Maternal and Child Health Advisory Task Force
Friday, June 7, 2013
Meeting Summary
Members Present:
Ken Bence
Joan Brandt
Carol Grady
Stephanie Graves
Tanya Hagre
Joel Hetler
Julie Jagim
Susan Morris
Michelle O’Brien
Martha Overby
Deb Purfeerst
Kristin Teipel
Angela Watts
Members Absent:
Carolyn Allshouse
Mary Braddock
Wendy Hellerstedt
John Hoffman
Neal Holtan
Nancy Jost
Daphne Lundstrom
Rosemond Owens
Wendy Ringer
Melissa Winger
Guests:
Tricia Brisbine
Chelsea Magadance
MDH Staff:
Jeanne Ayers
Jeanne Carls
Susan Castellano
Matthew Collie
Maggie Diebel
Kim Edelman
Ed Ehlinger
DeeAnn Finley
Sara Hollie
Candy Kragthorpe
Melanie PetersenHickey
Dave Orren
Megan Waltz
Kathy Wick
INTRODUCTIONS AND CHAIR’S REMARKS
Julie Jagim welcomed members. Introductions were made around the room. Julie welcomed Susan
Morris, Isanti County Commissioner, as a new member representing the State CHS Advisory Committee.
Julie Jagim made a motion to approve the March Task Force meeting minutes. Joan Brandt seconded the
motion. Motion carried.
COMMISSIONER’S REMARKS
Commissioner of Health Ed Ehlinger welcomed the Task Force members and introductions were made
around the room. Following is a summary of his remarks.
The state is poised to act on interest to address infant mortality rates in Minnesota. One important
initiative is the HRSA-sponsored Collaborative Improvement & Innovation Network (CoIIN). Minnesota
is involved in the HRSA Region 5 CoIIN. The purpose of CoIIN is to bring together representatives from
Region 5 and determine priorities and initiatives to work on as a region. The Commissioner noted that
infant mortality disparities in Region 5 are the greatest in the country. More information on the CoIIN is
available on the HRSA website at: http://mchb.hrsa.gov/infantmortality/coiin/index.html#
There are several other initiatives that address the health of children. The Healthy Minnesota 2020 plan
includes a section on a Healthy Start for All. The state is developing a prenatal to three plan to address
“building power for babies.” The Governor’s Children’s Cabinet is also coming together to address a
number of children’s issues.
The Minnesota legislature was very open to MCH issues this year. Matthew Collie will discuss these later
in the meeting. Following is listing of items address by the legislature specific to children:
• $40 million was awarded for early childhood education scholarships.
• Legislation to support all-day kindergarten.
• Rental assistance for low income families.
• Changes to the Minnesota Family Investment Program (MFIP) to pilot test the role of family
home visitors in MFIP.
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Safe Harbor legislation to protect sexually exploited youth. A position to coordinate this work
will be housed at MDH.
More generally, there were a number of successful initiatives that have an impact on children. This
includes the increase in tobacco tax. An additional $1.60/pack will go into the state general fund. This
increase will have an impact on youth smoking. Commissioner Ehlinger sent a letter to all Minnesota
physicians regarding the tax and what they, as providers, can do to support people in quitting. A second
successful legislation was the increase in funding to the State Health Improvement Partnership (SHIP).
The increase in funding will allow funding to all counties to reestablish policy, systems and
environmental approaches to health improvement.
Following is a summary of the discussion with Commissioner Ehlinger:
• Melvin Carter has been named the new head of the Minnesota Department of Education Office of
Early Learning. Mr. Carter will be replacing Karen Cadigan.
• Michelle O’Brian stressed the need for Medicaid coverage of doula services.
• Angela Watts noted that she is excited about how Minnesota is working on efforts to engage
fathers and how to engage more men in public health and MCH.
• Commissioner Ehlinger commented on how to engage pediatricians. He has met with
pediatricians and they are interested in newborn screenings. He added that professional groups
can be powerful in moving legislation forward.
• Maggie Diebel commented on Minnesota’s State Innovation Models (SIM) Initiative. The SIM is
a $45 million grant is an opportunity to change the health care system and how we integrate
medical care and social services. Part of this initiative is how we put the needs of mothers and
children front and center.
• The SIM Initiative will be integrated with some of the SHIP activities. The SIM grant will have a
number of advisory groups which will be announced soon. Meetings will be open to input.
• Ken Bence commented that it is important the MCH issues are considered. There are many
stakeholders will want their issues considered.
• A kick-off for the SIM grant will be held on July 19th.
NOTE: Ellen Benavides has been invited to the September MCH Advisory Task Force meeting to discuss
the SIM grant and implementation of the health insurance exchange (MNSURE) in Minnesota.
MDH UPDATE
Jeanne Ayers, MDH Assistant Commissioner, introduced Megan Waltz, Parental to Three Planner, to
provide an update on the Prenatal to Three planning activities. Following is a summary of Megan’s
remarks:
• The MDH recently cohosted an event (Building Power for Babies) with the Science Museum of
Minnesota and U of M CEED. Presenters included Terri Rose and representatives from
Washington State. The purpose of the event was to kick-off “Phase 2” of the prenatal to three
planning process. This phase has two goals:
o To develop set of policy recommendations
o Start to build public will around babies and the kind of environments they need
• A team of five traveled to Vermont (supported with national Zero to Three funding) to explore
what other states were doing to build public will, messaging advise, Medicaid funding for family
home visiting, etc. related to prenatal to three planning.
• Starting in July, Megan will be hosting meeting around the state to identify recommendations for
the plan. A larger group will be convened in October to prioritize those recommendations.
Jeanne provided an update on MDH activities. Following is a summary of her remarks:
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A team of people from Minnesota attended a “Building Health Equity” meeting in Denver. This
was a chance for the team to strategize about how to increase awareness of issues around in
Minnesota. Angela Watts attended as part of the team and noted that the meeting provided access
to key leaders and information on what is happening at the national level. A key component was
the involvement of pediatricians. The meeting provided an opportunity to work on a health equity
framework for Minnesota and determine who needs to be involved.
MDH continues work on ACES. Staff are continuing to share information about ACES and
Minnesota data and inviting people to become involved. Work is being done on how this
information will inform our work.
There is a companion initiative (SCHSAC work group) around mental health and examining
primary prevention around mental health. MDH has organized a state team to go to Washington
to spend time examining what is happening there. Tanya Hagre asked if Washington State is
really doing any better work than Minnesota. Have we examined if that state’s outcomes are
really better than Minnesota. Jeanne responded that this is just an opportunity to see what is
happening there and how we might make it a community-driven process.
A Tribal health symposium will be held at the end of July in Grand Portage. The symposium will
be co-hosted by the American Indian Cancer Society with the support of the Blandin Foundation.
The symposium will provide data on tobacco use and start a process to facilitate what health data
is available, what it means and how to use it to address health issues.
COMMUNITY & FAMILY HEALTH DIVISION UPDATE
Maggie Diebel, CFH Division Director, provided an update on CFH Division activities. Following is a
summary of her comments:
• The division is waiting to hear from different funding streams on the impact of sequestration on
federal grants and how to deal with the impact of these reductions. The reductions have been
factored into the most of the new funding being distributed.
• The Minnesota WIC Program recently contracted with the Wilder Foundation to conduct a study
on how WIC can better reach out to eligible individuals that are not participating in the program.
Focus Groups and interviews were held with 80 individuals, including former participants,
throughout the state on awareness, experience and access to the WIC Program and also ways to
reach out to eligible individuals. WIC received some great and helpful feedback on what people
appreciate and like about the program. The study also identified opportunities and ways to
improve awareness of WIC, experiences and access to the program, and also suggestions on ways
to market the program to eligible individuals. A work group including state staff and local agency
staff will be forming to work on next steps and responding to the opportunities identified in the
report. Once next steps are identified and prioritized, WIC will be working at all levels to respond
to the opportunities identified. The Executive Summary and Final Report are available on the
WIC website: http://www.health.state.mn.us/divs/fh/wic/whatsnew.html
Maggie also provided an update on Children and Youth with Special Health Needs (CYSHN) Section
activities. Following is a summary of her remarks:
• The CYSHN Strategic Plan developed by the CYSHN Work Group has been accepted by the
Commissioner. A final version will be distributed soon. CYSHN Section staff met recently to
examine the action plan outlined in the strategic plan and put these actions in to a Results Based
Accountability framework. This is one of the next steps to move the plan forward.
• The CYSHN Section is submitting a federal grant application to improve access to
comprehensive, coordinated health care and related services for children and youth with autism
spectrum disorder (ASD) and other developmental disabilities (DD). Funding will support
improved state systems of care and activities focused on improving early and continuous
screening, coordination of family-centered services through a medical home, and increasing
ASD/DD awareness. The funding will enhance work related to ensuring that infants and toddlers
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are screened early for developmental delays and disabilities, with a goal of ensuring that children
access the services they need as early as possible, in turn ensuring the best developmental
outcomes for success in school and life. The MDH is awaiting word on if the application will be
funded.
If funded, this work will also support work in the Autism State Plan. The plan is available on the
Minnesota Legislature’s Autism Spectrum Disorder website at: http://www.lcc.leg.mn/asd/.
There has been updated information on newborn screening and long term follow-up regarding the
impact of legislation and legal issues related to destruction of data. Dave Orren will provide more
information on this later in the agenda.
Susan Castellano, MCH Section Manager, provided an overview of MCH Section activities. Following is
a summary of her remarks:
• Commissioner Ehlinger approved and accepted the Final Report and Recommendations from the
Family Home Visiting Subcommittee and the Task Force. The report is available on the MCH
Advisory Task Force website:
http://www.health.state.mn.us/divs/fh/mchatf/FamilyHomeVisitingCommittee.html. The
Commissioner was impressed the group was able to take such a complex issues and identify a
roadmap for future activities. He was also impressed with the commitment of so many partners to
participate in the work group. It shows the strong partnership to family home visiting in
Minnesota.
• Candy Kragthorpe, FHV Unit Supervisor, provided additional information on FHV activities. An
action plan is being drafted. Karen Adamson, co-chair of the committee, has volunteered to draft
the action plan as a starting point for moving the recommendations in the report forward. The
action plan will attempt to align the recommendations in the report with all of the other planning
activities going taking place. The action plan will outline the role of MDH and other stakeholders.
• Sara Hollie, MDH Adolescent Health Consultant, provided an update on adolescent health
activities. MDH is reconvening the MDH Adolescent Health Collaborative. This is an internal
MDH meeting of 20 staff that will meet quarterly to discuss adolescent health activities and share
internal priorities. Sara will be working on updating the adolescent health website. A planning
committee (under the direction of the MCH Advisory Task Force) will be convened to create the
initial outline of a plan for adolescent health. The intent is for this initial group to conduct a needs
assessment and help craft how a larger work group might develop a more comprehensive strategic
plan to address adolescent health in Minnesota.
• The Task Force is convening a Preconception Health Work Group to identify preconception
health issues impacting women and infants in the state. The goal of the group is to develop a
strategic plan that identifies priorities, strategies, action steps and communication strategies that
the state, health care providers, health systems and other stakeholders could take to improve
preconception health.
• The MDH will be hosting an Infant Mortality Reduction Stakeholders Summit/Work Group on
July 22 to start the development of an action plan to reduce infant mortality in Minnesota. The
purpose of the work group is: To develop and implement recommended action steps expected to
have the greatest impact on reducing infant mortality in Minnesota with particular attention to
reducing disparities. The work group will:
o Work with partners and stakeholders to identify topics and action steps that are
reasonable and feasible for implementation.
o Consider priority intervention points across the lifespan, including preconception,
interconnection, prenatal, perinatal, and postnatal periods.
o Closely examine the impact of social determinants of health on infant mortality and
overall health across the lifespan.
o Identify and implement specific work/activities that can be accomplished without
additional funding and priorities to implement if additional funding is available.
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Engage stakeholders in maintaining ongoing work to completion, monitor progress, and
coordinate new and existing activities to avoid duplication and facilitate implementation.
The MDH submitted a grant to HRSA for the Minnesota Early Childhood Comprehensive
Systems (ECCS) grant. Minnesota will focus on coordination of the expansion of developmental
screening activities. The grant funding will be used to hire a staff person who will coordinate
cross-agency work.
The MCH Advisory Task Force is accepting nominations for the 2013 Betty Hubbard MCH
Leadership Awards. Solicitation information and the nomination form are available on the web at:
http://www.health.state.mn.us/divs/fh/mchatf/bettyhubbard.html.
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LOCAL PUBLIC HEALTH DEPARTMENT HEALTH EQUITY SURVEY
Melanie Peterson-Hickey and Kim Edelman from the MDH Center for Health Statistics presented on the
results of the health equity/social determinants of health survey completed by Minnesota’s local public
health departments. The slides from their presentation are available on the MCH Advisory Task Force
web site here: http://www.health.state.mn.us/divs/fh/mchatf/meetings.html.
In 2011, the Center for Health Statistics (MCHS) and the Office of Performance Improvement (OPI)
received a grant from the Robert Wood Johnson Foundation Administrative Supplements in Diversity.
The primary aims of the project were to examine the extent to which local health departments (LHDs)
were engaging in activities to reduce health inequities and to identify the characteristics of LPH systems
that facilitate and impede these activities. MCHS worked closely with representatives of the Minnesota
Practice Based Research Network (PBRN) Research to Action Network (RAN), the State Community
Health Services Advisory Committee (SCHSAC), and the Minnesota Local Public Health Association
(LPHA) along with local agencies and communities to conduct this study. Specific research questions
for the project include the following:
• To what extent are health inequities being addressed through local health department services and
activities with other departments and organizations?
• To what extent do LHDs collect, store, analyze, report data relating to health inequity including
health status disparities, racial/ethnic disparities, and social determinants of health?
• To what extent are LHDs engaged in policy and design and implementation of programs from a
health inequities perspective (i.e. “upstream” efforts that focus on avoidable group health
differences resulting from unequal social positions caused by policy decisions and societal
arrangements taken up and implemented by governments (Andress, 2009).
• How does the variation in health inequity efforts as a priority vary by LHD structure, governance,
and funding?
To answer these questions, staff conducted a document review, conducted key informant interviews, and
developed and administered a Health Inequity Survey to LDHs in Minnesota. The health equity themes
and survey focus areas included understanding and use of health equity terminology, prioritization of
health equity in LHDs, collecting and utilizing health equity data, building community partnerships and
power, and efforts of LHDs in moving policy and directing resources to health equity efforts. MCHS staff
in now in the process of analyzing the data and planning to disseminate the results of the project findings
to LPH leaders, practitioners and other key stakeholders.
MEMBER NEWS AND ISSUES
Ken Bence: The 2013 Community Health Conference is scheduled for September 25-27, 2013 at
Cragun's Conference Center, Brainerd, MN. The conference is sponsored by the State Community Health
Services Advisory Committee (SCHSAC) and the MDH Office of Performance Improvement. The theme
of this year’s conference is Working Together: Attaining Health Equity in Minnesota Communities.
Information is available at: http://www.health.state.mn.us/divs/opi/pm/conf/.
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The Minnesota Public Health Association (MPHA) is holding an annual meeting June 13 and 14. The
theme is “Health in All Policies.” Commissioner Ehlinger will be presenting. More information is
available on the MPHA website: http://www.mpha.net/Default.aspx?pageId=1526635
The Minnesota Department of Human Services is in the process of rebidding agreements with health
plans for Medicaid services in 27 non-Metro counties. This is a competitive bid process similar to what
was done in the Metro in 2011. Counties that are part of metropolitan statistical areas (MSAs) will likely
have two plans, while non-MSA counties will have one. None of the counties in this bid process currently
has only one plan, and most have at least three. This is concerning because having a limited number of
health plans reduces the choices for mothers and infants. DHS may feel it will reduce the administrative
burden. However, we will need to see how this will impact families.
Medica has hired Amy Burt, a pediatrician, as Medical Director for government programs. She will work
half time with a focus on pediatric issues, while another half-time medical director is primarily focused on
seniors and people with disabilities. She has served on the Governor’s Health Care Reform Task Force.
Michelle O’Brian: Michelle took a position at a Health Partners clinic and will continue to work on
MCH issues in that new role.
Angela Watts: Angela participated with other Minnesota representatives in the health equity conference
in Denver that Jeanne Ayers mentioned earlier. She will also be travel to Washington State to look at best
practices on the public health role in mental health.
Twin Cities Healthy Start and Minneapolis will be bringing someone from Alameda County to
Minneapolis in August. Alameda County has trained 80% of their providers through an effort to reduce
the stigma of mental health in Alameda County.
Martha Overby: Martha will be co-chairing the MCH Advisory Task Force Preconception Health Work
Group. There are a number of groups addressing similar issues that need to be coordinated. This includes
this group, the Prematurity Task Force, Low Birth weight Work Group. All of these groups are doing
good work and each have their own momentum, but we need to assure they are coordinated and not
duplicative.
The Prematurity Task Force was extended an additional two years by the Minnesota legislature.
Newborn screening added critical congenital heart disease (CCHD and severe combined
immunodeficiency (SCID) newborn screening protocol.
The March of Dimes has a subgroup that is developing guidelines on weight management during and
between pregnancies. The group is trying to touch on different cultural differences.
The March of Dimes will be hosting the fourth annual Nurse of the Year. Information is available on the
MOD website here: http://www.marchofdimes.com/minnesota/
Susan Morris: Susan is an Isanti County Commissioner and will be representing the State Community
Health Services Advisory Committee. She excited to be joining the Task Force and very privileged to be a
part of SCHSAC.
Joel Hetler: Joel is involved in a project at the U of M that is working on health disparities research.
There is a growing awareness that people with severe mental illness are a unique health disparities group.
Their health status is much worse than the general population and this need attention.
He has also been involved in a research project on smoking in the severely mentally ill. Forty percent of
cigarettes are sold to people with mental illness. The project is examining if there is an effective approach
to smoking cessation in the mentally ill. Many with mental illness indicate that they know it is bad, and
they want to quit. The U of M was approached because community organizations could not find a
smoking cessation group that was willing to work with the mentally ill.
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Martha Overby responded that more information emerging that smoking is self-medicating and that there
is more smoking in some types of mental illness. Susan Castellano added that DHS has project around
smoking and the mentally ill.
Kristin Teipel: The Konopka Institute received a small grant for an adolescent health systems building
project. The project involved bringing together six state teams to work on how to build a system around
adolescent health. They will be examining is the collective impact model works in adolescent health. The
project involves facilitation training and the teams working together collaboratively over the next year.
Glennis Shay is working with chlamydia partnership and completed parent support project for middle
school parents. The project involves developing text-based support parents text based to help them
support their kids in healthy sexuality.
Deb Purfeerst: Rice County has been work with a mental health collective group – three groups are
working on prevention, promotion, and access. The project involves working in small groups to help
people self-identity of wellness and their own mental health. The group is also working on communitywide messaging. The data on the project is looking positive. The project is funded through the Family
Services Collaborative.
Tanya Hagre: Tanya is involved in activities related to low birth weight reduction. She has also been
involved in the Hennepin community health improvement process – specifically addressing screening and
school readiness.
She participated as a Family Planning Special Projects reviewer. It was a very interesting process.
There have been a number of changes in eligibility in medical assistance. Eligibility has been separated
from eligibility for WIC and Supplemental Nutrition Program. We will need to watch how this will
impact families. As asset testing goes away will they still use the service.
Joan Brandt: Joan has participated in a NACCHO Task Force on return on investment for early
childhoods. The group has seen a preview of The Raising of America.
St. Paul-Ramsey County is ready to launch “Club Mom.” Club Mom is a model out of Alameda County
Healthy Start. It is an alternative to family home visiting in the African American community. The
support is done in a group setting vs. one on one.
Stephanie Graves:
Minneapolis is working with Hennepin County on the MFIP innovations project. The city will receive
support from DHS to work with MFIP teens that had chosen educational path. Hennepin County will
move it county wide. The project involves case management and workforce development. The services
will be wrapped into the work being done by MVNA
Stephanie has hired an intern for the summer to keep kids connected over the summer with activities.
They hope to learn from communities that have been successful in the same situation.
Minneapolis is involved in the early childhood CHIP process through a pilot with ABCDIII. Minneapolis
Public Schools have contracted with Tessa Wetjen to work with Hennepin County to close the loop on
early childhood screening and connect with Help Me Grow. The project involves four schools and
Bloomington Public Health.
Julie Jagim: St. Louis County Public Health was able to continue SHIP with four month bridge funding
from the MDH.
The county has had a lot of staff turnover. This can be very difficult and overwhelming due to the amount
of time needed for training and orientation.
The Attorney General is having a public hearing on synthetic drug use
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LEGISLATIVE UPDATE
Matthew Collie, MDH Legislative Coordinator, provided an overview of this year’s legislative session.
Following is a brief listing of the items discussed. The full summary of the 2013 legislative session
discussing issues related to public health can be found on the MDH website here:
http://www.health.state.mn.us/divs/opa/2013session.html. This document provides a more
comprehensive overview of the issues discussed.
• Tobacco tax increase
• Expansion of full day kindergarten
• Scholarships for childcare.
• Safe harbor for sexually exploited youth
• Health equity report
• “Back to Sleep” requirement in child care centers was returned
• Increased reimbursement for family planning in Medicaid
• Increase in SHIP funding
• Genetic information authority (discussed below)
REPORT ON GENETIC PRIVACY
Dave Orren provided an update on MDH Genetic Privacy activities and related legislative session
information and litigation information. Following is a summary of his remarks:
• The Newborn Screening Program finds an average of 50 infants per year that, with no treatment,
could suffer from severe disabilities or die. The purpose of the program is to identify the infant as
early as possible. It is urgent that they be found as soon as possible. A delay until diagnosis could
be too late and the child could already have suffered damage.
• The Genetic Privacy Act passed in 2006. In 2006 this law was good at protecting genetic
information, but needed more vetting. The language requires express authority to work with
genetic information. The language needed to be clearer.
• In 2009, the bloodspot collection component was sued, stating that it violated the infant’s genetic
privacy. A district court agreed. This was appealed and the appellate court confirmed the decision
of the district court.
• In 2011, the Minnesota Supreme Court found the program was in violation of the law and that
every step of the process needs express authority.
• This has had a significant impact on Minnesota’s newborn screening program. Because express
authority was required, the MDH lab did not have the authority to use blood samples to calibrate
testing machines, improve tests, or develop new tests for other conditions. Additionally, blood
spots would not be available to coroners if the infant died to determine if a condition was present.
• Subsequently, the Supreme Court remanded the issues back to district court for remediation. In
the meantime blood spots have been destroyed. This is still on ongoing with the courts in the
discovery phase. They expect a summary judgment later this year and the ruling will probably be
appealed.
• This issue is fundamentally being driven by the concern that government is involved in people’s
lives and a perceived potential that the government could use genetic information in some way.
• In 2012, the MDH had a legislative directive, which required the Commissioner to submit
proposed legislation by January 15, 2013, to authorize collection and use of genetic information
for existing activities where express authorization was not provided by law.
• As a result, in 2013 legislation passed (2013 Laws Ch. 82) that provides express authority for
MDH to continue collecting, storing, using, and disseminating biological specimens and health
data for health department program operations, public health practice, and public health oversight
activities. MS 13.386 requires express authority for these activities; and this law provides that
requirement. The law clarifies that MDH is expressly authorized to conduct its current activities;
it does not expand any department activities or authority. In certain circumstances, data collected,
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used, disseminated and stored by local public health agencies is also authorized. The department
is also required to develop and publish retention schedules for biological specimens. An annual
inventory of biological specimens, registries, health data, and databases collected by the
Commissioner of Health is required by the law. The retention schedules and inventory are to be
posted on the department’s Web site and submitted to the legislature. (Source: MDH Legislative
Summary)
Currently, screenings testing positive are kept for 2 years, negative screenings are kept for 71
days. The MDH will need to start destroying negative tests in November.
Parents still have the option to opt out of newborn screening of their infant. It is estimated that
three percent (four to five babies) would opt out each year. There are still discussions regarding
an “opt in” for retaining of blood spots. This has not yet been fully tested or implemented.
The MDH was more successful this year because significant time was spent educating legislators
and trying to be more proactive to make sure the correct information was presented.
INTRODUCTION TO LAB TOUR
Several Task Force members participated in a tour of the MDH Public Health Labs.
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