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MNAAP Newsletter

Inclusive and Equitable Care for LGBTQ Patients

By Angela Kade Goepferd, MD, FAAP, Director of Medical Education, Children’s Hospitals and Clinics of Minnesota and Rhamy N. Magid, MD

As pediatricians, we are dedicated to the health of all children. Increasingly, this means addressing matters of sexual health, including sexual orientation and gender identity. Issues surrounding the rights of the lesbian, gay, bisexual, transgender and questioning (LGBTQ) community have finally come to the forefront of public discourse in our country, presenting us with the opportunity to highlight the health needs of our LGBTQ patients.

As noted by the AAP Committee on Adolescence, “Being a member of this group of teenagers is not, in itself, a risk behavior…however, the presence of stigma from homophobia and heterosexism often leads to psychological distress, which may be accompanied by an increase in risk behaviors.” LGBTQ youth are at significantly higher risk than their peers for a number of health problems, including depression, suicidality, substance abuse, anxiety, eating disorders, homelessness, bullying, physical assault, survival sex, and sexual abuse. They are also significantly less likely to feel supported and understood by their parents, teachers and health care providers.

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Expanding Help Me Grow in Minnesota

By Elsa Keeler, MD, MPH

When a child age birth to five is at risk for or identified with developmental delays, referral for education evaluation through Minnesota’s current Help Me Grow connects the family to evaluation and possible early intervention/special education services. This robust system has positive developmental resources and assures early intervention for positive developmental outcomes (see sidebar).

Yet, we know that not all children at risk are referred, and even if referral takes place, many may not qualify for education-based early intervention services. We understand the need to refer a child with a medical diagnosis to early intervention. However, we also know that social determinants and toxic stress contribute to mental and physical health and developmental outcomes. That is, even a healthy appearing baby may be on an at-risk developmental trajectory when his family encounters environment stress, parent mental health concerns, trauma, poverty, or lack of social supports. For pediatric clinicians, knowing what referral resources are available to offer families can be challenging, given factors such as family culture, preference, and community.

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Screening Tool for Low-Income Families: Bridge to Benefits

By Rachel Tellez, MD, pediatrician at HCMC

Rachel Tellez 2-1Nearly 15 percent of Minnesota’s children live in poverty, with children of color being disproportionately affected: nearly half of African-American children, one-third of American Indian children, one-third of Hispanic children, and one-fifth of Asian children live in poverty. Living in poverty can result in poorer health outcomes for children, including negative effects on physical health, nutritional status, socioemotional development, language development and educational outcomes. Additionally, more than one-third of Minnesota children (419,000) live in low-income households that struggle to provide basic needs and opportunities resulting in similar long-term outcomes, according to Kids Count.

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Open Your Eyes: MDH Releases New Vision Screening Guidelines

MikeSeversonBy Michael Severson, MD, FAAP; Susan Schloff, MD, FAAP; Faith Kidder, APRN, CPNP, MS, PHN, Minnesota Department of Health

The Minnesota Department of Health (MDH) recently updated its vision screening guidelines and best practices in a succinct, easy-to-access document for providers who do not have the time nor the need to scan a procedure manual.

Developed by a cross section of screening entities and professional organizations, including Dr. Mike Severson representing the Minnesota Chapter of the American Academy of Pediatrics, the document provides at-a-glance information about recommended vision screening procedures for children post newborn through age 20.

In Minnesota, the number of kids who receive vision screening is above the national average. Still, many kids pass when they need further testing. The new guidelines direct practices, schools and early childhood programs to use correct methods to ensure accurate, reliable results.

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Telemed for Newborn Resuscitations: Finding the Right Technology

By Jennifer L. Fang, MD, FAAP1; Beth L. Kreofsky, MBA2; Matt Bushman, BS1; Lisa A. Stubert, PMP2; Hussain Mohammed3; Kathleen D. Stuart3; Joan K. Broers, MS, RN2; Robert V. Johnson, MD, FAAP1; Christopher E. Colby, MD, FAAP1

JenniferFangMinnesota’s current regionalized perinatal care system is designed to ensure that high-risk deliveries occur in tertiary care centers in order to optimize neonatal outcomes. However, an expectant mother’s access to these advanced-level services may be limited due to various factors including geography, transportation, or unanticipated need. When high-risk deliveries occur in community hospitals, the local providers may have limited expertise and resources to optimally respond to these newborn emergencies.

To address this issue, Mayo Clinic’s Division of Neonatal Medicine and Center for Connected Care have implemented telemedicine for high-risk neonatal resuscitations in six community-based health system sites over the last 24 months. This includes hospitals located in Blue Earth, Freeborn, Goodhue, Martin, Mower and Olmsted counties. To date, this video telemedicine service has been activated 70 times for a variety of cases, such as resuscitation of the extremely preterm infant, management of meconium aspiration syndrome, and identification of congenital anomalies.

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