Dr. Bob Underwood (Host): Welcome to Pediatrics in Practice, A CME podcast. I'm your host, Dr. Bob Underwood. Before we introduce our guests, I'd like to remind you to claim your CME credits after listening to today's episode. You can do so by visiting cmkc.link/cmepodcast. And then, click on the Claim CME button.

Today, we are diving into a vital discussion about school safety and health policies with Children's Mercy's pediatrician, Dr. Erin McCann. Dr. McCann, welcome to Pediatrics in Practice.

Dr. Erin McCann: Thank you for having me.

Host: Absolutely. So as we are recording this, it's the back-to-school time of year. So pediatricians today, they really have to be attuned to rising concerns for our kids. We have mental health to think about, school violence and, of course, disparities of care. All of these are issues, but the list doesn't exactly stop there. So, let's talk about health and safety in our schools. To you, what is the most pressing school safety concerns that pediatricians should be aware of today and how can they support families in navigating them?

Dr. Erin McCann: I think it is a hard question to narrow it down. But when I think about this, there's three big things that come to mind. So, I would say the first thing that I think about would be decreasing rates of vaccine uptake in school-age children. And unfortunately, many of our communities are now dropping below herd immunity. So, I think pediatricians should really be discussing vaccines, as we do at nearly every visit, but really, really honing in on this with families, answering questions, sharing reputable resources for vaccine education as this may be changing, and really focusing on that and keeping vaccine preventable illnesses in mind too, as we're going back to school and everybody's getting exposed to different illnesses again.

Host: Yep. And we've all seen the increased rates of measles cases.

Dr. Erin McCann: Yeah. And I think that's a big thing that parents may have questions for you. And then, I think for those that don't ask questions, we need to make sure we're informing parents about what to look for and how to prepare in case there is a measles outbreak in their individual school. So, I think that's one of the big issues.

Another one that I think about a lot is just the fact that firearms are now the leading cause of death in children ages one to 19. And so, this really has to be part of your anticipatory guidance as well at every well visit, and especially as you get into those teen years, you know, talking about it with the teens when you have your private discussions with them as well as with the families. And if your practice doesn't have resources for families such as like gun locks, knowing what resources may exist in your community so that you can make sure your patient families have a way to safely store their firearms, to do as much as we can to protect our patients and their families.

And then, I think, the last one I think about is just safety, mental health of our children, thinking about bullying. And I think in particular this year, certain groups may be facing some more targeted attacks in the current environment we're living in. So whether that's based on their religion, their gender identity, their experiences of poverty, or where their family's from or what language they may speak, I think all of these different groups of children may unfortunately feel a little bit more targeted. And so, I think really making sure that we're paying attention to the mental health of our patients and the students in school and our families, just so we can kind of be on top of things before it becomes a mental health crisis.

Host: Yeah, absolutely. Let's kind of stem a little bit off of that. So along with being a pediatrician, you hold a Master's in Public Health in Global Health from the Harvard Chan School of Public Health. So based on your expertise here, how have recent changes in public health policy such as those related to COVID-19, mental health, vaccinations, how have they impacted school environments and school well-being?

Dr. Erin McCann: I think, from a public health perspective, we're in a somewhat unprecedented time right now with so much information that may be conflicting, that is circulating. And certainly plenty of misinformation about both vaccines in general, the COVID vaccine in particular, threats to some of our evidence-based policies. And I think that can cause a lot of confusion, both for families and also school systems of what resources to rely on and who to trust.

And so, I think as pediatricians, we really have to serve as a sounding board for our families and our schools and direct our families and our school systems of what evidence to use what institutions or organizations they can use for these school-based policies, whether that's related to vaccine policies, return-to-school policies after illnesses; thinking about the different policies that may be impacted by all of the changes that have come over the last few months and how we need to, from the pediatrician standpoint, kind of put on an aligned front so we're all sharing the same information with our families.

Host: And that really kind of is my next question is, what is the role that pediatricians play in advocating for safer and healthier school policies at the local or state level? You've been doing advocacy since residency. So, it's something that you're used to, but maybe not every pediatrician is.

Dr. Erin McCann: Yeah. And I think actually this is one of my favorite parts of pediatrics, and I think often for pediatricians seems very intimidating, but I think we need to realize the impact that we can have as pediatricians, regardless of your specialty or subspecialty, or how much clinic time you do versus research.

You may not necessarily feel like an expert on a certain topic in particular, maybe one that's in the current news cycle, but you really are. And so, I would encourage pediatricians to feel empowered to write an op-ed to your local newsletter. Reach out to your local legislators. Form relationships with them. While you can serve as an expert now, they may come back to you later on when they have questions for you as well.

The American Academy of Pediatrics, they also have an advocacy action center that you can go to. And based on your address, they'll help you send letters directly to your legislators. So if it's a little bit more intimidating, you really don't even have to fill anything in. They have a form letter. You can personalize it if you want, but you don't have to. So, they make it really easy to advocate as frequently as you want to.

And then, I think even on a more local community-based level, you can join your local community groups, local school boards so that you can be part of ensuring that the health and safety of children is at the forefront when they're thinking about what new policies should be developed, how they'll tackle maybe some of these illnesses that may come up throughout the school year. So, I think pediatricians have lots of ways to stay engaged and involved in their local communities.

Host: Yeah. I think that there are lots of ways that you could do that. A lot of folks are often just kind of unaware that it's even there. But then once you know it's there, it really kind of facilitates or removes the friction from that communication with your local legislators, which I think is huge. So, you brought it back kind of to the community base. So, how can or even how do pediatricians collaborate locally with school nurses or school counselors and administrators to create a more integrated approach to student health and safety?

Dr. Erin McCann: I think the best thing we can do as pediatricians is try and form relationships with the people who are seeing these children on a daily basis at school. So whether that is the school nurse who sees the kids that have asthma flares every fall, or the counselors who see the students that are struggling from a mental health perspective, I think if a pediatric practice can identify those few schools that the majority of their patients may attend, really trying to make yourself available, make your practice available so that these school administrators, school staff, school nurses can touch base with your office if they have a concern, whether that's a mental health concern or a chronic illness exacerbation, or some acute social needs that they can communicate with your office directly and try and figure out how we can work together to come up with a solution for the student or the patient.

And, you know, some clinics even put their own, whether it's physicians or mid-level providers or psychologists into the school, in school-based health clinics. And those are a really effective way to try and intervene before an issue becomes an even larger problem.

Host: Yeah. And I've worked with some primary care offices that have done exactly that. So, what are some effective strategies for addressing mental health? We've talked about mental health challenges a couple of times this morning. So, what are some of the effective strategies for addressing mental health challenges in schools. We've talked about mental health a couple of times, so how do we address these in schools, especially in that underserved or high risk community?

Dr. Erin McCann: I think the biggest thing that we can emphasize that I said a little bit already, but working with your local community partners to make changes at the community level, not just an individual level. So, thinking about some upstream interventions that may be impacting students and your patients and their families before it becomes a mental health true crisis for the individual.

So, we think about, from a public health perspective, primary, secondary, tertiary interventions. So, that may mean interventions at schools that focus on individual students who may be encountering mental health challenges. But then, there may be programs for small groups of students or families that are at high risk, and then there may be full school programs that target all students. So really, a multi-tiered, multi-level approach to kind of address this. And within that, I think regular screening in the school for depression and anxiety, with the caveat that if you're doing that, you have to have a way to link students to resources if they do screen positive. because we don't want students screening positive and then being left with no resources.

Um.

Host: That is the last thing we want to do is find a need and then not give a resource to address the need.

Dr. Erin McCann: Exactly. And so, I think partnering with your local pediatric offices, if they have the capacity, but really we're going to have to rely on our community mental health partners as well. And then, I think a big aspect that I haven't mentioned yet is just making sure that school staff are trained in trauma-informed care, and also make sure that staff are prioritizing culturally responsive practices. So, those that reflect students' racial, ethnic, religious, and linguistic backgrounds, because that's really the way that we're going to make progress and make sure that we're identifying children who may need our help.

Host: So, how can pediatricians help parents understand and navigate school policies? You know, policies that are related to bullying, emergency preparedness, or chronic illness management?

Dr. Erin McCann: So, I think this time of year is the perfect time, as we're kind of rushing through all of the school physicals, going through all of our anticipatory guidance for the school year. From the perspective of chronic illness management, this is something that, as general pediatricians, we all know kind of the back of our hand. We got to make sure everybody how to use their chronic illness medications, that we provide appropriate documentation for schools so they know what to do, and if there are exacerbations or flares of illnesses. And I think making sure we are on top of things before we hit the change of weather and the illness season, that will be a big thing.

In terms of the policies related to bullying and mental health concerns, I think pediatricians can really help facilitate the connection with families between school leadership or school administrators. So, a lot of times we may hear about a bullying concern, but parents don't really know who to turn to. And so, whether we can use our own social workers or school liaisons or just providing a letter to families that they can present to the school and say, "Hey, this is an issue. Can you please help the family address it and make sure that the issue is taken care of in the school front?" And so, I think helping the family demystify that process and know who to turn to is something we can really provide for them from the provider perspective.

Then, I think that is something from the policy standpoint pediatricians can be involved in. So if your kids go to the same school, or if you have a local school district where you live, you can be involved in developing these policies, whether these are the bullying policies or the emergency preparedness or chronic illness disease. How do you want to see it play out in the school? You can be involved on that aspect as well to make sure it's evidence-based and up-to-date with the most current recommendations.

Host: So looking ahead, what innovations or policy changes do you think could significantly improve school safety and health outcomes for children?

Dr. Erin McCann: I think this is a great question, and I think we have a lot of opportunity, and I think a fair amount of challenges ahead of us that just require us to maybe be more innovative and more resourceful when we're thinking about ways to make change with maybe more limited resources. So obviously, I think technology is something that we will be relying on more and more. So for example, from the school safety standpoint, I know there's recent studies that are looking at how to use virtual reality curriculums to train pediatric trainees or potentially even broader than pediatricians, but maybe school officials and having firearm discussions with families, using technology to augment our training in that regard.

I think more innovations in terms of the school-based health centers or school-based mental health providers is something that we're going to have to lean on more and more. And really, from the policy standpoint in that aspect, I think pediatricians are going to have to continue to be loud and shout from the rooftops how important these policies are in order to affect change with our kids.

We have a lot ahead coming, that is going to be challenging from the pediatrician perspective, you know, thinking about vaccine exemptions and how those are rising too. I think that's another thing that, from a policy standpoint, pediatricians should really be working with their lawmakers to make it more difficult to have these exemptions so we can protect our kids from a public health standpoint as we're going back to school.

Host: Is there any legislation that you're aware of that's being introduced either at your state level or nationally?

Dr. Erin McCann: So, I think there are some local efforts to try and maintain some of the funding for, Medicaid that may be going away or some more local grassroots campaigns to kind of bring back some of these resources that are otherwise being cut. But I think they are all facing uphill battles, both in, I think, most of our community listeners are probably from the Kansas or Missouri areas.

And so, I think we have a lot of challenges, but I do think it makes a difference when we, as pediatricians call and speak with our legislators to tell them what we're seeing on the front line. Many of these legislators have children of their own or grandchildren, and so we can connect with them and share with them our experiences. And I think that's a really valuable aspect that we bring to the table.

Host: I absolutely agree with you on that. Anything else you'd like to add before we kind of shut down today?

Dr. Erin McCann: I would just encourage pediatricians to use their voice, speak up, speak out. And if anyone has questions about getting into that advocacy sphere, I'm always happy to make myself available and try and get other people to get the little advocacy bug that I have as well.

Host: That's awesome. It really is. Dr. McCann, thanks for being with us today.

Dr. Erin McCann: Thank you so much for having me. I really appreciate having the opportunity to talk with you.

Host: Absolutely. As a reminder, claim your CME credits after listening to this great episode today. You can do so by visiting cmkc.link/cmepodcast and click the claim CME button. For more information and for other fascinating topics, you can visit that same site, cmkc.link/cmepodcast. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics that interest you. I'm Dr. Bob Underwood. And this is Pediatrics in Practice, a CME podcast.