“Building” the Twenty-First Century Child and Adolescent Psychiatrist

Abstract

About 20% of children in the United States (US) have a diagnosed mental health disorder; half of them did not receive treatment from a mental health professional pre-pandemic [1]. The COVID-19 pandemic has exacerbated pre-existing mental health burden and healthcare disparities [2]. Improving pediatric mental health outcomes positively impacts educational and judicial systems, family functioning, and future employment, and decreases caregiving costs [3]. But access to care has been partly limited by the workforce shortage in child and adolescent psychiatry (CAP). We describe some possible solutions to this workforce shortage including introducing innovative shortened training pathways and tapping global trends in CAP training that efficiently address population needs.About 8300 physicians practice CAP in the US [4]; their distribution is skewed. Massachusetts has as many child and adolescent psychiatrists as Oklahoma, Indiana, Georgia, Mississippi, and Tennessee combined, though 5 times as

Child and Adolescent Psychiatry: New Concepts and New Strategies for the Future

“…This last essay by Agrawal [24] and all of the other papers in this special collection [1,[8][9][10][11][12][13][14][15][16][17][18][20][21][22][23] remind us that child and adolescent psychiatry training is not just of interest to child and adolescent psychiatrists. All psychiatrists, physicians, and most other professionals serve in roles that influence, whether directly or indirectly, the mental health of young people and adults who have had chronic conditions that began in youth.…”

“…As summarized by Shaligram et al [14], there have been various training pathway alternatives proposed in the USA to support workforce building. Some of these pathways involve early commitment (e.g., the so-called Child Track in the Match) and/or shortened training, including 3-year child and adolescent psychiatry training only or a 4-year combined general and child and adolescent psychiatry training model, while others have focused on broadened recruitment from other primary specialties, such as the 3-year post-family medicine fellowship model.…”

“…Taking an international perspective, Shaligram et al [14] discussed curricular aspects that may differ in child and adolescent psychiatry training across various countries. These included the duration of training, the balance of inpatient versus community experience, assessment, examination, and certification processes, the degree of focus on neurodevelopmental disorders, academic/research opportunities, psychotherapy experiences, experiences with transitional age youth, and infant and perinatal psychiatry experiences.…”

Advances in Child Psychiatry Education and Training

“…Trainees need to be aware of culturally informed child-rearing practices, behavior expectations, communication patterns, and acceptable coping skills to avoid diagnostic pitfalls and foster engagement. Adjunctive training in public health analysis, advocacy skills, and collaborative approaches with individuals with lived experience, parents, and caregivers are needed to disrupt systemic/structural barriers and create patient-friendly care systems [ 31 ].…”

“…Another broadening recruitment from other primary specialties (eg, 3-year postfamily medicine fellowship model). Some of these models are based on the triple board training experience, where general (18 months) and child and adolescent (18 months) psychiatry training is completed in a 3-year period [ 31 ].…”