Grant Status: Active
Grant Title: Developmental-Behavioral Pediatrics (DBP) Training
Heidi M Feldman, MD, PhD
Board of Trustees of the Leland Stanford Junior University
1265 Welch Road MC 5415
Stanford, CA 94305
Phone: (650) 497-8052
Over 19.5 million children nationally and 2.2 million children in CA have a disability. Over 2/3 of the 14.5 million children nationally and 1.39 million in CA with special health care needs also have a disability. Rates of autism spectrum disorder (ASD) rose over 10 years from 1 in 150 to 1 in 68. Adverse social and economic factors are common co-occurrences in children with disabilities, including ASD. Children with disabilities frequently experience unmet needs for care, including problems with referrals for subspecialty care, such as DBP. Pediatricians continue to feel ill-prepared to provide care to children with disabilities and developmental delays. Research is needed to improve clinical care and systems of care delivery.
The purpose of this training grant is to reduce the unmet needs of children with disabilities by increasing capacity in the health care system and infusing health care and related services with Maternal Child Health (MCH) values and practices. Objective 1 is to prepare DBP fellows for leadership roles in clinical care, research, education, and/or administration/policy. Objective 2 is to improve the knowledge, skills, attitudes and behaviors of trainees (practicing professionals to pre-professional students) regarding ASD, intellectual or developmental disabilities (IDD), and developmental delays (DD). PROPOSED ACTIVITIES: An innovative comprehensive 3-year DBP fellowship training program balances clinical preparation, classroom education, and community-based experiences. Rotations in the DBP clinics provides substantial exposure to children with ASD, IDD, and DD. Rotations in Child Psychiatry, Pediatric Neurology, Genetics, Adolescent Medicine, and General Pediatrics complement clinical preparation. Courses and seminars introduce the fellows to all competencies required for DBP certification and link to topics and objectives within Healthy People 2020, such as developmental screening, early identification of autism, medical home, school readiness, and recommended management of Attention Deficit Hyperactivity Disorder. Community experiences educate trainees about social determinants of health, enhance interdisciplinary collaboration, and provide first-hand experience with systems of care. The training infuses leadership development into all elements of the curriculum, following the MCH leadership model. Family-centered care, cultural competence, inter-disciplinary teaming, MCH principles, and the life course framework are also emphasized in all venues. A long-term pipeline strategy is designed to increase the diversity of candidates for DBP fellowship. To educate medium-term trainees, faculty members provide DBP services co-located in primary care offices. These programs support and educate practicing clinicians and residents while strengthening the medical home. A required one-month pediatric residency rotation provides residents from two different programs with knowledge and skills to provide developmental care. The Stanford Annual Autism Update provides continuing education to parents and professionals about issues across the life span. Faculty provide leadership for national and regional organizations.
Fellows are evaluated each year for progress in clinical skills, research, teaching, and leadership. The faculty and program are also evaluated annually. Graduates of the program are surveyed annually about their current position and leadership. Former residents are survey every other year about DBP practices. Recruitment strategies are evaluated biannually. A 5-year evaluation plan assesses impact by evaluating trends in developmental screening rates in CA and rates of unmet needs among children with disabilities on national and state surveys.