Category Archives: Advocacy and Health Policy

How Children’s is exploring the health impact of bullying

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Hardly a day goes by when we don’t hear a story about bullying: from television reports, to pending legislation, to our own children coming home with tear-streaked faces. For most, school is out for the summer and while our attention to this pressing health issue may wane during the next few months, the problem of bullying doesn’t disappear.

Today, we released a report on the health and developmental impacts bullying has on kids in our communities.

We know that kids and parents struggle with how to address this issue. From a developmental perspective, it’s important for children to learn how to resolve conflict independently. The trick for all of us is to understand when a conflict is no longer healthy and to intervene appropriately. We discuss this idea in the paper and offer some developmentally appropriate guidance to parents (see below) to monitor for and address bullying-related activity with their children.

So how do you do that? Here’s adapted guidance from the American Academy of Pediatrics and other experts on how to address conflict resolution and bullying.

Preschoolers (ages 5 and younger)

Parents can help their child handle conflict by teaching them to:

  • Share
  • Use language rather than action to express anger or feelings, and
  • Respond to physical aggression by another child by saying, “That hurts. Don’t do it.” Seek the help of an adult.

Grade school (ages 5-12)

To assess whether a child has been involved in bullying, parents should ask and consider enlisting others to help if the answers reveal that a child is experiencing bullying:

  • Have you been involved in any fights?
  • How do you avoid (or not avoid) getting into fights?
  • Are you afraid of getting hurt or bullied by other children?
  • How would you react if you saw a fight or bulling incident?

If responses to these questions are concerning, consider some of the following as next steps:

  • If the child is reluctant to talk about bullying, it may make sense to get a counselor or pediatrician involved.
  • Once the child talks about what happened and identifies the bully or bullies, contact the relevant teacher and/or administrator to develop an approach that works in the school setting and is comfortable for the bullied child.
  • Explore methods for providing the child skills he/she needs to respond to future situations.

Parents also need to stay on top of these issues as the child gets older. When their child is in second grade, parents should:

  • Assess if their child has a regular group of friends.
  • Ask what happens when friends disagree.
  • Be familiar with those friends, and
  • Observe what happens when your child is with those friends.

By fourth grade, it’s especially important that children develop self-esteem and feel good about themselves. Parents should observe if their child is:

  • Unhappy or withdrawn,
  • Unable to listen or do homework, or
  • Engaging in destructive behavior.

Middle school (ages 12-14)

Kids need to be encouraged to talk, but may be reluctant to be open and honest if parents or pediatricians come on too strong.

What parents can do:

Some questions for older kids might include:

  • How are things going at school?
  • What do you think of the other kids in your classes?
  • Does anyone get picked on?

Effective action

There are a number of actions parents can take once they determine their child is a target of bullying. These actions range from teaching kids social skills and building their self-confidence to knowing when and how to contact the school or law enforcement authorities.

We hope this report will contribute to important ongoing discussions happening in our state on how to best address bullying. If you’d like to learn more about our in-depth review of how bullying impacts the health of Minnesota kids, visit childrensmn.org/bullying.

Five Question Friday: Anna Youngerman

Meet Anna Youngerman, director of advocacy and health policy.

Describe your job as director of Children’s advocacy and health policy. As the director of advocacy and health policy, my job is to oversee our government relations, policy and community engagement work. I work with a great team — Kelly Wolfe who manages our lobbying and public policy efforts and Katie Rojas-Jahn who coordinates our community benefit work, social media efforts and participation in community/advocacy organizations. Together, we work on legislative issues that impact Children’s and children’s health at the state and federal level. We also work to understand the needs of the communities in which Children’s operates and kids across the state and develop plans for addressing those issues. Part of our work is focused on building advocacy interest within Children’s among employees, patients and families so I get the opportunity to present to and learn from medical professionals, our Family and Youth Advisory Councils and others within the organization about what matters to our Children’s community. At the end of the day, my job boils down to advancing and protecting our organization and kids’ health in the legislative arena, making sure we’re the best community partner we can be and equipping people to be effective advocates for children.

Anna Youngerman

Because of your role, you spend a lot of time at the state Legislature. What did you take away from this session? There were a lot of pre-conceived notions about what this state legislative session would yield because it was the first time in more than 20 years that the Governor’s Office, House and Senate were entirely in DFL control. For example, many in the healthcare community thought this would be the year (after more than a decade of cuts) that health and human services would see funding increases but, instead, legislators wanted to cut it again. In the end, Children’s and children’s health issues ended up doing fine, but what it showed is that the process is always unpredictable, it takes a lot of active monitoring and heavy lifting to make sure we come out OK in the end.

Your job extends beyond Children’s doors. What does that mean? Most of our work is focused on efforts outside the walls of Children’s. On the policy side of our work, we spend a lot of time with legislators and administrators to help them understand what Children’s does, why we’re unique and what we need on a legislative level to continue doing what Children’s does best. For those folks, our team is often “the face” of Children’s (for better or worse :)). We also spend time working with other organizations who have common interests, including public health leaders, health advocacy organizations and other health systems.

What drew you to Children’s? I had the opportunity to work with Children’s in my previous job and had a great feeling about the organization. I was interested in using the advocacy skills I’d developed to help drive a singular cause forward and, with Children’s, there is a strong commitment to the organizational mission of serving children. My sense of this place has absolutely been affirmed – everybody lives and breathes kids. I wasn’t a mom when I started but now that I have a little one of my own, being able to advocate on behalf of this organization is even more of a pleasure.

What is your favorite memory from working here? I don’t have one memory but rather a collection of experiences that have been powerful to me. It sounds hokey, but I often find myself in awe of this place. Walking through the cafeteria, participating in a meeting with clinicians, hearing from a doc about an issue he/she wants to address, listening to a family’s experiences, even talking about healthcare reform — in all of those encounters, I get to see and hear how amazing the kids, parents, nurses, doctors and administrators are when it comes to doing what’s right for kids.

New payment model values quality over quantity

At Children’s Hospitals and Clinics of Minnesota, we pride ourselves in getting the best outcomes for our patients. That includes keeping patients healthy so they don’t require extra visits and expensive procedures.

We have a long-standing commitment to innovative care delivery, which triggered our willingness to partner with the Minnesota Department of Human Services to test a new delivery and payment model aimed at better health outcomes and lower costs for our state’s Medicaid program. The shift in approach is to tie payment to delivering higher quality outcomes rather than relying on the historic model of publicly-funded health care programs in Minnesota where health care providers were paid for the procedure.

By participating in this new payment model, our job at Children’s will be to manage the care of 14,000 patients. Rather than a system that creates an incentive for more visits and procedures, the total cost of the care model creates an incentive for us to advance methods that keep people healthy so they don’t have to use expensive services.

The cool news is that we’ve already been doing this for nearly a decade. Children’s established the state’s first Medical Home in 2004 and this care coordination model has resulted in reduced hospitalization and fewer readmissions, among other outcomes.

“With nearly a decade of experience to draw on, Children’s is pleased to partner with the state on an approach that financially rewards better health outcomes,” said Maria Christu, General Counsel and Vice President of Advoacy and Policy at Children’s. “We are confident we’ll deliver on the quality outcomes the state and, more importantly, our patients expect.”

Children’s joins five other major health care providers. They include Essentia Health, CentraCare Health System, North Memorial Health Care, Federally Qualified Health Center Urban Health Network (FUHN) and Northwest Metro Alliance (a partnership between Allina Health System and HealthPartners). In all, we’ll be responsible for 100,000 Minnesotans enrolled in publicly-funded programs.

Minnesota is the first state in the country to implement this new payment model. “This new payment system will deliver better health care at a better price. By changing the way we pay health care providers we can incentivize reform, help Minnesotans live healthier lives, and slow the rising cost of health care in our state,” Gov. Mark Dayton said in a statement.

This model is being implemented at the same time as Minnesota’s Medicaid population is expected to increase. Gov. Dayton’s budget proposal, which we wrote about last week, includes expanding Medical Assistance to 145,000 more Minnesotans, including 47,000 kids.

 

Mark’s story: Making my voice heard

By Mark Olson

Mark, middle, cuts the ribbon at the opening of the new teen lounge.

I was born with transposition of the arteries in my heart and had surgery to repair them when I was four days old. In fifth grade, I had another surgery to repair a narrowing of my aorta. And in November 2010, I got a pacemaker. It’s possible I’ll have another surgery in a few years to make my aortic valve stronger because it’s expanding and beginning to tear.

I’m only 18.

Given the number of medical issues I’ve faced during my short life and still face, I’ve learned how important it is to advocate for yourself in the hospital. It’s important for a few reasons. First, your doctors and nurses then know what’s going on with you and can help you. Second, you can help the hospital itself improve.

One of the ways I advocate is by participating in the Youth Advisory Council (YAC) at Children’s Hospitals and Clinics of Minnesota. I’ve served on YAC for three years. I love Children’s, but I joined YAC because I thought I could make the hospital even better.

I believe I’ve made a difference in the lives of patients at Children’s. One way I’ve done that is by helping with the creation of the new teen lounge on the Minneapolis campus.

At meetings, I’m not one to be shy. I’m always asking questions. When I know a friend is going to the hospital, I ask him or her to give me feedback. How was the visit? Could Children’s have given better care? How? I bring the answers back to YAC.

Someday, I see myself advocating for others. And it’ll be at the bedside. I’m interested in going to medical school and specializing in cardiology. After my years of experience being a patient and a YAC member, I think I’d bring a unique perspective to the medical field.

I often tell people, “If you want something done, the only way people can know you want something done is to tell them. You’re the only person stopping something from happening.”

Mark Olson, 18, is a Youth Advisory Council Member at Children’s Hospitals and Clinics of Minnesota and a patient.

Addressing preemie care head on in 2013

By Dr. Ellen Bendel-Stenzel

As the Star Tribune so beautifully illustrated with its Thanksgiving cover story, “Home After 98 Days In Preemie Land,” the issue of prematurity is a heart-wrenching and persistent challenge for doctors and parents-to-be.  Preterm birth can, and does, affect every race, ethnicity, religion, age, socioeconomic status and demographic.

Here in the Upper Midwest, more than 200,000 babies are born every year. And about 22,000 of those babies or little more than 10 percent are born premature. However, as a preterm infant, you couldn’t ask to be born in a better place than Minnesota. We have some of the highest survival rates in the world, and yet we received a “B” on the March of Dimes 2012 Premature Birth Report Card.  Why?  Because even though an infant born beyond 28 weeks gestation, or 7 months of pregnancy, has a nearly 100 percent chance of survival, these infants still remain at risk for respiratory problems, feeding issues, developmental delays and behavioral and social disabilities.

Unfortunately, the amazing medical progress we’ve made over the past 25 years, which lead to the improved outcomes for so many premature infants, has begun to plateau. Now we as health care providers need to take the lead and drive future improvements.

There will always be high-risk pregnancies, and ensuring the best outcomes for these scenarios is not dependent upon reducing the prematurity rate alone.   We need to be proactive and provide optimal care to both mother and baby, so that we can decrease the incidence of prematurity and improve the outcomes of those born early or with complex medical conditions. In short, we need to address the needs of the infant long before a mother’s due date.

In early February of next year, Children’s Hospitals and Clinics of Minnesota and Abbott Northwestern Hospital will open The Mother Baby Center in Minneapolis. It will be the first of its kind in the Upper Midwest, and one of only a few in the nation where mother-baby care is fully integrated. This new Center will bring together maternal and infant specialists, with the understanding that every pregnancy has the potential to be high risk.

With a proactive approach, the goal is clear: optimize care from conception to delivery.  This means the sharing of information across all nine months of the pregnancy whenever possible.  It means providing quick access to specialists when concerns for the health of either the mother or baby arise. It means collecting data to look at the root cause of prematurity in our own community.  It means collaborating in clinical trials that start at the first obstetrical visit and end in the pediatrician’s office at school age follow-up.  And it means continuing to incorporate the latest technologies and therapies on the Newborn Intensive Care Unit (NICU), while simultaneously measuring their effects and proving their validity.

While simple in theory, these are lofty goals that are difficult to implement and execute, but are well worth the effort.  As physicians we must continue to set the bar high and help moms achieve term delivery whenever possible, while at the same time improve the care for the babies that are born early.  In doing so, we’ll create a recipe for success that will provide enormous benefits to Minnesota babies and families.

Dr. Bendel-Stenzel is a neonatologist and co-director of clinical research for the Newborn Intensive Care Unit at Children’s Hospitals and Clinics of Minnesota in Minneapolis.

Making democracy work for kids’ health: a letter to first-time voters

Dear first-time voters,

You’ve been hearing about the election for months. Maybe you’ve already registered to vote (if not, no worries, you can register at the polls). All that’s left is to wake up next Tuesday morning and head to your local polling place (need help finding it?)

That’s right, next Tuesday, Nov. 6, is Election Day. For many of you, this is the first time you’ll be able to vote. As a new voter, you can bring the issues that matter most to you and your family right into the booth. When you vote, you can be a voice for kids.

How does that work?

Making sure that elected officials help protect and promote children’s health means that we need to participate in the democratic process and speak up for the issues that matter to us. Voting is a critically important part of this advocacy. Your vote matters and the Children’s Advocacy and Health Policy department can help by keeping you up to date on some of the most important policies that affect kids’ health.

Why do young advocates matter?

Last year, Children’s Hospitals and Clinics saw more than 120,000 children and teens. That’s more than the entire city of Rochester. Unfortunately, the majority of them can’t vote. They can’t cast a ballot for the person they think will protect them, and you, the most. But you can.

You are the one with the experience, who knows what’s important to children who are sick or to the family of someone who is. Use this opportunity to advocate for all those who can’t advocate for themselves.

And every vote counts. In fact, during the 2010 election, three races in Minnesota were decided by fewer than 100 votes. If 100 Children’s patients were able to vote, it could have changed the result of the election.

So how do elections impact you?  

Every year, our elected officials consider laws that directly affect you. In the last five years, laws regarding seatbelt use, concussion safety and smoking in restaurants have all been passed at the state level. Legislation at the federal level is also extremely important: in 2012 a bill that would help address drug shortages was passed into law. The impact of this law on kids’ health is big: many kids at Children’s depend on those drugs for life-saving treatments.

In addition, legislation is often considered that impacts the funding we receive to train doctors and nurses that care for our kids, as well as our ability to offer all the great programs we currently provide like the Arts and Healing program.

The Children’s Advocacy and Health Policy department has great information on all the issues that affect Children’s Hospital, from funding to training our doctors and nurses to childhood obesity initiatives.

Get ready to vote

Now it’s time for you to go out and make a difference. Here are some resources that will hopefully make the voting process easy and seamless for you:

We want to know how your first experience at the polls went! Tweet us @ChildrensMN or post on our Facebook page with a photo of you wearing your “I voted” sticker and let us know what it was like.

Continue to be a voice for children

After Election Day, you can stay engaged by joining Children’s Advocacy Network. We make being informed easy: You’ll get an alert whenever your involvement can make a difference! You’ll also get periodic updates on progress on issues and how your elected officials voted on measures before them.

Wishing you the best of luck,

The whole Advocacy and Health Policy team: Anna Youngerman, Kelly Wolfe, Katie Rojas-Jahn and Julia Miller

Family Advocacy Day: A Q&A with the Johnstons

John, Nancy, Mike and Emma Johnston recently traveled to Washington, D.C., for Family Advocacy Day. In its eighth year, the Children’s Hospital Association 2012 Family Advocacy Day brings children’s hospitals patients and their families to tell their stories to lawmakers on Capitol Hill. In 2011, Mike, a Children’s patient, was diagnosed with a cancerous Germinoma tumor.

Upon his family’s return from a whirlwind tour of our nation’s capital, John answered a few questions about his family’s experience participating in Family Advocacy Day.

Mike, Emma, John and Nancy met Sen. Al Franken during Family Advocacy Day.

Q: Why did you share your story on Capitol Hill?

A: We shared our story because it was important for our legislators to put a face with a budget line item.  Our family does not want any other child to suffer waiting to receive care. We as a nation can’t afford to balance our budget on the backs of children.

Q: Do you think your story caught lawmakers’ attention?

A: Our story was very compelling. We had to wait for Mike to see a specialist for several months before we were ultimately told to go to Children’s.  Every legislator we spoke with agreed that this was unacceptable.  It is important for them to see the human impact of budget changes or cuts.

Q: What kind of reception did you get from the Minnesota delegation?

A: The Minnesota delegation was wonderful.  The four specific legislators we met with were; Reps. Betty McCollum and Eric Paulsen and Sens. Al Franken and Amy Klobuchar.  They were all up on the issues and understood our dilemma as parents.  They all agreed that this is an extremely important issue, and they vowed to keep up the fight.  The staffers we met also gave us ample time to share our story.  Rep. Paulsen commented on the trading card Mike gave him, so it was very important to leave something behind with our lawmakers.

Q: In addition to taking in the incredible sights of Washington, D.C., did you take anything away from your experience?

A: For our family, it was amazing to see how our government actually works.  It is very inspiring to know that a single family can make a difference in public policy. We’re a family that gives back to our community and have already offered our services at the state level.  We must stand up for children since they are our future. We know all too well the importance of excellent, timely care.  With any cuts to these programs, lives can be at risk.  We met so many wonderful people at Family Advocacy Day and would strongly urge others to do the same.  Our lives have been forever changed in a very positive way because of the role we were able to play.

John blogged before his family traveled to Washington, D.C. To read that post, click here

More kids covered

This is a post by Children’s Health Policy and Advocacy team. They’re nonpartisan and proudly serve as child health experts and as a resource for our elected officials. Follow Children’s Policy and Advocacy staff on Twitter.

Approximately 16,000 children will now be insured and have access to healthcare thanks to a finally implemented 2009 law. That is great news for kids and their families.

The healthcare expansion will cover working families who make between 150 percent and 200 percent of the federal poverty guideline(FPG) and will improve their access to care and preventative services. The new law eliminates the current four-month waiting period previously required and will allow every child under 18 to be eligible for MinnesotaCare, Minnesota’s subsidized insurance program for working families.

Those children under 200 percent of the FPG will be eligible for MinnesotaCare without premiums. Prior to the changes, a family of four earning less than $46,000 would have to pay premiums of up to $70 per child in order to participate in MinnesotaCare.

The new healthcare expansion is estimated to cost $11 million a year when fully implemented with the federal government covering half.

While this is certainly great news for the newly covered 16,000 children, officials estimate there are anywhere from 71,000 to 84,000 children who still lack health coverage. Minnesota is also the only state in the country that saw an increase in the number of children covered by health insurance last year, dropping in rankings to 27th in the country. According to the Annie Casey Foundation 2012 Kids Count Data Book, Minnesota also dropped from second to fifth in the nation in the overall well-being indicators for children.

While we applaud the new law and successes in getting more kids covered, it’s clear there is still a lot of work to do. Every child deserves a chance to be healthy.

To read the entire Kids Count Report, click here.

The Johnston family goes to Washington

This is a guest post by John Johnston, dad to patient Mike Johnston, who was diagnosed with a tumor in 2011. His family will be in Washington, D.C., next week for Family Advocacy Day. In its eighth year, the Children’s Hospital Association 2012 Family Advocacy Day brings patients from children’s hospitals and their families to tell their stories to lawmakers on Captiol Hill.

The Johnstons

On April 18, 2011, we took our 13-year-old son Mike to Children’s in St Paul. That day, our family began receiving treatment from Children’s. It turned out that Mike had a cancerous Germinoma tumor that was blocking the flow of cerebral spinal fluid. The fluid was building up in his skull, putting pressure on his brain and causing him to have tremors and headaches. As we began Mike’s cancer journey, it became obvious to our family that Children’s not only treated the patient, but they treated the entire family. Every staff member who came into our room introduced themselves to all of us, including 7-year-old Emma. We felt secure with the staff since they all made time for us and made us feel like we were their only patients at the moment.

Throughout Mike’s treatment, several important events were planned. The first was the American Cancer Society’s Relay for Life in White Bear Lake, Minn. Mike was one of the featured speakers. The oncology team scheduled chemotherapy and other appointments to make this special event possible for Mike and our family. The second major event for Mike that summer was his junior high school trip to Washington, D.C. This was an opportunity he couldn’t pass up since the teacher in charge was Mike’s favorite teacher and helped Mike get passionate about history. Mike enjoyed the monuments and museums in our nation’s capital and was able to take it all in despite his low blood counts.

Throughout our family’s journey with Children’s, we all felt blessed to have this institution charged with our son’s care. We felt so proud to have Children’s in our life that our family made a commitment to give back. Mike is now a member of the Youth Advisory Council, and my wife and I participate in the Families as Partners program. This all led to the upcoming opportunity for our family to travel to Washington, D.C., to advocate on behalf of Children’s. We’re very excited for this chance to give back. We even accepted this opportunity knowing that we would travel on Emma’s ninth birthday. We can hardly wait to see the sites as a family and meet many wonderful people who’ve also been touched by Children’s.

See you in Washington!

INFOGRAPHIC: The Weight of Childhood Obesity

At Children’s Hospitals and Clinics of Minnesota, we’re seeing a growing number of overweight and obese children. To address this new reality, we’re closely examining how we treat kids with weight problems. In a report we released today, we explore how Minnesota kids are faring in the battle against obesity. The earlier we tackle this problem, the better. To learn more, click here to see our report.