RFDASH 2008: An Act Relative to Children’s Mental Health, S.2518

It was a Friday night, and I was partway through my shift on the inpatient pediatric unit at the MassGeneral Hospital for Children when I got the call:“We have a 15 year old female we’re admitting to you after a suicide attempt.She’s medically stable, but we can’t find a psychiatric bed for her.”Mary, as I’ll call her, had spent the past four days in the emergency room while numerous psychiatrists and case managers scrambled to get her admitted to a psychiatric facility that would be covered by her insurance.By Friday evening, the emergency room staff decided that they were unlikely to find a bed over the weekend, so Mary was admitted to the pediatric floor for monitoring and observation while the hunt for psychiatric placement continued.

When I finally met her late that Friday night, it had been more than 4 days since her suicide attempt, and she and her family looked exhausted.As I interviewed them, I learned that Mary had been feeling depressed for over a year.Her family had been aware that Mary seemed down, but did not understand the extent of her depression.She had not received any outpatient treatment because it was not covered by her insurance.It was frustrating and sad to watch the story unfold and realize that this could have been caught much earlier.It was even more frustrating to not be able to get Mary the treatment she needed in a timely fashion.

It is because of my experience with patients like Mary that I have become involved in pediatric advocacy.As a new pediatrician, much of my time is spent learning the intricacies of the body, and I am only now realizing that I must begin to understand the intricacies of politics as well.Children cannot speak for themselves and so pediatricians must speak for them.Through the MassGeneral Hospital for Children Advocacy Group, I have recently become aware of a bill currently under consideration: “An Act Relative to Children’s Mental Health, S.2518.”

This bill dates back to a 2002 class action lawsuit, Rosie D vs. Romney, which was filed on behalf of eight children with serious psychiatric problems who were unable to obtain services at home.The lawsuit claimed that the Commonwealth violated the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program of the Medicaid Act which is designed to assure availability and accessibility of health care resources for low-income children.The trial began in 2005 and involved more than 30 witnesses over 6 weeks testifying about the need for home-based services and the harm that occurs when these services are not available.

In early 2006, Judge Michael Ponsor ruled in favor of the plaintiffs and went on to say that Massachusetts did not provide adequate screening, in-home behavioral and crisis services, case management and care coordination for an estimated 15,000 children with serious emotional disturbances.This landmark decision resulted in a flurry of activity to remedy the situation.After 2 years of work and numerous revisions, “An Act Relative to Children’s Mental Health” is currently under review.This bill would improve and expand mental health services for children in Massachusetts by mandating early screening for behavioral health problems, ensuring children are treated in the most appropriate setting, improving insurance coverage and broadening delivery of state services.

On April 8^th, I and other pediatricians from across Massachusetts gathered at the Statehouse to advocate for this bill and others like it.Residents and Fellows Day at the State House is organized by the residents at MassGeneral Hospital for Children and sponsored by the Massachusetts Chapter of the American Academy of Pediatrics.This event is an opportunity for new pediatricians to gather at the State House for lobbying workshops from leaders in the field, learn about pediatric-relevant bills currently undergoing review, and meet with their own legislators.

Politicians need to hear from parents and pediatricians about the importance of bill S.2518.If you’re interested in supporting this bill, please find your elected officials at http://www.wheredoivotema.com/bal/myelectioninfo.phpTo contact them, please visit http://www.mass.gov/legis/memmenu.htm.Hopefully through our joint efforts, other families will not have to experience a suicide attempt, 4 days in the emergency room and 2 days admitted to the hospital in order to get their daughter the help that she needs.

Pediatric Residents Day at the State House

Here at the MassGeneral Hospital for Children, we are all getting excited about the upcoming event “Residents’ Day at the State House”.  It is amazing that this event is already in it’s third year!  The planning for the first event in 2006 seems so fresh in our minds, and yet it also feels as if it has always been an MGHfC flagship event, as it so epitomizes the ethos of our department.

In 2005 and 2006 an energetic and motivated group of pediatric residents got together in their “spare” time (when not working every fourth night overnight and 12 hour days in between) and designed this advocacy event from the ground up.  A few of us on the faculty lent support, but there was never a  moment when this wasn’t 100% a resident initiated and driven event.  That fact is what makes this such a very special project.

Three years in, we again anticipate a landmark event.  Pediatric residents and fellows from all 5 of the Massachusetts pediatric residency programs (MGH, Tufts, UMass, Baystate and Boston Combined) will congregate at the State House on April 8th.  They will spend the morning with amazing lifelong child advocates who will inspire while giving them practical skills for lobbying on behalf of children.  After a networking lunch (both breakfast and lunch are free for all participants thanks to the fundraising by the residents and the generosity of some of the participating residency programs and matching funds from the Mass Chapter of the AAP), all of the participants will head off to pre-scheduled meetings with their state representatives.  The residents will lobby on issues such as the booster seat law–Massachusetts woefully lags most of the nation by not having a law on the books enforcing the AAP and National Highway and Transportation Safety Administration’s recommendation for booster seats for children who are too big for toddler carseats (typically children who weigh more than 40 lbs but are shorter than the 4 ft 9 in height needed to adequately utilize the shoulder safety belt).  The effect of 20 mins of a physician’s time in the office of a legislator describing the children he or she has seen in the PICU after unrestrained MVAs has the chance to really make a difference in passing critical legislation such as this.

Every day I am proud to be a part of the MGHfC community and I relish my role within the pediatric residency.  It is this event, however, which makes me most proud of the residents we train.  Watching these young pediatricians turn months of planning and organizing into a phenomenal program of advocacy education overwhelms me with pride.  We are training an amazing group of dedicated, energetic pediatricians who not only will take excellent care of the children in their offices and hospitals, but will take the extra steps necessary to advocate for children’s health and well being on all levels.   I’m thankful to have the opportunity to work with them.

Shannon Scott-Vernaglia, MD

Associate Residency Director