PROBLEM
In Hawaii, as across the nation, the role of the pediatrician is being redefined by the changing needs of young children and their families. “Children with special needs” refers to the broad category of children faced with or at risk for physical, behavioral, emotional or developmental conditions that require more care than that usually necessary by children. Increased knowledge of the critical importance of early environmental and social influences for successful child development, the availability of intervention services to manage disabilities, and changes in family structure and supports place major responsibilities in the hands of physicians. The Fellows will be trained to become leaders in ensuring that community pediatricians, residents, and medical students have orientation to this changing medical world.
The nation and in particular Hawaii needs leaders to move the fields of pediatric medicine and public health into the new millennium. Problems in the existing systems have been well described, including the fragmentation of health services, lack of coordination and communication between professionals from different disciplines serving the same patient which creates confusion and inconsistent care and outcomes, and disparities in access to and quality of health services. The limited monies for children to improve their health, although new technologies are constantly being developed, restricts the improvement in the course or burden of a disabling or long term condition. The burdens of the current system fall heavily on young children with disabilities, behavior, psychosocial or developmental problems, and their families. But taxpayers, health care insurers and providers are also seriously impacted.
The Hawaii DeeBeePeds project will directly address the systems issues around the care of children through the clinical and advocacy activities of the two Fellows who will be trained during the project.
GOALS & OBJECTIVES
Goal #1: Train future leaders to improve systems of care for children with developmental/behavioral/psychosocial needs.
Objective 1-A. Fellows will have high levels of clinical expertise, skills and competence in these physicians sufficient for Board Certification in Developmental Behavioral Pediatrics by the end of their program. This expertise includes the areas of biological sciences, physical and intellectual growth and development, adaptation, disease and injury prevention, and health promotion through pediatric care
Objective 1-B. Fellows will demonstrate the ability to achieve mutual goals through a network of colleagues from health, public health, education and social services during each year of their program.
Objective 1-C. Fellows will demonstrate the ability to teach developmental /behavioral/psychosocial issues to college students, medical students, residents and other physicians using effective and innovative methods by the end of their second year in the program.
Objective 1-D. Fellows will demonstrate understanding of the effects of culture, parenting styles, child care, medical compliance, impacts of injury or illness, and other psychosocial issues on child behavior and development through clinical work, consultation and teaching by the end of their second year.
Objective 1-E Fellows will accomplish research in significant developmental and/or behavioral topics consistent with MCH identified foci by the end of their third year.
Objective 1-F. Fellows will demonstrate skills in affecting policy and legislation consistent with MCH foci through consistent and timely written and oral communications with policy-making bodies by the end of their third year.
Objective 1-G. Fellows will demonstrate skill in grant writing by submitting a well-reviewed proposal by the end of their third year.
Goal#2: Provide exemplary behavioral, psychosocial and developmental care to enhance the quality of life for children and their families.
Objective 2-A. Each Fellow will increase the extent to which at least ten children with special needs are fully included in their communities by the end of the project.
Objective 2-B. Each Fellow will provide consultation in interdisciplinary hospital, clinic, early intervention and school environments to improve services for at least twenty children with special needs by the end of the project (Guralnick 2000).
Objective 2-C. Each Fellow will increase the extent to which preventive, diagnostic, treatment, management, and follow up care consistent with MCH guidelines provided to children with special needs and their families on a regular basis in at least four settings by the end of the project
Objective 2-D. Each Fellow will provide outreach and education through at least two public agencies which enhances messages designed to promote health and/or reduce preventable disability in pediatric populations by the end of the project.
METHODOLOGY
The Hawaii DeeBeePeds Project will refine and extend an existing Developmental Behavioral Pediatrics fellowship training program. The program will follow closely the guidelines for training Developmental Behavioral Pediatricians from the Accreditation Council for Graduate Medical Education (ACGME) and other important guidances. The training of the fellows covers four domains: Service, Consultation and Teaching, Advocacy and Research. An Individualized Learning Plan (IndiLeaP) guides the Fellow in their three year program. The IndiLeap includes structured activities and flexibility for the Fellow to create a more in depth experience and learning around areas of interest. Over a three year program, each Fellow will participate in continuing education for students and health providers, consultation to multiple Title V programs.
Project staff will develop and disseminate educational resources regarding innovative elements in the training program such as an advocacy curriculum and the use of the IndiLeap.
COORDINATION
Activities will be coordinated by an administrative team consisting of the project director and training director. Various faculty and community contacts including State Title V personnel support or directly train the Fellows. An advisory council with broad community and university representation will give recommendations to the administrative team on a regular basis.
EVALUATION
There are two evaluation components: 1) Process: How the major goals and objectives are being achieved through the quality of project implementation and timely completion of activities; 2) Outcomes: The extent to which the project achieved its goals and objectives. Monitoring and evaluation activities will be ongoing throughout the project period.
ANNOTATION
The purpose of this project is to train physicians to become highly qualified leaders in Developmental Behavioral Pediatrics. These physicians will provide exemplary developmental, behavioral and psychosocial support to children and their families, community agencies, and policy makers. The Developmental Behavioral Pediatric fellows (“Fellows”), will experience teaching, consultation, advocacy and research in a variety of multi-cultural and interdisciplinary milieus. The fellows will train in various environments including Developmental Behavioral Pediatrics clinics, Neurology and Child Psychiatry clinics and services, early intervention programs, schools, rehabilitation programs, public health nursing, and child protection clinics.
Two Fellows will be trained in the project period. Their subsequent activities in the areas of career, volunteerism and leadership will be closely followed to demonstrate the impact of their training.
This project will address local and national needs for qualified Developmental Behavioral Pediatricians who can provide leadership within their communities in meeting the special needs of children and families.
KEYWORDS
Professional Education in Developmental Behavioral Pediatrics
Mental Health, Developmental Evaluation, Integrated Service System
Cultural Diversity, Professional Education in Chronic Illnesses and Disabilities
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