California newborn hearing screening program

The Department of Health Services (DHS) is proud to announce the implementation of the California Newborn Hearing Screening Program (NHSP). Annually 400,000 infants will have the opportunity to have their hearing screened at the 200 California Children’s Services (CCS) approved acute care hospitals with licensed perinatal services and/or neonatal intensive care units (NICU). The goal of the NHSP is to identify infants with hearing loss by three months of age and to begin intervention services by six months of age. This is consistent with the February 1999 American Academy of Pediatrics policy statement regarding Newborn and Infant Hearing Loss: Detection and Intervention. Recent research shows infants with hearing loss who have appropriate diagnosis, treatment and early intervention services initiated before six months of age are more likely to develop normal language and communication skills. At full implementation, approximately 1,200 California infants will be identified each year with significant hearing loss.

The legislation establishing the California NHSP (Assembly Bill 2780, Chapter 310, Statutes of 1998) defined the components of the program:

• Newborn hearing screening offered to the parents of all babies born in CCS approved hospitals
• Screening of all babies receiving care in a CCS approved NICU; Hearing Coordination Centers (HCCs)
• A data management system
• An outreach and awareness campaign

The program will be administered through the Children’s Medical Services Branch.

The HCCs are a unique concept in state newborn hearing screening programs and will serve as a critical component in assuring that infants with a hearing loss are identified and receive intervention services as early as possible. HCCs will:

• Contract with DHS to assist hospitals to set up their screening programs
• Certify hospitals as screening providers; collect data from hospitals and outpatient providers
• Track and monitor babies to assure they receive diagnostic, treatment, and early intervention services as indicated
• Assure that infants’ primary care providers receive results of the outpatient exams
• Serve as a resource for parents and providers

  The HCCs that have been selected through a competitive process are:

• the House Ear Institute in Los Angeles, responsible for southern California:
• Sutter Memorial Hospital
• Sacramento for northern California including the central valley and foothills
• The University of California at San Francisco, Division of Audiology for the Bay Area and coastal regions

The DHS has developed standards for the CCS-approved hospitals that will serve as hearing screening providers. All CCS-approved hospitals must be certified as meeting these standards by December 31, 2002. After certification, they can be reimbursed by the State for hearing screening services provided to Medi-Cal eligible and uninsured infants. Standards have also been developed for providers or facilities who wish to participate as outpatient screening providers to perform the follow-up screening necessary for newborns and infants who do not pass the initial inpatient hearing screening.

A data management system developed for newborn hearing screening has been procured by DHS and will be provided to hospitals free of charge. After software installation in hospitals starts in January 2000, HCCs can begin the process of certifying hospitals which meet department standards. The hospitals, HCCs, and State will utilize the data system for recording test results, tracking follow-up appointments, case managing infants needing assistance in accessing services, monitoring program activities and quality indicators, and generating the data needed for reports. Additionally, the NHSP data management system will generate correspondence to the infants’ pediatricians regarding the results of the hearing screening and diagnostic evaluations performed on their patients, including recommended follow-up.

NHSP brochures will be available for distribution to families by physicians and hospitals prior to delivery and at various steps in the screening process. Information will be also be available for families of children identified with a hearing loss, including descriptions of communication options, early intervention services and other resources in their own community.

The NHSP recognizes that the infant’s pediatrician is a vital member of the multidisciplinary team and that medical evaluation is an essential aspect of the process. You are in a unique position to inform parents and families of the importance of hearing screening and to encourage them to keep the outpatient hearing re-screen or diagnostic evaluation appointments, if indicated. Your participation is critical to assure timely access to the needed audiologic and medical services. The State and HCC staff look forward to working with you and your families to facilitate the goal of early identification of hearing loss and entry into early intervention services before infants reach six months of age.

For more information about the NHSP or about becoming an outpatient screening provider, please contact Marian Dalsey, MD, MPH, at Children’s Medical Services, California Department of Health Services, at (916)654-0830

President’s Column

By Paul Jewett, MD

Update on Chapter Activities:

Since our last newsletter we sponsored a legislative day in September in Sacramento, held our Annual Getting to Know You Dinner, and gave two courses to residents on how to prepare for Life after Residency. The legislative day was well attended. We reviewed our District’s legislative priorities with a description of our progress to date and heard presentations from several other child advocacy groups with whom we hope to collaborate on significant legislative efforts. Although we tried to arrange meetings with individual state legislators, it turned out that September was an extremely busy time for them and we were not successful. We plan to transfer responsibility for arranging this meeting in the future to our District office, and encourage it to look at timing and other issues to determine how best to involve us with the legislators and staff. At our Chapter’s Board meeting that evening we heard presentations on the state Hearing Screening program (see the article in this issue) and on a special child care project being developed to pilot getting pediatricians more involved with their local child care facilities.

The Getting to Know You Dinner was a huge success, attracting residents from all the Northern California training programs. Mr. Michael Pritchard was the guest speaker, and a more entertaining and informative speaker would be hard to come by! Many thanks to Mr. Pritchard and to Myles Abbott who arranged for his talk. Our resident courses were highly appreciated and a special thanks is due to all those physicians who gave their time to help us brief the housestaff on “Life After Residency” issues.

Finally, if you haven’t as yet, please register, support and attend our Annual Winter meeting in San Francisco, December 11, on “Pediatric Infectious Diseases for the 21st Century”. Remember you can register online at the Chapter’s web site, (www.aapca1.org). The medical education committee has arranged for an outstanding faculty and range of topics, making this a “must see” meeting for all of us. At the noon luncheon Dr. Robin Hansen from UC Davis will make a presentation to us on “Early Child Brain Development.” She has volunteered to represent our Chapter along with others at a national workshop on this topic in November.

The Chapter Forum:

George Monteverdi, Lucy Crain, Mark Simonian, Tonya Chaffee and I attended the Annual Chapter Forum in Chicago last month. As usual this was an interesting and informative meeting. All the resolutions sponsored by District IX passed except for one about Medical Savings Accounts and one on cost-savings by room sharing at required national meetings (although there was an interesting debate on that one!). Most significantly, the outgoing National AAP President Dr. Joel Alpert presented a draft proposal calling for health insurance for all children and establishing a task force to study the reimbursement issues attendant to this proposal. Subsequently this proposal was released to the media at the AAP meeting in Washington D.C. this month. Details of this proposal are now available on the National AAP web site (www.aap.org). It is a lot to chew on so study it and please let us know your thoughts. In the meantime we need to continue our efforts to make Medi-Cal and Healthy Families more user friendly and to increase reimbursement to a reasonable level for pediatricians and pediatric subspecialists who provide care to children under these state programs. It is unconscionable that in a state with the world’s seventh largest economy we pay pediatricians at the lowest levels of any state in the nation to deliver this care. Health insurance is not access to care unless it is coupled with reimbursement that makes providing that care economically feasible!

At our last board meeting we decided to require Chapter Committee Chairs to attend board meetings on a scheduled basis to present briefly the accomplishments of their committees. Synopses of these presentations will then be placed in the newsletter to keep you informed of what progress is being made on issues of interest. In addition we are asking several of our committees to look at the topic of violence prevention, especially in the schools, to see if they can define a joint project for our Chapter to work on collectively. The District Initiative on violence prevention has ended with the work on this issue being passed on to the Chapters to pursue. Even though new gun laws have passed the state legislature there is much that can be done locally to educate parents and others about the role of Pediatricians in violence prevention.

Finally, Dr. Lucy Crain has decided not to seek another term as our District IX chairperson. The District Board has nominated Dr. Burt Willis and Dr. Jeff Penso for this office. Both of these gentlemen have been involved in their Chapters and the District for a number of years, know the issues well, and either of them would represent us vigorously and effectively both locally and nationally. Our many thanks go to Lucy for her enormous efforts on behalf of our District and California children.  As she goes about finishing her term as District Chair she can look back upon a solid record of achievement and be duly proud of what she has accomplished on our behalf. We look forward to working with Lucy in any role that she takes on in the future. See you in December!

By Lucy S. Crain, MD, MPH
Chairperson, CA District IX

Prior to the November, 1998 elections, the CA District of the American Academy of Pediatrics (CA-AAP, a partnership of the four AAP chapters in this state, has 5500 pediatrician members and is one of 10 geographic membership districts of the national AAP) presented statewide candidates for state and federal offices: our California Candidates Platform for Children’s Health. Our leadership met with then Lt. Governor Davis’ policy staff as well as with other candidates and obtained pledges of commitment to these child health issues and concerns thought by our leadership to represent some of the top priorities and areas of concern for the 9.4 million children and youth residing in California. (The platform of 12 items, each representing broader issues was discussed in the February District Chair column.)

In order to direct our District legislative strategic prioritization, California AAP leaders collaborated with other key child advocacy and health professional groups, including the CMA and California Childrens’ Lobby, deciding which groups would champion which items as their major areas of commitment. California AAP further identified 5 key priorities considered critical to the health of children and to the future of pediatrics in our state, and committed our limited state government fiscal and manpower resources to these areas. (Each of the five was given equal weight as special areas of concern to our members.) There is, of course, overlap with priorities of other child and health advocacy groups, as should be so in order to tackle such wide-reaching challenges.

The “Top Five” 1999 Legislative Priority areas for CA-AAP identified MICRA as crucial to the survival of children’s health care and our profession in this state. The $250,000 cap on non-economic damages is of particular concern to primary care and subspecialty pediatricians, especially for those committed to caring for high-risk newborns, infants, and medically fragile children with special health care needs. As this was also a top legislative priority for CMA, we were able to educate our child advocate allies regarding the essential protection from MICRA to preserve access to health care for children, as well as adults. Mr. Villairaigosa’s AB 1380 was defeated in the midst of disagreement whether to accept only a cost of living increase. We expect this issue to be back, and will continue to consider it a priority.

California AAP considered firearm safety issues another area of legislative priority, and actively participated with other similarly committed individuals and groups in leading the charge on Sacramento, which resulted in the signing by Gov. Davis of four landmark bills in limiting access to firearms in our state. These include AB106, (Scott, Hayden, and Aroner). As of January 1, 2002, all firearms sold, transferred to, or manufactured in California must have a Department of Justice approved firearms safety device. SB 23 (Perata) gives California the strictest assault weapons ban in the US SB 15 (Polanco) bans so called “Saturday night specials”, which do not pass even minimal safety expectations. (Ninety percent of these “junk guns” are manufactured within a 5-mile radius of Los Angeles.) AB 295 (Corbett & Wright) regulates gun shows in our state and restricts minors’ admission to shows.

Immunization bills did not fare as well in our Legislature. New vaccines and revised schedules offer great hope to reduce morbidity and mortality from hepatitis A and B, varicella, respiratory syncytial virus illness, and a host of other diseases. However, the concomitant expansion of capitated managed care plans which did not honor additional recommended vaccines as a covered benefit and the lack of inclusion of VFC (Vaccines for Children, federally subsidized vaccine program for socioeconomically challenged children) in the Healthy Families Program created financial nightmares for many pediatricians and family physicians. AB 1053 (Thompson) would have required health plans to pay for vaccines on a “fee for service” or “carve out” basis. Despite this bill unanimously passing the Assembly Health policy committee, the bill was encumbered by additional prescription drug carve out amendments and defeated in Assembly Appropriations. Vaccines remain a major priority issue for children and youth and will be a primary target for California AAP until our state can guarantee access to immunizations for more than 90% of its children.

In a 1998 survey of nearly 200 pediatricians, California AAP found that more than 80% limit or refuse to see new Medi-Cal patients, simply because they cannot afford to accept the reimbursement, which is inadequate even to cover per visit office overhead costs. These statistics indicate an additional 10% decrement in Medi-Cal accessible pediatricians since 1992. This is a dire prognosticator for access to an established continuity based medical home for socioeconomically challenged children who have Medi-Cal or Medi-Cal based reimbursed “commercial rate” insurance under the Healthy Families (California’s program under SCHIP – State Child Health Insurance Program) plans. Gov. Davis vetoed of AB 461 (Ducheny), which would have required annual Legislature report by DHS to assure adequate reimbursement for health services under Medi-Cal or Healthy Families (a federal mandate for Title XXI plans). In 1998,California AAP and collaborators were able to win a 20% Medi-Cal physician reimbursement increase for preventive and primary care services for children (the first such increase since 1985). This year’s legislature agreed with California AAP’s case to recommend a 20% physician reimbursement increase for subspecialty pediatric services (CCS health services for children with special health care needs), but Governor Davis chose to limit any such increase to only 5%. Still, California remains fifteenth in Medicaid reimbursement rates among all the states. Even when increases like last year’s 20% primary care reimbursement increase were passed, some health plans denied passing through the increment to physicians and IPAs. Unfortunately, AB 1068, which would have mandated such a pass through was heavily opposed by the health plans and died in Senate Appropriation. More challenges lie ahead for next year!

Among our “top 5” is the issue of insisting that tobacco settlement moneys be targeted toward health related-tobacco prevention and treatment-programs. California should receive $25 billion from the settlement through 2025, divided between state and local governments. Instead of targeting these moneys for health programs, the Governor’s budget takes all of the state’s share of the settlement dollars for the state General Fund. CA-AAP has co-aligned with numerous groups in AB 100 to direct the settlement dollars into a special fund for health programs, including youth tobacco prevention and increased access to health services. AB 100 passed both Legislative houses and is on the Governor’s desk at this time. California generated additional tobacco tax revenues through the passage of Proposition 10 (California Children and Families First Act) which will fund child development and child care programs for children ages 0 to 5, through a 50cent per pack increase on cigarettes. However, denying designation of health related tobacco settlement moneys to tobacco prevention and treatment programs would be ironic, to say the least.

Clearly, the legislative plate of AAP-Ca is full for the next session, and for the future. The future of California’s children and youth demands nothing less!

In August the AAP headquarters hosted a meeting for Chapter Breastfeeding Coordinators cosponsored by USDA and the MCH Bureau of DHHS. The meeting was held in partnership with ACOG, AAFP and the National Association of WIC Directors. A primary goal was to facilitate networking among attendees and to aid in creation of multi-disciplinary teams to address breastfeeding concerns. Representatives from California stated objectives to consolidate efforts to procure proposition 10 funding for breastfeeding promotion:

1. Completion of a statement on the interrelationship between breastfeeding and early childhood development

2. AAP/ACOG/AAFP endorsement of inclusion of breastfeeding promotion and outcome measures in propositon 10 sponsorship

3. Recruitment of breastfeeding advocates for attendance at public hearings on proposition 10

We in California are fortunate to have the booklet produced by the state health department under WIC leadership on benefits, current trends, and recommendations for future progress. All who have not seen this report (Breastfeeding Promotion Committee Report to the California Department of Health Services Primary Care and Family Health) should request a copy from Department of Health Services.

We are also fortunate to have coalitions throughout the state to promote breastfeeding, listed by our Southern California colleagues on the web site: http://www.breastfeeding.org/others.htm. An ongoing theme was the need for better documentation of health benefits of breastfeeding. Although women are told that “breast is best,” risk figures, which address duration and exclusivity of breastfeeding, remain elusive. Several participants called upon AAP leadership to facilitate gathering of appropriate data with which to address these concerns. The “Breastfeeding Promotion in Pediatric Office Practices” (BPPOP) will be gearing up soon. Forty-seven of 1000 pediatricians participating in this AAP sponsored program are from California. We, as Chapter Breastfeeding Coordinators, are available to all AAP members as resources whether participants in the BPPOP program or otherwise. Feel free to contact us with any breastfeeding questions or concerns you may have. Virginia Bachrach (vrgb@leland.Stanford.edu; 650-493-4422; Caroline Chantry (caroline.chantry@ucdmc.ucdavis.edu); 916-734-4455.

H.R. 1304
By George Monteverdi

The Honorable Tom Campbell [R-15^th] California

U.S. House of Representatives

What frustrates physicians when they attempt to provide quality care for those who are insured by California’s five largest for-profit health plans?  Is it the health plan’s power to :

• Disrupt the physician-patient relationship and continuity of care?
• Change contract language without physician consent or knowledge?
• Force physicians to participate in plan or product lines which they know nothing about?
• Violate laws designed to ensure medically necessary services are covered?
• Make medical necessity decisions without giving consideration to the judgment of the patient’s treating physician?
• NOT disclose how much physicians will be paid under contract [using capitation rates which are the lowest in the nation and inadequate to cover the cost of care]?
• Impose unfair penalties on physicians?
• Disturb the proper control of patient records?

Despite the flurry of state and national legislation advocating patients’ rights, the current ‘band-aid’ approach to the wounds of the corporate medical body fails to address the systemic nature of the pathology. The non-egalitarian negotiating positions of the physicians [the fiduciary agent of the patient and the profession] and the concentrated economic power of the California health plans remain intact.

My “Quality of Health Care Coalition Act of 1999” currently lies embargoed in the House of Representatives Judiciary Committee. It would allow professionals to negotiate collectively…i.e., it would relieve the ‘antitrust’ provisions which prevent physicians from exercising their potential negotiating power to advocate for relief from the contract terms described above. Now is the time to contact your national representatives to support H.R.1304. ( Six Californians sit on the House Judiciary Committee) H.R.1304 addresses the need to stem the current chaotic patchwork of legislative remedy for quality health care legislation. Groups of physicians will be able to negotiate effectively and responsibly for quality health care for their patients. Support the patient-physician team. Physicians will not represent the best interests of an insurance company ‘stockholders’.

To learn more and effectively advocate regarding H.R.1304 use the following resources:

1. Graham Newson, Director, Department of Federal Affairs, AAP e-mail : gnewson@aap.org

2. CMA Political Action Committee phone: 916-444-5532

3. AMA, Brenda Craine telephone: 202-789-7447

4. Web site for the H.R. Judiciary Committee http:/thomas.loc.gov/cgi-bin/bdquery/z?d106:HR1304:

Child Care: How Can Pediatricians Be Involved?

By Karen Sokal-Gutierrez, MD, MPH

Why do pediatricians need to be involved in childcare?

When the famous bank robber, Willie Horton, was asked why he robbed banks, he replied, “Because that’s where the money is.”  So why, then, do pediatricians need to be involved in child care?  Because that’s where the children are: today nearly 75% of children under 5 years of age, including 50% of infants, attend child care. The proportion of children in child care has doubled over the past 30 years as more parents return to work and school.

Over the past few decades, a considerable amount of research has examined outcomes for children in child care compared to children cared for at home. Overall, studies have found that children in child care are at greater risk for infectious diseases but at no increased risk for attachment difficulties, delays in socio-emotional or cognitive development, injuries, or child abuse. In addition, studies have found that children in high quality child care have significant advantages in socio-emotional and cognitive development. Over the years, the discourse on child care has shifted from examining the risks to identifying the opportunities that quality child care can provide children and families.

Recent discoveries about early brain and child development underscore the importance of high quality child care. “The human brain is relatively undeveloped at birth — its potential waiting to unfold as its structure takes shape — and depends upon individual experience to guide its growth,” writes Edward L. Schor, MD, FAAP, in the book Early Brain Development and Child Care. “Experiences and sensory inputs (visual, auditory, tactile, olfactory, and taste) organize patterns of communication between neurons. These neural patterns become the determinants of how we think, feel, and behave.”  There are “windows of opportunity” and “prime times,” largely during the first three years of life, during which the child’s brain is most effective in processing some experiences. Research has demonstrated that consistent, warm, and responsive relationships and a stimulating learning environment in early childhood are crucial to promote children’s early development and lay the foundation for socio-emotional and cognitive skills for life.

Since most young children spend a significant amount of time in child care, the quality of children’s relationships with their caregivers and the quality of the child care environment have a tremendous impact on children’s development, health, safety, and overall well-being. Studies of child care programs in the United States, however, have shown that the quality of care ranges from excellent to poor, and the majority of young children receive “mediocre” care that may compromise their development, health, and safety.

Pediatricians can play a vital role in promoting children’s health and well-being by becoming passionate advocates for quality child care. With your trusting relationship with families and frequent contact during children’s early years, you can make a difference by counseling families on how to find the child care that’s best for their child. And with your respected role in the community, you can help improve health and safety standards in child care by providing health consultation to child care programs in your community.

How involved are you in child care?

Take this opportunity to examine how involved you are in promoting children’s health in child care. Think about how confident you are in your ability to:

• help parents understand their child’s developmental and health needs, and how to find the child care that’s best for their child
• explain to parents the differences between in-home care, family child care, and child care centers; between licensed and unlicensed care; between preschool and Head Start
• tell parents where they can get referrals for child care programs in their local community
• advise parents what to look for in quality infant, toddler, and preschool programs
• give parents suggestions for easing the transition to child care
• tell parents which illnesses require exclusion from child care and for how many days
• develop a plan for caring for children with chronic conditions in child care
• explain to caregivers the specific standards for child care health policies
• conduct an on-site health and safety check at a child care program
• provide a hands-on training on health for child care professionals
• advocate for improved health and safety standards for child care in your state

Where can you get help if you want to be more involved with child care?

The American Academy of Pediatrics coordinates the “Healthy Child Care America Campaign” in collaboration with the Committee on Early Childhood and Dependent Care and the Department of Community Pediatrics, and funded by the federal Department of Health and Human Services Maternal and Child Health Bureau and Child Care Bureau. This project provides technical assistance to pediatricians as well as other health professionals, child care professionals, and families interested in promoting health and safety in child care.

In collaboration with Healthy Child Care America, and funded by Johnson & Johnson as part of the Initiative on Early Brain and Child Development, the Academy developed a curriculum on child care for pediatricians, Promoting Health and Safety in Child Care: Different Levels of Involvement for Pediatricians. This curriculum is a resource guide designed to help pediatricians become more involved in child care issues to promote children’s development, health, and safety. While it is oriented toward primary care pediatricians, it also contains issues that are relevant to pediatric subspecialists caring for children who may attend child care. It contains practical information and materials to help pediatricians work with families and child care providers in many different ways:

Level I: Providing guidance to families on child care issues

This section offers tips on incorporating child care issues into the clinical services that you’re currently providing. It should be helpful for all practicing pediatricians and requires very little extra time and effort to implement.

Level II: Advocating for quality child care

This section illustrates how you can take the extra step to promote quality child care in your community and beyond.  It is for pediatricians who have a particular interest in community outreach, education, and advocacy.

Level III: Providing health consultation to childcare programs

This section details how to reach out to provide health consultation to local child care programs. It is for pediatricians who are interested in providing community-based services and establishing an ongoing relationship with a child care program to promote health and safety.

The Chapter is proposing to conduct a pilot project to implement the child care curriculum in California. If you are interested in being involved in this project or joining your local Committee on Early Childhood and Dependent Care, please contact Beverly Busher at (415) 459-4775.

For more information about child care health contact:

AAP Healthy Child Care America Campaign (for technical assistance on health and safety in child care)  Tel: (800)433-9016 ext 7132; e-mail: childcare@aap.org

National Resource Center for Health and Safety in Child Care (for resources on health and safety in child care)  Tel: (800) 598-5437;  website: nrc.uchsc.edu

California Child Care Healthline, California Child Care Health Program, Healthy Child Care California (for technical assistance on health and safety in child care in California)  Tel: (800) 333-3212;  website: www.childcarehealth.org

Remember, the first few years of life are crucial for children’s health and development. Reach out to talk with families about child care and collaborate with local child care providers. By promoting health and safety in child care you can make a significant difference in the lives of children and families in your community.  The AAP Policy Statement on Child Care is available through the National AAP office (800) 433-9016.

By Jim LeMesurier, M.D.

Littleton, Atlanta, Santa Monica, and Fort Worth. These relentless massacres continue to horrify us and to scare our children. Between the headlines, the carnage is even worse. Thirteen children die each day and approximately 65 more are injured in less publicized shootings around the country.

For many of us, following the Academy’s guidelines to counsel patients and families regularly about the hazards associated with firearms is a start, but it is not enough. We would like to do even more to help our patients avoid becoming “statistics” and avoid being overwhelmed by the threat of more of these high profile rampages.

The Program

In 1995, Seattle physicians, prosecutors, and police officers joined forces to harness their passion and commitment to reduce the threat of gun violence among their children. They started Options, Choices, and Consequences, a middle school-based gun-violence prevention program. It was an instant success (see below).

After exploring the Options program in 1997, I pursued my own dream of bringing this approach to Sonoma County. I gained the support of many of the county’s leaders in medicine, education and law enforcement who shared my belief that we needed to do more. We launched our own pilot program in the spring of 1999 and renamed our presentation Gun-Violence Information for Teens (G.I.F.T.).

A police officer, a prosecuting attorney, and a physician or other medical professional present G.I.F.T. in the regular classroom in two, one-hour sessions over consecutive days. They take students through true case scenarios, which include pictures of such real medical injuries as a severe chest wound after an argument between a young couple and a self-inflicted, non-fatal, head wound in a depressed teen.

G.I.F.T. attempts to prevent gun violence through two principal approaches.

First, it exposes the harsh medical, legal, and emotional consequences of youth-gun possession and related gun violence. This information contradicts the glorified entertainment images of gun violence. It also dispels many myths commonly held by teens. These include (1) that gunshot victims either die or completely recover from their injuries. Therefore, permanently painful or disabling injuries are rare. (2) Gunshot trauma doesn’t hurt very much. (3) Guns are effective tools for resolving conflict.

The second approach is to emphasize the high level of self-determination that teens hold in this matter. It encourages them to consider the many options available to them in situations involving guns and the choices they can make to avoid violence.  In a generous exchange of ideas and information, the presenters pose dozens of questions, and the students respond with thoughtful, sincere answers and many of their own questions.

A further, possibly underappreciated benefit of the program is the sense of security it generates in these children.  As well-publicized shootings continue to instill a sense of powerlessness and hopelessness in so many of us, children involved in the G.I.F.T. program can find comfort in

1. Knowing more about how their own actions can reduce their personal risk.

2. Knowing that their peers also have been exposed to this critical information and, therefore, are also more likely to make good choices about guns.

3. Knowing that a substantial segment of their community is actively involved and standing behind them on this serious issue.

Results

Seattle leaders have credited the program with changing the culture associated with gun carrying among many Seattle students. After taking this program, students state that it is no longer “cool” to carry a gun, and they have expressed a greater willingness to report a threat of gun violence. Furthermore, the program has demonstrated measurable changes in other areas of attitude and behavior toward guns.

The Future

Our highly successful pilot generated a similar response from Sonoma County students, and a formal evaluation of G.I.F.T.’s effectiveness is planned for next year.  The G.I.F.T. presenters have enjoyed the direct contact, the eager participation, and the positive feedback from the students. School officials also have enthusiastically endorsed the program.  As a result of this initial success, G.I.F.T. is expanding to other areas of Sonoma County this fall.

Conclusion

The G.I.F.T. program appears to be a valuable tool in combating a demoralizing societal problem. Furthermore, it incorporates a traditional public health approach of using direct patient education to treating an epidemic, and it offers physicians a particularly satisfying hands-on experience in injury prevention.

Contacts

Dr LeMesurier can be contacted at drlemesu@kingston.net. Also contact physician leaders, Drs Russell Sawyer and Brian Schmidt at russs@Home.com. Chapter 1 pediatricians, Aparna Kota and Chihn Le also participated in the pilot program.