Maternal and Child Health Training Program
Grant Title: International Collaborative Office Rounds (i-COR)
Web Site: Yale University Project
Carol Weitzman, MD
School of Medicine
333 Cedar St.
New Haven, CT 06520
Phone: (203) 785-7521
FAX: (203) 737-1206
Pediatricians often must assess and manage developmental-behavioral problems in the context of shifting US demographics. They often lack understanding of how cultural practices influence the presentation of these problems. Multidisciplinary case conferences can increase cultural competence.
Goal 1: Demonstrate a comprehensive approach to the psychosocial aspects of child health and development, disorders and disability. Objective 1: Incorporate inquiry regarding psychosocial functioning into all routine health supervision visits in accordance with that which is outlined in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Objective 2: Identify children with functional impairment due to mental health problems using a combination of skilled interviews of children and parents, and standardized screening instruments. Objective 3: Utilize the major diagnostic classification systems including DSM-IV, DC 0-3 and DSM-PC to accurately assess children presenting with a range of developmental and behavioral problems. Goal 2: Become proficient in the ability to assess,manage and triage children with behavior and developmental problems in primary care and subspecialty settings. Objective 1: Provide compassionate family-centered care that engages families in the diagnostic and treatment process. Clinicians will become comfortable in the use of psychopharmacologic agents and other modalities of treatment, including brief-office based treatments. Objective 2: Recognize the spectrum of presentation of mental health disorders and identify signs of worsening functioning or increasing severity. Clinicians will: 1) become comfortable with using rating scales and interview techniques to assess children, and 2) be familiar with mental health "red flags." Objective 3: Recognize additional psychosocial challenges that are conferred upon underserved children by virtue of living in poverty. Understand how cumulative psychosocial risk adversely influences the presentation and outcome of developmental and behavioral problems during childhood. Goal 3: Enhance clinicians knowledge of local, national and international resources that are available to clinicians and families. Objective 1: Identify local resources for families, particularly those administered by Title V in their area, that include opportunities for education, material and social support, and tangible services. Objective 2: Identify specific local, regional, national and international professional resources that can be utilized to improve care of children with psychosocial challenges Goal 4: Increase clinicians ability to create meaningful connections between pediatricians and mental health providers within and across sites. Objective 1: Become proficient in developing partnerships between pediatricians and mental health professionals within different local, state, and national contexts. Clinicians will develop strategies to initiate and maintain partnerships and develop ways to understand each others profession more clearly. Objective 2: Discuss and develop strategies to overcome barriers to effective interdisciplinary collaboration. Clinicians will examine reasons why professionals often face barriers and examine more efficient means of communicating and exchanging information. Objective 3: Discuss existing successful partnerships between clinicians of different disciplines that exist locally, nationally and internationally. Goal 5: Develop a complex understanding of 1) the role of cultural differences in the presentation of developmental and behavioral problems in children, and 2)how families’ beliefs influence treatment. Objective 1: Compare and contrast specific cultural differences in families’ approaches towards mental health challenges in children across sites. Clinicians will use cases to develop culturally informed, competent, sensitive, and humble approaches to talking with families about mental health. Objective 2: Recognize potential barriers families face, such as stigma, in successfully obtaining appropriate care for their children. Strategies to identify and address barriers with patients will be discussed and participants will discuss examples from their practice. Objective 3: Examine their own cultural beliefs regarding psychosocial problems in children. During case conferences, clinicians will challenge some of their beliefs, contrast them with patients' beliefs, attitudes and practices and develop an appreciation of the diversity of customs, .
The format of the Yale COR group for the past 20 years and the approach that will be used for Icor is that of case-based learning sessions with relevant didactic materials provided afterwards to supplement the discussion. Meetings will be held monthly at 3 sites for 1 ½ hours across a 16 hour time difference. Participants will include child psychiatry, developmental-behavioral pediatrics and general pediatrics. Trainees and learners at multiple levels and from different training backgrounds will be included. Each of the three sites will gather in a conference room at their site and will be connect to each other through a videoconferencing bridge, supplied by Yale, which will allow for smooth audiovisual communication between all three locations. During the Icor session, participants from 1 or 2 sites and from varied disciplines will present cases to the group. Dr. Marachi, the child psychiatrist who will function as the key moderator, has vast experience moderating 2 different COR groups for many years. To foster a climate of respectful learning, Dr. Marachi and other senior faculty will present their own cases, challenges and dilemmas and seek consultation from all members of the group. This will encourage greater participation from junior members and allow them to also contribute as “experts”. Special emphasis will be placed on understanding cultural differences in the presentation and understanding of developmental, behavioral and psychosocial issues
Three academic center including Yale, Stanford and National University Hospital of Singapore are included in this project. It is critical for the success of this project for the number of participants to remain small,stable and consistent over time in order to enhance group dynamics. Although resources available locally and across states and even nationally or internationally will be extensively discussed, other agencies will not be directly involved in this project.
The conceptual framework for the evaluation process includes structured data gathering using carefully developed evaluation measures to assess: 1) Group functioning reflected in stable attendance, 2) Impact on individual attendees in regards to knowledge, skills, and practice, 3) Changes in cultural competence and the impact on practice, 4) Standardized assessment of impact of Icor on trainees and 5) Other impacts as a result of Icor participation including new initiatives and curricula.