Addiction Medicine Fellowship - Applicant Name: Boston Children’s Hospital Project Title: Expanding the Pediatric Addiction Medicine Workforce Substance use disorders during adolescence cause problems that can derail lives. Most adults with addiction began using substances before age 18, yet adolescents remain in the blind spot of clinical awareness and response. Signs of substance use problems in adolescents are often overlooked, misinterpreted, or ignored, and inattention to early warning signs has consequences: nationally, adolescent overdose deaths have doubled in recent years. Adolescents, the focus of this application, are underserved in relation to substance use disorder (SUD) treatment regardless of race/ethnicity, socioeconomic status, or any other parameter. Pediatric addiction medicine requires specialized training to address unique challenges and circumstances. The specific purpose of this project is to increase the number of physicians who are prepared to prevent and treat substance use disorders in children, adolescents, and young adults through Addiction Medicine training in the Division of Addiction Medicine (DADM) at Boston Children’s Hospital (BCH) via 4 objectives: 1) increase the number of addiction medicine training slots in an established, pediatric-focused addiction medicine fellowship program; 2) continue to provide an experiential rotation in pediatrics for addiction medicine fellows in adult-focused programs at other institutions; 3) continue to provide a rotation in pediatric addiction medicine for pediatric subspecialists; 4) support faculty development and leadership in pediatric-focused addiction medicine. The DADM at BCH is the first such Division at a Children’s Hospital in the US. The Division has three arms: patient care, research and training, in service of providing leadership in pediatric facing addiction medicine. The clinical arm is comprised of the Adolescent Substance Use and Addiction Program, which provides outpatient care to youth with substance use problems and disorders, and the Primary Care Plus (PC-plus) program, which provides clinician to clinician consultation and substance use counseling by specially trained social workers delivered virtually to pediatric primary care patients. Over the past 5 years the number of appointments provided has more than tripled, and DADM is on track to provide 10,000 individual patient visits in 2025. The rich resources devoted to pediatric addiction medicine provide excellent clinical experience for Pediatric Addiction Medicine fellows. Since 2018 BCH has been training fellows through a one-year, ACGME-accredited addiction medicine fellowship that is situated in DADM. Over the past 7 years the capacity of the program has grown from a single fellow to our current census of four fellows annually. In total, the program has graduated 17 fellows. With support of this funding mechanism, we will increase the annual number of fellows to 5 beginning this academic year (pending ACGME approval of a 5th fellowship position). Through this project, we advance efforts towards creating a clinical workforce with complementary strengths – addiction medicine through the lens of pediatrics, and pediatrics through the lens of addiction medicine – in service of the goal of increasing adolescent access to substance use prevention, intervention and treatment thereby decreasing the number of people who develop addiction. Statement of eligibility for funding priority: Health Information Technology The DADM model of care is provided by an inter-professional team that provides in-person as well as telehealth/remote services to pediatric patients at both an academic/teaching health center and throughout a network of community-based pediatric practices. All fellows (100%) are trained to provide care using telehealth, and DADM has developed and published best practice and safety protocols for delivering SUD care to youth via telehealth (DOI: 10.1097/ADM.0000000000000871).
