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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
as behavioral and developmental pediatrics are particularly relevant to the prevention of MEB disorders among young people. However, there is no accredited pathway for subspecialty training of physicians in the prevention of MEB disorders.
Resident and subspecialty resident (fellow) experiences are dictated by the Accreditation Council for Graduate Medical Education (ACGME) program requirements and by the content specifications of the specialty and subspecialty certifying boards. Prevention research experiences for specialty and subspecialty residents are available to trainees, only if there are current research activities or interests in the environment in which they train.
Two programs of the Robert Wood Johnson Foundation have fostered prevention training: the highly competitive Clinical Scholars Program for postresidency training and the equally competitive Physician Faculty Scholars Program for assistant professors in an array of specialty areas. Both have funded scholars who have explored areas of prevention related to mental health. These programs are models for training that can attract future leaders to the area of prevention of MEB disorders.
ACGME requirements for psychiatry, pediatrics, and preventive medicine training pay little attention to prevention. For example:
Psychiatry training requirements state that the didactic curriculum must include the fundamental principles of epidemiology, etiology, diagnosis, treatment, and prevention of all psychiatric disorders, including biological, psychosocial, sociocultural, and iatrogenic factors that affect the prevention, incidence, prevalence, long-term course, and treatment of psychiatric disorders. They state that the resident should “know how to advocate for the promotion of mental health and the prevention of disease.” These are the only 2 sentences in 34 pages of requirements that directly address prevention of mental disorders and substance abuse; only eight hours on average are devoted to substance use health care in psychiatry residency (Isaacson, Fleming, et al., 2000).
Pediatric residents must be instructed, during a required one-month block in development and behavioral pediatrics, in psychosocial screening techniques as well as approaches to the identification of the needs of children at risk, for example, in fragmented or substance abusing families or in foster care. As a component of their one-month experience in adolescent medicine, residents are expected to engage psychosocial issues, such as depression, eating disorders, and substance abuse. No mention is made of prevention. Residents are expected to know how to advocate for promotion of health and prevention of disease or injury, but with no specification of applications to behavioral disorders. Subspecialty residents