Mental and behavioral disorder diagnoses in children and youths are increasing at a concerning rate and are antecedent to many lifetime physical and behavioral health disorders.1 The cost to individuals, families, communities, and the American public is enormous. Comprehensive attention to the risks of all children, starting early in life, through behavioral health promotion, risk prevention, early detection of concerning behaviors, and effective treatment of behavioral disorders is an unmet need. Child health care holds considerable promise for improving child and lifespan behavioral outcomes.2 Wellchild visits, frequent in the first 3 years and continuing to early adulthood, provide opportunities to enhance family support of child social-emotional development, identify common behavioral problems, detect early signs of significant mental disorders, and provide or arrange beneficial interventions. Parents generally trust primary child health care professionals and view visits to their care settings as supportive and nonstigmatizing. Similarly, parents of children at risk for behavioral consequences of chronic disease repeatedly visit and trust their pediatric subspecialty care clinicians. However, most primary care and subspecialty care pediatricians are not trained to take on this role or participate in team efforts to do so.3 Integration of behavioral and medical expertise in practice has received increasing attention. Colocated and integrated care has focused largely on diagnosis and treatment of serious behavioral disorders and comorbidities of serious acute and chronic diseases and has not yet systematically engaged behavioral health promotion and risk prevention. Some subspecialties and a growing number of primary care child health practices now have interdisciplinary staff including behaviorally oriented pediatricians, psychiatrists, psychologists, nurse practitioners, social workers, or other health care professionals. Yet, child psychiatrists, pediatric psychologists, and developmental-behavioral pediatricians are in short supply; other professionals are often not trained to provide behavioral health promotion and care for children and families. Pediatricians of the future will be expected to more competently contribute to behavioral health promotion and care.4 However, most training programs in pediatrics, as well as other disciplines, are not prepared to create a workforce that can address the full spectrum of today’s child health needs in an interdisciplinary mode. All of these points were considered at a workshop conducted by the Board of Children, Youth, and Families of the National Academies of Science, Engineering, and Medicine, on November 29 to 30, 2016, and in an accompanying Perspectives Paper of the National Academy of Medicine.5 Attendees represented leadership from all the disciplines mentioned previously. There was overwhelming consensus that training around child behavioral health, both within and across disciplines, deserves immediate and energetic attention. The workshop highlighted the role of interdisciplinary training that addresses the attainment of competency in child and family behavioral health promotion and identified what was a shared core knowledge base across disciplines as well as important unique competencies and contributions of specific disciplines. An urgency to achieve these training goals was reinforced by 5 parents of children with an array of behavioral health needs, who shared their frustrations as well as their too-often elusive successes in finding behavioral support for their child, themselves, and other family members. Overarching levers for action (Box) were identified: (1) enhancing clinical care settings to better support education and training, (2) partnering with other innovative programs, evaluating those efforts, and disseminating learnings, (3) encouraging a focus on behavioral health by organizations that determine qualifications and standards for trainees and training programs, and (4) coordinating local, state, and national promotion of effective training programs and funding streams for their initiation and ongoing support. Eight themes were identified to promote training settings and experiences that better prepare health professionals to improve behavioral health outcomes for children. Important themes include multigenerational (familyfocused) behavioral health surveillance and care; embedding evidence-based interventions to improve parenting and social-emotional child development; improving training that addresses the behavioral outcomes of disabling and life-threatening chronic conditions; engaging parents in copromotion of behavioral health; training health care professionals to collaborate with community programs, including preschools and schools, that also promote child behavioral health; and, perhaps most urgently, advocating for funding that supports child behavioral health training in interdisciplinary settings. Promising models of child behavioral health care and training were introduced by speakers from all disciplines as well as by contributors of more than 30 abstracts describing model programs that address child behavioral health needs. Documenting program effect as well as readiness for interdisciplinary impleVIEWPOINT

中文翻译：

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卫生保健劳动力发展以提高儿童和青少年的心理和行为健康

儿童和青少年的精神和行为障碍诊断正在以令人担忧的速度增加，并且是许多终生身体和行为健康障碍的前因。1 个人、家庭、社区和美国公众的成本是巨大的。从生命早期开始，通过行为健康促进、风险预防、相关行为的早期发现和行为障碍的有效治疗，全面关注所有儿童的风险，这是一个未满足的需求。儿童保健在改善儿童和终生行为结果方面具有相当大的前景。 2 Wellchild 探访在前 3 年频繁并持续到成年早期，提供机会加强家庭对儿童社交情绪发展的支持，识别常见的行为问题，发现严重精神障碍的早期迹象，并提供或安排有益的干预措施。父母通常信任初级儿童保健专业人员，并将访问他们的保健场所视为支持性和非污名化。同样，面临慢性病行为后果风险的儿童的父母反复拜访并信任他们的儿科亚专科护理临床医生。然而，大多数初级保健和亚专科保健儿科医生都没有接受过承担这一角色或参与团队努力的培训。3 在实践中整合行为和医学专业知识已受到越来越多的关注。协同定位和综合护理主要侧重于严重行为障碍和严重急性和慢性疾病的合并症的诊断和治疗，尚未系统地参与行为健康促进和风险预防。一些亚专业和越来越多的初级保健儿童保健实践现在拥有跨学科的工作人员，包括面向行为的儿科医生、精神病学家、心理学家、执业护士、社会工作者或其他医疗保健专业人员。然而，儿童精神病学家、儿科心理学家和发育行为儿科医生供不应求。其他专业人员往往没有接受过为儿童和家庭提供行为健康促进和护理的培训。预计未来的儿科医生将更有能力为行为健康促进和护理做出贡献。 4 然而，大多数儿科和其他学科的培训计划并没有准备好建立一支能够解决当今儿童健康全方位问题的劳动力队伍跨学科模式的需求。2016 年 11 月 29 日至 30 日，美国国家科学、工程和医学院儿童、青年和家庭委员会在一次研讨会上以及美国国家科学院随附的观点论文中考虑了所有这些要点5 参加者代表了前面提到的所有学科的领导。压倒性的共识是，围绕儿童行为健康的培训，无论是在学科内还是跨学科，都值得立即和精力充沛地关注。研讨会强调了跨学科培训的作用，该培训解决了儿童和家庭行为健康促进能力的实现，并确定了跨学科共享的核心知识库以及特定学科的重要独特能力和贡献。有 5 位有一系列行为健康需求的孩子的父母强调了实现这些培训目标的紧迫性，他们分享了他们的挫折感以及在为孩子、他们自己和其他家庭成员寻找行为支持方面往往难以捉摸的成功。确定了总体行动杠杆（方框）：(1) 加强临床护理环境以更好地支持教育和培训，(2) 与其他创新项目合作，评估这些努力，并传播学习成果，(3) 鼓励确定受训人员和培训计划的资格和标准的组织关注行为健康，以及 (4) 协调地方、州和国家促进有效的培训计划和资金流，以启动和持续支持这些计划。确定了八个主题以促进培训环境和体验，从而更好地为卫生专业人员做好准备，以改善儿童的行为健康结果。重要主题包括多代（以家庭为中心）行为健康监测和护理；嵌入循证干预措施，以改善养育子女和社会情感儿童的发展；改进针对致残和危及生命的慢性病的行为结果的培训；让父母参与共同促进行为健康；培训卫生保健专业人员与社区项目合作，包括幼儿园和学校，这些项目也促进儿童行为健康；并且，也许最紧迫的是，倡导为跨学科环境中的儿童行为健康培训提供资金。来自所有学科的演讲者以及 30 多篇描述解决儿童行为健康需求的模型计划的摘要的贡献者介绍了有希望的儿童行为保健和培训模型。记录计划效果以及跨学科实施的准备情况VIEWPOINT 来自所有学科的演讲者以及 30 多篇描述解决儿童行为健康需求的模型计划的摘要的贡献者介绍了有希望的儿童行为保健和培训模型。记录计划效果以及跨学科实施的准备情况VIEWPOINT 来自所有学科的演讲者以及 30 多篇描述解决儿童行为健康需求的模型计划的摘要的贡献者介绍了有希望的儿童行为保健和培训模型。记录计划效果以及跨学科实施的准备情况VIEWPOINT