LAUSR

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 Medicine, on November 29 to 30, 2016, and in an accompanying Perspectives Paper of the National Academy of Medicine.5 Attendees represented leadership from all the disciplines mentioned previously. There was overwhelming consensus that training around child behavioral health, both within and across disciplines, deserves immediate and energetic attention. The workshop highlighted the role of interdisciplinary training that addresses the attainment of competency in child and family behavioral health promotion and identified what was a shared core knowledge base across disciplines as well as important unique competencies and contributions of specific disciplines. An urgency to achieve these training goals was reinforced by 5 parents of children with an array of behavioral health needs, who shared their frustrations as well as their too-often elusive successes in finding behavioral support for their child, themselves, and other family members. Overarching levers for action (Box) were identified: (1) enhancing clinical care settings to better support education and training, (2) partnering with other innovative programs, evaluating those efforts, and disseminating learnings, (3) encouraging a focus on behavioral health by organizations that determine qualifications and standards for trainees and training programs, and (4) coordinating local, state, and national promotion of effective training programs and funding streams for their initiation and ongoing support. Eight themes were identified to promote training settings and experiences that better prepare health professionals to improve behavioral health outcomes for children. Important themes include multigenerational (familyfocused) behavioral health surveillance and care; embedding evidence-based interventions to improve parenting and social-emotional child development; improving training that addresses the behavioral outcomes of disabling and life-threatening chronic conditions; engaging parents in copromotion of behavioral health; training health care professionals to collaborate with community programs, including preschools and schools, that also promote child behavioral health; and, perhaps most urgently, advocating for funding that supports child behavioral health training in interdisciplinary settings. Promising models of child behavioral health care and training were introduced by speakers from all disciplines as well as by contributors of more than 30 abstracts describing model programs that address child behavioral health needs. Documenting program effect as well as readiness for interdisciplinary impleVIEWPOINT