LEND Training in a Developmental-Behavioral Advanced Practice Nursing Fellowship:

Increasing Access to Evaluation and Follow Up

Kelly Keefe-Marcoux, MSN, APN, CPNP-AC1, Corey Sherlock, MSN, APN, CPNP-PC/AC1, Shayleigh Dickson, MSN, APN, CPNP-AC1, Caroline Coffield, PhD2, Deborah Spitalnik, PhD2

1 Children’s Specialized Hospital 2Rutgers Robert Wood Johnson Medical School, The Boggs Center on Developmental Disorders

One in six children ages 3 through 17 years old in the United States has one or
more developmental disabilities (CDC, 2015).
There has been a 15% increase in national prevalence of Autism Spectrum
Disorder (ASD) from previous estimates, with a national rate of 1 in 59 children
(CDC, 2018). New Jersey has the highest rate of ASD in the United States with
1 in 34 children.
Timeliness of diagnosis and subsequent treatment is correlated with positive
outcomes, however national wait time for initial evaluation is 5.4 months
(Jimenez, et al. 2017).
Developmental Behavioral Pediatrics (DBP) is facing a workforce shortage of
physician providers (Bridgemohan et al., 2018).
This poster describes how Children’s Specialized Hospital DBP-Advanced
Practice Nurse (APN) Fellowship and NJLEND collaborated to prepare APNs
with the expertise to identify and diagnose ASD and other disabilities and to
continue to care for patients and their families once a diagnosis has been
made.
Children’s Specialized Hospital (CSH) established an APN Fellowship program
in 2016,
•  To prepare the APN for specialized practice in Developmental-Behavioral
Pediatrics.
•  To increase the number of trained professionals, addressing the wait time for
initial evaluation and establishment of specialty care
The APN fellowship was implemented as an intensive 12 month program The APN Fellowship in DBP was successfully implemented as a
integrated with the Accreditation Council for Graduate Medical Education 12 month program. The partnership between NJLEND with the
(ACGME) DBP fellowship at the host organization. DBP-APN fellowship at CSH has allowed for a parallel
opportunity to learn about and work with diverse children and
Experienced MD & APN providers were chosen as mentors. Fellowship families.
director at CSH coordinated with LEND fellowship to enhance didactic
training. The APN Fellows that have completed the program have been
deemed as clinically competent, with increased specialty
The first six months focused on knowledge & clinical skill building. The knowledge and easier transition to full time practice.
second six months focused on development of clinical competence.
Training of APNs in development and behavior is an innovative
Weekly participation in NJLEND program supplemented clinical approach to address the increased demand for evaluation and
knowledge, with didactic, interdisciplinary lectures, mentorship by LEND treatment, the need for equitable access and address workforce
mentor-family, observational experiences and participation in Disability shortages. NJLEND acts as a central didactic component of the
Policy seminar. fellowship, allowing interdisciplinary discussion, exposure to
family perspective and mentorship and education on policy/
The fellow was a full time employee eligible for full salary, benefits, and advocacy.
medical staff privileges.
The leadership skills and Maternal and Child Health Bureau
(MCH) competencies developed through LEND training further
support this innovative role for APNs.
Didactic Clinical Professional
Development With increased training and support within a clinical fellowship
(4-8 hours/week) (32-36 hours/week) as well as the supplemental experiences provided by NJLEND,
•  NJLEND Fellowship •  Direct patient care
•  APN Mentor
•  Lecture covering ACGME •  Collaboration APN-DBP fellows are able to practice to full extent of their
•  Formal training on DBP
required content screening and diagnostic •  Research licensure and have training more comparable to physician-
•  Pediatric Grand Rounds tools •  Advocacy and Public Policy
•  KYSS mental health awareness counterparts than non-fellowship trained APNs, with unique
•  Interdisciplinary
fellowship through Ohio observational experiences perspective on family-centered care.
State University (e.g. ADOS, Early
•  DBP Board Review Course Intervention, ST, PT, OT, ABA
therapy, feeding team)

The Boggs Center’s NJ Leadership Education in Neurodevelopmental and

Related Disabilities program (NJLEND) was also established in 2016 with goals
to
•  Increase awareness of ASD
•  Reduce barriers to screening and diagnosis
•  Allow for practice of interdisciplinary communication
•  Encourage learning, understanding and navigation through system-level
issues impacting care of children and families served
•  Provide a family perspective, with mentorship by a LEND-mentor family
With shared missions, NJLEND participation was incorporated into the CSH
fellowship program, becoming a central component of didactic and clinical
training.
After completion of the 12-month fellowship program, both former APN
fellows began full-time employment within the DBP section of CSH.
Both APN fellows currently work in Newark Ambulatory Care Center,
serving a diverse and economically disadvantaged population.
APNs now provide initial developmental evaluations, diagnostic
appointments and provide on-going care for children with autism and
other disabilities.
APN Fellows transitioned to a full patient schedule within two months,
compared to new staff which typically takes six months.
REFERENCES
1.  Centers for Disease Control and Prevention and National Center on Birth Defects and Developmental Disabilities. 2015.
Developmental disabilities.
2.  Baio J, Wiggins L, Christensen DL, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism
and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ 2018;67(No. SS-6):
1–23. DOI: http://dx.doi.org/10.15585/mmwr.ss6706a1External
3.  Jimenez, et al. “Access to Developmental Pediatrics Evaluations for At-Risk Children.” Journal of Developmental & Behavioral
Pediatrics, 38 (3), Apr. 2017. doi:10.1097/DBP.0000000000000427.
4.  Children’s Hospital Association (August 2012)/ Pediatric specialist physician shortages affect access to care. Retrieved from
https://www.childrenshospitals.org/issues-and-advocacy/graduate-medical-education/fact-sheets/2012/pediatric-specialist-
physician-shortages-affect-access-to-care
5.  Bridgemohan, C, et al. (2018). A Workforce Survey on Developmental-Behavioral Pediatrics. Pediatrics. 141 (3).