Intimate partner violence screening protocols in the pediatric emergency department should take into consideration the beliefs and attitudes of both those doing the screening and those being screened. Those developing screening protocols for a pediatric emergency department should consider the following: (1) that those assigned to screen must demonstrate empathy, warmth, and a helping attitude; (2) the importance of addressing the child's medical needs first, and a screening process that is minimally disruptive to the emergency department; (3) a defined, organized approach to assessing danger to the child, and how and when it is appropriate to notify child protective services when a caregiver screens positive for intimate partner violence; and (4) that resources must be available immediately to a victim who requests them.

Objective. To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design. Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment. Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion. Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients.Keywords: simulation, standardized patients, interprofessional teams, communication INTRODUCTIONGraduates from health professional schools are expected to have competencies well beyond knowledge of drugs and diseases. A 2003 Institute of Medicine (IOM) report highlighted the need for health professional students to be educated to deliver patient-centered care, employ evidence-based practice, apply quality improvements, use informatics and practice in interdisciplinary teams as a way to improve patient safety.1 The 2007 Accreditation Council for Pharmacy Education (APCE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy aligned the IOM report recommendations in terms of changes for pharmacy education. Specifically, the ACPE Standards state that graduates must be competent to deliver patient-centered care and to communicate and collaborate with patients, their caregivers, physicians, nurses, and other health care providers. Additionally, the Standards highlight the importance of students developing critical-thinking and problem-solving skills.The Pharmaceutical Care section of the 2007 Center for the Advancement of Pharmaceutical Education (CAPE) Guidelines includes educational outcomes related to communication with patients, caregivers, and other health professionals. Specifically, the CAPE Guidelines state that students should develop competency in fostering collaborative relationships that embodies teambased care, demonstrates a caring and respectful attitude, and communicates information in a way that patients and healthcare professionals understand in order to communicate ''clearly, accurately, compassionately, confidently, and persuasively. '' 3 The ACPE Standards encourage working with actual or simulated patients and health care professionals whenever possible during the ins...

Students with emotional and behavioral disorders (E/BD) often receive educational services delivered in more restrictive settings. Positive behavioral interventions and supports (PBIS) is a framework that may address the complex needs of these students in these restrictive settings. This article describes the training and technical support provided to a residential school serving students with E/BD as they implemented school-wide PBIS (SWPBIS) over several years and when the external support was removed, follow-up focus groups of school staff were conducted. Results across three 6-month periods indicate a reduction in the number of discipline referrals and high levels of fidelity of implementation of SWPBIS when external support was provided. When the external supports were

BACKGROUND AND OBJECTIVES: Graduate medical education faces challenges as programs transition to the next accreditation system. Evidence supports the effectiveness of simulation for training and assessment. This study aims to describe the current use of simulation and barriers to its implementation in pediatric emergency medicine (PEM) fellowship programs.METHODS: A survey was developed by consensus methods and distributed to PEM program directors via an anonymous online survey.RESULTS: Sixty-nine (95%) fellowship programs responded. Simulation-based training is provided by 97% of PEM fellowship programs; the remainder plan to within 2 years. Thirty-seven percent incorporate .20 simulation hours per year. Barriers include the following: lack of faculty time (49%) and faculty simulation experience (39%); limited support for learner attendance (35%); and lack of established curricula (32%). Of those with written simulation curricula, most focus on resuscitation (71%), procedures (63%), and teamwork/communication (38%). Thirty-seven percent use simulation to evaluate procedural competency and resuscitation management. PEM fellows use simulation to teach (77%) and have conducted simulation-based research (33%). Thirty percent participate in a fellows' "boot camp"; however, finances (27%) and availability (15%) limit attendance. Programs receive simulation funding from hospitals (47%), academic institutions (22%), and PEM revenue (17%), with 22% reporting no direct simulation funding.CONCLUSIONS: PEM fellowships have rapidly integrated simulation into their curricula over the past 5 years. Current limitations primarily involve faculty and funding, with equipment and dedicated space less significant than previously reported. Shared curricula and assessment tools, increased faculty and financial support, and regionalization could ameliorate barriers to incorporating simulation into PEM fellowships.WHAT'S KNOWN ON THIS SUBJECT: Simulationbased education is increasing but its use in pediatric emergency medicine (PEM) fellowships has not been recently documented. Previous studies identified barriers including equipment and space, but growth of simulation centers and equipment has been widespread. WHAT THIS STUDY ADDS:Simulation is widely used in PEM fellowships, and current barriers include faculty and learner time, implementation of best practices in simulation; equipment is less significant. Future work should focus on curriculum and evaluation development, aligning with the milestones.

To more effectively instruct the entire class, teachers of students with emotional behavioral disorders (EBD) often choose to send students who display inappropriate behavior out of the room. A multiple baseline across settings was used to evaluate the effects of increasing teacher positive verbal reinforcement on the amount of time 2 students with EBD in a residential setting were spending outside of the classroom for separations or in-school suspension referrals. Results suggest that increasing positive verbal reinforcement decreased the amount of time students spent outside the classroom. Implications and future directions are provided.