In August's Warmth, the Sun Ascends...

In August's warmth, the sun ascends on high,

Its fiery gaze can scorch the sky,

Through extreme heat and dehydration pains,

Pediatricians weather all domains.

President's Column

Nicole Webb, MD, FAAP

Happy summer everyone! I hope you are enjoying time with family and friends and staying cool. My family and I recently took a trip from the Central Valley, where it has consistently been above 105 degrees, to the Central Coast, where it was nearly 50 degrees cooler. Many parts of our state have been seeing record heat and with that comes risk of heat exhaustion, heat stroke, and other heat-related illnesses. Many of you may be seeing such patients in your offices, particularly with summer and pre-season sports practices. Signs of heat illness include: feeling faint, extreme fatigue, mental status changes, headache, fever, intense thirst, oliguria, nausea, vomiting, rapid deep breathing, paresthesias, myalgias and muscle spasms. Hydration along with cooling, and prompt medical attention when there is lack of improvement or severe symptoms are critical. HealthyChildren.org has great resources for caregivers including tips to keep kids safe, and symptoms of heat illnesses to watch out for. Hopefully with this information we can help all our patients stay cool and safe.

In other news, I am delighted to introduce you all to some of our new AAPCA1 leaders!

Welcome to Dr. Chandni Jain, MD, who is one of our Advocacy Committee Resident Co-Chairs. Dr. Jain is a third-year pediatric resident at Kaiser Permanente Oakland Medical Center who completed medical school at Boston University School of Medicine. She is a first-generation American and the first in her family in medicine. She is from San Jose, CA, and she attended UC Berkeley (go Bears!). She has done several public health internships globally to help empower women and children through reproductive justice, and she also worked for UNICEF USA after college for two years, doing grassroots organizing, engaging in community partnerships, and leading advocacy groups in Congressional meetings. Dr. Jain is passionate about addressing health disparities and we are delighted to have her co-leading our Advocacy Committee!

Next, welcome to Dr. Josten Overall, MD, MPH, our other incoming Advocacy Committee Resident Co-Chair. Dr. Overall is a pediatric resident at the University of California, San Francisco. Dr. Overall obtained her Bachelor of Science at the University of California, Davis, and her medical degree at the University of Colorado School of Medicine. Her passion for caring for children and families began early on including her experiences working as a summer camp counselor, and she has dedicated much of her professional career to meaningful community engagement and mentorship for underrepresented youth. Her other professional and clinical interests include supporting diversity, equity and inclusion within her residency program, anti-racism initiatives, and pediatric mental health. Welcome Dr. Overall! We are delighted to have your expertise in our chapter and on the Advocacy Committee!

We are also thrilled to welcome our incoming Immigrant Health Task Force Co-Chair, Dr. Shazeen Suleman, MD, MPH. Dr. Suleman is a Clinical Associate Professor in the Division of General Pediatrics at Stanford University, where she is also the Co-Director of Community Engagement with the Office of Child Health Equity. She obtained her medical degree from the University of British Columbia and completed her residency at the Hospital for Sick Children in Toronto. Following this, she completed an MPH at Johns Hopkins University as a Sommer Scholar. She is an Affiliate Scientist with the MAP Centre for Urban Health Solutions at Unity Health Toronto at the University of Toronto. Prior to joining Stanford, she was an Assistant Professor at the University of Toronto, and the founder of the Compass Clinic, which provides low-barrier, trauma-informed and culturally-safe care to refugee and immigrant children with special healthcare needs. Welcome Dr. Suleman!

We are so fortunate to have such an amazing group of fierce pediatric advocates in our chapter, and we are truly humbled by all that you do. As always, we want to hear from you about how we can best serve our membership and our kids. Please don’t hesitate to reach out at either info@aapca1.org or to me directly at nwebb@board.aapca1.org. Have a great rest of your summer!

Yours in advocacy,

Nikki

Membership Spotlight:

Dr. Lena van der List & Dr. Dean Blumberg

Kids Considered™ is a UC Davis Children’s Hospital podcast, featuring two pediatricians, Dr. Dean Blumberg and Dr. Lena van der List who discuss child health topics of interest to parents in plain, non-medical language. In every episode, new subjects are considered, discussing issues that apply from healthy pregnancy to birth to teen years. The pediatricians have different styles of practice and viewpoints, but their goals are the same: they aim to optimize children’s health and development and help parents understand current recommendations and why policies are the way they are. The podcast aims to provide accurate and timely information in an entertaining manner to increase the confidence of parents as they address the sometimes confusing parenting issues of the day. Although the podcast is aimed mainly at parents, pediatricians and other health care providers might find the discussions of interest. Additionally, children might want to get a behind-the-scenes look at what their parents are listening to.

Listen in to their latest podcasts:

Water Safety – Summer Replay  

Travel with Kids Part 1- Summer Replay

Are You Ready for Data Exchange? Check Your Patient Portal

Diane Dooley, MD, MHS, FAAP

Project Consultant, Data Exchange Framework Education Grant

“Clinicians must be familiar with state laws and advocate for minors’ rights to confidential care by championing workflows that allow clinicians to safeguard confidential adolescent information but maximize information transparency.”

• Shikha Sinha MD, Raghuveer Puttagunta MD, and Jennifer Vodzak MD²

The world of real-time data exchange between health care agencies, hospitals, community-based organizations, and social service agencies is coming quickly, with electronic exchange of health and social services information for many Californian health and social services providers anticipated by January 31, 2024. As implementation progresses, we will no longer be unsure of the care offered in other health settings, such as inpatient stays, specialty visits and emergency rooms. We will also know which social service and non-profit agencies are providing support to our patients. Given time and a lot of work, California’s Data Exchange Framework will facilitate our understanding of patient needs and experiences and transform our practices. We encourage you to read through this newsletter that spotlights the importance of protecting sensitive data and provides resources on technical assistance grant funds that you may be eligible to procure.

Regardless of its benefit, part of our responsibility in supporting the exchange of information under the Data Exchange Framework is to ensure that we’re not inadvertently sharing confidential information that will harm our relationship with patients and their families. 

This is a critically important time to get involved in looking at your institutional policies regarding sensitive information, especially as reflected in your patient portal. Patient portals are a useful tool for physicians, families, and adolescent patients. They allow us to communicate with patients, provide educational materials, information regarding prescriptions, appointments and more. Depending upon the configuration of the portal, they may also provide access to visit notes, labs, problem lists, mental health concerns and more. However, providers have found the more information you reveal in a portal, the more risk you take that sensitive information will be revealed.  

Your portal is a window to view the types of health information that will soon be available for exchange to health systems throughout California. If your institution has simply adopted the policies proposed by “adult centric” national EHR vendors serving patients of all ages, you may lack the necessary systems to separate sensitive pediatric data. Federal rules prohibiting information-blocking encourage the release of almost all medical information. You may also be vulnerable to exposing protected information because you have not looked at your documentation systems critically to make sure that consistent with State law, confidential information is not routinely integrated into regular notes and workflow. In order to ensure confidentiality in the data exchange, we recommend you begin working with institutional information technology partners to identify sensitive data and develop workflows protecting our patients and ourselves from unintended sharing of confidential and sensitive information.

Developing Concerns Screening

Renee Wachtel, MD, FAAP

Committee on Developmental and Behavioral Pediatrics Chair

While California pediatricians are aware that Adverse Childhood Experiences (ACEs) can be associated with mental health disorders and chronic diseases such as asthma and adult-onset hypertension, we are not given the sufficient resources to intervene after we complete an ACEs screening with a tool such as the PEARLS.

Fortunately, the CA legislature and Governor Newsom have recently approved two new resources that can help our families access the services that they need to address ACEs and Social Determinants of Health. These resources are now approved for children with Medi-Cal and their families, and the state is providing funding to expand their availability. 

Community Health Workers (CHWs) are individuals working in the community who come from the community and share ethnicity, culture, language or life experiences. CHWs support the adults that children rely on, building self confidence, efficacy and health literacy. CHWs assist families in navigating the complex network of government and community-based resources that can address a family’s needs. This can include education, health care and social services. CA has recently developed the ability to bill for CHW services, and is supporting training and an increased CHW workforce to enable pediatricians to refer families for these services. Training leading to certificates are offered online, such as through Berkeley City College and Stanford. 

Dyadic Therapy:

Dyadic Services is a Medi-Cal benefit that is a family- and caregiver-focused model of care intended to address developmental and behavioral health conditions and foster access to preventative care for children. An All Plan letter (22-029) was issued March 20 instructing all Medi-Cal managed care organizations about the new Dyadic services and family therapy benefits that started January 1. Dyadic services work within the pediatric clinic setting to identify and address caregiver and family risk factors for the benefit of the child . This includes dyadic behavioral health well-child visits (often called integrated behavioral health in pediatric practices), dyadic psychoeducational services, dyadic family training and counseling for child development, and dyadic comprehensive community support services. All of these services enable the pediatric practice to bill for services to both the child and the caregiver at the same visit. Models of this approach have been implemented in Health Steps and Dulce programs. 

Pediatricians should reach out to their local Medi-Cal Managed Care Organizations to see what new services are available to their patients, and consider implementing some of these programs in their practices.

8th Annual Pediatric Puzzles CME Conference

SAVE THE DATE: Saturday, December 2

California Academy of Sciences

Save the date, Saturday, December 2 to join AAPCA1 in San Francisco at California Academy of Sciences for our 8th Annual Pediatric Puzzles CME Conference! We will have interactive lectures by experts in pediatric dermatology, sports medicine, mental health, and physical therapy. You won't want to miss the latest updates on sports, skin, and psych along with lunch networking and Q&A sessions. Participants are eligible for 5 hours of CME credits.

Date: Saturday, December 2

Time: 8:30am - 2:30pm

Location: California Academy of Sciences,

55 Music Concourse Drive, San Francisco, CA 94118

Credits: 5 CME credits available

Make sure to mark your calendars and stay tuned for more details in September!

California Chapter 1, American Academy of Pediatrics Signs On to Two Support Letters: 

AAPCA1 signed on to a support letter urging CMS to fulfill its obligation under Section 1902(a)(30)(A) of the  Social Security Act to ensure sufficient access for children enrolled in Medicaid/CHIP.  As mentioned in the letter:

“The unfortunate truth is that Medicaid/CHIP coverage does not always equate to sufficient access to care. Too  many barriers remain that prevent some children from accessing the care that they critically need, including  traveling long distances to get care, waiting weeks or months to get an appointment with a clinician, getting  care from clinicians with less specific training, or going without care altogether. Overall, the process can be  cumbersome and unreliable for patients, families, and providers, contributing to delays in care. ”

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. 

Multidisciplinary Approach to Pediatric Sports-Related Concussions Research Study Participant Recruitment

Are you a licensed pediatrician in the United States who has seen or treated a patient who has sustained a sports-related concussion? If so, you may be eligible to participate in our 5-minute research survey study to help improve and foster a collaborative approach with neuropsychologists to develop a multidisciplinary approach to pediatric sports-related concussions. To participate in this research study, please click on the following link: https://paloaltou.co1.qualtrics.com/jfe/form/SV_37tOa0TXdN2NfMO.

You can enter a drawing for one of five $100 Visa gift cards. If you have any questions or concerns, please feel free to contact us at brainlab@paloaltou.edu or (650) 417-2025.

California Newborn Screening Program

The California Newborn Screening (NBS) Program screens all babies for 80 different disorders. State law requires that all California babies have newborn screening soon after birth. The NBS Program’s goal is to identify babies with these disorders early, so that treatment can be started immediately. Parents can get their baby’s blood spots destroyed after the screening. To stay abreast of the NBS Program updates, sign up for the e-newsletter (https://tinyurl.com/GDSPOnline) or visit the NBS Program website (https://www.cdph.ca.gov/NBS).

September 6 - Developmental & Behavioral Pediatrics - Part 2 - SAVE THE DATE!

December 2 - 8th Annual Pediatric Puzzles CME Conference at the California Academy of Sciences! - SAVE THE DATE!

December 8-10 - 2023 Las Vegas Seminars - REGISTER HERE!

Executive Committee:

President: Nicole Webb • Vice President: Neel Patel

• Secretary: Resham Kaur • Treasurer: Amita Saxena • Past President: Nelson Branco

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: Bindya Singh• San Mateo MAL: Vacant • 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 Coordinator: Sana Sayyid