Number Of Child Psychiatrists Research Articles

Simpler Than Possible: Insurance Mandates for Autism Spectrum Disorders.

The diagnosis and management of autism spectrum disorder (ASD) and co-occurring medical and behavioral health conditions strain both health and educational resources in the United States. State mandates for insurance coverage for ASD-related health care were intended to improve access to indicated services, with inclusion of board-certified behavior analysts (BCBAs) as a newly licensed group of professionals to provide one approach to evidence-based intervention. McBain et al1 examined the association of the state by state passage of legislation on one indicator of access to services: number of providers who serve this population. Mandated insurance coverage, especially more-generous coverage, was associated with a greater growth in the workforce of BCBAs, a small increase in the number of child psychiatrists, and no change in the number of pediatricians.The authors acknowledged the associational nature of their study and their inability to explore use or distribution of services. However, when interpreting the impact of insurance mandates that focus primarily on reimbursement for applied behavioral analysis (ABA) as an intervention, there are additional implications that must be considered when examining actual health care provided for individuals with ASD. The insurance mandate did little to improve serious deficits in access to diagnostic services or to address the training needs of existing and available pediatric care providers.2 Augmenting workforce capacity includes current efforts to enhance pediatricians’ ability to contribute to timely ASD diagnosis, thereby promoting earlier entrance to intervention.3,4 Most interventions provided for children and youth with ASD have not been impacted by the wave of insurance legislation over the past decade but are provided through the legal mandate of the Individuals with Disabilities Education Act through the educational system. Consistent with patterns in specialty behavioral health care, special education and community services are not equitably distributed across a representative population (eg, based on race, ethnicity, age, income, language, and geographic region).5Increases in provider numbers resultant from insurance mandate legislation may imply false equivalence with evidence-based practice. Although behavior analytic services are efficacious for some,6 there is an increasing evidence base for interventions (eg, naturalistic developmental behavioral interventions7) that are not covered by insurance mandates. There is insufficient evidence to assume a single approach is effective for all individuals with ASD. Factors such as child characteristics and family choice become increasingly important drivers of treatment selection as predictors of success and outcome measurement are studied in greater depth. However, insurance legislation that is directly tied to funding ABA and advocated in parallel to licensure for BCBAs8 sends a message that ABA is the only effective intervention. This may come at the cost of awareness of and reimbursement for other possibly efficacious interventions, as well as development of comprehensive care plans including both the educational and medical systems.An additional erroneous assumption is that an increase in number of BCBAs and child psychiatrists leads to increased access to care. Indeed, families who are generally under-represented in service systems on the basis of race, ethnicity, and income level are especially likely to report unmet service needs.5 Such disparities are exacerbated by Medicaid restrictions for insurance mandates, which may disproportionately affect populations that are already underserved. Second, service quality remains independent from access. Community-based early intervention services, for instance, are delivered with highly variable fidelity, which may affect child outcomes. In addition, despite the general conviction in the field that more intensive intervention yields more positive results, conventions around the minimum recommended number of hours of ABA are not rooted in evidence.9 Recommendations to steer families toward readily available services should not supplant individualized, evidence-based determinations for intervention selection based on child and family variables and preferences.McBain et al1 add support to the evidence that the overall supply of child behavioral health services in the United States is inadequate to address the existing needs of not only children but people with ASD across the life span. We echo the recommendation that policies do need to address the existing behavioral and medical health needs but also suggest the following: (1) in addition to increasing the numbers of psychiatrists and BCBAs, the existing interprofessional workforce needs education and supports to improve quality of care; (2) care coordination must be recognized and funded as a method to improve efficiencies and access across health and educational systems; (3) providers and service systems must prioritize equitable access to services for all families; and (4) innovative research in this area will include the development and evaluation of cost-efficient and effective interventions for all people with ASD. Per Albert Einstein, “Everything should be made as simple as possible, but not simpler.” Full consideration of these numerous system complexities is necessary to adequately address the needs of individuals with ASD and their families.

Child psychiatrists fill gap by providing consultation to primary care pediatrics

We are in the midst of a child mental health crisis in the United States. Statistics from the Centers for Disease Control and Prevention indicate that up to 20% of all children have a mental health disorder and the rates of adolescent depression and suicide are increasing. Partnered with these high levels of mental health disorders is a workforce shortage in the area of child and adolescent psychiatry. Although the number of child psychiatrists has increased in the last 10 years, there are still not enough providers to meet the demand. Unfortunately, the shortage of child psychiatrists often necessitates that pediatric primary care providers (PPCPs) manage children's mental health. However, mental health training for pediatric residents is minimal, with over half of general pediatricians who are recent graduates of pediatric residency programs indicating that they need (or want or would benefit from) additional training in mental health. Increasing the demands on PPCPs to manage mental health without increasing access to child psychiatry services is unlikely to improve the outcomes for children and adolescents.

Growth and Distribution of Child Psychiatrists in the United States: 2007-2016.

Historically, there has been a shortage of child psychiatrists in the United States, undermining access to care. This study updated trends in the growth and distribution of child psychiatrists over the past decade. Data from the Area Health Resource Files were used to compare the number of child psychiatrists per 100 000 children ages 0 to 19 between 2007 and 2016 by state and county. We also examined sociodemographic characteristics associated with the density of child psychiatrists at the county level over this period using negative binomial multivariable models. From 2007 to 2016, the number of child psychiatrists in the United States increased from 6590 to 7991, a 21.3% gain. The number of child psychiatrists per 100 000 children also grew from 8.01 to 9.75, connoting a 21.7% increase. County- and state-level growth varied widely, with 6 states observing a decline in the ratio of child psychiatrists (ID, IN, KS, ND, SC, and SD) and 6 states increasing by >50% (AK, AR, NH, NV, OK, and RI). Seventy percent of counties had no child psychiatrists in both 2007 and 2016. Child psychiatrists were significantly more likely to practice in high-income counties (P < .001), counties with higher levels of postsecondary education (P < .001), and metropolitan counties compared with those adjacent to metropolitan regions (P < .05). Despite the increased ratio of child psychiatrists per 100 000 children in the United States over the past decade, there remains a dearth of child psychiatrists, particularly in parts of the United States with lower levels of income and education.

The characteristics and activities of child and adolescent mental health services in Italy: a regional survey

BackgroundTo date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years.MethodsUnit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail.ResultsEleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years.ConclusionThe percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).

P-317 - The characteristics and activities of child and adolescent mental health services in italy: a regional survey

Although service data are crucial for estimating the resources required by Child and Adolescent Mental Health Services (CAMHS) and to improve their quality, no studies have yet been conducted in Italy to this aim, and even in other countries health services research in this area has been extremely limited in scope and magnitude. To collect data on the physical characteristics, staffing arrangements, and activities of CAMHS in Emilia-Romagna, a densely populated Italian region with 633,725 inhabitants aged 0–17 years. Unit Chiefs of all the CAMHS filled in a structured ‘Facility Form’, with activity data referring to 2008 (for inpatient facilities we referred to 2009). Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0–17 years. All outpatient units were well equipped and all granted free service access. In 2008, approximately 6% of the target population was in contact with CAMHS; first-ever contacts accounted for 30% of annual visits. Hospital bed availability was 5 per 100,000 inhabitants aged 0–17 years. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours.

Growing Wealth and Growing Pains: Child and Adolescent Psychiatry in Hong Kong, Malaysia and Singapore

Several Asian regions have undergone a dramatic transformation, some becoming very affluent. This paper aims to ascertain how countries that are becoming wealthy have dealt with child and adolescent mental health issues. Population health status, child and adolescent mental health services, child psychiatry training, the number of child psychiatrists and related matters were examined in Hong Kong, Malaysia and Singapore. Hong Kong, Malaysia and Singapore are ethnically, religiously, socially and politically very different. In spite of considerable wealth and a growing recognition that mental health problems in the young are increasing, they face similar problems--lack of access to treatment due to a dearth of services and a lack of child psychiatrists (2.5, 0.5 and 2.8 per million people, respectively). Because the number of child psychiatrists is so small, their ability to provide services, advocate, train, maintain a professional identity, and deal with future crises is very limited. Other rapidly developing countries can learn from this experience and should take action early to prevent a similar outcome.

Developing rational protocols for paediatric psychopharmacological prescribing.

The number of child psychiatrists, paediatricians and general practitioners prescribing psychotropic medication for children in the UK is increasing. Medication is being used not just to treat children of normal intelligence with hyperkinetic disorder or depression, but also to modify behavioural problems in children with developmental disorders and severe learning difficulties. Literature reviews highlight the lack of robust randomized controlled drug trials on which to base clinical practice and the authors have found no appropriate existing protocols to help develop a systematized approach. Against such a background the authors have developed a comprehensive set of protocols covering prescribing details for individual drugs, and also addressing issues such as informed consent, long-term monitoring and school liaison. All children referred to the authors' clinics go through a standardized decision-making process. This article describes both the protocols themselves and the philosophies that guided their development. The authors describe how such a system benefits the children, their families, general practitioners and schools, whilst also facilitating audit and research.

Dr. Freud vs. Dr. Spock

Thomas Maeder's Children of Psychiatrists and other Psych otherapists seeks to answer the question: Are shrinks' kids nuts? To study th is topic, Maeder, the son of a psychiatrist-psychoanalyst and a psych iat r ic social worker , interviewed over two hundred children of psychotherapists and a number of child psychiatrists. He portrays children of psychotherapists as emotionally vacant, unhappy, analytical , and under constant analysis by their parents. He concludes that being raised by psychotherapist-parents has adverse ly affected these children. Maeder presents psychotherapists as inept parents wh o themselves are emotionally impaired, come from unhappy childhoods, or ha ve God complexes. While an interesting theory, it is undermined by the resentful tone of the author's writing. As the son of a psychiatrist I can say that Mr. Maeder's book contains a few familiarities. My upbringing, however, seems to ha ve been fundam entall y di fferent from that of the author and those interviewed. While psychoth erapy and psychology seem to have pervaded much of Maeder's and th e inte rviewees' childhoods, my fathers profession rarely took precedence over daily occurrences, discussions of current events, sports, etc. I found little , if any thing, in common with many of the supposedly typical experiences Maeder docu ment s. For example, a daughter's question as to why her father is angry is met with the reply, I'm not angry, you're just projecting. This kind of interaction d id not occur in my home. I believe that in trying to support his theories Maeder foc uses on the sensational; the end result shares little with my life 's exper iences. The book suffers from other shortcomings. Maeder continu all y states his beliefs as fact despite their lack ofstatistical basis. I believe th e bias of th is book is largely due to the finding of interviewees by word of mouth and through friends and aquaintances-a process the author calls randomization. Although Maed er states in his introduction that not all children of psychiatrists are impaired the entire book focuses on this topic. Moreover, Maeder appears biased; he assum es

Training child psychiatrists in rural public mental health.

Lack of appropriate training in both public mental health service and rural mental health service is a major factor in the critical shortage of child psychiatrists in rural settings. The authors describe a residency training program in rural public mental health designed to help alleviate that shortage. The program familiarizes fourth-year residents in child psychiatry with the clinical, political, and social aspects of rural public mental health services through didactic and supervisory sessions as well as an eight-month practicum experience involving provision of inservice training and administrative and case-related consultation to staff of mental health agencies. An assessment of the program indicated that participants felt it was beneficial, but the program was only partly successful in increasing the number of child psychiatrists entering practice in rural areas. The authors urge that residency programs in child psychiatry give priority to training child psychiatrists for work in rural settings.