The long and at times sordid history of the juvenile justice system in the United States.

IMPACT: The American Pediatric Society 'Issue of the Year' (2023-2024) has been focused on increasing access to quality healthcare for children who are incarcerated. Addressing the future of youth in the juvenile justice system requires that pediatricians understand the history of how that system has gotten to where it is now. This commentary examines the creation and growth of the United States juvenile justice system since its establishment 125 years ago, so as to guide a way forward.

Coming to America: Regulatory Oversight of United States Immigration Policies: A Brief History.

This article briefly covers the history of immigration from the US perspective, including the demographic variation over time and the ever-changing policies. Displaced children and their families are facing increasing challenges to their health and overall wellbeing. Since enactment of the Immigration and Nationality Act of 1965, the needs of minors have been caught up in complex immigration policy. Recognition of the unique needs of minors and the Dreamers must be addressed as part of comprehensive immigration reform or in more targeted legislative proposals. The challenges posed by the magnitude and scope of the immigration problem are discussed.

International Migration and Immigration Issues Related to the United States: Defining the Size and Scope of the Problem.

This article briefly examines the scope of international migration-related issues and issues related to the migration of individuals and families across the southern border of the United States. Immigration issues include designing oversight policies consistent with international treaties yet tailored to suit the unique circumstances of recipient countries; integrating refugees and asylum seekers; and dealing with undocumented foreigners who have gained entry across a border. Most importantly, ways must be found that allow accompanied and unaccompanied minors to live a full and healthy existence as they wend their way through a most difficult time in their lives.

Use of board certification and recertification of pediatricians in health plan credentialing policies.

CONTEXT: Health plans conduct credentialing processes to select and retain qualified physicians who will provide high-quality care to their subscribers. One of the tools available to health plans to help ensure physician competence is assessment of board certification status. OBJECTIVE: To determine the credentialing policies of health plans regarding the use of board certification and recertification for general pediatricians and pediatric subspecialists. DESIGN, SETTING, AND PARTICIPANTS: Telephone survey conducted February through July 2005 of credentialing personnel from a US national sample of 244 health plans stratified by enrollment size, Medicaid proportion, and for-profit or not-for-profit status. MAIN OUTCOME MEASURES: Proportion of health plans that require general or subspecialty board certification at initial contract or at any time during association with the plan and recertification to maintain credentialing or to bill as a specialist or subspecialist; percentage of physicians credentialed in each health plan and credentialing goals for each plan regarding the proportion of physicians to be board certified. RESULTS: Response rate was 193 of 244 (79%). Overall, 174 (90%) of the plans do not require general pediatricians to be board certified at the time of initial credentialing, and only 41% ever require a general pediatrician to become board certified. Similarly, only 80 (40%) ever require subspecialists to become board certified in their subspecialty. Although 80 of 192 (41%) report requiring recertification of general pediatricians, almost half do not have a time frame in which recertification must occur. Seventy-seven percent of plans allow physicians to bill as subspecialists with expired certificates. CONCLUSIONS: These findings, although specific to pediatrics, likely apply to other primary care disciplines and raise questions regarding the ability of plans to ensure initial or continued competence of their credentialed physicians. Growing public concern regarding patient safety, as well as demonstrated patient preferences for certified physicians, will likely result in greater emphasis on quality assessments in physician credentialing.

Policies and practices related to the role of board certification and recertification of pediatricians in hospital privileging.

CONTEXT: Privileging involves the granting of permission to perform specific professional activities under the jurisdiction of a governing body's (hospital) authority. In 1951, the Joint Commission on the Accreditation of Hospitals (later renamed the Joint Commission on Accreditation of Healthcare Organizations) was formed to codify the process of hospital assessment. In the early part of the 20th century, a parallel process was being undertaken by the medical specialties to evaluate and recognize competence among physicians through the creation of specialty boards. OBJECTIVES: To describe the use of board certification in hospital privileging policies for general pediatricians and pediatric subspecialists and to identify any variation among types of hospitals. DESIGN, SETTING, AND PARTICIPANTS: A telephone survey between January 1 and June 30, 2005, of privileging personnel among a random, weighted sample of 200 nonspecialty hospitals stratified by teaching status, children's vs general hospitals, freestanding children's hospital vs part of hospital system, and urban vs rural location. MAIN OUTCOME MEASURES: Proportion of hospitals that require board certification at initial privileging or at some point to maintain privileges and recertification to maintain privileges. RESULTS: Of 200 hospitals, 7 hospitals were ineligible because they did not have at least 1 pediatrician on staff. One hundred fifty-nine hospitals completed the telephone interview, resulting in an overall response rate of 82%. A total of 124 (78%) of 159 hospitals did not require general pediatricians to be board certified at initial privileging; however, 111 (70%) did require pediatricians to become board certified at some point during their tenure. Of these 124 hospitals, 52 (42%) did not report a time frame in which certification must be achieved. Forty-nine (43%) of 113 hospitals required pediatric subspecialists to achieve subspecialty certification within a specific time frame. CONCLUSIONS: These results raise issues regarding the manner in which board certification is used or not used by hospitals in their efforts to ensure the practice of high-quality care within their institutions. The premise for recertification is the need to assure the public of continued competence of physicians over the course of their professional careers. Increased attention by the public and regulatory agencies regarding patient safety and quality of care will likely have an impact on hospital privileging processes.

A continuum of competency assessment: the potential for reciprocal use of the Accreditation Council for Graduate Medical Education toolbox and the components of the American Board of Pediatrics Maintenance-of-Certification Program.

Reduction of unexplained variation in medical practice and health outcomes is of paramount importance, which indicates a need for a continuum of medical learning that begins in medical school and continues until the end of a professional career. That, in turn, indicates need for continuing assessment of professional competence. The American Board of Pediatrics, the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education are working together to develop a common approach to documenting acquisition of competence during residency and maintenance of competence thereafter. A common approach will eliminate redundancy and make it possible to follow the evolution of professional competence over time.