# Site: tnaap.org # URL: https://tnaap.org # Generated: 2026-08-23 03:04:23 # Version: 1.2 # File Type: llms-full.txt # Total Pages: 89 --- ## Tennessee Summer Food Service Program URL: https://tnaap.org/resources/blog/03/2018/tennessee-summer-food-service-program/ One of every four children in Tennessee face hunger every day.  During the school year that need is met for some children and families through free and reduced meal programs in schools across the state.  However, when children are out of school during breaks, nutritious meals and snacks may not be readily available.  The Tennessee Summer Food Service Program was created to help fill that hunger gap.  Established by Congress in 1968, the Summer Food Service Program (SFSP) serves to ensure that during school vacation,  children 18 years or younger of low-income could receive the same high quality meals provided during the school year.  The Tennessee Department of Human Services (DHS) administers the SFSP under an agreement with the U.S. Department of Agriculture (USDA) and in coordination with community partners. These Summer Food Service Programs usually begin in late spring when school dismisses for the summer and remain open until the new school year begins in the fall.  If you are aware of any patients in your care that may have a lack of food resources or face hunger concerns please help them by sharing the details of the Tennessee Summer Food Service Program.  Sites are open all across the state offering free breakfast and/or lunch.  Click here to find a summer meal site near you . Individuals can type in their zip code to find locations in their area.  You can also Text "FOOD" to 877-877.  The Division of TennCare is part of the Governor’s Children’s Cabinet which supports a unified approach to impacting childhood poverty in Tennessee.  We encourage you to share this free tool with families that may benefit from resources and information on how they may access free nutritious meals during these summer months. --- ## Schools Now Required to Test for Lead in Water URL: https://tnaap.org/resources/blog/11/2018/schools-now-required-to-test-for-lead-in-water/ ### New Tennessee Law Requires Schools to Test for Lead in Drinking Water Sources Public Chapter 977 was passed in the 2018 Tennessee Legislative session. It requires school districts to implement policies to test for lead in drinking water sources in schools. The legislation can be found at this link:  https://publications.tnsosfiles.com/acts/110/pub/pc0977.pdf Key points from the law are: • The legislation takes effect January 1, 2019. • All school districts must develop a policy to test drinking water sources in schools for lead. • Testing is to occur in schools constructed prior to January 1, 1998. • If results are greater than 15 parts per billion (ppb) but less than 20 ppb, the school shall conduct testing on an annual basis until retesting confirms the level is less than 15 ppb. • If results are equal to or greater than 20 parts per billion: • • The drinking water source must be removed from service. • • The Department of Health and other state agencies will be notified within 24 hours. • • The school must notify parents and guardians of students within 5 business days. • • Retesting of the lead level of the drinking water source must occur within 90 days of any corrective action. Childhood lead poisoning remains a leading environmental threat to the health of children. Children under the age of six are especially vulnerable to lead poisoning, which can affect their health and development. No safe blood lead level in children has been identified. Children can be exposed to lead from a number of sources, such as lead-based paint found in older homes and buildings, dust and soil contaminated with lead, and parents’ occupations. Lead exposure from tap water comes from the decay of plumbing or the solder that connects pipes, and the risk is higher in older homes or buildings. Water that remains in pipes overnight or when schools are not in session stays in contact with lead pipes or lead solder and could contain higher levels of lead. It is important to identify elevated levels of lead in drinking water in schools in order to reduce or prevent a child’s exposure to lead in the environment. For more information, please visit the Tennessee Childhood Lead Poisoning Prevention website at  http://www.tn.gov/health/topic/MCH-lead  or the Tennessee Department of Health, Healthy Homes website at  https://www.tn.gov/health/cedep/environmental/healthy-homes/hh/lead.html . --- ## FedEx Shipping for Newborn Screening Specimens URL: https://tnaap.org/resources/blog/11/2018/fedex-shipping-for-newborn-screening-specimens/ ### FedEx Shipping for Newborn Screening Specimens The Tennessee Department of Health appreciates the efforts of hospitals and primary care providers in assuring rapid testing of all newborns in the state for potentially life threatening genetic conditions. If a newborn has an initial dried blood spot that is unsatisfactory or abnormal, the primary care provider will be notified that a repeat specimen is needed if the child has been discharged from the hospital. To assist with submission of repeat specimens to the state laboratory, the Tennessee Newborn Screening Program is mailing FedEx overnight shipping labels to primary care providers who collect and submit newborn screening specimens to the state laboratory. Please note that these labels can only be used to send newborn screening specimens to the state laboratory, tracking is provided, and the labels do not expire. For questions about this process, please email  LabNBS.Health@tn.gov . To re-order labels, please email  DCLab.Supply@tn.gov . Please note that the  State Newborn Screening Laboratory has begun testing on Saturdays and Sundays.  The extended lab hours and FedEx overnight shipping will help the state meet the national goal of reporting out of range results by the fifth day of life and all results by the seventh day of life. Want more information? Click Here! --- ## 2018 Pediatric Practice Managers' Network Conference URL: https://tnaap.org/resources/blog/03/2018/2017-pediatric-practice-managers-network-conferen/ Our 2018 Pediatric Practice Managers' Network Conference (PMN) was another great success full of networking and education! Cristoph Diaso, MD, FAAP, Chair of AAP's Section on Administration and Practice Management, was our keynote speaker leading two sessions. The first titled "Herding Cats; How to Get Physcian Buy In" where he discussed how to motivate and encourage physicians to work with PCMH. DUring his second session, "The Doctor is In!" he answered questions related to a variety of areas in practice management. Other session topics included: Are you Losing Money on Vaccines? Effective Strategies for Optimal Success - Sheri Burnett, RN Reports = Revenue: Tips for Improving your Revenue with Value-Based Programs - Suzanne Berman, MD, FAAP Hey There's a Code for That! - Janet Sutton, CPC, RHIT The afternoon portions included some peer to peer networking and Q&A and an Employment Law Update with Kim Vance of Baker Donelson. Year after year we hear fantastic remarks about her conference presentations and we were thrilled to have her back again this year! PMN continues to be a huge resource for practice managers. If you didn't make it this year, we hope you will plan to join us in 2019. We build our agenda each year from YOUR feedback!! If you are interested in joining the 2019 conference focus group, have a topic you want discussed at the next PMN or have general feedback, please email  casey.lamarr@tnaap.org . Hope to see you in 2019! --- ## Summer Fun in Tennessee! URL: https://tnaap.org/resources/blog/06/2018/summer-fun-in-tennessee/ Summer is finally here! Are you finding yourself searching for something new to keep your children entertained? Are you tired of doing the same things or hanging around the house exhausting every last board game? Tennessee is full of exciting (and sometimes educational) things to keep families busy and entertained this summer! Some of these ideas are right out your backdoor and others just a few hours away. Bowling:  Check out Kidsbowlfree.com to register your children for two free games of bowling a week all summer long! These bowling vouchers are accepted at over thirty bowling alleys across the state. The Zoo:  Spending the day at the local zoo is always a crowd pleaser. Check out their show schedules online or in person to get the most out of the day! Local library:  Check out your local library because chances are they have loads of fun and free activities for the kids all summer! Local movie theater:  If your children love the movies, AMC movie theaters offer a Summer Movie Camp program that shows kid-friendly movies for $4 on Wednesdays. This fee also includes a small popcorn, drink, and fruit snack. Regal Cinemas is also offering their  summer movie express  with $1 movies on Tuesday and Wednesday. State and National Parks :Tennessee is full of great hiking trails, beautiful  waterfalls  and spectacular views of nature. You might be surprised how close some of these locations are to you! Pack a picnic, grab some outdoor games or just put on your walking shoes and check out the  National Parks  and  Tennessee Parks pages  to plan your next visit! ## West Tennessee: Tennessee Safari Park (Alamo, TN) -  This park is unlike anywhere you have been before! Children of all ages will be entertained as you travel by car encountering various animal from across the world. The Fire Museum (Memphis, TN)  - Do you have a child that loves all things fire? Give this museum a visit, and bring everyone along because it is sure to be a hit! Shelby Farms (Memphis, TN)  - This park is one of the largest in the country and features more than 40 miles of trails. Shelby Farms also has a fantastic Woodland Discovery playground and Water Play Spray ground that children are sure to love. ## Middle Tennessee: Lucky Ladd Farm (Eagleville, TN)  - If you’ve never been to Lucky Ladds, this should be the next destination on your list. There are over 100 animals in their petting zoo, many slides, a splash pad, and a town dedicated just to toddlers! Discovery Center at Murfree Springs (Murfreesboro, TN)   - Rainy day? Spend it at the Discovery Center because whether it’s science, trains, fossils, waterways or the rainforest, your children are sure to find something right up their alley. Chuckles Family Fun Center (Crossville, TN)  - Chuckles Family Fun Center truly is a fun center! Arcade games, go-carts, miniature golf, and lazer tag are sure to keep the children occupied for hours. Splash in Cumberland Park (Nashville, TN)  - This new park is free and located between the Shelby Street Pedestrian Bridge and the Korean War Veterans Memorial Bridge. Bring all the kids because there is plenty to do! Watch the Tennessee Titans (Nashville, TN)  - Near the end of the summer, the  Tennessee Titans will be hosting training camp practices  that are free and open to the public. ## East Tennessee: Wetlands Water Park (Jonesborough, TN)  - This waterpark is affordable and fun for the whole family! Enjoy a lazy river, three flume slides, and much more! Check out their website for special events! Dollywood (Sevierville, TN)  - Dollywood is another destination that is fun for the whole family! Don’t miss out on the rollercoasters, shows, carnival rides, and delicious food that this family-friendly park has to offer. The Muse (Knoxville, TN)  - Bring your children to The Muse for a fun and educational day! This museum has so much to offer for children of all ages. This museum also has the only public planetarium in Knoxville. They won’t even realize that they are learning along the way. Pigeon Forge  - Located near the Smoky Mountains, Pigeon Forge has plenty of fun activities for children of all ages! Whether your children want to spend the day outdoors, at a museum, or in an arcade, there is something fun for everyone. Have a safe and fun summer! --- ## Summer Safety URL: https://tnaap.org/resources/blog/07/2018/summer-safety/ The well-being of our children is our number one priority, and with summer fun comes the need for summer safety. Here are some things to keep in mind and be aware of when you and your children are enjoying the summer off. ### Water Safety Drowning is a leading cause of injury-related death in children. In 2006, fatal drowning claimed the lives of approximately 1100 US children younger than 20 years. A number of strategies are available to prevent these tragedies. Whether you will be spending your summer days in open water, on a boat or at the pool, it is important to know the key things to keep your children safe ! AAP's Guide for Water Safety Swim Safely Tips Pool, Open Water and Boating Tips ### Sun Safety Although our little ones love the sun, the sun may not always love them. Summer time activities typically reside outside, so make sure you are aware of the best ways to protect our children’s sensitive skin. AAP's Guide for Sun Safety More Sun Safety TIps ### Weather Safety Tennessee weather can be unpredictable, so make sure you know everything you need to keep your family safe during dangerous weather. Nashville's WKRN weather team tells your everything to need to know to be prepared in their summer weather special Summer Weather Safety Tips --- ## How TNAAP Is Working For YOU URL: https://tnaap.org/resources/blog/07/2018/how-tnaap-is-working-for-you/ TNAAP's Pediatric Council meets with payers regularly to resolve questions and concerns and improve quality of care for Tennessee children. The list below includes a few of the accomplishments so far this year.  ### BlueCare Tennessee #### Proof of Timely Filing Reminders TNAAP worked with BlueCare to clarify what constitutes proof of timely filing. As a reslut of the efforts, BlueCare Tennessee provided us with the following list: - If a claim for medical services is returned, your proof of timely filing is the black and white copy of the claim with error codes that we returned to you. Please keep this copy of the returned claim. - If a claim is accepted or rejected, we will store an electronic image of the claim in our archives for future reference. We will also generate 277CA Health Care Information Status Notification reports. - If a member didn't provide BlueCare Tennessee coverage information at the time of the visit, you may apply for timely filing reconsideration with documents showing your office confirmed the member had no coverage on the date of the visit and copies of billing statements that show the dates of bills, if members have no other insurance. #### Coding Issues- Flulaval 90686 – BlueCross will now allow 6 mos forward according to the ACIP recommendations 90461 denials corrected (commercial); incorrect edit put in place.  BlueCross corrected and reprocessed denied claims ### Amerigroup Amerigroup planned to implement a policy to reduce sick visit reimbursement to 50% when a sick and well visit were performed on the same day beginning in September of 2018.  In July, Amerigroup decided not to move forward with this policy. Sick and Well visits will continue to be reimbursed at 100% if performed on the same day; Amerigroup will be sending out a redaction. ### United HealthCare NDC edits removed to prevent denials  - edit put in place in the UHC system which should not have been that was causing the rejections.  The edit was removed UHC will reprocess denied claims. --- ## Important VFC Updates URL: https://tnaap.org/resources/blog/08/2018/vfc-important-updates/ Current VFC updates and information are posted below as we get them. If you have any questions please contact Janet Sutton (Janet.Sutton@tnaap.org) January 25, 2019 Important Update on Sanofi Fluzone Quadrivalent 0.5 mL Age Indication We recently learned about a change to the age indication for the Fluzone Quadrivalent Vaccine.  Full Details are availbale here.  Sanofi has just received the approval for use of 0.5 mL dose of Fluzone Quadrivalent in children down to 6 months of age. This covers NDC numbers 49281-0419-50 (0.5mL syringe) and 49281-0419-10 (0.5mL vial). The previous age on these presentations was for persons 36 months and older. December 3, 2018 2019 VFC Annual Phased Re-Enrollment - SCHEDULE CHANGES Please be advised that 2019 VFC Phased Re-Enrollment Schedule has undergone minor alterations affecting only Local Health Departments (LHD), East TN Region, Knox County Metro, and the Mid-Cumberland Region Annual re-enrollment for these regional groups will shift one month,resulting in the following change in Provider Agreement expiration dates for 2019 • LOCAL HEALTH DEPARTMENTS (LHD)- PA will expire March 4 • EAST TN Region and KNOX COUNTY Metro - PA will expire April 1 • MID-CUMBERLAND - PA will expire May 6 All other regional groups in the Phased Schedule remain unaffected and the process unchanged! View the Full Memo Here 2019 VFC Phased Re-Enrollment Scheulde October 27, 2018 Updated VIS for Hepatitis B The CDC has released a new Vaccine Information Statements (VIS) for Hepatitis B on October 12, 2018 with a minor change. The updated VIS states “The vaccine is usually given as 2, 3, or 4 shots over 1 to 6 months.” The previous VIS only mentions the 3 and 4 shot series available at the time of release. You can find this updated VIS online . Electronic Health Records (EHR) will need to be updated with the new VIS dates. Please contact your EHR vendor for assistance. The National Vaccine Childhood Injury Act (NCVIA – 42 U.S.C. § 300aa-26) requires healthcare providers to give the appropriate VIS to a patient, parent, or legal representative prior to administration of each dose of vaccine. The new VIS’s may be used starting immediately, although existing stock of previous versions can be used until exhausted.   October 9, 2018 Important Educational Materials: Know the Site, Get it Right! The Immunization Services Division of the CDC has created the following resources for you and your staff to prevent vaccine administration errors. These products educate and remind providers about proper influenza (flu) vaccine administration technique to help avoid shoulder injuries and other adverse events.   The materials include: • links to comprehensive  vaccine administration information • a short video on the correct technique for intramuscular injection • an infographic on administering flu vaccine to an adult • a link to the CDC vaccine administration e-Learn For future reference, links to these CDC resources and more are available on the Immunization Program’s  VFC Provider Guidance & Toolkits  webpage. August 28, 2018 Updated VIS’s for Meningococcal ACWY and DTaP Vaccines New versions of the Vaccine Information Statements (VIS) for  Meningococcal ACWY Vaccine  and  DTaP Vaccine  were posted on August 24, 2018.  All current VISs are posted online here . The new VIS’s may be used starting immediately, although existing stock of previous versions can be used until exhausted. July 26, 2018 New Look for TennIIS Certificates The look of Official Tennessee Certificates of Immunization printed from the state immunization registry (“TennIIS”) for school and daycare enrollment after July 26, 2018, will change. The new look includes the current Tennessee Department of Health logo and current web addresses. The previous version (Rev. 4/13) is still acceptable for students and certificates that have already been issued do not need to be re-issued on the new form.  A sample of both versions is attached . For questions about the Certificate of Immunization please contact TennIIS.Training@tn.gov. --- ## Back to School Vaccine Reminders URL: https://tnaap.org/resources/blog/08/2018/back-to-school-vaccine-reminders/ ### It’s that time again, Back to School! ### Is your child ready, and are they fully protected? #### Sheri Burnett, RN, Plateau Pediatrics “Protected from what?” you might wonder. As you prepare to send your child back to school, let’s not forget one of the most important things.  Which is, to make sure your child is fully protected against  all  vaccine preventable diseases. After all, isn’t the health and well-being of your child the most important thing? The most effective way to prevent the spread of disease and keep your child and their peers healthy, is to have them vaccinated! There are certain vaccines required prior to the start of preschool, kindergarten, seventh grade, and college. Students entering these grades, or who are entering school for the first time, will be required to show proof of immunization  prior  to school entry. Students who are not up-to-date on the required vaccines for their age, may not be allowed to attend school. Missed school days can lead to your child getting behind in their work and may cause them to struggle in getting caught up with their peers. Back-to-School time is hard enough as it is.  Don’t let your child get left behind! To see if your child is up to date on vaccines required for school entry, click here. While most vaccines are required for school entry, there are a couple which aren’t required. But, why wouldn’t you want your child fully protected? Who wants to pick and choose what diseases their child is protected against and which ones they aren’t? After all, isn’t the goal to keep your child as safe and healthy as possible? Don’t let your child go unprotected, make sure to discuss the following vaccines with your healthcare provider: Influenza Vaccine:  The flu virus is one of the most common illnesses, affecting both children and adults, and is one of the leading causes of missed school each year. While the flu may seem no worse than a common cold for some, it can be deadly for others. Why take this risk when there is a vaccine to prevent this serious, potentially life-threatening illness? The CDC recommends annual flu vaccination for everyone ages 6 months and older. To ensure full protection, get your child vaccinated as early as possible, and preferably, prior to the start of the flu season. For more information, click here:  https://www.cdc.gov/flu/protect/keyfacts.htm HPV Vaccine:  If you thought you could protect your child from cancer, wouldn’t you? Guess what, you can! Human Papilloma Virus, known as HPV, is a common virus that affects teens and adults. Did you know that 80% of people will get an HPV infection in their lifetime? HPV in its most serious form, causes cancer. HPV vaccination is safe and can provide long-lasting protection against cancers caused by HPV. It is routinely given between the ages of 11 and 12.   https://www.cdc.gov/hpv/parents/questions-answers.html#doses Meningococcal Vaccine:  Meningococcal infections are often severe, and can even be life-threatening. These infections affect the lining of the brain and spinal cord. Meningococcal conjugate vaccines are routinely given between the ages of 11 and 12, with a booster dose given at age 16. Meningococcal conjugate vaccination is a requirement for students entering college. Teens and young adults ages 16-23 may also be vaccinated with a meningococcal B vaccine. While rare in occurrence, meningococcal B is the most common form of meningococcal disease outbreak among college students.  This is often due to close living quarters, such as college dormitories and military barracks.  https://www.cdc.gov/vaccines/vpd/mening/public/index.html We know that vaccines save lives by preventing the spread of disease. Through routine vaccination, we have been able to completely eliminate certain diseases such as smallpox.  We have also been able to drastically reduce the occurrence of other serious, potentially life-threatening diseases, such as polio, pertussis, meningitis, measles, mumps, rubella, chickenpox, etc. As you prepare to send your child back to school, make sure they are up to date on all routinely recommended vaccines for their age. Just as you would want your child to have the best education possible, you also want them fully protected from as many diseases as possible. The best way to ensure this, is through vaccination. Remember, the health and safety of your child is of  utmost  importance. So, don’t wait, contact your healthcare provider today to see if your child is up-to-date on their vaccines and to answer any questions that you may have. --- ## Changes in UHC CLIA Policy URL: https://tnaap.org/resources/blog/09/2018/changes-in-uhc-clia-policy/ TNAAP has learned that UHC implemented a new edit on or around  August 19, 2018  for physician (CMS 1500) claims when billing any type of lab services. Some providers may not have received this information.  If you are having trouble with UHC claim denials for lab services, please see the policy changes below.  As always, TNAAP is here to help!  If you are having any issues with claims, billing, coding, policies, etc., PLEASE Let Us Know! The new changes apply to any servicing care provider performing testing on biological specimens for the purpose of diagnosis or treatment is required to submit a CLIA ID. The servicing care provider is the care provider where the billed laboratory service was actually performed.  In addition, the CLIA ID submitted must match the servicing location. The CLIA ID must be represented in field 23. ### Clinical Laboratory Improvement Amendments (CLIA) ID Requirement Policy Update, Spring 2018, United Health Care UnitedHealthcare’s CLIA policy: Applies to: All laboratory services subject to the CLIA submitted on either a CMS 1500 claim form or HIPAA 5010 837P claim file Requires that: All claims for laboratory services subject to the CLIA include the CLIA ID number for the servicing care provider and the servicing care provider’s physical laboratory address if that address is different than the billing care provider’s address listed on the claim The billing or servicing care provider address submitted on the claim must match the address associated with the CLIA ID number. Affects: All lines of business Contains: Specific guidance around the claim’s submission process and CLIA-specific resource links. We may reject or deny any claim as incomplete if it: • Doesn’t contain the CLIA ID • Is submitted with an invalid CLIA ID • Is submitted without the complete servicing care providers demographic information Claim line edits may also be applied if the provider’s CLIA certification type doesn’t support the billed service code. Laboratory service providers who don’t meet the reporting requirements and/or don’t have the appropriate type of CLIA certificate for the services reported may not be reimbursed. Applies to all laboratory services that are subject to the CLIA and submitted using: • CMS 1500 claim form; or • HIPAA 5010 837P claim file Include the CLIA ID number for: • The servicing care provider • The servicing care provider’s physical laboratory address if it’s different than the billing care provider’s address listed on the claim Check to make sure: The billing or servicing care provider’s address you submit on the claim  matches  the address associated with the CLIA ID number. Reference Materials • UnitedHealthcare Commercial Policies:   UHCprovider.com > Policies and Protocols > Commercial Policies >  Reimbursement Policies for UnitedHealthcare Commercial Plans • UnitedHealthcare Community Plan Policies:  UHCprovider.com > Policies and Protocols > Community Plan Policies > Reimbursement Policies for Community Plans Key Contacts • Debra L. Locke,  RN, MLT , CPC, Process Consultant, UHC Payment Integrity/ Laboratory SME • Shelly Woelfel,  CLIA Program Manager, UHC Payment Integrity --- ## Brain Links Offers New Educational Tool Kit URL: https://tnaap.org/resources/blog/12/2019/brain-links-offers-new-educational-tool-kit/ A statewide team of brain injury specialists,  Brain Links  equips professionals serving children and adults with brain injury with current, research-based training and tools. With almost 20 years of grant-funded work in Tennessee serving students of all ages with brain injury, Brain Links created a toolkit for healthcare providers to bridge the gaps in addressing this complex diagnosis. The toolkit includes items for in-office use, patient and family-friendly education, and Tennessee and national resources. This easy-to-use toolkit and training will prepare you to better treat and manage your patients with brain injury. Hear how the  toolkit  can help you improve outcomes from Dr. Pina Garza. Your practice and your patients will benefit from: • increased identification – screening tools and protocol • stream-lined visits – treatment and referrals • informed and empowered patients – return to learn, play, work • increased reimbursement opportunities   Brain Links' materials and all training, in-person or online, are available at no cost. For more information and to schedule a free training for your practice, email tbi@tndisability.org or visit  www.tndisability.org/brain .  Follow Brain Links on Facebook  and explore our  YouTube Training Channel . --- ## TEIS Updates Eligibility List! URL: https://tnaap.org/resources/blog/02/2020/teis-updates-eligibility-list/ TEIS Updates Eligibility Diagnosis List to Address Impact of Prenatal Substance Exposure In December 2019, TEIS, in collaboration with the Tennessee Chapter of the American Academy of Pediatrics (TNAAP), met with a group of neonatologists, pediatricians  and other stakeholders to develop recommendations to ensure TEIS's eligibility guidelines are reflective of current clinical practices in regard to diagnosis and coding of neonatal abstinence syndrome (NAS).  In recent years, TEIS's eligibility specialists had noted changes and regional differences in the application of the NAS diagnosis and had expressed concern that this could lead TEIS to miss children with opioid and other substance exposure that could impact the child's future development. This is of particular concern, as children with opioid or other substance exposure do not always exhibit developmental delays that would qualify them for TEIS services. TEIS brought this concern to the attention of TNAAP who began following-up on this concern. TNAAP was able to verify that the clinical application of the diagnosis had been updated, which could potentially be resulting in children not being eligible for TEIS services. This concern led to the convening of the December 2019 meeting, which was attended by the following individuals: • Amy Coble, Chief of Staff for Tennessee Department of Children's Services • Brenda Barker, Tennessee Initiative for Perinatal Quality Care (TIPQC) • Davida Singleton, Early Childhood Epidemiologist, Tennessee Department of Health • Dr. Anna Morad, Vanderbilt Newborn Nursery Director and TIPQC Medical Director • Dr. Bruce Davis, Clinical Director for Tennessee Department of Developmental and Intellectual Disabilities • Dr. Larry Faust, Developmental Pediatrician and Coding Consultant for TNAAP • Dr. Stacy Slagle, Neonatologist for Jackson-Madison County General Hospital and Vanderbilt • Dr. Stephen Patrick, Vanderbilt Pediatric Neonatologist • Jennifer Rose, Eligibility Specialist for TEIS • Ruth Allen, Executive Director of TNAAP • Shannon Pargin, Strategic Planning Coordinator for TEIS • Susan Rollyson, Program Manager of TNAAP As a result of this meeting and after follow-up with TEIS leadership and TEIS's State Interagency Coordinating Council, the following diagnosis codes have been added to the TEIS diagnosis list: • P04.14 Newborn affected by maternal use of opiates • P04.16 Newborn affected by maternal use of amphetamines • P04.3 Newborn affected by maternal use of alcohol • P04.4- Newborn affected by maternal use of drugs of addiction • P04.8- Newborn affected by other maternal noxious substances These codes have been added with a notation that they require secondary medical review for eligibility. This notation does not require providers or families to obtain a second opinion; it refers to an internal TEIS process where district eligibility specialists send records for children who would only be eligible by one of these codes (not by delay) to the TEIS central office for additional review. This allows the central office to gather additional data in order to better inform the eligibility diagnosis list. When needed, a developmental pediatrician on contract with TEIS from TNAAP reviews the records and makes recommendations about eligibility.  With the addition of these diagnosis codes in particular, TEIS is concerned about the impact of the prenatal drug exposure on the newborn. It would be helpful if the provider addresses the specifics of the drug exposure (types of substances, duration, quantity, clinical symptoms, etc.) and how they affected the infant in a discharge summary or discharge note that is provided to TEIS.  In addition to these codes, TEIS add code P77-, necrotizing enterocolitis, to the diagnosis list. The changes to the diagnosis list went into effect Feb. 1. The complete diagnosis list can be found in the  TEIS Eligibility  section of the  TEIS website . Questions may be directed to  Shannon.Pargin@tn.gov . --- ## Getting Patients Back to the Office URL: https://tnaap.org/resources/blog/05/2020/back-to-the-office-campaign/ Due to COVID-19, pediatricians across the country have seen a significant decrease in sick and well visits for children.  In Tennessee, we have experienced the same and  vaccinations are down   39%  in April 2020 compared to April 2019!  We need to get the message out that delaying care and immunizations for kids may create problems in the short and long term. In a recent member survey, you told us you were having difficulty getting patients in the office and communicating measures that have been taken to ensure safety as well as the importance of keeping appointments. TNAAP, in conjunction with many other chapters across the country, has created resources to help encourage patients to get back in for check-ups, sick visits and vaccinations. ### Press Release TNAAP has distributed the following press release to markets across the state. Tennessee Pediatricians Encourage Families to Keep Child Wellness Visits and Normal Vaccinations  - 5/19/2020 ### Communication Resources Sample Letter/Email to Patient Family Sample Phone Call/ Text Script ### Social Media Resources Sample Posts for Facebook, Twitter, Instagram Download Zipped folder with 7 Social Media Graphics (examples below) --- ## Developmental Screening in our NEW NORMAL …. URL: https://tnaap.org/resources/blog/05/2020/developmental-screening-in-our-new-normal/ As the COVID-19 Pandemic continues to change the way pediatric practices connect and identify with patients, developmental screeners are now helping providers conduct screenings virtually. Using ASQ-3 in a Virtual Environment Do you have questions about conducting ASQ-3 screenings with families virtually? FREE Fillable PDFs of all the summary/answer forms and JPEGS of all questionnairesare available at  https://agesandstages.com/using-asq-in-a-virtual-environment/ . Watch a webinar recording for strategies and resources to help you conduct screenings via telephone or video chats. VIEW THE WEBINAR Using PEDS in a Virtual Environment PEDS Tools publishers are offering substantial help to clinicians during the COVID-19 quarantine including the following: I. Freely available parenting information on topics such as behavior management, building school and social skills, along with links to reputable parenting websites https://pedstest.com/static/ParentingInformationResources.html II. Donations of Tools in translation (in more than 60 languages). For more information see:  https://pedstest.com/Translations/PEDSinOtherLanguages.html III. Donations of Tools to unfunded research in developing nations and to all developing nations, along with technical support. See:  https://pedstest.com/Translations/ IV. Donations of a .pdf of their textbook ,  “Identifying & Addressing Developmental-Behavioral Problems: A Practical Guide for Medical and Non-Medical Professionals, Trainees, Researchers and Advocates.” The book is suitable for distance learning/teaching with 3rd/4th-year medical students, residents, fellows and community providers). To request a free copy and online links to services and parenting information, send an email to:  online@pedstest.com V. A free and expanded trial of PEDS Tools Online. To sign up go to:  https://pedstestonline.com/  PEDS has also waived the set-up fee for PEDS Online. VI. Lower prices for the PEDS: Developmental Milestones – Assessment Level (PEDS:DM – AL) online. The PEDS:DM – AL is used in subspecialty clinics, early intervention intake and research and billable with the 96112/13 CPT code. See:  https://pedstestonline.com/ For more information about any of the above information please contact Susan Rollyson  Susan .Rollyson@tnaap.org ###   ## TEIS Referrals: There's an App for That! We are excited to announce that families, caregivers, and medical professionals can now refer a child to TEIS on the MyTN app. The MyTN app is meant to be a one-stop-shop for Tennesseans to access useful information. Services range from renewing your driver’s license to finding your favorite farmer’s market. We are hopeful that this new resource will help even more families and children find their way to TEIS and all of the helpful services that are available. To check out the new app and all it has to offer, download it for free in your device’s app store. --- ## 2020 Legislative Session Wrap Up URL: https://tnaap.org/resources/blog/07/2020/2020-legislative-session-wrap-up/ The 2020 legislative session was busy for TNAAP and, of course, complicated by the COVID-19 pandemic (which included cancellation of our day on the hill). The session’s activities were completely disrupted for a period and then the general assembly later reconvened to the address the budget and a few other key matters. Throughout this period TNAAP monitored hundreds of pieces of legislation and was active in discussions with legislators on numerous matters important to pediatricians including opposing the concept of full practice authority for nurse practitioners and lobbying against anti-vaccination legislation. Other key areas of focus included postpartum coverage for women on TennCare, supporting anti-tobacco/vaping efforts, weighing in on telehealth legislation, youth sports and much more. Full Details of TNAAP's efforts are detailed below: • Worked with the coalition of providers in opposition to the Nurse Independent Practice authority legislation; bill did not get a hearing; • Monitored various pieces of legislation relative to increased regulation of vaping and tobacco usage by minors; bill passed to conform regulations to federal law; • Worked with sponsor of "Safe Stars" legislation to provide additional training and education for youth athletic coaches across the state; the bill got movement in the House but stalled when COVID-19 ended consideration of bills; • Monitored legislation that would have restricted youth participation in athletics to their birth gender; the bill passed the House but stalled in the Senate; • Monitored anti-lunch shaming legislation (bill would prohibit the stigmatization of a child who is unable to pay for meals provided by schools under the National School Lunch Program or the School Breakfast Program) and assisted as possible; bill was held up in the House; • Monitored potential discussions on Medicaid expansion; there was not a serious effort to do so; • Monitored Medical Marijuana discussions; sponsors unveiled a new complicated system of regulatory use but did not pass; • Monitored activity of TennCare block grant application; no new information since the submission to CMS; • Planned a Day on the Hill for TNAAP which was unfortunately cancelled due to COVID restrictions; • Participated as a part of the ImmunizeTN coalition and helped support their Day on the Hill. --- ## TNAAP Statement on Immunizations & Public Health URL: https://tnaap.org/resources/blog/07/2021/tnaap-statement-on-immunizations-public-health/ FOR IMMEDIATE RELEASE July 13, 2021 TENNESEE AMERICAN ACADEMY OF PEDIATRICS ENDORSES IMMUNIZATIONS AND PUBLIC HEALTH (Nashville, Tenn) In light of recent news in our state, the Tennessee Chapter of the American Academy of Pediatrics (TNAAP) restates our strong and enduring endorsements of immunizations and public health. Dr. Anna Morad, TNAAP President, states "Actions that weaken Tennessee’s overall public health readiness are clearly a step in the wrong direction at the wrong time." Vaccines are safe. Vaccines are effective. Vaccines save lives. Childhood immunizations have drastically reduced disease and death from measles, polio, whooping cough, pneumonia, diarrhea, cancer, and so much more. Vaccines are one of modern medicine’s success stories. As pediatricians, we firmly stand behind their safety and benefit. Vaccines allow us to live in a safer and healthier world. We encourage parents to have their children vaccinated, and this is important now more than ever before. Throughout the pandemic, we have seen declining numbers of childhood immunizations. As children return to school and play, it is vital that they are up to date on all recommended vaccines. Vaccines are the best way to protect our children from numerous viruses and bacteria that cause real and devastating harm. Vaccines build a protective wall around our families and our communities, securing everyone’s freedom from disease. As pediatricians, we believe that immunizations are the safest and most cost-effective way of preventing disease, disability, and death. Public health measures save lives. Public health is the science of disease prevention. It is founded on preventing the spread of infectious diseases, preparing for emergencies, and responding to such threats. Public health protects the safety of communities and improves the health of citizens. It is a core and vital function in our communities. Our public health infrastructure has never been more important in our lifetimes than during the last year and a half. Public health officials have worked tirelessly in response to COVID-19 to save numerous lives. This includes the public health service of TNAAP member, Dr. Michelle Fiscus, a tireless champion for children and vaccines, and we appreciate her efforts. Vaccination is an essential component of these efforts. We strongly urge all eligible citizens to be fully vaccinated in order to protect themselves, their loved ones, and their community. We encourage children and parents to have open and honest discussions around vaccines. We encourage families to seek advice from their healthcare providers. As pediatricians, we are concerned for the health and well-being of all children in our state. Vaccination and a strong public health program work hand in hand to ensure that we have all the tools at our disposal employed to their fullest ability to keep our children safe, to promote their academic success, and to ensure their lifelong health. We ask all parents to stand with us in support of these goals. #### The Tennessee Chapter of American Academy of Pediatrics represents the voice of more than 1,000 Tennessee Pediatricians who are dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information visit  www.tnaap.org . --- ## COVID-19 Vaccinations and Universal Masking URL: https://tnaap.org/resources/blog/08/2021/covid-19-vaccinations-and-universal-masking/ FOR IMMEDIATE RELEASE August 4, 2021 TENNESSEE AMERICAN ACADEMY OF PEDIATRICS SUPPORTS COVID-19 IMMUNIZATIONS FOR THOSE ELIGIBLE AND INDOOR MASKING FOR ALL As our children return to school, it is critical that we provide a layered approach to mitigate the spread of COVID. This includes vaccination for those who are eligible and universal masking while indoors. In Tennessee the spread of COVID has increased again, and our hospital numbers are increasing as well. We are in a situation where masking can provide some reduction in spread while we increase vaccinations. We need to protect our children who are too young to be vaccinated. We support the rights of parents to make decisions for their children, but we also support the rights of children and school staff not to be harmed by decisions that go against science and current public health needs. It is false to believe that children don’t get COVID. They do. As Pediatricians, we have cared for them. Children can also spread COVID to vulnerable people in their homes and communities. We need our schools to remain open, our parents to be able to go work, and most important, our children and school staff to not get sick. The closures of schools not only have a negative impact on learning but also on the mental health of our children. We should have a shared goal to keep our schools open as safely as possible. The Tennessee Chapter of the American Academy of Pediatrics supports the CDC and AAP return to school guidance for universal masking for K-12 schools in the state. Masking works. Masks are not harmful. Masks are well tolerated. Let’s mask to stay in school! #### The Tennessee Chapter of American Academy of Pediatrics represents the voice of more than 1,000 Tennessee Pediatricians who are dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information visit www.tnaap.org. --- ## TNAAP Condemns Violent Behaviors Towards Medical Professionals URL: https://tnaap.org/resources/blog/08/2021/tnaap-condemns-violent-behaviors-towards-medical-professionals/ FOR IMMEDIATE RELEASE August 13, 2021 TENNESSEE AMERICAN ACADEMY OF PEDIATRICS CONDEMNS VIOLENT WORDS / AGGRESSIVE ACTIONS AIMED AT MEDICAL PROFESSIONALS. The Tennessee Chapter of the American Academy of Pediatrics (TNAAP) strongly condemns the violent words and aggressive actions aimed at medical professionals during and after the Williamson County School Board Meeting this week. We are deeply saddened by these attacks. Everyone should step back and question if this is the behavior we want to model for our children. As parents, we teach our children to have calm conversations and to respect others. The healthcare professionals who attended the meeting were there to provide recommendations based on evidence-based guidelines to allow for in-person schooling while also keeping children healthy and safe. TNAAP represents over 1000 pediatricians who have a duty to offer their expertise to protect the health of children and to advocate for their safe return to school. This is a critical effort that should never leave our pediatricians fearful of harm. It is a myth that children do not get COVID. They do and we have cared for them (and continue to do so with increasing numbers). People who use the death rate for children or discount the death of a child who had an underlying condition to minimize COVID’s impact are not only disrespectful to the lives of those precious children but also missing the bigger issue. It is true that for many children, COVID will not cause significant illness, but for others, it leads to hospitalization, Multisystem Inflammatory Syndrome (MIS-C) or long-term side effects. They can also pass it to more vulnerable people in their homes or in the community. Because children under 12 are not eligible for vaccinations, vaccination rates are low in our state, and transmission rates of COVID are high, we must have a layered approach to mitigate the spread of COVID. At this point in time, a layered approach includes masking in schools. It is not going to be forever, but it is clearly needed now. We all recognize that we do not want multiple rounds of quarantine again especially when virtual school is not an option in some places. Our children need to be in school and learning, and their families must be able to go to work. Parents expect that when they send their child to school that they will not only receive an education, but that they will be kept safe from harm. TNAAP supports the rights of parents to make decisions for their children, but those decisions should not infringe on the rights of other children and school staff, including our teachers. We hope parental decisions will be informed by public health needs and a desire to be a good neighbor. A recent Kaiser Family Foundation poll shared on Fox News revealed that most parents support masks. TNAAP President, Dr. Anna Morad, added “Discussing child welfare and advocating for children should never cause pediatricians to fear for their safety. These are the same pediatricians who are trusted to provide care for children to keep them healthy and safe. They deserve to be kept safe as well.” #### The Tennessee Chapter of American Academy of Pediatrics represents the voice of more than 1,000 Tennessee Pediatricians who are dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information visit www.tnaap.org. --- ## Tennessee Pediatricians Support Universal Masking URL: https://tnaap.org/resources/blog/08/2021/tennessee-pediatricians-support-universal-masking/ #### FOR IMMEDIATE RELEASE August 17, 2021 ###   Tennessee Pediatricians Stand by Guidelines and Support Universal Masking of ALL in Schools The Tennessee Chapter of the American Academy of Pediatrics stands by the American Academy of Pediatrics and Centers for Disease Control guidelines that both call for universal masking in schools of all students, teachers, staff, and visitors, regardless of vaccination status. We implore all parents to continue to send their children to school masked. For children who are eligible to be vaccinated, we implore parents to get them vaccinated as well. Studies show that layered protections, including masking, allow children to continue to learn in-person and that, when these guidelines are followed, schools are not a significant source of COVID transmission. A failure to mask all children while indoors puts all children at risk. The Tennessee Chapter of the American Academy of Pediatrics strongly disagrees with the actions outlined in Executive Order 84 signed by Governor Bill Lee yesterday. We are seeing more COVID cases and hospitalizations in children than at any other time during this pandemic. It is critically important, now more than ever, that we do all that we can to keep our children safe and healthy, especially children under 12 years of age who are not yet eligible for vaccination. A child’s health should never be political. TNAAP respectfully requests a meeting with Governor Lee to discuss the on-the-ground situation pediatricians face and calls for Governor Lee to reconsider Executive Order 84. We must take all action necessary to ensure the health and well-being of children in Tennessee. #### The Tennessee Chapter of American Academy of Pediatrics represents the voice of more than 1,000 Tennessee Pediatricians who are dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information visit www.tnaap.org. --- ## TEIS: Early Intervention, Eligibility & How They Rely on You! URL: https://tnaap.org/resources/blog/01/2022/teis-early-intervention-eligibility-how-they-rely-on-you/ There is no denying that early intervention in Tennessee is growing.  Today, the Tennessee Early Intervention System (TEIS) serves 2.5 times the number of families as they did 10 years ago. In the Fiscal Year 2020-2021, a record-breaking 20,751 referrals were made to TEIS.  So far, 2021-2022  is tracking to have more than 20,000 referrals once again.  From that large number of referrals, more than half were submitted by providers in the medical community.  In Tennessee, doctors, nurses, and healthcare social workers aren’t just a supporter of our program but a vital part of how TEIS supports children and families. The process of determining eligibility begins immediately after someone submits a referral for a child.  The TEIS district office has 45 days to determine eligibility and write a plan for that child’s services if they are accepted.  When our contracted eligibility providers begin their work, they consider many different factors.  A child is eligible for TEIS based on information that comes from their doctor, as well as the results of a developmental evaluation.  A child’s evaluation must show a 25% delay in two developmental areas or a 40% delay in one area. The  TEIS Diagnosis List  also serves as a helpful tool when considering eligibility.  TEIS works with developmental physicians to constantly update and evaluate the list and encourage medical professionals to use it as a tool when referring children to our program. During and after the evaluation process, medical records are vital to providing the early intervention team with information about the health of a child. First, we use the child’s overall health assessment as part of the required multi-disciplinary approach. We also use annual health updates and specialist information to inform overall program planning for the child and family.  Service coordinators, who work with the family throughout their early intervention journey, often encourage families to follow up with their physician if there are any questions the parents may have. Many physicians have questions about what happens after they submit a referral. As TEIS works diligently to begin services, you will be notified that your referral was submitted. After that, we encourage you to communicate with the families you refer about how the process is going. As TEIS grows and continues to reach more families, our program would love to hear from those in our medical community about how to engage more frequently about children we all want to see succeed.If you are interested to see how a child is developing, TEIS encourages physicians to follow up with the family. Physicians are also welcome to contact the district office to receive information about the child’s progress. Your support is invaluable for children and families along this journey. The 9 district offices across the state can also serve as a great resource for any questions that you may have about the process. There are also many valuable resources on our  website  including eligibility information, TEIS Diagnosis List, and family resources. Besides communicating regularly with families, you refer, your involvement with TEIS from a program level is also highly encouraged!  The best ways to participate are to build a relationship with your district office, familiarize yourself with the TEIS Diagnosis List, and participate with statewide and local councils where medical input and expertise are always appreciated. For more information on getting involved at the statewide level, please visit our website, or reach out to the TEIS Public Information Officer, Carly Carlton at  carly.carlton@tn.gov .  If you would like to get connected with TEIS leaders in your area, please email Joan Kennedy, Director of Program Implementation, at  joan.kennedy@tn.gov . TEIS is committed to finding every child and family in Tennessee that can benefit from our program.  It is a goal we can only accomplish with a strong relationship with our medical providers.  Thank you for your commitment to making sure every infant and toddler in Tennessee reach their optimal development. --- ## What You Should Know About the Updated Developmental Milestones URL: https://tnaap.org/resources/blog/03/2022/what-you-should-know-about-the-updated-developmental-milestones/ by Toni Whitaker, MD TNAAP START Medical Director ### Approach to Updating the Developmental Milestones   In partnership with CDC, the American Academy of Pediatrics (AAP) identified and convened eight early childhood developmental experts. This work group established criteria for revising “Learn the Signs. Act Early.” (LTSAE) milestones and conducted a comprehensive literature review, cross-referenced with current developmental resources, to inform the revisions. For information about the milestones checklists please visit  “Learn the Signs. Act Early.” | CDC . To learn more about the process for making these revisions, refer to the peer-reviewed article,  Evidence-Informed Milestones for Developmental Surveillance Tools | Pediatrics | American Academy of Pediatrics (aap.org) The milestones were revised for three reasons: 1. To be able to offer a free milestone checklist for every age at which there is an American Academy of Pediatrics (AAP) recommended well-child health supervision visit between 2 months and 5 years to best facilitate conversations between parents and care providers at each of those visits, which meant adding the 15- and 30-month checklists; 2. To assign milestones to ages when most children (75% or more) would be expected to exhibit them, to promote discussion and potentially action when a milestone is missed (rather than taking a “wait and see” approach).; and 3. To address parents’ and early childhood professionals’ feedback that having very similar milestones across checklist ages was confusing, especially in terms of knowing when to take action on possible developmental concerns. Of note, checklist revisions also include • Expanded tips and activities for supporting children’s development and • Added open-ended questions to help facilitate conversations between parents, healthcare providers, and others. Here is what’s new:   • Updated nearly all of the developmental milestones included in existing materials to improve clarity, reduce confusion, reflect the current evidence for milestones, and reduce the likelihood of a “wait and see” approach to missed milestones • Developed 15- and 30-month milestone checklists to match health supervision visits. All typical health supervision visit ages now have a corresponding milestone checklist • Milestones are at the health supervision visit age where  most  (75% or more) children would be expected to achieve them • Revised and expanded the tips and activities to support children’s development for all ages • Added open-ended questions to help facilitate conversations with healthcare providers and others • “Warning signs” of development are now embedded  within  the milestones to reduce confusion about when to take action on missing milestones (any milestone missed is one on which action should be taken, typically beginning with a discussion, and often prompting developmental screening whether at a health supervision visit where screening would occur or not) • Redesigned the  Milestone Moments  booklet, adding a new screening “passport”, and refreshed the design of the milestone checklists, promotional milestones brochure, and gameboard poster However, you will find that what you liked most about the materials has remained the same:   • They’re FREE  • Available in English, Spanish and some other languages • Colorful, engaging, and include images that reflect diversity • Written in family-friendly plain language at a 5 th  to 7 th  grade reading level  • Facilitate ongoing developmental surveillance and complement developmental screening  ### Approach to Updating the Parent Tips   The revised parent tips were developed through a comprehensive review process and cross-walked with common developmental promotion resources. The tips were revised based on previous experience with developing family-friendly, plain-language materials. ### Where Can You Find the New Materials?   Online:  To access the new milestones by age and view or download a milestone checklist visit  http://www.cdc.gov/Milestones .  Print Materials:  Order free copies of the  Milestone Moments  booklet in English or Spanish (in limited quantities) from  www.cdc.gov/ActEArly/Orders.  To request access to the customizable print files, email  ActEarly@cdc.gov .  Mobile App:  As of Feb. 8, 2022, CDC has updated all milestone materials with the revised milestones, however, there may be a brief delay in the release of the updated  Milestone Tracker  app. #### There has been significant interest in the new milestones since their release, along with some questions. The following answers to  frequently asked questions  may also be helpful: • The changes to the milestones were prompted by feedback over at least 15 years of use and began several years prior to publication. The review of evidence and revisions were completed in 2019 and parent testing for understanding and relatability was done in the summer of 2020.   • On many developmental milestone checklists and for many of the milestones on the prior CDC materials, milestones were included on a list if at least half of children would be expected to reach it by that age. This meant that for some milestones, only half of children (50% or more) would be expected to meet them by the specified age. As a result, it wasn’t clear whether any action should be taken if a child was not meeting the milestone. By improving the milestones, and using available evidence to inform the lists, the aim was to make it clearer to parents and other care providers that missing a milestone was something to  take action on . The updated milestones were chosen to reflect what  most  children  (75% or more)  would be expected to be able to do by specified ages to better identify potential concerns.    • In the process for review and revision, data were not available to support inclusion of all previous or all possible milestones. The new criteria sought data to support specific milestones for this revision. Data also supported that some milestones be kept where they were, and some milestones be moved to a different age, and sometimes to a new age checklist (to match health supervision visit time frames).   • More than two thirds of the retained CDC  Learn the Signs. Act Early.  milestones were kept at the ages at which they were placed in the previous milestone checklists, although the wording used to describe the milestone may have changed, primarily to make it easier to understand. Milestones regarding verbal and nonverbal communication were added across checklists along with parent tips to support language development. Efforts were made to show the progression of communication and other skills across checklists, and the addition of 15- and 30-month checklists provides more opportunities to discuss child development. Open-ended questions were added to encourage discussion of concerns that milestones may not capture, such as concerns about a child’s clarity of speech.   • Th e Learn the Signs. Act Early. Milestone  checklists are health communication  to engage families and support conversations about children’s development during well-child visits. They are NOT developmental guidelines or standards, nor are they meant to be used as a screening tool. These checklists may support, BUT DO NOT REPLACE, universal developmental screening recommended at well child/health supervision visits and any time there is a concern, as recommended by the American Academy of Pediatrics (AAP). The checklists and other  Learn the Signs. Act Early.  materials help inform parents of when screening is due, and support families in discussing concerns and asking about screening and other assessments if they have concerns. CDC’s  Learn the Signs. Act Early.  milestone checklists also provide parents with information on how to access early intervention programs in their state.   • Developmental screening is recommended for all children by the AAP at the 9-, 18-, and 30-month well-child visits or any time there is a developmental concern, along with autism screening at the 18- and 24-month well visits using validated developmental screening tools.  Screening tools (not the CDC’s  Learn the Signs. Act Early.  milestone checklists) can assess a child’s risk for developmental delays. Appropriate further evaluation is recommended if screening shows risks or if parents or providers still have concerns. Providers can refer with or without concerning screening results.   • The  Learn the Signs. Act Early.  checklists • • Inform parents that routine developmental screening is recommended at specific ages and any time there are concerns • • Support families with tips and activities for how to encourage their child’s development • • Inform families about how to access early intervention programs in their state • • Support and complement, but do NOT replace, developmental screening as recommended by the American Academy of Pediatrics • • Encourage parents to share any concerns they may have about their child’s development regardless of whether they are meeting the milestones   • CDC and AAP wanted to make sure that the process for updating the  Learn the Signs. Act Early.  milestones was transparent, and therefore waited to implement changes until a peer-reviewed article describing the process was published in  Pediatrics . This publication also • • Raises awareness of the gaps in the literature around developmental milestones and other developmental issues; • • Helps those using the  Learn the Signs. Act Early.  milestone checklists to know the purpose, as well as strengths and limitations, of developmental monitoring in general and of the  Learn the Signs. Act Early.  milestones specifically; and • • Invites dialogue and future research not only on developmental milestones, but also developmental monitoring/surveillance, early identification, and intervention for developmental delays and disabilities.   • The subject matter experts engaged by the American Academy of Pediatrics to review the  Learn the Signs. Act Early.  milestone evidence were: • • Developmental-behavioral pediatricians • • Neurodevelopmental pediatrician • • General pediatrician • • Speech language pathologist • • Child and developmental psychologists • • Professor of special education and early intervention • • Developer of developmental screening tools • • Editor of  Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,  4th Edition • • Authors of AAP’s 2020 clinical report  Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening Thank you for your continued support in promoting this important information and resources to families, healthcare professionals, and early childhood providers. If you have questions about these updates, please email  ActEarly@cdc.gov . --- ## A Pediatricians Role in Firearm Safety URL: https://tnaap.org/resources/blog/04/2022/a-pediatricians-role-in-firearm-safety/ ### Pediatrician’s Role in Protecting Kids from Firearm Injuries              Cookeville, Knoxville, La Vergne, Memphis, Humboldt. These places are not only linked because they are places Tennesseans call home, but because they were each a location of one of Tennessee’s five incidents of gunfire on school grounds in 2021. 1  While tragic, school shootings represent a small proportion of the gun violence that occurs every day in communities across the United States. When children and teens are killed with guns, 60% are homicides, 35% are suicides, and 5% are due to unintentional injuries.  2 These tragedies are largely driven by access to firearms. During incidents of gunfire on school grounds, 78% of shooters under the age of 18 obtained the gun from their home or the home of a friend or relative. 3  The firearm used in youth suicide comes from the home 9 out of 10 times. Nearly 90% of unintentional gun deaths and injuries in children occurred in the home. 4  Tennessee is not immune to the devastation seen by pediatric firearm injures, with firearms representing the 2 nd  leading cause of death among children and teens in our state, one where approximately 51.6% of adults own firearms. 5,6  The recent passage of the Permitless Carry Law will allow easier access to poorly secured firearms, which is associated with increases in homicide, suicide, and unintentional injury or death. Evidence-based prevention efforts can mitigate the deadly risk of easy firearm access. Households with locked firearms and separate locked ammunition have a 78% lower risk of self-inflicted firearm injuries and an 85% lower risk of unintentional firearm injuries. 4  Pediatricians are experts in preventative health for all ages: providing guidance on car seats, medication storage, bike helmets, and many more safety issues every day. Similar to these topics, counseling on firearm safety should be judgement-free, respectful, and collaborative. Consider incorporating the following practices into your daily safety discussions: Assess  how home firearms are stored in the context of safe storage principles (firearms stored unloaded, locked away, with ammunition stored separated). Identify  potential barriers to secure storage, working with the family to identify potential solutions including provision of a gun lock. Encourage  families to discuss secure storage in the other homes the child may visit, such as a friend or relative’s home. Pediatricians have long cited multiple barriers to firearm injury prevention counseling, including lack of training and desire for specific counseling language. 7,8  Led by Dr. Shari Barkin at Vanderbilt University Medical Center, the AAP collaborated with firearm injury experts across the nation to develop a free, interactive online curriculum available for MOC Part 2 credit to address these identified barriers. The training describes universal firearm injury prevention guidance for pediatric providers in clinic settings providing concrete counseling skills, pragmatic video counseling examples based on existing evidence, and resources to learn more about safe storage practices. You can find the training on the Pedialink website here:  https://shop.aap.org/safer-storing-firearms-prevents-harm/ . Pediatricians are a trusted voice in the clinic and the community. It is critical for us to engage in legislative advocacy for common sense gun laws. One such example to be introduced in the upcoming Tennessee legislative session is an Extreme Risk Protection Order (ERPO) law. Extreme Risk laws empower loved ones or law enforcement to intervene to temporarily prevent someone in crisis from accessing firearms. These laws can help de-escalate emergency situations and are a proven way to intervene before gun violence turns deadly.  9 As pediatricians, we see the effects on children who are exposed to violence resulting in depression, PTSD, school difficulties, and substance abuse. It is our responsibility to do everything we can to help every child grow up to be happy, healthy, and safe. We can encourage safer homes by providing effective, consistent firearm injury prevention counseling and support safer communities by advocating for common sense gun laws. Key Firearm Injury Prevention Counseling Tips 1. Utilize every encounter as an opportunity to discuss firearm safety 2. Frame the discussion in the context of other injury and safety topics 3. Use open-ended, non-judgmental language 4. Educate on safe storage options, involving the family in finding a solution to potential barriers 5. Provide firearm safety resources, such as a gun lock 6. Encourage asking about secure storage in other homes the child visits In response to AAP members request for firearm counseling education, the AAP partnered with Vanderbilt University Medical Center to develop an engaging training program called "Safer" offered for MOC Part 2 credit. The training provides up-to-date data on firearm injuries in children/teens, risk mitigation strategies, and showcases brief common counseling scenarios. Click here to enroll in the FREE online training. References 1.The long, shameful list of gunfire on school grounds in America. Everytown Research & Policy. Accessed January 11, 2022. https://everytownresearch.org/maps/gunfire-on-school-grounds/ 2.WISQARS Fatal Injury Reports. Accessed January 11, 2022. https://wisqars.cdc.gov/fatal-reports 3.  Li G. Factors Associated With the Intent of Firearm-Related Injuries in Pediatric Trauma Patients.  Arch Pediatr Adolesc Med . 1996;150(11):1160. doi:10.1001/archpedi.1996.02170360050008 4. Grossman DC, Reay DT, Baker SA. Self-inflicted and Unintentional Firearm Injuries Among Children and Adolescents: The Source of the Firearm.  Arch Pediatr Adolesc Med . 1999;153(8):875. doi:10.1001/archpedi.153.8.875 5. Injury Data Visualization Tools | WISQARS | CDC. Accessed January 11, 2022. https://wisqars.cdc.gov/data/non-fatal/home 6. Schell T, Peterson S, Vegetabile B, Scherling A, Smart R, Morral A.  State-Level Estimates of Household Firearm Ownership . RAND Corporation; 2020. doi:10.7249/TL354 7. Hoops K, Crifasi C. Pediatric resident firearm-related anticipatory guidance: Why are we still not talking about guns?  Prev Med . 2019;124:29-32. doi:10.1016/j.ypmed.2019.04.020 8. McKay S, Bagg M, Patnaik A, et al. Addressing Firearm Safety Counseling: Integration of a Multidisciplinary Workshop in a Pediatric Residency Program.  J Grad Med Educ . 2020;12(5):591-597. doi:10.4300/JGME-D-19-00947.1 9. Extreme Risk Laws. The Educational Fund to Stop Gun Violence. Accessed January 11, 2022. https://efsgv.org/learn/policies/extreme-risk-laws/ --- ## MOC Part IV Opportunities with TNAAP and TRIAD URL: https://tnaap.org/resources/blog/08/2020/moc-part-iv-opportunities-with-tnaap-and-triad/ ### Improving Screening and Referral Procedures for Children At-Risk for Autism Vanderbilt TRIAD  is partnering with primary care providers to provide MOC Part 4 credit through the HRSA-funded program entitled “Improving Screening and Referral Procedures for Children At-Risk for Autism.” This program is designed to help physicians improve care coordination for children at-risk for autism spectrum disorder (ASD) and other neurodevelopmental disabilities by providing coordinated education, training, and technical assistance to providers. This includes helping providers increase competence and comfort with enhanced screening, diagnosing when necessary, and caring for children with ASD within primary care. Training will include access to expert tele-consultation, optional formal CME workshops, and virtual learning opportunities that have been used to train community pediatric providers in a decision-making framework to identify many cases of ASD within practice and to more efficiently triage children with complex presentations to specialty centers for diagnostic clarification. This also includes helping families and staff access TRIAD Family Navigation services. Meaningful participation requirements include participating in at least four PDSA data cycles (minimum 6 months), completing brief online modules related to QI and screening practices, participating in learning collaboratives or TRIAD teleconsultation sessions, and entering bi-monthly practice-level data (25 MOC Part 4 credits).  If you are a primary care provider who does not need MOC credit, we would still be happy to chat with you about how to support your clinic. View the program flyer here! Contact Jeffrey Hine, PhD,  jeffrey.hine@vumc.org  or (615) 875-9515. ### TNAAP's Quality Improvement Initiative TNAAP’s Pediatric Health Improvement Initiative in Tennessee (PHiiT) program is the quality improvement arm of TNAAP. Each of TNAAP’s educational programs offers a QI project offering MOC part IV credit as described below. The EPSDT and Coding Program QI Project The QI project  will assist ambulatory pediatric and primary care providers in improving annual, well care visit completion rates. These rates will increase through the implementation and sustainment of process changes around patient recall, scheduling, and identifying opportunities for well exams at acute visits. START (Screening Tools And Referral Training) Program QI Project The QI project assists healthcare providers in increasing screening for the identified developmental and behavioral health concerns (developmental, ADD/ADHD, Autism, Depression or Substance Abuse) by 10% over at least a 6-month period using a validated tool. It allows practices to compare the percentage of patients screened using chosen tools as well as also reviewing well care screening rates for associated ages. Practices use quality improvement science to implement process changes and effective communication tools for the practice to visualize performance, value the process improvement work and better serve patients. Behavioral Healthcare in Pediatrics (BeHiP) Program QI Project The QI project  assists healthcare providers in implementing process changes to incorporate validated screening tools for depression and substance use for children ages 11-21. Practices compare screening rates using chosen tools to the overall patient population for that age group seen during the select time frame. Practices also have the opportunity to compare screening rates to the percentage of 11-21 year-olds that received a well visit within the past 12 months. For more information about these opportunities, contact Becky Brumley (becky.brumley@tnaap.org), TNAAP’s PHiiT Program Director and Quality Coach. --- ## 2022 Pediatrician of the Year! URL: https://tnaap.org/resources/blog/08/2022/tnaap-honors-morgan-mcdonald-md/ FOR IMMEDIATE RELEASE August 29, 2022 Tennessee Department of Health Interim Commissioner Named Pediatrician of the Year Morgan McDonald, MD, FACP, FAAP was awarded with the Pediatrician of the Year Award Saturday August 27 during the annual Tennessee State Pediatric Conference.  The Tennessee Chapter of the American Academy of Pediatrics (TNAAP)  recognized Dr. McDonald for her leadership and guidance during the pandemic.  Dr Anna Morad, Immediate Past President of TNAAP, recalled “Dr. McDonald is an accomplished public health leader who prioritizes the health and wellbeing of Tennessee children. She deserves this recognition along with our gratitude for her thoughtful leadership not only for the pandemic response but also the many other TDH missions that impact the lives of TN children on a daily basis”. Dr. McDonald is currently serving as Interim Commissioner for the Tennessee Department of Health (TDH). She has over 15 years of experience creating and managing systems of care for vulnerable populations. Prior to her current appointment, Dr. McDonald served as the TDH Deputy Commissioner for Population Health, responsible for implementation of the Department’s strategic plan and direct oversight of prevention and safety net services including Maternal and Child Health, Chronic Disease prevention, Rural Health, Minority Health and much of the Department’s data infrastructure. “We are so proud of Dr. McDonald’s many accomplishments both during the pandemic and beyond. Time and again we have relied on her expertise in navigating the many layers of the pandemic and its effect on the health and well-being of children and families. We are glad to call her a member and this honor is a well-deserved recognition of her great work as a pediatrician,” Jason Yaun, MD, TNAAP President. Dr. McDonald is board-certified in internal medicine and pediatrics.  She received her undergraduate and medical degrees from Vanderbilt University School of Medicine. She completed residency in internal medicine and pediatrics at the University of North Carolina – Chapel Hill.  She is a fellow of the American Academy of Pediatrics and the American College of Physicians. TNAAP also gave three other awards during the event. • Friend of Children Award: Isaiah 117 House, a non profit who cares for children awaiting foster placement • Lifetime Achievement Award: Noel K Frizzell, MD, Pediatrician, Memphis, TN • Lifetime Achievement Award: Joel F. Bradley, MD, Pediatrician, Nashville, TN --- ## A Pediatricians Role In Preventing Suicide URL: https://tnaap.org/resources/blog/08/2022/a-pediatricians-role-in-preventing-suicide/ #### A Pediatricians' Role in Preventing Suicide by Firearms Tim Fuller, DO, FAAP BeHiP Medical Director At the close of the 2022 school year, as many families were eagerly anticipating high school graduations and summer vacations without COVID restrictions, a new fear emerged. Suddenly our hearts were dimmed by the news of multiple mass shootings. Many involved children. Media outrage ensued, followed by a bipartisan legislative response. Discussions confirmed the declaration made by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association in October 2021 14 . We have a mental health crisis. With the unfortunate lack of mental health access, we as pediatricians, as well as other primary care providers once again find ourselves on the front lines of this battle. While the terror of an unpredictable, senseless, act of extreme violence such as a mass shooting draws the focus of the media and legislators, the biggest threat from gun violence remains suicide. When we break down the data surrounding gun violence, the link between suicide and gun violence becomes undeniable. According to CDC data published by PEW Research Center 6 in Feb 2022, deaths due to gun violence peaked in 2020, at the height of the COVID pandemic. Of the 45,222 people who died as a result of gun violence that year, 54% were the result of suicide, 43% homicide, and only 3% other. So far this year the numbers have not looked good either. According to CDC data published by gunviolencearchive.org 4 as of June 22 the US has lost 20,736 people to gun violence this year. Of those, 11, 418 were the result of suicide, with 278 deaths from mass shootings So, who is a greatest risk of suicide by gun violence? The highest risk group traditionally has been older, white men, usually from rural areas. This number has held fairly steady over the past ten years. However, data from the CDC WONDER database published by the Trace 7 , a non-profit journalism outlet devoted to gun related news,  reveal an increasing number of suicides in younger people of color. While there is no distinct single cause for suicidality, marginalizing influences such as racism, lack of community resource, food insecurity, parental unemployment, and lack of mental health services may be associated with higher trajectories of perceived stress 12 . Cultural barriers to engaging in mental health care is another contributing factor. Individuals who already feel marginalized because of their race often do not want to accept the cultural stigma of receiving mental health treatment. The highest rate of rise in suicide deaths by guns was in Asian and Pacific Islanders ages 10 to 19 7 , a group that seeks mental health treatment less frequently than any other group 1 . Data from the American Psychological Foundation 5 published by the TRACE 7 reveals only 3% of practicing psychologists are Black, 4 % are Asian, and 7 % are Latino. This emphasizes the need for culturally competent professionals. An increase in gun ownership may also contribute to increased access by children. In a study published in JAMA Psychiatry in 2021 examining the precipitating circumstances of suicide in children aged 5 -11 years old 8 guns were found to be the second leading method of suicide (18.7%) behind strangulation (78.4%). In every case in which the details of gun access were noted, the child obtained a firearm stored unsafely in the home.  In an eight center study of 1358 patient with suicidal ideation/suicidal attempts, in which 337 patient were discharged to home from the emergency room, 55% of those discharged did not have documentation of a screening for access to weapons or other lethal items at home. It was found later that 13 % of these patients actually had at least one firearm at home 13 . Clinicians should be culturally sensitive when discussing gun ownership. For those who live in unsafe areas, or may have strong personal beliefs surrounding gun ownership, conversations around firearms in the home may be divisive. There should, however, be opportunities to discuss gun safety Dr. Amy Barnhorst, a psychiatrist at the University of California, Davis directs a program called the BulletPoints Project, an initiative directed toward giving clinicians the knowledge and tools to reduce the risk of firearm injury and death in their patients. The BulletPoints website 3 offers clinical scenarios, interventions, and evidence-based counseling strategies. While some of the interventions are based on local California law, most of the information is universally relevant. Her program centers around the framework of “the 3 A’s” (Approach, Assess, and Act), with “Approach” being centered around the context of risk reduction. “Assess” focuses on determining if it is clinically relevant to ask about access to firearms, and willingness to work together at reducing risk. Finally, “Act” identifies actions clinicians can take to prevent firearm injury based on the level and type of risk. You can access the BulletPoints Project at www.bulletpointsproject.org. Remember that when dealing with mental health problems, one of the biggest challenges is identifying the problem. Without the use of screening tools, most mental illness will most likely continue to be missed. Routine use of screening tools and early identification of concerns continue to be vital to the management of mental health issues. In some instances, you may only have one opportunity to address the problem. If you miss it, they may never be back. Concerning the risk of suicidality in general, there are a few more resources beyond the PHQ -9. The National Institute of Mental Health has an Ask Suicide-Screening Questions (ASQ) Toolkit available 2 . The screener consists of four brief suicide screening question and only takes 20 seconds to administer. The website includes video instructions on how to use the tool kit as well as how to manage patients at risk for suicide. You can find the ASQ tool kit at www.nimh.nih.gov. Making the decision to send a depressed patient home vs sending them for inpatient care can sometimes be difficult. The “SAD- PERSONS” scale 9 can help guide planning with regards to the disposition of a depressed patient. It may be accessed at www.med.unc.edu as well as other sources. The REACH institute also has some great resources for assessment and management.  Their “Treatment of Maladaptive Aggression in Youth” (T-MAY) handbook 11 contains helpful aids and tools for screening for overt aggression, ADHD with comorbid aggression, and anxiety/depression with comorbid aggression. The handbook also contains algorithms and templates for creating short, intermediate, and long-term treatment plans. You can access T-MAY at www.ahrq.gov. Finally, if you do not have a safety plan in place, you may access a six-step safety plan QUICK GUIDE 10 at www.esc14.net. And above all, make sure that you are taking care of your own mental health as well. Stay safe! And keep changing the world, one person at a time! Dr.  Tim Fuller, BeHiP Co-Medical Director, has been involved with BeHiP since the launch of the foster care learning collaborative pilot project in Upper East Tennessee.  He has been in private practice in Greeneville, TN for the past 20 years.  Dr. Fuller serves as the executive officer of the 31st medical company in the TN State Guard.  Dr. Fuller is also a clinical adjunct professor at Debusk College of Osteopathic Medicine at Lincoln Memorial University. References: 1. Asian American and Pacific Islander, National Alliance on Mental Illness, https://www.nami.org, accessed 22 June 2022. 2. Ask Suicide-Screener Questions (ASQ) Toolkit, National Institute of Mental Health , NIH, https://www.nimh.nih.gov, Accessed 22 June 2022. 3. The BulletPoints Project, https://www.bulletpointsproject.org, accessed 22 June 22, 2022. 4. Charts and Maps, Gun Violence Archives 2022, https://www.gunviolencearchives.org, Accessed 22 June 2022 5. CWS Data Tool: Demographics of the U.S. Psychological Workforce, American Psychological Association, https://www.APA.org. Accessed 22 June 2022 6. Gramlich, John, What the Data Says About Gun Violence in the U.S., PEW Research Center, 3 Feb 2022, https://www.pewreearch.org 7. Moscia, Jennifer, Pierce, Olga, Youth Gun Suicide is Rising, Particularly Among Children of Color, 24 Feb 2022, The Trace, https://www.thetrace.org 8. Ruch, Donna A., PhD, Heck, Kendra, M., MPH, Sheftall, Arielle H. PhD, et al, Characteristics and Precipitating Circumstances od Suicide Among Children Aged 5 to 11 Years in the United States 2013-2017. JAMA Psychiatry, 27 July 2021. 9. SAD PERSONS Scale, https://www.med.unc.edu, accessed 22 June 2022 10. Safety Plane QUICK GUIDE, https://www.esq14.net, accessed 22 June 2022 11. Treatment of Maladaptive Aggression in Youth, New York State Office of Mental Health , https://www.ahrq.gov, accessed 22 June 2022. 12. Xiao, Yunyu PhD, Yip, Paul Siu-Fui, PhD, Pathak, Jyotishman, PhD, Association of Social Determinants of Health and Vaccinations with Child Mental Health During the COVID-19 Pandemic in the US, JAMA Psychiatry, 2022, 79 (6), 610-622, 27 April 2022. 13. Betz, Marian E, et al. Lethal Means Access and Assessment Among Suicidal Emergency Department Patients, Depress Anxiety, 2016, June. 14. https:// www.aap.org/en/advocacy/child-and-adolescent-heathy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health --- ## AAP Clinical Guideline for Obesity Treatment URL: https://tnaap.org/resources/blog/02/2023/aap-clinical-guideline-for-obesity-management/ By: Joani L. Jack, MD, FAAP Diplomate, American Board of Obesity Medicine Medical Director, Children’s Healthy Eating and Active Living Center Children’s Hospital at Erlanger Assistant Professor University of TN College of Medicine Chattanooga, TN The eagerly anticipated first edition of the American Academy of Pediatrics clinical practice guideline for evaluation and management of children and adolescents with overweight and obesity is now available, and promises to provide an invaluable resource to all who provide care for children. I am in awe of the passion, advocacy and tireless dedication represented in these guidelines. Any effort to summarize them would be inadequate, so I will instead choose to highlight the aspects that stand out, in hopes that you will set aside the time to read them with the care and attention that your patients deserve. You will not be disappointed! Childhood obesity is a chronic, complex disease and should be evaluated and managed accordingly. This clear, evidence-based statement is the bedrock of the clinical-practice guidelines. Pediatric obesity is the result of faulty weight regulation and is not caused by poor choices. This is the reason why so many thin children have poor eating habits, while many of our children with obesity try so hard to eat well without sustainable results. The fact that childhood obesity is a chronic disease is an important reason to address weight bias; to recognize inequities and disparities; to discover and undertake new and effective treatments; to learn to effectively manage comorbidities; and to continue treatments into adulthood. While physicians have long claimed that pediatric obesity is a disease, the CPG now challenges us to practice as though we mean it. Important disparities exist based on adverse childhood experiences, socioeconomic status, ethnicity and race. And what these guidelines do a wonderful job of highlighting is the reminder that disparity is the end-result of inequity. Our real job isn’t simply to recognize healthcare disparities, although this can certainly help us know who is at higher risk. Our greater job is to dig deeper… to understand what systemic, cultural, political and economic inequities caused certain groups of people to be disparately impacted. And ask ourselves how can we, as those who advocate for and care for children, be the world changers to make it better for those we are responsible for now as well as those who will come after us? Screening for and treating comorbidities is a vital aspect of managing pediatric obesity in the primary care setting. Children affected by obesity are more likely to have elevated blood pressure, dyslipidemia, fatty liver disease, obstructive sleep apnea, prediabetes or type 2 diabetes, anxiety and depression, PCOS, idiopathic intracranial hypertension, and orthopedic abnormalities. Understanding when to screen, when and how to treat, when to refer, and having all of this information easily available at your fingertips is a valuable aspect of the clinical practice guidelines. Children and youth with special healthcare needs are commonly impacted by childhood obesity yet have additional challenges to treatment. Children with autism, Down Syndrome, Prader-Willi Syndrome, chromosomal disorders, hypothalamic disorders, preterm infants and many children with other medical complex needs struggle with weight dysregulation as a complication of their primary disorder, due to medications, as a result of food restrictions/sensory aversions, or due to limited mobility. The guidelines thoughtfully address these issues with resources for managing these populations with efficacy and confidence. Medications may be offered to children in the primary care setting as an adjunct to lifestyle and behavioral treatment. A robust section is provided on the mechanism of action of available pediatric anti-obesity medications, including those that are sometimes used off-label. Consensus prescribing recommendations for children 8-11 years of age is provided, based upon medication indications, risks and benefits. Because studies do not support the use of medications as monotherapy, but only in conjunction with intensive dietary/physical activity intervention, the guidelines recommend that primary care providers who prescribed anti-obesity medications either provide intensive lifestyle intervention or refer to pediatric multidisciplinary obesity centers for treatment in conjunction with medication. Weight loss surgery is safe and effective for pediatric patients in comprehensive metabolic and bariatric surgery settings that have experience working with youth and their families. For those youth most severely affected (class 3 obesity, or class 2 obesity with comorbidities), metabolic bariatric surgery represents a safe and effective treatment modality that resolves many of the comorbidities, results in an average of 27% weight loss, and has relatively low risks. Adolescents 13 and older who meet criteria are recommended by the committee for referral to a qualified pediatric obesity center for management. Criteria for metabolic bariatric surgery: • Class 3 obesity, BMI ≥ 40 kg/m2 or 140% of the 95th percentile for age and sex, whichever is lower. Comorbidities are not required to be present • Class 2 obesity, BMI ≥ 35 kg/m2 or 120% of the 95th percentile for age and sex, whichever is lower, with the presence of clinically significant disease; examples include but are not limited to T2DM, IIH, NASH, Blount disease, SCFE, GERD, obstructive sleep apnea (AHI >5), cardiovascular disease risks (HTN, hyperlipidemia, insulin resistance), depressed health-related quality of life. In summary, pediatric obesity is a chronic, complex disease resulting from weight dysregulation. It results in multiple comorbidities, and as a result of healthcare inequities, certain groups are disparately impacted. Fortunately, we are on the cusp of an era with new and effective treatment options allowing patients with obesity to receive treatment for their disease. The American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity is a wonderful resource that should be on the desk of each and every pediatrician and those who provide for children. --- ## COVID-19 Information and Resources URL: https://tnaap.org/resources/blog/07/2020/covid-19-information-and-resources/ With the COVID-19 pandemic quickly spreading through the country, information and recommendations are changing daily. In order to better help providers and staff we are keeping up-to-date information, resources, and recommendations in the post below. We are also sending emails out as needed several times a week with up-to-date or urgent information.  If you would like to join our mailing list, click here .  Pediatric practices are encouraged to continue seeing patients as necessary, particularly infants and younger children needing vaccines.  This webpage contains tips on telehealth and in-office visits . ### Upcoming Webinar(s) TNAAP COVID-19 Vaccine 101 Webinar - January 25, 2021 - 6:00 pm Click Here to Register Dr. Michelle Fiscus, Immunization Director for the Tennessee Department of Health will discuss the science behind these vaccines and provide answers to common misconceptions.  She will also address the status of COVID-19  vaccines for children. The goal of the webinar is to build confidence among healthcare teams and staff around COVID-19 vaccinations. A live question and answer session will be available at the end of the webinar. ### COVID-19 Vaccine Resources • Facts Over Fear: Preparing for the COVID Vaccines Across Tennessee   - This course addresses four COVID-19 vaccines and aims to put healthcare professionals in a position to confidently administer and discuss these vaccines with patients and offers FREE CME. • Vaccine Distribution Information Town Hall with Tennessee Non-Profits  - Join Dr. Michelle Fiscus for a webinar on the COVID-19 vaccine and Tennessee's distribution plan. This recorded session includes information on how the COVID-19 vaccine was developed, the safety and efficacy of the available vaccines, the development and implementation of TN's vaccine distribution plan, and how you can help increase vaccination rates. • Infection Prevention and Control  - CDC's Project Firstline provides evidence-based infection prevention and control training. These brief (roughly five minute) modules are innovative, accessible, and designed for every single person who works in a healthcare setting. ### TNAAP Back to the Office Campagin We have created a series of resources practices can use to help encourage patients to come back to the office. These tools include social media graphics, sample letters, phone scripts and more! Click the link below to view the tool kit. Back to Office Toolkit ### Provider Relief Fund - Deadline July 20 As announced by the  US Department of Health and Human Services  and  American Academy of Pediatrics , HHS has now opened its relief fund for Medicaid providers. HHS has released approximately $15 billion to Medicaid and CHIP providers who were left out of the previous financial relief packages. Funding is NOT on a first-come, first-serve bases and practices have until July 20, 2020 to apply. Payments do not have to be repaid Click Here for a List of Resources and More Information Provider Relief Portal ### Telehealth Resources TNAAP Telehealth Coffeetalk Webinar -  AAP telehealth experts joined TNAAP for an interactive webinar. The webinar provides guidance on how to implement telehealth, including the technology that can be used, tips for workflow, how to get parents and patients on board and information on how to code and bill for these services for payers in Tennessee. TNAAP Tennessee Telehealth Coding Guidlines by Payer- Click to Download TennCare EPSDT & Well Child Telehealth Guidance (pdf) - Click to Download • TennCare Extends Telehealth Through June 30, 2021 • TNAAP COVID-19 Telehealth Coding Guidance (pdf) • Behavioral Health Telehealth Services for TennCare Enrollees – Novel COVID-19 (pdf) • TennCare MCO COVID-19 Telehealth and Dx Testing Update (pdf) • AAP Webinar on Telehealth and COVID-19 (Video) • AAP Guidance: Telehealth Payer Policy in Response to COVID-19 (pdf) • AAP Coding for COVID-19 and Non-Direct Care (pdf) Small Business Guidance for Pediatric Practices - Click here to download ### Medicaid Resources • COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies • Trump Administration Releases COVID-19 Checklists and Tools to Accelerate Relief for State Medicaid & CHIP Programs • Medicaid Telehealth Services • CMS COVID-19 Partner Toolkit ### HHS Resources • Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency • Telehealth FAQs ### Other Coronavirus (COVID-19) Resources • TN Department of Health • Centers for Disease Control and Prevention • American Academy of Pediatrics • Le Bonheur –  University of Tennessee Health Sciences Center • Niswonger – East Tennessee State University – Ballad Health • Monroe Carrell, Jr. – Vanderbilt University Medical Center ### Latest TNAAP Communications on COVID-19 • New Coverage for EPSDT & Well Child Telehealth Visits  (4/7/2020) • Tips for Telehelath and In-Office Visits  (4/3/2020) • New Listserv for TNAAP Members and DOH Updates  (4/2/2020) • Telehealth COVID-19 Updates and Resources  (3/26/2020) • COVID-19 Update for Tennessee Clinicians  (3/24/2020) • COVID-19 Update for Newborn Nursery Providers  (3/20/2020) • Update TDH COVID-19 Guidance  (3/19/2020) • COVID-19 Strategies and Resources for the Pediatric Practice  (3/17/2020) --- ## Day on the Hill 2023 in Pictures URL: https://tnaap.org/resources/blog/03/2023/day-on-the-hill-2023-in-pictures/ More than 40 TNAAP physicians, residents, and staff gathered in Nashville on March 8 for our annual Day on the Hill. Our group had the chance to hear from new Tennessee Health Commissioner Dr. Ralph Alvarado and had meetings with more than a dozen elected officials representing all three regions of the state. --- ## New Guidance: Mature Minor Immunization Changes URL: https://tnaap.org/resources/blog/06/2023/matureminor/ ##### June 26, 2023 TNAAP appreciates your patience as we have continued to work through the implications of SB1111/HB1380 “The Mature Minor Doctrine Clarification Act” and how to remain in compliance. We know that this has been a rapid, difficult, and worrying change in the landscape of immunizations in our state and we have been working diligently to get you the most accurate and up-to-date information. The information provided in this communication does not, and is not intended to, constitute legal advice; instead, this is for general information and discussion purposes only. Clinicians are advised to obtain an independent legal opinion on interpretation of this legislation. While various interpretations of the law have been presented, TNAAP has been fairly reassured in our findings. The essence is that the bill removes the Mature Minor Doctrine as it applies to immunizations (for children not in DCS custody). An adolescent patient that you may have previously considered to be a Mature Minor who could consent to an immunization on their own can no longer do so. We must now treat all children and adolescents under 18 years of age the same when it comes to informed consent for immunizations. The informed consent of the parent or legal guardian is required. The law is ambiguous as to the definition of informed consent and what type of consent must be obtained. Physicians, practices, and medical systems must consider their process for informed consent and documentation in the medical record. A key term in the law is informed consent, although the law does not clearly specify the content of what this must include. This typically includes discussing the nature of the treatment, risks, benefits, alternatives, etc. A conservative approach could be obtaining written, informed consent for each vaccine administered at each visit. However, a process for verbal informed consent with adequate documentation in the medical record may suffice. Thus, when a patient presents with someone who is not their parent or legal guardian, under this scenario verbal informed consent may be obtained over the phone from the parent or legal guardian at the time of the visit. However, if the parent or guardian cannot be reached or informed consent cannot be obtained, then immunizations should not be administered at that visit. We realize that this point on informed consent and whether it should be written is confusing and that you may have seen differing recommendations on this. Some are strongly urging written, informed consent, while others have felt that well documented verbal informed consent is sufficient. Please consider what you, your practice, or health system are most comfortable with, how to operationalize these options, and consider legal counsel if desired for clarification. We do recommend that this is carefully documented in your medical record each time immunizations are administered. If written consent is obtained, that should be put into the medical record. If verbal consent is obtained this should be well documented using a statement such as: Counseling was provided regarding immunizations administered at this visit. Risks and benefits were explained, and parent/guardian concerns were addressed. The CDC VIS handout was reviewed. Signs and symptoms of adverse reactions were discussed including when to seek medical attention for adverse effects; all questions were answered. Verbal informed consent obtained from parent/guardian who agreed to immunizations administered. For children in DCS custody, the law does require written informed consent from a parent or guardian or a court order and is very clear that consent here must be written. Written informed consent can be obtained using Form 4246 . If the parent or legal guardian is not available, a court order is required. In these cases, the courts cannot authorize consent for the HPV or COVID-19 vaccines- these require written, informed consent from the parent or guardian. Also, remember that the state requires written consent for the COVID-19 vaccine in all cases, even for children who are not in DCS custody. The remainder of the Mature Minor Doctrine for the other aspects of care that it covers still stands. We realize that there may still be situations where it can be difficult or nearly impossible to get informed consent from a parent or legal guardian. DCS is in the process of obtaining court orders authorizing consent for vaccines for children in custody. TNAAP is still awaiting the promulgation of rules from the Tennessee Department of Health as to what the penalties for non-compliance may be and if some of the ambiguous aspects of the guidance can be further clarified through this process. TNAAP will continue to work to obtain further guidance and push for an expedited rulemaking process to help our practices and our patients. Please know that we will continue to advocate for strong protections for immunizations in our state and will work to see if there are avenues for improving this new law. --- ## Importance of the Age One Dental Visit URL: https://tnaap.org/resources/blog/06/2023/importance-of-the-age-one-dental-visit/ ##### June 4, 2023 Dental caries is the most common childhood disease in the United States. National surveys report that more than 50 percent of children still experience caries in their primary teeth. If left untreated the child can experience pain and infection causing problems with eating, speaking, and learning. The American Academy of Pediatric Dentistry (AAPD), American Dental Association (ADA), American Public Health Association and American Academy of Pediatrics currently recommend that all children have their initial dental visit during the first year of life. The age one dental visit allows the dentist to identify the individual child risk factors for caries and provide advice on behavior modification, dietary habits, fluoride therapies, oral hygiene practices and importance of regular dental checkups for prevention of dental disease. Early detection of caries and use of conservative methods such as silver diamine fluoride (SDF) and fluoride varnish for caries management and prevention are also made possible with the age one dental visit. The longer the first dental visit is delayed, the more likely the possibility that dental disease can no longer be prevented or arrested but will require some surgical intervention. Younger kids often need to be moderately or deeply sedated in the hospital settings for caries treatment. Conservative therapies such as fluoride and SDF can prevent and arrest tooth caries and can minimize or delay the need for restorations (fillings) and other more involved procedures like pulpotomies and stainless-steel crowns, reducing the risk and adverse outcomes associated with sedation and general anesthesia. In addition to the savings on restorative dental care rendered in the office and hospital settings, preventive dentistry has the potential to save considerable amount per year on dental related emergency visits and hospitalizations. The cost of dental caries is not just the actual cost of treating decay which can exceed several thousand dollars, but also lost time from school and work and other family disruptions which could be effectively prevented by timely dental checkups.  Providing education to parents on the importance of age 1 dental visit and regular dental checkups can help prevent a great amount of pain and distress associated with dental decay. To learn more about the importance of the age one dental visit, please visit the following AAPD publication link: https://www.aapd.org/globalassets/media/policy-center/year1visit.pdf --- ## TennCare Redetermination Graphics and Posters URL: https://tnaap.org/resources/blog/03/2023/tenncare-redetermination-graphics-and-posters/ ##### Updated April 14, 2023 #### Click thumbnails to download full-quality graphics. TennCare Connect Poster TennCare Connect Flyer (Also available in Spanish , Kurdish , French ) TennCare Renewal Flyer for Members TennCare Renewal Mini-Reminders Social Media: April Renewals Social Media/Waiting Room: Find Your Month Social Media/Waiting Room: Family Social Media/Waiting Room: Gap in Coverage Social Media/Waiting Room: TennCare Connect Social Media: Address Change Social Media: Check Your Mail Social Media: Confirm Your Info --- ## Ordering Procedure Changing for COVID Vaccines URL: https://tnaap.org/resources/blog/07/2023/ordering-procedure-changing-for-covid-vaccines/ ##### July 20, 2023 The HHS Commercialization Transition Guide was published on July 6, 2023.  This guide provides direction to those participating in the COVID-19 Vaccination Program as the U.S. Government stops distributing COVID-19 vaccines through its current ordering system and the vaccines transition to the commercial market. It is anticipated that the U.S. Government (USG) will set vaccine thresholds to “0” for COVID-19 vaccines and ancillary supplies on August 3, 2023, at 4:00 PM ET. Providers are encouraged to place necessary orders prior to the cutoff date of August 3, 2023 . If a provider requires additional supply to be responsive to demand after USG closes the current ordering mechanism, COVID-19 vaccines will continue to be available for ordering via the established out-of-cycle request process. Requests received after August 3, 2023, will be processed twice every week. Please see the following guide. This guide is for planning purposes only and is based on potential, future action by FDA and CDC should they authorize and recommend the new vaccines this fall. Details may change. Click here to read HHS Commercialization Transition Guide: Sunsetting The U.S. Government COVID-19 Vaccine Distribution Program. --- ## Media Release: TNAAP Named Outstanding Large Chapter URL: https://tnaap.org/resources/blog/08/2023/tnaap-named-outstanding/ ###### August 31, 2023 NASHVILLE, TN – The Tennessee Chapter of the American Academy of Pediatrics (TNAAP) announced today that it was named the winner of The American Academy of Pediatrics 2022 Outstanding Chapter Award, in the Large Chapter category. The honor comes following a year of outreach to educate thousands of health professionals on topics like early childhood screenings and catching up on wellness vaccines. “We are so honored to receive the Outstanding Chapter Award for 2022. It is a testament to the hard work of our entire chapter around the advocacy work on behalf of all children in Tennessee, the extensive training and educational services we provide to our members, and the strength of our membership and finances,” said TNAAP President Dr. Jason Yaun, FAAP. “We are proud of the work that our staff, leadership team, and all members put in throughout the year that led to this award. We appreciate the recognition for the accomplishments we have achieved over the past year,” he said. The award was given by the AAP District Vice-chair Committee, which honors chapters for excellence in programs that support the health and welfare of children. The AAP District Vice-chair Committee provides support, resources, and collaboration experiences between the 66 chapters in the US and Canada. “The Outstanding Large Chapter Award of the American Academy of Pediatrics is presented to a Chapter with exceptional accomplishments and innovative ideas while maintaining a healthy chapter,” said Dr. Pat Purcell, American Academy of Pediatrics, District IV Vice Chair. “Congratulations to Tennessee for being the 2022 award recipient.” TNAAP worked throughout 2022 to expand its endowment to support young physicians and launch a new Immunization Program to give clinicians the tools they need to help parents understand the importance of childhood wellness vaccines. The Outstanding Chapter Award recognized the significance of this new program and its use of peer-to-peer learning known as the ECHO model (Extension for Community Health Outcomes). Also in 2022, TNAAP continued to offer in-person and virtual training on early childhood screening, behavioral health resources, and effective medical coding. These free sessions were provided to thousands of clinicians and practice managers across Tennessee. Pictured: TNAAP President Dr. Jason Yaun, Executive Director Ruth Allen, Vice President Dr. Carlenda Smith --- ## Resources to Help East Tennessee URL: https://tnaap.org/resources/blog/10/2024/resources-to-help-east-tennessee/ October 4, 2024 We have no words to describe how saddened we are about the tragic developments in eastern Tennessee following hurricane Helene. Our hearts go out to all who have been impacted. We have been in contact with many of our members in that part of the state and have reached out to all of them asking how we may be of assistance. For those wishing to help, donations can be made to the following organizations and/or these organizations can provide additional details about how to help. TNAAP has contributed to each of these, and we encourage others to do so. • Greene County AIDNET of Greene County Donations can be sent to AIDNET of Greene County at PO Box 2622, Greeneville, TN 37744. • Unicoi County Unicoi County Fund - East Tennessee Foundation • Cocke County - Cocke County Strong • Washington, Carter and Johnson Counties  - United Way of East Tennessee Highlands • Sevier County Disaster Donations - Sevier Co. Emergency Management • Other impacted counties: East Tennessee Foundation In addition, we offer the following resources for families. • AAP Tips on Talking to a Child after a Disaster (AAP YouTube) • How to Support Your Child’s Resilience in a Time of Crisis TNAAP will continue to monitor the recovery efforts in the coming days and months and assist where possible. --- ## Sponsored Fellows Reflect on NCE Attendance URL: https://tnaap.org/resources/blog/10/2025/sponsored-fellows-reflect-on-nce-attendance/ This year TNAAP covered the registration costs for two young physicians to attend the AAP National Conference and Exhibition in Denver. Dr. Samantha Lee writes "I am grateful for the opportunity to attend the 2025 AAP National Conference through the support of TNAAP. As a primary care pediatrician, I am front row to the complex challenges physicians face as we care for families and our Tennessee communities. In the last few months alone, I have seen families come to the office with increased confusion and even fear as they try to navigate what can seem like an ever changing landscape of information. As an early career physician, I sometimes feel discouraged trying to promote safe and effective care amidst so many challenges. Throughout the National Conference, a shared sense of camaraderie and steadfastness was present. The opening plenary session greeted us with a whimsical musical performance in tribute to Virginia Apgar, who developed her eponymous neonatal health score after being discouraged from a career in surgery. We then enjoyed a call to action from keynote speaker Dr. Will Flanary (AKA Dr. Glaucomflecken ), an ophthalmologist and internet comedian who delivers poignant commentary of our healthcare system through humor. And of course, AAP President Dr. Susan Kressly provided moving words reminding us that we must continue to do what we have always done as pediatricians - persist in the midst of challenges as we care for children. Ultimately, we remembered that the AAPs very founding was based on our dedication to promoting the health and well being of children. As a pediatric community, we are no strangers to challenges - that “even in the darkest times, we fight for what matters most.” While I left the conference with new clinical knowledge, I appreciate the opportunity to be with colleagues from around the country who are showing up to care for children every day. I look forward to continuing the important work of providing quality care for the children of Tennessee alongside our wonderful community of pediatric providers." Dr. Erin Von Klein writes "Thanks to the generous support of the Tennessee Chapter of the AAP Endowment Fund, I had the opportunity to attend the 2025 AAP National Conference & Exhibition (NCE) in Denver, Colorado. It was an inspiring and energizing weekend filled with cutting-edge science, practical clinical updates, and opportunities to connect with colleagues and leaders in pediatrics from across the country. The conference opened on Friday with excellent clinical sessions, including “Tips for Managing Atopic Dermatitis” and an update on Congenital CMV screening, both of which offered immediately applicable insights for clinical practice. I also had the opportunity to present my research during the poster session and attend the Section on Neonatal-Perinatal Medicine opening session, where experts discussed emerging evidence and priorities for the field of Neonatology. The day concluded with networking opportunities and welcome events, including our District IV networking event, providing a wonderful chance to meet peers and mentors from across the country. Saturday offered a rich array of sessions highlighting both advances in neonatal care and the broader challenges facing children and families. Highlights included sessions on neonatal neurocritical care (which announced changes to guidelines for cooling in the setting of HIE) and complex care navigation (which included an interesting talk on the potential impacts of Medicaid cuts). I also attended the TN Chapter’s Happy Hour, which provided a great opportunity for connecting with colleagues from across our state. It was especially exciting to see so many Tennessee pediatricians represented among the national speakers. Presentations from colleagues such as Dr. Trent Rosenbloom (AI and informatics in pediatrics), Dr. Buddy Creech (vaccine innovation), Dr. Toni Whitaker (special education advocacy), Dr. Regan Williams (firearm injury prevent forum) and many others highlighted the tremendous leadership and expertise coming from our state. Attending NCE not only strengthened my clinical knowledge but also was an excellent opportunity to expand my professional network and meet with passionate pediatricians from across the country. I’m already looking forward to next year’s AAP National Conference, which will be held in San Diego in October 2026, and I hope to see many of you there." --- ## Home URL: https://tnaap.org/ # Tennessee's Voice for Children & Pediatricians Tennessee Chapter of American Academy of Pediatrics is a statewide professional membership & child advocacy organization dedicated to the health, safety, and well-being of infants, children, and adolescents. ## Tennessee AAP Highlights ### 2026 Member Mixers Catch up with colleagues at our gatherings across the state. View Calendar ### Tennessee State Pediatric Conference Join us in Franklin, TN on August 14 & 15 for our annual conference and Excellence in Pediatrics Awards. More Info ## Tennessee AAP Programs BEHIP training provides pediatric healthcare providers with tools to screen, assess, and manage patients with emotional, behavioral and substance abuse concerns. START helps pediatric care providers learn skills and strategies to implement routine screening using standardized screening tools as part of their health care procedures. EPSDT & Coding provides training to help improve the quality of preventive health screens and can assist with pediatric coding issues through various resources and services. Quality Improvement Initiatives support practices in collecting high-value metrics on their patient population & assists with quality improvement efforts to assure the best health outcomes. --- ## Oral Health URL: https://tnaap.org/programs/epsdt-coding/oral-health/ # Oral Health Despite major efforts in recent years, oral health disease still poses a significant health threat to many children. Because pediatricians and other child health professionals are more likely to encounter new parents and infants, it is essential that they be aware of early childhood dental caries risk and preventive strategies to make appropriate decisions about timely and effective intervention. Many of the eligible children in Tennessee are not accessing dental services as needed. Physicians have a unique opportunity to help increase services. ### Current Recommendations Types of training assistance include: • Dental risk assessments and referrals are recommended for every child in accordance with the periodicity schedule. • Risk assessment performed at 6 and 9 months. • Referral to a dental home 6 months after the eruption of the first tooth or no later than 12 months, if available. Otherwise assess at 12, 18, 24 and 30 months. • If the primary water source is deficient in fluoride, consider oral fluoride supplementation. • Referral to dental home if one has not been established at 3 and 6 years. • If medically necessary, a child may be referred at any age. • Documentation of dental inspection, referral and education must be documented in the medical record. • Dental Risk Assessment Questionnaire ### TennCare Dental Screening and Fluoride Varnish Program - DentaQuest • What you need to know…Fluoride Varnish in a Medical Setting Brochure • Enrollment Process • Medical Provider Contact Information Form • Fluoride Varnish Ordering Information For questions on the Dental Screening and Fluoride Varnish Program, contact DentaQuest at 1-800-233-1468 or visit the  DentaQuest website . ### Locating a TennCare Dentist Dental Benefits for TennCare are provided by DentaQuest. To locate a TennCare dentist members or providers may call DentaQuest: • Customer Line: 1-855-418-1622 • Provider Line: 1-855-418-1623 • A formal referral is not necessary. ### Oral Health Resources • AAP – A Pediatric Guide to Children’s Oral Health Reference Guide • AAP - Oral Health Risk Assessment Timing and Establishment of the Dental Home (2003, reaffirmed in 2009) • AAP - Preventive Oral Health Intervention for Pediatricians (2008) • Campaign for Dental Health • Dental Partnership Agreement EPSDT & Coding Overview EPSDT & Well Child Visits Coding Resources Immunizations Oral Health Other Resources Developmental/Behavioral Health Screening Tools --- ## Other Resources URL: https://tnaap.org/programs/epsdt-coding/other-resources/ # Other Resources ### Care Management • Care Plan Oversight Worksheet • Chronic Care Management Worksheet • Pediatric Care Plan ### Prevention and Management • Anemia Prevention and Management • Dyslipidemia Prevention and Management ### Brochures TennCare Kids Brochures • TennCare Kids Brochure  (English & Spanish) Car Seat Brochures • TNAAP Child Car Seat Brochure (New - 2014)  (English) • TNAAP Child Car Seat Brochure (New - 2014)  (Spanish) Bike Helmet Brochures • TNAAP Bike Helmet Brochure (New - 2014)  (English) • TNAAP Bike Helmet Brochure (New - 2014)  (Spanish) EPSDT & Coding Overview EPSDT & Well Child Visits Coding Resources Immunizations Sports Physicals Oral Health Other Resources Developmental/Behavioral Health Screening Tools --- ## Sports Physicals URL: https://tnaap.org/programs/epsdt-coding/sports-physicals/ # Sports Physicals • 5 th  Edition PPE Monograph - AAP • Sports Physical/PPE History Form  (english) • Sports Physical/PPE History Form  (spanish) • Sports Physical/PPE Exam Form EPSDT & Coding Overview EPSDT & Well Child Visits Coding Resources Immunizations Sports Physicals Oral Health Other Resources Developmental/Behavioral Health Screening Tools --- ## Current News and Resources URL: https://tnaap.org/resources/blog/ # Current News and Resources ### A Pediatricians Role in Firearm Safety Learn More ### What You Should Know About the Updated Developmental Milestones Learn More ### TEIS: Early Intervention, Eligibility & How They Rely on You! Learn More ### Tennessee Pediatricians Support Universal Masking Learn More ### TNAAP Condemns Violent Behaviors Towards Medical Professionals Learn More ### COVID-19 Vaccinations and Universal Masking Learn More ### TNAAP Statement on Immunizations & Public Health Learn More ### MOC Part IV Opportunities with TNAAP and TRIAD Learn More ### COVID-19 Information and Resources Learn More ### 2020 Legislative Session Wrap Up Learn More ### Developmental Screening in our NEW NORMAL …. Learn More ### Getting Patients Back to the Office Learn More ### TEIS Updates Eligibility List! Learn More ### Brain Links Offers New Educational Tool Kit Learn More ### Schools Now Required to Test for Lead in Water Learn More ### FedEx Shipping for Newborn Screening Specimens Learn More ### Changes in UHC CLIA Policy Learn More ### Back to School Vaccine Reminders Learn More ### Important VFC Updates Learn More ### How TNAAP Is Working For YOU Learn More ### Summer Safety Learn More ### Summer Fun in Tennessee! Learn More ### 2018 Pediatric Practice Managers' Network Conference Learn More ### Tennessee Summer Food Service Program Learn More --- ## Education URL: https://tnaap.org/education/ # Education Your training didn’t end with residency! TNAAP provides opportunities to participate in educational programs focused on important areas of your practice, while also earning CME or MOC credits at no cost to you!! Visit each of the programs below for more information. We also offer CME and MOC at our  annual conference . BEHIP training provides pediatric healthcare providers with tools to screen, assess, and manage patients with emotional, behavioral and substance abuse concerns. PHiiT is a public-private partnership of organizations and individuals supporting the improvement of the physician-led clinical care for children in Tennessee. START helps pediatric care providers learn skills and strategies to implement routine screening using standardized screening tools as part of their health care procedures. EPSDT & Coding provides training to help improve the quality of preventive health screens and can assist with pediatric coding issues through various resources and services. --- ## Tennessee State Pediatric Conference Resources URL: https://tnaap.org/events/tennessee-state-pediatric-conference/resources/ # Conference Resources We are excited you are joining us for our annual Tennessee State Pediatric Conference (TSPC)!  View the Agenda Here! ### Friday, August 26: 5:00 - 7:30 | Embassy Suites, Franklin Happy Hour, Resident/Medical Student Posters & Pub Style Trivia • Poster Judging: 5:30 - 6:15 • Team Trivia: 6:30 - 7:30 ### Saturday, August 27: 7:30 am - 4:30 pm | Embassy Suites, Franklin ##### Slides for Sessions are posted below.  • Parent Engaged Developmental Monitoring Using CDC's New Developmental Milestone Checklists Toni M. Whitaker, MD, FAAP, Division Chief, Developmental Pediatrics, University of Tennessee Health Science Center Presentation Slides (pdf ) • Community-Acquired Pneumonia and the Case of Antimicrobial Stewardship Sophie Katz, MD, MPH, Associate Professor of Pediatrics, Infectious Diseases and Associate Director of Pediatric Antimicrobial Stewardship, Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center Presentation Slides (pdf ) • Articles that Could Change the Way You Practice: The Tennessee Edition Alex R. Kemper, MD, MPH, MS, Division Chief of Primary Care Pediatrics at Nationwide Children’s Hospital and Professor of Pediatrics at the Ohio State University College of Medicine and Deputy Editor of Pediatrics Presentation Slides (pdf) • The Crisis of Adolescent Mental Health: the Pandemic and Beyond Michelle Bowden, MD, FAAP, General Pediatrics and Adolescent Health Clinics, Le Bonheur Children’s Hospital & Associate Professor, The University of Tennessee Health Science Center Department of Pediatrics Presentation Slides (pdf)  • Seeing Spots: Rashes in Children Teresa Wright, MD, FAAD, FAAP, Division Chief, Pediatric Dermatology LeBonheur, Children’s Hospital; Associate Professor, Dermatology and Pediatrics, University of Tennessee Health Science Center Presentation Slides (pdf) ### CME and MOC Part II Information Upon completion of the webinar, participants will complete a 5 question quiz based on the content of the webinar as well as the CME Evaluation Form. Participants must successfully complete the post activity quiz with a minimum passing score of 70% or higher in order to receive MOC credit for this activity. CME Evaluation Form MOC Post Event Quiz ### Thanks to our Title Sponsors! ### Resident Poster Sessions TNAAP will post the winners from each category after they are announced on Saturday. Click here to view all the abstract submissions! --- ## Payer Advocacy - Pediatric Council URL: https://tnaap.org/advocacy/pediatric-council/ # Payer Advocacy - Pediatric Council TNAAP's Pediatric Council works with payers to facilitate better working relationships with pediatricians and health insurance plans and to improve the quality of care for children. The Pediatric Council is comprised of pediatricians, TNAAP's Executive Director, and TNAAP’s Coding Educator, who represent TNAAP members as a whole addressing important issues with payers. Over the last several years, the Pediatric Council has had success in negotiating change in reimbursement policies, negotiating coverage for services, and stopping recovery audits that were inappropriate. If you would like to participate in our Pediatric Council meetings or if your practice has concerns, suggestions or issues you would like the Pediatric Council to address, please let us know. Providing specific examples or scenarios is the most effective way for the Pediatric Council to address your concerns. Please note: The Pediatric Council is not a forum for joint contract negotiation, individual contract discussion or other fee-related concerns. ### To learn more about TNAAP’s Pediatric Council, please contact: Suzanne Berman, Pediatric Council Chair Email:  sberman@plateaupediatrics.com Janet Sutton, Pediatric Council Staff Email:  janet.sutton@tnaap.org Phone: (615) 447-3264 --- ## Privacy Policy URL: https://tnaap.org/privacy-policy/ # Privacy Policy Welcome to the Tennessee Chapter of American Academy of Pediatrics website available at "http://www.tnaap.org" (this "Site"). This Statement discloses the Privacy Policy (this "Policy") for this Site and describes how we collect, protect and use information we receive from visitors to our Site.Tennessee Chapter of American Academy of Pediatrics has created this Policy in order to demonstrate and inform you of our firm commitment to privacy. 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If you are a California resident and request information about how to exercise your third party disclosure choices, please send a request to info@tnaap.org with a preference on how our response to your request should be sent. ## Modifications to Privacy Policy Tennessee Chapter of American Academy of Pediatrics may modify this Policy at any time, at its discretion, and modifications are effective upon being posted on this Site. You are responsible for reviewing this Policy periodically to ensure that you are aware of any changes to it. ## Account Revisions, Revoking & Deleting Personal Information We welcome your questions, comments and all feedback pertaining to your privacy or any other issue with regard to this Site. At any time, you may ask us to cease further use of your email address to send you correspondence, and direct us to delete any Personally Identifiable Information you have supplied. Although it is not always possible to remove or modify such information, we will make reasonable efforts to do so. If you have given us information for one of those third parties we mentioned above and we have already passed it on, we may not be able to delete or change the information. In the event that you have given us Personally Identifiable Information in the past and then have second thoughts or want to update it, or if you have any other questions regarding this Policy or this Site, you may contact us at: Tennessee Chapter of American Academy of Pediatrics P.O. Box 159201 Nashville, TN 37215-9201 info@tnaap.org Phone: (615) 383-6004 --- ## Contact URL: https://tnaap.org/about/contact/ # Contact Us Tennessee Chapter of American Academy of Pediatrics P.O. Box 159201 Nashville, TN 37215-9201 Phone:  (615) 383-6004   Email:  info@tnaap.org --- ## TennCare Redetermination URL: https://tnaap.org/resources/tenncare-redetermination/ ### #### A policy that kept individuals continuously enrolled in TennCare during the COVID-19 public health emergency ended on March 31, 2023. Background: In January 2020, the U.S. Department of Health and Human Services (HHS) issued a Public Health Emergency due to the spread of Covid-19 in the United States. During the Emergency, the annual renewal process and most Medicaid terminations were suspended. On December 23, 2022, Congress set April 1, 2023 as the end of the continuous enrollment requirement and the beginning of Medicaid and Children’s Health Insurance Program renewals. State and federal law requires TennCare to resume the renewal process. TennCare is working with health plans (Managed Care Organizations), community partners, and TennCare providers to ensure that members receive accurate information during this time. The approach is informed by Center for Medicare & Medicaid Services (CMS) guidance. The most important step patients can take is to make sure their contact information is updated on their TennCare Connect account. TennCare will use this information to automatically renew coverage or contact patients if additional paperwork is needed.  Resources: • TennCare Renewals homepage • TennCare toolkit for partners (includes sample phone/website/email messaging) • TennCare information for patients • Sample reminder letter for patients • Tennessee Justice Center social media graphic ( English , Spanish ) • Tennessee Justice Center "Is it your turn?" graphic ( English ) • AAP quick guide on Medicaid unwinding • AAP homepage on Medicaid unwinding • AAP state advocacy webinar on Medicaid unwinding • Georgetown 50 State Unwinding Tracker --- ## COVID-19 Information and Resources URL: https://tnaap.org/resources/covid-19-information-and-resources/ This page has been archived as of April 2023. Please visit https://publications.aap.org/aapnews/news/1362/COVID-19-pandemic for the latest guidance. # COVID-19 Resources For Physicians In order to better help providers and staff we are keeping up-to-date information, resources, and recommendations on this webpage. We are also sending emails out as needed with up-to-date or urgent information to all current members.  If you are not a member, please join now and support all the chapter's hard work! ### Resources to Share with Patients • Parent Informational Handout  (pdf) • Social Media Tool Kit Click to download Click to download Click to download Click to download ### Updated Interim COVID-19 Guidance (September 27, 2021) • New : O utpatient COVID-19 Management Strategies in Children and Adolescents • New :  Caring for Patients in Inpatient and Outpatient Settings During Episodes of Surge • Updated :  Providing Acute Care in the Ambulatory Setting During the COVID-19 Pandemic ### AAP COVID-19 Vaccine Resources • COVID-19 Vaccine: What Pediatricians Can Do Now • COVID-19 Vaccine Implementation in Pediatric Practices • COVID-19 Vaccine Administration: Getting Paid • Considerations for COVID-19 Vaccination Cinics Through Pediatric Practices • About the COVID-19 Vaccine: Frequently Asked Questions • Becoming a COVID-19 Vaccinator Video Series • Children and COVID-19 Vaccination Trends • The Science Behind COVID-19 Vaccines: Parent FAQs ### COVID-19 Vaccine Webinars • COVID-19 Vaccine for Children: What We Know   - In this webinar internationally-recognized expert in vaccinology, Dr. Kathryn M. Edwards reviews all the latest information on the COVID-19 vaccine for children. • Facts Over Fear: Preparing for the COVID Vaccines Across Tennessee   - This course addresses four COVID-19 vaccines and aims to put healthcare professionals in a position to confidently administer and discuss these vaccines with patients and offers FREE CME. • Vaccine Distribution Information Town Hall with Tennessee Non-Profits  - Join Dr. Michelle Fiscus for a webinar on the COVID-19 vaccine and Tennessee's distribution plan. This recorded session includes information on how the COVID-19 vaccine was developed, the safety and efficacy of the available vaccines, the development and implementation of TN's vaccine distribution plan, and how you can help increase vaccination rates. • Infection Prevention and Control  - CDC's Project Firstline provides evidence-based infection prevention and control training. These brief (roughly five minute) modules are innovative, accessible, and designed for every single person who works in a healthcare setting. ### TNAAP Back to the Office Campaign We have created a series of resources practices can use to help encourage patients to come back to the office. These tools include social media graphics, sample letters, phone scripts and more! Click the link below to view the tool kit. Back to Office Toolkit ### Telehealth Resources TNAAP Telehealth Coffeetalk Webinar -  AAP telehealth experts joined TNAAP for an interactive webinar. The webinar provides guidance on how to implement telehealth, including the technology that can be used, tips for workflow, how to get parents and patients on board and information on how to code and bill for these services for payers in Tennessee. TNAAP Tennessee Telehealth Coding Guidlines by Payer- Click to Download TNAAP Tennessee Telehealth Coding Guidlines by Payer- Click to Download • TennCare Extends Telehealth Through June 30, 2021 • TNAAP COVID-19 Telehealth Coding Guidance (pdf) • Behavioral Health Telehealth Services for TennCare Enrollees - Novel COVID-19 (pdf) • TennCare MCO COVID-19 Telehealth and Dx Testing Update (pdf) • AAP Webinar on Telehealth and COVID-19 (Video) • AAP Guidance: Telehealth Payer Policy in Response to COVID-19 (pdf) • AAP Coding for COVID-19 and Non-Direct Care (pdf) Small Business Guidance for Pediatric Practices - Click here to download ### Medicaid Resources • COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies • Trump Administration Releases COVID-19 Checklists and Tools to Accelerate Relief for State Medicaid & CHIP Programs • Medicaid Telehealth Services • CMS COVID-19 Partner Toolkit ### HHS Resources • Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency • Telehealth FAQs ### Other Coronavirus (COVID-19) Resources • TN Department of Health • Centers for Disease Control and Prevention • American Academy of Pediatrics • Le Bonheur -  University of Tennessee Health Sciences Center • Niswonger - East Tennessee State University – Ballad Health • Monroe Carrell, Jr. - Vanderbilt University Medical Center --- ## Endowment Fund URL: https://tnaap.org/endowment-fund/ ## Tennessee Chapter of the AAP Endowment Fund ## Established 2020 ## Creating a Legacy for Future Pediatricians The TNAAP Endowment Fund will help fulfill TNAAP’s mission by supporting its long-term educational, advocacy and quality improvement programs. Contributions to the endowment also support the chapter over the long-term by increasing future annual distributions for tomorrow’s pediatricians. The fund was established by Stuart T. Weinberg, MD and is managed by The Community Foundation of Middle Tennessee . ## Endowment Contributors as of April 15, 2023: Ruth Allen✝ Deanna Bell, MD✝ Blake Bergeron, MD Suzanne Berman, MD*✝ Becky Brumley✝ Hunter Butler, MD* Miranda Butler, MD* Barbara Dentz, MD* Gayatri Jaishankar, MD✝ Elisha McCoy, MD✝ Anna Morad, MD*✝ Dorothy Sinard, MD* Carlenda Smith, MD✝ Lindsey Wargo, MD✝ Stuart Weinberg, MD*✝ Toni Whitaker, MD Jason Yaun, MD✝ ## * Major Donor - $1,000 or more ✝ Founding Donor in 2020 ## Annual Distributions:  Each July the TNAAP Executive Committee is informed of the current year's distribution amount from the Endowment Fund and is responsible for determining how to use those proceeds, which is announced at the Annual Meeting in the fall. Distributions from previous years have been used as follows: 2023 $ 2,188 Sponsoring resident or early career physician to attend AAP's 2023 National Conference and Exhibition. ( Click here for application ) 2022 $ 1,269 Provided a stipend to a resident to attend the AAP National Conference and Exhibition. 2021 $ 400 Funded a two-part (free) Media Training Opportunity for TNAAP Members during 2022 ## ## How to Contribute: Individuals interested in supporting the TNAAP Endowment Fund can donate online using the Community Foundation of Middle Tennessee's donation form or TNAAP's online donation form . --- ## Project Echo URL: https://tnaap.org/education-project-echo/ #### TNAAP currently hosts three ECHO projects, bringing together health professionals for peer-to-peer learning and advancement. https://www.youtube.com/watch?v=Faz3O1clDMU&t Project ECHO (Extension for Community Healthcare Outcomes) is an innovative telementoring program designed to create virtual communities of learners by bringing together healthcare providers and subject matter experts using videoconference technology, brief lecture presentations, and case-based learning, fostering an “all learn, all teach” approach. Participants are engaged in the bi-directional virtual knowledge network by sharing clinical challenges and learning from experts and peers. Project ECHO has been recognized globally as a successful tool to improve patient care outcomes. Unlike telemedicine, this tele-mentoring model does not foster a health care provider and patient relationship. ECHO follows these four key principles: 1. 2. 1. 3. 2. 1. ###### Subscribes to the disease management model of care that aims to improve quality, reduce variety, and standardize best practices. 4. 3. 2. ###### Fosters multidisciplinary partnerships that increase access to care and reduce health care costs. 5. 4. 3. ###### Engages health care providers to participate in case‐based learning under guided practice to provide specialized care to their own patients. 6. 5. 4. ###### Utilizes technology to promote face-to-face mentorship and sharing of knowledge and experience by experts and peers without the need for cost-intensive supervision, in-person trainings, and travel. ## Current ECHO Projects --- ## Calendar URL: https://tnaap.org/events/calendar/ # Calendar --- ## MATE / DEA Training URL: https://tnaap.org/education/mate-dea-training/ Prescribers with a DEA license must now complete eight hours of education on the treatment and management of patients with substance use disorders before applying for, or renewing, a DEA registration. This new training requirement is part of the Medication Access and Training Expansion (MATE) Act. The Tennessee Medical Association and Tennessee Chapter of the American Academy of Pediatrics have launched a new course for prescribers that fulfills the new DEA education requirement . What sets this offering apart from others is its applicability to all Tennessee prescribers. The cost of the course is $299. However, the special discounted rate of $249 is available exclusively through this partnership by using the code TN50 during registration. Not only will the course meet the DEA’s training requirement, but it will also satisfy the Tennessee licensing boards’ requirement for prescribers to complete a two-hour course on prescribing practices. You may  use this link  to access the course registration page. Please remember, you must use code TN50 to receive the discounted course rate of $249. Register for MATE Course An FAQ document resource is available at  tnmed.org/mateactfaq . Any additional questions may be directed to  legal@tnmed.org . --- ## BeHiP 101 URL: https://tnaap.org/programs/behip/behip-101/ # BeHiP 101 This 3-hour office-based, physician-led training is designed for pediatric providers serving children in Tennessee with behavioral health concerns. This training session is facilitated by a board-certified pediatrician that will offer tools and strategies to screen for, assess, and manage patients with emotional, behavioral and substance abuse concerns. The curriculum will cover topics such as trauma-informed care, ACEs, PCEs, use of screening tools, office-based interventions, psycho-pharmacology, coding and more! This training is applicable to the entire clinical team as it aimed to improve care coordination, communication, and the overall workflow for these patients. Trainings are scheduled when it’s convenient for you and are provided at no cost. We also offer BeHiP QI opportunities for providers to obtain MOC Part IV. #### BeHiP Provider Incentive Program: TNAAP’s BeHiP 101 training program offers an associated incentive program for providers to participate in the training!  Practices who enroll will receive a minimum of $1,500 per practice for participation in a training (as funding allows).  Incentives are based on a sliding scale with larger practices being eligible for additional incentive payments based on the number of providers (identified as MD, PA and NP). BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screener Tools ### BeHiP 101 Contact Information Grace Mayberry BeHiP Training Coordinator grace.mayberry@tnaap.org Co-Medical Directors, BeHiP Program: Tim Fuller, DO, FAAP Michelle Bowden, MD, FAAP --- ## BeHiP: TCAPES URL: https://tnaap.org/programs/behip/tcapes/ # TCAPES – Mental Health Access Line TCAPES (Tennessee Child and Adolescent Psychiatry Education and Support) is partnering with the Tennessee Chapter of the American Academy of Pediatrics to expand its Behavioral Healthcare in Pediatrics training program. TCAPES is a program that supports the integration of mental health care into pediatric primary care. TCAPES will help address the increasing behavioral health needs of children and adolescents and the mental health provider shortages in Tennessee.  TCAPES is funded by the Health Resources and Services Administration, or HRSA.  This program will provide pediatric Primary Care Providers in Tennessee, with training on screening and management of behavioral health conditions, assistance in finding community resources and access to pediatric and adolescent psychiatry consultation services through same day telephone consultation. About TCAPES (tn.gov) Mental Health Access Line Flyer TCAPES ECHO 2025 BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP TCAPES Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Medical Director, BeHiP TCAPES Program Michelle Bowden, MD, FAAP --- ## COVID-19 Vaccinations URL: https://tnaap.org/programs/tnaap-immunization-program/covid19vaccination/ # COVID-19 Vaccinations #### AAP COVID-19 Homepage #### Current Vaccine Dosing Guide #### AAP COVID-19 Digital Promotions #### Vaccine Picture Story for Kids Program Overview ECHO Project Quality Improvement Project Staff Training Modules Resources and Toolkits COVID-19 Vaccinations --- ## Partnership and Engagement URL: https://tnaap.org/partnershipengagement/ ## Partnership and Engagement #### The Tennessee chapter of the American Academy of Pediatrics is committed to providing equitable and inclusive care to the diverse patient population across our state so that every child and adolescent may achieve optimal health and well-being.  Please see below for resources and reading lists that may be helpful to you. If you have any suggestions or feedback, please email maya.neeley@vumc.org   #### Resource List: The Impact of Racism on Child and Adolescent Health Providing Care for Children in Immigrant Families Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents Necessary Conversations: Understanding Racism as a Barrier to Achieving Health Equity AAP Racial Equity Course (free to members) Health Equity for Children with Special Health Needs The Intersection of Race, Racism, and Child Health Microaggressions Overcoming Asian and Pacific Islander Racism Infant Mortality in Rural Areas, Structural Inequities ( Additional Reading Here ) Office-based care for LGBTQI youth Discrimination and the role of the clinician Eliminating Race Based Medicine Bright Futures Health Equity Resources   #### Healthy Children has a number of articles helpful for both practitioners and patients/families, see examples below: • Talking with children about racism • Talking with children about bias • Understanding gender identity development • Inclusive books for children   #### Reading List: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, the Institute of Medicine Bad Blood: The Tuskegee Syphilis Experiment, James Jones Citizen, An American Lyric, Claudia Rankine A Disability History of the United States, Kim Nielsen Belonging: the Key to Transforming and Maintaining Diversity, Inclusion, and Equality at Work, Sue Unerman Invisible Women, Caroline Criada-Perez The Warmth of Other Suns, Isabella Wilkerson How to Survive a Plague, David France The Health Gap, Michael Marmot --- ## Staff URL: https://tnaap.org/about/staff/ # Our Staff ### Ruth E. Allen TNAAP Executive Director Send Email ### Becky Brumley, RDH, MPH Program Director/Quality Coach Send Email ### Sara Chang Communications Manager Send Email ### Ned Dannenberg Communications Coordinator Send Email ### Melissa Koffman Financial Manager Send Email ### Grace Mayberry, MSSW Training Coordinator (BeHiP) Send Email ### Susan Rollyson, M.Ed Program Manager (START) Send Email ### Amber Stroupe, MBA Program Manager (BeHiP) Send Email ### Janet Sutton, RHIT, CPC Program Manager (EPSDT & Coding) Send Email ### Trudy Williams Practice Management QI Coach Send Email --- ## Training Modules URL: https://tnaap.org/programs/tnaap-immunization-program/staff-training-modules/ # Training Modules #### WATCH: TennIIS Usage for 2025 ###### Held January 16, 2025 Featuring a live demonstration from David Baron, BSN, RN, Clinical Applications Coordinator with Vaccine-Preventable Diseases & Immunization Program at Tennessee Department of Health ######   #### WATCH: Coding for Immunizations ###### Held March 20, 2025 Featuring Janet Sutton, CPC, RHIT EPSDT and Coding Program Manager at TNAAP #### WATCH: Improving HPV Vaccination Coverage ###### Held September 26, 2024:  Featuring Heather M. Brandt, PhD, Director of HPV Cancer Prevention Program at St. Jude Children’s Research Hospital and co-associate director for outreach at St. Jude Comprehensive Cancer Center #### WATCH: Social Media Strategies for Vaccine Communication ###### Held September 19, 2024 Featuring Beth Sundstrom, PhD Associate Professor, Director of the Women’s Health Research Team, College of Charleston #### WATCH: Starting a Flu Vaccination Drive-Thru ###### Held August 22, 2024 Featuring program medical director Catherine Wiggleton, MD, FAAP #### WATCH: Preparing for Fall Flu Season ###### Held July 25, 2024  Featuring Dr. Barron Patterson, general pediatrician and faculty member in the Division of Academic General Pediatrics at the Monroe Carell Jr Children’s Hospital at Vanderbilt.  #### Download: Coding for Immunizations ###### Presented May 23, 2024 by Janet Sutton, CPC, RHIT EPSDT and Coding Program Manager at TNAAP #### WATCH: Vaccine Hesitancy in 2024 ###### Held April 25, 2024 Featuring Jennifer C. Erves, PhD, MPH, Director of Community Engaged Research in the Office of Health Equity at Vanderbilt University Medical Center ####   #### WATCH: Quality Improvement in Your Practice ###### Held March 28, 2024 Featuring program director and quality coach Becky Brumley, and program medical director Catherine Wiggleton, MD, FAAP ####   #### WATCH:  Improve Your Clinic's TennIIS Game ###### Held March 21, 2024 Featuring a live demonstration from David Baron, BSN, RN, Clinical Applications Coordinator with Vaccine-Preventable Diseases & Immunization Program at Tennessee Department of Health #### WATCH:  Declining Childhood Immunizations in 2024 ###### Held February 22, 2024 Featuring Caitlyn Newhouse, MD, FAAP, Medical Director Vaccine-Preventable Diseases & Immunization Program at the Tennessee Department of Health, and Catherine Wiggleton, MD, FAAP #### WATCH: Flu to You: Efforts  to Improve Vaccine Rates ###### Held August 24, 2023 Featuring Dr. Barron Patterson, general pediatrician and faculty member in the Division of Academic General Pediatrics at the Monroe Carell Jr Children’s Hospital at Vanderbilt.  ####   #### WATCH: Motivational Interviewing ###### Held July 27, 2023 Featuring Sayward Harrison, PhD, a Health Psychologist and Assistant Professor in the Department of Psychology at the University of South Carolina, and Dr. Laura Fish, PhD, MPH, an Assistant Professor in Family Medicine and Community Health at Duke University School of Medicine. ####   #### WATCH: Lessons Learned & Successes from Managers ###### Held April 20, 2023  ####   #### WATCH: Social Media Strategies for Vaccine Communication ###### Held March 16, 2023 Featuring Beth Sundstrom, PhD Associate Professor, Director of the Women’s Health Research Team, College of Charleston #### WATCH: Improving Vaccine Confidence ###### Held February 16, 2023  Featuring Sean O’Leary, MD, MPH, Professor of Pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado, and AAP Chair on the Section of the Red Book committee #### WATCH: TENNIIS Reminder Recalls and Coverage Reports ###### Held January 19, 2023 Featuring Joseph Granato, Director, Program Effectiveness, Vaccine Preventable Disease Immunizations Program at Tennessee Department of Health #### WATCH: Keeping Your Cool: Training for Safe Vaccine Handling ###### Held December 15, 2022 #### WATCH:  Being a Vaccine for Children Provider: A Sound Investment for Your Practice ###### Held May 27, 2021 Featuring Suzanne Berman, MD, FAAP Program Overview Quality Improvement Project Training Modules Resources and Toolkits COVID-19 Vaccinations --- ## EPSDT & Well Child Visits URL: https://tnaap.org/programs/epsdt-coding/epsdt-well-child-visits/ # EPSDT & Well Child Visits ### Periodicity Schedule Periodicity Schedule   ### Interperiodic Screening Medicaid Guide (See pages 4-5) ### TNAAP EPSDT Coding Guide TNAAP EPSDT Coding Guide ### Well Child Forms Complete Set of Age Specific Encounter Forms ### Lead Screening • TN Lead Screening and Testing Guidelines • Lead Risk Assessment Questionnaire (English) • Lead Risk Assessment Questionnaire (Spanish) • Lead Reporting Instructions • TN Statewide Lead Screening Plan ### Risk Assessments Dental Risk Assessment Questionnaire ### EPSDT Resource Links to Other Sites American Academy of Pediatric Resources • American Academy of Pediatrics (AAP) - Home • AAP - Achieving Bright Futures Coding Documents • AAP – Developmental Behavioral Pediatrics • AAP - Immunizations • AAP – Medical Home • AAP - Oral Health • Bright Futures TennCare Resources • TennCare - Home • TennCare Kids • TennCare Managed Care Organizations (MCOs) TennCare Appeals • TennCare Eligibility Appeal  • TennCare Medical Appeal Form • TennCare Services Appeal Other Resources • TennCare Kids Brochure (English and Spanish) • Center for Disease Control • Centers for Disease Control – Lead • Center for Medicare/Medicaid Services • DentaQuest EPSDT & Coding Overview EPSDT & Well Child Visits Coding Resources Sports Physicals Oral Health Immunizations Other Resources Developmental/Behavioral Health Screening Tools --- ## BeHiP Overview URL: https://tnaap.org/programs/behip/behip-overview/ # Behavioral Health in Pediatrics The Tennessee Chapter of the American Academy of Pediatrics developed the Behavioral Healthcare in Pediatrics (BeHiP) training program with various partners. BeHiP training provides pediatric healthcare providers with tools and strategies to screen for, assess, and manage patients with emotional, behavioral and substance abuse concerns. It also encompasses strategies to provide for more efficient workflow (including information on coding), more effective care, and improved family and physician relationships. Download BeHiP Overview Flyer BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP Team Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Grace Mayberry BeHiP Training Coordinator grace.mayberry@tnaap.org Co-Medical Directors, BeHiP Program: Tim Fuller, DO, FAAP Michelle Bowden, MD, FAAP --- ## Additional Resources URL: https://tnaap.org/programs/behip/resources/ # Additional Resources Life-threatening situations: Dial 9-1-1 National Suicide Prevention Lifeline: Call or Text 9-8-8 Anxiety Algorithm: Assessment and Management Recommendations for PCPs ##### Tennessee Resources: Department of Mental Health and Substance Abuse Services Department of Health Suicide Prevention Tennessee Crisis Services for Children and Youths Tennessee Suicide Prevention Network NAMI-TN Tennessee Voices for Children ##### National Resources: Suicide Prevention Resource Center OCD (Obsessive Compulsive Disorder) Foundation Rethinking Drinking: Alcohol and Your Health (NIH) The Parents Toll-Free Helpline  (Text your message to 55753) BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP Team Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Grace Mayberry BeHiP Training Coordinator grace.mayberry@tnaap.org Co-Medical Directors, BeHiP Program: Tim Fuller, DO, FAAP Michelle Bowden, MD, FAAP --- ## Immunization Project URL: https://tnaap.org/programs/qi/projects/immunization-project/ # Immunization Project ## Background According to information from the Tennessee Department of Health In 2020, there were almost 140,000 fewer doses of childhood vaccines administered to children aged 24 months or less than in 2019. In 2021, there were almost 80,000 fewer doses of childhood vaccines administered to children aged 24 months or less than in 2020. Between 2019 and 2021, almost 220,000 (13.6%) fewer doses of childhood vaccines have been administered to Tennessee Children. This places Tennessee children severely behind on vaccinations, as to achieve catch-up doses of missed routine vaccinations, children must sustain or increase the number of weekly doses received to that of pre-pandemic counts. Black children were less likely to be fully immunized for all twelve of the recommended CDC vaccinations and statistically significantly less likely to receive DTaP, HIB, 4:3:1:FS:3:1:FS, Flu, and RTV compared to their white peers. Only 66.1% of black children were properly immunized with RTV vaccine compared to 78.9% of white children, and 35.0% of black children were immunized against influenza compared to 58.3% of white children. Tennessee has had poor uptake of COVID-19 in all age groups. According to CDC data and data from the state immunization registry (TennIIS) Tennesseans with at least one dose is currently at 59.5% of the total population compared to the national average of 76.1%. Tennesseans fully immunized is currently 52.6% of the total population compared to 64.7%. Primary care practices face as uphill battle to increase childhood immunization rates and to promote COVID-19 vaccines to children now that COVID-19 vaccines have been approved for children 6 months of age and older. Practices need educational support, resources for vaccine promotion and support to promote evidence-based process changes that can assist to increase all immunization rates. ## Project Aim Increase the percent of children and adolescents who have all the Bright Futures recommended vaccines by the appropriate age according to HEDIS measures identified as Combo 10 and Combo 2 by 5% over a 9–12 month period. Increase the percent of adolescents who have all the Bright Futures recommended vaccines before their thirteenth birthday: meningococcal vaccine, 1 Tdap vaccine, and at least 2 HPV vaccines on or before their thirteenth birthday. (Combo 2) by 5% over a 9-12 month period. Immunization Project Summary Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects For Your Practice --- ## Previous Projects URL: https://tnaap.org/programs/previous-projects/ # Previous Projects Please note these projects are not currently active and do not have current video education. ### Breastfeeding Sustainment The pediatrician’s role in advocating and supporting proper breastfeeding practices is essential to improve outcomes for both newborn and mother. Currently Tennessee newborns have poor breastfeeding success rates. In Tennessee, only 15.4% of mothers are exclusively breastfeeding at 6 months. This project assisted practices in identifying, implementing and maintaining process changes regarding breastfeeding support. Click here for the full Breastfeeding Sustainment project summary . #### Tools: • Breastfeeding Basics Handout • Breastfeeding Basics Handout (Spanish) ### Newborn Tobacco Exposure Reduction Both clinicians and the public tend to underestimate the effects of tobacco use and exposure on pregnancy and human development, though the science is now clear.  Pre-term and underweight births are more likely to result from tobacco use than alcohol, marijuana or harder drugs. We also know that 20% of children have at least one smoking parent. Tobacco use by caregivers represents a major modifiable risk factor for multiple poor health outcomes.  We know that pregnancy and the immediate post-partum period are a time of high motivation to alter tobacco use. This project assisted practices in identifying, implementing and maintaining simple steps to assess newborns tobacco exposure and increase the rate of caregivers that decrease tobacco exposure to improve health outcomes of their children. Click here for the full Tobacco Exposure Reduction project summary . #### Tools: • Tobacco Exposure Screening Tool • 7,000 Chemicals Handout • CEASE Bee Flyer • CEASE Car Flyer • I am not ready to Quit Smoking • I am not ready to Quit Smoking (Spanish) • Tobacco Pediatric Office Policy Sample ### Asthma This educational and practice improvement project was designed for primary care providers. This project presented, incorporated and sustained the use of high-value, chronic-care management processes for asthma. These key processes included: • Timely and scheduled chronic-care visits that mirror the trigger pattern for patients, • Appropriate use of inhaled corticosteroids in persistent asthmatics, • Updated asthma action plans, • Regular asthma control testing, • Annual spirometry, • Tobacco exposure reduction and Influenza prevention. Click here for the full Asthma project summary. #### Tools: • Asthma Management Authorization Form • Asthma Education Handout • Asthma Education Handout – Spanish   Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects For Your Practice ### To learn more, please contact Becky Brumley, RDH, MPH Program Director/Quality Coach Email:  becky.brumley@tnaap.org --- ## Immunization Program Overview URL: https://tnaap.org/programs/tnaap-immunization-program/immunization-program-overview/ # Immunization Overview Immunization rates and preventive care for children declined substantially during the pandemic. To assure patients get caught up on essential services, practices need effective strategies to mitigate barriers such as: • Identifying gaps in care • Improving strategies to get patients into the office • Increasing vaccine confidence of patients • Increasing workflow efficiency TNAAP has developed a number of resources to be of help: 1. Staff training modules 2. A QI project for the entire practice (offering MOC Part IV credit) 3. Additional associated resources Program Overview Quality Improvement Project Training Modules Resources and Toolkits COVID-19 Vaccinations --- ## Well Child URL: https://tnaap.org/programs/qi/projects/well-child/ # Well Child Project We know that well care is a fundamental component of the improving health of children over the last four decades.  “Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions, and that some services are also cost-effective 1 .”  In Tennessee, the rate of children participating in annual EPSDT screens has slowly declined from 64 percent in 2011 to 54 percent in 2016.  The rates are much lower in adolescent populations (40-50%) 2 .  The current system must be improved through practice collaboration or it will not be sustainable, effective or succeed in it’s current goals 3,4 . References 1 Maciosek, Michael V. "Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost."  Health Affairs  29.9 (2010): 1656-660. 2 CMS Form-416 Reporting,  https://www.medicaid.gov/medicaid/benefits/epsdt/index.html 3 Schor EL. Rethinking Well-Child Care. Pediatrics 2004;114: 210-216 4 Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:4 This project will assist ambulatory pediatric practices in improving annual, well care visit completion rates.  These rates will increase through the implementation and sustainment of several process changes. Click here for the full Well Child project summary. ## AIM To increase the percentage of children seen in office who are up to date on their last well check up by 5% for children ages 0-21 over the 6-12 month project. The evidence based process changes include: • Using practice billing data to identify active patients not completing annual well care • Create a monthly recall system • Assess the well child visit completion status at each acute visit • Scheduling next well care at each visit • Perform well care elements at acute visits • Other process developed by practice leadership • Annual learning collaborative session Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects --- ## START URL: https://tnaap.org/programs/qi/projects/newborn-tobacco-exposure-reduction-2/ # Screening Tools and Referral Project (START) According to the Centers for Disease Control, many children with developmental delays or behavior concerns are not identified as early as possible. As a result, these children must wait to get the help they need to do well in social and educational settings (for example, in school, at home, and in the community).In the United States, about 1 in 6 children aged 3 to 17 years have one or more developmental or behavioral disabilities, such as autism, a learning disorder, or attention-deficit/hyperactivity disorder. In addition, many children have delays in language or other areas that can affect how well they do in school. However, many children with developmental disabilities are not identified until they are in school, by which time significant delays might have occurred and opportunities for treatment might have been missed. Click here for the full Screening Tools and Referral project summary. ## AIM Increase screening for the identified developmental and behavioral health concern (developmental, ADD/ADHD, Autism, Depression or Substance Abuse) by 10% over a least a 6 month period using a validated tool. ## Education The Screening Tools and Referral Training can be offered in-person or virtually by pediatricians with special training in the screening tools and referral process. Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects --- ## Behavioral Health URL: https://tnaap.org/programs/qi/projects/behavioral-health/ # Behavioral Health Project (BeHiP) Mental Health is becoming a larger portion of primary care pediatrics. One in five children in the United States have emotional symptoms causing impairment. More than half of U.S. children (66%) experience a traumatic event by the age of 16. These children persistently suffer from chronic disease and will make up half of the adults with mental illness. This underscores the importance of screening and addressing these problems in early childhood and adolescence. It also points to the opportunity to impact change in childhood disease and prevent significant adult morbidity by improving our recognition and treatment in childhood. To learn more about the Behavioral Health program, please contact Grace Mayberry at  grace.mayberry@tnaap.org .  Click here for a full Behavioral Health Project Summary ## Special Focus: Foster Care Medical Home For children in the foster care system, mental and behavioral health is the largest unmet need.  Children in the foster care system have experienced at least one traumatic event, with most having multiple traumatic events.  These children also have a higher incidence of physical health problems, many of which are rooted in the adverse events they have experienced.  Ideally these children would have access to a well-trained, experienced mental health clinician.  However, the reality is that many communities lack mental and behavioral health providers for children.  In these cases, the primary care provider becomes the sole source of care.  As part of the PHiiT Behavioral Health Project, practices may choose to participate in a special project that focuses on caring for children in foster care.  Practices will be enrolled in the Behavioral Health in Pediatrics (BeHiP) Foster Care Learning Collaborative.  The Learning Collaborative and the PHiiT Foster Care Project, will bring together regional resources, the Department of Children’s Services, Centers of Excellence, and local pediatricians.  Through trainings and learning virtual learning collaborative sessions, these entities will learn from one another on how to provide the best care for foster care children, including appropriate trauma screening, medication management, and referral resources.  To learn more about the Foster Care program, please contact Amber Stroupe at  amber.stroupe@tnaap.org .  Click here for a full Behavioral Health Foster Care Project Summary. ## AIM The pediatric clinic will develop an office Quality Improvement Team to improve the screening, assessment and management of patients with behavioral health concerns in the pediatric practice as measured by monthly reporting of the team’s progress in QI Teamspace over the first 3 months of participation.  The pediatric practice will increase screening for the identified behavioral health concern (ADD/ADHD, Depression, Suicide, or Substance Abuse) and/or completion and documentation of recommended follow up planning by 10% over a 12-month period. ## Video Education • Behavioral Health in Pediatrics I Online Modules ## Tools • Behavioral Health Screening Tools • BeHiP Map the Workflow Document Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects --- ## Projects URL: https://tnaap.org/programs/qi/projects/ # Projects ## Introduction TNAAP's Quality Improvement projects are based on an Enhanced Medical Education format. State topic experts present the science in short, well-organized presentations that include a small number of high-value process changes for your practice to implement. Each practice collects a baseline data set and ongoing quarterly data to track progress over the course of the 6 to 12-month project. The goal is to demonstrate the successful short-term impact of process improvements. This impact can then be compared with costs incurred to provide a value assessment for further investment of each practice to sustain these process changes and develop future process improvement. ### Each project includes: • Maintenance of Certification (MOC) Part IV Credit • Enhanced Online Medical Education  • Quality Improvement Training • Metrics that are of high value to ambulatory pediatric care • Personalized reports of your practice’s progress • QI Team Training and Individual Practice Support ### Quality Improvement Tools • • • Structure of a QI Team   ### To learn more about TNAAP's Quality Improvement Program, please contact Becky Brumley, RDH, MPH Program Director/Quality Coach Email:  becky.brumley@tnaap.org Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects --- ## Quality Improvement Overview URL: https://tnaap.org/programs/qi/qi_overview/ # Quality Improvement Click here for a printable flyer version. Overview Projects Well Child START Behavioral Health Immunization Project Previous Projects ### To learn more about TNAAP's Quality Improvement Initiative, please contact Becky Brumley, RDH, MPH Program Director/Quality Coach Email:  becky.brumley@tnaap.org Trudy Williams Practice Management QI Coach Email: trudy.williams@tnaap.org --- ## Overview URL: https://tnaap.org/about/overview/ # Our Mission The Tennessee Chapter of the American Academy of Pediatrics is committed to being a leading voice, advocate and authority for the physical, mental and social welfare of infants, children and adolescents, as well as the pediatricians who care for them. View our 2025 Annual Report! ## Who is TNAAP? The Tennessee Chapter of the American Academy of Pediatrics is a 501-c-3 not for profit incorporated educational organization/professional society for pediatric providers. Our main office is in Nashville, TN, but our 10 staff members work across the state on various programs and initiatives. #### Educating Physicians Many of the member pediatricians participate as advisors, trainer educators, and members of state advisory committees on issues related to children’s health. The TNAAP educates physicians, parents, pediatric professionals and the public about the needs of children. The TNAAP accomplishes its mission through advocacy, education, quality improvement and practice support. In carrying out this mission, the TNAAP collaborates with state and local entities that touch the lives of children, including families, communities, media, public officials, insurers, and other advocacy groups. #### History The TNAAP has a 20+ year history of working in a public/private partnership with state government, state-wide and local nonprofit organizations, and foundations to meet the educational needs of pediatric professionals and the public as well as to accomplish public health goals. With our experienced staff, an established organizational infrastructure, and our expertise in medical education, the TNAAP strives to improve the health and well-being of Tennessee’s children and their families. --- ## Board URL: https://tnaap.org/about/board/ # Board Members ### Catherine Wiggleton, MD President Email Dr. Wiggleton ### Carlenda Smith, MD Immediate Past President Email Dr. Smith ### Tatanisha Smith, MD Vice President Email Dr. Smith ### Gayatri B. Jaishankar, MD Secretary-Treasurer Email Dr. Jaishankar ### James Antoon, MD Fellow-at-Large (Middle TN) Email Dr. Antoon ### Michelle Bowden, MD Fellow-at-Large (West TN) Email Dr. Bowden ### Stephanie Gorman, MD Fellow-at-Large (East TN) Email Dr. Gorman ### John Heise, MD Fellow-at-Large (East TN) Email Dr. Heise ### Nick Hysmith, MD Fellow-at-Large (West TN) Email Dr. Hysmith ### Maya Neeley, MD Fellow-at-Large (Middle TN) Email Dr. Neeley ### Karen Schetzina, MD Membership Chair Email Dr. Schetzina ## Ex-Officio Members ### Past Presidents (*deceased) • Carlenda Smith, MD (2024-2025) • Jason Yaun, M.D. (2022-2023) • Anna Morad, M.D. (2020-2021) • Deanna Bell, M.D. (2018-19) • Gail Beeman, M.D. (2016-17) • Michelle D. Fiscus M.D. (2014-15) • R. Allen Coffman, Jr., M.D. (2012-13) • Eddie D. Hamilton, M.D. (2010-11) • John R. Hill, M.D. (2008-2009) • Quentin A. Humberd, M.D. (2006-07) • David K. Kalwinsky, M.D. (2004-2005) • John C. Ring, M.D. (2002-2003) • Joseph F. Lentz, M.D. (2000-2001)* • Iris G. Snider, M.D. (1998-1999)* • Russell W. Chesney, M.D. (1995-97)* • Harold F. Vann, M.D. (1992-94)* • Hays Mitchell, M.D. (1989-91) • Bobby C. Higgs, M.D. (1986-88) • Luthur A. Beazley, M.D. (1983-85)* • George A. Zirkle, Jr., M.D. (1980-82)* • Walton W. Harrison, M.D. (1977-79)* • Felix G. Line, M.D. (1974-76)* ### Pediatric Department Chairs • Xylina D. Bean, MD, Meharry • William Basco, MD, UT Chattanooga • Terri Finkel, MD, PhD, UT Memphis • Suzanne Rybczynski, MD, UT Knoxville • Juan Salazar, MD, MPH, Vanderbilt • Dawn Tuell, MD, MPH, ETSU --- ## TNAAP Board Meetings URL: https://tnaap.org/events/tnaap-board-meetings/ # TNAAP Board Meetings The TNAAP Board of Directors is comprised of 25-30 pediatricians (15-20 of which are voting members) representing geographic distribution, pediatric academic centers, local pediatric societies, and more. The Board meets 3 to 4 times per year, typically in the centrally located city of Nashville. While all committee members and others holding volunteer leadership positions within TNAAP are invited to each meeting, all meetings are open to any TNAAP member. ## 2026 Meetings • January 24: Virtual Meeting • May 2:  Hybrid Meeting • August 14: Cool Springs Hilton in conjunction with Tennessee State Pediatric Conference  held in Franklin, TN. ### Sponsor a Board Meeting! Our 2026 Board Meeting Sponsorship is FULL. Please sign up to sponsor a meeting in 2027. These meetings are a great opportunity to get that often hard-to-find presentation time in front of our pediatricians.  ### Thank you to our Sponsors: --- ## TNAAP Publications URL: https://tnaap.org/resources/tnaap-publications/ # TNAAP Publications ### TNAAP Brief TNAAP's monthly electronic newsletter. • January 2025 • December 2025 • November 2025 • October 2025 • September 2025 • August 2025 • July 2025 • June 2025 • May 2025 • April 2025 • March 2025 • February 2025 • January 2025 • December 2024 • November 2024 • October 2024 • September 2024 • August 2024 • July 2024 • June 2024 • May 2024 • April 2024 • March 2024 • February 2024 • January 2024 • December 2023 • November 2023 • October 2023 • September 2023 • August 2023 • July 2023 • May 2023 • April 2023 • March 2023 • February 2023 • January 2023 • December 2022 • November 2022 • October 2022 • September 2022 • August 2022 • July 2022 • June 2022 • May 2022 • April 2022 • March 2022 • February 2022 • January 2022 Subscribe here ### Annual Report • 2025 Annual Report • 2024 Annual Report • 2023 Annual Report • 2022 Annual Report To receive annual reports via mail, contact TNAAP to confirm your membership is current. Sara Chang, sara.chang@tnaap.org Advertise with TNAAP! Have your ad visible to Pediatricians and their staff across the state! Sign up HERE . --- ## Resources and Toolkits URL: https://tnaap.org/programs/tnaap-immunization-program/resources-and-toolkits/ # Resources and Toolkits #### AAP Vaccinations Toolkit #### AAP Flu Toolkit #### CDC Vaccination Toolkit ### Immunization Schedules #### Birth - 18 Years Vaccine Schedule for Providers (2026) ### Additional Resources Current Vaccine Information Statements (VIS) Webinar: Frameworks to Boost Public Discourse The Vaccine-Hesitant Moment Civil Rights Training Video from TennCare Office of Civil Rights Compliance Stock Photographs for Vaccine Campaigns Tennessee Vaccines for Children (VFC) Program Click Here to Browse Additional Training Webinars ### Downloadable TNAAP Graphics Click here  to download full collection Unbranded versions for clinic use are available on request. Program Overview Quality Improvement Project Training Modules Resources and Toolkits COVID-19 Vaccinations --- ## Foster Care Medical Home URL: https://tnaap.org/programs/behip/foster-care-medical-home/ # Foster Care Medical Home This project was generated in partnership with the TN Chapter of the American Academy of Pediatrics and Bluecare Tennessee to improve behavioral healthcare in pediatrics with a specific focus on children in foster care in Tennessee. This 5-hour training session is facilitated by a board-certified pediatrician experienced with unique challenges of meeting the behavioral health needs of this patient population. Key topics include navigation of the Department of Children's Services system, connecting with local DCS staff, trauma-informed care, ACEs, use of screening tools, office-based interventions, psycho-pharmacology and more, with the goal of becoming a FCMH. Trainings are scheduled when it’s convenient for you and are provided at no cost. There are also BeHiP QI opportunities available for providers to obtain MOC Part IV. BeHiP provides ongoing support and resources such as a bi-monthly one-hour ECHO learning collaborative, FCMH toolkit, and quarterly check-ins. Foster Care Medical Home Toolkit Explore ECHO Project ### Transitioning Children in Foster Care https://vimeo.com/1181720497 #### Resources • DCS policy 19.10    • Child Welfare Information Gateway, Extension of Foster Care Beyond Age 18 – Tennessee   • Tennessee Division of TennCare, Employment and Community First CHOICES • Tennessee Department of Disability and Aging, Medicaid Alternative Pathways (MAPs) • BlueCare Tennessee Publications: Renee M. Tuchi, MD, MPH, FAAP, Counsil on Children with Disabilities; Committee on Medical Liability and Risk Management, Considerations for Alternative Decision-Making When Transitioning to Adulthood for Youth with Intellectual and Developmental Disabilities: Policy Statement , Pediatrics (2024) 153 (6):e2024066841. Peterson A, Karlawish J, Largent E. Supported decision with people at the margins of autonomy . Am J Bioeth. 2021; 21 (11): 4-18 Douglas J, Bigby C. Development of an evidenced based practice framework to guide decision making support for people with cognitive impairment due to acquired brain injury or intellectual disability .  Disabil Rehabil. 2020;42(3)434-441 This project is funded through a grant with BlueCare Tennessee. BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP FCMH Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Medical Director, BeHiP FCMH Program Tim Fuller, DO, FAAP --- ## Join URL: https://tnaap.org/join/ # Become a Member ## Membership Categories and Annual Dues Fellow Member   ($195) – Pediatrician or pediatric specialist licensed and practicing in Tennessee. Members of the AAP as fellows, candidate member, specialty fellows or post-residency training fellow shall be considered a fellow of the TNAAP. Fellow members may serve on committees, vote and hold elective office. Associate Member ($195) – A physician or pediatric dentist licensed and practicing in Tennessee who is also a member of the national AAP. Chapter Affiliate Member ($195) – A pediatrician, pediatric specialist or pediatric dentist licensed and practicing in Tennessee who wishes to join the state chapter only and is not currently a member of the national AAP. Chapter Affiliate Post-Residency Training ($60) – A pediatrician or pediatric specialist licensed and practicing in Tennessee currently pursuing post-residency fellowship who wishes to join the state chapter only and is not currently a member of the national AAP. Allied Health Professional (PA, NP, etc.) ($100) – Any health professional, not stated in another category, who works in the field or specialty of pediatrics. Professional Staff   ($100) – Practice managers or other office staff working in a pediatric field. Senior Member ($45) – Pediatrician or pediatric specialist who has attained the age of 70 or are 65 or older and no longer derives income from professional activities. Resident Member  (free) – Residents enrolled in a pediatric residency training program. Resident members of the AAP shall be considered a Resident member of the TNAAP. Medical Student Member  (free) – Medical students enrolled in a medical school and indicated a career choice in pediatrics.  ### Wondering why you should join the chapter? #### Click here to view our 2025 Annual Report  to see all that we do to help pediatricians and their staff. Chapter dues directly support all of our advocacy efforts. We would love your support! Contact info@tnaap.org with any questions or assistance with joining. Join/Renew Chapter Only Join/Renew National & Chapter --- ## START Overview URL: https://tnaap.org/programs/start/start-overview/ # Screening Tools and Referral Training ### The new TEIS (Tennessee Early Intervention System) Extended option is now available. #### What is the TEIS Extended Option ? The TEIS Extended Option allows current families to continue receiving TEIS services beyond age 3 if the child is determined eligible for special education services in their local school district. This extension will give families an additional choice to consider as they help their child develop and prepare for school. If a child is eligible for school district special education services, a family will have the following choices: • TEIS Extended Option • Special education services in the local school district • Choose to end all services If a family chooses the TEIS Extended Option, they can continue with TEIS services up to the start of the school year following the child’s 5th birthday. These services would continue to be provided through an Individualized Family Service Plan (IFSP). Families can choose to transition to the school district at any time during the TEIS Extended Option. Once a child transitions to special education services in the school, they cannot return to TEIS services. #### Who is eligible? To be eligible for the TEIS Extended Option, a child must meet the following criteria: • Have a current Individualized Family Service Plan through TEIS (IFSP) • Be determined eligible for school district special education services by the local education agency (LEA) Click here for an illustration of TEIS pathways. The Tennessee Chapter of the American Academy of Pediatrics (TNAAP) can be a tremendous resource to you in implementing the use of formal screening tools in your practice. TNAAP has a free training program for practices and medical schools called Screening Tools And Referral Training (START). START is an educational program developed by TNAAP to help pediatric care providers - including pediatricians, family physicians, physician assistants, nurse practitioners, nurses, and others - learn skills and strategies to implement routine developmental screening using standardized screening tools as part of their health care procedures. This training is also appropriate for residents and students in the medical field who plan to become primary care providers. It was adapted with permission from the Illinois Chapter of the American Academy of Pediatrics (ICAAP). The program is in collaboration with  Tennessee's Early Intervention System (TEIS) . TNAAP offers START training throughout the state to educate physicians, allied health care providers, and office staff about developmental and behavioral screening tools, referral procedures, and office workflow, and coding for payment for screening that can be easily incorporated into a practice routine. The START training has been updated in 2023 to incorporate the latest recommendations from the American Academy of Pediatrics’ and Bright Futures’ guidelines for developmental surveillance and screening as well as behavioral and mental health screening, including recommendations for family-center behavioral and social-emotional screening across childhood. START includes a variety of resources to help make health and early childhood professionals’ work in supporting families easier. To learn more about the START program,  download this overview . START Overview Developmental & Behavioral Screen Tools Tennessee Early Intervention System (TN.gov) Modified Checklist for Autism in Toddlers-Revised with Follow-up (MCHAT) ### START Contact Information Susan Rollyson, M.Ed. Program Manager Phone: 615-278-0548 Fax: 615-383-7170 Email:  susan.rollyson@tnaap.org Toni Whitaker, MD, FAAP Medical Director, START Program Developmental Behavioral Pediatrician Jason Yaun, MD, FAAP Training Director, START Program Pediatrician ## Learning Objectives for START The purpose of the START program is threefold: • To increase early identification and referral of children with developmental delays or behavioral problems using standardized screening tools. • To better understand referral resources in your community. • To learn about better documentation of services, coding and payment. ## Surveillance & Screening Most pediatric health professionals practice developmental surveillance. Surveillance is a flexible, ongoing process where knowledgeable professionals perform skilled observations of children during the health care visit. Developmental screening, on the other hand, is a brief procedure, using a standardized validated tool, available either commercially or in the public domain, to determine whether a child requires further and more comprehensive evaluation. Developmental screening enhances surveillance. Screening may be a part of routine well child visit or it may be used during acute care visits in response to a specific concern about a child. The AAP recommends routine surveillance and using standardized developmental and behavioral screening at least 3 specific times: the 9, 18 and 24/30 month visits. ## Evidence In an updated  2006 and 2007 policy statement  and the most recently updated  2020 policy statement , the AAP recommends routine surveillance and standardized developmental and behavioral screening. The statements provide strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in young children. It recommends that validated general developmental screening tools be administered regularly at the 9-, 18-, and 30-month health supervision visits and that screens for  autism spectrum disorder  be administered at the 18- and 24-month visits. In addition, developmental surveillance (monitoring) should be incorporated at every well-child preventive care visit and any concerns raised during surveillance should be promptly addressed. ## Resources • Tennessee disability pathfinder • Tennessee Regional Contacts for Autism Resources • Autism Spectrum Disorders Online Resources • Regional Autism Societies • Family Voices of Tennessee • Tennessee Voices for Children • Tennessee Department of Disability and Aging • CDC Learn the Signs Act Early Website • Wrightslaw ## Tennessee’s Early Intervention System (TEIS) The START program is a collaboration with  Tennessee's Early Intervention System (TEIS) funded by the Tennessee Department of Disability and Aging.  Tennessee Early Intervention System (TEIS) is a statewide program sponsored by the Tennessee Department of Disability and Aging. It is mandated under the Individuals with Disabilities Education Act (IDEA), Part C, to provide early intervention services to children eligible under this act. TEIS is a network of nine district offices that provide home-based, early intervention services to young children with special needs (birth to three years) and their families. --- ## EPSDT & Coding Overview URL: https://tnaap.org/programs/epsdt-coding/epsdt-coding-overview/ # EPSDT & Coding TNAAP's EPSDT and Coding Program provides training and educational resources FREE of charge to help you improve the quality of preventive health screens you perform and can assist with Pediatric Coding issues for both general and specialty practices through various resources and services. Educational training programs can be provided at individual practices and customized topic-specific sessions are available. TNAAP also offers annual EPSDT and Coding Update Trainings held regionally. To learn more about the EPSDT Program,  download this overview . Request a Training #### Bright Futures/AAP Recommendation for Preventive Services and EPSDT https://vimeo.com/1187928060?share=copy&fl=sv&fe=ci This 2026 webinar provides the most current Bright Futures/AAP recommendations for Preventive Services, defines the seven components and documentation requirements for EPSDT visits and reviews the age-specific services recommended for each well child visit and how these services should be reported. The EPSDT and Coding Program is funded by a grant from the Bureau of TennCare and carried out by The Tennessee Chapter of the American Academy of Pediatrics (TNAAP). EPSDT & Coding Overview EPSDT & Well Child Visits Coding Resources Sports Physicals Oral Health Immunizations Other Resources Developmental/Behavioral Health Screening Tools ### EPSDT & Coding Contact Information Janet Sutton, CPC, RHIT AHIMA Approved ICD-10-CM Trainer Coding Educator janet.sutton@tnaap.org --- ## Coding Resources URL: https://tnaap.org/programs/epsdt-coding/coding-resources/ # Coding Resources ### Annual Coding Updates The following is a list of annual coding updates of most interest to pediatricians and family practitioners. ICD-10-CM code updates are effective beginning October 1st of each year. The CPT code updates are effective beginning January 1st of each year. Please see the latest version of the ICD-10-CM and CPT code books for a complete list of codes. • 2026 ICD-10-CM Coding Updates • 2026 CPT Pediatric Coding Updates • Coding for Immunizations • Watch 2026 EPSDT and Coding Webinar Archives from Previous Years • 2025 CPT Coding Updates • 2024 CPT Coding Updates • 2024 ICD-10-CM Coding Updates • 2023 ICD-10-CM Coding Updates • 2023 CPT Coding Updates • 2022 EPSDT and Coding Update Webinar • 2022 CPT Coding Updates • 2022 ICD-10-CM Coding Updates • NEW! E/M Coding Resource • 2021 TNAAP E/M Coding Update Webinar Recording • AMA CPT 2021 EM Coding Changes  (pdf) • AMA CPT 2021 E/M Coding Chages Updates • 2021 ICD-10-CM Coding Updates • 2021 CPT Coding Updates • 2020 ICD-10-CM Coding Updates • 2019 ICD-10-CM Coding Updates • 2018 ICD-10-CM Coding Updates • 2019 CPT Coding Updates • 2018 CPT Coding Updates ### ICD-10 Transitioning to ICD-10 for Providers Webinar This webinar provides an update on implementation for ICD-10-CM*, an overview of the ICD-10-CM structure and how it differs from ICD-9-CM, discusses how ICD-10-CM will affect your practice, and reviews some common pediatric diagnoses codes and the new key documentation elements required for ICD-10-CM. • Click Here to View Now! ### ICD-10 Resources • AAP • Centers for Medicare and Medicaid Services (CMS) • TNAAP Top 25 Pediatric Codes Conversion List  • List of ICD-10 Resources • AAP Sample Superbill with ICD-10 Codes • AAP ICD-10 Coding FAQ • AAP Coding Preventive Medicine Services ICD-10 ### Coding Resource Links to Other Sites AAP Resources • 2017 RBRVS: What is It and How Does It Affect Pediatrics • Frequently Asked Questions for the Pediatric Immunization Administration Codes Books, Newsletters, and Journals • AAP Pediatric Coding Newsletter • AAPC Coding Resources • Advance Magazine HIM • AHIMA Journal • American Hospital Association Coding Clinic For ICD-9-CM • American Medical Association • Coding For Pediatrics • CPT Code Book • ICD-9/ICD-10-CM Code Books • National Correct Coding Initiative Resources – AAP • Optum Coding Books and Resources • Pediatric Coder's Pink Sheet Newsletter • Physician Desk Reference Book • Taber's Medical Dictionary • TNAAP Newsletter - The Tennessee Pediatrician • Understanding Modifiers Online Coding Resources • Gray's Anatomy Online • Find-A-Code • ICD-9-CM and ICD-10-CM Resources - CDC • Immunizations • Medical Home • Medicare Carrier Manuals • Medicare Learning Network • National Correct Coding Initiative Resources – Medicaid • National Correct Coding Initiative Resources – Medicare • Office of Inspector General • Physicians Fee Schedule • Private Payer Advocacy – Letters to Carriers EPSDT & Coding Overview EPSDT & Well Child Visits Coding Resources Sports Physicals Oral Health Immunizations Other Resources Developmental/Behavioral Health Screening Tools --- ## Pediatric Practice Management Conference URL: https://tnaap.org/events/pmc/ Presented by St. Jude Children’s Research Hospital Registration Now Open Meet Our Speakers ### CEU Information   CEU Information : In order to receive CEUs, you must attend the LIVE event and fill out the evaluation.  ## 2025 Recap TNAAP welcomed 28 in-person attendees and 35 virtual participants to our annual Pediatric Practice Management Conference, held as a hybrid live event for the second year on May 9. Our slate of speakers covered topics important to office operations, including strategies to increase vaccination rates, Social Media's Role in Healthcare, and discovering how to turn care management coding into revenue for practices. ### Thank you to our 2026 sponsors! ## Past Sponsors --- ## TNAAP Committees URL: https://tnaap.org/advocacy/tnaap-committees/ # TNAAP Committees/Advisors TNAAP Legislative Committee Focus : To identify, advise on and monitor legislative priorities Chair : Hunter Butler, MD Fundraising Committee Focus: TN State Pediatric Conference and other fundraising Chair: Jason Yaun, MD Advisors on Child Abuse and Neglect Focus : Improving the care of infants, children and adolescents who are abused and neglected Advisors: Karry Lakin, MD and Lauren Burge, MD Advisor on Immigrant Health Focus: Improving the care of immigrant children and their families by building competencies that promote health and well-being, identifying resources, creating community networks and promoting advocacy efforts. Advisor: Adriana Bialostozky, MD Advisors on Justice and Belonging Focus: Addressing minority health, racial/ethnic health disparities and equity and the inclusion of minority members in pediatric practice and leadership. Advisors: Maya Neeley, MD and Arshia Madni, MD ### Other Advisors Breastfeeding Allison Stiles. MD Stephanie Jane Attarian, MD Karen Schetzina, MD CATCH Facilitator Curtis Cary, MD Immunization Champion Caitlin Newhouse, MD --- ## Legislative URL: https://tnaap.org/advocacy/legislative/ ## TNAAP Day on the Hill ### Save the Date: March 3, 2027   Each spring, we invite members to join us for a day of advocacy. The day includes a general overview of the legislative process, a discussion of current proposed legislation, plus individual and group meetings with legislators and leadership. This is your chance to get involved and speak out on behalf of children and pediatricians. Whether you are new to the process or a "seasoned veteran", your participation helps us make a solid impact with Tennessee legislators. View photos from our 2026 Day on the Hill. 2026 Day on the Hill # 2025 Legislative Activities ###### Another year, another fight. As the 114 th General Assembly has come to a close, we are finally able to sit back, take a deep breath, and reflect over this past legislative session. We had some wins, we had some losses, and we had some good ole fashion political kicking the proverbial can down the road. But alas, we were able to fight for pediatricians and TN children throughout the state, and that’s always worth fighting for. ###### TNAAP tracked over 200 bills this legislative and through collaboration with our members and our lobbyists, we were able to testify at the Senate Health Committee, educate legislators on issues affecting pediatricians and kids, and advocate both for and against a number of issues that would directly affect child health and the way we practice medicine. #### First the good bills: TNAAP introduced a bill ( HB760/SB817 by Rep. Tandy Darby and Sen. Adam Lowe) allowing schools to keep emergency stock albuterol inhalers. This potentially lifesaving legislation will allow schools to keep albuterol on hand for emergency situations when a child may not have a previous asthma diagnosis, does not have an inhaler at school, or does not have a school medication form on file. It passed unanimously with bipartisan support and was signed by the Governor on May 2. TNAAP was able to support a grass roots movement called Say Yes to Recess getting a bill  ( HB85/SB158 by Rep. Scott Cepicky and Sen. Joey Hensley) passed that will increase exercise in kids. Elementary schools will now be required to provide students with 60 minutes of daily physical activity. It was signed into law by Governor Lee and will go into effect July 1, 2025. #### Bad bills: TNAAP fought hard against a physician gag order bill ( HB387/SB474 by Rep. Ed Butler and Sen. Janice Bowling) that would have prohibited physicians from discussing firearm safety with patients. Through grassroots advocacy, discussions during Day on the Hill, testimony in committee hearings, and direct lobbying, this bill was ultimately put off until next year’s legislative session. Another bill ( HB638/SB1389 by Rep. Michele Carringer and Sen. Bo Watson) that required a tremendous amount of effort to fight would prohibit physicians who accept TennCare from turning away patients based on their vaccination status. TNAAP and others were able to amend this bill in the House to include exceptions to the prohibition for physicians who see patients who are immunocompromised. This bill made it all the way to both the House and Senate floors. However the House and Senate could not agree on the amendment excluding doctors that see immunocompromised patients, delaying further discussion on the bill until next year’s legislative session. THANK YOU to those of you who responded to our “calls to action” regarding these two bills! Your calls and emails made an impact and helped us stop these! #### Other efforts and notes: Although the above mentioned bills took up an enormous amount of our time and effort this legislative session, TNAAP’s Legislative Committee, Members, and lobbyists also fought to kill a number of bills that would directly affect pediatricians and child health – a potential ban on fluoride in our water supply, unsupervised prescribing authorization for psychologists, and numerous anti-vaccine related bills, and we advocated for bills ranging from increasing counsellors in schools to providing free school breakfast and lunch for all TN children. Another hot topic has been Medicaid payment parity. Medicaid payment parity with increasing TennCare reimbursement rates has been a priority for TNAAP and is gaining traction with specialists and primary doctors of all medical fields throughout the state. TNAAP was able to meet with executive committees from various TN state medical organizations, compile data on member experiences and their plans for future TennCare patients and meet with TennCare’s Director Stephen Smith to share the concerns of our members. Although the current political environment in Washington has everyone concerned about various forms of Medicaid cuts, we continue to work with the Tennessee Medical Association and other specialty and primary care state organizations to fight for Medicaid payment parity. As always, every legislative session brings a new set of challenges and threats, both to us and to our patients. This year has been no different and we expect next year to be more of the same. Although it is too early to know, a few topics we expect to come up next year include repeated efforts to ban doctors from asking about firearm safety, efforts to force physicians to see non-vaccinating patients even if it puts other patients at risk, a renewed fight for independent practice for advanced practice providers, and various anti-vaccine bills. If you get a chance, please take time to thank any members of the legislative committee or members that have met with legislators or testified at committee hearings for all of their hard work over the last several months. TNAAP is you and you are TNAAP, and we need your help. Join us at a board meeting or join us for committee meetings. Reach out to your legislators. Let your voices be heard. And always, if you have any questions, would like more information, or are interested in getting involved, please do not hesitate to reach out to us. ### AAP Legislative Conference Sponsorship Every year TNAAP sponsors Tennessee Residents  and  Early Career Physicians (defined as first 10 years of practice) to attend the AAP Advocacy Conference held in March. ###### "I want to say a huge thank you to all of the members of TNAAP for allowing me the opportunity to attend the AAP National Conference and Exhibition. I can’t possibly summarize all of the numerous amazing encounters I had. Nevertheless, please know that your support provided a future pediatrician with an unforgettable experience, and I truly hope that the ideas I brought back to my program will provide tangible benefit to the state of Tennessee." ###### - Matthew Holland, DO, PGY-1 Pediatrics, University of Tennessee, College of Medicine - Chattanooga ### Advocacy Education Series TNAAP hosted four virtual advocacy sessions during 2020. We partnered with our lobbying firm, Schmidt Government Solutions, and the family advocacy organization, The Tennessee Justice Center, to address important topics of interest. The four Tennessee residency programs participated along with other TNAAP members! #### Missed a Session? View Recordings Here Session 1: Intro to the Series, AAP Early Career Resources & Learning to Become an Effective Advocate - Click Here to Watch Session 2: Understanding Health Disparities, COVID Mental Health and COVID Immunizations - Click Here to Watch Session 4: Mitigating Barriers for Families and Children's Access to Health Insurance - Click Here Watch ### Get Involved Contact  Ruth.Allen@tnaap.org  to find out how you can become a part of the TNAAP advocacy team. --- ## Foster Care Medical Home ECHO URL: https://tnaap.org/programs/behip/behip-learning-collaborative/ # Foster Care Medical Home ECHO Project Download Program Flyer Register for ECHO Here This group meets virtually bi-monthly to discuss the care of children in state custody who present with behavioral health issues, including trauma and physical abuse in the primary care setting and effective psycho-pharmacology management. Key to the success of this collaborative is that the enrolled practices will be able to communicate with one another and learn from each other's management of children with complicated behavioral health concerns in a consultative model with the COE.  Over time, enrolled practices should develop more confidence in their ability to care for these more complicated behavioral health patients and should be able to apply their new skills to their general pediatric population, as well. This project is funded through a grant with BlueCare Tennessee. Session Date/Time 2025 Topics Moderator Recording 1 January 23, 2025 11:00 am to 12:00 pm CT Keystone V Development Overview: Ages 4yr & 5 yr Mount Sinai Parenting Center Tim Fuller, DO, FAAP* Watch Now 2 March 6, 2025 11:00 am to 12:00 pm CT Trauma Informed Care Lauren Selzer, DO Tim Fuller, DO, FAAP* Watch Now 3 May 1, 2025 11:00am to 12:00pm CT Department of Children’s Services Overview DCS Team Tim Fuller, DO, FAAP Watch Now 4 July 3, 2025 11:00 am to 12:00 pm CT Family Voices of Tennessee Ashlie Bell-Seibers, Director of Family Voices of TN Tim Fuller, DO, FAAP* Watch Now 5 September 4, 2025 11:00 am to 12:00 pm CT TN Voices Michael Krishner, LPC/MHSP-S, MBA, Chief Growth Officer Tim Fuller, DO, FAAP* Watch Now 6 November 6, 2025 11:00 am to 12:00 pm CT Suicide Prevention for Pediatric Medical Providers Ashley Hamby, Centerstone Tim Fuller, DO, FAAP* Watch Now Session Date / Time 2026 Topics Moderator Recording 1 January 8, 2026 11:00 am to 12:00 pm CT MAPs (Medicaid Alternative Pathways) Jay Camperlino – Youth Transition Director | TDH & Tim Fuller, DO, FAAP Watch Now 2 March 5, 2026 11:00 am to 12:00 pm CT The Tennessee START Assessment & Stabilization Teams (TN START AST) Carrie Dhanarajan, MA, BCBA, LBA | TN START Director & Tim Fuller, DO, FAAP Watch Now 3 May 7, 2026 11:00 am to 12:00 pm CT Overview of Cumberland Heights Amara Townes & Tim Fuller, DO, FAAP Watch Now 4 July 2, 2026 11:00 am to 12:00 pm CT Pediatric Mood Disorders Debbie Christiansen, MD | ETCH & Tim Fuller, DO, FAAP Watch Now 5 September 3, 2026 11:00 am to 12:00 pm CT Quick Parenting Assessment (QPA) Seth Scholer, MD | Vanderbilt & Tim Fuller, DO, FAAP 6 November 5, 2026 11:00 am to 12:00 pm CT Overview of Acorn Health Sid Nichols & Tim Fuller, DO, FAAP Archived 2024 Sessions: WATCH: Trauma-Informed Care (April 4, 2024) WATCH: Quality Improvement (May 2, 2024) WATCH: Suicide Prevention in Pediatrics (June 6, 2024) WATCH: Science of the 6 Keystones (August 1, 2024) WATCH: Keystones: Newborn - 2 months (September 5, 2024) WATCH: Keystones: 4 - 9 months (October 3, 2024) WATCH: Keystones: 12 - 18 months (November 7, 2024) WATCH: Keystones: 2 - 3 years (December 5, 2024) BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Medical Director, BeHiP FCMH Program Tim Fuller, DO, FAAP --- ## Tennessee State Pediatric Conference URL: https://tnaap.org/events/tennessee-state-pediatric-conference/ # Tennessee State Pediatric Conference ### August 14-15, 2026 ### Franklin Marriott Cool Springs We hope you will join TNAAP for another wonderful Tennessee State Pediatric Conference. The fun starts Friday, August 14 with a welcome reception including happy hour. Sessions will be held Saturday, August 15.  A special Marriott room rate is available for conference participants needing accommodations, but must be booked by July 24. The Tennessee Chapter of the American Academy of Pediatrics (TNAAP) will hold its annual meeting on Saturday, August 15 at 12:00 pm CT.  The meeting will convene at Franklin Marriott Cool Springs, 700 Cool Springs Blvd, and will be held in conjunction with our Tennessee State Pediatric Conference.  Members are invited to attend.  The Annual Meeting will include: • TNAAP Operational Update • Financial Report Register for Conference Now View Program Hotel Accommodations (By July 24) Sponsorship Opportunities ##### Tennessee State Pediatric Conference Contact Information ###### Sara Chang Communications Manager Email: sara.chang@tnaap.org ### Thanks to our 2026 TSPC Diamond Presenting Sponsors! ## 2025 Photo Gallery ## 2024 Photo Gallery ## 2023 Photo Gallery --- ## For Parents URL: https://tnaap.org/parents/ # # Resources for Parents & Caregivers As a parent, nothing is more important to you than your child’s health and well-being. You know your child best. Yet, many parents have a lot of questions as their child grows up.  As pediatricians, we also want your child to grow up healthy, happy and safe. We’re here to help and be a partner to you and your children through each developmental stage. We know there’s a lot of information out there, and some of it can be confusing. We welcome conversations about your child’s health care and are here to help you navigate important questions.  AAP’s Healthy Children website has a wealth of information. Start here for guidance on childhood development, personal wellness, safety, and family life. And if you’re looking for trustworthy information on social media, here’s a great list of pediatricians to follow and to share with family and friends. #### Follow These Pediatricians for Trustworthy Content on Children's Health Dr. Tanya Altmann, MD, FAAP Dr. Alok Patel, MD, FAAP Dr. Meghan Martin, MD, FAAP Dr. Tiorra Ross, MD Find More Pediatricians on Social Media View this profile on Instagram TNAAP Parent Connect (@ tnaapparentconnect ) • Instagram photos and videos ### Childhood Vaccinations Kids love to be with other kids, laughing and learning. As a parent, you never know which viruses may ride home with them. Vaccines teach your child’s immune system how to recognize and resist the most dangerous germs. Thanks to these scientific breakthroughs, serious diseases that once made thousands of kids sick every year have become more and more rare. If you have questions about vaccines, your pediatrician is there to answer them.  • What to Know About Your Baby’s Immune System   • Vaccines Your Child Needs by Age 6   • 14 Diseases You Almost Forgot About Thanks to Vaccines   Vaccine Schedule – Why So Many? Children grow through predictable ages and stages — from learning to talk and walk, to learning to make friends. Your child’s immune system has stages, too and, because of that, vaccine timing matters. Vaccines work best when your child’s body is ready to respond best.  Building immunity is like learning to read. Newborn vaccines are the beginner books that teach your baby’s immune system to recognize and resist serious diseases. Just as a child grows from board books, to Dr. Seuss, to “Captain Underpants,” their immune system grows and gets stronger with each vaccine. All About the Recommended Immunization Schedules   Multiple Vaccinations at Once   Vaccine Safety Our communities in Tennessee have benefited from vaccines for more than 60 years. They’ve been scientifically designed to teach the immune system to recognize and resist serious diseases and are carefully tested and monitored over time.  As parents, you want to keep your kids healthy. Medical researchers care about children, too, so they carefully test and monitor the ingredients in vaccines. Each ingredient in a vaccine has a specific function, making the vaccine work better with your child’s immune system.    Vaccine Safety: Examine the Evidence   Vaccine Ingredients: Frequently Asked Questions   How Vaccines are Developed, Safety Tested and Approved: Step by Step Fact checked: Vaccines: Safe and Effective, No Link to Autism   Are Vaccines Safe for Children? The Truth About Risks & Benefits   Community Immunity Because routine childhood immunizations are widely available in the U.S., most kids today will never get whooping cough, tetanus, polio or meningitis.  When vaccination is widespread, contagious diseases have a hard time spreading.  That’s called community immunity, and it protects our family, friends and neighbors. It keeps preventable diseases at bay, keeps our children focused on growing and learning, and sets young people up for lifelong health and well-being.   Vaccine Protection: How Healthy is Your Community?   ### Other Important Topics While vaccines are in the news and discussed in social media a lot, we know parents have all kinds of questions.  Children’s Ages and Stages Breastfeeding Car Seats: Information for Families Food Allergies Health Issues Nutrition for Babies Sleep & Sleep Safety • Resource Map from Association of Infant Mental Health in Tennessee • Kid Central TN: Services from the State of Tennessee • BeSMART Gun Safety Printable Resources: • • Program Introduction ( English , Spanish ) • • Mini Bookmark ( English ) • • Program Brochure ( English , Spanish ) • • Publicity Posters ( English , Spanish ) • • Postcard • Advance Directives for Health Care: Message from Health Commissioner ( English , Spanish ), Create your form • Back to School Well Check & Vaccine Reminder Flyer • Back to School Well Check & Vaccine Reminder Flyer (Spanish) • Essentials for Parenting Toddlers and Preschoolers --- ## Developmental/Behavioral Health Screening Tools URL: https://tnaap.org/resources/developmental-behavioral-health-screening-tools/ # Developmental/Behavioral Health Screening Tools ### CRAFFT • CRAFFT Screening Questions – English (PDF) • CRAFFT Screening Questions – Spanish (PDF) • CRAFFT 2.1 • CRAFFT 2.1+N Self Administered • CRAFFT 2.1+N Interview ### FRAMES Brief Intervention Guide • FRAMES Brief Intervention Guide (PDF) ### Edinburgh Postnatal Depression Scale (EPDS) • Edinburgh Postnatal Depression Scale (EPDS) - English (PDF) • Edinburgh Postnatal Depression Scale (EPDS) - Spanish (PDF) • Edinburgh Postnatal Depression Scale (EPDS) - Scoring Instructions (PDF) • Sample Signature Page for New Mothers Re: Edinburgh Postnatal Depression Scale (PDF) • Sample Letter to Patient's Doctor Re: Edinburgh Postnatal Depression Scale Results (PDF ) ### Pediatric Symptom Checklist 17 (PSC-17) • Pediatric Symptom Checklist 17 (PSC 17) - English (PDF) • Pediatric Symptom Checklist 17 (PSC 17) - Spanish (PDF) • Pediatric Symptom Checklist 17 (PSC-17) - Spanish with Symbols (PDF) • Pediatric Symptom Checklist 17 (PSC 17) - Scoring Instructions (PDF) ### Pediatric Symptom Checklist 35 (PSC-35) • Pediatric Symptom Checklist 35 Youth (PSC-Youth) - English (PDF) • Pediatric Symptom Checklist 35 (PSC 35) - English (PDF) • Pediatric Symptom Checklist 35 (PSC 35) - Spanish (PDF) • Pediatric Symptom Checklist 35 (PSC 35) - Scoring Instructions (PDF) ### Strengths and Difficulties Questionnaire (SDQ) The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire about 2-17 year olds. It exists in several versions to meet the needs of researchers, clinicians and educationalists. Learn more here . • Versions of the SDQ for different ages along with scoring instructions are available in English here and Spanish here . ### Modified Patient Health Questionnaire • Modified PHQ-9 • PHQ-2 The PHQ is available for free with permission. Click on the link above to be taken to the TeenScreen website where you can access the PHQ and PSC-Y documents. ### Screen for Child Anxiety Related Disorders (SCARED) • GAD-7 Anxiety • Screen for Child Anxiety Related Disorders (SCARED): Child Version (PDF) • SCARED Child Version with Scoring (PDF) • Screen for Child Anxiety Related Disorders (SCARED): Parent Version (PDF) • SCARED Parent Version with Scoring (PDF) • The SCARED is available for free through the University of Pittsburgh Department of Psychiatry: https://www.pediatricbipolar.pitt.edu/clinical-services/clinical-tools ### Global Appraisal of Individual Needs Short Screener (GAIN-SS) • Click here to access the GAIN-SS through the TN Department of Mental Health (COMING SOON!) • To learn more about the GAIN-SS, visit  http://www.gaincc.org ### Trauma Screeners • PEARLS Trauma Screener (Current Gold Standard) • Trauma History Screener – Youth Version (PDF) • Trauma History Screener – Parent Version (PDF) • Trauma History Screener – Spanish (PDF) • Primary Care PTSD Screen (PDF) • Young Child PTSD Screen (PDF) ### Modified Checklist of Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) • Modified Checklist of Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F): English, Full Packet NEWEST VERSION updated March 2025 • Modified Checklist of Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F): Spanish, Full Packet ### Screening tools available with purchase: • Parents Evaluation of Developmental Status - Revised • Ages and Stages Questionnaires – Social Emotional   Looking for a free kit? Email Susan.Rollyson@tnaap.org to find out how. • Ages and Stages Questionnaire 3rd Edition   Looking for a free kit? Email Susan.Rollyson@tnaap.org to find out how. • Early Childhood Screening Assessments – The Early Childhood Screening Assessments (ECSA) can be accessed through purchase of the AAP Mental Health Toolkit. ### Other screening tools and references: • Bright Futures • MSPSS: Multidimensional Scale of Perceived Social Support • Suicide Prevention Risk Assessment • ADHD Toolkit --- ## Excellence in Pediatrics Annual Awards URL: https://tnaap.org/events/excellence-in-pediatrics-annual-awards/ # Excellence in Pediatrics Annual Awards The TNAAP Excellence in Pediatrics Awards recognize and honor pediatricians and community members who have made exceptional contributions to children's health advocacy in Tennessee. The celebration is held in conjunction with our annual Tennessee State Pediatric Conference .  ## 2026 Honorees Pediatrician of the Year • Cristin Q. Fritz, MD, MPH, FAAP Senior Pediatrician of the Year           • Margaret G. Rush, MD Early Career Physician of the Year   • Rebecca England, MD Friend of Children  • Nurses for Newborns ## 2025 Honorees Pediatrician of the Year • Hunter Butler MD, FAAP Senior Pediatrician of the Year           • Jim Johns, MD, FAAP Early Career Physician of the Year   • Edson Ruiz, MD, FAAP Friend of Children  • Say YES to RECESS Tennessee AAP Special Achievement Award  • Rosemary Hunter, MD FAAP ## 2024 Honorees Pediatrician of the Year • Suzanne Berman, MD (Crossville) Senior Pediatrician of the Year • Jennifer Najjar Leeper, MD (Nashville) Friend of Children • Melanie Bull & Jim Schmidt (Nashville) AAP Special Achievement Award • Barbara Dentz, MD & Dorothy Sinard, MD (Nashville) ## 2023 Honorees Pediatrician of the Year • Timothy Fuller, DO (Greeneville) Lifetime Achievement • Kathryn M. Edwards, MD, FAAP (Nashville) Senior Pediatricians of the Year • Gail Beeman, MD, MHPE, FAAP (Memphis) • Joan White, MD, FAAP (Goodlettsville) Early Career Physician of the Year • Kelsey Gastineau, MD, FAAP (Nashville) Friend of Children • Heather Brandt, PhD (Memphis) AAP Special Achievement Award • Cassandra Brady, MD, FAAP (Nashville) ## Sponsors ### Thanks to our sponsors who make this event possible! ## 2023 Photo Gallery Cassandra Brady, MD, FAAP Heather Brandt, PhD Kelsey Gastineau, MD, FAAP Gail Beeman, MD, MHPE, FAAP Joan White, MD, FAAP Kathryn M. Edwards, MD, FAAP Timothy Fuller, DO Honorees with TNAAP leadership --- ## For Physicians URL: https://tnaap.org/resources/for-physicians/ # Resources For Physicians • EPSDT & Coding Resources • 2025 Measles Toolkit (TN Dept. of Health) • Behavioral Health • Quality Improvment • Screening Tools • CDC Resources for Vaccines • Tennessee Early Intervention System • Centers for Disease Control • U.S. Food and Administration (FDA) • Centers for Medicare & Medicaid Services (CMS) • National Institutes of Health • Bright Futures • Immunization Action Coalition • The National Center of Medical Home Initiatives for Children with Special Needs • Lippincott Williams & Wilkins Medical Publishing ### Asthma • Asthma Management Authorization Form • Asthma Education Handout • Asthma Education Handout - Spanish ### Breastfeeding • Breastfeeding Basics Handout   • Breastfeeding Basics Handout (Spanish) ### Patient Support • Community Compass: Find Help Flyer • Community Compass: Find Help Flyer (Spanish) ### Tobacco • Tobacco Exposure Screening Tool • 7,000 Chemicals Handout • CEASE Bee Flyer • I am not ready to Quit Smoking • I am not ready to Quit Smoking (Spanish) • Tobacco Pediatric Office Policy Sample --- ## Online Training Modules URL: https://tnaap.org/programs/behip/online-training-modules/ # Online Training Modules The Tennessee Chapter of the American Academy of Pediatrics presents the Behavioral Health in Pediatrics (BeHiP) online training modules which provide pediatric healthcare providers with tools and strategies to screen for, assess, and manage patients with emotional, behavioral and or substance abuse concerns. All of the online training modules, including CME credit, are available for FREE. ### Part I Course Contents Each module involves a child with behavioral health or substance abuse concerns and each case has a corresponding screening tool for participants to review. The participants work through the screening tool to become familiar with the tool and calculate a score. • Module 1: Introduction to Behavioral Health in Pediatrics • Module 2: Postpartum Depression & Social Emotional Guidance for Birth to Five • Module 3: Disruptive Behavior - Guidance for Primary Care • Module 4: Inattention and Impulsivity - Guidance for Primary Care • Module 5: Anxiety -  Guidance for Primary Care • Module 6: Depression - Guidance for Primary Care • Module 7: Substance Use Disorder - Guidance for Primary Care • Module 8: Workflow & Coding Please Note: While some of the statistical data, references, and examples included in these educational modules may no longer reflect the most current information, the foundational concepts, best practices, and resources remain valuable and relevant. We encourage you to review the materials as they continue to provide useful guidance and educational content. These modules are currently undergoing a phased review and revision process. Updates will be made over the next two years to ensure the data, references, and supporting information reflect the latest evidence and recommendations. BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP Team Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Grace Mayberry BeHiP Training Coordinator grace.mayberry@tnaap.org Co-Medical Directors, BeHiP Program: Tim Fuller, DO, FAAP Michelle Bowden, MD, FAAP --- ## BeHiP: ECHO Project URL: https://tnaap.org/programs/behip/behip-echo/ # TCAPES ECHO Project #### Tennessee Child and Adolescent Psychiatry Education and Support (TCAPES) This project utilizes the peer-to-peer learning methodology, ECHO (Extension for Community Health Outcomes), to bring physicians together to learn and discuss the successes and challenges in meeting the behavioral health needs of their patients. Topic experts will lead each individual interactive ECHO session. ECHO participants are also eligible to participate in an associated QI project. #### Program Objectives: • Recognize the effects of trauma on the developing child • Identify children with psychological trauma and physical abuse in the primary care setting • Apply principals of trauma competent care in the primary care pediatric setting • Increase collaboration with community behavioral health providers • Effectively manage psychopharmacology #### Target Audience: Pediatricians and other primary care providers caring for children. #### CME Statement Vanderbilt University Medical Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Vanderbilt University Medical Center designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Click Here to Register Session Date 2025 Topics Recording 1 February 12, 2025 12:00 pm to 1:00 pm CT Introduction to Infant and Early Childhood Mental Health Watch Here 2 April 9, 2025 12:00 pm to 1:00 pm CT Therapeutic Modalities for Adolescent Behavioral Health Concerns Watch Here 3 June 11, 2025 12:00 pm to 1:00 pm CT Parent-focused Therapeutic Modalities for School Aged Children Watch Here 4 August 13, 2025 12:00 pm to 1:00 pm CT CHANT Overview Watch Here 5 October 8, 2025 12:00 pm to 1:00 pm CT Provider Wellbeing Watch Here 6 December 10, 2025 12:00 pm to 1:00 pm CT Healthy Outcomes from Positive Experiences (HOPE) National Resource Center Watch Here Session Date 2026 Topics Recording 1 February 11, 2026 12:00pm to 1:00pm CT Behavioral Health Case Conversations: ADHD Watch Now 2 April 8, 2026 12:00 pm to 1:00 pm CT Early Identification of Autism for Pediatric Providers: STAT and ASD-PEDS within Primary Care Watch Here 3 June 10, 2026 12:00 pm to 1:00 pm CT Behavioral Health Case Conversations: Depression Watch Here 4 August 12, 2026 12:00 pm to 1:00 pm CT Behavioral Health Case Conversations: Sleep Watch Here 5 October 7, 2026 12:00 pm to 1:00 pm CT Behavioral Health Case Conversations: Anxiety 6 December 9, 2026 12:00 pm to 1:00 pm CT Developmental Pediatrics Previous Recordings: Sleep Disorders Substance Use & Misuse Mount Sinai Resources BeHiP Overview‎ ‎ ‎ ‎‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ BeHiP 101 Foster Care Medical Home Foster Care Medical Home ECHO TCAPES Mental Health Access TCAPES ECHO Online Training Modules Screening Tools Additional Resources ### BeHiP TCAPES Contact Information Amber Stroupe, MBA BeHiP Program Manager amber.stroupe@tnaap.org Medical Director, BeHiP TCAPES Program Michelle Bowden, MD, FAAP ---