1.3 TRAINING AND SUPPORTING RURAL PEDIATRICIANS IN THE IDENTIFICATION AND CARE OF FAMILIES AFFECTED BY TRAUMA

Abstract

Kennedy Krieger Institute’s Network for Early Childhood Tele-Education (KKI-NECT) is a case-based learning collaborative to address behavioral, emotional, and developmental concerns in children ages birth to 5 years. The speaker will give a brief overview of KKI-NECT and present findings from the Health Resources and Services Administration (HRSA)-funded program. KKI-NECT replicates the Project ECHOTM (Extension for Community Healthcare Outcomes) model of a “hub” (KKI developmental pediatricians, child and adolescent psychiatrist, and behavioral psychologist), which hosts weekly “clinics” (teleconferences) with “spokes” (10-12 pediatric primary care providers) in underserved areas across the states of Maryland and West Virginia. The frequency and types of traumatic experiences in the cases discussed during the sessions, as well as the methods to train and support primary care providers in identifying and addressing trauma in their patients, will be presented. Finally, a short case example will illustrate the nature and complexity of cases being managed rurally by nonspecialists, with the support of the KKI-NECT team. Over 4 years, 85 unique cases were presented by rural pediatric providers for assistance with diagnosis and management by specialists in the hub. Among these 85 unique cases, 69% of the cases presented had a least 1 adverse childhood experience (ACE) as compared to 45% of children in the United States. In addition, 37% had 3 or more ACEs, putting them at higher risk for poor outcomes, as compared with 10% nationally. The most common ACEs were parental separation, household substance use, and parental mental illness. Pediatricians are uniquely positioned to intervene because early childhood trauma is often undetected or unreported. Traumatic experiences have been described in the majority of cases discussed during the KKI-NECT clinics. KKI-NECT provides an opportunity for both education and support for pediatric providers as they respond to trauma-related concerns in their patients.