Faculty Bibliography

OBJECTIVES/OBJECTIVE:Pediatric mental health emergency department (ED) visits continue to rise with 19% to 62% of youth presenting to the ED ultimately returning for a mental health-related complaint. To better understand the needs of children returning to the ED, this study examines the clinical, demographic, and environmental factors associated with revisits to a dedicated child psychiatric ED. METHODS:Clinical factors, home environment, and mental health service utilization of 885 children presenting to a dedicated child psychiatric ED over a 1-year period were abstracted by retrospective chart review. Bivariate analyses comparing demographic and clinical characteristics for children with and without revisits and a multivariable logistic regression were performed. RESULTS:Of the children presenting to the ED, 186 (21.0%) had at least 1 revisit in the subsequent 180 days. Thirty-one percent of initial visits presented as urgent, 55% presented as emergent. Children presenting with more severe symptoms at their initial visit were more likely to return within 6 months. Female gender, suicidal and disruptive behavioral symptomatology, and a diagnosis of oppositional defiant disorder were associated with repeat visits. Children with mental health system involvement were more likely to have revisits than those who were "treatment naive." CONCLUSIONS:Revisits to the ED are driven by both clinical factors, including severity and psychosocial complexity, and barriers to accessing services. Addressing the problem of return ED visits will require the development of a robust mental health service system that is accessible to children and families of all socioeconomic levels.

Deciding whether to grant an expanded access request for a child whose sibling is enrolled in a gene therapy trial involves a number of complex factors: considering the best interests of the child, the psychosocial and economic impact on the family, and the concerns and obligations of researchers. Despite the challenges in coming to a substantively fair outcome in cases of discordant eligibility, creating a procedurally fair decision-making process to adjudicate requests is essential.

Oppositional defiant disorder (ODD) is a common mental health concern and is particularly prevalent among children living in poverty-impacted communities. A family strengthening/parent management training (PMT)-based multiple family group (MFG) program entitled, the 4 Rs and 2 Ss for Strengthening Families, focuses on the following family process variables: rules, responsibilities, relationships, respectful communication, social support, and stress. While evidence supports effectiveness of this treatment program, less is known about the specific relationship between the family process variables and mental health outcomes of children and caregivers. The current study examined these relationships among a sample of 287 caregiver/child dyads who participated in a NIMH-funded Type II hybrid effectiveness-implementation study in New York City. Data were analyzed using SPSS 27 and Mplus 8. Results indicated that two of the six family process variables related to one or more child and caregiver mental health outcome. Caregiver stress significantly related to child inattention (b = 0.034, SE = 0.01, p < 0.001), child ODD (b = 0.053, SE = 0.02, p < 0.01), and caregiver depression (b = 0.049, SE = 0.02, p < 0.01). Family rules significantly related to caregiver depression (b = 0.228, SE = 0.11, p < 0.05) over time. Findings point towards the substantial role of caregiver stress in child and caregiver mental health, in addition to the impact of inconsistent discipline with difficulty establishing rules on caregiver depression. Examinations of treatment components in relation to improvements in child and caregiver mental health can guide practitioners towards utilizing models that result in positive therapeutic outcomes and/or making adaptations with added content that has been shown to be effective.

The late nineteenth century philosopher Hans Vaihinger and the preeminent contemporary philosopher, Kwame Anthony Appiah contend that in order to see a more complete picture of the world, we need a plurality of pictures with which to view it, not just one. This truth comes with epistemological burdens and with the inconvenient fact that the human mind is unable to juggle more than one picture or theory simultaneously. Thus, psychoanalytic clinicians tend to select one theory as a guide when treating patients. In this paper, I will offer ways to think about this conundrum as it appears in the child psychoanalytic setting and whether it is possible to shift from one"™s usual theoretical point of view to include alternate theoretical perspectives"“and thus, to gain a more complete "truth", as Vaihinger and Appiah suggest we should aspire to"“as the clinical situation allows.

Childhood anxiety is common, yet approximately half of youth do not receive treatment due to stigma, mistrust of the mental health service system, extensive wait lists for services and provider shortages. Alternative models and modes of treatment are needed. This paper describes the development of an alternative treatment that incorporates cognitive behavioral components for anxiety into an adaptive/therapeutic riding program delivered by certified riding instructors in a horse stable that offers horseback riding and therapeutic horsemanship programs. Using PracticeWise®, a well-established database of evidence-based mental health practices for youth, we identified five therapeutic elements that are the most commonly examined in rigorous research for childhood anxiety, and integrated them into a manualized program of adaptive riding sessions. Excellent fidelity to the intervention (98.7% mean score) and high inter-rater reliability (k = 0.92) were achieved. This approach has implications for expanding access to and engagement in adaptive/therapeutic riding interventions.

This letter to the editor continues the discussion about the similarities and differences between secondary psychosis and schizophrenia, which was initiated by the authors of the article «Substance-induced psychosis and schizophrenia: the interaction point» (Fedotov I.A., Quattrone D., Shustov D.I. Substance-induced psychosis and schizophrenia: the interaction point. I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):593-604. doi:10.23888/PAVLOVJ2020284593-604).

This is an introduction to a collection of papers that commemorates the twentieth anniversary of 9/11. The nature of the content of the papers which follow is spurred by reflections on this anniversary from a number of domains: child and adult psychoanalysis; the healing arts of theater; the parent-child treatment of Afghani and Iraqi asylum-seeking families; the Law of the Mother and siblingships; the changes occurring in psychoanalytic views of secularism; and the confrontation of racial prejudice and othering in the workplace and its repercussions upon the self. Concepts of splitting, the bearing of ambivalence, and the capacity to reflect and resist fragmentation are illuminated.

Despite the extensive literature on the deleterious effects of perceived neighborhood disadvantage on academic achievement, there is a dearth of information on racial/ethnic differences in the underlying roles of future orientation and parental support that may mediate or moderate this association. Using data from 3618 students in grades 6-9 (50% female, Mean_age = 12.9 [1.3], 6.99% Black, 10.39% Hispanic/Latino, 82.61% White) in two communities in North Carolina during 2009-2014 who completed the School Success Profile, a self-report social environmental assessment, this study conducted multiple group analyses across three racial/ethnic groups (Black, Hispanic/Latino, White), revealing that perceived neighborhood disadvantage was associated with lower future orientation, which in turn was related to poorer academic achievement. The mediating effects were stronger among Black youth compared to White and Hispanic/Latino adolescents. Adolescents with high parental support were minimally affected by perceived neighborhood disadvantage. The findings identify nuanced racial/ethnic disparities in perceived neighborhood influences on academic achievement and raise important intervention targets to promote academic achievement among disadvantaged subgroups.