Child Psychiatry Fellows Research Articles

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Assessing the Factors Affecting Recruitment to Child and Adolescent Psychiatry Fellowship Programs.

The objective of this pilot study was to sample early career child and adolescent psychiatrists (EC CAP), Child and Adolescent Psychiatry (CAP) fellows, adult residents, and medical students to identify factors affecting recruitment to CAP fellowship. A 25-item questionnaire was sent to all adult psychiatry, CAP fellowship, triple-board residency program directors, and coordinators in the US to disseminate to their trainees. Questionnaires also were disseminated via professional groups on social media, and through psychiatry student interest groups to medical students. A total of 369 people responded, of which 315 questionnaires were evaluable. Approximately half of the respondents were CAP fellows or EC CAP. Most decided to pursue a career in child psychiatry during medical school. Forty-three percent owed more than $200,000 in educational debt. The top reasons for pursuing a career in child and adolescent psychiatry included working with children, finding it to be a rewarding career, and finding it intellectually stimulating. A switch to a 1-year fellowship and higher income potential were noted to be factors that may increase consideration for CAP fellowship among those who chose not to pursue it. The majority of early career child and adolescent psychiatrists were recruited during medical school, motivated by altruistic reasons. Early child psychiatry exposure, a means of addressing physician debt, providing additional incentives in geographically undesirable locations, and improving compensation, is needed to improve recruitment to this specialty.

Evidence-Based Practices: An Opportunity to Enhance Psychiatric Residency Training

Staring back at me through the Zoom interface was a small, thin-faced boy, too nervous and overwhelmed to tell me anything more than his own name and the name of his dog: Cooper. This was the first child therapy case I was assigned as a resident trainee. He was a young adolescent with acute lymphoblastic leukemia. Two years ago, he was outgoing, playful, and sociable. Now he apprehensively stared at me, underweight and highly anxious. He was experiencing medical trauma through countless hospital admissions for chemotherapy and opportunistic infections during the ongoing global pandemic. At the time he was transferred to my care, he carried multiple psychiatric diagnoses, including generalized anxiety disorder, major depressive disorder, and posttraumatic stress disorder. I had no idea where to begin. Though I was in my third year of Triple Board training, which includes adult psychiatry, pediatrics, and child psychiatry fellowship, I felt unprepared. My education and exposure to psychotherapy had been somewhat limited; but even still, I knew that learning effective, evidence-based therapeutic skills would not be straightforward.

43.3 Functional Neurologic Disorders: A Child and Adolescent Psychiatry Fellow’s Experience in a Unique Clinical Elective

43.3 Functional Neurologic Disorders: A Child and Adolescent Psychiatry Fellow’s Experience in a Unique Clinical Elective

43.2 Challenges and Opportunities in Treating Functional Neurological Disorders: A Clinical Training Perspective for Child and Adolescent Psychiatry Fellows

43.2 Challenges and Opportunities in Treating Functional Neurological Disorders: A Clinical Training Perspective for Child and Adolescent Psychiatry Fellows

Clinicians' Experience with a Graduate Medical Education Implemented Child Psychiatry Access Program.

The authors aim to measure differences in primary care clinicians' (PCC's) perceptions of managing pediatric mental health before and after launch of a child psychiatry access program (the access program) and identify the impact of engaging trainees from child psychiatry, pediatrics, and family medicine in administration and use of this program. Child psychiatry fellows provide coverage of a grant-funded state-wide access program and engage trainee-peers in learning how to use the program. A survey measuring PCC's experience managing children's mental health conditions was administered before and after the child psychiatry access program launched. Rotation evaluations collect trainee's feedback. Statistically significant differences are identified before and after the program's launch in PCC's perception of access to child psychiatry (U = 294.5, p < 0.001) and between PCC's perceptions of the impact of behavioral health problems in their patients in those with less than 4years post-residency training compared with those with 4 or more years post-residency (U = 524.5, p < .01). Trainee evaluation of the rotation is consistently positive (average 5:6 rating). The authors conclude that (1) the presence of a state-wide access program positively impacts PCC's reported access to child psychiatry; (2) child psychiatry fellows rate the clinical rotation experience favorably; and (3) there appears to be an association between less time out of primary care residency training and perception of improved access to child psychiatry and less clinical burden from behavioral health issues. Further research is required to understand the impact of a training in this model.

The Clock Is Ticking: Are We Prepared for Mass Climate Migration?

Back to table of contents Previous article Next article ProfessionalFull AccessThe Clock Is Ticking: Are We Prepared for Mass Climate Migration?German Velez, M.D., Balkozar Adam, M.D., Olivia Shadid, M.D., Lauren Schooner, M.D.German VelezSearch for more papers by this author, M.D., Balkozar AdamSearch for more papers by this author, M.D., Olivia ShadidSearch for more papers by this author, M.D., Lauren SchoonerSearch for more papers by this author, M.D.Published Online:24 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.4.3AbstractOver the next several decades, the impact of climate change will force millions of people to leave their homes and seek shelter in other countries. These migrants will require significant mental health support.iStock/Cheryl RamalhoThe impact of climate change poses a major challenge to peace in the coming decades. As outlined in the Global Peace Index 2019 report, one of the most pressing concerns relates to the growth in climate-induced mass migration. According to a study in the Proceedings of the National Academy of Sciences, the planet could see a greater temperature increase in the next 50 years than it did in the last 6,000 years combined. Should climate-related displacement reach the scale that current research suggests is likely, it will amount to a vast remapping of the world’s populations. As mental health professionals, it is our responsibility to advocate for policies that help guarantee the human rights and well-being of the people affected by this uprooting and the inevitable change in worldwide demographics.Currently, 1% of the world is considered a barely livable hot zone, but by 2070, nearly a fifth of the land on the planet could hold this designation, from Central America to Sudan to the Mekong Delta. A 2017 study in Science Advances found that by 2100, temperatures could rise to the point that just going outside for a few hours in some places, including parts of India and Eastern China, “will result in death even for the fittest of humans.” The result will almost certainly be the greatest wave of global migration the world has seen. According to The New York Times, more than 30 million migrants could head toward the United States border over the next 30 years.People are already beginning to flee. In Southeast Asia, where increasingly unpredictable monsoon rainfall and drought have made farming more difficult, the World Bank points to more than 8 million people who have moved toward the Middle East, Europe, and North America. In the African Sahel, millions of rural people have been streaming toward the coasts and the cities amid drought and widespread crop failures.It is well documented that migration is a highly stressful, traumatic experience that includes potentially deadly situations before, during, and after the movement. As the world’s population shifts in response to climate change, mental health professionals are going to be faced with an increasingly culturally diverse patient population; patients with increased trauma related to migration; acculturation difficulties; and the consequences of migration in the host communities. The literature finds some evidence of poorer mental health and well-being among migrants and displaced populations compared with populations of non-movers in the countries and communities of origin. For example, a cross-national study found that Mexican migrants in the United States had higher levels of depression compared with their counterparts who never left Mexico.In June 2022, the World Health Organization issued a policy brief highlighting actions for countries to take. It emphasized the serious risk to the mental health and well-being of migrants and urged countries to include mental health support in their responses to the climate crisis. It is our responsibility to use our voices as trusted mental health professionals to advocate for policies that facilitate progressive migration, education that decreases fear, and political resistance to avoid anti-immigration backlash. We must actively prepare, both materially and politically, for climate change and migration to reshape the future. ■Resources“Deadly heat waves projected in the densely populated agricultural regions of South Asia”The World Health Organization’s policy brief: “Mental health and Climate Change: Policy Brief”German Velez, M.D., is a general psychiatry resident at Boston University Medical Center.Balkozar Adam, M.D., is a child and adolescent psychiatrist with Burrell Behavioral Health and a professor emeritus at the University of Missouri.Olivia Shadid, M.D., is a child psychiatry fellow at the University of New Mexico.Lauren Schooner, M.D., is a general psychiatry resident at Harbor-UCLA Medical Center. ISSUES NewArchived

Stimulating Reflections on This Issue

Back to table of contents Next article EditorialFull AccessStimulating Reflections on This IssueDanielle W. Lowe, M.D., Ph.D.Danielle W. LoweSearch for more papers by this author, M.D., Ph.D.Published Online:1 Mar 2023https://doi.org/10.1176/appi.ajp-rj.2023.180301AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Sometimes a natural theme occurs in an issue of the American Journal of Psychiatry Residents’ Journal (AJP-RJ), and it would be remiss not to reflect on these articles as a group. The issue starts with a literature review of repetitive transcranial magnetic stimulation (rTMS) as a treatment for anorexia nervosa by Jae H. Kim, B.S., and colleagues (1). Although the efficacy data are limited in both number of trials and length of follow up, the possibility of integrating rTMS into a larger multidisciplinary treatment program to help reduce maladaptive processes in the frontolimbic system is appealing. This review is followed by two History of Psychiatry articles that explore the development and science of rTMS. Dallas Hamlin, M.D., and John Garman, M.D., review the roots of neurostimulation by intertwining the discoveries of electricity and magnetism within the field of psychiatry (2). Alexander Levit, M.D., Ph.D., builds on this foundation, discussing some of the technical details of current and emerging protocols (3). Together, these articles help integrate the reader’s understanding of the fundamentals and potential future directions of rTMS, and I hope you enjoy reading them, as I have.It is also exciting that this issue of the AJP-RJ is being released just a few days before the conclusion of our third virtual residency and fellowship match cycles. I encourage you to read Chris Wang, M.D., and colleagues’ discussion of the limitations and benefits of a virtual match from the perspective of having both types of interviews at different stages of professional training (4). Continued dialogue about how to balance equity and affordability while having a meaningful interview experience is critical. We know even less about the effects of the virtual match on well-being and burnout throughout training. Trainee burnout is not a new topic, and the Accreditation Council for Graduate Medical Education common program requirements include the assessment of and support for well-being (5, 6). However, with only two classes of virtually matched trainees matriculated to date, the longer-term effects of virtual interviews on program satisfaction and burnout are yet to be fully realized. How do virtual interviews contribute to the sense of lack of control during training? What effects did in-person interview dinners and applicant interactions have on trainees in the program? What additional burdens do virtual interviews have on trainees? The authors concluded that a curated group of trainees and faculty could provide enough information about an institution and community’s culture for the interviewee’s match list—but how virtual interviews change the larger residency and fellowship experience remains relatively unknown.Dr. Lowe is a fifth-year child and adolescent psychiatry fellow at the University of North Carolina, Chapel Hill. She is also an American Psychiatric Association Foundation Child and Adolescent Psychiatry fellow (2021–2023) and editor-in-chief of the American Journal of Psychiatry Residents’ Journal (2022–2023).

Are In-Person Trainee Interviews a Relic of the Past?

Are In-Person Trainee Interviews a Relic of the Past?

63.3 Functional Neurological Disorders: Clinical Training for Child and Adolescent Psychiatry Fellows

The increase in youth with functional neurologic symptom disorders (FNSDs) during the COVID-19 pandemic has highlighted the need to increase psychiatrist training in FNSD treatment to meet community needs. Struggles in identifying psychiatrists who treat FNSDs are reported by both pediatric neurologists and patients’ families. Child and adolescent psychiatry fellows and fellowship programs have expressed an interest in more FNSD education beyond the consult liaison services experience. One of the most expedient ways to address these multiple challenges is to create specific FNSD training opportunities for child and adolescent psychiatry fellows.

1.49 Diversity, Equity, and Inclusion (DEI) Quality Improvement (QI) Toolbox as an Actionable Means to Effect Justice-Oriented Clinical Change

1.49 Diversity, Equity, and Inclusion (DEI) Quality Improvement (QI) Toolbox as an Actionable Means to Effect Justice-Oriented Clinical Change

63.4 Functional Neurologic Disorders: A Child and Adolescent Psychiatry Fellow’s Experience in a Unique Clinical Elective

Although common in the pediatric patient population, there lacks a formalized clinical curriculum for child and adolescent psychiatry fellows to learn how to recognize, diagnose, and treat those with functional neurological disorders (FNDs). As a result, fellows graduate with limited comfort in assessing and treating this patient population who respond well to treatment. This presentation will: 1) discuss the current state of education of FNDs in clinical education during child and adolescent psychiatry fellowship; 2) explore the challenges and opportunities of an FNDs elective from a fellow’s perspective; and 3) identify the essential skills that a child and adolescent psychiatry fellow should learn to be comfortable in the evaluation and treatment of FND cases.

3.51 School-Age Diagnostic ASD Assessments: A Pilot Clinic for Child and Adolescent Psychiatry Fellows

The supply of providers with adequate knowledge and training in ASD is failing to meet the current demand. This leads to long waits for diagnostic assessment and medical diagnosis and a delay in the provision of services. We piloted a diagnostic clinic for school-aged children with low-complexity, clinically unambiguous ASD to expedite access to services ahead of full neuropsychological testing. This process included creating a workflow, training tools, and documentation templates to facilitate learning during rotations at the Center for Autism Spectrum Disorders (CASD) and to improve the skill set and confidence of providers to perform diagnostic assessments of ASD.

14.3 Training Child and Adolescent Psychiatry Fellows to Care for Youths With Neurodevelopmental Disorders

There is an increasing need to provide evidence-based psychiatric care for youth with neurodevelopmental disorders and mental illness (NDDs/MI). MI occurs at a high rate in youth with NDDs, with estimates ranging from 30% to 50%. Rates of NDDs in the psychiatric setting are unknown, although studies suggest they are elevated while also representing underutilization of care due to a dearth of mental health services for this population. The interplay of NDDs, comorbid medical complexity, and mental illness impacts both presentation and treatment, making management more difficult without appropriate training.

51.2 Improving Access and Quality of Psychodynamic Psychotherapy Supervision for Child and Adolescent Psychiatry Fellows at Oregon Health & Science University: Follow-up Report

This presentation will provide an overview of the incorporation of psychodynamic psychotherapy supervision at a child and adolescent psychiatry fellowship training program, highlighting the benefit of a quality improvement process addressing new and ongoing challenges during the second year of this project.

Psychodynamic Child and Adolescent Psychiatry and the Future of Our Field

The Accreditation Council for Graduate Medical Education (ACGME) requirements for child and adolescent psychiatry training require that child and adolescent psychiatry fellows demonstrate competence in psychodynamic psychotherapy.1 Child and adolescent psychiatry educators may turn to JAACAP to find up-to-date advances in psychodynamic psychotherapy to teach. However, the term psychodynamic appears to be hard to find, literally. A search on https://www.jaacap.org/ of past issues for psychodynamic2 resulted in 4 articles published in the past year, but none have the word psychodynamic in the title. Three articles describe newer evidence-based forms of psychotherapy: brief focused parent-infant psychotherapy, adolescent-focused therapy, and mentalization-based treatment. These are are described in their respective articles as "psychodynamic-based," as "psychodynamically informed," and having "historical roots in psychodynamic psychotherapy." As none are specifically titled psychodynamic therapy, it is unclear whether teaching these modalities would satisfy the ACGME requirement of competence in psychodynamic psychotherapy. Comparatively, this linguistic dilution does not seem to affect cognitive-behavioral therapy (CBT), another psychotherapy required by the ACGME1: specialized branches such as trauma-focused CBT, CBT for psychosis, and CBT for insomnia all retain the parent name of CBT. Therefore, it is important to define psychodynamic.

Training during a global pandemic: A Child and Adolescent Psychiatry fellow's perspective

As the end of my fellowship in Child and Adolescent Psychiatry draws near, my days are occupied by shoring up my expertise in child and adolescent mental health. While I reflect on my training, I am struck by the role the COVID‐19 pandemic played throughout the past 20 months.

The Impact of COVID-19 on Pediatric Telepsychiatry Training in Child and Adolescent Psychiatry Fellowships.

ObjectiveThis report summarizes findings from a 2020 survey of US child and adolescent psychiatry training programs that explored the impact of the COVID-19 pandemic on pediatric telepsychiatry training. The authors hypothesized that telepsychiatry training significantly increased during the pandemic, in part due to legal and regulatory waivers during the COVID-19 public health emergency.MethodsIn August 2020, an anonymous, 28-question online survey was emailed to all (138) accredited child psychiatry fellowships on the Accreditation Council for Graduate Medical Education website. Forty-nine programs responded (36%). This analysis focuses on three of the 28 questions relevant to the hypotheses: characteristics of the program’s training in telepsychiatry; perceived impediments to clinical training; and perceived impediments to didactic training pre-COVID onset vs. post-COVID onset, respectively. Total scores were created to investigate differences in training programs and impediments to including telepsychiatry pre- and post-COVID onset. Paired sample t-tests were used to compare means pre- and post-COVID onset.ResultsResults provided support for significant differences between training components related to telepsychiatry pre- and post-COVID onset, with participants reporting more training components post-COVID onset (M = 5.69) than pre-COVID onset (M = 1.80); t(48) = 9.33, p < .001. Participants also reported significantly fewer barriers to providing clinical experiences in pediatric telepsychiatry post-COVID onset (M = 2.65) than pre-COVID onset (M = 4.90); t(48) = − 4.20, p < .001.ConclusionsDuring the COVID-19 pandemic, pediatric telepsychiatry training in child psychiatry fellowships increased significantly. Perceived barriers to providing clinical, but not didactic, training decreased significantly.

Addressing the Nationwide Shortage of Child and Adolescent Psychiatrists: Determining Factors that Influence the Decision for Psychiatry Residents to Pursue Child and Adolescent Psychiatry Training.

This study aimed to identify factors that influence whether adult psychiatry residents choose to pursue fellowship training, particularly in child psychiatry. The study also assessed how child psychiatry is perceived among adult psychiatry residents as a subspecialty. Electronic surveys were administered to all adult psychiatry residents at the University of Michigan, Henry Ford Health System, and Authority Health. These three programs were selected for geographic convenience. The survey included demographic questions as well as Likert-scale statements that assessed the importance of various factors in determining future career choice. The survey also assessed the agreeability of various statements pertaining to the field of child psychiatry. The most important factor for residents in deciding their specialty choice was personal interest, followed by work-life balance, the ability to work directly with patients, and the location of their future job. Over half of residents rated length of training as being "extremely important" or "very important," and fewer than 30% of residents surveyed felt that child psychiatry fellowship was too long. Child psychiatry is widely recognized by residents as having ample job opportunities. However, fewer than 30% of psychiatry residents surveyed rated a high level of interest in child psychiatry. The knowledge of psychiatry residents' views on specialty selection could inform decision making around recruitment efforts. It may also gauge the efficacy and impact of different propositions made to increase child psychiatry recruitment, such as shortening fellowship training in child psychiatry and sponsoring mentorships and interest groups.

Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry.

This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice. Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure. Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals. This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.