Faculty Bibliography

OBJECTIVE: The Child and Adolescent Mental Health Studies (CAMS) program is housed in a Liberal Arts undergraduate college of a large research university. Psychiatrists, clinical psychologists, and social workers at the university's medical center teach the courses. The purpose of this study is to evaluate the extent to which CAMS encourages graduates of the program to pursue a career in child and adolescent mental health (CAMH). METHODS: In 2015-2016, graduates of the CAMS program were invited to participate in a mixed methods study. In addition to statistical analyses, qualitative thematic analyses were performed to interpret free-text responses. RESULTS: Forty-five percent (314/702) of invited graduates completed the online survey. Interviews were conducted with 11% (34/314) of participants by study staff over the phone. Quantitative results suggested that 81% (149/185) of participants enrolled in educational programs after graduation due to an interest in CAMH. A significantly higher proportion of the total sample (t = 3.661, p < .001) reported that they changed their career goals while undergraduate students compared to those who did so after graduation. Results of qualitative interviews with 34 participants uncovered five key themes unique to CAMS that may explain the program's influence on graduates' career choices and career development: practitioners-as-instructors, instructor mentorship, novel course content, experiential learning opportunities, and career training and skills. CONCLUSIONS: Quantitative and qualitative results indicated that teaching college undergraduate students about CAMH encourages them to set career goals within the field. These findings suggest the utility of implementing similar programs at other undergraduate colleges.

Objectives: More and more youth are presenting to emergency departments (EDs) in psychiatric distress. Many of these youth present with agitated behavior or aggression as a result of psychosis, anxiety, mania, intoxication, or in relation to underlying behavioral disorder. Agitated patients can be dangerous to themselves, staff, and other patients in the ED and may require restraint. Although reduction of restraint and injury is a priority of every ED, there are little published data on the use and efficacy of PRN medications to treat or prevent acute agitation. In the absence of evidence-based guidelines, expert guidance is needed to assist clinicians in choosing effective and appropriate PRN medications for acute agitation. Methods: The Delphi method for consensus guideline development was used by a team of ED-based child and adolescent psychiatrists from across the United States. By use of an iterative, blinded process to reduce bias, participants reviewed existing or published PRN medication algorithms and guidelines for acute agitation and then developed consensus guidelines with identification of areas of dissension and need for further research. Results: There were significant variations in preferred medications across geography and type of ED setting (medical vs. psychiatric ED). Participants emphasized the importance of nonpharmacologic de-escalation strategies; clinical diagnostic assessment, even in the moment of acute agitation; consideration of individual patient factors in choosing medications; and careful monitoring for efficacy and adverse effects. A range of medications, including antipsychotic drugs, antihistamine, benzodiazepine, and a-adrenergic medications, was recommended. Conclusions: There are currently no AACAP Practice Parameters for the psychopharmacological management of agitation, and there is little published literature comparing effectiveness of different PRN medications or comparing those medications to placebo. Expert consensus guidelines such as these provide much-needed guidance to ED clinicians. These guidelines also demonstrate areas where further research is needed, especially into the comparative efficacy of different PRN medications in patients of different ages, clinical presentations, and diagnostic/treatment history

Objectives: Participants who attend this workshop will learn how to identify their current skills and how to advance and get their papers published. Relatively few students, trainees, and clinicians publish scientific or other educational manuscripts because of limitations in time, experience, and access to mentorship. Improving access to publishing opportunities is important because the process of authoring and publishing scientific manuscripts can increase competency in research literacy, engagement in evidence-based practices, and other skills needed to increase mastery in child and adolescent psychiatry. Methods: We aim to overcome these limitations by providing a "back stage pass" experience, combining hands-on training with practical instruction to build the early foundation for getting published. Topics include choosing a publishable topic of interest, practical steps toward publication, searching the literature and harnessing electronic library resources, writing using organizing principles, preparing an effective abstract, optimizing cover and revision letters, thinking like an editor, dealing with revisions, and the inevitability of rejection and constructively moving forward. Results: Attendees will learn practical steps toward getting published in scholarly journals and strategies to overcome current limitations and obstacles. Interested participants will also have the opportunity to get started with mentored-publishing experiences available through JAACAP and JAACAP Connect. Conclusions: Participating in this workshop will provide the preliminary knowledge and skills necessary for getting published

Objectives: CBT for insomnia (CBT-I) in adolescents and young adults is a brief intervention that includes both behavioral and psychological procedures. At the end of this presentation, participants will be able to 1) describe when and for whom CBT-I is an appropriate form of treatment intervention; 2) provide practical guidelines for conducting CBT-I, including stimulus control, sleep restriction, cognitive restructuring, and sleep hygiene; and 3) practice arousal reduction and biofeedback for the treatment of insomnia. Methods: This session will provide a comprehensive literature review, lecture, and discussion. Results: Medications for the treatment of insomnia are sometimes necessary but most often are insufficient to fully address the problem. CBT-I, by contrast, represents an easily taught series of skills that are portable and time and cost effective. The utility of CBT-I has been repeatedly demonstrated for adults and adolescents. The goal of CBT-I is to alter the factors that perpetuate insomnia and include the following: 1) behavioral factors, such as poor sleep habits, and irregular sleep schedules; 2) psychological factors, such as unrealistic expectations, and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. CBT-I is indicated for primary and secondary insomnia in adolescents and adults and can be delivered on a one on one basis; in groups; and via telephone, telemedicine, and video. This presentation will describe the use of CBT-I and necessary adjustments when applying these techniques with children. Participants will practice arousal reduction and biofeedback techniques. Conclusions: The use of cognitive-behavior therapy for insomnia will be described, and participants will engage in a series of applied exercises to enhance their therapeutic skills

The health of people ever incarcerated in New York City (NYC) jails during 2001 to 2005 was characterized by matching jail, shelter, mortality, sexually transmitted infection, HIV, and tuberculosis (TB) data from the NYC Departments of Health and Mental Hygiene, Correction, and Homeless Services. Compared with nonincarcerated people and those living in the lowest income NYC neighborhoods, those ever incarcerated had higher HIV prevalence and HIV case rates. Ever-incarcerated females also had higher rates of gonorrhea and syphilis than nonincarcerated females. Ever-incarcerated people who used the single adult homeless shelter system had higher HIV, gonorrhea, and TB case rates and all-cause mortality rates than ever-incarcerated people without shelter use, when adjusting for other variables. People ever incarcerated in NYC jails are at risk for conditions of public health importance. Sex-specific jail- and community-based interventions are needed.

Objectives: Temper outbursts are frequently considered symptoms of irritability within the context of ODD, mood disorder, and anxiety disorder. However, even when chronic irritability is not present, they are associated with significant functional impairments. We will provide an overview of our research program that takes a multimodal approach to understanding severe temper outbursts in young children. Methods: We evaluated 216 boys and girls (ages 5-9 years; 73% boys) from diverse socioeconomic backgrounds who comprised three groups: 1) children with severe temper outbursts (STO; n = 80); 2) children with ADHD without outbursts (ADHD; n = 79); and 3) typically developing children (TDC; n = 57). Severe temper outbursts were defined as follows: 1) occurring at least three times per week; 2) lasting >10 minutes; 3) excessive for developmental level; and 4) causing significant impairment. Parents completed a semistructured diagnostic interview about their child and questionnaires about their child's behavior and emotion regulation skills. Children completed brief IQ and language screeners, questionnaires about their emotions and behavior, and tasks assessing frustration tolerance and emotion regulation. A number of these children (64 percent) successfully completed an MRI session that included resting-state, structural, and diffusion tension imaging scans. Results: Approximately 84 percent of the STO group received an ADHD diagnosis, 67 percent were diagnosed with ODD, 28 percent were diagnosed with an anxiety disorder, and 12 percent were diagnosed with a mood disorder. Few exhibited chronic irritabilities based on parent report. On an emotion regulation task, the STO group demonstrated deficits in regulating negative affect in response to frustration. Findings from the resting-state fMRI analyses suggest disruptions in dorsal anterior cingulate cortex (dACC) circuitry associated with tantrum severity. Tantrum severity was also related to cortical thickness of the dACC. Conclusions: Children with severe temper outbursts represent a highly impaired group, even when chronic irritability is not present. Evidence suggests an association between these outbursts and disruptions in dACC circuitry, a region implicated in the expression and regulation of frustration. Such findings have important implications for future conceptualization and treatment of young children with severe temper outbursts

Objectives: The five presenters and discussant in this Clinical Perspectives highlight the challenges associated with pediatric psychiatric crises in standard emergency care settings. Each presenter will focus on a crisis care model that can address urgent patient needs, improve access to mental health care, and decrease unnecessary time or treatments in hospitals Methods: A literature review of pediatric mental health emergencies and crisis care systems will be provided. Each presenter will share her experience in creating, implementing, and/or practicing a particular crisis care model, including phone triage systems, mobile crisis clinics, and crisis stabilization and residential units. Presenters will discuss funding and community resources that have made such projects feasible and highlight key components of program development. Results: Communities and agencies are responding to increased emergent pediatric mental health needs by shifting treatment from standard emergency department settings to a continuum of team-based and nonhospital services. Each of the crisis care models included here has improved community access to behavioral health providers and helped triage children to more appropriate locations/programs of care. Data collected from individual sites indicate improved quality of care and interagency relationships, decreased length of stay or need for emergency department visits, increased outpatient follow-up, and decreased need for inpatient hospitalizations. Conclusions: Providing quality care to youth in mental health crises has become a challenge in our current health care system, with the decline of inpatient beds, lack of providers with mental health training, and limited access to community mental health services. A continuum of psychiatric crisis care services can better meet community and patient needs, thereby relieving burden on emergency departments and linking children and families to the services they need. More research on additional outcomes, as well as establishment of national standards of pediatric psychiatric crisis care, is needed

Objectives: The goal of this session is to bring Clinical Perspectives and the eponymous JAACAP column "into life" by casting content from recent and forthcoming installments of the series into the popular "TED Talk" (Technology, Education, and Design Talk) format. Methods: Following the format first established at the 2014 Annual Meeting, this will be a 180-minute session co-moderated by JAACAP Editor-in-Chief Andres Martin and Assistant Editor for Clinical Perspectives Laura Prager. The session will start with a brief introduction providing the background, context, and "ground rules" for an effective TED Talk, including adherence to tight time limits and minimal use of audiovisual supports. The authors of five published or forthcoming Clinical Perspectives will then each present a 15-minute TED Talk of their respective articles. Each presentation will be followed by five minutes of interactive and moderated discussion. There will be a short break between speakers, allowing for a brief introduction. The session will end with overarching concluding remarks, time for discussion, and an invitation for new submissions. Results: All five presentations will discuss child psychiatric takes on topics of acute public health relevance and social concern that have been featured prominently in the lay media. Conclusions: Child and adolescent psychiatry is grounded in solid clinical practice, and it is from this clinical substrate that important research questions and hypotheses first arise. Clinical Perspectives provides a forum to consider and revisit clinical phenomena anew, a platform from which to reclaim the excitement that first drew us into our chosen field. The TED Talk format, which has been so successful in the global dissemination of Technology, Education, and Design ideas, can be successfully borrowed to reveal that child and adolescent psychiatry does indeed have (clinical) "ideas worth spreading."