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June 16, 2021

Dave Renner

Minnesota’s constitution requires the legislature to complete its work and adjourn no later than the third Monday in May (which was May 17 this year). It also requires them to pass a balanced budget for the upcoming two-year period. May 17 passed, and they did not pass a budget, requiring Governor Tim Walz to call them back for a special session sometime before the end of the fiscal year on June 30.

For the seventh time in the last 10 budget sessions, the legislature was unable to reach an agreement on the budget before the required adjournment date. The good news is that legislative leaders and Gov. Walz did reach agreement on the overall spending levels for the next biennium, but the specifics on how those levels will be allocated have not been decided. The  most likely date when they will come back to pass the budget is for on or around June 14.

MNAAP was active this session in promoting our legislative priorities. Top among those was preserving access to health care and social services for Minnesota’s children. I am glad to report that the state’s safety net programs were protected. The feared cuts to eligibility and coverage did not happen.

A second priority was ensuring equitable and state access to telehealth services. Awaiting action in the special session is continuation of expanded coverage for telehealth that allows patients to receive care from their home and covers telephone-only services. Also awaiting action is funding for grants for improving broadband across the state. There is strong bipartisan support for both proposals, but the final costs still need to be agreed to.  

Two other priorities for which no action was taken was improving childhood vaccination rates and protecting children from firearm violence. Efforts to repeal the personal belief exemption in the childhood vaccine law were not heard in either body, and while there is strong statewide support for strengthening criminal background checks for those purchasing firearms, and for authorizing law enforcement to temporarily remove firearms for those who may be harmful to themselves or others, those bills did not received hearings.

There are other issues MNAAP is hopeful will pass in the special session. There is strong support to expand postpartum coverage for mothers on Medical Assistance at least for six months. The House is working to expand that to 12 months. And still to be decided is the amount of money that will be allocated to early childhood education. The global budget agreement allocates $525 million of new spending on E-12 programs, but again the details of that spending are still undecided.

What a year the last year has been – the murder of George Floyd and recent convictions of Derek Chauvin, increased attention on racism in our community and country, the pandemic, decreasing vaccination rates, border immigration issues; the list goes on and on. In a sense, all of these issues are related to the need for advocacy, which is what I want to focus on in this message to you as MNAAP members.

Throughout my career I have encouraged trainees and my younger colleagues to find something they are passionate about in health care, outside of their clinical practice, and spend some time on this topic. For me I was fortunate to fall in love with bioethics early in my medical career and stuck with it over the next 36 years. I found that I also enjoyed practice management – something I was involved with for 25 years. More recently, I have found myself spending more time on advocacy, which has been equally rewarding. 

In my opening remarks at this year’s Virtual Pediatricians’ Day at the Capitol, which about 120 individuals participated in, I mentioned that advocacy is defined as “any action that speaks in favor of, recommends, argues for a cause, supports or defends, or pleads on behalf of others.” I went on to give examples of what this might look like, from writing letters to the editor, being involved with an organization that advocates for social changes, posting on social media about important issues, getting out and non-violently protesting, or more classic advocacy at the legislature. That legislative advocacy can include working with legislators to craft bills, testifying for or against a bill or writing letters of support or against a bill. Being involved with our own chapter can also provide multiple opportunities to do advocacy. In fact, our chapter is committed to protecting and advancing the health of every child and adolescent in Minnesota through advocacy, education and special projects. And don’t forget about involvement with the National AAP through its many committees and sections.

 I encourage you to consider attending next year’s AAP Leadership Conference. I recently had the opportunity to attend this year’s conference with 13 other pediatricians, residents and medical students from Minnesota and it was great. It was energizing and educational. We also got to hear Stacey Abrams from Georgia, who was phenomenal. If you ever get the opportunity to hear her – do it! As one of the other speakers said, “Pediatrics is not just a 9-5 (or 7-6!) day. We all need to advocate for our kids all the time.” My charge to all of you is to simply get involved in whatever way you are comfortable doing and with whatever time you are able to devote. 

I want to give you an update on our anti-racism work. At our March special board of directors meeting and then at our April executive committee meeting, we approved and started working on six initiatives from the anti-racism taskforce:

  • Identify a chapter Diversity and Inclusion champion
  • Refresh/revise anti-racism resources on our the MNAAP webpage
  • Work with Reach Out and Read to include more anti-racism books
  • Combine our chapter Poverty and Disparities Work group with the now concluded anti-racism taskforce into a standing committee for the chapter
  • Figure out how to make sure all of our policy and legislative advocacy is done with an equity lens
  • Begin our internal review of all chapter policies and work to look for things that may need to be addressed and corrected

I would also like to suggest for your reading, two very thought-provoking recent articles:

“Firearms Injuries Involving Young Children in the United States during the COVID-19 Pandemic,” (Cohen JS, et al. Pediatrics. April 13, 2021,  https://doi.org/10.1542/peds.2020-042697)

“Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005–2015)” – discussed increased length of stay for Hispanic youth. (Nash KA, et al, Pediatrics. April 2021,  

https://doi.org/10.1542/peds.2020-030692) 

Finally, at our May 6 chapter board meeting, we were fortunate to be joined by AAP Board member, Dr. Joseph Wright, who gave a great presentation on, “At the Intersection of Equity, Science, and Social Justice: An Inflection Point for Organized Medicine.”  His talk was very powerful, thought provoking and provided a wonderful framework for the anti-racism work our chapter is doing, which Dr. Wright was very impressed with. 

Be well and have a great summer and let’s keep working to get this pandemic under control. 

May 28, 2021

May 26, 2021 (St. Paul, MN) – Minnesota children and youth are in the midst of an emergency situation as firearm violence continues to claim young lives and create life-long trauma. Five months into 2021, already 20 children in Minneapolis have been the victims of gun violence, including five in the last month. These heart-breaking incidents reinforce that something must be done to prevent more young lives from being taken.

The Minnesota Chapter of the American Academy of Pediatrics (MNAAP), which represents more than 1,000 pediatricians, residents, and medical students across the state, supports legislative measures which aim to reduce gun violence through background checks, “red flag laws,” prohibitions on the sale of semiautomatic assault weapons, and safe storage of firearms. We are committed to protecting and advancing the health of every child and adolescent in Minnesota.

Firearm-related violence is currently the second leading cause of death in children and youth in the U.S. behind motor vehicle crashes, and it is a cause of death that can be prevented. In 2020 at least 14 children were killed by gun violence in Minneapolis, and another 100 under the age of 20 were shot. According to Gun Violence Archive, more than 575 children and youth younger than 18 years old have been killed in the U.S. to date in 2021.

The Joyce Foundation reports that a recent Minnesota survey found that 61 percent of respondents believed that gun laws should be stronger, but 25 percent don’t believe stronger gun laws will make a difference. However, a study published in Pediatrics in 2019 showed that states with stricter gun laws, including requiring universal background checks for firearm purchases, had lower firearm-related pediatric deaths. Additional laws requiring background checks for ammunition purchases have also been found to be helpful. Another study showed that policy changes mandating better child access prevention with penalties for the gun owner could also lead to lower pediatric mortality. Other laws such as waiting periods between when someone can apply for a gun and actually get it as well as extreme risk laws (e.g., red flag laws) that allow a loved one to have a gun removed from the home of someone in crisis, can also reduce overall suicides and homicides in the population.

African American children bear a disproportionate brunt of firearm-related deaths from unintentional injuries, homicide, and police-related shootings. The reasons for this are complex and myriad but are rooted in poverty and systemic racism. These limit the opportunities for children to grow up in healthy, violence-free environments. Addressing these conditions is essential to decrease our children’s exposure to violence. Collaboration between different groups including pediatricians, public health experts, legislators, law enforcement, youth services, schools, churches, and neighborhood groups will be necessary. The environmental and systematic racism that have led to the significant disparities in firearm-related deaths and injuries in our communities require a true financial commitment from local, state, and federal governments. Strengthening household financial security, including tax credits for families with children, safe and affordable housing, paid parental leave, livable wages, and economic support for developmentally appropriate childcare, will go a long way in reducing poverty in our communities.  Investments through the provision of green spaces, playgrounds, and after-school programs are also important.

Death and injury by firearms are a public health crisis, especially for our youth. It is time for action. Our state leaders need to stand up, say “enough,” and pass common-sense gun violence prevention laws to protect our kids and save lives. Our communities must come together to address the social disparities that contribute to this ongoing crisis. We must respond to this emergency for our children and teens.

May 24, 2021

There are more than 24,000 children youth and young adults with Autism Spectrum Disorder (ASD) under the age of 21 on Minnesota state programs. ASD is the fastest-growing developmental disability in the United States. In 2015, Minnesota created the Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit. The benefit provides early intervention for children, youth and young adults with ASD and related conditions under the age of 21. The benefit promotes children’s independence and participation in family, school and community life. If you are working with a family that may benefit from EIDBI services, use the Pathway to EIDBI Services for Families online tool to find an EIDBI provider or make a referral to EIDBI services.

A comprehensive multi-disciplinary evaluation (CMDE) is required to determine medical necessity and eligibility for EIDBI services. This evaluation is similar to a diagnostic assessment, but brings together input and expertise from multiple professionals across disciplines. Since pediatricians are often the first point of contact for families, having more pediatricians enrolled to complete the evaluation will help increase access to medically necessary early intervention services.

The number of CMDE providers in the state has grown but there is still a huge need for more enrolled providers. To be an eligible CMDE provider, you must be a licensed physician, advanced practice registered nurse (APRN) or mental health professional with experience in the evaluation or treatment of people with ASD and/or related conditions. Pediatricians can make a difference. If you are interested in enrolling as a CMDE provider, contact ASD.DHS@state.mn.us  

The American Academy of Pediatrics (AAP) recommends ASD screenings to be part of all 18 and 24-month well-child checkups. By conducting ASD-specific screenings, enrolling as a CMDE provider, or making the referral to one, you can change the trajectory of a child’s life and help ensure the best possible outcomes. Refer to the MN Department of Health’s Child and Teen Checkup Fact Sheet for Primary Care Providers on Developmental, Social-Emotional and ASD Screening in Early Childhood for more information and screening guidelines.

 

Pathway to Services and Supports

Minnesota state agencies developed the Pathway to Services and Supports / Minnesota Autism Portal (mn.gov) resources to provide information on services and supports available in Minnesota for children, youth and young adults with Autism Spectrum Disorder (ASD). The Pathway resources help healthcare providers, care coordinators and other professionals assist families in determining which potential services and supports are right for them. For more information, visit the MN Autism Resource Portal or contact ASD.DHS@state.mn.us

As a part of Project Firstline, the AAP has launched an infection control video series that addresses the latest member questions in a case-based format.

Project Firstline is a collaboration led by the Centers for Disease Control and Prevention (CDC) that brings together diverse healthcare and public health partners to provide millions of frontline healthcare workers and members of the public health workforce the infection control training they need to protect the nation from infectious disease threats.

View and share these videos to keep you, your facility and your community safe.

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