In May, we pave the way
In educating and motivating patients to eat more healthy,
For the role of pediatricians in the National Pediatric Mental Health Emergency,
For vaccinating 5 and below, and much more!
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President's Column
Nelson Branco, MD, FAAP
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This newsletter should arrive in your inbox on Saturday, May 7, the same day we will be having our spring CME meeting - Itches, Wheezes, and Sneezes at the Partnership Health Plan offices in Fairfield, CA. I hope to see many of you there in person, and I’d like to thank Isra, Yolanda, Dr. Mika Hiramatsu, and all of the members of our CME Committee who worked hard to put on this meeting.
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The announcement that Moderna has applied for an EUA and submitted data to the FDA for their COVID vaccine for children younger than 6 is one that we have all been anxiously awaiting. With the news that we may have at least one vaccine available for kids under 5 sometime in June, we can start thinking about a phase of the pandemic where almost all of our patients have equal opportunity to be protected by a safe, effective vaccine. But, if you’re like me, you’re also concerned about the logistics of vaccinating all of the toddlers and pre-schoolers in your practice, especially if the dosing involves three doses instead of two. |
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Where I practice in Marin, our county Department of Public Health has done a great job of providing access to COVID vaccines in a variety of settings. Because of their focus on equity and education, our county residents had an opportunity to have their questions answered and be vaccinated in a location that is convenient and comfortable for them. We anticipated that as the vaccine became available for children that convenient and comfortable location would be our practice for a larger proportion of eligible kids. We also appreciate that this was especially true for the youngest kids in our practice. Public Health professionals at every level have acknowledged this, and several have reached out to discuss how they can support efforts to vaccinate younger kids in their medical home.
I know that there are some practices that have not yet started giving COVID vaccines for many reasons. This has become an increasing concern to public health officials here in California and nationwide. In our own practice, we began giving the vaccine in late 2021, initially giving the vaccine as part of drive-through flu shot clinics, then by adding spots at the end of the day on a regular basis. We now give the vaccine during visits for kids who are eligible, as well as by standing order at ‘nurse only’ visits. Our patients have been grateful to get their vaccine in a familiar setting with expert vaccinators like our medical assistants and nurses. There have been issues around storage, supply, staffing and waste. Especially in the early days when vaccine supply was more limited, we worked hard to use every dose.
Giving the COVID vaccine to children in our offices is not always easy, but it has been incredibly rewarding to be able to do something tangible to help protect our community through the pandemic. If you’re not yet giving the COVID vaccine in your office, please feel free to reach out to me or to one of your colleagues who has figured it out. I know that by mentoring one another and supporting our colleagues, we can expand the ability of parents to get their children vaccinated. This is the best and safest path to the end of the pandemic - let’s help each other do this! I’m happy to share my practice’s progress, mistakes and successes along the path to our current practice.
Another important topic - Chapter 1 elections will be happening soon. You should receive information by email from AAP National with a link to your ballot and information about all of the candidates. Please do take a look at the information shared about these impressive and accomplished colleagues. I’m looking forward to working with the new members of our executive committee and board. I also encourage you to take a look at the different AAPCA1 committees and see if there’s one that might benefit from your own expertise and interests.
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Vice President's Column
Nicole Webb, MD, FAAP
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As all of you know, May is Mental Health Awareness month. In October 2021, the AAP, the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) issued a joint statement declaring a state of emergency in child and adolescent mental health.
Our chapter is fortunate to have a very active Mental Health Committee, chaired by Dr. Diane Dooley, which has done and continues to do amazing work. You can click the link above, or reach out to info@aapca1.org if you would like to get involved or have questions about chapter-level activities addressing mental health. You can also explore a lot more information and resources at the AAP national level, including specific resources for chapters and individual practices, here.
I could fill this whole newsletter with the amazing work you are all doing to address mental health in your practices and at the chapter, state, and national levels. Today, however, I want to focus on suicide prevention and specifically lethal means restriction. What is lethal means restriction? It is assessing whether a person at increased risk of suicide has access to firearms (specifically) and other lethal means, as well as then providing resources for how to mitigate that risk.
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As of 2018, suicide became the second leading cause of death of us youth aged 10-24. The number one cause of death for US youth for many years has been and continues to be unintentional injury, of which there are multiple potential causes (i.e. motor vehicle collisions, firearms, drowning, poisoning…). However, firearms cause death from multiple causes (homicide, suicide, unintentional injury, undetermined, in that order). According to the latest data released by the CDC, firearms are now the number one leading cause of death of US children and adolescents, having surpassed motor vehicle collisions in 2020.
How does this relate to lethal means? ..
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AAP Advocacy Conference Updates
Meera Sankar, MD, FAAP
Santa Clara Member-At-Large
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I feel honored and thankful to have attended the 2022 AAP Virtual Advocacy Conference (my very first one) held on March 20-22.
Dr. Moira Szilyagi, President, AAP, and Melinda Williams-Willingham, MD Chair, AAP Committee on Federal Government Affairs kicked off the opening session followed by Mark DelMonte, JD’s presentation on practical politics. The afternoon session had great workshops on building physician advocacy skills and focused on the important current issues impacting children such as immigration policies, children’s coverage, and access to health care.
Our First Lady, Dr. Jill Biden presented the opening message on Monday, highlighting the important roles of pediatricians in child advocacy, especially relevant during this tough pandemic time.
The main areas of focus this year were youth mental health and suicide prevention efforts. We met in small groups to prepare and practice talking points for our meeting with the delegates. Special thanks to Drs. Yasuko Fakuda and Jacques Corriveau who were amazing coaches/mentors to guide us with the preparations for the meeting. With our well-prepared talk points, Tuesday was an exciting day to meet with Senate and House delegates at both national and local levels.
We met with CA senator's Diane Feinstein’s staff as a large group and with our House representatives (Anna Eshoo, Zoe Lofgren & Salud Carbajal) as a cozy group with four physician members. The sessions were very engaging and positive. We discussed the mental health challenges facing children and adolescents, including the impact of COVID-19 in exacerbating these challenges. We reviewed the importance of prioritizing the mental and behavioral health needs of children and adolescents in any mental health legislative package addressed by Congress. We requested the representatives to support children’s mental health care access act (H.R. 7076/S. 3864) and co-sponsor the Youth mental health and suicide prevention act (H.R. 1803/ S. 3628).
Overall, this has been a very rewarding and fulfilling experience and would like to recommend this strongly to anyone interested in advocacy efforts. Here are a few fun pictures from the events!
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Congratulations to CATCH 2022 Grantees! |
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On April 15 the Community Access to Child Health (CATCH) program awarded grants to 32 Fellows and Pediatric Trainees/Residents in 21 AAP chapters across 18 states and Canada, to implement innovative community-based child health projects. Three of these grantees are in our chapter! Congratulations to our Chapter 1 Grantees!
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The Role of Pediatricians in the National Pediatric Mental Health Emergency
Renee C. Wachtel MD, FAAP
Alameda Member-At-Large & Chair, Committees on Development and Behavior and School Health
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On the front page of the New York Times Sunday, April 24 was the headline ”It’s Life or Death: US Teenagers Face a Mental Health Crisis”, with a long report on “The Inner Pandemic”. This follows the National AAP declaring a National Pediatric Mental Health Emergency last month. The data from the CDC (CDC’s Youth Risk Behavior Surveillance Data Summary & Trends Report) are staggering. In 2019, before the pandemic:
- 13% of adolescents reported having a major depressive episode
- More than 1 in 3 high school students had experienced persistent feelings of sadness or hopelessness
- About 1 in 6 youth reported making a suicide plan in the past year
What is the role of pediatricians in this emergency?
According to the CDC, the role of pediatricians is to:
- Ask adolescents about family relationships and school experiences as a part of routine health screenings.
- Encourage positive parenting practices.
- Engage parents in discussions about how to connect with their adolescents, communicate effectively, and monitor activities and health behaviors.
- Educate parents and youth about adolescent development and health risks.
This ignores the significant role that pediatricians play in screening for depression and Adverse Childhood Experiences (ACEs) as part of the well child visits, identifying children and youth who are struggling with mental health issues including depression, performing an assessment, determining treatment options, supports and referrals, and potentially initiating treatment. One constant concern is that there are insufficient resources in all CA communities to accept referrals in a timely fashion.
Many pediatricians have raised concerns about the lack of recognition of the role of pediatricians in the mental/behavioral health system. In addition, they point to the need for longer well child visits to screen for these issues and provide appropriate care, and to be appropriately reimbursed for the time they take to provide this care. In addition, many pediatricians request further training to improve or update their skills in this area.
It is important for the AAP to advocate for these issues so that pediatricians can be part of the solution in addressing this Emergency.
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Lifeology Labs
Miriam Rhew, MD, MPH, CLC, FAAP & Caren Vance, MD, CCMS, FAAP
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As pediatricians for over 20 years in our respective Alameda County community-based private pediatric practices with populations that are primarily publicly insured, we see patients every day that have barriers to healthy eating. Sara came in yesterday with an elevated body mass index (BMI) that has rapidly increased during the pandemic. She lives alone with her mother who is an essential worker and while there are foods from the food bank at home, she chooses to have an easy meal of a bag of Cheetos, a ham sandwich, and chocolate milk for dinner. We see patients like Jamal who is afraid to leave the house because his brother was shot in their driveway last year and he spends most of his time looking at screens to distract him when he hears gunshots or yelling outside. We see patients like Kamila who is a refugee from Afghanistan and participates in the free school lunch program where she is provided pizza and skim milk which doesn’t taste all that great to her but she eats because it is the only meal available to her for the day.
Like many of you, we felt tasked in 15 - 30 minutes, to educate and motivate patients to “eat more fruits and vegetables and eat less sugar” or “exercise daily outside” or “be more mindful”. However, without providing our patients and their families with executable skills and practical knowledge, without changing their mindset to feel empowered to change, without being in a community where they can see others like them, and without addressing the real stresses their families face, we find ourselves repeating these recommendations at every visit without much effect. We are then witness to a progressive decline in their health from many toxic stresses which are known to impact health, as they move from infancy to adulthood, while under our care.
Over the past several years, we have both done work individually and collaboratively to address some of the helplessness and frustrations we felt. We have participated in MBSR (mindfulness-based stress reduction) programs. We have together run marathon relays and sprint triathlons. We created a short-lived program called “Walk Your Doc” where we walked with our patients at Lake Chabot every weekend. We have shared healthy recipes with each other and attended a mindful eating workshop together. During the pandemic, Caren became a certified culinary medicine specialist (CCMS) and Miriam became a certified life coach (CLC) through the Life Coach School and through Dovetail Learning. We also both were some of the earlier practices to incorporate trauma-informed care using the PEARLS (Pediatric ACEs and Related Life Events Screener) promoted by ACES Aware in the state. . .
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The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH, CFAAP
SGA Chapter Representatives
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AAP-CA1 signed on to a letter responding to the Department of Homeland Security’s (DHS) notice of proposed rulemaking (NPRM) on public charge published in the federal register on February 24, 2022.
We signed on to support the administration's proposed rule that would clearly “effectuate a more faithful interpretation of the statutory concept” as compared to the 2019 Final Rule. In implementing the 2019 rule, DHS ignored extensive data and research that organizations provided to the agency which clearly demonstrated the harmful effects it would have. As expected, immigrants and their families–including U.S. citizen children–suffered due to the widespread chilling effect that caused immigrants to avoid enrolling themselves or their family members in a wide range of public benefit programs. We believe the newly proposed NPRM reflects adequate consideration of policy data and corrects the gravest errors of the 2019 rule. Read the full letter here.
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 latest organizational advocacy updates follow @AAPCADocs on Twitter. If you have question and/or are interested in knowing more about a certain legislation, reach out to our State Government Affairs Chapter Representative Nora Pfaff, MD, FAAP and Zarah Iqbal, MD, MPH at info@aapca1.org
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Calling on Subspecialists: California Pediatric Survey of Parent Support |
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The Lucile Packard Foundation for Children’s Health (LPFCH) is requesting your participation to inform advocacy efforts in addressing needs and improving support for families of children with chronic health conditions. AAP-CA1 and LPFCH's four chapters, Children’s Specialty Care Coalition, California Children’s Hospital Association, and California Association of Neonatologists support this study. This 5-minute survey will help better understand the familiarity, opinions, and referral behaviors of pediatric subspecialists in California. We encourage your participation. The survey closes on May 20!
To complete the survey, please click on the link below:
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We'd Like to Feature You! |
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Opportunities for Your Benefit |
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Kids Vax Grant Opportunity Exclusively for VFC Providers
Application cycle is open until May 27, 2022, or when all funds are disbursed.
The State of California is offering grant funding to medical organizations enrolled in the federal Vaccines for Children (VFC) Program, serving eligible children from birth through 18 years of age. Administered by Physicians for a Healthy California (PHC), the California Department of Public Health (CDPH) is investing approximately $10 million to fund the KidsVaxGrant.
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VFC providers newly enrolled in California's COVID-19 vaccine program (myCAvax) could be eligible for $10,000 to support enrollment and launching of a vaccination center. Those that enroll in myCAvax from December 17, 2021, through May 27, 2022, will qualify for the grant.
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VFC providers already enrolled in myCAvax, who are expanding operating hours, could be eligible for $15,000. Eligible providers must expand hours of operations by a minimum of 15 hours to provide additional time options for working families.
- Expanded hours must be outside of normal or existing clinic hours, and they must be completed within 60 days of the application’s approval (not retroactive).
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AAP Anxiety and Depression ECHO Cohort 2
In partnership with the National Training and Technical Assistance Center for Child, Youth, and Family Mental Health (NTTAC), the American Academy of Pediatrics is recruiting primary care providers to join a 6-month learning collaborative. The goal of this ECHO is to build the capacity of primary care providers to provide quality behavioral and mental health care within the medical home setting, with a focus on anxiety and depression. The first session will be held on May 4, 2022. ECHO sessions will be held on the 1st and 3rd Wednesday of the month from 11am -12pm CT May 4, 2022 – October 19, 2022. For more information, click here and contact Lisa Brock, Program Manager, ECHO Initiatives at lbrock@aap.org. Register here.
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Pediatrician Survey on Climate Change
On behalf of fellow pediatricians and the University of Pittsburgh, we are inviting you to participate in a research survey to learn more about the opinions and practices of pediatricians and pediatric providers regarding discussing climate change within pediatric clinical settings. This study includes a 5-minute online survey reporting your opinions on discussing the health effects of climate change with patients and families. Following the survey, you will have a chance at one of twenty $50 Amazon gift cards. Chances of being chosen are expected to be approximately 1 in 20. In a second survey, you will be asked to enter personal contact information. This is only to contact you if you are chosen to receive a gift card and will not be linked to your first survey answers.
For questions, you can contact the study coordinator, Erin Mickievicz (mickieviczee@upmc.edu), or the principal investigator from the University of Pittsburgh, Dr. Maya Ragavan (ragavanm@chp.edu). Thank you so much for considering and we are so deeply grateful to learn from your expertise!
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May 11, 7:00PM - 8:30PM - Adolescent Depression: Screening and Follow-Up - REGISTER HERE
May 16, 7:00PM - 8:30PM - Follow-up Chat on the Children and Youth Behavioral Health Initiative (CYHBI) - SAVE THE DATE
June 8 - HP 2020 Medical-Legal Partnerships - SAVE THE DATE
June 22, 4:00PM - 5:15PM - Enhancing Adolescent Health & Immunization Services AAP Webinar 3 - REGISTER HERE
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Add our social media accounts to get the latest chapter updates!
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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.
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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.
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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: Maya Raman • Santa Clara MAL: Meera Sankar • 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: Yolanda Ruiz
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