Psychosocial Curriculum Research Articles

Transitioning from Pediatric to Adult Care: The Role of an Education Curriculum for Adolescents and Young Adults with Sickle Cell Disease

Introduction: Sickle Cell Disease (SCD) is the most common inherited blood disorder, affecting over 100,000 people in the United States. The latest medical managements have yielded better outcomes in mortality and morbidity among people with SCD. Despite these advancements, emerging young adults have complications transitioning from pediatric care to adult care and remain with the highest mortality rate in the population. Got Transition is a federally funded national resource center that aims to support youth and young adults moving from pediatric to adult care by implementing the Six Core Elements of Transition. At our institution, we established a transition program aimed at improving clinical care, medical management, and improvement in the transition from pediatric to adult medical care. Our goal was to develop a standardized, age appropriate sickle cell education curriculum to implement at clinic visits for our patients aged 13 and older.Hypothesis: We hypothesize that with a structured transition curriculum, we would be able to improve patient knowledge in medical aspect of the disease, academic resources and a better understanding of their complex psychosocial needs.Methods: We developed a transition program called Adolescent and Young Adult Sickle Cell Uplift and Learn Program for Transition (AYA SCULPT) that would focus on patients starting at 13 years old with a multidisciplinary approach of care. We adopted the Got Transition model implementing the Six Core Elements of Transition. Our team not only wanted to address educational topics related to their medical care, but also psychosocial and academic topics. A transition education curriculum was created spanning three age groups on the three major topics and further broken up into three smaller sections for clinic use to accommodate for time restraints (Table 1). A pilot of the medical curriculum was started August 2019 addressing medical topics relating to better understanding of sickle cell disease. We then introduced our psychosocial curriculum in January 2021. A member of our comprehensive sickle cell team provides the four-question pre-test to the patient at the beginning of their regularly scheduled clinic appointment. At the end of the appointment the nurse or provider will grade the pre-test and provide verbal education as well as printed material on the topics for the day. Scoring and topics are tracked in the patient's note as well as in a transition education database. At the patient's next visit, the same test is administered as a post-test in order to determine knowledge acquired and retention of the materials. Post-test scores are also recorded in the patient note and transition education database. Once the patient finishes a module, we move to the next topic at the next regularly scheduled visit. Depending on the patient's genotype and medication management, post-tests can be given between two to six months after the pre-test.Results: Scores from pre-test were compared to those of post-test for patients that had the opportunity to complete the medical curriculum quizzes. One hundred and fifty six patients range from age 13-21 were included in this pilot study. Of patients aged 19-21, 69% have taken at least one pre-test and post-test for the medical education (63 total pre- and post-tests). Forty-three (78%) patients aged 16-18 have taken at least one pre-test and post-test (75 total pre- and post-tests). Thirty-three (67%) patients aged 13-15 have taken at least one pre-test and post-test (53 total pre- and post-tests). Results were categorized as score increased, score unchanged (pre-test score was not 100%), maintained 100% (unable to increase in score), and score decreased. In every age group, the category with the most results was “score increased.” Shown in Table 2.Conclusion: Further extrapolation suggests that the medical curriculum provided in clinic improves the sickle cell knowledge in this adolescent and young adult population. Though all age groups improved, the biggest improvement was noted in knowledge with our 13-15 year olds. These results suggest that early transition education can be impactful even if started at the early phases of adolescence. Studies are still ongoing with our medical curriculum and early psychosocial data is beginning to support our previous findings. As part of transition health care, focusing on disease education can provide better knowledge and hopefully improve patient outcomes. [Display omitted] DisclosuresClay: Novartis: Honoraria; GBT: Membership on an entity's Board of Directors or advisory committees.

Social and Emotional Development of Gifted Students: Introducing the School-Based Psychosocial Curriculum Model

This column introduces the school-based psychosocial curriculum model. The model incorporates Erik Erikson’s theory of psychosocial development and applies it to a planned program of talent development.

Supporting Social and Emotional Skills After a Disaster: Findings from a Mixed Methods Study

Disasters can affect a youth’s physical and emotional well-being. They disrupt everyday life by displacing individuals and families, destroying homes, and splintering communities (Gewirtz et al. in J Marital Fam Ther 34(2):177–192, 2008; La Greca and Silverman in Child Dev Perspect 3(1):4–10, 2009). School-based interventions are one approach to mitigate emotional distress in youth who have experienced a disaster, as schools are one of the most common venues for youth to receive mental health services (Greenberg et al. in Am Psychol 58:466–474, 2003). This paper explores the impact of a school-based psychosocial curriculum entitled Journey of Hope (JoH). This eight-session intervention attempts to reduce the impact of a disaster by enhancing protective factors such as social support, coping, and psycho-education. The evaluation study was conducted in the 2014–2015 school year after an EF5 tornado struck Moore, Oklahoma. As a result of the tornado, 24 people were killed, 377 injured, and two schools were destroyed (National Weather Service Weather Forecast Office, 2014). This mixed methods study employed quantitative and qualitative measures to examine the impact of the JoH intervention. Quantitative measures examined coping, general self-efficacy, prosocial behaviors, and overall distress. Qualitative data were obtained through interviews with N = 16 students after participation in the JoH. Semi-structured interview guides were used to determine what children learned, liked, and felt was beneficial from taking part in the JoH. A two-way repeated-measures ANOVA was used to assess the differences between the experimental and control group at baseline and posttest. Results indicated a significant increase in positive coping skills including communication and tension management and prosocial behaviors from baseline to posttest for the Journey of Hope group. No significant differences were found on self-efficacy or overall distress. Content analysis was conducted to determine qualitative results. Themes that emerged from the qualitative interviews suggested participation in the Journey of Hope enhanced peer relationships and helped participants identify how to manage emotions such as anger, anxiety, and grief. Findings from this evaluation study suggest that participation in a broadly accessible psycho-educational program may help children cope with traumatic events such as a natural disaster. Further research should be conducted to assess whether the Journey of Hope is transferrable across disaster contexts.

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.

Ignacio Matte Blanco, MD, and the development of psychiatry teaching to medical students

Ignacio Matte Blanco had an important role in organizing the teaching of Psychiatry in medical school. In this paper we describe his training, that began as a physiologist, but turned into psychiatric and psychoanalysis in his formation in the United States and the United Kingdom during the forties. After returning to Chile, in the Chair of Psychiatry at the Faculty of Medicine of the Universidad de Chile he developed pioneering ideas about undergraduate teaching of psychiatry, that were exposed not only in Chile but to the Pan-American Health Organization. He advocated decreasing the time spent in lectures, and increase clinical practice and group dynamic experiences centered in the students. He insisted that teaching had to be focused in issues useful for general physicians and non psychiatric specialists, as well as in the need to extend the psychosocial curriculum to the internship. He also pointed to the need of increasing the humanistic formation of medical students. When Matte Blanco emigrated to Rome in 1966, his influences seemed to wane, since most of his disciples inverted exclamation markeft the Clínica Psiquiátrica Universitaria, where he taught. However, since the eighties, several of his viewpoints have been included in the medical curricula of Chilean schools of medicine.

Docencia universitaria y psicoanálisis: Los aportes de Ignacio Matte Blanco

Ignacio Matte Blanco had an important role in organizing the teaching of Psychiatry in medical school. In this paper we describe his training, that began as a physiologist, but turned into psychiatric and psychoanalysis in his formation in the United States and the United Kingdom during the forties. After returning to Chile, in the Chair of Psychiatry at the Faculty of Medicine of the Universidad de Chile he developed pioneering ideas about undergraduate teaching of psychiatry, that were exposed not only in Chile but to the Pan-American Health Organization. He advocated decreasing the time spent in lectures, and increase clinical practice and group dynamic experiences centered in the students. He insisted that teaching had to be focused in issues useful for general physicians and non psychiatric specialists, as well as in the need to extend the psychosocial curriculum to the internship. He also pointed to the need of increasing the humanistic formation of medical students. When Matte Blanco emigrated to Rome in 1966, his influences seemed to wane, since most of his disciples inverted exclamation markeft the Clínica Psiquiátrica Universitaria, where he taught. However, since the eighties, several of his viewpoints have been included in the medical curricula of Chilean schools of medicine.

Psychosocial curriculum for a primary care residency.

Psychosocial curriculum for a primary care residency.

Training general practitioners in family systems medicine

Finnish general practitioners (GPs) spend increasing time on patients' psychosocial problems, yet undergraduate medical education and specialty training in general practice have an inadequate psychosocial curriculum. To remedy this, a 2-year family systems medicine continuing education course for GPs was developed at the University of Oulu, Finland. The goal was to enhance the trainee's skills in work with families. The first trainee group included 12 GPs. Four trained family therapists planned and organized the course, which consisted of family systems theory seminars and small-group activities, including role playing and case supervision. At the end of the course, the trainees estimated how their clinical practice had changed by using Doherty and Baird's model to assess their level of involvement with families. The GPs evaluated themselves as having increased their level of involvement from simply providing medical information and advice (level two) to providing emotional support for families (level three) and conducting systematic family assessments and planned interventions (level four) during the course. After the 2-year family systems medicine training the GPs believed their family-centered treatment skills had improved. It was decided to continue and to develop the program. Further studies were started to assertain whether such a training affects the behavior of trainees in their medical practices.

Faculty and Housestaff Priorities in Psychosocial Education: Results of a Questionnaire

The authors surveyed houseofficers in internal medicine and faculty members integrally involved in the psychosocial curriculum using a previously published questionnaire. Results indicated strong agreement in priorities between the two groups (correlation coefficient—0.85). Items identifying broad conceptual skills and those related to practical application were similarly integrated. These data tend to support the concept of providing both levels of knowledge in a training program to allow more comprehensive teaching in psychosocial areas.

501 CONTINUITY IN A PRIMARY CARE RESIDENCY

New Federal Regulations now require at least 25% continuity experience for housestaff participating in new federally supported 3 year Primary Care (PC) Training programs. A PC residency was established in 1973 at BCH to educate principally for inner city needs. Four cohorts of trainees (n=40) have entered training and one cohort (n=6) has completed training. The program is characterized by a psychosocial curriculum, integration of pediatric and internal medicine pathways, multidisciplinary faculty, and the use of multiple ambulatory sites. Continuity occupies 10% of year 1, either in hospital or neighborhood health center. Continuity increases to 20% for 1/2 of year 2 and is followed by a 6 month period of 30%. During year 3, 40% time is spent in continuity clinic following patients longitudinally as well as in selected specialty clinics. During continuity, residents provide care to an identified panel of families. Total continuity for the three year program is 26% meeting the federal requirement. A modified pairing system has been established to free housestaff for expanded educational and clinical experiences Small structural changes in scheduling without major change in the number of housestaff allowed the added continuity experiences These changes included giving up elective time during years 2 and 3 to meet both service and educational requirements. Continuity is an important feature of PC Training and achieving a 25% goal requires multiple strategies.