Pediatric Mental Health Practice Change: A Scalable Model for Training and Evaluation

This study aimed to evaluate a theory-based measurement tool to assess primary care clinicians' (PCCs') knowledge, self-efficacy, and behavioral intentions across key pediatric mental health conditions. The authors used this tool to examine the impact of a comprehensive continuing medical education (CME) program.

The Patient-Centered Mental Health in Pediatric Primary Care (PPP) "mini-fellowship" included a 3-day interactive workshop and 12 follow-up coaching calls. PCCs (N=898) completed a 68-item assessment at baseline, postworkshop, and 6-month follow-up. Principal-components analysis identified 10 stable domains aligned with clinical priorities, distinguishing primary care-common disorders (PC-CDs; attention-deficit hyperactivity disorder, depression, anxiety, and suicidality) from specialty-level disorders (S-LDs; bipolar disorder, severe aggression, conduct disorders, etc.). All domains showed strong internal consistency (α≥0.77). Mixed-effects regression models examined change over time and predictors of behavioral intentions.

Significant improvements in knowledge, self-efficacy, and behavioral intentions were observed postworkshop, with sustained gains at the 6-month follow-up for PC-CDs. Improvements in knowledge of and comfort with S-LDs predicted stronger behavioral intentions across both common and specialty conditions. No baseline differences were observed between those who completed the 6-month follow-up (N=416) and those who did not. PCCs who completed training after the onset of the COVID-19 pandemic had slightly larger and more persistent improvements.

This CME model produced durable improvements in PCCs' readiness to deliver pediatric mental health care. The accompanying theory-informed measurement tool reliably captured these changes and may offer a practical, domain-specific framework for evaluating multidisorder pediatric mental health training initiatives in primary care.