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Objectives: Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves.Methods: The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up.Results: Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes.Conclusion: PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes. [ABSTRACT FROM AUTHOR]

The current study examined the mental health diagnostic profiles of infants and young children prenatally exposed to substances using the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0-3R) diagnostic system. Participants were 46 biological mother-infant dyads who were engaged in a clinical program for mothers with substance-use problems and their young children (aged 10-41 months). Diagnostic information was reported for each of the five axes listed in the DC:0-3R diagnostic system based on file reviews. In addition, the children's socioemotional and adaptive behaviors were assessed using the Child Behavior Checklist, Infant-Toddler Social Emotional Assessment, the Social-Emotional Scale, and the Adaptive Behavior Assessment System (2nd ed.). In this sample of young children with prenatal substance exposure, a broad range of socioemotional symptoms were evident, with almost one third of the children meeting criteria for at least one Axis I mental health diagnosis. In addition, the majority of dyads demonstrated features of a disordered relationship. Children in more problematic relationships demonstrated higher levels of socioemotional and adaptive functioning difficulties and were more likely to have an Axis I diagnosis than were children in adapted relationships. The importance of early intervention efforts aimed at infants with prenatal substance exposure and their biological mothers is highlighted, with a particular focus on enhancing the quality of the mother-child relationship. [ABSTRACT FROM AUTHOR]

Background: Primary care providers (PCPs) are increasingly called upon to assist in meeting the growing demand for paediatric mental health care in Canada, yet they report inadequate training and confidence to do so. The Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program was designed to fill this gap by teaching PCPs the skills needed to provide frontline care themselves, particularly in rural/remote regions where specialist resources are limited. This innovative educational intervention may improve paediatric mental health care capacity, but a pilot study is needed., Methods: We designed a cluster randomized, controlled pilot of PTCAP. Random assignment to intervention or control (treatment-as-usual) will occur at the practice level. Participating PCPs (N=61) at sites randomized to intervention will receive eight hours of training in the use of practice guidelines and brief counseling techniques (i.e., common skills/elements) for addressing diagnosable conditions and more general, transdiagnostic concerns. Mental health care capacity at one-week post-intervention will be the primary outcome, assessed through self-report questionnaires of mental health care confidence, and through a more objective, observational assessment of trained skills. We will also examine retention of these skills at one-month follow-up. We expect use of trained common skills/elements to be associated with better child mental health outcomes on the Strengths and Difficulties Questionnaire (N = 250)., Discussion: As one of the first RCTs of its kind in Canada, this study will provide unique, preliminary evidence in regards to the feasibility and efficacy of the PTCAP intervention for enhancing rural, paediatric mental health care capacity.