Mental Health Competencies for Pediatric Practice

Abstract

Pediatricians have unique opportunities and an increasing sense of responsibility to promote healthy social-emotional development of children and to prevent and address their mental health and substance use conditions. In this report, the American Academy of Pediatrics updates its 2009 policy statement, which proposed competencies for providing mental health care to children in primary care settings and recommended steps toward achieving them. This 2019 policy statement affirms the 2009 statement and expands competencies in response to science and policy that have emerged since: the impact of adverse childhood experiences and social determinants on mental health, trauma-informed practice, and team-based care. Importantly, it also recognizes ways in which the competencies are pertinent to pediatric subspecialty practice. Proposed mental health competencies include foundational communication skills, capacity to incorporate mental health content and tools into health promotion and primary and secondary preventive care, skills in the psychosocial assessment and care of children with mental health conditions, knowledge and skills of evidence-based psychosocial therapy and psychopharmacologic therapy, skills to function as a team member and comanager with mental health specialists, and commitment to embrace mental health practice as integral to pediatric care. Achievement of these competencies will necessarily be incremental, requiring partnership with fellow advocates, system changes, new payment mechanisms, practice enhancements, and decision support for pediatricians in their expanded scope of practice.

Improving Pediatrician’s Behavioral Health Competencies Through the Project ECHO Teleconsultation Model

“…This practice is often not evidence-based and increases the risk of long-term metabolic and neurologic side effects. The American Academy of Pediatrics has released competency statements emphasizing the need to increase PCPs ability to manage BH needs within primary care, 9 technical reports about how to achieve these competencies, 10 and mental health toolkits and guidelines to support PCPs in delivering BH services within primary care. 11-13 While these are important steps in addressing this need, they are often not in themselves sufficient to support PCPs in doing this work.…”

Clinical practice guidelines for monitoring children's behavioural development at the 18‐month well‐baby visit: A decision analysis comparing the expected benefit of two alternative strategies

“…Further, screening well toddlers can represent a significant burden for the child and his or her family who otherwise may not receive the help they need. In fact, some of these children and their families (ie, 41.73% of well toddlers have parents who are concerned about their behaviour) may benefit from some form of reassurance, guidance‐counselling, and brief behavioural intervention‐specific instructions on the use of behavioural management strategies 9,19,20 …”

Achieving the Pediatric Mental Health Competencies

“…50 Although there are no specifications as to which skills should be taught and how, medical school curricula offer opportunities to enhance physician-patient communication and professionalism. The first step in addressing any mental health concern is to engage the family and build a therapeutic relationship by using communication skills such as MI and a "common-factors" approach, which builds on MI (see Discussion in accompanying policy statement 6 ). These skills (eg, building hope, providing empathy, partnering with families, rolling with resistance, managing conflict) are necessary in all aspects of patient care and should be emphasized and taught throughout the continuum of medical education, starting with medical school.…”

“…See the accompanying policy statement for a full discussion. 6 Research will be necessary to develop and hone strategies for training residents and fellows in these approaches.…”

“…In 2009, the American Academy of Pediatrics (AAP) published a policy statement proposing mental health competencies for pediatric primary care and recommended steps toward achieving them. 5 The policy statement "Mental Health Competencies for Pediatric Practice," 6 accompanying this technical report, affirms and, importantly, provides updates to incorporate new science on early brain development, to articulate the pediatrician's role in addressing social determinants of health and trauma, and to consider mental health practice in subspecialty, as well as primary care, settings.…”