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March 7, 2019

A bill to promote the benefits of immunization will be heard in the House Health and Human Services Policy Committee on Friday, March 8.

Please take 1 minute to contact your House member and urge them to support this effort to increase immunization rates. Our voice needs to be louder than those contacting legislators with anti-vaccine rhetoric.

In short, HF 1182 would provide funding to the Minnesota Department of Health and community-based organizations to promote the benefits of immunization for those communities most at risk. The education efforts would be focused upon geographic areas or populations experiencing or at risk of experiencing an outbreak of a vaccine-preventable disease.

Talking points:
  • Vaccines prevent serious illness and save lives. Yet misinformation about vaccines is all too common, leading many parents to opt out of vaccines and put children and others at risk.
  • States with more permissive vaccination laws, such as Minnesota, are at increased risk for outbreaks of vaccine-preventable disease.
  • Data from the Minnesota Department of Health shows that several communities and schools have high rates of non-medical exemptions. In Wadena County, for example, 13 percent of Kindergartners are entering school without required vaccinations.
  • Targeted education is needed to counter myths and falsehoods about vaccination, especially in communities with high rates of non-medical exemptions.

Please take 1 minute to contact your House member and urge him or her to support HF 1182. 

1. Enter your home address to find your MN House member: https://www.gis.leg.mn/iMaps/districts/

2. Send him or her a brief email using the language above. Feel free to personalize or modify. Copy debilzan@mnaap.org so we can track outreach.

Another option is a quick call saying, “I’m a constituent in your district and pediatrician calling to convey my support for HF 1182, a bill to help provide education to communities with low vaccination rates.”

 

 

March 11, 2019

MNAAP President-elect Sheldon Berkowitz, MD, FAAP, spoke at a House hearing on March 8 in support of a bill to fund education efforts about the health benefits of immunizations in communities with low rates of vaccination. The bill would target such efforts at both geographic areas with lower immunization rates, as well as for racial and ethnic communities with lower rates. The bill cleared the House HHS Policy Committee and was referred to the HHS Finance Committee.

Tobacco and nicotine control efforts at the Capitol took important steps in recent weeks. The most prominent effort – bipartisan legislation to raise the age at which individuals can purchase products containing tobacco and nicotine from 18 to 21 years of age – cleared its second committee stop in the House and its first in the Senate in recent weeks. Bills to extend the state’s clean indoor air protections to many other public spaces and provide state funding for tobacco and nicotine cessation services also advanced.

This is a summary only. To receive full legislative updates on a biweekly basis, you must be a member of MNAAP. The emails provide additional details about legislative issues that are not posted on our website and are for members only.

February 27, 2019

By Vijay Chawla, MD, FAAP; and Sylvia Sekhon, MD, FAAP

Immunization outreach group

Immunization presentation panel at Dar Al-Hijrah Mosque in Minneapolis (left to right) Wali Dirie, Imam Sheikh Abdirahman Sharif, Michelle Dittrich (MDH), Dr. Nasreen Quadri, Sabah Yusuf (interpreter), Dr. Beth Thielen, Roble Aden (foreign trained Somali physician)

The Minnesota Department of Health (MDH) identified that children of Somali descent who were 24 months of age had an MMR vaccination rate of nearly half that of their non-Somali peers: 46 percent compared to the rate among non-Somali children, which was 88 percent. During the 2017 Minnesota measles outbreak, 65 cases of measles were identified with the majority in unvaccinated persons.  U.S.- born Somali children over age 12 months accounted for 55 of the cases.

Since 2017, 37 pediatricians, med-peds physicians and pediatric residents have volunteered to provide immunization education at mosques in Minnesota and answer immunization questions of parents and elders. The outreach is part of the effort by the MNAAP Immunization Taskforce, which is committed to increasing infant, child, and teen immunization rates and decreasing barriers to vaccination.

Improving the Minnesota pediatric immunization rates is one of the four strategic priorities of the MNAAP Board for 2017-2020. New immunization outreach/education sessions at mosques started in January 2019 and are scheduled to continue through June. The hope is that by taking information to the Somali communities throughout Minnesota and by having a dialogue with parents, elders, and religious leaders in the place where they meet weekly, we might be able to change a few minds and protect all our Minnesota children.

Somali resources and tips that are used at these education sessions and are available to clinics include:

• Somali/English version of the childhood immunization schedule from MDH. Order online, at www.health.state.mn.us and searching “immunization order form”.

• Somali/English child development wheel from the Minnesota Department of Education is available free to anyone in the seven-county metro area (and MNAAP has copies to share for greater Minnesota in English, Somali, Hmong, Spanish and Karen). One side of the wheel explains what a parent can do to further child development and the other side lists what skills a child should have starting at age 3 months to age 5 years. Contact Kathy McKay at kathy.mckay@metroecsu.org and complete an order form.

While most of our mosque outreach presentations have been in a formal format with speakers sitting behind a table in front of the room, a recent group of women requested that we return to attend a women’s group at the mosque to share food and conversation and all sit together. This is a positive sign that the information is reaching those who need it.

By Mat Edick, Ph.D.; Amy Gaviglio, MS, LCGC; Chuck Oberg, MD, MPH, FAAP; and Sue Berry, MD, FAAP

Newborn screening (NBS) is a baby’s first medical screen, but not all parents receive the screening results or understand their impact.  Primary care providers are often the only way parents receive their child’s newborn screening results; however, a recent survey of Minnesota families found that less than half of parent or guardians recall receiving NBS results from their primary care clinic.  No news is not good news, it is a missed opportunity to verify screening was completed and share important information with families.

With funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, the Midwest Genetics Network and MNAAP offered a free Maintenance of Certification Part 4 (MOC4) and training to pediatricians in Midwest states.  The MOC4 was designed to improve communications between providers, clinics, and parents around newborn screening results and referrals.  Nearly 60 Minnesota pediatricians participated in this MOC4 project along with 30 additional pediatricians from Wisconsin, North Dakota, South Dakota, Iowa, Michigan, Illinois, and Kentucky. Using a “virtual learning collaborative,” participants received training on three topics:

  • Newborn Screening: An introduction (with Amy Gaviglio, MS, LCGC)
  • Newborn Screening: Normal Results (with Susan A. Berry, MD and Whitney Thompson, MPHIL)
  • A Guide: Positive and Borderline Newborn Screen Results (with Miriam J. Behar, MD)

With two-thirds of the participating clinics completing their three audits by mid-December, the baseline rates of communication with parents about newborn screening results were only 30 percent in the participating clinics. Pediatricians implemented a variety of quality improvement projects to improve NBS results communications with parents including using the patient portal to communicate results to parents, new EHR tools/template changes to document NBS results communication with families, training staff at clinic to address misconceptions on NBS tests and need for results, new patient education materials and training on this topic for all new physicians and clinic staff

After two quality improvement initiatives at participating clinics, communication rates rose to over 60 percent. This was an encouraging result, however, there is still room for improvement. Participants who completed this MOC 4 have been offered additional MOC4 credits to complete additional rounds of quality improvement, and Midwest Genetics Network will be enrolling a new cohort of pediatricians to participate in this free MOC4 early in 2019.    

Additional free MOC4 opportunities in 2019 will be shared through upcoming MNAAP all member emails.

By Sarah J. Atunah-Jay, MD, MPH, Assistant Professor, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic; Darlene Fry, EdD, Executive Director, Irreducible Grade Foundation

Group: In the beginning my heart . . .

Irreducible Grace Foundation (IGF): Felt like it was in right place, but my mind led with skepticism and doubt.

Law Enforcement (LE): I was optimistic and uncertain. I knew we (law enforcement) needed this interaction with IGF. I thought that we were not going to be given a fair shake to explain why we do what we do. I was wrong.

IGF: Are these people here because they want to or have they been assigned a community service project?

LE: My heart is full and dedicated to this work.

IGF: Are they comfortable?

LE: My heart is soft and I have made myself and my life vulnerable.

IGF: Afraid?

LE: Which is what was needed.

IGF: Anxious, Excited, Interested?

LE: Breaking down barriers and obstacles one event at a time.

IGF: Or do they feel nothing at all?

These words are the reflections of young adult leaders of the Saint Paul-based Irreducible Grace Foundation (IGF) and Twin Cities law enforcement officers during collaborative work to develop a customized trauma-informed, youth-focused mental health first aid program. Supported by the American Academy of Pediatrics Community Access to Child Health (CATCH) program, the polarized groups engaged in structured perspective taking while learning about youth mental health and partnering to plan steps forward.

Workshop participants talking

An IGF workshop participant speaks with a law enforcement officer during a session.

 Since 2013, IGF has worked with Twin Cities youth, particularly youth of color and youth who are aging out of foster care or state guardianship, to become highly successful adults. IGF uses theater methods to engage youth to share experiences to promote personal growth and healing, and to positively impact their communities and public policy. In 2016, IGF began working in the area of mindfulness, including healing from trauma. During the same time, with the assistance of a Ramsey County Sheriff’s deputy, IGF leaders developed Handcuffs to Handshakes (H2H), a workshop aimed at providing a structured environment for youth and law enforcement to pursue perspective taking around antagonistic and dangerous community interactions. Aimed at reducing fear on both sides of the gun, H2H presented a timely opportunity for Saint Paul youth and law enforcement to meet to discuss community policing in the wake of Philando Castile’s death in June of 2016.

In 2017, informed by H2H, IGF partnered with the Saint Paul Police Department and Ramsey County Sheriff’s Office to pursue a collaborative effort around trauma-informed, youth-focused mental health community response. As first-line responders, law enforcement often encounters youth experiencing a mental health crisis and are tasked with providing a constructive response that maintains the safety of all involved. Yet, poor relationships between youth and law enforcement can escalate encounters and perpetuate fear and mistrust between the two groups. Titled IGF Mental Health First Aid (MHFA), the initiative provided an opportunity for structured and sustained contact between Saint Paul youth and law enforcement communities.

Over the course of four months, a planning team of IGF leaders and law enforcement participated in seven interactive sessions focused on perspective taking through storytelling and journaling. Two sessions were dedicated to the group collaboratively participating in the 8-hour USA Youth MHFA training which introduced common mental health challenges for youth, reviewed typical adolescent development, and engaged the group in a five-step action plan to help young people in both crisis and non-crisis situations.

A variety of outcomes resulted from the collaboration. At the end of the process IGF hosted Respect-Fest, which included a group presentation and a cookout.  Subsequent efforts influenced by IGF MHFA include Attack the Stigma, a workshop developed by an IGF leader to address the stigma of mental illness; a five-workshop series called Healing From Trauma offered by IGF; and several grant applications.

The collaborative work between IGF and law enforcement left each group with a greater understanding of the other. Planning process success was promoted by IGF leader mindfulness training, additional separate meetings for IGF leaders, buy-in from law enforcement administration, and sustained interaction between participants. IGF continues to work with law enforcement in order that “safe spaces” extend beyond the four walls of program space into the community in which IGF youth spend most of their hours.

“Something shifted or changed in me when I first told my story of becoming a police officer. I never tied my emotions to why I was drawn to the profession. Speaking it aloud made it possible to mold my path in the profession to why I wanted to protect people so long ago. Taking a different path in an effort to heal and protect is my personal goal as a law enforcement officer. If I can make positive connections throughout my career, hopefully the positive relationships will transfer to the profession and the community as a whole.” (Law enforcement participant)

“Something shifted or changed in me when the officers we were meeting with drove up (in the neighborhood) just to say, “Hi.” In that moment, I realized that I had to look at more than just the uniform but also the individual wearing the uniform. But it took me getting to know the officers for me to see that they are not the enemy or opposition and they are in it for the right reasons and they continue to do this work to make a difference.” (IGF participant)

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