Abstract
ObjectivesWe examined the personal and professional impacts of the COVID-19 pandemic on the development, practice, and shifting values of child and adolescent psychiatrists (CAP), in order to inform how the field may move forward post-pandemic.MethodsWe conducted individual semi-structured interviews of child and adolescent psychiatrists (n = 24) practicing in the United States. Participants were selected as a diverse purposive sample of active members of the American Academy of Child and Adolescent Psychiatry (AACAP). We analyzed anonymized transcripts through iterative coding using thematic analysis aided by NVivo software.ResultsWe identified three main thematic domains within participants’ response to the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These domains, paired with representative questions, include: (1) Unsettling, or “who have we been?” (identifying discontents such as daily inefficiencies and intraprofessional loss of trust); (2) Adaptation, or “who are we now?” (exploring affordances and limitations of virtual work, and the evolution of personal and professional identity); and (3) Reimagination, or “who will we become?” (renewing a commitment to psychiatry as advocacy). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested.ConclusionThese three thematic domains, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in its next generation of practitioners.
Highlights
With the COVID-19 pandemic’s arrival in the United States in early 2020 [1], healthcare workers faced a rapidly evolving set of novel demands and an uncertain course
I want to leave behind... meetings, where people need to have lots of meetings to justify their time and justify why they exist in an organization, these layers of bureaucracy and committees and task forces where it feels like things were made more difficult for pointless reasons
As participants looked toward the future of child and adolescent psychiatrists (CAP), we identified conflicting assessments of the field’s ongoing social justice work, and divergent mindsets toward the hope for lasting change
Summary
With the COVID-19 pandemic’s arrival in the United States in early 2020 [1], healthcare workers faced a rapidly evolving set of novel demands and an uncertain course. Frontline healthcare providers are not the only ones who experienced the negative mental health consequences of the pandemic. By mid-2020, American adults reported increased levels of depression, anxiety, substance use, and suicidal ideation [8], alongside significant shifts in how mental health providers could offer care given the restrictions of the pandemic [9]. Children and adolescents were one of several populations disproportionately affected by the mental health toll of the pandemic [8], given the increase in adverse childhood experiences such as child abuse, neglect, and intimate partner violence [10,11,12], and the loss of protective factors such as schools, a significant mental health resource for many American children [13, 14].
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