The proverb goes, it takes a village to raise a child. These days, though the child is still a child, the village is a complex global network of family, teachers, media influence, and healthcare services. Within healthcare, a myriad of disciplines interact and collaborate to best promote the health and wellbeing of the youth and families they serve. Behavioral health represents an increasingly common contributor within the umbrella of healthcare [1], especially as traditional medical and behavioral health disciplines are increasingly working not only in parallel, but also in tandem [2,3,4,5]. An important aspect of functional multidisciplinary care is therefore effective interdisciplinary collaboration. This highlights the importance of interdisciplinary learning opportunities early in training to bridge the disparate fields involved in ensuring children’s well being across healthcare in order to best promote competency regarding the clinical needs of children and adolescents.

The World Health Organization has defined interprofessional education (IPE) as “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” [6]. Specific competencies have even been outlined for IPE, including ethics and values, roles and responsibilities, IPE communication, and teamwork [7]. Literature on IPE has also increased over the past several decades, with the majority of investigations noting benefits (e.g., improved understanding of and attitudes towards other professions, improved communication, improved collaborative skills, improved patient care, etc.) [8,9,10,11,12]. Furthermore, reports have demonstrated medical learners’ positive attitudes towards structured IPE curricula [13–14]. IPE has thus been increasingly emphasized within training for a variety of medical professions (e.g., nursing, general medical, paramedicine, pharmacy, etc.) [15,16,17,18,19]. Though psychiatry is often included within this grou**, the same cannot be said of non-medical behavioral health professions (e.g., psychology, social work, etc.).

Despite the fact that practicing psychologists often contribute to education for medical learners [20], psychology learners are often excluded from IPE programming [9]. Rather, psychology learners are historically educated within siloed academic departments, private clinics, and specialty care settings, with only a minority gaining experience within multidisciplinary clinics or medical settings. This is in opposition to current recognition of the importance of IPE in training for psychology learners [21, 22], as well as the notable benefits psychology’s presence can offer to other disciplines (e.g., improved familiarity, confidence, effectiveness, and efficiency in medical residents’ interactions with patients with mental health concerns) [23,24,25,26]. Fortunately, language aligned with IPE has recently been incorporated as standard practice for clinical psychology learners in the United States [27], placing a greater emphasis on interdisciplinary training for all psychology learners and aligning the profession more closely with others in the healthcare field. Unfortunately, much of the literature representing IPE interactions with psychology learners is limited to direct immersion into multidisciplinary care settings (e.g., consulting roles) [28,29,30], rather than more structured education. Moreover, a dearth persists regarding the unique partnership of psychiatry and psychology learners within interprofessional learning experiences throughout stages of training (e.g., students, interns, residents, and fellows). This is particularly surprising later in training (i.e., fellowship) when professional specialization leads such learners to train in like settings more commonly (e.g., academic medical centers, multidisciplinary clinics, etc.).

Despite the fields being “engaged in a mutually cooperative enterprise” (p. 3), training in postdoctoral child and adolescent psychology fellowships has traditionally been separated from child and adolescent psychiatry fellowships [31]. Although such an approach is appropriate for several aspects of these complimentary training paths, a need also exists for trainees across psychology and psychiatry to be exposed to a broader range of interdisciplinary learning experiences and to share their collective knowledge and skill to mutual benefit. Aside from providing direct clinical services to youth and their families, child and adolescent psychologists and psychiatrists both often consult and collaborate with several of the same agencies, such as schools, daycare centers, pediatric practices, and/or family medicine clinics, to name a few. Accordingly, integrated training opportunities for both psychiatry and psychology learners not only allow for a more comprehensive learning experience, but also promote the spirit of collaborative work, help forge a foundation for develo** professional relationships, and provide a space to engage in cross-discipline communication. However, very few IPE programs specific to psychology and/or psychiatry have been discussed in the literature. Accordingly, this article endeavors to describe a sampling of related models, as well as to introduce the structure, application, and acceptability of an integrated training case seminar for clinically-focused learners in psychology and psychiatry.

Holmqvist, Button, and Heath [32] demonstrated how participation in highly structured IPE programming with various medical and behavioral health learners can improve clinical psychology trainees’ beliefs about the importance of collaborative practice, as well as their own collaborative skills. Encouraging psychology and nursing learners to collaborate demonstrated similar positive results [33]. Townsend and colleagues [34] describe a twelve-month semi-structured IPE program incorporating psychology and psychiatry interns in the context of an inpatient psychiatric service. A survey completed by all participants indicated that the IPE program successfully improved interns’ understanding of one another’s fields. With a separate focus, O’Hara and colleagues [35] found that multisite training for postdoctoral psychiatry and psychology fellows pursuing careers in academic clinical research resulted in a significant increase in learning opportunities and allowed trainees to develop opportunities for networking. Of course, factors other than potential benefit must be considered in the implementation of IPE programs, particularly as not all such programs produce favorable results (e.g., no detectible meaningful impact [36]. Finding the balance between more intensive IPE models that may be resource-prohibitive and others that require fewer resources but may demonstrate more limited effects (e.g., interdisciplinary didactics, case review) [37, 38] is also key in creating lasting programming.

Knowing the literature on the potential benefits of IPE and the wide range of implementation models utilized across training settings, a monthly one-hour interdisciplinary case presentation seminar (ICPS) was developed by the first two authors at a large Midwestern training hospital. The ICPS was developed with the support of psychology and psychiatry training faculty in response to learners’ concern regarding limited integration of training opportunities between psychology and psychiatry fellows. It was believed the ICPS would not only help address the fellows’ expressed interest in such a training opportunity directly, but that it would also better prepare them for the daily expectations of clinical practice (e.g., diagnosis, case formulation and conceptualizing, engaging others in patient care).

The current article presents the development, acceptability, feasibility, and benefit of the ICPS. Implementation science identifies the need to evaluate the feasibility and accessibility of new programs [39, 40]. Accessibility is the opinion of various stakeholders that a program or intervention is satisfactory. Feasibility is the extent a new program or intervention can be successfully implemented within a specific setting. A benefit of the ICPS is considered to be improved satisfaction with interdisciplinary training which will meet education expectations of accrediting training bodies for psychology and psychiatry. It was anticipated that the monthly one-hour ICPS will be acceptable to learners and can be successfully applied within the current learning environment. Additionally, satisfaction with the ICPS will benefit the training programs in line with meeting accreditation benchmarks.

Methods

Participants and Setting

Participants included 24 child and adolescent psychiatry fellows and psychology postdoctoral fellows who participated in the ICPS over three years with a majority, 17 (70.8%), representing psychiatry. Participation in the ICPS was a mandatory component of both training programs, and all ICPS participants were asked to complete the Case Presentation Seminar Survey, described later, at completion of the ICPS to aid in quality improvement of the seminar. The psychiatry and psychology fellowship programs follow a two-year cohort-based training plan. For example, the child psychiatry training program accepts a cohort of three fellows each year for an average total of six learners per year. The child psychology training program accepts one fellow and then two fellows in alternating years for an average total of three learners per year. The cohort of fellows involved in this study have limited exposure with colleagues from the other discipline in clinical setting and no engagement as a cohort in the same didactic or training seminars besides the ICPS. The child psychiatry and psychology fellowship training programs provide diverse experiences for advanced trainees related to the assessment, treatment and management of pediatric populations. There is exposure to a wide variety of presenting problems and diagnostic complexities including anxiety, mood disorders, psychosis, attention deficit hyperactivity disorder (ADHD) and other disruptive behaviors, medical comorbidity with psychiatric symptoms, and developmental disabilities. Training occurs across outpatient, intensive outpatient, partial hospitalization, psychiatric inpatient hospitalization, consultation and liaison hospital service, and other medical and non-medical settings. The level of clinical acuity varies from families presenting with adjustment concerns to requests for comprehensive first-time psychological or psychiatric assessments to acute psychiatric hospitalization.

Procedure

The ICPS was inspired by the first author’s internship training experience and the previous development and implementation of a similar program which was piloted for three years at a large Midwestern children’s hospital. The overarching goal of the ICPS model is to provide an initial step to facilitate cross-discipline interaction and learning during training. While the previous pilot included psychology interns, psychology fellows, master level social work students, and psychiatry residents and fellows, the current ICPS consisted of only psychiatry and psychology fellows due to the training structure at the current institution which did not include any psychology inters or master level social work students. Further psychiatry residents were not engaged in the program on a regular basis.

The six objectives for the ICPS include (1) provide a training opportunity for fellows that would allow for cross discipline interaction and a venue to present clinical cases to a diverse group of professionals; (2) expose fellows to a diverse range of clinical care (e.g. medication management, psychological assessment, and therapy) with a focus on evidence-based practice; (3) allow fellows to present their clinical cases to their training program directors and cross-discipline peers at a level that is consistent with their professional development; (4) provide an atmosphere to function as a professional consultant and opportunity to cultivate these skills; (5) allow for a supportive venue to implement and enhance case presentation format consistent with the fellow’s professional developmental skills in conjunction with feedback from supervisors and colleagues; and (6) expose fellows to cross-discipline case conceptualization and treatment methods. Each fellow was expected to present one clinical case each training year (see Fig. 1 for suggested case presentation template), and to incorporate at least one supplemental reading in the form of a peer reviewed journal article or book chapter with each case presentation. The content of the reading, which was made available two weeks prior to the fellow’s presentation, was required to support the conceptualization and goals of the case and to provide a topic for discussion in conjunction with the clinical presentation.

Fig. 1
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Case Presentation Directions and Template

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Facilitation of the ICPS was provided by the seminar director (first author), child and adolescent psychiatry fellowship training director, and the child psychology fellowship training director. Facilitators were present to address any administrative or organizational needs for scheduling and offering the seminar. Though facilitators were always present to encourage learner engagement, provide clinical questions, facilitate further discussion, or propose ideas of additional topics to be covered or considered, their role was not supervisory and instead allowed learners to largely lead the flow of the seminar.

Fellows’ case presentations covered a variety of topics and case characteristics, and the examples below are not intended to represent an exhaustive sampling. Examples of identified presentation foci include medication management, psychological assessment, and psychosocial interventions (e.g., outpatient, day treatment, and inpatient therapy). Specific clinical concerns addressed in ICPS included internalizing, externalizing, and psychotic disorders, as well as cases that presented as clinically and/or medically complex and utilized multiple treatment interventions. Therapy cases could represent initial, middle, or late phases of treatment. Assessment cases could represent initial intake evaluations or ongoing psychological assessment, and may have focused on concerns about diagnostic clarification, assessment strategies, and/or access to additional services. Importantly, elements of diversity and any ethical concerns associated with each case were woven into the presentation and discussion. Additional related discussion may include psychoeducation, conceptualizing and managing resistance to treatment, addressing treatment interfering behaviors, medications, legal concerns, and effects of research and/or evidence-based practice on treatment adherence and outcome. Additionally, there were opportunities each month to provide a short informal update for cases that were previously presented.

All completed Case Presentation Seminar Surveys were entered at the end of the training year and used to inform ICPS faculty on considerations for updates and modifications to future ICPS offerings. The site’s Institutional Review Board approved the retrospective review of the three-year data for the current study.

Measures

Acceptability

To measure learner satisfaction with the ICPS data was collected using the Case Presentation Seminar Survey. The Case Presentation Seminar Survey was developed to evaluate the ICPS and therefore is not a validated instrument. The survey consisted of 17 items that utilized a five-point Likert-scale (1 very dissatisfied to 5 very satisfied) that allowed respondents to rate their level of satisfaction with the seminar. Participants were also asked to respond with “yes” or “no” to a question asking whether they had participated in a similar case seminar previously, as well as to indicate how many years they had participated in the current ICPS (e.g., 1–3 years). An additional question asked respondents to indicate their training discipline (e.g., psychiatry or psychology). Lastly, two items requested free text responses regarding (1) feedback regarding ways to enhance the ICPS and (2) feedback regarding the respondent’s overall experience in ICPS. Survey responses were analyzed to assess overall satisfaction with various aspects of the ICPS across participating learners, as well as differences between learners from different training years and backgrounds (i.e., psychiatry vs. psychology).

Feasibility

To measure the successful implementation of the ICPS information from the Case Presentation Seminar Survey as well as the Division’s ability to offer the ICPS with support from the department and without interruption.

Results

All 24 (100%) respondents reported they had not participated in a similar case seminar presentation prior to fellowship. Respondents provided feedback indicating the positive aspects of the ICPS that covered topics of case formulation, working with and integrated group of providers, navigating clinical issues, treatment recommendations, and support (Table 1). Learners reported high levels of satisfaction across measured aspects of the ICPS (e.g., all satisfaction ratings M > 4.2; Table 2), with a mean overall satisfaction rating of 4.46. Learners rated “diversity of presenting problems presented” (M = 4.63) and “complexity of cases presented” (M = 4.67) particularly high. To this, the cases that were presented during the data collection period included 21 youth ages 7–18 (Mage = 14.24), 12 (57%) of whom were female, and 13 (62%) of whom were White. See Table 1 for additional case details, including diagnoses which ranged from unspecified depression and anxiety to intellectual disabilities and ADHD to budding psychosis and schizophrenia. Learners also provided comments about which aspects of the ICPS were particularly helpful for specific cases they presented. Themes from such comments included appreciation for the opportunity to collaborate across disciplines to establish interdisciplinary relationships, expand case conceptualization skills, and garner recommendations for treatment approaches from other perspectives.

Table 1 Demographics of 21 presented cases
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Table 2 ICPS satisfaction
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The format of the ICPS (i.e., one learner presents each month and all other attendees are encouraged to participate in the discussion; facilitators are present to aid in flow but not technically lead the seminar) was also well received (M = 4.46). In reviewing qualitative feedback regarding the role of the facilitator(s) during seminars, responses indicated that facilitators often became less actively involved following two or three sessions as learners became familiar with the format and the seminar progressed each year. Further, the typical location and physical environment of the seminar (e.g., in a room where learners could sit facing one another to facilitate open conversation; M = 4.33) and the frequency of the seminar (M = 4.54) were also rated as satisfactory on average. A one-way between-subjects ANOVA was conducted to compare the effects of training year on satisfaction with different elements of the case seminar. Of note, ten (43%) of the 23 respondents with otherwise complete data did not identify how many years they had participated in the ICPS. Interestingly, the only significant effect of training year illuminated involved satisfaction with the location of the seminar at the p < 0.05 level for the three conditions [F(2,21) = 5.35, p = 0.013] indicating that participants in the first year the program was offered did not like the space offered for the seminar which was subsequently changed, based on feedback, resulting in higher satisfaction in the following years. Importantly, fellows’ survey responses indicated that the current format meets a training need that was missing prior to the implementation of the ICPS.

Regarding the feasibility of the ICPS, the ICPS was rated favorably by trainees and was offered without interruption during the three-year implementation phase. Additionally, during that time the ICPS seminar facilitator and both fellowship training directors regularly attended the ICPS. Additionally, the department’s education committee supported the ongoing offering of the ICPS.

Discussion

Interdisciplinary collaboration is an important aspect of mental health care for youth, and includes a variety of specialties such as psychology, psychiatry, family medicine, social work, counseling, pediatrics, and neurology, to name a few. Common cross-discipline training models include shadowing and observation-based rotational experiences, as well as attending specialty didactics and seminars. However, active participation in these opportunities related to structured case conceptualization, formal case presentation, discussion of treatment recommendations, and formulation of follow-up care plans is often not available. Furthermore, though contact between multidisciplinary teams may be common during training, true interdisciplinary learning and partnership may not be prioritized, despite that previous studies have found benefits from regular interactions between specialty disciplines [25]. Additionally, there may be limited focus on science-based practice models depending on the training setting. The ICPS addresses these concerns in the spirt of IPE by providing a semi-structured format to encourage interdisciplinary learning, collaboration, and active discussion centered around evidence-based practices to ensure the best possible patient care. The current study thus tested the acceptability and feasibility of the monthly one-hour ICPS for psychiatry and psychology fellows who are in independent two-year fellowship training programs and have limited interactions outside of the ICPS.

Current results suggest many of the learners reported not having participated in a similar structured training experience with colleagues from other training disciplines, highlighting the rarity of such a program. Our survey generally found that learners experienced the ICPS to be satisfactory overall, including its format, frequency, opportunities for collaboration, and opportunities for exposure to diverse cases, case conceptualizations, and evidence-based interventions. Fellows also reflected positively on the support and feedback provided by other learners, as well as by seminar facilitators. Importantly, as fellows from both disciplines reported satisfaction with the ICPS, this seminar supports the training programs’ goals to meet established educational benchmarks set forth by accrediting bodies for psychiatry and psychology.

The benefits of the ICPS extend beyond addressing educational standards and satisfying learner interests. For example, increased communication and open discussion between psychiatry and psychology fellows can help bridge language gaps between the disciplines, such as those associated with different case conceptualization frameworks (e.g., labeling transference vs. functional analysis of a social behavior). Improved communication skills and understanding of one another may even help to level out antiquated hierarchies between psychology and psychiatry [41]. Furthermore, such an effort can increase interdisciplinary note literacy, curbing confusion associated with descriptions unfamiliar of treatment approaches, interpretations of testing results, and even discipline-specific wording and abbreviations within clinical documentation.

Additionally, allowing learners to take the lead in this seminar promotes in-the-moment experience providing feedback to others who may be less familiar with one’s area of expertise. In this, learners can gain modified supervisory and teaching experience within the guiding presence of other learners and seminar facilitators. Though no clear link has been established between supervision and therapy outcome, additional research addressing effective aspects of supervision strategies is necessary to establish best practices [42]. The ICPS may help in this effort by allowing for live observation by facilitators of different supervisory and teaching approaches while simultaneously eliciting informal feedback from those on the receiving end of instruction as to their experience and preferences. Furthermore, the interdisciplinary relationships established within the ICPS may form a foundation for ongoing collaboration with particular cases, as well as a crucible for the formulation of broader near-peer supervisory opportunities [43]. Because of this, and that facilitators typically adopt a more passive role within the seminar, the ICPS requires little urging to maintain its momentum following the first few meetings, making it a relatively low-burden and potentially self-sustaining training tool.

While offering training opportunities for learners is necessary to meet accreditation requirements for both fellowships, it also presents a potential burden to faculty and the learning environment (e.g., physical space to meet, time commitment on learners and faculty, etc.). As a result, the feasibility of the ICPS was necessary to understand. When develo** the ICPS the facilitator discussed the model with both fellowship training directors who agreed to the model and their regular attendance. After the three-year implementation study the training directors for both fellowships changed and this did not disrupt the offering of the ICPS or the training director’s regular attendance. Additionally, meeting space was already available as part of both fellowship training needs and did not present a hindrance to the offering of the ICPS. Further, the department’s education committee and both fellowship directors received formal and informal feedback about the learner’s satisfaction and benefit of the ICPS which provided additional support for offering the ICPS. Including the three-year implementation phase The ICPS has been offered annually for over six years. Two years ago, as a result of COVID-19 mitigation efforts, The ICPS was provided virtually via zoom platform.

Important limitations should be noted with regards to the present implementation study. Namely, the sample size is restricted and the proportion of learners from each discipline is necessarily uneven given the typical cohort sizes. Additionally, threats to anonymity due to the smaller sample size may have resulted in biased responses and/or some respondents declining to answer certain questions (e.g., number of years attending the seminar). Relatedly, no other demographic variables were assessed within the survey (i.e., age, gender, race, etc.) in order to minimize concerns related to identification of respondents, limiting aspects of the analyses that were feasible to conduct. As no follow-up data was collected post ICPS participation, there is no way to determine whether feedback and discussion resulted in application of new skills or ideas, or overall change in clinical practice. Lastly, the current data reflect results from an in-person model that was provided prior to COVID-19 mitigation efforts and may not be consistent with satisfaction with a virtual model.

Despite these limitations, the present study supports the feasibility, acceptability and benefits of the ICPS described herein. With regards to feasibility, survey results suggest that the present format and frequency of the ICPS (i.e., monthly hour-long meetings) are both satisfactory and sustainable. Bearing in mind the burdens associated with more intensive IPE models [23,24,25], as well as the shortcomings associated with smaller scale seminars [36,37,38,], the ICPS was designed to require minimal resources (e.g., time spent meeting, preparation of materials) while delivering maximum advantage (e.g., open discussion, exposure to variety of cases, development of interdisciplinary relationships). As survey respondents broadly indicated that the content, associated demands, and individualized benefits of the ICPS are reasonable and satisfactory, this training endeavor meets broader training needs which not only benefit the learners but the training institution, as well. Based on the current findings, the ICPS and associated efforts met each of the six goals outlined previously, while also aligning with the goals set forth by the Institute of Medicine’s reports [44, 45]. Furthermore, this article describes a template that can be used to establish similar training efforts to be disseminated across comparable training settings. Such expansion of formalized interdisciplinary training efforts could not only continue to meet learners’ needs and expectations in the moment, but it could also further understanding of formal programmatic interdisciplinary training in order to more broadly facilitate future improvements in existing multidisciplinary care networks and practices. When training programs consider implementing ICPS they may benefit from addressing potential limits or weaknesses of the program. This may include develo** and implementing strategies for supporting a trainee who is struggling personally and/or academically in their program as their struggles could impact the group directly or indirectly. Additionally, having faculty trained and aware of the program to assist with support and backup is necessary. While this can be a new and uneasy experience for some trainees many found it fairly easy to engage in with faculty initially demonstrating a case presentation and discussion in the first ICPS meeting of the year and having more senior learners present earlier in the seminar.

Summary

Given the likelihood of working together during training and in future professional activities there exists a need to expose psychology and psychiatry trainees to a range of interdisciplinary learning experiences and to share their collective knowledge and skills. To enhance these training opportunities, the current study reviews the development and implementation of a monthly one-hour ICPS for child and adolescent psychiatry and psychology fellows. The seminar provided exposure to conceptualization, diagnostic, and treatment strategies and skills, as well as science-based practice techniques for psychology and psychiatry trainees. The format may also allow for live observation by different supervisory and teaching approaches. Results support the implementation of a one-hour monthly interdisciplinary training program to increase training opportunities to learn from a broader and more diverse case presentation utilizing minimal resources while delivering maximum advantage. This seminar meets broader training needs which benefit the learners and the training institution. The reviewed ICPS could be utilized in other training settings. Considering future applications, limits of this implementation study include small sample size, and future studies should include a larger sample size and consider evaluating potential outcomes including the application of skills in clinical settings by collecting follow-up data.