LEAH - Leadership Education in Adolescent Health


Organization Diagram of Adolescent Medicine and Leadership Education in Adolescent Health Training Program (LEAH)


The following competencies and learning objectives are common to all interdisciplinary trainees.  They reflect the clinical, administrative, research and public health requirements for leaders to meet the needs of youth and are based on the Healthy People 2010 National Health Promotion and Disease Prevention Objectives.  (See the table at the end of the narrative that identifies the Healthy People Objectives targeted by each of the LEAH objectives/activities.)  The learning objectives for each trainee level according to clinical, technical/teaching, and research areas are presented.  The methods by which these objectives will be achieved are described in the next sections.  The LEAH program is funded by a grant from the Maternal Child Health Bureau under Title V. (http://mchb.hrsa.gov/training/projects.asp)

1.  CLINICAL -- using science to guide interdisciplinary diagnosis, management and prevention the competent graduate will:
a)  understand normal and abnormal growth and development (biologic, psychosocial,  family and environment) and the factors that support or impede optimal adaptation so that each trainee will recognize deviations if present, be able to develop interdisciplinary care plans, and effect treatment consonant with the primary discipline.
b)  understand and apply the principles of Positive Youth Development.
c)  use Bright Futures as the framework for delivering preventive services. 
d)  understand major causes and effects of, and acceptable prevention/intervention strategies for the health and psychosocial morbidities affecting youth, recognize morbidity if present and identify and initiate intervention appropriate to primary discipline.
e)  provide culturally competent, family-centered, interdisciplinary care (1) appreciate diversity and similarities in customs, values, beliefs and communication patterns; (2) understand and effectively respond to cultural differences; (3) engage in cultural self-assessment at the individual and organizational levels; (4) make adaptations to the delivery of services and enabling supports through policy, infrastructure building, program administration; (5) insitutionalize cultural knowledge and practices; (6) communication effectively with persons of limited English proficiency, reading and comprehension skills. 
f)  demonstrate problem-solving skills with youth and parents as reflected by: (l) the ability to initiate and maintain a therapeutic relationship consistent with the primary discipline, needs of the adolescent and family and the goals of the encounter; (2) knowledge of and ability to implement briefer therapies including strategies to strengthen self-confidence of adolescents to become successful, exercise responsible reproductive health behavior, and achieve gender-specific empowerment to become productive citizens; (3) the ability to recognize need for referral for more complex problems and to effectively complete the referral.
g)  interact therapeutically with adolescents from different racial, cultural, and socioeconomic groups and different family structures and lifestyles (single parent, divorced, gay/lesbian, abusive/neglectful and others) as demonstrated by: (1) recognizing the diverse factors that influence health; (2) identifying the sociocultural, familial, psychological, economic, environmental, legal, political and spiritual factors impacting health, health care and health care delivery; (3) responding to these factors by planning and advocating the appropriate course of culturally-competent action at individual and community levels.
h)  understand the issues involved in adolescents with chronic impairments and their families particularly as they relate to adaptation around transitional periods.
i)  be skillful in the care of hospitalized adolescents.
j)  understand public health functions and issues related to adolescents and their families.
2.  EFFECTIVE COMMUNICATION -- the competent graduate will be effective in oral and written communication with adolescents, and their families, interdisciplinary team members, professional and lay audiences, and community agencies as demonstrated by:
a)  attitudes that foster and support development of therapeutic relationships with adolescents and their families;
b)  knowledge of and skills in interviewing;
c)  active participation in interdisciplinary care meetings and clinics;
d)  the ability to lead small group discussions, teach and make educational and scientific presentations using state-of-the-art audiovisual materials;
e) preparation of formal critique of manuscripts submitted for publication using word processing and personal computer;
f) submission of a manuscript for publication in a peer reviewed journal. 
3.  TECHNICAL ASSISTANCE AND CONSULTATION -- the competent graduate will:
a)  be familiar with Healthy People 2010 as it relates to public health, especially as it relates to adolescents.
b)  have knowledge of and experience in public health, health systems, health planning, policy and administration, and consultation across disciplinesas demonstrated by satisfactory completion of seminars and field experiences. 
c)  participate with a core faculty member in a consultation to a Title V agency and prepare a written critique of the experience to include identification of the key issues involved and the specific strengths and weaknesses demonstrated by faculty member. 
d)  demonstrate a working understanding of the principles of advocacy and policy development.

4.  INTERDISCIPLINARY ADOLESCENT RESEARCH -- the competent graduate will:
a)  demonstrate a working knowledge of the principles of qualitative and quantitative research methods as demonstrated by conducting a journal club review in the critical analysis of a published research article.
b)   prepare a small grant application for presentation to LEAH faculty and trainees.
c)   develop and complete a research project, present to faculty and trainees, prepare and submit manuscript for publication.
d)  demonstrate an understanding of the principles of ethical research with human subjects through completion of the Indiana University course in research with human subjects and acceptance of their research proposal by the IUPUI Institutional Review Board for the Protection of Human Subjects
5.  LEADERSHIP  -- the competent graduate will:
a)  develop a shared vision with colleagues and direct attention to these shared goals;
b)  communicate a sense of purpose or meaning in long-range vision and department goals;
c)   foster collaboration and cooperation;
d)  empower and honor others; value diverse perspectives and talent;
e)  establish trust through behavior which is consistent with values and beliefs;
f)  actively set and pursue clear learning goals, exploit new opportunities for intellectual and professional growth in a manner so that behavior is consistent with beliefs.
g)  remain in an interdisciplinary position at least 5 years post-graduation.

(integrated with CITE Program Courses)

This year-long core course provides the knowledge base for adolescent growth and development; physical and social morbidities affecting youth; community youth-serving agencies; communication/problem-solving strategies; and introduction to health planning and policy. Topic areas include:  
a.         Family-centered, community-based, coordinated interdisciplinary care based on Bright Futures guidelines. 
b.         Growth and Development
c.         Nutrition in health and illness
d.         Changing Nature of Physical, Social and Psychologic Morbidities of Youth ?? Developmental Perspective of Risk
e.         Communicating with Adolescents and Their Parents; Interviewing and Problem Solving; Crisis Intervention; Briefer Treatments
f.          Using Community Resources
g.         Health Planning/Policy/Public Health/Title V

  1. Cultural competency
  2. Positive Youth Development – helping adolescents build on their assets and their potential and counter the problems that may affect them.

These field experience clinics will permit trainees to apply newly acquired knowledge and practice the interdisciplinary care of adolescents and their families.  Trainees are assigned to specific clinics based on their level, academic schedule and educational skills.  Community?based clinics include: six primary Adolescent and five Adolescent Parent Child Clinics, three school-based clinics.  University?based clinics include: Riley Adolescent Consultation Clinic, the Wishard Primary Care Adolescent Clinics, the Methodist Hospital Adolescent Clinics, Adolescent Young Women’s, School-based clinic, Sports Medicine Clinic, Eating Disorders Clinic

3.  JOURNAL CLUB -- is a biweekly critical analysis of a published manuscript.  Level I trainees, with the help of a core faculty member, select the articles and lead the discussion.   Critical thinking, research methods, data analysis, writing skills and clinical relevance of the research findings are stressed.  Faculty provide feedback to the presenter at a later time

4.  WORK-IN-PROGRESS – is a bi-weekly seminar in which faculty and Level I trainees present their current research project beginning with concept and progressing to presentation of findings at scientific meetings.  Group discussion of the methods, theory and presentation (including audio-visual) facilitate acquisition of skill in communication and research. 

5.  ADOLESCENT INPATIENT AND CONSULTATION SERVICEfosters attainment of competency in interdisciplinary care of hospitalized adolescents and cross?disciplinary consultation and effective communication with primary medical services, patient, family and staff.

6.  SEMINAR IN LEADERSHIP DEVELOPMENT is designed to teach long-term trainees how to be leaders.  It consists of a set of core modules presented in seminars and workshops throughout the academic year.  Topics include: personality style differences; habits of effective people; time management; negotiation skills and conflict management; meeting management and group behaviors; understanding/diagnosing organizations; leadership development; managing professional people; financial management/budgeting; and understanding and managing change. 

7.  OUTCOMES ASSESSMENT  is a seminar taught on the principles of outcomes research in clinical practice.  It includes extensive discussion and reading on assessing quality of life measures in maternal and child health. 

8.  ADOLESCENT MEDICINE REVIEW  is a biweekly discussion of the topics identified by the American Board of Pediatrics in their blueprint for the subspeciality certifying examination in Adolescent Medicine.  Participants include physician fellows, residents on adolescent rotation and core physician faculty.  Fellows take responsibility for leading the discussion of the topics and selection of the required reading. 

The following courses are taught as part of the CITE program (masters of science in clinical research) offered by the Indiana University Graduate School.  This two- to three year series (34 hours) will assure that fellows are well prepared for leadership positions in clinical research.

A.  PRINCIPLES OF PRIMARY CARE RESEARCH AND EDUCATION presents an overview of clinical research conducted in primary care and preventative health.  Ethical issues of research with human subjects, scientific misconduct and data archival are discussed by a health ethicist.  An interdisciplinary group of established investigators from nursing, dietetics, social work, law, education, psychology and medicine present current research in their topical areas. 

B.  MICROCOMPUTERS IN RESEARCH AND TEACHING prepares the trainees to work in a computer literate world.  Didactic and applied sessions deal with micro computing and mainframe environments, work processing, literature searching, spreadsheets, database development, statistical software (SAS), graphics and the Regenstrief Medical Record System. 

C.  BIOSTATISTICS covers probability, SAS, populations, descriptive and inferential statistical methods including linear and multiple regression, logistic regression, and analysis of variance and covariance.  The principles of research study design cover randomization, Latin square, and crossover techniques. 

D.  CLINICAL AND CLASSICAL EPIDEMIOLOGY presents current information on health epidemiology.  Included are study design, bias, case reports, case-control, cohorts, clinical trials and meta-analysis. 

E.  MEASUREMENT covers the principles of measurement in health research.  Topics include instrument development, reliability, validity, survey design, sampling and implementation, and data analysis and interpretation. 

F.  HEALTH CARE ADMINISTRATION covers principles of health planning, financing, managed care, management, and service delivery. 

G.  GRANTS AND EXTERNAL FUNDING IN CLINICAL AND HEALTH SERVICES RESEARCH (teaches the trainee how to write a grant including locating funding sources, preparation of budgets, writing the research plan and the peer review process.  Each student prepares a grant application of their research project as if they were submitting if for funding.  The grant application is reviewed by the trainee's faculty advisor and mentor. 

H.  CLINICAL RESEARCH is the mentored research project performed by the fellow.  The results are prepared for submission to a scientific journal and serve as evidence of completion the of the scholarship requirement of the ABP.