Treating Behavioral Health Conditions: What Worries Pediatric Residents?

Background: Changes in the delivery of health care have increased attention to behavioral health care. Particularly, there is an emphasis on improving the delivery of behavioral health care through integrated care delivery systems. Unfortunately, many medical students emerge from their medical school experience with little more than a brief exposure, often a 1-month rotation, in a psychiatric setting. As residents arrive for their first and subsequent years of training, formal exposure to behavioral training often does not occur. Pediatric residents frequently begin their residency in “continuity clinic,” where they are providing primary behavioral care to children, adolescents and their parents. This care often involves providing guidance about behavioral health issues. Residents are often “flying by the seat of their pants” in this particular care area because there has not been formal training. This study represents a qualitative study of Year 1 residents early in their first year of residency and as they transition into Year 2 of their pediatric residency. It is intended to document their concerns, knowledge and attitudes about providing behavioral health care. Residents will be followed in this project for 3 years as a program of formal didactic education. Integration of clinical psychologists, curbside consults and shared visits is implemented to address gaps in behavioral health experience and knowledge. Methods: Residents participated in focus groups during years 1 and 2 of their residency. Discussion focused on knowledge gaps, concerns and successes in delivery of behavioral health care within their general pediatric practice. Results: Several key themes emerged including time management, struggles with establishing rapport with patients, knowing referral sources and protocols, comfort level diagnosing but not knowing how to treat a variety of conditions, difficulties in establishing communication and relationships with adults and dysfunctional families, making mistakes that result in children dying, and the relative importance of behavioral health. Conclusion: Changes in residency training to improve skills in behavioral health treatment may be warranted