Current state of evidence for medication treatment of preschool internalizing disorders.

Psychotropic medications are being prescribed off-label by psychiatrists to treat preschool children diagnosed with internalizing disorders. In this review, the current state of evidence is presented for medications used to treat preschool children (ages 2-5 year olds) diagnosed with anxiety and/or depressive disorders. Eleven studies were systematically identified for this review based on a priori criteria. Overall, the available literature revealed that studies addressing the medication treatment of internalizing disorders in preschoolers are extremely limited and represent relatively weak research methodologies. Given the increasing prevalence of the use of psychotropic medications to treat preschool children and the unique challenges associated with working with this population, it is imperative that mental health practitioners are aware of the current, albeit limited, research on this practice to help make informed treatment decisions. Suggestions about how to monitor potential costs and benefits in those unique cases in which psychopharmacological treatments might be considered for young children are given. Moreover, areas of additional research for this population are discussed.

Feasibility and Acceptability of a Pediatric Primary Care Physician Training for Anxiety Screening and Evidence-based Intervention.

Anxiety is one of the most prevalent psychological conditions in the pediatric population, and its associated impairments often persist into adulthood. Pediatricians are in a unique position to screen, briefly intervene, and facilitate treatment to prevent long-term impacts. However, they often do not have adequate training to do so. The current study addressed this gap by providing a brief online educational workshop aimed to promote: (1) screening for anxiety and (2) follow-up with appropriate evidence-based interventions. Fifty-three providers participated, and 38 completed surveys pre- and post-training. Findings indicate acceptability of the training to providers, improved knowledge related to anxiety, and increased readiness to manage anxiety during a medical visit. This study supports the utility of a brief, online training on screening and provision of evidence-based treatment for anxiety in pediatric primary care.

Pediatrician Burnout Before and After the COVID-19 Pandemic.

OBJECTIVE: During the surge of the COVID-19 pandemic, burnout among physicians increased significantly. In the spring of 2023, the COVID national emergency was terminated in the U.S. To investigate whether provider burnout rates have returned to pre-pandemic levels, the current study compared dimensions of burnout among pediatricians pre- and post-pandemic. METHOD: As part of 2 separate behavioral health trainings held at a Midwest academic health center in 2019 and virtually in 2023, data on burnout was collected from 52 pediatricians pre-pandemic and 38 pediatricians post-pandemic. Participants completed an online survey during the trainings and responded to items reflecting 3 dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. RESULTS: There were no statistically significant differences in pre- and post-pandemic burnout amongst pediatricians in terms of total scores, number of pediatricians who met the clinical cutoff for each dimension, number of cutoffs met, or number of providers reporting elevated burnout on at least 1 dimension (p > .05 for all comparisons). Participants were 1.77 times more likely to meet the cutoff for emotional exhaustion post-pandemic than pre-pandemic. Over half of providers met this cutoff post-pandemic, compared to only 35% pre-pandemic. CONCLUSIONS: While post-pandemic rates of burnout among pediatricians appear to be statistically similar to pre-pandemic levels, there appear to be clinically significant differences in emotional exhaustion between groups. With 63% of the post-pandemic group meeting the cutoff score for at least 1 dimension, it is imperative for the healthcare system to consider ways to mitigate burnout.

Comparing primary care pediatricians' perceptions of clinics with and without integrated behavioral health.

Objective: The purpose of this study was to investigate primary care pediatrician (PCP) perceptions of prevalence of, time spent in, and satisfaction with behavioral health services across clinics with and without on-site behavioral health providers (BHPs). Methods: A cross-sectional survey design was used to examine satisfaction across sites. Data were collected on PCP perceptions of behavioral health services among 60 pediatricians within two academic medical systems. Results: PCPs perceived behavioral health issues are prevalent and a time-consuming aspect of medical appointments and preferred to have on-site BHPs over off-site referral sources. Compared to sites without an on-site BHP, sites with on-site BHPs were more satisfied with behavioral health service availability and resources, felt they spent more time addressing medical concerns, and spent less time providing anticipatory guidance. Discussion: Study limitations included questions surrounding the validity of survey items to accurately assess PCP perceptions, lack of rigorous experimental design, and reliance on self-report data.