Skills Needed in Psychiatrist Leadership for Building and Sustaining Child Mental Health Systems of Care.

Systems of care (SOC) is a proven and community-based service network addressing the mental health needs of children and families. Child and adolescent psychiatrists play a crucial role in leading SOCs, utilizing skills such as partnership building and strategic planning. Barriers to mental health care, including access issues and stigma, can be tackled through multisector collaboration. Overcoming challenges such as cultural differences and fragmented systems requires effective leadership. In a SOC, core principles involve culturally competent care, evidence-based practices, collaborative decision-making, and smooth transitions of care. Championing these principles fosters a holistic and supportive environment for those facing mental health challenges.

Originalarbeiten / Original Articles. Die partizipative, berufsgruppen- und abteilungsübergreifende Entwicklung eines Ethik- Leitbildes in einer kinder- und jugendpsychiatrischen Klinik: Der Ethik-Kompass der UPKKJ Basel.

The Participatory, Cross-Professional and Cross-Departmental Development of an EthicalMission Statement in a Child and Adolescent Psychiatric Clinic: The Ethics Compass of theUPKKJ Basel Employees in child and adolescent psychiatry navigate a complex field of ethical requirements. At the Clinic for Children and Adolescents of the University Psychiatric Clinics Basel (UPKKJ), these areas of tension were examined in a project that spanned across numerous departments and professional groups. Based on a survey study and a narrative literature review, ethical guidelines were developed: the UPKKJ Ethics Compass. The Ethics Compass highlights various areas such as participation, child welfare, justice and developmental health, which are relevant to the relationships between children, adolescents, parents, and the treatment team. To implement these principles in everyday clinical practice, the Ethics Compass is now regularly used in case work and as a communication aid with external partners. Furthermore, a procedural action plan was developed for collaboration with the Department of Clinical Ethics at the University Hospitals in Basel.

[Child and adolescent psychiatry mobile team: what care for victims of coercive control?] / Équipe mobile de psychiatrie de l'enfant et de l'adolescent : quelle prise en soins pour les victimes de contrôle coercitif ?

In this article, the authors wish to offer the product of their reflections on the concept of coercive control, and share various findings from their day-to-day practice. The text should be read as an invitation to clinical reflection on the conceptualization of a specific form of abuse. Reflection on this approach, initially ignored by the authors, has enriched clinical thinking on certain care situations.

[Increased self-reported eating disorder symptoms in outpatients at a Child and Adolescent Psychiatry Clinic in Sweden between 2018 and 2022]. / Fler tonåringar rapporterade ätstörningssymtom hos Bup.

Eating disorders are common disorders that cause significant suffering and functional impairment for those affected. They often emerge in adolescence and can go undetected for many years before an individual presents to services. Early diagnosis and treatment have been shown to significantly improve the prognosis, highlighting the need for proactive screening. This study compared the frequency of self-reported eating disorder symptoms in (n = 2137) outpatients at the Child and Adolescent Psychiatry Clinic (BUP) in Region Västmanland, Sweden between 2018 and 2022. The results showed that the proportion of young people reporting frequent eating disorder symptoms increased from 16% to 28% over this time period. This result is in line with previous research describing an increase in the prevalence of eating disorder symptoms among different groups in relation to the Covid-19 pandemic. It underscores the importance of screening for eating disorder symptoms to better address care needs.

[Twenty-five years of child and adolescent psychiatry in the Netherlands: patterns of practice]. / 25 jaar Nederlandse kinder- en jeugd­psychiatrie in de praktijk.

BACKGROUND: The department of child- and adolescent psychiatry of the Dutch Association of Psychiatry has regularly investigated the practice of child- and adolescent psychiatry since 1996. This article reports the results of the 2021 survey. AIM: Investigating the composition and practice of the group of child- and adolescent psychiatrists, with special attention to the effect of the decentralization of child mental healthcare to the municipalities in 2015. METHOD: A postal survey; descriptive analysis of collected data. RESULTS: The number of child- and adolescent psychiatrists remained constant since 2012: 445, with sixty-eight percent women. Eighty percent works in institutional practice. Ten percent holds an interim position. Eighty percent reports an increase in workload. Professional satisfaction is mainly derived from patient care. CONCLUSION: Despite the unrest caused by the decentralization, the number of child- and adolescent psychiatrists remained stable over the last ten years. Since 2021 there have been negative, as well as positive developments. Therefore repetition of this survey in a few years is recommended.

Psychiatric polygenic risk scores: Experience, hope for utility, and concerns among child and adolescent psychiatrists.

Recent advances in psychiatric genetics have enabled the use of polygenic risk scores (PRS) to estimate genetic risk for psychiatric disorders. However, the potential use of PRS in child and adolescent psychiatry has raised concerns. This study provides an in-depth examination of attitudes among child and adolescent psychiatrists (CAP) regarding the use of PRS in psychiatry. We conducted semi-structured interviews with U.S.-based CAP (n = 29) who possess expertise in genetics. The majority of CAP indicated that PRS have limited clinical utility in their current form and are not ready for clinical implementation. Most clinicians stated that nothing would motivate them to generate PRS at present; however, some exceptions were noted (e.g., parent/family request). Clinicians spoke to challenges related to ordering, interpreting, and explaining PRS to patients and families. CAP raised concerns regarding the potential for this information to be misinterpreted or misused by patients, families, clinicians, and outside entities such as insurance companies. Finally, some CAP noted that PRS may lead to increased stigmatization of psychiatric disorders, and at the extreme, could be used to support eugenics. As PRS testing increases, it will be critical to examine CAP and other stakeholders' views to ensure responsible implementation of this technology.

[The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations]. / Die S3-Leitlinie zur Therapie von Sprachentwicklungsstörungen.

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations Abstract: The German S3 Guidelines on the Treatment of Developmental Speech and Language Disorders (AWMF: No. 049-015) were published on the AWMF homepage at the end of 2022. The German Society for Phoniatrics and Paedaudiologie coordinated the work and developed the guideline text together with linguists and speech and language therapists. Many scientific medical societies consented to the respective recommendations. For the first time in the German-speaking area, the guideline group reviewed international research results on the treatment of various speech and language disorders and formulated evidence- or consensus-based recommendations for clinical care. The present article summarizes these recommendations and evaluates the guidelines from the perspective of child and adolescent psychiatry and psychotherapy.

Using Advocacy to Address the Crisis of Children's Mental Health.

Children and youth in the United States are experiencing a mental health crisis that predates the COVID-19 pandemic. Child and adolescent psychiatrists have the knowledge and skillset to advocate for improving the pediatric mental health care system at the local, state, and federal levels. Child psychiatrists can use their knowledge and expertise to advocate legislatively or through regulatory advocacy to improve access to mental health care for youth. Further, including advocacy education in psychiatry and child psychiatry graduate medical education would help empower child psychiatrists to make an impact through their advocacy efforts.

Preparing Trainees for Public Health Advocacy Through Community Partnerships.

This article reviews the existing literature related to medical training in public advocacy and provides the reader with several training examples to consider in a child and adolescent psychiatry fellowship or in combined training programs. Advocacy training embedded within community, forensic, integrated care, school, and many other experiences throughout training provides the skills and tools that the trainee will use in the future when they practice in any setting. This comprehensive training approach aligns with the evolving landscape of child and adolescent mental health where a deep commitment to public health and advocacy is increasingly essential.

Advancing Youth Justice: The Child and Adolescent Psychiatrist's Role.

Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.

Widening Our Lane: How Child and Adolescent Psychiatrists Can Embrace the Full Spectrum of Mental Health.

The majority of a psychiatrist's training and clinical attention is devoted to mental illness rather than mental health. This article suggests a broader understanding and application of mental well-being that can benefit both those already struggling with mental health challenges and those trying to stay well. Recommendations for being a well-being-oriented psychiatrist include increasing one's knowledge about well-being and health promotion and adjusting one's practice to incorporate these principles. Recommendations at the level of the field of psychiatry include revising the definition of a psychiatrist, increasing research on well-being and health promotion, improving financial incentives, expanding efforts in schools and community settings, and providing additional training.

The Role of School-based Interventions and Communities for Mental Health Prevention, Tiered Levels of Care, and Access to Care.

This article highlights the key role of schools in addressing rising mental health disorders among youth. It champions collaboration between health and educational sectors, emphasizing child and adolescent psychiatrists' significant contribution to school-based mental health literacy and interventions. This article encourages for child and adolescent psychiatrists' involvement in policy advocacy for accessible and inclusive mental health care, championing sustainable mental health services through advocating for funding, training, and policy support.

Workforce Initiatives to Advance Health Equity and Diverse Representation.

The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.

The Impact of a One-Day Workshop on Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder.

OBJECTIVE: Despite evidence validating the diagnosis of borderline personality disorder (BPD) in youth, specifically showing persistence of BPD symptoms and morbidity similar to adults, there is reluctance to diagnose this in teens. Further, there is a belief among many trainees and academic child and adolescent psychiatrists (CAPs) that only specialty programs are effective, leading to treatment delays. This study charts the impact of a full-day workshop offered to an entire academic CAP department. METHODS: A Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder in-person workshop was offered to department members. Participants were asked to complete a pre-survey, an immediate post-training survey, and a survey at 6 months post-training. Utilizing a Qualtrics questionnaire, both linear mixed-effect models and paired t-tests were used to estimate the immediate and sustained effects of the training. RESULTS: Thirty-two participants completed the workshop, with 31 answering the pre-survey, 27 the post-training survey, and 23 the 6-month follow-up survey. Immediately after the training and 6 months later, participants demonstrated statistically significant (p < .05) improvements in willingness to disclose the diagnosis of BPD, a reduced negative attitude around BPD, and an enhanced sense of confidence in addressing the needs of adolescents with BPD. CONCLUSIONS: GPM-A training can make a positive impact on groups of clinicians who work with youth who meet criteria for BPD, specifically reducing stigma, encouraging trainees and faculty members to make the diagnosis more readily, and helping them feel more competent in addressing the treatment needs of adolescents with BPD.

Living on Site While Renovating; Flexible Instructional Design of Post-Graduate Medical Training.

Background: Developing theoretical courses for post-graduate medical training that are aligned to current workplace-based learning practices and adaptive to change in the field is challenging, especially in (sub) specialties where time for re-design is limited and needs to be performed while education continues. Approach: An instructional design method was applied based on flexible co-design to improve post-graduate theoretical courses in child and adolescent psychiatry (CAP) in the Netherlands. In four phases over a period of three years, courses were re-designed at a national level. Evaluation: Once common vision and learning goals were agreed upon and the prototype was developed (phases 1 and 2), the first courses could be tested in daily practice (phase 3). Phase 4 refined these courses in brief iterative cycles and allowed for designing additional courses building on and adding to previous experiences in brief iterative cycles. The resulting national theoretical courses re-allocated resources previously spent on a local level using easily accessible online tools. This allowed trainees to align content with their clinical rotations, personal preferences and training schedules. Reflection: The development of theoretical courses for post-graduate medical training in smaller medical (sub-)specialties with limited resources may profit from a flexible instructional design method. We consider the potential merit of such a method to other medical specialties and other (inter-)national efforts to develop theoretical teaching courses. A longer-term implementation evaluation is needed to show to what extent the investment made in the re-design proves to be future-proof and enables rapid adaptation to changes in the field.