Moira A. Szilagyi Q&A

1. How will your skills and experiences help the AAP navigate the politically polarized national landscape?

The AAP masterfully navigates our politically polarized national landscape to advance the health and well-being of all children. I believe my career experiences integrate well with the AAP in this challenging endeavor.

My career as a primary care physician, child welfare specialist and academic pediatrician has been dedicated to developing pro-grams and advocating for improved health care for children and adolescents in foster and kinship care. I have worked in close partnership with and often led large interdisciplinary teams whose members had varying and sometimes conflicting viewpoints. Finding common ground and forging a workable compromise has required attentive, attuned listening to varied perspectives, using data wisely and forming respectful partnerships with leaders in health, mental health, child welfare, insurance and policy while keeping the ultimate shared goal of best serving children and families in mind. While progress toward a larger goal can sometimes feel incremental, goal-informed collaboration occasionally leads to large leaps forward.

In New York, on behalf of children in foster care, I led teams that created an integrated-care medical home; developed the national foster care health guidelines; and tested the transition from fee-for-service to Medicaid managed care. My work with the AAP Washington office reinforced the importance of collaborative cross-systems partnering to achieve important changes for children.

These leadership experiences have sometimes required me to reach across chasms to find common ground, while simultaneously identifying like-minded partners and advocating vigorously for children, families and pediatricians. Bridging chasms is always easier when we focus on what is best for children.

2. What is one of the most important issues facing today’s pediatricians, and how would you work with the board and CEO to address it?

Our country’s 75 million children are 20% of our population but 100% of our future. They are being reared in a demanding, stressful world for a future that often seems in peril. Nearly half live in poverty; 64% have experienced more than one adverse childhood experience. They face new challenges such as climate change, vaping and social media. Addressing these cumulative ad-versities is incredibly challenging but of critical importance to pediatricians because toxic stress, regardless of cause, can become biologically embedded resulting in poor outcomes now, throughout life and across generations.

As AAP president, I would work closely with the AAP’s CEO, board, chapter leadership and Washington office to implement the AAP Agenda for Children by:

• Supporting the work of pediatricians. Pediatricians do vital family-centered work to promote healthy growth, development and resilience, ameliorating the negative impact of stressors. Financing must be aligned to pay for the scientifically based preventive and therapeutic work we do and to support integrated care.
• Advocating for vulnerable children. The power of our advocacy is its foundation in science and demonstrated successes. With partners, we can address poverty, bias and discrimination, climate change, and negative social determinants of health, and pro-mote equity in access and workforce diversity.
• Promoting pediatrician and staff wellness. Massive transformations in health care require that we support wellness across gen-erations and specialties through team-based care, streamlined technology, improved financial margins and programs to reduce burnout.

We pediatricians have a crucial role as healers who promote resilience and buffer stress.

3. In your view, what is the most important child health priority for the AAP and how would you work with the board and CEO to move it forward?

The COVID-19 crisis has laid bare deeply entrenched disparities and inequities in health, wealth and opportunities in our country. Vulnerable children and families will suffer the greatest harm for they reside in disadvantaged communities where their air is more polluted, their housing more crowded, their neighborhoods less safe, and where childhood adversities are more frequent and profound. While COVID-generation children may be relatively spared from infection, they will be markedly affected by the struggles and stressors of their parents and recall COVID-19 as a defining experience in their lives. The question is whether this experience will build or erode their resilience.

COVID-19 has made the AAP’s Agenda for Children more important than ever.

Cumulative childhood adversities lead to lifelong poor health, mental health and social outcomes. Pediatricians already provide vital family-centered care to promote healthy growth, development and resilience but we must enhance our skills in trauma-informed care to identify children at risk or with symptoms of trauma and become adept at evidence-informed responses to ameliorate the long-term impacts of this pandemic. Health organizations must adopt trauma-informed principles that support team-based care and physician wellness.

The AAP’s advocacy powerhouse has masterfully responded to this crisis on behalf of children and pediatricians. Moving forward, advocacy must continue to promote the AAP’s Agenda for Children, which includes equitable universal access to high quality health care and quality education, and addressing bias and discrimination, poverty, and social risk factors.

Moving forward, we have tremendous work to do together on behalf of all children.