The Growing Years - Child Health and Disability Prevention

The Growing Years
A Newsletter of the Riverside County CHDP Program
In This Issue
July 2014
A Message from our Medical Director
Message from Dr. Dael
1
Success Story
2
Lead Updates/ Recalls
2
CHDP Vaccine Codes
3
Immunization/CAIR
4
Tobacco News
5
CHDP Honors/Staff
Changes
6&7
CHDP News Bulletin
8
Please share this
newsletter with
your staff.
Wrestling and Weight Loss
Christopher D. Dael, MD
Public Health Medical Program Director
Children’s Medical Services
County of Riverside
Wrestling is one of the oldest known sports and while it doesn’t draw the same fanbase here in the U.S. as baseball, basketball, hockey and football, it’s a very popular
form of competition in schools and at local clubs. With the rise of mixed martial arts
more children are likely to become interested in wrestling as a competitive sport.
Recently friends asked my opinion about younger kids “making weight” to get ready
for a wrestling tournament. They explained to me that coaches for young kids (8-12
years) and older kids alike are advising parents to have their children wrestle at a
weight class below their natural body weight. This involves up to several days of restricting fluids and foods to get kids to drop the required pounds to make a lower
weight class at weigh-in. In some cases the children are encouraged to spit all their
saliva out rather than swallow it to shave off ounces. Weight loss theoretically gives
an older, bigger kid an advantage against someone in a lower weight class who hasn’t cut weight.
This news was, of course, alarming. Children at this age should not be cutting weight
and I explained to my friends in clear terms the potential consequences of this practice. It got me wondering if there’s any guidance from the AAP on the issue. I was
pleased to discover that there is a good resource on wresting at the AAP’s healthychildren.org website and it addresses cutting weight:
http://www.healthychildren.org/English/healthy-living/sports/Pages/Wrestling.aspx
Riverside County
CHDP Office
1.800.346.6520
www.rivcochdp.org
The article describes the problems with rapid or extreme weight loss and mentions
that even children in junior high should not cut weight. High school and college students may undertake gradual weight loss of no more than 1.5% of body weight per
week—this amount largely comes from fat loss. Even this
weight loss should be undertaken carefully and with clearance from a physician.
I’d encourage you to probe a little deeper if you discover that
a patient is wrestling competitively. Even if they haven’t yet
been encouraged to begin this dangerous practice, they might
be prodded to in the future; having the talk ahead of time
could be very beneficial.
Have a wonderful summer!
1
CHDP Success Story
A five year old female was seen for a CHDP physical. Everything was normal except for
a failed vision test. She was referred to an optometrist who recommended she wear glasses. The first time she put on her glasses, she claimed with excitement, “Mom, I can see
well.” When asked why she did not complain in the first place, she responded by saying, “ I thought what I saw
was normal.”
On another occasion, a four year old male was diagnosed with dental caries during his physical. A referral was
made to a dentist of the patient’s choice. Since the child’s parent did not know where to take the child for dental care, the CHDP Nurse Care Coordinator located a dentist close to patient’s home and dental treatment was
immediately started.
If you would like to submit your CHDP success stories, please contact Dinah
Quinones or Neda Movahed at (951) 358-5481.
Lead Updates
Children who participate in government assisted health care programs such as WIC, CHDP and MediCal are at increased risk for lead poisoning. CHDP requires a blood lead risk assessment and anticipatory guidance at each health assessment visit from six months to 72 months of age. The responsibilities
of health care providers who care for children in the CHDP program include anticipatory guidance on
lead hazards and their harmful effects .
Blood lead testing must be performed at:
▪ 12 and 24 months of age
▪ between 12 and 24 months, if testing was not done at 12 months
▪ between 24 and 72 months in children who were not previously tested or who missed the 24 month
test.
Lead levels may additionally be measured at times other than those specified, if thought indicated by the
CHPD health assessment provider or in response to parental concerns.
Clear documentation of the blood lead test results, the level of the lead exposure, and the anticipatory
guidance provided must be found in both the child’s medical record and on the PM 160. Referrals for
blood lead tests are indicated on the PM 160 by checking the routine referral blood lead check box.
If you have any questions about blood lead testing requirements or documentation
please call (951) 358-5481.
LEAD RECALLS
For the Latest Lead Recalls please refer to “Consumer Product Safety Commission” by visiting:
WWW.CPSC.GOV or calling: 1-800-638-2772 for more information.
2
Affordable Care Act (ACA) 1202 Primary Care Physician Rate
Increase:
CHDP Vaccine Administration Codes and Rates
Pursuant to the ACA, primary care physicians (PCP) with a specialty designation of family medicine, general internal medicine, or pediatric medicine will receive increased reimbursement for specified services.
As a result, CHDP vaccine administration rates overall have increased and
can be found in the ACA 1202 PCP Rate Increase – Child Health and Disability Prevention (CHDP) Code Crosswalk.
http://files.medi-cal.ca.gov/pubsdoco/ACA/
ACA_VaccineAdmin_CHDP_Rates_22202Rev1.xls
Providers should continue to use the CHDP two-digit vaccine codes. Payments will be made retroactively to all eligible physicians who complete the ACA Self Attestation Form (SAF).
Physicians must self-attest to their eligibility by completing the SAF online.
https://www.medi-cal.ca.gov/acaattest/acaattestmenu.aspx
For detailed field-by-field instructions about completing the SAF, please read the Affordable Care
Act – Primary Care Physician Self Attestation Form Completion Instructions.
http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/ACA/
aca_attestation_form_instructions.pdf
Answers to Frequently Asked Questions can be found here: http://files.medical.ca.gov/pubsdoco/ACA/ACA_PCP_Increase_FAQs.pdf
The last day for submission of the SAF is December 31, 2014. The SAF will
cover the period from January 1, 2013, through December 31, 2014.
Dates of retroactive payments have not yet been determined. However, providers will not be able
to receive any payments if their SAF has not been completed.
For more information please call Riverside County CHDP Program at
(951) 358-5481.
3
IMMUNIZATION / CAIR PROGRAM
www.rivcoimm.org
Measles
As of May 2014, 60 cases of measles have been reported to the California Department of Public Health
(CDPH). This number compares with six cases reported at this time in 2013 and is the highest number of reported cases in any year since 1995. A total of 288 confirmed measles cases have been reported to CDC. Reported
measles cases have been associated with travel to China, England, France, Germany, India, Vietnam, among
other destinations including the Philippines, where there is a large ongoing measles outbreak. Measles is a highly contagious, acute viral illness that can lead to serious complications and death. Healthcare professionals are
recommended to be vigilant about measles; consider measles in patients of any age who have a fever and a rash
regardless of their travel or immunization history. Isolate suspected measles patients immediately. Obtain a thorough history. Notify Disease Control immediately of any suspect measles patients, (951) 358-5107 during regular business hours; or (951) 782-2974 after hours. Also visit: www.rivcocha.org and www.getimmunizedca.org
for more information.
Pertussis
Pertussis incidence is increasing in California. The disease is cyclical and peaks every 3-5 years. The last peak
in California occurred in 2010 so it is likely another peak is underway. Young infants are at greatest risk of hospitalization and death from pertussis, therefore pregnant women are recommended to receive pertussis vaccine
(Tdap) during each pregnancy in the 3rd trimester, preferably between 27 and 35 weeks’ gestation, to help protect infants until they are old enough to be vaccinated. The primary DTaP vaccine series is essential for reducing severe disease in young infants and should not be delayed. DTaP can be given to infants at an accelerated
schedule with the first dose given as early as 6 weeks of age.
The Immunization Program Provider Educators are available to provide onsite Immunization Updates.
Let our Educators assist your staff on topics such as vaccine administration, vaccine management and the
recommended immunization schedule for children/adolescents and adults. For information regarding Immunization in-services please call 951-358-7125.
__________________________________________________________________________________________
http://cairweb.org
TRAINING COURSES AVAILABLE: http://cairweb.org/live-webinars/
Regular Clinical Training: This basic training will introduce participants to the California Immunization Registry and educate users on the benefits of CAIR. After completing this course, users will know how to perform
the following skills: Login, Patient Search , Add Vaccines to Patient Records (New/Historical), Record Risks
and Waivers.
Inventory Training: Is for staff that will be handling vaccine inventory in CAIR. This training will cover the
basics of using the CAIR Inventory feature. Upon completion of the Inventory training attendees will be skilled
in the following areas: Adding Vaccine Lots, Performing Inventory Adjustments, Running Reports, and Recording Risks, and Waivers.
Reminder/Recall Training: The Reminder/Recall feature assists providers in identifying patients due for immunizations. This training will instruct participants on how to use the Reminder Recall system in CAIR. During
this training attendees will learn: About the Reminder and Recall systems, How to maintain data quality in
CAIR; prepare, perform and schedule outreach, and how to follow up and track outreach.
For assistance, contact the CAIR Help Desk at Phone: 1-800-578-7889 or the Local CAIR Representative
Twila Crook at Email: TCrook@rivcocha.org, Phone: 951-358-7143.
4
Determinants of Tobacco Use
By Kiran Gill
Tobacco Control Project Intern
Statistics show that nearly 42.1 million adults (aged 18 years or older) in the United States are cigarette smokers (Center for Disease Control, 2012). Are there
factors that motivate people to begin and continue to smoke?

Among adolescents and young adults, in particular, tobacco use is influenced by:
The use of tobacco and approval of tobacco use by peers or siblings
Smoking by parents or guardians
Accessibility of tobacco products
Exposure to tobacco use promotional campaigns
Low self-image or self-esteem

Additional factors associated with smoking include (CDC, 2012):
Socio-economic status:
People with income less than 100% below the poverty threshold (27.7%) are 3 times more likely to
smoke than those living at 600% of the poverty threshold (9.0%).
Education:
Higher educational attainment is associated with lower smoking rates. Adults aged 25 and older who
have less than High School education (26.3%) are more than 4 times more likely to smoke than those
with advanced degree (6.0%).
Access to resources:
Adults with public or no health insurance (29.0-29.6%) are nearly 2 times more likely to smoke than
those with private health insurance (15.2%).
Social support:
Lack of social support is associated with higher reliance on using tobacco products for stress relief.
Understanding and addressing these factors is key to reducing the number of Americans who use
tobacco or are exposed to secondhand smoke.
For more information on smoking cessation resources, please contact the
Tobacco Control Project at (951) 358-4977.
5
5
CHDP Honors…..
CHDP PROVIDERS OF EXCELLENCE
The CHDP program recognized providers who demonstrate excellence in the following areas:
Site review score of 100% , Chart review score of 98% and above;
and Desktop review score of 100%.
Molina Medical Group– Riverside
Palm Springs Family Care Center
6
Dr. Pallapati - Corona & Riverside
___________________________________________________________________________________
It is with great pleasure and excitement that Riverside County Child Health Programs welcomes three new
Public Health Nurses to the CHP Team.
Rebecca Fergus, RN, PHN is our full time Provider Relations Nurse in CHDP. She comes to us as a transfer within the county. She worked for 8 years with California Children’s Services (CCS). She is very excited for the new opportunity with CHDP.
Tonya Duckett, RN, BSN is our part-time Provider Relations nurse in CHDP. She comes from a background of correctional and emergency room nursing as well as experience with hospice and case management. She is new to the County of Riverside.
Ashley Carbajal, RN, PHN has hospital experience as a nursing assistant and we welcome her as our
Childhood Lead Poisoning Prevention Program (CLPPP) nurse. She is very excited to work in the public
health field of nursing. She is new to the County of Riverside.
We are very happy to have all three of these nurses join our team.
Thank you for your commitment to excellence!
7
CHDP Reminders:
Medically Necessary Inter-periodic Health Assessments (MNIHA): There are circumstances, classified as
MNIHA when a client needs to be seen before their next scheduled CHDP exam. CHDP clients may be seen
outside of the periodicity schedule for school/preschool entry physicals, sports and camp physicals, foster care/
out of home placement exams, visits for additional anticipatory guidance, significant developmental disabilities, or to complete health assessment requirement. For example, CHDP providers may see a child out of periodicity and screen/test for lead, by classifying the visit under MNIHA code seven. MNIHA code seven is defined in the provider manual as “a need to complete health assessment requirements”. The provider must indicate the reason for the MNIHA visit at the time of the submission of the Gateway transmission. The provider
must also document “MNIHA Code 7-completion of health assessment requirements” in the comments problems section on the PM-160. For more information please refer to your CHDP provider manual (PM-160
Claim Form: Completion Instructions pg 19, Eligibility Section pg 3, Gateway section pg 3, and Health
Assessment Section Pg 3.
If a CHDP-eligible child needs a physical for FosterCare/Out-of Home Placement exam outside of regular
periodicity, use MNIHA code number 2.
Upcoming CHDP Trainings:
Total
number of
CHDP
Providers:
133
CHDP Gateway
March: 256
April: 2,506
May: 2,487
CHDP Overview Workshops
July 9, 2014 ~ Riverside
August 14, 2014 ~ Palm Springs
BMI/Vision Training
July 23 ,2014 ~ Riverside
Audiometric Training
Sept. 24, 2014 ~ Riverside
For any billing questions please call the Telephone
Service Center 1-800-541-5555
Attention Providers!
If you are low on your educational materials,
please fill out the “CHDP Health Education
Order Form” and fax it to:
(951) 358-5002.
Editors: Neda Movahed, MPH, Health Educator CHDP/ Lead Programs; Susan J. Mora, Public Health Program
Chief, CMS; Diane Ewing, Nurse Manager, Child Health Programs.
Contributors: Dr. Dael, Medical Director, CMS; Linda Overton, Sr. PHN, Lead/CHDP Program; Karen Gordon
-Jones, PHN, Provider Relations; Dinah Quinones, RN, CHDP Care Coordinator; Cassandra Lynch, ANM,
Immunization Program; Kiran Gill, Tobacco Control Project Intern
8