David Ray DeMaso, M.D.
Associate Professor of Psychiatry, Harvard Medical School
Associate Psychiatrist-in-Chief, Children's Hospital, Boston, Massachusetts
It is estimated that the rate of serious emotional disturbance in children between the ages of 9 and 17 is in the range of 9 to 13 percent (Friedman et al., 1996). These disorders can have a long-term, even life-long impact on patients and their families. Increasingly the need for identification of "subthreshold" mental health problems in primary care has become apparent. Costello and Shugart (1992) found that 42% of children in a pediatric clinic met threshold-level disorder criteria. We know that prompt, clinically effective intervention can have an immediate and long-term impact on mitigating the effect of mental illness on children and adolescents. The combination of clinical level mental disorders, along with the subthreshold level disorders, will necessitate a robust work force in the future to respond to the needs of these families. In the future, psychiatrists and pediatricians will need to collaborate more closely on the development of new diagnostic and intervention models, as well as in the joint care of children with complex, comorbid, and chronic conditions.
The purpose of the "Collaboration Essentials for Child and Adolescent Psychiatry and Pediatric Residents: Working Together to Treat the Child" was to nurture this collaboration by bringing together residents from both specialties. Financially supported by Pfizer, Inc., the program at the 2000 AACAP Annual Meeting in New York was designed to establish dialogue and interaction between residents in training. It was based upon the premise that closer collaboration between psychiatrists and pediatricians is needed to adequately care for children's complex behavioral, developmental and psychosocial problems, and that the optimal time to foster this collaboration is during residency training. While there is a long history of joint teaching endeavors, this program is unique in bringing together trainees from both disciplines in a format that enhances communication, models collaboration and establishes new linkages.
The program was organized by Dr. David Ray DeMaso, a Child and Adolescent Psychiatrist, and Dr. John Knight, a Developmental-Behavioral Pediatrician, from Boston Children's Hospital. They invited six prominent faculty from both specialties and residents from 19 training programs in the greater New York area. Over the course of the day, residents, together with the faculty examined aspects of resident-patient interaction, recognized biopsychosocial problems, and discussed treatment options for childhood mental health problems.
The centerpiece of the program was the use of "Collaborative Office Rounds (COR)." COR is "a small group experience that promotes free exchange of ideas and provides for a continuing relationship with resource faculty and other group members" (Fishman et al., 1997). These rounds grew out of the increasing emphasis on the mental health aspects of primary health care for children and adolescents. The establishment of postgraduate COR with community pediatricians has been implemented in over 14 sites across the country (supported by The Maternal and Child Health Bureau). Jointly led by a pediatrician and child psychiatrist, these have been well received. The program was an application of the COR concept at a training program level.
Case-based teaching was selected for the content of the COR. Case discussions promoted critical thinking and analysis. The facilitators' goals were to maximize student interaction, as well as encourage residents to learn from one another. The facilitators were told that "the aim of the program is for the residents to learn collaboration first hand at the clinical crossroads where we often meet, rather than to learn one subject in expert depth." With grant support from The Genentech Foundation for Growth and Development and The Maternal and Child Health Bureau, Dr. Knight and his pediatric colleagues at Boston Children's Hospital developed a series of illustrative clinical cases with accompanying written educational information. These cases were used as the clinical material for the COR. The participants were given notebooks to organize the written educational material that was given to them after the discussion of each case.
The residents were divided into groups of six to ten participants, including both psychiatry and pediatric residents. Pediatric and psychiatry residents from the same institution were placed in the same group to help establish new linkages that would carry beyond a one-day program. The faculty members were grouped such that a psychiatrist and pediatrician were charged with facilitating a series of resident groups. Each group of residents moved from facilitator group to group over the course of the day. The cases were selected to illustrate a range of problems including depression, attention deficit hyperactivity disorder, learning problems, substance abuse, and somatoform illness.
The first "Collaboration" program was presented at the 1999 AACAP Annual Meeting in Chicago. In a follow-up survey, all residents and faculty who attended the program strongly recommended that the program be offered again. Residents indicated a much higher likelihood to consult with their counterparts, as a result of their participation in the program. As one of the faculty stated, "By the end of session, the residents were talking about calling each other if they needed help from colleagues." The 2000 program was part of the AACAP's continuing effort to foster collaboration between child and adolescent psychiatry and pediatrics. The intention is to develop a program that can be replicated in other locations on an ongoing basis.
The next program will be held May 18-19, 2001 in Baltimore, MD. Child and adolescent psychiatry residents and pediatric residents from the Mid-Atlantic region have been invited to attend. Contact Kayla Pope at (202) 966-7300, x113.
Associate Professor of Psychiatry, Harvard Medical School
Associate Psychiatrist-in-Chief, Children's Hospital, Boston, Massachusetts
It is estimated that the rate of serious emotional disturbance in children between the ages of 9 and 17 is in the range of 9 to 13 percent (Friedman et al., 1996). These disorders can have a long-term, even life-long impact on patients and their families. Increasingly the need for identification of "subthreshold" mental health problems in primary care has become apparent. Costello and Shugart (1992) found that 42% of children in a pediatric clinic met threshold-level disorder criteria. We know that prompt, clinically effective intervention can have an immediate and long-term impact on mitigating the effect of mental illness on children and adolescents. The combination of clinical level mental disorders, along with the subthreshold level disorders, will necessitate a robust work force in the future to respond to the needs of these families. In the future, psychiatrists and pediatricians will need to collaborate more closely on the development of new diagnostic and intervention models, as well as in the joint care of children with complex, comorbid, and chronic conditions.
The purpose of the "Collaboration Essentials for Child and Adolescent Psychiatry and Pediatric Residents: Working Together to Treat the Child" was to nurture this collaboration by bringing together residents from both specialties. Financially supported by Pfizer, Inc., the program at the 2000 AACAP Annual Meeting in New York was designed to establish dialogue and interaction between residents in training. It was based upon the premise that closer collaboration between psychiatrists and pediatricians is needed to adequately care for children's complex behavioral, developmental and psychosocial problems, and that the optimal time to foster this collaboration is during residency training. While there is a long history of joint teaching endeavors, this program is unique in bringing together trainees from both disciplines in a format that enhances communication, models collaboration and establishes new linkages.
The program was organized by Dr. David Ray DeMaso, a Child and Adolescent Psychiatrist, and Dr. John Knight, a Developmental-Behavioral Pediatrician, from Boston Children's Hospital. They invited six prominent faculty from both specialties and residents from 19 training programs in the greater New York area. Over the course of the day, residents, together with the faculty examined aspects of resident-patient interaction, recognized biopsychosocial problems, and discussed treatment options for childhood mental health problems.
The centerpiece of the program was the use of "Collaborative Office Rounds (COR)." COR is "a small group experience that promotes free exchange of ideas and provides for a continuing relationship with resource faculty and other group members" (Fishman et al., 1997). These rounds grew out of the increasing emphasis on the mental health aspects of primary health care for children and adolescents. The establishment of postgraduate COR with community pediatricians has been implemented in over 14 sites across the country (supported by The Maternal and Child Health Bureau). Jointly led by a pediatrician and child psychiatrist, these have been well received. The program was an application of the COR concept at a training program level.
Case-based teaching was selected for the content of the COR. Case discussions promoted critical thinking and analysis. The facilitators' goals were to maximize student interaction, as well as encourage residents to learn from one another. The facilitators were told that "the aim of the program is for the residents to learn collaboration first hand at the clinical crossroads where we often meet, rather than to learn one subject in expert depth." With grant support from The Genentech Foundation for Growth and Development and The Maternal and Child Health Bureau, Dr. Knight and his pediatric colleagues at Boston Children's Hospital developed a series of illustrative clinical cases with accompanying written educational information. These cases were used as the clinical material for the COR. The participants were given notebooks to organize the written educational material that was given to them after the discussion of each case.
The residents were divided into groups of six to ten participants, including both psychiatry and pediatric residents. Pediatric and psychiatry residents from the same institution were placed in the same group to help establish new linkages that would carry beyond a one-day program. The faculty members were grouped such that a psychiatrist and pediatrician were charged with facilitating a series of resident groups. Each group of residents moved from facilitator group to group over the course of the day. The cases were selected to illustrate a range of problems including depression, attention deficit hyperactivity disorder, learning problems, substance abuse, and somatoform illness.
The first "Collaboration" program was presented at the 1999 AACAP Annual Meeting in Chicago. In a follow-up survey, all residents and faculty who attended the program strongly recommended that the program be offered again. Residents indicated a much higher likelihood to consult with their counterparts, as a result of their participation in the program. As one of the faculty stated, "By the end of session, the residents were talking about calling each other if they needed help from colleagues." The 2000 program was part of the AACAP's continuing effort to foster collaboration between child and adolescent psychiatry and pediatrics. The intention is to develop a program that can be replicated in other locations on an ongoing basis.
The next program will be held May 18-19, 2001 in Baltimore, MD. Child and adolescent psychiatry residents and pediatric residents from the Mid-Atlantic region have been invited to attend. Contact Kayla Pope at (202) 966-7300, x113.
