2019 - June Edition
Alice Kuo, MD, PhD, MBA, FAAP   President, AAP - CA2    2018 - 2020 
President's Message
 
As my first year as your Chapter President draws to a close, I reflect on the number of initiatives that we have taken on in the last year and how much progress we are making in our communities. I want to thank each one of you for all that you do for children in all of the counties in our chapter - our chapter members are the foundation from which we can do work in community pediatrics and child advocacy. I also want to thank Tomás for all of his hard work this past year keeping up with me :) , and also the members of our Executive Committee for working towards a stronger presence of our AAP chapter in our community. A year ago, I said that I wanted our chapter to be the "go-to" organization for child health issues and activities in our counties. As you see the number of activities we are involved with in the community (below), I think you will agree that we are definitely putting ourselves on the map, not just locally, but also statewide and nationally.
 
I encourage all of you to sign up for alerts from the Los Angeles Health Alert Network (LAHAN) if you haven't already (here). Even if you do not live or practice in Los Angeles County, this alert network is a great source of information for issues related to communicable disease in our area. The latest alert from LAHAN last week states that there have been no new cases of measles in Los Angeles County since May 2, 2019. However, we should still be vigilant due to our increased risk from travelers, and to still offer early measles vaccine to 6-12 month-old infants if they will be traveling internationally.
 
SB276 (D-Pan), a bill co-sponsored by AAP-California to put stricter regulations for medical exemptions for vaccines, passed the Senate last week and is headed to the Assembly. As the LA Times has reported (here), state health officials estimate that nearly 40% of the 11,500 medical exemptions filed each year would be denied by public health if SB276 were to pass. I participated in a press conference earlier this month at UCLA to support Senator Pan's bill. In addition, in case you missed it, please check out the resources we put on our website about official guidelines for medical exemptions written by Candace Gragnani, MD, MPH, one of our chapter members, in conjunction with the Los Angeles County Department of Public Health (here).
 
As we reported earlier this year, our chapter was awarded one of the six Chapter Quality Network grants to work on Phase 2 of a national immunizations project. The project is well underway and poised to improve the immunization rates at 30 practices in the UCLA Health System. This phase of the Improving Pediatric Immunization Care (IPIC) project focuses on systems-level improvement strategies, particularly through the electronic health record. A component of our project is also better understanding the quality of uploads and downloads from the California Immunization Registry (CAIR2) and how to improve these. We hope that the lessons learned from our participation in this project can improve EHR- and CAIR2-related immunization issues for multiple practices throughout our chapter.
 
As you may have seen, our chapter was also awarded one of four Healthy People 2020 grants last month. The theme of this year's Healthy People grant cycle was improving health and safety in schools, and we submitted a proposal to expand our efforts to raise awareness among parents and pediatricians about the epidemic of teenage vaping in our community. Data from the CDC has been released that shows that the rates of teenage vaping are significantly higher in Southern California than the rest of the country. In briefly looking at data from our California Healthy Kids Survey (CHKS) for 2017-2018, it appears that this occurs in more affluent school districts. For example, while the national average is 21% for percentage of 11th-graders saying that they have vaped in the past 30 days, in Santa Monica (25%), Culver City (27%) and Manhattan Beach (31%) the rates are higher, and in Inglewood, the rate is lower at 12%. We will be using the CHKS data to identify 5-10 high schools with the highest rates of vaping and working with their districts and communities to raise awareness and implement strategies to address these. We have already begun our work in Culver City and Manhattan Beach (see below).
 
Lisa Gantz, MD, member of our chapter's Immigrant Health Committee and incoming pediatric chief resident at UCLA, successfully applied for a $50,000 grant earlier this year from the UCLA Pritzker Center for Strengthening Children and Families in their inaugural grant cycle. She organized an outstanding seminar held at UCLA on Family Separation, with speakers Steven Shafer, JD, from the Esperanza Immigrant Rights Project in East Los Angeles, and Katie McLaughlin, PhD, from Harvard's Department of Psychology and expert on the neurological implications of childhood trauma (please see below for more details). In addition to a Speakers Series, which will continue next year, the Pritzker project also aims to support the Los Angeles County Office of Immigrant Affairs with undergraduate and graduate student interns from any academic institution.
 
Finally, we held a successful Help Me Grow Strategic Forum last week at the downtown First 5 Los Angeles offices. Over 70 stakeholders from different public agencies and organizations attended, including members from Regional Centers, health plans, school districts, early care and education, and public health departments. This event was co-sponsored by our chapter, and Kim Belshé, the Executive Director of First 5 LA, recognized the expertise and leadership of our chapter in the issues of developmental screening and early identification and intervention for children with developmental delays. The theme of the Strategic Forum was "The Grey Zone: Strengthening Early Identification and Intervention for Children with Mild to Moderate Developmental Delays." Please see below for more details.
 
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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HPV Update

In collaboration with CDC's Division of Cancer Prevention and Control, this report
highlights California's human papillomavirus (HPV)-associated cancer burden, as well as the HPV vaccine distribution trend for 2018. Click this link to view the report. 
 
 
 
New Toolkit

Developmental/Behavioral Screening and Referral Toolkit for Pediatricians
 
  Eileen Yamada, MD, MPH, FAAP - California Department of Public Health, Maternal, Child and Adolescent Health Division
 
The American Academy of Pediatrics' (AAP) Bright Futures Guidelines include recommendations for developmental surveillance and screening for young children. Although developmental surveillance is recommended at each encounter with the child, developmental screening using a standardized developmental questionnaire is recommended at 9 months, 18 months, and 30 months. In addition, screening for autism spectrum disorder is recommended at the 18 month and 2 year visits, social-emotional screening is recommended at regular intervals and maternal depression screening is recommended at the 1 month through 6 month visits.
 
California's State Screening Collaborative (CSSC), with joint funding from the California Department of Public Health and Department of Developmental Services, developed an online toolkit for healthcare providers. The toolkit contains information on developmental and behavioral screening, tools for screening, resources, and how to refer infants and toddlers who are identified as needing additional support or intervention. It is a valuable resource for pediatricians and other healthcare providers who conduct routine healthcare visits and who are the first line of defense for developmental and socio-emotional concerns. Children who are screened and provided intervention at the earliest possible point are more likely to be successful in school and later life.  
 
You can find this helpful online toolkit at: https://www.cascreenbto5.org   Additional national screening resources may be found at the AAP's Screening Technical Assistance & Resource (STAR) Center at: http://www.aap.org/screening
 
CATCH

New Grant Cycle for CATCH: The Community Access to Child Health (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. In each district, Chapter CATCH Facilitators (CCFs) and District Residents Liaisons (DRLs) provide technical assistance to pediatricians and pediatric residents who have an idea to address specific child health issues (e.g., oral health, obesity prevention, mental health) and develop grant proposals for funding of up to $10,000. Once funded, these CATCH facilitators and liaisons provide ongoing support to grantees. 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. If you have questions or concerns, please reach out to your CCFs Melissa Ruiz (ruizmj@gmail.com) and Christine Thang (cthang@mednet.ucla.edu), or staff at CATCH@aap.org. Thank you for what you do on behalf of children!
 
 
Upcoming AAP-CA2 Event  -  Save The Date

June 4 - Town Hall in Woodland Hills
  
Ken Saul, MD, FAAP AAP-CA2 Member-At-Large
 
   
Join AAP-CA2 Member-At-Large Ken Saul, MD, FAAP for an evening of professional development and networking.
 
Topic: What's New With Probiotics 
Speaker: Tracy Shafizadeh, PhD     
 
 
 
 
 
 
 
 
 
 
Date: Tuesday, June 4,2019
Time: 6:30 PM 
Location: Maggiano's Little Italy 
6100 Topanga Canyon Blvd, Woodland Hills, CA 91367
RSVP by emailing to Dr. Saul:
Advocacy

Smoke Control - Multi-Unit Housing
Seeking Pediatrician in Favor of Smokefree Policies
   
City of Los Angeles Councilmember Paul Koretz has introduced a motion about passing a law that would regulate smoking in multi-unit housing in the city of Los Angeles. According to the CDC, more than 1/3 of apartment residents are breathing a neighbor's tobacco smoke. Thousands of surveys conducted by SAFE in the last 15 years (With funding from the California Department of Public Health) showed the same results.  
 
The office of Councilmember Koretz hopes that a pediatrician could join the next meeting (June 19 at noon at LA City Hall) of the health organizations and Tenants' Rights groups to join the effort to protect LA's children who live in apartments from tobacco and marijuana smoke. Are you interested? Register here 
   
Volunteering Opportunity: Assisting Immigrant Youth

Center for Human Rights and Constitutional Law  
 
From June 10-19, 2019 CHRCL will be conducting Court-approved interviews with 
Flores class member minors and parents detained at border patrol facilities in the Rio Grande Valley Sector in southern Texas.
Interested lawyers, doctors, paralegals, and interpreters are invited to participate as volunteer monitors in the planned interviews. The purpose of these monitoring visits is solely to gather information regarding the border patrol's compliance with the terms of the Flores settlement that require the humane treatment and prompt processing of minors in border patrol custody. To volunteer, please register or sign in to reunify.org , where you can select the dates you wish to participate.
 
In The Community

Beverly Hills City Council Meeting - May 7
   
The City of Beverly Hills Health and Safety Commission presented their recommendations to City Council to ban the sales of all tobacco products in Beverly Hills during a formal session on the evening of Tuesday, May 7, 2019. The City Council voted to move forward with an ordinance that would prohibit the sale of tobacco products at gas stations, convenience stores, and other establishments within city limits. It also carved out some exemptions: three cigar lounges. The final reading and vote is expected to take place on July 4th. If passed, the new law would take effect January 2021.       
 
 
AAP-CA2 Executive Director Tomás Torices, MD spoke in the best interest of youth stating that, "while so many passionate individuals advocate for themselves against the ban, [tobacco] poses a health impact on our society - and we cannot leave the fate of generations to come to the passionate desires of a few".   
 

Legislative Day in Sacramento - May 20
 
 

The AAP-CA Annual Legislative Day, also know as "Leg Day", took place on Monday, May 20 in Sacramento. District IX CEO Kris Calvin led an advocacy training session for the leadership that represented each of the four California Chapters. This daylong event provides Chapter leadership with an opportunity to speak with State legislators about issues that affect children and the practice of pediatrics.
 
(Left) California's Surgeon General Nadine Burke Harris, MD provided an overview of her new role, stating that she's
working with leaders within the state's public health infrastructure with the focus on social determinants of health, standardizing ACE screening, and reducing health inequities.
 
(Right) Erin Haney, JD presented on criminal justice issues that affect health and well-being of children and youth, including SB 294 (Skinner) which AAP-CA supports as expressed in this letter. Ms. Haney is National Policy Director at Cut50. Read her Bio.  
 
    
(Left) AAP-CA2 Exec. Dir. Tomás Torices, MD; Assemblymember Nazarian's Legislative Director Emellia Zamani; District IX DVC Paula Whiteman, MD, FACEP, FAAP, and Dana Anderson.  
(Right) Senator Portantino with Tomás Torices, MD. Alyssa Morse, MD and Caitlin Newhouse, MD 
 
 During the afternoon session, attendees walked to the State Capitol and met with legislators to advocate on behalf of the children of California on the following High Priority items: SB-276 (Vaccine exemptions), AB-764 and SB-347 (Soda related bills), SB-394 (Criminal justice, parents diversion option), and SB-458 (Pesticides).
 
 
 

Teenage Vaping and Alcopops - May 21
 
Pueblo y Salud, Inc (PYS) held a Community Town Hall in Palmdale on May 21 at Larry Chimbole Cultural Center to highlight the impact of alcohol and tobacco products on children. AAP-CA2 Executive Director Tomás Torices, MD presented data on the health impact of tobacco use in Los Angeles County, and discussed how the cities of Manhattan Beach, Hermosa Beach and Beverly Hills had implemented citywide tobacco restrictions.  Los Angeles County morbidity and mortality reports (2014) show great health disparities in the Antelope Valley (Service Planning Area 1) where the top four causes of death (All associated with tobacco use) are significantly greater than in LA County as a whole.    
 
(From Left) Xavier Flores (PYS Program Director) and Tomás Torices, MD (AAP-CA2 Executive Director). 
   
 
PYS Program Director, Xavier Flores, stated that the City of Palmdale has recently adopted new language for Alcopops but not yet for flavored tobacco, and that there's still a lot of work ahead to regulate flavored tobacco in the city.    PYS is a Social and Human Services Agency that focuses on Education, Prevention, Organizing, Mobilizing and Empowerment. PYS has successfully worked and enacted tobacco retailer licensing ordinances, self-service display ordinances, and tobacco billboard advertising ordinances in Antelope Valley and San Fernando Valley.  
 
Carson Benowitz-Fredericks, MSPH of Alcohol Justice said that Alcopops are sweet, often fruit-flavored or fizzy alcoholic drinks. They closely resemble soda or energy drinks, and many contain up to 12% alcohol by volume. Alcopops are industry's transition for youth (especially girls), from soda to alcohol, fueling alcohol-related harm. View the Alcopops 2020 Report
 
Related News: A federal judge ordered the Food and Drug Administration (FDA) to speed up its reviews of thousands of electronic cigarettes currently on the market. The lawsuit was filed in federal court in Maryland last year by the American Academy of Pediatrics, the Campaign for Tobacco-Free Kids and other public health groups. Read the story here
 

Immigrant Youth - May 23
 
The UCLA Immigrant Youth Task Force (IYTF) Speaker Series presented the topic of FAMILY SEPARATION: A Multidisciplinary Discussion of the Consequences of and Alternatives to the Detention of Immigrant Children. This event was held on May 23rd at Ronald Reagan UCLA Medical Center, Tamkin Auditorium. Read the full story on the Daily Bruin.   
 
 
 
(Top left) Steven Shafer, JD discussed past and current policies that led to family separations in the Spring 2018, proposed policies that may impact children in the future, and options to avoid further traumatization of young people and families.   
 
(Top right) Dr. Katie McLaughlin from Harvard University Department of Psychology discussed the impact of how adverse childhood experiences and institutionalization in childhood alter brain development and raise risk of mental health disorders in adolescence and adulthood. "This is how I conceptualize family separation. We're taking a group of children who are enormously vulnerable as a result of exposure to trauma and adversity early in life, and we are removing their largest source of protection: a stable and caring relationship - their caregiver."  
   
(Center) Dr. Sural Shah, MD, MPH, moderated a panel discussion during which the speakers addressed concerns from the audience. (On right) Lisa Gantz, MD presented the speakers with a special recognition for their contributions.  
 
The Immigrant Youth Task Force at UCLA was created in 2019 to advance research, advocacy, policy, inter-campus collaboration, and community engagement to promote the well-being of immigrant youth and families in Los Angeles County and beyond. Drs. Sural Shah, Lisa Gantz, and Alice Kuo are part of UCLA IYTF founding faculty. 
 

Culver City Council Meeting - May 28
   
The Culver City Council Meeting on Tuesday, May 28th was the site of a controversial discussion about the regulation of electronic cigarettes and flavored tobacco products in Culver City. While there was no concrete motion on the table, the agenda item prompted a heated discussion involving students, parents, medical professionals, and vendors of the products in question.  
 
(From left) AAP-CA2 President Alice Kuo, MD, PhD, MBA, FAAP and Culver City Mayor Meghan Sahli-Wells 
 
AAP-CA2 President Alice Kuo, MD, PhD, MBA, FAAP made the argument that the use of e-cigarettes is a gateway drug to others like marijuana, which can be ingested with the same technology. Dr. Kuo cited a study from USC that looked at communities with stricter regulations; Manhattan Beach and Hermosa Beach. View the full story here 
 

The Gray Zone - May 29
   
Multiple stakeholders met at First 5 LA headquarters in Los Angeles on May 28 for an event co-sponsored by F5LA and AAP-CA2: The Gray Zone: Strengthening Early Identification and Intervention for Children with Mild to Moderate Developmental Delays.  Panelists from First Connections, Inland Empire Health Plan (IEHP), Help Me Grow Ventura, and Help Me Grow Santa Clara presented their successes and lessons learned in serving children in the Gray Zone.
 
 
Participants broke out into groups to review case scenarios to identify practice and policy barriers, as well as to make recommendations for Improvement in Los Angeles County. First 5 LA will review these recommendations as they build the framework for Help Me Grow LA.  
 
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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