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Children's Capitol Connections - Fall 2009



Kids Need Specialized Care in Hospital Emergency Departments
With onset of novel H1N1 flu, pediatric preparedness is essential 

According to a recent Institute of Medicine (IOM) report, only six percent of U.S. hospital emergency departments are fully equipped to properly care for children. With high rates of novel H1N1 (swine) flu expected this winter, the time to address these deficiencies is immediate.

In a joint policy statement published in Pediatrics, “Guidelines for Care of Children in the Emergency Department,” pediatric emergency medicine specialists and others provide recommendations for appropriate equipment, training, medications, and policies for pediatric emergency care.

“Children account for 20 percent of all emergency department visits, yet most hospitals are unprepared to provide appropriate care,” said Joseph L. Wright, MD, MPH, Senior Vice President of the Child Health Advocacy Institute at Children’s National Medical Center in Washington, DC. “The potential widespread impact of the Novel H1N1 strain of influenza underscores the urgency to ensure that our kids receive the best care when they come to their community hospital’s emergency department.”

Dr. Wright is trained as a pediatric emergency medicine physician and helped write the revised policy statement, released in the journal Pediatrics. Dr. Wright was also on the Institute of Medicine committee that wrote the 2006 report, “Emergency Care for Children: Growing Pains.”

Examples of appropriate pediatric care can include having on hand varying sizes of equipment, such as tubes for intubation, as well as ready access to specialists like pediatric anesthesiologists. The existence of specific policies and procedures to address the needs of children and families, particularly in times of surge, are also critically important.

This policy statement was funded in part by the federal Emergency Medical Services for Children (EMSC) program, which, along with 21 other professional organizations, has endorsed the statement. Children’s National Medical Center houses the EMSC National Resource Center, which was established in 1991 to help improve the pediatric emergency care infrastructure throughout the United States and its territories.

What You Need to Know about Novel H1N1 Influenza and Kids

Visit Children’s National Medical Center’s H1N1 Flu Resource Center for valuable information on protecting children during flu season.

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Study Highlights Ongoing Pediatric Health Care Needs in the Nation’s Capital

On October 8, Children’s National Medical Center released its first Pediatric Health Needs Assessment, which was conducted by the RAND Corporation. The report, Health and Health Care among District of Columbia Youth, assesses the health status and health care services for the more than 100,000 youth (ages 0-17) residing in Washington, DC.  The study findings demonstrate that gaps in care and services persist for children in the District despite high levels of health coverage and point to the need for broadly inclusive partnerships across agencies, providers, and the government to address unmet pediatric health care needs.

Among the report’s extensive findings:

  • The District of Columbia leads the nation in children with health coverage, with only an estimated 3.5 percent uninsured children in DC in 2007 vs 9.1 percent uninsured nationally.
  • However, despite high levels of coverage, many barriers keep children from receiving primary and specialty health care in community-based settings, including:
    • Uneven distribution of primary and specialty care providers across the District; and
    • Infrastructure inequities, including ease of physical access and transportation.
    • As a result, many children rely on emergency rooms and are hospitalized for conditions that could be prevented.
  • Some health issues in the District are particularly alarming, including the highest or among the highest rates in the nation of obesity, asthma, sickle cell disease, HIV/AIDS, adolescent pregnancy, and teen dating violence.
  • Many of these health threats are more equitably dispersed across the city than one might assume, rather than concentrated “east of the Anacostia river” in Wards 7 and 8.

“Many of the study findings are confirmatory and overall provide valid quantitative and qualitative evidence in support of a data-driven approach to public health action,” said Joseph L. Wright, MD, MPH, senior vice president of the Child Health Advocacy Institute at Children’s National. “We look forward to using this information to work collaboratively with other stakeholders to improve the health and health status for children in the District of Columbia on a community-wide basis.”

The study will inform Children’s National’s programming and community benefit work, and will be shared broadly throughout the region to foster strategic partnerships among policy makers, government agencies, schools, faith-based organizations, insurance companies, and business entities all in the name of addressing children’s health.

“The RAND Corporation has produced an unprecedented review of pediatric-specific issues in the District,” said Jacqueline D. Bowens, executive vice president and chief government and external affairs officer, Children’s National Medical Center. “Children’s National serves a unique role in the District as the largest single provider of pediatric care as well as the largest employer of specialty and primary care pediatricians. In this era of health reform, it is important to remember that health care is not a one size fits all proposition. Health care reform must take into account the unique needs of children and their providers and recognize that coverage doesn’t guarantee access to care. We must address Medicaid payments for pediatric providers, workforce shortages in pediatric specialties and nursing, medical malpractice reform and the barriers to care that these challenges create. By addressing these and other findings in the report, we will ensure that all children have access to the right care at the right time and in the right setting.”

Commissioned by Children’s National and conducted by RAND, the report is the first of its kind done in the metropolitan area. The report’s methodology is based on a unique blend of quantitative and qualitative data sources that provide a nuanced and previously unavailable picture of the health status of children in the District. The complete study can be found at www.childrensnational.org/pediatricneeds and at http://www.rand.org/.

“Children’s National is already partnering with organizations across the District, and provides a great deal of community-based public health work through its research and advocacy institutes, its community clinics, mobile vans, networks of pediatricians, and partnerships with multiple health government agencies,” said David Catania, at-large, District of Columbia city councilmember, who chairs the Council’s Committee on Health. “This report shines a light on important work that remains to be done and helps all of us better direct our resources to serve the children of the District. We applaud Children’s National for commissioning this study that is already shaping community action.”

Related Links:

 Children's Pediatric Health Needs Assessment - RAND Report
 Download Pediatric Health Needs Assessment report - Executive Summary (PDF)
 Download Pediatric Health Needs Assessment report - Full Report (PDF)
 Sign up for more information and updates on Children's National's response to the Pediatric Health Needs Assessment


Giving Back: Children’s Community Benefit Tops $102 million

A strong commitment to our community has been synonymous with Children’s National Medical Center since we opened our doors in 1870. Even then, from a small rented row house, improving the health status of the city’s most vulnerable children was a priority.  In fact, some of the earliest community efforts were through the hospital’s “milk stations” in the 1920’s, where underserved families could receive healthier, germ-free milk. That commitment is alive and well today with a fiscal year 2008 community benefit investment topping $102 million. 

Through implementation of targeted programs and educational initiatives, Children’s National reaches beyond the normal perception of healthcare delivery to benefit children and families in the local, national, and international communities. Faculty and staff extend their expertise beyond the hospital walls through efforts that encapsulate our C.A.R.E. mission – Care, Advocacy, Research and Education.

We invite you to read our Community Benefit Report to learn about the many programs and activities that were conducted in fiscal year 2008. The report highlights our multi-faceted approach to tackling childhood obesity through clinical, policy and community efforts as well as other programming, including community education classes, Emergency Medical Services for Children, and the Freddie Mac Foundation Child and Adolescent Protection Center.

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Children's National to Lead National Mild Traumatic Brain Injury Effort

Sarah Jane Brain Foundation Names Gerard Gioia, PhD, as National Leader

Children’s National Medical Center was named the national lead center on mild traumatic brain injury (TBI) by the Sarah Jane Brain Project (SJBP), a national organization focused on the prevention and treatment of acquired brain injury in children. Gerard Gioia, PhD, pediatric concussion expert and division chief of Neuropsychology at Children’s National, will lead the nationwide effort to raise awareness and improve treatment of mild TBI, commonly called concussion, as part of a larger national initiative that addresses many aspects of acquired brain injury, the leading cause of death and disability among children, adolescents, and young adults.

“Consequences of childhood brain injury can be severe and life lasting,” said Dr. Gioia. “Children’s National is honored to be selected by the Sarah Jane Brain Project and to be recognized as a comprehensive resource for families with children suffering from brain injuries.”

Concussions make up between 80 and 90 percent of all brain injuries in the United States. More than 1,000,000 emergency department visits each year occur due to mild TBI.. These injuries can be caused by motor vehicle accidents, sports injuries, falls, being struck by an object, and violence or assault.

As the national lead center for concussion, Children’s National will spearhead the effort to implement a plan that will:

  • Establish a mild TBI-specific curriculum based training program for clinical staff
  • Emphasize proper diagnosis at the earliest point of identification
  • Focus on individualized treatment, thereby improving recovery and reducing adverse outcomes
  • Create a nationwide plan to implement the 2008 International Concussion in Sport Group recommendations for sport-related TBI in youth
  • Employ concussion toolkits to educate everyone involved in the care of a child
  • Improve communication between emergency departments, primary care physicians, schools, and sports programs to ensure that all can properly identify and diagnose concussions
  • Use research to better understand the effects of injury on the developing brain  

The SJBP was founded in 2007 by Patrick Donahue, whose 5-year-old daughter suffered a traumatic brain injury. In January 2009, the SJBP began developing a national pediatric acquired brain injury plan for children and young adults with brain injuries. The plan consists of guidelines that will standardize the assessment and follow-up treatment of TBI. The foundation has selected 52 centers across the nation—one in each state plus the District of Columbia and Puerto Rico—to allow children to receive comprehensive and integrated care regardless of where they live.

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Meet Our Kids: Ryan Cole

Ryan weighed less than two pounds when he was born. He was less than a foot long, and his biggest toe was the size of a Tic Tac ®. For the first 94 days of his life, Ryan slept in an incubator in the Neonatal Intensive Care Unit at Children's National Medical Center. Ryan’s dad created this emotional video to tell his son’s story.

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Did You Know?

In the last year, 400 individuals donated more than 46,000 hours of service to Children’s National Medical Center.

It takes only a small amount of time to make a big difference in a child’s life – the time it takes to read a story, play a game, greet a family, or color with a child. As a Children’s National Medical Center volunteer, you learn skills and meet friends while experiencing the special satisfaction that comes from seeing a child return your smile. Visit our Web site to learn more about volunteering at Children’s National.

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