GOALS & OBJECTIVES
The primary goal is for the trainee to meet the new requirements for Board Certification in Developmental and Behavioral Pediatrics. Equally important is for the trainee to meet MCH training goals of emerging as a leader to address the special needs of children, adolescents, and their families; fostering interdisciplinary care; incorporating family-centered and culturally competent care into standard practice; and emphasizing a population-focused public health approach. Finally, a goal of the project is to enhance the developmental and behavioral pediatric education of medical students, residents, and community practitioners.

METHODOLOGY
To meet the first goal of preparing trainees for Board Certification, the core curriculum incorporates all elements of training required by ACGME for fellowship program accreditation in Developmental and Behavioral Pediatrics. This includes core knowledge, clinical competence, advocacy and leadership skills, teaching and research. Fellows will acquire core knowledge (e.g. child development, family system, and learning theories) through directed readings, weekly Fellows’ conference, University seminars, and attendance at regional and national meetings. Fellows will rotate through both inpatient and outpatient clinics at the Kluge Children’s Rehabilitation Center for exposure to the complete range of developmental and behavioral problems (ABI, autism, feeding, CP, LD, ADHD, etc). Additional experiences in the adolescent, student health and Child Psychiatry clinics provide an emphasis on psychobiological disturbances. Two community pediatric practices that specialize in D-B problems give a primary care perspective. The breadth of clinical exposure is one of our greatest strengths. Under the supervision of the Program Director (who has a Master’s Degree in Maternal and Child Health) and the Head of the Division of General Pediatrics, Fellows will participate in numerous community advocacy activities (e.g. legislative committee testimony, early intervention advisory board, school smoking prevention campaign) along with faculty. Over three years, Fellows will become independent leaders in these activities. Few training programs focus on teaching, expecting future faculty to acquire this skill passively. Fellows attend faculty development seminars on teaching in the medical school and University and are expected to develop an array of lectures/case presentations/discussions for residents and medical students. A key feature of this project is the development by the Fellow of a model resident training module on child development that will form the basis of a complete D-B curriculum on the Developmental Pediatrics Website hosted by the AAP Section on Developmental and Behavioral Pediatrics. This model will be used to elicit participation from Fellows in the other MCH training programs. Research is another strength of the program. With over $5 million in active grant funds from federal agencies, foundations, and private sources, the faculty conduct a very active interdisciplinary research portfolio in areas such as executive function, autism, infant brain plasticity, growth in cerebral palsy, and psychopharmacology. Previous fellows have successful in receiving extramural funding for their research projects, have presented abstracts at national meetings, and published research findings in prestigious pediatric journals. Additional features of the program that particularly address MCH training goals include involvement with the Virginia’s Care Connection for Children (Title V CSHCN program) responsible for coordination of care, identification of payment mechanisms, and assurance of a medical home for each child with special health care needs. Fellows will participate in the VA-LEND leadership activities at Virginia Commonwealth University. Because the University of Virginia serves a predominantly rural population of Appalachia, Fellows will learn the challenges of providing comprehensive, community-based services in poor, isolated areas of the region in conjunction with Title V and other educational and social services agencies.

COORDINATION
The KCRC is the only development, behavioral, and pediatric rehabilitation facility in the eastern half of Virginia. Therefore, its services (and are training program) are closely coordinated with the Title V and other federal poverty programs (CSHCN, WIC, Medicaid), state agencies (health, substance abuse, education), and community services (public and private schools, United Way, social services). Mr. Frank Heron in the Philadelphia regional MCH office was consulted regarding this proposal. The University of Virginia is one of six sites for Virginia Care Connection for Children (Title V). To date, Virginia has not had an MCH training grant in Developmental-Behavioral Pediatrics. Our program works closely with Virginia’s only LEND program at Virginia Commonwealth University, which serves Richmond and central Virginia. In addition, the program is coordinated with the ABP and ACGME requirements for Board eligibility and fellowship program accreditation. We have applied to be among the first accredited training programs. Training of residents being coordinated with the AAP Section on D-B Pediatrics which sponsors the Developmental Pediatrics Website and with the Society for Developmental and Behavioral Pediatrics which has developed and published a resident training curriculum outline. We have linked to several community pediatric practices that have exemplary evaluation models of developmental and behavioral evaluation.

EVALUATION
We follow the ACGME’s recommended resident/fellow evaluation procedures by using the University of Virginia’s Postgraduate Trainee Performance and Efficiency Report annually. Using the “360 degree evaluation concept,” the form is completed not only by faculty, but also by representatives of the interdisciplinary team and peers. The KCRC has an existing evaluation mechanism by which patients and parents evaluate service providers, including the fellows. Residents and medical students evaluate fellows after each rotation. Fellows maintain a checklist of required competencies as defined by the ABP, ACGME and MCH, each of which requires sign-off by a faculty member when competency is achieved. The checklist is reviewed by the Program Director with the Fellow semi-annually. Fellows evaluate the faculty annually.

ANNOTATION
The Developmental and Behavioral Pediatrics Training Program at the University of Virginia reflects the broadened content of this newly recognized pediatric subspecialty as required by the American Board of Pediatrics and the Accreditation Council for Graduate Medical Education (ACGME). MCH requirements provide a public health orientation that enhances the trainees community-based, comprehensive, and family-centered approach to developmental and behavioral problems. A special focus of the program is on the rural poor and on a web-based D-B training curriculum for pediatric residents, designed by the fellows.

KEYWORDS
Behavioral Pediatrics;Training;Children with Special Health Needs;Developmental Disabilities;Rural Population;Pediatric Residency Training;Rural Population