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South Carolina Chapter AAP Annual MeetingAugust 11, 2019

Academy Leadership

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New Headquarters 5 floors erected on time and on budget

20 areas of LEED principals

AAP Major Activities

Policy Advocacy for

children’s health Education for

professionals and families

Service for AAP members

Research Global Child Health

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Health Consequences of Poverty

Increased infant mortality

Low birth weight, subsequent problems

Chronic diseases: asthma, obesity, MH, development

Food insecurity, poorer nutrition and growth

Less access to quality health care

Increased accidental injury, mortality

Higher exposure to toxic stressMoore KA et al. Children in poverty: trends, consequences, and policy options. 2009. Child Trends Research Brief

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Child Poverty

Race and Ethnicity Magnify Effects of Poverty

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https://www.instituteforchildsuccess.org/families-poverty-rate-half-the-story/ Downloaded July 7, 2109

South Carolina Children in Poverty

22.3% Ranked 45th

Percentage of children under 18 in

related families who had incomes

below the poverty line in 2017

What Can Pediatricians Do? Identify family needs

Health leads, medical-legal partnership, nutrition assistance

Connect to community resources

Strengthen parenting

Advocate at state, federal levels

Minimum wage

Welfare reform

Preschool education investment

Ensure good health benefits for low income families

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CATCH Accomplishments

25+ Years awarding over 1,500 grants

86% sustainability rate (Pediatrics, 2013)

Increased access to care & medical homes

National network of over 100 pediatrician & resident leaders

Grants available for practicing physicians and residents

SC Healthy Tomorrows and CATCH Grants

School-based Group Therapy for Behavioral Problems 2017 Behavioral Health

CATCH Planning

Pediatric Support Services: Improving Access to Mental and Behavioral Health Resources

2019Behavioral Health

Healthy Tomorrows

Igniting Community: Engaged School-Based Latino Health 2019

School Health

CATCH Planning

South Carolina CATCH Facilitators: Michael Foxworth, MD, mkfoxworth@gmail.comNancy Powers, MD, npowers@ghs.org

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Addressing Bias and Discrimination

Child Health Equity

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Immigrant Children “Immigrant children” are defined as children who are foreign-

born or children born in the United States who live with at least 1 parent who is foreign-born.

One in every 4 children in the United States, approximately 18.4 million children, live in an immigrant family. Eighty-nine percent of these children are born in the United States and are US citizens.

Although 64% of all children of immigrants live in 6 states (California, Texas, New York, Florida, Illinois, and New Jersey), immigrant children are dispersed throughout the country. Since 1990, the largest growth in percentage of immigrant children has occurred in North Carolina, Nevada, Georgia, and Arkansas.

SUPPORTING THE HEALTH AND WELL-

BEING OF IMMIGRANT CHILDREN:

RESOURCES FOR PEDIATRICIANS

Immigrant families are facing a rapidly changing political landscape and may be impacted by federal policies that increase deportation and detention, restrict travel, and prevent access to public benefits.

These developments may cause significant stress, anxiety, and uncertainty for immigrant families, and the pediatricians who care for their children.

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AAP Policy StatementProviding Care for Immigrant, Migrant and Border Children Detention of Immigrant Children

Immigrant Child Health Toolkit

This toolkit was designed to provide practical information and resources for pediatricians to address common matters related to immigrant child health.

Educational ResourcesTrauma-Informed Pediatric Care: Children of Immigrant/refugee Status (April 2019)

Tools Pediatricians Can Use to Advocate for Children & Families Who Have Immigrated (January 2019)Deportation: What Comes Next? (September 2018) Forensic Evaluation for Asylum Seekers (June 2019)

SUPPORTING THE HEALTH AND WELL-BEING

OF IMMIGRANT CHILDREN: RESOURCES FOR

PEDIATRICIANS

What AAP is doing Pediatricians have been speaking out in the media,

including NPR, USA Today, CBS This Morning and the New York Times.

The Academy is in constant communication with lawmakers, sharing our expertise and working to improve conditions for immigrant children at the border. Recommendations include: Ensure that children spend as little time in CBP facilities as possible.

Ensure that pediatric expertise is available at any facility that houses children.

Require higher humanitarian standards at CBP facilities, including for medical care, nutrition, hygiene, sanitation, and shelter.

Maintain existing legal protections for children, such as those under the Flores Settlement Agreement.

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AAP and Global health AAP declares that pediatricians are “dedicated to the

health of all children

Pediatricians can work domestically and collaboratively across borders to improve the health of children throughout the world, regardless of the nationality, culture, language, religion, or socioeconomic status of those children

25% of pediatric residencies have a formal global health track

Research, advocacy, education, service

Role of Pediatrician in Global Health 90% of the world’s children live in low or middle

income countries

Significant morbidity and mortality

5.4 million children under age 5 die each year

250 million (43%) children under 5 or at risk for not attaining their developmental potential due to poverty and/or malnutrition

December 2018, Pediatrics

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Global Health

AAP News, 2019

Advocacy

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E-cigarettes and Cigars

In 2016, the FDA expanded its authority to regulate tobacco products to include e-cigarettes and cigar

In 2017, it announced manufacturers would not have to provide information about cigars until 2021 and e-cigarettes until 2022. In the meantime, the products can stay on the market

While awaiting FDA review, more than 3 million high school students and 570,000 middle school students were current e-cigarette users in 2018, spikes of 78% and 48%, respectively over 2017

A federal judge ruled that the FDA cannot delay the review for several more years as planned, saying it gave "manufacturers responsible for the public harm a holiday from meeting the obligations of the law.

PEDIATRICS Volume 143, number 6, June 2019:e20182741

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E-cigarettes and Cigars FDA Needs Authority Over All Tobacco Products. Support several of the FDA’s

key proposals in the rule including: adding addictiveness warnings to all tobacco products, banning free samples, prohibiting unsubstantiated health claims, and prohibiting sales of all tobacco products to youth.

Don’t Create Loopholes for Cigars. An option in the proposed rule would allow “premium cigars” to escape all FDA regulation.

Prohibit Flavored Tobacco Products that Appeal to Children. Flavorings attract youth to a lifetime of nicotine addiction need to prohibit the use of flavors in all tobacco products.

Prevent Child Nicotine Poisoning. The potential for poisoning is a very real concern. Require child-resistant packaging and warning labels on liquid nicotine containers about the toxicity of nicotine.

Restrict the Sales and Marketing of Tobacco Products. E-cigarettes companies are marketing their products in inappropriate ways that appeal to children, such as sports and event sponsorship and the use of cartoons and celebrities in advertising.

No Grace Period for Dangerous Products. Urge FDA to offer no grace period to e-cigarette products that market to children, use flavors, or fail to use child-resistant packaging. Please swiftly publish a strong final rule to protect children and youth.

IQOS and other Heated Tobacco Products:

What Pediatricians and Families Need to Know

IQOS is a brand of heated tobacco product made by Philip Morris International. IQOS stands for “I-Quit-Ordinary-Smoking.”

In 2019, FDA approved IQOS for sale in the United States. The device costs approximately $80, and the accompanying tobacco sticks are comparable to the cost of a pack of cigarettes.

Heated tobacco products are not the same as e-cigarettes: heated tobacco products use tobacco to deliver nicotine, whereas e-cigarettes use an e-liquid solution to deliver nicotine.

https://downloads.aap.org/RCE/IQOS_Factsheet.pdf

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IQOS and other Heated Tobacco Products: What Pediatricians and Families Need to Know

Heated tobacco products contain tobacco. There is no safe type or level of tobacco use.

There is no evidence to demonstrate that heated tobacco products are less harmful than traditional cigarettes.

Tobacco companies claim that heated tobacco products are less toxic than cigarettes. However, all claims of lower risk have been based on research that is funded by the tobacco industry. Data are limited and do not include information about long-term health risks.

Independent research is needed

Public Health Concerns Heated tobacco products may appeal to youth: Heated

tobacco products are sleek, high-tech devices that are being designed and marketed in ways that are known to effectively target youth.

Heated tobacco products are highly addictive: IQOS and other heated tobacco products contain nicotine. The US Surgeon General has declared that youth use of nicotine in any form is unsafe.

Heated tobacco products are available in menthol flavor: Menthol masks the harshness associated with cigarette smoke, making cigarettes easier to smoke and harder to quit. Menthol cigarette use is disproportionately common among young smokers.

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Education for Professionals

Professional publications/Journals

Pediatric Care online CME programs Webinars Chapter programs Pedialink MOC programs

EQIPP CAQI QuIIN

Courses/Programs Offering MOC Part 2

▪ PREP®: ID

▪ DB:PREP ®

▪ PREP® The Course

▪ Practical Pediatrics Course

▪ PREP®:EM

▪ NCE: Pediatrics

Free tools for residents and trainees Individual learning plans

Teaching and learning resources wiki

Online courses, PREP® Self-Assessment and subspecialty self-assessments

Quality Improvement project manager

Scholarly activity tracking tool

Free tools for Program Directors View PREP® SA progress reports

Manager program rosters and AAP membership

Track learning plan progress

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Education in Quality Improvement for Pediatric Practice (EQIPP)▪ Online Quality Improvement CME Program

▪ Launched in 2002

▪ Robust quality improvement educational program

– Evidence-based

– Translates research into practice

– Weaves QI principles (Model for Improvement) with clinical content

– Interactive and action oriented

▪ Meets Maintenance of Certification IV requirements

▪ Member benefit at no charge

Financing and PaymentResources to help practices navigate changing health care environment, ensure proper payment for services provided

ACOs

Private payer advocacy

CINs

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Children's Health Care Coverage Fact Sheets State Medicaid and CHIP Snapshots, 2019: Underscores importance

of Medicaid in providing coverage for children to help them grow up healthy and thrive (in partnership with Georgetown University Policy Institute Center for Children and Families)

Medicaid Fact Sheets: Explains the importance of Medicaid for children in each state (in partnership with the Children's Hospital Association)

EPSDT State Profiles: Provides detailed information on each state Medicaid program's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit and how this compares to AAP/Bright Futures guidelines and recommendations (supported by the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration).

https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/Childrens-Health-Care-Coverage-Fact-Sheets.aspx?utm_source=MagnetMail&utm_medium=email&utm_term=rcgunther@aap.net&utm_content=2019%20State%20Fact%20Sheets%20Campaign&utm_campaign=Act%20now%20for%20healthier%20kids%20in%20INSERT%5FCUSTOM28

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https://downloads.aap.org/DOFA/Factsheets/SouthCarolinaSnapshot2019.pdf

https://downloads.aap.org/DOFA/Factsheets/SouthCarolinaSnapshot2019.pdf

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SC EPSDT and Bright Futures South Carolina’s 2018 EPSDT requirements follow the Bright Futures/AAP

Periodicity Schedule and screening recommendations.

According to CMS, in 2016, South Carolina selected 8 of the 10 pediatric preventive care measures in the Child Core Set. The measures not selected were childhood and adolescent immunizations.

South Carolina’s performance rates were higher than the national average for preventive dental services. The following pediatric preventive care measures were lower than the national average: PCP visits for children and adolescents, well care visits for children in the first 15 months of age, ages 3 to 6 years, and ages 12 and 21; chlamydia screening; HPV vaccinations; and BMI documentation.

South Carolina’s preventive care performance improvement projects relate to well child and adolescent visits.

https://www.aap.org/en-us/Documents/EPSDT_state_profile_southcarolina.pdf

Changes on the Near Horizon 2018 Bylaw Referendum was passed and so changes are

beginning to show up this year.

Elections in September-Please Vote! In District 4 we are voting for: AAP President-Elect

District Chair (serves on the Board)

District Vice Chair (advisory to the Board)

At Large Seats on Board (3)- to represent subspecialists

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