P4.011: Train New Trainers Child and Adolescent Psychiatry Fellowship: A Mental Health Certificate Program for Primary Care Providers

Background: In 2022, the Train New Trainer's Program (TNT) at UC-Irvine, which had an established adult mental/behavioral health training program for primary care providers (PCPs), started child and adolescent psychiatry (CAP) track to address the growing crisis in children's mental health.  Many youths see their PCPs for evaluations and ongoing treatment of mental health concerns. PCPs often have limited or no training in providing this care.  The TNT-CAP fellowship addresses the mental healthcare needs of youth and their family and keeps these youth in their primary care medical home by training PCPs to effectively prevent, diagnose, and manage mental health concerns within primary care. This is accomplished by TNT’s robust education model that includes two in-person conferences, twice monthly interactive virtual lectures, monthly small group mentorships sessions, multiple monthly topic-focused open office hours and access to career-long mentorship.

Methods: The TNT-CAP program recruits and trains PCPs from high-need areas across the United States. By training PCPs in evidence-informed mental health management practices, TNT-CAP significantly expands access to pediatric behavioral healthcare. The TNT program has steadily grown over the past 3 years and to assess program efficacy a 7-section program evaluation of the fellowship was implemented at three time points: prior to fellowship initiation, mid-fellowship, and post-fellowship. This evaluation consisted of assessing the comfort levels for assessing and treating psychiatric conditions, prescribing and managing medications, utilizing behavioral techniques, completing a suicide risk assessment, and utilizing evidence-based screening measures.

Results: PCPs from across the United States have participated in the TNT-CAP fellowship for three consecutive years. Many of the TNT-CAP fellows practiced in areas that were designated a medical shortage area and/or had high area deprivation indices. The TNT-CAP program’s approach to equip primary care clinicians with enhanced knowledge and skills in behavioral medicine has the potential to significantly reduce the access gap in disadvantaged and under-resourced communities. Results from the 7-section program evaluation demonstrate an increase in the PCPs' comfort in all areas assessed. Further, fellows demonstrated a statistical improvement in performance in a test of knowledge from start to completion of the program.

Conclusion: The goal of TNT-CAP fellowship is to successfully train primary care providers to: (1) Complete evidence-based and efficient psychiatric interviews in primary care or pediatric settings; (2) Effectively diagnose and treat commonly encountered psychiatric conditions; (3) Navigate boundaries and family dynamics with children and adolescents with behavioral or mental health concerns; (4) Teach these principles to their primary care colleagues. A unique aspect and strength of all TNT fellowships, including TNT-CAP, is career-long alumni lectures and small group mentorship that is accessible after the yearlong intensive fellowship program. Based on our results, the TNT-CAP fellowship is an effective program to help increase mental health capacity within primary care.