For Better Health SECTION C
THE NEWTOWN BEE, FRIDAY, OCTOBER 16, 2020
With Halloween 2020 Happening Amid A Pandemic, Is It Safe To Trick-Or-Treat? By Shannon Hicks Working from home. Online learning. Social distancing. Face masks. Restrictions on gatherings. These terms have become part of our everyday language this year thanks to the continued COVID-19 scourge. With the approach of the holiday season, a new discussion has begun: How do people safely celebrate winter celebrations? With the return of autumn and the approach of October 31, many people are wondering what to do about Halloween and trick-or-treating. Officials in many of Connecticut’s towns and cities have begun the discussion on whether to ban the longstanding tradition. On September 17, Governor Ned Lamont said he expects “to have a Halloween season.” Lamont has set out specifics since that press conference (see details on Page C-2), but pointed out that Halloween is “a time of the year when people automatically wear masks, they often wear gloves, so it seems like you’re 90 percent of the way towards a safe way to do Halloween just by definition.” A week earlier, Springfield (Mass.) Major Domenic J. Sarno announced that door-to-door trickor-treating will be banned this year in that city. A press release from the city said in part that “COVID-19-safe events, such as drive by, drive-through, drive-in, and/or car parade events may take place as long as proper public health and safety protocols and guidelines are followed and adhered to.” Halloween this year will be on a Saturday, under the pale light of a blue moon, a full moon, and the eve before the end of Daylight Saving Time. It seems like the perfect convergence of events… most years. Dr Jeannie Kenkare, chief medical officer of PhysicianOne Urgent Care, has concerns about the safe-
ty of trick-or-treating and other Halloween activities amid the COVID-19 pandemic. The mother of three said the transmission rate and number of positive cases will play into what to do about Halloween this season. When it comes to door-to-door trick-or-treating, Kenkare said the key thing to understand is what is already known about the disease, to make some educated decisions. “What we know is that COVID is transmitted through close contact,” she said during a September 24 interview. “Our definition of ‘close contact’ right now is more than 15 minutes within 6 feet.” Many parents will be quick to point out that children will not be that close to anyone for that length of time while trick-or-treating, and Kenkare says that is “good news.” While brief contacts will be beneficial, she said parents will need to also consider “what else they’ll be coming into contact with.” Hosts handing out candy, for instance, may be unaware that they are carrying the virus, said Kenkare. Children may contend with community bowls — “bowls of candy that other people who might have COVID have also stuck their hands into, too” — at an untold number of homes. “Those are the kinds of things that I think about as a medical professional when I think about the risks of door-to-door trick-ortreating,” she said. As of September 21, the Center for Disease Control and Prevention (CDC) said many traditional Halloween activities “can be highrisk for spreading viruses.” Listed within the activities with the highest risk of spread was traditional trick-or-treating. Higher Risk Activities According to the CDC, the following activities should be avoided to help prevent the spread of the virus
The Halloween & Costume Association, working with Harvard Global Health Institute, has unleashed Halloween inspiration to celebrate the season in safe, fun, and unexpected ways. Visit halloween2020.org to find the COVID risk level of any county in the country, and then find suggestions to safely celebrate Halloween based on those risk assessments. —Halloween & Costume Association graphic Face masks should not be put aside for Halloween, experts agree. Whether incorporated into a costume or worn under a decorative mask, health risks need to be considered more than ever when deciding what to wear — and whether or not to go trick-or-treating — this year. —Bee Photo, Hicks that causes COVID-19: *Traditional trick-or-treating where treats are handed to children who go door to door. *Trunk-or-treat events, when treats are handed out from trunks of cars lined up in large parking lots. *Attending crowded costume parties held indoors. *Going to an indoor haunted house where people may be crowded together and screaming. *Going on hayrides or tractor rides with people outside your household. *Using alcohol or drugs, which can cloud judgement and increase risky behaviors.
*Traveling to a rural fall festival outside one’s community. Moderate Risk Activities The following activities, while still deemed moderate risk, can be done as long as safety precautions are in place and strictly followed: *Participating in one-way Trick or Treating where individually wrapped goodie bags are lined up for families to grab and go while continuing to social distance, such as at the end of a driveway or the edge of a yard. Those preparing goodie bags should wash their hands with soap and water for at least 20 seconds before and after preparing the bags.
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Lower Risk Activities These lower risk activities can be safe alternatives, according to the CDC: *Carving or decorating pumpkins with members of one’s household and displaying them. *Carving or decorating pumpkins outside, at a safe distance, with neighbors or friends.
*Decorating your living space. *Doing a Halloween scavenger hunt where children are given lists of Halloween-themed things to look for while they walk outdoors from house to house admiring Halloween decorations at a distance. *Having a virtual Halloween costume contest. *Having a Halloween movie night within one’s household. *Having a scavenger huntstyle trick-or-treat search with your household members in or around your home rather than going house to house. Important Mask Information A costume mask, such as a Hal( continued on page C - 2 )
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*Having a small group, outdoor, open-air costume parade where people are distanced more than 6 feet apart. *Attending an outdoor costume party, where protective masks are used and people can remain more than 6 feet apart. *Going to an open-air, one-way, walk-through haunted forest/ park/yard where appropriate mask use is enforced, and people can remain more than 6 feet apart. If screaming will likely occur, the CDC advises greater distancing. The greater the distance, the lower the risk of spreading respiratory virus. *Visiting pumpkin patches or
orchards, where people use hand sanitizer before touching pumpkins or picking apples, wearing masks is encouraged or enforced, and people are able to maintain social distancing. *Having an outdoor Halloween movie night with local family and/or friends, with people spaced at least 6 feet apart. Again, if screaming will occur, greater distancing is strongly encouraged.
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THE NEWTOWN BEE, FRIDAY, OCTOBER 16, 2020
With Halloween 2020 Happening Amid A Pandemic, Is It Safe To Trick-Or-Treat? county, the website offers suggestions to safely celebrate Halloween for trick-or-treaters, homeowners, and parents. For those who are interested, the website also shows risk levels in multiple locations around the world.
( continued from page C - 1 ) loween mask, is not a substitute for a cloth mask, the CDC points out, unless it is made of two or more layers of breathable fabric, covers the mouth and nose, and does not leave gaps around the face. “A mask that’s protective from an infection control standpoint,” said Kenkare, “is one that creates a barrier from the breathed air — or the exhaled and inhaled air — that the child or adult is coming in contact with. It’s something that covers and filters both the air coming in and out through the nose and the mouth.” Halloween masks, she pointed out, generally have holes for the nose and/or mouth, and do not help to protect against the spread of the virus. The CDC also warns against wearing a costume mask over a cloth face mask, as the costume mask can make it difficult to breathe. Consider skipping the costume mask entirely and using a Halloween-themed cloth mask in its place. Risk Factors And Precautions Kenkare says parents should reconsider the tradition of going door to door on October 31. “What we’ve all been really cautious about is making sure that we know where our own contacts have been, and who else they’ve been in contact with,” she said. “When you’re going door to door, you’re really expanding that circle.” Kenkare recommends parents control that exposure. “I’m not saying ‘Let’s not Halloween,’ but maybe trick-or-treating isn’t the way to do it this year,” she said. Instead of going door to door to collect candy, Kendara suggests parents consider a Halloween celebration with a limited number of people, outside, with social distancing maintained, and minimizing
Newtown officials recently announced guidelines for Halloween in Newtown this year, including a request to curtail any trickor-treating on Main Street. The annual rite typically draws thousands from town and across the region, which officials believe could promote the transmission of COVID-19. See more details about alternate activities in our October 9 print edition, or at newtownbee.com. —Bee file photo shared food or drink, she suggested. “Maybe there’s somebody preparing small portions, that get individually packaged and handed out,” she added. Candies can be dispensed that way as well, Kenkare said. For those who are “really, really fixed on trick-or-treating,” Kenkare suggests going only to familiar
homes and locations. “And do that only with prepacked goods and without community bowls,” she said. Likewise, the CDC is offering “considerations” — along with the caveat that “these considerations are meant to supplement, not replace, any state, local, territorial, or tribal health and safety laws, rules, and regulations with this
Connecticut Halloween Guidelines
By Shannon Hicks During an afternoon press conference October 1, Governor Ned Lamont discussed the importance of continuing to wear cloth masks to prevent the spread of the coronavirus. Connecticut requires people to wear face masks when in public, and when it is not possible to maintain a 6-foot distance from others. Halloween was repeatedly asked about during the 45-minute event. The governor said he and others are “not standing in the way” of parents who want to take their children trick-or-treating this year. “We’re just giving you clear guidance on how you can do that safely,” he said. Shortly before the press conference, the State Department of Public Health (CT DPH) issued suggestions for reducing the risk of spreading the virus in light of the upcoming holiday. Citing the guidelines recently issued by the CDC (see related story), Connecticut’s health department is suggesting that anyone planning to participate in Halloween activities this month review those national guidelines. “DPH recommends that Connecticut residents avoid higher-risk Halloween traditions and focus celebrations on the lower- and moderate-risk activities,” the department stated on its website. “The ability to maintain social distancing and follow face covering rules is especially important with participating in Halloween activities,” the notice also stated. The CT DPH is asking Connecticut residents to avoid parties that exceed 25 people indoors or 150 people outdoors. The department reminds residents that as outlined by one of the governor’s recent executive orders, anyone hosting events that exceed those numbers will face fines of $500. Attending an event that exceeds those numbers can result in a fine of $250 for guests. Restaurants that choose to host Halloweenthemed events should strictly adhere to capacity and physical distancing guidelines already published by the state. Colleges and universities, the department also said October 1, should consider alternatives to on-campus parties or trick-ortreating between dorms.
“Guidance for safe Halloween activities should be shared widely and with on- and off-campus students,” the department posted. Like the CDC, the CT DPH is also suggesting one-way trick-or-treating for anyone who wants to partake in that activity. During the press conference, the governor showed photos of a pair of residences where homeowners have already set up safe trick-ortreating delivery systems. Lamont complimented that work. “These are two people who have both created a chute so you come to the door and the candy comes right to you,” he said. “You don’t have to get that elaborate, but it gives you some creative thinking,” he added. For those who do not feel safe having trick-ortreaters at their home this year, the governor suggested taking a traditional action: Keep the door closed. One further step, as many have pointed out, is to make sure front porch lights are off. That has long been a sign that trick-or-treaters should not approach a home. Those who prepare goodie bags should wash their hands with soap and water for at least 20 seconds before and after doing so. The state department also suggests parents or guardians limit the number of homes their children visit, and trick-or-treat only with those within a household. Adults and children should additionally remain 6 feet away from people outside their household. Dr Deidre Gifford, acting commissioner of the CT DPH, said October 1 that it is not necessary to avoid all Halloween events. Seated 6 feet away from the governor that afternoon, she reiterated her department’s just released guidelines. “We don’t think it is necessary to cancel Halloween activities,” she said, “but there are different risks associated with different traditional activities on Halloween night and we’re recommending that people avoid those high-risk activities.” Like the CDC, the state considers indoor haunted houses, hayrides and tractor rides, large parades, and trick-or-treat/trunk-or-treat all events that should be avoided this year.
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holiday gatherings must comply. “When planning to host a holiday celebration, you should assess current COVID-19 levels in your community to determine whether to postpone, cancel, or limit the number of attendees,” the agency said on its website as of September 21. The Halloween & Costume Association has unleashed Halloween inspiration to celebrate the season
in safe, fun, and unexpected ways. Visit halloween2020.org to find the COVID-19 risk level of any county in the country, thanks to an interactive map presented by Harvard Global Health Institute. Risk levels range from Green (safest) and Yellow (where Fairfield County rested on September 25) to Orange and Red (highest risks). Based on the zone of the visitor’s
Holiday Gathering Considerations The CDC continues to remind Americans that celebrating virtually or with members of one’s own household poses a low risk for spread of the virus. In-person gatherings “pose varying levels of risk,” according to the agency. Several factors contribute to the risk of getting infected or infecting others during any gathering, including holiday celebrations. It is important, the agency contends, to consider them individually and together: *Community levels of COVID19. Higher levels of COVID-19 cases and community spread in the gathering location, as well as where attendees are coming from, increase the risk of infection and spread among attendees. Family and friends should consider the number and rate of COVID-19 cases in their community and in the community where they plan to celebrate when considering whether to host or attend a holiday celebration. Information on the number of cases in an area can be found on the area’s health department website. *The location of the gathering. Indoor gatherings generally pose more risk than outdoor gatherings. Indoor gatherings with poor ventilation pose more risk than those with good ventilation, such as those with open windows or doors. *The duration of the gathering. Gatherings that last longer pose more risk than shorter gatherings. *The number of people at the
gathering. Gatherings with more people pose more risk than gatherings with fewer people. The CDC does not have a limit or recommend a specific number of attendees for gatherings; that responsibility rests with state and local leaders. The size of a holiday gathering should be determined based on the ability to reduce or limit contact between attendees, the risk of spread between attendees, and state, local, territorial, or tribal health and safety laws, rules, and regulations. *The locations attendees are traveling from. Gatherings with attendees who are traveling from different places pose a higher risk than gatherings with attendees who live in the same area. Higher levels of COVID-19 cases and community spread in the gathering location, or where attendees are coming from, increase the risk of infection and spread among attendees. *The behaviors of attendees prior to the gathering. Gatherings with attendees who are not adhering to social distancing (staying at least 6 feet apart), mask wearing, hand washing, and other prevention behaviors pose more risk than gatherings with attendees who are engaging in these preventative behaviors. *The behaviors of attendees during the gathering. Gatherings with more preventive measures, such as mask wearing, social distancing, and hand washing, in place pose less risk than gatherings where fewer or no preventive measures are being implemented. Suggestions and guidelines are changing regularly. The best thing anyone can do for Halloween this year is the same thing they should have been doing all along during this extraordinary year: Listen to health officials and follow their advice.
This Fall, NHS Athletes Adapted Around Restrictions To Stay In Shape By Andy Hutchison Newtown High School athletes put a lot of effort into summer training as they prepare for game season each year. With social distancing restrictions in place since early July, following cancelation of the end of winter postseason in March and all sports in the spring, things have been quite different this goaround. Football players have been hard at work since the summer, even with the season very much in question as the fall approached, and even after traditional 11 versus 11 football was canceled in early September. “The summer conditioning was very different this year compared to previous years. We did not have a lot of time or access to our weight room,” said Bobby Pattison, coach of the Newtown High School football team, who traditionally runs workout programs for football players four days a week for two-plus hours each session throughout the summer. This past summer, the team was limited to hour-long sessions three days each week, beginning July 6, after everything was shut down in the spring. Smaller Cohorts Pattison said the team was broken up into smaller cohorts and competed against each other in events to earn points and bragging rights. Some of the events were tire flip, timed running events, move the mountain (moving 45-pound plates back and forth), and agility races. “Our focus was to create a competitive environment that required a combination of strength and explosiveness,” said Pattison. Workouts and skill work continued in the fall as players protested and team members hoped for a change in decision and were allowed to continue conditioning and skill work for a football experience, even if games never happened. Teams continued to practice deep into September and into October before the start of 7 versus 7 football/ Strongman Competition. Because of the restrictions that resulted in team members working in cohorts of ten and no scrimmaging through Septemwber 20, sports squads had to rely on endurance and skill training to prepare as much as possible for their anticipated early Octo-
Newtown High School’s Luke Hannan, left, takes the handoff from quarterback Jack Street during preseason practice at Blue & Gold Stadium this fall. The traditional football season was canceled, but players continued to practice in hopes of either an unsanctioned season or competitions. —Bee Photo, Hutchison ber start to game play. The regular season was initially to begin in early September but was pushed back three weeks to allow for a gradual increase in training as well as contact in game-like preparation during preseason. Coming In Prepared “We’re not game fit. That’ll come. I think we’re all in the same boat. We’re behind and every school’s behind in terms of their game fitness level,” Marc Kenney, coach of Newtown’s girls’ soccer team said before full team practices were
allowed, beginning on September 21. Kenney praised NHS Athletic Trainer Sabrina Byrne for her efforts in preparing his athletes during her summer conditioning program for the 14th year. “They came in so well-conditioned,” Kenney said. “If you come in fit it’s not hard to stay fit.” Byrne said aside from no access to the weight room and following mask-wearing, temperature check, and social distancing protocols, the athletes got the usual workouts in during the hot days of summer.
Back in the spring, coaches worked with their athletes by conducting virtual workouts. "It went right into summer," said NHS Athletic Director Matt Memoli, adding that the Newtown players took it upon themselves to train and came into the fall in great shape. During the September preseason, teams initially were limited to 60-minute practices a couple days each week and that block of time was split between conditioning and individual skill work. Some sports had to hold two varsity practices in the same day to
divide large groups of athletes. The girls’ swimming and diving squad was one of them; team members practiced twice each week with athletes conditioning outside of the pool on non practice days to offset the time missed during in-pool training. “We just want to make sure everybody stays safe,” Becky Osborne, head coach of the NHS girls’ swim team, said in an article “Swim Meets Will Have New Look Necessitated By Social Distancing,” published in the September 18 edition of The Bee.
‘Sunny’s Story’ Site Aimed At Helping Kids Make Healthy Choices NORWALK — The Courage to Speak Foundation has unveiled a new website for Sunny’s Story that includes audio excerpts from the book, family album photos, testimonials, and more. Sunny’s Story is a compelling story for children, teenagers, parents, grandparents, and teachers written by Norwalk resident, Virginia “Ginger” Katz. It tells of joyful times and sad times, and of how a dog’s best
friend was needlessly lost. “During this time, many will find themselves needing to stay home with their children due to school closures,” Katz said. “Now is the time to read Sunny’s Story with your children to ensure they are empowered to be drugfree.” The story is narrated through the eyes, ears, and mind of Sunny, the family beagle. It shares the ups and downs of life
with his young master, beginning with their meeting at an animal shelter, and ending with a futile effort to ward off disaster. Katz has brought new life to her message of empowering youth to be drug-free. Sunny is a keen and intelligent observer of damage done by alcohol and other drug use to his master, Ian. This heartwarming but tragic
story will make readers young and old think twice about choices being made every day. The book, which is ultimately about love, compassion, caring, and understanding, offers universal messages for people of all ages. Sunny’s Story can also be used alongside the Courage to Speak drug prevention education curriculum available for elementary, middle, and high school. Learn more at sunnysstory.com,
THE NEWTOWN BEE, FRIDAY, OCTOBER 16, 2020
School District Nursing Supervisor Offers Information, Explains Common COVID-19 Terminology By Eliza Hallabeck Newtown School District Nursing Supervisor Anne Dalton recently shared information for families to use with students now in school while following COVID-19 precautions. She also offered a list of common COVID-19-related terms. At the start of the school year a self-screening tool was e-mailed to families to outline the daily health check that can be followed. “We are asking students and staff to screen each day before leaving the house to come to school,” Dalton wrote in a recent e-mail. “Each person is to be screened for an oral temperature of 100 or higher, new uncontrolled cough, shortness of breath, difficulty breathing, and loss of taste or smell.” The COVID Daily Health Check sent at the start of the year is available at docs.google.com/ document/d/1r6uzmfncoxitouhofawyq7hzlink5txpk uo65gcjytw/edit “Students younger than high school will probably need an adult to conduct the screening, and all students will most likely need reminders. The symptoms listed on the checklist are the five that have been identified by the Connecticut Department of Health (DPH) as the most predictive of COVID-19 diagnosis,” said Dalton. “If a student or staff member is experiencing one of these symptoms, they are advised to stay home; contact their health care provider for assessment and guidance and notify the school. COVID-19 can present with a wide range of symptoms beyond the five listed by the DPH, especially in children,” she said. “Any child who is feeling ill should be kept at home until recovered. Contact your health care provider if there is any question of COVID-19.” If someone is not feeling well at home, Dalton said parents should contact their health care provider for advice on whether COVID-19 testing is indicated. If any family member is having difficulty breathing, Dalton said the doctor should be contacted right away. Anyone who feels ill is urged to stay home and, if possible, stay away from other family members, Dalton said, adding that it is important to let the school know if a student is staying home due to illness. “Students and staff have been great across the district about wearing masks and adjusting to all of the protective measures that have been put in place in our buildings,” said Dalton. “So far, we have not seen ‘in school’ transmission of COVID, which speaks to the effectiveness of all of our mitigation efforts. If your child is staying home due to illness or exposure to COVID-19, please call your school nurse,” she said. “Avoid e-mailing this information to teachers. The school nurse will inform the staff that your child will be absent or distance learning and will keep health information confidential.” Dalton said the school nurses are working “very closely with our local Health Department” to track any exposures and positive cases of COVID-19, and the Newtown Health Director will be in touch with Newtown residents who test positive to offer specific instructions regarding isolation and quarantine. With students back in school buildings, Dalton said the district has learned that almost all students can learn to wear a mask during the school day, and the mitigation strategies put in place are working so far. “Students should know that everyone is working hard to be sure that they are getting a high-quality education this year,” Dalton wrote. “We are very proud of our students and the way that they have stepped up to all of the new expectations presented to them. “We count on all of our students to keep each other safe and healthy by cooperating with our COVID safety measures. Remember, this is temporary. You will be able to go back to sports and freely socializing with your friends when we get to the other side of this pandemic. We will all get through this together.” Dalton said everyone is part of this “team effort.” “In addition to continuing to protect each other by following public health guidance,” said Dalton, “we all need to remember to be especially kind to each other. Avoid gossip and blaming. Newtown is a strong and resilient community. Our strength is being tested. Let’s work together to rise to the occasion.” Frequently Questions, Answers Dalton also shared three frequently questions that parents and caregivers ask and the answers. To the question, “If my child was playing with the [sibling] of someone who tested positive for COVID, do they need to stay home?” She said, “No, [they
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Working to assure the conditions in which people can be healthy • Protecting our Environment Newtown School District Nursing Supervisor Anne Dalton stands beside optometrist Dr Joe Young in this Newtown Bee file photo. The local medical professional recently offered a raft of information and definitions of commonly used terminology related to the coronavirus, which she hopes will be helpful for students’ parents and caregivers. are] a ‘contact of a contact’ and therefore considered low risk.” To the question, “What are the rules for travel outside of Connecticut?” Dalton said, “The state has detailed travel advisory guidance [online] at portal. ct.gov/coronavirus/travel. Unnecessary travel is generally discouraged. If you must travel, consult the list of states with high case rates to see if you will be required to quarantine upon your return.” To the question, “How does contact tracing work?” Dalton shared, “If there is a report of a positive case at school, the Health Director is notified and conducts an investigation to identify anyone who
was directly exposed — within 6 feet for 15 minutes or more. The positive case is instructed to stay home, isolated from others in a separate room as much as possible. “Positive cases need to isolate for ten days from the start of symptoms — or from the test date if asymptomatic. Direct contacts of a positive case are notified and instructed to quarantine for 14 days from the date of exposure. Fourteen days is the window of time in which a contact could develop symptoms. For any positive case within the schools, a letter will be sent out from the superintendent’s office to inform the school community.”
Defining Common COVID-19-Related Terms Newtown School District Nursing Supervisor Anne Dalton shared some definitions for COVID-19-related terms that people may be hearing frequently. “COVID 19 has introduced all kinds of new terminology into our everyday lives. In the hope of clearing up some misconceptions, I am sharing this list of frequently used terms and a brief definition of each,” she wrote. Those terms are: Case: A “case” or “positive case” refers to an individual who has tested positive for COVID 19. Contact: A person who has had direct contact with a positive case. (15 minutes or more within 6 feet of a positive case). Contact of contact: A person who has been in contact with a person who had direct contact with a positive case. (This is a low-risk situation. No special treatment or restriction is needed) Isolation: A person who has tested positive is asked to strictly isolate themselves in a separate room away from others as much as possible for ten days from the beginning of symptoms or from the date of the positive test if no symptoms. Quarantine: People who are direct contacts
of a positive case need to quarantine (do not leave the house) for 14 days from their last exposure to a positive case. In the case that a person cannot avoid contact with the ill individual (e.g., a young child), quarantine begins from the last day of possible exposure which is the last day of the ill person’s isolation (for a total of 24 days) Rapid test: A test for COVID with results available within hours. If positive, the result is very reliable, but there are many false negatives. PCR Test: The gold standard for testing for COVID. Results usually within 48 hours. Contact Tracing: An investigation process conducted by the Health Department in coordination with the school district to identify and notify contacts of positive cases and to instruct them in any required quarantine or isolation procedures. Sibling questions: If a student is sick but has not been diagnosed with COVID-19, siblings usually do not need to be excluded from school. If a student is a case, siblings will need to quarantine for 14 days from their last exposure. If a student is a contact, their siblings do not need to be excluded unless they had direct contact with a positive case — per guidelines from the Connecticut DPH.
Lawmakers Demand Big Pharma Expand Access To 340B Schedule Drugs
WASHINGTON, DC — US Senator Richard Blumenthal (D-CT) led a group of 22 senators, including US Senator Chris Murphy (D-CT), in demanding that pharmaceutical manufacturers stop withholding medications discounted under the 340B Drug Pricing Program from qualified providers that use contract pharmacies — locking out lowincome patients from accessing life-saving drugs and care. In a letter to the drug industry trade group Pharmaceutical Research and Manufacturers of America (PhRMA), the senators pointed to multiple retaliatory, burdensome, and likely unlawful efforts by its member drug companies to prevent 340B-covered providers from receiving discounted drugs, including denials to providers using contract pharmacies and excessive claims data requests. “By improperly limiting access to 340B drugs, manufacturers will sever a lifeline to treatment for those who are overwhelmingly underserved, lowincome, and vulnerable,” the senators wrote in the letter to PhRMA President and CEO Stephen Ubl. “It is troubling that during a time of deep uncertainty involving access to health care, many of your member companies are taking retaliatory actions against FQHCs [Federally Qualified Health Centers] and other nonprofit health care providers that utilize legally permissible channels, such as con-
tract pharmacies, to dispense 340B drugs. This coercive behavior is ultimately most harmful to patients and should be reversed,” the letter states. The 340B Drug Pricing Program requires drug manufacturers who receive reimbursements through Medicaid to provide discounted drugs to eligible public and nonprofit health care
organizations, including FQHCs, hospitals, Ryan White HIV/AIDS clinics, and other safety net providers. Those providers in turn use 340B savings to provide discounted drugs to patients, especially those who are lowincome or uninsured, and expand access to essential patient care. Covered 340B providers are allowed to con-
Senators Chris Murphy and Richard Blumenthal of Connecticut are demanding pharmaceutical manufacturers stop withholding medications discounted under the 340B Drug Pricing Program and locking out lowincome patients from accessing life-saving drugs and care.
tract with pharmacies, known as “contract pharmacies,” to dispense 340B drugs. The senators also called on drug manufacturers to stop the practice of requiring 340B providers to submit claims data — and threatening to deny 340B pricing for drugs dispensed through contract pharmacies if providers did not provide the requested data — pointing out that this excessive and burdensome data request is not tied to federal 340B compliance obligations, stating “[t]hese onerous requirements from the pharmaceutical industry’s 340B program manufacturers are egregious oversteps that will limit the ability of 340B-covered entities to provide affordable care, and ultimately, harm patients.” The senators highlighted that the Health Resources and Services Administration (HRSA), which oversees the 340B program, has agreed that the steps taken by drug manufacturers put patient access to discounted drugs at risk. HRSA has recently stated, “Manufacturers that refuse to honor contract pharmacy orders may be significantly limiting access to 340B discounted drugs for many underserved and vulnerable populations. Many of these populations may reside in geographically isolated areas and rely on contract pharmacies as a critical point of access for obtaining their prescriptions.”
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Promoting Electric Vehicles Could Save State Millions In Health Costs HARTFORD — On September 15, the American Lung Association released The Road to Clean Air — a new report that outlines the broad benefits of a transition to electric transportation increasingly powered by clean, non-combustion renewable energy over the coming decades. The report finds a transition to electric cars, buses, and trucks by mid-century would both improve air quality and address climate change, benefiting the lives and health of Americans and Connecticut residents, and would result in significant local benefits. “The transportation sector is a leading contributor to air pollution and climate change,” said Ruth Canovi, director of advocacy for the American Lung Association in Connecticut. “We have the technology to transition to cleaner cars, trucks, and buses, and by taking that step we can prepare Connecticut for the future while also seeing the health and economic benefits forecasted in The Road to Clean Air. Especially as our state faces the impacts of climate change such as extreme heat and storms, this is a power-
The American Lung Assiation’s latest ‘Road To Clean Air’ report details how promoting zero emission electric vehicles could have a practical and financial benefit to Connecticut’s public health. ful and practical opportunity to take action to improve our economy, our health, and our future,” Canovi said. The report outlines the broad benefits of the transition to an
electric transportation sector over the coming decades. National benefits per year based on emission reductions in 2050: *Avoiding approximately 6,300
Zoom In On Virtual ‘Healthy Chats’ HARTFORD — Access Health CT (AHCT) is hosting a series of virtual educational sessions known as Healthy Chats. The purpose of these events is to help Connecticut residents become familiar with the state’s health insurance marketplace, and the available tools to get coverage during the Annual Open Enroll-
ment Period that starts on November 1. Healthy Chats can help Connecticut residents learn about plan options, financial help, lowcost and free coverage, and tips to stay covered. AHCT is Connecticut’s official health insurance marketplace, where you can shop, compare, and
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enroll in quality healthcare plans; and it is the only place where you can qualify for financial help to lower your costs, or be eligible for free or low-cost coverage through HUSKY Health (Medicaid/Children’s Health Insurance Plan or CHIP). Healthy Chats are free and will be held virtually via Zoom in English and Spanish — those interested can access the event by visiting eventbrite.com/e/ access-health-ct-open-enrollment2020-healthy-chats-tickets-118671681193. After a virtual AHCT Healthy Chat, event attendees will: *Know what Access Health CT (AHCT) is and how it can help. *Understand the types of financial help and coverage options available. *Be prepared for Annual Open Enrollment and the application process. Access Health CT Healthy Chats are set for October 21 at 3 pm; October 22 at 6 pm; November 12 at 6 pm, Spanish only; November 18 at 3 pm; and November 19 at 6 pm.
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premature deaths *Preventing more than 93,000 asthma attacks *Preventing 416,000 lost workdays *$72 billion in public health
A new American Lung Assoc report finds a transition to electric cars, buses, and trucks by mid-century would both improve air quality and address climate change, benefiting the lives and health of Americans and Connecticut residents, and would result in significant local benefits. —ALA image benefits *$113 billion in global climate impacts avoided Benefits in Connecticut per year based on emission reductions in 2050:
*Avoiding approximately 55 premature deaths *Preventing more than 726 asthma attacks *Preventing 3,479 lost workdays per year
*$637 million in public health benefits Climate change threatens the health of all Americans, from wildfires and extreme storms to worsening air pollution. And
poor air quality caused by transportation pollution contributes to a wide range of negative health impacts, including childhood asthma attacks, impaired lung function and development, lung cancer, heart attacks and strokes, and premature deaths. As shown in the Lung Association’s annual State of the Air report, nearly half of all Americans are living with unhealthy air quality, and low-income communities and communities of color are disproportionately impacted by bad air quality. In that report, Connecticut continued to earn failing grades for ozone pollution. Achieving these major benefits to health and climate will require dedicated and sustained leadership and investment at all levels of government and will require public education and engagement to ensure the transition to electric vehicles provides clean air for all. The Lung Association is encouraging all Connecticut residents to sign a petition to Governor Ned Lamont urging support for the critical transition to electric vehicles across the United States.
Physician Aims To Debunk ‘Squeaky Clean,’ Other Face-Cleansing Myths NEW YORK — Looking for a face wash? Countless choices are obviously available in your drug store aisle or online. “The number of facial cleansers out there may be overwhelming,” noted Dr Suzanne Friedler, a dermatologist with Advanced Dermatology PC, “so it’s helpful to remember that our skin has its own remarkable built-in maintenance system, which we want to support.” The skin is the body’s largest organ, and it performs a complex range of jobs, from regulating body temperature to teaming up with the immune system to ward off threats. “Skin is expansive,” said Friedler. “Both literally — adults have about 22 square feet — and figuratively: Among the skin’s functions is its ability to regularly regenerate.” Our skin’s maintenance system includes a turnover of skin cells, with new cells repopulating about every four weeks. “And our skin’s pores release a number of protective substances, including the skin oil sebum, which helps coat the surface,” explained Friedler. “Especially with the vast array of face-cleansing choices available,” Friedler said, “we want to keep in mind that our regimen should be supportive of our skin’s own self-care. An effective cleansing routine should steer clear of common face-washing mistakes.” With that in mind, Friedler offers five face-wash “do-nots” that will keep your skin dewy: 1. Do not overwash. “‘Squeaky clean’ skin has been stripped of its natural barrier protection,” emphasized Friedler. “Our skin’s processes are calibrated to maintain a balance of protective skin oil on the surface. If we get carried away and wash too often, we can disrupt this bal-
ance, causing overproduction of sebum, which can lead to clogged pores and acne. Aside from a postworkout wash, we should wash no more than twice a day with a non-soap cleanser. Instead of scrubbing, gently use your fingers. Then pat dry – no rubbing.” 2. Do not mess with the acid mantle. “We’ve heard a lot about the skin’s ‘acid mantle’ in health and beauty columns,” Friedler said. “The skin’s natural pH is below 7, creating an acidic surface environment that maintains its protective barrier and hosts a range of beneficial microflora. One reason we want to stay away from soap is that its pH is much higher, usually about 10 or 11, which can disrupt that mantle, causing a cascade of problems.
When we choose cleansing products, we want to make sure that the pH is in the range of 5 to 7 so that our skin’s surface pH is supported and its delicate ecosystem remains healthy.” 3. Do not forget to moisturize. “Our face-washing routine,” said Friedler, “should include moisturizing as the last step. Moisturize immediately after patting dry — within a minute to three minutes to lock in your skin’s moisture. Those with oily skin should use an oil-free, non-comedogenic gel product. Dryer skin does well with thicker lotions and creams. Products that include ceramides or hyaluronic acid can aid in providing protection.” 4. Do not over-exfoliate. “As with washing,” said Friedler, “exfoliation should be done with care. Gentle exfoliation can help prevent clogged pores, but we don’t want to overdo it: no more than once or twice a week for dry skin. Chemical-based exfoliants, such as glycolic or lactic acid, are typically gentler than mechanical exfoliants like brushes and scrubs. Just as with washing, we should apply gently and be sure to moisturize afterwards.” 5. Do not forget about the neighbor — your hair. “The success of our face-cleansing routine is also dependent on how we treat our hair,” advised Friedler. “We want to make sure that our hair-care and styling products are free from irritants and oils that can disrupt our skin’s balance.” “Staying focused on supporting our skin’s own processes,” concludes Friedler, “can help us navigate the myriad face-cleanser choices at the drug store.” Suzanne J. Friedler, MD FAAD, is a board-certified fellow of the American Academy of Dermatology, with expertise in many areas of medical and cosmetic dermatology. She has been with Advanced Dermatology PC (advanceddermatologypc.com) since 2002.
Connecticut Healthcare Advocate Unpacks Telehealth Law, New Web Tool HARTFORD — The Office of the Healthcare Advocate (OHA) recently issued a report explaining Connecticut’s new telehealth law and announced a brand new web tool to help those who have become unemployed and are losing their health insurance as a result of the COVID-19 pandemic or for other reasons. The 2020 legislative session was abruptly adjourned due to the COVID-19 pandemic, and the legislature did not have opportunity to take up its usual complement of bills. During a special session at the end of July, however, the legislature did pass two important measures that will expand access to necessary care for some Connecticut consumers. One bill limited a consumer’s out-of-pocket expenses for insulin and supplies to treat diabetes, and the other expanded coverage for health services delivered by telehealth. The new insulin law, Public Act 20-4, has a number of effects, including allowing pharmacists to dispense a 30-day supply of insulin and diabetic supplies once per year if the individual does not have a current prescription and is low on them. It also expands Connecticut’s diabetes mandate to include coverage for hemoglobin A1c testing and retinopathy screening, and coverage for prescribed insulin and non-insulin drugs and diabetic supplies. Perhaps most important for consumers, the law limits out-of-pocket costs to $25/month for insulin or non-insulin drugs and $100/month for diabetic supplies. This law, which undoubtedly benefits consumers who are diabetic, still does not address the rising prices of insulin, as advocates including OHA have been calling for. The new regulation applies only to plans that are overseen by the Connecticut Insurance Department, and thus does not affect many “self-insured,” employer-based health plans. It takes effect in 2021. The telehealth law, Public Act 20-2, temporarily establishes certain safety standards and limitations applicable to telehealth providers, such as: prohibitions on facility fees for telehealth services; limitations on prescribing controlled substances through telehealth; requirements for establishing patient consent; and limitations on out-of-pocket costs for insured and uninsured telehealth patients. It requires individual and group health insurance carriers to provide coverage parity for telehealth services — to cover all services available through telehealth if the same service is covered when delivered in person, and requires health insurance carriers to reimburse providers for telehealth visits at the same rate as an equivalent office visit. Finally, it requires
Ted Doolittle, the Connecticut State Healthcare Advocate HUSKY to cover audio-only telehealth services. In short, this law will temporarily require carriers to cover many telehealth services at the same level as in-person health services are covered under the same plan. This is very helpful for individuals to reduce their COVID-19 exposure during this pandemic. This law and its protections will expire on March 15, 2021, unless it is renewed by the legislature. As with the insulin law, the telehealth law only applies to plans that are regulated by the Connecticut Insurance Department, exempting many employer-based health plans. Losing Your Insurance? As Connecticut struggles to recover economic stability due to the coronavirus, many citizens are finding themselves in the unfamiliar territory of being unemployed and losing their health insurance, some for the first time. Many were caught unprepared because the economic fall-off was abrupt. “The OHA is here to help navigate any loss of
health care insurance. We can help keep your family covered and your bills for medical care to a minimum,” said Ted Doolittle, the Connecticut state health care advocate. “We are fielding calls every day from families in crisis, with lots of questions and it can be difficult to pick the best plan and track down the information you need.” The OHA’s new Loss of Coverage web portal offers easy access to detailed descriptions of consumer options to help families understand and choose their health care plan. People can also contact OHA for one-on-one assistance. The web tool can be found at https://portal.ct.gov/ oha/loss-of-coverage-options/loss-of-coverage. It may come as a surprise to many parents that they and their children qualify for free coverage under HUSKY, Connecticut’s Medicaid program. For instance, children in families of four making less than $83,172 a year could qualify. Some people may find that buying insurance in the health care marketplace through Access Health is a viable option, especially since many low- and moderate-income families will qualify for federal subsidies. Although open enrollment is not yet open for 2021, a life-changing event, such as sudden unemployment, may create an exception. There is also information for those attempting to continue insurance from their former employers via COBRA. “We don’t want our fellow residents to be uninsured, because the financial impact could be huge and we don’t want folks to feel total despair for lack of information, help, and guidance,” said Doolittle. “That’s why we created this important tool and why OHA is here as a resource with seasoned experts in all aspects of health care insurance. If you’re having any other issues with your policy coverages from loss or anything else, we’re here to help. Don’t worry alone about losing your health care coverage.” The OHA is a consumer advocacy agency in Connecticut. Its mission is to make sure consumers’ rights to health care access and coverage are protected. OHA employees are experts in the field of insurance and assist consumers in appealing claim denials, in addition to plan selection and any other problems they are having with their health coverage, including all public health plans such as Medicaid/ HUSKY, Medicare, CHIP or Tri-Care. OHA also monitors regulations and laws in the state and federal governments that can adversely affect Connecticut residents. More information is available at https://portal. ct.gov/oha.
THE NEWTOWN BEE, FRIDAY, OCTOBER 16, 2020
Shaky State Of Job-Connected Health Insurance More Unstable In COVID-19 Era
Tomatoes are rich in vitamin C whether eaten fresh, as pictured, or in the form of marinara sauce and tomato soup. Oranges, like other citrus fruits and berries, are rich in vitamin C. —Unsplash photos
Easy Ways To Strengthen Your Immune System During (And After) Flu Season By Alissa Silber While colder months can bring such delights as apple picking, seasonal holidays, and pumpkin spice lattes, the period between October and March also harbors the threat of influenza, more commonly referred to as the flu. The flu is a viral infection that primarily spreads in the fall and winter. This time of year is ideal for the flu to thrive, because it can stay in the air longer when it is cold and dry, compared to warm temperatures. People are more susceptible to catching the flu, among other sicknesses, when the body’s immune system is weakened. Jill Patterson, an award-winning registered dietitian nutritionist, says there are a variety of ways proven to boost a person’s immunity to illness. “Washing hands with warm water and soap, getting adequate sleep and rest, staying physically active, and minimizing stress will help defend against illness,” she explained. “In addition, consuming nutrient-rich foods will help keep
your body functioning optimally.” Specifically having Vitamin C, Vitamin B6, beta carotene, and probiotics can help support a healthy immune system. Adopting Healthy Practices To gain these nutrients, Patterson recommends incorporating these healthy practices: Drink plenty of fluids — Water is an excellent way to stay hydrated. Staying hydrated helps the body flush away toxins and function at its best. Include foods rich in vitamin C — Citrus fruits such as oranges, tangerines, and grapefruit, along with berries and melon, are great sources of vitamin C. Enjoy some tomatoes –—Tomatoes are rich in vitamin C. In addition to fresh tomatoes, try favorites including marinara sauce on pasta, pizza, and tomato soup. Incorporate foods high in beta carotene — Orange and dark green vegetables, including carrots, sweet potatoes, butternut squash, romaine lettuce, spinach, and kale, are good sources of beta carotene. These help
ward off respiratory infections. Choose whole grains — Choose whole grain bread, whole grain cereal, brown rice, or any whole grain version of your favorite grain foods. This contains vitamin B6, which may play a role in enhancing immunity. Snack on yogurt — Yogurt contains probiotics, which are good bacteria that help strengthen your immune system.” Ultimately, Patterson said, “Eating a well-balanced diet and planning meals that include the food groups (whole grains, vegetables, fruit, lowfat dairy, and lean protein) will provide the combination of nutrients that will help the body maintain a healthy immune system.” Vitamins/Supplement Intake When people cannot achieve taking in the necessary nutrients through foods and lifestyle, vitamins and supplements can help gain these immunity boosters. Leading infectious disease expert Dr Anthony Fauci announced in early September, during an interview on Instagram Live with actress
Jennifer Garner, that he specifically takes vitamin D and C supplements to keep a healthy immune system. “If you’re deficient in vitamin D, that does have an impact on your susceptibility to infection. I would not mind recommending, and I do it myself, taking vitamin D supplements,” he said. Fauci also said, “The other vitamin that people take is vitamin C because it’s a good antioxidant, so if people want to take a gram or so of vitamin C, that would be fine.” Patterson advises people always consult with their doctor before taking any vitamins or supplements, as some may negatively interact with certain medications and taking too many fat-soluble vitamins can create vitamin toxicity. She also urges people to “consult with a registered dietitian nutritionist who can help you to determine where there may be nutrient gaps in your diet.” To learn more, e-mail registered dietitian nutritionist Jill Patterson at email@example.com and visit her website at jillpatterson.com.
Music Can Improve Brain Health, Wellbeing In Older Adults WASHINGTON, DC — A new report from the Global Council on Brain Health (GCBH) concludes that music can potentially stimulate brain health, manage stress, and help treat brain health conditions as varied as dementia, stroke, and Parkinson’s disease. Brain health experts convened by the GCBH rec-
ommend people of all ages consider incorporating music in their lives to help improve quality of life and wellbeing. The GCBH issue experts were able to reach 13 points of consensus around music and healthy aging and five for treatment of disease or injuries causing cognitive impairment over the several months as the report developed.
“Music is a universal language that everyone can enjoy with remarkable benefits,” said Sarah Lenz Lock, AARP senior vice president for policy and executive director of the GCBH. According to the report, music can enhance mood and social connectedness, can reduce anxiety and depression, and may potentially reduce agitation for people living with dementia. Music can also be a tool for caregivers by helping ease the stress and burdens associated with caregiving, and help them engage in positive experiences with their loved ones. There is also strong evidence that specialized music-based treatment may improve movement and recovery in patients with Parkinson’s disease and stroke, including in walking and talking. Singing may also help people recover the loss of language functions after a stroke. “This report suggests music can have a powerful role to play in healthy aging by enriching our brains’ activity, improving our moods, and fostering social connections,” Lenz said. “Over the next several months, AARP will celebrate those enhancing their brain health through melody, while providing fun and unique virtual opportunities to engage with music and help make life better for older adults.” The GCBH report recommends ways people can engage with music, including: Dance, sing, or move to music, not only to provide physical exercise but also to potentially help relieve stress, build social connections, and stimulate your brain. Make music yourself by singing or playing an instrument. Learning to play a musical instrument can offer a sense of mastery and self-esteem while stimulating thinking skills. Listen to both familiar and new music. Evidence suggests music you know and like causes the strongest brain response and dopamine release, while new music can stimulate the brain and provide a new source of pleasure. Personalized playlists you can put together for yourself or loved ones by using music apps on computers or smart phones are good options, and these apps may suggest other new music you might be interested in. If you notice you are having trouble hearing, don’t delay getting your hearing checked. A recent AARP survey found that adults who engage in music are more likely to rate their brain health and cognitive function as excellent or very good. To celebrate the power of music and help strengthen the minds of the 50+, AARP is offering ways for older adults to engage with music, including the relaunch of its popular singing competition, AARP Superstar 2020. In addition, AARP recently teamed with Daybreaker to host a virtual Dancing Through the Decades, a two-hour livestream dance adventure through the ’60s, ’70s, and ’80s. To read the full report, “Music on Our Minds: The Rich Potential of Music to Promote Brain Health and Mental Wellbeing,” visit https://www.aarp.org/content/dam/aarp/health/ brain_health/2020/06/gcbh-music-report-english. doi.10.26419-2Fpia.00103.001.pdf.
WASHINGTON, DC — United States of Care (USofCare) recently released a new brief examining the precarious state of job-connected health insurance for people, employers, and our economy. With this report, USofCare is beginning a national conversation about the longstanding problem — magnified by COVID-19 — associated with tying people’s health insurance to their jobs. USofCare will bring together policy experts, employers, innovators, and everyday people experiencing the current health care system to understand what currently works and potential alternative solutions. The new USofCare report, “A System Under Stress, Exacerbated: The Employer-Sponsored Health Insurance System at a Crossroads,” also looks at approaches utilized by states and leading private companies to control the costs increasingly straining the system. According to new research from the Economic Policy Institute, over the past seven pandemic-ridden months, more than six million Americans have lost the health insurance they previously received from their employer. Once spouses and children are taken into account, the real number is closer to 12 million. Other estimates from the Kaiser Family Foundation found that as many as 27 million people could become uninsured following job loss. “COVID-19 has changed both the world and our health care system in ways that seemed unimaginable just months ago,” said Emily Barson, executive director, USofCare. “At a time when our nation needs people to have access to care now, more than ever, the pandemic has magnified the risks that come from tying our health security to our jobs.” “People want to know their health care coverage is secure when life changes, including if someone loses or changes a job,” added Kristin Wikelius, managing director, policy and external affairs at USofCare. “That is why in the coming months, USofCare will bring together policy experts, employers, innovators, and everyday people experiencing our health care system to understand what currently works and what alternatives could look like.” Additionally, the new report explores: *How American employees came to rely on employers for their health insurance coverage. *The tremendous financial strain this system places on the federal treasury, individual employees, state governments, and America’s largest businesses. *How the tax code treats job-connected health insurance and provides deeper discounts to those who earn more income. *How some state governments have attempted to mitigate the extraordinary costs of health insurance coverage.
*How three of America’s largest businesses have worked to balance both the ballooning costs of providing their workers with health insurance and the imperative to retain a healthy and satisfied workforce. *The complex shared role between state governments and Congress of regulating this space, which slows public policy progress. “As the report makes clear, the inefficiencies, challenges,
and inequities of connecting health security to job security have never been more glaring for both the American people and our nation’s employers,” said Andrew Schwab, the author of the report. “The time is now to rethink our 75-year-old system of job-connected health insurance, which can leave half the US population vulnerable to losing both at the same time.” The mission of United States of Care is to ensure that every single American has access to quality, affordable health care regardless of health status, social need, or income. A nonpartisan nonprofit, the organization is building and mobilizing a movement to achieve long-lasting solutions to make health care better for everyone. United States of Care will help make it happen by working with Americans from across the country: patients, caregivers, advocates, clinicians, policymakers, and business, civic, and religious leaders. To review this latest report, visit https://unitedstatesofcare.org/wp-content/ uploads/2020/09/esi-brief-september-2020.pdf
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Residency Training Better Preparing Pediatricians To Spot Behavioral Disorders HARTFORD — A recent issue brief from the Connecticut Child Development Institute (CHDI) is highlighting how the American Academy of Pediatrics (AAP) is increasingly calling on pediatric primary care providers to recognize and treat patients with common behavioral health disorders. However, pediatricians indicate concerns about their capacity to do so. In a recent survey conducted by the AAP, pediatricians reported lack of training and confidence in their ability to address behavioral health disorders. Pediatric residency training programs, which prepare pediatricians, family physicians, and nurse practitioners to deliver care to children, require extensive training in primary care and are the ideal place to better prepare future health care providers to address common behavioral health disorders. Pediatric residency training is the period of graduate medical education that offers indepth training designed to confer the knowledge and skills required for comprehensive pediatric health care. Behavioral health is important to the overall health and well-being of children. More than one in six children has a behavioral health disorder such as depression or anxiety, and that number is growing. According to the Centers for Disease Control and Prevention, diagnosed depression and anxiety among children ages 6 to 17 years old increased from 5.4 percent in 2003 to 8.4 percent in 2012. Suicide rates have also alarmingly increased by 56 percent between 2007 and 2017 among children ages 10 to 14 years old, and suicide is now the second leading cause of death in this age group. In Connecticut, the prevalence of diagnosed behavioral health conditions or developmental delay among children ages 3 to 17 years old increased from 16 percent in 2007 to 25 percent in 2018. According to the Centers for Disease Control and Prevention: *9.4 percent or approximately 6.1 million children nationally have been diagnosed with ADHD. *7.4 percent or approximately 4.5 million have a diagnosed behavior problem. *7.1 percent or approximately 4.4 million have been diagnosed with anxiety. *3.2 percent or approximately 1.9 million have been diagnosed with depression. Pediatric primary care providers are well positioned to identify and treat children with common behavioral health disorders. Ninety percent of children attend an annual wellchild visit, and many visit the pediatrician’s office several times per year. The long-term relationship that primary care providers have with families can ensure
proper and early identification of behavioral health concerns, opportunities for ongoing support, and monitoring of treatment progress in children with a behavioral health diagnosis. Primary care can also help connect families to appropriate behavioral health services. However, there is a need for enhanced
competency in identifying and treating behavioral health conditions among primary care providers. Robust Training Lacking Pediatric, family medicine, and nurse practitioner residency programs are responsible
State Residency Training Programs Funded By CFC Connecticut’s current pediatric residency training programs funded by CFC include: Asylum Hill Family Medical Center, Family Medicine Residency Program in Hartford — Medical residents and staff will be trained in trauma screening, referral, and family education during well-child and home visits using the Child Trauma Screen (CTS). Community Health Center, Inc, Nurse Practitioner Residency Program in Middletown — Training experiences that address socio-emotional health and provide support to families will be developed and evaluated for nurse practitioner residents. Enhanced training will include traumainformed care, adolescent behavioral health, and lactation support. Connecticut Children’s, Pediatric Residency Program in Hartford — Medical residents will develop and implement officebased projects that address infant and child emotional and behavioral health through caregiver education at well-child visits.
Yale School of Medicine, Pediatric Residency Program in New Haven — Behavioral health simulations will be developed and implemented for residents to practice the following skills: gathering a comprehensive health and behavioral health history, using clinical screening tools, working through a differential diagnosis, collaborating with a behavioral health professional, and monitoring children’s socio-emotional development in the pediatric primary care setting. Yale School of Nursing, Pediatric Nurse Practitioner Program in New Haven — An integrated behavioral health educational experience for residents will be designed and implemented. The experience will offer a new opportunity for nurse practitioner residents to learn and receive supervision from behavioral health providers in the pediatric primary care setting to help them build the capacity to manage common behavioral health problems.
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A Promising Solution Opportunities for improvement in residency training still exist despite excellent intentions and substantial improvements to behavioral health curricula over the last decade. This past year, the CHDI partnered with residency programs to identify training gaps and advance strategies to improve behavioral health training. A grant program funded by the Children’s Fund of Connecticut (CFC) and administered by CHDI awarded grants to five Connecticut-based pediatric primary care, family medicine, and nurse practitioner residency programs to support the planning and implementation of innovative, hands-on experiences in behavioral health care for their trainees. Although each residency program currently includes elements of clinical, didactic, and/or community-based experiences in behavioral health, the programs recognized opportunities for improving trainee experiences in behavioral health. In collaboration with the five grantees, CHDI will explore improvements in Connecticut’s pediatric residency training experiences with the goal of informing change in residency training across the state. Collaboration among national pediatric organizations is also needed to improve and influence behavioral health curricula and clinical experiences nationally.
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for developing competent child health providers and ensuring they can address behavioral health issues. The AAP recognizes this and has been calling for enhancements to residency programs for more than forty years. However, there is little consensus about how to fully prepare resident trainees to identify, treat, and manage care for children with behavioral health disorders. In 2018, the American Board of Pediatrics and the National Academy of Sciences, Engineering, and Medicine brought together a workgroup to improve the capacity of residency programs to provide comprehensive training experiences in behavioral health. The workgroup identified barriers to learning in current residency programs that, when fully addressed, could help prepare future pediatricians to address the behavioral health needs of their patients. Barriers articulated included inconsistencies in curricula and hands-on training experiences across residency programs; inadequate resident training to identify, diagnose, and manage care for children with behavioral health disorders; and faculty discomfort treating patients with behavioral health concerns. These barriers are also common in family medicine and nurse practitioner training.
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report indicates yearly decreases in non-operating revenue for fiscal years 20162019. Statewide, the total margin of revenue over expenses was 5.15 percent in FY 2019, a drop from 5.92 percent the previous year. For comparison, the five-year average total margin was reported to be 5.89 percent. Statewide uncompensated care charges totaled $806 million for all hospitals in FY 2019, a $41 million or 5.3 percent increase from the prior year. Other statewide figures extracted from the hospital financial data reported for FY19 include: Statewide net patient revenue (NPR) was approximately $12.4 billion and accounted for 94 percent of operating revenues. NPR increased by 6.3 percent ($734 million) over the previous year due to increased hospital payments. Operating expenses rose 5.8 percent to $12.6 billion from the previous year, reportedly attributable to increases in salaries and wages (3 percent), supplies and medications (11 percent), and other operating expenses (9 percent). “Hospital-audited financial statements, which include balance sheet and statement of operations information, are a primary verifying source of information in this report,” the Executive Summary reads. “OHS also uses data and information filed each year by hospitals in their annual reports and twelvemonth actual submissions, such as utilization statistics, uncompensated care data, and legal charts of corporate structure.” The newly released data is accessible at portal.ct.gov/ohs.
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HARTFORD — The state Office of Health Strategy (OHS) has released its report detailing the financial standing of Connecticut hospitals for the previous federal fiscal year. The annual report on the financial status of Connecticut’s short term acute care hospitals includes all manner of financial data on revenue, expenses, cost of uncompensated care, and resulting margins. More specifically, net patient revenue (highlighting major payer categories as well, i.e., nongovernmental, Medicare, Medicaid, etc.), other operating revenue, and nonoperating revenue are tabulated as are reported expenses and the aggregate, five-year trends in all categories of revenue, expense, and margins. “The report highlights Connecticut’s statewide hospital trends and includes individual hospital profiles of financial performance,” according to its Executive Summary. “It is intended to provide information that will enhance knowledge of the financial status of Connecticut’s hospitals.” This year’s report might well attract additional attention considering the ongoing coronavirus pandemic, but it includes only the financial data provided for the period through September 30, 2019. The dramatic financial impact of COVID-19 mobilization, equipment procurement, patient treatment, and lost revenue will be reported a year from now, with compilation of FY20 financial data. This year’s report details increases over the past four years in net patient revenue, other operating revenue, and total operating revenue, and commensurate yearly increases in expenses. Moreover, the
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