In July, We Watch As the Sun Sets...

In July, we watch as the sun sets on one leader's reign,

Our pediatric organization embraces the change.

On this upcoming day of independence pediatricians unite,

To heal, to nurture, and to mend, with all our might.

Outgoing President's Column

Nelson Branco, MD, FAAP

This is my last column as your chapter president. The past two years have been busy and rewarding, and I want to thank everyone who has participated in all of our chapter activities and efforts. It’s now the beginning of PGY-29 for me, and the past 2 years have been some of the most interesting and challenging of my career. 

When I moved from Chapter VP to Chapter President, we were beginning to vaccinate kids against COVID, talking about school re-opening and working on incorporating equity and diversity into all of our chapter efforts. In my first President’s Column, I wrote that “my guiding principle for the success of CA Chapter 1 is “What have we done for you lately?” As chapter president, I am committed to answering that question. Together with our chapter Executive Director Isra Uz-Zaman, I want to be able to connect you to resources, colleagues and the information you need to care for your patients, advocate for children and pursue your passion within our profession. By working together within our chapter and with our colleagues across California and nationally, we will help ensure the brightest future for all of the children in our communities.” 

I hope that you all feel as positively as I do about what we’ve been able to achieve over the past two years. In that time, we have navigated successive waves of COVID and evolving vaccination recommendations, led efforts to ensure our communities didn’t fall behind on routine vaccinations, managed the behavioral health crisis that has intensified over the past several years, advocated for climate change, immigrant health, racial justice, gun violence prevention and child health, provided education and support for each other, secured grants to help further our mission and worked with our colleagues at CMA, local medical societies and National AAP.

I must once again offer thanks to my dear friend and colleague, Dr. Raelene Walker. Raelene is ending her six-year cycle as chapter VP, president and past president. I am fortunate to have had these years to work with her on our chapter board and executive committee. We have all benefited from her hard work and leadership.

I’m excited to continue as past president on our chapter board and executive committee with Dr. Nikki Webb as president, Dr. Neel Patel as our new chapter VP, Dr. Resham Kaur as chapter secretary and Dr. Niki Saxena as treasurer. I want to congratulate Dr. Patel on his election to the VP role. Neel has been an active member of our board for several years, and I look forward to the contributions he will make in his new role. 

Our chapter is in good hands with Dr. Webb as our leader and representative. As I said two years ago when she became VP, her passion, expertise and commitment are going to serve us well. I continue to look forward to learning from her and supporting her in our efforts to make sure our chapter is helping all of you with the important work of caring for the children in our communities and elsewhere. 

I want to thank our chapter staff, Yolanda Ruiz and Sana Sayyid, for their hard work and willingness to do what is necessary to support us in our efforts. I remember interviewing both of them and being impressed by their maturity, intelligence and passion for our mission. I have really enjoyed watching them grow and learn, and I know that both of them will continue to work hard on behalf of our chapter members and the children we care for. I have a special thanks to Yolanda for stepping up to take on the role of interim ED and then becoming our ED as part of a competitive hiring process. It’s been a real pleasure working with Yolanda and I look forward to watching her ongoing development and growth in the role of Chapter ED.

I was able to have lunch with our former ED, Isra Uz-Zaman, a few weeks ago. She was home for a break after her first year of medical school - it was great to catch up and hear all about the challenges and successes. I’m happy to report that she is still planning to pursue a career in pediatrics, and I encouraged her to come back as a chapter member.

As many of you know, I’ve been involved with our chapter in many different ways since 2001, when I returned to California from working on the Navajo Nation. The AAP, both National and especially California Chapter 1, have been an important part of my career. I’ve written before about how my connection to you all and the work that we do together helps me avoid the fatigue, moral injury and burnout that is so prevalent in medicine. I am grateful to have had the opportunity to lead our chapter and I look forward to continuing to work with you all in the years to come. Thank you all for allowing me to be your chapter president over these past 2 years.

Incoming President's Column

Nicole Webb, MD, FAAP

To the over 2000 amazing, tireless pediatrician advocates and leaders in our wonderful chapter, I hope you are having a good summer and finding time to rest and recharge amidst the always present clinical and non-clinical demands. I can hardly believe it, because it feels like such a short while ago that I had the honor of becoming your chapter vice president, but this is my first column as your president. 

Thinking about this transition, one word comes to mind: gratitude. I am so grateful to be a part of such an amazing organization, full of innovative leaders doing incredible things not just in our region and state, but nationally as well. In the coming months I hope to highlight more of that work specifically.

For this month, however, I want to express my tremendous gratitude to two people. The first is the person who has led us, during a time of tremendous challenge, with grace, patience, wisdom and humor, and that is our outgoing president, Dr. Nelson Branco.

As many of you know, much of Nelson’s vice presidency, and his entire presidency, coincided with the COVID-19 pandemic. Despite the enormous challenges of leading in a virtual era of tremendous stress and uncertainty, under his leadership our chapter has continued to grow and adapt, and to demonstrate excellence, innovation and resilience in our advocacy for children’s health.

Nelson would be the first to tell you that the work of this chapter is done by its members, individually and in the many committees and task forces under our umbrella, and he would be right. But it takes a true leader to know when to encourage, when to push, and when to take a thorough step back and let others lead. Nelson excels at striking that balance. 

It has been an enormous privilege and honor learning from Nelson over the past several years and as we look forward to the next several I am so grateful for his decades-long dedication to our chapter, to our members, and to our kids. I am equally grateful for his ongoing presence on our board as our immediate past president.

The second person I want to thank and highlight is our newly elected vice president, Dr. Neel Patel. Dr. Patel has been a member of AAP CA-1 since completing training at Children’s Hospital Oakland in 2004 and has served in multiple leadership roles during that time, including co-leading our Young Physician’s group, leading quality improvement efforts through QUINN, and serving as our San Mateo Member-At-Large (MAL) since 2020. He also brings a wealth of experience as a former First 5 Commissioner and current First 5 San Mateo Physician Champion with a special focus on Help Me Grow. He has a particular interest in several critical areas including family and caregiver advocacy, strategic planning for philanthropy, and expanding our efforts to promote health equity through centering diversity, equity, and inclusion. I have had the privilege of working with Dr. Patel over the past several years, and I look forward to doing so in this new role. He is and will continue to be a phenomenal advocate and leader for our chapter.

As your chapter officers, we are here to serve you. I am humbled and honored to work with and learn from such an amazing leadership team, and even more amazed by the depth and breadth of the advocacy being done by all of you. We will continue to seek new and innovative ways to connect and support you in that. Please do not hesitate to reach out with suggestions, questions, and to let us know how we are doing.

How to Be Involved in AAPCA1

Resham Kaur, MD, FAAP

Secretary and Communications Director

Congratulations to all the residents and fellows who are beginning their training this July! This is a significant milestone in your journey towards achieving your goals, and it presents an incredible opportunity for immense learning and growth. On behalf of the AAP California Chapter 1, I extend a warm welcome to each one of you.

Allow me to share some information about the opportunities that AAPCA1 provides to its members, which can help you get involved and make a difference in the field of pediatrics.

Firstly, I would like to highlight our chapter’s 8th Annual Puzzles CME Conference happening December 2 (Save the date!). Events like these are organized by AAPCA1 every year and serve as invaluable resources for staying up to date with the latest developments in pediatrics. They feature outstanding speakers who are experts in their respective fields. I would like to commend the CME committee for their hard work in organizing these events. I strongly encourage all of you to attend these conferences and take advantage of the opportunity to interact with specialists and fellow professionals.

In addition to these educational events, AAPCA1 can also help you obtain AAP CATCH Grants to support you implement community-based child health initiatives. These grants can provide financial support for research projects, community initiatives, and other endeavors that contribute to the advancement of pediatric healthcare.

Furthermore, AAPCA1 has various committees that you can join to get involved in areas of interest. Advocacy Committee, Mental Health Committee, Climate Change and Child Health Committee are some of the many committees we have. These committees offer a platform for you to contribute your skills, knowledge, and passion, and to collaborate with like-minded professionals.

Once again, congratulations on embarking on this new phase of your medical training. AAPCA1 is here to support you throughout your journey, and we encourage you to take full advantage of the opportunities available within our organization. Together, we can make a positive impact on the lives of children and families in California.

Mental Health Update

Diane Dooley, MD, FAAP

Mental Health Committee Chair

As we’re all aware, a ‘tempestuous rage” of increased mental health concerns has been stressing all of us in pediatric practice for the past few years. This storm started before the pandemic and continues to rage angrily, impacting our children, our families, our practices, and our communities. In recognition of this problem, in 2022 the AAP Friends of the Children Fund offered grant funding to Chapters interested in developing advocacy projects supporting child and adolescent mental and behavioral health. With the leadership of AAP California’s CEO, Karmi Ferguson, and the AAP Executive Board, AAP California applied for, and received this short-term grant.  

For the past six months, the co-chairs of The Healthy Mental Development State Advocacy Grant, Diane Dooley, MD, FAAP and Renee Wachtel, MD, FAAP have been very busy working with partners to build a pediatric mental health advocacy platform to guide improvements in the access and quality of mental and behavioral health services for our patients. As participants in some of the early Think-Tanks advising Department of Health Care Services (DHCS) on the California Children and Youth Behavioral Health Initiative (CYBHI), Diane and Renee had noted that most of the State reforms addressing mental health did not include the pediatric perspective in the creation of the reforms. New systems of preventive and therapeutic mental health interventions in schools, on virtual platforms and in community settings were being developed without understanding the role of pediatricians in identifying and providing support and treatment for mental health concerns. We feared that the new Cal-AIM and CYBHI reforms might inadvertently create additional short-term, siloed sources of behavioral health support without adequate connection to the medical home and families. 

With the grant funding and a lot of good will, we formed a statewide Advocacy Panel composed of six AAP pediatricians, as well as a child and adolescent psychiatrist and a family physician (Photo: (Back Row) Joyce Javier, MD, Hilary M. Bowers, MD, Lisa Leavitt, MD, Lane Tanner, MD, Elizabeth Dohrmann, MD, Nivedita More, MD, Christina Buysse, MD, (Front Row) Karmi Ferguson CEO, Diane Dooley, MD, Yvonne Brouard ,MD, Catherine Marks, MD, Renee Wachtel, MD, Yasuko Fukuda, MD) to guide us in creating this Advocacy Platform. This incredibly insightful group has been meeting twice a month and building expertise on the behavioral health reforms impacting California’s children and youth. We also recruited a larger group of pediatricians and providers as a Circle of Support to reflect on our proposals and give additional comment and expert opinions on our work. The work to date has resulted in a number of proposals to strengthen the State’s reforms and address other pressing issues, including:

• Ensure that the County Mental Health and Medi-Cal health plans appropriately triage Medi-Cal enrolled children and youth to the correct system of care and provide adequate support to ensure timely access to an intake assessment and needed therapy.
• Ensure that physicians in all counties have an electronic referral system available to directly refer patients to mental health services and provide relevant clinical information related to the referral.
• Ensure that all County Mental Health and Medi-Cal health plans communicate with physicians immediately after a referral is made and provide a disposition regarding the referral.
• All provider referrals and patient calls seeking care should be tracked to ensure that patients receive care in a timely manner. Case management should be offered to all children, youth, and families seeking care. Assessment appointments should be consistently offered within two weeks of initial referral. Giving patients a list of possibly available therapists to call for an appointment should no longer be an allowable referral option for children, youth, and families seeking care.
• An age-appropriate, equity-based lens needs to be integrated into all aspects of education, screening, and referral for mental health services, including strategies to reduce stigma and address language and cultural barriers to care.
• We support CYBHI’s proposed support of a statewide consultation program for primary care providers who need support in addressing their patients’ mental health and developmental behavioral health. The consultation program should be flexible in its format and hours and should provide advice and a medical note documenting the consultation.
• In partnership with the CYBHI-proposed statewide consultation program, we support the development of multiple training platforms and programs to increase provider knowledge in managing mental health conditions in children and youth. The AAP Mental Health Competencies should be used as the basis for this curriculum.
• A regionalized program to access the complex mental health and developmental-behavioral resources needed for children should be developed. This may include using community health workers to assist families in understanding ways to support their children and implement the primary care-developed plan of action that meets their needs. 
• We urgently support the American Academy of Pediatrics and AAP California to advocate for resolution of the shortage of medications for patients with ADHD. Local reforms, such as the elimination of medication authorizations and pharmaceutical databases, should be initiated immediately in order to support continued availability of the medications.
• The American Academy of Pediatrics and AAP California should also develop and launch an educational campaign explaining the nature of ADHD and the continued need for medications in order to optimize the child’s development. The malicious stereotype that families or patients are “drug-seeking” when using their prescribed medication should be dispelled. 

This work has been very exciting, but it’s not over yet! We’re still looking at additional advocacy issues and working with partners to advance these issues. As pediatricians and child advocates, your comments and suggestions for our Advocacy Platform are important. Please contact Diane Dooley MD, 4dianedooley@gmail.com, if you want to comment on these, or other proposed advocacy statements.

Maternal Depression Screening

Renee Wachtel, MD, FAAP

Committee on Developmental and Behavioral Pediatrics Chair

Many pediatricians have not implemented maternal depression screening in the practice, for a number of reasons. This includes unfamiliarity with the screening tools available, the lack of knowledge about available resources should a screen be positive, and the general perception that “post-partum blues” are common but transient. A recent publication highlighted by the Centers for Disease Control and Prevention (CDC) is worth thinking about. 

In this study the authors (Trost et al., 2022 ) reviewed the data about 1018 pregnancy-related deaths from 2017-2019 from 36 US states, as reported by their Maternal Mortality Review Committees. They found that the leading underlying cause of death varied by race and ethnicity; they judged that more than 80% of the deaths were preventable. The most frequent underlying cause of pregnancy-related death during the pregnancy through the first year after delivery was mental health conditions (22.7%). But this varied considerably by race and ethnicity. 

Maternal Mortality Review Committees are multidisciplinary committees that convene at the state or local level to comprehensively review deaths during or within a year of pregnancy, and have access to clinical and nonclinical information (e.g., vital records, medical records, social service records) to more fully understand the circumstances surrounding each death, determine whether the death was pregnancy-related, and develop recommendations for action to prevent similar deaths in the future.

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

AAPCA1 signed on to a support letter urging the U.S. Department of Transportation (U.S. DOT) to take immediate action to prevent deaths and serious, lifelong injuries resulting from children who may have entered or been left unattended in motor vehicles. As mentioned in the letter:

“The tragedy of a child or companion animal dying in a hot car is entirely preventable. Yet, auto manufacturers, with limited exceptions, are not putting technological solutions into cars as standard equipment. As temperatures begin to rise, U.S. DOT must not defer, delay or dilute this lifesaving rulemaking.”

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. 

Identifying and Caring for Children and Adolescents with Anxiety and Anxiety Disorders - July 11, 11:00 AM - 12:30 PM CDT

Register today! This FREE virtual course is designed to support pediatricians and other health care providers with practical knowledge and resources to better identify, diagnose, and manage anxiety and anxiety disorders within their patient population. Participants will be able to differentiate between anxiety and anxiety disorders and learn strategies to effectively manage mild-to-moderate anxiety and how to co-manage patients with more severe conditions and/or common co-occuring conditions, like ADHD. Through this course, pediatricians and other pediatric health care providers will increase confidence to promote social-emotional health and further support families of children living with anxiety and anxiety disorders. This course is free to AAP members and non-members.

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).

July 30 - 40th Annual Conference on Pediatric Infectious Diseases - REGISTER HERE!

December 2 - 8th Annual Pediatric Puzzles CME Conference - 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: Vacant • 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 Coordinator: Sana Sayyid