In this Issue:

  • Vaccine Message from MCAAP President, Lloyd Fisher, MD
  • MCAAP Supports Masking for All in School this Fall
  • AAP Masking Resources
  • Department of Elementary and Secondary Education (DESE) Updates
  • MassHealth will Cover Short-term Preventive Behavioral Health Services for Children and Youth
  • Back-to-School Wellness Check Message from MCAAP Vice President, Mary Beth Miotto, MD, MPH
  • MCAAP Web Page with School Resources and Tools 
Vaccine Message from MCAAP President, Lloyd Fisher, MD
 
As we return all children in the Commonwealth to full time in-person learning this fall it is critically important that we do whatever we can to ensure that every child we see is up to date with all recommended immunizations. While our vaccine rates in Massachusetts are among the highest in the nation, we have seen a drop during the pandemic. We should use every visit with every patient as an opportunity to catch any child up who has fallen behind. We should also discuss the importance of the COVID-19 vaccine for all who are currently eligible. The rates of vaccination among the 12-17 population varies dramatically from community to community. Where some areas of the Commonwealth have >95% of the adolescent population vaccinated against COVID-19, some cities and towns are far lower (less than 50%). 

A high vaccination rate among our teen patients will give them the best chance for a successful in-person school year. In addition, the state has set a vaccination rate of at least 80% as a goal for all schools to achieve before a district can consider removing the in-school mask mandate. Let’s use this as an incentive for the teens to get their vaccine ASAP! It is likely that the vaccine will be authorized for those under age 12 sometime late fall or early winter; we should use the well-child visits for the younger children as an opportunity to discuss the vaccine with the parents and answer any questions which they may have. I have been telling all parents with whom I interact that the FDA is taking longer to authorize the vaccine and requiring more data in children under age 12 so that when it is available, I will be able to say with confidence that it is both safe and effective for ALL children.
MCAAP Supports Masking for All in School this Fall
The Massachusetts Chapter of the American Academy of Pediatrics (MCAAP), along with parents, caregivers, and schools, is committed to returning all of the Commonwealth’s children to full-time in-person learning this fall while mitigating the risks from COVID-19.  We have two mainstays for reducing COVID risk. The first is vaccination. The MCAAP strongly urges all who are eligible to obtain a COVID-19 vaccine as soon as possible. Doing so protects individuals, families, schools, and communities. The second includes strategies such as masking. In accordance with AAP and CDC guidance, MCAAP also urges all school districts in the Commonwealth to require students, teachers, staff, and visitors who enter a school building to wear masks when indoors to ensure a successful start to this school year and allow continued in person learning for all students. 

As the pandemic evolves, our primary prevention strategy remains vaccination of all eligible children and adults. At the same time, we must closely monitor disease prevalence and other key metrics to inform our decisions about other risk-reducing strategies. The evidence-based combination of prevention and mitigation will bring about the most expedient end to this public health challenge.

AAP Resources:

DESE Updates




Earlier this summer, the Department of Elementary and Secondary Education (DESE) updated its guidance on students who require home or hospital-based educational services. This FAQ contains the updated information. In addition, DESE created a form for parents to present to their child's pediatrician if the student receives special education and is likely to need home or hospital-based services for at least 60 days during the school year. We hope that this information is useful to pediatricians and if they have any questions about this topic, they can contact Russell Johnston, DESE Senior Associate Commissioner, at russell.johnston@mass.gov.  

From Amanda Cassel Kraft,
Acting Assistant Secretary for MassHealth

The COVID-19 pandemic is significantly and uniquely impacting the emotional well-being of children and adolescents. Earlier identification and intervention are key to providing children, adolescents, and their caregivers with needed behavioral health supports to preserve and promote their well-being. For many youth, short-term interventions in supportive group, individual, or family settings cultivate coping skills and strategies for symptoms of depression, anxiety, and other social/emotional concerns, which may prevent the development of behavioral health conditions.
 
Beginning on September 1, 2021, MassHealth will cover short-term preventive behavioral health services for children and youth who have behavioral health symptoms, as evidenced by a positive behavioral health screening. We anticipate that allowing providers in community-based settings, primary care, and schools to provide preventive services is an opportunity to address and mitigate negative impacts of the pandemic, and to further healthy developmental outcomes for MassHealth-enrolled youth. Further guidance on the implementation of these services within the School-Based Medicaid Program will be issued later this month.
 
 
Back-to-School Wellness Check Message from
MCAAP Vice President, Mary Beth Miotto, MD, MPH
 
As our patients return to school in the next few weeks, there will be an extra layer of preparation and possibly an extra layer of anxiety whether they’re starting preschool or returning to college. Pediatricians are still among the most trusted professionals and can help parents and youth face this school year with confidence and excitement. We’ve collected some tips and online resources for pediatricians and other trusted adults to support our children’s physical and mental health.

Children and youth returning to school this fall face a number of challenges including rusty social skills, changes or breakdown in friendships, grief of lost loved ones, concerns about racism, and increased bullying and peer pressure over choices and risk behaviors. Many are experiencing increased anxiety about the health and future of themselves, their loved ones, and the world. Parents may appreciate advice on how to prepare and offer ongoing support, how to recognize concerning signs of worsening mental health, and how to keep their families strong. https://www.childrens.com/health-wellness/back-to-school-anxiety-during-covid-19

Pediatricians looking to learn more about how youth resilience is built should take the opportunity to dig into the recent AAP policy statement:  Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. A great resource (and printable handout) for parents leveraging this new information can be found in Building Resilience in Children.

As resilience starts with strengthening relational health, we can encourage parents to be attentive to their own mental health needs during this transition time. The perennial advice for parents to “first put on their own oxygen mask” has never been more relevant than during the COVID-19 pandemic. It takes tip-top physical health, wellness, and energy to create a nurturing environment for kids and we can remind them of strategies to keep themselves up to the challenge. https://cmho.org/back-to-school-tips-for-parents/

Back-to-school time is a great time to renew the pediatrician’s partnership with teachers and school nurses too. We all can share information (in English and Spanish) to help families make the tough transitions, especially during the pandemic. https://www.cdc.gov/childrensmentalhealth/features/COVID-19-helping-children-transition-back-to-school.html. Districts throughout Massachusetts have added valuable mental health services for their students and pediatric offices can take this opportunity to reach out and ask their local school nurses about new resources located in the school or community.

We can all do better by proactively discussing concerning signs of depression and anxiety with families. Set up your office to support and refer families to mental health resources, and to educate them about the available therapies (https://www.cdc.gov/childrensmentalhealth/parent-behavior-therapy.html). If they are struggling with timely access to child psychiatry services, don’t forget all of the valuable resources at MCPAP (https://www.mcpap.com), including information on youth mobile crisis intervention. Your office can call 1-877-382-1609 for a list of local mental health emergency services for youth.

Teens can also be prompted to develop self-awareness of their own moods and seek out confidential support services. https://www.cdc.gov/howrightnow/ is a decision tool that brings information and resources directly to the teen. Now is a good time to also arm your teen and young adult patients with phone numbers that can be used for themselves or their friends. Many are available by phone or text.

  • National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
  • En español: 1-888-628-9454; deaf and hard of hearing: dial 711, then 1-800-273-8255.
  • Samaritans Statewide Hotline (call or text) at 1-877-870-HOPE (4673).
  • Call2Talk can be accessed by calling Massachusetts 211 or 508-532-2255 (or text c2t to 741741).

Finally, don’t forget the safety and wellness Back-to-School Tips that you’ve been offering for back to school in non-pandemic years. Parents still need to think about safe walking or biking to school, healthy lunches, sleep hygiene, and afterschool care and we don’t want to miss opportunities to reinforce healthy childhood anticipatory guidance.
MCAAP Web Page with School Resources and Tools

 
The MCAAP interactive and printable decision tools on COVID testing and quarantine are currently being updated to be consistent with this year’s DESE/DPH guidance.
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