Mental Health Training in Pediatric Residency: Where Can We Go?

Between 13% and 20% of children have mental health conditions, yet far fewer are identified. Only 25% of children who could benefit from treatment actually receive care. One-half of all mental health conditions have their onset in childhood or adolescence; adults with mental health conditions have higher rates of unemployment, poverty, and use of medical care. The pediatric primary care setting is ideal for assessing and managing common mental health concerns for children and adolescents. Common complaints often have emotional and behavioral underpinnings, which may have origins in the child or in the caregivers. However, many primary care practices do not feel comfortable identifying or treating these problems routinely and perceive that their mental health colleagues are inaccessible, or that families perceive societal stigmatization with mental health care. There has been growing recognition of the need to bolster mental health education during pediatric residency training. The Accreditation Council for Graduate Medical Education mandates block rotations in developmental-behavioral pediatrics and adolescent health. Recommendations were made to include mental health surveillance, screening, recognition, and counseling in the developmental-behavioral pediatrics curriculum. The American Academy of Pediatrics published Mental Health Competencies in 2009 that called for innovation in residency training and urged the enhanced commitment of individual clinicians. Areas of focus for expanded knowledge and skills included attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, substance abuse, and recognizing psychiatric and social emergencies. Additional areas of emphasis unique to primary care included building resilience and promoting healthy lifestyles; preventing, mitigating, and identifying risk factors for mental health problems; and partnering with families, schools, and other community agencies to plan assessment and care. The American Board of Pediatrics (ABP) released the pediatric entrustable professional activities in 2013, which highlighted the need for the pediatrician to demonstrate the ability to assess and manage patients with common behavioral and mental health issues.