Chapter Chat – October 2018

Message from the Chair

Welcome to the latest Chapter Chat.

The Chapter of Community Child Health (CCCH) Committee meets four times annually and has been working hard on key initiatives such as an Evolve list in Community Child Health (CCH) and developing the Chapter Satellite Day programs.

I would like to thank the Advanced Training Committee (ATC) in CCH for their continued support, and forward thinking collaboration on education, curriculum and accreditation. I acknowledge the renewed effort that is underway to ensure the maximum number of clinic and hospital sites are being accredited for CCH training. The Advanced Training Handbook is in the process of being updated.  There are now 176 trainees in CCH and all but seven are dual training or doing even more. A huge workload for the ATC.

This year the Chapter Committee has decided to join with the Australasian Chapter of Addiction Medicine to work on a statement expressing our concern about the children of parents with an addiction.  It is planned to use this statement to sensitise Fellows and trainees to the adverse outcomes for children in this situation

I urge you to remain aware of the plight of so many children at risk across the world.  These include the refugees in camps across Africa and those in the war zones there and in Syria.  The camps for Syrian refugees in Jordan and the Rohingya refugees in Bangladesh are but two areas where children are suffering from disease and lack of education. Nearer to home are the children on Nauru whose progressive deterioration in their mental health is something to be condemned.

Then there are the more subtle forms of abuse that are less well known such as the dancing boys of Afghanistan forced into a practice known as Bacha Baazi. The boys are generally prepubertal and kept by powerful men including warlords.  They are dressed in women’s clothing and forced to dance on special occasions and are subjected to other practices of physical and sexual abuse.  This was brought to light by the photographer Barat al Batoor and his work was published in the Washington Post.

As members of the Chapter I encourage you to stand up for the rights of children wherever they are threatened whether here in Australia and New Zealand or elsewhere in the world

As the year draws to a close, on behalf of the Chapter Committee I would like to wish all members the very best for the upcoming festive season.

Your feedback and comments are always welcomed. Please do not hesitate to contact me.

Dr Chris Pearson
Chair, Chapter of Community Child Health

What would you like your Chapter Chat to include? Do you have a topic you would like addressed or have a news item to share with your colleagues? 

Please send us your ideas, comments and photos to paed@racp.edu.au by the end of February 2019 so they can be considered for the next edition due out in April 2019. If an image is submitted, we'll assume appropriate permissions have been obtained to use any such photo, which must be of high resolution

Welcome to new Chapter Chat Editor, Dr Manina Pathak

I take great pleasure in introducing myself to my CCH colleagues and taking up the position as Editor of Chapter Chat. 

I have been a member of the Chapter Chat community since 2013. I graduated in Medicine from India, worked as a resident in United Kingdom for 18 months, prior to migrating to Australia in 2007. I completed my Basic Training in Paediatrics at The Canberra Hospital and Advanced Training in Community Child Health at the Women’s and Children’s Hospital, Adelaide, South Australia. I completed a Masters of Public Health from University of Newcastle in 2015 and was awarded Fellowship in CCH in 2016.

I must admit to developing a strong interest in Community and Developmental-Behavioural paediatrics while I completed my first community term under the supervision of Dr Chris Pearson in 2013, followed by a rotation in the Department of Psychology that same year. After having done other subspecialties prior to that, I was simply fascinated by the medical practice outside the realms of the acute hospital setting and the pathology we get to see in Community settings. In 2014, I undertook another 12-month Community position based in Adelaide that only strengthened my career choice.

After finishing my clinical training, I had the opportunity to spend two years in Philadelphia, USA and to work as a clinical research associate at Children’s Hospital of Philadelphia (CHOP) for one year. During that time, I worked on different projects being a part of Centre of Autism Research (CAR) at CHOP and Autism Treatment Network (ATN), a multisite network of stakeholders working together to develop effective approaches to medical care for children and adolescents with autism. I had the opportunity to participate in the local training program for DBP (Developmental-Behavioural Paediatrics) Fellows at CHOP and attend multidisciplinary clinics for management of children with complex developmental- behavioural issues. It was a great experience to meet with various DBPs with diverse academic and advocacy interests.

I returned to Canberra late last year and currently work in private practice as a Developmental-Behavioural Paediatrician. I look forward to being part of the communication platform – the Chapter Chat – that brings the people with similar interests and passion together and helps our speciality to flourish further.

NDIS update

The National Disability Insurance Scheme (NDIS) is continuing to roll out across Australia, supporting Australian residents living with disability to fully participate in their communities. The NDIS supports people with a permanent and significant disability that affects their ability to take part in everyday activities through an equitable, effective and responsive disability support system.

What is the RACP doing?

The NDIS serves as a platform where the community, government and industry can work together to help address the challenges faced by people with disability. The RACP is committed to advocating for all mainstream health services and programs to be as accessible as possible to Australian’s living with disability. Our NDIS Working Group has produced a position statement that outlines steps health services, specialists and paediatricians can take to maximise the positive impact of the NDIS for their patients living with disability. It also outlines steps that the National Disability Insurance Agency (NDIA) and governments can take to improve the roll out and function of the NDIS.

Our Policy and Advocacy Unit continues to work with the Chapter of Community Child Health - and the Paediatrics and Child Health Division - on specific issues effecting children living with disability. The most immediate focus centres on the NDIS’ Early Childhood, Early Intervention (ECEI) program. The RACP made a submission to the Commonwealth Government’s Joint Standing Committee on the NDIS outlining challenges facing the ECEI program, and our paediatricians were invited before the Committee to offer further input.

How can you work with the NDIS?

The NDIS Working Group collaborated with our Policy and Advocacy Unit and National Disability Services to produce NDIS Guides for Physicians and Paediatricians. These practical Guides are available on our website. They are updated periodically to reflect changes as the NDIS is rolled out.

We’re continuing to advocate for regular improvements to the NDIS. We regularly make submissions and representations to various jurisdictions, with a strong focus on helping the NDIS and health work together. 

Members who have feedback and anecdotes that might be useful in improving the outcomes of the NDIS for patients should email our Policy & Advocacy team

Further information on what we’re doing to help maximise the impact of the NDIS can be found at our NDIS hub here.

Fetal Alcohol Spectrum Disorder

Fetal alcohol spectrum disorder (FASD) results from prenatal alcohol exposure and exists within all paediatric caseloads in Australia. It is a chronic, costly, yet preventable condition that is often undiagnosed. A 2011 survey revealed that few Australian health professionals asked about alcohol use in pregnancy and only 16 per cent could identify the essential diagnostic features of FASD. Current NHMRC guidelines recommend that no alcohol is the safest option for women who are planning pregnancy or who are pregnant.

FASD is a disability of two parts: (1) a primary diffuse brain injury resulting in severe impairment; (2) secondary & tertiary disabilities eg anxiety, depression, school drop-out, substance misuse, unemployment, suicide, crime and dependent living.  Early diagnosis minimises the risk of secondary/tertiary disabilities and aids in prevention and identification of FASD in siblings. A formal diagnosis requires clear evidence of prenatal alcohol exposure with severe impairment in at least three of ten domains of brain structure/function stipulated in the Australian Guide to the Diagnosis of FASD (2016).  Contrary to early teaching neither the characteristic 'face', growth impairment or birth defects are necessary for a FASD diagnosis and only a small proportion of children have all three sentinel facial features. Diagnosis involves a multi-disciplinary assessment which is important to identify both the child’s needs and strengths and guide treatment.

Many caregivers say diagnosis is a relief, however the guilt that biological parents experience when a FASD diagnosis is made is real and must be managed with sensitivity and compassion.  Clinicians concerns about causing guilt is not supported by parents’ stories nor scientific data.  Paediatricians are uniquely trained to successfully negotiate complex situations and should be able to ask effective questions about prenatal alcohol exposure using validated tools to ‘get FASD out of the closet.’  Simply asking ‘did you drink alcohol during pregnancy’ is not reliable. The best sources of local information for paediatricians to update their skills are available in: The Australian Guide to the Diagnosis of FASD and The FASD Hub.

Dr Doug Shelton
Professor Elizabeth Elliott

Chapter Satellite Day 2018

The Chapter of Community Child Health held their annual Chapter Satellite Day on Sunday, 13 May 2018 at Karstens, 111 Harrington St, Sydney.

The meeting was attended by 44 members with positive feedback received indicating that the day was a success.

The day consisted of a plenary by Dr Paul Hutchins. An insight into the New Zealand policy for child protection, The White Paper for Vulnerable Children and other developments was provided by Dr Tim Jelleyman. An overview of the new changes in community child health training and implications for supervisors was explained by Dr Terry Donald and Dr Chris Pearson presented: New frontiers in pharmacotherapy of autism.

Thank you to all the speakers for taking the time and effort to present and to the organising committee for coordinating a great day.

Chapter Satellite Day 2019

Next year’s Chapter Satellite Day will be held in Auckland on Sunday, 5 May. It will align again with the NBPSA Education Day which is taking place on Saturday, 4 May. Full details of the program and how to register will follow shortly; you will be able to book through the RACP Congress website.  The NBPSA day rapidly filled up last year so make sure you register early– their theme will again be psychopharmacology.

The format of the Satellite Day is changing in 2019.  Current and recent trainees will be invited to submit their projects and the four best submissions will be offered the opportunity to present at the Satellite Day.

Remember to book a spot for the joint CCCH / NBPSA dinner which will be held on the Saturday evening, when you register.

Congress 2019

Registrations open next month for Congress 2019, to be held at the Aotea Centre in Auckland, New Zealand, from 6-8 May inclusive. The program is currently being developed and there will be many fantastic sessions of interest to Chapter Members, including the Rue Wright Memorial Award presentations (see item below).

The Chapter of Community Child Health Annual Meeting and Paediatrics & Child Health Division (PCHD) Annual Meeting will be held during the Congress; please check emails and watch the monthly PCHD newsletter Pot-pourri for more details as they are confirmed. Please raise any items for the CCH Annual Meeting agenda to paed@racp.edu.au

Rue Wright Memorial Award

The Rue Wright Memorial Award is awarded to a Fellow or trainee who demonstrates excellence in hypothesis, scientific merit and relevance to Community Child Health in an oral presentation at RACP Congress.

Applications will open next month via the RACP Congress website. The closing date for applications for next year’s Rue Wright Memorial Award will be Monday, 4 February 2019.

What does the Chapter mean to you?

The Chapter would like to hear your thoughts on how it can best meet your needs.

  • Are you aware who to approach to promote activities within the Chapter?
  • What are your thoughts on attending the Chapter Satellite Day? What would encourage or discourage you from registering your attendance?
  • Are you aware of the Community Child Health Special Interest Groups and what they represent?
  • What does the term community child health paediatrician mean to you? What would encourage or discourage you to obtain membership of the Chapter?
  • Do you feel that there is adequate and regular communication from the Chapter and its Committee in relation to their ongoing activity? Do you feel sufficiently engaged? 

The Committee is keen to understand how we can build upon a sense of identity and purpose within the Chapter, as well as identifying guiding key priorities for the membership. Send any thoughts or suggestions to our Paediatrics & Child Health Division team

Dr Chris Pearson
Chair, Chapter of Community Child Health

College Resources

Reminder: Recognition in the specialty of Community Child Health

We encourage you to consider submitting an application to become recognised in community child health.

The 2019-20 CCH Handbook is updated and available on the website. Pages 13-16 provide details on the core and non-core CCH requirements. Members should also be aware that there is a new updated CCH Site Survey and Accreditation Process Guide available on the website to assist sites in applying for CCH Advanced Training.

Contact Education Officer Laura Eutick for further information.

Trainee resources and support

A range of trainee resources and general training support tools are available on the RACP website. You are encouraged to access online learning tools on a range of topics. 

If you have any issues, comments, or feedback please contact us so that the voices of our trainees continue to be heard. 

Guide for New Fellows

resource for new Fellows is available on the RACP New Fellows webpage. This guide summarises the information and resources new Fellows need as they enter Fellowship, and start practicing as a physician or paediatrician.

Topics include:

  • using the College post nominal
  • introduction to MyCPD
  • physician wellbeing and support
  • becoming a supervisor
  • Foundation awards.

Neurodevelopmental and Behavioural Paediatric Society of Australasia (NBPSA) membership

The Chapter has a close collaboration with the NBPSA. Dr Lakshman Doddamani is the NBPSA representative on the Chapter Committee. Membership of the NBPSA is open to doctors working in the area of Neurodevelopmental Paediatrics, including Developmental-Behavioural and Developmental Disability Paediatrics.

For more information on how to join the society, and the benefits of membership please visit the NBPSA website.

Your Chapter Committee – our responsibility

The Chapter is the authoritative source of advice within the College for anything relating to Community Child Health. Links to useful information are below:

To raise matters with the Committee, please contact us.

Welcome new Chapter Members

It is always great to have new members of the Chapter and we are pleased to welcome the following:

  • Dr Pei Chan
  • Dr Tom Clemens
  • Dr Katherine Crerie
  • Dr Amber Seigel
  • Dr Muhammad Sial
  • Dr Thet Soe
  • Dr Elizabeth Tilse
  • Dr Samantha Williams
  • Dr Rachel Williams
Do you know someone who would like to join the Chapter? Refer them to the ‘becoming a Chapter member’ webpage.

Be involved – expression of interest

Take part in College activity or be an RACP representative to an external group. You can now go to the Expression of Interest page at any time, to find out if there are any opportunities that are of benefit to you.

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