Kings Quarterly

Kings County CHDP Program
Kings
Quarterly
330 Campus Drive, Hanford, CA 93230
Phone: (559) 852-4531
Michael L. MacLean, M.D., M.S.
Health Officer
Kings County CHDP Newsletter
Patricia Harder, MSN
CHDP Deputy Director
Summer
2013
Message from the Deputy Director
Summer has arrived and it looks like it is going to be a long, hot, and dry one.
Remind everyone, including yourself, to stay hydrated and find a cool place
to go if necessary. The Health Department has a list of “Cool Places” that are
available on the website. The Mall in Hanford and all public libraries are on
the list.
Inside this issue:
 Message from Deputy Director
 HEDIS results
 West Nile Virus update
 Top Ten CVIIS
 Women’s Health for Teens
 Heat Reminder
 Minor Consent for STD prevention
 Binge Drinking
 Hearing and Vision Trainings
 WIC Corner
 Cinnamon Challenge
 Drowning Prevention
 SIDS Conference Recap
 Safe to Sleep (English insert)
 Safe to Sleep (Spanish insert)
On the back page of the newsletter, Marjorie listed the 15 recommendations
from the American Academy of Pediatrics (AAP) that reduce the risk of
Sudden Infant Death Syndrome (SIDS). I was at the conference and felt the
speakers addressed this sad occurrence very well. One of Dr. Zorn’s
comparisons helped me understand the importance of decreasing the risk
factors. I may not write it exactly as Dr. Zorn explained (forgive me,
Dr. Zorn) but I will try.
Car accidents are caused by many factors which include:
 Problems with car, e.g. brake failure; bald tires
 Bad weather causing slippery roads or poor visibility
 Distracted drivers, e.g. cell phone use
 Driving too fast
 Driving under the influence of alcohol or drugs
 Driver too tired
 Etc., etc.
Eliminating one of these factors already decreases the number of accidents.
It does not eliminate all accidents from other causes. Eliminating more
factors would continue to decrease the accident rate. We may not be able to
eliminate SIDS but we can encourage adherence to the things that can be
done to decrease SIDS.
We have added a flyer from the U.S. Department of Health and Human
Services. It is in both English and Spanish and contains the 15 recommendations of the AAP. Please take a few minutes to inform all new moms about
these simple things they can do.
Breastfeeding also reduces the risk of SIDS.
Happy Summer,
Pat
Page 2
Kings Quarterly
Document, Document, Document
2013 HEDIS Results
By Marjorie Batin, PHN II
Everyone’s heard the saying “if it isn’t
documented, it didn’t happen.” We are taught
early on the importance of accurate and timely
documentation. In CHDP, we rely on what
you document, both in the patient’s chart and
on the PM-160, to ensure that the children in
our program get the care we are mandated by
Federal law to provide. The Early Periodic
Screening, Diagnosis, and Treatment (EPSDT)
program, implemented in 1967, ensures that
all children and young adults under 21 years
of age who are enrolled in or financially
eligible for Medicaid (Medi-Cal) get the
EPSDT they need to ensure healthy lives.
CHDP is California’s answer to that Federal
mandate. Therefore, all CHDP providers must
abide by the screening, diagnosis, and
treatment requirements set forth by the
EPSDT mandate.
According to the latest HEDIS report, shared
with us by Anthem Blue Cross, Kings County
providers scored well below other counties in
the following areas:





BMI Percentile documentation

Well-Child Visits (ages 3, 4, 5 & 6 years)
Nutritional Counseling
Physical Activity Counseling
Childhood Immunizations
Adolescent Immunizations (Tdap and
Meningococcal)
Because managed care is now in place, we are
no longer able to case manage each PM-160
that crosses our desks. We rely on you, the
providers, to ensure that our CHDP children
get the care and follow-up needed. Please
remember to complete all aspects of the
CHDP physical according to the periodicity
schedule, and document accordingly. We will
assist you in any way that we can, whether it
is through education of staff, flyers or
pamphlets, or questions over the phone. We
appreciate all that you do, and are here to help
you help the children of Kings County.
* (HEDIS® (The Healthcare Effectiveness Data and
Information Set) is the gold standard in health care
performance measurement, used by more than 90 percent of
the nation's health plans and many leading employers and
regulators. HEDIS is a set of standardized measures that
specifies how organizations collect, audit and report
performance information across the most pressing clinical
areas, as well as important dimensions of customer
satisfaction and patient experience.)
BIRD TESTS POSITIVE FOR WEST NILE VIRUS IN KINGS COUNTY
Excepts from West Nile Virus Update
June 13, 2013
LEMOORE, CA - - The Kings Mosquito Abatement District is
reporting that a crow collected in the City of Lemoore has tested
positive for West Nile Virus. This is Kings County’s first indication of
West Nile Virus activity in 2013, and a reminder to all residents to
protect themselves against mosquito bites.
Dr. Michael Mac Lean, Public Health Officer for Kings County, highlights the following points:
1. While we can expect a full recovery in most people with the disease,
WNV can result in lifelong disability in some cases and can be fatal.
2. Complicated disease is more likely to occur in people over age fifty
but can occur in any age group.
3. None of us should be complacent about WNV. Dr. Mac Lean
himself carefully follows all the recommendations about avoiding
mosquito bites.
On a Brighter Note
The Central Valley Immunization
Coalition (CVIS) recently listed the
top ten providers in this region with
the highest number of children listed in
the California Immunization Registry
(CAIR). CAIR makes it possible to
view a child’s immunization history
whether or not they bring a record in,
thus improving immunization rates and
efficiency in our county. Making the
top ten were Family Health Care
Network and United Health Centers.
Congratulations for a job well done!
Please educate families to:
 DEFEND against mosquitoes by using a repellent with an effective
ingredient, such as: Deet, Picaridin, or Oil of Lemon Eucalyptus.
 DRAIN all sources of standing water.
 Door and window screens should fit tight and be in good repair.
 Do vaccinate your horses. Horses are highly susceptible to West
Nile virus- approximately half of all horses that get WNV are
euthanized.
 DAWN and Dusk are times to avoid being outdoors, since this is
when mosquitoes are most active.
 Dress appropriately by wearing long sleeves and pants when outdoors and mosquitoes are present.
 Dead birds should be reported to 1-877-WNV-BIRD
(1-877-968-2473). Not all birds will be picked up and tested, but
reporting dead birds provides important information for mosquito
control efforts
Women’s Health for Teens: PLAN B
From the FDA News Release, April 30, 2013
“FDA approves Plan B One-Step emergency contraceptive without a prescription for women 15 years of age and older.
The U.S. Food and Drug Administration today announced that it has
approved an amended application submitted by Teva Women’s
Health, Inc. to market Plan B One-Step (active ingredient levonorgestrel) for use without a prescription by women 15 years of age and
older.”
“Research has shown that access to emergency contraceptive
products has the potential to further decrease the rate of unintended
pregnancies in the United States,” said FDA Commissioner Margaret
A. Hamburg, M.D. “The data reviewed by the agency demonstrated
that women 15 years of age and older were able to understand how
Plan B One-Step works, how to use it properly, and that it does not
prevent the transmission of a sexually transmitted disease.”
Heat Reminder
As temperatures rise here in the
San Joaquin Valley, we need to
remind all parents (including
staff, family, and friends) to
never, ever leave a child
unattended in a vehicle, not even
for a few minutes. Temperatures
can rise to dangerous levels very
quickly, and a baby or small child
will be at risk of developing heat
exhaustion, heat stroke, or even
death.
Make sure to remind
parents to have a routine to make
sure all children are out of the
vehicle when it is parked.
Kings Quarterly
Minor Consent for STD Prevention Services
From the California Immunization Coalition
On January 1, 2012, a California law (known as AB 499 or
Chapter 652, Statutes of 2011) expanded the legal authority of
minors 12 years and older to consent to confidential medical
services for the prevention of sexually transmitted diseases
(STDs) without their parents’ consent.
The law permits adolescents age 12 through 17 years to consent
to:
 Hepatitis B vaccination
 Human papillomavirus (HPV) vaccination
 HIV pre- and post- exposure medications
 Additional STD prevention services that may become
available in the future.
The law allows minors to consent only for vaccines that prevent
sexually-transmitted diseases. Currently, this includes only two
adolescent vaccines: HPV and Hepatitis B.
California law also allows youth to receive confidential care for
reproductive health care, mental health care, and substance abuse
treatment.
The law does not grant parents the right to prevent their child
from seeking confidential immunization with HPV or Hepatitis B
vaccine or to see records of a confidential vaccination.
To see the entire document, go to California’s Minor Consent
Law on STD Prevention Services FAQs.
Binge Drinking
The CDC released a statement in the January issue of Vital Signs
regarding women and girls who binge drink. Binge drinking for
women and girls is described as consuming four or more drinks at
any one time. Nearly 14 million women and girls in the U.S.
binge drink an average of three times a month. Often this is an
under-recognized problem, yet it can lead to multiple serious
health problems for women, including breast cancer, heart
disease, and sexually transmitted diseases. One in five high
school girls report binge drinking. Pregnant women and teens
who binge drink may potentially expose a developing fetus to
high levels of alcohol, sometimes even before they know they are
pregnant, and when crucial fetal development is taking place.
Binge drinking causes approximately 23,000 deaths annually in
the United States among women and girls. Although we, as
nurses and providers, may not get honest answers from teens
when we discuss alcohol use, the more we educate them of the
dangers and consequences of binge drinking, the better. Hopefully, the choices they make now and later will be influenced by the
things we taught them along the way.
Hearing and Vision Screenings
CHDP held a Hearing Screening Training on June 10th, with
guest speaker Charis Smith, Speech and Language Specialist.
The training was well-attended and we hope to coordinate at least
one CHDP training every year, rotating between hearing
screening and vision screening. We will keep you all posted for
the upcoming trainings!
Page 3
WIC Therapeutic Formula Update
By Michelle Bieber, RD
The Kings County WIC Program is pleased to partner with pediatric
healthcare providers to assure the children of our community receive the best
possible nutrition to support growth and health. We encourage the promotion
of exclusive breastfeeding for the first six months of life.
When prescribed for a qualifying medical condition, WIC can provide
therapeutic formula for one month, and will refer the participant to a
participating pharmacy for continued coverage of the therapeutic formula by
her health plan.
WIC requires a letter of denial from the participant’s health plan in order to
continue providing a therapeutic formula. WIC will encourage the participant
to appeal the decision to deny coverage.
This communication is to provide information about our guiding regulations
and what WIC requires to provide therapeutic formula while the participant
submits her request to her health plan for coverage.
According to Federal Regulation 7CFR 246.10 (e)(3) WIC is the payer of
last resort for therapeutic formula. This regulation reads as follows:
Therapeutic formula can be issued by WIC when:
there is a documented qualifying condition for the formula;
supported by medical documentation; and
formula is not provided by another provider
Qualifying conditions include but are not limited to:
Severe Food Allergies
GI Disorders
Prematurity
Low Birth Weight
Failure to Thrive
Medical documentation must include:
name of formula;
qualifying condition(s) for the issuance of the formula;
amount needed per day;
length of time the prescribed formula is required;
signature, date, and contact information of the professional
licensed by the State to write prescription
Therapeutic formula cannot be issued
for food/formula intolerance or food allergy that does not
require an exempt formula; or
solely for enhancing intake or managing body weight without
an underlying, qualifying condition
For questions regarding this information, please contact WIC at 582-0180
and ask to speak to a nutritionist.
The Cinnamon Challenge
With all the dangers facing youth today, this “game” may not seem as
dangerous as some. My teenage son has informed me that it is “not a big
deal” anymore, and that kids are moving on to other things. Nevertheless,
it is important that healthcare providers and parents are aware of these
trends, so that they may be diligent in educating teens of the dangers
beforehand, and addressing the medical problems that result from
participation. It’s called the cinnamon challenge and, according to the
American Association of Poison Control Center, it begins with a dare to
swallow a spoonful of ground cinnamon without drinking any water or
other liquid. It poses the risk of aspiration and permanent damage to the
lining of the trachea and lungs, leading to coughing, gagging, vomiting,
choking, and trouble breathing. Asthma sufferers are at even greater risk
for problems. The cinnamon game among teens ages 13 to 19 years of age
led to 222 calls to poison control centers in the United States in 2012.
Already this year, 29 such exposures were reported to poison centers.
What does a safe sleep
environment look like?
Reduce the Risk of Sudden Infant Death Syndrome (SIDS)
and Other Sleep-Related Causes of Infant Death
Make sure
nothing covers
the baby’s head.
Use a firm sleep
surface, such as
a mattress in a
safety-approved*
crib, covered by
a fitted sheet.
Always place your
baby on his or her
back to sleep, for
naps and at night.
Do not use
pillows, blankets,
sheepskins, or
crib bumpers
anywhere in your
baby’s sleep area.
Dress your baby
in light sleep
clothing, such as a
one-piece sleeper,
and do not use a
blanket.
Keep soft objects,
toys, and loose
bedding out
of your baby’s
sleep area.
Baby should not
sleep in an adult
bed, on a couch,
or on a chair
alone, with you, or
with anyone else.
Do not smoke
or let anyone
smoke around
your baby.
*For more information on crib safety guidelines, contact the Consumer Product
Safety Commission at 1-800-638-2772 or http://www.cpsc.gov.
SAFE TO SLEEP
Safe Sleep For Your Baby
Always place your baby on his or her back to sleep,
for naps and at night, to reduce the risk of SIDS.
Use a firm sleep surface, covered by a fitted sheet,
to reduce the risk of SIDS and other sleep-related
causes of infant death.
Your baby should not sleep in an adult bed, on
a couch, or on a chair alone, with you, or with
anyone else.
SAFE TO SLEEP
Avoid products that claim to reduce the risk of
SIDS and other sleep-related causes of infant
death.
Do not use home heart or breathing monitors to
reduce the risk of SIDS.
Give your baby plenty of Tummy Time when he or
she is awake and when someone is watching.
Keep soft objects, toys, and loose bedding out of
your baby’s sleep area to reduce the risk of SIDS
and other sleep-related causes of infant death.
To reduce the risk of SIDS, women should:
• Get regular health care during pregnancy, and
• Not smoke, drink alcohol, or use illegal drugs
during pregnancy or after the baby is born.
To reduce the risk of SIDS, do not smoke during
pregnancy, and do not smoke or allow smoking
around your baby.
Breastfeed your baby to reduce the risk of SIDS.
Give your baby a dry pacifier that is not attached
to a string for naps and at night to reduce the risk
of SIDS.
Do not let your baby get too hot during sleep.
Follow health care provider guidance on your
baby’s vaccines and regular health checkups.
For more information about SIDS and the Safe to Sleep campaign:
Mail: 31 Center Drive, 31/2A32, Bethesda, MD 20892-2425
Phone: 1-800-505-CRIB (2742)
Fax: 1-866-760-5947
Website: http://www.nichd.nih.gov/SIDS
NIH Pub. No. 12-5759
September 2012
Remember Tummy Time!
Place babies on their stomachs when they are awake
and when someone is watching. Tummy Time helps
your baby’s head, neck, and shoulder muscles get
stronger and helps to prevent flat spots on the head.
¿Cuál es la apariencia de un
ambiente seguro para dormir?
Reduzca el riesgo del síndrome de muerte súbita del bebé
y de otras causas de muerte relacionadas con el sueño
Asegúrese de
que ningún
objeto cubra la
cabeza del bebé.
Use una superficie
firme para
dormir como un
colchón en una
cuna que cumpla
con las normas
de seguridad
aprobadas* y
cubra el colchón
con una sábana
ajustable.
Tanto en las
siestas como
en la noche,
siempre ponga
a su bebé a
dormir boca
arriba.
No use
almohadas,
cobijas, pieles
de borrego o
protectores de
cuna en el lugar
donde duerme
el bebé.
Póngale a su
bebé ropa
ligera para
dormir, como
mamelucos o
pijamas de
una sola pieza,
en lugar de usar
una cobija.
Mantenga los
objetos suaves,
juguetes y ropa de
cama suelta fuera
del área donde
duerme su bebé.
Su bebé no
debe dormir
solo ni
acompañado
en una cama de
adultos, un sofá
o una silla.
No fume ni
permita que otros
fumen alrededor
de su bebé.
*Para obtener más información sobre las normas de seguridad de las cunas, llame gratis a la
Comisión de Seguridad de Productos del Consumidor al 1-800-638-2772 (en español o en
inglés) o visite su página electrónica en http://www.cpsc.gov.
Sueño seguro para su bebé
Tanto en las siestas como en la noche, siempre
ponga a su bebé a dormir boca arriba para reducir el
riesgo del síndrome de muerte súbita del bebé.
Use una superficie firme para poner a su bebé a
dormir y cúbrala con una sábana ajustable para reducir
el riesgo del síndrome de muerte súbita del bebé y de
otras causas de muerte relacionadas con el sueño.
Su bebé no debe dormir solo ni acompañado en una
cama de adultos, un sofá o una silla. Mantenga los
objetos suaves, juguetes o ropa de cama suelta fuera
del área donde duerme su hijo para reducir el riesgo
del síndrome de muerte súbita del bebé y de otras
causas de muerte relacionadas con el sueño.
Siga los consejos de un proveedor de servicios de la
salud para las vacunas y las visitas de rutina de su bebé.
Evite los productos que aseguran reducir el riesgo
del síndrome de muerte súbita del bebé y de otras
causas de muerte relacionadas con el sueño.
Para reducir el riesgo de este síndrome, no use
aparatos caseros para monitorear el corazón o
la respiración.
Ponga a su bebé boca abajo sobre su barriguita
cuando esté despierto y alguien lo esté vigilando.
Para reducir el riesgo de este síndrome, las mujeres:
Deben obtener cuidados de salud regulares
durante el embarazo y
•
•
No deben fumar, tomar alcohol o consumir
drogas ilegales durante el embarazo o después
de que nazca el bebé.
Para reducir el riesgo del síndrome de muerte
súbita del bebé, no fume durante el embarazo
y después no fume ni permita que otros fumen
alrededor de su bebé.
Dele el pecho a su bebé para reducir el riesgo del
síndrome de muerte súbita del bebé.
Para reducir el riesgo de este síndrome, en la
hora de la siesta o en la noche puede darle a su
bebé un chupete o chupón seco que no tenga un
cordón alrededor.
No deje que su bebé tenga demasiado calor al dormir.
Para obtener más información acerca del síndrome de muerte súbita
del bebé, comuníquese con la campaña “Seguro al dormir”:
Dirección: 31 Center Drive 31/2A32, Bethesda, MD 20892-2425
Teléfono: 1-800-505-2742 (1-800-505-CRIB)
Fax: 1-866-760-5947
Página electrónica: http://www.nichd.nih.gov/SIDS
NIH Pub. No. 12-5759(S)
Septiembre 2012
¡Su bebé también necesita estar boca abajo!
Ponga a su bebé sobre su barriguita cuando esté
despierto y alguien lo esté vigilando. El estar boca abajo
ayuda a fortalecer los músculos del cuello, los hombros
y la cabeza de su bebé y previene la formación de áreas
planas en la cabeza.
419000-419100
Kings County Health Department
CHDP Program
330 Campus Drive
Hanford, CA 93230
Email: [email protected]
Or
[email protected]
Phone: CHDP (559) 852-4531
Drowning Prevention
The Department of Developmental Services (DDS) has recently updated the Drowning
Prevention Webpage at http:/www.dds.ca.gov/Drowning/Index.cfm. There, you can
find links to drowning prevention education materials. In addition, please remind
families to take steps to prevent a devastating incident from happening. Drowning
Prevention is most effective with a “layers of protection” approach:


Never leave a child alone near water, even for a few seconds


Keep a constant adult eye on young children


Swimming pools should have fences, alarms, and drains that meet regulations


Keep reaching and throwing aids near a swimming pool

Parents and child caregivers should know how to perform rescue techniques and
strategies to respond in an emergency

If a child is missing, check the pool first
A supervising adult should be close enough to touch the child under 4 years old
near water
All collections of water are dangerous for infants and toddlers including bathtubs,
buckets, toilets, ponds, spas, swimming pools, and natural water sites
Pool gates should be self-latching, opening outward, with the latch out of reach
for a child
All children should wear a personal floatation device while playing near bodies of
water
SIDS
Recently, the KCHD hosted a SIDS (Sudden Infant Death
Syndrome) Awareness conference in Kings County,
presented by Maternal, Child, Adult Health (MCAH)
Director and SIDS coordinator, Amaya Ly. There were 40
people in attendance. The panel of expert speakers
included Dr. Elinor Zorn (pediatrician), Tom Edmonds
(Kings County Chief Deputy Coroner), Pastor Pensiero
(Lemoore Police and Hanford Fire Department Chaplain),
and Rick Smith (Hanford Fire Department Battalion
Chief). We heard perspectives from each discipline, and
how an infant death can affect, not only the family, but the
first responders as well. The take-home message of the
conference is that everyone who provides medical care for
the families of newborns should be advocating for safe
sleep practices. According to the American Academy of
Pediatrics, the recommendations are:
 Babies should be placed on their backs for sleeping up
to one year of age. Side sleeping is not advised.
 Use a firm surface (mattress) covered by a fitted sheet.
 Room-sharing without bed-sharing is recommended.
 Keep soft objects and loose objects out of the bed.
 Pregnant women should receive regular prenatal care.
 Avoid smoke exposure during pregnancy and after
birth.
 Avoid alcohol and illicit drug use during pregnancy
and after birth
 Breast feeding is recommended.
 Consider offering a pacifier at nap time and bedtime.
 Avoid overheating, over-bundling, and covering the
head of the baby.
 Infants should be immunized.
 Avoid commercial devices marketed to reduce risk of
SIDS (wedges, positioners, special mattresses and
sleeping surfaces.)
 Do not use home cardio-respiratory monitors to reduce
the risk of SIDS.
 Supervised tummy time is recommended.
 Health care professionals, staff in newborn nurseries,
and child care providers should endorse the SIDS risk
reduction recommendations from birth.