PROBLEM
Given the high prevalence of developmental, behavioral, and psychosocial issues as well as other chronic special health care needs in the childhood population, pediatricians in general practice, family physicians, and other health professionals must become proficient in providing a medical home for children and families with these issues. They must be able to assess and manage prevalent mild to moderate problems in these areas. They must also be comfortable in identifying severe or rare disorders and conditions unresponsive to first line treatments. They must develop skills for managing such conditions in collaboration with subspecialists and community-based organizations. Their care must be family-centered and culturally competent. Subspecialists in developmental-behavioral pediatrics must become expert in assessing and managing the full spectrum of developmental and behavioral disorders. They must teach students, physician generalists and other professionals about screening and treatment of mild to moderate disorders in ways that assure children easy access to service and family-centered, culturally competent practice. We believe that the new generation of subspecialists has a special obligation to contribute new knowledge to the burgeoning field of developmental-behavioral pediatrics through high quality research. In their research efforts, they should work effectively on interdisciplinary teams, address public health priorities, be culturally competent, consult the people who are impacted by their research and results, and demonstrate leadership skills to translate research into policy.
GOALS & OBJECTIVES
The overall purpose of this grant is to expand the number of pediatricians and other related health professionals who range from proficient to expert in the assessment and management of problems in child development, child behavior, and psychosocial medicine, that is “D-BP issues”. Thus, there are two major objectives of this grant: (1) Increase the number of practicing and future health care clinicians prepared to evaluate and manage D-BP issues in a family-centered and culturally competent manner. We will target practicing community pediatricians, family physicians and nurse practitioners, as well as residents in pediatrics, medicine-pediatrics and family practice. Furthermore, our educational activities will include undergraduate medical students and nurse practitioner students. The objectives under this goal are as follows: (a) Train 9 D-BP faculty in family-centered care, leadership, and cultural competence; (b) Develop a speakers’ bureau of 24 for training; (c) Diversify CME programs and train 200; (d) Reactivate the “ChildDevelopment RoundTable” for 24 pediatricians; (e) Intensify resident education with 20 additional training sessions; (f) Expand medical student education by 10 sessions (g) Contribute 20 new sessions for nurse practitioners. (2) Establish a new fellowship training program that prepares subspecialists for family-centered clinical practice in developmental-behavioral pediatrics, teaching, research, and leadership, all in diverse cultural contexts. The objectives under this goal are as follows: (a) Obtain program accreditation; (b) Organize the educational program; (c) Prepare community sites for training; (d) Enroll at least 4 fellows in the program; (e) Train fellows in family-centered care and cultural competence (f) Fellows complete a research project; (g) Fellows complete a leadership project; (h) Fellows assume a position with research and/or leadership.
METHODOLOGY
This new program will integrate the substantial resources of the Children’s Hospital of Pittsburgh (CHP: Child Development Unit, Child Neurology Service, research and training grants) and the University of Pittsburgh School of Medicine and Medical Center (Child Psychiatry Service, Center for Minority Health, Center for Instructional Development and Distance Education, and the UCLID Center at the University of Pittsburgh, a Leadership Education in Neurodevelopmental Disabilities Program). The Project Director and Co-Directors will actively work with the other D-BP faculty to incorporate the curriculum into multiple educational programs. The education will favor small group formats, such as Problem-based Learning (PBL). The advantages of PBL are its respect for the varying levels of learners’ knowledge and experience and its success in promoting specific practice change. We will also form a COR-like monthly meeting of local pediatricians and mental health professionals called the “ChildDevelopment RoundTable” to review topics and cases in D-BP. The fellowship will recruit for applicants nationally and from the CHP residency. The recruitment plan includes efforts to identify a diverse applicant pool. An Admissions Committee with make final decisions. The 3-year program will follow a specified curriculum and will include 2-months rotations in both Child Neurology and Child Psychiatry, as well as rotations in Primary Care and Child Advocacy to emphasize consultation as well as direct care. Interdisciplinary clinical training will occur in collaboration with the UCLID Center both in the hospital and at community sites. The formal educational program will use seminar series in leadership and research from other training programs and the Faculty Development seminars of the D-BP to facilitate application to their discipline. Each fellow will have a Fellowship committee, similar to a graduate student thesis committee, who serves to guide, mentor and evaluate the fellow. The education in cultural competence begins with a self-assessment of knowledge, skills and attitudes. Students and faculty will be required to attend a set of 6 seminars, lectures and other offerings from the Center for Minority Health and write reflections on each of the activities. Leadership training will include seminars and also participation in a leadership project. The research component will include formal training in research methods and statistics and a mentored research project. We anticipate that fellows will complete a project during the fellowship, present at scientific meetings, and submit a manuscript for peer-review. This training should prepare the fellows for an academic or leadership career in D-BP.
COORDINATION
The Project Direct and two Co-Directors will form an Executive Committee and meet initially on a weekly basis and eventually on a monthly basis to assure the smooth operation of the training programs. An interdisciplinary Advisory Board of faculty, representatives of the hospital, university, and community will meet quarterly to coordinate the program and evaluate efforts and trainees. The entire faculty group will meet quarterly to plan and evaluate the program.
EVALUATION
The evaluation of educational programs will be authentic, performance-based, and will maximize feedback to both learners and faculty members at the time of performance. Process will include both qualitative and quantitative performance measures of immediate, short-term, and long-term impact. In terms of CME programming, we plan additional methods to gather information at end of session regarding the participants’ intention to change or alter practice behaviors. We will then survey or call after 3 months & 6 months to learn what changes they have made. We will offer to monitor their medical charts for selected practice indicators to be used in Maintenance of Certification in General Pediatrics as evidence of Lifelong Learning & Self-assessment and Performance in Practice. Fellow evaluations will include a portfolio of accomplishments and self-reflection. Given our focus on research, the ultimate outcome measure of the fellowship research training program as a whole in terms of research will be the success of the trainees--number of presentations at national meetings, number of peer-reviewed publications, and career selection and advancement. Given the importance of cultural competence in this program, we will collaborate with the Center for Minority Health to develop a cultural competence evaluation tool for various participants in this and related programs, in particular fellows and faculty. Residents and fellows will also be observed in clinical practice by a team that has been trained to evaluate family-centered care and cultural competence in clinical practice.
ANNOTATION
This new program will diversify and expand on existing educational efforts for general pediatricians, family physicians, other health care professionals who provide medical homes, residents and students regarding child development, child behavior, developmental-behavioral disorders and psychosocial medicine, domains which we summarize as developmental-behavioral pediatrics. The program will also initiate a new developmental-behavioral pediatrics fellowship at the Children’s Hospital of Pittsburgh with an emphasis on research, leadership training, and cultural competence. The fellowship program will integrate interdisciplinary clinical training in developmental-behavioral pediatrics in the Child Development Unit of the Children’s Hospital of Pittsburgh with leadership education through a LEND program, research training through the impressive resources of the division of Developmental-Behavioral Pediatrics, the hospital and the University of Pittsburgh. A special emphasis will be given to the issues of family-centered care and cultural competence in clinical practice, education, research and leadership.
KEYWORDS
Developmental-behavioral pediatrics, maternal-child health, continuing medical education, distance learning, family-centered care cultural competence, leadership, interdisciplinary team
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