Systems Based Care

Outcome

By graduation, the residents will demonstrate the knowledge, attitude, and skills necessary to manage effectively in multiple, diverse, complex systems of care to provide effective assessments, treatment, consultation, and advocacy for children, adolescents, families, and child related agencies. Residents are expected to exhibit progressive improvement in their level of knowledge and skill throughout their training. Methods of demonstration may include the care of patients/ families, participation in didactics and clinical conferences, presentations, or exams.

Knowledge

Definition

Residents must have

• an awareness of and responsiveness to the larger context and system of health care with the ability to effectively utilize system resources to provide optimal patient care
• a theoretical and practical understanding of systems and the relevance to health and psychiatric care
• knowledge about local/ national organizations involved in advocating and caring for youth/ families

Expectations

Residents will learn about

• the interaction between and reciprocal impact of their own patient care and other professional practices and those of other professionals, health care organizations, and society
• the different public and private systems involved with children, adolescents, and families: the services, costs, and access to care
• cost effective health care practices and resource allocation while providing quality patient care
• mental health advocacy for children, adolescents, and families in general as well as for individual patients and families to negotiating systems and obtaining services
• collaboration with other professionals to understand and negotiate health care and other systems to provide and manage quality health care
• Suggested topics (not inclusive) include:
  • Educational systems
    • Special educational services
    • Legal mandates
  • Community programs, agencies, and systems (public and private)
  • Social Service systems
    • Public services
    • Child protective services, welfare, foster care, adoption
    • Institutional (hospital) services
    • Private agencies
  • Mental Health Systems (public and private)
  • Legal systems
  • Health Care systems (public and private)
  • Insurance systems (public and private)
  • Political systems

Attitudes

Definition

• Residents will exhibit interest in and an understanding of health care delivery and system interactions

Expectations

Residents will participate actively in didactic and clinical situations with an understanding of

• the impact of and interrelationships between patient care practices and other professional activities
• the systems and services available to children, adolescents, and families and their influence on patient care and clinical practices

Residents will demonstrate the abilities to negotiate and collaborate with

• systems to advocate for and provide the best possible care for children, adolescents, and families
• other professionals, patients, and their families to integrate services from multiple systems

Skills

Definition

Residents will demonstrate an understanding of how

• their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their practice
• types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
• to practice cost-effective health care and resource allocation in a manner that does not compromise quality of care
• to advocate for quality patient care and to assist patients in dealing with system complexities
• to partner with health care managers and health care providers to assess, coordinate, and improve health care and knowing how these activities can affect the system

Expectations

Residents will demonstrate

• the ability to provide cost effective quality patient care with appropriate utilization of resources
• an understanding of the advocacy needs of children, adolescents, and families and the ability to help patients and families negotiate systems and access to resources
• the ability to collaborate with other professionals to negotiate systems and provide patient care

Assessment/Measurement

Objective Measures

• Regular documentation by clinical and teaching faculty of participation in didactic modules, case conferences, and other teaching sessions
• Completion of CHILD PRITE annually with review of individual scores with the training director
• Completion of essay exam annually with review with the training director

Supervision

• Regular documentation of resident performance in areas relevant to systems based care by supervising outpatient and on-rotation faculty

Clinical Skill Evaluation

• Direct observation of the individual resident's clinical and didactic activities by identified faculty
• Completion and review of 360 input
• Observation and evaluation of videotaped patient interactions by supervisors and/ or teaching faculty on a regular basis
• Annual clinical examination of “mock board” type
• Biannual review of performance with training director

Independent Learning

• Demonstration of self-initiated as well as directed study through leadership of discussions in both didactic and clinical activities and through presentations to the residency program in various formats (e.g. required papers; seminars; grand rounds; etc)

Deficiency Remediation

• Regular review for each individual resident with the training director of the various measures of performance and competence with the
  • identification of any specific deficits
  • documentation of all identified areas requiring remediation or additional concentration
  • development of specific remediation plans based on the particular deficiencies identified
  • planning for further assessment with the outcome being determined by a method of assessment similar to the one used to identify the original deficiency (e.g. relative deficits identified on the CHILD PRITE might be subsequently reassessed by later performance on the CHILD PRITE or another written examination; deficits identified through the supervisory process might be reassessed by subsequent supervisory reports specifically targeted at assessing and remediating the identified deficits; etc)