July 6, 2020
Texas Pediatric Society - School Reopening
On behalf of over 4,000 members of The Texas Pediatric Society (TPS), the Texas Chapter of the American Academy of Pediatrics, we support the reopening of schools this fall for the well-being and education of our most precious asset, our children, only if it can be done in a safe manner. Texas pediatricians are increasingly concerned about the negative effects on the emotional health and well-being of continued absence from in-person education, especially for those children and adolescents from disadvantaged backgrounds and/or with special needs. For many reasons, schools should make every effort to provide in-person education in the fall, with appropriate steps to lessen risks and to provide flexibility for virtual instruction for students or staff who cannot attend in person:
- Schools offer more than formal education. Schools play a significant role in children’s lives and the community. Schools provide safety-net services such as nutrition (with free school meals), vaccination surveillance, mental health supports, English language services, Head Start programs, specialized education, and therapies, among many others.
- Schools are important to children’s emotional well-being. Schools are places where children interact and socialize with each other, and where skills are nurtured towards building relationships, especially with those of different backgrounds and abilities.
- Education is a continual experience. Prior to COVID-19, educators at the start of each school year deal with students’ loss of knowledge and skills after their return from a three-month summer vacation. The longer the absence from in-person education, the more significant will be the academic losses.
- Education is important to our society. Public schools strive to provide access to education to ensure the same opportunities for every child in our society. The attainment gap in children from disadvantaged backgrounds was significant long before the COVID-19 pandemic, and children of families with the fewest resources prior to COVID-19 had the most challenges with accommodating distance learning. Without returning to full access to education, the negative impact of COVID-19 will fall disproportionately on ethnic and racial minorities and will worsen inequities and opportunity gaps that already exist.
- Distance learning is challenging for many children and families. We applaud the efforts of school districts and teachers to provide distance learning during the period of school closure from March to May. Some children were able to access and to do well academically with virtual instruction during COVID-19. However, many families were unable to fully accommodate virtual instruction for many reasons including inadequate technology, internet access, space, and parental time for supervision.
- School reopening guidelines in Texas must be flexible in allowing local school districts and health departments, with community input, to further develop road maps that meet their unique needs, within the boundaries of CDC and AAP guidelines.
Schools are essential to help all children thrive. Schools are vital not just for educational attainment but for the overall health and emotional well-being of all children. Going forward, plans developed by each school district need to consider the overall impact of their plans on students, staff, and families, while keeping all as safe as possible while recognizing there cannot be a one size fits all approach to reopening, since each district, school, and student is different. Schools should not be penalized for variance in attendance during the COVID pandemic. We also recommend partnering with local pediatricians and pediatric infectious disease experts at health-related institutes. When considering contingency plans that include distance learning, such as if COVID-19 rates increase again, we urge schools to take into account the needs of the most vulnerable children and families, and to consider all possible ways to continue in-person if it can be done safely.
Without returning to in-person education, the effects of COVID-19 will linger far beyond the pandemic itself and will limit children and young people from reaching their fullest potential for years to come.
- AAP. COVID-19 Planning Considerations: Return to In-person Education in School. Accessed June 30, 2020, at https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools
- CDC, May 2020. CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again. Accessed June 22, 2020, at https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/CDC-Activities-Initiatives-for-COVID-19-Response.pdf
- CDC. Consideration for Schools. Accessed June 22, 2020, at https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools.html
June 5, 2020
Racism: A Social Determinant of Health
The Texas Pediatric Society, the Texas Chapter of the American Academy of Pediatrics, is deeply saddened and incensed by recent events which so distressingly reminded us of the racism that continues to pervade our country. While it was the needless death of George Floyd that has brought this back to the forefront, racism and its long-term implications for the children for whom we provide care should never be far from our mind. Like poverty, housing insecurity, and other adverse childhood experiences, racism is another social determinant of health that must be addressed by pediatricians.
According to the AAP policy statement, The Impact of Racism on Child and Adolescent Health, despite some gains, “…children raised in African American, Hispanic, and American Indian populations continue to face higher risks of parental unemployment and to reside in families with significantly lower household net wealth relative to white children in the United States, posing barriers to equal opportunities and services that optimize health and vocational outcomes.”
As a chapter we have addressed racism and its subsequent health inequities largely through the work of our committees. However, it is time for TPS to be more intentional in our approach to racism. This is a call to action for us to implement many of the recommendations from the AAP policy statement both as individual pediatricians and as a chapter. I encourage you to read the policy statement and to begin to incorporate many of the recommendations within your individual practice.
Our children spend much of their time within the education system, and their success in school has long-term implications for their health. As an organization we need to be even more active legislatively in monitoring and supporting bills that promote a diverse teacher workforce. Just as it has been shown in healthcare that patients experience better outcomes when cared for by someone from a similar background, so is the likelihood of graduation from high school by a student taught by someone from a similar background, even if only once in their early grades. Many of us encourage our patients to consider careers in medicine; we should do the same in encouraging them to become teachers. Perhaps we could even consider establishing a scholarship or funded project that addresses diversity in teaching and education for the benefit of our children.
We need to educate ourselves and be willing to have frank discussions. Our annual meeting is an excellent opportunity to have a plenary session addressing this critical topic followed by break-out sessions that allow us to explore meaningful measures in which we can engage to improve the health inequities caused by racism.
A workgroup will be established to explore the above ideas. TPS recognizes that there is a history of racism even within medicine, and we will work to educate and develop strategies to promote equity in our profession. The recent lives lost should not just become memories but should serve as an impetus for us to do more. A few positive stories from the news this week have shown some police chiefs and officers joining with peaceful protesters to express their solidarity against police brutality and racism. As TPS, the Texas Chapter of the American Academy of Pediatrics, and as individual pediatricians, it is time for our voice to be heard, and we should actively demonstrate that we believe racism is a social determinant of health that should no longer be tolerated.
May 15, 2020
May has always been one of my favorite months of the year…it is filled with the excitement of soon-to-be high school graduates coming in for their final meningitis vaccine before embarking on the next phase in their journey to independence, young athletes coming in for their first pre-participation physicals as they prepare to enter middle school, and kids coming in with an ever-growing excitement as school winds down and they plan for fun-filled summer activities.
This year has been different…children and their parents enter the waiting room with hesitation with masks covering their faces. The question “Will we ever return to normal?” inevitably comes at some time during the visit. And while we may not be able to answer with any certainty on the timing, we all know that at some point in the future, we will no longer be wearing masks when we see our patients and can return to the “serve and return” interactions we all enjoy about pediatrics.
However, some marks will be left indelibly on our patients, their families, and our practices. The mental health ramifications of the social isolation and distancing are already being felt by our children and adolescents, and the aftermath of this will continue for years to come. Families have lost both jobs and insurance coverage. Some may require resources that they never dreamed they would need to access, and may be completely unaware of how to do this.
Know that as you navigate these challenging times, the Texas Pediatric Society stands ready to assist you. Right now, members of the TPS Mental Health Committee are preparing a webinar for our members, focusing on navigating the care of children and adolescents with increased depression, anxiety, and experiencing adverse childhood events. TPS was active in the past legislative session with supporting funding to develop the Child Psychiatry Access Network, a line that allows you immediate access to a psychiatrist when you are seeing a complicated patient with mental health issues which requires immediate assistance. The CPAN phone line will be live on May 18th.
The Committees on Medicaid and Nutrition and Health have gathered resources for you to give to families who may need to apply for Medicaid, or who could use supplemental assistance from their local food banks. The Committee in Practice Management along with TPS staff have advocated daily with payers to assist practices during these dire times. As always, I am grateful for a wonderful TPS staff who have tirelessly advocated on behalf of the children and pediatricians of Texas. While it may take time before we return to “normal,” we will persevere through this and will emerge on the other side with greater insight into the care we provide for children and the approaches we employ. Blessings to you all as you continue to serve the children of Texas.
Tammy Camp, MD
March 16, 2020
I heard a story on the news this morning about a lady who upon entering a grocery store was called over by an elderly couple still sitting in their car. They desperately needed groceries but were fearful to enter the store. The woman took their list and money, purchased the groceries and loaded them into the trunk, and the couple was able to go on their way. I was reminded a few hours later that the fear this couple experienced in the wake of the COVID-19 situation is felt not only by the elderly. A teenager to whom I am close expressed to me her fears regarding the outbreak - concern for her aging grandparents, for her dad with a comorbid condition, and the recent layoff of her grandfather from his job at the airport.
As pediatricians we are blessed with the opportunity to assist children in dealing with these apprehensions. We help them navigate troubled times through providing perspective that sometimes is missing in news reports and social media stories. Please continue to refer to the Texas Pediatric Society website for up to date resources. Our hard-working, flexible staff continue to update it with information you may find useful in your practice.
Thank you to each of you for your hard work during a time of uncertainties. I know that for many, COVID-19 has already been identified in your communities, and you are actively working to combat the concerns of parents and families while providing care and instituting plans developed for times such as these. Others are still preparing for its inevitable appearance. The Texas Pediatric Society is grateful for what you do for the children of this state and the care that you provide. Please take care of yourselves and your families as you continue to care for our most precious resources.
For additional information, updates and resources go to: https://txpeds.org/coronavirus-disease-2019-covid-19
Previous message from TPS President Dr. Tammy Camp
March 3, 2020
Less than two weeks ago, I was privileged to sit in a morning report and participate in a discussion led by one of our residents regarding the ethical decisions raised by the recent novel corona virus infection. As this was discussed, the question was raised, “How will we handle the situation here, if and/or when, there is demonstrated community transmission of the virus in the United States?” Now, the question seems to be even more relevant as we follow the daily newscasts reporting on numbers quarantined, states affected, number of cases, and numbers of deaths. While the Texas Pediatric Society is unable to provide direct advice regarding the evaluation, diagnosis, or management of patients exposed to COVID-19, I do want to assure you that our staff and TPS Executive Board are actively engaged in gathering resources and links that may be relevant to your practice. We recognize that every day you, the practicing pediatrician, are on the frontlines and our goal is to provide a site that can serve as a repository for relevant information that can be easily accessible with practical suggestions to assist in your preparation.
Please use the TPS website for ongoing updates.