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MNAAP Newsletter

MNAAP Policy Priorities: Recap of 2013

By Anne Edwards, MD, FAAP, chair of MNAAP’s policy committee and chair of pediatrics at Park Nicollet

At the end of each session, I am reminded that we as children’s advocates participate in a marathon, not a sprint. MNAAP will continue to move forward, advocating on behalf of children to continue to move key issues forward in the coming year.

Many thanks to Eric Dick, MNAAP lobbyist, for his long hours of dedication. And many thanks to all of you who participated as child advocates during the session…look for more opportunities to engage in the coming months.

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A Word from the President: A Year in Review

At our annual meeting this May, we had an opportunity to put the preceding year in perspective. Our chapter accomplished a great deal in the last year. We’ve successfully obtained a grant to improve pediatric services for children in foster care and another to improve pediatric care through telemedicine and social media. We’ve achieved our largest membership ever now with close to 1,000 members. We’ve completely redesigned our web site to enhance our communications with our members as well as provide them better access to resources and news. In addition, we now offer a menu of discounted MOC 4 activities for maintenance of board certification. Finally, we have had real success with our advocacy for children.

Our highest priorities in advocacy included children’s access to care. This March our state’s health insurance exchange proposal was signed into law. As part of the goal of increasing access to care, we led efforts to instruct pediatricians across the state to sign up in time to make retroactive for the year increased primary care reimbursement increases under Medicaid. Our efforts to expand mental health services were made manifest in the Health and Human Services omnibus budget bill, the first bill to increase spending in the last six years; it specifically includes expanded services for mental health, chemical dependency, maternal depression, suicide prevention, and autism spectrum disorders therapy.

A second major priority was early brain development, and here we succeeded not only with the omnibus budget bill but also with the Minneminds financing package as part of the E-12 (early education through grade 12) bill, which dramatically expands scholarships to allow low income families access to quality education programs.

But two of our highest priorities for the year in advocacy did not fare as well.

While the Critical Congenital Heart Disease Testing Requirement did pass and was included in the omnibus bill, we were not successful in moving forward with legislation to prevent the destruction neither of the blood samples used to diagnose metabolic conditions in newborns nor of the actual documents of the results of the newborn screening. We are not giving up, however. We are already planning meetings with key allies to address this issue at the legislature again next year.

Similarly, the anti-bullying legislation that we pursued never made it out of committee. The proposal would require school districts to implement robust anti-bullying and anti-harassment policies to protect students, provide training to staff, and establish reporting protocols. It may have been killed in a legislative committee this year but we will be back next year.

Even as I write this, I am preparing to testify at an administrative hearing in the morning to fight for the updating of our state’s school and daycare rules. Given the tenor of the public comments from the anti-vaccinationists, we will be struggling to be heard and understood. But fighting for the health of our state’s children is always worth the effort, and no one ever told us it would be easy.

Perspectives on Advocacy: Annual CONACH Legislative Visit on Native American Children’s Health

By Damon Dixon, MD, a Native American physician and third-year pediatric cardiology fellow at the University of Minnesota Amplatz Children’s Hospital

As the fellow liaison to the Committee on Native American Children Health (CONACH), I had the opportunity to participate in the annual legislative visit to Washington DC. The agenda for the legislative meeting involved discussions on Native American child health issues, an opportunity to meet with U.S. representatives and senators and sponsorship of a congressional briefing.

CONACH is an AAP National Committee that develops policies and programs to improve the health of Native American Children. The members are committed to increasing the awareness of health care issues facing Native American children and advocating for legislation that ensures Native American children have access to high quality health care. CONACH also conducts annual pediatric consultation visits to Indian Health Service (IHS) and tribal health care facilities to promote the development of programs that support healthy lifestyles and optimal physical, mental and social health in Native American children.

IHS is a comprehensive community-oriented health care delivery system that serves American Indians and Alaska Natives (AI/AN). The IHS was established by treaties and trust agreements to provide basic health care needs to AI/AN by the U.S government. AI/AN have longstanding treaty rights with the U.S. government that guarantee federal provision of health care services, dating all the way back to the constitution. IHS serves 2.1 million American Indians and Alaska Natives (AI/AN) and is the primary source of basic health care services on Indian reservations.

Meeting in downtown Washington, D.C. at the Sofitel Hotel, CONACH members discussed several issues, including actions to improve medical providers’ recruitment and retention, coalition building with other health professional groups, updates on Reach Out and Read (ROR) programs on IHS clinics and updates on Area IHS health care facilities. The meeting was highlighted by a teleconference meeting with current IHS Director Dr Yvette Roubideaux. Dr.

Roubideaux discussed the current state of affairs and reviewed IHS’s four priorities, which are commitments to strengthen partnerships with tribes, bring reform to the IHS, improve the quality and access to care, and ensure that its work is transparent, accountable and fair.

AI/AN children suffer from significant health disparities compared to other children in the general population. A Native American child born today has a life expectancy four years shorter than that of the general population; moreover the rate of obesity and Type 2 diabetes is epidemic in Indian Country. IHS provides primary preventative care to a vulnerable population with unique health care needs.

Members of CONACH also had the opportunity to meet with U.S. Congressional representatives to discuss and advocate for federal policies that would protect AI/AN children from budget cuts under sequestration. The AAP also sponsored a Hill briefing on the importance of transportation infrastructure and transportation safety issues on the Indian reservations. Motor vehicle crashes are the leading causes of injury-related deaths for Native American 19 years old and younger.

The AAP has collaborated with the IHS for 48 years and has played an important role in the improvement of Native American health care. CONACH is an example of the AAP commitment to expanding its efforts to raise the status of Native American children’s health. Being a member of CONACH has strengthened my commitment to the IHS and has rekindled my passion for advocacy.

Member Profiles: Linda Thompson, MD and John Tobin, MD

Linda Thompson, MD and John Tobin, MD are retiring this summer after nearly 40 years as pediatricians at Hennepin County Medical Center (HCMC) where they’ve cared for underserved children and taught physicians who care for them. They have trained more physicians and medical professionals in primary care pediatrics than perhaps anyone else in Minnesota through their pediatric continuity clinics, everyday instruction to medical students and residents rotating through HCMC, and continuing education presentations.

What advice would you give to a young pediatrician?

Tobin: The costs are substantial, but the rewards considerable. You may be greeted with unabashed enthusiasm by a child, then criticized for being late or intrusive by the parents of another. Educational costs may be the same as those of colleagues going into more highly paid specialties, but the remuneration will not compare to theirs. You may make a difference in the life of the next Mozart or Einstein!

Thompson: Be prepared for hard work, long hours and a fair amount of worrying; this is the necessary price we pay for a life of fulfillment and enjoyment seeing kids grow and develop. Always listen to parents as carefully and empathetically as you can, bearing in mind that children sometimes hold the truth more so than their parents. Learning how to talk directly to children at a very young age is also important in order to provide optimal care. Read as much as time allows.

What are the biggest changes you have seen occur in your career affecting pediatric care and the health of children?

Tobin: Unquestionably, the continued development newer and more effective vaccines. Also, the Electronic Medical Record. There is now a premium placed on uniformity instead of molding the content of a visit to meet the needs of the child and family. Accompanying this is more and more requirement for measurable tasks with undocumented benefits.

Thompson: New vaccines and the virtual elimination of vaccine-preventable diseases; the disappearance of Reyes syndrome after the link with aspirin was shown; improvements in imaging techniques; advances in neonatal and pediatric intensive care; introduction of surfactant to prevent hyaline membrane disease; the explosion in medical genetics; and the increase in the proportion of women in medicine.

What are the biggest obstacles/challenges you foresee for pediatric care and children’s health in the future?

Tobin: Money. In this country we give lip service to the idea that children are important, but do not act on that principle. Witness the disparity between health care dollars spent on the end of life (much of it futile) and on the first years of life. Whether we speak of immunizations, nutrition, education, or drug development, children in the U.S. get short shrift.

Furthermore, private insurers have little incentive to provide more support, as they almost certainly will not be paying for the consequences of, say, obesity, for an individual child as an obese adult in the decades to come.

Thompson: Children’s mental health services need to improve; incentives for more people to train in child psychiatry and behavioral pediatrics and more collaborative efforts with schools, including preschools and day care centers, might help in this effort.

Racial disparities in health care access also need to be addressed. The quality of social services and the educational system are huge factors in determining children’s health. We as pediatricians need to partner with other professionals and not assume that we can solve all the problems facing children and families on our own.

What are highlights of your pediatric career? Your legacy?

Tobin: Time after time, the highlight of the week is my Continuity Clinic with University of Minnesota Pediatric residents. They have taught me far more than I have them! The fact that these residents and others have told me that they have learned the value of truly listening to what the parents have to say would unquestionably be my legacy.

Thompson: For 20 years I was the primary care doctor for NICU graduates at HCMC, often following them into their teenage years. I attended many funerals during those years and witnessed much sadness as well as some triumphs. During the past 27 years I have also worked with child abuse cases and have seen the development of this field culminating in the approval of child abuse pediatrics as a subspecialty by the ABP in 2009. Educating young pediatricians in Continuity Clinic has also been a great joy and has led to many long-term friendships for which I feel very privileged.

Pediatric Residency Programs Collaborate to Improve Physical Activity Policies in Early Childhood

By Leslie King-Schultz, MD, MPH, chief resident, Mayo Clinic Pediatric Residency program

More than three-quarters of Minnesota children age 0-5 are enrolled in childcare centers. As with the rest of the population, this demographic is also experiencing a rise in the rate of obesity. In fact, among low-income preschoolers, 30 percent are considered overweight or obese. As concerned pediatricians-in-training, the University of Minnesota and the Mayo Pediatric Residency programs teamed up to improve physical activity in daycare centers in Minneapolis and Rochester through the Move2Grow project, funded by a Healthy Active Living grant from the American Academy of Pediatrics. Most pediatric residents have limited knowledge of childcare environments and the challenges that childcare providers face in offering high quality care, including adequate physical activity opportunities. This project afforded residents the chance to become familiar with childcare centers in the context of promoting child health. Using pediatric obesity as a platform for community engagement, the project aimed to develop residents’ skills in advocacy, inspire interest in life-long activism, and impact child health on a community level.

Through the Move2Grow project, leadership teams of residents and faculty from each program in partnership with the Minnesota Chapter of the AAP identified childcare centers in each community interested in improving physical activity within the center. The University of Minnesota chose four distinct centers in different regions of the city. The Mayo residency partnered with the largest Head Start center in Rochester. Teams of residents visited the centers periodically throughout the academic year, serving as coaches for the teachers in the classroom to achieve the goals they set at the start of the year. At Mayo, residents also visited the centers to observe and participate in a typical day. At each site, the residents helped lead a parent night to share the messages about healthy lifestyles including adequate physical activity with parents. Additionally, the residents helped craft new physical activity policy statements for the centers to incorporate into their existing policies.

In total, 51 residents from both programs participated in the project. In comparing pre and post-survey responses, residents reported increased confidence in counseling families regarding physical activity guidelines. They also demonstrated increased self-efficacy with regards to community engagement and policy activities with more residents feeling prepared to work at the community level to impact child health. In addition, more residents reported interest in public health, health policy, and community advocacy after participating in the project. Overall the centers really enjoyed having residents in the classrooms. The residents were most helpful in sharing resources with the teachers to help parents improve activity levels at home. The teachers felt the parent nights were very helpful, with fun shared by all.

Pediatricians have a responsibility to promote child health not only at an individual level, but also at a community level. The Move2Grow project gave pediatric residents in Minnesota a better understanding of the childcare setting and its important role in supporting child well-being. The project began relationships between residents and childcare centers which will continue to grow with new projects in coming years. At the same time, residents gained important skills to become stronger and more confident child advocates through community engagement in their future careers.

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