PROBLEM
In 1978 the Task Force on Pediatric Education called for an "increased emphasis on the biosocial aspects of pediatrics… and vigorous support for programs…involving biosocial concerns; and the American Academy of Pediatrics regularly affirms as its focused professional goals "…to ensure for all young people the attainment of their full potential for physical, emotional and social health." Despite these affirmations and increased residency requirements for behavioral and developmental pediatrics training during residency, most pediatric residency graduates do no feel adequately prepared or confident in their skills to effectively manage the psychosocial/biobehavioral problems and disorders which make up an increasing proportion of their everyday pediatric practices. While the ongoing problem of substance use and abuse is increasingly affecting younger and younger children, while violence toward and by children is increasingly in the public eye, while the challenges of ever-changing definitions of family continue, and while a myriad of life-stressors adversely affect children in a wide variety of ways, the training of primary care pediatricians to contribute in a thoughtful, timely, and effective manner to the management of these "new morbidity" problems remains an essential challenge which must be met.
GOALS & OBJECTIVES
The overarching goal of the COR Project is the improvement of the socio-emotional well being of children through prevention, including identification of those at risk for, as well as early detection, and discerning diagnosis of, psychoemotional/biobehavioral problems/disorders. Objectives focus on common clinical dilemmas encountered by participant practitioners. 1. Create a common language toward an ongoing dialogue between child health care professionals, including pediatricians, pediatric nurse practitioners, behavioral and developmental pediatricians, child psychiatrists and child psychologists; 2. Promote and enhance understandiing of cultural and linguistic competence; and promote continuation of recruitment and maintenance of diverse membership within COR; 3. Enhance understanding of biopsychosocial aspects of child development, disorders, and disability, and improve the ability of providers to help children and families deal with these issues; 4. Increase the ability of primary care pediatricians to discriminate between transient and/or developmental challenges and difficulties and more serious psychiatric disorders; 5. Increase awareness of the scope of participants' competencies and strengthen orientation to consult with, or refer to, other professionals as appropriate; 6. Promote collaboration between primary care pediatricians, developmental-behavioral pediatricians, pediatric nurse practitioners, child psychiatrists, and child psychologists; 7. Facilitate a more comprehensive approach to health supervision, such as envisaged in Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents and Bright Futures in Practice: Mental Health; 8. Nurture the previous success to the COR program through development of additional COR group(s); i.e. within the community of senior residents in pediatrics and/or recent graduates of the University of Minnesota Pediatric Residency Program, and encourage their facilitation by senior participants of the now experienced, 6-year old UMN COR process.
METHODOLOGY
The goals will be achieved through increased collaboration between primary care pediatricians, pediatric nurse practitioners, developmental/behavioral pediatricians, child psychologists, and child psychiatrists. Through this bi-weekly seminar knowledge, diagnostic perspectives, and treatment options of primary providers will be expanded. Defining characteristics of this unique program include (1) focus upon pediatric practitioners' presentation of common clinical dilemmas encountered in daily practice; (2) creation of a common language, and supportive environment for participants; 3) enhancement of understaning of psychosocial aspects of child development, biobehavioral disorders, and disabilities, and ability of providers to help children and families manage these issues; 4) focus designed to increase the ability and comfort of pediatricians to differentiate between transient developmental challenges and more serious psychiatric disturbances. The COR format is case oriented. Sessions begin with actual case dilemmas from primary care clinicians. Prospective and retrospective analytical approaches to case management facilitate and promote understanding and foster optimum care. Videotaped interviews with a child or family are used occasionally, with appropriate advanced informed consent. The University of Minnesota COR Group includes two (2) moderators (one child psychiatrist and one developmental-behavioral pediatrician), five (5) primary care pediatricians, two (2) behavioral and developmental pediatricians, a pediatric nurse practitioner, a child psychologist, and fellow(s) in child psychiatry, fellow(s) in developmental/behavioral pediatrics, pediatric psychology interns (4-month rotations) and from one to three first-year Pediatrics residents rotating monthly on the developmental/behavioral pediatrics service. Learners with varying experiences in child health and illness are brought together in this forum to promote interdisciplinary sharing of experiences and perspectives to enhance learning and promote excellence in child health care.
COORDINATION
Coordination of the development, implementation, promotion and evaluation of the project is a shared endeavor of the collaborating pediatrician and child psychiatrist coordinators. Child Psychiatry and Pediatrics faculty coordinators also assist COR participants in selecting appropriate cases for discussion, and in the preparation, and distribution of learning materials for participants.
EVALUATION
Evaluation of the COR program is ongoing. An initial survey/needs assessment identifying learning needs provides foci for program planning and serve as core objectives against which learners measure outcomes. A eight-item evaluation form is used at each meeting; and an open review of group process is encouraged. A written evaluation is completed annually to identify progress toward achieving measurable objectives.
ANNOTATION
The overall goal of COR is the improvement of the socio-emotional well being of children through prevention and early, discerniig diagnosis of biobehavioral problems and disorders. Individual child and family case challenges/dilemmas are presented by their primary care child health car provider to a regularly convening COR group, an assemblage of primary care pediatricians and nurse practitioners, psychiatrists, and developmental-behavioral pediatricians. Through these multidisciplinary care conferences, knowledge of primary care providers is increased, and treatment options and diagnostic perspectives are expanded as well. A focus on common clinical dilemmas and challenges encountered by participant practitioners across culturally diverse clinical communities consistently results in enhanced clinical comfort and competence, and the promotion of growth in interdisciplinary collegial trust and mutual interdependence. This success is reflected not only in consistently positive evaluations from twice-monthly meetings, but also in the responses to annual program evaluations.
KEYWORDS
Behavioral pediatrician, behavioral/developmental pediatrician, biobehavioral disorders, biopsychosocial, biosocial, child development, child psychiatrist, collaborative office rounds, community pediatrics, continuing education, developmental disabilities, developmental pediatrician, early diagnosis, education, emotional health, interdisciplinary training, mental health, new morbidity, prevention, primary care pediatrician, primary care pediatrics, psychosocial problems, psychoemotional disorders
|
