Children's Hospital, Boston

Problem:

Children and families face intense biopsychosocial challenges such as poverty, violence, family fragmentation and inadequate health care. Our LEDBP trains DB pediatricians in academic, clinical, research and public policy leadership to ensure a brighter future for children and families.

Goals and Objectives:

Goal 1: To prepare DBP fellows for leadership roles as clinicians, teachers, investigators & advocates addressing behavioral, psychological & developmental issues for children from clinical to policy levels. Objective 1: Fellows will develop clinical expertise & skills critical to assessing children’s developmental & behavioral concerns; offering treatment recommendations; & advocating for appropriate support for families as part of interdisciplinary teams, as individual consultants and in community based settings. Objective 2: Fellows will develop their DB teaching skills by participating in an annual Fellows as Educators Symposium; precepting pediatric residents in primary care and specialty care settings; and participating in a Teaching Fellow rotation as primary preceptor on the DB Pediatrics block rotation. Objective 3: Fellows will develop research acumen via a weekly research curriculum; through formal Harvard School of Public Health didactic education and via development of an individualized mentored research idea leading to a completed research project. Goal 2: To provide pediatric practitioners, residents and medical students with knowledge and clinical expertise to provide children access to DB Pediatrics services based in their primary care medical home. Objective 1: DBP faculty and fellows will provide ongoing Continuing Medical Education as they present at and coordinate local and national activities, ranging from local presentations at Grand Rounds and COR meetings to national meetings (AAP, PREP, SDBP.) Objective 2: DBP faculty and fellows will precept medical students and resident with an emphasis on DB topics during their DB block and elective rotations as well as in primary care settings. Objective 3: DBP faculty and fellows will provide developmental behavioral consultation and training to primary care providers in hospital and community regarding the developmental, behavioral, emotional and psychosocial needs of their pediatric patients and their families. Goal 3: To integrate the activities of the LEDBP with existing primary care and community based initiatives targeted at Healthy People 2010 goals from the local to national level. Objective 1: Faculty and fellows will participate with the Office of Child Advocacy at Children’s Hospital Boston to be involved with community partnerships via the Advocating Success for Kids (ASK) Program and their community collaborations. Objective 2: Faculty and fellows will be involved with implementing and evaluating the Bright Futures Curriculum for use in primary care settings on a local and national level. Objective 3: Faculty and fellows will be involved with revising and adding new cases to the Developmental Behavioral Pediatrics case curriculum (www.pedicases.org) for use in primary care and teaching settings on a local and national level.

Methodology:

Methods: Our training goals and objectives are aimed to develop our trainees’ clinical, research, advocacy, and leadership skills. This is accomplished through coursework; supervised clinical and research training; individual mentoring; and leadership training which occurs at Children’s Hospital, Boston; community sites; and Harvard University with an emphasis on impacting child health outcomes. Evaluation of our objectives utilizes quantitative and qualitative methods to measure knowledge, process skills, professionals reached, and child health outcomes as outlined in the Healthy Children 2010 Goals. The methods used to accomplish these three goals involve hospital and community based primary care and developmental behavioral faculty working in a variety of clinical settings with learners of many disciplines at all levels of training. Specific methods include: 1. interdisciplinary model of training: a. theoretical coursework (including study for a Master of Public Health degree) b. research training c. clinical apprenticeship experiences. 2. graduated training experience: a. first year clinical emphasis b. second year research and public health focus c. third year refinement of clinical and research skills 3. community collaboration a. community based clinical consultations b. development of a primary care screening initiative c. local, regional and national CME offerings

Coordination:

Faculty have collaborated with professional organizations (AAP,SDBP,) health care providers and national institutions in working to implement developmental-behavioral principles in the community. One fellow (Patricia Schram) has worked with the Federation for Children with Special Needs to develop presentations specific to Portuguese speaking families in need of school services for their children.

Evaluation:

Specific objectives for each of our three goals are described in our initial grant included methods of evaluation. The evaluation of these objectives for the year July 2005-June 2006 and our plans for the coming year are described in 'project details.'

Experience to Date:

Major highlights of 2005-06 include: ACGME ACCREDITATION - maximum period NEW RESEARCH DIRECTOR - Charles Nelson, PhD, a cognitive neuroscientist joined our faculty in July, 2005 to spearhead the Developmental Medicine Center’s (DMC) research initiative. He has provided direct mentorship of our trainees (individually as research director; as a group during research and clinical seminar series.) He is also participating in a strategic planning process geared to foster collaboration between clinical, research and training initiatives in the DMC. COLLABORATIVE RESEARCH - Research initiatives have been solidified between two of our hospital's divisions (the DMC- home of our DBP program; and Genomics) and the Department of Brain and Massachusetts Institute of Technology (MIT). Clinicians and researchers are examining the genomics of autism and the neurodevelopmental profiles of children with autism spectrum disorders from the perspective of applied neuroscience. A citywide Boston-based autism research initiative has also developed to promote clinical and research collaboration between all clinicians and researchers currently working with children impacted by autism spectrum disorders. SCREENING INITIATIVE – A new initiative promoting screening for developmental and behavioral concerns for children in their primary care setting has resulted from work of the ASK Program – providing consultations for developmental and behavioral concerns in primary care settings.