135 - Pediatric Resident Comfort with Adolescent Mental Health Care: Influence of Continuity Clinic Type Site, School-Based Health Clinic Exposure, and Residency Year

Publication Number: 4132.135

Karen C. Manotas, University of Utah School of Medicine, Salt Lake City, UT, United States; Kim Hansen, University of Utah School of Medicine, Salt Lake City, UT, United States; Joni Hemond, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Adolescent and mental health (MH) concerns are central to pediatric primary care, with over half of visits addressing MH issues and pediatricians writing most psychotropic prescriptions for youth. Although ACGME requires at least a one-month rotation in developmental and behavioral pediatrics, exposure varies widely, and many residents report limited preparedness managing child and adolescent MH. Increasingly, programs incorporate school-based health clinic (SBHC) rotations, where ~20-30% of visits address MH needs.

Objective: To evaluate whether adding an SBHC rotation in an urban pediatric residency program increases resident comfort managing adolescent MH concerns and to compare MH comfort across continuity sites and training years.

Design/Methods: A cross-sectional survey (April 2025) assessed self-rated comfort (1-5 Likert) in anxiety/depression, suicidality, ADHD, and substance use. Residents reported their assigned continuity site, training year, and number of SBHC shifts. High SBHC exposure was defined as ≥3 shifts. Analyses included descriptive statistics and independent sample t-tests across sites and exposure levels, with multivariable regression controlling for residency year.

Results: 36 residents participated and breakdown of training year was similar across clinic sites. Comfort differed by continuity site (p = .005-.006), lowest at the hospital-based clinic (HBC) without a mental health integration (MHI) team. Residents at community-based (CBC) and private practice (PP) sites reported greater comfort managing anxiety/depression and suicidality (Table 1). SBHC exposure was not associated with higher comfort (Table 2); most SBHC participants were interns (57.7%). High exposure (≥3 shifts) did not improve comfort and correlated with slightly lower ADHD comfort (p = .048). Training year independently predicted increased comfort (p = .02-.05). Including Triple Board residents modestly raised absolute scores but did not change overall trends.

Conclusion(s): Training level significantly influenced resident comfort with adolescent MH care. The lack of association between SBHC exposure and comfort likely reflects early trainee placement at SBHCs rather than site-specific effects. Continuity site also impacted comfort, suggesting clinic culture and MHI presence may play key roles in building resident confidence.

Table 1. Mean Comfort Scores by Continuity Clinic Site
Table 1 Legend: PP = Private Practice; CBC = Community-Based Clinic; HBC = Hospital-Based Clinic. CBC and PP sites included integrated Mental Health Integration (MHI) teams, whereas the HBC site did not. The CBC serves a large, underserved, and diverse patient population. Mean comfort scores were based on 1-5 Likert with 1 representing lowest comfort and 5 representing highest. *P Value derived from ANOVA comparison to the mean comfort for all 3 continuity clinic sites.

Table 2. Mean Comfort Scores by SBHC Exposure