By Kirstin Grace-Simons (Madigan Army Medical Center)April 29, 2019
MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- April is recognized as the Month of the Military Child. Among the many events and activities surrounding this observance is the Caring for the Military Child Symposium. Taking place in Letterman Auditorium on April 18, this year's day-long conference observed the 40th anniversary of the Developmental-Behavioral Pediatrics Fellowship Program at Madigan Army Medical Center.
Air Force Lt. Col. (Dr.) Eric Flake presided over the day's activities just as he does for Madigan's DBPEDS Fellowship Program as its director.
"The intent of the symposium was to celebrate caring for military children and that for 40 years there has been a training program that has incredible trainees and faculty," said Flake.
Some of the program's former trainees and faculty returned to Madigan to speak to the current faculty and fellows.
Dr. Glenn Tripp was one of the program's earliest fellows. Speaking about the DBPEDS program, Tripp said, "It's a wonderful program at Madigan. But, the tapestry of a program is woven by the faculty."
Madigan's program was born in the heady days of reform for developmental pediatrics, a subspecialty that addresses the care of children with disabilities and special needs.
"1978 was the event horizon -- the sentinel year -- for developmental pediatrics. In 1978, a number of things happened," said Tripp.
"The (American) Academy of Pediatrics pushing for developmental training programs, special education coming on a law (the Individuals with Disabilities Education Act) that would govern my life, at least, for the next 30 years, and a change in mental health diagnostic criteria for the people we serve made for a huge year. And then, in 1979, we started our program here at Madigan," Tripp said.
One of the day's other speakers, Dr. Errol Alden, was the chief of Pediatrics at the time; he submitted a proposal to start a fellowship program at Madigan. Gaining immediate approval, Alden recruited Dr. Barbara Bascom.
Bascom was a contributor to the symposium but, as she was unable to attend in person, Dr. Mark Stephan shared Bascom's perspectives on the early days of the program.
"Community education including to professional groups is often part of providing services in developmental disabilities," said Bascom.
Getting into the communities and encouraging support for developmental pediatrics was often a hard sell.
Bascom recounted a visit to a clinic in Alaska where she gave a presentation to the commander in his office. When she finished and the floor was opened to questions, the commander replied that he had just one. "Can you take a hill?" he asked. Bascom's response was, "Yes, I think that's what we're doing right now."
In addition to the fellowship program, Bascom's advocacy resulted in the Exceptional Family Member Program.
She worked to drum up support for the program and knew that she would need the approval of the surgeon general. Eventually, she found herself briefing him in his office in the Pentagon. At one point, they both stood at a large picture window overlooking the Potomac. She told him, "I could circle this building with wheelchairs, if I have to. But, I cannot leave here and see these families still not served."
Her persistent approach worked. The EFMP was developed.
The symposium's slate of speakers displayed the broad reach of Madigan's influence and involvement in DBPEDS worldwide.
Alden has gone on to serve as the chief executive officer of the American Academy of Pediatrics and has recently been elected the president of the International Pediatric Association. He shared some of his experiences travelling the globe on behalf of children.
He discussed some of the international focus of pediatrics -- vaccine refusal, natural disasters and non-communicable diseases. Of the latter he said, "Children with special needs are most at risk for NCDs. We need to be aware of that and advocate for them."
"We've taken care, in the military, of kids at work all over the world and it pays dividends down the road in rapport between nations, for example," he said.
On this point, Vice Adm. (Dr.) Forrest Faison, the surgeon general of the Navy who is a pediatrician, stressed the advantage and opportunity the military has because of its unique, global role.
He provided the 2004 Indian Ocean earthquake as an example. Prior to that natural disaster, he said Indonesia had rather cool relations with the U.S. Seeing service members in uniform taking care of children shifted public opinion to where Indonesia is now one of the United States' strongest allies in the region. "Medical can get into countries and do things to build friendships and partnerships that others can't do," he said.
Instrumental in building strong alliances for EMFP families locally is the Joint Base Lewis-McChord Center for Autism Resources, Education and Services. Included in the symposium's activities was a tour of the facility led by its director, Dr. Dawn Peredo.
Alecia Grady, the director of the JBLM Directorate of Personnel and Family Readiness, under which the EFMP falls, worked the numbers in the push to make CARES a reality. She presented the data of service members who could not be assigned to JBLM because it did not have the services families with kids with autism needed.
Those numbers are significant.
As Peredo showed the group the facility, she explained the "motor skills room" is used for assessment and development work. "It's a very busy room; we get 30 to 70 new referrals a month. It's a very hopping place," she noted.
Peredo explained that the center focuses on, "Bridging services for kids who are new to the area or need to get connected to services."
Looking to the future, Tripp believes DBPEDS faces considerable challenges.
He offered insights on the difficulties in hiring developmental behavioral pediatricians. Among the reasons are that we (the medical professions) don't train for it well; pay is poor compared to other subspecialties; and it is hard to justify hiring for it specifically instead of breaking out the many parts and hiring those individually.
Ultimately, he focused on the shortfall of personnel.
"Historically, about a 1000 people (U.S.) have been board certified. About one third of those people are my age; I retired three weeks ago. A third of your workforce will retire in a few years and we train no more than 30 a year in active training programs," he said.
Tripp suggested that telemedicine may be one avenue to provide services where physicians are not in residence, such as rural areas. Faison echoed that expectation, but also other aspects that will play an increasing role in the future.
Faison noted that advances in medical practice are reducing the complexity of cases, pushing more patients into outpatient settings and allowing more care to be delivered by staff other than physicians.
He advised that physicians be viewed in line with their scarcity saying, "Stop treating physician time as a commodity and treat it as a treasure."
One thread that was picked up by multiple presenters and subject matter experts throughout the day was the great importance of partnership. Faison and Alden referenced the global scale while Grady and others talked about the close ties between base programs and Madigan. "I'm really proud of our partnership with Madigan," said Grady.
"We think pediatrics is a team sport; one group can't do it all themselves," said Alden.
Grady offered praise to the EFMP team and its system navigators who connect families with kids with special needs 120 days prior to their arrival date when they are assigned to JBLM. This centers the child and family so they do not get lost in an often complex and disparate array of services.
The goal of CARES, developmental behavioral pediatrics and the repeated sentiment of those in attendance at the symposium was best voiced by Alden.
"If you concentrate on the children and the children's needs, it's amazing what you'll get; if you concentrate on what's best for children, you'll never go wrong."