Boston Children's Hospital

CLINICAL CARE: The services we offer - from well child visits and treatment for typical child health issues (broken bones, tonsillitis, etc.) to chronic care (asthma, diabetes, obesity, etc.) and specialty services (oncology, cardiology, neurology) - benefit from our clinicians' high level of specialization, our collaboration with research scientists (many of whom are also physicians) affiliated with the hospital, and our significant investments in equipment, facilities and clinical and support staff. We also offer the only pediatrics Department of Addiction Medicine in the U.S., as well as the only Orthopedic Sports Medicine program located at a children's hospital. We also offer the largest programs in Pediatric Anesthesiology, Pediatric Cardiology, and Pediatric Critical Care, in the nation. Boston Children's is the safety net institution for very sick children throughout the region, supporting the entire health care system for the most complex pediatric cases. We receive referrals from community hospitals as well as from other academic medical centers throughout New England. Approximately 25% of our inpatients are transferred from hospitals & medical centers across Massachusetts for care that no one else can provide. In FY23, Boston Children's saw approximately 1.2 million outpatient visits, 60,000 emergency department visits, 22,000 inpatient or observation stays, and 26,000 inpatient or day surgeries. Our inpatient case mix index was 1.54 (MA only) and the average length of stay was 6.4 days. Of the bedded cases, more than 19.1% (CMI > 2.00) can be qualified as clinically complex. Of these patients, approximately 35% (patients on Medicaid/Medicare) are considered low income.Our Medicaid ACO provides primary care to 20% of the children covered by Medicaid in the state. The ability to support the health-related social needs of patients and families via the ACO complements the work that we are doing in communities to address the more systemic social determinants of health. We can address "downstream" immediate needs of children and families, but also to work with communities and partners to affect the "upstream" factors that drive poorer health outcomes for so many. This includes a focus on policy that can impact the health. We remain committed to advancing health equity through our Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion. Through the Institute's works, we seek to transform pediatrics by addressing persistent disparities in the delivery of care to our nation's children. In 2023, we continued to work closely and successfully with Tufts Medicine to implement a collaboration to ensure continuity of care for Tufts Medicine pediatric patients after Tufts Medical Center converted Tufts Children's Hospital's pediatric inpatient beds to adult ICU and medical/surgical beds. We came together with a mutual commitment to expanding Tufts Medicine Pediatrics through the creation of a shared and sustainable model of comprehensive pediatric care with Boston Children's. Our mutual vision for the collaboration is anchored in four goals:- Improving the health and well-being of the patients, families and communities we serve, with a particular lens on equity, diversity and inclusion.- Extending care into community settings closer to where people live and work.- Integrating with community-based pediatric and family medicine clinicians to better coordinate care.- Continuing the important work of research, education and training that is vital to any academic medical system.In 2023, we also finalized our affiliation agreement with Franciscan Children's Hospital, through which we will create a new, more effective and equitable system of fully integrated behavioral health and rehabilitative care, research and teaching that will significantly improve the lives of children and families in Massachusetts, New England and throughout the country. Increasingly, we have been able to care for and improve life and health outcomes for medically complex children, many with conditions such as congenital heart conditions, childhood cancers & complex neurological and neurosurgical conditions. Our capabilities are accelerating rapidly as we develop new clinical & surgical approaches including gene therapies, stem cell transplant procedures, fetal surgical interventions, and the like.Boston Children's is at the absolute forefront nationally in these & many other areas. As a result, we have seen significant growth in the number of complex patients served - patients who stay longer, require more resources (such as intensive care unit-level care), use a broader range of interdisciplinary specialists, and frequently require substantial support for their whole family. Some of them travel great distances, but equally many are from here in Massachusetts.Boston Children's MA/Regional network consists of our satellite/physician office locations, formal primary care relationships with groups such as the PPOC and Atrius, community health center relationships and a broad array of relationships with other hospitals in MA and New England including community hospitals, academic medical centers and specialty hospitals. We maintain relationships of varying structures, shapes and sizes with nearly all of the major academic medical centers and specialty hospitals in MA and New England, from a single service agreement such as providing remote EEG interpretations to Elliot Hospital to staffing community hospitals 24/7 365 per year to our multi-faceted Brigham relationship and joint cancer program with Dana-Farber. Our satellite/physician office locations and our community hospital relationships in eastern MA have been central to our commitment to increasing access to high quality pediatric services. Over the past 20+ years we have gradually grown our network of satellites/physician office locations and community hospital relationships providing a mix of neonatal, ED and inpatient services. Today, nearly 40% of our outpatient specialty visits and surgical cases take place in a Boston Children's satellite or physician office location. Our affiliated community hospitals account for nearly half of our MA community hospital transfers and 30% (~1,000) of all intra-hospital transfers. These community hospital relationships also generate important downstream referrals to our specialists including important neonatal referrals from the obstetrical programs at these community hospitals. As fewer community hospitals provide inpatient pediatric care, these hospitals are increasingly serving as regional pediatric hubs to help stem the tide of patients who have to be referred to Boston for community level care.

TEACHING: Boston Children's is committed to providing high quality continuing education for pediatric providers and specialists throughout the world. As the primary pediatric teaching affiliate of Harvard Medical School, our more than 2,000 attending physicians and researchers are on the clinical frontier of effectively understanding and treating many pediatric diseases and disorders.We are proud to be the primary teaching hospital of Harvard Medical School, and our Nursing Department partners with 27 schools of nursing throughout Massachusetts and New England. We are home to the largest and most competitive training program in pediatrics, seeding the world with the next generations of scientists, innovators and caregivers.We offer more than 70 Training Programs (44 are accredited - more than any other freestanding children's hospital). We host over 500 Boston Children's-based residents and clinical fellows annually, selected for their potential leadership in their respective fields and their commitment to advancing the frontiers of pediatric care. A 24-year analysis of residents who have graduated from our Department of Medicine found that roughly 40% go on to become leaders in academic medicine, filling positions such as deans, chairs and program heads across the country. More than one third of the chiefs of pediatric departments across the country trained at Boston Children's. Our simulation program, Immersive Design Systems, is the first hospital-based simulator program at a teaching hospital in New England. Our goal is to make "practice prior to game time" part of healthcare routine, offering a fully integrated quality assurance and improvement resource, preparation and testing environment for hospitals. Boston Children's offers the only training programs in New England for Adolescent Medicine, Congenital Cardiac Surgery, and Neurodevelopmental Disabilities; and the only training programs in Massachusetts for Adolescent Medicine, Congenital Cardiac Surgery, Neurodevelopmental Disabilities, Pediatric Cardiology, Pediatric Hematology/Oncology, Pediatric Nephrology, Pediatric Orthopedics, Pediatric Pathology, and Pediatric Surgery.

RESEARCH: Our Research Mission is to be the leading source of research and discovery. We are the leader in discovery and innovation that is dramatically advancing not only pediatric care but adult care as well. We have the world's largest pediatric research program for many reasons. The most important reason is our focus on our patients. We are constantly evolving care and caring for increasingly complex patients. Every child who walks through our doors teaches us something. In FY2023, Boston Children's was #1 in National Institutes of Health funding for all U.S. children's hospitals, and #4 in funding among all independent hospitals. More than 3,000 basic, clinical, and translational research employees work in our dedicated facilities, which total some 1 million square feet of space.Our more than 1,100 investigators include 13 members of the National Academy of Sciences, 28 members of the National Academy of Medicine, 23 Fellows of the American Academy of Arts and Sciences, 13 Fellows of the American Academy for the Advancement of Sciences, 12 current members and 13 alumni of the Howard Hughes Medical Institute. Twenty-seven faculty are members of the American Association of Physicians and 47 are members of the American Society of Clinical Investigation. Over the years, four Boston Children's investigators have won the Nobel Prize and six have won the nearly equally prestigious Lasker Award.Our investigators are Harvard Medical School faculty - basic scientists, clinical researchers and epidemiologists - who are accelerating the pace of medical discovery from brainstorm to bench to bedside. Our researchers were the first to develop 10 new disease-based stem cell lines by reprogramming adult stem cells that can be used to study treatments for diseases ranging from Parkinson's to Diabetes. Here are just a few research success stories from 2023:- A long-awaited gene therapy for sickle cell disease with deep roots at Boston Children's Hospital and Dana-Farber Cancer Institute was approved by the Food and Drug Administration (FDA). It is also the first therapy using CRISPR gene editing to gain FDA approval for any condition.- Boston Children's Gene Therapy Program, in close collaboration with the Leukodystrophy Clinic at Massachusetts General Hospital, infused the first patient ever to receive Skysona gene therapy outside of a clinical trial.- A team of specialists from Boston Children's and Brigham and Women's Hospital performed a first-of-its-kind intervention for a rare, life-threatening type of blood vessel anomaly called a vein of Galen malformation (VOGM) - performed in utero. The ultrasound-guided embolization involved deploying tiny metal coils into the affected vein via a microcatheter inserted through a needle that we guided through the mother's abdomen and into the fetus's brain.- Boston Children's researchers are investigating a cell or gene therapy approach to cystic fibrosis, targeting a cell type that's only recently been discovered.- Researchers in Boston Children's Department of Urology are developing a new approach to treating Clostridium difficile (C. diff) intestinal infections targeting the inflammation, not the bacteria.- Our cardiac surgeons are using 3D modeling to improve surgical planning by revealing details of patients' hearts.- Scientists in our Computational Health Informatics Program have found telltale markers of anxiety in electroencephalograms (EEGs), even in early childhood.- Sports medicine researchers at Boston Children's may have found a new pathway for preventing and treating medial tibial stress syndrome (shin splints) in young athletes by focusing on the muscles of the feet.

Community:Boston Children's Hospital was among the first academic medical centers in the country to expand the traditional missions of patient care, teaching, and research to embrace a fourth part of its mission - community. Through the years, Boston Children's has strived to ensure that community health is more than just words in its mission statement. The efforts have evolved from targeted services for individual families to innovative models that have proven to reduce health disparities, improve child health outcomes, and promote health equity.Boston Children's community mission is based on the needs of the community. It revolves around keeping children healthy through wellness and prevention efforts, ensuring that children have access to needed health care services, and partnering with others in the community to address the social determinants of health. These are issues that can have a significant impact on an individual's health such as exposure to violence, experiencing food insecurity, living in poverty or having unstable housing. In all its endeavors, Boston Children's focuses on meeting community needs and implementing programs that are aligned with the priorities of the City of Boston, the Boston Public Health Commission, the Boston Public Schools, as well as other key partners and city agencies.Understanding community needsBoston Children's conducts a comprehensive community health needs assessment every three years as required by the Internal Revenue Service. The full report from the 2022 assessment can be found at wwwchildrenshospitalorgcommunityh... The findings inform the direction of Boston Children's Community Health Improvement Plan, which outlines how the hospital will use its resources and partner with others to address those themes and improve community health. This process also ensures that the hospital is utilizing its resources and leveraging community partnerships in the most effective way. The assessment was approved by the Boston Children's Board of Trustees in the fall of 2022. The 2022 assessment identified the health-related needs, strengths, and resources available to children, youth, families, and residents in Boston - specifically the neighborhoods of Dorchester, Jamaica Plain, Mattapan, Mission Hill, and Roxbury. The assessment also looked at those living in the communities served by Boston Children's locations outside of Boston, which includes Brookline, Lexington, North Dartmouth, Peabody, Waltham, and Weymouth.Boston Children's 2022 assessment also included data from the Boston Community Health Collaborative. This assessment included a wide range of Boston stakeholders - community organizations, community development corporations, health centers, hospitals, and the Boston Public Health Commission. While community health assessment and planning work are often conducted by individual organizations, the Boston Collaborative aligns and coordinates resources between multi-sector stakeholders across the city. Boston Children's is a founding member, and staff participate in the steering committee and work groups.Key themes from the assessment include how poverty impacts child and community health, access to stable and affordable housing, concerns about food access and insecurity, and the importance of prevention and focus on early childhood and youth development. Health issues of concern for families continue to be around mental/behavioral health, asthma, and obesity. A formal and comprehensive needs assessment is only one part of Boston Children's approach to understanding the health needs and vital resources within the community. Boston Children's is continually listening and learning from patient families, community leaders, and staff. The staff rely on ongoing conversations with Boston Children's key partners - community health centers and community-based organizations, as well as the Boston Public Health Commission, and the Boston Public Schools.Through the Community Advisory Board, which meets on a quarterly basis, Boston Children's has a direct link to expertise on Boston neighborhoods, community organizations, and current health needs. Members of the Community Advisory Board are instrumental in providing feedback throughout the year and play a key role in the Boston Children's formal assessment process. This feedback from experts, community leaders, and partners as well as the Community Advisory Board informs the hospital's community mission, strengthens the development of partnerships, and helps to shape the implementation of the hospital's Strategic Implementation Plan. Being a community health leaderBoston Children's has identified priority health areas - asthma, obesity, mental and behavioral health, and early childhood development - and has a programmatic response to each. Community programs are focused where Boston Children's has the clinical expertise, resources, and partnerships to make a difference. Boston Children's strategy for improving community health is to: 1) address the most pressing health needs of children and families; 2) provide services through programs that can lead to improvements in health; or 3) build community capacity to better meet the needs of children and families. Some of these programs are described briefly below.- Since 2005, the Community Asthma Initiative (CAI) has helped to improve the health and lives of 2,611 Boston children with asthma. Through a comprehensive asthma home visiting program, CAI provides case management, home visits, offers education to caregivers and patients, distributes asthma control supplies, connects families to resources and increases access through advocacy. CAI surpassed its quality goal, reducing the percent of patients with any hospitalizations by 82% and any emergency department visits by 54% after one year in the program. The program provided education and training for 196 community meetings with 2,362 participants, 2 community events with 50 participants, 4 trainings/talks with 40 participants. It cared for 75 new patients with 58 completing at least one home visit. Boston Children's staff completed 86 visits, with 84 by Community Health Workers and 2 by the Nurse Practitioner.- Boston Children's Hospital Neighborhood Partnerships Program (BCHNP) is the hospital's community-based behavioral health program. BCHNP places clinicians in Boston schools to provide a comprehensive array of services to better meet the needs of children and adolescents. In FY23, 1,392 students participated in 32 BCHNP classroom interventions focused on a range of topics, including but not limited to community building, emotion regulation, identity/self-awareness, and social skills. BCHNP continued to train educators and behavioral health professionals in a depression awareness curriculum, Break Free From Depression, nationwide through online training. BCHNP's School-Based Program implemented clinical intervention, early intervention, and prevention/promotion services with 1,551 students across five elementary, K8, middle, and high schools. Clinicians intervened in 66 crisis situations with a median wait time of 7 minutes, provided individual therapy to 24 students, and provided care coordination services to 102 students. BCHNP provided professional development webinars through its Training and Access Project (TAP), reaching 340 school-based social workers in 2023. Average satisfaction ratings across all stakeholders (students, caregivers, educators, and school staff) and services were over 95% with the majority of average satisfaction ratings falling well over 90%. - The Healthy in the City (HIC) program is a community-based approach to addressing obesity by offering prevention and intervention strategies to support children and youth who are overweight or at-risk for obesity, in making healthier choices and behavior changes. HIC supports 10 Boston community health centers to provide more than 1,000 children annually with case-management support, as well as access to nutrition and physical activity programs. In FY23, 59% of children decreased and 5% maintained their BMI over the year. Children also reported consuming less fast food and sugar-sweetened beverages, consuming more fruits and vegetables, watching less TV, and increasing their amount of exercise after 12 weeks in the program. The program also engaged an additional 530 children who are at-risk of obesity or identify as food insecure in nutrition education and physical activity and connected them to food resources.

- Family Food Connections is a food pantry owned and operated by Boston Children's in the Mildred C. Hailey Apartments of the Boston Housing Authority. It opened for visitors in January 2022. This food pantry provides fresh fruits, vegetables, milk, eggs, bread, and staple items to families. The pantry is open to residents of Mildred C. Hailey Apartments, as well as the surrounding neighborhoods of Jamaica Plain and Roxbury. Boston Children's patients are also referred there and make up about 30% of the users. In FY23, there were 39,334 visits to the pantry. The food pantry became an official site of the Greater Boston Food Bank, and it has received great support from community partners and families. Families were also provided additional social and health care supports through our primary care locations at the Martha Eliot Health Center and the Primary Care Center at Longwood.Serving as an anchor for the communitySince 2018, Boston Children's has been a committed and proud member of the Healthcare Anchor Network, a national network of more than 70 hospitals and health care systems working to build more inclusive and sustainable local economies.Four focus areasThe Boston Children's anchor strategy puts corporate goals and business practices in place to address economic and racial inequities and aims to help improve community conditions that contribute to poor health. There are four pillars:1. Hiring and Workforce Development. Boston Children's partners with community organizations to recruit, hire, and train individuals from neighboring communities to ensure that employees are reflective of the communities we serve.2. Purchasing. Boston Children's supports community businesses by buying locally whenever possible, with a focus on increasing the participation of minority-owned, women-owned, and veteran-owned businesses.3. Investment. Boston Children's is investing in local projects that can produce significant health and social returns for our community. This includes projects that address affordable housing, early childhood education, youth engagement, and mental health efforts.4. Sustainability. Boston Children's is implementing approaches to advance reductions in hospital-generated greenhouse gas emissions and contribute to local climate resilience.The Boston Children's anchor strategy builds upon and amplifies the work of the hospital's community mission to improve the health and well-being of children and families.Boston Children's role as an anchor was further developed through a deployment of $2.5 million out of a $10 million allocation from the hospital's endowment for use in impact investments. Boston Children's Community Investment Advisory Committee provided input on strategy and reviewed projects for this investment. Four meetings were held to review and provide recommendations on this investment for a five-year low interest predevelopment loan that would benefit mixed-income housing projects in Jamaica Plain and Allston-Brighton. Boston Children's Hospital also secured a commitment from another community development financial institution to partner on a pipeline of affordable homeownership projects led by nontraditional developers and facility ownership projects for education and children's mental health service providers. The Community Health team has worked with the government, community leaders, and residents to identify projects and conduct due diligence. Expanded commitment through the Collaboration for Community HealthBoston Children's had an opportunity to build on its history of building partnerships with the community. In August 2018, Boston Children's started to distribute additional funds as part of an agreement with the Massachusetts Department of Public Health's Determination of Need/Community Health Initiative program.These funds - Boston Children's Collaboration for Community Health - are distributed to community organizations in addition to our ongoing commitments and support for programs and partners. The strategy to distribute funds followed a two-year community engagement process to inform how Boston Children's could make a long-lasting impact. That process resulted in identifying several strategic funding areas to address the critical needs of children and families.Funding and support for community-based projects are in the following strategic areas: Mental Health and Youth Support Systems, Community Trauma Response, Birth to Five Child Health and Development, Family Housing Stability and Economic Opportunity, Community Physical Activity, Recreation and Food Access and through the Children's Health Equity Collaborative.Through the Boston Children's Collaboration for Community Health, more than 80 organizations have now received funds and support from the hospital. The leadership and staff also have been convened by Boston Children's to network, share lessons learned, provide feedback, and receive assistance around advocacy and evaluation.More details on the Collaboration and the funded projects can be found at BostonChildrensorgfundingAddressing social determinants of healthBoston Children's also responds to the social determinants of health by focusing on support and partnerships in three areas: - Education and schools. Boston Children's partners with the Boston Public Schools (BPS) to support and strengthen the system as well as to work directly in school settings to reach students and help families.In FY23, BCHNP's Training and Access Project (TAP) continued to provide professional development and consultation services focused on building the capacity of school communities to address social, emotional, and behavioral health. Through TAP's online free training series for school communities, it increased its national reach to over 11,000 participants to date. In 2022-2023, TAP provided a webinar training series that reached 340 BPS social workers from over 88 schools. Trainings were developed based on needs identified by the social workers. The series included 11 interactive trainings. TAP trainings can be accessed at www.bostonchildrens.org/TAPOnline. - Workforce Development. Boston Children's strives to bridge community and incumbent talent to build diverse teams that provide the best service and care for patient families. With equity, diversity, and inclusion at the core of this work, the hospital partners with numerous community-based organizations to recruit community talent to job, internship, and career exploration opportunities. Once a community member joins Boston Children's as an employee, there are extensive offerings available as individuals build their career within the enterprise.Boston Children's also supports the pipeline of health care workers by exposing youth to careers in the health field. Programs include SCOOP for students interested in nursing careers and the COACH program, which provides opportunities for high school students to work at the hospital during the summer. Last year, the program had 69 high school and 35 college students participating. Boston Children's has hired more than 50 former COACH interns into permanent, per diem, temporary and internship positions. Examples of other programs include:- Aspire Internship Program (MGH): internship program for adults with high cognitive autism spectrum disorder or a related social profile to gain real-world work experience. - ARCH JVS Training Program: Training program developed by Boston Children's and JVS to train high intermediate ESOL speakers in the field of animal care in research operations. The program offers free training in contextualized ESOL for the role and on-the-job training. The program pays wages while trainees learn. Upon successful completion, graduates are offered full-time jobs. - JVS Pharmacy Technician Program: Boston Children's sponsors community members to attend the JVS Pharmacy Tech program at no cost and then hosts trainees for externship hours. Upon successful completion, graduates are offered a position.

- Partnering to support the health and social infrastructure in place for families. Boston Children's is also committed to and directs resources to build capacity within the existing infrastructure of care for Boston children and families. This means supporting key partners such as Boston community health centers. The hospital has relationships and strong partnerships with 11 Boston community health centers. Through these partnerships, Boston Children's improves access to care for underserved populations, helps efforts to better manage chronic diseases, and supports prevention and treatment services that improve the health of Boston children, youth, and families. Health center partners receive funding, training, and technical assistance. Due to the on-going mental and behavioral health crisis for children and youth, Boston Children's has made a substantial investment to develop internal resources to assist patients and their families (in coordination with state and community-based agencies) with crisis stabilization and care delivery transformation. Leveraging community partnerships and community-based providers, the focus is providing enhanced services to enable a safe transition to an appropriate level of care. Investments include but are not limited to enhanced behavioral response, state agency coordination, Emergency Department diversion programming, room-modifications, and more. Boston Children's also has relationships with a wide array of community organizations, which provide services as well as a voice for the families and neighborhoods they represent. Serving as a safety netBoston Children's remains committed to its local community, providing primary and preventative care, as well as inpatient care for complex illnesses. It is one of the leading providers of health care to low-income children in Massachusetts and it provides care unavailable elsewhere in the state and sometimes the nation. Boston Children's also is a safety net provider for Boston children. This safety net is financial in that the hospital provides free care, subsidizes care for Medicaid patients, and incurs bad debt for patient families who cannot pay for the care they receive. It is programmatic in that Boston Children's offers vital, hospital-subsidized services that are either unavailable elsewhere or available only in a limited capacity, such as mental health and dental care.Advocating for children and familiesAs the only freestanding children's hospital in Massachusetts, influencing public policy to improve child health is an important aspect of Boston Children's commitment to community health. The hospital is a leading provider of pediatric medical and behavioral health services to low-income children across the Commonwealth and is a critical component of the safety net for children throughout New England and the nation. Boston Children's has been an organized force and an influential advocate for health and wellbeing of children for more than 20 years.Boston Children's is an effective advocate on legislative and regulatory matters, both at state and federal levels, that affect children's wellbeing such as increasing access to quality pediatric mental health programs, promoting better treatment and access to services for children with medical complexity and chronic conditions, improving the landscape for pediatric medical research and advancing innovative public health policies grounded in racial equity. Boston Children's advocacy history is rooted in the promotion of better insurance coverage for children, including major child health expansions in the 1990s, the passage of Massachusetts's 2006 health reform law, and significant national involvement in work to promote child health access through the Children's Health Insurance Program, Medicaid, and the Affordable Care Act. As a result, Massachusetts has achieved near universal health access for children, with only 1.5 percent of children uninsured - the lowest rate in the country.Massachusetts has emphasized payment reform and cost containment policies within the health care system. Boston Children's played an active and vocal role in the development of the groundbreaking statewide payment reform legislation that was signed into law in August 2012. Nationally, Boston Children's engaged in efforts to preserve and improve Medicaid and the Children's Health Insurance Program, which serve as a safety net for children in all fifty states, ensuring their access to high-quality, effective coverage, and facilitates important quality measurement and improvement initiatives. We have also worked to ease the burdens on families in the Medicaid program who find it necessary to cross state lines for care.

In 2006, Boston Children's (including its Boston Children's Hospital Neighborhood Partnerships Program for details see above) and a coalition of community organizations launched the Children's Mental Health Campaign (CMHC). The CMHC has converted its credibility and influence into several major policy accomplishments which have redefined the landscape of the children's mental health system in Massachusetts. In 2008, the CMHC was instrumental in securing passage of two landmark state laws. An Act Relative to Children's Mental Health (Chapter 321) creates a structure for enhancing early identification of behavioral health needs, treating children in the most appropriate settings, enhancing coordination among state health care agencies, and establishing mechanisms for oversight of and input into the state children's mental health system. Chapter 256 strengthened the state's mental health parity law by expanding the categories of disorders for which health insurance plans must provide mental health benefits. The CMHC is determined to hold key stakeholders accountable for implementing the new laws secured through its advocacy efforts. Current efforts at the state level address: access to behavioral health services, addressing the emergency room boarding crisis, improving mental health in schools, and ensuring access to behavioral health services for children involved with state agencies. At the federal level, Boston Children's is working with our peers to bolster the pediatric mental health workforce and ensure the availability of a full continuum of care for kids. Additionally, Boston Children's works in collaboration with a host of public health and prevention advocates to ensure public policies work to keep children safe and healthy. Boston Children's public health work includes social determinants of health and racial and social justice as an essential component. With this in mind, our priorities include affordable and accessible access to early education and childcare and school meals; the provision of safe, stable and affordable housing; and supporting efforts to reduce violence and environmental health exposures where our most vulnerable kids live play and learn. The hospital also lends expertise in efforts to reduce racial inequities in maternal and infant health. Boston Children's has established the over 4,000 member Children's Advocacy Network (CAN), a grassroots advocacy network that leverages the many voices of families, hospital staff, and community partners in support of child health. Since 2006, the hospital has trained hundreds of advocates through an in-depth training series that gives advocates a better understanding of the legislative process and the skills needed for effective advocacy. The CAN hosts regular educational sessions, which offer hospital staff and community partners a monthly opportunity to learn about a current topic related to children's health policy and explore ways to advocate for children at the federal and state levels. Staff members from departments throughout the hospital regularly engage with the CAN to receive information about policy changes that may impact their patient population or schedule in-service presentations about current events in Washington and at the state level.