Judith Palfrey, MDPast President AAP

Generations TogetherMassachusetts AAPNovember 1, 2013

A LIFE IN PEDIATRICS:ADVOCACY, ADVENTURES AND

THE AAP

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

CHILD HEALTH IN AMERICA

Child health in America is not what it should be given the enormous resources we have in this country

INFANT MORTALITY

The United States ranks 34th in Infant Mortality

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

SOCIAL DETERMINANTS

COMMUNITY MEDICINE AND ADVOCACY

Pediatrics would be

stronger and

more effective if community medicine

and advocacy were core elements of our training and practice

PEDIATRIC ADVOCACY

SO I HAVE QUITE HAPPILY

ENDED UP WITH A LIFE IN

MOTIVATION

MOTIVATION

MOTIVATION

MOTIVATION

NEW YORK, NEW YORK

Vanderbilt Clinic: Take a ticket, sit on a bench, see whoever is next in line

Jacobi Hospital: Skydivers and Children Can’t Fly

Montefiore: Adolescent Medicine needs to be practiced where the teens are

BOSTON 1974-Present

Bullshark44

COMMUNITY CHILD HEALTH

Building strong communities

Honoring children and families

Emphasis on health of body, mind and spirit

Dr. Julius Richmond

COMMUNITY CHILD HEALTH

• Primary Care

• Community Involvement and Consultation

• Research into Programmatic Innovations– Early Childhood– School Health – Adolescent Health

PEDIATRIC ADVOCACY

ADVENTURES IN

PROJECT SCHOOL CARE

CHILDREN WITH SPECIAL HEALTH CARE NEEDS

13%

6%

30%

Mod/sev functional limitations

MCHB definition

Any occurrence

6%13%

30%

ABILITY NOT DISABILITY

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

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

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

TRAINING

• Training in the school• Bring in the experts• Involve the kids• Work together• Have fun

PEDIATRIC ALLIANCE FOR COORDINATED CARE

MEDICAL HOME

PACC MODELENHANCED CARE FOR

CHILDREN WITH (COMPLEX) SPECIAL HEALTH CARE NEEDS

PhysicianLocal Parent Consultant

Nurse Practitioner/Case Manager

Child and Family

PACC’S 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

PACC EXPERIENCE

Six primary care practitionersReal world, real time experimentAddition of a day a week of a nurse

practitionerFamily consultant time/Community

FocusDocumentation through an IHPContinuing medical education

THE INTERVENTION

Totals

About $15,000/yr/practice

8 hrs PNP CME/CEULPC

Stipend IHP+ ++

EMERGENCY VISITS

0

510

1520

2530

3540

4550

None One to Five Six-Nine >=10

PrePost

HOSPITALIZATIONS

0

10

20

30

40

50

60

None One-two Three-five Six-Ten

PrePost

IMPACT OF THE CONDITIONWORK MISSED IN LAST 6 MONTHS

FOR PARENTS (n=150 )

0

5

10

15

20

25

30

35

None 1 to 3 4 to 9 10 to 20 >20

PrePost

%

PEDIATRIC ADVOCACY

The AAP and

AGENDA FOR CHILDREN

2009-2011 HIGHLIGHTS

• Health Care Reform-ACA Passage

• H1N1

• Disasters – Haiti, Chile, Philippines, Pakistan

• Attacks on Immunizations

• Obesity Epidemic and Roll-Out of Let’s Move

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

HEALTH CARE REFORM

KIDS MADE A DIFFERENCE!!

HEALTH CARE REFORM ?!?

• Follow Info on www.aap.org

• Join FAAN or Key Contacts

• Meet with your Congress reps

• Send Op-Eds• Keep up the

Pressure

ACA

ASSURES HEALTH CARE ACCESS FOR ALL CHILDREN

Now all children (US citizens) assured accessIncluding up to 26 years

Including children with pre-existing conditions

THE AAP SUPPORTED HEALTH CARE REFORM AND URGED A SYSTEM THAT:

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:

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:

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:

FIRST LADY’S OBESITY INITIATIVE

• To end childhood obesity in one generation

• Public/Private

• Everybody

• Pediatricians will:– Calculate BMI

– Prescribe healthy foods and fitness

HELPING BABIES BREATHE

A BIG FAVORITE THING

A BIG FAVORITE THING

SOMSRFT

5th Annual Advocacy Project:

ImmuneWiseSection on Medical Students, Residents, and

Fellowship Trainees2009-2010

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

MeaslesEpidemiology

Measles Clinical Presentation

Section on Medical Students, Residents and Fellowship Trainees (SOMSRFT)

Advocacy Campaign 2013-2014

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

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

• 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/safe’s code– Discuss repercussions  

Advice to Parents

Source: healthychildren.org

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

FIREARM INJURY PREVENTION: STATE/FEDERAL LEVELS

Read AAP’s federal policy positionsContact your state and federal legislators Support common sense firearm legislation that protects kids

P.A.V.E template letter & http://federaladvocacy.aap.org

Organize or participate in a firearm injury prevention advocacy day

Write an op-ed or letter to the editor

PEDIATRIC ADVOCACY

THANK YOU.

KEEP DOING WHAT YOU DO IN

IT’S ABOUT THE KIDS