Promoting Our Civic Health

With a presidential election in our country’s near future, this month we dedicate our Equity Column to promoting Civic Health within our patient communities.

Many days it’s easy to feel overwhelmed with how to make a difference in the multitudes of issues that are currently facing our country. Working to ensure that our patients’ families plan to make their opinions formally heard in local and federal elections can make a critical difference for the overall health of our communities. Voting has recently been recognized as a public health priority and a social determinant of health by several important national organizations including the American Public Health Association (APHA) and the American Medical Association (AMA). Of great importance, both organizations emphasize that should we aspire to improve health disparities, we must encourage our community to engage with the political determinants of health. Since politics is essentially the struggle over the distribution of resources and opportunities in society, when we feel our vote has the potential to make a difference, this imbues a sense of hope that comes with potential options and opportunity. Communities where more people vote have better access to health care. Promoting civic participation is one way we can help our patients improve their access to health, equity, and justice.

As pediatricians, we have a unique opportunity to interface with multiple members of each family who have the potential to vote. We can leverage this proximity to patients by encouraging and emphasizing the importance of their civic participation. Our medical colleagues around the country are using an organization called Vot-ER to help people register to vote. VoteER is a nonpartisan group that promotes voter registration by providing healthcare providers with wearable badges with QR codes for easy scanning and access to voter registration platforms. Please read this brief but encouraging article about the origins of Vot-ER or if you prefer to listen, here is a podcast with more information.

Use of the VotER program is HIPAA compliant, as patients are lead to a website where they will enter their own information when they register to vote. Teens in California can pre-register to vote at age 16, so even if your patients will not be 18 by the next election, they can prepare to ensure their participation in future elections. If you are worried that you might inadvertently ostracize non-citizen patients or parents of patients, you can use appropriate signage and posters in your exam or waiting rooms instead of asking directly about voter eligibility or registration status. Please remember while we can encourage voter participation, but cannot promote a position or candidate.

In addition, past studies demonstrated historically that US physicians voted at lower rates than the general population. In recent decades, physician voter engagement is evolving largely due to the changing political landscape and importance of US health care reform, as highlighted by how our two major political parties differed in policies during the the COVID-19 pandemic. Encouraging our fellow healthcare providers and pediatricians to vote is integral to keeping families and children safe from gun violence, mitigating the harmful effects of poverty and racism, and promoting the safe expression of gender identity among many more interventions that require policy to create change. Voting by pediatricians is how we advocate for all children to attain their life’s potential and become thriving adults in the their communities in the future.

Amna Khan, MD, FAAP

Equity, Diversity, and Inclusion Champion, AAPCA1

Reader's Tip!

Go to Resources at the end of this newsletter for more reading, listening, and printing recommendations.

President's Column

GET OUT THE VOTE!

Fall is in the air, pumpkin spice is everywhere, and election day is just around the corner. As pediatricians, we know better than most how systematically children and those who care for them are often excluded, minimized, or marginalized in the policymaking process. It’s why we all spend so much time advocating for policies that help, rather than harm, kids.

As much as we all understand the importance of advocating to policymakers, sometimes competing priorities and other barriers may make us forget how important it is to play a role in the election of policymakers. Historically, physicians have had low voter participation. Happily, in recent years that seems to be changing, with physicians more likely to vote than the general public in the 2020 election.

As pediatricians, we also pride ourselves on being nonpartisan, because kids don’t have political parties, and they can’t vote. But the fact that kids don’t have a voice in the political process makes it vitally important that we, as experts in child health, use ours by voting for policies and policymakers who prioritize child health.

Many of you may be familiar with the AAP’s Vote Kids campaign, which is dedicated to giving members tools to promote their own voting as well as to promote voting among their patients and families. You can go to the website linked above for more information and resources, including infographics, messaging for social media, and even questions to ask candidates. You can also learn more about Vo+ER, which is a nonpartisan, HIPAA compliant movement to increase civic engagement by asking about voting registration during healthcare visits.

Please read our EDI champion, Dr. Amna Khan’s excellent column in this issue.

One innovative idea a Washington chapter member shared was mailing Happy birthday/get registered to vote postcards to patients nearing the age of eligibility to register. They included a pre-written message and QR code to Vo+ER. As a chapter, we are developing that resource to be able to share with you, so stay tuned! You may not realize it, but in California, teens are eligible to pre-register to vote at 16, so this could be a meaningful opportunity to promote civic engagement even when not an election year.

Another great resource is vote.org, where you can check your registration, register in under 2 minutes, get information about what’s on your local ballot, and even set up election reminders. We are so fortunate in California to have vote by mail, and in many counties, early voting is also allowed. If you’re not already registered, that’s ok too. The deadline to register for the November 5, 2024 election is October 21, 2024, so go to vote.org or the CA Secretary of State site and register right now!

In closing, I want to acknowledge that we are all busy, and often feel stretched beyond our limits. Most of us will likely have clinical or other duties on November 5. That’s why it’s so crucial to make a plan to vote now. Be brave and reach out to someone you know hasn’t always voted in the past. Share why it’s so important to you. Remind them that kids might be only 25% of the population, but they’re 100% of the future.

They’re counting on us to do what’s right, so VOTE KIDS!

Nikki Webb, MD, FAAP

President, AAPCA1

What You Might Not Know About California's Mental Health

Pediatricians are keenly aware of the national mental health crisis that affects children and youth in their practices. What they may not be aware of are the major initiatives that Governor Gavin Newsom has initiated to address the increased need for behavioral health services and supports. The following four initiatives are worth knowing about since they are available to you and your patients, many at no charge.

Children and Youth Behavioral Health Initiative (CYBHI): a New Initiative

CYBHI has three programs that are especially relevant to our patients and families:

CalMAP is a free psychiatric consultation service for pediatric health providers who have questions about the management of an individual patient. It also has a variety of online resources both for patient mental health screening and for physician education.

CYBHI has two free virtual platforms that provide both educational videos and direct peer counselor support. One is for families of children under 12 years and is called BrightlifeKids (https://hellobrightlife.com). The other is for children and youth to age 26 and their families and is called Soluna (https://solunaapp.com).

Both BrightLife Kids and Soluna offer:

Free Coaching: Pre-clinical and sub-clinical coaching sessions through in-app chat or video appointments with qualified behavioral health coaches. Telephone coaching will also be available in all Medi-Cal threshold languages.
Educational Content: Age-tailored educational articles, videos, podcasts, and stories.
Assessments and Tools: Stress-management tools and clinically validated assessments to understand and monitor behavioral health over time.
Care Navigation Services: A searchable directory and live care navigation support to connect users to their local behavioral health resources, including connecting users with their health plan, school-based services or community-based organizations that can provide clinical care options and care coordination services.
Peer Communities: Moderated forums and programs to connect users with other youth or caregivers.
Crisis and Safety Protocols: Crisis and emergency safety resources for platform users experiencing a mental health crisis or who require immediate assistance (e.g., 988).

CYBHI has also promoted School-based Behavioral Health services to provide support for children before, during or after school. Cohorts 1 and 2 includes more than 130 CA school/school systems including some community colleges. This will be paid for by the child’s health insurance starting in January 2025 when most schools in CA will be included during 2025.

Changes in Specialty Mental Health (SMH) services for MediCal-eligible Children & Youth

The Specialty Mental Health system, run by each county, has expanded the eligibility criteria for services. This now adds children and youth who are homeless, have a high Adverse Childhood Experiences (ACEs) score, are in foster care, or are involved with juvenile justice. This is in addition to children with complex behavioral health care needs. Direct physician referral is encouraged for eligible children and youth to facilitate access. . .

Continue reading . . .

Diane Dooley, MD, FAAP

Mental Health Committee Chair, AAPCA1

Renee Wachtel, MD, FAAP

Chair, School Health and Behavioral & Developmental Committees, AAPCA1

October is Domestic Violence & Intimate Partner Violence Awareness Month

Background: Intimate partner violence (IPV) is unfortunately, very common. 1:3 women and 1:3 men experience intimate partner violence by a previous or current partner. IPV includes any type of sexual, physical, or psychological violence, including stalking, intimidation, control, and financial control by a current or former partner (CDC). Women are much more likely than men to be killed by a current or former intimate partner (CDC and AAP). These abusive behaviors emerge during adolescence, around age 12 (CDC and AAP). As many as 69% of teens experience some form of teen dating violence and 1:4 children are exposed to caregiver IPV in their lifetime (AAP, CDC, Futures). In homes with IPV, about 50% of the time there is concurrent child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect). Gender diverse adults and teens experience higher rates of IPV (CDC and AAP). Societal inequities contribute both to the rates of IPV and the impacts of IPV including sexism, racism, transphobia, among others, creating barriers to disclosing, accessing resources, safety, health care and treatment (AAP).

Impact of IPV on Children and Survivors: The impact of exposure to IPV is profound. Exposure to IPV has significant short- and long-term physical and behavior health consequences. Compared to children not exposed to IPV, children who are exposed to IPV have more internalizing and externalizing behaviors, mental health problems such as depression and PTSD and higher rates of developmental delays, chronic health problems, and poor academic performance (CDC, AAP). Children are at increased risk for engaging in high-risk behaviors such as substance abuse and use, and high-risk sexual activity. Children can struggle with increased aggression toward their peers, including bullying. Teens adopt these problematic behaviors in their own relationships. Approximately 30% of children who were exposed to IPV become perpetrators of IPV.

Teen Dating Violence: 1:3 teens experience some form of physical, emotional or sexual abuse from a partner prior to adulthood (Love is Respect, AAP). Similar to younger children, IPV can have short-and long-term impacts on teens including depression and anxiety, suicide, high-risk behaviors, and anti-social behaviors (bullying, theft, lying). Teens who were in violent relationships are at increased risk for ongoing abuse during college (CDC, AAP, Love is Respect).

What can we do?: There are multiple barriers to disclosing IPV. While universal screening is practiced in some areas, the more nuanced process of “Universal Education” is recommended. This process helps normalize discussions of IPV and offers resources and non-judgmental support without requiring a patient or caregiver to disclose. Like anticipatory guidance, routinely discussing that IPV is common and there are supports and resources available, provides the needed resources without the teen or adult caregiver having to “disclose”. If a caregiver or teen does disclose IPV, practitioners should meet the caregiver/patient where they are at; they know best how to keep themselves safe and may not be ready or safe to leave the relationship. This can lead to safety concerns for the children in the home.

Reporting: In California, the decision to report exposure to IPV to Child Welfare is up to the practitioner; practitioners may report but are not mandated to. If a report is made, it is important to inform the caregiver so they can seek safety as leaving a violent relationship is the most unsafe time for survivors of IPV. However, if injuries are sustained by an intimate partner to a teen or adult caregiver, those must be reported as a suspicious injury report, and for teens, a suspected child abuse report. Conferring with your local child abuse team is recommended. . .

Continue reading . . .

Casey Brown, MD, FAAP

Co-chair, CAPET Comittee, AAPCA1

Developing Concerns: The Mind After "Midnight" Hypothesis

Suicide is the second leading cause of death among youth aged 15-24 years in the US, and as pediatricians we need to play a leading role in suicide prevention. Current AAP guidelines promote suicide screening at least yearly for all patients ages 12 and above. We are all aware of well-established “distal” risk factors, such as childhood adversity and ACEs, parental and patient psychopathology, family history of suicidality, and prior suicide attempts, but these are “not actionable”. However, understanding underlying “proximal” suicide risk factors could potentially enable us to intervene earlier than even the screening tools would suggest. That’s where the “Mind after Midnight Hypothesis” comes in. This hypothesis suggests that disrupted sleep can acutely increase the risk for dysregulated behaviors through nocturnal wakefulness. We know that sleep deprivation induces altered cognitive functions, such as decreased mood, altered risk/reward processing, and social isolation. . .

Continue reading . . .

Renee Wachtel, MD, FAAP

Chair, School Health and Behavioral & Developmental Committees, AAPCA1

The following are just a few of the key bills of interest to AAP-CA (our California AAP District advocacy group). Visit the AAP-CA website’s Advocacy page at https://aap-ca.org/legislative-bills/ to see the entire list of AAP-CA tracked bills that made it to the Governor’s desk where you can read the outcome of each bill and an in-depth analysis. AAPCA1 has recently supported several significant advocacy efforts. Here’s what we signed on to:

Title IV-B Child Welfare Bill

AAPCA1, alongside numerous national, state and local organizations, signed a letter to Congress endorsing this bipartisan bill. The act focuses on strengthening family support, enhancing mental health resources, and investing in a child welfare workforce that supports thriving families. It also includes vital funding increases for the Court Improvement Program and Regional Partnership Grants.

If you 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.

AAP-CA Bill Tracker

Chapter Events

Chapter Chat: Climate Change and Child Mental Health

Join us for an educational Climate Change and Child Mental Health brought to you by Climate Health Now on October 9 @ 12:30PM. This is an educational webinar on mental health impacts of climate change on kids and adolescents and tips and discussion about how to talk about climate change, facilitated by Dr. Chelsea Young, a child and adolescent psychiatrist in Northern California and Reverend Talitha Aho, hospital chaplain at UCSF Benioff Children’s Hospital Oakland and author of “In Deep Waters: Spiritual Care for Young People in a Climate Crisis."

Date: Wednesday, October 9

Time: 12:30- 1:30pm PDT

Location: via Zoom

Chapter Chat: AAPCA1 Annual Membership Meeting

Join us for our annual California Chapter 1, AAP Membership Meeting! This year’s meeting will feature an engaging discussion on the latest developments in pediatric advocacy and healthcare. We will also provide a comprehensive recap of the impactful work our chapter and dedicated leaders have accomplished throughout the year. It’s a chance to celebrate our successes, reflect on our shared commitment to child health, and learn about ongoing efforts to advance pediatric care.

Date: Thursday, October 17

Time: 6:30 - 8:00pm PDT

Location: via Zoom

Chapter Chat: Climate Change, Child Health, and CATCH grants

Are you a pediatrician or pediatric resident in the U.S. interested in working on a project related to climate change and child health? Please join us for an interactive webinar and Q&A session to learn about the CATCH grant program offered through American Academy of Pediatrics, hear from pediatricians who have successfully been funded via a CATCH grant for a project related to air pollution and/or climate change, and discuss ideas for possible projects and collaborations. No grant application experience OR climate health experience required!

Date: Thursday, October 24

Time: 5:00 - 6:30pm PDT

Location: via Zoom

9th Annual Pediatric Puzzles Conference

Join AAPCA1 at the Oakland Museum of California for our 9th Annual Pediatric Puzzles CME Conference! We will have interactive lectures by experts in pediatric pulmonology, allergy, refugee experience, immigrant health, and ableism. You won't want to miss the latest updates on asthma, the use of biologics in allergy, and enlightened, thoughtful ways to welcome and care for your patients.

Date: Saturday, December 7

Time: 8:30am - 2:30pm PDT

Location: Oakland Museum of California 1000 Oak St, Oakland, CA 94607

Credits: 5 CME credits available

All attendees will receive free admission to the Museum!

Event Page

Chapter Leadership Positions

Seeking Monterey Bay Area Director Applications!

As an Area Director, you'll be part of a dynamic team representing one of our 11 diverse geographic areas. You'll become a voting member of our chapter board and engage with local pediatric providers to advocate for children's health through the American Academy of Pediatrics (AAP). Volunteer alongside a supportive leadership team dedicated to shaping the future of pediatric care.

Apply Here

Role Description

CATCH Facilitator Position

The AAP Community Access to Child Health (CATCH) Program is seeking applicants for the volunteer position of Chapter CATCH Facilitator (CCF). CCFs are appointed by their state Chapter to serve a renewable three-year term. CATCH’s mission is to support pediatricians to collaborate within their communities to advance the health of all children. Our vision is that every child in every community reach optimal health and well-being.

To apply send CV to info@aapca1.org.

Role Description

Apply for the Care & Connect Microgrant for Up to $2,000!

AAPCA1 is excited to offer its members the opportunity to apply for a chapter microgrant. The Care & Connect Microgrant Project, offers microgrants valued at up to $2,000 (no amount is too small) which can be utilized in one of two impactful ways. The first option supports innovative community-based child health initiatives. The second option is to host member gatherings and meetings within your local area.

Along with the grant, you will have the full support of our AAPCA1 staff to carry out your grant goals. We encourage all members to take advantage of this chance to either drive community health improvements or enhance pediatric connections!

Application Materials

Call for Nominations! AAP National Committees - 2025 Chairperson Positions

The AAP Board of Directors is soliciting nominations to fill chairperson vacancies in the following AAP National Committees for terms beginning July 1, 2025:

Committee on Bioethics
Committee on Coding and Nomenclature
Committee on Continuing Medical Education
Committee on Fetus and Newborn
Committee on Nutrition
Committee on Pediatric Education
Committee on Pediatric Research

To be considered complete, an application must include a (1) factsheet, (2) biographical summary, (3) letter of nomination, and (4) letter of support. Once submitted, candidates will receive a request to complete their conflict of interest disclosure. Completion of this disclosure will finalize the application process. The deadline for nominations is October 31, 2024. Nominees must submit the completed application package to their Chapter President, Dr. Nikki Webb at info@aapca1.org, and the AAP Nominations Team (nominations@aap.org).

Application Materials

Meet the Adolescent Medicine Doctors!

Attend the October AACA3 Adolescent Health Committee Meeting on Zoom to meet local San Diego Adolescent Medicine Specialists!

Date: Monday, October 7

Time: 5:30 - 6:30pm PDT

Location: via Zoom

27th Annual San Diego Pediatric School Health Conference

Join the Annual Pediatric School Health Conference on Night One and Night Two! Several hot topics with Dr. Howard Taras including Pediatric dermatology updates, pediatric hearing loss, immunization updates, and many other topics will be discussed!

Date: Wednesday, October 9 & October 16

Time: 6:30 - 9:00pm PDT

Location: via Zoom

SIDS Webinar: Why Have We Failed to Eliminate Sleep-Related Infant Deaths?

Featuring: Tom Keens, MD - CME and MOC-2 Credit Available

Date: Thursday, October 10

Time: 6:30 - 7:30pm PDT

Location: via Zoom

Psychological First Aid for Children Workshop

Learn about common disaster distress responses in children, help caregivers to identify needs and concerns in the children under their care, and guidelines for helping children cope!

Date: Thursday, November 7

Time: 5:00 - 6:00pm PDT

Location: In-person at Rady Children's Hospital or via Zoom

Pediatric Careers in California!

View new available jobs or post one of your own. Visit our site to view member discounts https://aapca1.org/jobs/

Available Jobs!

BE/BC Pediatrician – Scenic Faculty Medical Group - Modesto, CA

BE/ CE Pediatrician Gould Medical Group, in partnership with Sutter Health - Modesto, Lodi, and Tracy, CA

Pediatric Generalist - Fresno, CA

Resources

Cal-MAP: Mental Health Support Resources

Cal-MAP’s team of mental health specialists supports primary care providers (PCPs) treating youth with mental health needs through education, consultation, and resource navigation.

Phone:

800-253-2103

Email: info@cal-map.org

Request a Consultation

Reading Recs

Books:

Goodnight, Little Blue Truck

Happy Birthday To You! - Dr. Seuss

Goodnight, Little B If You Give a Mouse a Cookie

AAP Voices Blogs:

National Latinx Physicians Day - Dr. Amna Khan

Election 2024: Vote Kids!

Voting is one of the most powerful ways to influence change at the local, state and national levels. There is a connection between voting and health equity.

AAP Get out the Vote Campaign

Download free tools including posters for display in clinical spaces

More here

Recommended by AAP.

Learn More

VotER Resources

Vo+ER, which is a nonpartisan, HIPAA compliant movement to increase civic engagement by asking about voting registration during healthcare visits.

Please read this brief b u t encouraging article about the origins of Vot-ER or if you prefer to listen, here is a podcast with more information.

You can use appropriate signage and posters in your exam or waiting rooms. Please remember we cannot promote a position or candidate.

Recommended by Dr. Amna Khan, EDI Champion

Learn More

Additional Voting Readings

Voting is Critical in our Pursuit of Health Equity

Increasing Voter Participation Through Health Care–Based Voter Registration

Analysis of Reported Voting Behaviors of US Physicians, 2000-2020

Teens in California can pre-register to vote at age 16, so even if your patients will not be 18 by the next election, they can pre-register to vote in future elections:

https://www.sos.ca.gov/elections/pre-register-16-vote-18/

Recommended by Dr. Amna Khan, EDI Champion

Survey

Domestic & Intimate Partner Violence Resources

Love is Respect

with before becoming adults. Read more here!

Future Without a Violence - a health and social justice nonprofit with a simple mission: to heal those among us who are traumatized by violence today – and to create healthy families and communities free of violence tomorrow.

The Trevor Project

Call, chat, or text 24/7/365 crisis and support focused on the LGBTQIIA+ community

Recommended by Dr. Casey Brown, CAPET Committee Chair

Resources

Outreach Immunization Brochure for Partners

Champions For Health is deeply committed to enhancing community health by offering accessible vaccination services. As a reputable nonprofit, we collaborate with local communities and organizations to host complimentary vaccine clinics for individuals of all age groups.

Recommended by Champions Health

Learn More

Pediatric Health Psychology: Medical Providers Survey!

A group of three pediatric health psychologists is dedicated to increasing access to vital pediatric health psychology interventions for underserved children.

They’ve created a brief survey for pediatric providers to better understand how to connect patients with these evidence-based services. Your input is valuable!

Recommended by AAPCA1

Survey

CYBHI Free Counselor Support

CYBHI has two free virtual platforms that provide both educational videos and direct peer counselor support.

One is for families of children under 12 years, and is called BrightlifeKids (https://hellobrightlife.com).

The other is for children and youth to age 26 and their families and is called Soluna (https://solunaapp.com).

Recommended by Dr. Diane Dooley & Dr. Renee Wachtel

Add our social media accounts to get the latest chapter updates!

Twitter: @AAPCA1

Instagram: @AAPCA1

Facebook: California Chapter 1, American Academy of Pediatrics

Linkedin: American Academy of Pediatrics, California Chapter 1

Website: https://aapca1.org/

Your membership makes a difference for children in California, thank you!

The AAPCA1's ability to advocate on behalf of children is only as strong as the support we receive from our members. Encourage your colleagues to join today by visiting the AAPCA1 website.

Our mission is to promote the optimal health and development of children and

adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.

Executive Committee:

President: Nicole Webb • Vice President: Neel Patel

• Secretary: Resham Kaur • Treasurer: Amita Saxena • Past President: Nelson Branco

Executive Director: Yolanda Ruiz

Area Directors:

North Valley : Aishwarya Taneja • Sacramento Valley: Lena van der List • Central Valley : Deborah Shassetz • South Valley: Sireesha Palkamsetti • San Francisco: VACANT • Santa Clara: Bindya Singh • San Mateo: Jonathon Everett • North Coastal: Jeffrey Ribordy • Monterey Bay: VACANT • Alameda County: Renee Wachtel • Contra Costa/Solano : Jennifer Anne Miller

Pediatric Insider News Editors:

Christy Capestany • Deborah Shassetz • Tim Sullivan • Nicole Anderson

Staff:

Executive Director: Yolanda Ruiz • Project Coordinator: Sana Sayyid •

Marketing Assistant: Arathzy Portillo