The Johns Hopkins University

Problem:

Pediatricians need more training in psychological and developmental aspects of caring for children. Complex problems are best addressed with combined expertise of pediatrics and child psychiatry. This is an ongoing case discussion group for pediatricians, especially those who train others.

Goals and Objectives:

Goal 1: To enhance the skills, knowledge, and attitudes of postgraduate pediatricians and their preceptees in the comprehensive care of the psychosocial and developmental aspects of their patients, Objective 1: Enhanced understanding of psychosocial aspects of child development, disorders, and disability, especially of those children with special health care needs, and increased ability to help children and families deal with these issues Objective 2: Expanded power to discriminate between transient disturbances and more serious psychiatric disorders facilitated by using the DSM-PC categories as provided by CHADIS Objective 3: Heightened awareness of the practitioners' own competencies in dealing with psychosocial and developmental problems Goal 2: To increase their understanding of the expertise of mental health professionals, Objective 1: Strengthened orientation to consult with or refer to other professionals as appropriate Objective 2: Increased collaboration between pediatricians and child psychiatrists through establishing new or enhancing old methods of collaboration with their own mental health resources, including formalized referral mechanisms and collaborative care models Objective 3: Increased interest in the practitioner's role in dealing with psychosocial and developmental issues of children and their families Goal 3: To facilitate their use of the Bright Futures and DSM-PC materials as synthesized in the computer based Child Health and Development Interactive System (CHADIS; see www.childhealthcare.org ) Objective 1: Increased facility with a comprehensive approach to health supervision as outlined in Bright Futures: Guidelines for Health Supervision including enhanced assessment and detection of development, socioemotional issues, and family strengths and weaknesses Objective 2: Increased familiarity with and use of information and techniques included in Bright Futures in Practice: Mental Health Objective 3: Increased awareness and use of the Child Health and Development Interactive System containing these materials Goal 4: To enhance understanding of and competence in working with families with cultural or linguistic differences from that of the practitioner Objective 1: Include discussion of cultural factors during case discussions Objective 2: Include pediatricians of various cultural backgrounds in the groups Goal 5: To enhance the skills, knowledge, and attitudes of preceptees in the comprehensive care of the psychosocial and developmental aspects of their patients, Objective 1: Increased teaching of the above skills and orientation by COR members to pediatric preceptees Objective 2: Provide a curriculum and instant access to state of the art information and tools to effectively precept trainees on psychosocial and developmental aspects of the care of children and families through the Child Health and Development Interactive System.

Methodology:

This project addresses these problems by offering two ongoing study groups providing CME for community and hospital pediatricians who are or are anticipated to provide resident training. The focus of the groups is the psychosocial-developmental aspects of pediatric care with co-leadership by child psychiatrists and developmental-behavioral pediatricians. Discussions focus on the members’ cases and deal with theoretical underpinnings, practical management, cultural issues and how to work with mental health professionals as well as on personal support for the practitioners in caring for these children and teaching this material. Case discussions are based around information from CHADIS specific to the patient to facilitate psychosocially and developmentally comprehensive health supervision and problem care. Enhancing observational and intervention skills for dealing with developmental and family issues during health supervision visits is one major focus of this program. The program will build skills to better serve the psychosocial and developmental needs of patients, conduct more comprehensive health supervision visits facilitating individualized anticipatory guidance and early intervention, detect the need for and effectively refer, and more effectively transmit these skills to their residents. The CHADIS system for practical use by pediatricians refined in part through this COR group process is now a comprehensive resource available nationally on the internet.

Coordination:

This COR group was a shared activity with the MCHB funded Johns Hopkins DBP Fellowship. Dr. Wissow is faculty for the Hopkins Bloomberg School of Public Health, a Title V program. Dr. Howard was an author of Bright Futures, Bright Futures in Practice: Mental Health and DSM-PC. Dr.s Howard and Sturner were faculty of MCHB funded Johns Hopkins DBP Fellowship Training Program. Participants have included MCHB DBP and LEND NDD Fellows. CHADIS was developed with funding through NICHD.

Evaluation:

This program is ongoing and evaluation will await the end of the year. The coleaders receive feedback from participants and adjust the topic, format and time of sessions accordingly. Attendance is monitored. The participation of several professionals who heard about the sessions and joined is considered a measure of success also.

Experience to Date:

There have been 26 COR sessions since the beginning of this grant period involving 36 clinicians. So far 3 major grants have been obtained that involve COR members in innovative programs to enhance mental health care and referral.