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Since its inception in 2010, the Concurrent Care for Children Provision of the Affordable Care Act has enabled seriously ill pediatric patients and their families to access comprehensive, supportive hospice services while simultaneously receiving ongoing treatment-directed therapies. Although this groundbreaking federal legislation has resulted in improvements in care for vulnerable pediatric patients, the implementation of the law has varied from state to state through Medicaid programming. The pediatric professional community is called to consider how Medicaid services can more effectively be delivered by leveraging legislative mandates and collaborative relationships between clinicians, Medicaid administrators, and policy makers. In this article, we examine ways concurrent care has been executed in 3 different states and how key stakeholders in care for children with serious illness advocated to ensure effective implementation of the legislation. The lessons learned in working with state Medicaid programs are applicable to any advocacy issue impacting children and families .

Background: The experience of starting and growing a pediatric palliative care program (PPCP) has changed over the last 10 years as rapid increases of patient volume have amplified challenges relat...

Pediatric patients receiving palliative care may experience itching as a distressing symptom for a wide variety of reasons. Antihistamine medications are widely used for treatment of this symptom and have effectiveness if histamine is the primary mechanism of itch. Pruritus is a known adverse effect of opioid therapy, occurring in 2–10% of patients. Opioid-induced pruritus is not primarily histamine related and therefore better treated by partial opioid antagonists. Chronic health conditions such as renal disease, cholestasis, and malignancy are all associated with pruritus. This chapter presents a broad differential for the symptom as well as a range of pharmacologic and nonpharmacologic therapies.

The Gulf State Pediatric Palliative Care Consortium formed in January 2019, and our most important focus currently is to transform pediatric hospice care in LA. It came to our attention in March 2019 that the Medicaid manual for pediatric concurrent care hospice benefit language changed, which caused thoughtful dialogue in our hospice community. Concurrent Care Hospice Benefit for children was made available by our Affordable Care Act in 2010. Concurrent Care means that seriously ill children who are

Objectives: 1 Discuss basic tenants of pediatric palliative care in single bootcamp session 2 Apply knowledge to validated case-based scenarios 3 Analyze changes in confident with pediatric palliative care topics as a result of the bootcamp Background: Formal education and training in pediatric palliative care (PPC) have been shown to improve confidence in providing quality palliative and end of life care to pediatric patients Our pediatrics residency identified a lack of training and designed a single five-hour intensive educational session (bootcamp) to increase resident knowledge and confidence in providing PPC Aim Statement: To increase resident knowledge and confidence with management of patients receiving pediatric palliative care by 1 point on a 5-point Likert scale after one bootcamp session Methods: Residents elected to attend one five-hour bootcamp session, facilitated by a PPC physician certified in Education in Palliative and End-of-Life-Care-Pediatrics (EPEC-Peds) Teaching topics included introduction to PPC, communication techniques with role play, delineation of goals of care, end of life symptom management, bereavement, and advance care planning Communication skills training followed evidence-based curriculum designed by EPEC-Peds, as well as videos from the Courageous Parents Network Participants completed a pre- and post-assessment, measuring self-perception of knowledge and confidence on a 5-point Likert scale One session was completed in-person and one session was completed virtually as a result of COVID-19 physical distancing requirements Results: Ten residents from two academic programs, PGY-1 to PGY-4, attended the PPC bootcamp Improvement in resident knowledge and confidence was found in all tested topics and both bootcamp formats, via analysis of pre- and post-test means Participants expressed the largest post-intervention change in the following categories: filling out POLST form and completing DNR orders in EPIC, feeling equipped to provide post-mortem aftercare, and feeling confident in communication with families with serious illness Conclusions and Implications: Pediatric residents who participated in the bootcamp expressed increased knowledge and confidence in multiple aspects of PPC The five-hour bootcamp was an effective instructional method, both in-person and virtually Though the sample size was small, we intend to continue to offer quarterly bootcamps and improve PPC instruction