ABSTRACT
An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.
Subject(s)
Child Health Services , Mental Health Services , Adolescent , Child , Humans , Adolescent Health Services/economics , Child Health Services/economics , Fee-for-Service Plans , Mental Health Services/economicsABSTRACT
Introduction: Pediatric behavioral and mental health (BMH) disorders are increasingly common, but most pediatricians feel inadequately trained to manage them. We implemented a case-based, longitudinal curriculum in BMH within a pediatric residency program to prepare trainees to diagnose and manage these conditions. Methods: The pediatric residency program at Wright State University/Wright-Patterson Medical Center implemented a new BMH curriculum in 2020-2021. The curriculum consisted of five simulated cases involving depression, anxiety, attention deficit disorder with hyperactivity (ADHD), developmental delays, behavioral concerns, and autism. To reflect follow-up within a continuity clinic, cases included initial encounters and multiple follow-up visits. Faculty facilitators led residents in monthly small-group meetings over the academic year, with each session consisting of two to three simulated patient encounters. Residents completed pre-post surveys regarding their confidence in diagnosing and managing BMH conditions and pre- and posttests to evaluate the impact of the curriculum on knowledge gains. Results: All 47 pediatric residents participated in the curriculum; 38 (81%) completed pre-post surveys. Upon completion of the curriculum, residents reported significantly increased confidence in managing ADHD, treating depression, creating safety plans for suicidality, recognizing autism, and counseling patients and families on special education services. Knowledge-based pre- and posttests completed by 25 residents (53%) also demonstrated significant improvement (M = 92.4, SD = 10.9, pre vs. M = 99.3, SD = 6.6, post, p = .009). Discussion: This case-based, longitudinal curriculum in pediatric BMH simulating patient continuity improved residents' confidence and knowledge in diagnosing and managing common BMH conditions.
Subject(s)
Adolescent Psychiatry , Child Psychiatry , Curriculum , Internship and Residency , Pediatrics , Humans , Male , Female , Pediatrics/education , Education, Medical, Graduate , Mental Disorders , Mental Health , Child Psychiatry/education , Competency-Based Education , Adolescent Psychiatry/education , Child , AdultABSTRACT
The increase in mental health issues among children and adolescents has been declared a health crisis in the United States, and recent increases in key measures (e.g., self-harm and suicidal behaviors) have been found to disproportionately impact youth from minority backgrounds. Access to mental health treatment for youth is limited, but for minority youth, access to culturally sensitive care is even more limited. This article discusses the ways in which misdiagnosis and underdiagnosis of mental health conditions can occur in minority youth and provides key points for clinicians to consider while working with minority youth to improve mental health outcomes.
ABSTRACT
To identify elements of effective interprofessional education (IPE) within child and adolescent mental health (CAMH), we conducted a scoping literature review. A search of four databases revealed 32 studies that met inclusion criteria describing IPE interventions regarding CAMH. Studies included a range of medical, mental health, allied health, educational, and community professionals in clinical, school-based, and community-based settings. The majority of studies have focused on autism or general child mental health. Outcomes were generally positive but skewed toward attitudinal and knowledge-based measures. Practice-based interventions tended to support higher levels of educational outcomes, including behavioral, patient-level, or systems-level changes.
Subject(s)
Interprofessional Education , Mental Health , Adolescent , Child , Cooperative Behavior , Humans , Interprofessional RelationsABSTRACT
The unmet behavioral health treatment needs of children and adolescents have become a public health crisis in the United States, with only 20% of youths obtaining assessment and intervention when indicated. Workforce shortages, including mental health professionals who can provide pharmacologic intervention within an appropriate biopsychosocial context, directly impede our ability to address this crisis. The authors examine the history, education, regulation, and practice of advanced practice psychiatric nurses and consider models of collaborative practice that can be beneficial across treatment settings in order to provide better care of vulnerable youth in ways that foster partnership rather than competition.
Subject(s)
Advanced Practice Nursing , Nurses , Psychiatric Nursing , Psychiatry , Adolescent , Child , Humans , United StatesABSTRACT
Many US military families have faced separations of at least 1 family member for extended periods of time. This article shows how changes in military culture have increased the repercussions for military families, and especially for military-connected children. This article provides an introduction to aspects of military culture that are most applicable to children, an overview of important aspects of childhood development, a discussion of the impact of deployment on the emotional development and behavior of children left at home and their caregivers, and a review of some interventions and resources available to help these families navigate these challenges.
Subject(s)
Child Behavior/psychology , Child Development , Child Welfare , Family/psychology , Military Personnel/psychology , Adaptation, Psychological , Adolescent , Child , Child Behavior Disorders/psychology , Female , Humans , Male , Mental Health , Risk Factors , Social SupportABSTRACT
Military child and adolescent psychiatry (CAP) fellowship programs offer educational experiences universal to all civilian training programs in the USA. They also offer unique training opportunities not found in civilian CAP fellowships in order to prepare graduates to serve the needs of military families. Military-specific curricula and exposures prepare trainees to address various issues faced by military families, in contending with frequent military moves, parental deployments, and disrupted social ties. Curricula are also designed to provide the psychiatrist with a greater understanding of the rigors of military service. CAP training and subsequent assignments prepare military psychiatrists for diverse career paths in the military environment. CAP military careers often include duties in addition to treating patients. Administrative roles, academic teaching positions, as well as school consultation positions are all career options available to military CAP.
