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

crisis mode

Adams 14 proposing expanding mindfulness and other programs for student well-being

First grade students practice reading in Spanish in their biliteracy classroom at Dupont Elementary School in Adams 14. (Photo by Yesenia Robles, Chalkbeat)

The Adams 14 school district is proposing an expansion next year of mental health staffing and two programs, including mindfulness, meant to help students get out of “crisis mode.”

After significant pushback in the current year on cuts that were meant to have schools sharing mental health professionals, every school will have their own next year.

Kim Cini, the district’s assistant director of student services believes, however, that the work of helping students with mental health problems, can’t be only the responsibility of a particular staff member in a school.

“You are never going to have enough mental health workers, ever. You just aren’t,” Cini said. “We are at a time and place in education, in the nation, that it’s time for all of us to step up and get involved. You need your classroom teachers, your parents, volunteers, front office staff, everybody.”

That belief is behind Cini’s push to introduce mindfulness programming in the district’s middle schools. That programming is meant to teach students to also take charge of their own mental well-being and to teach them ways to cope with stress.

In elementary school, Cini helped introduce a curriculum called Random Acts of Kindness to help younger children learn social and emotional skills including coping with trauma, a common challenge for students in the district where more than 86 percent qualify for free or reduced price lunch, a measure of poverty.

Three elementary school principals — from Dupont, Alsup and Kemp — tried out the Random Acts of Kindness this year, and Cini said they’ve seen results. Now, she is planning to expand the program to more schools next school year.

Pat Almeida, principal of Dupont Elementary, one of the three schools using the Random Acts of Kindness curriculum this year, said students get 30 minutes daily to learn coping skills, talk about current events on their mind, and plan activities meant to show compassion for one another.

“My staff is so much more focused on that time as being part of our wraparound services for all kids,” Almeida said. “It’s just part of what we do.”

Almeida said for most students the program has big benefits, but said for some students, it’s not enough help. That means often teachers are able to identify those students who need extra help more quickly and to provide them the right resources.

Long term, Cini said she will be looking at surveys in those schools working on mindfulness or Random Acts of Kindness to see if students report an increase in feeling safe, calm, or in sleeping better.

“We need to get them to go to sleep and stop that hypervigilance and hyperarousal,” Cini said. “They’re just hyperaroused at every little thing. I mean every time Trump comes on with something about DACA, we’re off to the races over here. It’s just crazy.”

Principal Almeida said the work has also made staff reflect more about the work as well.

“As adults we think we understand compassion and empathy,” Almeida said. “But to actually think about it and teach it is different.”

Cini said staff across the district are, like students, also in crisis, and often making decisions based on urgency.

“When you’re operating in crisis mode, you are hypervigilant and you start responding and your decisions become shaped around that,” Cini said. “You see a couple of kids wear a gang-related color and as a leader you make a decision to ban the color red based on the actions of a couple of kids. That’s a pretty big thing to do. We have got to stop making decisions like that.”

Police in schools

The Denver school district is exploring the idea of creating its own police officers

PHOTO: Photo by Katie Wood/The Denver Post via Getty Images

School safety patrol officers in the Denver district would get the authority to arrest students and write tickets under an idea being explored by the district’s safety department.

The head of Denver Public Schools’ safety department says the goal would actually be to end the “school-to-prison pipeline” that criminalizes students for misbehavior at school.

The idea is that giving more authority to school safety officers who have experience with children and training in the district’s restorative justice model would mean outside police get called less often, even for matters that are potentially criminal.

This is not yet a formal proposal, but the idea is already generating pushback.

Local organization Padres y Jóvenes Unidos has worked for years to reduce harsh disciplinary practices in the district, and its staff say certifying safety patrol officers as police officers would represent a big step backward.

“To do this would undo everything you have stood on national platforms bragging about,” said Monica Acosta, the organizing director at Padres y Jóvenes Unidos. “Going down this road would double down on policing and criminalizing students of color.”

About 77 percent of the 92,600 Denver Public Schools students are children of color. Approximately 67 percent of students come from low-income families.

Police in schools is a controversial topic in Denver. Staff and students at an alternative school called RiseUp Community School are speaking out this week about an incident in which Denver police searched for a student the principal told them wasn’t there. The principal said police officers pulled their guns on a teacher during the search.

The incident sparked intense backlash – and an apology from Denver Public Schools Superintendent Tom Boasberg.

“What happened should not have happened,” he said at a school board meeting Thursday night. He said the district will participate in a city investigation of the incident and work “to ensure something like this does not ever happen again.”

RiseUp student Mary Jimenez said she and her peers were left feeling disrespected and unsafe.

“Because we are students of color and students of low-income, we get harassed and pushed around and we’re expected not to fight back,” Jimenez told the school board.

Although the incident involved city police officers, not district safety officers, community activists said it’s an example of why law enforcement doesn’t belong in schools. Armed officers create a hostile learning environment, they said.

But Denver Public Schools Chief of Safety Mike Eaton said school policing is different than municipal policing. Whereas city police would be more likely to use the criminal justice system to respond to a report of a student getting into a physical fight or having illegal drugs on campus, Eaton said district officers would be trained to first look to the discipline policy.

The policy emphasizes that consequences should be age-appropriate and that the focus should be on correcting student behavior. “Interventions should provide students an opportunity to learn from their mistakes,” the policy says, “and re-engage the student in learning.”

The district safety department employs about 135 staff members, Eaton said. Of those, 35 are armed safety patrol officers who are not assigned to a particular school but respond to incidents across the district. Those are the only officers the district would seek to certify as police, he said. Unarmed school-based campus safety officers would not be certified.

Authorizing any new group as police officers requires approval from state lawmakers.

Denver Public Schools already has 16 “school resource officers,” which are city police officers assigned to work in its large high schools and a few middle schools. Eaton said his aim would not be to increase the number of school resource officers but rather to give the district’s own security staff the discretion to handle police matters.

“We have the opportunity to directly impact the school-to-prison pipeline, to eliminate or reduce it,” Eaton said. School policing, he said, “focuses on restorative and redemptive practices in dealing with students. Students are young. They’re going to make mistakes.”

Several large, urban school districts across the country have their own police forces, including districts in Cleveland, Atlanta, and Miami. Before moving forward with a proposal in Denver, Eaton said he’d seek input from students, parents, and community members.

He has floated the idea by the Denver school board. The board president and vice president said they’re open to discussing any ideas that would make students safer. But president Anne Rowe said she understands why the community might be concerned.

“I can appreciate the initial reaction of folks when they think about an urban district thinking about certifying their officers,” she said. “That’s going to require a lot of community engagement and getting down to: What are we trying to accomplish by doing that?”