2019 - July Edition
Alice Kuo, MD, PhD, MBA, FAAP   President, AAP - CA2    2018 - 2020 
President's Message
I hope everyone is enjoying summer and any vacation or travel plans. We have been busy in the chapter and district, working on behalf of children's health.
SB 276 (D-Pan) is making its way through the legislature - this is the bill that proposes to have stricter criteria for medical exemptions and to have the public health department monitor both physicians who write an excessive number of medical exemptions and schools who have a disproportionately large number of students with medical exemptions. SB 276 passed in the Senate Health and Senate Appropriations Committees and is now in the Assembly. It passed in the Assembly Health Committee last month and is now being discussed in the Assembly Appropriations Committee. Earlier in June, Governor Newsom indicated that he would not sign the bill, but as of a few weeks ago, the bill has been amended such that he now states that he will support it. SB 276 is co-sponsored by the AAP - we not only support this bill, we are putting significant resources in having members all over the state contact key legislators to make sure they will vote to support the bill. This is just one of the activities that your chapter dues support - legislative advocacy to improve the health of children in our state.
Last month, amidst the largest measles outbreak in the country in New York City, the state of New York passed a law to abolish religious exemptions for vaccines. We are in the midst of another measles outbreak in Los Angeles County. In the past week, there have been five new cases identified, bringing the total up to 14 measles cases among Los Angeles County residents, and an additional 8 cases among non-residents who were traveling through our county. The majority of these cases are among non-vaccinated individuals. The national total number of cases of measles is over 1100, according to the CDC. While 14 cases may feel like a low number (especially compared to over 530 in New York), the potential for increased numbers is significant because of the number of travelers we have going through LAX and LA in general. Please re-double your efforts in vaccinating the children in your practice who have vaccine-hesitant parents and have not had the MMR vaccine. If you need resources in how to work with vaccine-hesitant parents, please contact Tomás.
I would be remiss if I did not mention the dozens of Lights for Liberty vigils in Southern California this past Friday night, with thousands of protestors calling for the closure of human detention centers and an end to the practices of separating children from their families, caging children and incarcerating immigrants. This is a human rights issue. The AAP is a non-partisan organization, and we care about and work towards improving the health of all children, even undocumented immigrant children. National AAP has been vocal in strongly opposing these inhumane practices because we know the long-term effects that these traumas will have on the lives of the children who are experiencing them. If you end up taking care of a child who has recently been released from a detention center and needs to be hospitalized for medical care as a result, our AAP Federal Office suggests filing a report with the Department of Homeland Security's Office of the Inspector General on their hotline. Please include details with your report (e.g., exact facility where the child was held, dates of detention, age and gender of child, etc.). You can file reports athttps://www.oig.dhs.gov/hotline
For the immigration raids that are supposedly happening today, the Los Angeles County Sheriff's Office has stated that it will not help the federal authorities apprehend immigrants and has advised immigrants to ask for identification and a signed warrant by a judge if they appear at the door. Our Immigrant Health committee continues to work tirelessly on raising awareness of these issues and building a network of pediatricians who are willing to volunteer their time to do asylum exams and help immigrants with their asylum applications. Please register via this form if you are interested in joining.  
I will just mention briefly that Adam Schickedanz and Tomás have been working diligently to launch our chapter's new Adverse Childhood Experiences (ACEs) Committee. The committee will have its first call later this month, and for the next few months, the committee will feature a series of articles on ACEs in our newsletter. Addressing ACEs is a priority for our new Surgeon General, Nadine Burke-Harris, and this committee will be working closely with the other three AAP chapters in our state on ACEs. Please contact Tomás or sign up via this form if you are interested in joining.  
Another significant event that occurred last month is that the City Council in Beverly Hills voted to ban the sale of all tobacco products, making it the first city in the country to do so. Many thanks to those members of our chapter who testified at the Beverly Hills City Council meeting back in March - this local advocacy had a huge impact in the success of this ordinance. This is another example of an activity that your chapter dues supports. Tomás and I will be gearing up to work on our Healthy People 2020 project on vaping prevention and awareness later this month.
Finally, as the weather grows warm and children are out swimming in pools and at the beach, please be aware that drowning is the leading cause of death in children under 4 years of age. We have a list of resources and recommendations below in this newsletter.
As you can see, our chapter is very active addressing child health issues and supporting all of our work as pediatricians. Now is a good time to reach out to your pediatric colleagues who have not yet joined the chapter or paid their chapter dues. If there are pediatricians you know who would be willing to join the chapter, please direct them to our membership site (here). Also, it is possible to join our chapter to support local child health efforts without joining national AAP if there are cost prohibitions. Please contact Tomás for more information.
Please check out the rest of our newsletter for information on our Town Hall meetings and other CME opportunities, ways to get Maintenance of Certification (MOC) points with Quality Improvement (QI) projects, and statewide advocacy priorities that the AAP is working on behalf of children.
Thanks for all that you do on behalf of children in our communities!
Alice Kuo, MD, PhD, MBA, FAAP
Chapter President
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Immunizations and Medical Exemptions
Sacramento - June 20 
Candace M. Gragnani, MD, MPH, FAAP
UCLA Preventive Medicine Residency Program
On June 20, I had the privilege of attending the meeting of the Communicable Disease Control and Prevention Committee (CDCP) of the California Conference of Local Health Officers (CCLHO) in Sacramento at the California Department of Public Health. At the meeting, I had the opportunity to discuss my work on the Rx for Prevention article entitled, "Understanding California's Child Care and School Immunization Requirements and Medical Exemptions." The article, written alongside Dr. Franklin Pratt and Julia Heinzerling, is a summative resource for pediatric providers on current California legislation regarding required immunizations for child care and school entry. It also provides a review of current evidence and recommendations regarding precautions and contraindications for state-required immunizations from trusted sources like the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, the American Academy of Pediatrics Red Book, and the Immunization Action Coalition. 
With the ongoing work of SB 276 and its potential future legislative changes, it remains more important than ever for providers to have quick access to evidence-based resources that help guide evaluations for and discussions about immunizations and medical exemptions. As a member and representative of AAP-CA2, which has endorsed the article, I proposed that the CDCP vote to recommend that the CCLHO review and endorse our article for distribution to local health jurisdictions so that it can serve as an evidence-based resource for local providers. The proposition was positively received by the CDCP, who will review the article and bring back any questions before a final vote in August. It was a wonderful opportunity to discuss our article and meet with those doing the work of public health, and I look forward to the continuation of our discussion at the August meeting. 
TA Visit at CHLA

Let's CATCH Up!                                                                                
Christine Thang, MD
"Hablamos Juntos (Talking Together): A Childhood Language and Literacy Initiative"  
As our Chapter's Community Access to Child Health (CATCH) Facilitator, I was invited to attend a technical assistance meeting for a project funded by the Health Resources and Services Administration (HRSA) Healthy Tomorrows Partnership for Children grant program. This meeting was attended by organizational leaders, community partners, and program personnel. The project, "Hablamos Juntos (Talking Together): A Childhood Language and Literacy Initiative" is based at AltaMed in partnership with Children's Hospital Los Angeles (CHLA) led by project director, Dr. Gladys Felix, a CHLA pediatrician.
Implemented in 2018, Hablamos Juntos is a parent education program targeted for children with developmental concerns. It has been recognized as an innovative resource for AltaMed families with its focus on the parents in contrast to other developmental interventions that solely target the children. Not only is the program novel with respect to its targeted audience, but also in its implementation at a federally qualified health center and its accessibility for Spanish speaking parents. The project employs the Hanen Centre curriculum of "It Takes Two to Talk." As described by Dr. Felix, "Hablamos Juntos empower parents to be their child's first teacher." Since its inception in March 2018, the program has enrolled two cohorts of participants in its weekly seminars.  
To highlight the early success of Hablamos Juntos, participants and program personnel have observed an increase in children's language and communication skills. Preliminary outcomes have demonstrated improvements in child language, parent-child interaction, parents' ability to support child development, and case management. From one parent testimonial who attended this meeting, "I could really see improvements in how I interact with my child and how my child interacts with me. I would take the course again, no matter what the distance, 15 minutess to one hour drive, regardless."
Toward the end of the meeting, attendees participated in a brainstorming session to address operational challenges met thus far as presented by the program personnel. Although this was only a half-day meeting, the conversation will continue as the program talks together with other organization and community stakeholders all invested in this novel program improving childhood language and literacy.
Dr. Gladys Felix had her early start in child advocacy during residency with an AAP CATCH Planning Grant. If you have an idea to make a difference in your community, consider applying for a CATCH grant! The CATCH Program is a national initiative of the AAP that supports pediatricians to collaborate within their communities to advance the health of all children. Through the CATCH Program, pediatricians are empowered to identify promising solutions that work in their individual communities. CATCH recently changed its grant cycle from twice per year to once per year. The change takes effect on November 1, 2019 when the Call for Proposals will be released. The application can be found at - https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/commpeds/catch/Pages/CATCH-Grants.aspx If you have questions, please reach out to your CATCH Chapter Facilitators Melissa Ruiz (ruizmj@gmail.com) or Christine Thang (cthang@mednet.ucla.edu), or staff at CATCH@aap.org. Thank you for what you do on behalf of children!
AAP Recommendations to Prevent Drowning in Children 

On March 15, the AAP updated its recommendations to prevent drowning in children.
Drowning can happen to any family. It's quick, and it's silent. Drowning is the No. 1 cause of death among children aged 1-4, and is a leading cause of death among teens. We can lower these rates if pediatricians, parents and policy-makers work together to implement the types of solutions we know will keep children safe.  
This Toolkit contains recommendations for pool supervision, drowning prevention PSAs, infographics, social media graphics, information for parents, advocacy resources and links to AAP policy. Please share these resources with parents and caregivers.   
Disaster Preparedness

Southern California has recently experienced earthquakes higher than 6 in the Richter magnitude scale.  In this section you will find resources so that you may better prepare for such events. 
This publication features practical and low-cost techniques to make child care facilities safer in the event of an earthquake, whether they are based in a home or a larger facility. The publication offers tips for conducting earthquake drills and includes a checklist of supplies to keep on hand in an emergency kit. 
FEMA's E-mail Updates: Fast, Free, and Automatic
Get the FEMA Mobile App
The FEMA App is the best option to receive emergency alerts and information so that you and your loved ones know what to do before, during and after disasters. This simple and easy-to-use app provides safety notifications, emergency preparedness tips, and disaster resources. 
Install the FEMA App (Apple and Android mobile devices) 
BreastfeedLA.org - Gala

BreastfeedLA is dedicated to improving the health and wellbeing of in fants a nd  families through education, outreach, and advocacy - we do this by promoting and supporting breastfeeding.  
BreastfeedLA was founded 25 years ago by a group of dedicated volunteers who wanted to make a difference in the breastfeeding rates in Los Angeles County. This October (Thursday October 10th at Pickwick Gardens in Burbank, CA) we are celebrating our 25th Anniversary with a Gala Masquerade and we would like to invite AAP-CA2 members to attend and sponsor our event. ALL BreastfeedLA proceeds go directly to our education programs and advocacy efforts including: scholarship towards our Lactation Education Specialist Training and Lactation Consultant Education Course, continuing education seminars, conferences focused on equity and advocacy, and paid family leave advocacy efforts.

BreastfeedLA Educational Events 
What They Didn't Teach You About Breastfeeding In Your Training
MemorialCare Miller Children's & Women's Hospital Long Beach
September 6 @ 8:00 am - 4:15 pm
Speaker: Dr. Jack Newman 
The Return of Breastsleeping: Humankind's Oldest and Most Successful Sleep and Feeding Arrangement
Henry Mayo Newhall Hospital
October 11 @ 9:00 am - 4:15 pm
Speaker: Dr. James Mckenna
QI Opportunities - CME and MOC Part 4

eLearning Collaborative Quality Improvement (QI) Project:    

The California Department of Public Health, the Los Angeles County Department of Public Health, and Essential Access Health are partnering with STD and QI experts from the National Quality Improvement Center to host a QI initiative, funded by the  Centers for Disease Control and Prevention , which aims to support primary care practices in increasing chlamydia screening rates, with an emphasis on adolescent patients.
Who May Register: Primary care practices across the state of California and in Los Angeles County that serve a general patient population, including at least 20 adolescents patients per month (ages 12-24 years), e.g., federally-qualified health centers, pediatric practice groups, etc. 
Applications due: JULY 26!
Receive FREE training, tailored coaching, and peer-to-peer support on implementing QI methods to improve adolescent and STD clinical best practices. Earn FREE MOC-4, CME, and CEU credits; Meet ACGME residency program QI requirements!

 Dental Transformation Initiative
In a state-funded effort to improve the oral health of Los Angeles County children on Medi-Cal, UCLA's More LA Smiles Dental Transformation Initiative invites medical providers and their staff to participate in clinical trainings and quality improvement (QI) programs. Provided by UCLA faculty in collaboration with various program partners, the free education equips providers to deliver pediatric risk-based prevention and disease management services.  
The innovative and nationally recognized curriculum includes:
This 6-month program focuses on integrating oral health preventative services in well-child visits for children ages 0-6. This includes a 1-hour training for providers and clinical staff, followed by technical assistance and implementation support.
PCPs receive additional reimbursement from Medi-Cal for applying fluoride varnish, and earn 30-50 CME and 20-25 MOC Part IV credits for participation.
Overview Training: This 1-hour training explains the Medi-Cal 2020 Dental Transformation Initiative and provides contemporary understanding of dental caries and systems-based approaches to improving children's oral health. Participating providers may earn 1 CME credit online or can request an in-person training for their office by visiting www.morelasmiles.org.
Advanced Training: The 3-hour training includes in-depth instruction on performing caries risk assessments, applying fluoride varnish, utilizing self-management goals and contemporary approaches for prevention and management of dental caries as a chronic infectious disease. Participating providers earn 3 CME credits at a UCLA event or via webinar. Email morelasmiles@ucla.edu to register for Tuesday, JUNE 4th 6pm - 9pm at UCLA or via webinar or learn about future trainings. 
Join today!
Stay Connected!  @moreLAsmiles    
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AAP-CA2 is a 501(c)(3) non-profit organization. Please consider a tax-deductible charitable donation to one of our many programs
  • The Medicine-Biological Sciences Scholarship Program, which awards scholarships to exceptional high school students each year.
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Please contact Tomás Torices, MD (Chapter executive director) for all Chapter 2 related matters.
Cell. (818) 422-9877
Mailing Address: 
PO Box 94127  
Pasadena, CA 91109

Please visit our website at  http://aapca2.org/