April • 2022
April is to Address
Child abuse prevention and violence against children, 
Resources capacity framework, early intervention changes to assess
Chapter elections and COVID after a two year run.
President's Column
Nelson Branco, MD, FAAP
I hope that you have been able to enjoy the beginning of spring and a continued decline in the rates of COVID. Both positives, though at times the past few weeks seem full of contradictions and worries. We have beautiful weather, but an ongoing drought. COVID rates are declining but with less masking and more gathering, we’re seeing a return of other viral illnesses. Not to mention that many of our patients are still not vaccinated against COVID and we all know that future variants are likely a plane ride away from us and our communities. 

I’m sure that many of you are looking forward to being able to safely travel again this summer. At our house, the anticipation and excitement of a family trip to Europe has been overshadowed by the Russian invasion of Ukraine and the tragedies we are witnessing in the news every day. When I heard the news of the Russian attack on a maternity hospital in Mariupol last week, I was astounded. Watching mothers, infants and children being evacuated and fleeing the country, often without their fathers and other family members, I am heartbroken at the trauma that they are experiencing. I’d like to use this opportunity to share and reaffirm our AAPCA1 Statement on Violence Against Children, originally published in June 2021:
In light of recent events around the world, California Chapter 1 American Academy of Pediatrics (AAPCA1) unequivocally condemns violence against children. The intentional targeting of civilian sites, schools, clinics/hospital systems, and humanitarian missions is a violation of human rights and monumentally affects the well-being of children. As an organization that stands for the health and well-being of children, proactively advocates for equity and inclusion, and champions our work in mental health and Adverse Childhood Experiences (ACEs), we strive to address the disparities within societies, whether due to race, ethnicity, gender, sexual orientation or religion. We will work against discrimination, homelessness, trafficking, gun violence, abuse and more; on behalf of pediatric communities including Black, Indigenous, and People of Color (BIPOC), immigrant, LGBTQ+, and disabled. We will not stand silently as witnesses to inhumane acts. Every child is a human first. We will continue to advocate for children locally and globally and we ask you to join us in asking those in power to do the same.
I know that many of our colleagues are working hard in Ukraine and neighboring countries to care for the children injured, orphaned, displaced or otherwise affected by this war. Please support the organizations who are doing this important work, and let’s all hope and advocate for peace and stability for these children and those in any conflict zone across the globe.
Closer to home, I am happy to announce that we have filled our two board vacancies. Join me in welcoming Dr. Maya Raman to the position of San Francisco Member-At-Large (MAL), and Dr. Renee Wachtel as Alameda MAL. Did you know that you can contact any board member directly from their profile page on the chapter website? Please take advantage of that and let us know what’s on your mind.
Another way to let us know what you’re thinking about is on the What’s Up, Docs? page. Expertly curated by our chapter Secretary and Communications Director Dr. Janice Kim, this is a page where you can read short perspectives from other chapter members. What’s on your mind? We’re always looking for new content - email Janice or Isra with your ideas.
Vice President's Column
Nicole Webb, MD, FAAP
Two Years of COVID: Where are We Now?

It’s hard to believe, but the 2 year anniversary of COVID is upon us. But what does that mean, exactly? There are so many anniversaries wrapped up in that one statement. By the time you read this, many of those will have passed. For example, March 11, 2022 marked the 2-year anniversary of the WHO declaring COVID-19 a pandemic. Just 2 short days later, March 13, marked the 2-year anniversary of the US declaration of a national emergency regarding the COVID-19 pandemic. March 15 marked the 2-year anniversary of initial lockdowns in the US, beginning with the New York City public school system.

For many of us in our chapter and our state, that last anniversary likely corresponds with the closure of our own children’s schools and the beginning of a dual life as front-line health care workers and homeschoolers to confused and potentially very scared children. March 19, 2022 marked the 2-year anniversary of the statewide stay-at-home order in California. For those interested or wanting to remember, a detailed timeline of events in the era of COVID-19 can be found here

The second anniversary of the pandemic comes at the tail end of the Omicron variant wave, which infected more children than any previous wave of the virus. Since the outset of the COVID-19 pandemic, California has recorded 1,594,239 pediatric COVID cases, with 12,784,627 cumulative cases nationwide. California pediatricians continue to strongly recommend all eligible children receive vaccination against COVID-19. Even if a child has been previously infected, vaccination ensures they have the strongest immune response possible to future exposure. We want to continue to support each of you in your daily practice in providing accurate, up to date information to patients, families, colleagues and community members. If you have questions or suggestions for how we can support you better as a chapter, please reach out via info@aapca1.org. Parents can also find more information on HealthyChildren.org

In California, 65.7% of eligible children aged 12-17 are considered fully vaccinated, 8.2% have received at least 1 dose of the vaccine, and 26.1% in this age group remain unvaccinated. More sobering, of children aged 5-11 years, only 32.4% are fully vaccinated, with 6.3% partially vaccinated, leaving 61.3% unvaccinated. There is obviously still a tremendous need for advocacy around this. For more information, including county level data and breakdowns by race and ethnicity, you can visit covid19.ca.gov.
In our chapter, we are incredibly proud of the amazing work that has been done to promote vaccination of children. As you may have seen in last month’s newsletter, our chapter received a grant from National AAP to post social media ads to build confidence in COVID vaccines for adolescents. Spearheaded by Morgan Leighton, MD, MPH, FAAP, our chapter’s Immunization Champion, with the help of Megan Warner, MPH, Isra Uz-Zaman, MS, and Janice Kim, MD, FAAP, this project reached over 570,000 viewers and generated 4,000 clicks to a teen-focused COVID vaccine resource page on our website.
We have also tried to be timely and transparent in offering resources and avenues for discussion and sharing of knowledge with our chapter chats on topics such as the intersection of ACEs and the COVID-19 pandemic, school reopening, return to sports after COVID, diversity, equity and inclusion, addressing mental health, climate change, and many others. You can find the recordings of our past events here. Most recently, we are offering resiliency circles which are open to all members, and more information and registration details, along with words from our own Dr. Miriam Rhew and our president, Dr. Nelson Branco, can be found here.
So, while there is still much that is challenging—even seemingly impossible many days—about the daily realities of providing care in the midst of an ongoing global pandemic, there is also much to be proud of. There is so much that we as a chapter, and you individually, have accomplished, and that deserves acknowledgment and celebration. 
A number of us gathered recently in southern California for our annual AAP-CA retreat, and as we were reflecting on our “why” many of us shared similar stories: that advocating for kids was never not an option, that we do this work because it needs to be done, that we are a community that lifts one another up and propels us—individually and collectively—forward. I can honestly say that as I reflect on the past 2 years, I have never been prouder to be a pediatrician, to be a member of the AAP, and to be able to work with all of you to promote the health and well-being of all children.
Warm wishes and thoughtful reflections on this most unprecedented of anniversaries,
Leadership Opportunities for Members!
Raelene Walker, MD, FAAP
Past President & Nominating Committee Chair
We are actively seeking interested candidates for three important positions for chapter leadership. Elections will be this spring, with 2-year terms beginning July 2022 for the following positions: 

  • Secretary & Communications Director
  • Treasurer
  • Santa Clara County Member-at-Large

The most important qualification is being a chapter member who would like to be more involved with our chapter. In addition, for Secretary/Communications Director we need someone savvy with the media to lead us in connecting both internally and externally. For Treasurer, a candidate needs experience and interest in financial matters, and as this is a more unique skill set, may be a non-physician. For all MAL positions, candidates need to live and/or work in that geographic region. 

If you are potentially interested, have questions or suggestions for possible candidates, please contact Raelene Walker, Nominating Committee Chair or Isra Uz-Zaman, Chapter Executive Director or just apply! We avidly encourage members to consider these roles:
And while we look forward to having new faces and new energy in these positions, we also offer gratitude and appreciation to Drs. Janice Kim, Nivedita More, and Meera Sankar for their years of leadership and service. Thank you so much!
Child Abuse Prevention Month - Discussing Discipline
Casey L. Brown, MD, MPH, FAAP and Melissa K. Egge, MD, FAAP
CAPET Committee Co-Chairs
April is Child Abuse Prevention and Awareness month. This month, the AAP Chapter 1 CAPET (Child Abuse Prevention, Education, and Treatment) Committee is focusing on discipline. While causing physical harm to another adult is considered a crime, physical discipline/corporal punishment of children is legal in all US states. Multiple studies demonstrate the negative short- and long-term impacts of any type of physical discipline on children including increased aggression, behavior problems, and propagation of similar discipline strategies to their own children. Physical discipline can also lead to physical abuse. 

There is robust support for early intervention in pediatrics in preventing a wide variety of negative short- and long-term health outcomes - newborn metabolic screening, hearing loss, developmental screening, congenital heart disease, etc. Data also supports enhancing familial resilience through a medical home and connection with pediatricians. 

However, for many pediatricians, bringing up the subject of discipline can feel fraught; the subject is sensitive and imbued with cultural nuances. There are different discipline strategies employed by different cultures and religions for a variety of reasons, some of which include systems of structural racism and inequity. Since no one likes to make a mandated abuse report, discussing discipline can help let families know the negative impact of physical discipline, provide families with alternative discipline techniques, support familial resilience, and help prevent mandated reports. The sooner discipline discussions occur, the more preventive and trauma-informed they can be.
Event Featuring Chapter Member Suzanne Frank, MD, FAAP
Resources Capacity Framework Approach to Primary Pediatric Care 
Omoniyi Omotoso MD, MPH, FAAP
Contra Costa & Solano Counties Member-At-Large
“We’ve got what we need.” A phrase I’ve become accustomed to uttering intermittently over the past two years as we have coped with all the stressors both in our office and personal lives. And we continue to find ways to do our work. Browsing the National Help Me Grow (HMG) center website, one is reminded about how our medical homes are integral to early childhood development systems – high-quality integrated healthcare, education and family social services. All factors critical to early childhood wellness. Let’s use more of a strength-based approach to our work. Out went resource-limited lingo. In came resourceful creativity. How do we leverage our know-how, relationships and external resources to meet our patient’s needs?
All the resources may not be at our medical homes, but locally here for our patient-families to access with our support. Let’s go over some practical examples of existing and easily available external partnerships and resources. We already promote early childhood literacy during our preventive health visits. Our clinics registered with Reach Out and Read (ROR). . .
The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH, CFAAP
SGA Chapter Representatives
We will have SGA updates for you next month, but in the meantime, for the most up-to-date information on AAP California bill positions, letters, and outcomes from the current California Legislative year, go to aap-ca.org/bill. For the latest organizational advocacy updates follow @AAPCADocs on Twitter. If you have questions and/or are interested in knowing more about certain legislation, reach out to our State Government Affairs Chapter Representatives Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH at info@aapca1.org.
AAP SOOb (Section on Obesity) National COACH Network 
Natasha Agbai, MD, FAAP
Need advice on how to help a child with excess weight? Need a speaker for your event? The AAP Section on Obesity COACH (Childhood Obesity Advisor for Continuing Health) network is here to help. The COACH Network is a National cadre of pediatric care providers well-versed in childhood obesity who can serve as mentors, speakers, and/or advisors at a regional level to help support the needs of the Section on Obesity, its membership and the Academy. 

California Chapter 1 is proud to have 1 member on the COACH network, Natasha Agbai, MD, FAAP of San Francisco (natasha@weightlossforkids.com). 

Please reach out to Mala Thapar at mthapar@aap.org if you have questions about the Network and if you would like to be connected with a COACH in your state/region.
Early Intervention Ends at 3 years old??? Not anymore. Rules for Children Ages 3-5 in the Regional Centers 
Renee C. Wachtel, MD, FAAP
Chair, Committee on Development and Behavior
For many years, pediatricians have been confused by the eligibility rules for Early Intervention through the Regional Center system. These rules applied only to children under the age of 3, and then the children were either transitioned into Special Education programs through the school system or received no services at all. But that has now changed. In July 2021, California amended the Lanterman Act, allowing children who are 3 or 4 years old to be “provisionally eligible” for Regional Center services under the following conditions:
  • The child has significant functional limitations in at least 2 of the following areas of major life activity, as appropriate to the age of the child:
  • Self-care
  • Receptive/expressive language
  • Learning 
  • Mobility
  • Self-direction 
  • The child does not have a disability that is solely physical in nature

Previously, if the child did not have one of the specified and diagnosed developmental disabilities at age 3, they were no longer eligible for Regional Center services. 

There is a range of services available to children 3-4 through the Regional Center, based upon the developmental needs of the child and the family’s concerns. They can include services such as behavioral intervention programs, childcare, adaptive equipment, nursing services and respite. All of the children will receive case management. Evaluations for eligibility for Regional Center services are free of charge. 

Now, Pediatricians can refer to the Regional Center for their 3 and 4 year old patients, and the Regional Center will determine whether they are eligible. And the child will be reassessed at least 90 days prior to their fifth birthday to determine whether they would continue to be eligible for Regional Center services at age 5 years.  

Hopefully, this is the first step on the road to have Early Intervention Services covered for children 0-5 years. If you have any questions or find barriers to getting Regional Center services for your patients, please contact me at drrwachtel@aol.com.
What's Up Docs? Blog
We'd Like to Feature You!
Opportunities for Your Benefit
Quick COVID-19 Survey
On March 13, 2020, the Larry A. Green Center launched a national survey to better understand the response and capacity of US primary care practices to COVID-19, as well as the potential impact of the pandemic on primary care. This is a survey that all pediatricians should do to help get our ideas about how things are going and the need for improvements in primary care reimbursement and management to the HHS. Find the survey here.
Virtual Inflammatory Brain Disorders Conference May 20-21, 2022
The Neuroimmune Foundation is inviting you and your colleagues to attend their virtual Inflammatory Brain Disorders Conference May 20-21, 2022 via webcast. The focus is on both pediatric and adult patients. CME credit is available to all live attendees. As the planner have partnered with Stanford University School of Medicine to offer this virtual event, I will direct you to their website which subsequently links to the registration page. The virtual conference is being offered free of charge to physicians who have not attended a prior Neuroimmune Foundation event thanks to generous donations through April 1, 2022.
The Safer firearm counseling training platform and associated Safer Study
My name is Kelsey Gastineau and I am a second-year Pediatric Hospital Medicine fellow at Vanderbilt. Along with my mentor, Dr. Shari Barkin, and a national team of firearm injury prevention experts we have collaborated with the AAP to create the Safer training in response to AAP member interest to increase skills around firearm injury prevention counseling during pediatric visits. The training provides universal firearm injury prevention guidance for pediatric clinical settings and shows 6 specific examples of counseling approaches. MOC 2 credit can be earned for completing the course which takes about 45 minutes.
Our team has now been asked to evaluate the effectiveness of the platform, called the Safer Study. We are requesting your help to participate in the study. Participation includes completing 3 brief (5-10 minute) surveys: Pre-course survey, post-course survey, and one-month follow-up survey. Participation is open until April 1st and eligible participants will receive up to $30 in Amazon gift cards for completing the study!

Here is a direct link to the Safer Study: https://redcap.link/SaferSurveys

If you choose to participate, you can begin the pre-course survey right away. You will be redirected to the AAP shop to register for the course following survey completion.
Upcoming Annual CME Conference
You Can Register Now!
April 7, 6:30PM - 7:00PM - Pediatrician Resiliency Circles - REGISTER HERE
April 13 at 4:00PM - 5:30PM - Teen Empowerment: Engaging Teens in Healthcare Decisions - REGISTER HERE
April 20 at 7PM - 8:30PM - The Children and Youth Behavioral Health Initiative - Reimagining Behavioral Health support for All Children and Youth in California - REGISTER HERE
May 7 9AM - 1PM - Annual Spring CME Conference in Fairfield - REGISTER HERE

Save the Date!
May 11 - Mental Health with CAPP - SAVE THE DATE! 
June 8 - HP 2020 Medical Legal Partnerships - SAVE THE DATE! 
June 22 - Enhancing Adolescent Health & Immunization Services AAP Webinar 3 - SAVE THE DATE!
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Your membership makes a difference for children in California, thank you!

The AAPCA1's ability to advocate on behalf of children is only as strong as the support we receive from our members. Encourage your colleagues to join today by visiting the AAPCA1 website.

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.

Executive Committee:
President: Nelson Branco • Vice President: Nicole Webb
Secretary: Janice Kim • Treasurer: Nivedita More • Past President: Raelene Walker
Executive Director: Isra Uz-Zaman

Board Members:
North Valley MAL: Thiyagu Ganesan • Sacramento Valley MAL: Lena van der List • Central Valley MAL: Deborah Shassetz • South Valley MAL: Tashya Jayasuriya Whitehead • San Francisco MAL: Vacant • Santa Clara MAL: Meera Sankar • San Mateo MAL: Neel Patel • North Coastal MAL: Jeffrey Ribordy • Monterey Bay MAL: Graciela Wilcox • Alameda MAL: Vacant
• Contra Costa/Solano MAL: Omoniyi Omotoso

Pediatric Insider News Editors:
• Mika Hiramatsu • Deborah Shassetz • Alyssa Velasco

Project Assistant: Yolanda Ruiz