Data show that children are more likelyopens in new window to have mental health disorders than physical ailments, yet most children never receive the care they need because of stigma, cost and a shortage of mental health specialists, according to a report from the American Academy of Pediatrics (AAP). And although pediatricians are often the first providers to spot mental health issues in children, many say they feel ill-prepared to address these concerns, the report concludes.
In response, the AAP is urging pediatricians to pursue integrated and collaborative care models that incorporate psychologists into medical practices and to start including psychologists as training faculty in pediatric residency training programs.
“Psychologists are uniquely suited to teach pediatricians how to communicate with families and utilize brief interventions to help patients who are dealing with mild to moderate mental health conditions,” says Cori Meredith Green, MD, MS, one of the report’s authors and director of behavioral health education and integration in pediatrics at Weill Cornell Medicine in New York. “This type of training could potentially prevent untreated symptoms from becoming more serious disorders in the future.”
Although most pediatric residencies typically include a four-week developmental-behavioral pediatrics rotation, data suggest that this training is not equipping physicians to address common concerns such as attention-deficit hyperactivity disorder (ADHD), disruptive behaviors, sleep problems, anxiety, depression and suicidality. One national study showed that more than 62% of pediatric residency program directors described the quality of behavioral health training in their program as suboptimal or below ( Journal of Developmental & Behavioral Pediatrics opens in new window, Vol. 39, No. 4, 2018).
“The current training tends to focus on autism and lacks hands-on experience,” says study co-author Jeffrey Shahidullah, PhD, a psychologist at the University of Texas at Austin’s Dell Medical School. “Residents want to work alongside psychologists and other mental health specialists and have more than four weeks with patients.”
Training together
Geisinger Health System in Pennsylvania is one organization that has successfully integrated hands-on mental health training into its pediatric residency program. Psychologists work alongside primary-care pediatricians in many clinics, so residents can invite a psychologist into the exam room immediately if they encounter a child with a mental health concern.
“Residents are looking for practical ideas and action plans to help their patients,” says Paul Kettlewell, PhD, director of pediatric psychology at Geisinger, who is among the psychologists training residents how to assess for conditions like ADHD, depression and anxiety. He teaches residents how to use elements of cognitive-behavioral therapy and exposure treatment to help anxious kids face their fears and reduce excessive worry. Psychologists at Geisinger also demonstrate how to conduct a suicide risk assessment. “[Residents] learn to discern when a case is higher risk, which may require help from a psychologist or a referral to the emergency room,” he says.
Some pediatric residency programs are also asking pediatric psychologists to train actors to perform behavioral health scenarios that give the medical trainees a chance to practice their skills in a simulated environment. Pediatric residents are taught how to conduct motivational interviews and to build therapeutic alliances with patients and families, says Shahidullah.
Start building partnerships
Although it’s still somewhat uncommon to find pediatric residency programs that incorporate psychologists into clinical training, schools that use this approach are more likely to earn high ratings from residency directors, says Shahidullah.
Terry Stancin, PhD, ABPP, chief psychologist at MetroHealth in Ohio and a longtime advocate of collaborative care models, hopes the AAP report will stimulate more conversations between pediatric departments and psychology training programs. “Psychologists should ask pediatric residency program directors what they need and how they can contribute to the training,” says Stancin. “You could start by offering to give lectures or by inviting pediatric residents to rotate through mental health clinics.”
Creating opportunities for psychology and physician trainees to learn side-by-side not only helps future pediatricians learn how to address mental health issues, but also benefits the psychologists who watch physicians in action.
“Psychologists have a lot to learn from pediatricians about diseases, how to improve health outcomes and healthy child development,” says Stancin. “This kind of collaborative training is preparing a workforce to work together in the future, which will ultimately help patients.”
