Association of Behavioral and Mental Health Professionals in Continuity Clinic with Resident-Reported Competence

• Published in: The Journal of pediatrics Vol. 248; pp. 15 - 20.e1
• Main Authors: Green, Cori, Leyenaar, JoAnna K., Nuncio, Brenda, Leslie, Laurel K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2022
• Subjects: behavioral/mental health; continuity clinic; integrated care; pediatrics; B/MHP; AAP; continuity clinic; integrated care; aOR; behavioral/mental health; B/MH; CI; pediatrics; PDs; ABP
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2022.05.012

To assess whether residents who trained with a co-located or integrated behavioral/mental health professional (B/MHP) reported higher competence in the assessment and management of behavioral/mental health (B/MH) conditions than those who trained without an onsite B/MHP. We hypothesized that having an onsite B/MHP would be associated with higher self-reported competence, especially if integrated into clinic. Cross-sectional survey of applicants for the initial American Board of Pediatrics (ABP) certifying exam. The independent variable was training in continuity clinic with no onsite B/MHP, a co-located B/MHP, or an integrated B/MHP. Outcome variables were self-reported competence in 7 B/MH assessment skills and 8 treatment skills, summarized as two composite measures. Competence was rated on a 5-point scale; high competence was defined as mean scores >4. Logistic regression assessed relationships between independent and outcome variables adjusting for covariates including individual and residency program characteristics. Of 1503 eligible respondents, 645 (42.9%) reported no onsite B/MHP, 390 (26.0%) a co-located B/MHP, and 468 (31.1%) an integrated B/MHP. In multivariable models, respondents with a co-located B/MHP reported higher levels of B/MH assessment competence (adjusted odds ratio [aOR]=1.40 [95% confidence intervals (CI):1.06-1.86]) and treatment competence (aOR=1.45 [95% CI:1.03-2.05]) compared with those with no B/MHP. Respondents with an integrated B/MHP similarly reported higher odds of assessment (aOR=1.33 [95%CI 1.02-1.74]) and treatment competence (aOR=1.53 [95% CI: 1.10-2.13]) than the reference group. Although specific mechanisms were not tested, training with an onsite B/MHP within continuity clinic may improve pediatric trainees' competence for addressing B/MH conditions.