The burden of suffering experienced by children with mental health
needs and their families has created a health crisis in this country. There are far too many children with behavior problems and psychiatric disorders for them all to be seen by child psychiatrists. Yet, structured opportunities for child psychiatrists to directly communicate with community-based practitioners are almost nonexistent. COR offers one solution to bridge this gap by providing regular, case-based, joint pediatric-child psychiatry continuing education meetings. COR improves clinician knowledge, skills, and attitudes regarding the psychosocial and developmental aspects of child health while also addressing common barriers between disciplines.
This project addresses three broad MCH priorities including Healthy People (HP) 2010, Underserved Populations, and Cultural Competence. Our COR group focuses on three HP 2010 domains:1) Access to Quality Health Services; 2) Mental Health and Mental Disorders and 3) Health Communication/Patient Education. The community-based pediatricians and child psychiatrists participating in this project serve children/families from an inner city population: medicaid (70%), “self pay”/no pay (20%) and insured (10%). A major focus in each of the three project years is on cultural competence. In year 2, we sponsored a national expert to speak at Grand Rounds on “Cultural Diversity in Health Care.” In year 3, COR participants will design and carry out a small project at their community-based site that addresses an identified cultural/linguistic need for the population being served.
Goal(s) and Objectives:
Our long-range goal is to promote continued leadership skills and professional development among health and mental health clinicians in a way that ensures the continued improvement in health, safety and well being of the MCH population. The short-term goal for this application is to foster joint pediatric-child psychiatry continuing education in the psychosocial-developmental aspects of child health, utilizing a study group approach that emphasizes the practical challenges confronted by community-based practitioners. Specific objectives include:
1. Enhance understanding of psychosocial aspects of child development, disorders,
and disability;
2. Expand power to discriminate between transient disturbances and more serious
psychiatric disorders; increase ability of children/families to deal with these issues;
3. Heighten awareness of the scope of one’s competencies and strengthen orientation
to consult with or refer to other professionals, as appropriate;
4. Promote collaboration between pediatricians and child psychiatrists;
5. Facilitate a more comprehensive approach to health supervision as in Bright Futures: Guidelines for Health Supervision and Bright Futures in Practice: Mental Health;
6. Enhance understanding of cultural and linguistic competence;
7. Recruit and maintain diverse members within the COR group.
Methodology:
The rationale for this training program is that over time, COR participants will enhance their professional development through improved intra- and interdisciplinary communication. This will lead to stronger physician-patient/family relationships and ultimately will translate into higher quality care for children with varying mental health care needs. We are particularly well prepared to carry out this training program. We have considerable experience as moderators for COR groups, with four published articles on the topic and a demonstrated commitment to exploring variations of the model (e.g., including non-physicians as members). Dr. Thomasgard developed a web site www.oaimh.org with an entire section devoted to materials to start, maintain and evaluate collaborative peer supervision groups. There is exceptional support for COR from the Institute for Pediatric Education at Children’s Hospital. Reasonably priced food catering is available, while the following are provided free of charge: processing continuing medical education credits, a meeting room and audiovisual equipment such as a VCR or LCD projector.
Our program is innovative. We capitalize on the physical proximity between primary care and behavioral health providers at multiple community-based sites by introducing the interpersonal and interdisciplinary bridge of COR. We sponsored a visiting faculty member to address “Cultural Diversity in Health Care” in year two of the project. In year three COR participants will design and carry out a small project at their community-based site that addresses an identified cultural/linguistic need for the population being served. We expect to improve the clinician’s ability to assess and treat children with developmental variations, problems and disorders of mental health; to positively impact future “COR-type” groups via the World Wide Web and to underscore the importance of diversity in language/culture in our multicultural society.
Coordination:
Our project is well coordinated with local health agencies, state organizations (e.g., Ohio Department of Health) and at the national level via meetings with the co-moderators from other MCH-funded COR groups. At the local level, the community-based Health Care sites receive Title V money from the Ohio Department of Health (ODH) through a Child & Family Health Services grant. The latter grant provides funding for direct services for families without insurance and pays for enabling services such as Hispanic and Somali interpreters. Dr. Craig Boreman, a third year MCHB funded Leadership and Excellence in Neurodevelopmental Disabilities (LEND) trainee has been an active COR participant during this formative stage of his career.
Evaluation:
Impact of the project will be measured by: 1) COR Questionnaire; 2) Quantitative summary of continuing medical education forms; 3) Summary of attendance patterns; 4) Clinical utility of participants’ community-based cultural/linguistic competence projects in year three and 5) New Web-based resources added to www.oaimh.org during years two and three.
Experience to Date:
We are well into the second year of our COR group. Case discussions have involved nearly every member of the group and have at times been both animated and intense suggesting that trust among members has continued to evolve. The primary care pediatricians have consistently explored the challenges of how much care can actually be provided in a 10 minute visit, often to very stressed and chaotic families. Group ratings on the continuing medical education forms suggest that we are meeting project goals with mean scores of 4.8 to 4.9 (where 1 = Not at All and 5 = Excellent) for accomplishment of objectives, satisfaction of educational needs, impact on practice, and overall quality. COR members continue to report utilization of the four reference manuals provided to each of them (i.e., Bright Futures, The Classification of Child & Adolescent Mental Diagnoses in Primary Care and Bright Futures Mental Health, Volumes I and II). With respect to promoting increased collaboration between pediatricians and child psychiatrists, COR members continue to report an increase in face to face case discussions for consultation. In summary, the members of our COR group have succeeded in creating an environment in which regular, case-based discussion of difficult clinical issues continues to occur. We look forward to tracking both the progress of the group and its individual members during project year three.
