For at least 4 decades, the need for improved pediatric residency training in behavioral and mental health has been recognized. The prevalence of behavioral and mental health conditions in children, adolescents, and young adults has increased during that period. However, as recently as 2013, 65% of pediatricians surveyed by the American Academy of Pediatrics indicated that they lacked training in recognizing and treating mental health problems. Current pediatric residency training requirements do not stipulate curricular elements or assessment requirements in behavioral and mental health, and fewer than half of pediatric residents surveyed felt that their competence in dealing with mental health problems was good to excellent. It is time that pediatric residency programs develop the capacity to prepare their residents to meet the behavioral and mental health needs of their patients. Meeting this challenge will require a robust curriculum and effective assessment tools. Ideal training environments will include primary care ambulatory sites that encourage residents to work longitudinally in partnership with general pediatricians and behavioral and mental health trainees and providers; behavioral and mental health training must be integrated into both ambulatory and inpatient experiences. Faculty development will be needed, and in most programs it will be necessary to include nonpediatrician mental health providers to enhance pediatrician faculty expertise. The American Board of Pediatrics intends to partner with other organizations to ensure that pediatric trainees develop the competence needed to meet the behavioral and mental health needs of their patients.

Mental and behavioral disorder diagnoses in children and youths are increasing at a concerning rate and are antecedent to many lifetime physical and behavioral health disorders. 1 The cost to individuals, families, communities, and the American public is enormous. Comprehensive attention to the risks of all children, starting early in life, through behavioral health promotion, risk prevention, early detection of concerning behaviors, and effective treatment of behavioral disorders is an unmet need.Child health care holds considerable promise for improving child and lifespan behavioral outcomes. 2 Wellchild visits, frequent in the first 3 years and continuing to early adulthood, provide opportunities to enhance family support of child social-emotional development, identify common behavioral problems, detect early signs of significant mental disorders, and provide or arrange beneficial interventions. Parents generally trust primary child health care professionals and view visits to their care settings as supportive and nonstigmatizing. Similarly, parents of children at risk for behavioral consequences of chronic disease repeatedly visit and trust their pediatric subspecialty care clinicians. However, most primary care and subspecialty care pediatricians are not trained to take on this role or participate in team efforts to do so. 3 Integration of behavioral and medical expertise in practice has received increasing attention. Colocated and integrated care has focused largely on diagnosis and treatment of serious behavioral disorders and comorbidities of serious acute and chronic diseases and has not yet systematically engaged behavioral health promotion and risk prevention. Some subspecialties and a growing number of primary care child health practices now have interdisciplinary staff including behaviorally oriented pediatricians, psychiatrists, psychologists, nurse practitioners, social workers, or other health care professionals. Yet, child psychiatrists, pediatric psychologists, and developmental-behavioral pediatricians are in short supply; other professionals are often not trained to provide behavioral health promotion and care for children and families. Pediatricians of the future will be expected to more competently contribute to behavioral health promotion and care. 4 However, most training programs in pediatrics, as well as other disciplines, are not prepared to create a workforce that can address the full spectrum of today's child health needs in an interdisciplinary mode.All of these points were considered at a workshop conducted by the Board of Children, Youth, and Families of the National Academies of Science, Engineering, and

The increasing prevalence of behavioral and/or mental health (B/MH) problems among children, adolescents, and young adults is rapidly forcing the pediatric community to examine its professional responsibility in response to this epidemic. Stakeholders involved in pediatric workforce training were brought together in April 2018, invited by the American Board of Pediatrics and the National Academies of Sciences, Engineering, and Medicine, to consider facilitators and barriers for pediatrician training to enhance care for B/MH problems and to catalyze commitment to improvement efforts. During the interactive meeting, parents, young adult patients, and trainees, together with leaders of pediatric training programs and health care organizations, acknowledged the growing B/MH epidemic and discussed past and current efforts to improve training and care, including integrated delivery models. Attendees committed in writing to making a change within their department or organization to improve training. There also was agreement that organizations that set the standards for training and certification bear some responsibility to ensure that future pediatricians are prepared to meet the needs of children and adolescents. Reports on commitments to change 12 months after the meeting indicated that although attendees had encountered a variety of barriers, many had creatively moved forward to improve training at the program or organizational level. This article describes the context for the April 2018 meeting, themes arising from the meeting, results from the commitments to change, and 3 case studies. Taken together, they suggest we, as a pediatric community, can and must collaborate to improve training and, by extension, care.