Interesting News from the American Academy of Pediatrics-
Updates from a Meeting on November 5, 2015
This Thursday, I was attended a meeting of an important policy-making committee of the American Academy of Pediatrics (AAP).  
For the last 3 years, I have been honored to be a member of the Committee on the Psychosocial Aspects of Child and Family Health (COPACFH).   This Committee is charged with developing and publishing policy for the Academy on matters pertaining to the psychological well-being of children and their families.
Over the years COPACFH has crafted, or played a role in crafting the Academy’s policies regarding such issues as:
*   The best, evidence-based interventions for behavioral problems in children
*   The impact of poverty on childhood
*   The impact of divorce on families and children and how pediatricians can help
*   Promotion of teaching American pediatricians how to be most effective in helping diagnose and manage mental health problems
*   Issues regarding pain management in childhood
*   The best approaches to the pre-natal visit
*   The impact of sexual orientation on families and children
*   The best approaches to discipline, with special statements regarding corporal punishment
*   The role of the father in the life of a child
Many of these policies have had an enduring impact on American life, and certainly on the practice of pediatrics.   This makes my participation on this committee a special opportunity.
Another compelling aspect of COPACFH is that it brings together a wide range of professional societies to share their special insight on topics such as those noted above.   At today’s meeting we had representatives of the following national societies participating:
*   AAP Section on Developmental and Behavioral Pediatrics
*   American Academy of Child and Adolescent Psychiatry
*   National Association of Pediatric Nurse Practitioners
*   National Association of Social Workers
*   Society of Pediatric Psychology
This week the committee reviewed a number of interesting topics, which I am very pleased to share with you.
Integration of mental health services in the pediatrician’s office
This topic may be one of the hottest topics in the fields of pediatric psychology and general practice.   At our meeting, we  heard from the national societies representing pediatric psychiatry, psychology, social work, as well as the AAP, and its offices in Washington, that finding a way to provide counseling and therapy, in the pediatrician’s office, was an urgent and very high priority.
Why such intense interest in this concept?  Two reasons come to mind.  The first is the great need for help with emotional support and behavioral advice.  It is estimated that at least one in four children will have enough difficulty with their emotions and/or behavior to benefit from extra help from a counselor or therapist.  The second reason has to do with the power of the trusting relationship.  Across the country, professionals are noting that if a family has an established relationship with a pediatrician they know and trust, it makes the collaboration of a counsellor or therapist known to that pediatrician not only easier, but far more effective for the family.  This is all the more so for one actually in the pediatrician’s office.
Interestingly, this model of care has been put into place for 100,000 children of the US military who receive their care from the US Department of Defense (DOD).  We learned that the DOD mandates that every pediatrician office have mental health services present in their office.   We also heard of a wide range of solutions to this challenge from Boston to Minneapolis to Seattle.
Personally, I was very pleased that Advanced Pediatrics has been pursuing this concept of care for many years.  For a number of years we were fortunate to enjoy the collaboration of Dr. Solomon Zaraa, of child psychiatry, once a week in our office.   And we have been tremendously blessed to have one of our region’s most effective therapists available in our office for many years, Mr. Sam Selekman.   Further, we are also tremendously blessed to have one of our region’s most brilliant neuropsychologists, Dr. Carl Weitman in close association with our office for many yers.  We have long known just how powerful these collaborations are.  Time and again we have been so pleased to see very important issues addressed in such an effective manner through these collaborations.   This week’s meeting at COPACFH made clear much of the nation is seeking the sort of solutions we have been able to enjoy for some time.
The use of technology to connect the doctor to the patient has been exploding recently.  At our meeting we reviewed the intriguing development of a collaboration amongst a growing number of states to allow a doctor licensed in one state to offer long-distance video medical advice in other states.  So far 11 states have signed up for this consortium, Ohio is not yet one of them, but the list is growing.
At Advanced Pediatrics, we have been exploring new ways to be helpful, and many of the insights shared at this week’s COPACFH meeting may lead to exciting developments at the office, stay tuned.
The impact of policy at the state and Federal level
Without taking sides in our nation’s ongoing political debate, the meeting was able to remind us all that decisions made in state legislatures and Congress have a very  concrete impact on the health and well-being of children.  We were told of many states in which the election of a governor and/or legislature with a particular approach to policies placed millions of children at risk.
At every meeting we get to hear from the offices at the AAP that remain in close contact with Congress and all 50 state legislatures and it was their reports that dramatically demonstrated that elections do matter, policy decisions can help or hurt so many children.
The impact of poverty on being medicated for behaviors
One particularly disturbing fact presented to us at the meeting was the relationship between family income and the chance your child will be medicated for their behaviors.
We all know that poverty usually tends to make a service less available to a family.  But when it comes to the use of medications to inhibit a child’s behavior, the opposite is true.
It turns out that children living in poverty in the US are 3 to 4 times more likely to be prescribed stimulants or powerful sedatives to control their behavior than children from middle class or wealthy families.
Now, one could argue that the stress of poverty will increase the chances of having emotional and behavioral problems requiring medication, but the increase of 300-400% raises the concern that poor children’s behavior may be less tolerable than better off kids.
1.      The American Academy of Pediatrics (AAP) is the country’s leading professional society for pediatricians.  The committee of the AAP charged with creating and publishing its policies relating to the psychosocial health of children is called COPACFH and I have been honored to serve on it for the last 3 years.  I attended our last meeting this week.
2.     Over the years COPACFH has published a number of policies for the AAP on a wide range of important issues. 
3.     At this week’s meeting some key policy issues discussed included the urgency of having mental health services available in the pediatrician’s office, the emergence of telehealth, and the very real impact of policy decision making by politicians at the state and Federal level on the lives of children in the US.
4.     I remain very grateful for the opportunity to take part in fashioning policies that impact pediatricians, families, and children across the nation.  Specifically, over the last 3 years, a number of policy statement from this committee have been published in the journal Pediatrics with my name on them as a member of the committee.

To your health,
Dr. Arthur Lavin

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