1. Judith Palfrey, MD Past President AAP Generations Together Massachusetts AAP November 1, 2013 A LIFE IN PEDIATRICS: ADVOCACY, ADVENTURES AND THE AAP

2. PEDIATRICS ADVOCACY ROOTS George Armstrong Abraham Jacobi Mary Putnam Jacobi Emily Blackwell Job Lewis Smith Martha May Eliot HelenTaussig Robert Haggerty Joel Alpert Berry Brazelton Barry Zuckerman

3. CHILD HEALTH IN AMERICA Child health in America is not what it should be given the enormous resources we have in this country

4. INFANT MORTALITY The United States ranks 34 th in Infant Mortality

5. UNICEF RATINGS Compared to 29 other industrialized nations, Unicef ranked the US First (Worst) in Obesity First (Worst) inTeen Births 25th in Child Health and Safety

6. SOCIAL DETERMINANTS

7. COMMUNITY MEDICINE AND ADVOCACY Pediatrics would be stronger and more effective if community medicine and advocacy were core elements of our training and practice

8. PEDIATRIC ADVOCACY SO I HAVE QUITE HAPPILY ENDED UP WITH A LIFE IN

9. MOTIVATION

13. NEW YORK, NEW YORK Vanderbilt Clinic: Take a ticket, sit on a bench, see whoever is next in line Jacobi Hospital: Skydivers and Children Cant Fly Montefiore: Adolescent Medicine needs to be practiced where the teens are

14. BOSTON 1974-Present Bullshark44

15. COMMUNITY CHILD HEALTH Building strong communities Honoring children and families Emphasis on health of body, mind and spirit Dr. Julius Richmond

16. COMMUNITY CHILD HEALTH Primary Care Community Involvement and Consultation Research into Programmatic Innovations –Early Childhood –School Health –Adolescent Health

17. PEDIATRIC ADVOCACY ADVENTURES IN

18. PROJECT SCHOOL CARE

19. CHILDREN WITH SPECIAL HEALTH CARE NEEDS 13% 6% 30% Mod/sev functional limitations MCHB definition Any occurrence 6% 13% 30%

20. ABILITY NOT DISABILITY

21. PL94-142/IDEA The Education for All Handicapped Children Act passed in 1975 Advocacy by parents, policymakers, professionals Based on several court cases about classes of children PARC vs Pennsylvania, Mills vs the Board of Education Collaborative Study in 5 cities

22. PROJECT SCHOOL CARE Documenting the need – Census of children assisted by medical technology Program development – consultation to schools – Pediatric fellow and Nurse Practioner Creation of Guidelines for Care Promotion of the Project School Care Model

23. CENSUS ON CHILDREN ASSISTED BY MEDICAL TECHNOLOGY 1 in 1000 children in Massachusetts Consider that average pediatric practice is 1500 to 2000 children Small towns may have 2000-3000 children in the schools

24. TRAINING Training in the school Bring in the experts Involve the kids Work together Have fun

26. PEDIATRIC ALLIANCE FOR COORDINATED CARE

27. MEDICAL HOME

28. PACC MODEL ENHANCED CARE FOR CHILDREN WITH (COMPLEX) SPECIAL HEALTH CARE NEEDS Physician Local Parent Consultant Nurse Practitioner/Case Manager Child and Family

29. PACCS GOALS Comprehensive primary care services at the community level Enhanced availability and coordination of necessary secondary and tertiary services Improved communication between primary and secondary care providers Coordination of health and other services Maximization of family participation

30. PACC EXPERIENCE Six primary care practitioners Real world, real time experiment Addition of a day a week of a nurse practitioner Family consultant time/Community Focus Documentation through an IHP Continuing medical education

31. THE INTERVENTION Totals About $15,000/yr/practice 8 hrs PNPCME/CEU LPC Stipend IHP +++

32. EMERGENCY VISITS

33. HOSPITALIZATIONS

34. IMPACT OF THE CONDITION WORK MISSED IN LAST 6 MONTHS FOR PARENTS (n=150 ) %

35. PEDIATRIC ADVOCACY The AAP and

36. AGENDA FOR CHILDREN

37. 2009-2011 HIGHLIGHTS Health Care Reform-ACA Passage H1N1 Disasters – Haiti, Chile, Philippines, Pakistan Attacks on Immunizations Obesity Epidemic and Roll-Out of Lets Move

38. DISASTER RESPONSE www.aap.org/disasters/index.cfm –Hurricanes (Katrina, Ike, Gustav) –Pediatric Education in Disasters course –H1N1 Pandemic –International (China, Philippines, Haiti, Chile, Pakistan) –Oil Spill –Japan Nuclear Crisis

39. HEALTH CARE REFORM

40. KIDS MADE A DIFFERENCE!!

41. HEALTH CARE REFORM ?!? Follow Info on www.aap.org www.aap.org Join FAAN or Key Contacts Meet with your Congress reps Send Op-Eds Keep up the Pressure

42. ACA ASSURES HEALTH CARE ACCESS FOR ALL CHILDREN Now all children (US citizens) assured access Including up to 26 years Including children with pre-existing conditions THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:

43. ACA GUARANTEES SERVICES UNIVERSALLY IN A MEDICAL HOME, THAT COORDINATES PRIMARY CARE, EMERGENCY SERVICES, SUBSPECIALTY AND HOSPITAL CARE. Medicaid pilots and supportive language for the concept THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:

44. ACA HAS A CONSISTENT AND FAIR PAYMENT SCHEDULE THAT ASSURES PHYSICIANS AND THEIR STAFFS RECEIVE APPROPRIATE COMPENSATION FOR THE WORK THEY PROVIDE. Medicaid to Medicare Parity Included THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:

45. ACA IS COST SAVING THROUGH THE USE OF HIGH QUALITY, WELL DEVELOPED INTERVENTIONS AND TRIED AND TRUE PREVENTIVE SERVICES. Bright Futures Home Visiting Programs Dental Services THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:

46. FIRST LADYS OBESITY INITIATIVE To end childhood obesity in one generation Public/Private Everybody Pediatricians will: –Calculate BMI –Prescribe healthy foods and fitness

47. HELPING BABIES BREATHE

48. A BIG FAVORITE THING

49. SOMSRFT

51. 5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees 2009-2010

52. Brought to You By: SOMSRFT Executive Committee Advocacy Subcommittee – Co-Chairs Drs. Katie Snyder and Jennifer Williams – Members Drs. Shawn Batlivala, Clara Filice, Jenni Linebarger, Christina Robinson, Sara Slovin, Josh Smith, Amy Starmer, David Tayloe –Other Contributors/Supporters Lucy Crain, MD, FAAP, Buz Harlor, MD, FAAP, Michael Warren, MD, FAAP, Julie Raymond, Ian Van Dinther

53. Measles Epidemiology

54. Measles Clinical Presentation

55. Section on Medical Students, Residents and Fellowship Trainees (SOMSRFT) Advocacy Campaign 2013-2014

56. Firearm Injury Prevention: Clinic Create/distribute parent handouts –i.e. AAP Connected Kids –Display the 2013 P.A.V.E. poster Educational commercial/video in waiting rooms Dispensing of gun safe locks Discuss teen violence, how to to avoid it, and ways to have positive conflict resolution How to talk to children after a firearm-related injury

57. Educate Parents and Patients Safest way = no firearms in the home Discuss the dangers of guns; they are not toys ASK: Are guns in the homes where your children play? –Where is it stored? –How is it secured? –ASK Campaign Source: healthychildren.org

58. For parents who choose to keep firearms in the home: –Always keep the gun unloaded and locked up –Bullets locked and stored separately –Hide keys –Never tell child the lock/safes code –Discuss repercussions Advice to Parents Source: healthychildren.org

59. Firearm Injury Prevention: Community Speak to school groups about firearms –Incorporate guest speakers impacted by firearm injury Parent education at after school programs Collaborate with law enforcement, Boys & Girls Club, community centers, etc. Partner with ED/Trauma teams for high school education

60. FIREARM INJURY PREVENTION: STATE/FEDERAL LEVELS Read AAPs federal policy positions Contact your state and federal legislators Support common sense firearm legislation that protects kids P.A.V.E template letter & http://federaladvocacy.aap.orghttp://federaladvocacy.aap.org Organize or participate in a firearm injury prevention advocacy day Write an op-ed or letter to the editor

61. PEDIATRIC ADVOCACY THANK YOU. KEEP DOING WHAT YOU DO IN

62. ITS ABOUT THE KIDS