Pediatric Resident Comfort in Mental Health Management Before and After an Integrated Clinic Rotation.

Abstract

Objective: The purpose of the study was to evaluate pediatric residents' self-reported comfort in screening, assessment, and treatment of common child mental health problems before and 1 year after piloting an integrated mental health (IMH) rotation.

Methods: Residents evaluated patients with mental health problems in their continuity clinic. Residents were supervised remotely by a child psychiatrist. Residents rated their comfort in mental health skills on a scale from 1 = very uncomfortable to 5 = very comfortable before and 1 year after the rotation was implemented. Changes in mean comfort in screening, assessment, and treatment of child mental health problems were calculated.

Results: Baseline pediatric resident (n = 62) comfort in providing IMH care was low, with modestly higher rates for screening and assessment than treatment. Fewer than half of the residents at baseline were comfortable with any of the aspects of treatment. At 1 year follow-up, resident (n = 64) overall comfort in treatment significantly increased from baseline (3.3 ± 0.8 versus 2.8 ± 0.8, p ≤ 0.003). There was a significant increase in the proportion of residents who reported comfort screening for attention-deficit/hyperactivity disorder (ADHD) (63.9% vs. 79.7%, p ≤ 0.050), educating families about mental health problems (33.3% vs. 51.6%, p ≤ 0.041), and starting a medication for ADHD (36.2% vs. 54.0%, p < 0.05) from baseline to follow-up.

Conclusion: This IMH rotation allowed residents to improve their comfort in treating children with mental health conditions. Remote supervision by a child psychiatrist for IMH may be practical for dissemination given the limited workforce of child psychiatrists.