Policy push

How Colorado parents opt kids out of immunizations could soon change

PHOTO: Pan American Health Organization

Parents might have to work a little harder to opt their children out of required immunizations if the State Board of Health approves a set of policy changes on Wednesday.

Currently, parents can submit a “personal belief” or religious exemption form just once during their child’s K-12 schooling. If the new rules pass, parents would have to submit those exemption forms annually.

The rule changes also include a provision for a new public database of immunization and exemption rates for all Colorado schools and childcare facilities.

Such a database would be a significant expansion of the work Chalkbeat Colorado began in February by publishing a first-of-its-kind immunization database for schools in the state’s 20 largest districts.

State health department officials said the database amendment was a last-minute addition that came in response to feedback from stakeholders during the last two months. A state law passed last year — House Bill 14-1288 — requires schools to release immunization and exemption rates upon request.

That law doesn’t specify that the health department collect the data, but officials there believe it’s within the department’s broader legal authority as long as the Board of Health approves the plan.

Advocates of the new exemption requirements and database which would take effect in  2016, say they could help push down exemption rates and better inform the public about communicable disease risk in their communities.

Last year, about 4.6 percent of the state’s kindergarteners — around 3,000 — had “personal belief” exemptions from some or all shots.

At individual schools, those rates vary wildly. More than 140 schools in Chalkbeat’s database posted exemption rates of 10 percent or more and several had exemption rates higher than 30 percent.

It’s those schools that worry public health experts most.

That’s because exemption rates of 10 percent or higher can threaten herd immunity, which offers protection against disease outbreaks. Herd immunity usually requires immunization rates of 90-95 percent.

Toughening exemption rules…a little

Colorado currently has one of the most lenient personal belief exemption policies in the country.

To qualify for such exemptions parents simply sign a form on a one-time basis. In contrast, many of the other 19 states that allow philosophical or personal belief exemptions make the process tougher.

Some, such as Arkansas, require parents to submit notarized documents every year. Others, such as Washington and Michigan, require that parents be briefed by doctors or county health workers one or more times during the K-12 years.

Childhood vaccination rates in Colorado and the nation | Create infographics

Advocates of the exemption frequency rule say it will require parents who exempt to put forth a similar level of effort as parents who vaccinate — a tenet know as “equal effort.” 

“It should not be easier to exempt your child than to vaccinate your child,” said Rachel Herlihy, acting director of the Disease Control and Environmental Epidemiology Division at the Colorado Department of Public Health and Environment.

Under the proposed change, the increased number of times parents must submit paperwork aligns with the childhood schedule for doctor visits. While parents of school-age children would have to submit the forms annually, parents of younger children would have to submit the forms at any point new shots are required — up to five times before kindergarten.

Better data versus extra red tape

Proponents of the new rule also say increasing exemption frequency could also yield more accurate data. For example, when family circumstances change — say a hesitant parent later decides to vaccinate — the decision is recorded and the outdated exemption is removed.

Opponents worry the provision will heap new administrative work on already stretched schools and child care providers. One large district that is speaking out is the Boulder Valley School District, which has a districtwide exemption rate of 12 percent. In a letter to the state board, the district’s director of health services calls the new requirement an unfunded mandate.

But districts like Greeley-Evans, where school exemption rates range from 1 to 13 percent, have fewer concerns about extra work.

“It would put a burden on us…but it wouldn’t be a lot,” said Lead nurse Maribeth Appelhans.

Opponents of the frequency rule also worry that it amounts to government interference in carefully considered health care decisions.

“We believe it should, like any other medical decision, rest in the hands of the people who are taking the risk,” said Theresa Wrangham, executive director of the National Vaccine Information Center, a group opposed to vaccination mandates.

Besides worrying about new administrative burdens on schools, she has concerns about data privacy since the new exemption rule would shift from the current paper exemption form collected by schools to a new online exemption form that would go to the state health department.

“My concern is it’s not [the health department’s] job,” she said. “The law says the schools gather it… It’s information they should be handling and protecting.”

Combatting convenience exemptions

One amorphous group that comes up often in immunization discussions are parents who choose “personal belief” exemptions for convenience rather than strongly held convictions.

These might be frenzied parents who aren’t particularly worried about the risks of vaccinations, but signed the exemption form because it was quicker than searching for lost paperwork or scheduling last-minute doctors appointments.

The state health department has no firm data on convenience exemptions, but both advocates and opponents of the rule changes say they’ve heard anecdotal accounts of school staff offering parents the exemption option if their immunization paperwork is missing or incomplete.

“That’s a school problem, not a parent problem,” Wrangham said. “We need to revisit how school personnel are trained.”

But Appelhans said while some district staff may have taken such shortcuts years ago, they don’t anymore. Health clerks, and even substitute health clerks, now receive comprehensive training about immunization rules, she said.

While Wrangham doesn’t believe the rule change will reduce Colorado’s exemption rates, Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition, does. 

“Other states that have…common sense parameters around how parents can claim an exemption get much more meaningful, accurate data…in terms of getting rid of the convenience factor,” she said.

She doesn’t expect the rule to affect the decisions of parents who have strongly held beliefs about vaccinations, but thinks it could impact parents who are “fence-sitters.”

A missing conversation

Regardless of what happens at the Board of Health meeting, some observers say immunization advocates need to look at how they communicate with parents who are hesitant about vaccines.

Jennifer Reich, a sociology professor at the University of Colorado Denver, has studied how parents make vaccination decisions and found that those who opt out see it solely as an individual choice with little or no health impact on the broader community.

“The problem is that’s just not how vaccines and illness work,” she said.

Still, she said most messaging about immunization doesn’t focus on community benefits.

“We don’t talk about vaccination like that,” said Reich, who will publish a book about vaccine decision-making in 2016. “Most parents didn’t recognize the problem of free-riding.”

Even among parents who fully vaccinate, 25 percent have concerns about the standard immunization schedule, she said.

“I’m wondering more broadly how we haven’t succeeded in communicating science in a way parents can trust.”

Proposed changes

school support

When students miss school, they fall behind. Here’s how one group is curbing absenteeism.

PHOTO: Caroline Bauman
Two of Agape's staff members work with students on reading at Whitney Achievement Elementary School. The staff members, though employed by the Memphis nonprofit, are integrated into school life.

When Crystal Bullard moved to Memphis from the Bahamas last year, she was looking for a new life and a better education for her three young children.

What she found was an overwhelming school system that was hard to navigate, and an environment where her children felt like outsiders.

Her children, ages 4, 7 and 9, were initially bullied at Whitney Achievement Elementary School, the North Memphis school she chose because it was closest to her home. The bullying meant her kids didn’t want to go to school. For Bullard, missing a day or two was a common problem at the beginning of last school year.

“When I came here, I didn’t know nothing. I had nothing,” Bullard said. “I came to this school because it was the first I found. But it was so hard to get the kids up and here every day. We struggled with that for many weeks.”

Bullard is not alone in her daily battle to get the kids to school. Almost a fifth of Memphis students are considered chronically absent, which means they missed at least 18 days during the school year. Research has shown chronic absenteeism is linked to negative outcomes for students, including lower test scores, higher dropout rates, and even a greater risk of entering the criminal justice system.

Absenteeism has such a large impact on learning, districts are under pressure from new national legislation to include chronic absenteeism data in how they evaluate schools.

In Memphis, a local nonprofit is working to improve attendance numbers. Agape Child & Family Services places its employees in schools throughout Memphis to help with attendance, behavior, and academic issues.

Bullard said her life began to change when her family joined the Agape program. The three full-time Agape workers at Whitney walked Bullard through why it was crucial for her kids to come to school every day. They provided her with school supplies and uniforms, and tutored her children. Agape also provided counseling for Bullard and her children through another part of its organization.

“My kids have too many friends now,” Bullard said. “They aren’t afraid, they’re excited to come to school. My kids are 100 percent better now than when we came. We still have issues to work out, but we feel welcome.”

For schools like Whitney Elementary, days of missed instruction can quickly put students behind academically. Whitney was taken over in 2012 by the state’s Achievement School District, which is trying to turn around Tennessee’s worst-performing schools. Every day of instruction matters in their efforts to boost student achievement, Whitney principal LaSandra Young said.

“Our attendance is low at the start of the year because students have transferred or moved,” said Young. The school currently enrolls 263 kids — Agape helps the school track students down.

Agape, Whitney Elementary, Memphis
PHOTO: Caroline Bauman
Crystal Bullard’s children started preschool and elementary school at Whitney last year.

“Sometimes it’s as simple as they don’t have school supplies yet or are struggling with transportation,” Young said. “The extra support they provide is crucial because every day of attendance really does matter.”

Charity Ellis, one of Agape’s staff members at Whitney, said her job can look very different day-to-day, but working closely with students is consistent. Some days Agape pulls students out of class to work intensely on reading or math skills. Or if students are struggling with behavior in class, Agape staff members will pull the students into the hallway to speak with them and calm them down.

Agape staff also try to stay in constant communication with parents, especially if their kids are missing school, Ellis said.

If parents are running late, they might decide to keep their student at home rather than bring them for a half day, Ellis said. “But when we communicate with them how important every hour of learning is, they get that. Sometimes all it takes is one conversation and how deeply we care about their kids.”

Agape worked with 82 kids at Whitney Elementary last year, who were chosen by the school, including Bullard’s three children. About 90 percent of those students are now attending at least 90 percent of the school year, said David Jordan, CEO of Agape.

The program has grown every year from when it began in 2013 with 113 students. Now, more than 550 students are a part of Agape programs in 16 schools throughout the Frayser, Raleigh, Hickory Hill, and Whitehaven neighborhoods — and they are all now at school for at least 85 percent of the school year. This is just shy of their goal for Agape students to attend more than 90 percent of the year.

For comparison, 57 percent of all students in Shelby County Schools and the Achievement School District attend school for more than 90 percent of the year, Jordan said.

Jordan emphasized that keeping kids in school goes beyond daily attendance — the program also helps students with academics and behavior, so they don’t miss school because of suspensions. Agape helps out parents, too.

Agape, Whitney Elementary, Memphis
PHOTO: Caroline Bauman
Whitney Principal LaSandra Young (right) hugs a student who is pulled out of class to work with Agape.

“A lot of our parents are underemployed and dealing with trauma,” Jordan said. “We provide family therapy, but also job coaching and help. We see this as a two-generation approach, the parents and their children are in this together.”

Bullard said the family counseling provided by Agape at Whitney has made a huge difference in her family’s mental health. When they first moved in 2017, Sergio, her oldest child, struggled with his behavior at school and he was sometimes pulled out of class.

“We’ve been through a lot,” Bullard said. “When Sergio first came here, he had a mean spirit in him. A don’t-care attitude. But at our sessions, he opened up and up. He’s still fighting with his sister, but it isn’t the rage it used to be. He’s calmed down a lot.”

Sergio also had a habit of hiding his school work from her, Bullard said. That’s changed, too, and he enjoys showing off what he’s learning to his mom.

“Now he likes to say big words that he knows I don’t know,” Bullard said. “But it’s great. We’ve never had this kind of support before.”

Jordan said that stories like Bullard’s are encouraging but acknowledges there’s still a lot of work to be done. He said he’s hopeful Agape will be able to add more and more students to the program every year.

“We know that keeping kids in school consistently is one of the things that works,” Jordan said. “We also know that students in under-resourced neighborhoods in our city need more support. The schools need more people who can help. We can provide that.”

Here’s the full list of schools Agape is in, broken down by neighborhood:

out of pocket

Pencils, shelving, wiggly chairs: What Colorado teachers bought for their classrooms — and why

PHOTO: Laura Henry
Aurora kindergarten teacher Laura Henry provided the pencil totes, floor dots, balls and wiggle seats, and everything you see on the shelves out of her own pocket.

The rugs and bean bag chairs, the workboxes full of hands-on learning games, the file folders that help her track student progress — all came out of special education teacher Laura Keathley’s own pocket.

Robyn Premo, a high school science teacher, buys styrofoam and cans, glass rods and balloons, patches of fur and s’mores ingredients — just about all the materials except beakers that her students need to do hands-on experiments.

Marcea Copeland-Rodden, a middle school social studies teacher, bought an air-conditioning unit for her classroom because it was so hot students were getting bloody noses.

And everyone buys loads and loads of pencils.

“I don’t think that not having a pencil is a reason a kid should not learn today,” Premo said.

There’s nothing new about teachers spending money on their classrooms, but as rising housing prices and stagnant wages put more pressure on working families and as academic expectations rise even in kindergarten, teachers have to dig deep to meet their students’ basic needs and outfit their school rooms.

A national survey by the U.S. Department of Education found that 94 percent of teachers spend their own money for their students, with the average teacher spending $479 in the 2015-16 school year, the most recent data available.

When the Colorado Education Association surveyed more than 2,000 members in 2017, they reported spending an average of $656 out of their own pocket on classroom supplies.

The usual caveat applies: These numbers are self-reported.

To better understand what this looks like in Colorado classrooms, Chalkbeat reached out to teachers around the state to ask how much they spent out of pocket, what they bought, and why.

The teachers who responded to Chalkbeat’s survey work in districts large and small, urban and rural, and spent anywhere from $75 to $2,000. Most respondents spent several hundred dollars, and the majority said they do not get a stipend for school supplies.

Their spending covers the most basic of classroom supplies — pens, pencils, glue sticks, crayons, paper, folders, notebooks — but also the things that make classrooms feel inviting, that make learning engaging, that help a kid get through the day. Teachers bought snacks and spare clothes, earbuds for students to listen to audio books as part of reading lessons, wiggly chairs and yoga balls for fidgety learners, classroom decorations, tissues and wipes, prizes for good work and good behavior, fish for the fish tank, storage bins and shelving and fabric for makeshift blinds.

Premo teaches chemistry and physics at Westminster High School. Her department gets a $3,000 supply budget for the high school’s 2,400 kids. She emphasizes that she thinks her school is doing everything it can, but if she didn’t reach into her own pocket, her students would mostly experience science in online simulations.

“That is not, in my opinion, sufficient for rigorous, authentic science instruction, so I make the personal contributions to give my kids those learning opportunities,” she said.

Premo spent $2,000 getting ready for the school year, the most of any teacher who responded to Chalkbeat’s survey. She said she’s able to contribute more than many teachers, so she does.

“There are some fantastic online simulations, but kids learn better when they get to put their hands on things,” she said.

Fur patches help demonstrate static electricity, and s’mores help illustrate principles of chemical reactions. All these materials add up, and many of them are consumed in the process of lab work.

If Premo didn’t spend her own money, “we would run out of pencils very quickly. And we would run out of lab materials, and they would not be able to do anything hands-on. And we would lose our ability to be creative. We would work very bare-bones. It would be a lot of listening, a lot of videos.”

Laura Henry teaches kindergarten in Aurora Public Schools. It’s her 29th year in the classroom, and as kindergarten has moved away from play and more toward academics, she’s spent more and more of her own money on curriculum supplies.

Her school provides $500 a semester to each grade level, which has to be shared among three teachers, and the money goes fast. Teachers also get $10 a month for copying, which she burns through quickly, so she bought her own printer just for school use.

Because most of the students come from low-income families, the school tries to keep the school supply list modest, closer to $25, but only about three-quarters of the students bring in supplies.

PHOTO: Laura Henry
Aurora kindergarten teacher Laura Henry’s classroom after it has been cleaned during the summer. With the exception of the red shelf, a few alternative seating items, and the pencil coat rack, these items are school purchased.

She spent about $500 of her own money getting ready for the school year, on everything from folders to hold student poems to snacks and wipes to materials for dramatic play, building toys, puppet theater, books, and more.

“Kindergarten is supply-heavy because we use construction paper and glue like there is no tomorrow,” she said.

Many of our survey respondents said they don’t use online fundraisers like Donors Choose because the only people who donate are friends and family, and teachers feel bad hitting them up over and over again. Henry encounters the same dilemma, but she did turn to it this year for $550 in science and engineering supplies: gears, a light table, animal X-rays, a microscope and more.

Another advantage of Donors Choose: The money she puts into it herself is tax deductible, unlike the rest of what she spends on her classroom.

PHOTO: Laura Henry
Kindergarten teacher Laura Henry purchased the housekeeping table and chairs, everything on the wall and shelves, the books in the bin, tool bench, and playground buckets for her Aurora classroom.

Henry said she used to sometimes feel resentful about spending her own money, when her friends get reimbursed for their work expenses, but now she “rolls with it” as part of the teaching profession.

But she sees the lack of supplies as one more stumbling block for young teachers.

“I see these new teachers come in, and they’re so ready and eager to make a difference, and they don’t know how they get supplies or how they get copies,” she said. “I don’t know that our school board is even fully aware of how much we’re lacking at the classroom level. I don’t need 8,000 consultants to help me. I need my classroom funded.”

Keathley runs a multi-needs special education room with two paraprofessionals at Avery-Parsons Elementary in the Buena Vista district in the Arkansas Valley. She spent $485 getting the classroom ready this year. A lot of that money went to filing systems that help the teachers keep track of each student’s needs and progress. It also went to bulletin board supplies. These boards serve as the “411 wall” with everything kids need to know for the day, from what their classroom job is to what outside appointments they have.

PHOTO: Laura Keathley
The bulletin board in Laura Keathley’s Buena Vista classroom serves as a 411 wall for her students. She purchases all the supplies for the board herself.

Keathley and her team used their own money to outfit the “crash corner,” where students go when they need to decompress with fidget toys in a giant bean bag chair, and to make workboxes with activities that students can work on independently throughout the day.

Keathley said she hardly asks her parents for any school supplies.

“We know that a lot of times parents of kids with disabilities, we know their money goes other places and they spend so much on special things for their kids, we don’t want to ask them,” she said.

Without her own investment in the classroom, it would be a very different place.

“I could go with what the school provided me and stay within my budget, but my classroom would not be the place I would like it to be,” she said. “We wouldn’t have rugs. We wouldn’t have nearly the supplies to give snacks or do cooking in the classroom. Our desks would be much more utilitarian, and we wouldn’t have much on the walls.”

Copeland-Rodden teaches seventh grade social studies at Pueblo Academy of the Arts in southern Colorado.

She spent $500 this year, more than most, because she dropped $350 on the air conditioning unit. It might seem like an extravagance, but after years of buying more and more fans, for minimal relief, it felt like a necessity.

“It’s just really hot in the classroom,” she said. “We have kids get bloody noses, that’s how bad it is. By sixth and seventh period, everybody is done. They don’t do their work. They fall asleep. They get cranky and angry at each other. It makes it tough on everyone.”

She also bought materials for Civil War shadow puppets and other projects that will make history come alive, but most of her classroom spending is on basic supplies. She doesn’t feel like she can ask parents, most of whom are low-income, to pay for supplies when she only has their child for one period a day. Out of 130 students, one brought in a box of tissues at the start of the school year.

“I spend so much on pencils,” she said. “It’s not just once. I go through a big 50-pack of pencils every month. Every class there’s at least one kid who has lost a pencil. I’ve given up trying to get back the pencils.”

She used to ask kids for something in exchange for the pencil to prompt them to return it, but too many kids had nothing to give.

“One boy said, ‘Here’s a shoe,’ and I said, ‘I don’t want your shoe,’” she said. “I have kids walking from class to class with nothing.”

Teaching has been this way for a long time, and the teachers who talked to Chalkbeat don’t see it changing anytime soon.

“If we all collectively agreed we weren’t going to pay for school supplies, maybe eventually someone would do something,” Premo said. “But I don’t want to risk this year’s kids to make that point.”