism treatments?

ABA is endorsed by the American Medical Association, the American Academy of Pediatrics, and the U.S. Surgeon General. But insurance companies often object to paying for it because they say it is unproven and is largely educational, not medical.

Consumer advocates led by the Council for Affordable Health Insurance also argue that covering ABA is so costly it causes insurance premiums to rise, making basic health coverage unaffordable for millions of Americans.

What have states done to help ensure coverage of autism therapies?

Starting with Indiana in 2001, a total of 34 states and the District of Columbia have enacted autism insurance mandates, requiring carriers within their borders to provide coverage of ABA and other autism treatments in some or all of their policies.

States require insurers to cover nearly 2,300 categories of illness, treatments, and screenings.  Every state with an autism mandate requires insurers to cover ABA for state employees.

Beyond that, state laws vary widely. Some apply only to individual health policies, while others include small group and large corporate policies.

(No state mandates apply to the self-funded policies large employers typically offer, which is the type of coverage one-quarter of insured Americans have.)

Last year, the federal government began requiring coverage of ABA for the nation’s 8 million federal employees, retirees and their dependents.  Insurance coverage for members of the military also includes ABA treatments, with some restrictions.

Will existing state insurance mandates apply to policies sold on the state insurance exchanges?

Maybe.

The ACA says state insurance mandates in place before Dec. 31, 2011 may apply to policies offered on the exchanges.  If a state requires commercial carriers to cover ABA, that same requirement may be applied to policies sold on its exchange.

However, when the administration directed states to define “essential benefits,” every state either chose a “benchmark plan” (defined as the small business plan in the state with the most beneficiaries) or let the federal government choose a similar plan for them.

If a state’s benchmark plan includes a requirement to cover ABA and other autism treatments, then all the plans on its exchange must do the same.

But in 11 of the 34 states with autism mandates, the benchmark plan does not include autism coverage, according to an analysis by advocates Autism Speaks.

In those states, as well as the 16 states without autism mandates, state officials have the option of adding autism coverage as a required “supplemental” plan.

In Ohio, where the legislature is currently considering an autism bill, Gov. John Kasich, a Republican, mandated autism coverage by executive order in December 2012.

Alaska’s insurance chief, Bret Kolb, wrote to state lawmakers last month confirming that Alaska’s newly-minted autism mandate would apply to policies sold on the federally-run exchange.

How do state mental health parity laws affect autism patients?

According to the National Conference of State Legislatures, every state but Wyoming now has a mental health parity law on the books, requiring that when insurers cover mental illness and/or substance abuse they do so on an equal financial basis with physical illnesses.

A federal law – the Mental Health Parity and Addiction Act of 2008 – also requires equal treatment, but the Obama administration has yet tocomplete the federal rules that would enable states to enforce it.

Parity laws only require carriers to pay as much for mental health treatments as they pay for medical treatments, with the same co-pays, deductibles and coverage limitations.

The laws do not require carriers to cover specific treatments, such as ABA treatments. Still, state parity laws, combined with mandates, will maximize coverage for any given child.

What is “habilitation” and how does it affect autism coverage?

The federal government lists 10 categories of health care services states must include in their essential benefits. Two relate to autism: mental health services and habilitation, which is defined as therapies for children with developmental disabilities.

In accepting state benchmark plans last year, HHS told states they must spell out what services are covered under habilitation.

The way states define habilitation and how that plays out after 2014, when insurance companies begin processing claims, remains to be seen.

Stateline logo

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Fair season is here: win the blue ribbon for health and safety

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From the Washington State Department of Health

Hanging out with the goats, poultry, and cows can be the highlight of any trip to the local fair. Yet fair animals can also spread certain diseases.

“Going to see the animals at the fair is a treasured tradition for many families,” said Ron Wohrle, public health veterinarian for the Department of Health. “But even healthy animals can spread E. coli and Salmonella bacteria to people, which can make them sick. By following some basic safety tips you can enjoy the animals at the fair and stay healthy.”

Many kinds of animals can carry dangerous bacteria and viruses. The germs can be in their saliva, on their coats, and on surfaces contaminated by their waste. People can pick up those germs when they touch the animals or their surroundings. Most get sick by putting their hands or a contaminated object in their mouth or nose.

An estimated half-million people in the U.S. get sick every year because of a visit to animals at a fair, petting zoo, or other exhibit. Washington rules require signs warning people of the health risks, along with hand washing or sanitization stations near animal exhibits. Pregnant women, older adults, kids under five, and anyone who has an underlying illness should be especially careful to follow posted precautions.

Washing hands with running water and soap is the best way to avoid getting sick. It’s especially important after touching animals or their surroundings and before eating or drinking.

Children under five should be watched at all times while they visit animals to make sure they don’t put their hands or objects, like a pacifier, in their mouth while interacting with animals.

Stroller wheels can also pick up germs from animal areas and have been tied to illnesses in the past.

Call your health care provider immediately if someone in your family becomes sick after coming in contact with animals.

The Department of Health investigates cases and outbreaks of animal-related illnesses and works to make sure that places where animals are displayed follow state regulations. Information on staying healthy around animals is available online.

Photo courtesy of Christine Landis

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Tips for a less stressful shot visit – CDC

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Making the choice to vaccinate your child is vital for their health and well-being. Even so, getting shots can still be stressful for you and your little one. Fortunately, there are simple ways you can support your child before, during, and after shots.

Before Getting Shots

Come prepared! Take these steps before your child gets a shot to help make the immunization visit less stressful on you both.

Help children see vaccines as a good thing. Never threaten your child with shots, by saying “If you misbehave I will have the nurse give you a shot.” Instead, remind children that vaccines can keep them healthy.


Ways to soothe your baby:

  • Swaddling
  • Skin-to-skin contact
  • Offering a sweet beverage, like juice (when the child is older than 6 months)
  • Breastfeeding

Your health care professional may cool or numb the injection site to reduce the pain associated with your child’s shots.

  • Read any vaccine materials you received from your child’s health care professional and write down any questions you may have.
  • Find your child’s personal immunization record and bring it to your appointment. An up-to-date record tells your doctor exactly what shots your child has already received.
  • Pack a favorite toy or book, and a blanket that your child uses regularly to comfort your child.

For older children

  • Be honest with your child. Explain that shots can pinch or sting, but that it won’t hurt for long.
  • Engage other family members, especially older siblings, to support your child.
  • Avoid telling scary stories or making threats about shots.

At the Doctor’s Office

If you have questions about immunizations, ask your child’s doctor or nurse. Before you leave the appointment, ask your child’s doctor for advice on using non-aspirin pain reliever and other steps you can take at home to comfort your child.

Try these ideas for making the shots easier on your child.

  • Distract and comfort your child by cuddling, singing, or talking softly.
  • Smile and make eye contact with your child. Let your child know that everything is ok.
  • Comfort your child with a favorite toy or book. A blanket that smells familiar will help your child feel more comfortable.
  • Hold your child firmly on your lap, whenever possible.

For older children

Remember to schedule your next visit! Staying current with your child’s immunizations provides the best protection against disease.

  • Take deep breaths with your child to help “blow out” the pain.
  • Point out interesting things in the room to help create distractions.
  • Tell or read stories.
  • Support your child if he or she cries. Never scold a child for not “being brave.”

Once your child has received all of the shots, be especially supportive. Hold, cuddle, and, for infants, breastfeed or offer a bottle. A soothing voice, combined with praise and hugs will help reassure your child that everything is ok.

Take a moment to read the Vaccine Information Sheet your health care professional gives you during your visit. This sheet has helpful information and describes possible side effects your child may experience.

After the Shots

Sometimes children experience mild reactions from vaccines, such as pain at the injection site, a rash or a fever. These reactions are normal and will soon go away. The following tips will help you identify and minimize mild side effects.

  • Review any information your doctor gives you about the shots, especially the Vaccine Information Statements or other sheets that outline which side effects might be expected.
  • Use a cool, wet cloth to reduce redness, soreness, and swelling in the place where the shot was given.
  • Reduce any fever with a cool sponge bath. If your doctor approves, give non-aspirin pain reliever.
  • Give your child lots of liquid. It’s normal for some children to eat less during the 24 hours after getting vaccines.
  • Pay extra attention to your child for a few days. If you see something that concerns you, call your doctor.
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Teens missing recommended vaccines, Seattle study finds

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By Sharyn Alden, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

‘Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health.

Recommendations for routine vaccination of meningococcal (MCV), tetanus, diphtheria, and acellular pertussis (Tdap) and human papillomavirus (HPV) in adolescents are fairly new and many parents may be unaware of the need for adolescent vaccines.

“Our study found that when adolescents who are vaccine-eligible come to their health care provider for preventive visits, there are missed opportunities for vaccination. Adolescents who come in for non-preventive visits have even greater missed opportunities,” said lead author Rachel A. Katzenellenbogen, M.D., assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.

“Our data found that adolescents who have an appointment come into their health care provider’s office and leave without receiving all three recommended vaccines—Tdap, HPV and MCV,” Katzenellenbogen said.

Adolescents need fewer preventive care visits than infants and are a relatively new population to be targeted for vaccination when compared to infants and children, she explained.

Katzenellenbogen and her colleagues analyzed vaccination rates for 1,628 adolescents aged 11- 18 with 9,180 visits to health care providers between 2006 and 2011.

All of the teens in the study were seen at a pediatric clinic in Seattle. During that time frame, 82 percent missed being vaccinated against MCV, 85 percent missed Tdap and 82 percent missed the first dose of HPV1.

“If parents know to expect that their adolescent should receive three vaccines when they turn 11 or 12, they may be more likely to schedule a preventive visit or bring up vaccination with their child’s health care provider during any office visit,” commented Kristen A. Feemster, M.D., assistant professor in the division of infectious diseases at the University of Pennsylvania School of Medicine.

Feemster said she was not surprised that missed opportunities occur because there are many challenges to implanting adolescent vaccine recommendations. “It is more challenging, for example, to establish eligibility for adolescent vaccines—many registries do not yet reliably capture adolescent vaccination.  Providers may have questions or concerns about the recommended schedule, plus adolescents may seek care in alternative locations where it is particularly difficult to establish eligibility.”

The researchers suggest that improved vaccine tracking and screening systems, such as provider prompts through electronic health records or manual flags by nurses or medical assistants, would enable providers to more easily identify those teenagers eligible for vaccines at all visit types.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Rise in King County teen suicides prompts call to action

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Alert IconFrom Public Health – Seattle & King County

A committee of experts convened to review child deaths in King County is calling for action to prevent suicides among teenagers, after a high number of youth suicides in 2012.

Last year, eleven children died by suicide, according to the King County Medical Examiner’s office. That compares to four suicides in an average year among children younger than 18 years of age.

Of those eleven suicides, five were by firearm, five by hanging, and one by jumping.

In recent years, the highest number of youth suicides in any one year had been seven, based on a review of data from 1999 to the present. While the numbers do not represent a statistical trend, the suicides are worrisome.

Know the warning signs of suicide:

  • Talking about wanting to die or making a plan
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Depression such as moodiness or withdrawal
  • Displaying extreme mood swings

 

What to do, if you or someone you know exhibits warning signs of suicide:

  • Call the National Suicide Prevention Lifeline (800) 273-8255 (TALK)
  • Do not leave the person alone
  • Remove any firearms, alcohol, drugs, or sharp objects that could be used in a suicide attempt
  • Take the person to an emergency room or seek help from a medical or mental health professional

“As a community, it’s our duty to protect children from all forms of violence, including violence that is self-inflicted,” said King County Executive Dow Constantine.

“Suicide is a tragic and preventable public health problem,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “It calls for a comprehensive approach, so that we make sure all young people get the treatment they need, and we limit access to dangers such as guns and drugs.”

The King County Child Death Review (CDR) Committee, comprised of 37 people representing numerous agencies and communities, recently reviewed in-depth the circumstances of six suicide deaths from 2012, as well as data from prior years, to make recommendations for action and future prevention.

Recommendations from the CDR Committee include:

  • Increasing public awareness about the warning signs of suicide and risk factors for suicidal behavior and available crisis response resources.
  • Educating families and communities about the importance and methods for safe firearm storage.
  • Advocating for other methods that restrict access to lethal means, such as secure medicine return programs and safe firearm storage legislation.
  • Encouraging strong implementation of House Bill 1336, which took effect July 28, 2013. It requires suicide risk and referral training for school providers and teachers, and it also requires school districts and the Office of the Superintendent of Public Instruction to develop plans to recognize and respond to troubled youth.
  • Assuring medical and mental health care providers are trained to screen children for suicide and mental health risk factors and able to connect youth to resources or treatment.

The CDR committee includes members from health care, government agencies, law enforcement, fire departments, schools, community groups and others. The committee reviews the circumstances of preventable child deaths in King County, including suicides, and uses the information to take action to prevent future deaths.

 

“Suicide is everyone’s business. When young people and their families, teachers, health care providers, and other connected adults have the tools and skills to identify and respond to suicide risk, we can work together to save young people’s lives,” said Victoria Wagner, Executive Director of the Youth Suicide Prevention Program, a statewide non-profit organization based in King County.

According to the 2012 Healthy Youth survey data, an estimated 11,600 King County high school students (14% of students) indicated that in the prior 12 months they had made a plan of how to attempt suicide.

“Youth suicide is often an impulsive action with permanent consequences,” said Dr. Karen Milman, Prevention Division Director, Public Health – Seattle & King County.  “We can help save lives by making it harder for King County youth to access lethal means, including firearms.”

You can find more information here:

 

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What to say when mom or dad has cancer

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The Goodman family has dealt with mom Julie’s cancer diagnosis since 2009. Clockwise from top left are John, Julie, Jack and Lena (Photo by Carrie Feibel/KUHF).

HOUSTON — At any one time, an estimated 2.9 million children have a parent who has, or has had, cancer.

Dozens of studies show that many of these children experience worry and stress, but that good communication can ease their fears and isolation, even up to the point of a parent’s death.

Still, figuring out what to tell the kids – and when – is not an easy decision, and many parents who have cancer get little to no advice from their doctors about how to handle it.

Two hospitals in Houston are tackling the issue with support groups for parents and children. The Lyndon B. Johnson Hospitaland MD Anderson Cancer Centerwork with The Children’s Treehouse Foundation to offer emotional and practical support for families dealing with the disease.

Martha Aschenbrenner, a hospice counselor at MD Anderson, says that a very natural response to a cancer diagnosis is to try to protect children by hiding the facts or keeping them vague. But she urges parents to tell their children what’s happening in age-appropriate ways. Whether Mom or Dad is going to die is usually one of the first things a pre-teen will ask, she says.

“The wrong way to answer the question is ‘No, no, I’m not going to die.’ Because you can’t promise that,” Aschenbrenner says. “A better way that also invites more conversation is: ‘That is not my plan. And I’m going to a hospital where they’re going to give me very strong medicine, and I hope and my plan is I’m going to get better. And I’m going to tell you what happens, so you don’t have to worry that I’m keeping secrets from you. I’m going to keep you informed.’”

The Susan J. Komen Houston Affiliate funds a support group at LBJ, which is part of the publicly-funded Harris Health System, with a two-year grant of $237,500. That means women with breast cancer and their children can benefit from the six weeks of group sessions free of charge. The grant even covers parking charges for participants.

During a recent meeting of the group called Tender Drops of Love, Lindsey Leal, a child-life specialist at LBJ Hospital, explains to kids that parents with cancer sometimes feel sad, but it’s not the kids’ job to cheer them up.

“The thing is sometimes [your parents are] going to feel bad about themselves, and they’re going to feel sad and they’re going to feel angry. And sometimes you’re going to feel sad and you’re going to feel angry. And, is that okay?” Leal asks the group of kids aged six to 12. One boy answers, “No, that’s not helping.”

But Leal counters:  “It is okay. No, it’s not healthy to punch a wall. It’s not healthy to act on your anger. It is healthy to talk about your anger.”

Laura Molina, 9, shows the mask she created expressing the feeling of "sadness." Molina's mother is being treated for inflammatory breast cancer at the Lyndon B. Johnson hospital in Houston, Texas (Photo by Carrie Feibel/KUHF).

Laura Molina, 9, shows the mask she created expressing the feeling of “sadness.” Molina’s mother is being treated for inflammatory breast cancer at the Lyndon B. Johnson hospital in Houston, Texas (Photo by Carrie Feibel/KUHF).

As cancer progresses or retreats, parents need to keep the discussion going, therapists say.

Julie Goodman was diagnosed with colorectal cancer in 2009 at the age of 43. Her daughter Lena was in fourth grade and son Jack was in seventh. After the colorectal cancer spread to her lungs, she had more surgeries and chemo.

But now she’s had six months of clean scans.

“And whenever I come home from that, we just go ‘Yay, mom had clean scans!’ And they’re like ‘Yay, OK, what’s for dinner?’ You know, moving on,” Goodman says. “They may be desensitized a little bit to it now. Mom goes to the doctor, mom comes home, she’s fine.”

Goodman says she still struggles with how much to tell her kids. On the one hand, she wants her children to remember she’s not out of danger, not yet.

But she also loves the fact that they’re not worried anymore, that they don’t think about it every day. Instead, they have what every parent wants: that the everyday concerns be what’s for dinner, and walking the dogs, and homework, and time for bed.

This story is part of a collaboration that includes KUHFNPR and Kaiser Health News.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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