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October 24, 2022
Sheldon Berkowitz, MD, FAAP; Past MNAAP President and Current MAPF President

The Minnesota Chapter of the American Academy of Pediatrics (MNAAP), together with Gillette Children’s Specialty Healthcare, the Chloe Barnes Advisory Council on Rare Diseases and the Minnesota Department of Health, hosted a roundtable event to discuss barriers and potential solutions in transitioning medically complex pediatric patients to adult care. 

Close to 500 people from across the country and even other countries registered to be in the virtual audience for the event and close to 250 persons eventually “attended.” They were joined by six expert panelists and two moderators. The panelists included: Dr. Wendy Allen-Rhoades (Mayo Clinic); Dr. Nate Chomilo (Park Nicollet and the State of Minnesota Medicaid and MinnesotaCare Programs); Dr. Kurt Elting-Ballard (Allina Health); Pat Lang (PACER Center); Dr. Nancy Mendelsohn (Optum Frontiers Therapies at United Health Group); and Dr. Dave Tilstra (CentraCare Healthcare). The roundtable was moderated by Dr. Tori Bahr (Gillette ) and Dr. Sheldon Berkowitz (Children’s Minnesota and MNAAP). 

Prior to the afternoon event, a number of documents were sent to all the panelists and registrants, including “givens” that we could all agree were issues with transitioning these patients and that we didn’t need to dwell on (e.g. lack of enough adult clinicians willing to take these patients on to their practices), a set of questions for the panelists to think about, a document about health care transition in general and an article on transitioning these complex patients. The event then began with each panelist speaking to the prepared questions sent out to them dealing with barriers to transitioning these complex patients, followed by a panel discussion. There was then a one-hour audience Q&A with the panelists and the afternoon ended with the panelists sharing their major takeaways from the entire session.

Among the concluding statements made by the panelists were figuring out how to use technology to help with transitions (e.g. medical record transfers), partnering with other organizations to do transition well, making the right decision the easy decision, learning from other organizations and states that have had successes with transitioning, creating a robust clinician registry for clinicians willing to care for these patients and figuring out to include education on this topic with ongoing graduate medical education. 

Next steps will include making an audio recording of the event available to the public, developing a summary document of the event, convening the panelists again to discuss their reflections on the event and possible future direction for our attention and putting together a list of resources on this topic: currently posted at bit.ly/ComplexCareResources. If you want to learn more, please contact me at sberkowitz1@gmail.com

A subgroup of the chapter’s Anti-Racism & Disparities work group has successfully launched their first project: a partnership with Reach Out and Read Minnesota to train clinicians to work with parents on how to raise race-conscious children.

The program, currently in the pilot phase at several clinics throughout Minnesota, was the result of the group’s goal to work with existing community organizations to reach parents and families with anti-racism education efforts.

The program includes a training module for clinicians and two specially selected books depicting diverse children and families. The books are given out as part of the Reach Out and Read portion of the 6-month and 3-4 year visits. Clinicians have a brief discussion with families about raising race-conscious children, and provide a bookmark to help facilitate discussions at home.

Chad Fahning, MNAAP Lobbyist

As the leaves turn and we wave goodbye to summer, we also bid adieu to the likelihood of a special session in Minnesota. Labor Day typically marks the time when legislators are fully out of legislating mode and fully emersed in their door-knocking, fundraising, and other campaign events.

With that, the record-setting $9.3 billion budget surplus will likely sit idle until the 93rd Minnesota Legislature gavels in on Jan. 3. The 93rd legislature will look much different than the 92nd. With redistricting this past spring – an event that occurs following the census to reflect population shifts – many legislators retired after finding themselves in a politically unfriendly district or being paired in the same district with another member. Estimates expect over one-third of the Minnesota Legislature not to return again in 2023. With that comes immense loss of legislative and policy expertise, but also great opportunity and hope for movement on important issues in the future.

Very few of MNAAP’s legislative policy priorities passed this past session. In fact, very few bills were passed entirely. MNAAP was happy to see a bipartisan mental health package pass into law, dedicating nearly $100 million to mental health needs, including school and child mental health grants. However, the relative inaction on many major policy priorities was frustrating to many.

Looking ahead to the upcoming legislative session, the state constitution requires a state budget be finalized before the new fiscal year in July. Since the legislature will need to pass a state budget, the prospect of expanded state funding for early childhood initiatives will certainly be on the table. The future of other major MNAAP priority items, such as commonsense firearm reform, legislation to increase childhood vaccination rates, and reproductive healthcare policy, will largely depend on the outcome of the upcoming election.

On Tuesday, Nov. 8, Minnesotans will elect an entirely new government in the state. That is, all 201 state legislators and the five constitutional officers (governor, lieutenant governor, attorney general, secretary of state, and state auditor) will be up for election. 

Early voting in Minnesota goes through Monday, Nov. 7, including for those interested in voting-by-mail. More information can be found on the secretary of state’s website at www.sos.state.mn.us/elections-voting/.

Fall is upon us and that means we have just wrapped up the best time of the year. Summer in Minnesota is my favorite season and July 4th is always a highlight. I was thinking about how much I enjoy fireworks and thinking about how they are so representative of what we do in pediatrics. 

Fireworks often originate on some mysterious barge out on a darkened lake, streaking upward to explode into a dazzling display of twinkling lights. Sometimes they even form shapes or smiley faces. Who could imagine something could undergo such an amazing transformation? Pediatricians can.

Pediatricians handle special cargo all the time. Some of our “packages” can go off without warning, melting down into a full-blown tantrum right before our eyes. Pediatricians know we need to do our work with special care. 

Every child exam begins not with the “business at hand” but rather an attempt to establish some commonality. Either commiserating with the exhausted parents of a newborn to talking about the latest animated phenomenon (Bluey, anyone?), pediatricians strive to make a connection with our patients and their families. We know it is important to not just be able to get through the current visit but to establish goodwill for the next encounter.

Pediatrics is the long game. Each visit builds on the relationship between child and pediatrician so that from time-to-time, a previously sickly toddler or a child who has survived cancer treatment comes in for a camp physical or pre-college form completion and you think to yourself, “that is amazing.” Because like a good firework display, it is. 

Eileen Crespo, MD, FAAP, began her two-year term as MNAAP president in July 2022. Dr. Crespo practices at Hennepin Healthcare and is the vice president of medical services at Delta Dental. 

October 6, 2022

Oct. 6, 2022 (St. Paul, MN) – The rising case count of measles in the Twin Cities is serving as another painful reminder that vaccine-preventable diseases can spread quickly through unvaccinated populations, particularly among the young and medically fragile.

Minnesota has already experienced a measles outbreak. In 2017, almost all of the 75 people infected with measles were unvaccinated children under the age of 10. The outbreak led to costly medical interventions and a significant investment of public health resources to fight the disease and contain its spread.

“We don’t want to see history repeating itself at the expense of Minnesota’s children. Measles is more than just an uncomfortable rash,” said Dr. Eileen Crespo, president of the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). According to the Centers for Disease Control and Prevention (CDC), measles is highly contagious, painful, and potentially life-threatening. For some children, measles can lead to pneumonia, lifelong brain damage, deafness, and death. The CDC reports that one dose of the measles, mumps, rubella (MMR) vaccine is 93 percent effective against measles and two doses of the MMR vaccine are 97 percent effective against measles.

In Minnesota, under-vaccination is not isolated to a single location, region or community. Several Minnesota communities and schools have high rates of unvaccinated children, putting them at high risk for outbreaks of vaccine-preventable diseases. Childhood immunization rates continue to slip and have not yet regained the coverage rates of pre-pandemic years. According to the Minnesota Department of Health, the percentage of two-year-olds who were not up-to-date on immunizations increased from 20 percent to 30 percent from 2019 to 2021.

Vaccinations have long been one of the safest and most effective prevention against the spread of infectious diseases such as measles, meningitis, or polio. Vaccines are the primary reason for decreased rates of those diseases. Childhood vaccinations are critical to the health and future wellbeing of our youngest Minnesotans and will continue to be a top priority for the state’s pediatrician community.

MNAAP, on behalf of over 1,000 of its members, asks Minnesota’s families and caregivers to help prevent the spread of measles in our state with up-to-date immunization coverage for their infants, children and teens.  

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