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Introduction: Pediatric behavioral and mental health (BMH) disorders are increasingly common, but most pediatricians feel inadequately trained to manage them. We implemented a case-based, longitudinal curriculum in BMH within a pediatric residency program to prepare trainees to diagnose and manage these conditions., Methods: The pediatric residency program at Wright State University/Wright-Patterson Medical Center implemented a new BMH curriculum in 2020-2021. The curriculum consisted of five simulated cases involving depression, anxiety, attention deficit disorder with hyperactivity (ADHD), developmental delays, behavioral concerns, and autism. To reflect follow-up within a continuity clinic, cases included initial encounters and multiple follow-up visits. Faculty facilitators led residents in monthly small-group meetings over the academic year, with each session consisting of two to three simulated patient encounters. Residents completed pre-post surveys regarding their confidence in diagnosing and managing BMH conditions and pre- and posttests to evaluate the impact of the curriculum on knowledge gains., Results: All 47 pediatric residents participated in the curriculum; 38 (81%) completed pre-post surveys. Upon completion of the curriculum, residents reported significantly increased confidence in managing ADHD, treating depression, creating safety plans for suicidality, recognizing autism, and counseling patients and families on special education services. Knowledge-based pre- and posttests completed by 25 residents (53%) also demonstrated significant improvement ( M = 92.4, SD = 10.9, pre vs. M = 99.3, SD = 6.6, post, p = .009)., Discussion: This case-based, longitudinal curriculum in pediatric BMH simulating patient continuity improved residents' confidence and knowledge in diagnosing and managing common BMH conditions., (© 2024 Kiger et al.)

Training combining the disciplines of pediatrics, psychiatry, and child and adolescent psychiatry dates back to World War II, but formal combined programs began more than 3 decades ago as the Triple Board Program and 10 years ago as the Postpediatric Portal Program (PPPP). Triple board training was rigorously examined as a pilot program and ongoing surveys suggest that it provides successful training of physicians who can pass the required board examinations and contribute to clinical, academic, and administrative/advocacy endeavors. As evidence grows showing the value of integrated care, physicians with combined training will offer a unique perspective for developing systems., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Pediatric primary care providers (PPCPs) are increasingly expected to know how to assess, diagnose, and treat a wide range of mental health problems in children and adolescents. For many PPCPs, this means learning and performing new practice behaviors that were not taught in their residency training. Typical continuing education approaches to engage PPCPs in new practices have not yielded the desired changes in provider behavior. This article summarizes behavior change principles identified through basic behavior science, adult education, and communication research, and discusses their application to a patient-centered pediatric primary care mental health curriculum., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Integrated behavioral and mental health systems of care for children require multidisciplinary team members to have specific competencies and knowledge of the other disciplines' strengths and practice needs. Training models for multidisciplinary professionals should consider the developmental level of trainees. The authors describe a model of flexible scaffolding, increasing intensity, and depth of experience as trainees gain skills and knowledge., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: The objectives of this study were to examine the experiences of dual-trained child psychiatrists and paediatricians in Australia and New Zealand and inform the review of the Dual Fellowship Training Programme by the Royal Australian and New Zealand College of Psychiatrists and Royal Australasian College of Physicians., Methods: All dual-trained child psychiatrists and paediatricians and current trainees were electronically surveyed in 2015., Results: Seven out of eight specialists (88%) and four out of six trainees (67%) responded. Six (55%) completed or were undertaking training as part of the Dual Fellowship Training Programme. Most respondents entered dual training without difficulty, found the transition from paediatrics to adult psychiatry challenging, and were reassured by their decision to undertake dual training on reaching advanced training in child psychiatry. Benefits and downsides of dual training were noted during and following training. A significant proportion of specialists (55%) were working in hospital-based environments, especially consult liaison services, suggesting that they added long-term value to both the fields of child psychiatry and paediatrics., Conclusions: The Dual Fellowship Training Programme remains a valuable vehicle for gaining skills in paediatrics and child psychiatry. There is support for its continuation by previous and current participants., (© The Royal Australian and New Zealand College of Psychiatrists 2016.)

Objective: The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs., Methods: Data were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted., Results: Only 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents., Conclusions: Few pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care., (Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as part of routine health care for adolescents as well as adults. In an effort to promote universal SBIRT, the Substance Abuse and Mental Health Services Administration awarded funding to residency programs to develop and implement SBIRT education and training. Our project focused on creating scientifically based, developmentally appropriate strategies and teaching materials for the adolescent age range. This paper describes curriculum development and implementation and presents evaluation data., Methods: Pediatric and child psychiatry residents were trained. The training consisted of 4 activities: (1) case-based teaching modules, (2) role-play of motivational interviewing and brief interventions, (3) mock interviews with trained adolescents, and (4) supervised "hands-on" screening and brief interventions. Main outcome measures included trainee satisfaction, and SBIRT knowledge, perceived self-efficacy, and self- and observer report of use of the SBIRT algorithm., Results: Among 150 total participants completing the SBIRT training modules, nearly all (92.3%) were satisfied/very satisfied with the training modules. Knowledge accuracy immediately post training was high, but declined significantly by the end of the first residency year, with little change across subsequent years of residency. Confidence ratings also declined over time. Use of the SBIRT algorithm during the Adolescent Medicine rotation was high according to trainee self- and faculty observer report., Conclusions: We found evidence of training satisfaction, increased confidence in talking to adolescents about substance use, and widespread use of recommended practices immediately following training. Use of a highly structured algorithm to guide practice, and simple, highly structured brief interventions was a successful training approach, as residents self-reported accurate use of the SBIRT algorithm immediately after training. Knowledge and self-confidence declined over time. It is possible that "booster" sessions and ongoing opportunities to review materials could help residents retain knowledge and skills.

Objective: To assess pediatric residency program director (PD) perceptions of the current state of mental health (MH) training, their receptivity to curricular changes, and perceptions of their residents' knowledge and skills in MH care., Methods: We performed a cross-sectional study utilizing a Web-based survey of pediatric residency PDs to assess program characteristics, learning modalities PDs currently had or would implement, and their knowledge of the new American Academy of Pediatrics' MH competencies. PDs then ranked their residents' knowledge and skills for 29 MH competencies. Analyses included descriptive statistics and bivariate and multivariate analyses to assess for associations between variables, particularly MH model of care and perceived competence., Results: Ninety-nine PDs (51%) responded. A total of 87% of PDs reported that MH care was taught as part of another rotation, yet PDs were receptive to curricular changes. Only 45% of PDs were aware of the 2009 American Academy of Pediatrics competencies, and PDs infrequently rated their residents' MH skills and knowledge to be above average. Attention-deficit/hyperactivity disorder (ADHD) was an exception: 64% reported above-average ADHD knowledge in diagnoses and 57% in treatment. There was an association between enhanced MH services in continuity clinics and perceived resident systems-based practice (P < .01) and medical knowledge (P = .04)., Conclusions: PDs acknowledged that MH training is not emphasized, leading to deficiencies in their residents' knowledge and skills in MH care. The receptivity of PDs suggests the need for targeted dissemination of national guidelines or curriculum. Integrated models of care may be one way to improve resident competencies, but this deserves further study., (Published by Elsevier Inc.)

Objective: The objective of this study was to assess current trainee exposure to integrated mental health/primary care models in US child and adolescent psychiatry fellowship programs., Methods: In June 2013, an electronic survey was sent to all US child and adolescent psychiatry fellowship program directors (N=123)., Results: Fifty-two responses were obtained from the 120 eligible participants (43%). The majority of the program directors who responded (63%) indicated that fellows in their programs regularly participate in clinical care and/or consultation within an outpatient pediatric primary care setting. Program directors identified barriers to increasing training exposure to integrated care delivery as competing clinical demands and challenging financial models for indirect consultation in primary care settings., Discussion: Many child psychiatry fellowship program directors view training in integrated care models as an important part of their teaching and service mission, and are creating novel avenues for exposure. Current funding models, however, may limit the widespread implementation of these opportunities.

Objective: We hypothesized that a suicide risk assessment (SRA) training module incorporating standardized patients (SPs) would enhance pediatric resident SRA performance., Methods: We conducted an educational survey of pediatric residents regarding SRA (N = 80). In addition, we tested the performance of a SRA training module among pediatric interns who received SRA practice with SPs simulating suicidality scenarios, with (n = 6) or without (n = 6) SRA lecture, or SRA lecture only (n = 12) and control interns (n = 10). We examined postintervention confidence in SRA and self-reported and objectively measured knowledge of suicidal risk factors., Results: Resident confidence and knowledge regarding SRA were low, compared with assessment of medical illness. Interns in the SP plus lecture group had significantly greater confidence in screening adolescents for suicide risk factors and assessing suicidal adolescents (screening, 4.2 +/- 0.4; assessing, 4.2 +/- 0.4), compared with subjects in either the lecture-only (screening, 2.9 +/- 0.8; P = .005; assessing, 2.9 +/- 1.1; P = .01) or control (screening, 3.1 +/- 0.7; P = .025; assessing, 2.6 +/- 0.8; P = .003) group. In addition, only the SP plus lecture group demonstrated significantly greater objective knowledge of suicide risk factors (92% vs 25% correct; P = .008) than the control group. Neither the lecture-only group nor the SP-only group was significantly better than the control group in terms of knowledge or confidence relevant to SRA., Conclusion: This SRA training module was significantly more effective than lecture alone in enhancing pediatric intern knowledge and confidence in SRA.

Objectives: The authors describe the history, rationale, and outcomes of combined training programs in pediatrics, psychiatry, and child psychiatry ("triple board"), including narrative feedback from graduates and reflections upon the important components of the program., Methods: This article reviews the background and experiences of triple board graduates and programs using published data regarding triple board history and outcomes, reflections and follow-up information collected from triple board graduates as part of a national triple board network development, and direct experiences with triple board training programs., Results: The triple board training program provides a unique training background for physicians who serve children and their families. The programs train physicians who seek out additional training opportunities, succeed in passing board certification examinations, and earn national recognition. Additionally, feedback from graduates reflects satisfaction with training experiences., Conclusion: The outcomes from this experiment in integrated training in child psychiatry support the consideration of expanding triple board training programs and introducing new innovations in training.

Objective: This article presents a DVD-based educational program intended to help pediatric residents and practicing pediatricians recognize and respond to adolescent depression in busy primary care settings., Methods: Representatives from pediatrics and adolescent medicine, child and adolescent psychiatry and psychology, and experts in the creation of educational mental health programs met to design a multimedia approach to improving the mental health diagnostic skills among pediatric residents. The authors chose depression as the initial topic because of its relatively high prevalence among children and adolescents, and evidence suggesting that pediatricians may have difficulty diagnosing this disorder in the primary care setting. The authors created a 30-minute DVD program featuring depressed adolescents and experts in child psychiatry and adolescent medicine. After viewing the DVD, residents in the training program, as well as practicing pediatricians, completed a standardized survey to assess the usefulness and attractiveness of this approach to pediatric education., Results: The survey results support the potential value of this type of material and the feasibility of similar programs in addressing an array of mental health concerns in pediatric residencies. Participants found the program useful and indicated interest in receiving more educational programs in this format., Conclusion: The authors suggest that the relative ease with which initiatives such as this media-based approach can be implemented make this educational technique appropriate and feasible on a large scale for programs throughout the nation and for a variety of mental health concerns.

Originally an experiment in medical training, the triple board program has established itself as a permanent and successful training program. It offers a viable 5-year alternative to the traditional 7 to 8 years of residency training required for board eligibility in pediatrics, general psychiatry, and child and adolescent psychiatry. One primary objective of this course was to address for workforce shortage of child psychiatrists by recruiting medical students who may otherwise have pursued general pediatrics. The second objective was to bridge the gap between child psychiatry and pediatrics by training physicians proficient in the culture, language, and content of both specialty fields. Although the shortage crisis continues, both objectives were met. The success of the triple board experiment has facilitated further consideration and support for the development of other novel training portals into child psychiatry.

Objective: To describe program outcomes for the Combined Training Program in Child and Adolescent Psychiatry, Pediatrics, and Psychiatry (Triple Board Program)., Method: All Triple Board Program graduates to date (1991-2003) were asked to participate in a 37-item written survey from February to April 2004., Results: The response rate was 80.7%. Most graduates go on to careers in child and adolescent psychiatry, spending a mean of 72.3% of their time in the field; however, 24.8% of respondents spend at least one fourth of their time in pediatrics and 8.0% spend one fourth of their time or more in general psychiatry. Many graduates are involved in academics, teaching, and research. Board pass rates (including repeat attempts) were highest for general (95.8%) and child and adolescent psychiatry (91.4%) and lowest for pediatrics (77.2%), and a minority (36.3%) of graduates are fully "triple boarded" (i.e., have completed oral and written boards in all three fields). Of graduates, 93.8% stated they would re-enroll in the Triple Board Program, and satisfaction with the curriculum was high., Conclusion: The Triple Board Program is successful in terms of career outcomes, involvement in academics, boards pass rates, and graduate reported satisfaction. These data may help determine the future of this combined program in addressing workforce issues in child and adolescent psychiatry.

The authors describe their experience to support the view that training in child psychiatry is an effective way for the paediatrician in training to gain an understanding of that specialty. It is also an efficient way to acquire certain skills, which will be helpful in the future, either in hospital or community paediatrics.

Since August 1993, child psychiatry training by a full-time child psychiatrist has become an essential component of the postgraduate training programme at the Department of Paediatrics, Keio University Hospital, Japan. Thirty trainees, 15 first-years and 15 second-years, had first-hand experience in residential child psychiatric treatment concurrently with pediatric training. With the trainees as primary care workers, 31 cases have been successfully treated, of whom seven were school refusals, 11 were anorexia nervosas and eight somatoform disorders. Consistent maternal care, such as three spoon-feeding sessions each day, were prescribed for anorexic patients, which enhanced sensitivity in the trainees to the unmet infantile needs of their patients and facilitated awareness of their chronic unhappiness since early life and to the therapeutic implications of empathic understanding based on trustful relationships. After the 2 years of training the first group of trainees showed competency in handling children's emotional problems on their own in distant affiliated hospitals. The flexible multidisciplinary style of training that has evolved over the past 2 years has proved to have enormous relevance in the changing contexts of the pediatric practice in Japan.

In Norway, the first paediatric department was founded in Oslo 100 years ago. The first child psychiatric department was opened in 1950. To assess qualitative and quantitative aspects of child psychiatric liaison work, questionnaires were sent to the heads of 25 paediatric departments and 53 child psychiatric units. Scarce child psychiatric resources were spent in paediatrics. The average score for satisfaction with collaboration was moderate (5.5 on a 10-cm visual analogue scale) and agreement between the parties was modest. Improvement will involve development of a common language and a shared model for understanding the psychosocial aspects of acute and chronic childhood illnesses. In-service training for paediatricians in child psychiatry and vice versa may help. Both parties indicated a need for more training in consultation/liaison and in multi-professional assessments and therapeutic interventions with children with physical illnesses.

This article describes a 21-year experience of recruiting and training child and adolescent psychiatry residents with pediatric backgrounds. Three grounds of physicians are compared: those with previous training in general psychiatry alone, those with previous training in both general psychiatry and pediatrics, and those with previous training in pediatrics alone. Residents with pediatric backgrounds compared favorably with those with general psychiatry training. Those with only pediatric training were not only able to successfully complete the residency, but also the majority entered the field of child psychiatry. The findings support accepting residents directly from pediatrics as a viable pathway into child psychiatry.

Attitudes to childhood in general and towards one's own childhood in particular are compared in a survey of 152 Australian and New Zealand child psychiatric and paediatric trainees. Results confirm the findings of Enzer et al that paediatricians view childhood more positively than do child psychiatrists. Although there is a significant difference between the two groups on measures of their perceptions of the parenting they received with child psychiatrists rating their own parents as less caring than do paediatricians, there is no relationship between attitudes to childhood and perceptions of the parenting they received. Implications of these findings are examined, both in terms of motivation for choosing one or other specialty and for the working relationship between the two professions.

Eighty graduates of a pediatric residency that required training in behavior and development completed a survey of their perceptions regarding the quality of this training, the utility of behavior and development for modern pediatric practice, their competence in applying behavior and development knowledge, and their desire to pursue additional training in behavior and development. Surveys were completed 1 to 5 years (mean = 3.4 years) after graduation from the residency program. Graduates consistently rated child development and anticipatory guidance/counseling as the areas that were best taught, most useful, and in which they felt the most competent. The highest ratings of behavioral/developmental pediatrics (BDP) competence and usefulness were from graduates who received additional BDP training after residency. However, a large percentage of graduates did not endorse the usefulness of several dimensions of behavior and development that have been considered integral components of training. Implications and limitations of the present study are discussed.

The author draws on his own experience to support the view that some practical experience and training in child psychiatry is an effective way for the paediatrician in training to gain understanding of that specialty. It is also an efficient way to acquire certain perspectives and skills which will be helpful in the future, either in hospital or community paediatrics.

The functions and operation of two outpatient clinics, the Pediatric Family Clinic and the Child Psychiatric Consultative Service, are described to illustrate an approach to teaching residents and medical students how to diagnose and deal with the psychosocial problems frequently encountered in children. Learning experiences in this busy ambulatory setting are pediatric and family practice.

Pregnancy and parturition represent stressful situations in the human life cycle, affecting both parents and family members. Psychological, physiological, social, and cultural changes during these periods demand new adjustments and adaptations by the family. Health care professionals can help parents cope effectively with these normal developmental crises by providing support, reassurance, and guidance. Unfortunately, during these periods many physicians feel incompetent in relating to their patients. Medical school and residency training programs have not provided adequate supports for the emotional and cognitive development of the student. The student of medicine often leaves training feeling insecure in this area and is reluctant to initiate and perpetuate collaborative liaison programs and psychiatric colleagues. The authors developed a pediatric-child psychiatry liaison program on the postpartum division of a community hospital, realizing the need for medical students and pediatric residents to appreciate and understand the normal developmental crises inherent in parturition and pregnancy. The program was created within the context of a developmental framework which emphasizes the normal psychophysiological experiences occurring during these periods. Issues concerning the emotional well-being of patients and the responsibility of training programs promoting emotional and intellectual growth are discussed.

As part of an evaluation of a program to train pediatric residents in child psychiatry, measures were made of the following variables predictive of the residents' performance in the program: personality traits, attitude toward psychiatry, willingness to treat psychological problems, preprogram interview performance, length of commitment to pediatrics, and frequency of interaction with teachers in the program. Outcome variables were pediatric residents' course evaluation, frequency of interaction with teachers in the program, and postprogram interview performance. In multiple regression equations the variables predictive of the residents' performance explained up to 72 percent of the variance of the residents' participation in the program, 88 percent of the variance of the postprogram interview, and 61 percent of the variance of the residents' course evaluations.