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

How I Help

Why this high school counselor asks students, ‘What do you wish your parents knew?’

Today, we launch a new series called “How I Help,” which features school counselors, social workers and psychologists across Colorado. It is a companion to our popular “How I Teach” and “How I Lead” series.

Through “How I Help,” we hope to give readers a glimpse into the professional lives of school staff members who often work behind the scenes but nevertheless have a big impact on the day-to-day lives of students.

Our first “How I Help” features Cassie Poncelow, a counselor at Poudre High School in Fort Collins. She was the 2016 Colorado School Counselor of the Year and is one of six finalists for the 2018 National School Counselor of the Year award.

Poncelow talked to Chalkbeat about how she creates a legacy of caring, what teens want their parents to know and why peer-to-peer mentoring is better than a social-emotional curriculum taught by adults.

This interview has been condensed and lightly edited.

Why did you become a school counselor?
I was incredibly fortunate to have many powerful educators shape my life in my time as a student, but none did more so than my school counselors. My counselor from high school remains a dear friend and mentor. I knew that I wanted to be a part of what is happening in education and loved the diversity of the school counselor job. They get to collaborate with so many different stakeholders, get to know students in really cool ways and be involved with so many aspects of making change.

Cassie Poncelow

Tell us about an effort or initiative you spearheaded at your school that you’re particularly proud of.
Three years ago, we noticed that students were dropping out continuously because they were short on graduation credits and tired of taking the same classes over and over again. I worked with a team to create Opportunities Unlimited, which is a dropout recovery program for students ages 17-21 that is focused on GED completion and concurrent enrollment opportunities. A fifth cohort started this fall and the program has graduated 26 students in two years.

Is there a tool, curriculum or program you couldn’t live without in your job?
Our Ambassadors program is in many ways the backbone of our climate and culture at Poudre High School. This program trains 50 upperclassmen to mentor freshmen through a year-long curriculum that includes topics like stress management, suicide prevention and sexual assault. This mentoring model means that every freshman has an ambassador that is connecting with them for almost three hours each month. The ambassadors deliver comprehensive, peer-to-peer education that is far beyond and better than any social-emotional learning curriculum that counselors could facilitate. As the co-leader for this program, I also couldn’t live without the hope that this crew gives me. They are the best part of my job.

What’s the biggest misconception you’ve encountered about your role in the school(s) where you work?
I am grateful to work in a place and with people who see the vital role of school counselors and are eager to partner with them. In my time at Poudre High School we have added two new school counseling positions, further demonstrating our school’s belief in the work we do. I have worked at schools in the past that created a lot of systemic barriers to accessing school counselors and I think this was based on a misconception that we were a more frivolous part of services for students.

You spend lots of time with students. Knowing what you know, what advice would you give to parents?
I often ask my students, “What do you wish your parents knew?” What I hear consistently is a plea for them to remember what it was like to be 16: How painful and awkward it was, how boys were all the rage and not getting invited somewhere really was the actual worst.

So, I advise parents to remember that. And remember that a lot of what they dealt with at 16 is even more complicated by the world our kids are experiencing. Social media wasn’t a reality when they were kids and our current students have never known a world where mass shootings haven’t happened often. I know it’s no, “I walked uphill both ways without shoes in the snow,” but this is a scary time to be student — different, but equally hard. Our kids need us to hear them in that. And believe that they can change it.

Tell us about a time when you managed to connect with a challenging student or a student facing a difficult situation. How did you do it?
At my core, I think we all thrive on authentic relationships and I do whatever I can to create these with my students. I want each of my students to feel like I am truly in their corner and a champion not only of what they do but more so of who they are. I hope to not only live this, but to model it for my students in ways that inspire them to do the same.

This semester I have a freshman boy who was consistently skipping class (who knew gas station tacos were such a draw?) and failing multiple classes. His “consequence” is that he has to spend a period working on missing work in my office. I also have a slew of seniors who have made my office their home during this fifth hour, many who are excellent students and are just looking for a place to study. They have taken this freshman under their wing and are committed to his success far beyond what I could ever be. They are constantly asking about his upcoming exams, what he needs help with and celebrating his rising grades with him. I think I have built really authentic relationships with these upperclassmen who then remember what it means to feel connected and cared for and are passionate about showing this student just that. I often stress “legacy” to my students and this seems like a clear picture of that.

What is the hardest part of your job?
Kid stuff is hard. I hurt for kids a lot, as I think all educators do. They live lives far beyond our walls and far beyond what we could imagine and ever control. That’s the hardest. Close second would be trying to operate in a system that seems to be driven by folks who aren’t doing the work. I recognize that there are so many moving pieces and would love to have some of the actual “decision-makers” come spend the day in our role and better understand the work we do.

Tell us about a memorable time — good or bad — when contact with a student’s family changed your perspective or approach.
A year ago, I had a student who was really struggling with some significant mental health issues. I knew that we needed to bring in a parent but the girl was very anxious about this idea, to the point where she had literally crumpled up on my office floor. After calling her mom to meet with us, I joined her on the floor of my office to talk more. Her mom walked in shortly after, assessed the scene and sat right down on the floor with us, despite the chair-filled room. This move shifted everything and I was so grateful for her wisdom to be where her kid was at. It was a good reminder to me to do that always: be where kids are at.

You spend your days trying to help students and staff with any number of things. How do you wind down after a stressful day?
A lot of my unwinding still includes my students as I announce volleyball games or attend other sporting events or performances. I love these opportunities because they let me see my kids in a different light and remind me how awesome they are. I also spend as much time outside as possible, whether it’s going for a quick hike with my pup or a bike ride. Beyond traveling and reading, I cheer hard for the CSU Rams! Go State!

Big money

Millions in grant dollars will bring more counselors to Indiana’s underserved students

KIPP Indy was one of several schools in the county to receive a counseling grant.

Scores of Indiana schools were awarded private grants that will allow them to bolster counseling services for students, many of whom are lacking help for an increasing portfolio of problems, including fallout from the state’s drug epidemic and basic needs like advice on college applications.

The $26.4 million in grants, decided last month, include six for Marion County districts and charter schools. They were awarded by Lilly Endowment, a prominent Indianapolis-based philanthropy founded by key players in the pharmaceutical giant Eli Lilly.

The grants went to 52 school districts and five charter schools, covering about a third of the state’s counties. Based on enrollment, they ranged from about $68,000 to almost $3 million.

Lilly began its push to help schools build better counseling programs last year.

“The response from school corporations and charter schools far exceeded the Endowment’s expectations,” said Sara B. Cobb, the Endowment’s vice president for education. “We believe that this response demonstrates a growing awareness that enhanced and expanded counseling programs are urgently needed to address the academic, college, career, and social and emotional counseling needs of Indiana’s K-12 students.”

As Chalkbeat previously reported, school counselors have been stretched exceedingly thin in recent years, both in Indiana and across the country. On average, each Hoosier counselor is responsible for 630 students, making Indiana 45th out of 50 states and the District of Columbia for counselor-to-student ratios. The American School Counselor Association recommends a ratio of no higher than one counselor for every 250 students.

So far, state-led efforts to expand counseling have fallen short; a bill proposed in 2015 to require a counselor in every school was withdrawn for further study, and the issue hasn’t resurfaced significantly in the legislature since. At the time, cost was the sticking point.

Schools and districts had to apply for the grants and show how they would use the money. Lilly reported that mental health and business partnerships, mentoring programs, improving curriculum and adding in more training for staff were all strategies that grant-winners have proposed.

Initially, 254 districts and charter schools applied, many pointing out how Indiana’s recent opioid crisis has increased social and emotional challenges for students. Counselors have to juggle those serious needs with college and career advising and, increasingly, responsibilities that have nothing to do with counseling, such as overseeing standardized tests.

Because of the level of interest, Lilly is planning a second round of grants, which would total up to $10 million.

“Because the implementation grant process was so competitive, the Endowment had to decline several proposals that had many promising features,” Cobb said. “We believe that with a few enhancements, many of these proposals will be very competitive in the second round of the Counseling Initiative.”

These are the districts and schools in Marion County that received counseling grants. (Find the full list here.)

  • Indianapolis Public Schools: $2,871,400
  • KIPP Indianapolis: $100,000
  • Lawrence Township: $1,527,400
  • Pike Township: $1,114,700
  • Neighborhood Charter Network: $68,312
  • Southeast Neighborhood School of Excellence: $99,870

IPS said in a news release that it planned to use the grant money to build counseling centers in each of the district’s high schools, which would begin operating in 2018 after IPS transitions to four high schools. Superintendent Lewis Ferebee said counselors are “critical” for students as they prepare to graduate high school and pursue higher education and careers.

“We’re thrilled that the students and families we serve will benefit from this gift,” Ferebee said.