Legislative Advocacy: A Pediatric Provider’s Ethical Responsibility

Lauren Gambill MDTara Greendyk MD

Objectives

• Understand the concept of legislative advocacy as it pertains to pediatrics

• Evaluate the obligation of the a pediatric provider to participate in legislative advocacy

• Identify avenues to practice legislative advocacy in pediatrics

WHAT? What Does “Legislative Advocacy” Even Mean?

What is Legislative Advocacy?

• Almost anything done to influence a legislator's position on legislation or public policy.

• It is a practical way for individuals to translate their concerns about children into policies and laws.

OUR STORYAnd Who Made You the Expert?

Politics?

WHO?Who Can and Should be a Legislative Advocate?

Who is a Legislative Advocate?

• Anyone who has ever spoken on behalf of a child. It's that simple.

• Physicians, nurses, teachers, social workers, parents, child care providers…

Evidence Based Advocacy

• 93.5% of pediatricians rated political involvement as important, however only;

• 27.2% reported any involvement with political advocacy in the 3 years prior to survey

Why Not?

• Lack of understanding• Lack of comfort• Lack of training• Time

Attitude

0123456789

10

PGY1PGY2PGY3

Participation (thus far)

Never 61%

1-2 Times 34%

2-5 Times 5%

More than 5 times 0%

Participation Prediction

How likely are you to participate as a resident How likely are you to participate after residency0

1

2

3

4

5

6

7

8

9

10

PGY1PGY2PGY3

Why?Knowledge/Comfort

overall understanding Understanding of the role of pediatrician

Comfort contacting government official

Comfort using media0

1

2

3

4

5

6

7

8

9

10

PGY1PGY2PGY3

WHY BOTHER?Is It Worth My Time?

Why is it Important?

• Legislators rarely hear about children's issues.

• Officials who are unfamiliar with children's needs make decisions

• Legislative advocacy is the bridge between imagining a better life for children and making it a reality.

Why Would They Listen to Me?

• Pediatric providers have an powerful voice• YOU are an expert in children's health,

legislators are NOT• We can change real problems• You are a constituent

What Can I Influence?

Anything…• Medicaid• Immunizations• WIC• Helmet laws• Car seat laws• School lunches• Obesity interventions• Asthma education

And Everything…• Anti-bullying laws• Smoking bans• Gun violence laws• Mental health funding• Family immigration policy• Poison prevention

packaging• Funding for safe spaces in

communities

HOW?Ok But…

Basics

• Register to vote• Vote!• Learn who represents you– www.fyi.legis.state.tx.us/

Home.aspx

Wake Up and Advocate Challenge

• The first person to use: www.fyi.legis.state.tx.us/Home.aspx

To correctly identify my Texas State House Representative wins $5 gift card to starbucks!

My Information2006 Hamilton AveAustin Texas 78702

Wake Up and Advocate Challenge

• Answer:• Dawnna Dukes (district 46)

Advocate in Your Pajamas

• Call, Email, Write• Use: www.fyi.legis.state.tx.us/Home.aspx To find legislators

websites and contact information.• Make it personal• Calls: Plan you message: succinct, personal, be prepared to talk to

legislator or staff, and Call!• Email/write:

– State that you are a [pediatrician/nurse/Social worker] AND a constituent. – Make it personal and LOCAL. – Brief (1 page)! – Use your subject line. Follow up.

Take it to the Capitol

• Meet with your legislators or staffers for a better connection– Plan your message– Bring information to

leave behind– Follow up!

Go Public

• Op-Ed, Letters to the Editor, Television, Radio, internet

• Builds awareness on behalf of an issue to get more attention from decision-makers

Go Public – Social Media• At least 75% of adults are on some type of

social media.• At least 43% of adults get health

information through social media.

What Social Media Can Be

• Powerful tool to spread awareness of issues as well as health information

• Another platform to reach decision-makers

• As of Jan. 2013, 90% of Representatives & 100% of Senators are on Twitter

What Social Media Is Not

The Basics: Twitter Cheat SheetWhile you have 140 characters to use on Twitter, using < 120 allows for easier RTs

Retweet: Good Twitter etiquette calls for RTs before forwarding on someone else’s post. Use “MT” when modifying a tweet before sharing.

@usernames allow for quick shout-outs & public conversations between users; a “.” before an @ mention allows your followers to easily follow

Direct messages are private conversations between two users on Twitter

“Trending” topics are those popular across Twitter, and can be filtered by country or regional and found on the lefthand side of your home page

#Hashtags are used to organize posts and to easily create and surf trends

FollowFriday: On Fridays, use #ff to recommend others your followers may be interested in following (a great way to promote partners’ & colleagues’ work)

120

RT

@

DM

Trends

#

#ff

HIPAA & Social Media

• Think before you tweet: HIPAA applies to social media platforms• No identifiable information

• Online, your digital footprint is holistic and accessible• consider what you share • What would you want your patients to know

(or not) about you?

Wake Up and Advocate Challenge

• The first 3 people to tweet something they have learned about advocacy @renkate (that’s me!) will win $5 starbucks card

Advocate in Less Than 5 minutes

• Join your professional organizations!– American Academy of Pediatrics– Texas Pediatrics Society– National Association of Pediatric Nurse

Practitioners– Society of Pediatric Nurses

WHAT TO ADVOCATE?Ok I’m Convinced, So…

Hot Topics in Pediatrics - Texas

• 2014 is legislative off year – relationship building, discussion of 2015 priorities– ECI & Home Visiting Programs– Medicaid– Training for Pediatricians– Obesity

ECI

• Early intervention proven by the research to improve outcomes for children with– Autism, premature children, and other

developmental disabilities• Outcomes reduced– Academic achievement, behavior, delinquency and

crime• Saves money in public spending later

Medicaid

• Medicaid served >2.5 million children in Texas• Preventative services much more cost

effective then ER services• We need more Medicaid providers.

Challenges?– Medicare and Medicaid rates are not equal (hard

to attract providers if they can’t afford these patients)

– Medicaid more cumbersome (Let’s streamline)

Training more Providers

• Physician Shortage• Med students >

residency spots• Most residents end up

practicing near where they train

• Bring our doctors back to Texas by increasing GME funding

Obesity • Public policy and programs

targeted at obesity– Incentivizing healthy food

purchases through public programs

– Nutrition in schools– Addressing “food deserts”– PE in schools– Enhance opportunity for

exercise through environment (ex. Complete Streets & Safe Routes to Schools)

Hot Topics in Pediatrics - Nationally

• Poverty • Do Not Track Kids Act of

2013• Child Care and

Development Block Grant Act or 2014

• Emergency Medical Services for Children (EMSC) Program

Childhood Poverty• The poorest group

in U.S.• 22% live below

poverty level & 10% live in deep poverty

• Multiple devastating health consequences

Do Not Track Kids Act of 2013

• Children’s Online Privacy Protection Act (COPPA) - 1998

• S.1700/H.R.3481• Strengthens privacy

protections for children

Child Care and Development Block Grant Act or 2014

• Legislation aimed at ensuring the health and safety of children in child care– Access to child care – Child care assistance– Health and safety of children in

child care– Quality of child care– Coordination of early care and

education

Emergency Medical Services for Children (EMSC) Program

• Federal program that focuses on improving the pediatric components of the emergency medical services system.

• S. 2154/H.R. 4290 reauthorizes the EMSC program through 2019

• The EMSC program supports: – EMSC State Partnership Program– Rural & Tribal Communities & Other Areas of National

Significance Grants– Pediatric Emergency Care Applied Research Network (PECARN) – National EMSC Data Resource Center (NEDARC) – National Pediatric Readiness Project (Peds Ready)

QUESTIONS?Thank you!

References• Texas Pediatric Society, Children’s Hospital Association of Texas. Legislative Advocacy Day

Briefing. March, 2014 www.txpeds.org• American Academy of Pediatrics. Protect Children’s Online Privacy: Support the Do Not

Track Kids Act. 2013 http://www.aap.org/en-us/Documents/AAP%20DNTK%20Leave%20Behind.pdf

• American Academy of Pediatrics. Emergency Medical Services for Children (EMSC) Program. http://federaladvocacy.aap.org/?nfstatus=200&nftoken=fb963b18-1ff6-4ec6-ad9e-7f7aaa5e3b27&nfstatusdescription=SUCCESS%3a+Login+worked 2013

• National Women’s Law Center. Child Care and Devlopment Block Grant Act of 2014: Summary http://federaladvocacy.aap.org/?nfstatus=200&nftoken=fb963b18-1ff6-4ec6-ad9e-7f7aaa5e3b27&nfstatusdescription=SUCCESS%3a+Login+worked March 2014

• The Texas Tribune. Interactive: Mapping Access to Health Care in Texas http://www.texastribune.org/library/data/texas-shortage-health-care-providers / May 2012

• American Academy of Pediatrics Advocacy Training Module: Working with Decision-Makers http://www2.aap.org/commpeds/CPTI/training-modules.cfm?module=3