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March 10, 2021

Janna Gewirtz O’Brien, MD, FAAP

Abbe Penziner-Bokde, MD, FAAP

Since the early 1970s, and among the first in the nation, school-based health centers in Minnesota have been embedded within schools as a way to meet the healthcare needs of school-aged children who may otherwise be underserved by traditional models of office-based healthcare.  They have been, and continue to be, a literal and figurative home team, a whole-health advantage for thousands of Minnesota students each year, and are uniquely positioned to intentionally disrupt known systemic inequities in both the health and educational realms.

In short, a school-based or school-linked healthcare center is a federally recognized, evidence-based safety net model of healthcare that by design integrates primary care and mental healthcare into a “one-stop” hub located where children and youth spend the majority of their waking hours: in school. No one is turned away for inability to pay, and fees are not transferred to students or their families.

 

 

The Minnesota School-Based Health Alliance (MNSBHA) is the collective voice of school-based health centers across the state. Here in Minnesota, they are present in 25 distinct locations, with seven sponsoring organizations and growing.

Locations:

Sponsoring organizations:

9 in Minneapolis high schools 

Minneapolis Health Department

9 in St. Paul high schools, with one middle school/HS program and 1 parenting teen and infant/child program Northpoint Health and Wellness
6 suburban programs in Brooklyn Center, St. Louis Park, Richfield, Burnsville, Bloomington and White Bear Lake Minnesota Community Care

1 in Rochester Alternative Learning Center

Park Nicollet Foundation
Minnesota State University, Mankato
Mayo Clinic
St. Catherine University

Below, the MNSBHA shares how school-based health centers have innovated and adapted to reach and support students during the pandemic and the recent social upheaval in the wake of George Floyd’s murder. 

Expanding Outreach

“When the COVID-19 pandemic hit, in addition to rolling out telehealth for medical, mental health, nutrition and health education visits, we also knew that we needed to meet students where they were physically,” said Shawna Hedlund, president of the MNSBHA. Barbara Kyle, manager of Minneapolis Health Department’s school-based program shares, “We developed protocols to keep our students and staff safe, while still maintaining face-to-face connections when needed. To overcome transportation barriers, when students called Minneapolis clinics needing time-sensitive medicines (e.g. emergency contraception, SSRI refills and asthma inhalers), clinicians would do a brief telehealth visit and then bring it to them at home or in their communities. We even met students at fast food restaurants, if that was most convenient for them.”

Partnering with Schools

Building on our long-standing relationships with school partners, we coordinated events, like STI Testing Days, in parallel with times when students were most likely to be present (e.g. food and textbook pick-ups and sports practices).  We have also added information to school and district-wide print, digital communications and social media to update students and families about available services despite school closures. 

Keeping Kids Vaccinated

At a time when vaccination rates are falling nationwide, Minnesota school-based health centers have been offering vaccination clinics and doing vaccine catch-up in clinics and classrooms. A new school-based clinic in White Bear Lake, sponsored by St. Catherine University, hosted a large influenza vaccination clinic this past fall.  

Supporting Families

We also recognized that many of our families were struggling, and continued our work to help them maintain health insurance coverage and to access basic resources like food and housing.  Health Commons at Pond in Bloomington Schools screen students for social determinants of health at each visit and have partnered with Hunger Solutions to address food insecurity.

MNSBHA is working with stakeholders such as the Minnesota  Department of Health, the Minnesota Department of Education and the Department of Human Services, as well as school districts, health care providers and public policymakers to strategize on strengthening and expanding this equity model for children in Minnesota. Learn more about school-based health centers and advancing school health in your community at www.sbhc4mn.org/.

About the Authors

Janna Gewirtz O’Brien, MD, FAAP, is an adolescent medicine fellow at the University of Minnesota Department of Pediatrics. Abbe Penziner-Bokde, MD, FAAP, is a pediatrician with Allina Health and Minnesota Community Care. 

Eileen Crespo, MD, FAAP

Katie Sadak, MD, FAAP

 At the MNAAP Board of Directors July 2020 meeting, the group discussed the importance of recognizing our own racism and working to become actively anti-racist. MNAAP condemns racism, discrimination and oppression in all forms. We affirm that racism and oppression are public health crises with serious physical and mental health consequences for our communities.

Soon thereafter in September, the chapter’s anti-racism task force was formed with 20 members from health systems and private practices all over Minnesota. The task force was guided by the following principles:

Amplify the voices of those most directly affected by racism and injustice; racism and oppression are not their responsibility to solve. The responsibility to dismantle racism falls on white people.

Ensure a just, equitable and inclusive educational, clinical, research and advocacy environment for pediatricians in Minnesota.

Take all needed steps to identify and dismantle unjust and inequitable systems, as individuals and collectively. This includes systems of white supremacy and other forms of oppression and discrimination within our organization, pediatric practices and hospital systems in Minnesota.

Over the course of monthly meetings, the members who volunteered their time and insights broke into  three sub-groups:

Clinical Practice: to provide recommendations to address racism among our pediatric practice as well as with clinical and office staff.

Workforce: to provide recommendations to promote anti-racism among pediatric training programs, medical schools and recommendations that promote diversity in the workforce.

Advocacy: to promote anti-racism at the state and community level.

The anti-racism task force will work directly with chapter leadership to ensure all decisions regarding policies, finances, legislative priorities, leadership positions and other chapter functions are made while applying a racial equity lens. The anti-racism task force also identified the need to conduct an internal review of the chapter: our membership and our bylaws/meeting minutes/grant proposals, as well as our suppliers with an equity and anti-racist lens. 

The task force is set to discuss and propose initial, measurable action steps to the Board at a special meeting on Thursday, March 18. Following that meeting, the MNAAP Board will report back which recommendations they can implement through one or more action steps within a given timeframe of six months, one year and 18 months.

Task Force Members:

Bonnie Bentson, MD

Abbe Penziner – Bokde, MD, FAAP  

Carol Carlson, MD, FAAP 

Vijay Chawla, MD, FAAP  

Elena Galindo, MD

Anjali Goel, MD, FAAP 

Lucien Gonzalez, MD, MS, FAAP 

Kimara Gustafson, MD, FAAP

Margie Hogan, MD, FAAP  

Yasmin Khan, MD, FAAP

Sandy Liu, MD 

Robert Mills, MD 

Jennifer Myaeng, DO, FAAP 

Ifelayo Ojo, MBBS, MPH, FAAP 

Liz Placzek, MD, FAAP

Rachel Tellez, MD, MS, FAAP 

Amanda Webb, MD, FAAP 

Chris Williams, MD

About the Authors

Eileen Crespo, MD, FAAP, serves as MNAAP’s President-elect, and co-chaired the Anti-Racism Task Force with Katie Sadak, MD, FAAP.

Dave Renner

The 2021 legislative session started this year on Jan. 5 and is scheduled to meet through the third week in May. Once again, Minnesota holds the distinction of having the only legislature in the country with split control. The House of Representatives remains in DFL control with a 70-64 majority and the Senate remains in Republican control with a 34-31-2 majority. (There are two Independent members who are caucusing with the Republicans). 

Adding to the challenge of working together and passing bills is the fact that both bodies are starting the session by only having virtual hearings. The Capital and House and Senate office buildings are closed to the public. That may change as the session goes on, with the Senate announcing they want to move to hybrid hearings as quickly as possible.

This being the odd-numbered year, the Legislature has one task it must complete. They are required to pass a balanced budget for the next two-year period before they adjourn in May. That will require leaders from both bodies, along with Gov. Tim Walz, reaching a budget agreement.  

The first step of that process happened on Jan. 26 when Gov. Walz released his budget recommendations. His recommendations were based on the November 2020 budget forecast that projected the state to have a $1.3 billion deficit. The governor’s recommendations included a combination of tax increases, program spending cuts, and use of the state’s budget reserve fund.

However, an updated budget forecast reported at the end of February showed an improvement in the budget picture with a $1.6 billion surplus. The Legislature will use these updated budget numbers to develop their recommendations that will be passed in mid-April. The final month of the session will be where the final negotiations happen to reach agreement.

MNAAP has developed legislative priorities designed to advocate on behalf of our patients:

We will be strongly working to preserve access to health care and social services for our state’s children, particularly those who are underserved, and will vigorously oppose cuts to funding or changes in eligibility.  MNAAP supports early education programs that provide early education, nurse home visiting, and other social support services that serve a high proportion of minority and underserved children. 

We will be promoting continued coverage for telehealth services throughout the state, including supporting broadband services across the state. MNAAP supports efforts to ensure that all children and families have access to high-speed internet for telehealth services to support their physical health and mental health, and for education needs. The MNAAP further supports payment parity for services delivered via telehealth to a patient in their home, as well as care delivered by telephone only (when clinically appropriate). 

We must increase our vaccination rates by reducing barriers to immunizations. One of the biggest barriers is the growing use of “personal belief exemptions” by parents who do not want their children vaccinated. 

We will be working to protect children from firearm violence. MNAAP supports commonsense gun laws to protect children – including universal background checks and red flag laws – which are supported the majority of Minnesotans.

This is an aggressive set of priorities that will require pediatricians across the state to engage and advocate with their own legislators. We will be working to make sure every legislator understands how important these issues are to improve the lives of our youngest Minnesotans. We need your help. Join us.

I hope this note finds you at least partially vaccinated against COVID-19 and doing well. I would like to use this Word from the President article to talk to you about four issues: the pandemic, anti-racism, rare diseases and transitions. 

As the pandemic continues to rage and people are starting to get vaccinated (although slower than I would like), there are three aspects of the pandemic I have noticed and want to mention. The first is loneliness. Much has been written about how the isolation that many are feeling is impacting them. I can tell you personally that now that I am working from home and not seeing patients (or my former colleagues), both my wife and I are definitely feeling the isolation. I can also reinforce what we all know, which is the importance of family during this time. Both the nuclear families we live with, but also our families that we don’t live with and may only see on FaceTime or Zoom. The lack of that close contact (and hugs) is huge and can’t be overlooked. I think we are also seeing the isolation play out on the mental health of our adolescents. As I write this, we have 16 adolescent patients in our hospital, either with suicidal ideation/attempt and/or intentional drug ingestions, which is higher than I can ever recall.

At our recent January chapter Board of Directors meeting, we heard from our anti-racism task force co-chairs, Drs. Eileen Crespo and Katie Sadak. They presented that the work group has developed a number of sub-committees working on various issues and will finalize their recommendations to the board in the near future. These recommendations will be reviewed at a special board meeting this month. I also want to make sure that you all are aware of the increasing amount of medical literature looking at common medical tests and mortality rates that have a racist undertone. Two that have caught my attention are “Racial Bias in Pulse Oximetry” in the New England Journal of Medicine (https://www.nejm.org/doi/full/10.1056/NEJMc2029240) and the second was “Physician-patient racial concordance and disparities in birthing mortality for newborns” in the Proceedings of the National Academy of Sciences of the United States of America by Dr. Rachel Hardeman at the University of Minnesota (https://www.pnas.org/content/117/35/21194). Both are worth reading.

I also want to briefly tell you about the Chloe Barnes Council on Rare Disease, of which I am a member. This council was established by the Minnesota Legislature several years ago to bring attention to and improve the care provided to those with a rare disease. A rare disease is defined as a disease with an incidence <1:200,000, of which there are currently 7,000. I am the lead for the work group on the issue of transitions of care and care coordination, and included within this is the topic of transitioning pediatric patients with complex health care needs to adult clinicians. Among the goals our work group hopes to accomplish is the development of a registry of adult clinicians willing to take on these patients. More to come on this subject. 

Finally, and sadly, Eric Dick, our chapter’s lobbyist for the last decade, died in early January. He was a much-loved colleague and a wonderful advocate for our chapter and Minnesota’s children. May his memory always be a blessing. We are fortunate to have Dave Renner, director of advocacy at the Minnesota Medical Association, to fill in for MNAAP’s lobbying needs and to advise us during this legislative session.

Sheldon Berkowitz, MD, FAAP

MNAAP Chapter President

sheldon.berkowitz@mnaap.org

March 7, 2021

More than 120 pediatricians, trainees, and medical students participated in the Virtual Pediatricians’ Day at the Capitol on Thursday, March 4. The event is the chapter’s largest advocacy initiative of the year and offered the opportunity for MNAAP members to learn more about the chapter’s legislative priorities, receive training in effective advocacy, and connect with legislators during breakout sessions.

In addition to hearing from five Minnesota key legislators who spoke to the group about the child health issues being debated at the Capitol this year, a total of 40 individual breakout sessions took place to connect participants with their individual legislators.

Thank you to all who joined us for Pediatricians’ Day at the Capitol this year! If you participated, please be sure to fill out the online evaluation form to help us in future planning efforts.

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