Connecticut Initiative Seeks to Better Prepare Future Pediatricians to Address Behavioral Health Needs of Children
/In Connecticut, the prevalence of diagnosed behavioral health conditions or developmental delay among children ages 3 to 17 years old increased from 16% in 2007 to 25% in 2018. Few would be surprised if the percentage today, seven months after the arrival of COVID-19 in Connecticut and all that it has wrought, is even larger.
Concern regarding how best to respond is prevalent nationwide, including in Connecticut. The American Academy of Pediatrics (AAP) has increasingly called on pediatric primary care providers to recognize and treat patients with common behavioral health disorders.
However, according to an Issue Brief released this week by the Child Health and Development Institute (CHDI) of Connecticut, pediatricians indicate concerns about their capacity to do so. In a recent survey conducted by the AAP, pediatricians reported lack of training and confidence in their ability to address behavioral health disorders.
CHDI pointed out that pediatric residency training programs, which prepare pediatricians, family physicians and nurse practitioners to deliver care to children, require extensive training in primary care and are the ideal place to better prepare future child health providers to address common behavioral health disorders.
In collaboration with the five grantees, CHDI has set out to explore improvements in Connecticut’s pediatric residency training experiences with the goal of informing change in residency training across the state. Collaboration among national pediatric organizations is also being sought to improve and influence behavioral health curricula and clinical experiences nationally.
Behavioral health is important to the overall health and well-being of children, the Issue Brief stressed. More than one in six children has a behavioral health disorder such as depression or anxiety nationally and that number has been growing – even prior to the pandemic.
According to the Centers for Disease Control and Prevention:
Diagnosed depression and anxiety among children ages 6 to 17 years old increased from 5.4% in 2003 to 8.4% in 2012.
Suicide rates increased 56% between 2007 and 2017 among children ages 10 to 14 years old and is now the second leading cause of death in this age group.
7.4% (approximately 4.5 million) have a diagnosed behavior problem
7.1% (approximately 4.4 million) have been diagnosed with anxiety
3.2% (approximately 1.9 million) have been diagnosed with depression.
CDHI indicates that pediatric primary care providers are well positioned to identify and treat children with common behavioral health disorders, because:
Ninety percent of children attend an annual well-child visit, and many visit the pediatrician’s office several times per year.
The long-term relationship that primary care providers have with families can ensure proper and early identification of behavioral health concerns, opportunities for on-going support, and monitoring of treatment progress
Primary care can help connect families to appropriate behavioral health services.
However, CDHI points out, there is a need for enhanced competency in identifying and treating behavioral health conditions among primary care providers. Generally, current pediatric residency programs often lack robust training experiences in behavioral health – a reality that some in Connecticut are working to change.
During the past year, the CHDI partnered with local residency programs in Connecticut to identify training gaps and advance strategies to improve behavioral health training. A grant program funded by the Children’s Fund of Connecticut (CFC) and administered by CHDI awarded grants to five, Connecticut-based, pediatric primary care, family medicine, and nurse practitioner residency programs to support the planning and implementation of innovative, hands-on experiences in behavioral health care for their trainees, CHDI explained.
Residency training programs include:
Asylum Hill Family Medical Center, Family Medicine Residency Program in Hartford - Medical residents and staff will be trained in trauma screening, referral, and family education during well-child and home visits using the Child Trauma Screen (CTS).
Community Health Center, Inc., Nurse Practitioner Residency Program in Middletown - Training experiences that address socio-emotional health and provide de support to families will be developed and evaluated for nurse practitioner residents. Enhanced training will include trauma-informed care, adolescent behavioral health, and lactation support.
Connecticut Children’s, Pediatric Residency Program in Hartford - Medical residents will develop and implement office-based projects that address infant and child emotional and behavioral health through caregiver education at well-child visits.
Yale School of Medicine, Pediatric Residency Program in New Haven - Behavioral health simulations will be developed and implemented for residents to practice the following skills: gathering a comprehensive health and behavioral health history, using clinical screening tools, working through a differential diagnosis, collaborating with a behavioral health professional, and monitoring children’s socio-emotional development in the pediatric primary care setting.
Yale School of Nursing, Pediatric Nurse Practitioner Program in New Haven - An integrated behavioral health educational experience for residents will be designed and implemented. The experience will offer a new opportunity for nurse practitioner residents to learn and receive supervision from behavioral health providers in the pediatric primary care setting to help them build the capacity to manage common behavioral health problems.
The Child Health and Development Institute is a catalyst for improving the health, mental health and early care systems for children in Connecticut.
