WASHINGTON – Behavioral and mental health issues are the largest group of conditions that you see in your practice, but pediatric residency training does not adequately prepare you for this challenge, Dr. Julia A. McMillan said in a video roundtable at the annual meeting of the American Academy of Pediatrics.
Dr. John D. Duby, professor and chair of pediatrics at Wright State University, Dayton, Ohio, added, “as we think about the innovation and transformation in pediatric education, pediatricians alone can’t do this work. We need to think more about integrated models for training that bring in psychologists, licensed social workers, care coordinators, community health workers, maybe even child psychiatrists.”
Dr. McMillan, professor of pediatrics and associate dean for graduate medical education at the Johns Hopkins University, Baltimore, agreed, and said that training about behavioral and mental health issues needs to be reinforced throughout pediatric residency training, not just in a block rotation about mental health, but also during critical care or continuity clinic training.
Dr. Duby emphasized that although there are roadblocks to preparing pediatricians of the future to deal with children confronted with trauma or the most common mental health issues – attention-deficit/hyperactivity disorder, anxiety, depression, or disruptive behavior – the difficulty of handling these disorders in the pediatric medical home is not insurmountable. This really requires only about 10 skills, simple strategies that pediatricians can learn. One of these is assessing a patient’s readiness to change.
Dr. Michelle M. Macias, a professor of pediatrics and director of the division of developmental-behavioral pediatrics at the Medical University of South Carolina, Charleston, who also took part in the roundtable, added it is important to emphasize strength-based approaches, positive parenting, and preventive medicine to deal with behavioral and mental health issues in children.
For those already in practice, there also is help from the AAP. Dr. McMillan mentioned a 2009 article in Pediatrics (2009;124:410-21) written by the AAP Task Force on Mental Health and an online curriculum to aid residency continuity clinic preceptors in training residents to help children in their care with mental health issues.