LEND Fellowship Childrens Seashore House of The Childrens Hospital of Philadelphia The University of

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LEND FellowshipChildrens Seashore House
of The Childrens Hospital of PhiladelphiaThe
University of Pennsylvania
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The Hospital

• The Childrens Hospital of Philadelphia
• Nations first pediatric hospital (1855)
• 375 bed tertiary care referral center
• Primary teaching hospital for UPENN School of
  Medicine
• Childrens Seashore House
• Nations first hospital for children with NDD or
  SHCN (1872)
• 40 inpatient beds
• 25,000 outpatient visits per year
• Merger 1998

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The Physical Therapy Department

• 20 PTs, 3 PTAs, 2 supervisors, 1 PT manager, 1
  aide, 2 clerical staff
• 8 PTs at outpatient satellite clinics in PA and
  NJ 3 PTs at Sports Medicine Clinic
• 4 PTs at early intervention program
• Approx. 15 PTs and PTAs in weekend/per diem pool.

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PT department student program

• Active affiliating student program for PTs and
  PTAs
• 10-12 full time students per year from 15
  academic institutions
• 11 model typically followed
• 1-2 LEND fellows/year

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LEND Mission

• to support the development of exemplary clinical
  expertise, skills and competence in the care of
  children with neurodevelopmental and related
  disorders and to instill the qualities that
  promote interpersonal leadership in the service
  of improving the quality of life and outcomes for
  these children and their families

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LEND Mission

• Leadership Training
• To prepare the next generations leaders in the
  field of neurodevelopmental and related
  disabilities
• Scholarship
• Define best practices
• Partnership
• Provide consultation, continuing education, and
  technical assistance to community-based programs
• Identify needs at the level of systems of care

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LEND Leadership Training Core Disciplines
mandated by MCHB

• Audiology
• Dentistry
• Health Care Administration
• Nursing
• Nutrition
• Occupational Therapy
• Pediatrics
• Physical Therapy
• Psychology
• Public Health Social Work
• Speech Pathology

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LEND Training Objectives

• Achievement of a broad understanding of clinical
  issues relevant to providing services to children
  with neurodevelopmental and related disorders

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LEND Training Objectives, continued

• Achievement of the knowledge, skills, and
  attitudes needed to support an interdisciplinary
  team process

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LEND Training Objectives, continued

• Achievement of the knowledge, skills, and
  attitudes needed to foster family-centered,
  coordinated, community-based and culturally
  sensitive service delivery and consultation

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LEND Training Objectives, continued

• Ability to assess and critically evaluate
  research literature pertaining to child
  development, health and disease/disability, and
  the ability to contribute to this body of
  knowledge

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LEND Training Objectives, continued

• Increased knowledge of current regulations,
  entitlements, court decisions, and controversies
  that impact children with neurodevelopmental and
  related disabilities

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PT Fellowship

• Post-degree, entry-level training program,
  requiring licensure
• 12 month fellowship, July 1-June 30
• Competitive application process for
• 1 or 2 openings

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Selection of Fellows

• Comprehensive application including submission of
  scientific work, transcripts, letters of
  reference, interviews
• Looking from candidates with demonstrated
  interest in working with children with NDD and
  their families

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Training Program

• Didactic
• LEND core curriculum and activities
• Department in-services
• Clinical Mentoring
• Direct patient care on 1 or 2 rotations
• Multidisciplinary clinic assignment
• Mentored research project

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LEND Core Curriculum

• 12 courses, including
• Family-Professional Collaboration
• Cultural diversity
• Health, Educational and Family Policy and Laws
• Conducting research
• Multidisciplinary
• Lectures and Problem-based learning

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Community Experiences

• Visits to community-based programs
• EI, School-based
• Community presentations
• Caring Student Helpers
• Community service
• Homeless Initiative
• Transition to Adulthood Program

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Family-Professional Collaboration

• Family Resource Center
• Family Advisory Council
• Youth Advisory Council
• Family Mentorship
• Sibling Workshops
• Evenstar Bereavement Program

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Clinical Practica

• 21 training opportunities with clinical faculty,
  such as
• Augmentative and Alternative Communication
  Program Cochlear Implant Program
• Cerebral Palsy Program
• Center for Childrens Policy, Practice and
  Research at UPenn
• Clinical Nutrition Program
• Early Intervention Program ATCO
• Neonatal Follow-up Clinic
• Pediatric Rheumatology Service
• Special Immunology Program

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Research Leadership Project

• Core curriculum course on research
• Multidisciplinary advisory committee
• Interdisciplinary projects encouraged
• Project can be new or can continue ongoing
  research within department
• Dissemination via poster, platform, or
  publication required

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PT Research Projects

• Business plan for new aquatic program
• Adding the Gross Motor Classification of CP to CP
  clinic patient assessments
• Transition of children s/p TBI from rehab to
  school
• Training team to write IEP objectives
• Integrating children with disabilities into
  Sunday school classes

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Clinical Mentoring

• Assignment to clinical rotation
• Mentored by supervisor and/or senior staff
• Expected to achieve clinical competencies at
  basic level for rotation by end of year
• Productivity expected at 45
• (75 of fulltime staff requirement)

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Clinical Mentoring

• Assigned to multidisciplinary clinic
• Cerebral Palsy Program
• Adaptive Equipment Clinic
• Spina Bifida Program
• Cystic Fibrosis Clinic
• Myopathy Clinic
• Mentored by senior PT on clinic team

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Assessment

• Individualized Training Plan (ITP)
• Portfolio
• Clinical Competency Assessment
• Presentation of Research

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Financial Support of Fellow

• MCHB grant stipend
• Trainee position within department with partial
  salary support
• Benefit package including healthcare, paid time
  off, and conference attendance through MCHB grant

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Financial Support of Training

• Salary support of LEND faculty through MCHB grant
• Trainee provides billable clinical care

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Unique Advantages for the PT Fellow

• Salaried training year with benefits
• Multidisciplinary interactions at all levels.
  Networking not only with other fellows, but with
  administration and senior clinicians in other
  disciplines
• Integral role of family faculty
• Emphasis on multifaceted role of clinicians in
  care of children with NDD

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The down side

• Low salary
• No guarantee of employment at end of training
  year
• Long hours AND homework

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Advantages for PT department

• Fellows cost less than full time staff
• LEND training superior to discipline-specific
  clinical mentoring
• No obligation to continue employment at end of
  training year
• Trainee recruitment costs less than staff
  recruitment, and
• Attracts candidates from greater geographic area

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Disadvantages

• Fellows provide less patient care and need
  protected time away from clinic
• Fellows take mentoring resources away from other
  staff and students
• Selected PT staff need to attend regular LEND
  faculty and committee meetings

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Where are they now?

• PT staff within the Childrens Hospital
  Healthcare Network
• PT staff in other facilities
• Researchers at other medical centers