In Classrooms Bright, Where Laughter...

In classrooms bright, where laughter rules the day,

Pediatricians watch as children play.

Flu shots prepared, their caring hearts ignite,

In upcoming conferences, they'll share their light.

President's Column

Nicole Webb, MD, FAAP

Hello to all our wonderful advocates! I hope you are all faring well with back to school in full swing. 

As many of you know, the AAP held its Annual Leadership Conference, or ALC, in early August. Much of this issue will be devoted to that, with testimonials from several of our leaders including Dr. Nelson Branco, Dr. Bindya Singh, Dr. John Takayama, and our wonderful executive director, Yolanda Ruiz. I encourage you to read their excellent columns for highly relevant information about the conference and its proceedings.

One of the main functions of the ALC is to debate and vote on the resolutions submitted by members. Resolutions which are adopted are then ranked by conference attendees, and the top 10 resolutions are thus determined. This Top 10 list has historically had a significant impact in informing the Academy’s strategic advocacy priorities. 

This year’s top resolution comes from our District (IX) and was authored by Dr. Paula Whiteman of AAP CA2. It is entitled Federal Protections of Gender-Affirming Care for Both Patients and Their Doctors. You can view the full resolution text by clicking the link above. It discusses the current state of legislative attacks on gender-affirming care and asks “that the Academy advocate for Federal protections of gender-affirming care for both patients and their doctors, including payments for medical services” as well as “that the Academy advocate for gender-affirming care as a human right.”

The AAP has long supported gender-affirming care as the evidence-based standard for transgender and gender-diverse youth and has advocated for protections for the pediatricians who care for them. As such, this resolution is in line with current Academy policy, including the policy statement Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents, which will be reviewed this year as part of the Academy’s ongoing commitment to ensuring its policy is based on current and relevant evidence.

Despite this long standing support, the current legal landscape for trans and gender-diverse youth and their caregivers is alarming, with 494 anti-LGBTQ bills currently being considered across the US. In fact, the only states and territories not considering legislation targeting LGBTQ youth are Delaware, Illinois, New York, Washington, DC, Guam, Puerto Rico and the US Virgin Islands. 

This includes our own state of California, with AB 1314. . . (Read more of Dr. Webb's article HERE!)

. . . The fact that this issue was declared the most important advocacy needed by elected Academy leaders from across the US speaks to how deeply passionate pediatricians are for caring for these children, even amidst growing legal threats. 

Speaking for myself, that shared passion for doing what is evidence-based and right for our kids is what fuels me when I am feeling discouraged. I hope you feel the same. It is critical that we continue to support one another. We will continue to disseminate information about how to effectively advocate on this issue and we welcome your suggestions and feedback.

In solidarity,

Nikki

Annual Leadership Conference - Different Perspectives

New Attendee Perspective

Bindya HSB Singh, MD, FAAP - Santa Clara Member-At-Large

The AAP Leadership Conference 2023 held in Chicago August 3 to 6 was home to a well-organized platform for discussing some of the crucial current topics needing critical attention by Pediatricians and Allied Healthcare Providers. With the elegant AAP headquarters in the backdrop, the attendees witnessed a plethora of brilliant intellectual and compassionate discussions on some compelling current topics. These included legal updates on use of Electronic communications, advocacy and suggested measures for preventing Gun violence, enhancing mental health screening and provisions for care, and addressing substance abuse concerns, amongst others. It was a delightful experience to realize that the spirit of improving health and safety initiatives for children and youth continues to motivate the care and undertakings of the present generation of practicing pediatricians.

Resolutions

John I. Takayama, MD, MPH, FAAP - District IX Representative, Chapter Forum Management Committee (CFMC)

The 2023 Leadership Conference was held on August 3-6, 2023; participants discussed resolutions about the critical themes on the minds of pediatricians and their patients and families. Voting members, the Chapter Presidents, VP’s and the Council, Committee and Section Chairs, adopted 63 of the 75 resolutions submitted. The Top Ten Resolutions, garnering the most votes, reflected such key topics: gender affirming care; pediatrician payment; autism diagnosis by pediatricians; reproductive healthcare; education of residents and medical students; access to mental health care; equity, diversity and inclusion; gun violence; and telehealth (https://publications.aap.org/aapnews/news/25346/Leadership-Conference-Top-resolution-calls-for). . . (Read more here)

The Election Perspective

Nelson Branco, MD, FAAP - Immediate Past President, AAPCA1

As you’ve read in Dr. Singh and Dr. Takayama’s articles, the 2023 Annual Leadership Conference (ALC) was inspiring, exhausting, fun and meaningful. I was fortunate to be able to attend as Past President in place of Nikki Webb, who couldn’t attend ALC due to a conflict with a Pediatric Hospitalist conference. That should not happen in the future, since a resolution that she co-authored, “Avoiding Scheduling Conflicts Between the Leadership Conference and Other Large Pediatric Conferences," was accepted at the meeting and will go on to the AAP leadership for study and implementation. As I’ve written before, any time you think “the AAP should” - put that idea down on paper, figure out the details and write a resolution. The 2024 Call for Resolutions is right around the corner . . . (Read more here)

The Executive Director Perspective

Yolanda Ruiz - Executive Director, AAPCA1

Before the ALC officially kicked off, I attended the Chapter Executive Director’s Leadership Conference. Our incredible Executive Directors’ Steering Committee (EDSC) worked tirelessly for a year to bring Executive Directors (EDs) from all AAP chapters together for a day and a half. We connected, learned from one another, and left with fresh ideas and motivation. I had the privilege of delving into the remarkable ways in which other chapter EDs support pediatricians in their regions and I can't wait to bring these ideas back to support all of you! During the ALC . . . (Read more here)

State and Federal Efforts Promote Greater Health Information Sharing

Seth Bokser, MD, MPH, FAAP, Diane Dooley, MD, MHS, FAAP, and Resham Kaur, MD, FAAP

Project Leads, Data Exchange Framework Education Grant

In July 2021, Governor Gavin Newsom and the California State Assembly enacted AB 133 (Chapter 143, Statutes of 2021), which calls for a statewide health and human services data exchange framework. This framework, known as the Data Exchange Framework (DxF) consists of a statewide data sharing agreement (DSA) and a common set of policies and procedures to promote and govern the exchange of health information among California government agencies, providers, and healthcare entities. By January 31, 2023, all health providers in the state of California were due to sign the DSA. A list of current signatories can be found here.

The vision is that by January 31, 2026, all participating entities in the state of California will exchange health information or provide access to health information to and from every other entity in real-time for treatment, payment, or health care operations. Note that some DxF participants must begin exchanging by January 31, 2024. However, not all do - specifically, physician practices of fewer than 25 physicians have until January 31, 2026.

At the federal level, in March of 2020, the Office of the National Coordinator for Health IT established the final rule for the 21st Century Cures Act requiring Health IT vendor technical standards and institutional policies to promote interoperability between health IT systems. Additionally, the final rule requires healthcare providers to share data on behalf of the patient (“information blocking prohibited”). The American Academy of Pediatrics has shared a practice management guide for member pediatricians about the 21st Century Cures Act here: 

As pediatricians prepare for expanded health data sharing, we suggest you consult with your Administrative/IT leadership and your EHR vendor regarding participation in the California DxF and the balance between information sharing and pediatrics/adolescent patient privacy. Consider the healthcare systems or networks you'll most frequently interact with and ensure mechanism(s) of safe and efficient health data exchange.

We have listed here some of the common EHR vendors used by AAPCA1 members and provide a high level summary of their approaches to health information sharing. It’s important to understand from your EHR vendor how to use the features you and your practice have turned on and may turn on in the future. . . (Read more here)

. . . It is important to note that health data exchange isn't just about technology. Organizational policies, regional regulations, and standard practices also play a significant role. Secure health information sharing has many anticipated benefits for pediatrics, including ensuring clinicians have the information they need at the point of care and empowering parents and teens to manage their own health and wellness. There are also risks inherent in providing expanded access to minor/adolescent health data. The Society for Adolescent Health and Medicine (SAHM) and the North American Society for Pediatric and Adolescent Gynecology (NASPAG) have published recommendations to advocate for appropriate health care privacy for adolescents here.

Three keys to adhering to this guidance . . .

8th Annual Pediatric Puzzles CME Conference

REGISTRATION NOW OPEN: Saturday, December 2

California Academy of Sciences

Our 8th Annual Pediatric Puzzles CME Conference is back this December! Pediatricians, family practitioners, nurse practitioners, and Physicians-in-Training are invited to receive the latest updates on pediatric sports medicine, dermatology, mental health, and physical therapy from lectures, Q&As, and networking lunches with our faculty. Participants are tentatively eligible for 5 hours of CME credits. This year’s event is in-person-only at the California Academy of Sciences in San Francisco, making it a great opportunity for a family trip! Join us Saturday, December 2 where the first 25 registrants will receive a FREE Cal Academy pass.

California Water Safety Strategy 2023

Mark Simonian, MD, FAAP

Chair, Water Safety Council of Fresno County

Board Member, CA Water Safety Coalition

In April of this year the California Water Safety Strategy was released to the public. It is the result of 2 years of meetings and hundreds of hours of collaboration with many safety advocates throughout California. This significant achievement foreshadowed the U.S. National Water Safety Action Plan that was released in June of 2023. Both groups utilized some of the same state and national experts (including the AAP), who led the way in developing a framework for drowning prevention. Both the Strategy and Action Plan were modeled from international plans with the same goal to reduce drowning. 

All pediatricians are aware of the impact drowning plays for 1-4-year-olds. It is the number one killer in that age group from unintentional injuries. It is not only a pediatric issue since all age groups are affected. We Californians experience 400 deaths annually, and 1,200 hospitalizations and emergency room visits from non-fatal drowning incidents in all ages.

Water safety advocates believe that there would be value to network with like minded individuals and organizations. It was that intention that led to workshops and summits that followed from a core group of water safety advocates to build this California Coalition. The California Water Safety Coalition continues to operate as a non-profit to educate the people on the front line of advocacy and interventions. 

The Strategy plans to be a foundation for evolving methods and outlines for drowning prevention. The hope is that individuals and organizations might refer to it to recognize and address water injuries wherever they may happen.

There are 8 priorities at the forefront in the Strategy document with workgroups to address each priority. 

• Priority 1: Public significance - to elevate drowning prevention and water safety as an issue of public significance. . .

New Registry Requirement to Submit Immunization and TB Data 

Submitted by Anya Gutman, MPH, Health Educator

California Department of Public Health, Immunization Branch

AB 1797, a new California bill effective January 1, 2023, requires providers to enter immunizations and TB tests they administer, as well as a patient’s race and ethnicity, into a California immunization registry (CAIR OR RIDE/Healthy Futures). 

This reporting requirement includes newly recommended immunizations, such as: 

• Nirsevimab to prevent severe RSV disease for infants and toddlers 
• RSV vaccines for adults 60 years and older.   

Many of your questions can be answered by visiting the AB 1797 Immunization Registry FAQs page.

Not Yet Enrolled? Enroll Now!

Joining CAIR helps providers meet requirements for AB 1797, Medi-Cal, and the Vaccines for Children (VFC) program. There are many other benefits to participating in an immunization registry: save time, improve patient care, boost immunization rates, and quickly run vaccine reports to access data for reporting.

Refer to the How to Enroll in CAIR2 page for guidance on the CAIR2 setup that works best for your practice and contact your Local CAIR Representative with any questions.

If you immunize patients in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties visit myhealthyfutures.org and contact the Healthy Futures/RIDE Help Desk at (209) 468-2292 or support@myhealthyfutures.org to enroll.

Not Sure if You’re Already Enrolled or Need to Update Your Account?

If you are not sure if your practice is already enrolled or need to update your read-only account to be able to submit doses, contact the CAIR Help Desk (CAIRHelpdesk@cdph.ca.gov or 800-578-7889) or your Local CAIR Representative.

For more information, see the AB 1797 Immunization Registry FAQs. 

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

AAPCA1 signed on to a support letter urging the movement of the bipartisan Kids Online Safety Act (S. 1409) as well as strong privacy protections for kids and teens online toward swift passage out of the U.S. Senate Committee on Commerce, Justice, and Transportation this summer and move to the floor for a vote.

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. 

Now Recruiting - AAP Rural Pediatrics: Adolescent Health Communication (ECHO)

Now Recruiting - The AAP National Rural Adolescent and Child Health Communication (NRACH) ECHO Training Center in partnership with the University of Minnesota Healthy Youth Development-Prevention Research Center (UMN HYD-PRC) is recruiting Primary Care Clinicians and other health professionals in rural, frontier, and underserved areas who serve pediatric populations to be a part of a 5-month Rural Pediatrics: Adolescent Health Communication ECHO.  This ECHO will serve as a forum for primary care providers and others that provide care to adolescent patients to develop effective communication strategies and skills that will enable them to facilitate conversations around sensitive and/or psychosocial health topics with adolescents and their families. 

The ECHO will have a Kickoff call on Aug 18, 2023, from 12pm- 1pm CT and will meet on the 1st and 3rd Fridays of each month 12pm -1pm, from September to December 2023. To learn more, view the flyer here.

Register Online Here! Questions?  Contact Oyin Oloniniyi, Program Manager, ECHO Initiatives at  ooloniniyi@aap.org .

ACEs Health Champions Gathering - Wednesday, September 13, 12pm - 1pm

Meet the Presenter: Dr. Kate Margolis (she/her pronouns) is a UCSF Associate Professor of Psychiatry and Pediatrics and is the Director of the Division of Integrated Behavioral Health at the Zuckerberg San Francisco General Hospital Campus. She is a Spanish-speaking, licensed child clinical psychologist and leads the integrated behavioral health program at the ZSFG Children’s Health Center, which includes the HealthySteps services. Dr. Margolis specializes in implementation of pediatric primary care integrated behavioral health programs and brings expertise in Medicaid financing and sustainability to this work. She has directly supported the implementation and uptake of pediatric integrated behavioral health services to over 50 publicly insured pediatric and family clinics across California and Colorado. Dr. Margolis was a leading collaborator in the development of the new Medi-Cal Dyadic Benefit and is the founding director of the UCSF Center for Advancing Dyadic Care in Pediatrics.

Healthy Families: Festival of Fitness - Saturday, September 23, 9am - 1pm

This free family festival will promote healthy families and introduce the public to our Adverse Childhood Experiences (ACEs) Program. SCMF strives to improve the lives of families and communities through physical and mental health by addressing the impact of ACEs and toxic stress.

September 14 - The Balance Between Data Exchange and Privacy: Ask the Experts! - REGISTER HERE!

December 2 - 8th Annual Pediatric Puzzles CME Conference at the California Academy of Sciences! - REGISTER HERE!

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