In April, We Withstand
In April, we withstand the bountiful showers
Hoping and praying for an abundance of May flowers,
We plant our seeds for the Spring CME Conference,
Allowing our chats and resolutions to flourish with confidence.
|
|
President's Column
Nelson Branco, MD, FAAP
|
|
Last month’s column started out by encouraging anyone who said “the AAP should…” to write a resolution for this year’s Annual Leadership Conference. By the time you read this, the resolution submission date will have passed and the District IX leadership will be reading all of the resolutions submitted by our members, offering feedback and suggestions and planning on how to best support the resolutions that come from our district. I want to thank Dr. John Takayama for presenting a chapter chat about how to write a resolution, and for doing all the hard work as our District Chapter Forum Management Committee (CFMC) representative. I can’t wait to see all of your ideas for what we, the AAP, can do to better care for children and support those who care for and about them.
I had the pleasure and the privilege to participate in an AMA/AAP Behavioral Health Integration Program last week. My role was to be a subject matter expert (SME) and lead the discussion on “Assessing Readiness and Establishing Goals.” I have to admit that I felt a little nervous being presented as an expert but with the support of the planning team I think we shared some great information. We’ve been working on adding behavioral health to our practice over the past several years and I know that my team would have been quite amused to hear me talk about “planning” and “assessing readiness.” Somehow, my favorite strategies like “let’s just try it and see what happens” and “don’t worry, we’ll figure it out as we go” didn’t make it into the final presentation slides. I know that many of us are struggling to provide mental health support for our patients. I’d love to have a discussion on our Practice Support Task Force listserv to share experiences, ideas and resources. Join us there if you’re interested.
|
|
I would like to recognize our new Chapter Immunization Representative, Dr. Omoniyi Omotoso. I’m looking forward to learning new ways to promote vaccination from Dr. Omotoso - thank you for stepping up.
I would also like to recognize Dr. Aparna Kota for her 27 years of service and volunteering as Chapter 1 CATCH Grant Facilitator. Dr. Kota began as a resident CATCH Grant Facilitator in 1995, and continued to advise, encourage and promote the CATCH applicants through all these years. Thank you, Dr. Kota, for all of your work and for sharing your expertise with us. If you’re interested in getting more involved with our chapter, please consider joining a committee or volunteering for one of our open positions: CATCH Facilitator, Chapter Equity, Diversity, and
|
|
Inclusion (EDI) Champion and South Valley Member At Large (South Valley Counties include Fresno, Inyo, Kings, Madera, Mariposa, Merced, Mono and Tulare). We will also be holding elections for Chapter Vice President this summer. Please let us know if you’re interested in becoming one of our chapter leaders.
I hope to see many of you at the spring CME, Ask the Experts. The meeting will be held on May 6 at the Partnership HealthPlan of CA in Fairfield. We’ll be discussing and learning about Adolescent Gynecology, Endocrinology and Gastroenterology. Follow the link to learn more and to register. Thanks to our CME committee for all of the planning and preparation, and many thanks to Partnership HealthPlan for allowing us the use of their space. I’ve already registered - don’t wait, sign up ASAP!
|
|
Developing Concerns: Is it Autism?
Renee Wachtel, MD, FAAP
Committee on Developmental and Behavioral Pediatrics Chair
|
|
In the past, if parents would visit their pediatrician with concerns about delayed speech, they would ask if the child was “just a late talker” or if it was because “boys talk later than girls”. Now, however, parents ask “My child is not talking, could it be Autism?”. It is our job as pediatricians to evaluate the child’s development and behavior and make appropriate referrals.
As you know, autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by core deficits in social communication and restricted and repetitive behaviors. It can be accurately detected by 18-24 months of age, although the diagnosis usually occurs much later. Early detection of ASD enables referral for autism-specific early intervention, which improves outcomes. The American Academy of Pediatrics (AAP) recommends all children undergo general developmental and autism-specific screening paired with developmental surveillance. Although most primary care professionals screen for autism with a standardized autism-specific tool (reported to be about 72%), implementation of ASD screening is inconsistent.
The Modified Checklist for Autism in Toddlers (M-CHAT) and the M-CHAT, Revised With Follow-up (M-CHAT-R/F) are the most commonly used ASD-specific screening tools. However, implementation often diverges from that in the original validation studies, including limited use of the Follow-up portion of the M-CHAT-R/F administration, which limits interpretation of sensitivity and specificity.
The AAP identifies sensitivity and specificity above 70% to be acceptable for screening measures. A recently published meta-analysis of the MCHAT-R/F (see below) found that across the 51 studies reviewed, the sensitivity and specificity of the M-CHAT-R/F was found to be strong, with pooled values of 0.83 and 0.94, respectively. The variability of the estimates of sensitivity and specificity of M-CHAT-R/F, however, highlights a need to consider factors that influence screening performance.
|
|
Positive Childhood Experiences/Benevolent Childhood Experiences (BCEs) in Primary Care Clinics to Prevent ACEs Sequelae, Child Maltreatment and Neglect
Suzanne Frank, MD, FAAP
Child Abuse Prevention, Education, and Treatment (CAPET) Committee
|
|
Background: Positive or Benevolent Childhood Experiences (PCEs/BCEs) are experiences in childhood that build a child's sense of belongingness and connection. Past research has demonstrated that both positive and adverse experiences shape brain development and health across the lifespan. Just as adverse childhood experiences (ACEs) can negatively impact short and long-term physical and mental health; positive childhood experiences (PCEs) can mitigate ACEs and help support resilience. We will review what PCEs/BCEs are, why adding another screening tool matters, and how one site did so.
What are PCEs?
Research shows that PCEs/BCEs predict positive health outcomes and success in learning. Here are three examples of PCE research.
Bethell et al. looked to determine if any protective childhood experiences (PCEs) could be correlated with positive outcomes as adults—increasing resiliency and offsetting some of the trauma or damage caused by ACEs. They concluded “Positive childhood experiences show dose-response associations with D/PMH (adult Depression/Poor Mental Health) and ARSES (Adult reported social and emotional support) after accounting for exposure to ACEs.”
There are seven experiences included in the positive childhood experience (PCE) psychometric analysis.* Respondents were asked to reply “yes” or “no” to each prompt - “Before the age of 18, I was . . .”
- Able to talk with my family about my feelings.
- Felt that my family stood by me during difficult times.
- Enjoyed participating in community traditions.
- Felt a sense of belonging in high school.
- Felt supported by friends.
- Had at least two non-parent adults who took a genuine interest in me.
- Felt safe and protected by an adult in my home.
*Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample Associations Across Adverse Childhood Experiences. Levels Christina Bethell, PhD, MBA, MPH; Jennifer Jones, MSW; Narangerel Gombojav, MD, PhD; Jeff Linkenbach, EdD; Robert Sege, MD, PhD. JAMA Pediatrics. 2019.
Another screening tool for PCEs is the BCEs scale, a brief and culturally sensitive index of childhood experiences linked to long-term resilience. We like the addition of culturally sensitive screening. Check it out here: Benevolent Childhood Experiences (BCEs) Scale
And finally, Dr. Bob Sege has built on the basic PCEs research by creating HOPE, Healthy Outcomes from Positive Experiences. This project includes PCEs assessment and positive parenting skill training. His group has created the:
Four Building Blocks of HOPE:
- Relationships within the family and with other children and adults through interpersonal activities.
- Safe, equitable, stable environments for living, playing, learning at home and in school.
- Social and civic engagement to develop a sense of belonging and connectedness.
- Emotional growth through playing and interacting with peers for self-awareness and self-regulation.
Why another screening tool?
|
|
2023 Annual Spring CME Conference: Ask the Experts - May 6
Mika Hiramatsu, MD, FAAP
Continuing Medical Education (CME) Committee Chair
|
|
Come to Fairfield on Saturday, May 6 for an interactive, in-person conference addressing some of your most difficult-to-manage conditions! Our chapter spring CME meeting, “Ask the Experts,” will focus on dysfunctional uterine bleeding, irritable bowel syndrome, and short stature. We have asked 4 of our favorite local speakers to each give a short lecture, have a combined panel, and then each host a Q & A session. Learn what you need to know from Drs. Suruchi Bhatia, Jenifer Matthews, Rosie Monardo and Vivien Nguyen. Stay for lunch and network with colleagues — last year we had a very convivial meal and discussion on the sunny patio.
Register and send in your cases to be addressed at the meeting. According to one of last year’s attendees: “This is a great location for a conference! We should come here all the time.” Right off the freeway and on the way to outlet shopping and Napa wineries — I invite you to join us next month.
|
|
Advocacy Committee: Quarterly Dinner & New Trainee Chair
Stephanie Y. Fong Gomez, MD, MS, FAAP
|
|
Advocacy Committee Quarterly Dinner Meeting Monday 4/24
Join fellow pediatricians from across our chapter for an advocacy-focused evening on Monday 4/24! We are excited to share opportunities in Mental Health Advocacy and spotlight the advocacy journey of our very own chapter Vice President and gun violence prevention advocate, Nicole Webb! Dinner will be provided from 6:30-7:15pm, with a hybrid (virtual & in person) meeting from 7:15-8:15pm at Stephanie Fong Gomez’s home in Oakland.
RSVP HERE to receive the zoom link and address. Please include any dietary restrictions and whether you plan to attend in person or virtually. Let us know if you have advocacy opportunities or interests to add to the agenda, as well. We look forward to working together!
Seeking applications for a new Advocacy Committee Trainee Chair! DEADLINE: 5/15
Are you a trainee (student, resident or fellow) who is passionate about child health, health equity, and advocacy? Are you looking for an outlet to meet others with similar interests and to expand your advocacy and leadership skills? If so, we invite you to apply to serve as the next Trainee Chair for the Advocacy Committee!
The AAP-CA1 Advocacy Committee brings together pediatricians and trainees from throughout Northern and Central California to build relationships, enhance advocacy skills, and effect change towards healthier, more equitable ecosystems for young people. We meet on a quarterly basis and also organize advocacy-related events and collaborations, such as the recent Legislative Advocacy Chapter Chat and Advocating for Children Together (ACT) conferences. Our leadership structure consists of 2-3 attending co-chairs and 1 trainee co-chair, because we value a diverse range of perspectives and experiences.
If you are interested, please apply HERE by May 15. If you have questions about the role or would like to learn more, please contact info@aapca1.org.
As we prepare for the coming academic year, we would also like to congratulate our current Trainee Chair, Nate Kralik! They are graduating this spring with an MPH through the Kaiser Permanente Oakland Peds/MPH program and will start Adolescent Medicine fellowship this summer. Nate, thank you for your compassion, care, and advocacy for children and young people here in the Bay Area—we wish you a wonderful next chapter in Pittsburg!
|
|
What is Yearning to Come Alive in You with Renewed Energy This Spring?
Gail Wright, MD, FAAP
|
|
Join us nearby at the coast for a one day “Honoring Diastole” retreat to pause and reset - to remember what sustainability means for ourselves and the Earth.
Upcoming dates: May 31, June 10, August 28, Sept 24t, and Oct 27.
We spend the day outside- mindful movement and yoga, reflective writing on the hillside with sweeping vistas of the ocean, small group mindful coaching in a meadow, a delicious and nourishing seed to table lunch directly from the farm, and walking meditation around an orchard and fields of flowers.
Pediatricians Dr. Gail Wright and Dr. Jessie Mahoney offer evidence-based practices to improve physical health, sleep, mood, energy, and mental clarity. CME available for MD/NP/PAs and CEUs for RNs. Spouses and friends are definitely welcome too.
|
|
As a cardiac ICU attending, Dr. Gail Wright frequently dealt with uncertainty, fear, vulnerability, and death. She led elite performance teams in high-stakes settings. To do so sustainably, she had to develop skill sets to engage with work in ways that nourished rather than depleted her. She believes that maintaining a strong sense of purpose and meaning is key, and that professional connection and community are also crucial. Since her time as a collegiate athlete and team captain, she has been a “connector” and team builder. She has extensive experience mentoring and coaching diverse groups. Drawing on all these experiences, Dr. Wright now offers professional development and resilience boosting workshops for individuals, teams, and organizations. Check out her other offerings here: https://redwoodresilience.com/
Check out the Honoring Diastole retreat website to register or get more details:
Dr. Wright’s “Wellness Bites”: Small offerings to allow healthier shifts to feel accessible.
|
|
The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Anna Kaplan, MD, FAAP
SGA Chapter Representatives
|
|
For the most up-to-date information on AAP California bill positions, letters, and outcomes from the current California Legislative year, go to www.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 Representative Nora Pfaff, MD, FAAP and Anna Kaplan MD, FAAP at info@aapca1.org.
|
|
See All Available Pediatric Jobs on our Job Board! |
|
Opportunities for Your Benefit |
|
About Enviro-Art
Calling all young artists (18 and under)! San Diego Pediatricians for Clean Air and San Diego Audubon Society are happy to present Enviro-Art, an art contest with climate change and environmental conservation themes. Our goal is to provide youth artists an opportunity to create an art piece based on the current climate crisis, then to provide our artists a space to present their artwork. Please share with your family, friends, and patients!
This Year’s Theme: Clear Skies
This year, we are partnering with Audubon societies all across the country in celebration of all the birds around us, the skies they fly through, and the habitats that they live in. We encourage all participants to consider this theme as they create their art pieces. Join us as we imagine a world of clear skies that we can all enjoy!
How to submit your art:
For every art piece, we will donate a tree to the Eden Reforestation Project!
|
|
Keep Your Child Safe from Cannabis Edibles |
|
As you know, there has been a significant increase in accidental consumption of cannabis edibles by children. A recent study in the journal Pediatrics, January 3, 2023, found that in 2017, there were just over 200 reported cases of accidental consumption of cannabis edibles by children under six. In 2021, the number shot up to 3,054 – an increase of 1,375%! In total, there were 7,043 exposures to edible marijuana reported to poison control from 2017 to 2021 in children under six. The vast majority of the kids found the drug in their own home. While most children suffered mild impacts, 22.7% of exposed children needed hospitalization, and 8% of them – 573 children over the five years of the study – needed critical care. Reference (Pediatric Edible Cannabis Exposures and Acute Toxicity: 2017–2021. Pediatrics (2023) 151 (2): e2022057761).
AAP-OC Chapter in collaboration with the Pasadena Public Health Department have created this informational flyer titled, "Keep Your Child Safe from Cannabis Edibles" to promote awareness about the risks of edible cannabis especially as it becomes more easily accessible and as the rate of consumption increases among children.
|
|
April 26 - Climate Change, Child Health, and the Role of the Pediatrician - REGISTER HERE!
May 6 - 2023 Annual Spring CME Conference: “Ask the Experts” in Fairfield, CA - REGISTER HERE!
May 17 - Developmental Chat Part 1 - SAVE THE DATE!
May 25 - Data Exchange Framework Chat - SAVE THE DATE!
December 2 - 8th Annual Pediatric Puzzles CME Conference - SAVE THE DATE!
Other Events for Your Interest:
May 18-19 - Inflammatory Brain Disorders Conference 2023 - REGISTER HERE!
July 30 - 40th Annual Conference on Pediatric Infectious Diseases - REGISTER HERE!
|
|
Add our social media accounts to get the latest chapter updates!
|
|
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: Resham Kaur • Treasurer: Amita Saxena • Past President: Raelene Walker
Executive Director: Yolanda Ruiz
Board Members:
North Valley MAL: Thiyagu Ganesan • Sacramento Valley MAL: Lena van der List • Central Valley MAL: Deborah Shassetz • South Valley MAL: Vacant • San Francisco MAL: Maya Raman • Santa Clara MAL: Vacant • San Mateo MAL: Neel Patel • North Coastal MAL: Jeffrey Ribordy • Monterey Bay MAL: Graciela Wilcox • Alameda MAL: Renee Wachtel • Contra Costa/Solano MAL: Omoniyi Omotoso
Pediatric Insider News Editors:
• Mika Hiramatsu • Deborah Shassetz • Alyssa Velasco
Staff:
• Project Assistant: Sana Sayyid
|
|
|
|
|
|
|
