Engaging Black youth in depression and suicide prevention treatment within urban schools: study protocol for a randomized controlled pilot
BACKGROUND:Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. METHODS:A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. DISCUSSION/CONCLUSIONS:This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. TRIAL REGISTRATION/BACKGROUND:Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.
The Positive Approach to the Psychiatric Assessment: A Randomized Trial of a Novel Interviewing Technique
OBJECTIVE:This pilot study compared a novel communication strategy, the positive approach to the psychiatric interview, with the traditional approach to see if the positive approach can be taught to psychiatric residents; reproduced with standardized patients; measured with a structured scale, the "Positive Approach Outcome Measure," by blinded raters; and used to improve rapport (assessed with the Bond score), a key driver of engagement. METHODS:Thirty psychiatric residents were randomly assigned to conduct two psychiatric interviews with standardized patients. The standardized patients completed the Working Alliance Inventory-Short Revised, an assessment of the therapeutic alliance. T tests and linear regression examined the effect of the training on the outcome of interest, the Bond score. RESULTS:The Bond scores for the positive approach group (M = 19.27, SD = 2.87) and the traditional approach group (M = 16.90, SD = 3.44) were statistically significantly different (p = 0.05). All residents trained in the positive approach received a positive score on the Positive Approach Outcome Measure while none of the traditional approach-trained residents attained the threshold. The inter-rater reliability for the blinded raters was high (0.857), as was the intra-rater reliability (1.0). CONCLUSIONS:The positive approach can be taught to residents and reproduced consistently and was associated with improvement in a key driver of treatment engagement: rapport. The positive approach may be an important, inexpensive intervention to improve treatment engagement and ultimately treatment outcomes.
Race, Ethnicity, and the Medical "One-Liner": How Child and Adolescent Psychiatry Can Chart Its Own Antiracist Path Forward [Editorial]
Patient and Clinician Satisfaction with the Early Implementation of Telemental Health Services in an Urban Behavioral Health Clinic During the COVID-19 Pandemic
The Behavioral Health Needs of Youth With Preexisting Psychiatric Disorders in the Aftermath of COVID-19
Children and adolescents with psychiatric disorders are a sizable population of children and youth with special health care needs. While the capabilities of behavioral health resources to meet these youth's needs were already strained, the Coronavirus Disease 2019 (COVID-19) pandemic extended resource limitations just as this subgroup of children and youth with special health care needs faced new stressors and potential exacerbations of their underlying psychiatric illnesses. In this article, we provide a brief narrative review of the factors' manifestations with an emphasis upon their disproportionate impact upon children of color and their families and particularly those from disadvantaged communities. We proceed to provide policy proposals for addressing these disparities. These include raising reimbursement for behavioral health services, increasing telehealth care delivery, reducing inter-state licensing requirements, increasing community-based services, and addressing social determinants of health. Conclusions and directions for strengthening behavioral health service delivery capabilities and addressing systemic injustices are made.
Holding Space for Facilitated Dialogues on Antiracism in Academic Medicine [Letter]
The year 2020 brought unprecedented challenges and renewed focus on racial disparities and inequities in the United States. For racial and ethnic minority groups, and in particular African Americans, racial disparities have been a constant presence and threat from the time of slavery through the present day. These racial disparities, sanctioned and maintained by institutional racism, manifest in all aspects of life for African Americans-segregated and unequal education and housing systems, health and mental health care disparities, disproportionally elevated incarceration rates, and, as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. In addition, most recently, there has been a renewed focus on the increased suicide rate for Black youth and its relationship to these racial disparities.1 In a large urban environment, our academic Child Psychiatry Department recognized that progress toward addressing racial disparities would be impeded without raising awareness and taking individual and collective action to identify implicit bias, power, and privilege differentials, and systemic racism inherent within academic medicine and our own lived experiences. This letter describes the development of such examination through facilitated dialogues on race and antiracism in our department.
44.1 THE EXPERIENCE OF BLACK YOUTH IN THE UNITED STATES [Meeting Abstract]
Objectives: The history of racial discrimination against African American (AfAm) and Black people in the United States is deeply rooted in the history of this country. This presentation will help participants understand the intersection between racism, structural racism, and subsequent hardships as it relates to the AfAm youth's experience of discrimination. This presentation will also help participants learn practical approaches for exploring issues of discrimination with AfAm patients.
Method(s): The presenter will review the history of racial discrimination toward AfAm groups in the United States and give an overview of common experiences of discrimination for AfAm youth. Additionally, using the models of adolescent development of Erik Erikson, William Cross, James Marcia, and Beverly Tatum, the presenter will describe how racial prejudice impacts adolescent socialization and (racial) identity development, and the risk that this may confer for mental illness. Finally, the presenter will offer clinical pearls for clinicians to explore topics of racial and religious prejudice with AfAm patients.
Result(s): For AfAms, racism, segregation, and the resultant impacts on self-esteem and identity have been a constant reality and threat from the time of slavery through the present day. These brutal institutions, sanctioned and maintained by institutional racism, clearly manifest in all aspects of life for African Americans-segregated and unequal education system and housing, healthcare disparities, mental healthcare disparities, disproportionally elevated incarceration rates, and as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. These disastrous long-term consequences have been documented and are clear. However, the experience of Black youth, introduced to these harsh realities over time, has strong implications during crucial periods of development, including physical, emotional, and identity development.
Conclusion(s): There is benefit for clinicians to incorporate exploration of the impact of racial discrimination, although it is challenging, in the evaluation and treatment of AfAm and Black youth. DEI, DEV, ADOL
CREATING AND IMPLEMENTING FACILITATED DIALOGS ON ANTIRACISM IN PSYCHIATRY, CHILD PSYCHIATRY, AND ACADEMIC MEDICINE [Meeting Abstract]
Objectives: There is a significant and urgent need across psychiatry and other academic medicine departments to design, create, and execute effective dialogues on race, while examining unconscious bias and privilege. The overarching goal of facilitated dialogue is to create a safe space for faculty, staff, and trainees of different racial backgrounds to engage in meaningful dialogue that helps all develop an antiracist approach to their work and lives.
Method(s): Based on the literature and the findings of a departmental needs assessment survey that we designed, we developed clear learning objectives, community norms, an 8-month curriculum, facilitator training and supervision, mixed-race dialogue group composition and logistics, and continuous improvement and comprehensive program evaluation. The curriculum covered topics spanning social identity, power and privilege, bias and discrimination, microaggressions, historical and structural racism, current events, cultural formulation and application to practice, allyship, and antiracism stance and action. Each facilitated dialogue session incorporated antiracist readings, videos, podcasts, immersive activities, and interactive group discussion.
Result(s): A total of 114 department faculty, staff, and trainees completed the antiracism education needs assessment survey. Ten clinical leaders were trained to serve as dialogue facilitators. Ninety-seven faculty, staff, and trainees from diverse sociodemographic backgrounds opted to participate, and 179 learner experience surveys were collected from October 2020 to January 2021. At least 94% of respondents felt engaged, safe in the dialogue environment, learned key antiracism concepts, and learned tools on how to take an antiracist stance in their work and lives.
Conclusion(s): Our curriculum, process, and facilitators have successfully addressed our goals of creating a safe space to discuss experiences with race and racism, staying open to the experiences of others, being open to new ways of viewing race, and furthermore use this new perspective to adopt an antiracist stance in their lives. Our workshop format is designed to help participants understand our process and to think through creating their own dialogues. It involves a mix of instructive and highly interactive activities, performed through breakouts and debriefings. AC, DEI, REST
MEANINGFUL CHANGE: APPROACHING PHYSICIAN TRAINEE WELL-BEING THROUGH EVIDENCE-BASED INDIVIDUAL, STRUCTURAL, AND SYSTEMS-LEVEL INITIATIVES [Meeting Abstract]
THE ART OF DESIGNING AND IMPLEMENTING SUCCESSFUL SCHOLARLY ACTIVITY PROGRAMS IN CHILD PSYCHIATRY FELLOWSHIPS FOR TRAINEES AND FACULTY [Meeting Abstract]