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Implementing the Behavioral and Mental Health Entrustable Professional Activity: Insights for a Path Forward

Authors
Ovalle VW, Martini A, Tanguay S, Carraccio C, Schumacher DJ
Year
2020
Journal
Academic Pediatrics
Abstract

Objective
Mental health problems in children are growing exponentially. General pediatricians, while in a unique position to address these issues as they arise, report they lack adequate training in assessing and managing behavioral/mental health (B/MH) problems. Underscoring the importance of this area, the American Board of Pediatrics has defined B/MH as one of only 17 foundational entrustable professional activities (EPAs) for general pediatric practice. Our goal was to explore the facilitators and barriers associated with implementing and assessing the B/MH EPA among pediatric residency programs in order to identify best practices and potential solutions to common barriers.

Methods
In this qualitative study, 18 key faculty members from 4 residency programs with 3 years' experience implementing and assessing their residents on the B/MH EPA were purposively sampled. Semistructured interviews were conducted with each participant, and interviews were analyzed utilizing a thematic analysis.

Results
Five themes were defined in the thematic analysis 1) B/MH training: who's responsible? 2) local context can serve as a barrier or facilitator, 3) B/MH may require longitudinal, integrated, and multidisciplinary training, 4) B/MH specialists: indispensable, yet a hurdle?, and 5) resident and faculty confidence and skill impact B/MH training.

Conclusions
The need for robust training to prepare pediatric residency graduates to meet the needs of patients with B/MH problems has never been greater. This study provides important insights about gaps in B/MH training. These should inform future directions focused on addressing this need.