Training in preventive child psychiatry

Effective prevention targeted at children and adolescents is likely to generate greater psychological and socioeconomic benefits than interventions at any other time in the lifespan. It includes resilience training; strengthening the parent–child bond; promoting positive peer interactions; teaching coping skills for stress/anxiety; school-based mental health support; and targeted interventions focusing on vulnerable individuals subjected to life stressors and abuse (including victims of war) (Poli Reference Poli, Correll and Arango2021). Developmental perspectives underpinning these strategies are increasingly recognised as essential to training in child psychiatry. For example, this is highlighted in the Royal College of Psychiatrists’ (RCPsych’s) curriculum for specialty training in child and adolescent psychiatry, which specifies competencies in preventive psychiatry – working collaboratively with communities to address health inequalities and risk factors (High Level Outcome HLO 4). Similarly, developing trainee doctors’ educational and teaching skills in public education is gaining increasing traction. For example, a manualised public education campaign has been developed by the World Psychiatric Association and World Health Organization encompassing some preventive strategies (Doan Reference Doan, Herbig and Karim2004).

Integrating clinical and research training in child psychiatry

Child psychiatry trainees with an interest in research face several challenges, including lack of professional development pathways, limited mentorship, difficulty combining clinical and research commitments, securing project funding and work–life balance. In the UK, the above-mentioned RCPsych child and adolescent psychiatry curriculum highlights the need to develop competency in applying advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles (HLO 9). Specialty trainees are expected to conduct at least a structured review of the literature in one aspect of child and adolescent mental health that is of an academic standard to be potentially published to meet this competency. This would be undertaken under the supervision of an appropriate academic supervisor. In the USA, there are dedicated integrated clinical and research training programmes in child psychiatry for academically minded trainees, such as the federally supported Albert J. Solnit Integrated Program at Yale School of Medicine. These programmes combine clinical psychiatric training with protected research time, allowing doctors to develop clinical and academic skills.

Training in advocacy and leadership skills

Training in advocacy and leadership skills is beneficial to any professional, but it is especially important for child and adolescent psychiatry, considering the multiple agencies typically involved in child mental healthcare and preventive services. This typically encompasses numerous themes, such as managing stigma, human rights, quality improvement work and developing sustainable child mental healthcare systems (Skokauskas Reference Skokauskas, Fung and Flaherty2019). There is increasing emphasis on integrating mental health services into primary care, particularly in low- and middle-income countries with limited human resources. This involves greater advocacy efforts and utilising appropriate leadership skills. However, these competencies are articulated explicitly as an intended learning outcome in the curriculum in only a few countries, such as the UK.

International collaborative models of child psychiatry training

In several countries, child psychiatry training is not structured and developed at all. However, digital and online modalities of training that have emerged particularly since the COVID-19 pandemic have opened new avenues for training and education. There are now several examples of initiatives with collaboration between training programmes in high-income countries and those in resource-stretched settings (Gnanavel Reference Gnanavel, Sharma and Sebela2020). There is an ongoing PhD programme in child psychiatry at a tertiary care centre in Nepal (Kanti Hospital) in collaboration with the University of Oslo, Norway. This is part of the Collaboration in Higher Education in Mental Health (COMENTH) project between Nepal and Norway. Other examples include the bilateral collaboration between the University of Michigan and the Ghana College of Physicians, and Universitas Indonesia’s collaboration with the University of Hawaii (this programme introduced the specialty of child psychiatry to Indonesia in the early 1970s). Such collaborations should be reciprocal, sensitive to local culture and facilitate establishing achievable sustainable goals. Also, the European Psychiatric Association’s Gaining Experience Programme offers short (2–8 weeks) observerships (including virtual observerships) in European psychiatric institutions, thus providing another model for international collaborative training in child psychiatry.

Future directions

Developing standardised, competency-based curricula utilising collaborative learning methods with clearly articulated learning outcomes is an important first step, particularly in countries that lack structured child and adolescent psychiatry training programmes. These curricula should include essential elements such as preventive psychiatry.

Ideally, training would include clinical experience in parental mental health services and early intervention clinics for children and families. This would facilitate training in psychiatric care across the lifespan. Appropriate learning objectives include effective use of screening questionnaires, identifying at-risk youth and families early and then liaising with appropriate community services (Adiba Reference Adiba, Sidhu and Shaligram2023).

There is growing evidence of the physical and psychological impact of adverse childhood experiences. Trauma-informed care, including training in trauma-based psychotherapeutic techniques such as eye movement desensitisation and reprocessing (EMDR) and trauma-informed cognitive–behavioural therapy, is essential to child psychiatry training.

Developing cultural competencies in child psychiatry is imperative, considering the increase in migration across the globe. For example, the American Academy of Child and Adolescent Psychiatry’s Diversity and Cultural Competency Curriculum for Child and Adolescent Psychiatry Training recommends specific skills, including effective interviewing and communication with children and families from diverse backgrounds, and formulating culturally sensitive diagnoses and treatment plans.

The development of skills in engaging with the broader health and social care system and multiple stakeholders, and in influencing policies, needs to be incorporated in any state-of-art curriculum in child psychiatry.

The COVID-19 pandemic paved the way for increasing use of technology in mental health services. Training in telemental health tailored to themes in child psychiatry such as remote neurodevelopmental assessments, attention-deficit hyperactivity disorder reviews and remote psychotherapy should be essential curriculum components.

Child psychiatry trainees should be taught about the potential of artificial intelligence (AI) in the field of child psychiatry, focusing on screening, detection, diagnosis and therapeutic tools (Till Reference Till and Briganti2023). Learning outcomes should also focus on understanding the impact of social media on children and adolescents as well as competencies in providing appropriate guidance in this regard.