PERSPECTIVE: A Needed Credential to Advance Infant and Early Childhood Mental Health

by Abby Alter and Heidi Maderia Professionals who care for young children play an important role in promoting social-emotional development, positive mental health, and relational health, as well as identifying problems early and connecting young children to intervention and treatment services when necessary. Unfortunately, most pre-professional education and training programs lack specific courses or modules related to infant and toddler mental health, and many professionals lack the critical skills needed to work with very young children.

Many states, including Connecticut, are taking steps to ensure that professionals working with infants, toddlers, and their families are well-trained to promote optimal mental health, promote preventive strategies, and facilitate linkage to early intervention or treatment.

Attention to the Mental Health of Young Children is Critical for their Healthy Development

Infant and early childhood mental health is defined as a young child’s capacity to regulate and express emotions, form close and secure relationships, safely explore their environment, and learn. Young children develop these capabilities within the context of their family, environment, community, and culture, as well as through relationships with their primary caregivers. Infants and toddlers who develop healthy and strong social and emotional competency are better prepared for school and have healthier and more prosperous lifelong outcomes.

A System of Professional Endorsement is Improving Connecticut’s Workforce

The Connecticut Association for Infant Mental Health (CT-AIMH) purchased a license in 2010 from the Michigan Association of Infant Mental Health to provide the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health®. The license was purchased with support from the Children’s Fund of Connecticut, the Connecticut Head Start State Collaborative Office, and others. Since obtaining the license, CT-AIMH has built a statewide competency system known as the CT-AIMH Endorsement® for providers caring for children up to age 3. The system provides professional development through training and education programs with a goal of building a more skilled workforce.  In 2017, with help and guidance from a national workgroup, the endorsement system was expanded to include professionals working with children from 3 to age 6.

Becoming endorsed demonstrates that an individual has completed specialized education, related work, in-service training, and reflective supervision/consultation experiences that have led to competency in the promotion and/or practice of infant or early childhood mental health. The credential does not replace licensure or certification, but is meant as evidence of a specialization in the promotion and practice of infant and/or early childhood mental health within each professional field, such as child development, early care and education, pediatrics, psychiatry, psychology, social work, and others. To date, 56 professionals in Connecticut are endorsed in Infant Mental Health through this system, and three providers have earned the Early Childhood Mental Health Endorsement® (currently in its pilot phase). CT-AIMH plans to revise the endorsement program based on lessons learned during this pilot, and offer the Early Childhood Mental Health Endorsement® to professionals in 2019.

Additional Measures to Build a More Competent Infant and Early Childhood Workforce

Connecticut agencies and stakeholders have taken several steps to build a more competent infant and early childhood workforce. Examples include: increasing support for reflective supervision/consultation groups in Birth to Three and home visiting programs; committing to having at least one endorsed infant mental health professional on staff for every Birth to Three operated program; and providing a bi-annual infant mental health training series for child welfare and Head Start staff through a partnership with Head Start, the Department of Children and Families, and CT-AIMH.

While these measures are expanding the capacity of the early childhood workforce in Connecticut to address the social and emotional needs of young children, more can and should be done. Recommendations for Connecticut include:

• Increase public funding to support endorsement activities, including funding for: infant and early childhood mental health training, release time for staff to attend training, reflective supervision/consultation, deployment of a university-level cross-discipline Faculty Infant Mental Health Training Institute with accompanying materials.
• Ensure that all State and/or public agencies serving the most vulnerable children and their families have infant/early childhood mental health endorsed staff in every region.
• Follow Michigan’s practice requiring Endorsement® in infant and early childhood mental health for practitioners who bill Medicaid for mental health services provided to infants and toddlers. Additionally, Medicaid and commercial insurers should pay for infant and early childhood mental health services delivered to young children birth to 6 years who show signs of risk (without a diagnosis) if delivered by a professional holding the Endorsement.
• Require state institutions of higher education to include infant and early childhood mental health competencies in their infant, young child, and family related courses (e.g., nursing, social work, education, psychology) and/or support an Endorsement requirement to develop a pipeline of professionals who can pursue endorsement within their careers. Use the Faculty Infant Mental Health Training Institute to help faculty across disciplines to incorporate infant mental health into existing courses.

These additional actions can advance and sustain a statewide system of professionals who are endorsed and credentialed in infant and early childhood mental health. In that way, we can best promote optimal mental health and preventive strategies, and facilitate, as needed, early intervention or treatment.

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Abby Alter is Senior Associate for Early Childhood Initiatives at the Child Health and Development Institute, and Heidi Maderia is Executive Director of the Connecticut Association for Infant Mental Health. To learn more, visit www.ct-aimh.org or read "The Infant Mental Health Workforce: Key to Promoting the Healthy Social and Emotional Development of Children."  This article was adapted from an Issue Brief developed for Child Health and Development Institute of Connecticut, Inc, a catalyst for improving the health, mental health and early care systems for children in Connecticut.

PERSPECTIVE: Legalizing Marijuana Would Jeopardize Safety on Connecticut Roads

By Amy Parmenter A poll by AAA of almost a thousand drivers across Connecticut found earlier this year that 50 percent do not support the legalization of recreational marijuana. Of younger respondents (ages 18-24) opposed to legalization, 40 percent expressed ‘concern that marijuana is a national public health issue’.

As the advocacy organization for all motorists, AAA opposes the legalization of marijuana for recreational purposes because of a broad range of traffic safety concerns including, but not limited to, the following three factors detailed in the testimony below:

• A significant increase in drugged driving and marijuana-involved fatal crashes
• An inability to simply and accurately measure impairment
• The complexities and challenges legalization would present to law enforcement, our courts and state agencies

Increase in Drugged Driving and Marijuana-involved Fatal Crashes

Recent research by the AAA Foundation for Traffic Safety found that in the year following the legalization of recreational marijuana in Washington State, the number of drivers in fatal crashes who had recently used Marijuana more than doubled.

We know drugged driving, and driving under the influence of marijuana in particular, is on the rise across the country.

According to a 2013-2014 survey by the National Highway Traffic Safety Administration (NHTSA), drug use among nighttime weekend drivers increased 25 percent since the previous study in 2007. The drug showing the greatest spike was marijuana, with an increase of almost 50 percent.

This trend is particularly disturbing among our younger drivers.

A AAA poll conducted in 2016 found that, of those between the ages of 18-29, almost 25 percent admitted that within the past year they ‘regularly’ or ‘fairly often’ drove after using marijuana – whereas only about 15 percent admitted to driving drunk during the same time frame.

Inability to Accurately Measure Impairment

While there is the understandable temptation to measure impairment by alcohol and marijuana in the same way, it cannot be done.

Unlike with alcohol, the amount of active THC (the psycho-active ingredient in marijuana) in the blood has NO scientific correlation with a driver’s level of impairment or propensity to crash. Active-THC, is fat soluble and is metabolized differently than alcohol, which is water soluble. To accurately predict driver impairment or crash risk as a function of how much active-THC a person has in their body would require us to measure how much of the drug is in the fatty tissue of the brain—not the blood.

While roadside drug tests may soon be available, even the most accurate of these tests will be of no use in determining impairment. They will only show the presence of THC in the blood.

Challenges to Law Enforcement and Courts 

Because of the inability to accurately determine impairment at the roadside as described above, law enforcement and the court system face unique challenges and complexities when it comes to marijuana that do not exist for alcohol.

One of the most common ways lawmakers in marijuana states have attempted to address traffic safety concerns is to establish an impairment threshold for marijuana, a ‘per se’ standard for it, (similar to the 0.08 BAC standards in every state for alcohol).

After analyzing data from nine states, the AAA Foundation published a report last year in which researchers concluded that ‘to establish a per se standard for marijuana is meaningless as a tool to address impaired driving’.

Additional considerations:

• This is not the marijuana of previous generations. The concentration of the impairing chemicals in most marijuana range from 25-30% in plant form – 10 TIMES as much as in the 70's and 80's.
• There have been two systematic reviews of multiple studies on the impact of marijuana on driving. Both determined that, conservatively, marijuana at least doubles the risk of causing a traffic crash.

It has taken many years to change attitudes about drinking and driving, and we must now begin the same process of educating the public about drugged driving.

Legalizing marijuana before we are prepared to manage the potential highway safety consequences, before we have prepared our law enforcement officers with all the training and resources they need to address this issue, endangers the Public Health of our state.

While some people are focused on revenue to be generated, AAA is focused on traffic safety and the unintended consequences of legalization, for which we believe Connecticut and other states are ill-prepared.

Legalization of marijuana will, without question, increase the number of people who use it and get behind the wheel and drive. That puts all of us at greater risk on the road.

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Amy Parmenter is Manager of Public and Government Affairs for the AAA Allied Group.  This was provided as testimony to the state legislature’s General Law Committee during the 2018 session, when the legislature was considering a proposal to legalize marijuana in Connecticut. It is on behalf of both AAA clubs in Connecticut, the AAA Allied Group and AAA Northeast, which together represent more than a million members.

PERSPECTIVE: Unhealthy Options Persist in Fast Food; Voluntary Efforts Falling Short

Fast-food consumption is associated with poor diet quality in youth. Therefore, improving the nutritional quality of fast-food meals consumed by children is an important public health objective. In response to public health concerns, several of the largest fast-food restaurants have introduced policies to offer healthier drinks and/or sides with their kids’ meals. However, few research studies have examined the menu items that parents purchase for their children at fast-food restaurants or their attitudes about healthier kids’ meal offerings.

The primary purpose of [a study by the UConn Rudd Center for Food Policy & Obesity] was to document parents’ reported fast-food purchases for their children (ages 2-11) and examine changes over time.  [The] findings indicate numerous reasons for continued concern about the impact of fast-food consumption on children’s diets and health.

In 2016, we identified 10 different fast-food restaurants where at least one-quarter of parents reported that they purchased food for their child(ren) weekly or more often. In addition, more than 90% of parents surveyed reported that they visited at least one of the four largest fast-food restaurants to purchase lunch or dinner for their child (ages 2-11) in the past week, and they purchased food for their child at 2.4 of these restaurants on average.

These numbers are high, but they correspond to previous research showing that on any given day, one-third of children consume fast-food… Furthermore, parents’ purchases of fast-food for their children increased significantly during the years examined, with parents reporting increased frequency of visits to most individual fast-food restaurants from 2013 to 2016…

These results also suggest that healthier kids’ meal policies could result in unintended public health consequences if they lead parents to view the restaurants more positively and increase their visits, but continue to order the unhealthy items for their child.

These findings indicate numerous opportunities for restaurants to enhance their efforts to improve the nutritional quality of fast-food consumed by children.

First, restaurants should introduce healthier kids’ meals that are also appropriate and appealing to older children… In addition, restaurants must discontinue the increasingly common practice of offering unhealthy sides together with healthier sides, and/or they should remove unhealthy sides from their kids’ meal menus altogether, as they have pledged to do with kids’ meal drinks…

Finally, since parents often choose restaurants that are convenient and that their kids like (more than for healthy options), restaurants should make the healthier items the most appealing options for children to choose. They should also make the healthier items the easiest options for parents to order, for example, by making them the default for kids’ meals. Given parents’ positive attitudes about healthier kids’ meals, there appears to be a substantial marketing opportunity for restaurants to introduce and promote healthier kids’ meals that appeal to both parents and children…

If restaurants do not implement further improvements voluntarily, advocates should continue to work with state and local municipalities to introduce public policies to improve the healthfulness of kids’ meals. Policy makers should follow the lead of communities in California and Colorado and consider legislation or regulation to require that all restaurants serve healthier kids’ meals…

Unhealthy options, including main dishes, sides, and desserts, remain on kids’ meal menus at most restaurants, and purchases of a kids’ meal plus another menu item for their child have increased. Although future research is required to explain the reasons for these trends, they do indicate that restaurants’ voluntary pledges, as currently implemented, are unlikely to substantially reduce children’s fast-food consumption overall, or increase their selection of available healthier drink and side options.

Furthermore, parents’ positive attitudes about restaurants’ healthier kids’ meal policies indicate that such policies could backfire for public health and increase the frequency of purchasing fast-food for their children without increasing healthier purchases. These findings demonstrate that restaurants must implement more effective healthier kids’ meal policies to avoid additional state and local regulations that would mandate healthier options for children.

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This is an excerpt from Parents’ Reports of Fast Food Purchases for Their Children:  Have They Improved?, published in September 2018 by the Rudd Center for Food Policy & Obesity at the University of Connecticut.  The report’s authors are Jennifer L. Harris, Maia Hyary, Nicole Seymour and Yoon Young Choi.  The full report is available here.

https://youtu.be/2Ng_X4D4SSA

PERSPECTIVE: Patient Protections Fall Short in Proposed Plan for Pre-existing Conditions

Our 33 organizations, representing the interests of the millions of patients and consumers who live with serious, acute, and chronic conditions, have worked together for many months to ensure that patient voices are reflected in the ongoing Congressional debate regarding the accessibility of health coverage for all Americans and families. In March 2017, we identified three overarching principles to guide and measure any work to further reform and improve the nation’s health insurance system. Our core principles are that health care must be adequate, affordable, and accessible. Together, our organizations understand what individuals and families need to prevent disease, manage health, and cure illness. Individuals and families with pre-existing conditions rely on critical protections in current law to help them access comprehensive, affordable health coverage that meets their medical needs. Unfortunately, the arguments of the plaintiffs in Texas v. U.S. – a lawsuit brought by 20 states and two individual plaintiffs – represent a serious threat to these protections. In this case, the plaintiffs argue that the court must invalidate the entire Affordable Care Act (ACA) due to Congress’ repeal of the individual mandate. We are further troubled that the Department of Justice has also declined to defend the constitutionality of many of the ACA provisions that directly protect people with pre-existing conditions.

While we are pleased to see that you share our concerns about the potential impact of Texas v. U.S. on people with pre-existing conditions, as evidenced by your recent introduction of the Ensuring Coverage for Patients with Pre-Existing Conditions Act (S.3388), the safeguards presented in this legislation fall far short of the patient protections encompassed in existing law. This bill as written is far from an adequate replacement for the protections for individuals with pre-existing conditions that are provided under current law.

Current law requires issuers to comply with a set of provisions which work together to promote adequate, affordable, and accessible coverage for people with pre-existing conditions. Specifically, community rating, guaranteed issue, essential health benefits, cost-sharing limits, and the ban on pre-existing condition exclusions protect people with serious health care needs from discriminatory coverage practices. These policies are inextricably linked and removing any of them threatens access to critical care for people with life-threatening, disabling, chronic, or serious health care needs.

Adequacy

Health care must be adequate, covering the services and treatments patients need, including patients with unique and complex health care needs. It is paramount that protections including the Essential Health Benefit (EHB) requirement, the ban on annual and lifetime caps, caps on out-of-pocket costs, and restrictions on premium rating be preserved in all health care plans to which they currently apply.

We were particularly disappointed that S. 3388 fails to include an outright ban on pre-existing condition exclusions. While a consumer with pre-existing conditions can gain coverage, the bill would allow issuers to underwrite plans to exclude any type of care based on medical history or health status. For example, under S. 3388 a patient with a history of cancer may be able to gain coverage, but an issuer would still be allowed to exclude coverage for screenings or treatment for a reoccurrence. Continuing to allow issuers to sell plans that undermine access to comprehensive coverage directly contradicts the presumed intent of this legislation, puts consumers at risk for catastrophic healthcare costs or being forced to delay care, and creates additional confusion for consumers and patients.

Affordability

Our second principle recognizes that illness and disease impacts individuals across the economic spectrum. We believe that everyone – regardless of their economic situation – should be able to obtain the treatment they need to manage, maintain, or improve their health. This means that coverage should be affordable, including reasonable premiums and cost-sharing, and that individuals with pre-existing conditions should be protected from being charged more for their coverage.

Although this legislation protects against higher rates based on health status, we remain concerned that it leaves patients and consumers exposed to higher premiums based on other factors that can be used as proxies for health status, such as age, gender, or occupation. For instance, there is no limit on how much more insurers in the individual market could charge a 50-year-old with heart disease because of his age. Insurers could also charge higher rates to a woman of childbearing age because of her gender. This legislation would exacerbate the affordability challenges facing many Americans today by neglecting to maintain current protections and subjecting patients to even higher premiums should the ACA be completely invalidated.

Accessibility

Lastly, health care coverage must be accessible. All people, regardless of employment, health status or geographic location, should be able to gain coverage without waiting periods or undue barriers to coverage. While we appreciate that the legislation would continue to prohibit insurers from denying coverage to individuals with pre-existing conditions, we are deeply troubled that, absent other quality and financial protection standards, this provision would offer only minimal assurance to consumers.

Conclusion

While we do not yet know the outcome or scope of the ruling in the Texas v U.S. case, failure to preserve key ACA provisions could have catastrophic implications for both the insurance markets and the millions of patients who rely on them. Partially restoring only two (guaranteed issue and some rating protections) of the multiple provisions that currently protect patients is inadequate and would leave many people without the level of coverage they need and deserve. Should the ACA be struck down and this legislation implemented as a replacement, consumers with pre-existing conditions would face significant financial and coverage barriers. In short, for people with pre-existing conditions, the bill would provide access to coverage in name only.

We share your interest in continuing to make health insurance accessible to Americans with pre-existing conditions and appreciate your efforts to preserve certain protections in law, regardless of the outcome of Texas vs. US. However, the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” as currently drafted, falls far short of providing coverage and security to your constituents, including those who are or will face significant health care needs. We urge you and your Senate colleagues to reconsider your approach to S. 3388 and ensure that any future legislation provides protections for people with pre-existing conditions that are the same or better than those included in current law.

Our organizations stand ready to work with you on solutions that serve the patients we represent and would be pleased to meet with you about how this legislation can be improved to meet the needs of people with pre-existing conditions.

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This is the complete text of correspondence sent on September 19, 2018 to 16 members of the U.S. Senate, on behalf of 33 organizations including Danbury-headquartered National Organization for Rare Disorders (NORD) and many others with active chapters in Connecticut. Signatories also included Adult Congenital Heart Association, Alpha-1 Foundation, ALS Association, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Chronic Disease Coalition, COPD Foundation, Crohn’s & Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Family Voices, Global Healthy Living Foundation, Hemophilia Federation of America, Leukemia & Lymphoma Foundation, Lutheran Services in America, March of Dimes, Mended Little Hearts, Muscular Dystrophy Association, National Alliance on Mental Illness, National Coalition for Cancer Survivorship, National Health Council, National Hemophilia Foundation, National Kidney Foundation, National Multiple Sclerosis Society, National Patient Advocate Foundation, Susan G. Komen, United Way Worldwide, and WomenHeart: The National Coalition for Women with Heart Disease.

PERSPECTIVE – Nonprofit Board Members: Take Off Your “Stupid Hats”

by Jack Horak The National Association of Nonprofit Organizations and Executives (NANOE) is a relatively new and modest organization, but that hasn’t stopped it from challenging nonprofit sector dogma at the most fundamental level. A case in point is its suggestion that the “volunteer governing board” model should be upgraded to a “paid board” model.

As NANOE sees it, nonprofits adopting this practice would have a line item for “directors fees” in both their budget and their fund-raising literature – and they would do this proudly to let the world know that they are so committed to the mission that they have raised the money necessary to attract and retain the best talent available to fill seats on their governing boards.

The objective is not simply to start paying current volunteers to attend board meetings, but to induce very talented people to join the board where they will be expected to do real work in return for the money. After all, nonprofits pay their management team in exchange for work, so why not follow the same protocol with board members?

This is a sweeping reversal of sector orthodoxy — which presupposes that directors donate both their time and their money to the organizations they serve. Consequently, it’s no surprise that some of the more prominent sector voices were quick to dismiss NANOE’s message as it was rolled out. See, for example, the March 30, 2017 Chronicle of Philanthropy (New Nonprofit Puts Money over Mission and Ethics) and the April 18, 2017 Nonprofit Quarterly (NANOE’s Approach to Nonprofit Leadership: An Insult to your Intelligence).

The negative reaction is understandable to some extent. NANOE’s paradigm turns conventional wisdom on its head so criticism in defense of the status quo is expected. However, after nearly 40 years as a legal and business advisor in the sector, I respectfully disagree with NANOE’s critics. I suggest that if they take their analysis to a deeper and broader level they will find considerable insight in NANOE’s suggestion, and perhaps conclude, as I have, that the paid professional board model may be the optimal choice for some, but not all, organizations.

Here’s why.

We start with a fundamental question — what is a board of directors – and answer it with some history. The concept (and law) of what we commonly refer to as “charity” emerged in medieval England as part of the law of trusts. A charitable trust is an organization governed by a board trustees who hold and manage assets in their names for the benefit of a charitable purpose.

The trust form was predominant for centuries. While it still works well for organizations with activities limited to grant making, it is poorly suited for operating organizations which have service contracts, payrolls, real estate, borrowed money, licensure requirements, and much more. Consequently, as the sector grew and modernized in the middle of the last century, the trust form was pushed aside in favor of the corporate form because corporations have a bifurcated governance structure specifically designed for operating activities.

Corporations have both a board of directors (our topic), and a group of officers who comprise management (such as the CEO or CFO). Corporate law vests all power and authority of the organization in the board, which then delegates power and responsibility to management to conduct operations, but with the board overseeing management’s performance. In other words, the board of directors is at the top of the chain of command. It is not there for show.

Second, operating a nonprofit has become amazingly complicated over the last fifty years. The complexity has fallen on the backs of management, which must deal daily with everything from public expectations, to the morass of state and federal regulation which touches upon everything from HR policy and plans, credentialing, licensing, financial reporting and other challenges that are simply part of the modern turf. Management cannot take this on without board members rolling up their sleeves and doing some real work. Talented CEOs have told me how they long for a strong board to back them up -while expressing their frustration with the common fare offered by “volunteer board recruitment” efforts that don’t always deliver what is needed.

Finally, there is the “Stupid Hat Syndrome.” I first heard this expression from a successful businessman, famously generous with both his money and his volunteer board service. He coined the phrase to express his frustration after years of observing “some of the smartest and most successful business people he knew join a nonprofit board and immediately put on their Stupid Hat.” In other words, they habitually checked their immense brain power and experience at the door. The Stupid Hat metaphor may be hard edged, but the phenomenon is real and all too commonplace in the sector. It’s the 800-pound gorilla in the corner, and it’s as true as the truism that in general “you get what you pay for.”

In contrast, when you pay someone, even a modest amount, you demonstrate respect for what they have to offer; and in return you can comfortably tell them that they are expected to do real work -show up at meetings, read the circulated minutes and financial reports before the meetings, ask informed questions and offer ideas, chair important committees, have calls and meetings with management between meetings to discuss how things are going, and more as necessary. Paying someone for their service is a commercial exchange of value, not an expense. The brain power, experience and work of talented directors who keep their smart hat on at board meetings is worth the money.

I’ll close by saying that there is a lot more to this question than space permits, and by noting that modern nonprofit corporation law is very flexible and allows for use of committees, advisory boards, and other structures that would keep an organization tightly bound to its community while giving this alternative model a chance in appropriate cases —indeed, NANOE’s New Guidelines for Nonprofits may revealed what could be the wave of the future and we should be willing to give it a chance.

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Jack Horak joined The Alliance for Non-Profit Growth and Opportunity (TANGO) in 2016 after a 36-year legal career at the Hartford office of the law firm Reid and Riege, P.C. He was a member of the firm’s Business Law Practice, where he created the firm’s Nonprofit Organization Practice Group. He was the principal author of the Reid and Riege Nonprofit Organization Report, a quarterly publication distributed throughout the United States; and also regularly published articles and editorials on legal and policy issues in Philanthropy Magazine, The Hartford Courant, Connecticut Law Tribune, and the Hartford Business Journal, where he writes a regular editorial column entitled “Rule of Law.”  This column first appeared in InsideCharity and the TANGO newsletter.

PERSPECTIVE: CT's Small Towns Receptive to Regional Resource-Sharing

by Leo Paul Connecticut’s small towns and cities support initiatives to encourage voluntary regional cooperation to provide programs and services to meet the needs of local residents in a more efficient, cost-effective manner. As Connecticut’s small towns and cities struggle to do more with less, many communities are exploring new opportunities to share resources to meet these growing needs.

Connecticut’s Regional Councils of Government (COGs) have been instrumental in developing programs to assist towns in delivering services more cost effectively through shared services agreements and regional partnerships. These programs include a wide range of services and functions, including:

• Regional Dispatch Centers
• Regional Animal Control Facilities
• Consolidation of Back Office Functions, i.e. IT, human resources, accounting
• Regional Transfer Stations/Solid Waste Management
• Regional School Districts
• Regional Health Districts
• Group Purchasing of Goods and Services
• Shared Back Office Functions
• Regional online permitting, GIS mapping, and property revaluation.

Programs such as the Regional Performance Incentive Program and Intertown Capital Equipment (ICE) Sharing program have been successful in encouraging communities to utilize regional approaches to delivering services and purchasing equipment to stretch limited municipal dollars. The ICE program, for example, provided state support for the shared purchase of capital equipment, an initiative that allowed towns to share the cost of new/replacement equipment needed to perform critical town services, such as plowing, mowing and fire trucks, etc.

Several years ago, town leaders in Litchfield County implemented a program to share heavy equipment. Ten towns in the area benefit from this program, the Litchfield Hills Public Works Equipment Cooperative, which allows the towns to share major equipment for road maintenance. Two street sweepers and one catch basin cleaner were purchased through the program, which was made possible by a $700,000 grant the council received from the state’s Regional Performance Incentive Program.

Unfortunately, funding for RPIP has been significantly reduced over the years and the ICE program has been eliminated. This is unfortunate because regional sharing programs that allow towns to reduce costs without undermining efficiency are certainly a win-win for the towns and taxpayers.

Regionalism is no Silver Bullet

COGs have been successful in fostering collaborate shared service programs because they work with member towns to identify needs and perform feasibility studies to determine how regional approaches will impact costs and service delivery. This approach recognizes that regional approaches don’t always save money or ensure that services will be delivered more efficiently. According to a 2008 study by Dr. Steve Lanza, editor of The Connecticut Economy, “Municipal consolidation or other service-sharing plans offer no silver bullet for the problem of costly, local public services.”

Too often, legislation promoting regionalism is proposed without fully analyzing whether regionalizing certain programs or services makes sense from an economic and/or service delivery standpoint. A prime example of this is the proposal from the state Department of Public Health to consolidate health districts. This was a top down approach to regionalism that failed because it would have consolidated health districts without regard for cost or for the impact on service delivery to residents. COST attended meetings along with representatives from towns, cities, health districts and health professionals and not one person in the room supported the consolidation proposal.

Unless it can be demonstrated through a thoughtful and comprehensive policy analysis that regional proposals will provide significant benefit or savings, the state should not push towns to rush headlong into such arrangements. Fortunately, COGs are actively working with member towns to determine when regionalism and shared service programs make sense and what it takes to get there.

Successful State/Local Partnerships

In promoting regionalization of services, policymakers should recognize the value of strong state/local partnerships in providing critical services to residents in a cost-effective, value added manner. For more than 60 years, the Resident State Trooper program has been a successful model of a strong state/local partnership that allows towns to share resources and provide critical public safety services to our communities. Not only does the program assist small towns in maintaining a public safety presence, resident state troopers are routinely dispatched from their towns to respond to state police matters outside of their community. The program is a win-win for the state and our small towns and residents.

Unfortunately, towns have had to pay an increasing amount to continue to participate in the program and we are concerned that any additional increases in costs will make it too costly for municipalities to maintain their resident troopers. Towns have explored options to create stand-alone police departments or regional police departments, but these programs are much more costly than the resident trooper program. The towns of Roxbury and Bridgewater have entered into an arrangement to share a resident trooper, which has proven beneficial for both communities, which are very small.

In addition to regional and shared service models, towns have been exploring opportunities to consolidate non-educational expenditures and functions within their communities. For example, the Town of Canton recently entered into an agreement with its Board of Education to share a Finance Director. Other towns have consolidated back office functions under the state’s Nutmeg Network, consolidated maintenance, Human Resource, and other functions. COST supports efforts to assist towns and boards of education in consolidating non-educational expenditures and functions.

Barriers to Regionalism

COGs have worked with towns to successfully identify and support municipal opportunities to regionalize services and improve efficiencies and, as mentioned, there are a number of success stories. However, consolidating services can be difficult and towns often require assistance in 1) undertaking feasibility studies to determine whether consolidation is cost-effective; 2) addressing liability issues that may arise due to sharing arrangements; 3) negotiating contracts for shared services; and 4) addressing collective bargaining/union issues that may undermine savings associated with regional efforts.

COST stands ready to work with lawmakers to develop and support common sense proposals that facilitate the ability of municipalities to

• regionalize certain programs and functions in ways that make sense for the communities involved and for our property taxpayers;
• maintain strong state/local partnership approaches to the delivery of services, such as the Resident Trooper program;
• support the consolidation of non-educational expenditures and functions to improve municipal efficiencies;
• enhance the management of regional school districts; and 5) address barriers to regionalization, including collective bargaining agreements and statutory requirements.

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Leo Paul is First Selectman of the Town of Litchfield, and President, Connecticut Council of Small Towns.  This is an excerpt of testimony submitted to the Connecticut state legislature’s Planning and Development Committee at an Informational Forum on Shared Services and Regional Efficiencies held during the legislative session, earlier this year.

PERSPECTIVE - Discovering Common Ground, Developing Friendships and Creating Impact: A Teenage Sisterhood Driven by Faith

by Olivia Rotter and Layan Alnajjar Around the time of the presidential election of 2016, we embarked on a journey to find peace and unity amidst high tension in our society and government. Coming from moderately conservative Jewish and Muslim homes, we were encouraged to raise our voices during this time of bigotry.

We have been friends throughout high school and were both passionate about social justice issues. Specifically, we were concerned about the hate speech and discriminatory language that was being used to target faith groups - including our own.

With this knowledge, we decided to form the first official teen chapter of the Sisterhood of Salaam Shalom, an international organization that aims to eliminate stereotypes and celebrate the power of friendship and compassion between Muslim and Jewish women. Historically, these two religions have had turmoil in reference to the Israeli-Palestinian conflict. However, this empowering sisterhood distances themselves from any opinionated topics and instead focuses on the similarities of the Jewish and Muslim practice.

The nonprofit organization Civil Politics conducted a study of participants in the Sisterhood. They concluded that “having more in common with members of each faith, more improvement in their comfort with others, and greater commitment to speaking out against divisive rhetoric,” is an extremely powerful agent for change. In correlation with our chapter’s success, this Civil Politics study proved that friendship and acceptance can overcome misunderstanding and misconceptions.

After a lot of hard work in recruitment and creating lesson plans, we had our first meeting in September of 2017. We were both excited and anxious that this day had finally arrived and that our hard work had paid off.

The excitement stemmed from our curiosity and hope that this one chapter could change our local community’s outlook. Our angst was in regards to the possibility that these fourteen high school girls - seven Jewish and seven Muslim - might not get along. To our pleasant surprise, the first meeting went exceptionally well and early friendships quickly began to form. Despite our previous concerns, the girls truly found comfort and confidence as they identified common ground with each other.

Since then, these friendships have taken flight and evolved through the process of giving back to our community. Our first charitable act was around the holiday season when we collected food cans, toiletries, and books for a local family shelter in Hartford. We unloaded and stocked hundreds of supplies that would be given to various families in need. This experience was a gateway to many more acts of service that brought us even closer as a sisterhood.

Soon after, we partnered with the Muslim Coalition of Connecticut to serve those in need of a healthy meal and a place to relax at Mercy Shelter in Hartford. Some of us were in charge of plating the food, while others waitressed. The facilitator for Mercy Shelter was so happy to have us all there and commented that we had the best teamwork he had ever seen. We look forward to going back this year and to gaining even more perspective.

The highlight of our year was teaching our own curriculum to 5th grade students at Beth El Hebrew School in West Hartford. For months our group spent time together creating an intricate lesson plan to teach these young students. The curriculum had a few different components, beginning with a Venn diagram activity that demonstrated the ways that Muslims and Jews are alike. The students soon caught on that every element was a part of both religions, falling into the center section of the diagram.

After many insightful discussions with the students, we then moved on to passing out a coloring page with the Jerusalem skyline on it. During that time, we played music in both Arabic and Hebrew. Lastly, we had each student write on a poster what they thought before versus what they know now, after the activity.

One student wrote on the before side of the poster that they feared “we might not be able to get along.” However, after our lesson they wrote on the after side of the poster that now they know “we are so similar and can be close friends.” It was truly inspiring to see how much new knowledge they acquired regarding the similarities between the two religions in just one short hour. The kids were so excited to learn this material and fascinated by the common ground.

A few weeks ago we were contacted by the coordinator of the Hebrew school and asked to officially be a part of the curriculum for 5th grade students. We feel so fortunate that we will be able to make an even greater impact this year.

In just a few short weeks our chapter will reunite for the first meeting of this new school year! We look forward to another successful year full of friendship, knowledge, and service.

Next year, we are beginning another chapter in our lives as we head off to college. We both plan on bringing all we have learned to our universities, and hopefully starting the first Salaam Shalom college chapter! We urge you to begin making an impact by starting a new chapter of the sisterhood in your own community.  For us, this has been the most rewarding and empowering experience of our entire lives; we hope that you will join us on our journey towards peace and acceptance!

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Olivia Rotter and Layan Alnajjar are seniors at William H. Hall High School in West Hartford; dedicated students and active leaders within their community. This year, they will continue helping to start new chapters across Northern America and will mentor future teen leaders, giving them advice and ideas for meetings. They will be honored for their hard work and devotion to the Sisterhood at the organization’s annual conference in November.

 For more information about the sisterhood, visit https://sosspeace.org, follow the organization on facebook at the Sisterhood of Salaam Shalom, and follow their new teen-run instagram@sossteens.

PERSPECTIVE: Making Our Own Individual End-of-Life Decisions

by Paul Bluestein I am speaking out about this because my friend Hal can’t.

Hal was an international systems analyst until his retirement after which he devoted his time to things he loved including music, theatre, painting, sailing, windsurfing, gardening, and photography. He volunteered for the CATCH Program in Bridgeport, and the Norwalk Senior Center. Over the years, he served on boards of the American Red Cross, his church, the Carver Center in Norwalk and the Voluntary Action Center.

Hal was physically active and involved in the life of his community then, at age 90, he was diagnosed with a terminal illness. He did not want to endure the inevitable period of declining mental and physical capability or the pain of being dependent on his wife and children after a lifetime of independence. Hal had lived a long, productive and rewarding life and wanted to die with dignity … just as he had lived and not spending his hours and his days between medical treatments and interventions that would only prolong, for a short period, the remaining time he had. He wanted to bring a rapid end to what had been a life well-lived.

Hal’s wife of 57 years agreed with his decision and so did his children. He talked to his doctor who, not surprisingly, was unable to do anything for his patient. Hal wrote to his friends to say goodbye and to let them know that he had decided to not eat or drink – anything – until he died. He had made the calculations and figured that would be the way he could accomplish his quickest exit. It took Hal more than a week to die, but during that time he never voiced any regret about his decision but he often said that he wished there had been an easier option for him.

It would be easy to see Hal’s story as just an anecdote, especially if you don’t happen to agree with the decision he made. But this is not just an anecdote to me. It’s personal. For me, for my wife, and for most of my friends who are about my age, one of the biggest worries that we share is that we may end up without having the right to make the our own most personal decisions at the end of our lives.

We live with the fear that, because we live here in Connecticut, a state that does not honor individuals’ rights to use prescribed medication to end their lives peacefully rather than suffering a painful and protracted death, we may end up having to leave our home to travel to a more humane state, or to do as our friend Hal, and more recently Denny, did and quit eating and drinking to hasten our own final exits.

I sit before you now as someone past 70 wondering why you - strangers to me, members of this Public Health Committee as well as your colleagues in the CT General Assembly - get to decide what my end of life is going to be like. This is very real … and gets more real every day for me and thousands of other people in Connecticut.

I have been a practicing physician. I’ve seen firsthand the indignities and suffering that dying can inflict. I am no stranger to the American way of dying. But, in my last days or months, what I want for myself, for my wife and friends, and also for my physician, is to have available all options for care at the end of life. I do not want others to consign me to starving myself to death to avoid prolongation of life that has lost its meaning to me.

More than 20 years ago, Oregon implemented its Death with Dignity Act. Since then, Washington, Vermont, California, Montana, Colorado and Washington DC have passed legislation authorizing medical aid in dying for terminally ill adults, and just this week, the Hawaii State House approved the Our Care, Our Choice Act.

Last November, the Vermont Medical Society dropped its opposition to Death with Dignity; in December, its Massachusetts counterpart followed suit. Physicians are increasingly becoming Death with Dignity proponents and 7 in 10 Americans support death with dignity.

What about Connecticut? Death with Dignity bills have been considered several times. The first attempts came in 1995 and 1997. After Washington passed the second Death with Dignity statute in the nation, the issue returned to the Connecticut legislature in 2009. Bills considered in 2013, 2014, 2015 and 2017 received Committee hearings but were not put up for a vote.

Isn’t it finally time for the citizens of this state, and their doctors, to have the right to make their own decisions about the care they will receive at the end of their own lives?

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Dr. Paul Bluestein, MD, FACOG is an obstetrics & gynecology specialist in Fairfield, and has been practicing for four decades. This testimony was submitted to the Connecticut General Assembly’s Public Health Committee earlier this year and is included in the record of a public hearing on proposed legislation that would have allowed “a physician to dispense or prescribe medication at the request of a mentally competent patient that has a terminal illness that such patient may self- administer to bring about his or her death.”  The proposal was not approved during the 2018 legislative session.

PERSPECTIVE - Both Sides of the Wall: What Being in Mexico Taught Me

by Skylar Haines She loves nonfiction books about animals. She has a group of friends. She laughs and cries. She does her homework and sometimes struggles with silent letters on spelling quizzes. She tucks her hair behind her ears when trying to concentrate. She watches TV before her chores are done.

He plays soccer in the streets and stays out past his mom's calls to come inside for dinner. He knows everything about music, but can't wrap his mind around grammar and sentence structure. He sneaks dessert before dinner. He has a math teacher who changed his life just by believing in him. He makes jokes and gets angry. He takes the long walk home on nice days.  They could be my brother or sister. They could be the kid who sits next to you in class and shares their gum. They could be the neighbor that you drive by each morning. They could be a friend. They could be your child.

Yet, their streets look different than ours, with cracked sidewalks and stray dogs. Homes are turned into storefronts and host traditional embroidery, dulce de leche caramels, and cold grapefruit soda. People sit on the porch and call out to you as you make your way to the line of buses with people going to different jobs and different streets. No matter what street you're on, you'll see crucifixes and Virgin Mary portraits, food carts and hard-working owners, and strangers welcoming strangers with "Bienvenidos" and smiles.

Their schools look different than ours, with torn pages escaping their notebooks, desks missing a leg and chairs that sink too low, broken pencil stubs, and faded writing pressed into the old whiteboards. The bare courtyard has no toys and cracks all along the middle so they stumble while they run. The plaster of the walls peels slowly and teachers try to make do with a few pieces of colored paper and an eraser. Lunch stains are deep in the wrinkled uniform that hasn't been washed since the students started sleeping at the Salvation Army during the week, just so they could get to class consistently.

Instead of seeing the similarities that lie within these differences, and appreciating the uniqueness of culture, and finding ways to share our blessings… our nation has pushed them away. They have become a "them", divided from our population out of fear of these differences and blindness to the multitudes of commonalities. If you could talk to Reyna about her dream of being a doctor and how much she loves learning new words, if you could talk to Munir about his favorite songs and how he tells jokes to make friends… then you would see the similarities we share, and yet how many differences they face. However, do not be mistaken, this doesn't stop them.

On our last day at the Serapio School, a government school in the impoverished community, my Mother and I, volunteers teaching English, had to explain that we were leaving. Try explaining that to people who became familia in just one week. As I stumbled through a goodbye that day, Estefania, a fourth-grade student, reached into her Hello Kitty purse and placed something in my palm. A single confetti butterfly, smaller than a penny, that sparkled when it caught the sunlight. Holding that gift and looking at the school's empty concrete courtyard, the streets and people that occupy them, the faces of broken children sitting in disheveled desks- it was a piece of hope, and she knew that.

She didn't have to say a word at that moment, the butterfly was a tangible reminder of all they had taught me. They might remember a few English words or have held onto their pencils and eraser caps from the time I was there, but they taught me something I have held onto for much longer. The children I know find beauty in everything, despite the hardships they deal with each day, and every time I look at that butterfly I am reminded of their resiliency and resounding hope.

That's why I know they can do beautiful things. Being given so little- one ripped uniform, broken pencils without a sharpener, expo markers that have been dry for years- and still holding warmth for others and wonderful visions of a future through it all, cherishing the tiny butterflies in life, that is resiliency. I can only imagine what they could accomplish with just a little bit of support.

In fact, I know. My foundation, "Peace, Love and Art: Hope for the Children of the Serapio School in Mexico" provides creative therapies like art and musical instruments and classes for all the students where they express their culture, backgrounds, and dreams. We also raised money to install a computer lab which allows them to learn and grow. What I am most excited about though, is the letter exchange program.

This school year students from Hebron, Connecticut will be emailing with the students I taught in Serapio, Mexico. This cross-cultural understanding is vital in our world today, especially in younger generations, in order to ensure collaboration, empathy, and peace in our global community in the future. Also, children who have expanded worlds through travel, cultural research, and outreach have more perspective and a better insight into the world and our human interactions… I can truly attest to this. This emphasis on humanity as children reach over divisive boundaries that have been set for centuries, is more important now than ever.

Over 11.6 million Mexican immigrants live in the United States currently. Yet, national dialogue that fuels schismatic rhetoric isolates these people… the people I know, the children I taught, the faces that mean more to me than "Mexican" now. We see this dialogue leading directly to policy under the new administration - the administration that was elected while I was in a nation stereotyped and degraded throughout their campaign.

If you could see them the way I see them, as hard-working individuals that will do anything to provide for their family (like many of us would do), as welcoming neighbors who will open their doors to anyone...and as people. Not Mexicans, not drug-traffickers, not prostitutes, not foreigners, not aliens, not "them"...humans, people, children. These 11.6 million US citizens have names, stories, hopes, and families. The 303, 916 people who were apprehended at the Mexican border in 2017 have names, stories, hopes, and families. As do we.

A line drawn by hands who fear a color other than their own is not a line that should dictate who is human and our hearts should cross that border if our bodies will not. And whenever I see faces of children being torn away at the borders, people being turned away and unwelcome… I see the children I laughed with and learned with in Mexico. The same people who never isolated me for being an American, even on that Tuesday when the whole world woke up to a new president who had called the people I lived with "enemies", "criminals", "terrorists", and "rapists".

I only hope that in the future if we are ever faced with having to flee our nation, that Mexico will forgive us and not treat us with the same degradation and disdain. If we do not extend the decency of providing asylum and even treating them with respect and compassion, then they will never do the same for us. Or they might, because that is how they treat people in Mexico, no matter what. Their culture could teach us a thing or two.

When I share glimpses about my journey in Mexico, my experience of the culture, and all the people who touched me while there, I generally get asked one big question: "Are you afraid of the wall being built?!"

Well, here's my answer: the wall has been up for a long, long time. The real question is, when will we start breaking it down?

________________________________

Skylar Haines is a senior at RHAM High School in Hebron and the founder of “Peace, Love and Art: Hope for the Children of the Serapio School in Mexico”.  She is an active volunteer and advocate for those who are often not given a voice or platform. Her work was recognized by the World Affairs Council of Connecticut, where she received the Global Engagement Award in 2018. She is also the director, reporter and writer of the program “Speaking Through Stories” on the Community Voice Channel in Bolton. Skylar hopes to pursue a career in broadcast journalism that will encourage open dialogue as well as share people’s unique stories and perspectives.

PERSPECTIVE: Homelessness at State Universities Hidden in Plain Sight

The CT Youth Count! is part of a statewide effort to better understand and end youth homelessness by 2020. For the past three years, the Connecticut Coalition to End Homelessness has led this data-gathering and awareness-raising census in which teams of youth and volunteers survey young people in cities and towns, rural areas, within youth-serving organizations, in schools, and at local “hotspots” to collect information on their housing status.

Youth are not identified by name, but the count is an opportunity to gauge how many youth face housing insecurity and homelessness and to share information about available services. The Youth Count is an opportunity for communities to work toward a quicker system of identification when a student is struggling with a housing crisis.

Linkages to services to address acute instances of homelessness were established during the count. The data from the count resides at CCEH to analyze and share with the wider community, state, and federal partners. (The full Youth Count report can be found on the CCEH website, here.)

In the Connecticut State Colleges and Universities (CSCU) system, unstable housing - or the lack of housing altogether – is a barrier to academic success and stability for many students. Faculty, counselors and deans report that students are living in cars and “couch surfing” at friends’ or relatives’ homes while, at the same time, they are trying to attend college because they know that education is their path to a better future. During Town Hall meetings across the state during the 2016-17 academic year, CSCU President Ojakian was approached by many students who said that they were homeless and needed additional support.

CSCU partnered with the Connecticut Coalition to End Homelessness (CCEH) to address this significant barrier to student success. A forum was held at Manchester Community College on September 15, 2017 to address this issue, along with mental health and other needs faced by CSCU students. Several CSCU institutions attended, including Norwalk Community College and Central Connecticut State University.

As a follow-up to that forum, Vice Presidents and Deans of Students Affairs, along with the system office, the Connecticut Coalition to End Homelessness (CCEH) and others, have been exploring how to get more accurate data concerning homelessness and housing insecurity and how to implement a Single Point of Contact (SPOC) system to provide a more comprehensive, consistent and trackable response to homeless students.

CSCU agreed to have 16 institutions serve as sites for conducting the Youth Count survey from January 24 – 31, 2018 (Charter Oak State College did not participate because it is a fully online institution.). Because the Youth Count focuses on youth age 24 and under, the survey instrument was modified to capture CSCU students over the age of 24. The Youth Count, occurs in conjunction with the HUD-required Point-in-Time (PIT) count, an annual census of sheltered and unsheltered individuals and families experiencing homelessness on one night in January. For more details on the PIT or Youth Count methodology, visit CCEH’s website at www.cceh.org.

The [December 4] event focused on important steps to take leading to the count and provided an introduction to the Connecticut Coordinated Access Network (CAN) system of services. Each participating college or university identified leads for the effort and formed local steering committees to begin to articulate how the Youth Count would be conducted in each community. Specifically, each CSCU institution was asked to prepare an implementation plan, including how it would recruit volunteers, work with existing groups, schedule the survey times and places and spread the word to the school and region.

While additional research needs to be done, this preliminary research indicates some important findings on CSCU students and their housing instability. The total number of CT college and university students surveyed was 1,978, with CSCU schools representing the majority with 1,623 surveys completed by CSCU students. Of those surveyed, an average of 17.5% of CSCU students reported recent housing instability or homelessness. For those schools surveying less than 30 individuals, it is more difficult to have confidence in the percentages experiencing a housing crisis.

However, 12 of the 16 CSCU schools surveyed over 30 individuals, with some participating CSCU institutions completing over 100 surveys; including 320 surveys at Housatonic Community College, 290 surveys at Manchester Community College, 243 at Naugatuck Valley, 164 at Three Rivers and 117 at Eastern Connecticut State University.

Of those schools reporting more than 30 individuals surveyed, the schools with the largest percentages of students experiencing a housing crisis are as follows: 38% at Gateway Community College with 42 students surveyed; 21% at Middlesex with 71 students surveyed; 26% at Eastern CT State University with 117 students surveyed; 19% at Housatonic with 320 students surveyed; 14% at Manchester Community College with 290 students surveyed; 13% at Three Rivers Community College with 164 surveys completed; 10% at Northwestern CCC with 88 completed surveys;11% at Asnuntuck with 81 surveys completed; 9% at Naugatuck Valley Community College with 243 completed surveys; 13% at Norwalk Community College with 72 surveys completed, and 38 surveys completed at Tunxis Community College with a 13% rate of housing instability and homelessness.

The University of Connecticut system also completed 289 surveys and showed a rate of 10% of students experiencing housing instability or homelessness.

These percentages highlight the high levels of homelessness and housing instability among students on CT campuses. Although more precise data is needed, this data reinforces the need to create coordinated systems to address homelessness and housing instability on CSCU and other campuses across the state.

The establishment of a Single Point-of-Contact (SPOC) system within the CSCU system will provide a visible campus office that can assist in increasing student awareness, enabling earlier identification and intervention, and augmenting the expertise of administration, staff, and faculty to help these students find housing solutions.

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This is an excerpt of the introduction to Homelessness and Housing Instability in Connecticut Colleges and Universities, a report prepared by the Connecticut Coalition to End Homelessness for the Connecticut State Colleges and Universities (CSCU) system and published in July 2018.