Preparing Trainees for Public Health Advocacy Through Community Partnerships.

This article reviews the existing literature related to medical training in public advocacy and provides the reader with several training examples to consider in a child and adolescent psychiatry fellowship or in combined training programs. Advocacy training embedded within community, forensic, integrated care, school, and many other experiences throughout training provides the skills and tools that the trainee will use in the future when they practice in any setting. This comprehensive training approach aligns with the evolving landscape of child and adolescent mental health where a deep commitment to public health and advocacy is increasingly essential.

Workforce Initiatives to Advance Health Equity and Diverse Representation.

The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.

Forensic Psychiatry Education in Child and Adolescent Psychiatry (CAP) Fellowship: Results from a Multi-site Survey.

OBJECTIVE: This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. METHODS: The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. RESULTS: Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. CONCLUSIONS: Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.

AACAP's Strategic Plans to Enhance the Diversity of the Child Psychiatry and Child Mental Health Workforce Across all Mission Areas.

The American Academy of Child and Adolescent Psychiatry (AACAP) promotes the healthy development of children, adolescents, and families through advocacy, education, and research. This requires effectively meeting the mental health needs of historically minoritized communities. A diverse clinician workforce is an essential component of meeting those needs. This article will discuss AACAP's strategic plan for diversifying the workforce, this will be done with 3 main points: promoting diversity, equity, and inclusion (DEI) across all mission area, creating a pipeline of child and adolescent psychiatrists, and monitoring DEI activities and progress on an organizational level.

Exploring the effectiveness of a cascading mentorship model in developing CanMEDS competencies in postgraduate medical education: a qualitative interview study among resident mentors at a medical school in Canada.

OBJECTIVES: The CanMEDS framework, an educational framework for physicians used in Canada, defined competencies that physicians require to meet patients' needs, all of which can be cultivated through mentorship activities. The Advocacy Mentorship Initiative (AMI) at the University of Toronto used a cascading mentorship model (CMM), whereby resident mentors (RMs) mentored undergraduate medical student mentors (MSMs), who in turn mentored youth raised in at-risk environments. Both RMs and MSMs were mentored by the AMI programme lead, a staff psychiatrist, with expertise in child and adolescent psychiatry. The research question of this study was as follows: What were the merits of using a CMM in enhancing the knowledge, competencies and residency experiences of RMs in AMI? DESIGN: Qualitative interview study. SETTING AND PARTICIPANTS: RMs involved in AMI from January 2017 to December 2020 were invited to participate in the study. A total of 11 RMs agreed to participate. METHODS: Interviews were conducted to canvas participants about how AMI impacted them, and these were recorded, transcribed and anonymised. Braun and Clarke's approach to thematic analysis was used to identify 'subthemes' and 'themes'. RESULTS: Eleven RMs participated in the study. A major theme identified was how AMI enhanced the medical learner experience by augmenting the educational experience of MSMs, strengthening RMs' values and attitudes, and strengthening RMs' knowledge and competencies. The second theme captured was the effective facets of a mentorship programme in AMI, including the CMM, and collaborative and inclusive relationships between mentors and mentees. CONCLUSIONS: RMs identified that the CMM of AMI cultivated CanMEDS competencies in medical learners; deepened medical learners' understanding of social determinants of health; and offered a bidirectional approach to teaching and learning between MSMs and RMs. MSMs and RMs also learnt from the staff psychiatrist.

An Exploratory Survey of Career Choice, Training, and Practice Trends in Early Career Child and Adolescent Psychiatrists and Fellows.

OBJECTIVE: A pilot survey was created to sample early career child and adolescent psychiatrists (CAPs) and fellows to identify factors contributing to recruitment, satisfaction, and general practice trends. METHOD: A 44-item survey was developed based on a previous study of early career CAPs and discussion at an early career forum. Participants were recruited at a professional meeting and through emails sent to all 125 US training program directors. RESULTS: Only 184 out of 2209 responses were received. Approximately two-thirds were female and one-third had completed fellowship. Most decided to pursue a career in child psychiatry during medical school and expected full time salaries between $175,000 and $250,000 after fellowship. Forty-five percent owed more than $150,000 in educational debt. The top reasons for pursuing a career in child psychiatry included the following: working with children, working in an interesting field, and helping society. Males (x = 85.7, SD 22.9) compared with females (x = 77.5, SD 25.3) were more interested in pursuing full time work. A higher proportion of participants were confident in prescribing medications (x = 79.9, SD 17.1) compared with providing psychotherapy (X = 63.3, SD 23.9). CONCLUSIONS: The vast majority of early career CAPs were recruited during medical school, motivated by altruistic reasons, and rated high confidence in their career choice despite significant student loan debt. Training directors should consider increasing competency in psychotherapeutic skills. Early child psychiatry exposure and a means of addressing physician debt are needed to improve recruitment to this specialty.

A National Pediatric Telepsychiatry Curriculum for Graduate Medical Education and Continuing Medical Education.

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.

The Path to Child and Adolescent Psychiatry.

The United States has a critical shortage of child and adolescent psychiatrists such that 70% of counties in the United States do not have any child and adolescent psychiatrists.1 Since 2014, the number of US and Canadian medical school applicants to psychiatry residencies has increased by 69%; however, the number of child and adolescent psychiatry fellowship applicants has increased by only 11%.2 Up to two-thirds of psychiatry residents report considering a career in child and adolescent psychiatry; however, only one-fourth of residents ultimately apply for a child and adolescent psychiatry subspecialty training.3,4 We surveyed child and adolescent psychiatry fellows across the country to understand the different pathways into child and adolescent psychiatry, with the hope of providing program directors' and faculty mentors' guidance on how to generate interest in child and adolescent psychiatry and to support residents in this pursuit.

Integrating Measurement-Based Care into Trainee Education.

Although there is no published literature on the use of rating scales in child and adolescent psychiatry fellowships, there is evidence of use of rating scales in other residency programs including general psychiatry, pediatrics, and family medicine. The authors surveyed the American Association of Directors of Psychiatric Residency Training listserv inquiring how rating scales are used in child and adolescent psychiatry training programs. Results included the use of specific rating scales, if they are optional or required, presence or absence of didactics, perception of rating instruments by fellows and faculty, integration with quality improvement projects, and use in practice after graduation.

Identification and Management of COVID-19 Related Child and Adolescent Mental Health Problems: A Multi-Tier Intervention Model.

Nepal is a low and medium-income country (LMIC), situated in South-east Asia, with a population of 29 million, of which, 40-50% are children and adolescents. The Coronavirus Disease 2019 (COVID-19) pandemic has affected the lives of people around the world, including Nepal. The child and adolescent mental health (CAMH) needs and services in Nepal have a significant gap. CAMH in Nepal suffers from lack of specialized training in this field as well as scarcity of human resources and services. There is only one full-time child and adolescent psychiatry (CAP) out-patient clinic in the country. Some recent activities have focused on CAMH in Nepal but the COVID-19 pandemic has produced new challenges. Access to mental health services for children and adolescents (C&A) across Nepal has been adversely affected. Factors such as closure of schools, confinement at home, lockdown, transportation problems, uncertainty, loss of usual routine and fear of infection have affected the mental health of C&A. This has highlighted a need to build capacity of available local human resources, enhance community support, teach measures of coping with stress and improve CAMH service delivery by strengthening the referral system, but these have to be addressed overcoming problems of travel restrictions and limited resources. To address these needs, online platform can be a suitable approach. With this view, a multi-tier CAMH intervention model was developed, which utilizes online platform for training mental health professionals across Nepal, who would then facilitate sessions for C&A, teachers, parents and caregivers; and link them to CAMH services locally, and remotely through teleconsultation. This started as a pilot from June 2020 and will continue till end of February 2021, with the aim to reach 40,000 C&A, parents, teachers and caregivers. As of Nov 2020, this model has been used to successfully conduct 1,415 sessions, with 28,597 population reached. Among them, 16,571 are C&A and 12,026 are parents, teachers and caregivers, across all 7 provinces of Nepal. In this paper, the multi-tier intervention to address the COVID-19 related CAMH problems has been discussed as a feasible framework for resource limited settings and LMICs like Nepal.

Child and adolescent psychiatry training and services in the Middle East region: a current status assessment.

Mental health is a key component of health, yet appropriate care is limited. Evidence concerning child and adolescent mental health has predominantly come from western countries, while the Middle East region, with a large youth population, has reported very little on it. This original, cross-sectional study of child and adolescent psychiatry in the Middle East provides an assessment of current postgraduate programs, services and what is needed to build workforce capacity. Academic psychiatrists from 16 Middle East countries were invited to form a Consortium to map current postgraduate training as one of the determinants of available child and adolescent psychiatry services, identify gaps in the distribution of child and adolescent psychiatrists, and propose potential steps to improve access to child and adolescent mental health care. The study collected data from 15 of the 16 countries invited (no data provided from Yemen). The study revealed underdeveloped child and adolescent psychiatry academic systems throughout the region. Despite recognition of the specialty in a majority of the countries (11/15), only six countries had established a designated child and adolescent psychiatry training program. The overall shortage of child and adolescent mental health specialists varied, yet all Consortium members reported a need for additional child and adolescent psychiatry specialists and allied professionals. Lack of child and adolescent psychiatry specialized programs in place throughout the region has evidently contributed to the shortage of qualified child and adolescent mental health workforce in the Middle East.

Core Competencies for Pediatric Consultation-Liaison Psychiatry in Child and Adolescent Psychiatry Fellowship Training.

BACKGROUND: Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship. OBJECTIVE: The objective of this project was to develop a national consensus on pediatric CLP competencies to help guide training in this specialty. METHODS: An expert working group developed a list of candidate competences based on previously established educational outcomes for CLP (formerly Psychosomatic Medicine), child and adolescent psychiatry, and general psychiatry. A survey was distributed to members of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee to determine child and adolescent psychiatry fellowship educational needs on pediatric CLP services and generate consensus regarding pediatric CLP competencies. RESULTS: Most survey respondents were supportive of the need for a national consensus on core competencies for pediatric CLP. Consensus from a panel of experts in the field of pediatric CLP generated a list of proposed core competencies that track the Accreditation Council for Graduate Medical Education's six core competencies. CONCLUSIONS: Consistent learning outcomes provide the foundation for further development of tools to support training in pediatric CLP. There is a need to develop further tools including outcome assessment instruments and self-directed learning materials that can be used to support lifelong learning.

Teaching Well-Being: From Kindergarten to Child Psychiatry Fellowship Programs.

Psychiatric training for medical students, residents, and fellows can integrate well-being principles to improve mental health. From preschool to college, principles of wellness and health promotion are increasingly prevalent and are showing promising results. Courses on happiness and well-being have been embraced at colleges and universities. Well-being is now a required component of child and adolescent psychiatry training. Training residents and fellows in emotional and behavioral well-being requires incorporation into clinical supervision and the overall culture and infrastructure of the training program.

Addictions Training in Child and Adolescent Psychiatry Fellowships.

OBJECTIVE: The primary purpose of this article is to identify current gaps in adolescent addictions training in order to develop a strategic plan to enhance clinical and didactic curricula for child and adolescent psychiatry fellowships. METHODS: The American Association of Directors of Psychiatric Residency Training (AADPRT) Taskforce on Addictions was assembled in 2017 and consisted of 10 AADPRT members and 4 consultants to the committee with known experience in addictions treatment and training. A 21-item survey was developed and disseminated to all AADPRT members who were Child and Adolescent Psychiatrist (CAP) fellowship directors using the AADPRT Listserv (n = 109). Data were exported from the SurveyMonkey platform to provide deidentified responses to each question. RESULTS: Forty-seven programs (43%) responded to the survey. In supervision and education, 40.43% of programs denied making use of expertise from Addiction Psychiatry Fellows, faculty, and resources. Common reasons for not offering specific teaching and clinical exposure include a limited number of faculty/staff, limited number of faculty/staff with expertise, and insufficient clinical sites. Curriculum content and teaching exposure varied substantially between programs. CONCLUSION: While a lack of services in adolescent addictions may be a limiting factor, developing expertise through faculty development activities, as well as nationally disseminated model curricula with educational resources has the potential to improve national adolescent addictions training.

APA Council Reports.

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 13-16, 2017, the APA councils heard reports from their components. Following are summaries of the activities of the councils and their components.

Zebras in the Forest: the experiences of Dual-Trained Child Psychiatrists and Paediatricians in Australia and New Zealand.

OBJECTIVES: The objectives of this study were to examine the experiences of dual-trained child psychiatrists and paediatricians in Australia and New Zealand and inform the review of the Dual Fellowship Training Programme by the Royal Australian and New Zealand College of Psychiatrists and Royal Australasian College of Physicians. METHODS: All dual-trained child psychiatrists and paediatricians and current trainees were electronically surveyed in 2015. RESULTS: Seven out of eight specialists (88%) and four out of six trainees (67%) responded. Six (55%) completed or were undertaking training as part of the Dual Fellowship Training Programme. Most respondents entered dual training without difficulty, found the transition from paediatrics to adult psychiatry challenging, and were reassured by their decision to undertake dual training on reaching advanced training in child psychiatry. Benefits and downsides of dual training were noted during and following training. A significant proportion of specialists (55%) were working in hospital-based environments, especially consult liaison services, suggesting that they added long-term value to both the fields of child psychiatry and paediatrics. CONCLUSIONS: The Dual Fellowship Training Programme remains a valuable vehicle for gaining skills in paediatrics and child psychiatry. There is support for its continuation by previous and current participants.