happy children, mother and child, and expecting mother and father

Funded Projects

Grant Status: Completed

Grant Title: Collaborative Office Rounds

Project Director(s):

Diane Kittredge, MD
Dartmouth University
Dartmouth- Hitchcock Medical Center
Dartmouth Medical School
Department of Pediatrics
One Medical Center Drive
Lebanon, NH  03756-0001
Phone: (603) 653-9662
FAX: (603) 653-3585
Email: Diane.Kittredge@hitchcock.org


Developmental and psychiatric care resources are limited in Northern NE. Medical Home providers are often the only resource families have when they need help. Primary care providers will gain valuable knowledge and support through family focused, community-based teaching and collaboration.

Goals and Objectives:

Goal 1: This collaborative project will help pediatricians develop knowledge, skills, and attitudes listed in the following objectives: Objective 1: 80% of participants will understand the scope of behavioral health practice they can undertake in the course of their practices by 2008; Objective 2: 50% of participants will become actively involved in a community-based initiative intended to address psychosocial aspects of child health, by 2009; Objective 3: 100% of participants will feel they know how to present symptoms and signs to a consulting child psychiatrist and understand basic psychopharmacology, by 2009 Activities/Methodology undertaken to meet project goals: Combined the study group will consist of a total of 38 primary care pediatrician, approximately 25% of whom are members of the full-time general pediatrics, child psychiatry, and developmental pediatrics faculties at the Children's Hospital at Dartmouth (CHaD), and approximately 75% of whom are practicing pediatricians from surrounding rural communities in NH and VT. The format of all sessions will involve the presentation and discussion of up to two current clients from participants' practices who brings a developmental or emotional concern to the pediatrician. Led by the presenter, and a moderator the group will then discuss the case from multiple perspectives, including data gathering, assessment instruments, DSM-IV diagnosis, DSM-PC coding, individual psychodynamics, family and cultural factors, and possible interventions by the pediatrician or consultant. Quaterly, a non-binding theme topic will be posted to give participants ideas and guidance to help them identify children to discuss.


This project relies greatly on the strength of the Medical Home environments represented by those participating in the Group. As such, relationships with existing community-based networks will be enhanced through COR participants' increased understanding and appreciation of the need to access these services through the peer training, updates, and case-based discussion.


The moderators will be responsible for monitoring the sessions for content and objectives with direction from the PI and Co-PI. Satisfaction of the pediatrician in the delivery of behavioral health care in his or her primary care practice; satisfaction of the pediatrician in the referral of pediatric patients to area MHPs, and satisfaction of the MHP in the process of receiving referrals from pediatricians and in ongoing communications and collaboration with the pediatrician

Experience to Date:

50 participants attend COR at 3 sites, strengthening the mental health skills of providers in NH's northern, eastern and most populated counties. Spinoff's include a) increasing capacity in video-conferencing, b) frequent email and phone consultation among participating COR Group members, c) regular Child Psychiatry presentations at both states' (NH, VT) annual professional meetings on topics such as Pediatric Psychopharmacology, PTSD and ADHD, d) a variety of successful collaborative projects, highlighting COR as a central training module to interagency, interdisciplinary training in behavioral health, e) establishment of a user-friendly resource website for practitioners and families, f) adding resident clinical experiences, g) tele-psychiatric evaluations and consultations for the northern third of the state of NH through collaboration with Weeks Medical Center. The COR model was adapted to teach pediatric and child psychiatry residents and medical students at Lebanon (DHMC) campus. We work closely with the NH Special Medical Services, the NH and VT Pediatric Societies, the MCH-LEND Program, and professional organizations representing pediatricians and family practitioners. We now have two grants from New Hampshire Endowment for Health to develop: 1) mental health and developmental screening for families of children 0-5 years on the Lebanon campus (Kittredge); and 2) new models of interdisciplinary behavioral health care delivery to children living in Northern NH (Keenan).

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