A model for training pediatricians to expand mental health services in the community practice setting.

A model of training pediatricians in mental health diagnosis and intervention was developed to increase the pediatrician's competency in dealing with the increasing number of children with these problems. The model consisted of a pediatric psychiatrist working in collaboration with community pediatricians and training pediatricians in mental health interview and evaluation techniques, recognition and diagnosis of behavioral and mental disorders, and intervention and treatment. Following implementation of this model, the community pediatricians demonstrated an increase in mental health diagnoses in their practices. This model represents one approach in preparing pediatricians to respond to the increasing number of children with mental health and behavioral problems.

Psychosocial care of severely malnourished children. A hospital in Haiti has greatly improved the prospects for the children it treats.

The psychosocial intervention program for malnourished children at Hôpital Albert Schweitzer has evolved over several years and now consists of daily interventions including music on the unit, cooking and feeding instruction, exercise sessions, supervised play sessions, daily massage of children by their parents, toy making, and singing and dancing. The interventions are supervised by Haitian personnel and have been developed according to what is interesting and stimulating for Haitian parents and their children. These interventions appear to have greatly improved the moods of the parents and their children. They seem happier. There is more interaction between the parents and the children throughout the day, including touching, playing, and talking. The feeding situation has improved. Parents feed their children; there is more socializing and eye contact during meals. Our experience supports the concept that the rehabilitation of the malnourished child is facilitated by interventions that restore a positive parent-child relationship. These interventions should be tailored to the local culture. Future studies could evaluate the effect of such interventions on the parent-child interaction at the beginning and end of the hospitalization, as well as on parameters such as mortality, rate of weight gain, length of stay, and readmission rates.