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: Developmental and Behavioral Pediatrics Training Program

Project Director(s):

Carol C. Weitzman, MD
Associate Professor of Pediatrics
Yale University
Pediatric Department
Yale University School of Medicine
333 Cedar Street
PO Box 208064
New Haven, CT  06520-8064
Phone: (203) 688-4548
FAX: (203) 785-3932
Email: carol.weitzman@yale.edu

Problem:

There is a need to train DBP physicians to:1) produce quality research, 2) teach about DBP issues to other health professionals, 3) provide DBP clinical excellence and 4) inform policy related to DBP issues affecting children and families and 5) become national DBP leaders.

Goals and Objectives:

Goal 1: Provide patient care in DBP that is compassionate, family-centered, culturally competent and effective in the areas of assessment, patient management and consultation. Objective 1: Be able to understand, administer and interpret a range of developmental and behavioral screening, surveillance and assessment instruments Objective 2: Be familiar with the evaluation, diagnosis and treatment of children with a broad range of developmental and behavioral problems, including cognitive, behavioral,psychological, relational and regulatory difficulties Objective 3: Perform with proficiency complex evaluations of children who present with symptoms suggestive of an Autism Spectrum Disorder including the Autism Diagnostic Observation Scales and Autism screeners including the M-CHAT and CARS. Goal 2: Develop the knowledge, skills and attitudes needed to achieve clinical expertise in DBP and an ability to integrate this knowledge into Primary Care Pediatrics. Objective 1: Possess considerable expertise in DBP to supervise at least 20 residents during their continuity clinics. Fellows will use these opportunities to enhance integration of DBP concepts into the provision of Primary Care Pediatrics. Objective 2: Teach pediatric residents about core topics in DBP including screening, psychopharmacology, autism, developmental disabilities, using many formats including lecture, case-based discussion, small group sessions and clinical mentoring. Objective 3: Expertly evaluate hospitalized children who present with a range of psychological and behavioral symptoms related to or exacerbated by their underlying illness and current health concerns, and work with pediatric Primary Care providers to address these issues effectively. Goal 3: Work effectively in interdisciplinary settings with other professionals, such as psychiatry, nursing and psychology and systems of care, such as education and public health. Objective 1: Participate in at least 11 interdisciplinary clinical teams that provide DBP care in a range of settings. These interdisiplinary experiences provide opportunities for DBP fellows to develop collaborative care models and to learn about the expertise of other disciplines. Objective 2: Provide consultation to a number of community agencies, including Head Start and schools for typically developing children and children with special health care needs. Fellows will work within a range of settings to gain expertise in working with other systems that care for children. Objective 3: Attain a complex understanding of state and federal programs that provide services or benefits to children and families, including Title V, Medicaid, and SCHIP. Goal 4: Develop administrative, leadership and advocacy skills to enable DBP fellows to become MCH leaders Objective 1: Participate in at least 2 university, local, state, or national committees over three years, such as being a resident representative on the Graduate Medical Education Committee Objective 2: Assist faculty in offering technical assistance to community-based agencies and to the Department of Public Health, which administers the Title V MCH programs in CT. Objective 3: Attend a legislative hearing on a specific DBP topic that the fellows has researched and gained complex understanding. The fellow will provide testimony if this is relevant. Goal 5: Complete a research project that advances DBP knowledge. Fellows will become proficient at appraising and assimilating scientific evidence, and will develop skills for life-long learning. Objective 1: Design, execute, collect, analyze and interpret data on 1 DBP-related research project. Objective 2: Prepare, submit and present at least 1 abstract and manuscript for presentation and/or publication that reflects original contribution to a research project. Fellows will be responsible for conducting a substantive portion of the research that they write about. Objective 3: Understand the principles of Evidence-Based Medicine (EBM), including asking clinical questions, searching the literature and applying a critical appraisal of the medical literature.

Methodology:

Fellows will be trained within a three-year program by a multidisciplinary faculty. Elements of the program include: 1. A broad range of clinical training sites, many of which involve interdisciplinary teams, located within the DBP Subsection, the Yale Child Study Center, the inpatient and outpatient units of Yale-New Haven Children's Hospital, and community sites. 2. Clinical supervision provided individually and in groups (including utilizing Collaborative Office Rounds) provided by faculty of many disciplines (e.g., DBP, child and adolescent psychiatry, psychology, social work, etc.). 3. Didactic coursework and seminars, especially within the DBP Program, the Yale Child Study Center, and the Robert Wood Johnson Clinical Scholars Program. 4. Extensive public health, policy, leadership, and advocacy training. 5. Training in cultural sensitivity, especially through education and mentorship provided by a visiting faculty member from the University of Connecticut with expertise in this area and through direct involvement within an innovative program in the Department of Pediatrics. 6. Research training involving coursework (participation in Methods of Clinical Research Course provided by the Clinical Scholars Program and the Investigative Medicine), participation in an ongoing research project of one of the faculty and development of an independent research project, and participation and presentation of ongoing work in weekly departmental and section research seminars.

Coordination:

Key personnel from state, and local health agencies interface with DBP fellows as part of their core DBP seminar. Faculty in the Program have active relationships with Title V/MCH programs in CT. Each fellow will work with a faculty person to provide technical assistance to a local or state agency. These activities will provide the fellows with an understanding of national and local public health issues, contact with regional experts, and detailed understanding of at least one state agency.

Evaluation:

Evaluation is conducted in 3 areas: 1) Fellow Performance, 2) Faculty Performance and 3) Overall Program Performance. Fellows' skills in clinical, research and teaching performance are evaluated throughout the year with structured evaluation forms. DBP Faculty are evaluated by DBP fellows, and short- and medium-term trainees. Each year the Curriculum committee meets to review how successfully we have met the program's goals and objectives and identify areas in need of change.

Experience to Date:

In the past year, the program has had a number of clinical, research and advocacy successes. Clinically, the program has expanded to an additional site. Drs. Weitzman and Major have partnered with a local community hospital to develop a multidisciplinary Child Development Center that will encompass evaluation and treatment for children with a range of developmental concerns. Significant philanthropic funds have been raised and space has been identified and renovated. This is anticipated to be a rich training site for DBP fellows. This past year, Dr. Weitzman was awarded a COR (Collaborative Office Rounds) grant, for a program entitled Icor (international COR). It is a novel means of conducting a COR group across sites using telemedicine services. Yale is partnering with DBP, general pediatrics and child psychiatry at Stanford University and Singapore to examine cross-cultural similarities and differences around developmental disabilities. DBP fellows at Yale will participate in Icor and this should prove to be a rich training opportunity. The ACT (Autism Case Training) curriculum which Dr. Weitzman conceptualized and edited was completed this year and represents a partnership between multiple agencies (CDC and MCHB), and faculty and fellows across MCHB DBP training sites. Yale DBP fellows and faculty participated in developing cases and completing an evaluation of the curriculum. This curriculum holds the potential to standardize and improve training for all trainees.

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