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Advocacy Update: Get to Know Your Legislators! 
Lelach Rave, MD, FAAP
Chair, WCAAP Legislative Committee
Interim meetings
Now's the time to meet with your legislator, while he or she is working back in your district! Building these relationships is critical to our success during the legislative session, as meetings provide an opportunity to educate legislators about the issues that patients, families and pediatricians are facing every day. 
We are happy to support you in arranging and preparing for these meetings! Feel free to contact us with questions, and use this document to learn more about meeting with legislators during the interim. 

Advocacy Day
Join the Washington Chapter of the American Academy of Pediatrics on Friday, February 3rd at our 2017 Advocacy Day and Annual Meeting - it's a day of advocacy in action and a way to care for kids beyond the clinic walls! 
  • Learn how to be an effective advocate.
  • Get in-depth information about our top legislative priorities.
  • Hear from champions for children about issues that affect kids in our state.
Depending on availability, you'll also have the opportunity to meet with your own legislators and their staff - don't worry, we'll schedule these meetings on your behalf! Invited speakers include Medicaid Director Mary Anne Lindeblad and Representative Tana Senn, as well as legislators from both sides of the aisle. 

Don't miss this full day of advocacy and action on behalf of our state's children! Register today!

Update: WCAAP Early Learning Committee
Danette Glassy, MD, FAAP
Abigail Grant, MD, FAAP
WCAAP Early Learning Committee Co-Chairs

New Co-Chair 
 Please welcome Dr. Abigail Grant as the new co-chair, joining Dr. Danette Glassy. Dr. Grant is an outpatient pediatrician at the Harborview Pediatric Clinic and provides care to children of diverse backgrounds including many refugee and immigrant families, and families challenged by complex social and medical conditions. She has established a medical home-Head Start partnership to directly connect families with early learning programs and is currently focused on developmental screening for diverse patient populations. Dr. Grant is faculty for Seattle Children's REACH (Resident Education and Advocacy for Child Health) pathway and mentors residents interested in child advocacy locally and globally. She is also helping teach Promoting First Relationships for pediatric residents.

National Policy
The Office of Child Care and Head Start have continued to collaborate to improve early learning for all children. Current efforts focus on improving quality as called for in the 2014 requirements in the  Child Care Developmental Block Grant.  The law made many important changes to strengthen child care and emphasize the importance of providing high-quality early education.  Head Start has also just released new Performance Standards, which will be implemented beginning in November.   Quality in Head Start has been improved through a new Training and Technical Assistance program that includes the National Center on Early Childhood Health and Wellness.  This is administered by the national AAP with some partners.  See here for all of the important supports that have been developed.
National Legislative Update
An important national legislative ask is for the support of the Families First Preventive Services Act.  The bipartisan bill (S.3065), which was introduced by Senate Finance Committee Chair Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR), redirects federal funds to provide services to keep children safely with their families and out of foster care, and when foster care is needed allows federal reimbursement only for family-based settings and certain residential treatment programs for children with emotional and behavioral disturbance requiring special treatment. Please consider contacting Senators Cantwell and Murray to urge them to support this bill.
AAP NCE in San Francisco, Early Childhood Sessions
The Council on Early Childhood program at the AAP National Conference is Sunday, October 23, from 1-5 PM, and the educational session will be on Bridging the Word Gap, featuring Robert Needlman, MD, FAAP and Judith Carta, PhD. In addition, research and program poster abstracts will be available for viewing with the authors at the beginning of the session.  The annual presentation of the Susan S. Aronson for Early Education and Child Care Advocacy award will take place during the program. Finally, the session ends with a short business meeting where you can learn more about the Council's activities and how you can become more involved.
See the WCAAP's Washington Guide to the NCE for other sessions that might be of interest to you! 

A Mindful Eating Approach to Healthy Weight
Ruth McDonald, MD 
Vice President of Medical Affairs 
Seattle Children's Hospital

Though obesity has been a problem in the U.S. for decades, the field of childhood obesity prevention is still relatively young. The predominant approach to weight management in our culture has focused on caloric balance and attention to the types of food we eat. Stigma and judgment abounds: is a food good or bad? Is it right or wrong to eat it?
Encouraging families to adopt a mindful approach to eating can help to break the negativity around food and the restrictive approach to eating and weight control for obese youth. A mindful eating paradigm recasts food as enjoyable and necessary for physical and emotional health and well-being. This compassionate, holistic approach asks people to tune into their bodies, learn to recognize what hunger and fullness feel like, understand the role relationships play in meals and eating, identify emotional connections to food, and bring compassion to body acceptance and self-image.
Because children are still developing, even small changes in their eating habits can result in more normalized weight as they grow, as well as set the stage for a healthier relationship to food and eating throughout their lives.
You can help patients and families get started by introducing them to these ideas:
  1. Mindful eating - paying attention while you eat, knowing that food fuels your life, tuning into your own sensations of hunger and fullness, and recognizing that what you choose to eat impacts your health and well-being.
  2.  Competent eaters - feel positive about eating, are reliable about feeding themselves and naturally eat foods they enjoy in quantities that are satisfying.
  3. The division of responsibility  - parents provide the structure for eating and decide when, where and what to serve; children choose whether to eat and how much.

Improving Asthma Management
Jim Stout, MD, MPH, FAAP
Professor, Department of Pediatrics
Adjunct Professor, Department of Health Services
University of Washington
Pediatrician, Odessa Brown Children's Clinic
The Health Care Authority has laid out it's roadmap for transitioning Apple Health to value based payment and has identified the seven measures (from the common measure set) that will be tied to incentives via the one percent withhold for all 2017 Apple Health Medicaid contracts.  Three of the seven measures are pediatric and include: childhood immunization status (combo 10); well- child visits in the 3rd, 4th, 5th and 6 years of life; and medication management for people with asthma.
ICD-10 affords the opportunity to include an asthma severity classification as part of the billing process. Today's billing and information systems enable a focus on the sub-population of children with some level of persistent asthma (as opposed to intermittent asthma, which requires occasional rescue inhaler and trigger avoidance only). The clinical importance of these "persistent" children is that, by definition, they should all be taking a daily controller medication, typically an inhaled corticosteroid.
This is where the challenges begin. First, unlike a daily controller medication, which takes days or weeks to reduce inflammation, a rescue inhaler (albuterol) works in minutes. We all like immediate results, so, people with asthma typically overuse albuterol, and underuse inhaled corticosteroids.
Even in the most efficient office system, it takes time to create a shared understanding of medication use, and to develop a written asthma action plan. A patient and/or caregiver needs to understand how and why to use a controller medicine (pictures help). Real barriers such as steroid phobia, other competing health beliefs, or challenging life circumstances such as dual households need to be addressed.  Making sure inhaler and holding chamber technique and maintenance are appropriate, planning together where routine medication use fits into the patient's day, and when and how to seek help are all equally important elements of a planned preventive visit.  
Practical solutions
Does accomplishing this, in addition to physical exam and history, and any other problem that might come up (this is primary care; it happens) fit into a 15-minute visit? No. It's like trying to fit a size 12 foot into a size 6 shoe. Either a different schedule template or a team-based approach where support staff does this teaching, or both, are the only practical solutions in a primary care environment.
Finally, office-based spirometry should be an essential part of such a planned visit, and collected as one of the vital signs. If you're going to take the time to accomplish these tasks, you want to be sure you've done a thorough severity (or control) assessment, so that you're neither creating unnecessary work, nor missing kids with a benign history but who are "silently" obstructed (one in three kids with asthma). A flow volume curve is also an excellent teaching tool when depicting asthma severity or control.  Spirometry performed and interpreted well is technically challenging, and is best accomplished with training and feedback.
An online training and feedback program known as Spirometry 360 is a resource designed to meet this need in primary care. Some scholarships are available through the  Pediatric Transforming Clinical Practice Initiative (P-TCPI), a collaborative partnership of WCAAP, the Department of Health and Molina Healthcare working to help prepare pediatric providers for value based payment, with a particular focus on the three pediatric measures for value based payment described above. Toward this end, P-TCPI provides clinics support in improving their performance on medication management for people with asthma. P-TCPI is offering a limited number of clinics per year scholarships in Spirometry 360. Download an application for a Spirometry 360 scholarship here. 

Population Health in Pediatrics

Save the Date: 
Friday evening, January 20 and Saturday, January 21
Mary Bridge Children's Hospital, Tacoma
Join Mary Bridge Children's Hospital, WCAAP, and the Pediatric Transforming Clinical Practice Initiative for a statewide event on health care transformation in pediatrics and improving the social determinants of health at Mary Bridge Children's Hospital in Tacoma.
LEARN: Learn how to be prepared to support the social and behavioral needs of your patients. Hear from health care leaders on the topic of accountable care and care management, managing patients in a population health frame, value based payment, and Primary Care Medical Home certification.

WATCH: View Paper Tigers, an award-winning film set around the campus of Lincoln Alternative High School in Walla Walla. The film asks what it means to be a trauma-informed school and how to educate teens emerging from childhoods that left them with brains and bodies ill-suited to learn.  
DISCUSS: Engage in dialogue with pediatricians and educators about how to support children and youth who have experienced adverse childhood experiences (ACEs).
REGISTRATION: Coming soon! 

BestStart Washington is Your Foundation! 
Danette Glassy, MD, FAAP

BestStart Washington (BSW) collaborates with community pediatricians, families and other partnersto develop and fund innovative programs that give children the best possible start on healthy and productive lives. BSW was formed by three WCAAP past-presidents to carry out advocacy projects and is the non-profit associated with the Washington Chapter.  For more information see www.BestStartWA.org.

Working with BSW
All members of the WCAAP are able to use BSW as your 501(c)3 fiscal sponsor for community projects and grants.  Congratulations to Dr. Matthew Nestander, pediatrician in Tacoma, for being awarded an AAP CATCH grant titled Healthy Lungs, Longer Lives.  He is currently running his CATCH grant through BSW for tax purposes.

BSW Nature Project
BestStart Washington announces the launch of the BSW Nature Project. Children who experience nature are healthier, grow up more supportive of natural settings, and are more likely to pursue STEM-related careers.  But not all children and families spend time in nature. There are many barriers, and disadvantaged families have more barriers than others.  Washington State has an abundance of natural resources, as well as programs and organizations that are creatively and effectively helping families experience nature. The BSW Nature Project will bring information about these programs to families through their trusted advisors: pediatric practitioners and child care providers.  In addition, we will have a specific health intervention that pediatricians can easily present to families of young children in a creative way.  This next year will be planning and implementation of pilot projects.  For more information contact Edna Maddalena at Edna@beststartwa.org.

Medicaid Transformation - Waiver Update
Sarah Rafton
Executive Director, WCAAP

Washington State has reached a preliminary agreement in principle with the federal government on a Medicaid Transformation demonstration waiver, intended to improve population health and accelerate health care transformation.  During the coming month, we will have the opportunity to comment on this demonstration waiver before final CMS authorization for it to move forward. WCAAP's Health Care Transformation Committee will lead our comments and we encourage you to tell us what you think.

The waiver will bring $1.5 billion to Washington of which $1.125 billion will flow to the Accountable Communities of Health (ACHs) for demonstration projects throughout the state. Last winter, we proposed three projects to the Health Care Authority (HCA) to be included in the waiver: telehealth (video) access to primary care pediatrics; care coordination in pediatric primary care; and the expansion of the Partnership Access Line (PAL) to provide in-between care when children await access to mental health services. These projects will not move forward as proposed but gave HCA ideas about improving pediatric health and contributed to the HCA's Project Framework which will now be used to prioritize regional projects funded under the waiver.
We encourage you to check out the following resources, including a 7-minute video below which provides a helpful overview of the waiver:


Are you headed to the 2016 AAP National Conference in San Francisco this month? If so, take a look at our Washington State guide to the NCE, for topics of interest for our state and a listing of WCAAP members who will be speaking. 

You're invited! The Washington State Firearm Tragedy Prevention Network, a partnership of Seattle Children's Hospital, The Washington Chapter of the American Academy of Pediatrics, Lok-It-Up and Harborview Injury Prevention & Research Center is hosting its Fall Meeting on Monday, November 14, 2016, 12:30 to 4:30 p.m. at Children's Village in Yakima. The event will  bring people, organizations and resources together in a non-political way to share resources  and identify tangible ways to work together to reduce firearm tragedy. LEARN MORE and RSVP HERE by Monday, November 7.

Register Today For the 2017 Washington Immunization Summit! Please join WithinReach for the first-ever Washington State Immunization Summit on April 26, 2017 at The Conference Center at Sea-Tac Airport. This one-day event, with the aim of becoming an annual opportunity for immunization professionals in Washington, will have an evolving focus.  In 2017 the Summit will focus on vaccine hesitancy, reaching underserved populations, and the use of data and systems to improve immunization rates. The cost is just $100 (including free parking!) at the early bird rate. Continuing education for this activity is pending.  Register today at: www.waimmzsummit.eventbrite.com

Congratulations to WCAAP member Megan Moreno, MD, MSEd, MPH, FAAP, who received the University of Washington School of Public Health's Distinguished Faculty Mentor Award and University of Washington Undergraduate Mentor Award.

Congratulations New Fellows! 
Rebecca Drooger, MD, FAAP
Matthew Fradkin, MD, FAAP
Anna Hedstrom, MD, FAAP
Jennifer Kett, MD, FAAP
Jennifer Wild, MD, FAAP

Coming Up: WCAAP Committee Meetings & Events
Are you interested in getting more involved with the Chapter's work? We welcome new committee members! Watch this space upcoming meeting dates and times for Chapter committees and interest groups. Most committees meet by phone for one hour. 

Health Care Transformation Committee 
October 18 - 8:00-9:00am
Meets by telephone
Contact Mike Dudas to learn more.

Legislative Affairs Committee
After session, during the interim, the committee meets monthly by phone. 
During the legislative session the committee meets weekly by phone. 
October 18 - 7:00-8:00am
Contact Lelach Rave to learn more. 

Early Learning Committee 
Meets periodically by telephone
Contact Danette Glassy or Abby Grant to learn more. 

Sustainability & Engagement Committee 
October 11 - 12:00-1:00pm
Meets by telephone
Contact Elizabeth Meade  to learn more. 

News & Events
What's Happening? 
Find all of the latest upcoming events on our website's News & Events page!
Here are just a few of the events we have listed: 
Register Now! 2017 WCAAP Advocacy Day - February 3, 2017
WA Chapter AAP | WA Chapter of the AAP | jdonahue@wcaap.org

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