Kenneth Haller, MD Associate Professor of Pediatrics

1. PEDIATRIC ADVOCACY DAY JEFFERSON CITY, MISSOURI TUESDAY, MARCH 7, 2012 Kenneth Haller, MDAssociate Professor of Pediatrics

2. PEDIATRICIANS AS ADVOCATES American academy of pediatrics

3. PRESENTATION OVERVIEW • Designed to make it easier for you to advocate on behalf of children and profession of pediatrics. • http://www.aap.org/en-us/advocacy-and-policy/state-advocacy/Pages/State-Advocacy.aspx • AAP Advocacy Guide: • The What and Why’s of Advocacy • Pediatricians are Natural Advocates • Getting Comfortable by Learning the Process • Core Advocacy Skills • Broadening Participation • Media Advocacy and Communications • Political Campaigns and Elections

4. Welcome • Advocacy is central to AAP mission and one of the top reasons pediatricians join the AAP. • AAP state chapters are actively engaged in advocacy activities and serve as a source of assistance and support. • Growing number of pediatricians advocating on behalf of children’s health and well-being.

5. THE WHAT AND WHYS OF ADVOCACY An overview of what advocacy is and why it matters to pediatricians.

6. Advocacy Defined • Advocacy: Speaking out on your patients’ behalf. • There are three levels of advocacy: • Individual • Community • State and federal advocacy

7. Content Patient Safety and Advocacy Setting Lecture/Seminar/Conference Clinical teaching Individual or Group Projects Conducting a root cause analysis on near miss or sentinel event Systems based approach to M & M ACGME COMPETENCY:“Teaching Systems Based Practice”

8. Content Patient Safety and Advocacy Setting Lecture/Seminar/Conference Clinical teaching Individual or Group Projects Conducting a root cause analysis on near miss or sentinel event Systems based approach to M & M ACGME COMPETENCY:“Teaching Systems Based Practice”

9. WHY ADVOCACY MATTERS • Provides opportunity to move beyond individual solutions to create broader systemic change. • Pediatricians can help change community norms and public policy to protect children’s health and well-being. • All people, including legislators, respond better to stories than to statistics. • Pediatricians have compelling stories to tell.

10. THREE LEVELS OF ADVOCACY • Individual Advocacy: Work you do every day to improve the health and well-being of individual patients. • Community Advocacy: Builds on and reaches beyond individual advocacy by shifting focus from children in your professional setting to children within the community. • State and Federal Advocacy: Changing public policies, laws, and rules at state or federal level with potential to create broad systemic change.

11. THREE LEVELS OF ADVOCACY Individual Advocacy: Work you do every day to improve the health and well-being of individual patients. Community Advocacy: Builds on and reaches beyond individual advocacy by shifting focus from children in your professional setting to children within the community. State and Federal Advocacy: Changing public policies, laws, and rules at state or federal level with potential to create broad systemic change.

12. Why Move Beyond Individual Advocacy Community and state/federal advocacy: • Works systemically to raise awareness, educate, and/or provide treatment solutions that can help keep children safe and healthy. • Collectively gain attention of decision-makers, the media, and the general public to create change on behalf of children’s health and well-being.

13. Advocacy Within the AAP “It should be our aim to discover neglected problems and, so far as in our power, to correct evils and introduce reform.” — Isaac Abt, MD, the first AAP President • AAP founded to assure patient advocacy remains a priority for the profession.  • Advocacy is part of pediatrician training, i.e., “Systems-based Practice” • Reflects commitment to not only treat sick and injured children in the professional setting, but also work systemically to correct the injustices that contribute to children’s illnesses and injuries in the first place.

14. Pediatricians are Natural Advocates What makes pediatricians powerful advocates and how to incorporate advocacy into your professional setting.

15. The Pediatrician’s Story: The Foundation of Advocacy • Our patients’ stories put a human face on broader issues that need to be changed. • Our stories makes the issue real in a way that fact sheets and statistics alone do not. • Our stories can capture the attention of community leaders, elected officials, the media, and the general public, and help propel your issues and concerns forward.

16. Pediatricians Uniquely Qualified to Advocate • Credibility: Our position, reputation, experience. • Skill set: Advocacy skills are not much different from the direct care skills you use everyday. • Strength in numbers: Each of us is one of many, both within your profession and within your community, who cares about children’s health and well-being.

17. Fitting Advocacy into Your Professional Responsibilities • Doesn’t require a lot of time: Can affect change in as little as an hour a month or less to as much time as you can give. • Prioritize your interests: Don’t have to be an advocate on every issue. • AAP state chapters help to focus and concentrate these efforts.

18. Getting Comfortable by Learning the Process An overview of the state advocacy process.

19. GOVERNMENTAL ADVOCACY • Born out of belief that children’s health is influenced by social, economic, environmental, and political factors within a community. • State and federal advocacy is about changing public policies and laws that affect children’s health. • Policies, legislation, regulations, or judicial actions can happen at the state or federal level. • State and federal government has three independent components: • Legislative branch makes the laws • Executive branch carries out the laws • Judicial branch interprets the laws

20. State Advocacy Essentials • State legislatures are increasingly active players in the day-to-day governing of the country and are critical to the formation of public health policy. • Each state operates under a different law-making process, but many commonalities exist among states. • Legislative sessions vary from state to state and year to year. • The governor is the chief executive of a state and is responsible for the administration of the government.

21. MISSOURI STATE BASICS Missouri General Assembly meets at the Capitol in Jefferson City. General Assembly convenes on the first Wednesday after the first Monday in January and adjourns by midnight on May 30 Two houses: House of Representatives with 163 members, 2 year term Senate with 34 members, 4 year term Legislators are term-limited and may serve a maximum of 8 years in each chamber. Any citizen can make appointments to meet their Rep or Senator to discuss issues. Find your Rep and/or Senator with contact info at: http://www.senate.mo.gov/llookup/leg_lookup.aspx

22. Core Advocacy Skills Identifying the issues you care about and persuading the people who make decisions on your issues to act.

23. Identifying Issues You Care About • There are many problems that affect the lives of your patients and your ability to provide care and treatment. These individual problems are often part of a broader issue. • Many of the broader issues that children and pediatricians face can be resolved through changing community norms or systemic policy change. • When beginning your advocacy efforts, choose issues that reflect your personal interests and the unique stories you see in your professional setting.

24. Setting Goals to Advance Your Issue • Creating tangible community or public policy change is critical to advocacy. • Pediatricians get involved because they want to fight for something and want to win victories. • Winning on children’s health issues comes from defining and setting clear goals. When setting goals: • Be realistic. • It’s about the $$$$$. • Think incrementally. • Think broadly: there is no one definition of winning.

25. MOTIVATING LEGISLATORS TO ACT • For every issue you care about, there is a legislator who can affect or influence the outcome. • Effective advocacy involves identifying and persuading these legislators to act on behalf of your issue. • What motivates legislators: • what their constituents think and value. • their personal values and beliefs. • impact on state budget. • Research the legislator’s: • Interests and commitments • Committee assignments • Voting record

26. CONTACTING YOUR LEGISLATORS Legislators influenced by personal contact: • The more personal the better! • Include a concrete or direct “ask”. • Communicate more than once. • If you are a constituent, say so!

27. Sustaining Your Efforts Over Time • Getting legislators to act on behalf of your issue may not happen overnight. • Process of developing relationships over time. • Recognize and celebrate your progress along the way. • Our advocacy is not occurring in isolation.

28. We’re Not Alone: Broadening Participation Using your influence to build strength in numbers by getting others involved in advocating on behalf of children’s health and well-being.

29. Building Strength in Numbers • As a pediatrician, you are both a credible and natural advocate for children and your profession. • However, even with compelling issues, a powerful story and ongoing advocacy, there is a greater chance of winning when we build strength in numbers. • There are two ways to build strength in numbers: • Getting more people involved. • Getting more organizations involved.

30. GETTING MORE PEOPLE INVOLVED • Generates hope and excitement for your issue. • The more others see they are not alone, the more they will be willing to advocate and believe that a broader solution is possible. • More people means increased pressure on decision-makers to act. • Opposition to your issues frequently emerges. Strength in numbers is one of the best ways to counter it.

31. GETTING MORE PEDIATRICIANS INVOLVED • Begin with a recognition that some pediatricians may be unfamiliar with advocacy work and therefore, hesitant to get involved. • Start with colleagues you already know and who care about children’s health. • ASK! (– a natural and acceptable thing to do.) • Connect your issue to other’s self-interests. • Convey why your issue is important and why their help is needed. • Have a concrete request and be clear about the time commitment.

32. DELIVERING YOUR MESSAGE • Strength in numbers. Visit legislative offices with others on Advocacy Day. • Prepare: Decide who will speak and in what order. Show that you value the legislator’s time. • Rehearse: Deliver your message to other group members and get their feedback before you go into the legislator’s office. • Combine your message with personal stories to illustrate the importance of your message and put a human face on issue. • Connect your message to what is happening locally. • Highlight solutions and inform others of how they can help bring about a solution.

33. ADVOCACY DAY MESSAGES 2012 Message is the core statement of why your issue is important and should be the underpinning of all your media and communications work. 3 issues were identified as current in the legislature, important for children’s health, and amenable to input from pediatricians. Advocacy Day materials include fact sheets and bullet points to help you create an effective message. Effective messages: Create consistency in the way your issue is talked about and cuts across the many stories that relate to your issue. Are easily understood and can they be internalized and repeated by others. Convince people that your issue is something they can support.

34. 3 ADVOCACY DAY ISSUES 2012 Medicaid for kids Vision screening Vaccination policy

35. KEEPING MEDICAID STRONG FOR KIDS • >600,000 children in Missouri are insured through Medicaid • 117,000 Missouri children have no health insurance • 2/3 of these uninsured children are eligible for Medicaid but are not enrolled • For every $1 cut from Missouri instate Medicaid, Missouri loses $1.72 in in federal matching funds -- and virtually ALL of this money stays in Missouri • Half of all Medicaid enrollees are children and 61% live in households where at least one parent works. • Each child on Medicaid costs Missouri just $2,416/year whereas the average adult enrollee costs the state $8,369/year.

36. VISION SCREENING • Current law requires comprehensive eye exams of all children before entering kindergarten by an optometrist or peds ophthalmologist. These exams are about 4 times more expensive than vision screening in a primary care physician’s office and are no more successful in detecting visual problems than routine vision screening. Law currently has a sunset provision. • SB 649/HB 1333 WE FAVOR. Allows nurse screenings in school prior to any mandatory vision exam by an optometrist • SB 641/HB 1339 WE OPPOSE.The legislation removes the sunset on mandatory comprehensive eye exams.

37. VACCINATION POLICY • No current bills to change vaccine policy. • Advocacy primarily pro-active and educational to: • Emphasize importance to children’s health of maintaining a strong vaccine policy for school entry. • Emphasize that vaccines are safe and effective and reduce health care costs. • Affirm appropriateness of opt-outs for reasons of religious convictions of demonstrated allergy to vaccine components • Oppose any so-called “ethical opt-out” legislation that would essentially allow anyone to refuse vaccination and put all children at risk of disease.

38. ADVOCACY DAY DETAILS • Child Health Advocacy Day, Wednesday, March 7, 2012. • Plan to arrive Jefferson City, 9:00 AM, leave 1:30 PM. • Further details at http://moaap.org/ and will be emailed after RSVP • RSVP: • Kansas City: • Beth Simpson, easimpson@cmh.edu • Columbia: • Kristin A. Sohl, sohlk@health.missouri.edu • St. Louis: • Sarah Garwood, Garwood_S@kids.wustl.edu • Ken Haller, hallerka@slu.edu • Sandy McKay, Sandra.McKay@mercy.net

39. ADVOCACY DAY ATTENDEES 2011