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Behavioral and Mental Health: Gaps and Challenges

Monday, March 12, 2018 - 11:30

Pediatricians are often the first professionals parents turn to when their child needs behavioral or mental health services — because of their trusting doctor-patient relationship or to avoid the perceived stigma of going to a mental health professional. So when Alexis King’s* middle child needed mental health services, she looked for help where Simon* was already receiving care.

“Unfortunately, our pediatrician was not trained to help us find support,” she says, “and I was left with desperately searching for mental health services for my son. I worry about Simon every day as his self-esteem goes from bad to worse and his depression is left untreated.”

Recent surveys indicate that one in seven children younger than age 8 and one in five adolescents have a diagnosable behavioral, mental, or developmental disorder. Yet many pediatricians do not feel adequately trained to identify or treat these conditions.

Madison Barnes* thinks her first pediatrician’s inability to explain her son’s atypical behavior came from a lack of knowledge. She says she spent years looking for answers on her own before finding a new pediatrician when she moved to another state.

“It’s tough to find a doctor who understands,” she says. “If [our first pediatricians] just had a little bit of knowledge, they could have saved us years of struggle, confusion, and heartache.”

- Madison Barnes,* Mother


ABP Narrows Focus on Behavioral Mental Health Crisis

The ABP has been focusing more closely on behavioral and mental health since 2014, when its Strategic Planning Committee recommended that the ABP rank behavioral and mental health needs as its highest strategic priority. Since then, the ABP has been raising awareness of the scope, morbidity, and mortality associated with this issue, and is leading an effort with other organizations to help pediatricians better care for children with behavioral and mental health needs. In 2016, the ABP convened a conference of 10 other pediatric and medical organizations to share interests and insights about training residents and fellows to prevent, identify, diagnose, and treat behavioral and mental health issues. This group acknowledged the American Academy of Pediatrics’ earlier work to publish a toolkit for primary care providers, identify seven symptom clusters, and begin developing mental health modules for residents and training faculty who might use the modules.

"Awareness of behavioral and mental health symptoms and treatment is critical because pediatricians may be in a position to identify children at risk, sometimes before symptoms appear,” says Marshall Land Jr., MD, a general pediatrician in South Burlington, Vermont, who was a member of the ABP’s Strategic Planning Committee that identified the importance of behavioral and mental health.

Although the ABP can create expectations for the education, training, and assessment of pediatricians, partnerships with the organizations that conduct training and assessment are needed to make an impact. In early 2017, the ABP published a call to action paper in Pediatrics. “The paper sets goals that cannot be reached without the collaboration of other pediatric organizations,” says primary author Julia McMillan, MD, Professor Emerita of Pediatrics at the Johns Hopkins School of Medicine.

As a follow-up to the paper, the Association of Pediatric Program Directors (APPD) and the ABP hosted a daylong session ― “The Mental Health Crisis: Preparing Future Pediatricians to Meet the Challenge” ― during APPD’s annual meeting in April. Directors of residency and fellowship programs discussed the magnitude and urgency of the mental health crisis, barriers and facilitators to incorporate behavioral and mental health experience into training programs, and ways to achieve resident and fellow competence in providing care.

“We need to focus our efforts on improving the knowledge and skills of both general pediatricians and subspecialists around behavioral and mental health issues, starting with trainees and continuing into lifelong learning and practice improvement.”

- Laurel K. Leslie, MD, MPH, ABP Vice President for Research


Additional ABP behavioral and mental health activities in 2017 included:

  • Encouraging pediatric subspecialty committees to include behavioral and mental health competencies in the subspecialty entrustable professional activities (EPAs) 
  • Analyzing the current questions in the general pediatrics certifying exam to evaluate behavioral and mental health content
  • Enlisting members of the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Board of Psychiatry and Neurology (ABPN), who write questions for trainee exams in child psychiatry, to help write questions on mental and behavioral health for the ABP’s general pediatrics exam
  • Reviewing MOC Part 2 and Part 4 activities and continuing medical education (CME) activities available through the ABP, the American Academy of Pediatrics (AAP), and AACAP to compile behavioral and mental health activities and identify gaps
  • Partnering with parents, young adult patients, and other key stakeholders to identify levers of change

The ABP will continue to partner with other organizations and focus on the behavioral and mental health of pediatric patients (and their families) in 2018 and beyond.

*Names have been changed.