News

View the Summer 2023 Minnesota Pediatrician issue as a PDF :  Summer 2023 Minnesota Pediatrician For Web

Word from the President: Eileen Crespo, MD, FAAP

Busy Legislative Session Comes to a Close

MOC4 Cohort Examines Teen Mental Health Screening Process to Improve Experience

Scholarship Inspires Advocacy and Action for Inaugural Recipients

Member Spotlight: Adam Langenfeld, MD, PhD, FAAP

Children’s Minnesota Opens First-of-its-Kind iMRI Neurosurgery Suite in North America

Dr. Meysam Kebriaei, Children’s Minnesota

In my decade of service as a pediatric neurosurgeon at Children’s Minnesota, I have performed more than 1,400 procedures on fetal patients, children and adolescents with diagnoses such as epilepsy, brain and spine tumors, and traumatic brain injuries. No matter the diagnosis or procedure, I’ve learned several factors remain the same when it comes to delivering consistent positive patient outcomes. Those critical factors are the clinical expertise of a multi-disciplinary team, partnering throughout the continuum of care, and having the technology at our disposal to care for patients.

In March 2023, Children’s Minnesota debuted a gamechanger in intraoperative magnetic resonance imaging (iMRI) technology. That’s when the Richard M. Schulze Family Foundat ion iMRI Surgical Suite – the first facility of its kind in North America – opened at our Minneapolis hospital. If you’re wondering what makes this 2,970 square-foot, three-room neurosurgery suite the only one of its kind on the continent – it’s the first pediatric hybrid iMRI suite equipped with both moving-scanner and moving-patient MRI technology in the same surgical space. Now, Children’s Minnesota’s neurosciences program and radiology department use the facility to perform both brain and total spine scans mid-procedure directly at the point of care.

The iMRI suite’s design allows experts to seamlessly move a 16,200-pound MRI scanner directly from the facility’s diagnostic room into one of the space’s neurosurgery operating rooms via a ceiling-mounted rail system. The floorplan also allows patients in the suite’s second operating room to be moved next door into the diagnostic room for a mid-procedure MRI. Its design also allows procedures to take place in both operating rooms as the scanner is being used in the diagnostic room simultaneously. Simply put, the iMRI suite enhances how my team makes important decisions at the point of care before a patient’s incision is closed. For example, if a mid-procedure scan detects additional tumors, our team can develop a plan in real-time to remove the remaining cancerous tissue. This crucial process will help prevent additional procedures for many of our patients and maximize their chances for a good outcome. The strength of the MRI scanner in the suite, measured in the unit of Tesla (T), is also a significant upgrade. The suite’s 3T MRI scanner, compared to 1.5T or smaller scanners at other medical facilities, makes a major difference in the quality of each scan used to locate and remove remaining cancerous tissue. I often compare the clarity of our new facility’s 3T scanner to watching an ultra-high-definition TV rather than a standard TV.

To date, our team has performed more than a dozen procedures in this state-of-the-art facility. The Richard M. Schulze Family Foundation iMRI Surgical Suite – which shares its namesake with the philanthropic foundation that generously committed a $5.5 million lead gift to the facility – is another arrow in our quiver to provide the best care possible at Children’s Minnesota.

If you would like to refer a patient or connect with a Children’s Minnesota kid expert 24/7, call the Children’s Minnesota Physician Access line at 866-755-2121.

This information was provided by Children’s Minnesota, a MNAAP annual sponsor. 

Engaging in advocacy activities can feel daunting for a medical school student or pediatric resident. From choosing an advocacy topic, to setting up meetings with legislators or collaborative partners, to following the progress of related policies and proposed bills – there is a lot to consider. For two MNAAP members, participating in a newly formed scholarship helped them navigate their advocacy experiences in a way that each says was rewarding and inspiring.

Dr. Wendy Sun

Dr. Sarah Swenson

Dr. Wendy Sun and Dr. Sarah Swenson are the inaugural recipients of the Eric Dick Advocacy Scholarship. The scholarship formed when a MNAAP board member wanted to honor longtime chapter lobbyist, Eric Dick, after his sudden passing in January of 2021. Eric was deeply committed to improving the health and wellbeing of every child in Minnesota and he not only personally fought for policies to achieve this goal, but also engaged so many beyond himself in the legislative process. The Eric Dick Memorial Advocacy Scholarship is awarded annually to one or more fellows, residents, medical students or trainees each year to engage in legislative advocacy projects aimed at improving the health and wellbeing of children in Minnesota – particularly those focused on eliminating health disparities. 

Drs. Sun and Swenson took different approaches to their advocacy projects but found the support from the chapter provided an important foundation to engage in the work as champions for their causes.

Dr. Sun is a pediatric resident who says she has always been interested in advocacy work and was looking for an advocacy mentor when MNAAP Treasurer Janna Gewirtz O’Brien encouraged her to apply for the scholarship. 

“Advocacy is something that has brought me a lot of meaning in my work on top of my clinical work. In our clinic work we aren’t always able to address the higher systems that create disparities for our patients,” said Dr. Sun.

After meeting virtually with MNAAP leadership and receiving an orientation about the legislative process, Dr. Sun was able to zero in on school-based mental health as her area of interest. Chapter lobbyist Chad Fahning played a role in helping connect her with the issue, which was already receiving attention at the Capitol. It was a particularly meaningful topic, she said, because school-based mental health services are a good way to address disparities. It can remove the financial barrier or the challenge of taking time out of a work or school day for an appointment. In her work at Hennepin Healthcare she said she often sees teens who need mental health help, but they have parents with a stigma or a cultural concern about mental health services.

“I see kids hanging on by a thread and the first thing I say is, ‘where do you go to school?’ to see how I can connect them with school-based mental health services,” explained Dr. Sun. 

As part of her advocacy project, Dr. Sun was able to meet with Senator Erin Maye Quade and Representative Robert Bierman. She voiced support for HF564, which allocates 25 percent of new funding to target providers that can serve schools that have high special education or a high rate of families experiencing poverty, especially in rural and urban settings. She also learned how to prepare a testimony and be ready to present if the opportunity arose. 

Dr. Sun says even though the work for her project is complete, she wants to build on the connections she formed with other mental health advocates to address systemic issues. It left her energized to stay involved in advocacy work: “I’ve been asking myself – what’s the next step?” she said.

For Dr. Sarah Swenson, she knows exactly when and where her advocacy interests took root. As a teen, she was a hospital volunteer and saw firsthand the importance of perinatal mental health support for families of babies in the NICU. She witnessed the strain having a baby in the NICU for an extended stay can have on parents, affecting their ability to be present for their child and preserve their own mental health. A stay in the NICU can be a potentially traumatic event for families, she said.

“I saw the scholarship and thought, ‘what an opportunity to receive some mentorship so I can move things from bothering me to addressing them,’ “ she said. Dr. Swenson reached out to MNAAP Policy Co-Chair Hannah Lichtsinn, MD, FAAP. Dr. Lichtsinn helped Dr. Swenson work through her ideas about perinatal mental health to refine a potential solution for the problem she was seeing in the families of her NICU patients. 

Dr. Swenson focused her advocacy scholarship project on initiating policy change that would allow for a Medicaid waiver in which out-of-state-parents who traveled to Minnesota to receive NICU services for their children could be screened for mental health services themselves and receive care while they are in Minnesota. Insurance and financial barriers are often the reason a referred family member does not following through to treatment for their perinatal mental health. 

Such a shift in policy requires a long-term approach, but she says she’s made some good connections so far to help continue the conversation even after this legislative session (and the term of the advocacy scholarship project) are over. “I got connected with the Policy Center for Maternal Mental Health and NAMI. I’m planning to meet and collaborate with Sen. Bonnie Westlin to see if we could do something like a resolution or form a task force to better understand perinatal mental health needs in the state,” explained Dr. Swenson. 

When asked if they would encourage interested residents or medical students to apply for the next round of Eric Dick Advocacy Scholarships, both Drs. Sun and Swenson gave a heartfelt endorsement of the program. 

“I am 100% biased,” laughed Dr. Sun, “but absolutely. Interested people should apply. As trainees, we are digging out of the pandemic hole, and now we are so much more aware of the systemic problems that exist. This is a way to address those issues.”

Dr. Swenson pointed out that the scholarship is a great way to move past any self-imposed barriers. 

“I would tell a scholarship recipient: imposter syndrome can be a barrier to trying to do this type of work and trying to do new things like advocacy. So although there are barriers such as time, or confidence, or knowledge to doing this type of work, I would encourage people to pursue it and not let that get in the way. There are great mentors who can help you. You don’t have to be an expert in policy to try and make meaningful change that affects the health and wellbeing of your patients and families.”

The Eric Dick Memorial Advocacy Scholarship is fully funded for the next round of interested participants. The application link will be shared in an upcoming All Member Email from the chapter. 

Late MNAAP Lobbyist Eric Dick

Consider Giving to the Eric Dick Memorial Scholarship

The Eric Dick Memorial Scholarship was seeded with a generous, 10-year financial commitment from a MNAAP board member who wanted to see Eric’s legacy continued through the members of the MNAAP.

Eric worked tirelessly to advocate on behalf of Minnesota’s children and teens, and was passionate about helping medical students and early career physicians learn the ropes of legislative advocacy.

We invite you to consider contributing to the scholarship fund in order to help many more recipients to benefit from training and support as they launch their own advocacy projects.

To give, you can visit the Foundation’s webpage at mnaap.org/mapf and click the donate button, or mail a check, made payable to the Minnesota Academy of Pediatrics Foundation, to the address below. Please include “Eric Dick Memorial Advocacy Scholarship” in the memo line.

Minnesota Academy of Pediatrics Foundation

c/o Jeff Bauer, Executive Director

1609 County Road 42 W. #305

Burnsville, MN 55306

The first cohort of the Minnesota Pediatric Mental Health Access Program MOC4 project is underway, having gathered via Zoom for its launch meeting in early May. 

The project, which is made possible with grant funding provided by the American Academy of Pediatrics (AAP) and the federal Health Resources and Services Administration (HRSA), aims to improve the mental health screening and referral process for BIPOC and LGBTQ adolescents. 

Integration of mental and behavioral health services into the pediatric primary care setting offers opportunity to increase access to culturally-relevant behavioral and mental health services and decrease barriers to care, especially those faced by children and youth from underserved racial, ethnic, geographic and lesbian, gay, bisexual, and transgender backgrounds. MNAAP is partnering with the Minnesota Department of Health (MDH) to provide the training to enrolled providers and clinics. 

Five clinics are participating in the MOC4 module that runs through August: CentraCare, Essentia Health, St. Luke’s, MHealth Fairview in Blaine, and Allina in Eagan. As part of the project, providers and clinic staff will collect data about current adolescent mental health screening and referral practices. 

Objectives of the MOC4 include: 

Increase provider/clinic rates of mental health or depression screening (using MDH identified screening tools) among patients 12-20 years of age attending Child & Teen Checkups or preventive health visits, particularly in rural or underserved areas of the state.

Increase the rate of documented consultation visits or referrals to mental health professional supports and services for those patients who screen positive for mental health concerns.

Increase the rate of documented completed follow-up by type (primary care based mental health/behavioral health services, community-based mental health/behavioral health services, or other) for those patients who screen positive for mental health concerns.

Document the comments from participating providers/clinicians uncovered in the audits related to gaps, barriers or lost to follow-up concerns

Two webinars will be presented to the group: the first will feature pediatricians with expertise in providing care and facilitating mental health support for BIPOC and LGBTQ patients; the second will be presented by members of a youth advisory council who will offer their own feedback about the mental health process. 

The youth leader component of the project is essential, explained MNAAP Executive Director Jeff Bauer: “The youth voice will be centered in this project. We are seeking improvements to the process for BIPOC and LGBTQ youth and the point is for them to feel safe, seen, and supported.” 

According to Minnesota Community Measurement, half of all lifetime cases of mental illness begin by age 14. Anxiety disorders are the most common mental health condition among young people, particularly BIPOC and LGBTQI+ youth. But many young people are never treated – or not until they’re in crisis. As cohort members introduced themselves during the first meeting, many commented on how excited they were to begin the work of addressing adolescent mental health — saying it was a much needed focus for their patients and families.

Community partners for the project include Lutheran Social Service of Minnesota, Family Partnership, and Rainbow Health. The Psychiatric Assistance Line (PAL) is also participating. Psychiatric Assistance Line (PAL) provides free consultative and referral services for medical providers in Minnesota. Through the PAL program, Minnesota medical providers receive triaged consultation and referrals for patients who experience mental and emotional health issues.  A goal outcome of the project is to enhance the quality and reach of the PAL program. 

Physicians participating in the MOC4 project can receive up to 25 MOC4 credits, and each participating clinic receives $4,000 to support quality improvement-related activities. A second cohort will form in the fall. If you are interested in learning more about participating in the next cohort, email MNAAP Executive Director Jeff Bauer at bauer@mnaap.org. 

Chad Fahning, MNAAP Lobbyist

With the legislature now adjourned until February 2024, many commentators have labeled the 2023 legislative session as “historic.” In hindsight, few groups have a better claim to that word when describing the impact of the policies passed this year than Minnesota’s children and families.

The legislature was busy this session – the busiest many have seen in decades, if ever. DFLers came into the session with an enormous budget surplus, (narrow) control of the Senate, State House, and governor’s office, and a long checklist of progressive priorities. 

At the top of the list were reproductive health items like the Protect Reproductive Options (PRO) Act, Reproductive Freedom Defense Act, and repealing obstructions to abortion services. The legislature did not only pass those, but also banned the barbaric practice of so-called “conversion therapy” and authorized legal protection for those providing and seeking gender-affirming care in Minnesota.

Next on the checklist were significant investments into early childhood. Governor Tim Walz, when unveiling his budget proposals, said he wanted to make the Minnesota the “best state for kids and families.” The 2024-25 state budget reflected that intention and includes $1.2 billion of new funding for early childhood initiatives, $800 million for a comprehensive paid family and medica leave program, $200 million for free school meals, the creation of a new Department of Children, Youth, and Families, a child tax credit increase, and much more.

The legislature was also finally able to push through firearm safety measures. Specifically, these measures include expanded background checks for firearm sales and transfers and extreme risk protection orders, or “red flag” laws, so a family member or law enforcement can petition a court to temporarily remove firearms from someone who has been determined to be a harm to themselves or others.

There is still much work to be done. Pediatricians advocated for stricter firearm storage laws and for the removal of the current statute exempting children from public school immunization requirements based on “conscientiously held beliefs.” These items did not make it across the finish line this year, but that does not mean we should ignore all the great bills that became law this year. 

I do not have the space in this article to list everything that will help kids be safe, healthy, and happy. I want to extend my gratitude to those who engaged in advocacy efforts this session. Pediatricians were at the forefront of the public discussion and will need to continue that going forward. In the meantime, though, we should hold our collective heads high and celebrate this year’s legislative session and the impact it will have on Minnesota’s children and families. I can think of no better word to describe it than “historic.”