Inside the Beltway – June 2022

Injury by Firearm is the Leading Cause of Death in Children: A Call to Action for the Pediatric Nurse Practitioner

Contributed by Health Policy Committee member Allison Clark Young, MS, APRN, CPNP-PC, IBCLC

The May 24, 2022, school shooting at Robb Elementary in Uvalde, Texas that left nineteen children and two teachers dead has brought a renewed focus on the issue of gun violence as a public health crisis for the children of the United States. This was the 27th school shooting that resulted in death and injury in 2022 alone. Recently released data from the CDC shows that injury by firearms became the leading cause of death in children and adolescents in the United States in 2020. More children in the United States were killed by firearms than motor vehicle accidents, cancers, asthma, and any other condition we routinely discuss and give anticipatory guidance on to our patients and families.

As pediatric-focused APRNs, none of our patients are left unharmed by gun violence or the threat of gun violence in our schools and communities. While we recognize the problem, we may often feel overwhelmed and unsure where we can start. As experts in children’s health, we hold a unique position within our communities and with our representatives to make our voice heard in order to gain a critical mass to impact change.

NAPNAP has many resources available to aid in talking points with your community members as well as local, state and federal representatives. We must use evidenced-based resources and community outreach to reduce gun violence as well as to enact bipartisan policy change.

Here are some ways you can help:

Be vocal in your communities, on social media, and through outreach to your representatives.
Gather colleagues to request meetings with your representatives and community leaders to discuss how policy change and community outreach, harm reduction and evidenced based violence prevention can progress in your community.
Directly contact your federal representatives, regardless of their stance, and make your voice heard and do so frequently.

When speaking with others in your communities, consider these talking points outlined in NAPNAP’s recent official statement:

Increase funding for CDC, NIH and other programs aimed at researching and tracking gun violence effects and implementing violence prevention programs.
Strengthen background checks and close loopholes that prevent background checks for all firearm sales, including those at firearm shows and private sales.
Enact a firearm purchase waiting period of 72 hours to allow time for background checks to occur.
Enact a federal minimum age to purchase a firearm of 21 years-old with exemptions for those in law enforcement or the military.
Ban the sale, importation, or transfer of modifiers that convert firearms to act like semi-automatic or automatic weapons.
Form a process to allow for gun violence restraining orders (GVROs) to allow temporary emergency restraining orders to prevent firearm possession and purchases of firearms by mentally ill or potentially violent individuals until they can be proven to be capable of responsible firearm ownership.
Limit the sale and import of high-capacity magazines.
Enact legislation and funding to address the significant issue of firearms trafficking and law enforcement capacity to enforce current firearm laws.

Unsure how to contact your represntatives? Visit NAPNAP’s Advocacy Center and scroll down to the Locate Your Legislator section. Simply enter your address to find your federal and state elected officials and their contact information.

In your clinical setting, it is imperative to use every encounter to discuss gun violence prevention.

Talk about firearm safety with patients and families. Ensure that firearms are safely stored and not accessible to children or adolescents in the home.
Discuss safety plans for children and teens having thoughts of suicide and implore how important not having access to weapons is to families.
Use a trauma informed approach when talking with patients and families affected by gun violence.
Incorporate adverse childhood events (ACEs) screening into your practice.
Become better informed yourself about ways to prevent gun violence, treat patients affected by gun violence and become a better advocate by seeking out continuing education on the topic.

Call your reps and encourage the people in your life to do the same! Have conversations with people in your life advocating for the safety of children. Join NAPNAP in working to eliminate the threat of gun violence on our children.

Resources:

Andrews, A.L., Killings, X., Oddo, E.R., Gastineau, K.A.B., & Hink, A.B. (2022). Pediatric firearm injury mortality epidemiology. Pediatrics, 149(3); e2021052739.
Centers for Disease Control and Prevention. Violence Prevention available online at www.cdc.gov/violenceprevention/index.html. Last accessed April 16, 2018. Http://gov/violenceprevention/firearms/fastfact.html
Cunningham, R., Carter, P. M., Ranney, M. L., Walton, M., Zeoli, A. M., Alpern, E. R., Branas, C., Beidas, R. S., Ehrlich, P. F., Goyal, M. K., Goldstick, J. E., Hemenway, D., Hargarten, S. W., King, C. A., Massey, L., Ngo, Q., Pizarro, J., Prosser, L., Rowhani-Rahbar, A., … Zimmerman, M. A. (2019). Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium. Archives of Pediatrics & Adolescent Medicine, 173(8), 780–789. https://doi.org/10.1001/jamapediatrics.2019.1494
Goldstick, Cunningham, R. M., & Carter, P. M. (2022). Current Causes of Death in Children and Adolescents in the United States. The New England Journal of Medicine, 386(20), 1955–1956. https://doi.org/10.1056/NEJMc2201761
National Association of Pediatric Nurse Practitioners (2022, May 25). NAPNAP calls for solutions to gun violence epidemic. https://www.napnap.org/napnap-calls-for-solutions-to-gun-violence-epidemic/

Congress Seeks Compromise on Gun Control Measures

Following a wave of horrific shootings involving children and families, a bipartisan group of 20 senators – 10 Republicans and 10 Democrats – announced June 12 that they reached agreement on a “framework” for a gun control package. The agreement included funding to help states adopt their own “red flag” laws allowing families and law enforcement agencies to seek “extreme risk protection orders” to temporarily remove guns from those considered a danger to themselves and others and as much as $7 billion in new funding for school safety and community mental health clinics. The package would also close the “boyfriend loophole” to add domestic violence abusers to the National Instant Criminal Background Check System, provide new limits on illegal weapons trafficking, and provide enhanced background checks for gun buyers under 21 including checks of juvenile criminal and mental health records.

The Senate agreement came days after the House voted 223 to 204, largely along partisan lines, on June 8 to pass the “Protecting Our Kids Act” (H.R. 7910), including measures to raise the minimum age for purchasing most semiautomatic rifles to 21 and banning high-capacity ammunition magazines. A day later, the House voted 224 to 202 June 9 to approve a separate bill, the “Federal Extreme Risk Protection Order Act of 2021” (H.R. 2377), creating a federal “red-flag” law.

Senate Majority Leader Chuck Schumer, House Speaker Nancy Pelosi and President Joe Biden all applauded the bipartisan Senate proposal, which they hope the Senate will pass by the July 4th congressional recess. With at least 10 Senate Republicans in favor, supporters would be able to prevent a potential filibuster. Senate Minority Leader Mitch McConnell praised the senators negotiating the deal, but he didn’t formally endorse their proposal.

COVID Vaccine for Youngsters Nears Approval

The Food and Drug Administration Vaccines and Related Biological Products Advisory Committee voted on June 14 to approve Moderna’s application for its COVID-19 vaccine for children 6 to 17 years old and again June 15 to recommend emergency use authorization for Moderna’s vaccine for children 6 months to 5 years old and for Pfizer-BioNTech’s vaccine for children 6 months to 4 years old. The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices will meet June 17 and 18 to review both vaccines for children 5 years old and under.

Currently, only the Pfizer-BioNTech vaccine is available for kids as young as 5. There are currently about 19 million children who are still ineligible for vaccination. If the vaccines are approved, White House coronavirus response coordinator Ashish Jha June 2 that said he expected the youngest children to begin receiving vaccines as early as June 21.

Meanwhile, the administration’s request for supplemental funding for its coronavirus response efforts remains stalled in the Senate. It appeared that lawmakers had reached a bipartisan agreement in March on a $10 billion funding deal, but Senate Republicans withheld their support after the Biden administration took steps to end public health-related expedited deportation of migrants – an effort blocked by a federal court injunction.

Mental Health Measures Advance in Congress

A key House committee approved bipartisan legislation to renew and expand federal mental health programs May 18, while members of a Senate committee began releasing draft provisions of its mental health proposal May 26. The House Energy and Commerce Committee approved its “Restoring Hope for Mental Health and Well-Being Act of 2022” (H.R. 7666) by voice vote after adding several amendment including language to eliminate a requirement that advanced practice registered nurses and other health care providers obtain a Drug Enforcement Administration waiver in order to prescribe buprenorphine as an addiction treatment.

Separately, Senate Finance Committee Chair Ron Wyden (D-OR) and the committee’s ranking member, Sen. Mike Crapo (R-ID), released a discussion draft of legislation to expand telehealth access for mental health services. Their “Telemental Health Access to Care Act” is expected to become part of a larger comprehensive mental health reform proposal to be unveiled in the coming weeks. The draft legislation would eliminate Medicare’s in-person visit requirement prior to patients seeking online mental health services and calls for states to use their Children’s Health Insurance Programs to address mental health in schools using telehealth.

The Senate Health, Education, Labor, and Pensions Committee is also working on mental health policies within its jurisdiction. Committee members Sens. Chris Murphy (D-CT) and Bill Cassidy (R-LA) introduced the “Mental Health Reform Reauthorization Act” (S. 4170) May 10, which would enhance community health services, expand access to mental health care for children, increase the diversity of the mental health workforce, and authorize $25 million to help states enforce mental health parity laws. Provisions of that bill could become part of the committee’s comprehensive proposal.

Thank You!

Volunteers are critical to NAPNAP’s health policy efforts. We truly appreciate the time and expertise that the following members contributed to our committee during their multi-year terms ending on June 30: Danielle Altares Sarik, PhD, APRN; Kristin Gigli, PhD, RN, CPNP-AC, CCRN; Catherine Lux, DNP, RN, CPNP-PC; Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP; and Linda Zekas, MSN, MJ, APRN, NNP-BC, CPNP-PC, CWON. We offer a very special thank you to our chair, Kelli Garber, DNP, APRN, PPCNP-BC for her leadership and we look forward to her continued success as a member of the NAPNAP Executive Board starting on July 1.

Chapter officers, especially legislative or advocacy chairs, work tirelessly to monitor state and local legislation and regulations to educate and rally members on important pediatric and advanced practice nursing issues. For those chapter officers retiring in June, we salute your amazing efforts as experts in pediatrics and advocates for children.

Infant Formula Shortage Tests Federal Response

Abbott Nutrition resumed production at its shuttered Sturgis, Michigan, baby formula factory June 4, offering hope to parents that a nationwide shortage could ease in the coming weeks. Production restarted after the company responded to a Food and Drug Administration consent decree after an inspection earlier this year turned up allegedly unsanitary conditions that led to its closure. President Biden invoked the Defense Production Act May 19 to speed up U.S. production of formula while also initiating “Operation Fly Formula,” directing agencies to use the Defense Department’s commercial aircraft to pick up products from overseas as the FDA eased import restrictions.

The House passed $28 billion emergency supplemental spending bill (H.R. 7790) May 18 to help the FDA ramp up its oversight of formula manufacturing, although the measure stalled in the Senate as Republicans opposed it as a “blank check” for the agency. Separately, House Appropriations Committee Chair Rep. Rosa DeLauro (D-CT) introduced legislation June 3 that would require the Food and Drug Administration to inspect infant formula manufacturing facilities at least every six months.

Pulse of the Profession

For the first time ever, NAPNAP has published a Pulse of the Profession report which provides an in-depth look at PNPs’ and their fellow pediatric-focused APRNs’ assessment of current realities for the profession, outlook for the future and opportunities to make a greater impact. Click here to read the report.

In Other News

HHS Expected to Extend Public Health Emergency
Health and Human Services Sec. Xavier Becerra has promised state Medicaid officials that the Biden administration will give them 60 days advance notice when it intends to let the federal coronavirus public health emergency expire. Since no notice was given 60 days ahead of the July 15 expiration of the current emergency designation, stakeholder expect Becerra to extend the emergency until at least mid-October – and possibly longer – although an official announcement may not come until next month. The extension is important to advance practice registered nurses and other providers since many pandemic policies waiving barriers to practice are tied to the public health emergency.

However, efforts to permanently extend many of those federal waivers remain stalled along with many of President Biden’s domestic policy priorities that were part of the “Build Back Better Act” (H.R. 5376). While he continues to talk with Democratic leaders, Sen. Joe Manchin (D-WV) appears no closer to reaching an agreement on provisions of a budget reconciliation bill that could include policies to remove barriers to practice, extend enhanced health insurance premium subsidies, or permanently authorize the Children’s Health Insurance Program. The clock is ticking on reaching an agreement: legislation authorizing a partisan budget reconciliation bill will expire Sept. 30 at the end of the current fiscal year.

House Passes Workers’ Compensation Access Bill
The House of Representatives voted 325 to 83 June 7 to pass the “Improving Access to Workers’ Compensation for Injured Federal Workers Act” (H.R. 6087), a bill authorizing nurse practitioners to certify a federal employee’s injury or illness and oversee their health care delivery in accordance state law. The vote came after NAPNAP and other nursing organizations pushed back against last-minute opposition to the bill from physician groups. The legislation now moves to the Senate for further consideration.