Overview: The United States and the state of Tennessee are experiencing a mental and behavioral health crisis. The prevalence of mental illnesses, such as mood and anxiety disorders, and cognitive, developmental, and psychotic disorders is extremely high. In 2020, suicide was the second leading cause of death among youth and young adults ages 10-14 in the United States. The impact of this crisis is felt and is reflected in the suicide rate at 10% for children in Tennessee. A shortage of behavioral health care professionals adds to this crisis by reducing accessibility, availability, and acceptability of mental and behavior health services for children and adolescents. To address this shortage, this application proposes to implement an integrated Pediatric focused mental and behavioral training center with the department of Family and Community Medicine in collaboration with Cherokee Health Systems and Tennessee Area Health Education Center (TN AHEC). The center will use a Differentiated service delivery (DSD) model that will include training and wraparound services: implementing a person centered approach to mental and behavioral health service delivery. Objectives: 1) Train 18 family and community residents in prevention, identification, diagnosis, treatment, and referral of services for mental and behavioral health conditions each year of the proposal for a total of 90; 2) Identify, expand, and recruit of 30 underserved and rural health sites in Tennessee. 3) Design and implement the one-month clinical rotation with didactic and clinical training for family medicine residents with additional exposure mental and behavioral health on existing rotations (psychiatry, obstetrics and Gynecology, and pediatrics). Methodology: The department of Pediatrics, the departments of Family and Community Medicine, and the department of Psychiatry will establish and operate a training site with a community walk-in center for youth and families experiencing
mental and behavior health issues in collaboration with Cherokee Health Systems and TN AHEC. The center will offer training for family medicine residents who will see persons and families experiencing mental and behavioral issues including ADHD, autism, and substance abuse. Pediatric and faculty from psychiatry will be assigned to this center to model skills including how to prescribe medications for opioid use disorders (MOUD) and how to screen, diagnose, and treat children with mental and behavioral health issue. In Years 1-5, the center will be staffed by certified behavioral health providers (social workers, child psychiatrists, and/or counselors). Family medicine residents will be paired with residents from psychiatry for peer learning and training. In the HUB, children and youth will come to a safe space to receive an assessment without having to go to an emergency room or psychiatric hospital. Additionally, the medical residency specialties that will benefit most will be family medicine and pediatrics. The departments of Pediatrics will collaborate with the department of Family and Community Medicine to offer didactics and clinical services to train all of its 18 residents in Years 1-5. A month (4 weeks) mental and behavioral health rotation with Cherokee Health Systems will be implemented. Joint webinars will be offered to add additional didactics in mental and behavioral webinar series on a monthly basis. Tennessee Primary Care Association will assist in identifying 10 new rural mental and behavioral sites across the state of Tennessee. Evaluation: Residents will be evaluated by the pediatric faculty preceptor, the pediatric mental and behavioral health preceptor, and the family medicine residency director to reinforce skills and learning in mental and behavioral health practice. Funding Priority and Funding Preference: A funding priority and funding preference have been requested based on high-rate and placement of residents in rural health site
s.