Behavioral Health Takes Center Stage at PAS 2023

Katie K. Lockwood, MD, MEd


May 12, 2023

Editorial Collaboration

Medscape &

This transcript has been edited for clarity.

Hi. I'm Dr Katie Lockwood, a primary care pediatrician from Children's Hospital of Philadelphia (CHOP).

I just returned from the 2023 Pediatric Academic Societies (PAS) meeting, which took place in Washington, DC, this year. I do behavioral health education for pediatric residents at CHOP, so I attended many talks on behavioral health and heard some great research findings to share.

I learned about EPA 9, an entrustable educational activity for residents that focuses on competence in the assessment and management of common behavioral health conditions. Although this program has existed for a long time, residents want and need this education to help them reach competency goals. In a recent study, only about one third of residents reported competence in assessment and management of these conditions. Residency programs report similar numbers: Only about 50% of residents are competent in behavioral health at the time of graduation.

Efforts are underway to improve these competency rates. We don't know exactly which educational interventions are going to work. The American Board of Pediatrics has created an Empower curriculum as well as Empower Echoes, which they are piloting now, and they hope to standardize some of those curricula across the country. This is just in time for the new ACGME requirements for behavioral health competency that we expect to be passed, increasing the amount of time that residents spend learning about behavioral health topics. We look forward to hearing more about this in the future.

The PAS meeting also had presidential plenary talks on behavioral health that were fascinating. Dr Chua and colleagues, from the University of Michigan Medical School, reported on their study of antidepressant dispensing during the pandemic in a session titled "Association Between the COVID-19 Outbreak and Antidepressant Use in US Adolescents and Young Adults." They showed that from 2016 to 2022, dispensing rates of antidepressants went up 61%. This increase was greater in girls than boys. We still don't know the exact driving factors, but we think that the pandemic exacerbated some of the rising rates of mental health conditions that we were already seeing pre-pandemic. This is in line with what many of us are seeing clinically.

Another talk that struck home with me was by Dr Ruiz, from Warren Alpert Medical School at Brown University. Dr Ruiz talked about the time to treatment for patients who had a new mental health diagnosis in the past month and compared 2004 with 2019, and whether patients were hospitalized or not. He found that patients who were admitted to the ICU had shorter times to treatment of their mental health condition than patients who were not admitted to the ICU (67 days for ICU vs 85 days for non-ICU). Patients who weren't hospitalized at all had even longer times to treatment (90 days). It's likely that some of the care coordination resources that are available to medically complex patients and those admitted to intensive care expedited time to treatment for a mental health condition, even though the mental health diagnosis was not the primary reason for hospital admission.

Dr Lennon, from Lurie Children's Hospital, studied gun violence in Chicago, finding that one third of children in Chicago have had exposure to firearm violence. The extent of exposure correlated with mental health impact based on parent report. Dr Lennon argued that reducing firearm violence may mitigate the mental health impact of gun violence on children. This was an important talk with many policy implications.

Overall, we heard some great behavioral health content at this conference from both an educational and policy perspective. I learned a lot, and I was happy to share some of our work on behavioral health during the conference. I hope to see you all there next year in Toronto. Thank you.

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