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Course Credit

The following credits are available for this course:

AMA PRA Category 1 Credits™ (MD, DO, NP, PA)5.0 hours
American Academy of Physician Assistants (AAPA) Category 1 CME Credits5.0 hours
Contact Hours (Nurse)5.0 hours

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(See the References tab for research citations.)

This introductory course for pediatric primary care practitioners (PPCPs) provides a comprehensive overview of the identification, assessment, and management of anxiety, depression and attention-deficit/hyperactivity disorder (ADHD) in the primary care setting.  By completing this course, PPCPs can acquire the core mental health competencies1 essential for the safe and effective management of mild to moderate presentations of these common disorders.

The course begins with the rationale for providing behavioral health services in pediatric primary care, including the preference of patients to receive behavioral health care in their convenient, trusted medical home. The course then proceeds to introduce a straightforward, four-step model of care for anxiety, depression, and ADHD in the pediatric setting, entailing screening, assessment, primary care treatment, and referral for specialty care treatment.  

The course includes detailed information about universal behavioral health screening for children and adolescents; guided self-management tools for preventive management of sub-clinical behavioral health concerns; focused behavioral health assessment for the primary care setting; and evidence-based, first-line medications for anxiety, depression, and ADHD.  The course also provides an overview of evidence-based psychotherapies for these disorders to guide brief psychotherapeutic interventions by PPCPs, and an overview of adjunctive home and school-based supports.  Indications for referral to specialty behavioral health care also are reviewed. 

The course concludes with a summary of the information presented, along with resources to support the provision of behavioral health care to pediatric patients, including a Clinical Manual for Pediatric Practitioners; a series of educational flyers for families on Understanding Anxiety, Depression, ADHD, and Behavior Problems; and Guided Self-Management Toolkits for Families. The course also recommends Clinical Practice Guidelines/Clinical Updates developed by the American Academy of Child and Adolescent Psychiatry2-4 and the American Academy of Pediatrics5 for advanced learning.

Learning Objectives

At the conclusion of this course, participants will be able to:

  • describe the central role pediatric primary care practitioners play in the management of mild to moderate presentations of anxiety, depression, and ADHD
  • describe the stepped model of behavioral health care in pediatrics and how to implement universal behavioral health screening
  • describe the evidence-based management of mild to moderate presentations of anxiety, depression, and ADHD in the primary care setting, and when to refer severe/complex presentations of these disorders to specialty BH care

Course Format

COURSE FORMAT (each session approximates 15-20 minutes in duration)

  • Pre-Course Survey
  • Introduction to BH in pediatric primary care module
    • Session 1:  Introduction to BH in pediatric primary care
    • Session 2:  Screening for anxiety, depression, and ADHD
    • Introduction Module Assessment
  • Anxiety Module
    • Session 3:  Understanding anxiety
    • Session 4:  Assessing anxiety
    • Session 5:  Treating anxiety
    • Session 6:  Using guided self-management for anxiety
    • Anxiety Module Assessment
  • Depression Module
    • Session 7:  Understanding depression
    • Session 8:  Assessing depression
    • Session 9:  Treating depression
    • Session 10: Using guided self-management for depression
    • Depression Module Assessment
  • ADHD Module
    • Session 11: Understanding ADHD
    • Session 12: Assessing ADHD
    • Session 13: Treating ADHD
    • Session 14: Using guided self-management for ADHD
    • Session 15: Using guided self-management for behavior problems
    • ADHD Module Assessment
  • Summary and Conclusion Module
    • Session 16: Summary and conclusion
    • Post Course Survey
    • Resources

Course Background


(See the References tab for research citations.)

Psychiatric disorders are estimated to occur in 15 million children and adolescents in the United States, with annual total costs approximating $12 billion.6  Despite effective treatments, because of the protracted shortage of child-trained behavioral health specialists,7 many youth with psychiatric disorders receive no or untimely services.8  Untreated child and adolescent psychiatric disorders persist over decades, become increasingly intractable to treatment, and incur progressively greater social, educational, occupational, and economic consequences over time.9 

More than one-half of pediatric primary care visits address behavioral health problems,and PPCPs write the majority of psychotropic medication prescriptions for youth.10 The psychiatric disorders presenting most commonly in pediatric practices are anxiety, depression, and ADHD, at least three-quarters of which are mild to moderate in severity. If PPCPs can become confident and skilled in identifying, assessing, and managing mild to moderate presentations of these disorders, then child and adolescent psychiatrists and other scarce specialty behavioral health resources could be conserved for the management of severe, complex, unsafe, and treatment-unresponsive disorders. In this way, PPCPs can play a key role in narrowing the gap between the millions of youths needing effective BH services and those receiving them. 

The Behavioral Health Education for Pediatric Primary Care course was developed by the Boston Children’s Hospital Department of Psychiatry and Behavioral Sciences and the Boston Children’s Hospital Pediatric Physicians’ Organization at Children’s (PPOC).  The course was initially created as one of the three components (behavioral health education, child psychiatry consultation, integrated practice transformation) of a behavioral health integration program (BHIP) implemented in Massachusetts among the PPOC’s 500 PPCPs.  The published findings from BHIP have demonstrated acquisition of target behavioral health knowledge, skills, and confidence by participating PPCPs, increased access to behavioral health services in the pediatric primary care setting, and high acceptability, feasibility, adoption, penetration, and sustainability of the program.11-13  Since the initial implementation in the PPOC, the educational course has been successfully exported to PPCPs in the Children’s Hospital Los Angeles, Connecticut Children’s Hospital, and Collier County, Florida pediatric practice networks.

Suggested Audience:

  • Pediatric primary care practitioners
  • Developmental behavioral pediatricians
  • Adolescent medicine practitioners
  • Family practice practitioners
  • Nurse practitioners
  • Physician assistants
  • Pediatric trainees
  • Psychiatry trainees
  • Trainees from other medical disciplines



Heather J. Walter, MD, MPH

Senior Attending Psychiatrist, Boston Children’s Hospital

Professor of Psychiatry, Harvard Medical School


David R. DeMaso, MD

Psychiatrist-in-Chief Emeritus, Boston Children’s Hospital

George P. Gardner – Olga E. Monks Professor of Child Psychiatry and Professor of Pediatrics, Harvard Medical School

Erica Lee, PhD

Attending Psychologist, Boston Children’s Hospital

Assistant Professor of Psychology in Psychiatry, Harvard Medical School

Keneisha Sinclair-McBride, PhD

Attending Psychologist, Boston Children’s Hospital

Assistant Professor of Psychology in Psychiatry, Harvard Medical School;



  • Boston Children’s Hospital
  • Sidney A. Swensrud Foundation
  • Nancy Adams and Scott Schoen Family
  • Naples Children and Education Foundation 

Graphic Design

  • Zoë Judd, MS

Video Production

  • Giro Studio

Online Course Development

  • BCH Education Department

Release Date


  • November 3, 2022


In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team



Boston Children’s Hospital designates this live activity for a maximum of 5.00 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.


Boston Children’s Hospital designates this activity for 5.00 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity. 

Physician Assistant

Boston Children’s Hospital has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credits for activities planned in accordance with AAPA CME Criteria. This activity is designated for 5.00 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g., planners, faculty, authors, reviewers, and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials, along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.

The following planners, speakers, and content reviewers, on behalf of themselves and their spouse or partner, have reported no relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients.

Heather J. Walter, MD, MPHErica Lee, PhD
David R. DeMaso, MDKeneisha Sinclair-McBride, PhD

CME Reviewer

Lesley Niccolini No Relevant Financial Relationships to Disclose

Greg Durkin (Nursing) No Relevant Financial Relationships to Disclose or as appropriate

Crystal Tom (Pharmacy) No Relevant Financial Relationships to Disclose or as appropriate

Pamela Charmarro (Social Work) No Relevant Financial Relationships to Disclose or as appropriate

Eugene D’Angelo (Psychology) No Relevant Financial Relationships to Disclose or as appropriate


Course Background:

  1. Foy JM, Green CM, Earls MF, et al.  American Academy of Pediatrics Policy Statement.  Mental health competencies for pediatric practice.  Pediatrics. 2019;144(5):e20192757.
  2. Walter HJ, Bukstein OG, Abright AR, et al.  Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders.  J Am Acad Child Adolesc Psychiatry. 2020;59(10):1107-1124.
  3. Walter HJ, Abright AR, Bukstein OG, et al.  Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders.  J Am Acad Child Adolesc Psychiatry.  In press.
  4. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated Care and AACAP Committee on Quality Issues.  Clinical Update:  Collaborative mental health care for children and adolescents in pediatric primary care.  J Am Acad Child Adolesc Psychiatry.  In press.
  5. American Academy of Pediatrics.  Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.  Pediatrics. 2019;144(4):20192528.
  6. Perou R, Bitsko RH, Blumberg SJ, et al.  Mental health surveillance among children – United States, 2005-2011.  MMWR Suppl. 2013;62(2):1-35.
  7. American Academy of Child and Adolescent Psychiatry.  Severe shortage of child and adolescent psychiatrists illustrated in AACAP workforce maps, 2022.  Available at:
  8. Wang PS, Berglund PA, Olfson M, et al.  Delays in initial treatment contact after first onset of a mental disorder.  Health Serv Res. 2004;39(2):393-415. 
  9. Copeland WE, et al.  Adult functional outcomes of common childhood psychiatric problems: a prospective, longitudinal study.  JAMA Psychiatry. 2015;72(9):892-899.
  10. Olfson M, Blanco C, Wang S, et al.  National trends in the mental health care of children, adolescents, and adults by office-based physicians.  JAMA Psychiatry. 2014;71:81-90.
  11. Walter HJ, Kackloudis G, Trudell EK, et al.  Enhancing pediatricians’ behavioral health competencies through child psychiatry consultation and education.  Clin Pediatr. 2018;57(8):958-969.
  12. Walter HJ, Vernacchio L, Trudell EK, et al.  Five-year outcomes of behavioral health integration in pediatric primary care.  Pediatrics. 2019;144(1):e20183243.
  13. Walter HJ, Vernacchio L, Correa ET, et al.  Five-phase replication of behavioral health integration in pediatric primary care.  Pediatrics. 2021;148(2):e2020001073. 

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