University of Washington, Children's Hospital & Medical Center, Seattle

Problem:

This project seeks to reduce the prevalence of emotional and behavioral problems among children and adolescents and improve the care received by minorities. Adolescents with significant psychological disorders are more likely to visit health care providers, and many pediatricians are deficient in their ability to screen effectively for psychosocial problems.

Goals and Objectives:

Goal 1: Enhance the pediatrician’s understanding of psychosocial aspects of adolescent development, disorders, and disability. Objective 1: Enhance the pediatrician’s ability to screen for and discriminate between transient disturbances and more serious adolescent psychiatric disorders. Objective 2: Heighten self-awareness of all group participants’ competencies and strengthen orientation to consult or refer to other professionals as appropriate Goal 2: Increase the pediatrician’s ability to formulate an appropriate psychological differential diagnosis. Objective 1: Establishment of a monthly COR case-oriented discussion group bringing together diverse academically-based pediatric/adolescent medicine specialists and child psychiatrists with community-based primary care pediatricians and child psychiatrists who have a special interest in adolescent health care. Objective 2: This COR group will discuss pertinent case-related issues, formulate a differential diagnosis and discuss the ultimate diagnosis in an interactive and didactic manner while modeling a consultative relationship between pediatricians and child psychiatrists. Goal 3: Enhance the child psychiatrist’s understanding of the medical aspects that relate to adolescent mental health Objective 1: Promote collaboration between pediatricians and child psychiatrists. Objective 2: Choose a variety of topics with medical and psychiatric ramifications. Goal 4: Facilitate the approach recommended in the AMA Guidelines for Adolescent Preventive Services; the MCHB Bright Futures: Guidelines for Health Supervision of Adolescents and Bright Futures in Practice: Mental Health. Objective 1: Enhance the knowledge and skills of health care providers to help them practice developmentally appropriate, preventive health care in the context of family and community. Objective 2: Encourage family participation in health promotion and disease prevention activities. Goal 5: Enhance the understanding of cultural and linguistic competence. Objective 1: Improve care for mental health problems among minorities. Objective 2: Raise awareness among group members to improve their own cultural competence through increasing understanding of other cultures.

Methodology:

The University of Washington component of the COR group is composed of one adolescent medicine specialist, one behavioral pediatrician, one child psychiatrist, one adolescent medicine fellow and one child psychiatry fellow. The community component includes 7 pediatricians and one child psychiatrist. The COR group meets once monthly for 1 ½ hours at Children’s Hospital and Regional Medical Center in Seattle, Washington. Primary emphasis is placed on non-structured time during which group members may present cases, identify appropriate community resources for consultation and referral and further promote collaborative efforts. Case-oriented discussion utilizing a structured format including diagnostic evaluation, differential diagnosis, and management are pursued. As appropriate, one or more of the COR group members may be designated to present a brief didactic discussion at the next meeting regarding an issue highlighted by the case presentation, and provide appropriate current references from the literature for all group members. Between group meetings members use an e-mail distribution list of COR participants to pose clinical questions and share pertinent information.

Coordination:

This project represents a cooperative effort between the Adolescent Medicine Section / Division of General Pediatrics in the Department of Pediatrics and the Division of Child Psychiatry in the Department of Psychiatry at the University of Washington School of Medicine.

Evaluation:

Program evaluation is based on the goals, objectives, and activities outlined above for the UW Collaborative Adolescent Medicine Office Rounds. A combination of outcome and process evaluation approaches will be utilized to address both broad-based programmatic goals and individually defined training objectives. Evaluations will assess: 1. Individual adolescent medicine & child psychiatry fellow progress 2. Training impact on development of leaders 3. Perceived usefulness of the group for community practitioners 4. Faculty contribution to program goals 5. Program success in achieving goals and objectives.