P3.223: Evaluation of Pediatric Residency Mental Health Training Program in the Primary Care Setting

Background: Pediatric mental health (MH) concerns are increasingly prevalent, yet there continues to be a scarcity of available resources. Pediatric primary care is an ideal setting for addressing MH concerns, particularly in underserved communities. However, pediatric trainees report low competency in addressing MH. We developed an interdisciplinary training program for pediatric residents with the Health Resources and Services Administration’s Primary Care Training and Enhancement - Residency Training in Mental and Behavioral Health program.

Methods: The training program was co-designed by pediatricians and MH providers. It included three modalities: (1) Didactics led by trained preceptors including accompanying guides for common pediatric MH concerns (e.g., ADHD, anxiety, suicidal ideation); (2) Service Learning with community-based partners addressing trauma-informed care, violence prevention, and substance use; and (3) Experiential Learning through suicidal ideation simulations, shadowing MH providers, and participation in parenting and other groups.

To evaluate the program, we assessed (1) process measures; and (2) self-efficacy (SE) and self-reported MH care practices in the primary care setting through a pre-intervention survey.

Results: Since December 2022, 135 residents have participated in 12 different Didactic sessions, 5 Service Learning opportunities and 8 Experiential Learning opportunities. Feedback from residents was positive; one resident reported, “It was helpful to observe a [psychiatric evaluation through Experiential Learning] and see how counseling approaches are implemented.”

Overall, 24% of residents participated in an intensive MH training delivered by The REACH Institute. To support a sustainable training model, 90% of pediatric primary care faculty completed the training.

Baseline survey data were collected from 94 pediatric residents. The sample was predominantly white (58.5%) and female (76.6%). Approximately half of the residents (48.9%) reported that their SE in assessing and treating common pediatric MH concerns was ineffective.

Residents reported the highest SE in diagnosing depression (76.6% reported effective) and the lowest SE in diagnosing ADHD (61.7% reported effective). They also reported the highest SE in addressing MH treatment hesitancies (66.0% reported effective) and the lowest SE in dosing ADHD medications (25.5% reported effective).

Residents reported that they were most likely to independently review MH screenings with patients and most likely to consult a MH provider when conducting an assessment for suicidality.

Conclusion: This comprehensive pediatric residency MH training program, comprised of Didactics, Service Learning and Experiential Learning, has been feasible within our residency program and well received.

Baseline surveys reveal gaps in residents' SE in addressing pediatric MH. Specifically, residents reported the lowest SE in ADHD assessment and management, a key finding given that ADHD is a significant aspect of pediatric care. Residents reported greater independence in MH screening and less independence in managing MH safety and crises.

These findings will inform the development of the training program to enhance MH competencies. Further analyses of post-intervention surveys are forthcoming.