Maternal and Child Health Advisory Task Force
Meeting Summary
Friday, March 8, 2013
Members Present:
Carolyn Allshouse
Ken Bence
Joan Brandt
Carol Grady
Stephanie Graves
Tanya Hagre
Wendy Hellerstedt
Joel Hetler
Neal Holtan
Julie Jagim
Nancy Jost
Meredith Martinez
(for Karen Cadigan)
Michelle O’Brien
Martha Overby
Rosemond Owens
Deb Purfeerst
Wendy Ringer
Kristin Teipel
Angela Watts
Members Absent:
Mary Braddock
Karen Cadigan
John Hoffman
Daphne Lundstrom
Melissa Winger
Guests:
Karen Adamson
Tricia Brisbine
Ruthie Dallas
Katie Freeman
Kraig Gratke
Babette Jamison
Micah Kalb
Andrea Robinson
Kara Hall Tempel
Catherine Wright
MDH Staff:
Jeanne Ayers
Autumn Baum
Jeanne Carls
Susan Castellano
Barb Dalbec
Guisselle del Salto
Maggie Diebel
DeeAnn Finley
Sara Hollie
Candy Kragthorpe
Melanie PetersenHickey
Megan Waltz
Kathy Wick
WELCOME AND INTRODUCTIONS
Julie Jagim, MCH Advisory Task Force Chair, welcomed members. Introductions were made around the
room. This was the first meeting for several new members. Prior to the Task Force meeting new members
received an orientation from MDH staff and executive committee members.
Julie also noted that we have a number of guests at the meeting. Several members of the Family Home
Visiting Committee and the Children and Youth with Special Health Needs Work Group were at the
meeting to hear the discussion on the reports from those groups.
Julie asked for a motion to approve the minutes of the December 2012 meeting. A motion was made by
Ken Bence to approve the December minutes. Rosemond Owens seconded the motion. Motion carried.
MDH UPDATE
Jeanne Ayers, MDH Assistant Commissioner provided an update on a number of MDH issues that may
be of interest to Task Force members. Following is a summary of her remarks:
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Federal sequestration is beginning to have an impact on public health programs in Minnesota.
Federally funded programs are beginning to get information regarding a five percent cut in
funding. MDH programs have gotten mixed and varied information regarding the cuts.
Commissioner Ehlinger is in Washington, DC sharing his concerns about the impact of
sequestration with Minnesota’s legislators. He expressed his regret for not being able to attend the
meeting.
There has been a prenatal to three planning process underway with MDH taking the lead. The
planning process has led to a framework for planning and a set of indicators. The next step will be
to increase engagement in the planning process through regional meetings. Megan Waltz
discussed the prenatal to three planning process:
o The goal of the prenatal to three framework is to make children and families a priority.
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The project has two phases. The first phase is to develop a framework that outlines the
values, guiding principles and outcome indicators for five areas. These outcomes are crosswalked with the Healthy Minnesota 2020 and the School Readiness Report card.
o The second phase is to explore what we do with the framework. This will involve developing
regional teams of health, human services, education, and community partners.
o They hope to have the larger plan done by the end of 2013.
The MDH recently released the Adverse Childhood Experiences (ACEs) study data. The study
used information from a BRFSS “module” to identify the impact of childhood experiences on
adult health. The main theme the study is that adverse childhood experiences burden the health of
the adult population. Efforts must be undertaken to break the cycle. The ACEs study was
discussed in greater detail later in the meeting.
The documentarians that produced Unnatural Causes are now producing another project called
Raising America. The MDH would like to use the release of Raising America and the parental to
three plan to increase understanding of the need to invest in children.
The Healthy Minnesota 2020 Partnership has been involved in a number of projects previously
discussed with the Task Force. This included the Statewide Health Assessment and the Statewide
Health Improvement Framework. The next steps in the process involve creating strategy teams to
move the framework forward. One team will focus on “health in all policies” to address how to
increase the consideration of the health impact of decisions made in other policy areas. A second
team will examine how to change the way we talk about health. A third team will address the
politics of chronic disease prevention by creating prevention vs. disease-focused approaches. The
forth team (not yet established) will try to link the parental to three planning process to the
framework. If anyone is interested in participating in one of the teams, they should contact
Jeanne.
A number of legislative issues are being followed by the MDH. The MDH is asking for a
restoration of SHIP funding to $40 million. Genetic privacy is being discussed as well as the
health care exchange. DHS is discussing legislation based on a model in Ramsey County
connecting MFIP teen mothers with family home visiting.
The State CHS Advisory Committee (SCHSAC) has a Mental Health Work Group looking at the
role of public health in mental health.
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COMMUNITY & FAMILY HEALTH DIVISION UPDATE
Susan Castellano provided an overview of activities in the Maternal and Child Health Section. Following
is a summary of her remarks:
• Sara Hollie has been hired as the new Adolescent Health Coordinator. She will be working with
stakeholders and the Task Force to develop an adolescent health plan.
• The Pregnancy Risk Assessment and Monitoring System (PRAMS) recently submitted their
federal grant application. PRAMS attempts to oversample in some at-risk communities. This has
become more difficult due to a decrease in available funding. The MDH will try to preserve the
data for these communities.
• MCH programs are beginning to see the impact of sequestration. Two grants have received
warnings of 5.1% reductions. Many questions still exist about how the cuts will be rolled out and
the impact that will have on MCH programming.
• MDH is involved in the Collaborative Innovation and Information Network (CoIIN).
o This is an initiative of HRSA and MCHB undertaken to reduce infant mortality. There have
been regional planning around infant mortality starting in the south. Many have developed
regional plans and have found that this issue is one that benefits from regional work. Each
region is coming up with its own plan and how to address infant mortality in their region.
o HRSA Region 5 (Minnesota’s region) will be meeting in two weeks. Following this meeting,
Minnesota will begin to develop a state infant mortality plan. The issues identified as part of
the CoIIN initiative are very short term (18 months), clinical and policy-focused. The will
only be a subset of Minnesota’s plan.
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There is no funding available to support the CoIIN initiative. The MCHB is providing
technical assistance.
There is a bill moving through the Minnesota legislature on “back to sleep” in day care centers
unless directed otherwise by a physician. This initiative is intended to move safe sleep and SIDS
reduction beyond the home and into child care settings.
Efforts are underway to expand interconception care through increased Medicaid coverage of
post-partum care from the current coverage of 60 days to one year. The goal is to improve birth
outcomes. There is also a state bill on maternal depression to expand coverage up to two years.
Tanya Hagre added that there is a focus on interconcepton care in the health plans efforts to
reduce low birth weight babies.
The MDH recently submitted a federal application for the Parent Student Support Initiative grant.
This grant is to support parenting college students. The MDH currently has this funding.
Elizabeth Gardner, the grant coordinator, could present the results on the previous grant to the
Task Force.
The Minnesota Early Childhood Comprehensive Systems (ECCS) grant funding was due to end
this year. HRSA recently released a new competitive funding application for new ECCS funding.
The funding supports one of three strategies: 1) Mitigation of toxic stress and trauma in infancy
and early childhood 2) Coordination of the expansion of developmental screening activities; or 3)
Improvement of state infant/toddler child care quality initiatives. Note: Minnesota chose to
address strategy #2.
DHS has received an adult quality measures grant. One of the projects is how to address maternal
depression during a well-child screening. The MDH will be implementing this program in
partnership with DHS. One of the barriers that will need to be addressed is legal liability around
screening someone who is not a patient. The Task Force will be updated as the project progresses.
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Barb Dalbec provided an update on the activities of the Children and Youth with Special Health Needs
Section. Following is a summary of her remarks:
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Celebrating 50 years of newborn screening: The MDH is hosting a celebration of 50 years of
Newborn Screening. A traveling display from the Association of Public Health Laboratories
(APHL) will make Minnesota its first stop at the Minnesota State Capitol on a thirteen state tour.
The APHL display will also will be on exhibit at a number of other venues around the state
throughout March.
Proposed legislation on genetic privacy is being heard in the Minnesota legislature. Many
programs at MDH could be affected. This could impact the department’s authority to collect and
keep samples. More information on this will be presented at the June meeting.
Critical Congenital Heart Disease (CCHD) was added to Minnesota’s Newborn Screening Panel
in August of 2012. There is also new legislation being proposed around CCHD reporting to the
state in conjunction with a fee increase for implementation across the state. This is a point of
service test similar to hearing that uses pulse oximetry.
Several activities are taking place around Autism. Following is a summary:
o Autism Spectrum Disorders: Report to the Minnesota Commissioner of Human Services, Feb.
13, 2013, (PDF) is a study of treatments for autism conducted by the Health Services
Advisory Council. The 2012 Minnesota Legislature asked the Health Services Advisory
Council to recommend coverage for evidence-based treatments for people with autism
spectrum disorders. (Omnibus Health and Human Services Bill, Chapter 247, Section 26).
The Health Services Advisory Council is a panel of medical experts that advises DHS about
health care benefits for enrollees in publicly funded programs. Community stakeholder input
was included.
o The Study on Housing with Supports for Children with Severe Autism, (PDF) was completed
by the University of Minnesota under a contract with DHS and takes a comprehensive look at
housing and service options currently available as well as best practices.
o The Autism Spectrum Disorder Task Force Strategic Plan Report, December 2012 (PDF)
includes a brief introduction, a three- to five-year vision for the state as it would be improved
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by the work coordinated through the ASD strategic plan, and broad strategies for achieving
that vision. The 2011 Minnesota Legislature created the Minnesota Autism Spectrum
Disorder Task Force to “develop an autism spectrum disorder statewide strategic plan that
focuses on improving awareness, early diagnosis, and intervention” by Jan. 15, 2013. This
expanded task force added representation from four state agencies: education, employment
and economic development, health, and human services.
CDC’s Learn the Signs Act Early Campaign is being promoted through regional consultants
that attended a Summit last November and are now participating in ongoing learning and
networking sessions with the goal to spread the Act Early materials to identify children with
Autism as early as possible.
Minneapolis Autism Prevalence Study: The MDH is providing technical assistance to the U
of M Leadership Education in Neurodevelopmental and Related Disabilities LEND program
where a study of 7–9 year olds in Minneapolis is under way to estimate ASD prevalence. The
study is funded by CDC, National Institutes of Health, and Autism Speaks and seeks to
determine whether there is a higher rate of autism among Somali children compared to non–
Somali children.
Qualitative Study of Cultural Influences on Early Identification and Access to Services: In
2012, the legislature designated $200,000 for a study on how culture influences Somali
parents’ understanding of the signs and symptoms of ASD and the treatment options they
choose for their children with ASD. In partnership with the U of M School of Public Health,
SoLaHmo (Somali, Latino and Hmong Partnership for Health and Wellness) will use a
community–based participatory research approach in which communities generate the
questions that are most important to them. The 2014 results of this study may guide and
inform program planners and policy makers in developing more culturally meaningful or
relevant outreach, educational or training programs, and intervention programs for parents
and their children. Further, the information developed from this study can be used to guide
future researchers in developing larger studies to explore broader cultural issues regarding
ASD diagnosis and treatment.
REPORT ON ACE FINDING AND RECOMMENDATIONS
Melanie Peterson-Hickey, Ph.D., Senior Research Scientist, with the MN Center for Health Statistics and
Autumn Baum, MDH Adverse Childhood Experiences Planner, presented information on the recently
released data on adverse childhood experiences in Minnesota. The finding and recommendations in the
report are based on the 2011 Minnesota Behavioral Risk Factor Surveillance System. A copy of the
presentation and the Executive Summary of the report can be found on the Minnesota Center for Health
Statistics website.
Following is a summary of the discussion regarding the presentation:
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Joel Hetler commented that while it is clear that community prevention works to reduce ACEs, it
is not clear what can ameliorate ACEs after they have occurred.
Catherine Wright noted that there are evidence based practices in children’s mental health that
build attachments to recover from trauma. However, it is not yet demonstrated what that may
mean across the lifespan.
Jeanne Ayers shared that the work being done in Washington State does not focus only on
prevention. They use the data spark community interest and make changes in the system to create
community-level thinking about how the data can be used. As they become thriving communities,
they are able to demonstrate how you break the cycle of trauma for the next generation.
Stephanie Graves asked what can be done to combat issues of children in poverty and historical
trauma.
Rosemond Owens asked if the survey was done in underserved communities (e.g. refugees). How
do we make this inclusive? Autumn responded that they are presenting this information to as
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many groups as possible to bring people into the discussion and making it relevant in many
communities.
Angela Watts commented that work needs to be diverse and inclusive. There are a lot of
pathways from childhood experiences and communities need to help themselves. It is important
that communities do this work, but need to know the best interventions.
Joel Hetler asked if there were community-level reports available. Jeanne Ayers responded that
more data should be available. There is a need to create a sense of urgency and the ability to track
data that is linked to a strategy for intervention. Joel also asked what MDH is doing to keep the
ACEs module in the BRFSS. The questions in this module were only asked in 2011.
Someone asked about the call to action. Jeanne responded that the final report should be available
in the next week or so. A website will be developed with the release of the report to get people
connected around the data. Jeanne asked for continued Task Force support for this ongoing work
over the course of the next year.
Autumn will send information about next steps to Task Force.
CYSHN WORK GROUP
Barb Dalbec presented the report from the MCH Advisory Task Force Children and Youth with Special
Health Needs Work Group. Following is a summary of her remarks. The full report will be available on
the MCH Advisory Task Force webpage.
The work group identified Vision Elements (desired outcomes for the next 3-5 years, Strategies (activities
and initiatives employed to accomplished desired outcomes), and Implementation Activities (the first
steps to take toward achievement of the strategies).
The work group used the Six National Core Outcomes as a base and starting framework to establish their
Vision Elements and identify strategies for the children and youth with special health needs.
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Children and youth with special health care needs will receive coordinated, ongoing,
comprehensive care within a medical home.
Strategies:
o Increase demand for quality pediatric health care home (HCH) services by improving
knowledge and understanding of HCH
o Build capacity of quality pediatric HCH to work with CYSHN
o Evaluate and monitor HCH to determine if families of CYSHN are receiving quality familycentered, culturally responsive, coordinated, cost-effective care
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Families of children and youth with special health care needs will have access to adequate private
and/or public insurance and financing to pay for the services they need.
Strategies:
o Enhance & improve tools for navigating health insurance and financing options
o Assure CYSHN needs are a priority in policy-making and allocating resources
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Children and youth will be screened early and continuously for special health care needs.
Strategies:
o Create and promote infrastructure to support best-practice screening
o Develop and implement best-practice for appropriate follow-up
o Develop policies that ensure cross-organization/cross-stakeholder data sharing to support best
practice screening and follow-up
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Community-based service systems will be organized so families can use them easily.
Strategies:
o Enhance and improve tools to access and navigate services for CYSHN
o Engage appropriate partners to create mechanisms that produce effective access and ease use
of services
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Promote best practice strategies for underserved populations to improve access to services to
eliminate disparities
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Children and youth with special health care needs and their families will partner in decisionmaking at all levels and will be satisfied with the services they receive.
Strategies:
o Promote meaningful parent partnerships in program and policy development, implementation
and evaluation, and in decision-making at all levels
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Youth with special health care needs will receive the services necessary to make transitions to all
aspects of adult life, including health care, work, and independence.
Strategies:
o Identify and promote models for successful transition among youth, families, providers and
community through collaboration
Report Discussion:
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Carol Grady commented that it was good to see families included in the work group. That is a
voice that is needed and it feeds well into the AMCHP activities around involving families.
There was discussion in the work group about talking with youth and how to involve them.
Perhaps convene a youth committee to inform our work in transition.
Kristin Teipel commented that it is important to include the youth voices. Not just in transition,
but living as a youth with a disability. At the AMCHP conference there was discussion of putting
young people at the center and exploring how that changes the discussion.
Neal Holtan suggested adding information about Healthy Minnesota 2020 to the introduction to
tie the work to the HM 2020 framework.
Ken Bence noted that the health insurance exchange should be kept in mind as a navigator of
resources for CYCHN.
Barb clarified that there was an attempt made to have DHS representation on the work group but
no one was available.
A motion was made by Ken Bence to approve the CYSHN Work Group Strategic Plan. Rosemond Owens
seconded the motion. Motion carried.
FAMILY HOME VISITING COMMITTEE
Candy Kragthorpe presented the final report and recommendations from the MCH Advisory Task Force
Family Home Visiting Committee. The final report will be available on the MCH Advisory Task Force
webpage. The charge of the Committee was to: Provide direction and guidance to the Commissioner of
Health and to MDH staff on issues related to the expansion and integration of evidence-based public
health home visiting programs in Minnesota’s health and early childhood systems.
The Committee identified the following Vision for public health family home visiting in Minnesota:
“Minnesota’s public health family home visiting program is further expanded and integrated with health
and early childhood systems to support the health and development of infants, children and families.”
The Committee then developed the following guiding principles:
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Families statewide will have access to continuity and consistency of home visiting services.
Access is facilitated by culturally competent service planning and delivery strategies.
Programs will be informed by data and the most current research while also allowing for
innovation.
Services will be relationship-based, child and family focused and responsive to the many factors
that impact families and communities.
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Services will be voluntary in nature, strengths-based and grounded in best practices for respectful
engagement.
Program staff will be highly skilled, engaged in continuous professional development, and
supported by effective supervision based on the principles of reflective practice.
Programs will be accountable to families and communities, measuring and reporting on progress
toward defined maternal and child health outcomes.
Lastly, the Committee developed seven recommendations to forward to the Commissioner of Health:
Recommendation 1: Increase awareness of, and further develop an action plan to, achieve the vision,
guiding principles and recommendations of the MCH Task Force Family Home Visiting Committee.
Recommendation 2: Provide enhanced leadership and advocacy to clarify and sustain the unique role
of public health evidence-based family home visiting as a foundational cornerstone of early childhood
service systems focused on prenatal to age three family home visiting services impacting positive
pregnancy and infant health outcomes, brain development, school readiness, and safe and secure
parent-child interactions.
Recommendation 3: Enhance the consistent delivery of high quality, evidence-based public health
family home visiting services across the state through the exploration of: 1) The recruitment and
retention of home visitors of diverse cultures, 2) The development and promotion of statewide
minimum professional qualifications, 3) Statewide access to training and reflective practice
mentoring, 4) The identification and promotion of practice standards, 5) An expanded role in
statewide technical assistance to assure fidelity, continuous quality improvement, and 6) Statewide
efficiencies in administrative functions (accreditation, data collection) as required of evidence-based
family home visiting models.
Recommendation 4: Further promote as a best practice the ongoing coordination and communication
between early childhood service providers to build and maintain family access to a continuum of
health and early childhood services maximizing the effective use of resources.
Recommendation 5: Ensure adequate and sustainable funding for public health evidence-based home
visiting.
Recommendation 6: Continue to partner with local public health departments to develop and/or
improve a system of data collection, management and interoperability to demonstrate program
outcomes at the state and local level, providing accountability to families, communities, policy
makers and funders.
Report Discussion:
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Angela Watts asked about the role of fathers in the FHV model. Public health needs to be more
intentional about involving fathers.
All families access services differently. Some families are choosing to not participate in FHV
services. How can that be monitored? Candy responded that the federal MIECHV benchmarks
monitor the level of engagement of families based on the populations being served.
Rosemond Owens commended the work of the committee.
A motion was made by Ken Bence to approve the Family Home Visiting Committee report and
recommendations. Rosemond Owens seconded the motion. Motion carried.
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MEMBER NEWS AND ISSUES
Ken Bence: The Start Early Funders Coalition is a collaboration of more than 20 members of
Minnesota’s philanthropic community providing leadership and advocacy on early childhood research
and policy.
The Medica Foundation recently released their 2013 funding priorities funding.
Several organizations are involved in the low birth weight initiative.
The Health Exchange bill has been passed by the Minnesota House and Senate and will go to committee.
There is still a lot of rulemaking that needs to be done at the federal level to see how this impacts women
and children and how Medicaid program will interact with the exchange.
June 13 and 14 is the Minnesota Public Health Association conference. This year’s conference theme is
“Health in All Policies.” The 2012-2013 MPHA policy forum is on The Teenage Experience. The next
forum is March 29 and will address teens and addictions.
Ken attended the national chlamydia coalition. He was invited to attend to provide the health plan
perspective. Health plans are involved through the HEDIS report to monitor chlamydia screening rates.
Neal Holtan: The community paramedic program is awaiting federal approval. It will take additional
training to be community paramedic. The purpose of the program is to allow trained paramedics to help
with medication management and checking in on the health people in communities. The program was
originally designed for rural communities, but is expanding as a concept to urban areas. The community
paramedics will work out of existing ambulance services.
Neal added that there is a nationwide shortage of isonicotinic acid hydrazide (INH), an antibacterial
compound used in treatment of tuberculosis.
Carol Grady: Carol attended a breakout session at AMCHP on marketing your Title V block grant. It is
exciting to see the prospect of beginning a family advisory committee. Many states have family
involvement and there are several opportunities for Minnesota to use some of these models to get
stakeholder input into Title V. You need to meet people where they are and consider their schedules when
planning meetings. In some states, the family delegate actually works in the state agency. Because that is
not the case in Minnesota, we need to build tools and determine what to do with the skills of the family
delegate once they have them.
Another interesting concept discussed at AMCHP was the need for peer navigators. The Task Force will
need to keep informed about the Affordable Care Act to inform our populations about what it means for
them. Oregon had a poster session on health care home and how it is working in their state, including
satisfaction in the care they receive. However, the terminology is getting muddled – health care home,
health home, medical home.
Kristin Teipel: Also attended the AMCHP conference. The federal Maternal and Child Health Bureau is
stressing workforce development. There was also information on using social media to market services
and provide support to families. Alameda County CA did an excellent job on social media and developed
a Facebook page as a support tool for families.
Wendy Ringer: The Star Tribune ran a feature on the cost of special education. The article was seen as
very divisive and blaming. Several people are submitting comments. The next article will be on health
care costs.
Rosemond Owens: CentraCare is doing work in underserved communities. They have partnered with
Medica and ECHO Minnesota on appropriate use of the emergency room. They have also produced
another vides with ECHO on health care homes.
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St. Cloud is diverse community. Hospitals and clinics see a diverse audience of patients. CentraCare
received grant for training of providers on cultural diversity.
Joel Hetler: Deb Hendricks has taken a new position as the Assistant Director of Community-engaged
Research Programs, Office of Community Engagement for Health at the U of M. This program will bring
a community perspective to research. There is currently a request for proposals for Community Health
Collaborative grants. Note: Information on the grant was forwarded via e-mail to Task Force members.
Joel has been part the Hennepin County work group to set up a reporting dashboard to do countywide
surveillance on the health of children. This includes examining what it means to take a public health
approach to children’s mental health by including factors of social determinants of health and resiliency.
The final report will be out soon. Note: The report was subsequently sent to Task Force members about
the Hennepin County Youth Mental Health and Wellness Dashboard.
Stephanie Graves: Stephanie has been working on early childhood screening, specifically for children in
foster care with special needs. There is a group a Hennepin County Medical Center and Park Nicolet
working to increase both screening and follow-up. They are developing a pilot project to make sure that
the family continues to be followed regardless of final placement of the child.
Joan Brandt: Joan is working with human services on collaborative effort on safe sleep that includes
assuring the completion of a home safety and sleep assessment regardless of who goes into the home.
Ramsey County continues to hire staff for MIECHV.
Nancy Jost: MinnieMinds continues to work with the Minnesota legislature to assure funding for
scholarships in high quality child care. The group continues to meet to discuss legislation regarding the
birth to three populations. Additionally, they are proposing an amendment to the proposed legislative
language to include teen parents working on GED to be able to get scholarships for their children even if
their child is not in the birth to three age range.
Meredith Martinez: President Obama recently signed the Uninterrupted Scholars Act. This will now
allow child welfare agencies to access foster children and foster youth's education records to help with
educational stability and to ensure that children do not have to repeat classes as a result of placement
moves. Under the current education laws regarding access to education records, the Family Educational
Rights and Privacy Act (FERPA), social workers struggled in obtaining records that would help provide
stability and smoother education transitions.
AMCHP CONFERENCE UPDATE
Several MDH staff and Task Force members attended the AMCHP conference. The MDH supported Julie
Jagim to represent the Task Force and Carol Grady as a family delegate. Susan Castellano, Barb Dalbec,
Maggie Diebel and Kristin Teipel also attended.
The overall themes of the conference included family home visiting, early intervention, continuous
quality improvement and the lifecourse approach to MCH. With the lifecourse approach, it is difficult to
see how the state can take this approach and actually implement it into what we are doing. Several states
provided example at the conference.
Julie Jagim commented that is was a wonderful experience. It is interesting to see what other state and
local agencies are doing. In addition, Superior Babies won an AMCHP innovation award. Julie added that
there were two issues that Minnesota should examine: 1) enrollment for Text-4-baby is low in Minnesota,
and 2) the impact of the Affordable Care Act on MCH and CYSHN activities.
The next MCH Advisory Task Force meeting is scheduled for June 7, 2013.
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