Maternal and Child Health Training Program

H H S Department of Health and Human Services
Health Resources and Services Administration

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Funded Projects

Grant Status: Completed

Grant Title: Collaborative Office Rounds

Project Director(s):

Barbara J. Howard, MD
Johns Hopkins University
600 N. Wolfe Street
Park 356
Baltimore, MD  21287-3144
Phone: (410) 614-3865
FAX: (410) 502-5440
Email: bjhoward@jhmi.edu

Problem:

PCP training is inadequate to psychosocial-developmental problems of children. This discussion group supports PCPs with pediatric-psychiatry leaders and a computer system for assessment, treatment, and referral of mental health problems to enhance detection, triage, care and collaboration.

Goals and Objectives:

Goal 1: Enhanced understanding of child development, disorders, and disability, especially for special health care needs, and better ability to help families in a culturally competent, family-centered way Objective 1: Obj. 1- increase COR practitioners' knowledge of psychosocial-developmental issues each year over 5 years through case-based learning and use of CHADIS Objective 2: Obj. 2- increase numbers of patients for whom practitioner detected and addressed relevant family issues each year Goal 2: 2.Increased collaboration between pediatricians and child psychiatrists using CHADIS as a communication and collaborative care vehicle Objective 1: Obj. 1- implement CHADIS as a referral tool between 8 COR members and mental health providers in the first year Objective 2: Obj. 2- implement CHADIS as a communication tool between 8 COR members and mental health providers in the first year Goal 3: 3.Increased facility with health supervision as outlined in Bright Futures including assessment and detection of development, socioemotional issues, and family strengths and weaknesses Objective 1: Obj.1- assure that COR members have and understand Bright Futures materials year one Objective 2: Obj.2- increase members' use of Bright Futures' handouts each year Goal 4: 4. Expanded power to discriminate between transient disturbances and more serious psychiatric disorders facilitated by using the DSM-PC categories as provided by CHADIS Objective 1: Obj.1- increase COR members use of DSM-PC categories of variation, problem and disorder when identifying mental health problems in children year one Objective 2: Obj.2- increase members' comfort in addressing milder mental health disturbances each year Goal 5: 5.Increased teaching of above skills to preceptees using CHADIS as a curriculum, communication tool, and access point to community resources to assist in the care of children and families Objective 1: Obj.1- provide CHADIS to COR members year one for teaching Objective 2: Obj.2- increase trainee use of CHADIS each year Activities/Methodology undertaken to meet project goals: The intervention will consist of a study group of 8-10 primary care practitioners meeting once a month for 1 hour with child psychiatry and pediatric co-moderators to discuss clinical cases from their pediatric practices especially utilizing the innovative tool the Child Health and Development Interactive System (CHADIS) for clinical care, learning and communication with mental health providers. CHADIS and CME credit will be provided free to COR members and to a local mental health facility. Children cared for with the help of CHADIS will be one focus for this group simultaneously serving to improve care, education, access to resources and communication and care coordination via CHADIS with participating mental health providers. Psychosocial and developmental aspects of these cases will be discussed including issues of differential diagnosis, determining severity, primary care management, implementing comprehensive family-centered care as described in Bright Futures materials including cultural issues, and ideas for teaching this material to trainees.

Coordination:

COR members will be from practices serving low income Baltimore families. Dr. Howard was an author of Bright Futures, Bright Futures: Mental Health and DSM-PC and Co-Director of the former Johns Hopkins Developmental-Behavioral Fellowship funded by MCHB. The Sturner was the Director of the Johns Hopkins Developmental-Behavioral Fellowship funded by MCHB. CHADIS was developed with SBIR funding through NICHD. Comoderators will attend the biennial national COR meeting.

Evaluation:

The evaluation of course objectives will include questionnaire about COR objectives, session feedback, attendance and use of aspects of the CHADIS system.

Experience to Date:

The intervention has consisted of a study group of 5-10 primary care practitioners meeting once a month for 1 hour for the past 34 months with child psychiatry and pediatric co-moderators to discuss clinical cases from their pediatric practices especially utilizing the innovative tool the Child Health and Development Interactive System (www.CHADIS.com) for clinical care and learning. CHADIS and CME credit have been provided free to COR members. Children cared for with the help of CHADIS have been one focus for this group simultaneously serving to improve care, education, and access to resources. Psychosocial and developmental aspects of these cases have been discussed including issues of differential diagnosis, determining severity, primary care management, implementing comprehensive family-centered care as described in Bright Futures materials including cultural issues, and ideas for teaching this material to trainees. We conduct sessionssimultaneously in person and online showing case materials, teaching materials and resources within CHADIS to participants on site or remotely. 33 pediatricians, 1 PNP and 2 Family Physicians have participated. We also presented a day long CME session for 40 child psychiatrists and 40 pediatricians to improve collaboration where CHADIS as well as the COR concept were highlighted and follow up collaboration is occurring.

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