County public health director Dr. Bob England says Lowell Elementary School has been “experiencing a much higher than normal rate of absenteeism due to illness that looks like flu.”

England ordered the school closed as a precaution until May 26.

He says with swine flu and seasonal flu behaving much the same way, it’s not recommended that students already home with mild illness be tested for swine flu. So, England says it’s likely that the strain of flu will remain unknown.

Lowell Elementary School spokeswoman Sara Bresnahan said officials saw a spike of absences on Monday among the school’s 700-student population. About 20 percent of the student body called in sick.

England ordered three schools closed April 29 after students contracted swine flu. A few days later, he announced he wouldn’t order new closures unless a particular school had a widespread outbreak.

The Pascua Yaqui Tribe will get $215,000 for child care and the Tohono O’odham Nation will receive $461,000 for child care. The money will provide vouchers to needy working families so they can get child care and continue to be employed.

Gov. Jan Brewer

PHOENIX – It looks like legislators may give Gov. Jan Brewer the fast-track legislation she wants to maintain child care subsidies now slated to be eliminated Friday because of midyear budget cuts.

A budget cleanup bill being drafted at the behest of House and Senate Republican leaders for consideration by the full Legislature this week will include a provision to authorize using $18.2 million of federal stimulus money to pay for continuing the child care subsidies through the current fiscal year, a senior Senate aide said Tuesday.

“We are targeting getting it done this week,” said Michael Hunter, a senior policy adviser to the Senate’s Republican majority.

The renewed funding would maintain subsidies for 15,000 children in low-income families now receiving the benefits. It could also benefit families of 5,000 additional children expected to start getting the subsidies in coming months if the program continues.

The subsidies, intended to provide safe care for children so their low-income parents can work, were a casualty of midyear budget cuts made by the Department of Economic Security after legislators and Brewer reduced the social-welfare agency’s budget in January to help close a big state budget shortfall.

DES sent termination notices late last week to care providers and current recipients, saying that subsidies will end Friday.

In her March 4 speech, Brewer had asked lawmakers to “quickly, and no later than March 14,” send her legislation authorizing her to use $20 million of federal stimulus money to restore the child care funding.

“This is assistance for working parents (who) won’t be working without child care; 20,000 children are depending on us,” Brewer said March 4.

According to a proposal prepared by Brewer’s office, the stimulus money provided for child care subsidies can’t be used for any other purpose. Also, it’s assumed that newly available money from an Arizona early childhood-development program funded by a tobacco tax will provide subsidies for some children who lose DES benefits, the proposal said.

In addition to maintaining subsidies, the stimulus money also would be used to roll back higher copays and reduced payments for providers that also resulted from the budget cuts, Brewer’s office said.

Unlike most categories of stimulus money, the governor cannot spend child care dollars without legislative authorization, according to both Hunter and Brewer’s office.

Though some legislative leaders had suggested that DES actually had enough money to keep the subsidies going well into spring, a department spokeswoman said it would have been irresponsible for DES officials to not send the notices to families and providers when they did.

“Every week that we do not implement these reductions means more than $1 million spent that we don’t have,” said Liz Barker Alvarez.

The authorization would be for the current fiscal year, which ends June 30, Hunter said. “One thing that needs to be understood is that this is just a temporary fix,” he said.

Legislators are now in the early stages of work on a budget for the next fiscal year, which starts July 1.

Hunter said the budget cleanup bill also could include other provisions, such as changes intended to respond to actual or potential lawsuits over budget issues.

Another round of job cuts to the state’s Child Protective Services program means 112 case specialists are out of jobs, leaving the staff 15 percent smaller than it was earlier this year.

That translates into fewer workers to investigate complaints about child abuse, a move that one state lawmaker predicted would lead to children dying due to abusive conditions.

The agency late last week laid off 112 specialists, bringing to 159 the total number of case workers and investigators who have been dismissed as the state Department of Economic Security makes cuts to help the state balance its current-year budget.

In all, 181 CPS workers have lost their jobs due to budget cuts. DES does not expect further cuts, but lawmakers have said new budget reductions may be needed this spring.

Lawmakers on Jan. 31 approved budget revisions to resolve a $1.6 billion budget deficit; DES’ contribution is $153 million. Sen. Jonathan Paton, R-Tucson, said CPS workers should not be cut to the same extent as other social-service programs.

“They should be the last ones to be cut because they interact with parents and kids,” said Paton, who last year, along with now-House Speaker Kirk Adams, led the charge to increase CPS funding and make the agency more transparent.

“I think it will result in dead kids,” Paton said.

The agency last month announced that a first round of cuts meant CPS would not be able to investigate all “potential risk” reports. These are the lowest level of suspected abuse cases, but Paton said the reports, also called “priority four” reports, can lead to horrific cases.

“I’ve seen some of those priority fours turn into ‘priority nevers,’ ” he said, even when the state was able to investigate.

Early, low-level complaints can uncover horrific conditions that could avert bigger problems down the road, he said.

He said he would work to find money to reverse the cuts, noting that lawmakers are expected to revisit the current-year budget this spring.

The First Things First board voted this week to release the funds six months earlier than planned to help working families and their children in the beleaguered economy. About $24 million will be used in discretionary funding and another $24 million will be allocated to First Things First’s 31 regional councils.

The package will be used to help families with children aged 5 and under.

• $23.3 million will provide four months of child care scholarships for working families whose incomes are at or below the 200 percent of the federal poverty level.

• $500,000 for emergency food boxes.

• $24 million for family support programs, including those designed to prevent abuse and neglect.

First Things First is a voter-approved initiative and assesses an 80 cent tax on packs of cigarettes and other tobacco products. The organization relies on goals created by 31 regional councils and the first round of funding was set to be dispersed in July.

Because of the tax, First Things First isn’t directly affected by the funding shortfalls facing the state, but the state Legislature did sweep $7 million of interest earned on the organization’s coffers as lawmakers worked to close this year’s budget deficit.

J. Elliott Hibbs, First Things First executive director, will also send a letter to Gov. Jan Brewer and the state Legislature to urge them to use the federal stimulus funds to re-instate services for families of young children per the board’s direction.

More children with access to health care. Quality ratings for child-care centers. “Childhood-development kits” sent home with newborns.

Those and other plans to benefit Arizona children are being unveiled by an organization created to funnel tobacco taxes into programs to improve child development and early education in the state.

Voters in 2006 passed the First Things First initiative, or Proposition 203, adding an 80-cent-per-pack tax on cigarettes and raising taxes on other tobacco products. The law set up 31 regional councils to establish goals. Beginning in July, those councils will put their goals into action.

The Arizona Republic obtained the councils’ goals this week in interviews and documents.

Because the law sets aside the tax specifically for childhood programs, those programs aren’t directly affected by the funding shortfalls facing the state, which have caused deep budget cuts elsewhere.

First Things First ended fiscal 2008 with $236.6 million: $82.7 million in its administrative account and $153.9 million for programs to benefit Arizona’s children. The organization plans to spend $91 million in its first full year on strategies set up by the regional councils, plus more money on statewide initiatives.

The state Legislature took $7 million in interest earned on First Things First’s accounts to close this year’s budget deficit. That loss won’t affect the initiative’s plans in the next few years but could hurt the organization’s long-term progress, especially if the Legislature decides to take more interest earnings to balance future budgets.

Supporting youths

First Things First relies on goals created by the councils that address concerns specific to Arizona’s regions and tribes. Each region’s funding is based on need and the number of children age 4 and younger.

The Southeast Maricopa Regional Partnership Council will use its more than $8 million in part to provide more children with access to quality health care.

The Central Phoenix Council plans to use part of its more than $11 million to help literacy development so children come to kindergarten ready to read.

Health screenings in various regions will also be done because many children start school with health issues that can impede their ability to learn. Dental care is considered especially important.

The Southeast Maricopa Council, along with other councils, plans to collaborate with existing Arizona early-childhood health care systems to improve access to health care. Outreach and enrollment assistance will be available to help connect families to public-health programs.

First Things First would also like to increase the number of child-development specialists in rural Arizona. Slight speech problems can worsen, for example, if children don’t receive therapy before they start school, said Karen Woodhouse, deputy director of the First Things First board.

“We were down in Yuma last week and heard a story about a parent who had a child diagnosed as having a predisposition for autism, and the only services she could get for that child was either in Scottsdale or 15 minutes a week of speech therapy at a local school district,” Woodhouse said. “That’s what they could provide for the family. Imagine being in a place where you couldn’t get service.”

While organizers work to meet regional goals, there are also statewide initiatives. Parents of newborns will be sent home from the hospital with kits that provide information and resources on childhood development and how to create a home that’s a good learning environment.

“Far too many children don’t come to school ready to learn,” said J. Elliott Hibbs, executive director of First Things First. “The whole idea of First Things First is to get kids ready to learn, so when they start school they are ready” for classes.

Quality child care

One of the larger initiatives will bring quality ratings and improvement to child care centers and help parents such as Julie French of Mesa find day-care centers they feel comfortable using. When French goes to work, her 7-month-old daughter, Lindsay, goes with her.

French looked for day care when she was pregnant, checking a home facility, church groups and day care centers before her mother, who is also her boss, decided that Lindsay should come to work.

French was glad to learn that the First Things First initiative will rank day-care quality on a scale of three to five stars and push centers for improvement.

The program’s first year beginning in July will be voluntary, but in two years, all such centers in Arizona will be ranked. Also, First Things First will make scholarships available to child care center workers who want to go back to school for early-childhood education.

“We haven’t dumped centers into a rating program,” said Nadine Mathis Basha, chairwoman of the First Things First board. “We are helping to support and make the facilities better.”

What’s next

Money the initiative makes off the tobacco tax is expected to decrease over time, as Arizona’s population growth levels off and more people never start or quit smoking. Because that decrease is anticipated, there is a need to save funds now. Hibbs said he was disappointed by the legislative decision to appropriate money from the fund’s interest, even though that’s not likely to have a short-term effect.

“This is a time . . . when we should be looking at the long-term needs of the state,” he said. “If you want a better education system, a highly productive work force . . . it starts with childhood development.”

For now, the regional councils are gearing up to pursue their initiatives for the next three years.

Supporting families with young children is a goal for all the regional councils.

The equivalent of a full kindergarten class is born every day at Banner Desert Medical Center in Mesa.

Parents of about 5,000 children won’t be able to enroll for the subsidies before June 30, under cuts announced last week by the state Department of Economic Security.

The subsidies average $350 a month. So what happens when working parents can’t pay for child care? Sometimes the result isn’t pretty.

Pressed to keep their jobs, some parents leave underage children alone to fend for themselves or with people who should not be trusted.

Those dangerous practices resulted in several tragedies across the nation after welfare reform was enacted in 1996 via the Personal Responsibility and Work Opportunity Reconciliation Act .

Nowadays, with unemployment rates soaring, most people won’t give up a job willingly, even if they can’t afford child care.

Arizonans can only hope that the 5,000 or so children at issue here will be left under responsible adult supervision when their parents head off to work.

The state’s $200 million child care subsidy program is serving about 45,000 kids this fiscal year, and those lucky families should be able to continue getting state help through June 30.

Of course, the freeze on new applications could be extended into the next fiscal year, particularly considering the projected $3 billion-plus deficit looming for 2009-2010.

But we hope the federal economic stimulus legislation will provide money for Arizona to add to its child care subsidy rolls rather than freeze out more families.

We understand that state leaders must make cuts wherever conceivable to balance the budget despite extreme revenue shortfalls. But we cannot condone cuts that have the potential to put vulnerable children at even higher risk.

One lawmaker suggested the state tap money from a tobacco tax increase approved by voters in 2006 for early childhood development programs through First Things First.

That money, however, was earmarked specifically for the nonprofit First Things First, which has regional councils of residents, teachers, parents and others decide how money best would be spent in any given geographic area.

Voters approved the tax increase on the understanding that expenditures would be decided by those grass-roots local councils – not by lawmakers facing a couple of tough budget years.

As much as we want the subsidies reinstated, it must be done fair and square – and the federal stimulus package is the best approach. We hope the money needed will be there.

The program is a state and federal collaboration that provides health coverage to low-income children and their parents. Supporters marked the 10th anniversary of KidsCare in Arizona with a birthday celebration attended by a gaggle of squirming 4- and 5-year olds, lawmakers and the Phoenix Suns Gorilla.

The celebration came as lawmakers are mulling a proposal to eliminate the program as the state looks for ways to close a $1.6 billion deficit. Cutting the program for the rest of this fiscal year – through June 30 – would save the state $23 million. Next year, the savings would be $43 million.

The program covers about 63,000 children and 9,400 parents.

“Shorting kids’ health care is penny-wise and pound-foolish,” said Dr. Mike McQueen, a neonatologist. “Children’s health care is one of the examples of preventive health that we do in this country.”

Valarie Klein knows the value of that. Her son, Gaites, was complaining of sporadic migraine headaches. After visiting various specialists, an MRI revealed a tumor lodged between his optic nerve and pituitary gland.

“Because of KidsCare, Gaites was given the most advanced medical technology,” said Klein.

Rep. John Kavanagh, whose list of budget options sparked alarm among KidsCare advocates, said the program goes beyond the federal government’s original intent with Medicaid. KidsCare is available to people making up to 40 percent more than the federal poverty limit.

However, Kavanagh said there may be hope for the program if the federal stimulus plan addresses health-care programs.

A team of more than 20 doctors and nurses at Phoenix Children’s Hospital worked for more than 12 hours to take the boys, who had been conjoined from their chests to their pelvises, and give them two separate bodies.

The boys were stable throughout the operation, but challenges remained.

Surgery continued late Thursday night, as separate teams worked on the long process of reconstruction to close each boy’s body.

Even if each surgery is successfully completed by Friday, as doctors expect, the boys will face more surgeries and intensive rehabilitation. Still, for the first time, their doctors can look at each one – and treat each one – as a separate person.

On the day Alex and Angel were born at Good Samaritan Hospital in Phoenix, doctors immediately began planning the operation that would separate them.

That day, their great-grandmother, Joan Bandel of Kingman, said, “The good Lord gave us this for a reason. We will love them together or apart.”

Conjoined twins Alex (left) and Angel Mendoza are shown on Jan. 8 at Phoenix Children's Hospital in Phoenix. A surgery to separate the conjoined twins is set for Thursday.

PHOENIX – Conjoined twins were doing well Friday after Phoenix doctors successfully separated them.

A Phoenix Children’s Hospital spokeswoman said it took 12 hours to separate the twins and then several more hours of work on each boy before surgeons finished about 1 a.m. Friday.

She says the procedure couldn’t have gone better for Alex and Angel Mendoza and the boys were resting in the hospital’s neonatal unit.

The twins were born last summer and were joined from just below their sternums all the way down through their pelvises.

A team of more than 20 doctors and nurses worked to give the boys separate bodies and the two were stable throughout the surgery.

Ashley Frank of Kingman gave birth in mid-August to the twins at Good Samaritan Hospital in Phoenix.