Category Archives: Advocacy and Health Policy

Live chat on bullying with the Star Tribune

 

It’s hard to go a day without reading or hearing about someone being bullied. Earlier this month, two young girls in Florida were arrested after allegedly harassing a classmate who ultimately committed suicide. The story made national headlines. 

It’s national bullying prevention month, and we can’t think of a better time to talk about this important issue. Join us and local experts on Monday, Oct. 28, at noon for an hour-long discussion on bullying. We’ll talk about defining bullying, the difference between bullying and healthy peer-to-peer conflict, signs a child may be involved in bullying, what parents can do when their child is bullying others and what kids and families can do to raise awareness.

To participate, visit the Star Tribune. You can also sign up for a reminder.

The following individuals will be on hand to answer your questions:

  • Dr. Mike Troy, Medical director, behavioral health services, Children’s Hospitals and Clinics of Minnesota
  • Kelly Wolfe, Senior advocacy and health policy specialist, Children’s Hospitals and Clinics of Minnesota
  • Julie Hertzog, Director, PACER’s National Bullying Prevention Center
  • Christina Wagner, high school student and activist

This summer, Children’s released a white paper on bullying.

When is it bullying?

Classroom bullyingIt’s bullying prevention month, so you may be hearing a lot about the problem of bullying and how to address it. But what exactly is bullying? It turns out that defining this problem is not as easy as it might seem.

Bullying, defined

Perhaps the most commonly used definition is one offered by Dan Olweus, a psychology professor from Norway and one of the world’s leading experts on the subject.

According to Olweus, “Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself.”1

The definition may not say it all

The Olweus definition is a sound starting point for discussions on bullying, but other experts have pointed out some grey areas that require attention when determining if a child is involved in bullying behavior:

  • On purpose or not? Some bullies may be too young to know exactly what they are doing and why. In such cases, the bullying may not be done “on purpose,” but it may be bullying nonetheless.
  • Was that a joke? A child may perceive a remark as “bullying” when it was intended to be a joke, especially in the case of cyberbullying, where there are no facial cues to help interpret the intention of the remark.
  • Who’s in charge? Sometimes bullying takes place between kids of equal standing, which may be especially common in cyberbullying.
  • Kids with mental health conditions. Children who suffer from pre-existing mental health issues, such as depression, or are used to being bullied, may be predisposed to assume a negative intent behind a comment or action that isn’t there.2

Normal conflict vs. bullying

Spectrum of conflict infrographic

Click image to view full-size version

Conflict is an inevitable part of human association and resolving conflict constructively, rather than destructively, is a critical skill set that children begin to develop even as infants. The infographic at right (click for a full size version) is a guide to help us consider whether a conflict has crossed into “bullying territory.”3

While parents and teachers can help children learn how to successfully resolve conflict, most children need to learn conflict resolution skills on their own through experience. Aside from problem-solving, one of the most critical conflict resolution skills is for children to know when they can resolve the conflict on their own and when they need help from others.4

Learning to use problem-solving skills to resolve conflict is associated with:

  • Increased achievement
  • Motivation to learn and improve
  • Higher-level reasoning
  • Healthy social and cognitive development
  • Enriched relationships
  • Clarified self-image
  • Increased self-confidence
  • Resilience in the face of adversity5

On the other hand, the inability to successfully resolve conflict often leads to aggression and violence.

How to tell the difference between bullying and healthy conflict

Drawing a distinction between bullying and day-to-day conflict isn’t always easy, said Emily P. Chapman, MD, medical director of Children’s Hospitals and Clinics of Minnesota hospitalist program.

“If a child teases a good buddy, it can be in fun,” Dr. Chapman said. “If trust isn’t there, it could be intimidating or alienating, and that is bullying. It’s also likely to be bullying if there is mismatched stature between the ‘teaser’ and the ‘teased’ — older versus younger, popular versus not so popular.”

“Learning how to handle and resolve conflict is important to a child’s psychosocial development,” Dr. Troy said. “If we as parents or other responsible adults constantly intervene to help resolve these conflicts, then we may hinder rather than help the children involved. Bullying is different — it is outside the normal range of conflict, and it can be very harmful if not stopped.”

For more tips on how to address bullying check out this blog entry, or visit our resources page at ChildrensMN.org/bullying.

Notes:

[1] The Olweus Bullying Prevention Program, U.S., 2011.

[2] Dempsey AG, Storch EA. Psychopathology and Health Problems Affecting Involvement in Bullying. Preventing and Treating Bullying and Victimization (2010), Oxford University Press: 107-131.

[3] Broadbear BC, Broadbear JT. Development of Conflict Resolution Skills in Infancy and Early Childhood. The International Electronic Journal of Health Education (2000);3(4):284-290.

[4] ibid.

[5] Johnson DW, Johnson R. Why violence prevention programs don’t work and what does. Educational Leadership (1995);52(5): 63-67.

MNsure: What you need to know

Family with health professionalOct. 1 marks the much anticipated launch of MNsure, the state’s new health insurance exchange. You may have recently seen ads and billboards featuring Paul Bunyon and Babe the Blue Ox talking about MNsure and encouraging Minnesotans to sign up for health insurance. That’s because under the Affordable Care Act (ACA), everyone is required to have healthcare insurance starting in 2014. Beginning Oct. 1, Minnesotans will have a new way to shop for health insurance coverage using MNsure, our state’s health insurance exchange.

So, what is MNsure? It’s an on online marketplace that you can use to compare plans and costs, enroll in public programs and purchase your own health insurance.

Who can use MNsure to buy policies? Individuals who don’t have health insurance, Medicaid recipients and small businesses with 50 or fewer employees can use MNsure.

How does this affect Children’s patient families?

  • If you currently have health insurance, you will likely see no change.
  • If you are enrolled in Medicaid already, you will be automatically transferred into the exchange for the first year. You will need to re-enroll for Medicaid through the exchange the second year.
  • If you do not have access to affordable coverage you can sign up for coverage through the exchange.
  • Enrollment begins Oct. 1, 2013 for coverage that takes effect on Jan. 1, 2014.
  • Low-cost plans, financial assistance and tax credits are available for those who qualify.
  • If you do not purchase health insurance you will be subject to a tax penalty.

Things to consider when picking your plan

  • Costs (premiums and out-of-pocket): MNsure users will be able to choose from a number of different plans: bronze, silver, gold or platinum. The various levels are based on the percentage of costs that the plans will cover. Be sure to pick a plan that works best for you and your family.
  • Access to health professionals: You will be able to look up your current pediatrician or provider on the MNsure website to ensure they participate in the plan you choose.

Children’s is here to help! Our financial counselors are being trained to help patients and families apply and enroll in health insurance through the exchange. They may also refer families to the MNsure Customer Service Center. Patient families can contact our financial counselors at the phone numbers listed below:

  • Minneapolis: 612-813-6432
  • St. Paul: 651-220-6367

The MNsure Customer Service Center: Customer contact specialists will be available to answer any questions online or through a toll-free number: 1-855-3-MNSURE (1-855-366-7873)

  • Monday – Friday: 7:30 a.m. – 8 p.m.
  • Saturday: 9 a.m. – 4:30 p.m.

Assistance will be available in English, Spanish, Hmong and Somali. Additional interpreter services are offered in more than 140 languages.

MNsure.org

You can also download and print a factsheet with this information.

Recap: Our discussion with Emily Bazelon on bullying

Emily Bazelon takes on the topic of bullying.

We read and hear about bullying in the news daily. But, what is bullying, exactly? Is it conflict? Picking on someone?

Emily Bazelon, a New York Times best-selling author of “Sticks and Stones: Defeating the Culture of Bullying and Rediscovering the Power of Character and Empathy” and Slate contributor, defines it as verbal or physical aggression that is repeated over time and involves a power imbalance.

Bazelon addressed approximately 130 health professionals, lawmakers, researchers and educators at the Minnesota Children’s Museum on Sept. 11. The event built upon work Children’s Hospitals and Clinics of Minnesota has done around bullying, including a report released earlier this summer: “Understanding the threat of bullying.”

Here are some noteworthy messages from the evening:

  • Social media is a vehicle for bullying. But if it’s happening online, it’s probably happening offline, too.
  • For the target of an online bully: The Internet makes it feel like bullying is happening 24/7. It’s permanent and visible, and it can potentially reach a bigger audience.
  • For the online bully: He or she doesn’t have to look the target in the eye, there’s no face-to-face feedback and it can be anonymous.
  • We spend little time talking about whether social media companies need to play a role. That needs to change.
  • We need to send the message to kids that bullying isn’t normal behavior, and it’s not something everyone does.
  • Bystanders who watch bullying often have the most power to stop it. Bystander kids intervene about 20 percent of time.
  • A message for kid bystanders: You don’t have to be a hero. A thoughtful or empathetic message like “Are you OK?” can be helpful.
  • What do we do about bullying? Bazelon emphasizes prevention and intervention, which can’t be done in a day. We need to help shape who kids are.

Read more about bullying and how one local family overcame it.

 

Being bullied: One family’s story

Kelly was bullied every day. First on the school bus. Then in her classroom. She was called “every name in the book.”

It went on for months, and her parents never knew.

Then, one day the bullying turned physically violent. Kelly was sitting quietly at her desk, her mom Lynn Miland described, when a student began repeatedly hitting her in the head. A teacher had to remove the student.

“I felt helpless to protect my daughter,” Miland said.

While Kelly had been bullied previously for months and months, it escalated when she moved to high school, Miland said. Transitioning from one school to another is a common time for kids to be bullied. And Kelly, on the autism spectrum, was an easy target.

“It can be hard to be different in any way especially during the early teen years,” said Dr. Michael Troy, Medical Director of Behavioral Health Services at Children’s Hospitals and Clinics of Minnesota.

While anyone can be bullied, targets of bullying have some common traits, including being different in behavior. Children who act differently due to developmental problems, psychological conditions, behavior disorders or aggressive medical treatment can be targets.

During early adolescence, anything that makes a child different from most of his or her peers is potentially problematic, even positive differences like being tall or smart, or having a musical talent, Troy said.

But, it’s especially hard for children with physical or mental differences who can’t modify them, he said.

As an adolescent, learning to negotiate the social world is a key developmental task. Something like autism spectrum disorder can make social communication difficult, Troy said. Consequently, since this is a time when the demand is greatest to learn and use social skills, it can also be a time that kids on this spectrum can be especially vulnerable to bullying.

Additionally, other kids who may be feeling insecure about their own social status, may resort to teasing or bullying peers they see as more vulnerable in an attempt to protect their own fragile self-esteem, Troy said.

When Kelly was initially bullied, her teacher told her to ignore it, Miland said. Kelly took this suggestion quite literally and didn’t say anything to anyone, even as the bullying continued to escalate.

“Never should a student who is being bullied be left to resolve a bullying situation. It’s really about an imbalance of power. If the adults don’t step in, it can really escalate,” Miland said.

After the incident and talking with school authorities, she reassured her daughter she wouldn’t be bullied again. But, when Kelly’s bus arrived near their home, it carried the same student who had been bullying Kelly for months.

That was a red flag, Miland said.

Miland turned to the PACER Center for help. The Minneapolis-based nonprofit had recently launched its National Bullying Prevention Center (PACER.org/bullying), which offers a variety of web-based resources for parents, students, and educators to deal with bullying situations.

“I was very grateful for the help I received because at that point, I didn’t know want to do,” she said of PACER, which she later joined as a parent advocate.

She then requested a meeting with school leaders to determine ways to keep her daughter safe.

“Fortunately, the school responded in a very positive way,” she said.

School leaders and Miland made sure Kelly wasn’t alone and established positive relationships with peers and school staff she could go to and trust if she felt unsafe. They also looked out for her.

To help Kelly adjust to returning to school, Miland gave her a note card with something positive written on it every day. The card also included names of people she could talk to in times of need.

Years have passed since the incident, but Kelly still remembers what she wore the day it happened.

When there’s an upsetting and unhappy memory, the more a child’s life is filled with rewarding social experiences, the less central the painful memory becomes by comparison, Troy said. 

“It’s something that’s etched in her mind always,” Miland said. “It’s something she won’t forget, but it’s something she has overcome.”

Miland’s advice for other parents:

  • If you notice a change in behavior, talk to your child. Kelly stopped wanting to go to school and wouldn’t say why she became isolated. That was a red flag.
  • Talk to your child about what bullying is and, if it’s happening to them, give them strategies so they can talk to parents, teachers and other adults.
  • Parents should report bullying to the proper authorities and put it in writing so there’s an investigation and follow-up. The report should include the name of the bully, when and where the incident occurred and any bystanders who may have been present. If cyber bullying occurred, include the information in the report.
  • Work with the proper authorities so there’s a plan for the child to feel safe. 

Check out Children’s newly released report on bullying, which includes a guide for parents. For more tips on bullying prevention, visit PACER.org/bullying.

Having a voice at Children’s

Eleanor Christiansen and her husband Tyler got an unexpected crash course in hospital life. 

Their usually healthy daughter, Greta, had few reasons to go to the doctor. Then, in January 2010, she developed croup and landed in the Emergency Department on the Minneapolis campus of Children’s Hospitals and Clinics of Minnesota.

Croup became secondary pneumonia. The ventilator became ECMO, which acts as a replacement for a child’s heart and lungs. An emergency visit became a nearly month-long stay in the hospital, with two-and-a-half weeks in the pediatric intensive care unit (PICU).

“Had she been somewhere else in the state, somewhere else in the country, there was a really good chance we would have lost our child,” Christiansen said. “We have this well of gratitude that we’ll always be able to tap and will probably never run out.”

Christiansen is about to begin her third year on the Family Advisory Council – showing her gratitude in a big way. The council comprises families whose children are past or current patients at Children’s. The group meets once a month for two hours for 10 months of the year.

Its members draw from their own experiences to make those for other families even better. The council recently created a resource guide for families. They’re currently working on a project to help families, especially with those who have special needs and may have equipment, access the hospital more easily.

“We provide a voice that nobody at the hospital can provide and be a real powerhouse of change,” Christiansen said.

Every member’s experience – the good and the bad – is important to the council, Christiansen said. And every story is important, too.

Stories like those of Michelle and Chris Jackman. Their daughter Samantha was born at 24 weeks gestation weighing a little over 1 pound and spent 128 days in the neonatal intensive care unit (NICU).

She quit her job to stay home and care for Samantha and during that time joined the NICU experience team in St. Paul. When she transitioned off the team, she joined the council.

“I wanted my experience and my knowledge to have some meaning and to have value,” Jackman said. “One of the things I’ve just loved about Children’s is that they’ve allowed me to find that value in that experience I had.”

Not every experience during their four-month stay at Children’s was a good one, Jackman said. But for every negative experience, there was a positive one, she said.

“I realize how fortunate I am on a million different levels. How fortunate I am in my personal experience. How fortunate I am to have a place like Children’s to bring my child,” Jackman said. 

Today, not only does she feel like she gets to help Children’s, she is grateful for the opportunity to share her story with others.

“Personally I wouldn’t be involved with the Family Advisory Council if I didn’t believe Children’s values the opinions and the work we do,” Jackman said. “I’m here because I know that they really value what we say and what we do, and we do have an impact.”

Interested in making an impact at Children’s, too? Please contact Tessa Billman, patient-family centered care coordinator, at 612-813-7407 today.

How Children’s is exploring the health impact of bullying

Click to see the full image.

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.