The Current and Ideal State of Mental Health Training: Pediatric Program Director Perspectives

Green, Cori; Hampton, Elisa; Ward, Mary J.; Shao, Huibo; Bostwick, Susan

doi:10.1016/j.acap.2014.05.011

Cited by 32 publications

(34 citation statements)

References 28 publications

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“…15,26 However, more than half of pediatric program directors are unaware of the MH competencies and teach the majority of MH care during a rotation. 27 Since specific training in managing conditions with medications is consistently associated with practices, 15 these trainings must be present in all programs. This finding is in contrast to trainings in non-medical behavioral management strategies, which were not associated with co-managing ≥50% of patients with MHCs.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately one-third of pediatric residency programs have enhanced models of MH care in their trainees’ primary care practices and data do suggest that training in these practices influences trainees’ confidence and competence. 27,30 However, there is a spectrum of integration within enhanced models of care and which model components encourage pediatricians to provide treatment for common MHCs is unknown. Our findings on the importance of education may strengthen the argument that fully integrated models of care may provide the most promise in changing providers’ behaviors and helping to build their skills in MH care.…”

Section: Discussionmentioning

confidence: 99%

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Which Pediatricians Comanage Mental Health Conditions?

Green

Storfer‐Isser

Stein

et al. 2017

Academic Pediatrics

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Objective/Background Given the prevalence of mental health (MH) conditions (MHCs) in children, pediatricians should initiate treatment alone or in collaboration with a specialist for children with MHCs. However, the majority of pediatricians do not manage or co-manage common MHCs even with an onsite MH provider. This study examines which physician, practice, and training characteristics are associated with pediatricians’ co-managing at least half of their patients with MHCs. Methods We analyzed responses of general pediatricians (n=305) from the AAP 2013 Periodic Survey. Practice characteristics include presence of an onsite MH provider and perceived access to services. Independent variables included socio-demographics, training experiences, and interest in further training. The outcome was co-management of ≥ 50% of patients with MHCs. Weighted univariate, bivariate and multivariable analyses were performed. Results Of the pediatricians who reported co-managing ≥50% of their patients with MHCs, logistic regression analysis showed that pediatricians who completed ≥ 4 weeks of DBP training had 1.8 increased odds (1.06, 3.08, p=0.03) of co-management, those very interested in further education in managing/treating MHCs had 2.75 increased odds (1.63, 3.08, p<0.001), and those with more training in MH treatment with medications had 1.4 increased odds (1.12, 1.75, p=0.004) of co-managing children with MHCs. Conclusion Specific educational experiences and interest in further education in managing/treating MHCs were significantly associated with co-managing ≥50% of patients suggesting that enhanced MH training among pediatricians could increase the co-management of children with MHCs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Which Pediatricians Comanage Mental Health Conditions?

Green

Storfer‐Isser

Stein

et al. 2017

Academic Pediatrics

Self Cite

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“…Both trainees and program directors acknowledge insufficient mental health training during residency, with many trainees expressing a lack of comfort managing child mental health problems. 26,27 In this setting the Five S’s tool may be helpful for increasing facility with addressing such problems. The infographics in the Figure can be used as a prompt until PCCs or trainees become comfortable using the tool.…”

Section: Discussionmentioning

confidence: 99%

The Five S’s: A Communication Tool for Child Psychiatric Access Projects

Harrison

Wasserman

Steinberg

et al. 2016

Current Problems in Pediatric and Adolescent Health Care

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Given the gap in child psychiatric services available to meet existing pediatric behavioral health needs, children and families are increasingly seeking behavioral health services from their primary care clinicians (PCCs). However, many pediatricians report not feeling adequately trained to meet these needs. As a result, child psychiatric access projects (CPAPs) are being developed around the country to support the integration of care for children. Despite the promise and success of these programs, there are barriers, including the challenge of effective communication between PCCs and child psychiatrists. Consultants from the Maryland CPAP, the Behavioral Health Integration in Pediatric Primary Care (BHIPP) project, have developed a framework called the Five S’s. The Five S’s are Safety, Specific Behaviors, Setting, Scary Things, and Screening/Services. It is a tool that can be used to help PCCs and child psychiatrists communicate and collaborate to formulate pediatric behavioral health cases for consultation or referral requests. Each of these components and its importance to the case consultation are described. Two case studies are presented that illustrate how the Five S’s tool can be used in clinical consultation between PCC and child psychiatrist. We also describe the utility of the tool beyond its use in behavioral health consultation.

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“…4,9,10 Pediatric residents and program directors alike acknowledge a lack of skills and knowledge among residents in the management of behavioral health concerns. 11,12 Despite ongoing efforts to improve behavioral and psychiatric training, pediatricians generally do not consider themselves to be competent in the management of mental health complaints. In a 2014 survey, 65% of pediatricians reported a lack of training in, and .50% did not feel comfortable managing, behavioral conditions.…”

Section: Training and Educationmentioning

confidence: 99%

Opportunities to Improve Inpatient Care for Children With Behavioral Comorbidities

Rudnick¹,

Henry²,

Trost³

2019

Hospital Pediatrics

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A 14-year-old girl with autism spectrum disorder (ASD), intellectual disability, aggressive behavior, and constipation presented to the emergency department (ED) with her aunt and uncle (legal guardians), with 3 days of worsening aggression and abdominal pain. Caregivers reported escalating aggression over the last few months despite regular psychiatric follow-up and titration of her psychotropic medications. She had 2 ED visits during this time for similar complaints, was diagnosed with constipation, and was discharged from the hospital after receiving an enema. Three days before this presentation, she began hitting and scratching herself and caregivers and so was brought to the ED because they felt unsafe caring for her at home.In the ED, vital signs were within normal limits. She was alert but was withdrawn, delayed, and nonverbal, and she was intermittently crying, scratching, and hitting herself and bystanders. Her abdomen was tender in the lower quadrants. The remainder of her examination was unremarkable. An abdominal radiograph demonstrated a significant stool burden. She was admitted for a bowel cleanout and adjustment of her psychotropic medications.On admission, she was placed in an enclosed bed with one-to-one supervision by a dedicated staff member because of aggressive behavior. She was transitioned to an oral bowel regimen after an initial bowel cleanout and stooling well with resolution of abdominal pain by hospital day 3.The inpatient psychiatry team was consulted for escalating aggressive behaviors. In discussion with her primary outpatient psychiatrist, a new pharmacologic regimen was started to manage her aggression and agitation. Despite these changes, she continued having behavioral outbursts (hitting, kicking, and scratching multiple care providers and herself) leading to frequent use of physical and chemical restraints to protect all involved parties. She remained withdrawn and agitated, with no improvement in behavior after 5 days on the new medication regimen. On day 6, further adjustments were made to the medication regimen; social work was consulted to assist with placement in a long-term psychiatric care facility.Her medications were adjusted over the next 4 days while placement was sought. Ultimately, no care facilities were identified that would accept this patient. Although her behavior slightly improved on the new medication regimen, she continued having intermittent aggressive outbursts, making it difficult to provide appropriate care (ie, bathing, administering medications, checking vital signs).

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The Current and Ideal State of Mental Health Training: Pediatric Program Director Perspectives

Cited by 32 publications

References 28 publications

Which Pediatricians Comanage Mental Health Conditions?

Which Pediatricians Comanage Mental Health Conditions?

The Five S’s: A Communication Tool for Child Psychiatric Access Projects

Opportunities to Improve Inpatient Care for Children With Behavioral Comorbidities

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