Funded Projects

Goals and Objectives:

Background. With this application, Boston Medical Center (BMC), the largest safety net hospital in New England, proposes to expand and enrich its three-year Developmental and Behavioral Pediatrics (DBP) Fellowship and 400-hour "mini-internships" for pediatric and child psychiatry providers. Initiated in the 1970s, our long-term training program has graduated 33 fellows and 10 mini-fellows, many of whom have gone on to establish new DBP programs around the country and who have generated nearly 200 journal articles. We have retained 100% of long-term trainees through program completion, and all of our DBP fellows have earned board certification. We attribute these successes to our ability to attract mission-driven, dedicated women and men who plan to commit their careers to serving culturally and linguistic diverse children and adolescents with developmental and behavioral issues. In the past two years, two of our four long-term trainees have been racial and ethnic minorities. Our medium-term training opportunities consist of 72- to 160-hour rotations in the DBP Clinic provided to 20 to 22 residents in pediatrics, child neurology, child psychiatry, and 4th year medical students each year. This intensive exposure prepares trainees to go forward in their careers with a good working knowledge of best practices in screening, assessment and management of less complex DBP patients in primary care settings. Our short-term trainings, offered to more than 1,000 pediatric providers and allied health professionals annually, range from one-hour lectures to day-long workshops to teach practical DBP skills. Need. There exists an enormous need in safety net pediatric settings for culturally competent DBPs of the highest caliber who are prepared to address the needs of under- and unserved racial and ethnic minorities and who can train other pediatric providers to manage less complex patients in their medical homes. There is also a need to increase the number of pediatric primary care providers who can confidently screen, assess and treat autism spectrum disorder (ASD) and other developmental disabilities (DD). Goals. We propose, first, to provide long-term training to a diverse group of 20 clinicians to prepare them to provide excellent clinical care; to perform research and quality improvement (QI); to provide the advocacy needed to meet the needs of diverse urban families and complex patients; and to provide the leadership and training needed to transform systems of care. Second, we propose to offer a range of clinical skill-building opportunities to medium- and short-term trainees across a variety of disciplines and levels including seminars, lectures, and week-long rotations in the DBP Clinic, to enable them to better serve low-income children with ASD and other DD. We are especially intent on increasing the number of pediatric providers recruited from the CHCs, with whom we have many strong working relationships and who can readily be trained to provide onsite management of ASD and other DD. Activities. With grant funds, we will enrich our longterm training to emphasize training skills, cultural competency, social determinants, and research and quality improvement. We will add new long-term training slots; "manualize" and freely distribute our mini-fellowship and medium-term training curricula; and plan and deliver a menu of short-term trainings. Using New Innovations, our planned REDCap database, and qualitative feedback, we will perform rigorous process and outcomes evaluation and reporting.