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April 2020
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Pulling Together
Elizabeth Meade, MD, FAAP
President, Washington Chapter of the American Academy of Pediatrics


Dear WCAAP family,

I intentionally use the word "family" rather than "members, because in this time of crisis it feels like we are pulling together, supporting each other, sharing, and rooting for one another in a way that I have never experienced. Primary care pediatricians, subspecialists, hospitalists, NPs/PAs, and other colleagues are working as one pool of providers - even supporting our adult colleagues on the front lines of care as they deal with the unimaginable clinical chaos that we are luckily somewhat spared from. Yes, we are lucky that this is the rare, extraordinary infectious illness that is far less dangerous for children than for adults - but we are still faced with trying to protect ourselves, our patients and their families, our own families, and our communities at large.



Step by Step
Sterling Clarren, MD, FAAP
Retired Robert A Aldrich Professor of Pediatrics, UW
Clinical Professor of Paediatrics, UBC, retired


Trips were cancelled
Then the parties
The bar mitzvah
The memorial service
And
The schools
The shops
The offices
The restaurants
The borders
All closed

We sit by the window
The cherry and apple blossoms
Explode white and pink
Against a clear blue sky
Proclaiming the spring
As the radio announces the
Death of the first one
I knew

We sit by the window
And watch
And wait


Washington's Mental Health Referral Service for Children and Teens


Many children and teens in our state are struggling with the upheaval and uncertainty that has come to define all of our lives during the COVID-19 pandemic. 

Help is available! Washington's Mental Health Referral Service for Children and Teens connects families with outpatient mental health providers who have openings in their schedule and can meet the child's needs. The service links families to providers in their local area who fit the child's specialty needs and insurance coverage. Washington state funds the free referral service and Seattle Children's operates it.

The wait list for service is almost gone now.  Families can call 833-303-5437, Monday through Friday from 8 a.m. to 5 p.m. Pacific time, to connect with a referral specialist.


Caring for Ourselves by Caring for Each Other
Joe Sherman, MD, FAAP

stones_balance_beach.jpg

It was 1984, and I was rotating through the PICU as a sub-intern during my fourth year of medical school. Her name was Aisha, my first PICU patient, a two-year-old with a presumed diagnosis of a new mysterious disease that was only seen in IV drug users and gay men - AIDS.

Aisha was the first child in our hospital who had acquired the infection through maternal-child transmission. Every day, I gowned, gloved, goggled, masked and went into her glass-enclosed isolation room to perform all the procedures she needed. Aisha's nurse was the only other person allowed in the room routinely.



WCAAP Member Survey: 
Potential Provider Well-Being Offering to Members


WCAAP wants to support provider well-being, especially as we face the COVID-19 pandemic, and we need your input!
 
Possible support includes opportunities for members to talk with each other regarding feelings of uncertainty, social isolation, anxiety, fear, financial instability, with the following structure and components: 
  • Facilitated by a pediatrician who specializes in provider well-being 
  • Weekly for 30 minutes via phone/webinar platform
  • Participants could drop-in for the sessions that work for them
  • Tools for self-care, how to help peers and support staff, how to integrate mindfulness into leadership and daily interactions
  • Conversations grounded in finding joy in practice, values-based decision making, self-compassion, community, humor, hope 
Support may also include curated resources unique to the needs of pediatric providers available via static video, audio, and text. 

You can help us by completing this quick 4-question survey by Sunday, April 12: WCAAP Member Survey 


Concrete Resources for Families
Crystal Shen, MD, MPH, FAAP
Public Health Seattle & King County - Eastgate Clinic

Due to COVID-19, many families are struggling economically and may benefit from help with concrete resources. I find that with my patients' families, it's been helpful to directly ask about recent changes in their life due to COVID-19 and how they are doing with resources.

Sometimes I'll find ways to tie my questions into topics relevant to the visit itself. For instance, during an in-person infant well child visit when I'm discussing feeding and nutrition, I may ask if parents are experiencing any difficulties in accessing food or formula at stores and if so, provide advice.


Telehealth and Adolscent Visits
Aaron Grigg, MD, FAAP
Yakima Valley Farm Workers Clinic - Toppenish

As with many practices, we have started "seeing our patients" over the phone initially with a plan to roll out video visits within the next couple of weeks.  I have to admit I initially had some reservations, but most of my patients have been very comfortable with this and were appreciative to be able to access care without leaving their home during this challenging time.


Well Child Visits during COVID-19
Erika Phelps Nishiguchi, MD
Developmental Behavioral Pediatrics Fellow
Seattle Children's/University of Washington

To keep patients safe, clinics around the state are triaging care and converting as many visits as possible to telehealth visits. A key consideration has been how to handle well child visits. The WCAAP has been working closely with community providers and infectious disease physicians at Seattle Children's Hospital to ensure that we promote policies for well child care that appropriately consider the risks and benefits of in-person compared to virtual visits.


WCAAP Behavioral Health Integration Networking Group

Amerigroup is supporting WCAAP, with leadership from Dr. Francie Chalmers, to convene a networking group for pediatric practices who are planning or who have implemented a behavioral health integration (BHI) program. Our current focus is on strategies for effective behavioral health care in telemedicine.  

The Behavioral Health Integration networking and collaboration group meets the last Tuesday of every month from 7:30 to 8:30 AM. Next meeting is Tuesday, April 28 7:30-8:30 AM. If you are interested in being a part of this group, please contact Tatiana Sarkhosh at tsarkhosh@wcaap.org

Firearms and the Pandemic
Frederick P. Rivara, MD, MPH, FAAP
Ali Rowhani-Rahbar, MD, MPH, PhD
Harborview Injury Prevention and Research Program


We all are experiencing a truly unprecedented time right now, with multiple unique stresses for all of us and for the families of our patients.  For some families, this has also meant an increase in potential dangers from firearms in the home.  Stories from many sources indicate that there has been a dramatic increase in firearm and ammunition sales across the country, with sales doubling or even tripling in the last 4 to 6 weeks.


Pediatric Practice Resources:
Business Impact of the COVID-19 Pandemic
Francie Chalmers MD, FAAP
Trustee, Washington Chapter of the American Academy of Pediatrics


If your pediatric practice is struggling on the business side during the COVID-19 Pandemic you are not alone. Your WCAAP staff are working overtime to help. See the numerous resources on the COVID-19 page of the Chapter website.

PCC, one of the pediatric EHR solutions, has created a COVID-19 Forum which offers links to government documents regarding Small Business Administration Loans, The Payroll Protection Program loans, unemployment options that fall short of actual layoffs so employees can retain their benefits, and discussion forums on numerous topics having to do with the business impact of COVID-19.



Paradigm Shift in Management of Mild Asthma
Seattle Children's Pulmonary and Sleep Medicine team


Asthma is the most common chronic disease of childhood throughout the world and exacts a high toll in terms of healthcare utilization and family and school disruption.
About 120,000 children in Washington state have asthma. Typical symptoms include chronic cough, wheezing, dyspnea and chest tightness. Allergens and/or viral infections are often triggers. Children whose asthma is poorly controlled are at higher risk for exacerbation with virus - something worth noting given the presence of COVID-19 this season.



Noteworthy

Community Pediatrics COVID-19 Meetings
Join WCAAP for our biweekly Community Pediatrics COVID-19 meetings on Tuesday and Friday mornings at 7:00AM. To join from your computer, tablet or smartphone: https://www.gotomeet.me/wcaap/wcaap-covid-19 
You can also dial in using your phone:  (872) 240-3212 Access Code: 160-795-397 

The Congressional Black Caucus has released an emergency task force report on black youth suicide and mental health in America, Ring the Alarm: The Crisis of Black Youth Suicide.  On April 21, an HHS/NIH/NIMH webinar will highlight the report in "Responding to the Alarm: Addressing Black Youth Suicide." The webinar will feature the co-authors of the report and panelists will cover topics including: the latest trends and prevalence of suicide and suicide-related behaviors among black children and youth; common risk and protective factors; perspectives on this crisis and ways to identify black children and youth who are at risk for suicide; and thoughts on how to best engage this population and provide them with developmentally and culturally appropriate support and care.  Learn more and register here. 

Distance Learning About Vaccines
With  teachers looking for virtual teaching options there may be an opportunity  to partner with our Vancouver BC colleagues to bring Kids Boost Immunity (KBI) to some WA State schools. This is a wonderful program whereby  student learn about vaccines, answer questions that earn points which are converted to dollars to buy vaccines for developing countries. Check out this brief video. 
Although not initially designed for home-based learning,  KBI is ideally positioned for this type of circumstance. The program requires online access for students to take quizzes to both earn vaccines for other children as well as test their knowledge of the science and social studies curriculum. Many new materials (worksheets, rubrics etc.) as well as a new series of lessons on Coronavirus that are constructive and calming for kids have been added. Contact: Ian Roe Ian.Roe@bccdc.ca or  Ed Marcuse emarcuse@uw.edu. 
 
Perinatal Support of Washington reports a worsening of anxiety (new anxiety and worsened preexisting mental health conditions) related to COVID-19 among many birthing parents. They invite providers to reach out to their perinatal mental health consultation line (available weekdays 9:00-5:00pm, 877-725-4666) if you have any questions around your patient's mental health in this difficult time. Learn more about the consult line here

WCAAP WebinarsView archived WCAAP webinars, on topics like motivational interviewing, brief parent management training, autism screening, and adolescent and maternal depression screening here: https://wcaap.org/webinars .


Coming Up: WCAAP Committee Meetings
Join us! Committees are a great way to meet other members and get involved with Chapter work! Watch this space for upcoming meeting dates and times for Chapter committees and interest groups. Most committees meet by phone for one hour. 

Health Care Transformation Committee 
TBD - contact Tatiana Sarkhosh for meeting details
Meets quarterly by telephone
Contact Francie Chalmers to learn more about the committee.

Legislative Affairs Committee
May 5, 7:00-8:00am
Meets weekly by phone during the legislative session & special session 
Meets monthly by phone during the interim
Contact Lelach Rave or Beth Ebel to learn more about the committee. 

Early Childhood Committee 
Meets periodically by phone, 2x/year in person
Contact Diane Liebe or Betsy Browder to learn more about the committee. 

Membership Engagement Committee 
April 21 - 12:00-1:00pm
Meets quarterly by telephone
Contact Kim Hauff or Wei-Jen Hsieh to learn more about the committee. 
 
Vaccine Committee
Meets periodically by telephone
Contact John Dunn to learn more about the committee. 


News & Events
What's Happening? 
Many events and gatherings are being cancelled and turning to virtual events. We will try to keep you up to date, and list events here as details are available. 
  • April 30: WCAAP Board of Trustees Meeting (phone)
  • June 6: WCAAP Board of Trustees Meeting - SeaTac or via phone
  • Sept 18-20: WCAAP Annual Board Retreat - Chelan
Thank you to our sponsors: 
WA Chapter AAP | WA Chapter of the AAP | jdonahue@wcaap.org
 

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