Growing the Child and Adolescent Psychiatry Workforce
A $4 million grant from UnitedHealth Group (UHG) is changing lives. The grant, which was made in 2020, has enabled the University of California San Diego School of Medicine to create the Child and Adolescent Psychiatry Inclusive Excellence program (CAPIE). With a goal of expanding and diversifying the pipeline of child and adolescent psychiatrists in California, the program is addressing a severe shortage of those equipped to serve children and teens. According to the American Academy of Child and Adolescent Psychiatry, California mirrors the national average of about 15 child and adolescent psychiatrists per 100,000 children.
“Nationwide, we have a mental health crisis,” said Desiree Shapiro, MD, associate clinical professor of child and adolescent psychiatry at the School of Medicine and medical director for CAPIE. “There is a shortage of child and adolescent psychiatrists, paired with a lot of suffering among our youth, which creates opportunity to implement positive change. Through the CAPIE program, we are supporting a community of future physician leaders who are now championing the field of Child and Adolescent Psychiatry (CAP).”
The grant-funded CAPIE program is two-fold. It includes a summer immersion program, as well as a yearlong exposure program. Both share a common goal, to increase the child and adolescent psychiatry workforce by promoting inclusivity, diversity and building community among medical students.
“By providing early exposure to this specialty, emphasizing the importance of youth and family mental health, we are impacting the way students view pediatric mental health concerns and increasing interest in CAP as a career,” said Shapiro. “Before this program, these exposures did not exist.”
Since its inception, 40 medical students have completed the summer immersion program which focuses on exposure to the field and encourages further exploration through mentorship, outreach and education initiatives and engagement in a community action project. More than 50 students have completed the yearlong program which includes pediatric mental health workshops, personalized mentorship, preclinical courses, financial support, and community action programs and initiatives specifically focused on children and teens. Harnessing the students’ special interests ranging from general wellness and mental health to yoga and intergenerational mentorship programs, the students have already made lasting impacts on the community through their community action projects.
“Though we are just medical students, the program allowed us to develop our professional identities, and feel inspired about a field that can transform the lives of children and their families,” said Sahit Menon, a fourth-year medical student. “Because of CAPIE, I have learned from psychiatrists who work in juvenile settings, forensics, inpatient facilities, private practice, telehealth and research. It’s rewarding to pursue a field where the need is clear, and the opportunities are diverse.”
Current CAPIE students have shown a deep commitment to the field of child and adolescent psychiatry. Approximately 92% of the yearlong scholars and 82% of the summer scholars reported they were more likely to pursue child and adolescent psychiatry as their medical specialty because of the CAPIE program. Remarkably, 100% of the initial cohort of yearlong participants noted that not only has CAPIE has been important to their professional development, but also to their personal wellbeing.
“For some students, the field of CAP feels different than other medical fields,” said Shapiro. “There is complexity and uncertainty. There are a lot of moving factors because there is no quick fix to some of the problems youth and families face. But that’s part of its beauty. It’s quite dynamic and multi-factorial. There are so many different components that allow someone to be well.”
A Lasting Impact
For fourth-year medical student Heidi Banh, who has participated in CAPIE since its inception, the program has been life changing.
“The CAPIE program ultimately taught me that there is so much hope and meaning to be found in this field,” said Banh. “I quickly fell in love with the topics, the patients, the vast opportunities, the interdisciplinary nature of the work, and the warm and collaborative community. The more I listened, learned and engaged, the more I found myself resonating deeply with the values and themes that repeatedly came up from the sessions. I realized that all my own values and hopes for a career in medicine were wrapped up in the path to child and adolescent psychiatry training.”
Camila Reyes-Martinez, a third-year medical student, participated in the summer program after her first year of medical school. Her experience as a middle school science teacher prior to medical school provided her with the perspective to truly understand the need for child and adolescent mental health providers.
“It’s a challenge and a joy to work with adolescents,” said Reyes-Martinez. “There are so many young people who are in need of mental health providers that specialize in working just with children and adolescents because it’s such a different time period in their lives.”
For her project, Reyes-Martinez hosted a workshop on healthy relationships. The participating high school students were engaged and came away from the workshop better equipped to identify healthy relationships.
“There is not a ton of messaging in the school curriculum about what a healthy relationship looks like,” said Reyes-Martinez. “Primary care providers may not necessarily have time to discuss healthy relationships with their patients, but my workshop showed how important these types of conversations are because relationships truly impact your health.”
The grant from UnitedHealth Group, has provided the School of Medicine the opportunity to encourage anyone and everyone who’s thinking about child and adolescent psychiatry, whether in the program or not, to get support, mentorship and sponsorship. It has showcased UC San Diego’s commitment to building a more inclusive workforce and partnering with the community to better serve patients and families.
“This program has fit just beautifully with the chancellor and the School of Medicine’s diversity initiatives,” said Shapiro. “We couldn’t be more grateful to UnitedHealth Group to see this need and accept our proposal to create the Child and Adolescent Psychiatry Inclusive Excellence program.”
In addition to increasing interest in CAP, the program has created lasting community connections. As an example, Menon and two other students joined together to create a student interest group, called Unedited Voices of Medicine. The group gathers and shares experiences and narratives on the medical school journeys that they and their classmates have embarked on. By sharing these common experiences among themselves, and also with high school students, they are working to destigmatize mental health in medicine.
“We created this organization because we felt that there wasn’t a place for students, trainees and medical professionals to share their struggles with mental health openly,” said Menon. “I personally joined because there wasn’t an opportunity for me to be honest with my own struggles with mental health and adversities when I entered medical school. I noticed the same was true for many of my peers when I began my first year.”
For many of the students who have been a part of CAPIE, the sense of belonging and community they found through the program has helped them to thrive.
“In my first year I really struggled to find a community,” said Reyes-Martinez. “There were a lot of times in the first year that I asked, why am I in medical school? Was this the right choice? Through my project and being a part of CAPIE, I found something that aligns with my vision and helped me find like-minded people who view medicine the way I do. That was very invigorating. The CAPIE program connected so many things for me. I had no idea you could combine so many things I was interested in and be a doctor doing it all.”
An annual survey is sent out to medical students and psychiatry residents about attitudes towards and interests in CAP. Over the years, the program has had a positive impact on students’ perceptions.
“More students are learning about CAP, requesting CAP for clinical rotations and engaging in innovative pediatric mental health projects,” said Shapiro. “We are so fortunate to have received this grant. Without UHG’s support, we could not have created CAPIE or the ripple effect it has had on students and their future patients.”
Banh noted that she came into medical school with a strong interest in primary care after witnessing how her parents served as primary caregivers to her grandparents. Being in the CAPIE program has shifted her career goals.
“I came in with a blank slate as I did not know CAP was a field,” said Banh. “My perception of CAP is continually being molded. When I see the innocence of our youth, the gaps of our system through which they fall through, and the potential we have as providers to rise to the challenge to educate ourselves and families, I feel more strongly than ever that CAP is a field I can truly see myself making an impact in a patient’s life. Through the intersection of health equity, social justice, and excellent and compassionate patient care, I am excited to keep seeking out opportunities to explore CAP as a future career.”
As the CAPIE program enters its final year, Shapiro is looking forward to seeing how the impact will continue to grow exponentially.
“The students have really driven the success of CAPIE,” said Shapiro. “They have built this community. They lean on each other. They celebrate each other. They’ve formed lasting connections.”
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