LAUSR

Child and adolescent psychiatry continues to be an important and unique sub-specialty.While it is commonplace for general psychiatrists to see elderly patients, patients with addictions, forensic patients, and patients with co-existing medical illnesses, it is uncommon in many places for psychiatrists to see children and adolescents, a group which currently represents nearly one-quarter of the entire US population, without fellowship or other equivalent training (via a triple-board or post-pediatric portal program). Current Accreditation Council for Graduate Medical Education (ACGME) psychiatry residency training program requirements call for no less than 2 months of child and adolescent psychiatry, supervised by child and adolescent psychiatrists who have been certified by the American Board of Psychiatry and Neurology. This training prepares psychiatrists with general adult training to provide care, for example, to transitional age youth (16–24 years) under many circumstances. This 2-month requirement stands in contrast to other sub-specialty requirements, which are either of shorter duration (1 month for geriatric and addiction psychiatry, not specified exactly for forensic psychiatry) or do not necessarily require the supervision of board-certified subspecialists (geriatric, addiction, forensic, and consultationliaison psychiatry) [1]. Updated workforce statistics have confirmed a continued shortage of child and adolescent psychiatrists in the USA. The current workforce of approximately 8300 child psychiatrists remains inadequate, as nearly 20% of all children and adolescents experience psychiatric disturbances [2]. Child and adolescent psychiatry training programs, therefore, have the important challenge of building a workforce that is adequate in number, fully competent in the basic skills of the subspecialty (currently defined by ACGME milestones), and additionally qualified and prepared to practice in a short supply/ high demand context. In this issue of Academic Psychiatry, we are pleased to feature articles on child and adolescent psychiatric training initiatives that are innovative responses to these contemporary challenges. Specifically, we touch upon modernizing training towards improving access, ensuring basic competency and compliance with milestones and new accreditation requirements, and, finally, improving recruitment. Two of the most prominent strategies for improving accessibility to child and adolescent psychiatric services are telepsychiatry and primary care integration [3]. While the former can mitigate geographic barriers to access and reduce inefficiencies related to travel time, the latter further leverages child and adolescent psychiatrists’ time and expertise through collaboration with primary care providers. Parmar et al. [4] describe child and adolescent telepsychiatry training for general psychiatry residents and Biel et al. [5] describe child and adolescent mental health training for pediatric primary care providers. While neither telepsychiatry nor primary care integration are mandated training experiences for psychiatry or its sub-specialties, these new models will likely play a greater role in the careers of future psychiatrists, and the need for psychiatric curricula in these areas, as introduced in these two articles, will increase. Several of the articles in this issue describe strategies for improving recruitment into child and adolescent mental healthcare careers. Diamond et al. [6] deserve special commendation for their focus on undergraduate college students, who are at an earlier stage of career development than the * Anthony P. S. Guerrero [email protected]