Maternal and Child Health Advisory Task Force
Friday, December 7, 2012
Meeting Summary
Members:
Julie Jagim
Martha Overby
Bev Wangerin
Joan Brandt
Carol Grady
Neal Holtan
Deb Purfeerst
Kristin Teipel
Tanya Hagre
Carolyn Allshouse
Stephanie Graves
Nancy Jost
Stephanie Watts
John Hoffman
Ken Bence
Meredith Martinez
Rosemond Owens
Michelle O’Brien
Guests:
Jolene Tesch
Kelly Harder
Gay Bakken
Richard Chase
Cindy Toppin
Phyllis Haag
Carol Miller
Karen Muller
Jane Jasmin
Daniel Runion
Joan GrangerKopecky
Mary Montague
Bonnie Brueshoff
Paul, Annamarie,
Eve Saarinen
Sheila Kiscaden
Sharon Diedrich
Wendy Bauman
MDH Staff:
Amy Gaviglio
Kathy Wick
Pat Adams
Maren Harris
Maggie Diebel
Faith Kidder
Mark McCann
Nafla Poff
Guisselle del Salto
Candy Kragthorpe
Jeanne Carls
Barb Dalbec
Jen Harvey
Tony Steyermark
Michelle Chiezah
WELCOME AND INTRODUCTIONS AND CHAIR REMARKS
Julie Jagim, Task Force Chair welcomed members and guests. The agenda for the meeting was reviewed. Julie
asked for a motion to approve the September meeting minutes. Ken Bence made a motion to approve the
September minutes, Nancy Jost seconded the motion. Motion carried.
PRESENTATION OF THE BETTY HUBBARD MCH LEADERSHIP AWARDS
Commissioner of Health Ed Ehlinger presented the 2012 Betty Hubbard MCH Leadership Awards. Annamarie
Saarinen received the statewide award for work on assuring screening of newborns for critical congenital heart
disease (CCHD). Congenital heart disease is a heart defect that affects one in every 100 newborns. She has
spearheaded both state and national efforts to ensure that all newborns are screened.
Gay Bakken received the community award for her work on a program that provides home visiting support to
families with multiple risk factors in the Twin Cities metro area. Gay has had a long career working in Dakota
County. Gay promoted an intensive home visiting model that became the Dakota Healthy Families program.
This program has expanded to the Metro Alliance for Healthy Families.
The press release is available at the following link on the MDH website. More information about the Betty
Hubbard Award recipients and photos from ceremony are available on the following link on MCH Advisory
Task Force website.
PRESENTATION OF CERTIFICATES OF APPRECIATION
Commissioner Ed Ehlinger recognized those Task Force members who will be leaving the Task Force at the end
of the year. He acknowledged the following people and thanked them for their service to the Task Force and the
MDH:
• Susan Castellano
• Bev Wangerin
• Coral Gardner
• Marianne Keuhn
• Lydia Caros
• Linda Hanson
• Amos Dienard
• Rich Lussky
• Grit Youngquist
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MINNESOTA DEPARTMENT OF HEALTH UPDATES
Maggie Diebel provided updates on MDH activities. Following is a summary of her remarks:
• The MDH is involved in the development of a Prenatal to Three Plan. The group has had its final meeting.
The MDH is also pursuing a grant to receive technical assistance on the development and implementation of
the plan. More information about both of these issues will be shared with the Task Force as it becomes
available.
• The MDH hopes to release Adverse Childhood Experiences (ACE) data from the Behavioral Risk Factor
Surveillance System (BRFSS) in January. The data is generally reflective of results seen at the national
level. The ACE data comes from a series of questions included in the BRFSS which look at early childhood
experiences and their impact on health later in life.
• The Task Force previously received an update on Healthy Minnesota 2020. The needs assessment and
Healthy Minnesota Framework were released earlier in the year. One of the areas of focus is “Healthy Start
for All Children.” The next steps include working with stakeholders to build support to focus efforts and
resources on the identified outcomes. More information can be found on the following link to the Healthy
Minnesota 2020 website.
• Governor Dayton’s Children’s Cabinet – including the commissioners of Health, Human Services and
Education – is beginning to roll out a strategic plan. The plan includes early childhood, children’s mental
health, and family home visiting. This strategic plan my manifest itself by some of these issues going
forward as priorities for the Governor during the upcoming legislative session.
• The MDH and the state are monitoring the impact of the state deficit on programs. State agencies recently
submitted a report to the Minnesota federal legislators about the impact of the “fiscal cliff” on state
programs.
• Last legislative session, the MDH was awarded $200,000 for a qualitative study on autism – primarily in the
Somali community. The MDH is finalizing an agreement with the University of Minnesota School of Public
Health to serve as the technical lead on the study. The MDH is contributing additional funding to add a
focus on the Hispanic and Hmong communities. This will be a participatory study in that the community
develops the research questions.
• Laurel is leaving the MDH on January 15, 2013. She will be greatly missed by the MCH program and the
MDH. Maggie is in the process of looking for her replacement. The Task Force will be kept informed.
COMMUNITY & FAMILY HEALTH DIVISION UPDATE
Laurel Briske, MCH Section Manager and Barb Dalbec, CYSHN Section Manager provided updates on
Community and Family Health Division activities. Following is a summary of their remarks.
Laurel:
• There are several new staff in the MCH Section and several were in attendance at the meeting.
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Michelle Chiezah, the new Infant Mortality Coordinator, will be responsible for developing a state plan
to reduce infant mortality. This plan will be discussed/reviewed by the Task Force. Information on
tracking infant mortality reduction activities is included in the 2013 Task Force work plan.
o
Kathy Wick was recently hired as the new supervisor of the Child and Adolescent Health Unit. There
has been some reorganization and the adolescent health activities have been added back into this unit.
Kathy is in the process of hiring an adolescent health coordinator.
o
Mary Jo Chippendale has been hired as the second supervisor in the Family Home Visiting Unit. Mary
Jo was the Women and Infant Health Unit supervisor. That position is currently open.
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• When the adolescent health coordinator is hired, they will be working on the development of a state
adolescent health plan. Kristin Teipel has agreed to chair a work group that will assist in the development of
that plan.
• Martha Overby has been hired as the State Director of Programs and Government Affairs for the March of
Dimes. The March of Dimes and MDH work working on a prematurity reduction project. Members viewed
three videos featuring the Commissioner of Health. These videos will be distributed to clinics, public health
and WIC programs around the state to be played in waiting rooms. The videos can be viewed on the
following links:
o Why babies need time
o Don’t rush your baby’s birthday
o Questions to ask your health care provider
Barb:
• Barb introduced Tony Steyermark. Tony is the supervisor of the Newborn Screening and Long Term
Follow-Up Unit.
• There is currently a pilot project underway in rural Minnesota to determine how quickly infants identified
with Critical Congenital Heart Defects (CCHD) can be transported to hospitals equipped to deal with their
issues.
• The Minnesota Public Health Lab has started to identify Severe Combined Immune Deficiency (SCID). The
public health lab has been working with the Wisconsin Public Health Lab to confirm testing and get lab
approval. Four cases have been identified since testing began.
• The last CYSHN Work Group meeting was held recently. A draft report from the work group will be shared
with the Task Force (probably at the March meeting) for review and input. The work group has identified
some focus areas and will be doing some prioritization of issues.
• January is Birth Defects Prevention month. Packets will go out to local public health and physicians. The
MDH is waiting for CDC to finalize the materials before it can be distributed. The Governor will sign a
proclamation in mid-January.
• The legislatively-mandated Autism Task Force is developing their final recommendations. The report will
be released to the legislature and Governor Dayton in January. The recommendations do not contain any
surprises. The main benefit of the group was to garner agency and advocate support to focus on a few key
items. The report will be shared with the Task Force when it is finalized.
• The MDH Follow-Along Program completed a survey of local public health to track the minimum
components for developmental screening being conducted in local programs. The goal is to identify best
practices. The FAP is working with the Minnesota Department of Education to determine next steps.
INFANT MORTALITY REVIEW: NEXT STEPS
Stephanie Grave, Task Force member from the Minneapolis Dept. of Health and Family Support provided an
update on the American Indian and African American infant mortality review projects and discussed the next
steps in the process. Following is a summary of her remarks:
• Infant mortality reviews begun in 2011-2012 in both the American Indian and African American (U.S. born)
communities for the years 2009 and 2010.
• The reviews were community-driven with support (facilitation, technical expertise) from the Office of
Minority and Multicultural Health and Maternal Child Health Section of MDH.
• A prior review was done in the American Indian community with recommendations made and Community
Action Teams (CAT) developed. This was the first African American infant mortality review conducted.
• Both the American Indian and the African American reviews contained approximately 29 cases.
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• Maternal interviewers from both communities were trained in conducting maternal interviews.
• Reviews involved all available resources including birth and death records for all cases and autopsy records
for cases where autopsies were conducted. For cases where the mother was able to be contacted and
consented to participate, medical records were abstracted and a maternal interview conducted.
• Barriers to contacting families included:
o Lack of current contact information including addresses and phone nos.
o Inability due to data privacy to utilize other means of locating families
• Approximately four families were located in each community. Two cases in each community provided
consent that allowed for medical records to be abstracted. Some consents included wrong dates for birth or
death or different name which precluded release of records from health care providers.
• Based on previous experience of the American Indian case review team, recommendations were made that
will move forward for work by three Community Action Teams.
• Only a few members attended the one African American case review team meeting. The meeting was rich in
discussion but due to the small number of members and cases, recommendations could not be generalized
and moved to implementation.
•
Considerations:
o Timely review of deaths (families contacted 6-9 months after death)
o Data sharing agreements that would facilitate access to current addresses and phone numbers of families
o Ongoing infant mortality reviews vs. periodic infant mortality reviews
o Community or population specific vs. all infant deaths or other options such as all infant deaths with
specific communities/populations reviewed together
o Availability of funding
o Utilize the next year as a planning year for recommendations regarding the above considerations and the
future of infant mortality reviews in Minnesota.
MEMBER NEWS AND ISSUES
John Hoffman: John was elected to the Minnesota Senate during the last election. He received is legislative
committee assignments, including E-12, Finance and Elections.
Midway Training Services is going to rebrand in January as Allied People Solutions. They have seen the
employment numbers for people with disabilities go up, but unemployment for people with disabilities is still a
chronic problem. The company is very excited about the change.
Ken Bence: The commissioner of Human Services recently gave out the Commissioner Circle of Excellence
Awards. One of the recipients was the Wellness Preferred Integrated Network (PIN), a physical and mental
health services partnership between Medica Health Plans and Dakota County. PIN brings together resources to
coordinate physical and mental health care services for people with mental illness living in Dakota County. The
program is trying to reduce the difference in life expectancy for the mentally ill.
Hearth Connection is a program that integrates health and homeless services to help people get out of
homelessness. The program has extra spots so Medica is help to fill those spots with people enrolled in Medica
to assure access to health services.
Tanya and Ken are involved in health plan efforts to decrease low birth weight infants. This effort is aligned
with the March of Dimes initiative. Health plans have been working over the past year to reduce elective
inductions in Medicaid enrollees.
A group is working on reestablishing the Center for Population Health. The Center existed about 10 years ago
and worked on how to support population health. There is currently an interest in bringing this organization
back. There is also some interest in getting a Public Health Institute working again in Minnesota. The Minnesota
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Institute of Public Health was housed at Blue Cross Blue Shield, but was disbanded. Many feel that the work of
a Public Health Institute is similar to the work of the Center for Population Health, so perhaps the two efforts
could be aligned. Ken clarified that the purpose of a public health institute is to serve as an independent entity to
formulate data and research into a public health clearinghouse for the examination and identification of best
practices. It could also serve as a resource for public health agencies in the state and support their work.
Bev Wangerin: Commissioner Ehlinger came to Meeker-McLeod-Sibley Community Health Board meeting in
mid-November for a “pitch the commissioner.” Bev is on the board for the 18-county Nurse Family Partnership
Program – Supporting Hands.
Nancy Jost: Nancy worked with the March of Dimes to identify those hospitals in her area that did not have a
plan to reduce low birth weight deliveries. She has since contact those without a plan and is meeting with them.
MinneMinds is a consortium of supporting organizations with a goal to increase public funding for access to
high quality early care and education programs proven to prepare children for success in school and in life.
Nancy serves on the executive committee of this organization. You can find out more about the campaign on the
following link to the MinneMinds website.
Angela Watts: Infant mortality issues are on the national radar. As a result, Healthy Start nationally is being
redesigned. The federal Maternal and Child Health Bureau (MCHB) is looking at places with high rates of infant
mortality, but also high resources (like Minneapolis). The MCHB is redesigning the system to address
diversifying the public health workforce and engaging communities of color in the health care employment.
There was a short discussion on increasing the diversity of the public health and health care workforce. Maggie
Diebel commented that Minnesota is looking at workforce as a part of the state’s Health Reform Task Force.
Minnesota applied for a State Innovative Model Grant. The announcement of awardees is expected soon. More
information can be found on the following link to the Health Reform Minnesota website . The MDH also
recently met with the Association of Community Health Workers to discuss the role of CHWs and assuring
appropriate levels of providers to meet the needs of the community.
Ken Bence added that there is a community paramedic program. The program is mainly in rural areas, but also
in the metro area. The purpose of the program is to expand the roles of EMS workers to provide health services
where access to physicians, clinics and/or hospitals is difficult or may not exist. More information can be found
on the following link to the community paramedic program.
There was also a suggestion to continue discussions with the U of M School of Public Health. The change in
leadership in the MCHB may lead to funding opportunities that would allow the School of Public Health to
develop programs that encourage the diversity of public health students.
Deb Purfeerst: Rice County Public Health is working on strategic planning for the agency and continuing to
work with local hospitals on community health planning. While Rice County did not receive MIECHV
expansion funding, they are continuing to work on expanding family home visiting. She added that while Rice
County is not currently using Community Health Workers, there is a quickly growing Somali community in the
county and they hope to expand the role of the CHW.
Tanya Hagre: Health Partners has been doing some work around childhood obesity. They are working with the
Neighborhood Alliance and Allina in the northwest metro area by following 50 families. Additionally, the
Minnesota Council of Health Plans has been meeting with Minnesota Chapter of the American Academy of
Pediatrics to identify measures that all health plans could use a measurement of childhood obesity. This would
initially include indicators that all plans have the capacity to measure.
Tanya is involved in Twin Cities Healthy Start and a low birth weight initiative. The goal is to have positive
movement in reducing low birth weight babies in Ramsey, Cass and parts of Hennepin counties. The group is
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looking for ideas on how to address issues that will significantly impact low birth weight in targeted
populations.
She is also involved in the Metro Breastfeeding Alliance. Her role is to examine how health plans can support
breastfeeding and determine the impact of the Affordable Care Act on breastfeeding support.
Health Partners Virtuwell program provides online diagnosis and medical treatment for common conditions. The
program had 60 visits in 2011and have had over 600 by September 2012. The program is being promoted in the
Medicaid population to help keep people out of the emergency room, assuring better care and reducing health
care costs.
Carolyn Allshouse: Family Voices of Minnesota is part of the national Family Voices network. The
organization focuses primarily on health care issues for children and youth with special health needs. They are
involved in a number of projects, including:
• An MCHB grant for parent support. Through this project they have six parent support leaders. The
organization does outreach to find families that could benefit from parent-to-parent support in dealing
with the health issues of their children. The goal is to provide the parents with support and make sure
they get the most accurate and up to date information.
• An AHRQ grant to work with children receiving care coordination services in their primary care clinics.
• Working on issues to address youth transitioning from pediatric to adult health care.
• Staff participating in the AMCHP Family Scholar program.
Martha Overby: The March of Dimes has a new app out that pregnant women can use to monitor their
pregnancy. It can be used to do a time lap photos throughout the pregnancy.
January 15 is March of Dimes lobby day at the state capitol. In the morning, legislators will tour the NICU at
Gillette Children’s Hospital. There will be a Governor’s Proclamation in the capitol rotunda and people will be
meeting with legislators to discuss key issues. This is the 75th anniversary of the March of Dimes, so this will be
part of the message. Information about the March of Dimes Day at the State Capitol can be found on the
following link to the March of Dimes website.
The March of Dimes is currently seeking an bill author to request an extension to 2015 for the Prematurity Task
Force.
Neal Holtan: Last June, Neal presented an initial report for input on a Minnesota Department of Human
Services grant from the Centers for Substance Abuse Prevention to develop a comprehensive state strategic plan
with the goal of aligning substance abuse prevention into mental health and primary healthcare systems to
promote overall health and wellness. The report is finalized and includes data and minutes from public meeting.
Minnesota has submitted a request for extension to continue the work on this project. The plan is now available
on the Minnesota Department of Human Services website at the following link: Minnesota Prevention Systems
Alignment Plan.
Maggie responded that she was involved in a SAMHSA project that provides technical assistance to states to
align initiatives. This is reflective of an effort by SAMHSA enhance work on mental health promotion. The
work in is being done in partnership with DHS, MDH, the Department of Education, Prevention Child Abuse
Minnesota, and tribal governments. They have had technical assistance calls that focused on trauma and
resilience in the adolescent population.
Neal also commented that he agreed with Ken on the need to reestablish the Minnesota Institute of Public
Health. He served as the medical director for five years. It was an organization that could serve as neutral entity.
Grants are often available to organizations to do research but the funding cannot go to government. The Public
Health Institute served as an intermediary to receive the funding.
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Carol Grady: Carol is going to the annual AMCHP conference as a Minnesota family delegate this year. HRSA
Region 5 is one of the few regions that has family delegates. She has been participating in webinars as part of
the family delegate program. Carol is working on her capstone project for her Master’s degree from St. Kate’s.
The project is on the role of social media on parent support.
Joan Brandt: St. Paul-Ramsey County Public Health is working on MIECHV implementation. They are one of
the local public health departments receiving funding. Public Health has received approval to hire positions to
work on the grant.
Kristin Teipel: The Kanopka Institute does a lot of work outside state borders. They received funding from
MCHB to gather innovative and evidence-based practices being implemented in state health departments in the
field of adolescent health. These evidence-based practices must be related to Healthy People 2020 objectives.
Right now they are identifying state-level activities and would appreciate any information about innovative
ideas members are aware of. This work will continue over the next eight months.
The Institute is also training health care providers on how to talk to youth. They train and teach providers in the
academic setting. The work is being done in collaboration with the Child and Teen Check-up Program. They are
also working with teams from other states on how they will implement this training program as a partnership
between academia and public health. Kristin will share any lessons learned.
Rosemond Owens: ECHO (Emergency, Community, Health, and Outreach) has collaborated with St. Cloud
Hospital, CentraCare Health Foundation, and Medica Foundation to create a short video on Understanding the
Emergency Room that is available in English, Spanish, Hmong and Somali. The video was broadcast on tpt’s
Minnesota Channel and is also available for streaming online at the following link: “Understanding the
Emergency Room”.
CentraCare has hired a community health worker. She is involved in community events and created a video and
question and answer session to improve immunization numbers in diverse communities. CentraCare is also
training all physicians on ways to improve culturally competent care. CentraCare has a real sense of excitement
around culturally competent care.
Julie Jagim: Julie will be representing the Task Force at the 2013 AMCHP conference. She will report back to
the Task Force the March meeting. The Superior Babies program is receiving an award for innovation in the
field of maternal and child health at the conference.
St. Louis County Public Health, the Family Service Collaborative and ECFE are discussing how potential
legislative changes may impact some if the families they work with. The proposal is that ECFE would need to
target service to those families eligible for free and reduced lunch. That would be a significant impact on what
agencies could offer families.
TASK FORCE BUSINESS
The Task Force discussed a number of business issues. Following is a summary:
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Julie Jagim acknowledged the new members in attendance at the meeting.
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Julie will continue serve as Task Force chair for 2013. Ken Bence has been named as chair-elect and will
serve as chair for 2014-2015.
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Julie asked for any consumer representative volunteers for the Executive Committee. NOTE: since the
meeting Carol Grady has agreed to serve on the committee.
•
Dee Finley shared that the 2013 meeting dates are posted at the following link on the MCH Advisory Task
Force website. Please mark your calendars. A location has not been found for the December meeting.
Members will be informed when one is identified.
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•
Members received a 2013 membership list. There are still two vacancies on the Task Force. A representative
of the State CHS Advisory Committee is needed to fill a public health representative position and a
representative of the Office of Minority and Multicultural Health Advisory Committee to serve as an exofficio member to replace Rosemond Owens who is now a full member of the committee.
•
Members reviewed and discussed the 2013 Task Force Work Plan. Modifications to the work plan will be
reflected in the final version. Ken Bence made a motion to approve the 2013 Work Plan, Nancy Jost
seconded the motion. Motion carried.
WORK GROUP UPDATES
Family Home Visiting Committee: Candy Kragthorpe noted that federal Maternal and Infant Early Childhood
Home Visiting funding of approximately $6 million is being distributed to 20 Community Health Boards. The
grant agreements are currently being finalized. MDH is working with CHBs to prepare for implementation of
Nurse-Family Partnership and Healthy Families America. This includes a significant amount of training for
staff. She added that the Family Home Visiting Committee has been meeting to discuss the expansion and
integration of Minnesota’s public health family home visiting program into early childhood systems. The plan is
to have a present a report and recommendations to the Task Force at the March meeting.
Children and Youth With Special Health Needs Work Group: See Barb Dalbec’s comments under
Community and Family Health Division Update.
Prematurity Task Force: See Martha Overby’s comments under Members News and Updates.
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