2018 – Annual Leadership Forum
District II
Richard Ancona, MD FAAP
CFMC Representative
bramjel@aol.com

     The 2018 ALF is over.   The voting for the top ten is complete.   Ten resolutions were offered from District II.   You can log on to the AAP website (after signing in, go to “my AAP” and then click on “Leadership Programs” and finally the Annual Leadership Forum) to read the full resolutions, the background information and the on-line discussion.   The adopted resolutions will now be assigned to specific locations at the AAP for further action.   A disposition document reporting AAP action on those adopted resolutions will be available next winter.

Thanks to all who wrote resolutions and those of you who attended the ALF for your participation.  It’s not too soon to think about resolutions for next year.  If you had a resolution this year that did not pass or one in previous years that has not been addressed, think about resubmitting it.   As always we are available to help craft your resolutions.

 Resolutions from District II

• 14 – Advocating for Universal and Affordable Contraception – Authors: Gale Burstein MD, MPH, FAAP (NY1) and Carolyn Cleary MD, FAAP (NY-1)
• 19  – Removing the Tax Subsidy for All Advertising for Unhealthy Food Products – Authors: Carolyn Cleary MD, FAAP (NY-1) and Stephen Cook, MD, FAAP (NY-1)
• 21SA – Relief from Unfunded Mandates for Participation in the Vaccines for Children (VFC) Program – Author: Steven J. Goldstein, MD, FAAP (NY-2)
• 22 – Support for Payment of Vaccine Administration Code 90461 by Medicaid Plans – Author: Steven J. Goldstein, MD, FAAP (NY-2)
• 32SB – Medical Services at School for Children with Diabetes – Author: Irene N. Sills, MD, FAAP (NY-3)
• 64 – Creation of Mindfulness Note to be Included in Other Regular AAP Communications to Promote Member Well-Being – Author: Carolyn Cleary MD, FAAP (NY-1)
• 65 – Establishing a Relationship Between the AAP and the American Public Health Association (APHA) – Author: Sheila Palevsky, MD, MPH, FAAP (NY-3)
• 68 – Addressing Barriers to Implementation of New AAP Policies and Recommendations – Authors: Jesse Hackell, MD, FAAP (NY-3) and Jeanne Marconi, MD, FAAP (CT)
• 70 – Thoughtful Food Portrayal in the Media – Author: Ruth Milanaik, DO, FAAP (NY2)
• 76SC – Advocacy to Support Major AAP Policies at the Annual AAP National Conference and Exhibition – Author: Jack Levine, MD, FAAP (NY-2)

 Board of Directors Top Ten Resolutions from the 2018 ALF Update
May 2018

1. Resolution LR4SA: Schools as Gun-Free Zones – Arming Teachers is not the Answer!  and
2. Resolution LR2SA: Gun Restraining Order  and
3. Resolution 69: Promotion of Safe Gun Storage – The AAP has long advocated for gun safety interventions, including legislative and policy approaches, support of research and surveillance, and physician engagement in counseling families about firearm safety, including safe storage. Because children and families continue to experience a heavy burden of firearm morbidity and mortality, the AAP is undertaking a Gun Safety and Injury Prevention Initiative to address this public health emergency.  By leveraging the strengths and expertise of the Academy, the initiative will develop a comprehensive outline of existing evidence and research needs, carry out studies to fill the gaps that are identified,
   translate research findings into tools and guidance, and engage clinicians and advocates to implement these approaches in practice and community settings.  After the mass shooting tragedy in which 17 people lost their lives in a high school in Parkland, Florida, President Trump and other policymakers recommended the arming of teachers as a tactic to prevent future school shootings.  In February 2018, the administration also announced the creation of a Federal Commission on School Safety comprised of the Secretaries of Education, Health and Human Services, Homeland Security, and the U.S. Attorney General.  The Academy submitted a letter to this Commission offering the expertise of AAP members on the full
   landscape of child health and well being, including pediatric mental health, school health, injury and violence prevention, the influence of media, and pediatric emergency medicine.  It is expected that the Federal Commission on School Safety will be releasing a report in the summer of 2018, followed by public stakeholder meetings, in which the AAP will seek to participate.  The Department of Federal Affairs will also continue to oppose federal legislation that seeks to provide funds for the arming of educators.
4. Resolution 71: Creation of a Suicide Prevention Task Force and Resources for Pediatricians, Healthcare Organizations, Schools and Community Organizations Who Serve Children and Adolescents – The rate of suicide among children, adolescents and young adults is an area of great concern.  Across the AAP, various groups are addressing different aspects of this complex issue.  Policy statements have been issued on suicide and suicide attempts, firearm related injuries, and adolescent depression, and educational sessions have been offered regarding populations at increased risk (eg, LGBT youth, Native American youth, youth who have been bullied).  A number of tools exist to help pediatricians implement AAP policies related to suicide prevention including the AAP’s mental health toolkit, Connected Kids resources, and a video series on motivational interviewing approaches to behavioral health issues (including self-harm and suicide).  A number of patient and family resources also exist on HealthyChildren.org.  In March 2018, the AAP released a video public service announcement on depression/suicide.  To facilitate access to these resources, the AAP will create a centralized location on the AAP Web site.  In addition, the AAP will continue to partner with other national organizations to enhance training and educational efforts for pediatricians and to advocate at the community, state, and federal levels for access to evidence-based mental health services.
5. Resolution 8SA: The AAP Setting the Standards for Marijuana Regulations – The Committee on Substance Use and Prevention has reviewed and provides the following information.  The committee published The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update policy statement and technical report in 2015.  The committee will
   soon release a clinical report on Marijuana Use During Pregnancy and Breastfeeding: A compendium of relevant resources about marijuana are available at www.aap.org/marijuana.  AAP State Advocacy works closely with chapters in states with “medical” and recreational marijuana laws to establish regulations that protect children from marijuana.  These policies
   include edible marijuana product restrictions, childproof packaging requirements, advertising and marketing restrictions, taxation and use of tax funds for marijuana education programs, and restrictions on the locations where marijuana can be used. Costs to develop and maintain a clearinghouse could cost $20,000 to > $200,000 depending on methodology and dissemination strategy.
6. Resolution 26SA: Funding and Support for Autism Therapy – The American Academy of Pediatrics (AAP) Council on Children with Disabilities (COCWD) and Section on Developmental and Behavioral Pediatrics (SODBP) are co-authoring a revision of two clinical reports which will be published as one clinical report, “Identification, Evaluation, and Management of Children with Autism Spectrum Disorder.”  The revised report outlines evidence supporting Applied Behavior Analysis, as well as other interventions, for children with autism spectrum disorder (ASD).  The revised report also provides recommendations that support the elimination of disparities in access to care for children with ASD.  Following the publication of the revised report in 2018, the COCWD and SODBP will collaborate with numerous Academy groups including, but not limited to, the State and Federal Advocacy staff team, to disseminate recommendations from the report to pediatricians, families, and policymakers.
7. Resolution 61: Granting Candidate Fellows the Right to Vote in AAP Elections – The current AAP bylaws state that Candidate Members “may not vote on any matter submitted to a vote of the members.”  The Section on Pediatric Trainees strongly urged the Board to grant Candidate Members the right to vote in the AAP Bylaws during their meeting with the Executive Committee at the ALF. Additionally, 15 comments have been submitted to the AAP Bylaws Member Comment Opportunity that support granting Candidate Members right to vote.  This number represents approximately 31% of the total comments submitted.  In May 2018, the Board will approve final language for a proposed bylaw revision that will then go before a vote of the full AAP membership during the 2018 National AAP Election.  The Board will have an opportunity to consider the merits of the resolution when having the final bylaws deliberation at the Board Working Session in May.  Currently the voting privilege is tied to granting of FAAP status, which occurs after board certification.  Candidate members who have not yet received board scores, but have completed training and are members of the AAP, are not currently eligible to vote in elections.  If Candidate members were allowed to vote, an additional 1,687 Candidate members would have been able to vote in the National Election in September 2017, versus only 737.  Implementing this change would require a to-be-determined level of effort from IT along with a fiscal note.
8. Resolution 20SA: Increasing Immunization Rates by Universal Access to Immunizations – The AAP is a leading advocate for vaccine access programs, including the Vaccines for Children (VFC) program, Section 317 Immunization program, the Prevention and Public Health Fund, and the Centers for Disease Control and Prevention vaccine programs.  Groups across the academy engage in activities to increase access to vaccines and to improve vaccine delivery.  Historically, the AAP supports efforts to expand universal vaccination programs through advocacy and policy.  However, recognizing that adequate payment to clinics is required to support a robust vaccine delivery system, the AAP monitors closely how such programs may impact vaccine purchase and funding mechanisms for vaccines.  Additional note: Considerable debate occurred at ALF on this resolution with some members voicing concern that without strong consideration of payment mechanisms and resource support for a universal vaccination program that fewer pediatricians might participate in such a
   program leading the unintended result of decreased access to vaccines (including access to vaccines in the medical home).
9. Resolution 14: Universal and Affordable Contraception – Reproductive and sexual health care for adolescents and young adults are among the top priorities of the Committee on Adolescence.  Several policy statements have been published on contraception, emergency contraception, and pregnancy prevention, which include a strong advocacy component for making contraception more accessible and affordable to this population.  COA is writing a statement specific to Long-Acting Reversible Contraception (LARC).  COA will continue to work with AAP Federal and State Government Affairs on advocating for over-the-counter access to contraceptives.  The AAP will continue to partner with other national organizations (eg, ACOG, AAFP, SAHM) on advocacy efforts at the state and federal levels.  COA supports access to training on use of LARCs.
10. Resolution 37: Opioid Prescription Policy Statement – Currently key member groups under the leadership of the Section on Anesthesiology and Pain Medicine are finalizing two policy statements on this topic – “the Assessment and Management of Acute Pain in Infants, Children, and Adolescents” and “Care of Pediatric Patients with Chronic Pain.”  Additionally, two Pedialink online learning modules – “Acute Pain” and “Opioid Crisis and Chronic Pain Management” provide educational support for appropriate use of opioids.  State advocacy continues to provide strategy guidance to AAP chapters on opioid prescribing limitations, safe disposal laws and other policy measures to address the opioid epidemic.