Meeting 1 Notes
October 6, 2006
Workgroup Members Present: Mary Baskett, Dennis Cooley (phone), Shannon Cotsoradis (phone), David Dzewaltowski, James Early (phone), Kathy Ermler, Paul Getto, Mary Jo Hafliger, Vicki Hoffman, Wayne Osness, Doug Vance, Claudia Welch, Mim Wilkey (phone)
KDHE Representatives and Staff Present: Jennifer Church, Patricia Dunovan, Tara Gillum, Allison Koonce, Marti Macchi, Paula Marmet, Brenda Nickel
***** The following text represents notes taken at the meeting, but it is not a transcript of all comments made. Although an attempt was made to accurately portray the key themes discussed, some comments may have been incorrectly summarized or inadvertently attributed to the wrong member. Due to time limitations during note-taking, not all comments were attributed to a committee member and several comments were missed entirely. Please submit additions and corrections to Connie Satzler at csatzler@kansas.net. *****
**Jennifer Church: Introductions.
**Paula Marmet: Goals of workgroup.
Child Health Advisory Committee and Governor's Council on Fitness charged to convene a discussion and develop recommendations on policy and could be forwarded to Governor Legislature.
We would like two to three policy recommendations that could have an impact on childhood obesity.
At this meeting, we hope to develop recommendations.
At the October 24th meeting, we hope to narrow to 2-3 key recommendations.
**Jennifer Church: Review of materials sent out, review of recommendations for these sources.
IOM report focuses on school, home, and community. They have a box for each of these settings.
New IOM publication does have helpful recommendations. Jennifer Church passed out summary boxes (one for each setting) from IOM.
Next item - Active Living Research - do a lot in terms of the environment.
Nutrition side isn't very strong for evidence-based programs, but this doesn't mean that we shouldn't do anything.
Did anyone access the CDC legislative bill search?
Wayne Osness: I thought that this was very interesting. A lot of the states had good information.
Jennifer: I focused on schools, but there is also quite a bit on communities. Search is a great resource.
Washington Department of Health - several recommendations. Jennifer focused on schools, but they also have great recommendations on communities.
Nationwide compilation of policies.
Jennifer: I focused on what was effective and promising.
Another handout - example of bills - examples of what was found on the CDC website.
This is a summary of what was sent out. Hopefully you've had a chance to review.
Now, let's move on to the discussion portion.
**Discussion - led by Paula Marmet
David Dzewaltowsk: A lot of the things that I think will work will cost money. Are you thinking about legislation that will require funding to implement, or should we choose policies that won't cost money?
Paula Marmet: We are not to rule out recommendations we feel strongly about that do cost. But, we’re most interested in recommendations that do NOT have big price tag. Chances of getting something approved that has a big price tag are small.
Brenda Nickel: Wellness policy passed has started to be beneficial. With the new wellness policy, schools are starting programs to help staff and students. Even though a it’s a relatively small amount of time throughout of the day, where we have a captive audience (school, preschool, child care) - look at some of educational standards that have had to be modified; have gone by the wayside a bit - physical education requirements. So, look at that 6-7 hours where captive. Then, we have family issues for other 18 hours.
Paul Getto: If look at entire time kids in school throughout their entire childhood, less than 10% of a child’s time, he thinks. The other 90% is important. Have conflicting mandates. It will be interesting to connect the school and community.
Brenda Nickel: Role-modeling, demonstrating, once they progress through school is helpful.
James Early: Are we just focusing on kids? When we impact parents, we impact children.
Paula Marmet: The scope of this group’s discussion is limited to children.
Wayne Osness: Do we have legislation in Kansas that sets the pace statewide?
Vicki Hoffman: The wellness policy comes from a USDA requirement. Each state had to implement to continue in the program. Kansas took this approach: instead of mandating detail, specific criteria, the state developed a model policy. Each school district develops its own. Mandate is to develop a policy, but doesn't mandate which policy the local school district has to use.
Paul Getto: Most schools adopted model policy. Easy to adopt. We actually need to promote and track progress. This is how we're approaching boards.
Vicki Hoffman: The challenge is funding, balancing this and no child left behind.
Kathy Ermler: Think physical education in school - there is no policy, except for one year requirement in Kansas. This needs to be changed for children of all ages. There is no assessment of fitness data. California is leader now that collects fitness data. We need to have a state databank to focus on. Also, a lot of junk food is sold in schools. Tax junk food, and then put this money back into wellness for schools.
Paul Getto: I think people confuse physical activity (PA) with Physical Education. It doesn't have to necessarily be Physical Education (PE). Can integrate it math, etc. Agree with what you're saying. But we can't mandate PE minutes without making the school day longer, which will be problematic. It would cost a huge amount of money to fund this. And we don't have an oversupply of P.E. teachers.
Allison Koonce: As an example of what you’re saying, North Carolina has mandated physical activity, but NOT physical education.
Wayne Osness: Physical education teachers have implemented programs that extend throughout the day. Need to start with commitment now. Have we already adopted recommendations from USDA?
David Dzewaltowski: All that the USDA requires is a wellness policy. At the state, rather than requiring what would be in that plan, we had recommendations only. The strategy - try to encourage a locally-owned plan because there won't be any funding tied to a policy mandate.
Local committees put together plan. It’s a good jump start. But it is different than what some states did.
Wayne Osness: Do we need to take the legislation approach, or are we past that?
Vicki Hoffman: Kansas started as legislative approach, and then moved to consider state recommendations, with actual policy set at the local level.
David Dzewaltowski: People making this decision decided school boards didn't need another unfunded mandate. They went with the grass roots strategy.
Wayne Osness: Perhaps we need to make sure the schools implemented their local plan.
David Dzewaltowski: The hook is USDA money controls – schools must have this in place to get USDA money.
Paul Getto: I think we will see it moving in this direction.
Vicki Hoffman: But the USDA is slow to actually withhold funds.
Paul Getto: Yes, and if/when they do this, it will be at the end of a long, drawn-out process.
Mary Baskett: On the board, could you change preschool to early care and education? Really want to go back to birth, if possible. Early care and education programs in the state include child care licensing (KDHE), child care subsidy (SRS), CASFP (child and adult care food program) (KSDE), child nutrition programs (equivalent of school lunch program only for little ones) (KSDE), and WIC (KDHE).
Paul Getto: Another huge issue - trying to get all of these agencies to come together for a common approach.
David Dzewaltowsk: Common theme among these (except maybe WIC), there no common surveillance for this.
Brenda Nickel: Example - Implementing pilot project in school. The school does BMIs and sends referrals out. Once a referral is made, we have had parents who are concerned. But when go to their health provider, the provider says oh this is just a big child, wasn't appropriate for school nurse to bring it up. Also, there is inconsistency between agencies that are identifying child at risk, but no one to follow-up, counsel with children and families.
David Dzewaltowsk: I’m not really recommending screening; I’m recommending surveillance at this point. There might be debate on whether to send BMI home, but I don't think there's debate on the fact that we need to do surveillance.
Paul Getto: I have mixed emotions on BMI data, but in general I think it's good. Again, we run into unfunded mandate problem.
Paula Marmet: Any idea how many schools do height and weight?
Paul Getto: Most schools are still rural. Most struggle getting what they need. Relatively few nurses in buildings full-time across the state. Most just do the screenings that they are required to do. Could recommend that they should do height and weight.
David Dzewaltowsk: Arkansas has moved to online system inputting data, provides immediate central database statewide.
Kathy Ermler: We don't have to let it fall to nurses, eg., physical educators could assist with this data collection. This could be part of their professional job.
Brenda Nickel: We don't recommend that school nurses do height and weight unless they will chart on a growth chart and follow-up.
James Early: We’re seeing dramatic results in our clinic, but the amount of energy put into one adolescent child within a family is enormous. When families are interested, it is possible.
Kathy Ermler: Physicians do have enormous amount of power – they can bring you to realization very quickly that you need to make a change.
James Early: All physicians I have talked with are wondering how they can bring into their practice without taking an enormous amount of time. The Preventive Vital Signs program will help them do this.
Dennis Cooley: The committee is working on getting this out to all physicians in the state - wheel to help calculate BMI, what screening tests need to be done, treatment, recommendations, where they can get referrals (kids will need referrals to endocrinologists, e.g.). Lot of different groups doing a lot of things that not everyone knows about. Wonder how much of this is being coordinated.
James Early: Everybody had a program - everybody wanted to educate docs. But it’s generally very complicated. We never get simple enough to get step 1 done. Most falls on deaf ears because to difficult to implement. Need to get down to the ABCs of this.
Dennis Cooley: We're looking at a 3 x 4 sheet of laminated paper, very simple. Like BMI, for example, if the primary care provider doesn't get this, it is wasted. We need to educate primary care providers.
James Early: I agree.
David Dzewaltowski: I would disagree. Some research has shown that obesity problem will not be solved by the primary care system. BMI screening is for public health use.
Dennis Cooley: Agree that there is public health information, but it's much more than that! I use BMI for diabetes screening, etc.
David Dzewaltowski: But I’m talking about implementing a surveillance system to describe a problem, a system where primary care physicians, schools, public health can have this information to use. Track results by year, identify problems by geographic area. Use to tell us - are our programs, interventions working?
Wayne Osness: We’re talking about the need for an assessment system. If we decide we’re going to go with the BMI, then can move to what we want to accomplish, how to implement. We can stratify data and make decisions appropriately. We need some type of assessment system.
Brenda Nickel: But if we’re doing this, we’re really looking at screening.
James Early: It's not easy. When 95% of physicians know they are supposed to do this and don't. Weights and heights aren't on all charts. Maybe the school is the place it can be done. As simple as it seems, it's not being done now!
Brenda Nickel: It is more complicated. It's height and weight, but it's also plotting the results.
David Dzewaltowski: CA is using FitnessGram software. They are doing 2 tests: BMI and aerobic test. Data points on 4th grade, 7th, and 9th graders, I think.
[Note: For more information on FitnessGram, see www.fitnessgram.net.]
Paula Marmet: Think the students create a plan; the focus is on fitness more than just getting the BMI #.
David Dzewaltowski: Yes, what to collect, then what do you do with it?
Kathy Ermler: First, we need the data. You might find that schools that have eliminated PE have the biggest problems. Or maybe not. You don't know until you have that data.
Brenda Nickel: Regarding school screening requirements, growth screening is not required. With vision and hearing screening, the school is required to notify parents. Would probably need to require to notify parents for this, too.
Marty Mackey: What do parents do if they get the information sent home? As an example – my child was sent home sit-up results, but this doesn't seem very helpful.
Brenda Nickel: There are parents that are anxious to try to get involved, but they are not sure how to do so.
Claudia Welch: We have implemented FitnessGram. Based on # of kids, lots of research. We put in height and weight. It will give you back BMI. We’re looking at overall wellness. We do the pacer test, situps, push ups. This way, teachers and parents know what to focus on. There's a parent report you can send home. This will be our 3rd or perhaps 4th year of doing BMI. We were right up there amongst heavier weights. We are starting to see a change. Rather than just trying to hit one group, we’re trying to include all. Not just nurses, PE teachers - all. If we see BMI in 95% range, nurses are notified, we notify parents. We have teams. We look at a Fit Team to buddy up with kids and parents. But it goes back to resources and finances. This will not happen without funding unless you have super-dedicated people.
Jennifer Church: How to do in a way so children don't feel ostracized?
Claudia Welch: It’s very private
Brenda Nickel: I appreciate your sensitivity, Jennifer. This does get back to lifestyles. How do we improve lifestyles without being critical?
Paula Marmet: Claudia, you have had some success with this. Do you have policy recommendations that would encourage other schools to implement what you are seeing be successful?
Claudia Welch: First of all, you must have data to show you have a need. When you go to apply for a grant, you must be able to show need.
Claudia Welch: FitnessGram is a good way to go. We chose this because of all the data that comes with it. Because of the health of our kids, the level was much higher 10 years ago than it is now regarding fitness (because of more sedentary lifestyle). You need buy-in from administrators, teachers, community. You have to bring in the community, plan for entire community. Last month we had 582 people at a fitness activity. All types of people came. That original group of 6th graders was the first group targeted. They are now 9th graders. We are making a difference. There is no PE requirement at the junior high level. If you look at data between elementary and junior high, you generally see more problems, more in at-risk group between elementary and junior high. Lots of committees, etc. working on getting everyone to buy in.
Paula Marmet: The state has an electronic system. There’s a grant for this. Whose decision is it about what additional elements could also be included? Is this a choice of KSDE or not?
Paul Getto: Not sure, generally they don't go beyond what is required by federal grant.
Paula Marmet: So if they would collect additional information, it would be a cost to somebody?
Paul Getto: Yes, probably, plus might have privacy concerns if you are tying what could be considered health data to individual kids. ...if not the data is tied to the individual child, it’s pretty easy to collect and distribute.
Wayne Osness: What does it cost per student?
Claudia Welch: Don't buy per student. We buy a license for one teacher or several teachers.
David Dzewaltowski: Not very much, $200 a license or so.
Wayne Osness: We don't want to reinvent the wheel.
Marty Mackey: Is easy to understand. When I saw, it was presented with a parent-teacher conference or with a report card, which made it seem as something you should take seriously. Everybody gets one.
David Dzewaltowski: We have been researching a new module, ActivityGram. It has reports on kids' activity. There isn't a diet module as part of FitnessGram now. If you want developer of this to come down and give a talk, he probably would (in Iowa now). Arkansas is developing their own. Do you want to do your own or do you want to use what is already there? How would you write in legislation? State could provide a tool to schools as a resource.
Wayne Osness: I think we're saying assessment is necessary. Then, we need to discuss/determine the tool.
Paula Marmet: Review suggestions that came up so far. What can KDHE staff do to research additional information? We didn't talk much about early child care.
Mary Baskett: Think we (early child) have the same issues but less ability to impact these settings. Think it can still be done.
Pat Donovan: Collect height, weight, BMI, hemoglobin. Collecting on 0-5, on lower end of income, not much on higher end. We have 39,000 kids in the system at any one time.
Mary Baskett: We have about 8,000 Head Start kids where we have this data. So, that’s 45,000 children between the two programs.
Jennfier Church: I think parents sending kids to licensed day care have to provide health assessment upon starting day care, which includes height and weight. This is a possible source for data.
Mary Baskett: It’s definitely worth exploring. It would be helpful to me to know, where do we have leverage in terms of policy?
Jennifer Church: Regarding nutrition in schools, we have control over the breakfast and lunch program. Then, there are competitive foods, which include everything outside break/lunch program. There’s a disconnect between the two, but there is an opportunity to better impact/control competitive foods. For example, have food service control all foods, or include health options only in vending, or limit times vending is available. Comments?
Vicki Hoffman: Related to competitive foods, it’s a funding issue. [revenue source for schools]
Brenda Nickel: It goes back to parent education. We are also teaching why it’s a better choice. We are limiting choices in a controlled setting.
Claudia Welch: Some vending machine providers are helping. They are/can make choices to provide better options. We need to make healthy choices CHEAPER than unhealthy options, use revenue from the unhealthy options to supplement the healthy options.
Paula Marmet: At next meeting...
There is a directive to Department of Education to look at policies in schools. Sunflower Foundation made a grant to KHI to study school policies. They will be able to share these results with us at the next meeting. They will provide information on school policies; this will give us quantitative information for the next meeting.
Any last comments?
Paul Getto: Obvious this is a huge system issue and lifestyle issue. I would like to see if we have any communities that have had long-term workable systemic efforts in place to try to deal with this. If we don't get parents and the entire community moving, we're just talking. We have to get everyone doing something. I’m curious if we can find some effective community models.
Mary Jo Hafliger: Think there are a lot of communities out there trying to change, asking for help.
Doug Vance: We should consider creating an awareness campaign about the issue around the state.
Wayne Osness: The data that were going to get [with the Sunflower/KHI study], will this be state of the art data? Or, will this be data about the problem?
Paula Marmet: Yes, it will be data about what is going on around the state, about what policies are actually in place in schools.
Allison Koonce: I would add to this – there is school health profile data for middle and high schools. This goes to the lead health teacher and lead principal. [Allison will pull out some of this before the next meeting.]
Claudia Welch: Maybe look at P.E. as a state assessment.
James Early: Will these kids be the first generation where their parents outlive them?
Jennifer Church: You may go to website and post comments in the future.
Thank you!
| Meeting 1 Discussion Board is now closed. Please add additional comments to the Meeting 2 Discussion Board. |