TABLE 3

Suggestions for Advancing Pediatric Training in B/MH

Topic 1: establishing curricula, goals, experience, and assessment
 Critical curricular components
  Prevention of B/MH problems, including fostering child and family resiliency and strength-based approaches
  Screening and early identification of B/MH problems by using functional assessment tools, including 2 generational family history, prenatal risks, and adverse childhood experiences
  Socioemotional and MH “review of systems” incorporated into all health supervision visits
  Recognition and understanding of social determinants of health and ACEs
  Recognition and understanding of the importance of B/MH in physical health outcomes
  Evidence-based skills training, including motivational interviewing
  Cultural and linguistic competency training
  Competence in psychopharmacology
  Experiences with nonpediatrician MH providers, including psychologists, child psychiatrists, and social workers
  Community experiences
 Curricular approaches
  Integrate B/MH competency goals and assessment across the entire training curriculum; primary as well as subspecialty care
  Create a system for true continuity of patient contact with resident as primary contact for patients, which might include a year-long continuity experience, exclusive of other clinical responsibilities
  Institute home visits
  Include parents and patients in development of curriculum
  Institute general pediatrician-led B/MH clinics
  Institute regular mentoring by MH specialists
  Incorporate self-reflection and/or Balint groupsa to promote resident resilience
  Develop simulated experiences, including use of technology to simulate patient and family encounters
  Incorporate telehealth to access MH care of trainee patients
  Include use of social media in addressing B/MH needs
 Assessment methods
  Use case logs of screenings performed by trainees
  Include direct observation, including by nonpediatrician faculty (social workers, psychologists, psychiatrists, or nurses) and parents in trainee assessment
  Develop 360-degree assessment of video-recorded clinical encounters, some done by nonexperts with simple training
  Include assessment of simulated patient encounters
  Develop PALS-like certification course on interviewing skills
  Create assessment tools based on curricular elements of EPA 9
  Enhance B/MH content specifications and certifying examination questions
Topic 2: enhancing faculty engagement and development
 Faculty engagement
  Identify a faculty champion, preferably the department chair or other department leader, who would promote a sense of urgency and passion for promoting B/MH care
  Develop a departmental policy or statement of goals to enhance a culture for improving B/MH training and care, including developing a scorecard to ensure accountability
  Identify or assign a faculty member, possibly as associate program director, with responsibility for integrating B/MH curriculum and assessment throughout training
  Identify family voices to inform and motivate
  Solicit and review feedback from parents and adolescent patients related to B/MH care
  Create a safe environment for faculty development with feedback and opportunities for improvement
  Develop quality improvement projects, including part 4 MOC credit, related to B/MH care
  Incentivize interprofessional teaching activities and faculty attendance at meetings and conferences at which B/MH training and care is discussed
  Encourage influential non-B/MH faculty members who develop B/MH approaches to model their newly developed skills
  Identify opportunities for faculty members to discuss their own family struggles with MH and patient care incidents related to B/MH
 Faculty development
  Perform a faculty needs assessment: identify needed knowledge and skills
  Identify community resources for involving faculty and residents in B/MH care
  Take advantage of national resources for faculty development, for example:
   National Network of Child Psychiatry Access Programs (http://www.nncpap.org/)
   The REACH Institute (http://www.thereachinstitute.org/)
   LEND, Maternal and Child Health Bureau, Health Resources and Services Administration (https://mchb.hrsa.gov/training/projects.asp?program=9)
   AAP MH resources (www.aap.org/mentalhealth)
  Integrate developmental/behavioral faculty member(s) and/or MH professional(s) into clinics, daily rounds, grand rounds and conference schedules
  Encourage participation in networking opportunities to learn about successful models for interprofessional training
  • ACE, adverse childhood experience; LEND, Leadership Education in Neurodevelopmental Disabilities; MOC, Maintenance of Certification; PALS, pediatric advanced life support; REACH, Resource for Advancing Children’s Health.

  • a Balint groups: a group of clinicians who meet regularly to present clinical cases to improve and better understand the clinician-patient relationship. It focuses on enhancing the clinician’s ability to connect with and care for the patient sustainably.