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Problem:
In 1978 the Task Force on Pediatric Education called for an ".increased emphasis on the biosocial aspects of pediatrics…and vigorous support for programs…involving biosocial concerns; and the American Academy of Pediatrics regularly affirms as its focused professional goal "…to ensure for all young people the attainment of their full potential for physical, emotional, and social health." Despite these affirmations and increased residency requirements for behavioral and developmental pediatrics training during residency, most pediatric residency graduates still do not feel adequately prepared or confident and competent to effectively manage the psychosocial/biobehavioral problems and disorders which make up an increasing proportion of everyday pediatric practice. While violence toward and by children is increasingly evident, while the challenges of ever-changing definitions of family continue, while the ongoing problem of substance use and abuse increasingly affect younger and younger children, and while a myriad of life-stressors adversely affect children in a wide variety of ways, the training of primary care pediatricians to contribute in a thoughtful, timely, and effective manner to the management of these 'new morbidity' problems remains an essential challenge which must be met.
Goals and Objectives:
The overarching goal of the COR Project is the improvement of the socio-emotional well being of children through prevention, including identification of those at risk for, and early and discerning diagnosis of, biobehavioral problems/disorders. Objectives focus on common clinical dilemmas encountered by participant practitioners:
1. Create a common language toward an ongoing dialogue between child health care professionals, including pediatricians, pediatric nurse practitioners, behavioral and developmental pediatricians, child psychiatrists and child psychologists;
2. Promote and enhance understanding of cultural and linguistic competence; and promote continuation of recruitment and maintenance of diverse membership in COR;
3. Enhance understanding of biopsychosocial aspects of child development, disorders, and disability, and improve the ability of providers to help children and families deal with these issues;
4. Increase the ability of primary care pediatricians to discriminate between transient and/or developmental challenges and difficulties and more serious psychiatric disorders.
5. Increase awareness of the scope of participants' competencies and strengthen orientation to consult with, or refer to, other professionals as appropriate.
6. Promote collaboration between primary care pediatricians, developmental-behavioral pediatricians, pediatric nurse practitioners, child psychiatrists, and child psychologists.
7. Facilitate a more comprehensive approach to health supervision, such as envisaged in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents and Bright Futures in Practice: Mental Health.
8. Nurture the previous success of COR through development of additional COR group(s); i.e. within the community of senior residents in pediatrics and/or recent graduates of the U. of Minnesota Pediatric Residency Program, and encourage their facilitation by senior participants of the now over 7 years, experienced, UMN COR.
Methodology:
The goals will be achieved through increased collaboration between primary care pediatricians, pediatric nurse practitioners, developmental-behavioral/pediatricians, child psychologists and child psychiatrists. Through this bi-weekly seminar knowledge, diagnostic perspectives, and treatment options of primary providers will be expanded. Defining characteristics of this unique program include (1) focus upon pediatric practitioners' presentation of common clinical dilemmas encountered in daily practice; (2) creation of a common language, and supportive environment for participants; (3) enhancement of understanding of psychosocial aspects of child development, biobehavioral disorders, and disabilities, and ability of providers to help children and families manage these issues;(4) focus designed to increase the ability and comfort of pediatricians to differentiate between transient developmental challenges and more serious psychiatric disturbances. The COR format is case oriented. Sessions begin with actual and current case dilemmas of primary care clinicians. Prospective and retrospective analytical approaches to case management facilitate understanding and foster optimum care. Videotaped interviews with a child or family are used occasionally, with appropriate advanced informed consent. The U of Minnesota COR Group includes two moderators (child psychiatrist and developmental-behavioral pediatrician), six primary care pediatricians, two behavioral and developmental pediatricians, a pediatric nurse practitioner, two child psychologists, and fellow(s) in child psychiatry, fellow in developmental-behavioral pediatrics, [psychology] fellows in Adolescent Health, and pediatric psychology interns. Learners with varying experiences in child health and illness are brought together to promote interdisciplinary sharing of experiences and perspectives to enhance learning and promote excellence in child health care.
Coordination:
Coordination of the development, implementation, promotion, and evaluation of the project is a shared endeavor of the collaborating pediatrician and child psychiatrist coordinators. Child Psychiatry and Pediatrics faculty coordinators also assist COR participants in selecting appropriate cases for discussion, and in the preparation, and distribution of learning materials for participants.
Evaluation:
Evaluation of the COR program is ongoing. An initial survey/needs assessment identifying learning needs provides foci for program planning and serve as core objectives against which learners measure outcomes. An 8-item evaluation form is used at each meeting; and an open review of group process is encouraged. A written evaluation is completed annually to identify progress toward achieving measurable objectives.
EXPERIENCE TO DATE:
The COR Program has enjoyed continued success and exciting growth in participation over the past year, with an average of 12 participants in the 22 meetings of COR since the last annual report. An increase of almost 50% over preceding years, this has been in part a result of continued commitment from long time participants and the addition of new members who have become consistent participants and contributors. Significant activities have included a several-session focus on psychopharmacology including “Psychopharmacology and Cross-Cultural Challenges,” a two-part training for participants in Transference and Counter-Transference, the beginning of a new series of “How Can Schools and Clinicians Collaborate?” and a forthcoming series of monthly sessions on Cultural Competency.
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