Together on Behalf of All Children

The AAP masterfully navigates our politically polarized national landscape to advance the health and well-being of all children. I believe my career experiences integrate well with the AAP in this challenging endeavor. My career as a primary care physician, child welfare specialist and academic pediatrician has been dedicated to developing programs and advocating for improved health care for children and adolescents in foster and kinship care. I have worked in close partnership with and often led large inter-disciplinary teams whose members had varying and sometimes conflicting viewpoints. Finding common ground and forging a workable compromise has required attentive attuned listening to varied perspectives, using data wisely and forming respectful partnerships with leaders in health, mental health, child welfare, insurance, and policy while keeping the ultimate shared goal of best serving children and families in mind. While progress toward a larger goal can sometimes feel incremental, goal-informed collaboration occasionally leads to large leaps forward. In NY, on behalf of children in foster care, I led teams that: created an integrated-care medical home; developed the national foster care health guidelines; and, tested the transition from fee-for-service to Medicaid Managed Care. My work with the AAP Washington Office reinforced the importance of collaborative cross-systems partnering to achieve important changes for children. These leadership experiences have sometimes required me to reach across chasms to find common ground while simultaneously identifying like-minded partners and advocating vigorously for children, families and pediatricians. Bridging chasms is always easier when we focus on what is best for children.

Our country’s 75,000,000 children are 20% of our population but 100% of our future. They are being reared in a demanding, stressful world for a future that often seems in peril. Nearly half live in poverty; 64% have experienced >1 Adverse Childhood Experience. They face new challenges such as climate change, vaping and social media. Addressing these cumulative adversities is incredibly challenging but of critical importance to pediatricians because toxic stress, regardless of cause, can become biologically embedded resulting in poor outcomes now, throughout life and across generations. As AAP President, I would work closely with the AAP’s CEO, Board, chapter leadership, and Washington office to implement the AAP’s Agenda for Children by: Supporting the work of pediatricians. Pediatricians do vital family-centered work to promote healthy growth, development and resilience, ameliorating the negative impact of stressors. Financing must be aligned to pay for the scientifically-based preventive and therapeutic work we do and to support integrated-care. Advocating for vulnerable children. The power of our advocacy is its foundation in science and demonstrated multiple past successes. With partners, we can address poverty, bias and discrimination, climate change, and the negative social determinants of health, and promote equity in access and workforce diversity. Promoting pediatrician and staff wellness. Massive transformations in health care require that we support wellness across generations and specialties through team-based care, stream-lined technology, improved financial margins, and programs to reduce burnout.

Some of my most cherished work with the AAP has been on advocacy issues. I started in the 90s with Chapter 2 in NY, then District II, and finally with the Washington Office. The AAP calls on member expertise to delineate powerful persuasive positions based in evidence and ethics. It speaks with the voice of 67,000 members and engages legislators on both sides of the aisle. The last few years have been very busy for the AAP. Somehow, in the midst, the DC office led a large collaborative effort to enact what we colloquially refer to in child welfare as Family First —two bills that together have the potential to transform child welfare—to move it toward prevention and away from family disruption, toward evidence-based care and away from catch-as-catch can interventions. This is nothing short of astonishing. The next several years though will be crucial to ensuring it is enacted as intended.

My professional focus on children in foster and kinship care has enabled me to straddle 3 different worlds—primary care, including private practice, academic pediatrics, and public health. I have worked collaboratively across systems with mental health, child welfare, the legal system, policy-makers and with the AAP as a part of its large and formidable volunteer member work-force. I've had the opportunity to lead large interdisciplinary teams focused on a common mission to improve the health and mental health care of a vulnerable child population, to reduce disparities in access to care, and, more recently, to create a more skilled workforce through pediatric education to prevent some of the horrible outcomes I have borne witness to in both my professional and personal life.