Center for Promotion of Child Development through Primary Care

The Johns Hopkins Developmental-Behavioral Pediatrics Fellowship

Focusing on Application to Primary Care

RATIONALE: As psychosocial problems have increased in relative impact to the waning morbidity from problems of infectious disease and nutrition, pediatricians are being called on to shift the focus of their work to this "new morbidity". Yet to be helpful, pediatricians must learn to recognize these problems during the brief repeated contacts that are typical of their practice and acquire new skills to deal with them. New knowledge is needed in the field to determine and develop the best strategies for accomplishing this work in pediatric practice. The Bright Futures Guidelines and DSM - PC coding system take an important step in that direction. However, steps for recognition of the newly defined early stages of behavioral and developmental disorders and any interventions must be accomplished in a scientifically valid and economically accountable manner to be integrated into the health care system. The purpose of this program is to train academic Developmental-Behavioral Pediatricians to be leaders in researching these questions and transforming general pediatrics to meet the demands of caring for the whole child in our new environment.

GOALS:
  1. The clinical training goal of the program is to provide the knowledge and skills needed to be a competent consultant in Developmental and Behavioral Pediatrics (DBP) and also to be expert in strategies for early intervention and prevention within primary care.

  2. The research-training goal is to provide the foundation for each fellow to become a competent researcher, research evaluator and research teacher.

  3. The teaching training goal is to provide each fellow with a solid foundation in pedagogy, a broadened repertoire of techniques, and opportunities for observed and evaluated practice teaching.

  4. The leadership and administration training goals of the program are to introduce the administrative aspect of academic life affecting clinical, teaching, advocacy and research activities.

CURRICULUM: Throughout the three years fellows are actively involved in the demonstration/research laboratory of the Center for Promotion of Child Development through Primary Care (Center Lab) where they are engaged in primary care and consultation activities with the aid of an electronic parent/child/clinician system and under the supervision of senior DBP Pediatricians along with staff child clinical/research psychologists. Fellows will also participate in the associated weekly DBP Seminar. Throughout the three-year program they also participate in a weekly General Academic Fellowship Seminar Series. Individual clinical and research supervision and behavioral pediatrics study groups (COR) also continue throughout. They share in teaching residents and students.

The focus during the first year is on acquiring basic research and clinical skills and on acquiring a knowledge base of normal and deviant patterns of development and prevention methodologies. In the first year courses in epidemiology, biostatistics, normal development, and mental health related prevention research at the Hopkins Bloomberg School of Public Health (HBSPH) supplement the more application based discussions, role modeling and experiential based learning in the ongoing activities listed above. In addition, during the first year the fellows complete a secondary data analysis project with a mentor from HBSPH.

During the second year fellows focus their effort on their independent research project and related elective experiences. Several laboratories have now been established as particularly suitable for DBP fellowship projects including an ongoing school/community psychiatry service/research setting, a microanalytic digital video lab of child health supervision visits, an ongoing parent focus group, and programming support for computerized parent/child inventories. However, the projects are of the fellows' own choosing and may involve any of a wide array of potential faculty members with many other interests.

During the third year the focus is on the further development of consultative skills through weekly lectures on child and adolescent psychiatry and a weekly child psychiatry treatment seminar with the child psychiatry fellows at Johns Hopkins and also a series of lectures at the Kennedy-Krieger Institute regarding neurodevelopmental disabilities. In addition to didactics fellows will rotate through a variety of clinical training experiences providing direct clinical care with supervision seeing children with the full range of outpatient child psychiatric problems at Hopkins and children with neurodevelopmental disabilities at the Kennedy-Krieger specialty clinics. They will also participate in community consultation in school and preschool settings. The unique features of this fellowship program include the opportunity for selected training experiences in the above outstanding training programs in child psychiatry, neurodevelopmental disabilities, and public health. Yet the most unique feature of the program is the way the above experiences are woven together into defining a distinct and exciting domain for the new subspecialty of developmental-behavioral pediatrics. This is accomplished through ongoing modeling and supervision from three senior DBP Pediatricians in primary care and developmental-behavioral consultation areas and in a unique Center for Promotion of Child Development through Primary Care Laboratory (Center Lab).

The Center Lab experience includes observation and primary care for a sample of children followed longitudinally by the fellows and DBP faculty through video monitored and protocol driven child health supervision visits and an associated parent group. The protocols under development explore strategies for implementation of Bright Futures Guidelines and DSM - PC coding and build on previous MCH funded research of the Program Director. Children, parents, and clinicians interact with an electronic system (Child Health and Development Interactive System or CHADIS) under development to facilitate care, provide the clinician with clinical guides and act as a source of clinical information as well as a way to collect data for research. For example, one electronic parent inventory is now a validated method for identification of DSM-PC diagnoses. This system prompts the clinician with clinical guides during the clinical contact and also provides an in-depth complete DBP curriculum to review after the clinical contact. The experience also exposes the fellows to a multidisciplinary "think tank" designed to help refine this electronic system and define new roles for pediatricians in developmental-behavioral aspects of care. Several other national academic DBP sites will be piloting CHADIS and will provide a means for collaboration with an ongoing and large centrally archived database for research.

Another unique experience is the fellow's ongoing participation in the Fellowship Seminar Series. The format of this series has been refined over the past twenty years as the core of a successful fellowship program in general pediatrics that has produced a number of DBP oriented research projects. This Seminar will facilitate the attainment of research, teaching, advocacy and leadership goals. Of the 50 seminars held annually, 30 focus on pediatric clinical research, 10 are devoted to presentations by fellows on their independent research, and 10 deal with teaching and administrative issues. The teaching module is supplemented by shadowing and individual feedback by education faculty during the fellows' teaching experiences, observed and structured didactic teaching practice, and experience with standardized patient methodology.