Training primary care practitioners in psychosocial-developmental pediatrics and QI.
Grant Status: Completed
Training Category: Collaborative Office Rounds
Project Director(s):
Barbara Howard, MD
Johns Hopkins University
200 N. Wolfe St.
Baltimore, MD 21205
Phone: (443) 618-9104
FAX: (530) 484-2347
Email: bjhoward@jhmi.edu
Problem:
Primary care providers' training is inadequate for addressing the complex psychosocial-developmental problems of children. This case-based discussion group supports providers with pediatrics-psychiatry leaders and a computer system for assessment, treatment, and referral to mental health providers.
Goals and Objectives:
Goal 1: 1.Enhanced understanding of psychosocial aspects of child development, disorders, and disability, especially of those children with special health care needs, and increased ability to help children Objective 1: Obj. 1- increase COR practitioners' knowledge of psychosocial-developmental issues each year over 5 years through case-based learning Objective 2: Obj. 2- increase proportion of patients for whom practitioner screened for relevant family and issues each year Goal 2: 2.Increased collaboration between pediatricians and child psychiatrists using case discussions Objective 1: Obj. 1- increase confidence in assessing need for referral each year Objective 2: Obj. 2- increase familiarity of pediatricians with individual child psychiatrists Goal 3: 3.Increased facility with a comprehensive health supervision as outlined in Bright Futures documents including assessment of development, socioemotional issues, and family strengths and weaknesses. Objective 1: Obj.1- assure that COR members have access to Bright Futures materials year one Objective 2: Obj.2- increase use of Bright Futures recommended screening tools each year Goal 4: 4. Expanded power to discriminate between transient disturbances and more serious psychiatric disorders facilitated by using the DSM-PC categories Objective 1: Obj.1- increase COR members use of DSM-PC categories of variation, problem and disorder when identifying mental health problems in children each year Objective 2: Obj.2- increase COR members' practice of addressing less severe mental health disturbances each year
Methodology:
The intervention has consisted of a study group of 5-10 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. 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, access to resources and communication via CHADIS. 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.
Coordination:
COR members: serving low income families, many on Medicaid. Dr. Howard: author of Bright Futures, Bright Futures: Mental Health and DSM-PC and Co-Director of the former Johns Hopkins DBP Fellowship; Dr. Frosch: Director of the Johns Hopkins Child Psychiatry Fellowship which includes Community Mental Health Clinics. Dr. Bierman: faculty preceptor for JH Fellows;Dr. Sturner: past Director of JH Fellowship. CHADIS: SBIR funding NICHD;Dr. Laraque: coordinator NY pediatrics-child psych project.
Evaluation:
The evaluation of course objectives is assessed by a questionnaire about COR objectives, session feedback, attendance and use of aspects of the CHADIS system.