AZ Dept. of Health Services Director's Blog

ADHS Annual Report

Will Humble — Wed, 30 Nov -0001 00:00:00 +0000

There’s a state statute (ARS 36-137) that requires the ADHS to publish an annual report that outlines “the condition of public health in the state”, including the activities of the Department during the fiscal year, work done by the counties, an analysis of disease trends, expenditures, public health recommendations, a hospital financial statement, and the operations and administration of Children’s Rehabilitative Services”. Like the Department itself, this year’s ADHS Annual Report is trimmed downed and focused. Rather than creating a large document that includes a lot of details, we’ve created a report that relies heavily on hyperlinks that will take you to the required report elements. There are a number of other statutorily required reports- all of which are available on our reports web page at: http://www.azdhs.gov/diro/reports/index.htm.

Bats, Rabies, & Schools

Will Humble — Wed, 30 Nov -0001 00:00:00 +0000

Bats are one of three rabies reservoirs in AZ – the others being skunks and foxes. Our skunk rabies season often peaks during winter & spring (although last year – it went all year). Our bat season goes late-March through early-October. Most (but not all) of the 28 species of bats in AZ do migrate south to warmer climates. When the bats do return, we get into “bat season” - which certainly has begun. So, we’re officially in rabies bat season. We’ve had several bats sent to our state laboratory for testing- and 5 have been rabid so far. For some reason, grounded bats often seem to end up at schools as curious elementary school kids (usually boys) drag them into classrooms and playgrounds. It’s just the beginning of bat season, and we’ve already had 2 bat exposure incidents at AZ schools. We’re preparing a state-wide press release next week to remind people to leave bats and other wild creatures alone, and call attention to rabies prevention education resources, including the recently posted 14 minute ADHS video "Bats and Rabies at Schools Video. The video and other resources for schools and school administrators are posted on our “Bats in Schools” page at http://www.azdhs.gov/batsatschools/.

Fairness and Transparency are the Keys to Effectively Implementing the AZ Medical Marijuana Act

Will Humble — Wed, 30 Nov -0001 00:00:00 +0000

Throughout my career I’ve learned that a cornerstone of working with the community is to make sure you have a true partnership. Every partnership starts with trust. In order to establish and maintain trust throughout our implementation period, the ADHS needs to ensure that our process is completely fair, open, honest and transparent. Part of establishing these pillars that result in trust means that we need to ensure that everybody has equal access to information and making sure that everybody has an equal voice in the process. Our top priority as we implement the Arizona Medical Marijuana Act over the coming months is to ensure that the processes we use to develop the regulations for the program are fair and transparent. Moreover, I want to ensure that we have the opportunity to benefit from everybody’s ideas. It’s my understanding that there are individuals in the community that are suggesting that they somehow have inside information into our processes and decision-making. Some are even suggesting that they already have a dispensary or that they have one on “reserve”. This is not the case. Nobody outside the department is involved in the development of our informal draft rule that will be posted for public comment on December 17. Nobody and no organization has any influence on our decision making- nor does anybody have any inside track to a license of any kind. Period. We are committed to ensuring that the process is completely transparent and that everybody in the State has an equal chance at input which is why I’ve directed my rules team to write a completely internally driven first initial draft. On December 17 we’ll invite (electronic) input to everybody at once from our hub 203 website. We look forward to receiving input from all of Arizona’s residents once our draft is posted.

Drug-related mortality vs. motor vehicle-related deaths

Will Humble — Wed, 30 Nov -0001 00:00:00 +0000

The number of drug-induced deaths (mostly unintentional overdoses but also suicides) increased by 16.3 percent from 2007 to 2009. In 2009, the number of deaths in motor vehicle accidents declined to 771, the lowest annual number of deaths since 1991. (Due to high unemployment and high gas prices there were, arguably, fewer drivers on Arizona roads, and less driving). In contrast, Arizonans experienced a particularly large increase in the number of accidental drug overdoses from 383 deaths in 1999 to 802 deaths in 2009. In 2009, the number of deaths from accidental poisoning by drugs exceeded the number of deaths from motor vehicle-related injuries. Narcotics (including opioids analgesics usually prescribed to relieve pain) accounted for the majority of drug overdoses. In 2009, 423 deaths of young adults (ages 20-44 years) were attributed to accidental poisoning, and 390 of these deaths were classified as accidental drug overdoses compared to 269 deaths in 1999. The mortality rate for drug overdoses among young adults (16.7/100,000) for the first time exceeded the mortality rate for motor vehicle-related injuries (14.1/100,000).

New Year’s Promises

Will Humble — Wed, 30 Nov -0001 00:00:00 +0000

New Year's Eve has always been a time for looking back to the past, and more importantly, forward to the coming year. It's a great time to reflect on the changes we want to make and resolve to follow through on those changes. A special thanks to Michael Ealick for sharing the following links with us. 1. Spend More Time with Family & Friends http://genealogy.about.com/od/family_connections/ Recent polls conducted by General Nutrition Centers, Quicken, and others shows that more than 50% of Americans vow to appreciate loved ones and spend more time with family and friends this year. Make plans to meet up with friends for an evening of camaraderie. 2. Fit in Fitness http://exercise.about.com/library/weekly/aa2002resolutions.htm The evidence is in for fitness. Regular exercise has been associated with more health benefits than anything else known to man. Studies show that it reduces the risk of some cancers, increases longevity, helps achieve and maintain weight loss, enhances mood, lowers blood pressure, and even improves arthritis. In short, exercise keeps you healthy and makes you look and feel better. Why not make this the time to start getting in shape? 3. Tame the Bulge http://weightloss.about.com/library/weekly/aa010101a.htm Over 66 percent of adult Americans are considered overweight or obese by recent studies, so it is not surprising to find that weight loss is one of the most popular New Year's resolutions. Setting reasonable goals and staying focused are the two most important factors in sticking with a weight loss program, and the key to success for those millions of Americans who made a New Year's commitment to shed extra pounds. 4. Quit Smoking http://quitsmoking.about.com/c/ec/1.htm If you have resolved to make this the year that you stamp out your smoking habit, over-the-counter availability of nicotine replacement therapy now provides easier access to proven quit-smoking aids. Even if you've tried to quit before and failed, don't let it get you down. On average, smokers try about four times before they quit for good. Start enjoying the rest of your smoke-free life! There are a variety of free support services, hotlines and smoking cessation classes to help you kick the smoking habit. 5. Enjoy Life More http://healing.about.com/od/cocreate/ss/happieryousteps_8.htm Given the hectic, stressful lifestyles of millions of Americans, it is no wonder that "enjoying life more" has become a popular resolution in recent years. It's an important step to a happier and healthier you! Bring balance to your body, mind and soul. Or just get out and try something new! Take up a new hobby or try your hand at skiing. Go to a theater performance, or head to the local spa. 6. Quit Drinking http://alcoholism.about.com/cs/support/a/aa092497.htm If you have decided that you want to stop drinking, there is a world of help and support available. There are also a number of treatment-based programs, as well as support groups for families of alcoholics. 7. Get Out of Debt http://financialplan.about.com/cs/creditdebt/a/GetOutOfDebt.htm Was money a big source of stress in your life last year? Join the millions of Americans who have resolved to spend this year getting a handle on their finances. It's a promise that will repay itself many times over in the year ahead. 8. Learn Something New http://adulted.about.com/od/personaldevelopment/u/lifelonglearneruserpath.htm Have you vowed to make this year the year to learn something new? Perhaps you are considering a career change, want to learn a new language, or just how to fix your computer? Whether you take a course or read a book, you'll find education to be one of the easiest, most motivating New Year's resolutions to keep. 9. Help Others http://nonprofit.about.com/od/volunteers/a/flexiblevol.htm A popular, non-selfish New Year's resolution, volunteerism can take many forms. Whether you choose to spend time helping out at your local library, mentoring a child, or building a house, there are many nonprofit volunteer organizations that could really use your help. If your time is really in short supply, maybe you can at least find it in you to donate the furniture, clothing and other household items that you no longer need, rather than leaving them out by the curb to fill up our landfills. 10. Get Organized http://interiordec.about.com/od/homeorgarticles/a/a_organizelinks.htm On just about every New Year resolution top ten list, organization can be a very reasonable goal. Whether you want your home organized enough that you can invite someone over on a whim, or your office organized enough that you can find the stapler when you need it, these tips and resources should get you started on the way to a more organized life. Professional organizers can help you reduce the clutter in your life and find peace in your home.

About ADHS

admin — Thu, 03 Dec 2009 23:17:04 +0000

The Arizona Department of Health Services promotes and protects the health of Arizona’s children and adults. Its mission is to set the standard for personal and community health through direct care, science, public policy, and leadership. The Department operates programs in behavioral health, disease prevention and control, health promotion, community public health, environmental health, maternal and child health, emergency preparedness and regulation of childcare and assisted living centers, nursing homes, hospitals, other health care providers and emergency services. Arizona Department of Health Services 150 North 18th Avenue Phoenix, Arizona 85007 General and Public Information: (602) 542-1025 About Director Humble:

Will Humble, M.P.H.

Director

Arizona Department of Health Services

Current Appointments

Jan. 2010 – Director Arizona Department of Health Services Phoenix, AZ

Currently direct, operate, and control the Arizona Department of Health Services. The Department provides a wide array of health related services including Arizona’s behavioral and public health systems, the Arizona State Hospital, medical and child care licensure and certification services, and the Arizona Public Health Laboratory. The Department has approximately 2,000 employees and budget of $2B.

Successfully leading the Arizona public health system response to the 2009 H1N1 influenza pandemic, demonstrating public health leadership by coordinating Arizona’s public health epidemiological and laboratory surveillance, implementing key public health interventions, supervising special needs population readiness, efficiently distributing Strategic National Stockpile assets, ensuring health care surge capacity readiness, and coordinating statewide public health messaging. Collaborating with governmental entities including local, state, federal, tribal, and other stakeholders such as health care providers, school systems, the public and media.

Providing key leadership and management during unprecedented budget reductions by focusing on Department priorities established through strategic planning and by implementing budget reductions that minimized negative health impacts on the most vulnerable populations. Converted previously state funded programs into fee-for-service delivery models, including State Hospital ACPTC, and the Departments licensing programs.

Sharpening the Licensing Division’s emphasis on utilizing high priority compliance criteria to conduct facility surveys, resulting in reduced backlog without compromising quality of the reviews.

Leading efforts to improve accountability of the ADHS behavioral health contractors through enhanced monitoring of outcome based performance measures that improve mental health outcomes. Continuing to develop health informatics for management decision making.

Implemented a new nutritionally balanced food package for participants of the Arizona Women Infants and Children (WIC) Program to address the increasing obesity epidemic. The new package was successfully implemented, with both retailers and participants expressing satisfaction with the transition to this new healthy blend of foods.

Actively leading public health policy development within the US Mexico Border Health Commission and acting as the health co-chair for the US Mexico Border Governors Conference. Focused policy developments to address the cross-border obesity by leveraging the Department’s WIC menu changes and by calling for nutritional criteria under the USDAs Supplemental Nutrition Assistance Program.

Provided oversight for divisional reorganizations as a result of budget reductions. Areas of streamlined staffing patterns include Behavioral Health Services, Public Health Prevention, and Division of Operations units including Financial Services, Information Technology, Human Resources and Business Services.

2002 - Adjunct Faculty University of Arizona

Mel and Enid Zuckerman Arizona College of Public Health

University of Arizona Tucson, Arizona 2009 - Council Member Arizona Developmental Disabilities Planning Council Governor’s Office for Children, Youth and Families Phoenix, Arizona 2010 - Governor’s Homeland Security Advisory Committee

Past Appointments

2009 – 2010 Interim Director Arizona Department of Health Services Phoenix, AZ 2008 - 2009 Deputy Director Arizona Department of Health Services Division of Public Health Phoenix, AZ

Managed the Arizona Public Health Laboratory, Emergency Medical Services, Epidemiology & Disease Control, and Public Health Emergency Management, Vital Records, and Public Health Statistics, including 400 staff and a budget of more than $140M.

Managed a wide variety of public health programs during several rounds of significant budget reductions. Successful challenges overcome include organized prioritization of public health program funding, personnel placement decisions, and consolidating public health and business functions.

Led the development of Arizona’s trauma system by increasing the number of participating trauma system hospitals by 100% during 2008. System enhancements have improved the administrative effectiveness of the state pre-hospital care system, improved Stakeholder relations, and measurably improved patient outcomes.

2005 - 2008 Assistant Director Arizona Department of Health Services Public Health Preparedness Phoenix, AZ

Managed the Arizona Public Health Laboratory, Emergency Medical Services, Epidemiology & Disease Control, and Public Health Emergency Management, including 300 staff and a budget of more than $110M.

Improved the effectiveness of the Strategic National Stockpile program, public health volunteer coordination, special needs population readiness, hospital and local health preparedness, and increasing laboratory capacity.

Coordinated the development of the ADHS pandemic readiness plan and Arizona’s interagency pandemic influenza operational plan.

Led the successful implementation of the Smoke Free Arizona Act, resulting in good compliance and satisfaction among businesses and public health Stakeholders.

Improved the administrative effectiveness of the Department’s emergency medical services programs, improving Stakeholder relations, initiating the development of Arizona’s new trauma system, and leading the development of public health initiatives such as cardio-cerebral resuscitation (CCR), stroke telemedicine, and cardiac care centers. CCR has been adopted statewide and in other states, and recent research studies show that CCR as compared to CPR results in 300% increase in survival rates.

Led the expansion of Arizona’s newborn screening program and took the lead in integrating the newborn testing and follow-up programs.

2003 - 2005 Bureau Chief Arizona Department of Health Services Epidemiology & Disease Control Phoenix, Arizona

Managed the Epidemiology & Disease Control programs including the Office of Infectious Disease Epidemiology, the Office of Environmental Health, the Arizona Immunizations Program Office, and the Office of HIV/STD Services. Responsible for approximately 120 staff and a budget of more than $80M.

Successfully managed public health interventions and communications during Arizona’s 2004 West Nile virus season.

Successfully managed the 2004 influenza vaccine shortage.

Led interventions to improve Arizona’s vaccination rates and expanded vaccination requirements for school entry. Current data show that more than 95% of Arizona’s children receive all recommended vaccinations by school entry age.

Integrated STD and HIV surveillance, prevention, and care services to improve efficiency and stakeholder involvement.

1997 - 2003 Office Chief Arizona Department of Health Services Office of Environmental Health Phoenix, Arizona

Led the overhaul of Arizona’s food safety regulations and implemented a more effective food safety network in Arizona.

Developed statewide soil remediation levels (SRLs) for the Arizona Department of Environmental Quality and led Stakeholder groups to develop consensus about their implementation.

Developed Arizona’s targeted Lead Poisoning screening program, resulting in a more targeted approach to screening that is more cost effective.

Developed the highly successful Arizona “Sunwise” sun safety program improving sun safety awareness among families.

Authored over 50 environmental health risk assessments and public health consultations at various environmental contamination sites, and led public meetings and workshops to communicate health risks to the public and media.

Successfully managed environmental health issues during the 2002 Rodeo-Chediski fire.

Responsible for 25 staff and a budget of $2M.

1993 - 1997 Manager, Environmental Health Sciences Program Arizona Department of Health Services Office of Environmental Health Phoenix, Arizona

Authored more than 75 environmental health risk assessments and public health consultations at various environmental contamination sites, and led public meetings and workshops to communicate health risks to the public and media.

1992 - 1993 Environmental Program Specialist Arizona Department of Health Services Office of Environmental Health Environmental Health Sciences Program Phoenix, Arizona 1986 - 1990 Public Health Sanitarian Maricopa County Environmental Services Department

Education

1991 Masters Degree in Public Health (MPH) University of California at Berkeley Berkeley, California 1985 Bachelors of Science in Microbiology Arizona State University Tempe, Arizona 1982 Bachelors of Science in Business Administration Northern Arizona University Flagstaff, Arizona

under_construction

admin — Fri, 04 Dec 2009 17:58:54 +0000

Salt, BPA, CCR & the Budget

Will Humble — Fri, 22 Jan 2010 21:25:16 +0000

NaCl It’s been no secret that the U.S. (and Arizona) diet is high in salt- and almost 90% of that salt comes from pre-processed foods (as opposed to the salt that you might add while cooking or eating). Reducing dietary salt is an important public health target- and it’s among one of the cheapest and easiest public health interventions. In fact, the cardiovascular benefits of reduced saltintake are on par with the benefits of population-wide reductionsin tobacco use, obesity, and cholesterol levels.

A new study this week in the New England Journal of Medicine http://content.nejm.org/cgi/content/full/NEJMoa0907355 found that reducing dietary salt by 3 g per day would reduce the annual number of new cases of coronary heart disease in Arizona by up to 2,400 per year, reduce the number of strokes in AZ by up to 1,300, heart attacks by up to 2,000 and reduce the annual number of deaths from anycause by between 880 and 1,800. All from a modest reduction in salt intake.

In fact, Japan,the UK, Finland, & Portugal have successfully reduced population-widesalt intake by using a combination of regulations on the saltcontent in processed foods, labeling of processed and preparedfoods, public education, and by collaborating with the food industry to reduce the amount of salt that is added to foods.

The New York City Health Department has been coordinating a nationwide effort to reduce the salt in both packaged and restaurant foods by 25% over five years http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml. Our nutrition team is exploring whether and how we can sign-on to this growing national initiative… 15 state health departments are already among the supporters. More on this soon.

BPA On the other end of the risk spectrum is recent concern about a chemical called bisphenol a, which is a plasticizer that’s used in some kinds of water bottles and in plastics that cover processed foods. Previous studies have found a slight association between urinary BPA concentrations and heart disease, diabetes and liver enzymes in adult participants of the National Health and Nutrition Examination Survey. A new study out this week published at: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0008673 concluded that “Higher BPA exposure, reflected in higher urinary concentrations of BPA, is consistently associated with reported heart disease in the general adult population of the USA.”

When I heard about this new study I didn’t think much of it, because the association is weak and the risk increase is slight- and because the studies that have been conducted have shown as association- not causation. But, when I saw my wife throwing away all of our perfectly good plastic water jugs this morning because of something she heard on the radio- I thought I should include something in this week’s update.

You can read the study yourself and do your own research, but I’m not convinced that the low levels that we’re exposed to from containers is a problem. So, if you see me in the elevator, you will still see me with my bisphenol A containing refillable water bottle (that I fill up with tap water).

CCR There was a very good article in the paper this week about our efforts to convert the world to using the new CCR to resuscitate adults that have a cardiac arrest. You can read the full article at: http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html and you can review the new CCR method at www.azshare.gov.

Extraordinary Measures A new movie called Extraordinary Measures will be released today. The film is about a family’s efforts to find a cure for Pompe disease http://en.wikipedia.org/wiki/Pompe_disease (a metabolic disorder), which affects their two children. In a sense, it’s a public health film, because it’s directly related to our newborn screening program. There is currently no reliable newborn screening test for this disorder yet (so we don’t test for it yet), but Illinois and Missouri have been mandated to implement the test. You can read more about Arizona’s Newborn Screening Program on our website.

Budget Requests and Bill Inquiries Please respond quickly to any request that comes from Duane regarding budgetary or bill information. The Legislature is now in session, and bills that impact our programs are coming out daily. It’s critical that we look over the bills and get any feedback to Duane right away so that we can relay and suggestions to the appropriate place quickly.

As I mentioned last week, the Governor recently released her budget for FY ’11 (the fiscal year that begins on July 1, 2010). The Agency Detail Book contains the budget proposal for the ADHS starting on Page 80.

Congrats… … to our team from the Arizona State Hospital that completed the PF Chang's half marathon. They got together last summer and started planning and training, with group runs at Papago and South Mountain Parks. Team Captain Crystal Gilbert led the pack on Sunday when the team took off. 17 people crossed the finish line 13.1 miles later. Team AzSH placed second in the municipal team category!

Terms of Participation

Will Humble — Fri, 22 Jan 2010 21:41:28 +0000

All submissions to this blog are screened for content. To ensure a productive discussion you agree to post only comments directly related to the posting on which you are commenting and to refrain from posting threats, obscenity, abusive language, sexually explicit material, and other material that would violate the law if published here. You agree not to post content that: * Contains obscene or threatening language or discrimination (including hate speech) based on race, gender, sex, national origin, age, sexual orientation, religion, or disability; * Promotes services or products (not including non-commercial links that are relevant to the post or comment); or * Includes private phone numbers, email addresses, or postal addresses. Comments containing any content that is not eligible for posting according to this comments policy will not be published. Comments made by individuals or entities other than the Arizona Department of Health Services are the opinions of those individuals or entities and are not necessarily the views of or endorsed by the Arizona Department of Health Services. For specific health-related recommendations and information visit http://azdhs.gov. We make every effort to moderate all comments in a timely manner. Please allow up to 3 business days for new content to be published to the blog. Thank you for taking the time to read the Terms of Participation. We encourage your participation in the discussion and look forward to an active exchange of ideas.

WillHumble

Will Humble — Fri, 22 Jan 2010 21:54:38 +0000

Read about Director Humble in About ADHS

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Vaccines, Homeless Count, Cardiac Care & Tribal Preparedness

Will Humble — Fri, 29 Jan 2010 18:59:02 +0000

Hi… Leverage The Bill and Melinda Gates Foundation http://www.gatesfoundation.org/Pages/home.aspx is one place that understands leverage. The foundation announced this morning (in Davos, at the World Economic Summit) that their foundation will commit $10 billion over the next 10 years to help research, develop and deliver vaccines for the world’s poorest countries http://www.gatesfoundation.org/vaccines/Pages/decade-of-vaccines.aspx. Vaccine development and delivery is the number-one priority at the Gates Foundation because if the impact that they have on children’s lives. A model developed by the Institute of International Programs at the Johns Hopkins Bloomberg School of Public Health suggests that we could prevent the deaths of some 7.6 million children under 5 from 2010-2019. The foundation also estimates that an additional 1.1 million children could be saved with the rapid introduction of a malaria vaccine beginning in 2014, bringing the total number of potential lives saved to 8.7 million. If additional vaccines are developed and introduced in this decade—such as for tuberculosis—even more lives could be saved. The new funding announced today is in addition to the $4.5 billion that the Gates Foundation has already committed to vaccine research, development and delivery to date across its entire disease portfolio since its inception. Investments like this are critical for the people in developing nations. While vaccines for illnesses in developed countries are profitable, preventative treatment and vaccines for diseases that are prevalent in developing nations are not as profitable- putting them at a disadvantage when it comes to research and development. Investments like this help to turn the tide- and have a remarkable impact. Counting the Homeless Thanks to all of you that participated in this year’s “Count the Homeless” event. Each year, Teams count homeless to secure federal aid including the City of Phoenix, our Behavioral Health team, RBHAs, the PATH Outreach program, ADES, and the MAG Continuum of Care Regional Committee on Homelessness conduct an annual count of homeless men, women, and children sleeping on the streets in Maricopa County. On Tuesday this week, over 350 volunteers canvassed streets, parks, vehicles, allies, and other gathering places where homeless people camp; to conduct this year’s street count. The count went around the clock. Homeless Street Count is a requirement for receiving federal homeless assistance funding from the U.S. Department of Housing and Urban Development (HUD) and the Substance Abuse and Mental Health Services Administration (SAMHSA). More than $200 million funding has been awarded to Maricopa County, over the past 11 years from these two federal agencies for housing subsidy, outreach, case management and support services for homeless assistance programs. Each year the point-in-time count provides valuable data on the number of people experiencing homelessness. Last year, per MAG, 2,918 people were counted on the streets, representing an overall increase of 20 percent more homeless than the previous year. The number of homeless families increased by 300% (as a result of the economic and housing crisis) and the number of youth on their own increased by nearly 250%. The information gathered from the street count helps set priorities for addressing the needs of people experiencing homelessness. Volunteer participation is critical to conducting a successful street count. Once again employees from ADHS/DBHS volunteered to complete this year’s Homeless Street Count. I sincerely thank them for helping to make a difference in the lives of people who have no place to sleep at night in Arizona. Thanks to the ADHS volunteers including Paige Finley, Brenda Robbins, Linda Cram, Idalia Brown, John Gallagher, Sylvia Dodge, Amy Sather, Adam Robson, Dave Bonney, Jessica Moore, and Dr. Tim Flood, this year’s event was a success. Tribal Preparedness Strategic Plan After much hard work by Michael Allison the Arizona Tribal Public Health Emergency Preparedness Coordinators developed and finalized their Strategic Plan for 2010-2013.This plan has been posted on our ADHS Native American web site. The direct link is http://www.azdhs.gov/phs/tribal/TribalPreparedness.htm. As far as we know this is the first such statewide plan developed by tribal nations and most likely will serve as a model for other tribes throughout the nation. Nursing Home Ratings You might have seen a news report this week that stated that stated that 20% of nursing homes rated consistently poor in quality according to data released Thursday by Medicare. The ratings are derived from inspections, complaint investigations and other data collected mostly in 2008 and 2009. Information about the program is posted at Nursing Home Compare and it allows you to Compare the quality of the nursing Homes you're considering using CMS’s Five-Star Quality Ratings, health inspection results, nursing home staff data, quality measures, and fire safety inspection results. For another frame of reference, you can check our licensing website where you can conduct a Facility Search to find how local places have done on their latest survey. Cardiac Care Centers About two years ago we invented the concept of developing Cardiac Care Centers in Arizona. By following simple protocols like lowering a patient’s body temperature when they are being treated, hospitals can become part of our voluntary consortium. We are proud to welcome Carondelet St. Joseph’s Hospital, Carondelet St. Mary’s Hospital and Tucson Heart Hospital to the Arizona Cardiac Center Consortium. There are now 30 Arizona hospitals recognized and operational: You can see the full List of Arizona Cardiac Receiving Centers on our http://www.azshare.gov/Info4CAC.htm website. We have entered a new era of providing complete cardiac arrest care in Arizona and your efforts are saving more lives than ever before. Our website is continuously updated and we encourage everyone to visit www.azshare.gov for more information on the Arizona Cardiac Center Consortium. Annual Reports Galore Did you know that various state statutes require us to produce several annual reports on various topics every year? The topics and reports include: Annual Report of the Incidence and Reported Causes of Stillbirths Tobacco Education & Prevention Program Biennial Evaluation Report Designation of Arizona Medically Underserved Areas Division of Behavioral Health Services & Arizona State Hospital Annual Report Arizona Child Fatality Review Team Annual Report Smoke-Free Arizona Annual Report Annual Report on Substance Abuse Treatment Programs Of course, there are several more reports that we put together, but these are the ones that are required by statute. We just completed our new annual report page, which is posted at: http://azdhs.gov/diro/reports. Department Blog I’m learning all kinds of new things in this job, like what a “blog” is. It is kinda like my weekly updates but it’s a chronological accumulation of the updates, plus I can add things through the week. Blogs also let people comment on the stuff too. OK, since blogs are good, and people like them, we started one for the department. It’s called the Director’s Blog and it’s posted on our home page on the link that says Visit the Director's Blog. The actual URL is at: http://directorsblog.health.azdhs.gov/. We don’t have my updates from the past year posted there, but as the weeks go by we will keep adding them to the blog. Thank you for your professionalism and work ethic over the past year. We’re a darn good team- and our accomplishments and successes over the past year are a testament to your hard work, creativity, focus, professionalism, positive attitude, and your commitment to the folks of Arizona. Thanks… will

Behavioral Health Milestone

Will Humble — Mon, 01 Feb 2010 16:12:57 +0000

The tumblers have clicked, and we’re well down the road of significantly improving the behavioral health system in Maricopa County. A few months ago, we joined forces with Magellan of Arizona (our contractor for behavioral health services in Maricopa County) to begin development of a revolutionary new outcomes dashboard that will improve transparency & accountability in our behavioral health system. The system is now up and running, and you can check it out at the Provider outcomes dashboard site. The provider outcomes dashboard measures the key elements that improve actual life outcomes for folks that are being treated for serious mental illnesses. The dashboard provides near real-time data for 18 outcome indicators at each of the clinics that provide behavioral health services in Maricopa County. Indicators that folks can view and compare include employment, staffing and caseload ratios, recipient/patient satisfaction, individual service plan quality, primary care and physician follow-up, admissions and readmissions data, court ordered treatment compliance, individuals' community reintegration and involvement, and much more. The dashboard can be reached quickly at any time by using the URL www.MagellanofAZ.com/dashboards. The online dashboard provides key information for our service recipients and their families as well as the providers themselves. The dashboard measures areas that are working well and those that need improvement. Magellan's 4 adult provider network organizations (CHOICES Network, People of Color Network, Partners In Recovery Network and Southwest Network) collaborated in the development and implementation of the dashboard. The bottom line- the new dashboard gives folks in the behavioral health system a way to evaluate their treatment options and provides them information to make better choices for them; it gives Magellan an easy to use way of better managing their provider networks; and it gives the ADHS a way top better evaluate the performance of the entire system and to make interventions when necessary. It gives everybody transparency into the system and its performance. It will also allow the provider networks to see how each other are doing in the various 18 areas of performance- sparking healthy competition. We think that this new tool will become an expectation throughout the country and in Arizona moving forward. Well done Team!

Haiti National Medical Response

Will Humble — Tue, 02 Feb 2010 15:44:23 +0000

Relief efforts are continuing in Haiti. As of Sunday, almost 19,000 patients have been treated by US Dept. of Health and Human Services (HHS) doctors and nurses on the ground in Haiti, with an additional 19,000 being treated on the Comfort (a medical ship). 435 patients have been evacuated to the US for more extensive treatment- through the HHS National Disaster Medical System (NDMS) http://www.hhs.gov/aspr/opeo/ndms/index.html. Most of these patients have been going to Florida and other states in the southeast. The Florida high-level trauma care infrastructure is at capacity as of last weekend- and patients could be flown to more distant treatment hospitals in the coming days. In anticipation of that, the government activated federal coordinating centers (FCC) in Atlanta and Tampa yesterday. There are 32 hospitals in Arizona that are part of the NDMS medical treatment system, which, if activated would provide treatment to Haitians at local hospitals. Folks (if it happens) would arrive on civilian reserve air fleet or military aircraft landing at Sky Harbor, followed by patient reception will be at the 161 ARW and then dispersion to area NDMS hospitals. You can also help immediately by donating to the Red Cross to assist the relief effort. Contribute online to the Red Cross, or donate $10 to be charged to your cell phone bill by texting "HAITI" to "90999." Find more ways to help by visiting http://www.charitywatch.org/hottopics/Haiti.html which provides a listing of various charities along with effectiveness ratings.

Lancet Withdraws 12 Year Old Flawed Autism Article

Will Humble — Wed, 03 Feb 2010 15:27:42 +0000

An article published in the journal Lancet nearly 12 years ago set the public health world on fire. The article published by Wakefield and 12 other authors suggested that they had found a link between the MMR (measles mumps rubella) vaccine and autism and bowel disease. Since that time, a great deal of research has been conducted and numerous articles have been written, but none found a link. Nevertheless, the rumor has persisted in some circles that there is some kind of association- usually citing the 1998 Lancet article. On Tuesday this week, the authors of The Lancet finally retracted the article that they published in 1998 from the public record, stating that should never have published the research because the study was seriously flawed. In fact, 10 of Wakefield's 13 co-authors renounced the study's conclusions several years ago. In addition, Britain's General Medical Council ruled that the authors of the study had shown a "callous disregard" for the children used in his study and had even acted unethically. Here’s the full retraction statement from The Lancet: “Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.” You need to register to get access to the site, but the introduction is posted at: http://www.lancet.com/journals/lancet/article/PIIS0140-6736(10)60175-7/fulltext#bib1. Registration is free.

A Year of Progress at ADHS

Will Humble — Thu, 04 Feb 2010 15:34:40 +0000

We started on this journey together a year ago. Thanks for being such good traveling companions. We’ve been through a lot. We’ve had challenges, fears, anxiety, good times, laughs, & fun. We’ve sacrificed some of our programs, but we’ve made a great deal of progress too. Overall- the year was a net plus. I say that because we maximized our progress in areas that we have control. We’ve made a great deal of progress in many areas and have just done a plain old good job with most everything this year. I jotted down a few things the came to mind below. We:

Aced the first influenza pandemic in 40 years http://www.azdhs.gov/flu/;

Overhauled the WIC program to focus on a much more nutritious blend of foods www.azwic.gov, and started a nationwide movement to change the food stamp program (SNAP) from a calorie program to a nutrition program;

Created the new Empower Pack program for preschools that improve physical activity and nutrition for our youngest- an idea that came out of our licensing fee increase;

Developed a network of more than 20 new Cardiac Arrest Centers and Primary Stroke
Centers across the state that are dramatically improving outcomes for folks that have a cardiac arrest or a stroke;

Led the national shift to continuous chest compression CPR from the old compression/breathing method http://www.azshare.gov/;

Figured out a way to vaccinate underinsured kids through our Vaccine for Children Program even though our state vaccination funds were completely eliminated;

Began development of Arizona’s TRAUMA SYSTEM- adding 8 new Level IV Trauma Centers and 1 new nationally recognized pediatric trauma center;

Implemented a brand new and tested youth tobacco campaign (called Venomocity) http://www.venomocity.com/ and helping thousands of Arizonan’s Kick the Habit through our www.ashline.com services;

Helped develop a state of the art on-line Outcomes Dashboard to give choice and voice to folks with serious mental illnesses in Maricopa County- improving their ability to better participate ion their path to Recovery (Download the Dashboard);

Helped thousands of folks statewide with their journey toward Mental/Behavioral Health;

Made a difference in hundreds of peoples lives at the Arizona State Hospital- by helping them in their road to recovery by treating them with dignity, care and respect;

Inspected hundreds of Nursing Homes (Long-term Care), Assisted Living Facilities, Medical Facilities, Behavioral Health Providers, and Child Care centers and homes to make sure that folks are being treated right and have a safe environment;

Converted our licensing programs to become self sufficient, and sharpened our surveys to focus on the most important elements of care, and allowing folks to review the latest scores using our Facility Search tool;

Identified hundreds of kids with metabolic disorders and hearing and helped their doctors conduct interventions to help them avoid serious complications from their condition through our Newborn Screening program;

Helped thousands of folks at some of the most intense parts of their lives get critical documents in an efficient way through our Vital Records, Health Data & Evaluation programs;

Tested thousands of biological samples for all kinds of viruses and bacteria including H1N1, tuberculosis, West Nile virus, rabies, and literally dozens of other diseases so that counties and doctors can help slow the spread of disease and help people get better in our Public Health Microbiology program;

Ensured that hundreds of clinical and environmental laboratories across the state are doing things right and providing good results through our Laboratory Licensure & Certification program;

Tested thousands of water samples for Environmental & Analytical Chemistry and bacteria so that counties and cities can protect their residents in our;

Identified Nursing Homes (Long-term Care) and Assisted Living Facilities that were jeopardizing the health of their residents and worked with them to make immediate corrections so that the residents are safe;

Created an inter-disciplinary team from around the Department to develop an integrated tobacco prevention program together- expanding our tobacco prevention efforts way beyond it’s former borders- integrating tobacco control into programs throughout AZ’s behavioral health system.

Holy smokes… who did all this stuff? ADHS did. Thanks to the staff for rowing in the same direction together this year- forward. Next year will have challenges just like this past year— but as long as we work and collaborate with one another we will continue to press ahead and make progress next year too. Thanks, and take a second this week to thank the folks around you, and let them know you appreciate their help this year.

Special Session & Sales Tax Referral

Will Humble — Fri, 05 Feb 2010 15:44:27 +0000

The Governor called a special session of the Legislature this week (special session) to address various budget issues including education rollover payment issues, additional sale and leaseback issues, a sales tax referral, and a proration of income tax for out-of-state filers. All of these matters have a link to our budget and the future of our Agency and mission- but there aren’t any direct line item proposals that talk specifically about the ADHS budget in this special session proposals. The Senate passed the proposals earlier this week, and on Thursday afternoon the proposal to have a Public vote on sales-tax hike passed the House. The proposal had rare bi-partisan support in both chambers. The ballot proposal for the sales tax increase will become official as soon as the Governor signs the bill and it is certified by the Secretary of State. The public vote will most likely be on Tuesday, May 18. If the ballot measure passes, there will still need to be additional budget reductions to state agencies (including ADHS)- but if the measure fails, the reductions will be far more dramatic. As of the time I'm writing this on Thursday evening, I don't think that the House has taken a vote on the education rollover payment issues, additional sale and leaseback issues, or the prorating of income tax for out-of-state filers- yet.

Adult Vaccination Rates

Will Humble — Mon, 08 Feb 2010 16:00:02 +0000

The Trust for America’s Health released a report about adult immunization rates across the country last week at: healthyamericans.org. The Complete Report (PDF 0.2Mb) provides all of the details… but for a snapshot, the report says that about 69% of Arizona’s seniors have been vaccinated for pneumococcal disease. Vaccinations are an important part of public health strategy. When people are vaccinated, it not only protects them from catching that virus, it reduces the chance they will infect someone else. The term herd immunity means enough people are immune to a disease through vaccination or exposure that a community is protected from a major outbreak. Arizonans can learn what vaccinations are available to them and their family on the ADHS website. It is not too late to get seasonal and H1N1 influenza vaccines. Find out where at StoptheSpreadaz.com

AZ Trauma System Development Progress

Will Humble — Tue, 09 Feb 2010 15:34:30 +0000

One of our Department priorities over the last couple of years has been to better develop Arizona’s TRAUMA SYSTEM. Here’s a thumbnail sketch of why having a system of trauma care is so important: More than 24,000 people are severely injured (called trauma) every year in Arizona. More than 60% of these severe injuries occur in the rural and frontier areas of Arizona. Most patients are treated at one of the eight designated Level I Trauma Centers in Arizona, which are concentrated in urban areas. As a result, trauma patients are often transported long distances to receive treatment for their injuries. In fact, more than 40% of Arizona trauma patients don’t reach a designated Trauma Center within the first hour or “Golden Hour” after their injury. Receiving treatment in this first hour may be critical to survival. Patient care in Arizona can be dramatically improved and costs reduced by developing a coordinated and integrated system of trauma care for the entire state. Designation as a Level I Trauma Center requires the most resources and capabilities, providing total care for every aspect of injury. Designation as a Level IV requires the least resources and capabilities and typically will resuscitate and stabilize a patient and transfer the patient to a more appropriate Level, based on the patient’s injuries. Over the last year or so, our priority has been to establish Level IV Trauma Centers in rural AZ hospitals so that folks can be treated closer to where they’re hurt- or to be resuscitated and stabilized so they can be transported (preferably by ground) to a higher level of care if necessary. I’m proud to announce that we have been successful in developing this rural system of care. We recently added Copper Queen Community Hospital in Bisbee as our 8^th designated Level IV Trauma Center. Here’s a list of the other sites: Designated Trauma Centers Thanks go out to Vicki Conditt and her team for doing the shoe-leather work to get this done. Also, Wes Korteum put together a Trauma Center map that identifies the four EMS regions, acute care hospitals and the trauma centers throughout the state. The blue “T’s” identify the Level I’s and the red “T’s” identify the Level IV’s. The map is posted on the Bureau’s website, trauma designation page, along with the list of designated trauma centers.

Abstinence

Will Humble — Wed, 10 Feb 2010 18:41:56 +0000

Perhaps nothing in public is more controversial than the question of what is the best way to delay sexual activity in youth. Some say abstinence education is the best way. Some say it’s a more broad approach and boosting self esteem. Some say it’s keeping kids involved in sports and other activities. Some people say it has to be one way or the other, while others say it shouldn’t be a one size fits all approach. Anyway, there is an interesting new article in the Archives of Pediatrics & Adolescent Medicine that is sure to stir the pot. Researchers compared the effectiveness of: 1) an 8-hour abstinence-only intervention that targetedreduced sexual intercourse; 2) an 8-hour safer sex–only interventiontargeted increased condom use; and 3) an 8-hour comprehensiveintervention that targeted sexual intercourse and condom use; and 4) an 8-hour health-promotion control intervention that targeted healthissues unrelated to sexual behavior. Here at ADHS we recently started back up abstinence only education using some lottery funds that are designated for that purpose. It sounds like the successful intervention mentioned in this week’s study did a lot of the same things we do in Arizona in our abstinence program, which is increasing skills to be abstinent and resist pressure to have sex as well as strengthening the belief that abstinence can help prevent pregnancy and STIs/HIV.

H1N1

Will Humble — Fri, 12 Feb 2010 15:28:04 +0000

When’s the last time you heard anything about the pandemic? It’s been awhile, huh? Well, it’s still around. The number of cases is back down to where it was this summer, with cases here and there. Nothing like it was last October- but the flu is still out there. We’re still encouraging the stragglers to get vaccinated… and the best place to find a vaccine is still at www.stopthespreadaz.org. You can see the latest Weekly Flu Updateon our H1N1 website. We had 1 more lab confirmed H1N1 death last week, bringing the total number of deaths directly attributable to H1N1 to 146 since April.

Eat Well Be Well

Will Humble — Tue, 16 Feb 2010 15:58:36 +0000

Throughout history, mankind’s future was largely determined by fate. Infectious diseases like Diphtheria and Smallpox could wipe out an entire family in just a few days. People were vulnerable to outside threats ranging from a lack of clean drinking water to poor sanitation to gaps in environmental infrastructure that led to a host of infectious diseases. Science had not discovered medications to help prevent or treat infectious diseases; people weren’t aware of the direct link between lifestyle and health; and the lack of safe transportation and workplace safety standards led to all sorts of accidents that took lives. But it is very different for us. We control our own destiny. We’ve developed effective public health interventions over the last 100 years like vaccine, environmental engineering, vehicle safety, sanitation and the like. The things that threaten your health today are things that you have control over- and they’re pretty simple. Stay physically active. Make better food choices. Drink & eat in moderation. Don’t smoke. Get vaccinated. Buckle up and drive sober. Look both ways before crossing the street. Talk to your doctor about routine health screenings. Monitor and control your blood pressure & blood sugar. Sounds simple enough, right? The problem is that many of us slip into sloppy routines. We don’t do the simple things that can make a big difference in how we age and feel day to day. But the great thing is that it’s never too late to grab your bootstraps and clean up your lifestyle. That’s where Arizona’s public health system can be your partner. During the next year, we’ll be providing simple information you can use to update your family’s lifestyle. Our 2010 Champion for Change program (at www.eatwellbewell.org) can help. By taking one step at a time, you can make lasting changes to improve your family’s health. To help you get started, we've added resources and tools to help you to shape your family’s food consumption in a positive way, and help you to take positive steps toward increasing your physical activity. Here are some examples of how to get started. A recent study found we can save thousands of lives in Arizona every year just by reducing how much salt we eat. By learning to read the Nutrition Facts, paying attention to the Sodium part of the label, and incorporating sodium levels into your purchasing decision, you can cut way back on your family’s salt consumption- and save their heart to boot. You can also sign up to receive a “healthy recipe a week” in your Inbox by joining our growing list of folks making the commitment to improve their family’s health at www.eatwellbewell.org. Even putting a white board up in your kitchen and asking your family to track their physical activity can help. And, of course, if you need help kicking the habit you can visit the www.ashline.org website.

Out of Control Diabetes Treatment Costs

Will Humble — Wed, 17 Feb 2010 23:38:39 +0000

The US obesity epidemic is costing Americans more and more each year. It’s not just the decreased quality of life that it causes, but it causes a whole host of downstream problems like diabetes and circulatory problems. Type 2 diabetes had been a disease of folks over 40 that became seriously overweight over time- but it’s increasingly becoming a pediatric disease. The Medicaid, Medicare and regular private insurance treatment costs for Type 2 diabetes is rapidly increasing- and becoming not just an epidemic- but a financial crisis as well. Researchers from the journal Diabetes Care published a paper recently http://care.diabetesjournals.org/content/32/12/2225.full that projects that over the next 25 years, the number of Americans with diabetes will increase from 24 million to 44 million. During the same time period, annual spending related to diabetes is expected to increase from the current $113 billion to $336 billion (in constant $2007). The health care costs for treating diabetes in AZ today is about $2 Billion dollars annually- and if we don’t do something about this epidemic with a better diet and exercise, the costs will be nearly $7 Billion annually in AZ- again in constant dollars. Now pause for a second and take a breath… the out year costs for treating diabetes nationally are projected to be almost half the size of the financial bailout or the ARRA stimulus package every year (if we don’t do something about this epidemic).

ADHS Electronic Updates

Will Humble — Thu, 18 Feb 2010 15:29:02 +0000

Please take a couple of minutes to sign up for our new ADHS electronic updates feature. When you sign up to receive electronic updates from the Department, you can click on the kinds of things that you want to receive, like our new “healthy and in-season recipe of the week”, media releases, immunizations newsletters and other Department newsy items. This is our latest attempt to make it easier and simpler to get out the great information that we’re working on every day- stuff that makes a difference in people’s lives.

MY LIFE

Will Humble — Thu, 18 Feb 2010 19:57:04 +0000

The MY LIFE program is an award winning approach to helping youth that have experience mental health, substance abuse and/or foster care-related issues to use their experiences, talents and voice to make positive changes in their lives while helping others to do the same. MY LIFE provides an excellent opportunity for youth to have an active voice in the planning and implementation of system transformations to improve behavioral health care in Maricopa County. Through regular meetings and local and national workshops, presentations and performances, the group focuses on important issues affecting youth. This week, MY LIFE members met face-to-face with Arizona State Representatives, Senators and staff to share ideas on how to reduce stigma and educate our community on mental health, substance abuse, and foster care-related issues. MY LIFE members shared information initiatives, performances, poetry and art. It was a real treat. MY LIFE meetings are held the first and third Wednesday of the month from 6 to 7:30 p.m. at Community Bridges’ Bill Wilson Hall located at 2770 E. Van Buren St. You can find out more at: www.MagellanofAZ.com/MYLIFE. Take about 4 minutes out of your day to watch this inspirational video that will give you a flavor of what the My Life program is and what it means: http://www.youtube.com/watch?v=ZMT40tB8GCs

Pressing Ahead

Will Humble — Fri, 19 Feb 2010 15:42:54 +0000

This is what I shared with ADHS staff earlier this week - "Thanks again for all of your hard and creative work over the last year. We’ve made a great deal of progress despite the complicated financial problems that the State has faced. I’m not just saying that- I know it’s true and so do you. If you don’t believe me, remind yourself by looking at the “Year of Progress” blog post a couple of weeks ago. Because of our success together over the last year, the Governor nominated me to the post of Director a few weeks ago, and today the AZ State Senate voted to confirm the nomination- so I’m officially now serving as your Director. The post from the Senate website is pasted at this link under Health Services: http://www.azleg.gov/ExecutiveNominationsByAgency.asp We’re on a good course, so that’s where we’re going to stay.

In our Licensing programs, we’re going to continue to focus on our customer service and to continue to sharpen our efforts on the health and safety elements of our mission. We’ll continue to do our time and effort studies to see where we can improve efficiency- and we’ll continue our efforts (with the help of IT) to deliver a paper-free licensing application- due for delivery later this spring.

In our Behavioral Health programs- we’re going to stay on course to evaluate the effectiveness system based on solid scientific criteria- looking to outcome measures to evaluate our effectiveness and to use that information and data to continue to drive the entire system toward the principles of Recovery.

At the Hospital- we’re going to keep on track with our efforts to get folks through Recovery- and we’ll continue to better integrate Security and our Clinical teams so that we’re using state-of-the-art information to develop and integrate a system that protects our staff while helping our patients and residents to recover and re-integrate into society.

In our Public Health Programs, we’re going to continue to help Arizonans with the tools they’ll need to improve their lifestyle- whether it’s nutritional guidance, help with physical activity goals, chronic disease prevention and tobacco cessation, and of course preventing folks from starting smoking in the first place.

We’re also going to continue to provide the public health system in Arizona with the data they need to drive good and targeted public health interventions. We’ll also make sure that folks get their vital records when they need them, help the counties to do the same- all while ensuring that we’re protecting people’s identity and privacy.

In terms of Preparedness, we’re going to keep on track doing the things that we’ve always done- keep our surveillance system vigilant, react quickly when there’s a problem & implement swift and reasonable interventions, and ensure that all the pieces fit together with the local health departments, tribal partners, and our healthcare community so that we can enhance the system’s ability to prevent and respond to public health threats.

Our Operations team, including IT, Financial Services, Human Resources, Procurement, Auditing and Special Investigations and Administrative Counsel & Rules will continue to play a key role in helping our programs better integrate up-to-date technology, whether it’s IT infrastructure, business processes, policy development or employee relations. After all- none of our programs would have accomplished anything without our crack Operations team.

OK… let’s keep going…"

Salt Initiative

Will Humble — Mon, 22 Feb 2010 18:05:50 +0000

We launched our salt reduction initiative this week http://www.azdhs.gov/salt/. The overall goal is to get Arizonans to reduce their salt intake by paying more attention to the Sodium line in the nutrition facts and being a better- by selecting foods for the family that are lower in sodium. Sodium can increase your blood pressure and the chances of you having a heart attack or stroke… and heart disease is the leading cause of death in Arizona. National dietary guidelines recommend that many adults eat no more than 2,300 milligrams of sodium each day. For best health, some adults should eat no more than 1,500 milligrams of sodium each day, and you should really pay attention if you’re over 40, are African American or if you already have high blood pressure. Most people think that they get their salt mostly from adding it with the shaker- but in reality, 80% of the salt that we get is from processed foods. That’s the reason why it’s so important to read the label and buy foods that are lower in sodium. Start today and become a “Champion for Change” to cut back on your sodium intake. A Champion for Change” is anyone that makes healthy changes in their home or community. Being a Champion is about being committed to keeping you and your family healthy. You can begin today by looking at our salt education resources on the www.eatwellbewell.org web site, pledge to eat less salt, and signing up for email alerts and pledge to reduce your salt intake.

Baja Health Tourism

Will Humble — Mon, 22 Feb 2010 18:07:15 +0000

The Mexican Federal Government announced a new policy this week to promote medical tourism in Mexico. Medical tourism is when you go abroad for medical care. Their goal is to encourage U.S. residents (with an initial focus on the uninsured) to travel to Mexico for their medical needs, generating jobs and investment. Another objective is to use the additional revenue to continue the expansion of the medical infrastructure in Mexico. Phase I of the policy is to set up the infrastructure for basic and intermediate procedures- with a focus on drawing down folks that are uninsured in the US for things like orthopedics, heart, cancer, dental, ophthalmology and plastic surgery. The goal for Phase II is to get US Citizens (especially Arizonans and Californians) to consider treatment in Mexico for advanced medical services. Health tourism is also a main priority for the new Governor of Sonora (Padrés Elías) http://www.sonora.gob.mx/ for several reasons, not the least of which is Sonora’s close proximity to large populations in Arizona and California, and that fact that the Hospital CIMA Hermosillo in Hermosillo is certified by the Joint Commission (the largest certification and accreditation of the United States), and it has the capacity to provide high-quality services. In all, there are 8 hospitals in Mexico that are accredited by the Joint Commission http://www.jointcommissioninternational.org/JCI-Accredited-Organizations/.

Black History Month Celebration

Will Humble — Mon, 22 Feb 2010 18:16:34 +0000

Please try to carve out some time to celebrate ADHS' 7^th Annual Black History Month event. The 2010 celebration will happen Thursday, February 25, from 11:00am – 1:00pm, in the parking lot west of 1740 Building . The theme is… “ Health Care… Where We’ve Been… and Where We’re Going”. We’ll take you back in the past of the African American community with a medical perspective this year. The Black Theater Troupe will be with us for a short presentation about the “Tuskegee Study” along with other special surprises. All will enjoy while you learn a lot about health care from days gone by. Besides excellent speakers, you'll have the opportunity for food and fun.

New Earache & Pneumonia Shot

Will Humble — Fri, 26 Feb 2010 16:00:04 +0000

This week, the FDA approved and the CDC has recommended the use of a new vaccine called Prevnar 13™ for healthy kids children age 2-59 months. The new shot prevents invasive pneumococcal disease from 13 different kinds of pneumonia germs. It also prevents many germs that cause middle ear infections and some kinds of meningitis. It's also exciting that it now covers something called the 19A serotype, which is the fastest growing serotype for invasive pneumococcal disease, and particularly impacts Native American children. You can see more on the FDA website.

Do You Know Your Blood Pressure?

Will Humble — Mon, 01 Mar 2010 15:43:08 +0000

High blood pressure is at the source of roughly one in six deaths among adults annually. About one in three adult Arizonans have blood pressure that’s too high, putting huge economic demands on Medicaid, Medicare (AHCCCS) and our private health insurers (plus, of course, the loss of life). The Institute of Medicine put out a report last week that identifies high-priority areas on which we (public health & Arizona’s medical system) should focus in order to accelerate progress in hypertension reduction and control. The IOM report recommends that we focus on population-based strategies that can reach large numbers of people. The keys are really behavioral and lifestyle interventions like reducing sodium (salt) intake, eating more fruits and vegetables, and increasing physical activity www.eatwellbewell.org. The report also calls for the country’s public health system to promote policies that make it easier for people to engage in regular physical activity, cut calories, and reduce their intake of foods containing high levels of sodium while increasing their exposure and access to produce and other foods containing potassium. This new IOM report fits quite well with our new Champions for Change salt initiative www.azdhs.gov/salt. Touche´.

ADHS Going Viral

Will Humble — Tue, 02 Mar 2010 16:45:27 +0000

We’re coming up on the 3 millionth view of our hand only chest compression CPR video that we posted on the Arizona Department of Health Services channel. Technically, right now we’re at 2.8M views now. This is by far the most watched video (http://www.youtube.com/watch?v=E5huVSebZpM) on our YouTube channel. Close to 1M of those views are attributed to viral sharing.

Infections

Will Humble — Wed, 03 Mar 2010 15:48:06 +0000

Post-surgery infections cost a fortune. Health care–associated infections cause 1.7 million extended hospitalizations each year. A study published last week in the Archives of Internal Medicine looked at the clinical andeconomic costs from these infections which are poorly understood. The researchers looked at national hospital discharge records to find sepsis (blood borne infections) and pneumoniacases- specifically excluding community-acquired infections. They found that the average extra hospital stay from sepsis after an invasive surgery was about 11 days, costs were about $33,000 extra each, and about 20% of the folks who contracted sepsis died. For pneumonia, the average extra stay was 14 days, cost $46,400, and 11% of patients with pneumonia died. You can read more in the report and, don’t forget, our final report contains an assessment of infection control activities in AZ and highlights a series of recommendations to improve AZ’s track-record for controlling infections that occur in health care settings.

Arizona Serves

Will Humble — Fri, 05 Mar 2010 15:34:33 +0000

The Governor established a 20-member ArizonaSERVES Task Force www.arizonaserves.gov by Executive Order on Tuesday to help connect faith-based and non-profit organizations with opportunities to assist folks in Arizona who’ve been impacted by economic hardship. The goal of the Task Force is to better coordinate volunteer efforts statewide, and find new strategies to promote outreach and maximize existing resources to serve the community. The Task Force includes representatives from faith-based and community organizations, the Directors or designees from the Arizona Departments of Economic Security, Health Services and Transportation, a representative from the Arizona Coalition for Military Families and representatives from an urban and a rural regional planning organization. For more information about the Task Force or how to apply, click here.

School Nutrition Overhaul

Will Humble — Mon, 08 Mar 2010 15:57:52 +0000

The USDA’s Child Nutrition Act is up for re-authorization this year. The program provides food to more than 31M school children through the National School Lunch Program as well as 11M that qualify for the School Breakfast Program. Many children get ½ of their daily calories at schools- making this program a great leverage point to improve nutrition for kids by placing more rigorous nutrition standards on the foods that are served in the program. The Institute of Medicine published a book recently that makes recommendations that would improve the nutritional value of the meals. The federal Executive budget proposes improving the quality of school meals and make sure schools have the resources they need to make changes. I’m going to DC this week to meet with the staff from some of the AZ delegation about a variety of public health issues- but one of the things I will be emphasizing (along with SNAP Reform)- will be the importance of placing better nutritional criteria on this important child nutrition program.

Child Obesity Research

Will Humble — Tue, 09 Mar 2010 21:05:29 +0000

The latest issue of Health Affairs http://www.healthaffairs.org/ has some important resources and research related to the increasing problem of childhood obesity. Kids are eating more snacks -- salty chips, sweetened sodas, candy bars -- than ever before. Trend data show that children are averaging nearly three snacks per day, with 27% of their daily calories coming from snacks. This greater intake coincides with the increase in childhood obesity -- and a decline in reliance on consuming three main meals a day. Experts say it also underscores the role that food marketing and distribution play in adding pounds to children. Anyway- if you’re interested there are some important ideas and research at the link above.

Healthier US Schools Challenge Program

Will Humble — Wed, 10 Mar 2010 15:25:59 +0000

The federal Healthier US Schools Challenge Program establishes rigorous standards for schools’ food quality, participation in meal programs, physical activity, and nutrition education – key components that make for healthy and active kids – and provides recognition for schools that meet these standards. In the next school year, the USDA’s goal is to double the number of schools that meet the Healthier US Schools Challenge. Schools can participate in this model program by going to http://www.fns.usda.gov/tn/healthierus/index.html and learning about the range of educational and technical assistance materials that promote key aspects of the Dietary Guidelines, including a Menu Planner for Healthy School Meals, which provides tips on serving more whole grains, fruits, and vegetables, and lower amounts of sugar, sodium, and saturated and trans-fats in school menus. In addition, major school food suppliers have agreed to meet the Institute of Medicine’s recommendations (mentioned in the yesterday's blog) within 5 years to decrease the amount of sugar, fat and salt in school meals; increase whole grains; and double the amount of produce they serve.

Mental Health & Tobacco

Will Humble — Thu, 11 Mar 2010 14:33:24 +0000

Folks that face challenges with mental & behavioral health tend to smoke at a higher rate than others. That makes this group a high priority for interventions to reduce their smoking rates. Throughout 2010, we’ll be focusing on various intervention strategies for important health topics along these lines- and March is the final month of this year’s first Quarterly Health Initiative addressing “Tobacco and Mental Health.” Through the Initiative, we’ll be providing education on health topics affecting people who receive behavioral health services in an effort to improve their overall health and well-being. A new “QHI Kit” is introduced each quarter and includes a Consumer Handout, a Provider Handout and a Provider Webinar. The handouts and training materials are developed in collaboration with one or more public health partners: for this quarter’s initiative, Behavioral Health partnered with the Bureau of Tobacco and Chronic Disease & the Arizona Smokers’ Helpline. For more information on this health initiative and to access the handouts and recorded Provider Webinar, please visit http://www.azdhs.gov/bhs/qhi/. We’re getting geared up for next quarter’s topic which is “Hepatitis and Mental Health.” If you have questions on this initiative, please contact Claudia Sloan.

SNAP Reform

Will Humble — Fri, 12 Mar 2010 15:26:30 +0000

I met with the staff of most of the members of Arizona’s congressional delegation Wednesday in Washington DC at an event called Hill Day sponsored by the Robert Woods Johnson Foundation. I used the opportunity to talk to them about nutritional policy issues like boosting the nutritional strength of the foods that are served under the free and reduced lunch programs- and to urge them to consider placing nutritional criteria on the foods that would qualify for reimbursement under the food stamp (Supplemental Nutrition Assistance Program- SNAP) program.

Arnold v. Sarn Stipulation Agreement

Will Humble — Tue, 16 Mar 2010 17:46:36 +0000

I haven't written much about the Arnold v. Sarn lawsuit because its so complicated and difficult to explain. Basically, it's a lawsuit filed against ADHS in 1981 (adding the Governor as a defendant in 2000) that has held the Department accountable to certain court orders about community-based behavioral health services for adults with serious mental illness in Maricopa County. This week there was a major event in the history of this decades-long case. The Plaintiffs and Defendants entered into a joint stipulation agreement that suspends many aspects of the case through 2012 as a result of the budget crisis. This week Judge O’Connor signed a court order approving a "Joint Stipulation to Stay Litigation During Fiscal Budget Crisis". The Stipulation essentially:

Puts a “hold” on litigation and enforcement of all current Court Orders through June 30, 2012, including the Appointment Order for the Court Monitor, enforcement, monitoring and compliance activity;
Suspends some of the requirements in Article 3 of the Serious Mental Illness Rules (Title 9, Chapter 21, Article 3 of the Arizona Administrative Code) to the extent that compliance with those rules is impacted by the budget crisis. This section of the Rules addresses assessments and service planning and can be found at http://www.azsos.gov/public_services/Title_09/9-21.htm.;
Requires the Defendants to use their best efforts to serve the class members with all available resources during the time period of this stay;
Requires the parties to, in good faith, revisit and revise the Court Orders with consideration for funding, defining terms and conditions regarding the potential use of a Court monitor in the future, and redefine the services, supports, and benefits that must be provided.

We're optimistic that revised Court Orders will focus on outcome based objectives that are measurable and more consistent with Recovery. Our entire team will remain committed to maintaining the best possible service delivery and service quality that we can with the resources and funding that we have.... and we'll maintain our intensive oversight and monitoring of our behavioral health contractors. We'll continue to hold our tribal & regional behavioral health authorities accountable for the quality of services they provide and how public funds are used. We're working on bringing much more transparency to the behavioral health system (along the lines of the "dashboard"), so stakeholders can easily see for themselves how providers are performing.... and we'll continue to promote recovery and consumer choice. (See ADHS letter to stakeholders.) The bottom line is that coming year is a crucial time for the behavioral health system in Arizona... and we're committed to ensuring that we do our very best to provide the highest quality of care that we can given our resources.

Greater AZ RFP Awards

Will Humble — Wed, 17 Mar 2010 20:11:25 +0000

Today, we announced who will handle behavioral health care in Arizona except for Maricopa County starting in July. Northern Arizona Behavioral Health Authority, Cenpatico Behavioral Health of Arizona, and Community Partnership of Southern Arizona won the contracts. We're excited about the content in these new contracts. They are taking consumer choice and voice to a new level by including specific and measurable touchstones that drive home the recovery model Every 3 to 5 years, the ADHS goes out to bid to find contractors to act as our Regional & Tribal Behavioral Health Authorities (RBHAs and TRBHAs) to deliver behavioral health services across the state. RBHAs and TRBHAs contract with a network of service providers to deliver behavioral health care services, including behavioral health prevention programs for adults and children, services for adults with substance abuse and general mental health disorders, adults with serious mental illness, and children with serious emotional disturbance. Since we’re in our 5^th year of our contracts with all of the contractors (except for Magellan, our contractor in Maricopa County), we released a Request for Proposals (RFP) for each of the service areas outside of Maricopa County in October 2009. Since then, the procurement process has progressed through each of the required phases of the decision making process, and the awards for the next contract period were announced today. You can see the award announcement in our media release today. A special thanks go out to our Procurement team and all of the folks that were involved in the review and evaluation process. The procurement process is rigorous and demanding, and our team did a very good job crossing the t’s and dotting the i’s to make sure that the whole process was done by the book. Thank you.

Budget Signed

Will Humble — Fri, 19 Mar 2010 16:17:32 +0000

Thursday afternoon the Governor signed the budget bills that the Legislature passed that prescribed budgets for the remaining part of FY 2010 and FY 2011. The deal is complicated and contains lots of details. Most of the provisions for our agency pertain to reductions in services that will begin next fiscal year (which starts July 1)- including orders to reduce mental and behavioral health services that we provide to folks that don’t qualify for coverage under AHCCCS. The Kids Care program was also eliminated, meaning that about 1,000 kids that formerly qualified for benefits under the Children’s Rehabilitative Services program through KidsCare will lose their coverage, and about 2,500 kids that get behavioral health care through KidsCare will also lose coverage. There's alot more to it, of course, but that's the thumbnail sketch. The law include the elimination of performance pay (2.75%). In addition, we will take 1 mandatory furlough day in what remains of FY 2010; 6 furlough days in FY 2011; and 6 more in FY 2012. When you do the math, this is roughly equivalent to a 5% reduction (when you combine the furloughs with the suspension of the performance pay). I believe that the actual furlough dates will be established by ADOA and it’s possible that state government offices would close on those days. Obviously, our State Hospital can't close for a day, so we’re looking at other options for the Hospital.

Pima Nabs Big Obesity Prevention Grant

Will Humble — Mon, 22 Mar 2010 18:46:54 +0000

Pima County will receive a $16 million grant as part of the national Communities Putting Prevention to Work efforts funded through the federal Stimulus program. They’ll be creating a community-wide set of strategies and interventions to reduce obesity by ensuring safe, attractive accessible places for physical activity and making healthy foods available, accessible, and affordable. The initiative is building on the established work of Activate Tucson, a large, multi-disciplinary, multi-agency, community-based coalition. Activate Tucson and its member organizations have a strong track-record of success in developing policy and programs to combat obesity. Take a look at the kinds of accomplishments already achieved by this organization. Congrats to Elizabeth Temple and her team in Pima County for siezing this highly competetive grant.

State-of-the-Art Online Complaint System

Will Humble — Tue, 23 Mar 2010 20:02:56 +0000

Our Licensing & Operations Divisions went live with our new Online Complaint Form system. It took some old fashioned elbow grease and creativity to put together this new time saving application- that will allow our licensing folks to more efficiently take and track complaints- and to more efficiently get back with folks that file them. It will save considerable staff “phone time”- as folks that want to make complaints can directly enter their information into our database- and we can electronically get back with them with our findings. Links to forms for each area in licensing are located at: http://www.azdhs.gov/als/index.htm. Our next automation task for Licensure is to complete our work with electronic applications including renewal applications, which will save time with data entry, but also administrative time spent tracking down information that’s needed on the application but that's forgotten when people use paper applications.

Furlough & Pay News

Will Humble — Wed, 24 Mar 2010 15:43:08 +0000

Performance Pay Reduction The state budget that was recently signed included an indefinite (probably permanent) suspension of performance pay (2.75%) beginning May 29. The effective date of the bill (HB2003) is June 15- so that's the day that the reduction will be actually implemented. But since this is in the middle of a pay period, we won't begin to actually remove the performance pay from your paycheck until the pay period that begins on June 26 and ends on July 9. This creates an 11-day gap between when the funds will be reduced from the Department's budget and when your pay will actually go down. This "gap" amount totals about $70K for the agency- and I've asked Jim Humble to find a way to make this up with some vacancy savings or other operating funds. The bottom line is that your paychecks for the performance pay reduction will kick in during the June 26 - July 9 pay period. FY '10 Furlough Day We'll also all be taking one furlough day in what remains of FY 2010. Since we need to capture the furlough funds this fiscal year, we need to complete our FY '10 furlough by June 11th. Your furlough day could technically be on any of your regularly scheduled work days- but please coordinate your FY '10 furlough day with your team so that you have appropriate coverage at all times. If you work at the Hospital- your team will also need to make sure we're covered for our patients and residents. FY '11 Furlough Days State Government will also take for 6 furlough days next fiscal year. The ADOA has pre-identified these furlough days for most everybody... and most people will be taking them together. Most of state government will shut down on those days, which will be: July 23, 2010 August 20, 2010 September 17, 2010 November 26, 2010 December 23, 2010 June 10, 2011 You can check the calendar, but I think these are on Fridays or tied to a holiday. Obviously we can't shut down the Hospital on these days, so we're working on a plan for the Hospital (and maybe Vital Records) to have flexible furlough time that will allow us to take care of our patients but also achieve the salary savings FY '12 Furlough Days It's pretty much the same drill for FY '12, with furlough days on: July 22, 2011 August 19, 2011 September 16, 2011 November 25, 2011 December 23, 2011 June 15, 2012 For more details on the furlough and performance pay see the ADOA website. The Future I'm not a fortune teller, but there may be more to come in the mid-term if the temporary sales tax increase referral (also known as Proposition 100) isn't approved by Arizona’s voters. We'll need to wait and see the results of that election on May 18. I'll try to get out a more comprehensive list of our newest service reductions etc. that were in the recently passed budget.

Sunset Hearing

Will Humble — Thu, 25 Mar 2010 16:14:44 +0000

We had our agency Sunset Hearing last Wednesday in the Senate. Every 10 years our agency comes up for a redetermination to see if the mission of the department is still necessary etc. If so, then ADHS is “reauthorized”- hopefully for another 10 years. The bill (HB 2029) passed out of the House several weeks ago- and it passed the test in the Senate Health Committee last week. The bill reauthorizes ADHS for the next 10 years and goes to a full vote in the Senate soon. We don’t expect any trouble. The sunset is also tied to the Auditor General Report entitled: Department of Health Services—Sunset Factors (September 2009, Report No. 09-11) which also recommended that our authorization be extended for another 10 years.

ADHS Budget Summary

Will Humble — Mon, 29 Mar 2010 23:59:43 +0000

I don’t have to tell you that we’ve faced unprecedented challenges over the last couple of years. State revenues have declined for nearly 3 years now, and we’ve dramatically reduced our spending and staffing levels in an effort to bring spending in line with state revenues. Excluding the money that goes toward the matching funds that are required for Medicaid (AHCCCS) behavioral health & children’s rehabilitative services, the overall ADHS General Fund budget has been reduced by more than 47% during the past 3 years. On July 1, 2008, our budget for non-Medicaid services was approximately $270M, compared with $143M for the fiscal year that will begin on July 1, 2010; a reduction of more than $127M. But these are just numbers. What’s more important is the practical and real impact of these reductions on the lives of Arizonans. We put together an open letter to the public to summarize the reductions that we’ve taken over the last couple of years to document where we’ve been – which is posted on our home page. The link also includes the quantitative budget reduction details and a line-by-line summary of the reductions. The dominant budget reduction that will occur during Fiscal Year 2011 is an additional and substantial reduction to the behavioral health services that are provided to folks who don’t qualify for the state Medicaid program (AHCCCS). Beginning in July, the only behavioral health services that will remain for individuals who don’t qualify for AHCCCS will be medications and related necessary services for adults with serious mental illness, crisis services, and some housing support. People who qualify for their behavioral health services under AHCCCS will continue to qualify for their current services. Our Behavioral Health Division is very busy coming up with the implementation plans for these reductions. The ways in which we implement these service reductions are critically important, so these implementation plans are of course our top priority right now. Our management team has spent a great deal of time and effort to do our very best to make our budget reductions in a thoughtful way and to minimize their impacts. However, with General Fund budget reductions that have approached 50%, this has been a real challenge. We know that these budget reductions have had and will continue to have real effects on people and families like yours. We’ll continue to do our very best to try to minimize the impacts to the extent possible.

3rd Annual MyFest

Will Humble — Tue, 30 Mar 2010 20:08:18 +0000

Saturday is the third annual MyFest event out a Tempe town Lake. This is a huge Magellan-organized youth event aimed at combating stigma associated with mental illness and is a great opportunity to get positive messages out there to youth across the state. We expect several thousand youth to be there. It’s a youth involvement festival, featuring live music, entertainment, art, food, and information about resources and services from a wide-variety of youth and family-based Valley organizations, produced by MY LIFE. Last year more than 2,500 people, the festival and gave youth and families the opportunity to get involved and learn about employment, volunteering, youth programs and other community activities. To view news footage and video highlights of MY Fest '08 & '09, click HERE. The festival will be held Saturday, April 3 from 11 a.m. - 4 p.m. at Tempe Beach Park. Free parking is available across the street from the park in the US Airways garage next to the US Airways building, between 3rd Street and Rio Salado. Or you can take the rail top the Mill Ave & 3^rd St stop and walk North a couple blocks.

Fighting Healthcare-Associated Infections (HAIs)

Will Humble — Thu, 01 Apr 2010 00:10:21 +0000

Some of the best infection control experts are laying out the plan on how to fight Healthcare-Associated Infections in the next decade. The International Conference on HAIs just wrapped up in Atlanta – it marked the first time that four leading scientific organizations committed to infection prevention are working together to further a scientific and educational agenda toward elimination of HAIs. The Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiologists of America (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC) spent five days discussing various types of infections and how to curb them. You can read more about the conference online. Some research shows there are some low-tech ways to cut down the possibility of HAIs – doing a quick nasal swab before surgery and using a different cleanser on the skin before surgery. These simple steps and a long term plan can make a difference in protecting those in hospitals. You can help prevent these infections when you go to visit someone in a healthcare facility by using good personal hygiene, like washing your hands and covering your cough.

Breakfast & Lunch

Will Humble — Mon, 05 Apr 2010 15:51:39 +0000

The US Senate Agriculture, Nutrition, and Forestry Committee, passed legislation out of their Committee to reauthorize WIC and the other Child Nutrition Programs last week. It’s called the Healthy, Hunger-Free Kids Act of 2010. The bill http://ag.senate.gov/site/legislation.html includes the reauthorization of the free and reduced lunch and breakfast programs. I was in DC a couple of weeks ago to talk to the delegation about this upcoming reauthorization- urging better nutritional standards for the breakfast & lunch programs. The bill was amended in the Senate to include elements of our Empower Pack http://www.azdhs.gov/empowerpack/index.htm! The Amendment directs the US Secretary of Agriculture to work with the Secretary of HHS to encourage state licensing agencies to include wellness standards within state licensing standards in order to ensure that licensed and regulated child care centers and family child care homes provide physical activity opportunities, limit screen time and offer food consistent with the healthy meals patterns and nutrition standards. More than 31M school kids participate in the National School Lunch Program and 11M qualify for the School Breakfast Program. Many children get ½ of their daily calories at schools- making this program a great leverage point to improve nutrition for kids by placing more rigorous nutrition standards on the foods that are served in the program. Some key language in the Act is on Page 64 http://ag.senate.gov/Legislation/WEI10137.pdf, where the bill states that: “not later than 18 months after the date of enactment of this paragraph, the (USDA) Secretary shall promulgate proposed regulations to update the meal patterns and nutrition standards for the school lunch program authorized under this Act and the school breakfast program… based on recommendations made by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences (NAS).” The bill also includes provisions for schools that participate in the program to implement wellness policies that address physical activity. If it passed as-is, the USDA would establish new free lunch and breakfast standards by rule. Since the bill (at least right now) says that the standards should be based on the NAS Food and Nutrition Board… that document would become important. It’s not expressly stated, but it looks to me like the bill might be referring to the Review of Child and Adult Care Food Program Meal Requirements that the Board is working on.

Underage Drinking Prevention

Will Humble — Tue, 06 Apr 2010 17:05:32 +0000

Our Behavioral Health Office of Prevention http://www.azdhs.gov/bhs/ops.htm provides tools, resources and technical support to promote the resiliency and prevention of behavioral health/substance abuse disorders in our communities. Our goal is to empower communities and kids to make healthier choices by collaborating with Arizona’s prevention workforce, including our Tribal/Regional Behavioral Health Authorities and local communities; strategically reducing substance abuse and suicide rates; and evaluating the effectiveness of prevention programs. Check out this month’s newsletter Not Just a Minor Thing; Arizona Statewide Underage Drinking News (March 2010 Newsletter of the Under Age Drinking Prevention Committee) which has the: 1) latest research on the effects drinking laws and attitudes of peers and parents on drinking; 2) amazing work done in your own communities done by the C.O.P.E coalition; and 3) resources, events and more!

National H1N1 Vaccination Rates

Will Humble — Wed, 07 Apr 2010 15:52:37 +0000

The latest CDC Morbidity & Mortality Weekly Report has the latest on the state-by-state H1N1 vaccination rates for kids as well as national percentages for healthcare workers. Arizona had the highest vaccination rates for kids in the western U.S. The national vaccination rates for healthcare workers were a little disappointing (about 40%)- but keep in mind that the data in the report is for the period ending in mid January.

Congrats Licensing Team

Will Humble — Thu, 08 Apr 2010 15:23:59 +0000

Our Licensing programs for medical and long-term care facilities have been nominated for a national award by the Region IX Centers for Medicaid and Medicare Services office for our High-quality work in the area of Survey and Certification under difficult circumstances; Significant performance improvement in meeting the goals of the Medicare and Medicaid Survey &Certification program; Outstanding leadership in crafting creative solutions to difficult problems; and Effective use of information to promote the goals and objectives of the Survey & Certification program. Whether we end up winning this national award, it’s clear that this nomination recognizes our Licensing team (and the Operations folks in IT and Rules that help them) for their outstanding contributions to meet CMS performance expectations, enhancing consumer complaint management, and to improving health outcomes in the areas of pressure ulcer and restraint reduction.

Behavioral Health Information Center

Will Humble — Fri, 09 Apr 2010 16:01:24 +0000

We updated our home page this week and added an information hub for behavioral health. The information at this site will be regularly updated in the coming weeks as we begin to implement behavioral health service reductions for folks that don’t qualify for benefits under AHCCCS. Our commitment is to continually share updated information with you including through the use of a dedicated Web site, frequent emails, and numerous community meetings around the state. We want to make sure we hear and properly address people’s questions and concerns, while we continue to focus on providing high quality care. Responsibly implementing these service transitions are a top priority for the department and for me personally. The main changes to the system in the coming months will be: 1) Changes to the covered benefits for adults with serious mental illness who do not qualify for Medicaid (AHCCCS); 2) Ensuring that we have a comprehensive and effective statewide crisis system for anyone experiencing a behavioral health crisis; and 3) Clarifying the benefits related to supported housing for adults with serious mental illness. We understand how important any decisions made in these 3 service areas are, and all of these decisions must be carefully and thoughtfully considered. We’ve asked our behavioral health authorities to turn in a transition plan for the benefit changes for folks that don’t qualify for Medicaid and how they plan to ensure a functional crisis system. We have received some of these plans already and will be getting the rest shortly; at that point we will review and either approve their transition plans or ask for some changes.

New “Go Low” Campaign

Will Humble — Tue, 13 Apr 2010 00:15:40 +0000

Let’s start with a quick quiz on this one… Which of the following food items contains more fat:

2 slices of pepperoni pizza
1 order of large fries
3 glasses of whole milk
8 strips of bacon

The answer is 3. 3 glasses of whole milk. If you pour whole milk at mealtime for your kids instead of 1% milk, it is like adding about as much fat as in eight strips of bacon, six pats of butter, a large order of French Fries, or two slices of pepperoni pizza to your child’s diet every day. And that’s just one glass. Now that you know that, it’s easy to see why the next stop in our Champions for Change initiative through our (federally funded) Supplemental Nutrition Assistance Education Program (formerly called food stamps) is our “Go Low” campaign. Our “Go Low” campaign kickoff is just around the corner- and it’s all about getting mom’s to make a better choice at the supermarket by choosing fat free or 1% low fat milk instead of whole milk. You can view our former and upcoming video spots at: http://www.eatwellbewell.org/parents/resources/videos Nutritionists recommend that children over the age of two should drink fat free or 1% low fat milk with the rest of their family. Babies less than one year old should have breast-milk or iron-fortified formula and children between the ages of one and two should drink whole milk. For tips on how to make the change, visit www.eatwellbewell.org. Remember, fat free and 1% low fat milk have all the vitamins and minerals found in whole milk, but without all the fat.

Health Matters Web Resource

Will Humble — Wed, 14 Apr 2010 18:11:02 +0000

We rolled out our new public health information system … called Arizona Health Matters http://www.arizonahealthmatters.org/. It’s an electronic one stop source of unbiased data and information about community health and healthy communities in general. It’s intended to help planners, policy makers, and community members learn about issues and identify improvements. On the site, you can compare Arizona's health with other communities and the nation, using more than 100 health and quality of life indicators ; search and compare data by County and zip code within Arizona; learn about promising practices on a variety of topics that affect community health; submit a promising practice ; or use the Report Assistant to create quick reports and summaries. This site has been in the planning stages for the last couple of years and is funded with federal grants that we and the county health departments receive. We think the site has a large potential to influence policy by providing key and easily digestible data on everything from physical activity to nutrition to infectious diseases etc. Using these indicators, people in decision making positions at all levels can develop and implement interventions. It’s also includes promising practices that are updated weekly that allow officials and the public to see what works. It’s also updated to keep current with local and national news related to public health issues.

Congratulations

Will Humble — Thu, 15 Apr 2010 21:11:48 +0000

Go out to our own Carol Hensell (from the Bureau of Women’s and Children’s Health). Carol won the 2010 Cherish the Children Award in the Individual category. This Award is given each April as part of Child Abuse Prevention Awareness Month by the Greater Phoenix Child Abuse Prevention Council, a volunteer organization that works to promote all efforts across the state to prevent child abuse. Carol won the award for her work in the Sexual Violence Prevention Program, which is being recognized as a significant contribution to our state’s efforts to raise public awareness of the child abuse issue.

Proposition 100 Voter Registration Deadline

Will Humble — Fri, 16 Apr 2010 15:47:09 +0000

Monday, April 19 is the registration deadline to vote on Proposition 100- which is the Special Election for the 3 year, 1% sales tax that would benefit education, public safety and health services (including behavioral health). The election will be held on May 18, but many people will be voting using early mail-in ballots. If you still need to register to vote, you can Register online now! using the EZ Voter Program on the Secretary of State’s website. Of course, if you are already registered to vote in Arizona, you are already good to go and don’t need to register. Remember, the deadline to register is next Monday, April 19. You can also educate yourself about the issue by reading the on-line voter guide on the Secretary of State’s Website. The voter guide contains the actual language of the Proposition along with arguments that have been submitted for and against the measure. You can see a letter in the voter guide that the Directors of AHCCCS and ADES and I wrote. You can also read a letter submitted by our former Director, Susan Gerard inside the voter pamphlet.

Behavioral Health Community Meeting Schedule

Will Humble — Mon, 19 Apr 2010 16:35:52 +0000

As I’ve mentioned in earlier posts, the covered services will be changing for adults with serious mental illness who do not qualify for Medicaid in response to recent budget reductions. We’ve established a dedicated project team to research strategies to responsibly implement the benefit reductions. The project team, composed of peers, family members and agency representatives, is looking at a variety of options, including a medication only benefit, which would include a generic formulary paired with necessary blood work and appointments with prescribing clinicians. We are also looking at potential options for making some name-brand medications available as well. Over the next three weeks, our behavioral health team will discuss these options and others with community members in order to arrive at a benefit package that is responsive to the needs of individuals while taking the limited funding into consideration. Our information hub on our homepage is being updated weekly with a variety of critical information regarding this transition, including updated policy changes, questions and answers, an updated community meeting schedule, and a place to Submit questions, comments or concerns and sign up to receive information and updates!.

New Childcare Center Licensing Rules

Will Humble — Tue, 20 Apr 2010 16:16:23 +0000

Our child care licensing & rules team, along with a long list of Stakeholders, have been working very hard over the last few months to put together a new list of criteria for operating a child care center. This week, their hard work paid off- and we were able to post a draft of our Child Care Facilities Rulemaking. The information that you see on the site is the final step in Phase 1 of the rulemaking. Department will be accepting informal comments until April 27, 2010, after which the Department will review comments that have been submitted, make changes to the draft as necessary, and submit a Notice of Proposed Rulemaking. We think that these new rules will be good for kids and public health- while at the same time streamlining the rules that child care center’s need to follow. We’ve eliminated quite a few unnecessary and burdensome paperwork and administrative obligations for facilities- but at the same time, we’re asking them to incorporate simple but important activities into the kids’ day. For example, “tummy time” is very important for infants because it helps them develop better gross motor skills, so we’re asking facilities to give kids some “tummy time” every day. We’re also asking that they be put to sleep on their backs (which helps prevent SIDS), and to make sure that kids less than 2 don’t watch any TV, because watching TV as an infant is a risk factor for developing ADD later in life. We’ve also included more nutritional criteria, like asking them to work on portion control at mealtime and serve 1% or skim milk for the older kids. These are just a few examples, but you get the idea. Basically, we tried to eliminate the unnecessary paperwork that consumes time, but added simple and effective physical activity and nutritional elements. Thank you all for your help with these rules. They’re going to make a difference.

Medical Marijuana

Will Humble — Thu, 22 Apr 2010 20:40:19 +0000

A group called the Arizona Medical Marijuana Policy Project turned in signatures in support of a proposed “medical marijuana” voter initiative for the November 2 ballot. Election officials will be busy over the next couple of months to determine whether enough of the submitted signatures are valid. If enough of the signatures are valid, if it passes, and if it survives any court challenges, the ADHS would be responsible for implementing many of the provisions of the act. Basically, the initiative would create a system whereby people could register to dispense, use, and assist with the use of “medical marijuana” if they have a doctor’s recommendation. The ADHS’s responsibilities would be to administer the registration, application and approval process for users and dispensers; set some of the approval criteria; provide for and administer a renewal application process; set the fees that to run the program; issue cards to patients, caregivers and dispensary employees; register the dispensing facilities; create and manage web-based verification system for law enforcement; and generate an annual report. It would provide exempt rulemaking authority for a limited period.

Interesting Support for Overhauling Breakfast & Lunch Programs

Will Humble — Fri, 23 Apr 2010 22:49:11 +0000

A couple of weeks ago, I mentioned that the US Senate Agriculture, Nutrition, and Forestry Committee, passed legislation out of their Committee to reauthorize WIC and the other Child Nutrition Programs last week. It’s called the Healthy, Hunger-Free Kids Act of 2010. The bill includes the reauthorization of the free and reduced lunch and breakfast programs along with better nutritional standards for the program. There was some interesting support for the elements in the bill to improve the nutritional quality of foods in the program this week from a group called Mission: Readiness, which is an organization of retired senior military leaders. In a report released this week, they warned Congress that the recruiting pool for the military is shrinking because so many young adults are obese. The report says that 27% percent of all young adults don’t qualify for service because of their obesity. The opening of the report says that… ”Obesity rates among children and young adults have increased so dramatically that they threaten not only the overall health of America but also the future strength of our military.” Incidentally, the original school lunch program was born out of military concerns about the fitness of children. In 1946, General Lewis Hershey was instrumental in convincing Congress to pass the original National School Lunch Act as a way to improve the nutrition of America’s children, increase their height and weight, and ensure America’s national security. At that time, recruits for WW II were undernourished creating a problem for the military. Now we have the opposite problem.

New Strategies to Reduce NaCl Intake

Will Humble — Mon, 26 Apr 2010 16:19:12 +0000

Last Wednesday, April 21, the Institute of Medicine (IOM) released a new report on high blood pressure entitled Strategies to Reduce Sodium Intake in the United States. The report was sponsored by the CDC, FDA, and NIH. High blood pressure is one of the nation’s leading causes of death, responsible for roughly one in six deaths among adults annually. Nearly one in three adults have high blood pressure, placing huge economic demands on the health care system- estimated at $73.4 billion in direct and indirect costs in 2009 alone. We’re still in the process of reviewing the report to see how we could leverage some of our nutrition programs to make a difference. The report concludes that a coordinated approach is needed to reduce sodium content in food including the setting of standards for acceptable sodium levels in processed foods. The report recommends setting a national goal to slowly, over time, reduce the sodium content of the food supply in a way that goes unnoticed by most consumers as individuals’ taste sensors adjust to the lower levels of sodium. The FDA issued a Statement on IOM Sodium Report this week that they will be reviewing the IOM report over the coming weeks and build plans for how they can work with other federal agencies, public health and consumer groups, and the food industry to support the reduction of sodium levels in the food supply. The Department of Health and Human Services will be also establishing an interagency working group on sodium at the Department that will review options and next steps. Don't forget you can pledge to eat less sodium, sign up for healthy recipes and learn more about sodium reduction at Eatwellbewell.org.

Clostridium difficile

Will Humble — Wed, 28 Apr 2010 23:16:02 +0000

The Maricopa County Department of Public Health has discovered a pretty significant outbreak of a bacteria called Clostridium difficile this week. This organism can cause severe diarrheal illness, and is commonly associated with antibiotic use and healthcare facilities. Most people who come into contact with Clostridium difficile do not develop disease. Being on long-term antibiotics can clean out the naturally occurring and helpful bacteria in the intestinal tract. When the person is later exposed to the Clostridium difficile germ, there isn’t much competition- so it has a field day. It also can produce a toxin which damages the upper layers of tissue- creating additional problems. It’s spread by what we call in the business the “fecal-oral” route- meaning that it’s spread in the feces to another surface4 (i.e. hands) and then to the next person through the mouth- perpetuating the cycle. You can view more on our updated webpage. We’re working with our county public health partners and our licensed facilities to spread the word that this bacteria is circulating in AZ and to make sure everyone knows about the proper control measures.

Pandemic Turns 1

Will Humble — Thu, 29 Apr 2010 15:28:29 +0000

The H1N1 pandemic strain virus turns 1 this month. The first indication that there may be a problem was published in an April 24, 2009 Morbidity & Mortality Weekly Report. The CDC announced the new virus in their usual low-key way, with an MMWR lead that said: “On April 17, 2009, CDC determined that two cases of febrile respiratory illness occurring in children who resided in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus. Although this is not a new subtype of influenza A in humans, concern exists that this new strain of swine influenza A (H1N1) is substantially different from human influenza A (H1N1) viruses, that a large proportion of the population might be susceptible to infection, and that the seasonal influenza vaccine H1N1 strain might not provide protection.” And so, a pandemic was born. The CDC news brief was followed quickly by reports from Mexico of hundreds, perhaps thousands of respiratory deaths, sparking perhaps the quickest and most comprehensive public health campaign in a decade. The US public health system began tracking and reporting cases, hospitalizations and deaths, assessing the severity of the virus, and implementing public health interventions to slow the virus’s spread. The strategic national stockpile assets (i.e. antivirals) were deployed, and a vaccine was developed, delivered, and a mass vaccination campaign took place. Oh yeah- and it all happened in the middle of the biggest fiscal crisis that the state has ever seen. Pretty busy year. So where are we now? The best national estimate is that between 43 and 88 million people have gotten sick from the H1N1 virus. There have been an estimated 192,000 & 398,000 H1N1-related hospitalizations, and between about 8,720 and 18,050 H1N1-related deaths so far. These are the estimates from A paper in Emerging Infectious Diseases authored by CDC staff entitled “Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009”. In the report, the authors concluded that every reported case of H1N1 represented an estimated 79 total cases, and every hospitalized case reported actually represented an average of 2.7 total hospitalized people. We’re still putting together our weekly flu reports if you’re interested in the latest in AZ. We’re still getting sporadic reports of cases… and we’ve recorded 149 deaths so far. The pandemic strain almost totally displaced all other strains- and more than 98% of all sub-typed samples analyzed by our laboratory have been the pandemic strain. There were virtually no H3N2 or B strains floating around. The FDA's Vaccines and Related Biological Products Advisory Committee has recommended that the 2010-2011 influenza vaccine be manufactured with the A/California/7/09 (H1N1)-like virus strain (i.e. the pandemic strain); an A/Perth /16/2009 (H3N2)-like virus; and the B/Brisbane/60/2008-like virus. The FDA recommendation is also consistent with the World Health Organization recommendation for the Northern Hemisphere's 2010-2011 influenza season.

How to Live 12 Years Longer

Will Humble — Fri, 30 Apr 2010 21:54:20 +0000

This week the Archives of Internal Medicine published the results of a 20-year lifestyle study on 4886 people in the UK between 1985 and 2005. The study compared mortality rates among the group and analyzed longevity’s relationship to behavior. The study compared people that had various bad behaviors- allocating 1 point for: 1) smoking; 2) not eating enough fruits and vegetables consumed; 3) getting less than 2 hours physical activity per week; and 4) drinking more than 14 ounces of alcohol (in women) and 21 ounces (in men). During the study period, people with 1 bad behavior were 1.85 times more likely to die than those with all good behaviors, people with 2 bad behaviors were 2.23 more likely to die, people with 3 were 2.76 times more likely, and people with 4 bad behaviors were 3.49 X more likely to perish during the study. People that had 4 bad behaviors had a mortality risk equivalent to being 12 years older (than the good behavior group). The study concluded that “The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits.”… but you already knew that, didn’t you.

Behavioral Health Crunch Time

Will Humble — Mon, 03 May 2010 15:17:17 +0000

Last week was very busy for our behavioral health team. Staff held several community meetings all across the state and met with the people in charge of the Regional Behavioral Health Authorities regarding on the upcoming service package reductions for folks that don’t qualify for AHCCCS benefits. You can see our ADHS Continues to Seek Input Regarding Pending Behavioral Health Changes media release on our home page, and you'll see Dr. Nelson’s latest video message on our YouTube site. This week we expect to have a clear listing of the new (reduced) benefit package on our website. In order to preserve as many behavioral health services as we can, it will be increasingly important for our RBHAs to ensure that everybody who qualifies for AHCCCS benefits applies and submits all the required information. We’re encouraging our RBHAs to use the Health-e-Arizona website at https://www.healthearizona.org/app/Default.aspx, which walks applicants through the application process and provides assistance on how to submit necessary documents (i.e., social security card) and prints bar coded fax cover sheets that tie back to the application so documents are not lost in the submission process. It also does a cross-check with other benefit programs and lets applicants know if they might qualify for other programs.

Bats, Rabies, & Schools

Will Humble — Tue, 04 May 2010 13:53:35 +0000

Bats are one of three rabies reservoirs in AZ – the others being skunks and foxes. Our skunk rabies season often peaks during winter & spring (although last year – it went all year). Our bat season goes late-March through early-October. Most (but not all) of the 28 species of bats in AZ do migrate south to warmer climates. When the bats do return, we get into “bat season” - which certainly has begun. So, we’re officially in rabies bat season. We’ve had several bats sent to our state laboratory for testing- and 5 have been rabid so far. For some reason, grounded bats often seem to end up at schools as curious elementary school kids (usually boys) drag them into classrooms and playgrounds. It’s just the beginning of bat season, and we’ve already had 2 bat exposure incidents at AZ schools. We’re sending a state-wide press release today to remind people to leave bats and other wild creatures alone, and call attention to rabies prevention education resources, including the recently posted 14 minute ADHS video "Bats and Rabies at Schools Video. The video and other resources for schools and school administrators are posted on our “Bats in Schools” page.

Arizona Cancer Registry

Will Humble — Wed, 05 May 2010 16:24:38 +0000

The ADHS Arizona Cancer Registry is a population-based surveillance system that collects, manages and analyzes information on the incidence, survival and mortality of persons having been diagnosed with cancer. We began collecting cancer case information in 1981. The Registry has data available describing cancer in Arizona using a variety of descriptors, including site of origin, age, gender, race, ethnicity, geographic area, and year of diagnosis. Strict confidentiality safeguards require that data be reported only in aggregate; no individual can be identified from a data. A few years ago, we calculated cancer rates etc. on a county by county level- but didn’t have any pre-calculated analyses on a smaller scale. This led to numerous requests for special analyses for smaller areas (with perceived “cancer clusters”) creating lots of extra work. So, we revamped the program and created 126 pre-designated Community Health Analysis Areas (CHAAs) so that we can track rates over time and have more resolution with the rates. You can see more in our CHAA Q & A fact sheet. Using these CHAAs, we can map cancer rates over time in smaller areas. If you’re interested, you can check out our 2001-2004 Cancer Incidence Reports on our Vital Statistics website.

Colorectal Cancer

Will Humble — Fri, 07 May 2010 00:07:31 +0000

Colorectal cancer is the third leading cause of cancer in Arizona, with 2,213 cases in 2006 (according to our Cancer Data Query System) But only about half the folks in Arizona take advantage of a simple screening test that can save their life. Last week, The Lancet published the first clinical trial that clearly demonstrates that getting the test and removing any polyps that are found save lots of lives. The test is recommended for everyone right after their 50^th birthday (when you get your AARP application stuff in the mail) and consists of a flexible tube with a small camera that examines the lower third of the bowel, where more than half of all bowel cancers occur. The new study found that after 11 years of follow-up, the incidence of colorectal cancer in those who did the test was reduced by 31% and deaths from the cancer were reduced by 43%. The test is best in the early 50s because people have virtually all the polyps they’re ever going to have by the time they’re in their mid-50s. If you remove them at that point, you’re pretty much OK.

New Behavioral Health Service Package

Will Humble — Fri, 07 May 2010 16:17:02 +0000

Our behavioral health team has completed work on the new behavioral health service package for our folks that are receiving services but don't qualify for AHCCCS benefits. We've posted a Guidelines Fact Sheet or you can view ADHS guidance to contractors regarding services to Non-Title XIX members with serious mental illness, services to individuals experiencing a behavioral health crisis and support housing services. This new "non-title XIX" service package will be effective July 1.

Arizona Stroke Research

Will Humble — Mon, 10 May 2010 15:55:18 +0000

Dr. Ben Bobrow, our EMS Medical Director is at it again, with yet another publication that positively measured the value and effectiveness of another public health intervention. Ben and his team published this month in Stroke and demonstrated that telemedicine is incredibly valuable for saving lives in rural and remote communities, by giving rural and frontier health care providers critical access to specialists that can help the rural providers save lives- and quality of life. The bottom line is that the rural provider needs good advice about whether to administer thrombolysis medication. If given quickly and when appropriate, this kind of medicine can dramatically improve outcomes- but it requires very quick judgment and administration... including deciding who needs it and who doesn't. making a bad call can be a real problem, and making a good call can save a life. Good work Ben.

Tucson Women’s Clinic v. Eden

Will Humble — Tue, 11 May 2010 16:52:12 +0000

Back in 1999, a law was passed and signed (ARS § 36-449.01 36-449.02 36-449.03) that required ADHS to license and inspect abortion providers if they provide 5 or more first-trimester abortions in a month or if they provide any 2nd or 3rd trimester abortions as an abortion clinic. Hospitals were exempted. The Tucson Women’s Clinic sued the ADHS director (Cathy Eden) to prevent the Department from implementing the inspection program, arguing that there were a number of problems with the new law. The District Court decided that some of the new law was legal but some of it wasn’t. The next stop in the case was the Appellate court, which reversed some of the District Court decisions and sent the case back (remanded the case) to District Court. Some of the issues that they instructed the court to deal with included record access, the redaction of records, the Department’s ability to conduct unannounced inspections, and a regulation that required abortion providers to submit copies of fetal ultrasound prints to a private contractor and the Department. After the remand, ADHS worked with the Tucson Women’s Clinic to negotiate a stipulated settlement which eliminated some of the requirements and added a regulation that provided the Department only strictly regulated access to patient records. Eventually, a stipulation agreement was reached. The US District Court approved the Stipulation of Settlement in September of 2008 and we began the process of writing a Rule to implement the 1999 statute. A couple of weeks ago, the Governor's Regulatory Review Council passed our rule package with the inspection requirements. The new rules are posted in the Arizona Administrative Register, November 6, 2009 (15 AAR 1822). Last week we filed a Motion to Vacate the previous court orders, which would allow us to begin licensing and inspecting abortion clinics. Now that the court has approved our request, our licensing division is beginninglicensing and inspection programs to enforce the new rules on November 1, 2010.

Abortion Reporting

Will Humble — Wed, 12 May 2010 18:05:39 +0000

The Legislature passed (and the Governor signed) a new law this past session that expands the number of reportable fields for abortion procedures that occur in Arizona. There are about 17 reportable fields and new reporting requirements for complications that occur as a result of the procedure. All of the data is confidential and there are no personally identifiable patient fields that are reported. The law also requires the Department to write up an annual report summarizing the data that we collect. The new law SB1304 will become effective at the beginning of July. The law specifies that the data needs to be submitted electronically, which is an important provision because we have limited ability to do the data entry ourselves. Out IT and Vital Statistics areas are busy getting the computer application up and running so that we're ready to go on July 1. We'll also be coordinating the new reporting requirements with Licensure, as it will be in the process of setting up the inspection procedures over the summer, with the expectation that we will begin licensing and surveying the clinics starting November 1.

Mental Health Awareness Month

Will Humble — Thu, 13 May 2010 15:35:13 +0000

We’ve come a long way since the days of institutionalization and separation from community, the stigma and bias associated with mental illness, but we're not where we need to be yet. Reducing the stigma and bias against those facing mental health challenges is a tall order, but it can be done. Efforts to increase public awareness and understanding of mental illness are important steps in the right direction. May is Mental Health Awareness Month. Our partners, stakeholders and RBHAs will celebrate it in various ways with outreach and education, communication and interaction. For example, Magellan is partnering with NAMI Arizona, Family Involvement Center and the Mental Health Awareness Coalition to highlight “Extraordinary People”—individuals who make valuable contributions to our community despite challenges with mental illness or substance abuse. Through town hall meetings, presentations and other outreach efforts, the campaign will target advocates, public policy makers and community decision makers as well as the general public. As these groups will be “Extraordinary People,” who are just like everybody else, but have shown extraordinary determination to overcome their mental health challenges and achieve a fulfilling life in the community, a rewarding job and loving relationships with family and friends. To learn more about the “Extraordinary People” and the activities surrounding Mental Health Awareness Month, please visit www.OneinFour.info (or www.UnoenCuatro.info in Spanish).

Proposition 100

Will Humble — Fri, 14 May 2010 16:22:07 +0000

Next Tuesday is the Special Election for Proposition 100. It’s a 3-year, 1 cent sales tax that would benefit education, public safety and health services. According to Section 149 of the budget bill that was passed last session, “If proposition 100 is not approved by the voters at the May 18, 2010 special election, notwithstanding any other law, the following state general fund amounts are reduced from appropriations made to state agencies in fiscal year 2010‑2011 as listed below: Department of health services - $40,000,000.” In other words, if it doesn’t pass next Tuesday we’ll be facing an additional $40M budget reduction. For some perspective, on July 1, 2008, the ADHS budget for our non-Medicaid services was approximately $276M. Our non-Medicaid services budget for the fiscal year that begins on July 1, 2010 is $143M… which is $127M (or about 47%) less than it was 2 years ago. We have limited options if 100 fails because of the substantial reductions we’ve taken over the last couple of years. One option would be to try to reduce the Medicaid match portion of our budget by $40M by reducing reimbursements to contractors that provide mental health services. However, this would actually represent a $160M reduction because this approach would also eliminate our 3:1 match from the feds. It would also need to be approved by the federal government (CMS). Another alternative would be to eliminate medications for people with severe mental illnesses that don’t qualify for AHCCCS (often because they have some social security income). None of the options that we have is pleasant. The election will be held on next Tuesday, May 18, but many people are voting using early mail-in ballots. Vote by mail ballots must be received by the county recorder on the 18^th or may be dropped off at any polling place in your county before 7 p.m. on Tuesday the 18^th. The polls will be open on Tuesday, May 18 from 6 a.m. until 7 p.m. This is a Special Election, and your polling place may be different that your usual spot, so you should look up your Polling Place on the AZ Secretary of State's website before election day.

Childhood Obesity Task Force Report

Will Humble — Mon, 17 May 2010 15:44:32 +0000

The President signed a Memorandum in February establishing the Task Force on Childhood Obesity and charged them with developing an interagency action plan to solve the problem of obesity in the US. The Task Force included the Secretaries of the Health, Agriculture, Interior, Education, Office of Management and Budget, Assistant to the President and Chief of Staff to the First Lady, and the Assistant to the President for Economic Policy. The Task Force published its action plan this month entitled Solving the Problem of Childhood Obesity Within a Generation. Those of you who work in our physical activity and nutrition shop will probably want to read the 99 page report. In particular, you should take a look at the conclusions and recommendations table. The task force also announced the Apps for Healthy Kids competition which challenges software developers, game designers, and students to develop fun and engaging software tools and games that drive children, especially “tweens” (ages 9-12) – directly or through their parents – to eat better and be more physically active.

New Heat Study

Will Humble — Tue, 18 May 2010 16:28:55 +0000

In March 2004, our Vital Statistics team produced a special report that examined deaths from exposure to heat in Arizona between 1992-2002. The report attracted a wide audience well beyond Arizona’s borders. It provided about deaths from heat exposure and analyzed heat mortality occurring in the State to both residents and non-residents (e.g. migrants crossing the desert). We’ve just completed an update of the original report and it’s sure to get a lot of attention. The new report Deaths from Exposure to Excessive Natural Heat Occurring in Arizona, 1992-2009 updates and expands the original report, and includes information about when and where people die from heat exposure. From 1992 to 2009, 1,485 people died from exposure to heat in Arizona. Undocumented persons crossing Arizona’s border with Mexico accounted for 666 of the deaths, with the vast majority (464) occurring in the eight years between 2000 and 2007. Meanwhile, there were 646 deaths from hyperthermia among Arizona residents or 36 deaths on average per year in 1992-2009. I won’t go into the details of the findings here, but if you’re interested in the subject, you should definitely take a look at the report, including the appendices. Also, if you work with Stakeholder groups that conduct public health or safety activities you should forward the link so they can use these data for their intervention work.

Into the Inferno

Will Humble — Wed, 19 May 2010 17:21:36 +0000

It’s not just the Phoenix Suns that are hot; your backyard will be one of the hottest places on the globe for the next 4 months. The heat on the desert floor isn’t just a nuisance, it’s expensive & lethal. Do you know what to do to protect yourself and your family? Do you follow through? Year in and year out, nearly 1,400 Arizonans get a heat related illnesses so serious that they end up in an emergency department and hundreds of them are so ill that they end up being admitted to the hospital. In 2008, the average per-person hospital treatment cost for heat related illnesses in Arizona was about $7,500, leading to a whopping $11,000,000 dollars in treatment costs in 2008. And that’s not all. On average, between 30 and 80 Arizona residents die from heat related illnesses every summer. More than 70% of these hospitalizations and deaths are males. The good news is that preventing heat related illness is easy to do if you just use common sense. You can learn how to Protect yourself from heat with some resources on our website including our a Heat Brochure [252k PDF] and our Heat Emergency Response Plan [135K PDF] .

New Tobacco Quitline Ad’s

Will Humble — Thu, 20 May 2010 18:40:47 +0000

We began running our new smoking cessation TV ad’s this month in targeted markets. They use a “call to action” format and encourage smokers to call a phone number (the ASHline http://www.ashline.org/ 1-800-55-66-222) to get help- including free nicotine patches, gum and lozenges. When the first ad started running, the quitline was swamped with calls. By the way- this tobacco prevention program (including the ad placements) are paid with a voter-protected tobacco tax that’s earmarked specifically for tobacco prevention activities.

Did smallpox vaccination halt spread of HIV?

Will Humble — Fri, 21 May 2010 15:12:59 +0000

A study published this week in the journal BMC Immunology suggests that being vaccinated for smallpox triggered by the smallpox vaccine may inhibit the growth of the HIV. The researchers extracted white blood cells from subjects and exposed them to HIV in a culture dish. The results showed that HIV replication was slowed by about 80 percent in the cells from those who had received smallpox vaccination. The full article is posted at: http://www.biomedcentral.com/content/pdf/1471-2172-11-23.pdf. Before drawing conclusions, consider that this in an in-vitro study cell culture study and the sample size is only 20, but it may suggest that further research is warranted to find out whether there is some kind of cross protection that the smallpox vaccine provides.

5 “Winnable Public Health Battles” Infection Control

Will Humble — Mon, 24 May 2010 17:13:57 +0000

I was in Atlanta a couple of weeks ago for new health officer orientation and was able to meet with Dr. Frieden (the new head of the CDC) a couple of times. Each time that we met he referred to a general theme that the CDC will be using over the next 3 years to drive public health policy- it’s called Public Health’s "Winnable Battles". CDC will be increasingly focusing its strategic planning on public health and policy interventions to help win the 5 “Winnable Battles”. There’s not much on the CDC’s website yet on the new strategy- but moving forward you’re sure to hear about them. I'll introduce them to you this week: 1. Infection Control This one is probably the most winnable “Winnable Battle” in the short run. Healthcare-associated infections are acquired when being treated for something else in a healthcare setting. They're one of the top-10 leading causes of death in the US. We’ve developed a Healthcare-Associated Infection (HAI) and Antibiotic Resistance resource page to help healthcare providers to develop and implement better plans to reduce healthcare associated infections. Unlike the problems of teen pregnancy, smoking, and obesity- interventions to reduce healthcare acquired infections can have an impact even in the short run. The CDC’s Infection Control website also has information to help providers do better in this area.

“Winnable Public Health Battles” Childhood Overweight and Obesity

Will Humble — Tue, 25 May 2010 15:42:17 +0000

This week, I'm sharing the CDC's 5 Winnable Battles as set forth by the new head of the CDC), Dr. Frieden. During the next 3 years, CDC will be increasingly focusing its strategic planning on public health and policy interventions to help win the 5 “Winnable Battles”. There’s not much on the CDC’s website yet on the new strategy, but moving forward you’re sure to hear about them. Today, a look at the second winnable battle: 2. Childhood Overweight and Obesity Obesity is a serious health concern for children and adolescents. Results from the 2007-2008 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that (nationally) an 17% of children ages 2-19 years are obese. Among pre-school age children 2-5 years of age, obesity increased from 5 to 10.4% between 1976-1980 and 2007-2008 and from 6.5 to 19.6% among 6-11 year olds. Among adolescents aged 12-19, obesity increased from 5 to 18.1% during the same period. Obese children and adolescents are at risk for health problems during their youth and as adults. For example, during their youth, obese children and adolescents are more likely to have risk factors associated with cardiovascular disease (such as high blood pressure, high cholesterol and Type 2 diabetes) than are other children and adolescents. For more info on how we’re working to do something about the problem in Arizona, you can visit our http://www.azwic.gov/ and Physical Activity Program

“Winnable Public Health Battles” Smoking and Tobacco Use

Will Humble — Wed, 26 May 2010 19:45:22 +0000

All this week, I'm talking about the five "winnable battles" in public health as laid out by the new CDC Director - Dr. Thomas Frieden. Dr. Frieden talked about focusing its strategic planning on public health and policy interventions to help win the 5 “Winnable Battles” in the next 3 years. There’s not much on the CDC’s website yet on the new strategy- but moving forward you’re sure to hear about them. 3. Smoking and Tobacco Use Cigarette smoking is the leading preventable cause of death in the US and in Arizona. Cigarettes are responsible for about one in five deaths annually in the US, or about 443,000 deaths per year. Enough said about the problem, but what can be done? Here in Arizona, we’ve taken an aggressive stand over the years and have focused a great deal of our voter-protected tobacco prevention funds toward preventing kids from starting. If you can keep a kid from smoking past age 21, they are unlikely to ever become addicted. If they do, they will have a good chance of kicking the habit. When kids start smoking as an adolescent, their brain get’s “hard wired” to the nicotine and they are much more likely to become a life-long smoker. You can check out our youth prevention campaign including the media spots on our http://www.venomocity.com/ website. Nationally, there will be some policy changes, as the FDA now has authority to regulate the nicotine in cigarettes as a drug. The Family Smoking Prevention and Tobacco Control Act was signed last year will put into motion a series of regulations over time that regulate tobacco products. The first in the series will start in June, when Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco kick in. Most of the things on the June list regulate smokeless tobacco (chew). There is a lot more information on the FDA’s website.

“Winnable Public Health Battles” Motor Vehicle Injuries

Will Humble — Thu, 27 May 2010 15:41:13 +0000

This week I'm looking at what you are sure to hear a lot about in the coming three years. The CDC, led by Dr. Thomas Frieden, will be strategically addressing 5 "winnable battles" in public health. So far, I told you about Healthcare associated infections, childhood obesity and preventing smoking. We can make a difference in all of these, if people make personal changes. It is the same with the fourth winnable battle: 4. Motor Vehicle Injuries In the US, car crashes are the leading cause of death for people ages 1–34, and nearly 5 million people get injuries that require an emergency department visit each year. The economic impact is huge: car crashes cost around $230 Billion. Big problems include child passenger safety, teen drivers, impaired driving, distracted driving (e.g. texting, BlackBerrying), speeding, and senior driving. You can visit our injury prevention website and look at the response end of traumatic injury on our trauma site where you’ll find Arizona specific reports like: Golden Hour by Region ASTR 2005-2008; Mode of Transportation ASTR 2005-2008; Over and Under-Triage Report 2009; Air Ambulance Abstract Final Version Sept09; All-Terrain Vehicle Related Unintentional Injuries Arizona 2003 - 2007; ATV Injuries in Children Fact Sheet; Helmet Your Child; Trauma Fast Facts - Injuries, Charges, Payor Mix and Cause of Injury by Legislative District and County; MVA Injury Fact Sheet; and Trauma Incidence in Maricopa County by Zip Code.

“Winnable Public Health Battles” Teen Pregnancy

Will Humble — Fri, 28 May 2010 15:48:59 +0000

For regular readers, you know this is the last topic of the CDCs 5 "winnable battles". CDC's new leader, Dr. Thomas Frieden, is focusing the agency's energies on these topics because he believes we can beat them in three years. 5. Teen Pregnancy Preventing teen childbearing could save the United States about $9 Billion per year.Teen mothers face higher rates of preterm birth, and their kids have higher rates of low birth weight, and infant death. Compared to women who delay childbearing until the age of 20 to 21 years, teenage moms are more likely to drop out of high school, and to be and remain single parents.The children of teenage mothers are more likely to have lower grades and proficiency scores at kindergarten entry; they're more likley to have behavior problems and chronic medical conditions; and they rely more heavily on publicly-provided health care (AHCCCS). They're more likely to be jailed at some time during adolescence until their early 30s, drop out of high school, give birth as a teenager, and be unemployed or underemployed as a young adult. That’s basically why the CDC’s picking this as a battle. But, just like childhood obesity- interventions to decrease teen pregnancies will take time and involve a lot more than just public health… it’s multi-factorial and will require coordinated interventions from many sectors. You can read more on our website about Arizona’s Teen Pregnancy Prevention Programs on our Abstinence Education and Comprehensive Education sites.

Community Health Centers

Will Humble — Tue, 01 Jun 2010 22:51:12 +0000

The federal government has committed to significant new funding for community health centers in the coming years. Nationally, about $13B will become available over the next 5 years for community health center expansion ($9.5B); facility improvement ($1.5B) and workforce development ($1.5B). This translates into about 7,000 to 10,000 new community health center sites nationally over the next 5 years. We don’t know how much will eventually end up in Arizona- but we’re roughly 2% of the national population- translating to 140 new sites (potentially). The centers will be funded through a competitive national competition and service elements will include medical, dental, mental health, substance abuse, lab, pharmacy and x-ray services. The services will focus on folks that earn at or below 200% of the federal poverty level. One of the elements in the competitive process will include demonstrating that the center will be located in a Medically Underserved Area, which is a place that has a more critical need for medical services because of various factors like a low ratio of primary care physicians per person, a high infant mortality rate, a high percentage of people below the federal poverty level, and a high percentage of people over 65. There’s a host of information about medically underserved areas etc. on our Health systems Development website at: http://www.azdhs.gov/hsd/index.htm. Also, potential community health centers can visit the federal Shortage Designation Advisor website to check specific addresses to see whether they are in an underserved area. To find out more about community health centers visit http://bphc.hrsa.gov/about/requirements.htm

2010 American Fitness Report

Will Humble — Wed, 02 Jun 2010 18:00:41 +0000

Which city do you think is overall more fit and healthy, Phoenix or Pittsburgh. I won’t give you the answer, you’ll have to go to this year’s The ACSM American Fitness Index Report at http://www.americanfitnessindex.org/ to get the answer. They put this report out every year to help city planners, policy makers, health educators, and other professionals understand how the health of the city, residents and community assets that support healthy lifestyles compare to other cities nationwide. The report includes health indicators like the percentage of people who exercise regularly, maintain a healthy weight, eat the recommended daily servings of fruits and vegetables, have access to health care, have health insurance, and don’t smoke. Environmental (community) factors included the availability of parks, walking/bike trails and public transportation. I will tell you that we do better on personal health indicators than on community indicators.

Behavioral Health Service “Conversions”

Will Humble — Thu, 03 Jun 2010 15:53:15 +0000

As I’ve mentioned in previous updates, the service package for folks with serious mental illnesses that don’t qualify for our state Medicaid program (AHCCCS) is being reduced beginning July 1 because of budget reductions. As a result, it’s more important than ever to make sure that everybody that may qualify has the opportunity top get Medicaid benefits (the more robust service package). That’s why we’ve been pressing our contractors (regional behavioral health authorities (RBHAs)) to canvass as many people as possible in case they qualify for the full benefit package. All of the RBHAs have been making these efforts- but I thought I’d give you an example of what’s been happening in the Valley. 2009 Screening As an example of what some of the contractors are doing… last spring and summer Magellan completed an organized AHCCCS eligibility screening initiative that increased enrollment from 52% to 61%. They screened 75% of the folks that hadn’t yet qualified and successfully converted 1,541 to Medicaid eligibility, found that another 2,623 were eligible (pending an application), 1,258 were potentially eligible (application pursued) and that 2,249 (37%) were financially ineligible for enrollment in Medicaid. 2010 Screening Following the 2009 screening initiative, they better integrated routine screening of people that weren’t enrolled in AHCCCS and began a second effort to re-screen folks for Medicaid. As of last week, 72% (6,070) of the folks had been screened (along with other transition service work). In this most recent screening, 880 of those screened (11%) were successfully enrolled. These efforts are on-going. Administrative Conversion Efforts We’re encouraging our RBHAs to use the subscription version of the Health-e-Arizona website at https://www.healthearizona.org/app/Default.aspx, which walks applicants through the application process and provides assistance on how to submit necessary documents (i.e., social security card) and prints bar coded fax cover sheets that tie back to the application so documents are not lost in the submission process. It also does a cross-check with other benefit programs and lets applicants know if they might qualify for other programs. As of this week, all of the RBHAs have either signed up for the subscription service or have responded and are on their way. For example, Magellan amended their contracts earlier this year to pay for 25 new eligibility specialists for the clinic sites to track & convert when possible. They started using the subscription Health-e Arizona service last summer at some of their sites and are now adding 60 individual subscription licenses to bring the total available to 75. Each of the clinic sites are designating key Health-e Arizona staff experts who will receive orientation Friday (June 4).

Smoke Free Arizona Annual Report

Will Humble — Fri, 04 Jun 2010 16:10:57 +0000

Our Smoke Free Arizona team published our 3^rd annual ADHS Smoke-Free Arizona Annual Report 2010 this week. The report found (just like last year) that compliance the law is excellent, thanks in large part to the common-sense approach that we took when implementing the act since 2007. Over the last year, the county health departments conducted more than 71,000 on-site visits at bars, restaurants and other businesses providing education and technical assistance to ensure continued compliance. We received 1,389 complaints last year, mostly for smoking within 20 feet of an entrance. Our goal is always to get compliance without enforcement, but we were forced to issue 36 notices of violation last year (resulting in $3,500 in fines). these violations were mostly in businesses (usually not bars or restaurants) that allowed employees, customers or visitors to smoke inside. For more information about how things are going visit the http://www.smokefreearizona.org/ website.

Medical Marijuana’s on the Ballot

Will Humble — Mon, 07 Jun 2010 18:31:14 +0000

The Arizona Secretary of State’s Office determined that enough valid signatures were turned in to put “The Arizona Medical Marijuana Act” on the November 2 ballot as a voter initiative. Basically, if the Act were to pass and be certified, it would create a system so that “qualifying patients” could apply to dispense, use and assist with the use of “medical marijuana” if they have a doctor’s recommendation. If it passes and is certified, ADHS would be responsible for administering the program, setting the registration, application and approval processes for qualifying patients and dispensers; setting some of the approval criteria; providing for and administering a renewal application process; setting the fees; issuing cards to patients, caregivers and dispensary employees; registering the dispensing facilities; creating and managing a web-based verification system for law enforcement; and generating an annual report. It would require us to implement the program within 120 days after the effective date, so we’d be on a short leash to finish the rules and execute the law in time. The Act provides for exempt rulemaking (meaning the rules don’t need to go to the Governor’s Regulatory Review Council), which speeds things up considerably. It’s impossible to fully summarize the proposed Act’s provisions here, but you can read the full text of the initiative at: http://www.azsos.gov/election/2010/general/ballotmeasuretext/I-04-2010.pdf.

Limit the Sun, Not the Fun

Will Humble — Tue, 08 Jun 2010 17:49:00 +0000

School is out & the UV index will be over 10 for the next couple of months, meaning that it’s sun safety season. Since the majority of a person’s lifetime exposure to the sun occurs by the age of 18, it’s crucial to protect and educate parents and children about the simple steps to take to limit sun exposure. With little more than a good idea and some pocket change from the preventive health block grant, we created the Arizona SunWise School Program in 2003. In August 2005, Arizona became the first state to mandate sun safety education by requiring that all K-8 public and charter schools teach the SunWise Sun Safety School Program. The SunWise Program shows kids & teachers simple steps they can take to protect themselves from overexposure to the sun. Children also develop an understanding of the environmental concepts related to sun safety. Students demonstrate the ability to practice health-enhancing behaviors and reduce health risks at an early age. These good sun safety habits can last a lifetime. Also, here’s a link to common-sense Skin Cancer Prevention materials from the CDC for families and summer schools. You can also tell someone how to protect their skin from the sun with CDC's Skin Cancer electronic greeting card. The SunWise program works with the Arizona Diamondbacks every year on a Sun Safety Poster - the winner was announced at last night's Diamondbacks game - check it out on our Facebook page. Also, a new study this week found that frequently using indoor tanning studios increased melanoma (skin cancer) risk no matter when the person started to go to indoor tanning salons. Elevated risks were found with all different kinds of tanning beds. You can see the Full Text (PDF) of the article on-line.

An H1N1 Retrospective

Will Humble — Wed, 09 Jun 2010 19:19:15 +0000

An article in last month’s New England Journal of Medicine provides a good summary of the public’s perception of the H1N1 response in an article called The Public's Response to the 2009 H1N1 Influenza Pandemic. It’s a comprehensivereview of data from 20 national public opinion pollsconducted between April 2009 and January 2010. Early in the pandemic (when no vaccine was available) two thirdsof Americans (59 to 67%) said that they routinely washed their hands or clean them with sanitizermore frequently; and a majority (55%) had made preparationsto stay at home if they or a family member got sick. Most people (87%) believed that the vaccine was safe (it was), but 50% of those surveyed said they weren’t concerned that they would get sick with H1N1 in the next 12 months and 28% of people thought that they weren’t at risk forgetting a serious case of H1N1 infection. A similar percentage thought that they could get medication (antivirals) totreat it (26%), citing that as a reason to not get vaccinated. By early November, 17% of adults had already tried to get vaccinated, but 70% couldn’t find a shot. Only 21% of high-priority adults tried to get the vaccine, 33% found a shot in November and only 7% of high-priorityadults were actually vaccinated in November. Parents were more motivated to vaccinate their kids than themselves and 40%of parents had had one or more of their children vaccinatedby mid-January. January2010, 59% believed that public health officials did an excellentor good job in their overall response to the pandemic, whereas39% believed they did a fair or poor job. The main reason for reporting that public health did a poor job was disappointment that the vaccine wasn’t available earlier.

Empower Pack Going National?

Will Humble — Thu, 10 Jun 2010 15:46:25 +0000

In an effort to spread the good word about our innovative Empower Pack program, we submitted an article for presentation at the American Public Health Association’s annual meeting this fall. We heard last week that our submission entitled "EMPOWER – Arizona's collaborative leadership efforts in implementing policy on childhood obesity and tobacco use in child care settings" was selected for the elite Roundtable session during the 138th APHA Annual Meeting http://apha.confex.com/apha/138am/webprogram/Paper223951.html. We’ll be discussing the strategic implementation of our policy which teaches and shows kids how to develop good health habits and leverages our child care providers to get it done in exchange for an off-setting of their child care licensing fee. The presentation will focus on how public health issues can be effectively and efficiently addressed through creative thinking, collaborative leadership, blending funding streams, and using evidence-based practices to drive good outcomes. We've also turned in an article for publication in the main APHA journal. We haven’t heard back on that yet- but I would bet my career that we’ll get published because it’s such a good and practical idea.

ADHS Lab Selected for Gulf Fish Testing

Will Humble — Fri, 11 Jun 2010 16:14:40 +0000

Our state public health laboratory Environmental & Analytical Chemistry unit has been selected as 1 of 8 chemistry laboratories across the country that will be examining commercial seafood for contaminants from the gusher in the Gulf. The goal is find out whether commercial seafood has been contaminated by the oil spill and if so, to determine whether the levels pose a health risk. Our team, and other labs will specialize in testing for Polycyclic aromatic hydrocarbons (PAH). All our work will be 100% federally funded under our current FDA Food Emergency Response Network http://www.fernlab.org/ cooperative agreement. Our chemistry team in the Lab is calibrating the instruments we have in house for the National Oceanic and Atmospheric Administration testing method as you’re reading this. We expect to receive additional extraction instruments in the near future which will allow us to process the fish tissue for analysis. We’ll be testing as many as 300 samples per week (starting with fin fish samples) from the Gulf beginning in July. It’s possible that the testing will continue well into the foreseeable future.

AZ Wildland Fire Season Peaking

Will Humble — Mon, 14 Jun 2010 17:09:16 +0000

After a much wetter than usual winter in the Southwest, spring winds blew away most of the surface moisture and increased fire dangers. Until the monsoon arrives (probably sometime in early July), we’ll be in the peak season for wildland fires in Arizona. Our Department plays a significant role in the response for major wildland fires. Our initial roles mostly include environmental health functions- especially surrounding health risks from smoke, sanitary conditions and food safety in shelters. However, the longest lasting response for major fire events (like Rodeo-Chediski) are related to behavioral health during the Recovery period. You can read more in our Wildfire Smoke and Your Health brochure and in The ADHS Wildfire Plan [PDF 1.5M].

Updating AZ Childcare Center Standards

Will Humble — Tue, 15 Jun 2010 22:28:07 +0000

You probably remember how we shifted from general funds to fee-based inspection programs. The most controversial fee increase was for child care facilities, as the costs of inspecting child care facilities had been almost entirely subsidized by the state’s general fund. In the end, we found a way to use alternative funding sources to provide a 50% subsidy for the child care licensure fees in exchange for participating in the Empower Pack program. After implementing our successful Empower program, a new law was passed (SB 1315) that makes some changes to the way we need to run our child care licensing program. The new law requires us to conduct a cost analysis of our child care licensing program by February and then review and adjust our fees accordingly. We can use the exempt rulemaking process to lower, but not raise, the fees. The law gives child care facilities perpetual licenses, in other words they don’t expire. We still have the authority to revoke or suspend licenses if licensees don’t pay their license fee. We also need to set up a payment program. If funding is available, the law says we should convert from 3 year licensure fees to a 1 year fee. It also requires us to amend the child care center rules by October 1 and amend the child care group home rules by October 1, 2011. We have a 1-year rulemaking exemption for amending the child care facility and child care group home rules. You might be out of breath after reading the new requirements, but we’ll continue to do our best. We’re starting by providing our new draft child care facility rules for comment today. The newly proposed rules are posted on the AZDHS website. We’ll have a 30-day comment period that will include public meetings in Tucson and Phoenix. The new child care facility rules are expected to be effective on or before our October 1, 2010 deadline.

Childhood Obesity Assessment Grant

Will Humble — Wed, 16 Jun 2010 22:48:45 +0000

Congratulations to our Bureau of Nutrition and Physical Activity for their grant award announced this month from the Association of State and Territorial Health Officials Leadership for Healthy Communities program. Over the coming year, we’ll be strengthening our capacity to make a dent in childhood obesity by conducting a health impact assessment to prevent childhood obesity in Arizona. We’ll be working with Maricopa County to develop a health impact assessment that locals can access in their land use decisions- helping communities to make development and land use decisions that better support healthy eating and active living. Communities will be able to voluntarily sign up for the process which will help them look at options like sidewalks, bike paths and green areas to promote physical activity and community gardens to increase access to fresh locally grown fruits and vegetables.

Cardiac Arrest Survivor Program Launched

Will Humble — Thu, 17 Jun 2010 20:50:27 +0000

We’ve made a lot of progress toward doing something about one of the biggest killers in the state and U.S.- cardiac arrest. We’ve published peer-reviewed journal articles that demonstrate the superiority of the new hands-only CPR technique, implemented the new approach throughout the EMS community, made inroads with getting the public aware of the new technique, trained 911 dispatchers, put together a series of cardiac arrest care centers and made AED’s a lot more common in public buildings. But what about the people that survive a cardiac arrest (and their families)? Up until now, there weren’t many resources to help them cope with life after a cardiac arrest, like dealing with their internal defibrillator and their families emotions. Although surviving a cardiac arrest is cause for great celebration, survivors face concerns about their implanted defibrillator, guilt for the stress one’s family is experiencing and the need to process what has happened. The fact that they were dead and are now alive can bring on some intense emotions. That’s why we worked with the University of Arizona Sarver Heart Center to launch the SCA Foundation’s Arizona Affiliate of National Survivor Network™ this month. We’re encouraging all AZ cardiac arrest survivors to register with the SCAF and share their stories. They’ll be helping their families, other survivors, and themselves. Arizona survivor stories can be found on the SCAF website and the SHARE website.

Congratulations Mohave and Yuma Counties!

Will Humble — Fri, 18 Jun 2010 16:43:37 +0000

A big round of applause is due for Patty Mead and Becky Brooks and their teams at Mohave & Yuma Counties for receiving full recognition for Project Public Health Ready (PPHR). Their teams persevered through the process, didn't give into frustration when additional documentation was needed and came out on the winning end. ADHS is proud to be a partner in the process and hope that this will provide some encouragement to those going through the process right now. PPHR is a public health preparedness training and recognition program that helps local health departments to build organizational capacity to respond to public health emergencies. The program is the only national standard for local public health preparedness and includes preparedness planning, workforce capacity development, and demonstration of readiness through exercises or real events and it's been the primary deliverable under our CDC public health preparedness cooperative agreement. Nice work getting this done, especially since you did in the middle of an influenza pandemic!

ASHLine Ringing off the Hook

Will Humble — Mon, 21 Jun 2010 20:09:17 +0000

Our new advertising campaign that encourages people to call our Arizona Smokers’ Helpline is going great. The ads continue to bring in unprecedented call volumes to the ASHLine. Since the commercials began airing less than a month ago, we’ve gotten more than 8,100 calls- which is more than the ASHLine receives typically in a five-month period. Overall, calls are up more than 900% from the same time period last year. Quit coaches report that callers are engaging in the quit process and most are saying it’s the bad economy/cost of the habit that is getting them to take action to call now. If you, or someone you know is ready to quit they should call the ASHLine at 1-800-55-66-222 or visit www.ASHLine.org. Today is also the first anniversary of the Tobacco Control Act. The Act gives the FDA stronger powers to keep tobacco out of the hands of children. FDA is trying to prevent kids from being the next generation of Americans to die early from tobacco use. It also is working to reduce death and disease associated with tobacco use for all ages. Find out more at the FDA.

Community Health Data Initiative

Will Humble — Tue, 22 Jun 2010 19:44:04 +0000

Earlier this month, the US Department of Health & Human Services announced a new public-private effort that aims to help Americans understand health and health care performance in their communities and to help spark and facilitate action to improve performance. It’s called the Community Health Data Initiative l. The goals are to provide Community Health Data Sets harvested from across HHS- data that’s easily accessible, standardized, structured, downloadable data on health care, health, and determinants of health performance at the national, state, and county levels. The national point person called me this week to talk about our arizonahealthmatters.org website- because it’s a state example of the kind of site that meets most of their national objectives.

"Sink or Swim" Exercise

Will Humble — Wed, 23 Jun 2010 17:34:51 +0000

Our preparedness team organized and executed a Functional Exercise on Tuesday last week to test Arizona’s hospital system for Interoperable Communications, Tracking of Bed Availability, Deploying Volunteer Health Professionals, Fatality Management, and Medical Evacuation/Shelter-In-Place capabilities. The exercise focused on hospital, local health, and state health Emergency Operations Center coordination. The exercise scenario was called Sink or Swim, and tested the system’s response to simulated flooding from a severe tropical storm that moved up the Gulf of California to Arizona. Hospitals and clinic systems tested their emergency plans for communications outages, patient movement within facilities, and medical surge. Seventy two hospitals, 11 county health departments, 6 community health centers, Indian Health Services, and the ADHS participated in the exercise. In addition, the ADEM participated by activating the volunteer network. These exercises require a great deal of up-front work. Congratulations to our federally funded preparedness team for putting together the successful drill.

Youth Behavioral Risk Factor Survey Released

Will Humble — Thu, 24 Jun 2010 18:29:05 +0000

The vast majority of deaths among kids and young adults in the US are preventable- and many involve the choices theymake. Car crashes are responsible for 30% of deaths, unintentional injuries 16%, murder 16%, and suicide 12%. Teen pregnancy causes a wide range of social problems, and there are more than 9 million cases of sexually transmitted diseases (STDs) among people aged 15–24 every year in the US. The leading health and safety problem for this age group are basically related to: 1) behaviors that contribute to injuries and violence; 2) alcohol and other drug use; 3) sexual behavior; 4) unhealthy eating; and 5) physical inactivity. These behaviors frequently are interrelated and are established during childhood and adolescence and extend into adulthood. The CDC released their Youth Risk Behavior Surveillance—United States, 2009 this month which examines the national trends. They conduct the surveillance annually so that we have better data with which to craft and implement public health interventions to do something about these preventable health issues.

Arizona Black AIDS Task Force

Will Humble — Fri, 25 Jun 2010 15:04:54 +0000

The "Arizona Black AIDS Task Force" is hosting, "Voices of Change HIV/AIDS Leadership Summit" this Saturday. The task force welcomes those who envision an Arizona with no new HIV/AIDS cases in our African American community and with the best possible life for HIV positive folks. Interested folks can call 602.845.9437 or abatf2010@yahoo.com to information about this important summit.

Schultz Fire Update

Will Humble — Fri, 25 Jun 2010 19:58:36 +0000

The “Schultz” fire started last weekend to the north and east of Flagstaff. It’s grown rapidly and is now over 14,000 acres but is about 40% contained. The actual fire is in a sparsely populated area off of Highway 89. But- the public health threat from wildland fires are from the smoke- not so much the fire. So far, the winds have (luckily) generally been out of the west or southwest- driving the smoke away from town. Our preparedness team is keeping a close eye on the wind direction- because if it shifts and comes out of the NE for a consistent period of time- Flagstaff could have very poor air quality- posing a problem for folks with respiratory problems. Our licensing team is also closely watching the fire because there is a nursing home, 10 assisted living centers, a hospital, and 63 group homes for people with developmental disabilities in the Flagstaff area. You can read more about our responsibilities in a wildfire emergency in our Wildfire Smoke and Your Health brochure and in The ADHS Wildfire Plan. The ADEQ has moved some of their portable particulate air monitors (that were bought for the Rodeo Chediski fire) to the area just in case the wind shifts for decision making purposes. So far air quality in Flagstaff proper has been pretty good- although there are some neighborhoods on the far east side that have had what we call “drainage smoke” in the middle of the night. So far the extended forecast has prevailing winds from the SW- which is good.

Giving Babies a Boost

Will Humble — Mon, 28 Jun 2010 16:30:40 +0000

We kicked off an initiative this month to increase the percentage of mom’s that choose to breastfeed their newborn. The real key to success turns out to be the first couple of days after the baby is born (actually the first few hours are the most important). Our new program is called Baby Steps to Breastfeeding. It’s a voluntary 5-point plan that we’d like hospitals to implement (for newborns and moms) before they leave the hospital. When they implement the program they become an ADHS “Baby Friendly Hospital”. The program is sponsored by WIC, and it’s based on the WHO’s Steps to Successful Breastfeeding. We’ll be providing guidance, training, ongoing technical support, materials and model policies for hospitals that want to participate. The initiative provides benefits to the participating hospitals, including marketing opportunities through our website, increased patient satisfaction and compliance with governing organizations requirements and standards. But, the biggest beneficiary will be Arizona mothers and infants, as private and public sectors work together to promote, protect and support this valuable foundation of good health.

Child Nutrition Act

Will Humble — Tue, 29 Jun 2010 16:29:12 +0000

As you remember from previous posts- the Child Nutrition Act has been introduced in the Senate and moved out of Committee. This month, a bipartisan group of members in the U.S. House introduced a similar bill to reauthorize and amend the Child Nutrition Act, “Improving Nutrition for America’s Children Act.” The bill is posted at Improving Nutrition for Americas Children Act, but it’s 253 pages long- so don’t print! The bill in the Senate to include elements of our Empower Pack . The Amendment directs the Secretary of Agriculture to work with the Secretary of HHS to encourage state licensing agencies to include wellness standards within state licensing standards in order to ensure that licensed and regulated child care centers and family child care homes provide physical activity opportunities, limit screen time and offer food consistent with the healthy meals patterns and nutrition standards. More than 31 million school kids participate in the National School Lunch Program and 11 million qualify for the School Breakfast Program. Many children get ½ of their daily calories at schools- making this program a great leverage point to improve nutrition for kids by placing more rigorous nutrition standards on the foods that are served in the program.

CDC’s “Science Clips”

Will Humble — Wed, 30 Jun 2010 17:00:56 +0000

I have a new bookmark spot for you. It’s called Science Clips; it’s the CDC’s newest weekly publication. Each week selected science clips will be posted on the site for the public health community with the goal of enhancing awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health today- in other words- things that can be done by health departments right now. Science Clips will cover Top Ten Articles of the Week, CDC-authored publications, Key scientific articles in featured topic areas, and Public health articles noted in the media. You can also read the comments page.

Behavioral Health Services Package Preparations

Will Humble — Thu, 01 Jul 2010 16:49:59 +0000

Our behavioral health team has been working for months to ensure a smooth transition to the new behavioral health service package for our folks that are receiving services but don’t qualify for AHCCCS benefits. We’re continuing to update our Guidelines Fact Sheet and our guidance to contractors regarding services to Non-Title XIX members with serious mental illness, crisis services and support housing services Our behavioral health teams have been very busy working on priority projects related to the transition. Here are a few of the most recent accomplishments: 1) Two new Crisis system support documents were posted and numerous revised policies were released at the beginning of last week; 2) the RBHA transition plans were reviewed and feedback was disseminated this week; and 3) monitoring plans for crisis services, non-Title XIX supported housing programs were discussed internally and were reviewed with the RBHA CEOs this week. As always, check out the updated material at www.azdhs.gov/bhs/updates.

Whooping Cough (aka Pertussis)

Will Humble — Fri, 02 Jul 2010 19:42:23 +0000

Whooping cough (pertussis) is a vaccine preventable disease that causes a severe and chronic cough. It’s a nuisance for adults and adolescents, but it’s potentially lethal for infants. California is having a serious outbreak right now with 4 times the normal number of cases this year. Our numbers are up too, but nothing like in California. So far this year, we’ve had 152 cases vs. 82 last year at this time, so while we’re up from last year, our epidemiologists haven’t called it an outbreak yet. Infants should get their first pertussis shot at two months of age, but aren’t adequately protected until after their 3^rd shot at 6 months old. So it’s really important to make sure that the people around the infant aren’t sick with the whooping cough. We had a pretty bad outbreak about 6 years ago and found that a lot of the infants were getting sick from parents, adolescent siblings and babysitters whose immunity had waned. That’s why we added a pertussis booster shot for 6^th – 8^th graders. California hasn’t added that requirement yet, so we’re better off than CA is in terms of that intervention. We’re keeping a close eye on this (as are the counties) and various counties are investigating additional public health interventions to slow the spread. Most of the strategies are around the concept of “cocconing” which simply means doing things to make sure that everyone that takes care of infants gets a booster shot.

CDC’s “Science Clips”

Will Humble — Tue, 06 Jul 2010 17:52:43 +0000

I have a new bookmark spot for you. It’s called Science Clips, and it’s the CDC’s newest weekly publication. Each week selected science clips will be posted on the site for the public health community with the goal of enhancing awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health today- in other words- things that can be done by health departments right now. Science Clips will cover Top Ten Articles of the Week; CDC-authored publications; Key scientific articles in featured topic areas; and Public health articles noted in the media. The comments web address is scienceclips@cdc.gov>.

AZ Obesity Update

Will Humble — Tue, 06 Jul 2010 22:59:20 +0000

The Trust for America’s Health released their annual obesity report. Overall, the national trend toward increasing obesity rates continued it’s march forward. Arizona ranked in the middle of the pack, but the pack itself in increasingly unhealthy. More than two-thirds of states have adult obesity rates above 25 percent. In 1991, no state had an obesity rate above 20 percent. Most Americans think that being overweight is a simple matter of personal responsibility. While it’s clear that people need to make healthy choices and get more exercise if we’re going to turn this thing around, there are some other factors. Healthy foods cost more than junk food and good food is hard to find in many neighborhoods. But you can be sure that cheap processed foods are available everywhere. Also, finding safe, accessible places to be physically active can be a challenge. While everyone faces barriers to healthy choices, the obstacles are often higher for people with lower incomes and less education. Those of you that work on public health prevention should become familiar with the key elements in the report, especially the intervention strategies in the second half of the report. By the way… our Empower Pack is an example of the kind of strategy that we need more of to turn this ship around.

ACPTC

Will Humble — Wed, 07 Jul 2010 18:09:38 +0000

Our ACPTC provides for the civil commitment of people who have a mental disorder that predisposes a person to commit sexual acts that pose a danger to the health and safety of others (A.R.S. § 36-3701, et. seq.). The mission of the center is to provide therapy to those individuals who have been civilly committed- with the goal of reintegrating them into the community if they successfully complete the treatment program and show that their presence in the community doesn’t pose a risk to public safety. Here’s a link to an interesting AP budget story this week regarding facilities like our ACPTC.

New Urgent Psychiatric Center on the Way

Will Humble — Thu, 08 Jul 2010 15:19:50 +0000

One of the behavioral health challenges that we’ve been facing in the valley over the last several years has been the lack of places that are available for urgent psychiatric care. Oftentimes persons in an acute psychiatric crisis end up being treated in an emergency department where they might not have the expertise to provide optimal treatment. If there isn’t enough capacity to transfer the person from the emergency department to a psychiatric care center- then the folks sometimes end up staying in the ED- which can aggravate the emergency department capacity problems. There’s some good news on the horizon. Banner is planning to open an 24/7 Banner Behavioral Health Hospital Urgent Care Psychiatric Center on August 30 that will have room for 23 patients, including an observation area. Patients that arrive at a hospital Emergency department that are in a psychiatric crisis could be transferred to either the Banner Psychiatric Center or the Urgent Psychiatric Center, based on location and level of psychiatric crisis. The goal is to make the transfer from the hospital within an hour, either by ambulance or other secure transportation, and for the patient to be seen by a psychiatrist shortly after arrival. Once on-line, this capacity will be a big help and will supplement the care that can be provided through the urgent care facility run by St Luke’s Behavioral Health Center.

AZ Developmental Disability Planning Council Grant Opportunity

Will Humble — Fri, 09 Jul 2010 16:00:33 +0000

The Arizona Developmental Disabilities Planning Council was established by the Governor in September 2009. It’s part of the Developmental Disabilities Assistance and Bill of Rights Act of 2000. I’m on the Council. Our mission is to represent the interests and needs of persons with developmental disabilities throughout Arizona- especially people that are underserved. We support capacity building and systems change with the goal of increasing inclusion and involvement in the community. We also promote self-determination, independence, productivity and integration to support persons with developmental disabilities and their families in all facets of community life. The Council has some federal funds that we’re supposed to use to support the implementation of our State Plan. We just announced a brand new grant opportunity for applicants that want to work toward our goals. We posted our Notice on our Council website this week. The grant opportunity includes elements to help work toward our Housing goals (up to $150K); Health and Wellness (up to $200K) and Advocacy (up to $200K). We’ll be accepting applications from interested organizations through August 2. Please forward this to parties that might be interested in helping- as the wider we cast our net the more likely we will be to get good ideas and applications.

America's Drug Abusers Going Gray

Will Humble — Mon, 12 Jul 2010 16:55:36 +0000

The proportion of people admitted for drug abuse treatment over 50 nearly doubled between 1992 and 2008. While alcohol still is the leading cause of admissions in this age group, sharp increases were noted in those needing treatment for heroin, cocaine and marijuana, according to the study published by the Substance Abuse and Mental Health Services Administration (SAMHSA). You can read more in the The DASIS Report: Older Adults in Substance Abuse Treatment. You can read more Arizona specific stuff in our Annual Report on Substance Abuse Treatment Programs which is posted along with all of our other Reports Required by State Statute.

Arizona Loses a Children’s Health Evangelist

Will Humble — Tue, 13 Jul 2010 19:04:54 +0000

Daniel T. Cloud, Jr., M.D., one of Arizona’s most dedicated health and public health professionals, passed away last week. We’ll miss him, but his life work lives on. Dr. Cloud made his dream come true to establish a children's hospital in Arizona- and became the Founding President of Phoenix Children's Hospital in 1983. He was also one of our key partners in improving immunization rates in Arizona. As the chair for The Arizona Partnership for Immunizations, he provided credibility to or statewide effort to continually improve pediatric office immunization performance. TAPI even established the Daniel T. Cloud Outstanding Practice Award for practices or clinics that reach 90% immunization coverage for 2 year olds in their populations. As always, he was committed to serving children. The family requests that donations be made to TAPI jennifert@aachc.org, or Phoenix Children's Hospital Foundation foundation@phoenixchildrens.com, in memory of Dr. Daniel T. Cloud.

New ADHS Chief Medical Officer

Will Humble — Wed, 14 Jul 2010 18:18:57 +0000

I’m happy to announce that Laura Nelson, M.D. will be taking on some additional responsibilities in her expanded role as the ADHS’ Chief Medical Officer. She will continue in her role as the Deputy Director for Behavioral Health Services as well (notice the “Acting” label is gone now). As is the case with many of you over the last year, she’s willing to take on these additional responsibilities without asking for a salary increase. The role of Chief Medical Officer was previously handled by a Medical Committee which hasn’t been operational for some time. I decided we needed to have a medical chief for a few reasons, including our new requirements in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the recent adoption of the Patient Protection and Affordable Care Act (health care reform). She’ll be contacting all of the MDs in the Department soon to begin work on developing and implementing the Department’s medical policy and goals including public health prevention, public health preparedness, vital records and statistics, behavioral health, special health care needs for children, licensing, clinical laboratory, and state hospital care.

Medical Marijuana (Proposition 203)

Will Humble — Thu, 15 Jul 2010 17:45:34 +0000

As I’ve mentioned in previous posts, an Initiative called the Arizona Medical Marijuana Act will be on the Ballot this November. We organized several teams (behavioral health, substance abuse, public health, licensure, rules, IT, and administrative council etc.) to examine the Initiative over the last few weeks. You can read a news article this week that highlights some of my concerns about the Initiative. Here’s some background: The active ingredient in marijuana that’s cited for its medicinal value is called Tetrahydrocannabinol (or THC). A synthetic version of THC called dronabinol is available by prescription (tradename Marinol^®). Marinol (dronabinol) is approved by the FDA for the treatment of anorexia in AIDS patients and for nausea and vomiting in folks undergoing chemo. It’s a Schedule III medicine, which means that doctors can prescribe it off label (e.g. for things other than nausea, vomiting, and chemotherapy) and it can be refilled. It’s generally considered to be non-narcotic and to have a low risk of dependence. But, the Initiative would allow people to apply for and get marijuana registration cards (from us) that allows them to buy & use marijuana itself for therapeutic purposes. The basic problem is that the FDA doesn’t recognize the smoking of marijuana as a treatment for any medical condition. The medical conditions that qualify for a medical marijuana registration card in the Voter Initiative include “a chronic or debilitating disease or medical condition or its treatment that produces severe or chronic pain.” Smoking marijuana isn’t part of any conventional, licensed or approved medical management of pain; it hasn’t been tested by the FDA for its safety or effectiveness for pain management. However, numerous FDA-approved medications are available that have been clinically proven to be safe and effective for pain relief and management and new strategies like acupuncture and biofeedback are showing more promise all the time. And remember, if a doctor thought that THC might be helpful for a patient’s pain management, they could always prescribe dronabinol. Many states that have implemented medical marijuana laws found most applicants cite “severe or chronic pain” as part of their qualifying medical condition. Severe or chronic pain was a factor for more than 88% of all medical marijuana cardholders in Montana. In Colorado, 91% of applicants qualified because of chronic pain (the majority of them were under 45 years old)- and only 3% of the cardholders qualified because of HIV or the symptoms from chemotherapy (areas where there’s evidence that marijuana can be helpful). The bottom line is that the Initiative would allow people to apply for and receive registration cards so they can purchase and use marijuana even though the FDA doesn’t recognize smoking marijuana as a treatment for any medical condition. The majority of cardholders in Arizona will likely qualify because of severe or chronic pain, which has dozens of approved safe and effective treatment alternatives. It also leaves the door open for recreational users to claim they have pain issues in order to get a card to avoid getting in trouble in case they get caught with marijuana (for their recreational use). And remember, doctors can always prescribe dronabinolfor their patients when they think THC may be helpful to their patient. Dr. Nelson and I co-wrote a statement along these lines that will be in the upcoming voter guide. Our letter represents our opinions. Every voter should examine the proposal for themselves and make their own decision about how to vote.

W_Humble Summer 2010 CV

Will Humble — Thu, 15 Jul 2010 17:52:21 +0000

Substance Abuse in AZ

Will Humble — Mon, 19 Jul 2010 20:58:25 +0000

Our Division of Behavioral Health Services is the point guard for substance abuse prevention & treatment in Arizona (also referred to as the Single State Authority for Substance Abuse Services at the federal level). One of those concerns is the abuse of marijuana- which continues to be in high demand and abused in our state. Marijuana use and abuse is a significant problem in Arizona according to the latest Arizona Statewide Substance Abuse Epidemiology Profile 2009. There’s been an upward trend in use since 2005, and the prevalence of its use in Arizona was higher than the U.S. average for most age groups. It continues to be a popular drug for Arizona’s kids - the average age of first marijuana use was only 13 years old. According to the Youth Risk Behavior Survey Data, there’s been an increased use of marijuana between 2005 and 2009 among Arizona’s high school kids. We use grant funds from the Substance Abuse & Mental Health Services Administration (SAMHSA) to conduct many of our substance abuse interventions in Arizona. We get the Grant funds through an annual application that details how we’ll spend the Substance Abuse Prevention and Treatment Block Grant. As is the case with all of our programs- we need to target the funds toward our highest priority populations. You can see the basics in our latest Substance Abuse FAQs.

About Will Humble

Will Humble — Tue, 20 Jul 2010 16:05:18 +0000

Will Humble, M.P.H. Director Arizona Department of Health Services

Current Appointments

Jan. 2010 – Present Director Arizona Department of Health Services Phoenix, AZ

Currently direct, operate, and control the Arizona Department of Health Services. The Department provides a wide array of health related services including Arizona’s behavioral and public health systems, the Arizona State Hospital, medical and child care licensure and certification services, and the Arizona Public Health Laboratory. The Department has approximately 2,000 employees and budget of $2B.
Successfully leading the Arizona public health system response to the 2009 H1N1 influenza pandemic, demonstrating public health leadership by coordinating Arizona’s public health epidemiological and laboratory surveillance, implementing key public health interventions, supervising special needs population readiness, efficiently distributing Strategic National Stockpile assets, ensuring health care surge capacity readiness, and coordinating statewide public health messaging. Collaborating with governmental entities including local, state, federal, tribal, and other stakeholders such as health care providers, school systems, the public and media.
Providing key leadership and management during unprecedented budget reductions by focusing on Department priorities established through strategic planning and by implementing budget reductions that minimized negative health impacts on the most vulnerable populations. Converted previously state funded programs into fee-for-service delivery models, including State Hospital ACPTC, and the Departments licensing programs.
Sharpening the Licensing Division’s emphasis on utilizing high priority compliance criteria to conduct facility surveys, resulting in reduced backlog without compromising quality of the reviews.
Leading efforts to improve accountability of the ADHS behavioral health contractors through enhanced monitoring of outcome based performance measures that improve mental health outcomes. Continuing to develop health informatics for management decision making.
Implemented a new nutritionally balanced food package for participants of the Arizona Women Infants and Children (WIC) Program to address the increasing obesity epidemic. The new package was successfully implemented, with both retailers and participants expressing satisfaction with the transition to this new healthy blend of foods.
Actively leading public health policy development within the US Mexico Border Health Commission and acting as the health co-chair for the US Mexico Border Governors Conference. Focused policy developments to address the cross-border obesity by leveraging the Department’s WIC menu changes and by calling for nutritional criteria under the USDAs Supplemental Nutrition Assistance Program.
Provided oversight for divisional reorganizations as a result of budget reductions. Areas of streamlined staffing patterns include Behavioral Health Services, Public Health Prevention, and Division of Operations units including Financial Services, Information Technology, Human Resources and Business Services.

2002 - Present Adjunct Faculty University of Arizona Mel and Enid Zuckerman Arizona College of Public Health University of Arizona Tucson, Arizona 2009 - Present Council Member Arizona Developmental Disabilities Planning Council Governor’s Office for Children, Youth and Families Phoenix, Arizona 2010 - Present Governor’s Homeland Security Advisory Committee

Past Appointments

2009 – 2010 Interim Director Arizona Department of Health Services Phoenix, AZ 2008 - 2009 Deputy Director Arizona Department of Health Services Division of Public Health Phoenix, AZ

Managed the Arizona Public Health Laboratory, Emergency Medical Services, Epidemiology & Disease Control, and Public Health Emergency Management, Vital Records, and Public Health Statistics, including 400 staff and a budget of more than $140M.
Managed a wide variety of public health programs during several rounds of significant budget reductions. Successful challenges overcome include organized prioritization of public health program funding, personnel placement decisions, and consolidating public health and business functions.
Led the development of Arizona’s trauma system by increasing the number of participating trauma system hospitals by 100% during 2008. System enhancements have improved the administrative effectiveness of the state pre-hospital care system, improved Stakeholder relations, and measurably improved patient outcomes.

2005 - 2008 Assistant Director Arizona Department of Health Services Public Health Preparedness Phoenix, AZ

Managed the Arizona Public Health Laboratory, Emergency Medical Services, Epidemiology & Disease Control, and Public Health Emergency Management, including 300 staff and a budget of more than $110M.
Improved the effectiveness of the Strategic National Stockpile program, public health volunteer coordination, special needs population readiness, hospital and local health preparedness, and increasing laboratory capacity.
Coordinated the development of the ADHS pandemic readiness plan and Arizona’s interagency pandemic influenza operational plan.
Led the successful implementation of the Smoke Free Arizona Act, resulting in good compliance and satisfaction among businesses and public health Stakeholders.
Improved the administrative effectiveness of the Department’s emergency medical services programs, improving Stakeholder relations, initiating the development of Arizona’s new trauma system, and leading the development of public health initiatives such as cardio-cerebral resuscitation (CCR), stroke telemedicine, and cardiac care centers. CCR has been adopted statewide and in other states, and recent research studies show that CCR as compared to CPR results in 300% increase in survival rates.
Led the expansion of Arizona’s newborn screening program and took the lead in integrating the newborn testing and follow-up programs.

2003 - 2005 Bureau Chief Arizona Department of Health Services Epidemiology & Disease Control Phoenix, Arizona

Managed the Epidemiology & Disease Control programs including the Office of Infectious Disease Epidemiology, the Office of Environmental Health, the Arizona Immunizations Program Office, and the Office of HIV/STD Services. Responsible for approximately 120 staff and a budget of more than $80M.
Successfully managed public health interventions and communications during Arizona’s 2004 West Nile virus season.
Successfully managed the 2004 influenza vaccine shortage.
Led interventions to improve Arizona’s vaccination rates and expanded vaccination requirements for school entry. Current data show that more than 95% of Arizona’s children receive all recommended vaccinations by school entry age.
Integrated STD and HIV surveillance, prevention, and care services to improve efficiency and stakeholder involvement.

1997 - 2003 Office Chief Arizona Department of Health Services Office of Environmental Health Phoenix, Arizona

Led the overhaul of Arizona’s food safety regulations and implemented a more effective food safety network in Arizona.
Developed statewide soil remediation levels (SRLs) for the Arizona Department of Environmental Quality and led Stakeholder groups to develop consensus about their implementation.
Developed Arizona’s targeted Lead Poisoning screening program, resulting in a more targeted approach to screening that is more cost effective.
Developed the highly successful Arizona “Sunwise” sun safety program improving sun safety awareness among families.
Authored over 50 environmental health risk assessments and public health consultations at various environmental contamination sites, and led public meetings and workshops to communicate health risks to the public and media.
Successfully managed environmental health issues during the 2002 Rodeo-Chediski fire.
Responsible for 25 staff and a budget of $2M.

1993 - 1997 Manager, Environmental Health Sciences Program Arizona Department of Health Services Office of Environmental Health Phoenix, Arizona

Authored more than 75 environmental health risk assessments and public health consultations at various environmental contamination sites, and led public meetings and workshops to communicate health risks to the public and media.

1992 - 1993 Environmental Program Specialist Arizona Department of Health Services Office of Environmental Health Environmental Health Sciences Program Phoenix, Arizona 1986 - 1990 Public Health Sanitarian Maricopa County Environmental Services Department

Education

1991 Masters Degree in Public Health (MPH) University of California at Berkeley Berkeley, California 1985 Bachelors of Science in Microbiology Arizona State University Tempe, Arizona 1982 Bachelors of Science in Business Administration Northern Arizona University Flagstaff, Arizona

Aging Healthy in Arizona

Will Humble — Tue, 20 Jul 2010 21:45:44 +0000

In the next 2 decades Arizona’s population will age rapidly, increasing the demand for services related to management of chronic illnesses and disability, as well as increase health care and long term care costs. That’s why we need to focus efforts to improve the health and wellbeing of all older adults in Arizona. Our new Report on the State of Aging in Arizona – 2010 examines the demographic characteristics, quality of life, chronic diseases trends and health behaviors of Arizona’s aging population, and identifies opportunities for health promotion and risk reduction that can improve the health status and quality of life for older adults. It also provides information to state and local government agencies, as well as nonprofits and the business sector for planning, allocation of resources, partnership and policy development- emphasizing healthy aging and making sure older adults remain engaged in communities across Arizona.

Integrating Physical & Mental Health

Will Humble — Tue, 20 Jul 2010 22:03:06 +0000

One of our top priorities in behavioral health over the coming years will be to better integrate physical health and mental health services in Arizona. Why is this a priority you ask? It’s because folks with the most serious mental illnesses die at least 25 years earlier than the average Arizonan (this is consistent across the country). Physical and mental illnesses are often linked- and nearly ¼ of Americans (over 18) suffer from a diagnosable mental disorder in a given year. When left untreated, folks can experience lost productivity, unsuccessful relationships, significant distress and dysfunction; it can also affect how well they care for their kids. There’s broad consensus that integrating mental health services into primary care settings offers a promising and efficient way to ensure that people have access to needed mental health services. Additionally, mental health care delivered in an integrated setting can help to minimize stigma and discrimination, while increasing opportunities to improve overall health outcomes. Likewise, integrating physical healthcare services into behavioral health clinics has increased access to physical health care screening and treatment for individuals who are more likely to see their behavioral health provider than a primary care physician. Successful integration requires the support of a strengthened primary care delivery system as well as a long-term commitment from our Department. A timely new report from the Millbank Foundation called Evolving Behavioral Health Models in Primary Care assesses integration models in primary care settings. The report reviews 8 model examples, including Improving Collaboration between Separate Providers; Medical-Provided Behavioral Health Care; Co-location; Disease Management; Reverse Co-location; Unified Primary Care and Behavioral Health; Primary Care Behavioral Health; and a Collaborative System of Care. Dr. Laura Nelson will be facilitating a panel presentation on integrated behavioral health services at the 11th Annual Behavioral Health Summer Institute in Sedona this week.

ADHS Status

Will Humble — Wed, 21 Jul 2010 15:09:09 +0000

We’ve got a lot to be proud of over the last year and an half. It’s been hard, I know because of all of the budget reductions and the lower staffing level. On the other hand, we’ve got an incredible mission and we’re doing a good job. I often tell people that we work in the most interesting agency in state government. Why? Because we touch the lives of Arizonans in dozens of different ways everyday. We:

Make sure that Arizonans are healthy and protected from infectious diseases like the flu and foodborne illnesses- and prevent diseases in the first place through our Vaccine for Children Program

Provide families with young kids access to nutritious blend of foods www.azwic.gov.

Make sure that the kids at Child Care facilities are safe and sound and that they get some exercise thanks to our Empower Pack program.

Make sure that Arizona’s Nursing Homes (Long-term Care), Assisted Living Facilities, Medical Facilities, Behavioral Health Providers treat people right and provide a safe environment. We’ve also sharpened our surveys to focus on the most important elements of care, and allowing folks to review the latest scores using our Facility Search tool. When we find Nursing Homes (Long-term Care) and Assisted Living Facilities that were jeopardizing the health of their residents- we make sure they make immediate corrections so that the residents are safe.

Help save lives by doing things like developing Cardiac Arrest Centers and Primary Stroke Centers across the state that are dramatically improving outcomes for folks that have a cardiac arrest or a stroke and are leading the national shift to continuous chest compression CPR from the old compression/breathing method .

Are building a new Trauma System from the ground up- which saves lives every day.

Are leading the state’s anti tobacco efforts like the prevention activities in our youth tobacco campaign (called Venomocity) and helping thousands of Arizonan’s Kick the Habit through our www.ashline.com services.

Are improving the performance of the state’s mental health system by giving choice and voice to folks with mental health and substance abuse needs- improving their ability to better participate in their path to Recovery from Mental illnesses. Over this past year, we have developed the new Nine Adult Guiding Principles to compliment our Children’s 12 Principles. We developed an RFP, went out for bid, and issued awards for all Geographic Service Areas outside of Maricopa County. We also planned for and implemented the most severe budget reductions in the behavioral health system in Arizona’s history.

Make a difference in hundreds of peoples lives at the Arizona State Hospital- by helping them in their road to recovery by treating them with dignity, care and respect.

Run one of the state’s most well respected public health laboratories- providing the backbone for Arizona’s public health system. For example, we find hundreds of kids with metabolic disorders and hearing and helped their doctors conduct interventions to help them avoid serious complications from their condition through our newborn screening program.

Administer the Office of Children with Special Healthcare Needs (OCSHCN) program, which includes the Children’s Rehabilitative Services (CRS) program. CRS provides family-centered medical treatment, rehabilitation, and related support services for children under age 21 with qualifying chronic and disabling conditions such as congenital heart disease, neuromuscular conditions, spina bifida, cleft lip, cerebral palsy, and many others.

Test 1000s of biological samples for all kinds of viruses and bacteria including H1N1, tuberculosis, West Nile virus, rabies, and literally dozens of other diseases so that counties and doctors can help slow the spread of disease and help people get better in our Public Health Microbiology program.

Helped thousands of folks at some of the most intense parts of their lives get critical documents in an efficient way through our Vital Records, Health Data & Evaluation programs.

Ensure that hundreds of clinical and environmental laboratories across the state are doing things right and providing good results through our Laboratory Licensure & Certification program.

Test 1000s of water samples for Environmental & Analytical Chemistry and bacteria so that counties and cities can protect their residents.

And that’s just a fraction of the incredibly interesting and important things that we do. Do you have any doubt now that this is the most fascinating place to work in state government? We’re successful at all of these things because of your commitment to the folks of Arizona and to each other. It takes a wide range of help from everyone including our IT, Human Resources, Rules, Procurement, Auditing, Financial Services and other Operations Teams to make these things happen. Thank you all for rowing in the same direction. I really appreciate your can-do attitude. Thanks… and make sure that you take the time to thank the folks around you from operations that make this place tick.

Aging Healthy in Arizona

Will Humble — Thu, 22 Jul 2010 16:45:31 +0000

In the next 2 decades Arizona’s population will age rapidly, increasing the demand for services related to management of chronic illnesses and disability, as well as increase health care and long term care costs. That’s why we need to focus efforts to improve the health and wellbeing of all older adults in Arizona. Our new Report on the State of Aging in Arizona – 2010 examines the demographic characteristics, quality of life, chronic diseases trends and health behaviors of Arizona’s aging population- and identifies opportunities for health promotion and risk reduction that can improve the health status and quality of life for older adults. It also provides information to state and local government agencies, as well as nonprofits and the business sector for planning, allocation of resources, partnership and policy development- emphasizing healthy aging and making sure older adults remain engaged in communities across Arizona.

Healthcare Reform Questions

Will Humble — Fri, 23 Jul 2010 15:00:38 +0000

I know that many of you are getting questions from your stakeholders about healthcare reform. The website that HHS posted recently should help, as it provides the latest information on the health care reform law. It’s seems to mainly be focused on consumer awareness etc. For example, the website provides information about the new option for people that have been denied health insurance by insurance companies because of a pre-existing condition and shows them how they can apply for coverage through the Pre-Existing Condition Insurance Plan run by the HHS.

West Nile Ramping Up

Will Humble — Tue, 27 Jul 2010 15:13:36 +0000

The West Nile virus is making its annual visit to Arizona. We’ve had several cases now in Arizona (and 1 death) - mostly from the East Valley in Maricopa and Pinal Counties. Most of these cases have the more severe form of West Nile virus which causes meningitis or encephalitis. We rarely hear of most cases because people with milder symptoms of West Nile stay at home and don’t seek medical care. That means there are a lot more people sick with West Nile than we know about. So far this year, over 120 mosquito samples have tested positive for West Nile virus all over the state, although many have been in the East Valley. West Nile virus can cause severe illness in people but only about 20% of those infected get flu-like symptoms like fever, headache, body aches and muscle weakness. Some people, especially the elderly, may get more severe symptoms like high fever, severe headache, neck stiffness, and/or encephalitis or inflammation of the brain. The virus mostly goes back and forth between mosquitoes and birds (the mosquito’s blood of choice), but when an infected female mosquito bites a person, the person can get West Nile. Prior to 1999, the virus was endemic in the Middle East, Africa, much of Asia and parts of Europe. It first showed up on the US East Coast in 1999. Every summer it traveled a little farther west- first reaching Arizona in the late 2003. 2004 was our worst summer for the virus because most of the Arizona birds were susceptible and it spread like wildfire that spring and summer. While we expect the virus to come back every summer in Arizona, we don’t ever expect to have one like 2004 because most of our urban birds have antibodies now. However we could have 100 or more cases this year based on the fact that we have more than a dozen cases this early in the summer. You can see our prevention messaging and tactics at: http://www.westnileaz.com/. By the way… Maricopa County will be monitoring the Salt River bed over the next few days to make sure that any downstream pools of water that result from the Tempe town lake dam burst are addressed so they don’t breed mosquitoes.

Title This, Title That

Will Humble — Wed, 28 Jul 2010 15:55:02 +0000

You’ve most likely heard the words Title XIX, Title XXI, and Title V (aka Title 19, Title 21, Title 5) bandied about in the halls and elevators throughout your careers- but some of you might not know what those words mean. Here’s a thumbnail sketch: Title V When you hear someone say “Title V”, they’re talking about our maternal; and child health prevention programs. “Title V” is the shortcut way of talking about maternal and child health because it’s Title V of the Social Security Act. 2010 is the 75^th Anniversary of the Social Security Act which established the Title V Maternal and Child Health Services program. Our Bureau of Women's & Children's Health and our Office of Children with Special Health Care Needs executes the Title V program in Arizona. Title V programs provide the infrastructure that has led to big health improvements among our most vulnerable citizens. The primary goals are to: 1) Reduce infant mortality and disabilities; 2) Increase immunization rates; 3) Increase the number of kids in low-income households that get assessments and follow-up diagnostic and treatment services; and 4) Ensure access to comprehensive perinatal care for women; 5) Ensure preventative and comprehensive care (including long-term care services) for kids with special health care needs; 6) Enhance rehabilitation services for blind and disabled children under 16 years of age who are eligible for Supplemental Security Income; and 7) Facilitate the development of comprehensive, family-centered, community-based, culturally competent, coordinated systems of care for kids with special healthcare needs. Title XIX When you hear the words Title XIX, it’s a shortcut for saying Medicaid- which is the national health care program for low income folks. Medicaid was created in 1965, through Title XIX of the Social Security Act (that’s why it’s called Title XIX). Each state administers its own Medicaid program. The federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs, matches state investments in the program (normally at about a 2:1 ratio- but more than that during certain times like now), and establishes requirements for service delivery, quality, funding, and eligibility standards. In our state, the Medicaid program is run by AHCCCS. Many of the services that we provide (most of our behavioral health services and children’s rehabilitative services) are run through the Title XIX state Medicare program (AHCCCS). Title XXI Title XXI is the shortcut way to describe the Children's Health Insurance Program (CHIP). It’s a program administered by the fed's, providing matching funds to states for health insurance for families with kids. The program was designed to cover uninsured children in families with incomes that are pretty low, but too high to qualify for Medicaid. CHIP was created in 1997, and was the largest expansion of health insurance coverage for kids since Medicaid began. It’s called Title XXI because CHIP was formed under Title XXI of the Social Security Act. In Arizona, the program is called KidsCare, which is administered by AHCCCS. Some of the services that we provide run through the Title XXI program- like some of our behavioral health services for kids and some of the kids in our children’s rehabilitative services program.

Farmers' Market Locator

Will Humble — Mon, 02 Aug 2010 14:47:01 +0000

We’ve got a groovy new Farmers' Market Locator up on our WIC website. It help anybody in Arizona find the closest farmers market. Simply go to the application link and put in any address and city and push “Find Market”. The program will list all the markets including links that give you the time of year, dates and times that the market is open. It’ll also give you a map of the market’s location, provided on a printer friendly page. Thanks team IT & WIC for developing this useful and important new tool.

ADHS E-Communications Site

Will Humble — Mon, 02 Aug 2010 21:26:51 +0000

Just a reminder that you can sign up for electronic notifications in your in-box of our media releases, and lots of other cool communications like our weekly, in-season, healthy recipe at: http://visitor.constantcontact.com/email.jsp?m=1101362445484. Tell your friends too.

Citizenship, Benefits & Services

Will Humble — Tue, 03 Aug 2010 16:33:05 +0000

Many of our Stakeholders and the folks that we serve have asked about how Arizona and Federal laws affect the kinds of services that the ADHS provides. The answer is (of course) “it depends.” It depends on what kind of benefit or service you’re talking about. Tom Salow, Lynn Golder and others have put together a fact sheet on our website that answers some of the key questions. You can visit our Frequently Asked Questions about Citizenship & Legal Status Eligibility Requirements for Public Benefits document on our legislative services web page to answer these questions. But remember… the fact sheet provides general answers to citizenship and eligibility questions. It’s not legal advice and it doesn’t provide definitive statements of law. Please let Tom Salow know as questions arise that aren’t addressed in the fact sheet so we can add to the FAQ. Also, our Division of Behavioral Health Services posted behavioral health specific guidelines regarding screening for and verifying citizenship and reporting violations at: http://www.azdhs.gov/bhs/updates/index.htm.

Mental Health ED Visits

Will Humble — Tue, 03 Aug 2010 22:24:39 +0000

Did you know that nearly 1/8 of all emergency department visits in the US are because of a mental disorder, substance abuse problem or both? A new federal report found that depression and other mood disorders accounted for 43% of behavioral health visits, 26% were for anxiety disorders and 23% involved alcohol-related problems. These data are from AHRQ News and Numbers in their Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007 report.

Title V Needs Assessment Complete!

Will Humble — Wed, 04 Aug 2010 15:17:01 +0000

This week our team completed and turned in our 2010 MCH Needs Assessment for the Title V Maternal & Child Health Block Grant (about $7M/year). The federal Title V program requires us conduct a comprehensive needs assessments every 5 years that identifies state maternal and child health needs and prioritizes them for strategic planning. While needs assessment is always part of an ongoing planning cycle, the 5 year needs assessment is an opportunity to formally examine trends and issues, review progress and set priorities for the next 5 years. The statewide needs assessment identifies the need for: 1) preventive and primary care services for pregnant women, women of reproductive age and infants up to age one year; 2) preventive and primary care services for children; and 3) family-centered, community-based services for CSHCN and their families. Thanks to all of you in our Bureau of Women's & Children’s Health and the Office of Children with Special Health Care Needs for your hard work on this important planning document. Well done.

Congrats Arizona State Hospital

Will Humble — Wed, 04 Aug 2010 20:23:44 +0000

Congratulations to our team at the Arizona State Hospital- which was ranked in the top 20% of all US psychiatric hospitals. The report was put together by the US News and World Report and ranks psychiatric hospitals using objective criteria as well as the hospital’s reputation with clinicians. Overall, ASH ranked number 31 of 159. You can see the data we were partially evaluated with in the report. Thanks for everything that you do. I know that your jobs aren’t always easy, but the work that you do is critically important. Thanks.

Delta Society

Will Humble — Thu, 05 Aug 2010 14:25:25 +0000

Cindy from the Delta Society began making visits with her therapy dogs at the Arizona State Hospital a couple of weeks ago. The Delta Society is a volunteer organization that improves people's health and well-being using positive interactions with animals. Their mission is to help people by incorporating therapy, service and companion animals into their lives. The response from our patients has been great as a wide range of folks have enjoyed the dogs. Some of the patients and staff sent me some awesome thank you cards this week- thanks that was very nice. It’s been a helpful and healing opportunity for our patients. Thanks Cindy.

Successful Budget Load

Will Humble — Thu, 05 Aug 2010 22:08:53 +0000

The first part of the fiscal year (July) is always a busy time for our budget folks. The new fiscal year requires a lot of data entry, cross-checks, analysis and review. It was a busy time of year even when we had several people in the budget office. This year we got the job done in the same time with fewer people- thanks to good organization, hard work- and some assistance from program financial folks in several areas of the Department. Thanks for the team effort.

Arizona’s Pre-Existing Condition Insurance Plan Goes Live

Will Humble — Fri, 06 Aug 2010 16:16:38 +0000

Some of the folks that we serve in our diverse mission have complicated medical conditions and may have had trouble in the past finding health insurance because of a pre-existing health problem. The new federal healthcare reform law may be able to help some of these folks under the newly created “Pre-Existing Condition Insurance Plan (PCIP)”… which is designed to help people with pre-existing conditions find health insurance. In Arizona, the Pre-Existing Condition Insurance Plan (administered by HHS) went live this week. In order to qualify for the program, folks need to have been uninsured for at least six months, have been denied health coverage because of a health condition, and be a US citizen (or living here legally). The monthly premiums for the Arizona PCIP range from $323/month for people 0-34 years old to $688/month for people over 55. There’s a $2,500 annual deductible and a $25 copayment for doctor visits after that. There are also some medicine co-pay costs. The person’s out-of-pocket costs are capped at $5,950 per year. Of course, there’s a lot more to the plan than this… so folks that are interested should go to the Pre-existing Condition Insurance Plan Website and can Apply on the HHS web site. Make sure you reach out to your Stakeholders and clients to ensure they’re aware of this new program. Examples of people that might be interested include Non Title XIX behavioral health patients, children with special healthcare needs and folks enrolled in the AIDS Drugs Assistance Program etc.

World Breastfeeding Week

Will Humble — Fri, 06 Aug 2010 20:25:59 +0000

Arizona enjoys a relatively high breastfeeding rate compared to the rest of the country- with 78% of all newborns being breastfed. But we can always do better, that’s why we’re joining the rest of the world in celebrating World Breastfeeding Week, which promotes the health and well-being of mothers, babies and families throughout the world. Studies show that most pregnant women want to breastfeed after they deliver, but face various problems. Recently released CDC data shows breastfeeding rates in Arizona are above the national average. ADHS partners with hospitals to implement the Arizona Baby Steps to Breastfeeding Success program to improve our performance. We also have information for Moms and Families and Health Professionals that help us reach our goals. Folks can learn more about nursing on our website, at local our local WIC offices and (coming soon) in 28 of Arizona’s hospitals.

Gulf Fish Testing

Will Humble — Mon, 09 Aug 2010 17:54:18 +0000

Our laboratory expects to get our first seafood samples from the Gulf next week. The goal is find out whether commercial seafood has been contaminated by the oil spill and if so, to determine whether the levels pose a health risk. Our team will specialize in testing for Polycyclic aromatic hydrocarbons (PAHs). The FDA and NOAA will use our data to help make decisions about which areas in the Gulf are safe to re-open for commercial fishing again.

Seasonal Flu News

Will Humble — Mon, 09 Aug 2010 22:09:34 +0000

The FDA approved this year’s (2010-2011) flu vaccine for the US. This year's shot will protect folks from 3 strains of influenza including the pandemic strain from last year. The technical terms for the strains in this year’s shot are the “A/California/7/09 (H1N1)-like virus (i.e. pandemic virus”; the “A/Perth /16/2009 (H3N2)-like virus”; and the “B/Brisbane/60/2008-like virus”. For the first time, the CDC is recommending that everybody over 6 months old get a seasonal flu shot. The supply of vaccine should be robust- as there are now 13 brand names and manufacturers for this year's vaccine, so if there is a problem with one of the suppliers (as was the case in 2004) it’s unlikely to create a major supply disruption. You can read more in the FDA’s announcement this week. Last week, the CDC’s Advisory Committee on Immunization Practices recommended that doctors avoid using the flu vaccine made by CSL Biotherapies (an Australian company) for kids under 8 years old because of unexplained fevers in kids that got the vaccine over the last several months in Australia and New Zealand. The pandemic flu strain (A/California/7/09 (H1N1)-like virus) pretty much completely displaced the H3N2 strain last flu season in North America. However, the flu outbreaks that have occurred this summer (at summer camps, day care centers and sports camps and the like) have mostly been the A/Perth/16/2009-like H3N2 virus. Both strains are included in this year’s seasonal flu shot.

New Electronic Smokefree AZ Reporting Module

Will Humble — Tue, 10 Aug 2010 15:05:17 +0000

Our Smoke Free Arizona and ITS teams polished off their electronic Complaint Reporting System this week. Our county partners can use the new tool to manage complaints electronically. The reports can be downloaded in PDF format or Excel. This is a great example of a solid team effort with participation from both teams including Harmony Duport, Myrna Motta, Mohibul Khan, Michelle St. Germain, Michael Conklin, and Lloyd Kalicki.

Seat Belts

Will Humble — Wed, 11 Aug 2010 21:07:42 +0000

Check this out. Here’s a 3 minute You Tube Video clip that St. Mary's Key Club did on seat belt & texting safety. St. Mary's High School has participated in ADHS' Battle of the Belt program for 3 years now. This will be played during morning announcements, etc. in High Schools around the state.

ACPTC Security Enhancements

Will Humble — Thu, 12 Aug 2010 15:59:24 +0000

Last October a person that was awaiting a civil commitment hearing escaped from our Arizona Community Protection and Treatment Center ACPTC, which provides for the civil commitment of people who have a mental disorder that predisposes them to commit sexual acts that pose a danger to the health and safety of others. Fortunately the person that escaped was apprehended by an alert law enforcement officer. That event triggered a thorough investigation by ourselves with help from our partners at the Arizona Department of Corrections. We concluded that the escape happened because of a combination of physical security weaknesses along with some operational problems. We were able to fix the operational problems right away- but it took until this week to finish the physical security enhancements. We completed major security enhancements this week including miles of new razor wire, new security cameras, night-time lighting improvements, motion detectors on the fences, and new visual security technology. We were able to keep the labor costs way down by using qualified inmates from the Arizona Department of Corrections for much of the labor. This transition time has been difficult for our team at the ACPTC because daily patterns needed to be changed so that we could complete the security enhancements safely. Thank you all out at the ACPTC for your hard work day-in and day-out during the transition.

Magellan Year 5

Will Humble — Thu, 12 Aug 2010 21:54:25 +0000

Last month we approved the renewal of the fifth and final year of the Magellan behavioral health contract in Maricopa County. Before making the decision to grant the 5^th year of the contract, our team assessed the progress that has been made in various areas, including access to and coordination of care; grievance and appeal processes; case manager expansion for kids and with complex needs; service utilization in the areas of supported employment, peer support and housing; and fiscal management. These performance measures focus on both quality and fiscal accountability, and most of these key measures demonstrate progress toward meeting or exceeding the performance expectations. Magellan has demonstrated a successful strategic allocation of funds toward high risk populations while minimizing administrative overhead expenses. Because we need to realign the contract year for Maricopa County back to the standard state Fiscal Year; however, Year 5 will run from September 1, 2011 - June 30, 2012.

The 2010 Infectious Disease Training and Tabletop Exercise

Will Humble — Fri, 13 Aug 2010 14:36:30 +0000

was held at ASU July 27^th -29^th. This is the first time that we have brought together all of the fields of infectious disease including HIV, TB, STDs, Vector-borne Disease, Foodborne Disease and Invasive Bacterial Infections in a unified training. The training:

Had almost 300 attendees from across the state, including physicians, nurses, sanitarians, local health department staff, and public health partners.
Was conducted at ASU without a facility charge
Had speakers from agencies nationwide, including FDA, USDA, Fry’s, CDC, and Universities in two states (Iowa and New Mexico)
Demonstrated great collaboration across areas to provide valuable information to our partners
Received great reviews from participants
Provided professional continuing education credit
Accomplished inexpensively through collaboration with partners, internal team work and creative thinking.

New Vital Statistics computer application

Will Humble — Mon, 16 Aug 2010 14:54:18 +0000

We have developed a new computer application and website to support the new abortion reporting requirements introduced with the passing of SB1304 into law. This new law requires additional information to be provided to AHDS when abortions are performed or complications develop. Currently, medical providers are required to report particular information to ADHS in an effort to collect Arizona specific data regarding abortion care. In the past this reporting has been manual via paper and we took this opportunity to automate this data collection by creating a reporting website for provider use. In addition, we created a user registration site so that the management of users could be streamlined with self-service for account establishment and password management and we created an administration site for ADHS use. Training has been developed and is available for new users. This project had an extremely short development cycle so it took a true team effort. Thanks to all who were involved! The team consisted of both Vital Statistics and ITS personnel including Beverlee Hall, Christopher Mrela, Richard Porter, Frank Caglio, Madan Gopal, Ellen Rayer, Michelle St. Germain, Michael Conklin, Shandy Odell, Jeanie Milnes and Raghu Ramaswamy.

Health and Safety of Residential Clients Protected

Will Humble — Tue, 17 Aug 2010 15:17:49 +0000

Last month, the City of Phoenix submitted a complaint against a supervisory care center in Phoenix, alleging neglect of the residents. Our team from Assisted Living Licensing worked with the Phoenix Police Department, Phoenix Fire Department, and a Phoenix neighborhood association to conduct an investigation of the supervisory care center. The investigation substantiated that approximately 50 residents were experiencing neglect. The owner was cooperative, and agreed to our request to relinquish the license. The residents were all relocated and their care was monitored until this could safely be accomplished. The Division of Behavioral Health Services, AHCCCS, Attorney General's Office, the Long Term Care Ombudsman, Adult Protective Services, and Magellan all worked with our Licensing Team to respond to this urgent need. Thanks to everyone for their hard work in helping protect the health and safety of the residents but especially Rosey Diaz, Christy Neal, Ellie Strang, Zakiya Torkwase, Jim Tiffany, Brenda Robbins, Idalia Brown, and Bob Sorce!

Winnable Battle- Healthcare Acquired Infections

Will Humble — Wed, 18 Aug 2010 16:05:59 +0000

Each year in the US there are 1.7 million health care associated infections that cause approximately 99,000 deaths in US hospitals. There are lots of germs that can cause health care associatedinfections, but 16% are in the really bad category because they’re resistant to antibiotics. These multidrug-resistant organisms pose huge problems once they get started, which is why preventing their transmission in health carefacilities so important. The germ that gets the most attention is methicillin-resistantStaphylococcus aureus (MRSA)- and preventing health care MRSA infections is one of our top public health goals in AZ. A new study this week suggests that we may be making some headway. A new study published in JAMA found that the rates of invasive health care associatedMRSA infections decreased in recent years among patients with infections that began outside and inside hospitals. We’ve developed a Healthcare-Associated Infection (HAI) and Antibiotic Resistance resource page to help healthcare providers to develop and implement better plans to reduce healthcare associated infections. We’re also working in various ways through our medical and long term care licensing programs and our public health programs to keep making headway on this important CDC Winnable Battle.

Yet Another Obesity Call to Action

Will Humble — Thu, 19 Aug 2010 17:21:37 +0000

You probably think I sound like a broken record because I’m always writing about obesity… but it really is the dominant public health issue of our time. Last week, the CDC released its latest Vital Signs report called "State-Specific Obesity Prevalence Among Adults – United States, 2009,"… which finds that nine states had an obesity rate of 30 percent or higher in 2009. In comparison, no state had an obesity rate of 30% or more 10 years ago. The report also finds that people who are obese incurred $1,429 per person more in medical costs every year when compared to people of healthy weight, and that the nation's total medical costs of obesity were $147 billion in 2008. OK that’s the problem- so what’s the solution? The solution is a combination of public policy changes and community planning, combined with better education and personal responsibility. For example, people need to eat more fruits and vegetables and fewer foods high in fat and sugar; drink more water instead of sugary drinks; be more physically active; and watch less TV. As a society, we need to promote policies and programs at school, at work and in the community that make the healthy choice the easy choice. You can read a lot more on the CDC’s Vital Signs Adult Obesity website.

ADHS Aces FY ’10 Licensing Timeframes

Will Humble — Mon, 23 Aug 2010 15:03:17 +0000

Did you know that we issue nearly 20,000 licenses every year- on everything from hospitals to childcare centers, midwives, trauma centers and sanitarians? We’re required to have meet certain time-frames for each license or approval the Department issues- and we issue a lot of licenses. If we don’t process the license within the timeframe, we’re required to return any application or license fee. We’re also required to complete a report every year that summarizes our performance. Most of our licenses are issued by our Assurance and Licensure Division- but we issue plenty of others in our laboratory licensing program, EMS, and in environmental health. We did fantastic during FY ’10- we hit the mark on 99.6% (19,275/19,467) of all of our licenses. The full report is on our Administrative Rules Homepage. Remember- you did this in the midst of the biggest budget crisis in the state’s history and despite all of our budget reductions. Sweet job.

Medical Marijuana (Cannabis) Ballot Language Finalized

Will Humble — Mon, 23 Aug 2010 22:34:48 +0000

The language for all of the ballot propositions, including the Arizona Medical Marijuana (Cannabis) Act, was approved this week. Last week, an analysis of the initiative for the voter guide was written by the Legislative Council. The actual words that will be on the ballot for Proposition 203 is as follows: Proposition 203 – proposed by initiative petition relating to the medical use of marijuana ALLOWS THE USE OF MARIJUANA FOR PEOPLE WITH DEBILITATING MEDICAL CONDITIONS WHO OBTAIN A WRITTEN CERTIFICATION FROM A PHYSICIAN AND ESTABLISHES A REGULATORY SYSTEM GOVERNED BY THE ARIZONA DEPARTMENT OF HEALTH SERVICES FOR ESTABLISHING AND LICENSING MEDICAL MARIJUANA DISPENSARIES. A “yes” vote shall have the effect of authorizing the use of marijuana for people with debilitating medical conditions who obtain a written certification from a physician and establishing a regulatory system governed by the Arizona Department of Health Services for establishing and licensing medical marijuana dispensaries. A “no” vote shall have the effect of retaining current law regarding the use of marijuana. We’ve been getting a fair number of phone calls regarding the Initiative (especially about dispensaries) - so we put together information on the proposed Arizona Medical Marijuana Act on our homepage in the lower right corner. If you get a call about the Initiative you can simply refer the caller to our Frequently Asked Questions document on the lower right portion of our home page.

New “Health Center Access Point” Grants

Will Humble — Tue, 24 Aug 2010 15:20:35 +0000

The HHS announced availability of the “Health Center New Access Point” Grants. Up to $250M is available for the delivery of primary health care services for underserved and vulnerable populations under the Health Center Program. A new access point is a new full-time service delivery site that provides comprehensive primary and preventive health care services. New access points improve the health status and decrease health disparities of the medically underserved populations to be served. For more information, including a link to the funding announcement see: http://www.hhs.gov/news/press/2010pres/08/20100809a.html.

Inpatient Behavioral Health Hospitals Licensing

Will Humble — Wed, 25 Aug 2010 15:08:24 +0000

For many years, the Centers for Medicare & Medicaid Services (CMS) has required inpatient hospitals that serve people under 21 to be accredited by The Joint Commission (formerly called the Joint Commission on Accreditation of Healthcare Organizations or JCAHO). Because the Commission standards are pretty rigorous, we’ve had limited network capacity for the inpatient treatment for adolescents and young adults in Arizona- because so few facilities have maintained Commission certification. But that’s about to change. CMS is amending the rule that had required Commission accreditation- and beginning October 1, psychiatric hospitals (and hospitals with inpatient psychiatric programs) will have the choice of undergoing a State survey (from us) to determine whether the hospital meets the requirements to participate in Medicare as a psychiatric hospital. They’d also be able to get accreditation from an alternative national accrediting organization (as long as their psychiatric hospital accrediting program has been approved by CMS). Here’s the link to the changes, which start on page 1168 of the document. We think this change will help us develop a more robust psychiatric inpatient treatment network for adolescents & young adults in Arizona.

Losing Stuff

Will Humble — Thu, 26 Aug 2010 18:05:44 +0000

Please make sure that you tell the ITS Help Desk (602-364-4444 opt 5, email HelpDesk) or HIPAA office (602-542-1020), email HIPAA) right away if you ever lose a computer, PC, laptop, BlackBerry, hard drive, CD, flash drive, copier, printer, server, or anything that could be used to store, transmit, or process data. Our official Policy ADM022 Reporting an Information Resource Privacy or Security Incident was developed so that we can better protect important and confidential information for the folks that we serve.

How Do You Take Your Eggs?

Will Humble — Fri, 27 Aug 2010 16:41:44 +0000

Cooked all the way through, I hope. I’m certain that you heard about the national egg recall this month. I’ll try to put it in perspective. Epidemiologists across the country and at the CDC found a nationwide outbreak of Salmonella that has made a few hundred people sick. The investigation found that people that ate raw or undercooked eggs were at most risk. A trace back to the source found that eggs produced by Wright County Egg and it “voluntarily” recalled about 400 million shell eggs. The FDA and state agriculture departments have been monitoring the recall and auditing retail stores, wholesalers and distributors to make sure the recalled shell eggs are being removed from the market. Many of the recalled eggs are being sent to facilities to be pasteurized (which will destroy the bacteria). By the way, when eggs get contaminated like this it’s usually because rats (who often carry salmonella) get into the chicken feed. Eggs with clean, uncracked shells occasionally contain Salmonella. That’s why we always recommend that people cook their eggs until both the yolk and the white are firm. Scrambled eggs are OK as long as they’re not runny. Casseroles and other dishes containing eggs should be cooked to 160°F. If you still want to eat foods that call for raw or undercooked eggs (like Caesar salad dressing and homemade ice cream), you should buy pasteurized egg products (they’re usually in cartons). AZ restaurants that serve recipes that contain raw or undercooked eggs are required to let you know that the food can make you sick. You may hear that this event provides evidence that the nation’s food safety and epidemiology network is inadequate. I would say quite the opposite. The very fact that the public health system identified the outbreak and source shows that epidemiology works. Before we had a good public health network, including solid laboratories, people just got sick from something, nobody noticed, the food was never identified and nothing was done. To be sure, the farmer should have kept the chicken feed clean and prevented this, but that doesn’t mean the network is bad.

Abortion Clinic Inspections

Will Humble — Mon, 30 Aug 2010 17:28:50 +0000

In 1999 a bill was passed to regulate abortion clinics. Before the law could take effect, a lawsuit was filed that “stayed” the regulation of abortion clinics until a settlement agreement could be finalized with the Department and the plaintiffs. Last year the settlement agreement was finalized and the Department was able to write rules for the regulation of abortion clinics. The new rules are complete and have been filed with the Secretary of State's office; they go into effect on November 1, 2010. This has been a complicated process for the Office of Administrative Rules, the AG’s Office and the Office of Medical Facilities (OMF) in the Division of Licensing. In order to allow abortion clinics to begin performing abortions on November 1, the providers of free standing abortion services will need to apply for a license by September 2, 2010 in order to be licensed by November 1, 2010 (by law, abortion clinics can’t qualify for a temporary license). If a facility provides abortions and already has a license, they will need to apply for an amended license. Our medical facility licensing folks will be providing training and surveys to all of the providers before November 1, 2010. Special thanks go to Kevin Ray and Don Schmidt from the AG’s Office, Tom Salow and Valerie Grina from the Office of Administrative Rules, Alan Oppenheim and Mary Wiley from the Division of Licensing and Kathy McCanna and Connie Belden from our medical licensing shop.

Folic Acid Outreach

Will Humble — Mon, 30 Aug 2010 20:40:10 +0000

Each year in the U.S., 2,500 babies are born with neural tube defects (NTDs). These include such conditions as spina bifida and anencephaly, which can lead to paralysis or even early childhood death. Many of these birth defects can be avoided by simply remembering to take a multivitamin every day. A daily dose of 400 micrograms (mcg) of folic acid before pregnancy and 800 mcg during pregnancy is all it takes. We’ve been partnering with the March of Dimes to help reduce the rate of birth defects in Arizona, especially among Latina women of childbearing age. Check out the article, including pictures of the team. Congratulations to Saidee White, Claudia Sloan, Veronica Perez, Hong Chartrand and Zipatly Mendoza, for their great work on the Folic Acid education and outreach campaign. The team used some unique outreach approaches including a rock band that performed in English and Spanish. The goal was to create a campaign that resonated with the target audience by getting them interested and involved. Saidee has worked very hard to coordinate the distribution of folic acid vitamins to partners all over the state. If ADHS partners are interested in folic acid materials, they can be ordered from the Warehouse Order Form if they have a citrix account. If not, partners can visit the website, download an order form and fax it to the warehouse at (602) 442-6867.. Thanks for all your hard work Saidee and the entire Folic Acid Team.

Check out Arizona’s 2009 Behavioral Risk Factor Survey

Will Humble — Tue, 31 Aug 2010 19:57:58 +0000

Decades ago, how long you lived depended mostly on fate. Infectious diseases, poor sanitation and unsafe conditions called the shots. However, because of advances in public health, much of the fate part is gone and the risk factors for premature death are dominated by behavioral and lifestyle choices. Of course, income and access to resources are a factor, but behavior choices play a very important role. Our job is to help people make better choices and give the them resources and or education to execute those choices. In order to effectively target our interventions we need to know the behavioral trends and the demographic background so that we can target our resources effectively. That’s where our annual Behavioral Risk Factor Survey (BRFS) plays a role. We conduct the survey every year (using federal funds) to help keep a pulse on how we’re doing. We just completed the analyses for the 2009 survey, which is posted on our Vital Statistics website. There are numerous examples of how we use the data in this report, smoking rate is one example. From previous BRFS reports, we know that AZ’s overall smoking rate is declining, from about 24% in 2002 to about 16% last year. The demographic information in the study tells us that the highest smoking rates are among those folks with the lowest incomes (26% of people making less than $25K/year smoke while only 8% of people making more than $75K smoke). That’s key information because it gives our tobacco prevention folks a better idea of who to target with cessation messaging and resources (like AHCCCS recipients). Judy Bass was the point person for this year’s report. Well done Judy!

Marijuana (Cannabis) in AZ’s Nursing Homes?

Will Humble — Tue, 31 Aug 2010 23:23:17 +0000

Close your eyes and imagine you're one of our surveyors, you're doing an inspection of a nursing home or assisted living center and you find residents smoking marijuana. Could that really happen? Maybe. One of the provisions of the Arizona Medical Marijuana Act talks about the ways nursing homes and assisted living centers (that we license) can manage marijuana use among residents (if the Initiative passes). Page 16 of the Initiative (would be ARS 36-2805) says that nursing homes and assisted living centers can adopt reasonable restrictions on their resident’s marijuana use. For example, our licensed facilities can decline to provide or store the marijuana for residents and they can ask the residents to consume the marijuana in a specified place in the facility. Facilities could prohibit Cannabis smoking as long as they allow residents to consume it in another way (like in brownies). Nursing homes wouldn’t be able to make “unreasonable” restrictions on marijuana use by residents unless the limitations are required in order to avoid being fined or losing their license (under federal law e.g. CMS).

ADHS Scores New Heat Illness Prevention Grant

Will Humble — Wed, 01 Sep 2010 08:51:53 +0000

The scorching summer of 2005 motivated us to get our act together and do a better job preventing heat related illnesses in Arizona. That summer, we completed a needs assessment and developed a Heat Emergency Response Plan and Heat Brochure that identifies interventions using triggers from the National Weather Service. These days, we identify risk factors and strategies to improve healthy environments for Arizona residents, we have an enhanced surveillance system to more readily respond to increases in heat related public health events and we’ve been promoting better awareness of preventing heat related illnesses through public education. Our Environmental Health shop scored a new grant to go the next mile. The new $115K/year grant will pay for us to implement a heat related illness education campaign which focuses on school-aged kids, seniors and occupational exposures. We’ll be providing information to Arizonans on decreasing their heat-related risk factors, developing educational videos, enhancing our advisories to school nurses and PE teachers and creating a website and a bimonthly newsletter. FYI… heat related illnesses are a significant risk in Arizona among high school football players because of the extreme heat. The CDC just published a new surveillance report on this topic.

AZ a National Runner-up for Nutrition Pilot

Will Humble — Wed, 01 Sep 2010 13:28:41 +0000

An Arizona team from ADHS and ADES put together a great application for the new USDA pilot program called the Healthy Incentives Pilot, which provides incentives to encourage low-income folks to eat more fruits and vegetables. Massachusetts came in first and got the grant, but our applications came in second. The pilot program would have researched whether incentives for participants in the Supplemental Nutrition Assistance Program (formerly Food Stamps) would lead to eating healthier food. For every dollar participants spent on fruits and vegetables using their SNAP Electronic Benefit Transfer cards, 30 cents would have been added to their benefit balance, thus cutting the cost of fruits and vegetables. Thank you all for the hard work putting together the application. Our work isn’t in vain because we will always have our template for future opportunities.

Acting Shmackting

Will Humble — Thu, 02 Sep 2010 09:15:46 +0000

I’m glad to announce that Rodgers Wilson, MD is our permanent Behavioral Health Medical Director. Dr. Wilson oversees the clinical/prevention and quality management/medical management areas of our behavioral health system. He has spearheaded Quarterly Health Initiatives that address common physical health needs among individuals with behavioral health illnesses and is currently developing collaborative training programs for identifying individuals with traumatic brain injury and emergency room physicians treating behavioral health conditions. Don Herrington is now our Assistant Director for Public Health Preparedness and is responsible for EMS, the Lab, Vital Records, EDC and Emergency Preparedness. Cara Christ, MD is now our Bureau Chief for Epidemiology & Disease Control and Chief Medical Officer for Public Health. Please join me in congratulating them for shaking their “Acting” labels.

Council of State Government’s Award Nomination

Will Humble — Thu, 02 Sep 2010 12:08:52 +0000

In early September the Council of State Governments (CSG) will be awarding their highly competitive CSG Awards for innovative practices. Magellan Health Services of Arizona is a regional finalist for the award because of their innovative online provider outcomes dashboard. The dashboard has been a partnership between our Division of Behavioral Services, Magellan and 4 adult provider network organizations (CHOICES Network, People of Color Network, Partners In Recovery Network and Southwest Network). It provides key information for our service recipients and their families as well as the providers themselves with the goal of improving consumer choice and outcomes. The dashboard measures areas that are working well and those that need improvement. Magellan’s collaborated in the development and implementation of the dashboard. The other Regional Behavioral Health Authorities (RBHAs) including CPSA, NARBHA, and Cenpatico also have developed web-based dashboards that depict provider-level performance. At the upcoming RBHA CEO meeting next week, each RBHA will be demonstrating their dashboard to share best practices. Congrats DBHS Team!

Healthy Schools

Will Humble — Fri, 03 Sep 2010 09:24:51 +0000

I thought I’d do a piece on school environmental health now that school’s back in session. About 1 million Arizona kids and 100,000 adults spend a big chunk of their day in Arizona’s public, private and charter schools. Because schools can often be crowded environments, it’s important operate them in a way that maximizes a healthy environment. A few years ago the U.S. Environmental Protection Agency developed a healthy school environments web site and computer tool designed to provide one-stop access for administrators get the tools they need. It’s simple to get started by Downloading the HealthySEAT Software program. EPA’s software tool helps school districts evaluate and manage their school facilities for key environmental, safety and health issues. The Healthy Seat Assessment Tool is designed to be customized and used by district-level staff to conduct completely voluntary self-assessments of their school facilities and to track and manage information on environmental conditions school by school. Districts and others can download the program for free from the EPA web site. I’ll give a couple of simple examples. By changing or modifying school bus idling policies, a school can significantly improve the outdoor air environment before and after school with little or no cost; that same action can reduce asthma triggers for sensitive kids before and after school. By mowing grass on Friday afternoons (after the kids have left), a school can cut back on biological asthma triggers. By putting weather stripping under classroom doors, schools can inexpensively eliminate rodent infestations and get rid of dander triggers for allergies and asthma. Many of the most effective tools are also the least expensive.

ICM pick up

Will Humble — Fri, 03 Sep 2010 14:10:51 +0000

Thanks to all who brought in clothes and personal items the first week.

SECC Campaign

Will Humble — Fri, 03 Sep 2010 14:13:03 +0000

The annual State Employee Charitable Campaign starts this month and will run for 6 weeks. Employees will get some additional information about this year’s campaign shortly, but I wanted to let you know about a special part of the campaign for ADHS this year. I know that the furloughs and the unemployment situation (for your family members) are a hardship for you, making it difficult for some of you to contribute financially this year, so I wanted to add a new component for our agency this year. This year, ADHS will partner with the Interfaith Cooperative Ministries (or ICM) to provide you with another way to contribute. ICM is a non-profit clothing bank in south central Phoenix. They provide an immediate response to basic human needs for folks including clothing, toiletries and financial assistance to those in need. ICM serves 60,000 clients each year, including families with children. All of their donations go directly to people that need them and for free. For 6 weeks, ADHS will have donation boxes in the lobbies of our buildings. This will provide staff with a great and easy way to contribute clothes from your closet that no longer fit because of the new physical activity program that you’ve started, clothes that your kids have outgrown, or clothes that you figure you just plain won’t wear anymore. As you come into work, simply toss your stuff in the box. They need all kinds of clothes, but especially baby and kid clothes, clothes for both men and women (including shoes) and toiletry products.

The Drive Continues Remember to go through your closets over the long weekend and bring back the stuff you won’t be using anymore for our Interfaith Cooperative Ministries (ICM) donation boxes which are in the lobbies of the downtown offices and in the lobby of the Admin building at the hospital. We’re partnering with ICM this year as part of the SECC. All donations go directly to people that need them -- for free.

ICM pick up

Will Humble — Fri, 03 Sep 2010 14:18:00 +0000

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Will Humble — Fri, 03 Sep 2010 14:22:17 +0000

First Pick Up

Will Humble — Fri, 03 Sep 2010 14:24:24 +0000

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Will Humble — Fri, 03 Sep 2010 14:29:27 +0000

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Will Humble — Fri, 03 Sep 2010 14:31:26 +0000

Behavioral Health Performance Improvements

Will Humble — Tue, 07 Sep 2010 11:44:54 +0000

By working closely with our behavioral health contractors over the last couple of years we’ve been able to make some significant improvements in the quality of care that we’re providing. Examples of our accomplishments are available in newly created outcome dashboards developed by CPSA, NARBHA, Cenpatico and Magellan. The dashboards provide monthly reports using web-based tools, are accessible to anyone and highlight indicators of quality of care for recipients and their families that they can use for consumer choice. In addition, some of our contractors have been summarizing additional performance measures that demonstrate progress. One example is the new accomplishments report put together for us by Magellan Health Services of Arizona, the organization we have contracted with to manage the Maricopa County system. Elements in the report include:

1) Fewer readmissions once a recipient has an inpatient stay at one of the county’s psychiatric hospitals;

2) An increase of 759 housing and residential units/ beds for folks with serious mental illness;

3) A large decrease in the use of residential settings for children- meaning more kids are staying in their homes, communities and schools; and

4) A successful suicide intervention and prevention initiative that has now trained more than 1000 members of the behavioral healthcare workforce to be better equipped to assess and prevent suicide.

If you’re interested in more, you can check out the full report. (Note: it is a large file and may take awhile to open.)

ADHS Wins National Award for Cardiac Receiving Center Program

Will Humble — Tue, 07 Sep 2010 14:32:39 +0000

Our Bureau of EMS received 1^st Place in this year’s 2010 Association of State and Territorial Health Officials “Vision Award” for our creative (and really inexpensive) Arizona Cardiac Receiving Center Program. The annual ASTHO Vision Awards recognize outstanding state health department programs and initiatives that use a creative approach to address public health needs or problems. We’ll be recognized at the 2010 ASTHO Annual Meeting in October. Way to go Dr. Ben Bobrow, Paula Brazil, Terry Mullins and Team EMS! Back in 2007, our Bureau of EMS set up a network of cardiac arrest receiving centers in Arizona that now covers more than three-quarters of the state. While cooling the body is only one of the requirements for being part of the network, it has been a fundamental game changer. We did it with nothing but a good idea and some elbow grease. It’s based on the concept of getting emergency departments to use simple techniques like therapeutic hypothermia to improve the chances of survival and for a decent quality of life after someone suffers a cardiac event or stroke because of a clogged artery. It’s basically an innovative medical treatment that lowers a person’s body temperature to reduce the risk of tissue damage when there isn’t enough blood flow to a part of the body because of a clogged artery. Despite it’s simplicity, it’s a relatively new procedure. You might be surprised to know that many medical centers don’t routinely use therapeutic hypothermia to treat cardiac or stroke patients. But, Arizona has been leading the way as usual. There’s been some national attention on the Arizona program recently, in addition to the Vision Award. More and more states are urging their emergency departments to implement the simple measures. It’s cheap too… 99% of the total cost for cardiac arrest patients who are cooled is incurred by care delivered after re-warming the patient, such as inserting a defibrillator or rehabilitation.

Nourishing Arizona’s “Food Deserts”

Will Humble — Wed, 08 Sep 2010 08:59:30 +0000

One of the ways ADHS can help eliminate Arizona’s food deserts is to try to get our vendors (the businesses that accept WIC coupons) to broaden their food inventories with healthier foods. The ADHS Program Integrity Team works to get this done. The Team actively reaches out to the vendor communities (grocery stores and other food retailers) to conduct technical assistance visits called Vendor Site Reviews. A few months ago, our Product Integrity Teams began encouraging (and compelling) vendors to stock new (healthier) foods including fresh fruits and vegetables, brown rice, canned salmon, and whole wheat breads, which we call Minimum Stock Requirements. So far, our teams have reached more than 550 vendors. At the beginning of the initiative, about 35% of our WIC vendors weren’t carrying the right kinds of healthy foods. As of a couple of months ago, 92% of the vendors are carrying the right blend of healthy foods. The project has been a success for the Arizona WIC Program and clearly demonstrates the impact of policy changes and the success of providing training and support to our partners. But, we need to do more. The Supplemental Nutrition Assistance Program (formerly called food stamps) program is a much bigger leverage point that our much smaller WIC program. One of the things that we will be pushing for when the Farm Bill comes up for federal re-authorization in 2013 is to include nutritious food inventory criteria for SNAP vendors to meet in order to qualify as a SNAP vendor. By hitting this leverage point, we should be able to make significant progress toward nourishing food deserts in Arizona, as well as the whole country. Why is SNAP a good leverage point for changing vendor behavior? Because the federal government provides more than $50B in SNAP benefits to families every year. For a point of reference- the total 2006 value of all food shipments in the US was roughly $538B- meaning that the SNAP program represents a sizable percentage of the US food basket. That’s called leverage.

Behavioral Health Medicine Transition Update

Will Humble — Thu, 09 Sep 2010 08:58:43 +0000

As you recall, the ADHS budget reduction last fiscal year required us to scale back the services we provide to folks who were receiving behavioral health services but don’t qualify for AHCCCS (called Non-Title XIX). We also needed to switch to a “generic formulary” for Non-Title XIX folks on July 1 (which saves about $7M/year). We had initially intended to implement the generic formulary on July 1, 2010, but as that date approached, it became clear that some individuals needed more time to ensure that patients could be safely transitioned, so we modified our guidance document to allow the transition of remaining members by October 1, 2010. We also added one name brand medication called Risperidal Consta, a long-acting injectable antipsychotic medication, to the formulary. There are numerous class equivalent antipsychotic medications still on the formulary to choose from as an alternative to the remaining name brand med’s, including long-acting injectables like Haldol Decanoate and Prolixin Decanoate. (As an aside, our TXIX formulary is among the most robust in the nation). We’ve also asked our Regional Behavioral Health Authorities (RBHA) & Providers to have their doctors and patients apply for the pharmaceutical Patient Assistance Program if they or their patient believe a brand name med that has no substitute and is not on the formulary. We developed tips for accessing brand name meds to help streamline the process. We have been getting feedback that many individuals have been successful getting on Patient Assistance Programs. If the patient doesn’t qualify for a pharmacy Patient Assistance Program (usually because of income), we’ve asked the RBHAs to make sure the patient knows about the new Pre-existing Condition Insurance Plan, which they may be able to afford. We also encourage the RBHAs to help patients apply for a medication discount card so they can get medicine at a reduced rate. Also, doctors may be able to obtain samples from the pharmaceutical company and provide those to patients at their discretion. We’ve been conservative in our financial modeling and projections to make sure we avoid the need to cap enrollment and wait list new members later in the fiscal year. We’ll continue to carefully examine our Non-Title XIX expenses as the first quarter progresses. We’d like to expand the formulary to include additional name brand meds if we can later in the fiscal year, but our top priority is to make sure we avoid an enrollment cap toward the end of the fiscal year.

Arizona Breaking Through the National Smoking Trend

Will Humble — Fri, 10 Sep 2010 11:19:40 +0000

A new report from the CDC this week showed that the smoking rate across the US has stayed flat at about 20% over the last 5 years. Not so in Arizona, where we’ve decreased from 20% in 2005 to 16% in 2009, according to our latest BRFS report. As is the case across the country, the folks in Arizona that make the least amount of money are the most likely to smoke, which is why we’ve focused our tobacco prevention and cessation (quitting) efforts on that demographic- with aggressive targeted marketing, quitline services (including quit coaches) and by paying AHCCCS (using our voter-protected tobacco control funds) to cover medicine to help people succeed. We also think that our youth prevention campaign and the implementation of the Smoke Free Arizona Act in 2007 are factors that have helped us buck the national trend.

Behavioral Health Services in SE Arizona

Will Humble — Mon, 13 Sep 2010 12:41:35 +0000

Folks that receive publicly-funded behavioral health services in Cochise, Santa Cruz, Greenlee and Graham Counties will soon transition to a new Regional Behavioral Health Authority (RBHA). In March, ADHS awarded contracts for all of the areas outside of Maricopa County. We awarded the contract for Cochise, Santa Cruz, Greenlee and Graham Counties to Cenpatico Behavioral Health of Arizona (Cenpatico) but Community Partnership of Southern Arizona (CPSA) challenged our decision, which suspended the transition. That challenge has now been resolved and beginning December 1, 2010, Cenpatico will operate as the RBHA for these counties; currently there are approximately 5,300 adults and children receiving publicly-funded behavioral health services in these counties. A special thanks go out to our Procurement team and all of the folks who were involved in the review and evaluation process. The procurement process is rigorous and demanding, and our team did a very good job crossing the t’s and dotting the i’s to make sure that the whole process was done by the book.

AHCCCS Acute Care Enrollee’s to be Automatically Enrolled in RBHAs

Will Humble — Tue, 14 Sep 2010 09:15:03 +0000

Beginning October 1, Arizona Health Care Cost Containment System will automatically enroll all Acute Care members into their local Regional Behavioral Health Authority (RBHA) or Tribal RBHA (T/RBHA). The plan eliminates the need for a separate administrative enrollment with the T/RBHA (and the associated paperwork) and streamlines the delivery of services, better integrate physical & behavioral health care. The T/RBHAs will also assume financial responsibility for behavioral health services immediately upon enrollment with AHCCCS, including: 1) any behavioral health services provided during the allowable time period after the application for AHCCCS has been submitted and the individual is actually enrolled with AHCCS (called Prior Period Coverage); and 2) the first 72 hours of inpatient emergency behavioral health services. Acute Care AHCCCS contractors will continue to be responsible for all emergency medical services including triage, physician assessment and diagnostic tests.

“Health Tourism”

Will Humble — Wed, 15 Sep 2010 15:44:56 +0000

I attended the “First Forum of Health and Retirement Tourism” at the beginning of September in Alamos, Sonora. The meeting was part of a Sonora’s health tourism initiative that’s focused on improving the retirement infrastructure, providing more opportunities for “Baby Boomers” to retire in Sonora. They also have a goal of building an infrastructure for Assisted Living so that folks who need some help with some daily living tasks could have options in places like San Carlos, Penasco, Alamos and other Sonora locations. I presented information about our quality assurance programs (e.g. our licensing system for assisted living) to help the Secretaria de Salud (Dr. Bernardo Campillo, the person in my job in Sonora) develop a quality assurance program. You can see a (Spanish) write-up on the Sonora Health Secretary’s website at: Sonora Health Secretary’s website. The assisted living industry in Arizona brings in more than $1B in revenue every year and with the number of retirees expected to continue to increase in the coming years, the folks in Sonora recognize that there’s an opportunity to tap into some of the retirement market.

AIDS Drug Assistance Program (ADAP) News

Will Humble — Thu, 16 Sep 2010 11:29:05 +0000

Our AIDS Drug Assistance Program (ADAP) uses about $10M of federal funds to provide medicine to treat HIV and prevent related infections to low-income folks with HIV who have limited or no coverage from private insurance, AHCCCS or Medicare. Applicants for the program need to show that their annual income is less than 300% of federal poverty level and be screened for AHCCCS eligibility in order to ensure that ADAP is the “payer of last resort” (which means all applicants must have AHCCCS denial letters). Our program currently serves about 1,000 clients statewide each month. ADAP has had a large increase in client enrollment during 2010 because of job losses in this difficult economy, putting a financial strain on the program’s budget. In the last year, we’ve implemented cost-reducing measures like limiting the medicine formulary and instituting drug rebate agreements which have saved $2 million/year (about 20%). However, these savings aren’t enough to stay solvent at the current pace. We’ve been seriously considering starting a waiting list for new applicants, but we have been able to avoid implementing the waiting list so far because of some funds promised from the Maricopa County Ryan White program. If we had implemented a waiting list last month, it would have been “prioritized” meaning that if someone has a really low cell mediated immunity or is pregnant, they'd be enrolled and wouldn't have been put on the wait list. Folks already enrolled would have stayed on the program, but as clients drop off the program we would have filled their slot with someone from the list. As I mentioned, we've avoided going to a wait list for the moment but we'll need to keep a close eye on the budget to make sure we stay okay. Further information and updates are available at our ADAP Website.

Crash Deaths Down in Arizona & Across the US

Will Humble — Mon, 20 Sep 2010 11:55:10 +0000

In Arizona, we’ve been able to decrease the rate of deaths from car, truck and motorcycle crashes by 43% in the last 4 years, from about 19 deaths per 100,000 in 2005 to 11 per 100,000 Arizonans in 2009. While this is good progress, we still have a long way to go. Crashes are still the leading cause of death for people between 3 and 34, and 710 Arizonans died from vehicle crashes in 2009. This is a dramatic decrease from 2005 when 1,128 Arizonans died in crashes. Rates are highest among males, American Indians, people aged 20 through 24 years, and residents of our rural counties. How have we made this progress? Between 2005 and 2009 Arizona improved roadways, implemented a graduated drivers license for people under 18, and strengthened our DUI laws and enforcement. More cities are decreasing red light running by various methods including red-light cameras. Also, our fleet of cars gets safer each year as older vehicles break down and get discarded. Still, there’s a lot of work to be done: seatbelt and child safety seat usage use is only at 80% and speeding and distracted driving remain a problem. The national trends are going in the right direction as well. National highway deaths fell to 33,808 in 2009 which is the lowest number since 1950 (the number of deaths per mile driven is 7 times lower than it was in 1950). Nationally, alcohol impaired driving fatalities declined by 7.4% in 2009 compared to 2008. You can read more about this Winnable Battle on the CDC’s website. You can also visit our injury prevention website and look at the response end of traumatic injury on our trauma site where you’ll find Arizona specific reports.

Spotlight: Newborn Screening

Will Humble — Tue, 21 Sep 2010 11:42:26 +0000

Last year Arizona welcomed about 98,000 newborns to our world. Our Newborn Screening Program (in the State Laboratory) ensures that each newborn is tested for 28 inherited disorders and hearing problems. The goal is to help kids avoid illness, developmental delays and even death. Teamwork, communication and coordination are to critical in making this program effective, thus benefiting both newborns and their families. A quick look at the numbers reveals how monumental this screening task really is. On any given day our newborn screening team receives and tests from 600 to 1,500 bloodspot samples for each of the 28 disorders. Our demographics team verifies the results and confirms all of the data associated with each sample as well as ensuring that lab results are sent out to the health care provider. Our case management team follows up on about 140 potentially positive results (including hearing) each week, coordinates the confirmation test and works with pediatricians, clinical specialists and families. The end result? Because of the dedication and commitment of each member of the Team, hundreds of families are afforded the opportunity for their newborn to receive the early treatment, intervention and support services that will allow them to lead normal lives. Of course, none of this would be possible without the gasoline that runs the engine, the billing department brings in the dough that keeps this effective machine helping families every day. Well done.

ADHS Aces the 2010 Strategic National Stockpile Test

Will Humble — Tue, 21 Sep 2010 16:17:07 +0000

The Strategic National Stockpile is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items which are stored in a few locations around the country. The stockpile is designed to supplement public health agencies in case there’s a national emergency anywhere and at anytime within the U.S. or its territories. At the beginning of the H1N1 pandemic, Arizona received and distributed hundreds of thousands of treatment courses of antiviral medication and other hospital supplies. We turned around our supplies and shipped everything to their final destinations at the local health departments within 36 hours. Each year the CDC comes out to “grade” our readiness by reviewing our plans, exercises, our execution during actual events (e.g. H1N1) and our after action reports. This week, our project officer gave us a final grade of A+ or 97%. Well done Preparedness Team. The reviewer gave us glowing commendations for factors including leadership support, effective coordination and collaboration with the state/local/private sectors (Scott Voss & Kaitlin Henslee), and development and implementation of a multi-year Training and Exercise Plan (Andrew Lawless). We already knew we were ready because we smoked the H1N1 stockpile distribution, but it’s nice to know that we’re still in crackerjack shape.

Licensing Customer Service

Will Humble — Wed, 22 Sep 2010 08:19:56 +0000

Our Office of Assisted Living Licensure has developed several classes to help assisted living providers to better follow our quality assurance rules for assisted living facilities. Over the past year, surveyors have presented monthly classes on Medication Rules and a refresher class on the Administration of Medications for caregivers and managers. A new presentation on the rules for Service Plans is being offered this month, and will soon be joined by classes on how to complete a Plan of Correction and suggestions for providing activities. The classes are being developed so that they are suitable for placement on the ADHS website for public access. Once all of the classes have been developed, they'll be developing an award for completion of all 4 classes. Those involved in the production of these classes include Ellie Strang, Pat Greenquist, Rosey Diaz, Lori Schrock, Jim Tiffany, Zakiya Torkwase and Larry Martens. Thanks.

ADHS Scores Electronic Medical Records Grant

Will Humble — Thu, 23 Sep 2010 12:12:33 +0000

ADHS just scored a $1.3M grant for “enhancing the interoperability of electronic health records and immunization information systems”. This grant allows us to accelerate work with public and private health care provider offices and Electronic Health Record vendors to develop interfaces for the automated vaccination data to the Arizona State Immunization Information System (ASIIS). These electronic interfaces will minimize data entry and allow seamless, timely and efficient reporting of immunization data for our partners. Thanks to Patty Gast, Lisa Rassmussen, Madan Gopal, and Raghu Ramaswamy for their efforts in preparing this successful grant application. Well done.

Buggy Infant Formula

Will Humble — Thu, 23 Sep 2010 15:34:51 +0000

Certain “Similac®” powdered baby formulas were recalled this week by the manufacturer (Abbott Labs) because they discovered there were bugs (beetles) in the formula from one of their manufacturing plants. According to the FDA (who regulates foods including formula), the formula that contains beetles doesn’t pose an immediate health risk but babies that drink it could get stomach aches and stop eating because the insect parts could irritate their stomach & intestines. The recall includes Similac® powder in plastic containers and in 8-ounce, 12.4-ounce and 12.9-ounce cans. The bugs are really small so you can’t go by looks, so parents need to visit www.similac.com/recall and type in their lot number to see if they have recalled formula powder. (The lot number is printed on the bottom of the cans.) There shouldn’t be any recalled product left on store shelves by now, but some people probably have some in their pantries. We notified our WIC providers so they can reach out to our WIC families, but the recall covers less than 2% of the eligible formulas that our program provides. Meanwhile, our partners at the county health department (Sanitarians) do checks at stores to make sure that the formula actually makes it off the shelves.

AZ Smokes CDC's Preparedness Report Card

Will Humble — Fri, 24 Sep 2010 08:20:59 +0000

Arizona got a great public health preparedness report card from the CDC this week, getting a solid A by scoring 30/32. The report (Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State) examines each state’s readiness using 32 criteria designed to drive states toward demonstrating results, measuring their program improvements and increasing accountability. Examples of the criteria used to assess state’s performance include:

Laboratory proficiency testing performance measure data;
Performance measures during exercises, drills, and real incidents, activation of emergency operations centers, and after action report assessments; and
Readiness for executing strategic national stockpile assets.

Each state has a fact sheet that shows jurisdiction scores, allowing folks to compare readiness in our sister states and helping us to adopt best practices from each other. Our success on this year’s report is a testament to solid collaboration with our counties and hospitals as well as a rock-solid teamwork among our staff. Right on.

Are Medical Marijuana Cards a Vital Record?

Will Humble — Fri, 24 Sep 2010 12:36:45 +0000

Maybe. I’ve read the Arizona Medical Marijuana Act several times with an eye toward how we’d execute it’s requirements in case it passes. One of the key decisions is figuring our which of our areas is in the best position to get the job done. I think the best place is Vital Records- at least for issuing the cards. Why? Because their business operations, work flow, verification policies, and their cash management systems most closely match the business requirements in 203 for processing medical marijuana cards. They’ve also demonstrated that they can handle high volume and more than a dozen different kinds of vital records. For example, they sold 93,662 birth certificates and 13,867 death certificates last fiscal year, all while ensuring that each sale met very specific criteria. All of which will be critical when issuing medical marijuana cards given that fact that we could be issuing 100,000 cards/year by 2013. Vital Records would most likely be issuing the cards (if it passes), but our IT , Rules, and Procurement Teams (with help from our Attorney General team) will be absolutely critical in order to hit the ground running. We’d only have 120 days to get the program going, which means that we’ll need rock-solid rules (Administrative Code) and a completely functioning (and paperless) IT system on day one in order to manage the workflow by the end of March. If Prop 203 passes, the only way we could possibly handle the workload is to make the application process completely electronic from beginning to end. If we do it right, we may be able to do it almost all on-line and without window service. P.S. I haven’t figured out who’s in the best position to regulate the dispensaries yet, but Environmental Health’s in the lead.

September is National Preparedness Month

Will Humble — Mon, 27 Sep 2010 08:21:52 +0000

September is national preparedness month, which is dedicated to encourage individual preparation for the full range of hazards including natural disasters, cyber attacks, pandemic disease and acts of terrorism. Hurricane Katrina taught us that we have to be independently prepared and not expect government resources to be able to rapidly respond in the initial stages of an emergency. The www.ready.gov site has information that any family can use to insure they are fully prepared should it become necessary to leave their home on short notice or "hunker down" for a period of time. The site has specific instructions for more than a dozen types of catastrophes. Follow just three steps to prepare your family:

Get a Kit
Make a Plan
Be informed

The checklists available on this site guide you through the details of how you can keep your family, critical financial information, pets and beloved keepsakes safe. Of special importance is the Emergency Financial First Aid Kit which tells you exactly what information and copies of documents you should keep in a waterproof folder ready to take at a moment’s notice. Discount stores (like Costco) now have readiness kits in a five gallon bucket that contain hand crank radio, first aid kit, water filtration system, emergency blanket sand much more for under $150. Cheap, easy to store kits with a long shelf life now make it easy to “grab and go” if the need ever arises. Preparation takes a little time, but can reap huge benefits in peace of mind and, if ever needed, may keep an emergency from becoming a tragedy for your family. Our own ADHS Emergency Preparedness Bureau can give you more information and each county has a Citizen Corps contact where you can volunteer to assist with emergency education and preparedness in your community. You can also volunteer as a health professional.

Behavioral Health Services in SE Arizona

Will Humble — Mon, 27 Sep 2010 12:43:16 +0000

Folks that receive publicly-funded behavioral health services in Cochise, Santa Cruz, Greenlee and Graham Counties will soon transition to a new Regional Behavioral Health Authority (RBHA). In March, ADHS awarded contracts for all of the areas outside of Maricopa County. We awarded the contract for Cochise, Santa Cruz, Greenlee and Graham Counties to Cenpatico Behavioral Health of Arizona (Cenpatico) but Community Partnership of Southern Arizona (CPSA) challenged our decision, suspending the transition. That challenge has now been resolved and beginning December 1, 2010, Cenpatico will operate as the RBHA for these counties. There are approximately 5,300 adults and children receiving publicly-funded behavioral health services in these counties. A special thanks go out to our Procurement Team and all of the folks that were involved in the review and evaluation process. The procurement process is rigorous and demanding, and our team did a very good job crossing the t’s and dotting the i’s to make sure that the whole process was done by the book.

Another New AZ Health Status & Vital Statistics Report

Will Humble — Tue, 28 Sep 2010 07:59:13 +0000

We published one of our most popular annual documents this month, our 500-page Arizona Health Status and Vital Statistics Annual Report. It provides refined health statistics on pregnancies, births, reportable diseases, deaths, inpatient hospitalizations, emergency room visits, marriages, divorces and population of the State. The site got more than 2,000,000 hits last year! The report provides needed data for health policy formulation, local, state, and federal programs and interventions, and resource allocation. All universities in the State utilize our Arizona-specific health status reports in classroom teaching. In addition, we’ve prepared and published 17 (grant-funded) health status monitoring monographs on public health issues of special concern in the State such as mortality from exposure to excessive heat, community vital statistics, emergency room visit and inpatient hospitalization patterns, asthma, diabetes, alcohol & substance abuse, influenza and pneumonia, injury and behavioral health disorders. In the coming year, we’ll add a report called “Heart Disease v. Cancer: An Epidemiologic Transition in Mortality Risks”, which will highlight the fact that cancer has replaced heart disease as the leading cause of death in Arizona. OK, but who is doing this work? Believe it or not, we do all this with just 2 Full Time Employees (Christopher Mrela and Clare Torres). But that’s not all they do… they also maintain and develop the popular website, systematically updating approximately 40 online reports, collect monthly marriage and divorce statistics from the Clerk of the Superior Court; develop customized annual population estimates; and respond to 2,500 requests annually from concerned individuals and health professionals in need of health status data, data-based information, and technical assistance.

Sleep Deprivation a Factor in Childhood Obesity?

Will Humble — Tue, 28 Sep 2010 12:48:48 +0000

Previous studies have found a link between not getting enough sleep and an increased risk of obesity in adults and new research this month suggests that sleep deprivation could be a powerful factor for obesity in kids as well. A new study in the Archives of Pediatric and Adolescent Medicine found that toddlers that got less than 10 hours of sleep per night were almost twice as likely to become overweight or obese later in life. Kids more than 5 years old didn’t show the same result; naps had little effecton later obesity in either group. It’s not clear exactly why toddlers who don’t get enough sleep have a higher risk of becoming obese later in life, but getting toddlers to bed on time looks like it’s a good idea. By the way, insufficient sleep in adults has been linked to developing diabetes, cardiovascular disease, obesity and depression. Our latest BRFS Survey found that only about 30% of AZ adults consistently get enough sleep. Are you yawning today?

New TB Diagnostic Test on Horizon?

Will Humble — Wed, 29 Sep 2010 08:49:41 +0000

One of the major challenges for global control of tuberculosis is that the current diagnostic tests are very slow and can require significant laboratory infrastructure. The tests are particularly difficult to manage in developing countries and are more complicated for folks with HIV. It’s also difficult to test for drug sensitivity. The challenge is that early detection is essential to interrupt transmission. However, a new rapid (2-3 hour) test may be on the horizon. Researchers published an article in the New England Journal of Medicine this month that demonstrates promising results. The new test (called MTB/RIF) correctly identified more than 98% of patients with “smear-positive tuberculosis” and 72% of patients with “smear-negative tuberculosis”. The test also have very few false positives. Importantly, the new MTB/RIF test correctly identified (97%) of patients that had rifampin-resistant or -sensitive TB. More work will need to be done before the test replaces the current slow and labor intensive tests, but these are encouraging results that could provide a valuable new tool in the global TB fight.

Licensing Stuff

Will Humble — Wed, 29 Sep 2010 14:02:24 +0000

Medical licensing has been busy over the last few months preparing to license Abortion Clinics. Back in 1999, a law was passed (ARS § 36-449.01 36-449.02 36-449.03) that required ADHS to license and inspect abortion providers if they provide 5 or more first-trimester abortions in a month or if they provide any 2nd or 3rd trimester abortions as an abortion clinic. Hospitals were exempted. The 10-year legal battle over how to implement the law ended earlier this year- with an agreement that we’ll begin licensing and inspecting the clinics beginning November 1. The new rules are posted in the Arizona Administrative Register, November 6, 2009 (15 AAR 1822). Our medical licensing team has been busy providing technical assistance trainings which focus on ways to comply with the new licensing requirements, including going over easy to understand checklists, so that we have a smooth transition. In addition, our medical facilities website has been enhanced to provide all the licensing materials and resources to meet this new licensing category. In other news, our Long Term Care team will be conducting an interactive training program on October 14 for folks at the ADES, AHCCCS and the 12 ICFMR (intermediate care facilities for the mentally challenged) facilities in Arizona regarding the Medicare requirements for these kinds of facilities. There are 12 facilities like these in Arizona that require Medicare certification. Our goal for the training is to help get staff up to speed with the changing dynamics and requirements for these kinds of facilities so that they’re all squared away when we get there for our routine surveys. Thanks for being proactive!

2010 HEMMY Awards

Will Humble — Thu, 30 Sep 2010 17:05:22 +0000

Congratulations to Dallas Teat from IT and our vector control team (including Elisabeth Lawaczeck who moved to Colorado) on the 2010 Arizona Public Health Association’s HEMMY (Health Education Media Makers Yearly) Award for Bats at Schools: Prevention of Rabies. The video won in the Grassroots category and focuses on educating children and school staff about the danger of rabid bats. More congratulations go to Toni Means and Veronica Vaughn for taking 1^st, 2^nd and 3^rd places in the professional category. Toni’s work on the Live It, Change It campaign took top honors, while Veronica’s efforts for Go Low, 1% Milk and 2010 Grow a Healthy Child rounded out the rest of the top 3. HEMMY 2010 Awards were given for health education or patient education material produced in Arizona by Arizona residents during August 2008 and August 2009.

Children’s Rehabilitative Services Transferring to AHCCCS January 1

Will Humble — Fri, 01 Oct 2010 08:30:09 +0000

AHCCCS will take over the administrative oversight (and the statutory responsibilities) of the Children’s Rehabilitative Services (CRS) program on January 1. The CRS program (which began in the 1920s as the Crippled Children's Program) provides medical care and support services to kids who have certain chronic or disabling conditions. This administrative change won’t impact the kids that we serve or their families, in fact they won’t really even notice any changes. For the past several years both the ADHS and AHCCCS have been involved in overseeing the CRS program including the contract with Arizona Physicians IPA-Children's Rehabilitative Services or APIPA (who manages the CRS program). All of us in state government have been looking for ways to streamline and simplify how we manage our programs these days, and we’ve (ADHS & AHCCCS) decided to move all of the oversight for the program to one agency (AHCCCS) in order to simplify the administrative structure and workflow. As I mentioned, families and doctors will experience a seamless transition, and the same providers will continue to provide exactly the same services through the same clinics as today. In fact, most folks won’t even notice that this is happening. Although the ADHS won’t oversee the APIPA’s contract after 1/1/11, our Office for Children with Special Healthcare Needs will continue to be available to support families with information and resources and will continue to provide the same Title V services that we provide today. This transition has nothing to do with the performance of our program; it’s really a decision we’re making to simplify administration and oversight of the program. In fact, we’re proud of the many accomplishments that our program has achieved over the past several years. Our dedicated team of professionals has increased contract compliance from 49% in 2006 to 95% in 2009. We’ve also maintained high levels of family satisfaction (averaging 9 on a 10 point scale for overall healthcare) while reducing administrative costs by 30%. We’ve also found creative ways to improve performance in CRS and leverage Title V resources on behalf of all children with special health care needs throughout the state and completed a new needs assessment that takes a fresh look at statewide resources. In short, we’ve done a dynamite job. We still need to work out a number of details and I’ll be able to let you know about those in a few weeks.

Fresh Childcare Center Rules Go Live

Will Humble — Mon, 04 Oct 2010 08:44:26 +0000

The new child care center standards went into effect last week. Check out our newly revamped child care licensing website, which has the latest for parents, consumers, childcare operators and others. Our Licensing, rules, and all the other ADHS experts who contributed to the new rules and did a fantastic job. Our success was directly tied to the open and inclusive process that brought to the table the expertise of our internal staff, our partners and the public. These changes will go far to ensure a healthy and safe environment for our kids. Our childcare licensing folks have been busy providing training events throughout the state so that providers are up to speed on all the changes by October 1^st. Operators can also find our new licensing checklist on the new website. Several of the new changes will support and reinforce our Empower Pack guidelines. The new rules for childcare centers will reinforce: 1) “tummy time” each day for infants; 2) lessons plans each week that include opportunities for each child to participate in structured large muscle physical activity; 3) policies and procedures for limiting TV watching & computer use; 4) limits on the amount of screen time including documenting the screen time in minutes when it is included in the lesson plan; and 5) serving 1% or skim milk for older kids; and 6) limiting fruit juice to 100% juice (120 ml/day for children younger than 6 and 180 ml/day for older kids). After the first of the year, the Empower program will be celebrating its first anniversary and we’ll be putting together the 1^st performance evaluation report. Right after that, we’ll take another look at the guidelines and have some discussions around the need to update them based on the evaluation results, partner input and the rules changes. Again, thank you for all your effort this year. Not only have we have had a wonderful time working more closely with each other, the children of Arizona are getting a healthy start in life thanks to our work. You make a difference every day.

Coming Soon: A Marijuana Dispensary Near You?

Will Humble — Wed, 06 Oct 2010 11:41:49 +0000

Will a marijuana dispensary pop up in your neighborhood at the old payday loan store? It depends. If the Arizona Medical Marijuana Act passes, there could be up to 120 dispensaries (and their indoor cultivation facilities) setting up shop across the state. Where they actually go will depend on what kind of local zoning restrictions exist at the time the application comes in to us. The Initiative just says the dispensaries can’t be located within 500 feet of existing schools (a little more than from the backstop to center field), but that local jurisdictions can “enact reasonable zoning restrictions that limit the use of land for… dispensaries”. Here’s the rub. Since legal marijuana dispensaries (or cultivation facilities) don’t currently exist, cities, towns and counties don’t have any zoning restrictions in place right now. With the turn-key date of the Initiative only 120 days after the election is certified, cities, towns and counties will need to get on the stick right now in order to have something in place before we get our first dispensary application (assuming 203 passes of course). The way I read the Initiative, if jurisdictions don’t have a restriction in place at the time the application is filed, we’d have no choice but to approve the location as long as it’s 500 feet away from existing schools. It could even be right next to a church, playground, or whatever. I’ve been reaching out to the League of Cities & Towns so that they can help towns get ready, and I’ve talked to some county folks as well. I’m basically trying to make sure they get ready with zoning restrictions now, so cities etc. don’t get mad at me when we approve a marijuana dispensary license next door to playground or something, because they didn’t have a zoning restriction in place when we got the application.

More support for nutrition in the food stamp program

Will Humble — Thu, 07 Oct 2010 10:01:02 +0000

NYC is climbing on the SNAP better nutrition train today; it is asking the feds to forbid people from buying sugary drinks with food stamps. This should sound pretty familiar to my blog readers. I’ve been banging on this drum for months – we need to add nutritional standards to the criteria for folks who benefit from the nutritional package. After all, it is called Supplemental NUTRITION Assistance Program. In March when I was in DC, I talked to AZ Congressional staff about adding it to the language when they review the farm bill that authorizes SNAP. I also got to talk to folks at USDA about the impact of obesity on public health. Childhood obesity is one of the CDCs 5 Winnable Battles and one that has a great impact on the future health of our state. Changing what can be bought by people with SNAP money could greatly impact the rate of obesity for kids and adults in this country. There are two ways to do it – the government could prohibit the purchase of specific products or there could be an industry panel to establish SNAP recommended products with higher nutritional standards. If parents were able to tell their kids they can’t buy certain products because it doesn’t have a special stamp or logo, they could give their kids better food and not be the bad person – parents can blame the government. The feds could also do it by what they require the stores who accept SNAP money to carry. It already does that with the Women, Infants and Children (WIC) program. Because of the change in the WIC food package last year, more convenience stores have fresh fruits and vegetables in Arizona.

ADHS Rocks Resuscitation World (Again)

Will Humble — Fri, 08 Oct 2010 11:21:48 +0000

We were part of a landmark journal article in JAMA this week that will most likely change the way CPR is done in the US and maybe worldwide. Our ADHS EMS team partnered with the UA, municipal fire departments & hospitals across the state to accurately track bystander CPR and survival rates from cardiac arrest and look at outcomes. The article is in the Oct. 6 issue of the Journal of the American Medical Association concludes that when bystanders used the new chest-compression-only CPR, patients had a much better chance of living when compared to folks that were given the old fashioned CPR (the kind with chest compressions interrupted by mouth-to-mouth). Our study found that about 5% of people that had an out of hospital cardiac arrest lived if no bystanders helped with CPR, about 8% lived when a bystander did conventional CPR (with rescue breaths), and more than 13% lived if they got the new chest-compression-only CPR from a bystander. More people are more willing to help by giving CPR these days too. In 2005 only 28% of people got bystander help compared with 40% in 2009. The rate of chest-compression-only CPR rose from 20% in 2005 to 76% in 2009! Not only is the new CPR more effective- but more people are willing to do it because it’s not as confusing and because people don’t need to do the mouth-to-mouth part. Our team has published previous studies showing that a lot more people live when EMTs use the chest compression only method, but this is the first major study that has found similar results for bystanders. You can learn chest-compression-only CPR by viewing a six-minute instructional video produced by the UA Sarver Heart Center.

Home Visiting Needs Assessment

Will Humble — Tue, 12 Oct 2010 09:00:17 +0000

Recent research on brain development has found long-term benefits for families when they receive home visits during pregnancy and after the birth of a child. Benefits include enhanced child health and development, reduced child abuse and neglect, early identification and treatment of developmental delays and health issues, improved pregnancy outcomes, improved self-sufficiency of the family, improved school readiness and better parenting. It’s no wonder that grant funding under the new healthcare reform law provides $1.5B over the next five years to support evidence-based home visiting programs. Arizona is expected to receive $1.8M in FY 2010. Our ADHS team led an interagency group that included ADES, the Department of Education, First Things First, Inter-Tribal Council of Arizona and ADHS Behavioral Health in submitting Arizona’s application for these funds. As part of the grant requirements, we just finished our AZ Home Visiting Needs Assessment, which evaluates and ranks Arizona communities based on risk factors identified in the grant and by the inter-agency team. Thirty-one communities in AZ were identified to be at the highest level of maternal, infant and social risk. While Arizona currently has many home visiting programs, this funding will support better coordination and we’ll be able to implement new evidence based programs in communities with the highest need. The next great hurdle for the team will be matching the evidence based home visiting models to the needs of the highest risk communities. Congratulations to the Home Visiting team on developing such an objective way of ranking community need in Arizona and on the submission of such an excellent Home Visiting needs assessment.

New Housing and Chronic Disease Prevention Grants

Will Humble — Wed, 13 Oct 2010 08:46:36 +0000

Our Behavioral Health Division picked up a cool $2M (federal) grant from the AZ Department of Housing last month. This $2M plus the $2M we received several months ago, now equals $4M that we’ll be able to use in our bridge subsidy voucher program. Just like in sales, the cornerstone for making public health progress is to sharpen your focus on your target market. That’s just what our Arizona Health Disparities Center will be doing when they execute our new $500K grant to reduce diabetes, cardiovascular disease and other conditions among targeted populations in Arizona. The grant will allow us to identify and address policy, systems, and/or environmental changes and then use a community driven process and applying comprehensive, evidenced-based approaches to achieve health equity improvement. We’ll develop and implement a community action plan; provide trainings to strengthen and build capacity; build partnerships with policymakers; and assist in the development of linguistically and culturally appropriate programs and materials. The same shop also got a Minority Health State Partnership Improvement Grant. This grant $140K/year for 3 years will support the development of a health equity strategic plan; assist targeted high-risk populations to implement policy, system, and environmental change strategies; and to improve the availability of socio-economic and health data on racial and ethnic minority populations in Arizona.

Cimex lectularius & You (aka Bed Bugs & You)

Will Humble — Thu, 14 Oct 2010 11:09:55 +0000

Bed bugs (Cimex lectularius) haven’t really been a problem in AZ for the last few decades. Sure, we’ve had reports of bed bug infestations, but they’ve mostly been limited to areas around the Grand Canyon where lots of international travelers come and go toting their sleeping bags. After all, bed bugs are basically hitch-hikers, so it makes sense that they’d be where there are a lot of bedrolls coming and going. For whatever reason (probably a combination of lots of things), it’s gotten a lot worse lately- statewide. Luckily, bed bugs don’t transmit disease, although they can be a public health issue because of the physical and mental health problems (e.g. anxiety) they can cause. Bed bugs are basically blood-sucking parasites similar to head lice. They feed on human blood. Like I said, they don’t transmit disease, but some people can have an allergic reaction to the bites. Plus if people itch the bites with dirty fingernails, they can get infected with things like Staph. The bottom line is that they’re gross and nobody wants them around. In your home, the key is prevention. The most important thing to remember is that they’re hitch-hikers, so preventing them from getting in your house in the first place is important. For example, if your kids have sleepovers, discourage guests from bringing their own bedrolls, provide the sheets yourself. Cimex are experts at hiding… in places like in the seams of mattresses, stuffed animals and under any clutter or objects around a bed. They’ve got small flat bodies allow them to fit into real small spaces and can stay there for a long time even without a blood meal. They can travel over 30 meters in one night, but they tend to live within a meter or so of where people sleep. They molt their “skin” (exoskeleton) occasionally, so one way to tell if you have a problem is if you find their “shell” around beds. Think prevention, because once they get in your house it's a real challenge to get rid of them. Controlling them in multi-family homes is more challenging because bed bugs frequently travel between units. Integrated Pest Management is the most effective way to prevent and get rid of infestations. It’s an approach that focuses on prevention, observation and intervention. It’s an ecological approach that significantly reduces the use of pesticides while at the same time managing pest populations at an acceptable level. The CDC & EPA have a helpful fact sheet that explains more.

Cannabis Cultivation- Post Prop. 203

Will Humble — Fri, 15 Oct 2010 09:25:03 +0000

Where would the inventory come from if Proposition 203 (the Arizona Medical Marijuana Act) passes? As near as I can tell… it could come from at least 3 places:

enclosed cultivation facilities associated with dispensaries;
enclosed cultivation facilities operated by caregivers on behalf of cardholders, if the people they care for live 25 miles from the nearest dispensary; or
in enclosed locations at cardholders houses if they live more than 25 miles from the nearest dispensary.

I think the intent is for all the inventory to come from these 3 places and not the “street”, but the Initiative doesn’t explicitly say that it can’t come from outside sources (e.g. the “street”). We’d definitely need to nail that part down in our Rule if this passes and if we have the authority. Dispensaries that apply for and receive a license from the ADHS would be authorized to cultivate marijuana plants in …“an enclosed locked facility at a physical address provided to the department during the registration process”. Only registered dispensary agents would be allowed access. The grow rooms could be a closet, room or greenhouse that have locks or other security that we approve. Interestingly, enclosed may not necessarily mean “indoors”, it could just be inaccessible (possibly 4 tall walls exposed to the sky). Cardholders that live more than about 25 miles from the nearest dispensary would be able to grow at an enclosed location at their own house if they have the right kind of security, however they’d only be able to grow 12 Cannabis plants at any given time. Caregivers could also grow at their house or another closed locked facility if the people that they care for live more than 25 miles from the nearest dispensary. Since caregivers are limited to 5 patients, they are presumably limited to growing 60 plants at any given time, although I can’t find that limit explicitly stated in the Initiative. I think caregivers might actually be able to grow 72 plants at a time indoors if they’re a cardholder themselves and also care for 5 other people. P.S. Some of the information above might be influenced by local zoning restrictions that could come later.

Hospital Potpourri

Will Humble — Mon, 18 Oct 2010 11:54:12 +0000

The State Hospital folks have been very generous with their clothing donations to ICM as part of our SECC campaign. In one week our Hospital folks donated a completely full pickup load of clothes etc. that went to ICM for distribution to needy folks. Awesome job- thanks. I also had an opportunity to do a walk through of the new Forensic Unit this week and it was really exciting to see the progress. Enough of the new facility is complete to get a feel for how it will look and it’s impressive. The highlight for me is that it’s laid out so that there isn’t any visible fencing. The ADHS design team used a concept that incorporates the building itself as the perimeter rather than relying on fencing to create the barrier. It leads to a much more welcoming and therapeutic environment for our patients and staff. The interior will have a large courtyard with shade that incorporates exercise and therapy areas, including room for a community garden for fresh vegetables. The day rooms will have large windows that look toward the courtyard, which has a real campus feel. The layout of the nursing stations is terrific because it allows for full visibility to all residential wings from the same spot. It’s one thing to see all these things on a blueprint, but it’s quite another to see it in person. It’s clear that our team did a great job working with the architects to create a unique and healthy feel. The entire project is on track for completion on time in October 2011. Nice work! I also had a chance to go over all of the completed security infrastructure improvements at the ACPTC. We now have a state of the art security control room that monitors numerous cameras, the new “shaker fence” monitoring system, the repaired electromagnetic perimeter units, and of course the miles of new razor wire and the pony fences. The security improvements have been a several months-long project that we completed as a result of our security assessment in collaboration with the Department of Corrections after a detainee escaped from the facility last October. It sure feels good to know that these new security features are now in place.

Teen Pregnancy Interventions

Will Humble — Tue, 19 Oct 2010 12:38:55 +0000

Preventing teen pregnancies could save Arizona more than $180M/year. Teen mothers face higher rates of preterm birth, and their kids have higher rates of low birth weight and infant death. Compared to women who delay childbearing until the age of 20 to 21 years, teenage moms are more likely to drop out of high school and to be and remain single parents. The kids of teenage mothers are more likely to:

have lower grades and proficiency scores at kindergarten entry
have behavior problems and chronic medical conditions
rely more heavily on publicly-provided health care (AHCCCS)
be jailed at some time during adolescence until their early 30s
drop out of high school
give birth as a teenager
be unemployed or underemployed as a young adult.

That’s why CDC picked this as a Winnable Battle. Our Women’s and Children’s Health shop got a grant this fall that will help. We’ll be getting about $1M per year to address teen pregnancy through the new federal Personal Responsibility Education Program. This program will educate adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted infections, using evidence based programs or elements of effective programs. In addition, we’ll get $1M/year in federal Abstinence Education funds for programs that support young people in delaying initiation of sexual activity and promote abstinence from sexual activity. The award of both of these grants will enable Arizona to use multiple approaches that best fit with the needs of targeted high-risk communities. The additional good news for Arizona is that four community organizations also received federal funding in the fight to prevent teen pregnancy, and we use $3M in lottery funds for the cause- which is a total of $8M to prevent teen pregnancy.

Licensing and the Arizona Ambulatory Surgery Center Association

Will Humble — Thu, 21 Oct 2010 10:05:04 +0000

The Licensing Division, Office of Medical Facilities recently presented extensive technical assistance during the Arizona Ambulatory Surgery Center Association Fall Conference this month. Staff from the Licensing Division including Tucson and Phoenix Surveyors as well as Life Safety Code Surveyors and State Architects provided information to about 180 participants. Topics included the state of current regulatory compliance of the state licensed and Medicare certified outpatient surgery centers in Arizona and included the top 10 deficiencies cited, Life Safety Code, AIA Building Codes, Survey and Certification Process, Interactive Table Discussions, Q and A and ended with "Jeopardy" to reinforce the information presented throughout the day. Jeopardy Question: The very first Ambulatory Surgery Center in the country was formed and opened in 1970. Answer: Where is Phoenix Arizona?

Infection Prevention in AZ

Will Humble — Fri, 22 Oct 2010 10:13:03 +0000

Healthcare-associated infections claim more lives in Arizona every year than auto accidents or influenza. Surprised? That’s why the Governor issued a proclamation making this week as Infection Prevention week in Arizona- providing us with an opportunity to call attention to one of the CDC’s Winnable Battles- defeating Healthcare-Associated Infections. We had a news conference (along with hospital partners) this week to talk about our statewide efforts reduce these unnecessary and preventable infections. These infections don’t just claim lives, they’re real expensive too, on my blog in March, I talked about a study in the Annals of Internal Medicine outlining just how expensive these infections are. New numbers from the just released 2009 Vital Statistics report talk about one of these infections called C.diff. In 2009, about 2,500 Arizonans were hospitalized with intestinal inflammation from Clostridium difficile, a bacterial inflammation of the intestines. This disease is of growing public health concern because it is sometimes acquired in hospitals and other health care institutions with long-term patients as residents. In 2009, 161 Arizonans died from intestinal inflammation (enterocolitis) due to Clostridium difficile. Those 65 years or older accounted for about 90% of the deaths. We’ve got to work smart to get rid of healthcare-associated infections, educating both providers and the public. Our Licensing division works with all healthcare and long term care facilities to make sure they use best practices. Some of the most effective interventions are the most simple and low-tech: good hand washing by all healthcare professionals, doing a quick nasal swab before surgery and using a different cleanser on the skin before surgery. Simple steps like these and a long term plan can make a difference in protecting those in hospitals. We're also working a different angle to educate the public; we are holding a contest asking the public to make a video to teach the rest of the folks and there's a $500 prize (paid for by an association control specialists in the state). Even though staff and family can't win, be sure to let your friends know - we really want a creative answer to teach the public. More details are on our website: preventHAIaz.org

Getting a Recommendation for Medical Marijuana

Will Humble — Fri, 22 Oct 2010 15:24:51 +0000

Some of the most important words in the 13-page Arizona Medical Marijuana Act are: “Physician Patient Relationship” and “A Full Assessment of the Qualifying Patient’s Medical History”. The real gatekeepers that’ll determine which applicants ultimately would qualify for a medical marijuana card are Arizona MDs, DOs, Naturopaths and Homeopaths, as they evaluate their patient's medical conditions and determine who could benefit from the medical use of marijuana. That’s why the key words above are so important when (or if) we define our Administrative Code. Before a physician signs a recommendation for a patient, they’re supposed to do a “full assessment of the patient’s medical history” and be in a “physician patient relationship”. If we don’t define these words carefully we could end up like Colorado and California where patients can walk into a medical practice that specializes in medical marijuana recommendations and get a recommendation after a very short exam (which includes a fee). One of the first things I’ll do if the Initiative passes is to ask our legal team at the AGs Office to determine how much authority we have to define these words. If we have the authority, I’d like to somehow craft some criteria that would make sure that some real assessment happens including a discussion of the range of medical management strategies that could be taken to help manage the patient’s condition before a physician can hand out a recommendation. I don’t know if we have that authority, but I sure hope so.

Heart Disease v. Cancer in AZ

Will Humble — Mon, 25 Oct 2010 08:12:57 +0000

As predicted by our 1990 ADHS Vital Statistics Bureau in 1990- cancer is now the number one killer in Arizona – surpassing heart disease. Does this mean that cancer is getting worse? Probably not- it really says that because of better management, treatment, and prevention of heart disease- people with heart conditions are living longer. Effective medications to control high blood pressure and reduce cholesterol levels (statins) have been developed, medical procedures have improved such as removal of coronary artery obstructions, coronary artery bypass, cardiac catheterization, pacemakers; and widely available supplements (certain Omega-3 fatty acids) or even a margarine such as ‘Promise’ which is ‘cardiologist endorsed’. We’re also making more progress educating the public about the importance of controlling your blood pressure- which is the #1 risk factor for heart disease. Check out the full report “Heart Disease vs. Cancer: An Epidemiologic Transition in Mortality Risks” on our website.

Personal BP Story

Will Humble — Tue, 26 Oct 2010 13:27:34 +0000

When we implemented our Salt Initiative earlier this year we asked people to know their blood pressure and consider reducing their sodium intake by shopping more carefully and preparing recipes that are lower in sodium. One of the main messages was to encourage people to know their own blood pressure. Then it occurred to me- I don’t know my own blood pressure. So I went to the drug store and bought a blood pressure machine and used it at work. Low and behold- I was consistently at 140/90 mmHg- which is too high. I went downstairs and had our prevention staff check me and it was 140/90. The next week, I had a checkup, and my pressure in the office was 140/90. She told me I needed to take these little pills every day, which I did for 3 days. Then I took my own advice. We cut down on sodium at home and I started doing the treadmill every day (instead of just 2-3 times a week). Guess what. It worked. Not right away- but within a few weeks I was down in the 130/85 range- and by late summer it was down to about 120/78 mmHg- which is fine. In the end I was able to do it with just diet and exercise. It might not work the same for you, but it might- and it’s worth the try- because remember elevated blood pressure puts you at much higher risk for heart disease and stroke. So give it a try.

Babies, Babies, Babies

Will Humble — Wed, 27 Oct 2010 14:32:02 +0000

More interesting information from Vital Statistics– this time about babies and births in Arizona. The number of births each year in AZ has been on a downward trend for the last couple of years, and 2009 was no exception. There were a lot fewer babies born in 2009 (92,616) than in 2007 (102,687)- which is an overall drop of 10% over 2 years. There was a 16% drop in birth numbers of Hispanics or Latinos in 2009. We don’t know for sure, but that may be because there are fewer Hispanics or Latinos in the state. Hispanics faced the economic recession in 2008-2009, like everyone else, but also additional legal challenges such as the employer-sanction law (a penalty on employers hiring illegal immigrants), and e-verify (checking the legal-residence status of those seeking employment). One good drop in numbers for babies is the infant mortality rate . Arizona’s infant mortality rate decreased by 22% between 2007 and 2009. It’s still tragic that 547 infants died before reaching their first birthday, but the 2007 rate of 6 deaths per 1,000 births is the lowest in the State’s history. Birth weight is one of the most important predictors of an infant’s survival chances (Figure 2C-3) <http://www.azdhs.gov/plan/report/ahs/ahs2009/pdf/text_infants.pdf> . Together, births of infants weighing less than 1 Kilogram accounted for 0.6% of births but 44%- a sobering statistic. Infants weighing less than 500 grams had a very high mortality rate (93%). Clearly birth weight is a critical factor for reducing our mortality rate moving forward. More about that in a future update.

Emergency Room Care

Will Humble — Thu, 28 Oct 2010 15:09:33 +0000

Thanks to the 2009 Vital Statistics report, we also know that AZ residents went to the ER more than 1.8 million times. The top reasons (about 25%) for those visits were abdominal pain, acute upper respiratory infection, chest pain, cuts, mental disorders, and spinal disorders. More than 1,300 Arizonans were treated in an emergency room for exposure to excessive natural heat, more than 2/3 of them male- and 338 were hospitalized as inpatients for the heat related illnesses.

Visit Your Local Farmers Market

Will Humble — Thu, 28 Oct 2010 15:10:59 +0000

Now that the weather has finally broken here in the desert you can visit your local farmers market without having to get up at the crack of dawn. Check out our Farmers’ Market Locator to find the nearest farmers market. Simply go to the application link and put in any address and city and push “Find Market”. The program will list all the markets including links that give you the time of year, dates and times that the market is open. It’ll also give you a map of the market’s location, provided on a printer friendly page.

Selecting Marijuana Dispensaries

Will Humble — Fri, 29 Oct 2010 09:58:46 +0000

If Proposition 203 passes (the Arizona Medical Marijuana Act), one of our key decisions will be how to set up some kind of selection process for approving marijuana dispensary applications. The Act states that the number of Cannabis dispensaries will be limited to 10% of the number of pharmacies in the state. As of right now, that would cap the number of dispensary licenses at around 124. Experiences in other states suggest that we can expect to receive far more than 124 applications… meaning that we need to think ahead about how we’d select the successful applicants from all of the folks who send in complete applications. There are probably a number of ways to do it, but 3 come to mind right away. We could, for example:

Use some kind of first-come first-served process and simply approve the first 124 complete dispensary applications;
Place the complete applications in a pool and have some kind of random drawing on a particular date; or
Evaluate the complete applications using some kind of objective criteria (such as the professional quality of their business model, security plan, customer validation and inventory system etc) and select the best applications from the stack for approval.

Method 3 is probably the best because we’d be able to select the best of the qualified applicants, but it would also be far more labor intensive than methods 1 or 2. Method 3 would also be more challenging in terms of ensuring transparency etc. An interesting twist on method 3 would be to send the completed (and blindfolded) applications to a 3^rd party (e.g. a consulting law firm) and ask them to score the applications for us. We’d also need to think about how to distribute the licenses geographically. The Act states that each county is entitled to at least 1 dispensary, however we might also consider allocating potential license “quotas” on a “per capita” basis by county across the state. Anyway, we’ll know next week whether we need to deal with any of the things I’ve written about over the last few weeks.

AZ's Improving Our Birth Outcomes

Will Humble — Mon, 01 Nov 2010 08:42:02 +0000

Did you know that Arizona achieved an historic low Infant Mortality Rate (5.9 infant deaths for every 1,000 live births) in 2009? Infant mortality has long been a public health barometer to assess the general health of a community because good birth outcomes require a host of things to go right. There are many risk factors for poor birth outcomes. The main causes of infant mortality are low birth weight and prematurity. Some risk factors include smoking, alcohol & other drug use, hypertension, diabetes, gum disease. Maternal obesity increases the risk of birth defects, preterm births, and fetal/infant deaths. Risk of prematurity, low birth weight, and infant mortality increases significantly with multiple births (having twins, triplets, or more). The risk of infant mortality among twins/triplet’s etc. is 3.65 times greater than for among “singletons” in AZ. Improving birth outcomes by minimizing risk factors is called preconception health and it’s a top priority for our Bureau of Women’s and Children’s Health. Important elements to improve outcomes include several factors before pregnancy including:

stopping smoking;
avoiding alcohol & other drugs;
maintaining a healthy weight;
taking a multivitamin with folic acid (before pregnancy);
planning and properly spacing pregnancies;
brushing your teeth and gums twice a day with a fluoride toothpaste and floss;
seeing a dentist;
keeping stress in check; and
using seat belts throughout pregnancy to prevent maternal & infant mortality.

It’s also important to get early prenatal care to help manage chronic conditions like high blood pressure and diabetes. You can read more about our specific interventions at our Bureau of Women’s and Children’s Health page and you can also check out our “Every Woman Arizona” educational materials- which promote health before pregnancy.

Post Election 203 Communications

Will Humble — Tue, 02 Nov 2010 08:32:12 +0000

If Prop 203 passes today, we’ll definitely get flooded with phone calls from people that want information on how they can get a license to become a dispensary starting Wednesday. There’s absolutely no way we could ever try to answer the inevitable questions over the phone. Number 1, we won’t have full answers until at least March of 2011 (assuming it passes). Number 2, we don’t have the staff to be able to cover the phones. If it passes, we’ll be doing all of our communication with the public on-line using a featured site on our homepage that’ll be our information hub. We’d also develop an electronic application for interested folks to sign up for the weekly updates that we’d develop. I'm recording a video message that we’d post on the featured page that discusses the process that we’d use to implement the law. I'm also recording a voice message for the phone system. The bottom line is that (if it passes) and someone calls ADHS about how we plan to implement the law, whoever answers the phone will refer the caller to the website hub or if they really want to hear a voice over the phone, refer them to my voice message.

Annual Statewide Environmental Health Annual Report Published

Will Humble — Wed, 03 Nov 2010 13:17:55 +0000

I started my career in public health working as a county Sanitarian doing inspections of restaurants, motels and the like in the mid- 1980s. My area was right around here down toward South Mountain and I inspected the cafeteria in the basement of the Executive Tower and the cafeteria that used to be on the 4^th floor of the 1740 Adams DHS building . It doesn’t seem like that was 25 years ago, but life is funny that way. Anyway, I guess it’s both a blessing and a curse for the folks in environmental health that I started my career that way, because I know all about their stuff. Our core environmental health responsibilities include administering the statewide public health sanitation program for food safety, bottled water, hotels and motels, children’s camps, public schools, and public and semi-public swimming pools. We delegate the actual inspection work to the county health departments. Statewide, there are about 170 Sanitarians that are employed by the counties that inspect the roughly 34,500 restaurants and food stores in AZ. We just finished our FY ’10 Annual Report. Last fiscal year the Sanitarians completed about 72,000 food safety inspections and about 95,000 overall inspections (including school grounds, swimming pools, trailer parks, motels and hotels.)

Suicide Prevention

Will Humble — Thu, 04 Nov 2010 08:00:40 +0000

Suicide is one of the most challenging and sensitive public health issues that we face, partly because so many folks have a hard time talking about the subject. It’s especially challenging for families that experience suicide first hand. 1,060 Arizonans died from suicide in 2009 the highest number ever, making it the 6th leading cause of death among men and 9th for women. The age-adjusted suicide rate increased by 8.8% from 14.8 suicides per 100,000 residents in 2008 to 16 per 100,000 in 2009, which is the highest suicide rate since 1998. There were 7,979 suicide attempt-related ER visits in 2009, 71% more than in 2007. The rate is much higher for men 24.6 per 100,000 compared with 8.1 per 100,000 for women. Every part of the state has a suicide hotline that’s linked to 911 operators etc. Also, each of our RBHA’s have suicide prevention resources and have training in how to spot high risk folks ahead of time. You can see more in out Strategic Plan. We also have a Substance Abuse and Mental Health Services Administration Cooperative Agreement for State-Sponsored Youth Suicide Prevention and Early Intervention. The total award is $500K per year for 3 years- and it’s geared toward preventing suicide among young people. The majority of the grant goes toward not-for-profit prevention organizations for direct suicide prevention services in the community. Most of the remainder of these grant funds will be awarded to not-for-profit prevention organizations for direct suicide prevention services in the community (for all populations). Additionally, a portion is being used to prepare emergency department staff to identify persons with substance abuse disorders and/or suicidal thoughts and make referrals to behavioral health and other community resources.

E. coli Outbreak

Will Humble — Fri, 05 Nov 2010 09:00:26 +0000

We’ve just confirmed 11 cases of E. coli in AZ. Our cases appear to be part of a multi-state outbreak that’s associated with Gouda cheese sold at Costco. Maricopa (5 stores), Pima (1 store) and Yavapai counties (1 store) are involved with the investigation and the suspect cheese has been held in back stock until testing is completed. Costco is cooperating with the investigation and is making it easy to return the cheese. You can check out the FDA media release for information about the investigation and some other basic information for consumers. Our lab is testing samples of suspect cheese right now. Normally we could get results within a few hours, but cheese is full of all kinds of natural bacteria and we can’t run the typical rapid PCR test because of the competing DNA. Our culture test takes 72 hours, so we’ll know whether these cheeses are truly contaminated by Monday.

It is Valley Fever Awareness Week

Will Humble — Mon, 08 Nov 2010 09:51:06 +0000

Valley Fever has been in the media a lot lately. Part of the reason is because last Saturday we kicked off the 8^th annual Valley Fever Awareness Week in recognition of the outstanding treatment and research conducted by the Valley Fever Center for Excellence as well as the advances in Valley Fever education and public health done here at ADHS. Some recent public health advances by ADHS include the publication of enhanced surveillance of coccidioidomycosis (the scientific name for valley fever) in Arizona, which highlights the effects that valley fever has on Arizonans, healthcare costs, and the economy. This investigation found that persons with valley fever had symptoms for a median of 4 months and missed a median of 2 weeks from work. Hospital charges totaled $86M among Arizona patients who had primary or secondary diagnoses of valley fever in 2007. Persons with valley fever who were aware of the disease were more likely to get an earlier diagnosis of the disease and more likely to ask their doctors to test them for valley fever. These findings warrant the importance of public and provider education of valley fever. With that being said, in light of Valley Fever Awareness Week, there was a “Learn about Valley Fever – Ask the Doctors your Questions” public forum in Tucson, Saturday, Nov. 6, and a fundraising Walk for Valley Fever in Phoenix, Sunday, Nov. 7, where I attended and spoke. Last year, we had over 200 people and 70 dogs registered for the Walk. Let’s keep supporting education, research and treatment for valley fever! Physicians can obtain free continuing medical education online or in Scottsdale, Saturday, Nov. 13: “Coccidioidomycosis for the Primary Care Physician” and “Advanced Clinical Aspects of Coccidioidomycosis (Valley Fever)”. For more information, please visit http://www.valleyfeverarizona.org.

Flu Season

Will Humble — Tue, 09 Nov 2010 08:43:16 +0000

Last year at this time the new H1N1 flu virus was going gangbusters. Loads of Arizonans were getting sick (especially kids), the vaccine was still in short supply. The county health departments were prioritizing which doctors could get the vaccine. What a difference a year makes. Flu activity across the country is light (so far), and there is plenty of vaccine, making this an excellent time to get a flu vaccine. This season, everyone 6 months and older should get vaccinated, even if they got a seasonal or 2009 H1N1 vaccine last season. The 2010-2011 flu vaccine has been updated to protect against the three flu viruses that’ll be circulating in the next few months. The H1N1 influenza strain from last year has been remarkably stable and hasn’t changed very much at all. A report published last week examined the genetic changes in the pandemic H1N1 influenza virus. Some minor changes were detected in Singapore in early 2010, spreading through Australia and New Zealand over their winter (our summer). At this stage, the changes aren’t drastic enough to make this season’s vaccine less effective, but scientists are carefully monitoring the virus as winter approaches in our hemisphere. FYI- State employees, retirees, spouses and their kids over 4 years old have three options to get a free flu shot through the Benefit Options Flu Shot Program including Worksite Flu Clinics, Family Day Clinics, and Healthwaves Public Clinics.

Abortion Clinics Finally Licensed

Will Humble — Wed, 10 Nov 2010 08:00:18 +0000

In 1999 a bill was passed that charged the ADHS with licensing and inspecting abortion clinics. Before the law could take effect, a lawsuit was filed that “stayed” the regulation of abortion clinics until a settlement agreement could be finalized with the Department and the plaintiffs. Last year the settlement agreement was finalized, we developed our licensing rules for the clinics, reached out to the providers to let them know about the new rules and how to apply for a license, and conducted inspections. The rules went into effect November 1 and our medical licensing team was able to issue licenses to the facilities right away. This has been a complicated process and required collaboration among our Office of Administrative Rules, the AG’s Office and the Office of Medical Facilities in our Licensing Division. Thanks for the teamwork!

E-Licensing for Assisted Living Facilities Goes Live

Will Humble — Wed, 10 Nov 2010 12:29:34 +0000

Starting today Assisted Living facilities in Arizona can renew their ADHS licenses through the internet, 24/7/365. Thanks go out to our IT and Assisted Living folks (Cindy Caglio, Madan Gopal, Raghuraman Ramaswamy, Jim Tiffany, Larry Martens, Tom Salow, Valerie Grina, Randy LaRoche, Lynne Smith, John Lake, Mary Benkert, Mary Wiley, Alan Oppenheim, and Paula Mattingly) for completing this important project. As a result of our team’s hard work, we have an electronic system that’ll ease the renewal process for centers and homes. Our new electronic online system will allow current license holders to register, use a prefilled form, make needed changes, pay immediately with a credit card & print the renewal confirmation. Our goal is to bring this level of service to nursing homes next. Now that 203 is (probably) behind us, we’ll press ahead with that project shortly. Check out our Assisted Living renewal website portal for details.

Raise Your Voice, Arizona!

Will Humble — Fri, 12 Nov 2010 11:16:44 +0000

If you or one of your family members receives behavioral health services in Arizona, it’s time to raise your voice and be heard. Over the next few weeks our ADHS Behavioral Health System Transformation Team will be sponsoring a series of forums so that folks can express their opinions about how we should shape the future of behavioral health system in Arizona. The forums will actively involve the community through a series of focus groups that’ll gather the collective opinion of members on what they want and need from the behavioral health system. The team will be using an evidence-based practice called Community Based Participatory Research- which is used in public health research to engage the community in designing programs that are responsive to the public’s needs. Using this approach, we’ll be able to build a sense of shared responsibility, ownership and buy-in for system redesign. We’ll have 14 focus groups throughout Maricopa County and 6 others statewide over the next few weeks. Peers and family members have volunteered and have been trained to assist in the facilitation of the focus groups. Each focus group will be conducted using a script of instructions and questions which were developed with peer and family member input. Each group will be divided into smaller groups of four to eight participants to discuss each question. The consensus answers will be recorded on sheets of easel paper and collected at the conclusion of the meetings. The data we collect at the forums will be entered into a database and analyzed for themes, trends and issues using an SPSS (Statistical Package for the Social Sciences) software program. Our objective is develop a report of the findings to help us transform the system. We’ll also use the information as a first step toward developing draft new court orders under the Arnold v. Sarn court case. After we see the results from the focus groups, we can determine next steps. Information about the forums is posted on our BHS Transformation Page and our Department Homepage. Thanks to Teresita Oaks, Claudia Sloan, Stacy Mobbs, Robert Sorce & Team DBHS for your work on this initiative!

Check Out Our New Empower Training Videos

Will Humble — Mon, 15 Nov 2010 09:31:52 +0000

Our collaborative team of professionals from WIC, Maternal & Child Health, the Office of Children with Special Healthcare Needs and our Office of Childcare Licensure just finished and posted 4 dynamite videos to help our AZ Childcare Centers and Homes to adopt our Empower Pack wellness program. The videos range from about 7 to 9 minutes, and they break down the Empower criteria into easy to understand vignettes to help operators effectively implement the standards. All the videos were filmed at real childcare facilities with real childcare staff and kids. Teachers and caregivers talk about how they incorporated empower activities into their day and give helpful hints. There are lots of great things about the videos, but one of the things that I like the best is that each of them include elements where they talk about how easy it is to incorporate the empower criteria for the kids that may have special needs. The way the team accomplished that part is remarkable. Anyway, check it out and make sure you promote it with our stakeholders and partners. Empower was also featured at a roundtable discussion for American Public Health Association national meeting this week. Jeanette Shea was asked to present on our policy that incorporates childhood obesity and tobacco use prevention—two critical public health issues - into an innovative prevention program, by blending dollars from three funding streams. The APHA Annual Meeting & Exposition is the oldest and largest gathering of public health professionals in the world, attracting more than 13,000 national and international physicians, administrators, nurses, educators, researchers, epidemiologists, and related health specialists – a great audience to hear about EMPOWER.

Medical Marijuana Implementation Plan

Will Humble — Mon, 15 Nov 2010 10:19:22 +0000

By now you probably know that Proposition 203, the Arizona Medical Marijuana Act appears to have passed after all (although the final determination will actually be made when the election is certified). The Act identifies the ADHS as the organization that’s responsible for carrying out the provisions of the law. There will be several teams of folks here at ADHS that’ll be working hard during the next 4 months or so as we set up the regulatory network. We’ve set up a featured site on our homepage that’ll be our information hub for communicating with the public as we make decisions in preparation for implementing the Act. The website contains (and will continue to contain) all of the relevant public information that we’ll have regarding our implementation activities. You can also sign up to receive weekly updates on the site. Implementing the Act will take at least 4 months… and we expect to be able to accept our first applications for medical marijuana cards and dispensaries in early April, 2011. In the mean time, we’ll be developing the Administrative Code (Rules) for actually operating and regulating the program. Here is our schedule for Rule development:

December 17, 2010: ADHS posts an initial informal draft of the Rules

December 17, 2010 - January 7, 2011: ADHS receives informal (electronic) public comment on the initial informal draft rules

January 31, 2011: ADHS posts official draft Rules for public comment

January 31, 2011 - February 18, 2011: ADHS receive public comment on a revised draft of the rules

February 15 - 17, 2011: ADHS holds 3 public meetings about the draft rules

Phoenix, Tuesday, February 15, 2011 – 1 pm, 250 N 17th Ave

Tucson, Wednesday, February, 16, 2011 – 1 pm, 400 W. Congress, Room 222

Phoenix, Thursday, February 17, 2011 – 1 pm, 250 N 17th Ave

March 28, 2011: ADHS publishes the final Rules that will be used to implement the Act

April 2011: ADHS begins to accept applications for registry identification cards and for dispensary certificates

Our goal is to put together a responsible set of regulations between now and April 2011 with the rule package that will capture the core of the Initiative's intent while placing some checks and balances in the system to prevent some of the excesses that have occurred in other states that have medical marijuana laws (CO, CA, MT etc.). I also want to make sure that our implementation activities are completely transparent and that everybody has equal access to information. By using an inclusive proves we will also ensure that we are getting the best input we can as we implement this new program.

New ACPTC Program Activities

Will Humble — Tue, 16 Nov 2010 10:12:57 +0000

Ever since our Arizona Community Protection and Treatment Center (on the grounds of the Arizona State Hospital) opened in 1998, we’ve been providing treatment to sexually violent persons who have a mental disorder and who have been convicted (or found guilty except insane) of a sexually violent offense or were charged with a sexually violent offense and determined incompetent to stand trial. Through the years, our treatment has consisted mostly of therapies to address the persons’ offense history, analyze their own cycle of behavior, to develop self-management techniques in order to reduce the risk of re-offending, and to develop empathy for their victims. While our historic approach has been solid, it doesn’t really help them to eventually successfully reintegrate into the community, because they also need to know how to get (and keep) a job, budget & pay bills, prepare (balanced) meals, navigate public transportation, interact with people in socially acceptable ways, form healthy relationships, maintain social and personal boundaries, and eliminate addictions- you get the idea- they also need skills to live in society. Many of our ACPTC residents come from impoverished, traumatic backgrounds and haven’t lived successfully in society, so a lot of work is needed to prepare them to (eventually) live in the community. This month, we kicked off our new therapeutic program which will help residents gain and practice skills that will help them to (eventually) function in the community. While the psychosexual treatment remains the cornerstone of our therapeutic approach, residents are now being offered therapies for social and living skills, educational and vocational assessment and exploration, addictive behavior therapy, anger management, therapeutic recreation and structured daily therapeutic schedules that include self-directed leisure and work. The new program goals help them on their way to forming healthy social relationships with guidance of trained staff. In other words, the whole person is being treated with the goal of helping the person lead a productive life and affording protection to the community when they’re eventually transitioned to the community. Ann Froio and her team at the ACPTC have been working on this new therapy design for the last few months and it’s great to see it actually being executed. This new approach doesn’t really cost any additional money, rather, it’s a re-design of the daily activities. It’s actually a lot like the Empower Pack, a redesign of daily activities to achieve a goal but without requiring a huge financial investment.

ADES Offices Win National Nutrition Medals

Will Humble — Wed, 17 Nov 2010 11:29:56 +0000

Two ADES offices in Maricopa County were awarded Bronze Medals for the prestigious 2010 Supplemental Nutrition Assistance Program Hunger Champion Award. The East Southern Office in Phoenix, and the Gilbert Office on W. Guadalupe both received the Bronze Award, and were chosen from DES offices all over the U.S. The USDA only gave out 23 awards nationally- so this is a very selective award. The award goes out to program offices that demonstrate exemplary service in providing education about healthy eating to their clients as well as conducting outreach activities to assist eligible clients to obtain nutrition benefits. The Offices are also “adopted” partners of the Arizona Nutrition Network, which means they provide materials and innovative nutrition education to the clients. The Maricopa County Department of Public Health has adopted the East Southern Office and the University of Arizona Bone Builders has adopted the Gilbert office.

Action Plan for Integrating Acute & Behavioral Health Care

Will Humble — Thu, 18 Nov 2010 08:28:39 +0000

Arizona citizens with a serious mental illness have a life expectancy that’s 30 years less than the general population. These folks don’t die early because of their mental illness; rather, they die from preventable physical health conditions like obesity, smoking, lung disease, stroke and heart disease. That’s why the Department is partnering with the Milbank Foundation to sponsor a day- long seminar focusing on how we can further develop a more integrated system of care to help treat folks with a mental illness or substance abuse disorder. As community health centers continue to expand over the coming years, we’ll have a unique opportunity to develop an integrated model of care in Arizona. Our goal is to make it so folks can be treated for chronic disabling conditions, both physical and mental, at a person-centered health home, with providers who understand both issues and communicate with each other for the best possible outcomes. Integration will be a long but important road. One of our initial steps will be to help the key players, from behavioral health providers, Regional Behavioral Health Authorities, community health centers and our licensing management team to learn about current integrated models in Arizona and about models that other states have used to better serve this population. We’ll be coordinating a forum in January in conjunction with the Foundation to help grease the wheels and move forward. We’ll have more details about this as we get closer to the January seminar.

Medical Marijuana (Cannabis) Implementation Schedule & Info

Will Humble — Fri, 19 Nov 2010 05:00:27 +0000

By now you probably know that Proposition 203, the Arizona Medical Marijuana Act, appears to have passed after all (although the final determination will actually be made when the election is certified on November 29). The Act identifies ADHS as the organization that’s responsible for carrying out the provisions of the law. There will be several teams of folks here at ADHS that’ll be working hard during the next 4 months or so as we set up the regulatory network. We’ve set up a featured site on our homepage that’ll be our information hub for communicating with the public as we make decisions in preparation for implementing the Act. The website contains (and will continue to contain) all of the relevant public information that we’ll have regarding our implementation activities. You can also sign up to receive weekly updates on the site.

Implementing the Act will take at least 4 months… and we expect to be able to accept our first applications for medical marijuana (Cannabis) cards and dispensaries in early April, 2011. In the mean time, we’ll be developing the Administrative Code (Rules) for actually operating and regulating the program. Here is our schedule for Rule development:

December 17, 2010: ADHS posts an initial informal draft of the Rules.

December 17, 2010 – January 7, 2011: ADHS receives informal (electronic) public comment on the initial informal draft Rules.

January 31, 2011: ADHS posts official draft Rules for public comment.

January 31, 2011 – February 18, 2011: ADHS receive public comment on a revised draft of the Rules.

February 15 – 17, 2011: ADHS holds 3 public meetings about the draft Rules

Tuesday, February 15, 2011 – 1 pm, 250 N 17th Ave., Phoenix

Wednesday, February, 16, 2011 – 1 pm, 400 W. Congress, Room 222, Tucson

Thursday, February 17, 2011 – 1 pm, 250 N 17th Ave., Phoenix

March 28, 2011: ADHS publishes the final Rules that will be used to implement the Act.

April 2011: ADHS begins to accept applications for registry identification cards and for dispensary certificates.

Our goal is to put together a responsible set of regulations between now and April 2011 with the rule package that will capture the core of the Initiative’s intent while placing some checks and balances in the system to prevent some of the excesses that have occurred in other states that have medical marijuana laws (CO, CA, MT etc.). I also want to make sure that our implementation activities are completely transparent and that everybody has equal access to information. By using an inclusive process we’ll ensure that we’re getting the best input we can as we implement this new program.

Behavioral Health Licensing Rule Change Suspended

Will Humble — Mon, 22 Nov 2010 15:42:27 +0000

A couple of weeks ago I planned to open the docket to overhaul the Administrative Code (Rules) that we use to evaluate and monitor health and safety in licensed behavioral health facilities in AZ. That plan was based on the assumption that the Medical Marijuana Act was going down to defeat because at that time it was trailing by several thousand votes. The unexpected turnaround means we'll need to devote substantial resources to the rule development and administrative infrastructure to implement the law. We'll only have 120 days (from the certification date of the election) to get the program up and running (including a substantial rulemaking), all of which means we’ll need to postpone the plan to rewrite the behavioral health licensing rules until early 2011. This is not something I want to do, because everyone agrees the behavioral health licensing rules need work, but we just can't handle both jobs at once. Of course, if something strange happens and the election somehow turns direction during the canvass, we’ll proceed with the behavioral health rules. Otherwise, we’ll start the behavioral health licensing rule package as soon as we complete the 203 package- which will be late March.

Qualified Patient Applicants

Will Humble — Tue, 23 Nov 2010 09:59:08 +0000

One thing that folks have mentioned on my blog over and over is concern about who will need to submit fingerprints as part of their application under the AZ Medical Marijuana Act. Here’s the short answer: All applicants except a qualifying patient will need to submit a full set of fingerprints before getting a card or license. So the majority of people who want to use medical marijuana will not need to send in fingerprints to the Department. Everyone else (caregivers, dispensary owners and those who work in dispensaries) will need to send in fingerprints. The initiative also says clearly that ADHS can, at its discretion, run a background check on anyone who submits those fingerprints and, if need be, deny the application based on the results.

Whooping Cough Just Across the River

Will Humble — Wed, 24 Nov 2010 09:06:28 +0000

California has had 6,400 + cases of whooping cough (pertussis) and 10 infant deaths so far in 2010, which is the highest number of cases they've had since the age of immunizations began (about 60 years ago). Meanwhile, Arizona has had 361 cases and no deaths in 2010 compared to 277 cases in all of 2009. Even with California's much higher population, their rate is much higher than ours. We don't know exactly why it's exploding across the river, but it might have something to do with the fact that we require middle-schoolers (who often spread the disease among each other and to little kids) to be vaccinated against whooping cough, California did not. Late this summer, the California legislature passed a law requiring 7th graders and above to get a pertussis booster starting next year. Of course it could be alot of other factors too. As an aside, check out a new article in Science that explains the changing epidemiology of pertussis.

Wait a Minute, Isn’t Marijuana Illegal?

Will Humble — Mon, 29 Nov 2010 08:11:15 +0000

I get this question a lot from folks. While Congress has determined that it’s illegal to distribute and sell marijuana, several states have passed laws authorizing the distribution and use of marijuana for medical purposes. Arizona will likely be the 15^th state to do so if the election is certified today (November 29). So, in some states it’s OK by state law but still against federal law. To address this conundrum, the US Department of Justice produced guidelines for federal prosecutors for states that have enacted laws authorizing the use of marijuana for medical purposes. The memo provides clarification and guidance to federal prosecutors in states that have enacted laws authorizing the medical use of marijuana. Basically, it provides uniform guidance to focus federal investigations and prosecutions in these States on core federal enforcement priorities. In one sentence in the memo, it says: …“As a general matter, pursuit of these priorities should not focus federal resources in your States on individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.” The memo goes on to say that the prosecution of people with cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen consistent with applicable state law is unlikely to be an efficient use of limited federal resources. On the other hand, prosecution of commercial enterprises that unlawfully market and sell marijuana for profit continues to be an enforcement priority of the USDOJ. So there you have it. Normally, I’d try to boil this down a little bit more, but I think I should leave it right there (since I’m just a health official, not a lawyer).

Raise Your Voice Forums

Will Humble — Tue, 30 Nov 2010 09:07:59 +0000

Our Raise Your Voice Behavioral Health Forums are going quite well. You’ll remember that our objective for the Forums is to help us transform our behavioral health system for the better. Our behavioral health team has been traveling to most parts of the state to hold focus groups including 14 in Maricopa County and focus groups in Sierra Vista, Payson, Casa Grande, Yuma and Tucson. Overall, participation has been consistent with an average of 20 people attending in each meeting. We didn't hold focus groups during Thanksgiving week, but resumed them this week beginning with a forum in Flag on November 29. We’re getting excellent response and many good ideas are being shared. One person asked, “Why did it take thirty years for you to do this?” So far, we’ve learned that members are most concerned with the way they’re treated. Things like listening, respect and having a meaningful role within the clinical team are some of the themes that we are hearing. For example, members have repeatedly expressed that it’s important for the treatment team and service providers to listen to and value their opinion and views when it comes to treatment and service delivery decisions. One member summarized it best by saying, “We know what works better for our own recovery.” We’ve heard lots of expressions of gratitude for the opportunity to voice their opinion in a safe and structured environment. We expect to complete the focus group meetings in early December. However, the forums have been so successful that we may schedule more to make sure all segments of the community have the opportunity to share their opinion. As the focus groups wind down, we’ll enter the data into a database and identify themes, trends and issues. This information will be used in a report, which will be released to the public sometime in January 2011 and subsequently play a key role as we begin the process of drafting revised court orders. Information about the forums is posted on our BHS Transformation Page and our Department Homepage.

New High-Tech Interactive Arizona Cancer Registry Website

Will Humble — Wed, 01 Dec 2010 06:27:54 +0000

Our Arizona Cancer Center has developed a highly interactive new website using state-of-the-art GIS technology. This nifty new website lets the public and researchers access cancer data by communities (Community Health Analysis Areas). It allows easy access to age adjusted incidence rates and counts for 13 cancers that have public health implications. The website visualizes cancer data with interactive maps, tables and graphs including a rate distribution graph, a time series chart and a rate classification chart. All the elements are linked, so a selected community in one chart or map will be selected in all others. Confidence intervals and the Arizona State rate were added to increase understanding of complex statistics and minimize misinterpretation of the data. All 13 Cancer data tables can be downloaded in an Excel format. Use this link to explore the website and its many features. If you have any questions or need any additional information contact our local (but federally-funded) guru Wesley Kortuem at wes.kortuem@azdhs.gov.

World AIDS Day

Will Humble — Wed, 01 Dec 2010 20:18:40 +0000

Today is World AIDS Day – an opportunity to remember those impacted by HIV/AIDS, look back at its history and toward future developments that may prevent limit its spread. HIV was first identified in the United States in 1981. In the early 1980’s, public health efforts focused heavily on identification of the virus. Once the virus was identified, resources have gone to develop drugs to treat the virus, vaccines and other methods to prevent infection. According to the CDC, more than 55,000 people are infected with HIV each year in the US, 18,000 plus die from AIDS each year and about one million people are living with HIV in the US. But about 1 in 5 people with HIV don’t know they are infected and are unknowingly transmitting the infection. The US numbers are small compared to the global numbers - 33.4 million people are living with HIV/AIDS and 2 million die from AIDS each year. While HIV/AIDS numbers are high – they are only a part of the public health fight against disease. Most deaths are caused by non-communicable diseases, particularly cardiovascular disease (over 8,700,000 deaths annually). However, over 9 million people die each year from infectious diseases. The majority of these deaths are caused by common respiratory and diarrheal infections due to poor sanitation and limited access to health care. No matter what disease you are looking at - you, the public, must take an active role to protect yourself with healthy habits. Eat healthy foods, exercise, wash your hands, don’t take part in risky behaviors. Today is World AIDS Day – a good time to look at what you are doing and protect yourself and your family.

Preconception Health II

Will Humble — Thu, 02 Dec 2010 08:54:46 +0000

If you picked up a U.S. Vital Statistics edition in say 1940, you’d notice an emphasis on stillbirth statistics in the maternal and child health sections. Today while infant mortality (rather than stillbirths) receives more attention as a sentinel indicator of maternal and child health, it’s still significant. You may recall reading in a previous blog about Arizona’s historic low infant mortality rate in 2009 (5.9 infant deaths for every 1,000 live births). Unfortunately the rate of stillbirth in 2009 (5.5 per 1,000) remained unchanged. In fact, the total number of stillbirths in 2009 nearly equaled the total number of infant deaths. Smoking remains the leading known behavioral cause of stillbirth. Not smoking at all is the best, but quitting early in the first trimester reduces the risk to baseline. The Incidence and Reported Causes of Stillbirth in Arizona is produced annually by our Bureau of Women’s and Children’s Health and is a good resource for further information about stillbirth in Arizona. The bottom line is that preconception health remains the most promising strategy we have to reduce both stillbirth and infant mortality in Arizona. For more information, you can access the “Every Woman Arizona” educational materials- which promote health before pregnancy.

Thanks for Giving (note to staff before Thanksgiving)

Will Humble — Thu, 02 Dec 2010 17:00:12 +0000

Thanks for giving your all over the last year. I know it hasn’t been easy. We’ve been though a lot over the last year with budget reductions, furloughs, short staffing and other uncertainty- yet you’ve remained committed to our mission, stayed at your post and helped move our mission ahead for the people of Arizona. Thanks. We have an enormous responsibility. There isn’t a single person in the State that doesn’t rely on your commitment and dedication. I certainly appreciate your hard work and I know that the people of Arizona do too. Remember that even though your job may be difficult at times, you’re privileged to be in a profession that truly makes a difference. As you reflect over the last year this weekend remember to look at the big picture and focus on the positive things we’ve accomplished together. We’re an incredible team. My grandmother used to have something hanging in her bathroom wall that said: “You can do what I can’t do, I can do what you can’t do- Together we can do anything.”

Medical Marijuana (Cannabis) Dispensary Zoning

Will Humble — Fri, 03 Dec 2010 06:14:59 +0000

The AZ Medical Marijuana Act states that cities and towns may adopt "reasonable regulations" regarding the location and operations of medical marijuana dispensaries and growing operations in their jurisdictions. The ADHS still has the responsibility to issue the dispensary license- but any license that we ultimately issue would be contingent on the prospective facility being in compliance with local zoning requirements. To help, the League of Arizona Cities and Towns has put together a model ordinance to help cities and towns get their arms around the zoning issue. The League has also posted examples of ordinances that have been passed by other cities and towns like Globe, Marana, Oro Valley and Tucson.

Fairness and Transparency are the Keys to Effectively Implementing the AZ Medical Marijuana Act

Will Humble — Fri, 03 Dec 2010 09:51:20 +0000

Throughout my career I’ve learned that a cornerstone of working with the community is to make sure you have a true partnership. Every partnership starts with trust. In order to establish and maintain trust throughout our implementation period, the ADHS needs to ensure that our process is completely fair, open, honest and transparent. Part of establishing these pillars that result in trust means that we need to ensure that everybody has equal access to information and making sure that everybody has an equal voice in the process. Our top priority as we implement the Arizona Medical Marijuana Act over the coming months is to ensure that the processes we use to develop the regulations for the program are fair and transparent. Moreover, I want to ensure that we have the opportunity to benefit from everybody’s ideas. It’s my understanding that there are individuals in the community that are suggesting that they somehow have inside information into - or influence on - our processes and decision-making. Some are even suggesting that they already have a dispensary or that they have one on “reserve”. This is not the case. Nobody outside the department is involved in the development of our informal draft rule that will be posted for public comment on December 17. Nobody and no organization has any influence on our decision making, nor does anybody have any inside track to a license of any kind. Period. We are committed to ensuring that the process is completely transparent and that everybody in the State has an equal chance at input, which is why I’ve directed my rules team to write a completely internally driven first initial draft. On December 17 we’ll invite (electronic) input to everybody at once from our hub 203 website. We look forward to receiving input from all of Arizona’s residents once our draft is posted. Follow Medical Marijuana information.

Cholera in Haiti

Will Humble — Sat, 04 Dec 2010 08:37:13 +0000

There’s a big outbreak of cholera in Haiti, and health officials are working with international agencies to control the outbreak. Cholera causes severe watery diarrhea and can spread easily from person to person through contaminated food and water. The diarrhea caused by cholera results in loss of body fluids, which can cause severe dehydration and, without treatment, can kill. The best treatment for cholera is a fluid known as oral rehydration solution that replaces body fluids and salts. Outbreaks are common in areas with crowded living conditions and in communities with poor sanitation programs. However, outbreaks of cholera can also occur after major disasters that disrupt the public health infrastructure.

Arizona hasn't had any locally transmitted cholera cases in decades. If you ever travel to a country with cholera, one of the best ways to prevent it is to be sure that you're drinking clean water. Boiling or filtering water will prevent the spread of cholera. Another great way to prevent numerous diseases, including cholera, is to wash your hands with soap and water. In areas with disrupted sanitation services (as is the case in Haiti), it's important to be sure that water sources don't become contaminated with fecal matter (easier said than done in a makeshift camp). To help stop the spread, individuals should bathe and wash clothes in separate areas from drinking water and food preparation. Latrines or toilets should be built away from all bodies of water. It's also important to cook your foods thoroughly. You can read more about the outbreak in Haiti on the CDC's special website.

Kids and tobacco

Will Humble — Sun, 05 Dec 2010 09:18:34 +0000

The Bureau of Tobacco and Chronic Disease sponsored their 2010 Youth Première Event to mobilize Arizona youth in the battle against tobacco. This event marked the first time youth from around the State were brought together to learn about establishing a comprehensive and sustainable statewide youth coalition on issues related to tobacco control and addiction. More than 240 youth attended from every corner of the State on the campus of Northern Arizona University for two days in June to learn how to be leaders in their communities and to learn how they could be involved in a statewide initiative to address issues related to tobacco control within their communities. The success of the Première Event was largely dependent on the youth’s participation and enthusiasm as they were charged with carrying forth the message of tobacco prevention to their peers.

Vitamin D & Calcium

Will Humble — Mon, 06 Dec 2010 08:54:37 +0000

Calcium and Vitamin D are two essential nutrients long known for their role in bone health. Over the last 10 years there’s been a fair amount of controversy about how much people need to stay healthy. To help clarify this issue the Institute of Medicine (IOM) assessed the current data on health outcomes associated with calcium and vitamin D and used their research to update the Dietary Reference Intakes. The IOM report published this month: 1) assessed whether Americans are generally getting enough vitamin D and calcium; 2) looked into what they’re for (biologically); and 3) proposed new reference values. They basically found that vitamin D and calcium are important for bone health but not for other health conditions and that the majority of Americans are getting enough vitamin D (mostly from sun exposure). The exceptions are people living in institutions (e.g. assisted living and nursing homes) and people who have dark skin pigmentation. The report found that girls aged 9–18 often don’t get enough calcium. Vitamin D levels in the body come not only from the diet and intake, but also sunlight exposure. The body synthesizes vitamin D via UV rays. Very little sun exposure is actually needed to provide the body’s needs (for most people). The amount of sun exposure required varies greatly based on skin tone, sunscreen use, UVB rays, regional residence, time of day, and time of the year. In general most people benefit from sensible sun exposure which means 10-15 minutes/day to the arms and legs. This time could vary by up to 5 times that amount for darker complexions (as melanin slows down the reaction that creates vitamin D from sun exposure).

2011 Department Priorities Spotlight- Assurance & Licensing Services

Will Humble — Tue, 07 Dec 2010 06:46:03 +0000

I thought I’d do a piece each week between now and the end of the year that outlines our goals for the coming year. I’ll start with Licensing this week… We’ll continue on our quest to make the most of our time and effort during our surveys. We’re already doing a good job now, but as we press through 2011, I’d like to continue our efforts to focus on high-priority survey elements. The best use of our time is to focus on the things that matter the most, so that we identify important deficient practices and so that we leave a clear picture of what’s important with our licensees. We’ll also continue to develop our relationships with associations and stakeholder groups so we can leverage our time. As part of this effort, I’ve scheduled meetings with each of the associations that represent our licensees between now and the end of the year to talk about big-picture priorities and to find new ways for us to work together to improve the quality of the 1000’s of places we license and inspect. Over the course of the coming year, I’d like to overhaul behavioral health rules to streamline requirements and oversight and improve our efficient use of time in the field- as well as make it easier for facilities to provide both psychiatric care and acute care services- something that’s a challenge under our current rules. We’ll also be developing new rules for child care homes. In terms of enforcement, we’ll be reevaluating the way we approach to Civil Money Penalty assessment so that we’re more creative and use that tool to drive positive change rather than as a strictly punitive instrument. Finally, I’d like to continue to make some progress on our electronic licensing project by expanding electronic licensing tools into skilled nursing and medical facilities.

Compliance v. Enforcement

Will Humble — Wed, 08 Dec 2010 08:00:37 +0000

Those of you in Licensing have heard me talk about the difference between compliance and enforcement more than once, but I’ve never written about it. Some people are confused about the distinction I always make between compliance and enforcement. They are 2 very different things. Compliance (as it relates to our licensees) means that a facility or person in general accord with our requirements while enforcement is an action that we occasionally reluctantly take in order to get a facility into compliance. In other words, our goal is always compliance, while we never have a goal of enforcement. The most cost effective way to achieve compliance is to provide clear and understandable customer assistance, provide general education during on-site surveys, set clear expectations of our licensees, and work effectively with our licensees and associations to find out what’s working and what’s not. At the end of the line, when customer assistance, education and clarity aren’t enough to get compliance on important health and safety criteria, we sometimes need to resort to enforcement actions to move a licensee into compliance. The bottom line is that it’s the least cost-effective tool in our toolbox.

17th Annual Child Fatality Review Annual Report

Will Humble — Thu, 09 Dec 2010 08:14:38 +0000

We published our 17th Annual Child Fatality Review Report this week. Our interdisciplinary team reviewed each and every childhood death that occurred in 2009 with the goal of figuring out how each child died, so that we as public health officials, medical practitioners, families, parents and policymakers can design and implement strategies for avoiding preventable deaths in the future. This annual report has been very valuable over time because it has often found simple ways to prevent deaths (e.g. SIDS, Car Seats, etc.). This report is used by many of our stakeholders to guide program planning and interventions. The report includes recommendations that address child passenger safety, suicide investigation, reporting of suspected maltreatment and child injury prevention. While the number of deaths among children declined between 2008 and 2009, 33% of the childhood deaths last year were preventable. Three-fourths of the deaths among children ages 15-17 were from non-medical causes and 70% of these deaths were preventable. In many cases, simply buckling up would have made a difference. Fewer kids died in Arizona in 2009. A total of 947 children died in 2009 compared to 1,038 in 2008. Lack of supervision was the primary factor in 66% of the 122 home injury related deaths, which included drowning, falls and infant sleep environments. The recommendations of the interdisciplinary team are located at the end of the report.

Successful Disaster Drill

Will Humble — Fri, 10 Dec 2010 06:07:34 +0000

The Phoenix National Disaster Medical System conducted a successful Full-Scale Exercise on Thursday. We sponsored the exercise (with our federal cooperative agreement funds) along with the Phoenix Veterans Affairs Health Care System. The NDMS is a federally coordinated system that supplements the Nation’s medical response capability when local resources are overwhelmed during disasters. The exercise tested several important areas of disaster response that affect the healthcare system in the Phoenix area, including the ability of hospitals to receive, triage, and transfer patients. Our team’s role was to assist with patient tracking, communications, and emergency operations center management. Well done.

All Systems Go for Friday

Will Humble — Fri, 10 Dec 2010 08:35:31 +0000

Our preparation for the implementation of the AZ Medical Marijuana Act is on track. We've made a great deal of progress on all fronts over the last couple of weeks. The informal draft of the Administrative Code that we'll release next Friday is really starting to gel. We've got the key elements hammered out and our Rules team will be doing the cross matching with the initiative as well as the internal rule indexing over the coming week. Once our Medical Officers team reviews the draft rule next Wednesday, I'll check out their recommendations and we'll put the finishing touches on the informal draft Rule. IT has made tremendous progress on the "front end" of the database for the qualified patient and caregiver electronic application. They've started work on the "back end" and relational pieces. Our Webmaster and Marketing Committee helped polish the website for next Friday when you'll see our re-vamped website including FAQs for the general public and Stakeholders. Out IT team has also finished development of the electronic tool that we'll use to solicit electronic comments from the public from December 17 through January 7. Vital Records and Environmental Health have begun developing workflow templates and resource needs assessments. Procurement and finance have done some background work on their pieces too. Communications has begun writing the media release for next Friday and is putting the finishing touches on the FAQ for the general public that we'll post next Friday. All in all, it's been a very productive couple of weeks. Thanks for stepping up everyone!

Prescription Drugs - a Double Edged Sword

Will Humble — Sun, 12 Dec 2010 08:18:08 +0000

When taken as directed for legitimate medical purposes (and prescribed appropriately) prescription drugs can be safe and effective at treating illnesses and conditions. However, the increasing rates of prescription drug abuse are a growing and now urgent problem, especially among young people. Powerful prescription drugs are often available and easily accessible in many, if not most, homes and many parents don’t recognize that these (sometimes dangerous) meds can be tempting for teens. They’re often easily accessible in home medicine cabinets, and hundreds Arizonans face the devastating effects of prescription drug abuse every day. Accidental overdoses of drugs, followed by intentional self-poisoning (suicide) and drug abuse are the three major categories of drug-related mortality. In 2009, 1,101 Arizonans died from drug poisoning- which is twice as many as in 1999. Opioids (such as codeine, morphine, oxycodone, and other synthetic narcotics) were responsible for most drug overdoses. On top of the 1,101 deaths from poisoning (due to dependence, abuse or misuse of drugs) drug poisoning was mentioned as a secondary factor on another 511 death certificates where the main cause was heart disease or cancer or some other chronic condition. Our drug-related death statistics for 1985-2009 are available online. Only 8 of these deaths (0.7 percent) were due to drugs causing adverse effects in therapeutic use. Parents of teens should really pay attention to what they have around the house, maybe you should make a New Years Resolution to clean up your medicine cabinet. There are a number of online resources and tips for prevention . If you know a teen that needs help you can visit the national crisis information webpage.

2011 Department Priorities Spotlight- Behavioral Health

Will Humble — Mon, 13 Dec 2010 06:42:08 +0000

Last week, I outlined goals and priorities for the Licensing Division in the coming year. This week I’ll hit on the Division of Behavioral Health… One of our primary objectives will be to better integrate behavioral health, physical health, and wellness at the "retail" level (i.e. at the point of care). By strengthening integration and collaboration with community health centers and other providers of primary care, we expect to improve overall wellness as well as lower the use of emergency departments, decrease admissions and readmissions to hospitals, improve service delivery and improve adherence to treatment plans. This'll translate into lower healthcare costs while producing improved health outcomes. To kick off this year-long effort- we'll be spearheading a statewide, day-long forum in late January called Integrated Models of Care. It's being funded by the Milbank Foundation and will bring together leadership from the behavioral health and community health centers, acute care health plans, AHCCCS, Legislators, and other important stakeholders to address how we can more effectively integrate care & have a positive impact on overall public health and wellness in Arizona. Another priority will be to roll-out our new ADHS Behavioral Health Outcomes Dashboard. It's kind of like a consumer reports report that doubles as a performance touchstone. The Dashboard will track important performance measures statewide and by Regional Behavioral Health Authorities in the areas of access to care, coordination of care, service delivery, and quality of life outcomes. The Dashboard will provide helpful information to our stakeholders on our performance while demonstrating our ongoing commitment to transparency. As I've mentioned before, we need to be more focused on actual outcomes rather than processes. We need to turn timely, accurate, and meaningful data to information we can use and act on. This priority will help us in our constant quest to do better but also to recognize progress and achievements along the way. A third priority is our relationship with stakeholders, including individuals and family members receiving services in our system, advocates, and providers. The importance of a unified community with common goals, mutual trust and respect cannot be underestimated. Especially during these challenging economic times, strong relationships can facilitate compromise, creativity, and system stability and resilience. Strong leadership is needed, and we're committed to meeting that need. We'll also continue to focus on overall efficiency, reducing paperwork and maximizing the use of electronic data systems. We'll be eliminating our mandated clinical assessment tool that has been in place for many years; instead we'll focus on making sure that adequate credentialing and clinical supervision occurs for providers who conduct assessments and that clinical outcomes demonstrate individuals are getting better. The need for service providers have more “face-to-face time” with individuals (instead of filling out paperwork) is something we clearly need to address better. This will be a big year for behavioral health.

Public Health Preparedness - an AZ Strength

Will Humble — Tue, 14 Dec 2010 06:49:31 +0000

Public health threats are always present. They include natural disasters; biological, chemical, and radiological incidents; and explosions. The impact of these threats can range from local outbreaks to incidents with national or global ramifications. Last year’s influenza pandemic underscored the importance of communities being prepared for potential threats. Being prepared to prevent, respond to, and rapidly recover from public health threats can protect the health and safety of the public and emergency responders. The federal government has made large investments in public health readiness over the last 10 years. Accountability means everything these days- and the CDC continually evaluates states’ performance. In addition, every other year the CDC publishes a comprehensive report that evaluates each state’s performance. This year’s report was entitled Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State. The report evaluates each state on a broad range of preparedness and response activities and they use the results to drive program improvements, improve performance and to increase accountability for the nation’s investment in public health preparedness. Examples of criteria that are evaluated include: 1) Biological laboratory capabilities and capacities; 2) Chemical laboratory proficiency; 3) Disease reporting including 24/7 intervention response; 4) Rapid methods to communicate with other laboratories and the healthcare community for outbreaks, routine updates, and other needs; 5) Demonstrated ability to receive, distribute, and dispense medical assets from CDC’s Strategic National Stockpile and other sources; and 6) Demonstrated the ability to activate and rapidly staff their emergency operations centers for drills, exercises, or real incidents, and developed after action reports and improvement plans following these activities. I’m proud to announce that Arizona’s public health system did fantastic on this year’s report- hitting the mark on 32 of the 33 indicators- a solid “A” in anybody’s book. Congratulations Preparedness team. Keep up the good work.

New Tobacco Warning Labels on the Way

Will Humble — Wed, 15 Dec 2010 08:18:31 +0000

The Family Smoking Prevention and Tobacco Control Act (also known as H.R. 1256) went into effect last summer. The law basically gives the FDA the power to regulate some aspects of the tobacco industry. A signature element of the law imposes new warnings and labels on tobacco packaging and their advertisements, with the goal of discouraging kids from smoking. A few weeks ago, the FDA issued a proposed rule that would modify the required warnings that appear on cigarette packages and advertisements. These proposed new required warnings would consist of 9 new warning statements and color graphics showing the negative health consequences of smoking. The proposed graphic health warnings would appear on the top 50% percent front and back each cigarette package. The warnings would also need to appear in at least 20% of each cigarette ad. The FDA is required to issue final regulations requiring these color graphics by June 22, 2011. It also specifies that the requirement for the new health warnings on cigarette packages and advertisements will take effect 15 months after issuance of this final rule. Here are some of the proposed labels: Addiction, Kids, Lungs, Cancer, Stroke, Babies, Lethal, Lung Disease, and Quit. The FDA is seeking public comment on the proposed rule until Tuesday, January 11, 2011. You can submit an official comment during this time period by going to www.regulations.gov and inserting the docket number FDA-2010-N-0568 into the “search” box.

Physical Activity Improves Academic Performance

Will Humble — Thu, 16 Dec 2010 08:12:13 +0000

Everyone knows that physical activity is good for kids, actually its good for everyone. However, partly because of the increasing pressure to include more academic work in the classroom, most kids aren’t getting the recommended levels of physical activity at school. Now, there’s growing evidence that physical activity and academic achievement go hand in hand. A growing body of research is finding that there’s a connection between school-based physical activity and academic performance. To better understand these connections, the CDC recently published a review of published studies to find out what’s up. The report examined 50 studies from 43 published articles and found 251 associations between physical activity and improved academic performance. They looked at academic achievement, academic behavior, cognitive skills and attitudes. The report found what is intuitively obvious, that physical activity during the school day improves cognitive skills and attitudes and enhanced concentration and attention as well as improved classroom behavior. Maybe it’s time to think about PE as a subject that’s not just important for physical wellness, but as a tool to improve academic performance.

Flag Drops on First Medical Marijuana Comment Period

Will Humble — Fri, 17 Dec 2010 09:10:09 +0000

One of our top priorities as we implement the AZ Medical Marijuana Act over the coming months is to ensure that we develop good Rules (called Administrative Code) so we can regulate medical marijuana effectively. Rules that are clear, objective, well-researched, and that balance competing interests are absolutely critical in order to effectively implement a responsible medical marijuana program. Our goal is to develop rules that’ll ensure qualified patients have access to marijuana for their medical condition while preventing (to the extent possible) recreational marijuana users from accessing marijuana through the Act’s provisions. In addition, we want to develop Rules that ensure that marijuana dispensaries act responsibly and have adequate security and inventory controls. In order to achieve these goals we will need your help. Over the coming months we need input from all Arizona residents so that we’re able to balance all of the competing interests and come up with the most responsible set of regulations possible. I’m certain we’ll have plenty of comments from the people who intend to apply for a dispensary license or become a qualified patient, caregiver, dispensary agent, or provide medical marijuana recommendations. However, it’s more challenging to get input from residents who will have no direct interest in the industry but still want the law to be implemented in an effective way that minimizes abuse. Please reach out to some of your stakeholder groups and ask them to check out our new website, review our informal draft rules and provide us with input so that we can make good decisions. Here are a few tips for people that would like to provide input:

Use our comment website so that you can submit electronic comments

Encourage folks to tell us what they like about the informal draft rule as well as what they don’t like. There’s a tendency for people to focus on things they don’t like and it’s just as important for us to know when something is on target.

Encourage constructive comments and pragmatic alternative. It is even better if people submit alternate Rule language.

Encourage people to focus on what’s good public policy rather than submitting comments that are designed to give themselves a competitive advantage or that are self-serving.

Remember to remind stakeholders as they comment that the provisions of the Act limit our ability to regulate in many ways. For example, while the Act gives ADHS broad authority to regulate dispensaries but little authority to regulate caregivers or employer employee relations. You might want to remind folks to make sure that the Act provides the ADHS with the regulatory authority to act before spending a lot of time submitting comments.

Also, if you aren’t able to comment on this informal draft Rule between now and January 7, there will be additional time to comment in February and March. P.S. The Governor signed the Proclamation that makes Proposition 203 law on Tuesday, so the 120 day implementation period will end on April 13.

Child Nutrition Act of 2010

Will Humble — Mon, 20 Dec 2010 09:28:07 +0000

The Healthy, Hunger-Free Kids Act of 2010 became law this month. This reauthorization of the federal school nutrition program includes a number of elements that will help move the needle on childhood obesity. The Act recognizes the importance of school meals to the health and academic success of kids and gives school nutrition programs new responsibilities and resources to bring more fresh produce, whole grains and low-fat dairy products into school cafeterias. More than 31 million school kids participate in the National School Lunch Program and 11 million qualify for the School Breakfast Program. Many children get ½ of their daily calories at schools, making this program a great leverage point to improve nutrition for kids by placing more rigorous nutrition standards on the foods that are served in the program. We were actually able to get elements of our childcare Empower Pack included in the new law. When the Request For Information came out several months ago we turned in our Empower program as a best practice and it ended up being included in Section 222 of the Act. That part of the law directs the Secretaries of Agriculture and Health and Human Services to develop programming that encourages state licensing agencies to include wellness criteria within state licensing standards to ensure that licensed and regulated child care centers and family child care homes provide physical activity opportunities, limit screen time and offer food consistent with the healthy meals patterns and nutrition standards.

AZ Public Health Laboratory Capacity

Will Humble — Tue, 21 Dec 2010 08:11:19 +0000

A few years ago it became pretty clear that we were facing some budget reductions. At the time, we had no idea that our budget reductions would be as extensive as they turned out to be. However, we did know that if we were going to maintain our laboratory capacity to protect the folks of AZ, we’d have to diversify our funding sources. We looked toward the federal government primarily (mostly the FDA), but also toward places like the Arizona Biomedical Research Commission. We’ve been quite successful on both fronts in the laboratory, and we’ve been able to just about break even in terms of capacity after our steep state budget reductions. A couple of weeks ago our Lab found out that we’ve been awarded a new cooperative agreement from the USDA Food Safety Inspection Service, which is part of the Food Emergency Response Network. The new grant will support the development of new methods and validation of new technologies to rapidly detect pathogens like Salmonella and E. coli in food allowing for more rapid recalls in instances where food is contaminated. We recently used some of these technologies to isolate E. coli from certain kinds of cheese. Our new funding will also cover training activities as part of the FERN Regional Training Program where laboratory professionals and National Guard Civil Support Teams from other states come to Arizona to be trained on new state of the art instruments and methods developed to detect not only dangerous pathogens in food but also toxins and poisons in food. Finally, we were one of the few states selected to participate in developing methods to detect melamine in pig tissues as part of an ongoing USDA surveillance program for melamine in the food supply. Thanks to laboratory staff who participate in these very important FERN programs as we have been able to secure this funding and more importantly contribute to better food safety not only in Arizona but across the nation.

2011 Department Priorities Spotlight - Arizona State Hospital

Will Humble — Wed, 22 Dec 2010 11:31:28 +0000

We’ve got an exiting year in store for the Arizona State Hospital in 2011. One of the highlights will be our New Forensic Hospital which will open in the Fall. During 2010 our Forensic team reorganized their treatment groups to focus on both psychiatric symptom stability and pro-social skill development and engagement. During 2011 we’ll further apply these principles and group patients in their various phases of recovery by physical unit in the new facility. We’ll also be developing staff teams for the new units that have skill sets that better meet the therapeutic needs of the patient group. Additionally, we’ll study the new hospital environment and develop safe procedures for operation. We’ll also continue to consolidate and organize all clinical services, moving away from our silo approach (civil, forensic, ACPTC). This will enhance and improve the efficiency of our clinical expertise throughout campus. Another priority is to examine the day to day operation of all the units with the treatment staff as well as with our Security Department. We know there are opportunities to improve the inter-relationships of treatment and security, which will result in a safer treatment setting and better efficiency. Additionally, the “workforce development” training being offered in Training and Education will be provided globally throughout campus to all levels of staff. This training will be expanded for any staff providing supervision to other staff to include supervisory and leadership skill development. Another top priority in 2011 will be to improve our ability to respond during emergencies. We’ll be working on a new Continuity of Operations Planning; in it each area of the Hospital will create a specific plan that can immediately be placed into operation during an emergency. We’re also participating in the ADHS Hospital Preparedness Program, which will provide new (federal) resources to improve the State Hospital’s Incident Command Center’s communication equipment, staff training and exercises. In 2011 the Hospital will continue to enhance critical IT applications that will improve work efficiency while decreasing medical errors. This will include a fully implemented pharmacy management system that will not only aid in the ordering, dispensing and administration of medications but will also improve data for billing and drug ordering. We’ll further evaluate this system for other advanced practices such as electronic medication administration record, bar code medication administration and electronic physician order entry. In addition, we’ll continue to explore IT enhancements to other hospital operations such as Lab ordering, drawing and reporting of results. All in all- an exciting year.

Gulf Fish Testing?

Will Humble — Wed, 22 Dec 2010 13:47:01 +0000

In a post last Summer, I mentioned that our state public health laboratory Environmental & Analytical Chemistry unit has been selected as 1 of 8 chemistry laboratories across the country that would be examining commercial seafood for contaminants from the gusher in the Gulf. The goal was to find out whether commercial seafood has been contaminated by the oil spill and, if so, to determine whether the levels pose a health risk. We never actually received any samples for testing, and were recently told that no more re-opening samples will be collected through the Winter. Only a few fisheries are currently closed (in LA) and they expect to re-open these areas in Spring. There’s a chance we may be asked to participate in the reopening sample in the Spring and we could still do ongoing surveillance. We did get some new instruments along with training for our staff in Chemistry- so our quick reaction paid off last summer with increased capacity. It may have also been a factor in our successful application for the FERN funding I mentioned above.

Body Mass Index - the Future Leading Health Indicator?

Will Humble — Fri, 24 Dec 2010 07:05:58 +0000

Every year that goes by brings more solid information suggesting that the body mass index (BMI) may become the future leading health indicator. If you’re wondering what BMI is; it’s your weight in kilograms (Kg) divided by the square of your height in meters (m2). There’s solid evidence that BMIs in the upper 20s and higher are associated with a host of medical problems, many of them serious. The main risks are increased mortality from cardiovascular disease and certain cancers, but also a host of other conditions like diabetes. A new study published this month in the New England Journal of Medicine looked at the bottom line, how increasing BMI results in death (in the epidemiology world called total mortality). In the study researchers used a “reference group” of people with healthy BMIs (between 22.5 and 25) and compared them to people with higher and lower BMIs. They found what you’d expect, that people with really low and really high BMIs had a higher risk of dying early. Even being moderately overweight turns out to be a risk. For example, BMIs between 25 and 30 had a 44% increased risk of death. BMIs between 30 and 35 had an 88% increased risk of dying. It gets worse after that. BMIs between 40 and 50 were at almost 240% higher risk. These percentages are based on the ”hazard ratios” that the researchers describe in the paper. I’ve oversimplified in the paragraph above, so if you’re an epi, you better go straight to the source. Their conclusion was that “overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.” Translation: try to maintain a healthy weight if you want to live longer. There is an easy to use BMI calculator on the National Heart Lung and Blood Institute's website.

What's a Certificate of Necessity, Anyway?

Will Humble — Mon, 27 Dec 2010 08:21:59 +0000

Arizona uses a Certificate of Necessity (CON) system to regulate ground ambulance service in Arizona- and to make sure that every place in the State has adequate emergency medical services, including the frontier parts of AZ. The CON actually describes the geographic service area, level of service (advanced life support or basic life support), hours of operation, response times, effective date, expiration date and any limiting or special provisions for emergency medical services in the specific geographic area. A ground ambulance service that is awarded one of our CONs must stick with the criteria on their certificate and operate in accordance to the statutes and rules by which it is governed. Check out these links for statutes and ground ambulance rules for the details of how it works. We just posted some new guidance for folks who are interested in applying for new CONs for emergency medical services. The new guidance basically summarizes our statutes and rules for applying for a new CONs, which includes a requirement that the applicant shows that there is a "public necessity" for the new service. Our new guidance makes it clear that we'll evaluate public necessity by analyzing the needs of the community, the adequacy of the current services provided, maximizing the use of contemporary EMS protocols that have been demonstrated to save lives and quality of life, and ensuring cost controls. Specifically, our new guidance clarifies the kind of information we'll use to make our decision whether to approve new CONs, including whether the applicant demonstrates:

A plan for a robust, on-going benchmarking and performance improvement process that encompasses all components of the EMS system from emergency medical dispatch through emergency department arrival;
A plan to collect and submit electronic patient care reports consistent with our EMS Bureau’s guidelines;
A plan to adopt clinical guidelines and operating procedures for time sensitive illness consistent with American Heart Association best practice guidelines;
A plan to initiate guideline-based pre-arrival instructions for all callers accessing 9-1-1 for assistance;
Evidence of regular attendance and participation in meetings of the regional and State EMS Councils;
A plan to ensure that ambulance service will be maintained and improved for rural communities; and
Assurance that the service model will be cost effective and not result in higher ambulance rates.

Our overall goal is to basically improve the quality of EMS service by championing effective life-saving practices while making sure that costs are contained. The good news is that many of the recent developments in EMS care are operational and inexpensive (like using the new CCR method for resuscitation).

2011 Department Priorities Spotlight- Public Health Prevention

Will Humble — Tue, 28 Dec 2010 08:52:07 +0000

The name of the game for Public Health Prevention in 2011 is integration and leverage. Our Public Health Prevention Team will be focusing on the social determinants of health and working to implement policies, systems and environmental changes that make the healthy choices easy. Here are some examples of our public health prevention priorities for the coming year: Worksite Wellness Perhaps one of the biggest leverage points for improving community health lies with Arizona employers. Employers are increasingly recognizing that a healthier workforce is a more productive and efficient workforce and by applying simple public health prevention tools that can improve their productivity. We’ll be using our Worksite Wellness Tool to help Arizona businesses to adopt wellness and health promotion activities for their employees. The kinds of simple things we’ll be working with them on are smoking cessation, weight management, nutrition, heart disease prevention, diabetes prevention, etc. Businesses that are self-insured (for health insurance) have double the potential gains because they’ll eventually benefit from worksite wellness with lowered premiums. State Government Wellness We’ll also build on our partnership with the ADOA to offer our services in augmenting the State wellness initiative and working with St. Luke’s Health Initiatives and others to make evidence based public health resources available to employers. Included in this effort will be:

Diabetes Self-Management Training - Almost 10% of state employees have diabetes, and we’ll be partnering with ADOA to increase use of self-management (the cornerstone of treatment and care) to improve care;
Launching a state-wide "Hands Only" CPR initiative on three fronts: Public (bystander) Awareness, Systems-Level Protocol Change (Dispatch - 911), and Worksite (employee) training;
Design and launch a public awareness campaign focusing on early detection and effective disease management for Arizonans with colon, breast and cervical cancers;
Expand our reach and utilization of tobacco cessation efforts via ASHline (phone and web-based services) among the behavioral health population, through partnering with some of our Regional Behavioral Health Authorities to create systems-based referrals in each behavioral health clinical site.

Nutrition & Food Stamps We’ll also be working with other interested states and public health associations to change what foods qualify for purchase under the federal Supplemental Nutrition Assistance Program or SNAP (formerly called food stamps). This is an idea that is getting national attention, including a recent article in the American Journal of Public Health that outlined a number of ways to improve diets of SNAP participants along with everyone else. This issue will be considered when Congress votes on the new Farm Bill in 2013. The Healthy Hunger Free Act of 2010 signed by the President this week will strengthen nutrition education provided to SNAP participants by focusing on obesity prevention and allowing public health approaches to be more fully incorporated into SNAP nutrition education activities. Visit www.eatwellbewell.org to see the nutrition education currently available to families receiving SNAP benefits in Arizona (don’t miss the videos and games). Breastfeeding We’ll be continuing to press our efforts to make institutional changes in maternity care practices and increase breastfeeding initiation and duration. Arizona’s “5 Baby Steps to Breastfeeding Success” are the hospital practices that make the biggest difference. Our Breastfeeding Team is working with Arizona Perinatal Trust to train 5,100 nurses in 31 APT-certified hospitals statewide on Arizona’s 5 Baby Steps to Breastfeeding Success. All of these hospitals are committed to changing their policies to support breastfeeding. The technical assistance from ADHS is the key in mentoring the hospitals through model policy training and moving the policy from paper to action. Health in Schools We’ll also be using a more coordinated approach as we work with Arizona schools on various health initiatives. Our new school coordinating committee will continue to share resources, streamline access and improve outreach for all of our programs. The bottom line is that healthy children learn better and offering daily physical education or daily school breakfast can improve academic performance. We’ll be helping schools to complete the CDCs School Health Index assessment tool that they can use to develop a plan to improve their health-related policies and programs. Strengthening school wellness policies, supporting farm-to-school programs, and increasing physical activity throughout the school day are all high priorities for the collaborative work. Check out the Coordinated School Health website at http://www.healthologyaz.com/ to learn more about school health in action. Of course there will be alot more than just these things going on in public health prevention in 2011, but this gives you a taste of what’s up.

Community Health Center Expansion News

Will Humble — Wed, 29 Dec 2010 08:28:09 +0000

The US Department of Health and Human Services is in line to receive $11 Billion in funding over the next 5 years for the operation, expansion and construction of health centers nationwide. These funds will be made available through a nationwide competitive grant application process. Our Bureau of Health Systems Development is the Arizona designated Primary Care Office, which means we’re the linkage between community health centers and workforce development, healthcare shortage designations, community development, technical assistance and Need for Assistance Worksheets. All are components of the establishment, expansion and sustainability of a Federally Qualified Health Center (FQHC). In August 2010, the HHS primary care program released $250M for New Access Points (basically new FQHCs) and substantially expanded the level of data sets a grant applicant would need to report on to establish need in a given community or area. This is known as the Need for Assistance Worksheet. Our staff has been working hard to update the database, gather data, establish a quality assurance process that’s used to produce the NFA Worksheet. The worksheet looks at census tracts and provides a score that is based on specific core barriers to care and other health indicators to prioritize underserved areas in need of more healthcare resources. On October 26, 2010 HHS released another $335M for existing community health centers nationwide under the Expanded Services Initiative. These funds are intended for increased access to preventive and primary health care, including dental health, behavioral health, pharmacy, vision, and/or enabling services at existing health center sites. Grant applications are due on January 6, 2011. What does all of this mean for Arizona? Potentially new health centers and the expansion of services (hours of operation, more doctors, dentists, addition of onsite pharmacy, etc) at existing centers will result in the near future from these grant funds. Today there are 16 federally qualified health center organizations in Arizona with over 100 physical locations statewide. The availability of funding will provide a great opportunity for growth of FQHCs in Arizona and nationwide while improving access to care. This also provides us with a unique opportunity to build better linkages between primary/acute healthcare and psychiatry because the expansion initiative for community health centers includes both acute/primary care as well as behavioral health. Do you know where the nearest Community Health Center is to your house? Cure your curiosity by using this HHSs Electronic Tool.

Masters in Public Health Program Comes to the Valley

Will Humble — Thu, 30 Dec 2010 10:24:30 +0000

The new Phoenix-Collaborative MPH in Public Health Practice program as well as a distance learning Graduate Certificate in Public Health are two great options for individuals looking to advance their knowledge about public health. The Master of Public Health in Public Health Practice is a new interdisciplinary program that prepares students to develop the public health skills needed to work in a variety of governmental and non-governmental settings including the local, county and state departments of health, the Indian Health Service, Medicaid and Medicare programs, hospitals, and community health centers. Students learn to work effectively as part of multidisciplinary teams to develop, manage and evaluate public health programs that are appropriate for decreasing health disparities between and within diverse populations. If you’re interested in expanding your professional horizons or if you simply have some intellectual curiosity about our growing field, check it out!

New Year's Resolutions & Public Health

Will Humble — Fri, 31 Dec 2010 08:04:43 +0000

Our Tobacco Prevention Program will be hitting targeted audiences (lower income Arizonans) a few days before New Years and during January with smoking cessation messages. There’s no better time to motivate folks to quit smoking than January because that’s the time of year when people generally set health goals for themselves. The ads (funded by a dedicated and voter protected tobacco tax) are designed to give people tools to increase their chances of success. There’s no easy way out once you are addicted to nicotine, but there are nicotine replacement therapies like the patch, gum, and lozenge; and there are medications such as Zyban^® and Chantix^® that can help. You can read more about cessation strategies and resources on our ASHline. Thanks to ADHS staff and all of our partners in the community and other government agencies for their hard work this year. We have a lot to be proud of… and have a great Holiday…

2011 Department Priorities Spotlight - Public Health Preparedness

Will Humble — Tue, 04 Jan 2011 09:37:59 +0000

Medical Marijuana will be implemented in April, 2011. The coordination of tasks to ensure smooth and efficient implementation is a huge goal for 2011 and cuts across Bureau lines, involving many distinct portions of not only Public Health Preparedness but the Agency as a whole. Emergency Medical Services Within the Bureau of Emergency Services and Trauma Systems, the highest priority is to conclude planning and implement a web-based EMT certification process. The Bureau processes approximately 10,000 initial or renewal EMT certifications each year by hand. Additionally, our highly successful Trauma Systems will continue to add level IV trauma hospitals and repeat our 2008 “Access to Trauma Care” analysis to determine the impact of the level IV Trauma Center Designation on delays in accessing trauma care in rural Arizona. We will perform a review and analysis of our current trauma triage criteria to determine if they are effective in matching the patient with the appropriate trauma care and trauma center Bureau of Public Health Statistics The Bureau of Public Health Statistics’ priorities for 2011 include making the Medical Marijuana Program successful, creating a self sufficient Vital Records Office, increasing the stability of our Cancer Registry, and ensuring high quality and timely vital statistics, hospital discharge, Behavioral Risk Factor Surveillance System (BRFSS) and registry data is available to the Department and our public health partners. Emergency Preparedness The Bureau will continue to focus on building partnerships and coalitions. The best use of time is to focus on lessons learned from real events and exercises, so that we identify important deficient practices and that we leave a clear picture of what’s important for ADHS to assist our partners with during a response to Public Health Emergencies. Another goal is to assist our healthcare partners with plans to develop integration and interoperable communication strategies along with assisting them on training needs. Epidemiology and Disease Control Services As we move into 2011, the priorities of the Bureau of Epidemiology and Disease Control are to streamline our programs and become more efficient, all while continuing to serve our stakeholders, partners, and the public. Many of our offices are collaborating and looking for ways to provide more comprehensive programs: programs that don’t just address one disease or issue, but the entire patient as a whole. For example, we are currently working on developing a healthy homes program that will not only encompass childhood lead, but will also address asthma triggers, integrated pest management, utilization of green household cleaners, and appropriate weatherization. Improving our public health response is one of the top priorities and will involve improving the percent of tuberculosis cases that complete recommended treatment, ensuring that outbreaks and critical infectious disease cases are investigated within 48 hours and that appropriate interventions are implemented as soon as possible, enrolling HIV/AIDS clients into health reform insurance programs to provide them with better coverage and comprehensive care, promoting pertussis immunization initiative by serving as the inaugural state for the 2011 National Infant Immunization Week (NIIW). Arizona State Public Health Laboratory The primary goal of the Lab is to continue to seek out new grants and other sources of funding to expand and enhance our state of the art facility’s potential for serving public health needs in Arizona. The Lab is enhancing its Laboratory Information Management Systems (LIMS), and STARLIMS, to standardize its work processes with other public health laboratories throughout the country and satisfy federal grant requirements for reporting of communicable diseases. The Lab/Epidemiology and Information Technology Services are working on the Public Health Laboratory Interoperability Project (PHLIP) to share results of influenza testing performed at the Lab directly with the Centers for Disease Control and Prevention (CDC) through electronic encrypted messaging. Expansion of the PHLIP and HITECH projects will be continuing throughout the Fiscal Year 2011. The Lab will be enhancing its Tuberculosis (TB) testing services by expanding its nucleic acid amplification testing capacity, providing more rapid services to the community through the use of newer, less labor-intensive testing methods in 2011. The procedure also will allow for molecular detection of the gene linked with drug resistance to Rifampin, which is associated with multi-drug resistance in TB. The use of the new TB assay will reduce the turnaround time for drug resistance reporting from an estimated 7-14 days down to 2 hours. The Newborn Screening Program has received approximately $300,000 in grant funding from Health Resources Services Administration (HRSA) for Early Hearing Detection and Intervention for 2011. The program is partnering with the Ear Foundation to support efforts to detect hearing disorders. The Newborn Screening Program has received $150,000 in federal funds through the CDC to upgrade the hearing database for ongoing monitoring of newborn hearing screens.

Dead Bats

admin — Wed, 05 Jan 2011 08:13:01 +0000

The Department is helping investigate a recent die off of bats in the Tucson Area. About 70 bats were found dead at the overpass near Speedway and Pantono. Initially, there was concern that the animals may have died from rabies, as rabies is always a concern when bats are downed or behaving strangely. However, a sample of bats was sent to the state laboratory and all have tested negative for rabies. There has been an increase in bat deaths nationally, due to the spread of a fungus, and Arizona Game and Fish will continue the investigation to determine the cause of these deaths. Since there was a recent application of chemicals near the area, it is likely that these deaths may be due to accidental poisoning. It is also possible that changes in weather and delayed migration of the bats may have caused these recent deaths. The following are some important bat safety tips: * Do not touch down or dead bats * Call animal control to remove injured bats from your property * Teach children not to handle or touch sick or injured animals including bats If a bat bites you, consult your physician or local health department to determine whether you need treatment. UPDATE 01/05/2011 An update to the dead bat in Tucson investigation from Arizona Game and Fish Department. Trauma caused by BB gun appears to be the cause of bat mortality. But, further testing is pending. This is based on: - 4 or 5 bats checked by USGS lab found signs of trauma and extracted BB pellets from a bat or two. - Bats were Negative for white nose syndrome. - No evidence of poisoning. The de-icing salts used on bridge would not have been considered toxic to the degree to cause the bat mortality. AZ Game & Fish has 10+ bats that are waiting for necropsy to see if the BB gun theory holds up. So, human caused trauma appears to be the primary theory. But, the final answer is still pending.

Influenza Widespread in AZ

Will Humble — Thu, 06 Jan 2011 09:13:23 +0000

With last year’s pandemic, we saw how influenza can be unpredictable in terms of who it affects most, when it occurs, and what strains will circulate. This season we are back to a more usual flu season, at least so far. Our first laboratory-confirmed cases were detected earlier than most years (at the end of September), but influenza just kind of bumped along until it really started picking up speed in the in the last few weeks. All counties have found laboratory-confirmed cases this season, and we’re declaring flu to be at “widespread” levels in this week’s Surveillance Report. We’ve found all three of the common types of influenza virus in Arizona this season, our old friend Influenza A (H3N2), the 2009 H1N1 pandemic strain and influenza B. In most seasons we see at least two different strains (like this year). Last year was unique, and the H1N1 virus displaced all the other influenza viruses. Our state lab has done a lot of PCR and culture testing to find out more details about the circulating viruses, and the good news is that, so far, the three strains in the vaccine are a good match with the circulating strains in Arizona and nationally. This year, CDC started distributing vaccine to state and local programs earlier than ever. Despite the fact that there has been plenty of vaccine in Arizona since early fall, demand by the public for flu vaccine has been very light this year. Because Arizona normally has a late season peak in flu, it is not too late to vaccinate. Our Immunizations team continues to work with counties and The Arizona Partnership for Immunization (TAPI) to encourage continuing flu vaccination through the spring. You can find your nearest flu shot clinic by visiting our flu shot locator.

Medical Marijuana Public Comments

Will Humble — Fri, 07 Jan 2011 08:06:29 +0000

So far, we’ve received well over 1,300 comments on the Informal Draft Rules that we posted December 17. Our first comment period ends today. We’ll be reviewing the comments and revising our initial draft over the next couple of weeks. We’ll be releasing new draft rules for public comment on Monday, January 31, kicking off our next comment period (which will go through February 18). After that, we'll craft the final Rules and publish the finished package on March 28. The following issues are generating the most comments:

The definition/requirements for patient-physician relationship;
Adding additional medical conditions including mental illness, PTSD, fibromyalgia, depression, etc.;
The fee structure (especially for patients with limited income);
The 25 mile limit for patient/caregiver cultivation (which is actually in the Initiative, not the rules);
The requirement that dispensaries cultivate 70% of their own product;
The processes for approving dispensary registration certificate;
The requirement that dispensaries have a medical director;
The qualifications for medical directors (e.g. allow other medical professionals including a pharmacist, naturopathic physician, homeopathic physician, family nurse practitioner, physician assistant, or registered nurse to be the medical director);
The 2 year residency requirement for dispensary applicants; and
The requirement that cultivation facilities be licensed in association with a dispensary (which is actually in the Initiative).

Overall, the comments so far have been constructive and many have been positive and support much of the overall language in informal draft rules. All the comments on the informal draft rule are part of the public record and will be available for review on our hub 203 website (with personal identifiers removed) by next Wednesday.

Tucson Response

Will Humble — Tue, 11 Jan 2011 17:37:07 +0000

I know many of you are following the tragedy that occurred over the weekend in Tucson. If you’re like me, you’ve been trying to make sense of something that is senseless. It is not uncommon to have a variety of reactions to a sudden and violent event such as this, and you may be struggling with how to respond to your own feelings or those of your family members, especially your kids. We’ve got a variety of resources that you might find helpful. And, as an employee, you have access to the Guidance Resources Program 24 hours a day, 7 days a week just by calling 1-877-327-2362. You can also access it online at www.guidanceresources.com. You can schedule a time with an Employee Assistance Program (EAP) approved counselor and receive up to 6 free individual sessions. For those who don't have programs like that, there are two hotlines set up to help answer your questions and deal with any issues you may have. Those who live in Pima County can call 520-284-3517 and those who live in the rest of the state can call 800-203-CARES (2273). And a special thanks to the Division of Behavioral Health Services and Emergency Preparedness Teams as they are working to support the Pima County RHBA—CPSA and Local Health Office to help coordinate the crisis response.

Medical Marijuana Public Comments Available

Will Humble — Wed, 12 Jan 2011 17:37:53 +0000

Medical Marijuana Public Comments Posted We received more than 1,500 comments on our initial proposed rules to regulate medical marijuana. All the comments (over 1,000 pages) are posted on our http://www.azdhs.gov/prop203/ website for viewing. Our team is very busy reviewing the comments and suggestions looking for good ideas that will help build a more effective program. By the way, as we review the comments that we've received, we're not really interested in the sheer number of comments by category. Rather, we're examining the quality and content of the suggestions with an eye to finding comments that will help to build a more effective, efficient, and practical medical marijuana program (as opposed to a recreational marijuana program). We're also looking at whether the comments fit within the statutory authority as outlined in the Initiative. Our next draft rule package is due January 31, which will kick off our next comment period.

What’s Respiratory Syncytial Virus?

Will Humble — Thu, 13 Jan 2011 09:18:26 +0000

Respiratory syncytial virus (or RSV) is another respiratory infection that mainly affects little kids and circulates every year. It occurs in the winter, like flu, but flu and RSV usually don’t peak at the same time. Since our flu season is early this year, it looks like our RSV season may be a little later than usual. We’ve had quite a few laboratory-confirmed cases already and we’ve let clinicians know a few weeks ago that RSV was circulating in Arizona. There’s no vaccine for RSV but clinicians can give a preventive antibody treatment while RSV is active to those at greatest risk, like premature infants. You can check out our weekly RSV Surveillance Report for more info.

Ensuring Healthy Birth Outcomes

Will Humble — Fri, 14 Jan 2011 15:49:54 +0000

What’s the most important thing we can do to ensure a good birth outcome? During the 1980s and 1990s, public health focused on the importance of prenatal care and ensuring that every woman got into prenatal care early in the pregnancy and continued with consistent care throughout the pregnancy. Programs like Health Start enlisted lay health workers in communities to identify women early in their pregnancy and link them with prenatal care were successful in improving our prenatal care rates. In 1999, Arizona was one of the first states to employ a new analytic method called the Perinatal Periods of Risk Model to examine birth and death records to pinpoint the greatest risk for poor birth outcomes. To our surprise, we found that the greatest contributing factor to poor birth outcomes were conditions that existed prior to pregnancy. Things like the general state of the mother’s health including nutrition, tobacco and alcohol use, and chronic conditions such as obesity, diabetes and high blood pressure. A major shift began at that point to focus more resources on women’s health including family planning, nutrition and physical activity and early screening, diagnosis and control of chronic conditions prior to pregnancy. It turns out that obesity has become the most common risk factor for a poor birth outcome because of the link to complicating conditions that increase risk in pregnancy. For more information on the department’s efforts around preconception care, check out the website for Perinatal Periods of Risk analysis and Every Woman Arizona materials.

Update on the Governor's Budget Proposal Regarding Persons with Serious Mental Illness

Will Humble — Sat, 15 Jan 2011 15:53:32 +0000

On January 15, 2011, Governor Brewer released her proposed budget for next fiscal year (which begins July 1, 2011). One of the budget items would change AHCCCS (Medicaid) eligibility for adults without children (called childless adults). The ADHS currently provides behavioral health services to approximately 5,200 persons with serious mental illnesses that are childless adults. While it may appear, and we were originally concerned, that this would mean that childless adults with a serious mental illness may lose their current benefits if the proposal is implemented, we think there's a way to ensure that more than 80% of these folks can maintain their current benefits under a different Medicaid category. We believe that most of the childless adults that have a serious mental illness and are currently receiving services from the ADHS could still qualify for their full benefits including behavioral health services under a different federal category for the disabled (called Supplemental Security Income Medical Assistance Only). Qualifying for this new category requires a review of each person's medical condition to see whether they meet the standard. We believe that more than 80% of the childless adults with a serious mental illness that are receiving behavioral health services can qualify under the Supplemental Security Income Medical Assistance Only category. This means they would maintain their current benefits. In order to help these individuals retain coverage, we are instructing our Regional Behavioral Health Authorities and our behavioral health providers to immediately implement a coordinated approach to screen every single childless adult with a serious mental illness that is currently receiving services from the ADHS for eligibility under the Supplemental Security Income Medical Assistance Only category.

Teen Pregnancy Prevention Resources in AZ

Will Humble — Tue, 18 Jan 2011 08:37:06 +0000

To combat teen pregnancy, ADHS uses multiple approaches that best fit with needs of local communities. Our Bureau of Women’s & Children’s Health has implemented teen pregnancy prevention programs since 1997 and currently administers the Abstinence Education Program and Comprehensive Education using lottery dollars and new federal funding authorized through the Affordable Care Act. The federal Title V Abstinence Education Program was reauthorized and funded through June 30, 2014 under federal Health Care reform. Arizona’s annual award is $1.3M. The Healthcare reform law also amended Title V (of the Social Security Act) to include a new formula grant program entitled the Personal Responsibility Education Program funded through FY 2014. The program must be designed to educate adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted infections. Our annual award is $1.1M for this new program. Lottery funds that ADHS receives (about $3M per year) for teen pregnancy prevention serve to meet federal match requirements for Abstinence Education and federal maintenance of effort requirements for the Personal Responsibility Education Program. Local programs funded by ADHS implement evidence-based strategies, such as:

service learning programs which focus on keeping young people constructively engaged in their communities doing community service;
youth development programs that take a broad approach to encouraging young people to think and plan for their future;
curriculum-based education that is offered as part of regular school classes or in after-school programs; and
parent programs that seek to improve parent-child communication.

Parents are very important in preventing teen pregnancy. A public opinion survey, With One Voice 2010, recently released by The National Campaign to Prevent Teen and Unplanned Pregnancy provides some critical insight:

Teens (46%) say parents most influence their decisions about sex. By comparison only 20% say friends most influence their decisions.
Eight in ten teens (80%) say that it would be easier for teens to delay sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations about these topics with their parents.
Six in ten teens (62%) wish they were able to talk more openly about relationships with their parents.

The National Campaign to Prevent Teen and Unplanned Pregnancy offers great resources and tips for parents through its parent portal, including the new Talking Back publication identifying the top ten things that teens want adults to know about teen pregnancy.