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March 4, 2020

On a chilly evening last November, a group of local medical and dental professionals interested in oral health and improved collaboration met for an evening of relaxed networking. We played a fun version of speed-networking (speed-dating style), enjoyed appetizers and beverages. Attendees were so invested in their conversations it was difficult to get people to move on when time was called. The event was funded by the American Academy of Pediatrics and Delta Dental of Minnesota.

The idea grew out of a similar program in Massachusetts created by Dr. Hugh Silk where he arranged informal gatherings of medical and dental professionals to create more collegiality. Dentistry is one of the few specialties where pediatricians don’t pick up the phone to discuss a complicated referral or challenging case.

What I learned was that the pediatric dental community, particularly, and the dental community overall was very interested in an opportunity to get to know their colleagues in primary care. We had an overwhelming response with 16 pediatric dentists attending! Unfortunately, only four pediatric providers attended, though Valeria Cristiani, MD, pediatrician at Mayo Clinic and oral health advocate, won for traveling the farthest.

Many voiced the desire to meet again so plans are underway. We will plan the next event with more emphasis on representation by pediatricians and primary care providers. The evening taught us that we are all passionate in caring for children and want them to grow up healthy.

I hope to see many more of you at our next event. Look for an invite later this spring.

 

About the Author

Eileen Crespo, MD, FAAP, is a pediatrician at Hennepin Healthcare and is the Vice President of Medical Services, Delta Dental of Minnesota.

Dr. Crespo serves on the MNAAP/MAPF Board of Directors as the treasurer.

The Minnesota Positive Behavior Support Network acts as a partner in promoting positive approaches to support children with challenging behaviors and can be a useful resource to pediatricians in their interactions with families.

What is Positive Behavior Support (PBS)?

PBS includes a range of empirically supported practices to teach people new skills, decrease problem behavior, and increase quality of life. This is done by adjusting what we (professionals, caregivers, families, teachers, and others) do and say, and how we arrange systems of support around the person. Positive Behavior Support is widely applied across settings (early childhood, K-12 education, home, community, residential, vocational), lifespan, disability types, and typically developing children with behavioral challenges.

In December 2018, the American Academy of Pediatrics issued updated guidance on effective child discipline, which took a definitive stance against parents spanking their children and instead focusing exclusively on positive means to teach skills and address problematic behavior. This is consistent with AAP’s guidance since the late 1990s, including creating a nurturing home environment based in loving relationships, and rewarding desirable behavior. These features are entirely consistent with Positive Behavior Support.

The Minnesota Positive Behavior Support Network

The MNPBS Network launched in 2016 as a statewide interagency effort to bring together professionals and family members interested in implementing and promoting Positive Behavior Support (PBS) to address challenging behavior and unique learning needs in home, community, educational, and mental health settings for people of all ages. Led by both the Minnesota Departments of Education and Human Services, the Universities of Minnesota and St. Thomas, and in partnership with community services providers and regional implementation projects, the main functions of MNPBS are:

Providing information, resources, and tools for implementing PBS to communities across Minnesota

Building on current and ongoing PBS efforts

Creating mechanisms to share news across agencies, programs, and groups

The primary vehicles for engaging in this work have been our annual conference (the Collaborators Forum, held each spring since 2017), social media and web presence and nurturing an active membership of providers, administrators, and state agency leadership from early childhood and K-12 education, human services, and higher education. In addition, an interactive map will be available through our website in 2020 that will highlight the locations of PBS providers and trainers across the state working in early childhood, educational, home, community, and residential settings.

Partnership with Pediatricians

The leadership of MNPBS offers the Network as a helpful addition to resources that pediatricians can share with families in clinic who present with difficulties in managing challenging behavior. We have developed a brochure for distribution to families through pediatric clinics describing the basic tenets of PBS (please find at https://mnpsp.org/mnpbs/). In it we offer simple suggestions for what parents can start doing now to shift their disciplinary approach toward the positive, and provide guidance to web-based resources and other literature for learning more. We invite connection with parents and providers, and value the opportunity to provide additional information and resources about PBS.

Connect with MNPBS

Web: mnpsp.org/mnpbs

Facebook: @mnpbsnetwork

Twitter: @mnpbs

YouTube: MN Positive Behavior Support Network

Email: mnpbsnetwork@gmail.com

 

About the Author

Tim Moore, PhD, LP, BCBA-D is clinical services manager for Positive Behavior Support at Fraser where his team provides services to improve quality of life for children and families with behavioral and skill acquisition challenges. He is also adjunct faculty in the School of Education at Webster University.

Eric Dick, MNAAP Lobbyist

The 2020 legislative session started with the crack of a gavel midday on Tuesday, Feb. 11. Legislators wasted no time in beginning the work of the session with committees immediately meeting to begin processing bills. With 2020 being a short legislative session, legislators and advocates alike are moving quickly to advance their priorities.

Vaccine proponents opened the session with a rally on Feb. 18 to celebrate the tremendous success of vaccines in preventing disease and death. Patsy Stinchfield, an APRN with expertise in pediatric infectious diseases who practices at Children’s Hospitals and Clinics, acted as emcee for the rally, which featured remarks by health care providers as well as individuals with weakened immune systems wary of the risk of rising rates of non-vaccination. A 12-year-old with Crohn’s Disease, a young cervical cancer survivor, and the parents of a newborn hospitalized with pertussis all spoke to their concern that the return of vaccine-preventable diseases pose serious risks to their and their families’ health.  Rally goers also warmly welcomed remarks by the legislators leading the effort to strengthen our immunization law.  Rep. Mike Freiberg (DFL – Golden Valley) and Sen. Chris Eaton (DFL – Brooklyn Center) thanked the attendees for their advocacy and urged them to keep the pressure on legislators.  All too often, they noted, anti-vaccine advocates have dominated the airwaves, pushing aside the majority of parents who strongly support vaccines.

Vaccines were also the subject of several pieces of legislation recently introduced. The two bills, authored by Sen. Scott Jensen, MD (R – Chaska), are seen by most observers to be designed to weaken Minnesota’s already inadequate laws governing immunizations. One bill would prohibit employers from requiring vaccinations of employees if the employee has a “conscientiously-held belief” against being immunized. The second bill would require the Minnesota Department of Health (MDH) to post on their website a number of studies about vaccine safety. Some of the required studies – including safety trials using placebos – are seen by many as a means to weaken existing law even further. The bills are unlikely to become law.

The coming weeks will see the pace of the session continue to accelerate.  Legislative leaders have set very tight deadlines to process bills for consideration by the full House and Senate, so legislators and advocates alike are scrambling to get their proposals scheduled for hearings. The speedy start to the session, combined with the growing use by legislators of large omnibus bills that gather dozens of bills together into a single package, can often make tracking and influencing legislation challenging.

If you haven’t already done so, please make plans to attend the annual Pediatricians’ Day at the Capitol.  The event, set for March 23, is the single most important advocacy effort for the MNAAP.  The day is one of fun, fellowship, and advocacy on behalf of kids.

 I want to start off with a hearty congratulations to Dr. Nathan Chomilo who recently started his new position as Minnesota’s Medicaid medical director. He is an impassioned advocate who has highlighted the deep racial, health, and educational inequities in our state. He also serves as one of the early childhood champions to the MNAAP Board.

Leadership of the MNAAP met with Minnesota Commissioner of Education Mary Cathryn Ricker in February to discuss recommendations for safe and healthy schools, including the need for every school to have access to mental health professionals and physical activity. Included in the meeting were Drs. Janna Gewirtz-O’Brien, Tom Scott and Gretchen Karstens along with MNAAP Lobbyist Eric Dick and Executive Director Melissa DeBilzan. It was a focused discussion and hopefully the first of more to come.

As we continue to work through this winter’s seemingly relentless wave of RSV, influenza and unfortunately pertussis, I want to encourage all of you to take care of yourselves.  I attended a Bounce Back conference in Minneapolis this winter which provided reflection and a reminder of our human experience and vulnerability as we navigate challenges in our professional and personal lives.  This was the fourth annual event sponsored by the Bounce Back Project.  The conference focused on stories, strategies and assembling our toolbox to renew and strengthen our resilience. I encourage you to take a look at their website www.bouncebackproject.org and consider attending one of their events.

I want to end with a deep and sincere thank you to each and every one of you. You make a difference every day as you care for children and families in their worst and best moments.

Elijah Cummings, former politician and civil rights advocate, said, “Children are the living messengers we send to the future we will never see. The future we are creating needs to be a brighter one for every child.”

 

Take care,

Lori DeFrance, MD, FAAP

MNAAP President

February 26, 2020

Public charge is an immigration policy that will prevent people from obtaining legal residency (a green card) if immigration officials deem them to be at risk of depending on public services. Specifically, people can be denied a path to citizenship if they use public resources for health coverage, housing support or food assistance.

The new public charge rule took effect nationally (except for Illinois) on February 24, 2020. Many immigrant families are very afraid of public charge even if it does not apply to them.

This website provides an excellent guide for talking to families about this policy, including the document “Public Charge: Does this apply to me?” in English and Spanish.

You can ensure that your clinic is a safe space for immigrant families by using this toolkit from the Minnesota Immigrant Health Alliance (MIHA).

If patients have specific questions about their situation, please encourage them to speak with an immigration attorney.

Special thanks to MNAAP members Drs. Hannah Lichtsinn and Calla Brown for sharing resources and information on this important issue.

Annual Sponsors