Smoke-free Foster Care: Tales from the Field. June 24, 2014

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1 Smoke-free Foster Care: Tales from the Field June 24, 2014

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Presenters Smoke-free Foster Care in Maryland

Public Health Policy, U of MD School of Law

The Local Story Pat McKone, American Lung

Nonsmokers - MN Smoke-free Foster Care in

5 Presenters Smoke-free Foster Care in Maryland Kathleen Hoke, Legal Resource Center for Public Health Policy, U of MD School of Law Smoke-free Foster Care in Minnesota: Part 1 -- The Local Story Pat McKone, American Lung Association Jeanne Weigum, Association for Nonsmokers - MN Smoke-free Foster Care in Minnesota: Part 2 The State Story Molly Moilanen, ClearWay Minnesota

6 Smoke-free Foster Care in Brief A Vulnerable Population Public Health Rationale Common Arguments U.S. Landscape

7 A Uniquely Vulnerable Population 80% of foster children have at least one chronic medical condition One quarter have 3 or more chronic problems (e.g., diabetes, HIV, tuberculosis, asthma)

8 Public Health Rationale Health risks of secondhand smoke Health care costs for children exposed to tobacco smoke

9 Fire Hazard Each year, 300 children in the U.S. suffer injuries resulting from smokingcaused fires Half of all U.S. home fires result from children playing with tobacco products

10 Toxic Litter Ingesting one cigarette butt can be toxic to a child Ingesting an entire cigarette can be lethal 77 percent of children who ingest cigarettes are 6 to 12 months old

11 Duty to Protect State is legal guardian. State has legal obligation To protect foster children Ensure that they reside in safe and healthy foster care environments.

12 Why Not Act?

13 Common Arguments Privacy and autonomy Effect on parent retention & recruitment Monitoring compliance & enforceability

14 Effect on Foster Parent Recruitment No decline in number of foster parent applicants or retention Smoke-free residences becoming a social norm

15 Compliance & Enforceability Routine compliance checks Only rarely do states report violations or complaints about the policy Limited value of voluntary measures

care homes Three of these policies are in statutes ( clean

16 Smoke-free Foster Care Policies in Effect 27 states have passed laws or regulations regulating smoking in foster care homes Three of these policies are in statutes ( clean indoor air acts ) 24 are in administrative codes or regulations

17 Public and Professional Support Therefore, be it resolved that the National Foster Parent Association supports legislation and other rules that prohibit the use of tobacco in foster or kinship homes and in vehicles while transporting a child in foster or kinship care. National Foster Parent Association

18 Kerry Cork, Staff Attorney (651)

19 Smokefree Foster Homes: The Maryland Experience Kathleen Hoke

20 Power of the Executive Agency Social Services Administration within the Department of Human Resources: The Administration shall adopt rules and regulations to carry out the child welfare services and foster care programs under this subtitle. Maryland Family Law Code Ann

21 Scope of Agency Power Plain language of the statute indicates broad power in agency; Existing regulations show how the agency construed this power; Sometimes case law will help define the scope; Political appointee head of agency ultimately has control over regulations.

22 The Politics of 2006 Agency had power to issue regulations protecting foster children from exposure to secondhand smoke but would not take action, despite requests from the public health community and child welfare advocates and despite internal support from agency personnel.

23 2006 Legislative Effort (Unsuccessful) 2006: House Bill 1353 Bill would have given agency the authority to adopt regulations to: Require local departments of social services to consider SHS exposure when developing a permanency plan for a child in foster care; and Require a foster parent to protect a foster child from exposure to SHS in enclosed.

24 2007 Legislative Effort House Bill 661 was identical to HB 1353 (2006). Change in administration; Agency testified in favor of the bill, taking the position that they would likely do this by regulation regardless of the outcome of the bill.

25 DHR Regulations Prior to publishing regulations: Agency conducted informal survey of 175 foster families; overwhelming support from families (virtually no opposition--2 families did not support); Reached out to other states with such a provision to talk about implementation and enforcement.

26 DHR Regulations In Spring 2008, DHR published proposed regulations, open for public comment. LRC encouraged public health and child advocacy groups to submit comments; LRC submitted comments; No oppositional comments were filed.

27 Current Regulation COMAR (A)(17): A foster parent shall: Provide an environment for foster children free from exposure to secondhand smoke. Agency personnel report that the policy was implemented and is in effect with virtually no opposition or problems.

28 Kathleen Susan Hoke The End. Director, Legal Resource Center for Public Health Policy University of Maryland Carey School of Law 500 West Baltimore Street Baltimore, Maryland (410)

29 Smoke-free Foster Care in Minnesota: The Local Level Pat McKone American Lung Association of the Upper Midwest

30 Minnesota Foster Care: State-Supervised & County-Administered State Dept. of Human Services / Division of Licensing County Agencies Includes Local Services Agencies, Human Services Boards, etc. Private Agencies Foster Care Providers Foster Care Providers

31 American Lung Association in MN Rationale for smoke free foster care Lung Health Fire hazard 3 rd Hand Smoke Toxic Litter Staff commitment to the issue

32 Foster Care Efforts at the Local Level Gathered data Used the data to inform local decision makers and address concerns Worked with Public Health Law Center to develop case statement Provided training to others across the state

33 Passed local policies.

34 Thank you! Pat McKone American Lung Association of the Upper Midwest

35 Smoke-Free Foster Care Ramsey County Jeanne Weigum President Association for Nonsmokers- MN

Health of Foster Children 90% of children entering child welfare system had physical health problems Source: L.K. Leslie, J. N. Gordon, L. Meneken, K. Premji, K. L. Michelmore, and W. Ganger.

36 Health of Foster Children 90% of children entering child welfare system had physical health problems Source: L.K. Leslie, J. N. Gordon, L. Meneken, K. Premji, K. L. Michelmore, and W. Ganger. The Physical, Developmental, and Mental Health Needs of Young Children in Child Welfare by Initial Placement Type. Journal of Developmental & Behavioral Pediatrics, June 2005, v26 i3 p177(9)

25% of Foster Kids have 3 or more chronic medical conditions Asthma Vision and hearing problems Mal-nutrition Skin abnormalities Anemia Failure to thrive Dental concerns Manifestations

37 25% of Foster Kids have 3 or more chronic medical conditions Asthma Vision and hearing problems Mal-nutrition Skin abnormalities Anemia Failure to thrive Dental concerns Manifestations of abuse. Source: L. K. Leslie, M. S. Hurlburt, J. Landsverk, K. Kelleher et al. Comprehensive Assessments for Children Entering Foster Care: A National Perspective. Pediatrics, July 2003.

38 Duty to Protect Foster Kids Children are placed in foster care to escape unhealthy and unsafe environments. The state (foster care system) is responsible for placing children in temporary homes that are safe, nurturing, stable. Ultimate goal is to protect the health and wellbeing of the child.

39 Minnesota Counties who have adopted Smoke-Free Foster Care Policies: - Redwood County - Cottonwood County - Lake County - St. Louis County *Hennepin has done research.

40 18 Other States Have Established Smoke Free Foster Care laws Alaska Arizona Colorado Illinois Iowa Kansas Maine Maryland Montana New Jersey North Dakota Oklahoma Oregon Pennsylvania Texas Vermont Washington Wyoming

41 Commissioner Jim McDonough

42 Commissioner Rafael Ortega

43 Commissioner Toni Carter

44 Media

45 Letter to the Editor Media

46 Mshale Article African Community Newspaper Media

47 Pioneer Press

48 Smoke-free Foster Care in Minnesota Molly Moilanen ClearWay Minnesota

Sarah s Story I am writing to bring attention to a matter of grave injustice, a public health concern and an unnecessary burden on the Minnesota tax payer.

49 Sarah s Story I am writing to bring attention to a matter of grave injustice, a public health concern and an unnecessary burden on the Minnesota tax payer... Minnesota requires foster homes to be free of dirt, rubbish, peeling paint and rodents but makes no provision about keeping the air free from the 4,000+ chemicals found in cigarette smoke!

50 Rep. Liebling Rochester

51 Stakeholder Meetings Association of Minnesota Counties Assn of County Social Service Admins Local Public Health Association Department of Human Services Private Placing Agencies Child Advocacy Groups

52 Bill Summary Provide a safe, healthy, smoke-free home environment Home Enclosed space connected to the home Garage, Porch, Deck Vehicle Outdoor areas when a foster child is present and exposed

53 Bill Summary Smoking is permitted in outdoor areas when the child is not present/exposed Exemptions Family Placement Emergency Placement Native American Ceremonies

54 2014 Session

55 Challenges 1. Short Session 2. Chair of Early Childhood Committee 3. Floor Amendments

56 We Won!

57 Top 10 List 1. Legislative Champion 2. Effective Coalition 3. Support from Key Stakeholders 4. Local Policies and Local Action 5. Strong Public Support 6. Grassroots 7. Powerful Testimony 8. Earned Media 9. Messaging and Materials 10.Sarah s Story

58 1. Champion

59 2. The Coalition 3. Key Stakeholders

60 Beltrami Cottonwood Dakota Jackson Lake Ramsey Redwood Steele St. Louis Bois Forte 4. Local Action

61 Resolutions of Support Lake County Otter Tail County Beltrami County Pipestone County Redwood County St. Louis County Southwest Health and Human Services HHS for Cottonwood and Jackson Counties 61

62 5. Strong Public Support 6% 1%

63 6. Grassroots 63

64 7. Powerful Testimony 64

65 8. Earned Media Fargo Forum: Editorial: Again, Big Tobacco is wrong Minneapolis Star Tribune: Letter: Smoking around kids is simply bad news Duluth News Tribune: Opinion: Lawmaker s view: Smoke-free foster care will help youths grow

66 9. Messaging and Materials

67 10. Sarah s Story!

68 Thank You Molly Moilanen, M.P.P. ClearWay Minnesota SM

69 Additional Resources

70 Questions Now? Q&A panel on your screen Questions Later? publichealthlawcenter.org

Association for Nonsmokers - Minnesota

Association for Nonsmokers - Minnesota January 2014 Vol 28 Number 1 ANSR Works on 24/7 Smoke-Free Foster Care The Ramsey Tobacco Coalition, a program of ANSR, is teaming up with state advocates to protect