May • 2021
In May We Marvel on "Educate, Advocate, Agitate"

“Educate, Advocate, Agitate”
And so we do, pull our weight
In fighting for equity, strengthening vaccines programs, drowning prevention,
Mental health, immigrant health and more. To these, we keep our attention.
President's Column
Raelene Walker, MD, FAAP
The 2021 AAP Virtual Advocacy Conference (formerly known as Leg Con) was held last week and despite Zoom fatigue and the challenges of hosting 720 pediatricians and trainees, and coordinating hundreds of meetings with members of Congress, it was outstanding. Thank you and much appreciation to the AAP for organizing this meeting and advocating for children and their neglected needs amidst the COVID-19 pandemic, and for leading support for the bipartisan bill  Strengthening the Vaccines for Children Program Act of 2021. This bill, H.R. 2347, builds surge capacity and makes long-term program improvements, in addition to funding, that will enable our children to be protected from vaccine-preventable diseases and will facilitate and support pediatricians in these endeavors. We will continue to strongly advocate for these goals.

The highlight of the conference for me by far was A Conversation with Stacey Abrams, the Plenary Session on Monday morning. She is brilliant, inspirational, and thoughtful. She frames ideas in the most perfect ways I have ever heard and every time I hear her speak, days later I continue to think about her words. Because her focus for this was children and advocacy, her ideas in this talk particularly resonated with me and though she is not a pediatrician nor directly involved with healthcare, she encapsulates much of what drew many of us to pediatrics: the mission of improving the lives and wellbeing of children and families, of justice, and the joy and potential in all children.  

Thank you to our CME committee for our Spring CME meeting on Adolescent Health, held Saturday April 24. These were outstanding speakers, with very timely topics. Well done!
As children and families have not had the same social interactions and students have primarily done distance learning for a year, pediatricians and parents are all concerned about the effects on children’s development. Here is a link to a free app for parents developed by Dr. Barry Zuckerman and colleagues that I’d like to share. Dr. Zuckerman is an amazing developmental pediatrician and co-founder of Reach Out and Read, and a career-long advocate for children and families. (On a side note, I did an away elective as a resident with his group in the 1990’s which was a fabulous experience.) Please check it out if you’re interested by visiting the link attached HERE.

Finally, our chapter elections are coming up mid-May so please be on the lookout for your ballot and vote. And as always, thank you for all your incredibly hard work for children. Please also take care of yourselves and each other. 
Vice President's Column
Nelson Branco, MD, FAAP
This month has had a theme - Advocacy. Those of us who were able to take some time out from our ‘day jobs’ to attend the AAP Advocacy Conference got to hear from Stacey Abrams about her experience advocating and fighting for equity and voting rights. She told us to “educate, advocate, agitate.” And so we did - hundreds of pediatricians from across the US met with congressional staff, senators and representatives to talk about the importance of vaccines and the Vaccines for Children program. We educated them on the importance of the VFC program, advocated for changes to improve it and are ready to agitate as needed!

The week prior, our chapter members got a chance to learn about advocacy closer to home (never mind that it’s all happening at home, right here on the screen) at the Advocating for Advocacy Symposium, supported by the AAP Leonard P. Rome Visiting Professorship and planned and executed by our colleagues at Valley Children’s Healthcare. We were lucky to have Dr. Ben Hoffman from Oregon Health Sciences University and the chair of the AAP Committee on Injury, Violence and Poison Prevention present on his experience advocating for child safety. Dr. Hoffman and I worked together on the Navajo Nation in the late 90’s - hearing him recount the story of his car seat program brought back powerful memories of the beginning of my career and some of the people and efforts that sparked my own interest in advocacy and the AAP.

This past weekend, at our chapter spring meeting on Adolescent Health, Dr. Bonnie Halpern-Felsher talked to us about risk taking in adolescence and described her own efforts to “make policy to raise hell.” We’re all grateful for her willingness to take on those tough fights to keep kids safe from addiction to nicotine and other substances. 

If you’re like me, podcasts have become a favorite way to stay informed, entertained and educated. I want to share some podcasts featuring CA1 chapter members that I’ve come across recently. Chapter Members Dr. Rhea Boyd, Dr. Bonnie Maldonado and Dr. Tiffani Johnson have been guests on the AAP Pediatrics On Call Podcast. In addition to this, Dr. Boyd will be joining Dr. Bob Wachter on the In the Bubble Podcast sometime soon. I’m anxiously awaiting that episode. I know there are many more - please feel free to share your favorites. I’m always looking for good suggestions!
Incoming North Coastal Member-At-Large
Jeffrey Ribordy, MD, FAAP
North Coastal Member-At-Large
Hello from Northern California! My name is Jeff Ribordy and I’m your MAL rep for the Northern Coastal region. However, I am not new to this position as I was a North Coastal MAL rep some time in the past (don’t ask me when - all the years have blended together, especially after 2020) as well as previously the Secretary for the AAPCA1 Board. (My shorthand is terrible) I am a Children’s Hospital Oakland alum (Class of ‘98) and since then have lived in Humboldt County, among the redwoods and beautiful, deserted beaches. I currently see patients (very infrequently) at United Indian Health Services here. The rest of the time I am a Regional Medical Director for Partnership HealthPlan of California, a Medi-Cal Managed Care health plan. I look forward to representing the Northern Coastal area. Please reach out to me with any concerns at [email protected].
Mental Health Committee Update
Diane Dooley, MD, FAAP
Mental Health Committee Chair
We’re all aware of the fact that the ongoing COVID-19 pandemic has impacted the mental health, physical health and well-being of children and youth in our communities. Suicide attempts, mental health hospitalizations and reported rates of anxiety and depression among youth have skyrocketed. A recent survey done of the pediatricians in the AAP Section on Senior Members showed that 91.5% rated access to mental/behavioral health services as a topic of very high or high importance to address. If you’re interested in working on these issues, please consider joining the AAPCA1 Mental Health Committee.
The continuation of telehealth payment, along with telephonic communications with patients significantly impacts our ability to provide care, and particularly behavioral health care to vulnerable families. Our members recently wrote of their experiences and concerns regarding this issue, which we compiled as a comment for the California legislative hearing on this issue. At our next meeting on May 6, we have invited Mei Wa Kwong, JD, the Executive Director of the California Telehealth Policy Coalition, to give us information on the recent proposals to extend telehealth coverage in California. We will also be discussing the recent Cal-AIM Waiver to revamp coverage and referrals for child, youth and adult mental health. Finally, we will share projects and activities that members have been doing to promote mental health in their practice – integrated behavioral health, ACEs screening and trauma-informed care, participation in Child Psychiatry Access Portals, and improving billing and in-office short term interventions and screening. 

As Raelene Walker, our Chapter President, said recently “I belong to AAP because these are my people!”. I love that statement. By working together, we can make this a better world for our children.
Reminder: Join our Chapter Book Club!
Call for Applications and Members for the Immigrant Health Task Force
Alexandria Valdrighi, MD, FAAP
Immigrant Health Task Force Co-Chair
The CA-1 Immigration Task Force was formed to collaborate efforts to promote immigrant health in the Northern California area. We have 5 subcommittees: education, legislative advocacy, clinical resources, community partners and social media/recruitment and 3 co-chairs that oversee all subcommittees. If interested in joining--AAPCA1 Immigrant Health Task Force - Join Survey 

Call For AAPCA1 Immigration Task Force Education Subcommittee Chair!  

We are opening a call for applications for chair of our Education Subcommittee. The Education Subcommittee is focused on creating educational resources for physicians centered on providing care to immigrant patients and their families. Past work has included creating an educational webinar for the ACT conference and designing an AAP webinar series covering various immigration health topics. If interested, you can find a further description of the position here. Please fill out this form to apply (will require answering a few questions and attaching a current CV). For additional questions, e-mail [email protected]

Call For AAPCA1 Immigration Task Force Legislative Advocacy Subcommittee Chair!

The Legislative Advocacy Subcommittee provides the task force with timely updates on ongoing legislative issues that impact immigrant health and organizes actionable events to advocate for important immigrant health policies. Past work has included op-ed writing, letter writing campaigns and social media outreach. The group is currently working on organizing a call with legislative representatives. If interested, you can find a further description of the position here. Please fill out this form to apply (will require answering a few questions and attaching a current CV). For additional questions, e-mail [email protected].
Welcoming Immigrant Families in a Clinical Setting Chapter Chat with Clarisa Reyes-Becerra, Esq. and Dr. Anisa Ibrahim
View the recording of our April 21, 2021 chapter chat put on by the Healthy People 2020 Combatting Public Charge Misinformation Initiative. 
Is Advocacy Failure Killing Children?
Mark M. Simonian, MD, FAAP
In 1977 a new UC Irvine pediatric resident noticed a trend in admissions. Every week small children were treated in the emergency department (E.D.) or transferred from other hospitals or another E.D. after surviving drowning. One bigger-than-life pulmonologist-intensivist attending, Ralph Rucker, MD, at the now Children’s of Orange County Hospital (C.H.O.C.) in Orange was quite convincing in his arguments that these common injuries and deaths were preventable. His message made a life-long impression on that same resident. 

The newly graduated pediatrician returned to his hometown in Fresno in 1980. During his first summer months of practice, it was obvious as he walked the central hallway of that small children’s hospital that the same pattern of injured and killed mirrored the children’s hospital 250 miles away. The May through September months generated the highest admission numbers, and residential swimming pools were the most common site of injury for children. Drownings for children and adults were so common that the news media became complacent about reporting on radio, TV, and newspapers. 

Not many in the community had done much to reduce these drownings, yet fortuitously there was a resurgence of interest in safety efforts when a few community leaders decided combining efforts might make a difference.
AAPCA1 & ACEs Aware
The ACEs Screening tool and initiative to address childhood trauma is a small step in a long history of pediatric research and programs on understanding how children thrive, and how we can support them. 

This month's article focuses on the powerful impact of positive parenting in decreasing the risk of childhood developmental, social or behavioral delays.
Pediatric Perspectives: Positive Parenting
How do parenting practices protect against ACEs (Adverse Childhood Experiences)?

By Dr. Renee Wachtel, MD, FAAP
Chair, Committees on Development and Behavior and School Health
CA Surgeon General Nadine Burke-Harris has established the ACEs Aware initiative for ACEs screening in California using the PEARLS screening tool for children, but some pediatricians question the value of the screening, and wonder what action they can take when ACEs screening is positive. Two recent studies point the way, showing pediatricians how we can reduce the “Toxic Stress Response” that may result from ACEs and impact the potential negative effects of ACEs in young children. Since we screen young children 0-5 years old for developmental and behavioral issues on a regular basis, we should incorporate ACEs screening into our pediatric practice as well. 
Guideline for "When Things Aren't Perfect: Caring for Yourself and Your Children" is available here.
Upcoming Event:
AAPCA1 & Project Firstline
April Blog Post: 
Protecting People From Pathogens in Schools
Welcome to the third blog post for the CDC Project Firstline/AAP Partnership! 

This month’s case study involves a 7th grade patient and her mother with questions regarding safely returning to school at this time during the COVID-19 pandemic. Share your experiences supporting patients with these types of concerns and find resources to share out with your networks.

Picture this: You are seeing one of your regular patients who is a 7th grader. She is a generally healthy child, who is due for a couple of vaccines today. She is very bright and always has a lot of questions. Her mom, who accompanies her today, is on the school board. They have been discussing returning to school during the COVID pandemic. Overall your patient is happy to be back in the classroom but she is also feeling a bit nervous. Her mom wishes there was a vaccine available for her daughter at this time. They are hoping you can discuss with them how to stay safe from COVID while attending school. 

Being on the school board, the mom is familiar with the site Safe Schools for all CA. She does, however, have some specific questions and is seeking resources, both to help her better consider her child’s safety and to be able to better discuss this topic with other parents and members of the school board. 
Membership Spotlight!
Amanda Millstein, MD, FAAP & Lisa Patel, MD, FAAP 
Working Together to Safely Reopen Schools Now
It is time to safely reopen schools for kids in California! After a year of school closures, there is excitement and hope mixed with understandable fear and uncertainty. Parents, teachers, and community members are wondering what it will look like to go back to in-person learning. They are reasonably asking if it will be safe for everyone. We're launching this effort to answer those questions. Hear directly from students, teachers, and administrators on what it looks like to go back to the classroom.
COVID-19 Vaccination Education and Outreach Videos

These videos were shared by Lee Anna Botkin, MD, FAAP. Please feel free to share with your networks. Courtesy of Santa Clara Valley Medical Center.
Parents Become Superheroes in New American Academy of Pediatrics PSA
In Other AAP News
Mark Del Monte, JD
The last year has been one of enormous challenge and sacrifice for each of us. Through it all, the AAP has adapted its advocacy to ensure pediatricians, pediatric medical subspecialists, and pediatric surgical specialists have the support they need to continue providing care to children during the COVID-19 pandemic and beyond. Despite the difficult environment, we have also moved the ball forward on a number of issues of importance to AAP subspecialty members. 
I’m pleased to share with you our latest AAP Academic and Subspecialty Advocacy Report, which takes stock of key AAP advocacy efforts for subspecialists over the last year. It details the Academy’s important advocacy work on issues including COVID-19 relief, vaccine development, and school reopening. It also includes updates on efforts to bolster the pediatric subspecialty workforce through loan repayment, increase Medicaid payment for evaluation and management services, fund research into firearm injury and death prevention, and support youth mental health.
I hope you find this to be a helpful resource and look forward to hearing from you about ways we can continue to improve this tool. If you have questions or comments about the AAP’s advocacy work for subspecialists, please be in touch. And thank you for all you are doing for children and families.
The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH, CFAAP
SGA Chapter Representatives

The SGA committee continues to review and discuss bills during this legislative cycle. This past month, we were honored to welcome a new Executive Director of AAP-CA—Karmi Ferguson, MBA! 
We have enjoyed a more hands-on approach this legislative cycle as SGA members—taking on a couple bills ourselves and then presenting them to the rest of the committee leading to robust discussion about the intentions, possible consequences, and impact on child health and wellbeing that each piece of proposed legislation may have. Some of the bills we have been discussing lately center on maternal healthcare services, expanding access to mental and behavioral health services for children, safety around sedation during dental procedures, and many more. Please continue to send us your thoughts, concerns, or possible legislation that you would like us to weigh in on. 
For the most up to date information on AAP California bill positions, letters & outcomes from the current CA Legislative year, go to For latest organizational advocacy updates follow @AAPCADocs on twitter. If you have questions and/or are interested in knowing more about a certain legislation, reach out to our State Government Affairs Chapter Representatives Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH at [email protected].  
Opportunities for Your Benefit
Small Moments Big Impact
Small Moments Big Impact (SMBI) is a free app developed by pediatric clinicians and mothers. It was designed to promote the parent-infant relationship and emotional wellbeing with 24 weekly episodes. SMBI is not like other apps that provide information and answers to common questions. It was designed to elicit and discuss a mother’s stress and coping to promote a deeper and more therapeutic connection between parents and providers. 

The app’s main feature is the weekly, brief videos of mothers, primarily low-income, telling their stories. They share how they cope with stress while sharing their joys and aspirations. SMBI also includes reflection questions, a mood meter, self-care prompts, and cartoons suggested by mothers. In addition, the app allows parents to record their own video of their baby or feelings to keep as a personal journal. A Spanish version should be available in the next 2 months. SMBI can be downloaded free from the App Store for iPhones or directly from the SMBI website for Androids.

AAP SBIRT Substance Use ECHO 
The AAP invites primary care practices to participate in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Substance Use ECHO project. Participants will increase knowledge and skills regarding the use of SBIRT approaches, as part of health supervision and appropriate acute care visits, to improve the overall health and safety of adolescents. With the ongoing mental and behavioral health impact of the COVID-19 pandemic on adolescents, it is especially important for practices to be equipped with substance use prevention, detection, intervention, and treatment approaches. This program will meet regularly, once per month on the third Tuesday of the month from 12:00-1:00 pm ET beginning in June. The program recruiting flyer, including a link to the online application and additional information, is attached and available online here: Substance Use SBIRT ECHO Flyer. Contact Jessica Leffelman at [email protected] or Eileen Glasstetter at [email protected] with any questions. Register online here by May 25.
May 11: Chapter Chat on Strengthening Families with Trauma-Informed Care - REGISTER!
May 18: AAP-CA Early Career Pediatricians Virtual Town Hall - REGISTER!
November 18-21: The 42nd Annual Las Vegas Seminars at Caesars Palace - SAVE-THE-DATE!
December 4: 6th Annual Pediatric Puzzles CME Conference at O’Connor Hospital - 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: Raelene Walker • Vice President: Nelson Branco
Secretary: Janice Kim • Treasurer: Nivedita More • Past President: John Takayama
Executive Director: Isra Uz-Zaman

Board Members:
North Valley MAL: Thiyagu Ganesan • Sacramento Valley MAL: Ravinder Khaira • Central Valley MAL: Yvonne Brouard • South Valley MAL: Nicole Webb • San Francisco MAL: Rhea Boyd • Santa Clara MAL: Meera Sankar • San Mateo MAL: Neel Patel • North Coastal MAL: Jeffrey Ribordy • Monterey Bay MAL: Graciela Wilcox • Alameda MAL: Reshem Agarwal
Contra Costa/Solano MAL: Diane Dooley

Pediatric Insider News Editors:
• Yvonne Brouard • Mika Hiramatsu • Alyssa Velasco

Staff Members:
Executive Assistant: Sabah Elias • Project Coordinator: Aliza Newman