Scaling Pediatric Mental Health Care Through Primary Care Workforce Re-Training: A Task-Shifting Implementation Strategy

Background: Anxiety and depression are among the most prevalent and disabling mental health conditions in children and adolescents, yet they remain under-recognized and undertreated in primary care. Persistent shortages of child mental health specialists in the U.S., Canada, and other countries represent a major implementation barrier to timely access to evidence-based care. Scalable workforce re-training of primary care clinicians represents a promising task-shifting strategy to address this gap. Methods: We conducted a longitudinal evaluation of 3,246 primary care clinicians across the United States and Canada who participated in a pediatric mental health workforce re-training program between 2017 and 2024. The program combined a 3-day interactive workshop with 6 months of twice-monthly, case-based group coaching and was explicitly designed to support implementation of evidence-based assessment and treatment for pediatric anxiety and depression in primary care. Clinician outcomes were assessed at baseline (T1), post-workshop (T2), and 6-month follow-up (T3), including knowledge, self-efficacy, use of standardized rating scales, and diagnostic and treatment practices. Resullts: From T1 to T3, clinicians demonstrated sustained improvements across all domains, including increased adoption of evidence-based rating scales, greater willingness to initiate and manage antidepressant treatment, and increased self-efficacy in diagnosis and management. Mixed-effects regression analyses showed comparable outcomes for in-person and live-online delivery modalities, supporting the feasibility of remote implementation at scale. Conclusions: Intensive, theory-informed workforce re-training can function as an effective implementation strategy to expand primary care capacity for pediatric anxiety and depression across disciplines and health systems. Embedding structured training and longitudinal coaching within routine practice environments may represent a pragmatic approach to addressing workforce-related implementation barriers in pediatric mental health care.