Trustees of Columbia University in the City of New York

Problem:

Although studies show a high prevalence of psychosocial problems in children and adolescents in primary care settings, they often go untreated. Under-diagnosis, misdiagnosis, and less than optimal outcomes of primary care managed psychiatric problems are pressing issues. Pediatric providers suffer from lack of cross-training and support to address these problems.

Goals and Objectives:

1. During Years One and Two, to enhance pediatrician understanding of psychosocial aspects of child development, disorders, and disability and increase practitioners’ ability to help children and families deal with these issues by a) learning to practice aloud discussions of psychosocial aspects of care with families and b) identifying culturally influenced aspects of care. 2. During Years One-Five, to increase providers’ ability to discriminate between transient disturbances and more serious psychiatric disorders which require additional treatment in primary care or referral when needed, specifically aiming to a) increase the confidence and accuracy of pediatricians in making psychiatric diagnoses. 3. During Years One-Five, via the promotion of collaborations between pediatricians and child psychiatrists, to a) increase the ability of pediatricians to manage patients in primary care where appropriate, with the help of mental health collaboration, and b) increase the number of patients that child mental health professionals ask pediatric providers to co-manage. 4. By the end of Year One, to facilitate a more comprehensive approach to health supervision and a) increase the number of pediatric providers that systematically ask routine health supervision questions relevant to emotional and behavioral health; and b) increase the use of evidence-based culturally-appropriate mental health identification tools as clinic policy.

Methodology:

1) Monthly rounds where information on topics of interest will be presented by faculty. Specific cases provided by participating pediatricians will be discussed and guidance on how knowledge and specific skills that are taught can be applied to pediatricians’ actual cases. 2) Interim assistance and problem solving between monthly rounds will be provided by the Integrated Mental Health Primary Care Program, already in existence. 3) Articles, toolkits, and other pertinent information will be distributed prior to each rounds and 4) Brief monthly evaluations will be obtained to note changes in physician knowledge and skill application, as well as attitudes and intentions, augmented by once-yearly evaluations for changes in pediatricians’ knowledge and skills. 5) Monitoring of the number of cases co-managed by pediatric providers and mental health as the program unfolds.

Coordination:

This project will coordinate through extensive input and teamwork of the pediatric faculty of New York Presbyterian Hospital’s Children’s Hospital of New York and the Ambulatory Care Network’s Chief Medical Officer with leading researchers and teachers of child psychiatry at Columbia University and New York State Psychiatric Institute. The five key people will meet weekly during the initial phases of the project to provide continual curriculum refinement and to publicize the activities. Ongoing evaluations will be reviewed by the five key persons on an ongoing basis. Quarterly input from all participants will be used to guide key persons’ modifications and improvements and effective use of the overall COR program. The Division of Child Psychiatry’s connection with the New York State Office of Mental Health will be used to link with key state, city, and community agencies.

Evaluation:

1. Pre-and-Post Meeting Surveys: One month prior to a specific topic meeting, trainees will complete a brief set of questions about their knowledge base, comfort with, and intentions regarding management in conjunction with the proposed topic for the next block’s meeting. One month post, participants will complete a post-meeting survey about the topic taught one block earlier. This format will enable us to compare results four weeks prior to the topic meeting to results four weeks after the topic meeting. 2. At the start of each project year and at the end of each project year, we will administer a 40-question knowledge survey that covers issues ranging from psychopharmacology and treatment planning to available advocacy organizations and community resources and compare pre- and post- knowledge one year later. 3. To determine if more collaboration has occurred, we will track cases in which the psychosocial and mental health issues have been jointly managed by pediatrics and child mental health. 4. We will monitor new mental health identification and assessment protocols initiated in the clinics.