Judith Palfrey, MD Past President AAP Generations Together Massachusetts AAP November 1, 2013

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

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 34th in Infant Mortality

5. Compared to 29 other industrialized nations, Unicef ranked the US UNICEF RATINGS • 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 strongerand more effective if community medicine and advocacy were core elementsof our training and practice

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

9. MOTIVATION

10. MOTIVATION

11. MOTIVATION

12. 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 Can’t 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. ADVENTURES IN PEDIATRIC ADVOCACY

18. PROJECT School Care

19. CHILDREN WITH SPECIAL HEALTH CARE NEEDS 13% 6% 6% Mod/sev functional limitations 13% MCHB definition 30% Any occurrence 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 Nurse Practitioner/Case Manager Child and Family Local Parent Consultant Physician

29. 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

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 + + + LPC Stipend 8 hrs PNP IHP CME/CEU Totals About $15,000/yr/practice

32. EMERGENCY VISITS

33. HOSPITALIZATIONS

34. IMPACT OF THE CONDITIONWORK MISSED IN LAST 6 MONTHSFOR PARENTS (n=150 ) %

35. The AAP and PEDIATRIC ADVOCACY

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 Let’s 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 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 LADY’S 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. A BIG FAVORITE THING • SOMSRFT

50. 5th Annual Advocacy Project: ImmuneWiseSection on Medical Students, Residents, and Fellowship Trainees2009-2010