Child Psychiatrists and Psychologists: Enhanced Collaboration in Primary Care.

Psychiatry and psychology have a long history of competition that too often interferes with the collaboration that can characterize complementary contributions to our common missions. We hope this article will inspire our disciplines to expand on this collaboration, for the sake of our children and families, our communities, our colleagues, and honestly, ourselves. We are better together than apart. This text is a blueprint for the assumptions, attitudes, skills, and advocacy that can make this partnership healthy and successful.

Da ludoterapia não-diretiva à ludoterapia centrada na criança - desenvolvimento histórico / From non-directive play therapy to child-centered play therapy - historical development / De la terapia de juego no-directiva a terapia de juego centrada en el nino - desarollo histórico

O desenvolvimento da Abordagem Centrada na Pessoa foi dividido em fases que apresentam as atitudes que fazem parte da relação terapêutica, independente do público atendido. Contudo, na especificidade da psicoterapia infantil, o desenvolvimento teórico e prático da própria abordagem aponta para a existência de peculiaridades. Este estudo tem como objetivo apresentar, através de uma revisão narrativa de literatura, fundamentada na hermenêutica filosófica de Gadamer, as possíveis características relativas ao atendimento de crianças a partir de um retorno às fases da ACP. Discutimos os fundamentos iniciais do atendimento com crianças em Rogers ena perspectiva clássica de Axline, compreendendo como a ludoterapia com crianças se caracteriza nas fases não-diretiva, reflexiva, experiencial e pós-rogeriana. Discutimos sobre propostas contemporâneas nos contextos europeu, estadunidense e brasileiro. Concluímos que essa delimitação do atendimento infantil possibilita uma percepção mais clara das mudanças e aprimoramentos em relação aos trabalhos pioneiros de Rogers e Axline, sempre tendo como eixo a dimensão relacional e a tendência ao crescimento como motor do processo terapêutico.

The development of the Person-Centered Approach was divided into phases that presents the attitudes that are part of therapeutic relationship, regardless of the public served. However, in the specificity of child psychotherapy, the theoretical and practical development of the approach points to the existence of peculiarities. This study aims to present, through narrative literature review, based on Gadamer's philosophical hermeneutics, the possible characteristics related to the child therapy, starting from a return to the PCA phases. We discuss the foundations of child therapy in Rogers and Axline's classic perspective, understanding how child play therapy is characterized in non-directive, reflective, experiential and post-Rogerian phases. We discuss contemporary proposals in the European, American, and Brazilian contexts. We conclude that this delimitation enables a clearer perception of changes and improvements amongst to the Rogers and Axline's pioneering work, always having as its axis the relational dimension and the tendency to growth as a motor of the therapeutic process.

El desarrollo del Enfoque Centrado en la Persona se dividió en fases que presentan las actitudes de la relación terapéutica, independiente del público. Sin embargo, en la especificidad de la psicoterapia infantil, el desarrollo teórico y práctico del enfoque en sí mismo apunta la existencia de peculiaridades. Este estudio tiene como objetivo presentar, a través de una revisión narrativa de la literatura, basado em la hermenéutica filosófica de Gadamer, las posibles características de la psicoterapia con niños, desde el retorno a las fases de ECP. Discutimos los fundamentos de la psicoterapia con niños en Rogers, la perspectiva clásica de Axline, comprendiendo como la terapia de juego com los niños se caracterizan em las fases no directiva, reflexiva, experiencial y pos-rogeriana. Discutimos propuestas contemporáneas en los contextos europeo, estadounidense y brasileño. Concluimos que esta delimitación permite una percepción más clara de los cambios y mejoras en relación con los trabajos pioneros de Rogers y Axline, teniendo siempre como eje la dimensión relacional y la tendencia al crecimiento como motor del proceso terapéutico.

The relationship between integrated pediatric psychology and primary care visit length, revenue, content over 24 months.

Introduction: Integrating behavioral health providers into pediatric primary care to provide behavioral health (BH) services is both effective and efficient; however, the impact of pediatric integrated services on the operational and financial outcomes of primary care provider (PCP) visits has not been thoroughly investigated. The present study examined whether length of practice integration predicts the relationship between BH content addressed in a PCP visit, visit length, and revenue generation. Method: A total of 1,209 pediatric encounters with 25 PCPs across 7 primary care offices in a predominantly rural health system were abstracted for the presence or absence of BH content, visit length, duration of integration, and revenue. χ2 analyses and the generalized linear model framework were used to address the study objectives. Results: Integration was associated with more PCP visits with a BH topic discussed at 6-11 months of integration but not at 14-24 months. Visits with a BH topic were longer than medical-only visits and shorter when a practice was integrated for 6-11 months but not at 14-24 months of integration. Public insurance and integration were associated with lower revenue generation per minute. Visit content was not associated with PCP revenue. Discussion: Results suggest a relationship between integration and the operational and financial outcomes of PCP visits. This study shows that initial efficiencies or improvements (e.g., time, cost, content) associated with integrating BH may be lost over time. Future studies should evaluate sustainability in relation to program impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fútbol y psicoanálisis: una experiencia entre varios

En el Centro de Salud Mental Nº 1 de la Ciudad de Buenos Aires, el equipo de Niños Tarde comenzó en 2018 a integrar a los niños en tratamiento a un taller de fútbol, pensado como un espacio en el cual pudieran jugar con otros, y posibilitar múltiples transferencias e intervenciones. Se describe cómo fueron desarrollándose las actividades de este dispositivo.

Reaching underserved youth: A pilot implementation of a skills-based intervention in short-term juvenile detention.

Despite a clear need, psychological interventions are lacking in detention facilities. In particular, efforts to implement such interventions in short-term juvenile detainment are virtually absent from scholarly literature. However, short-term juvenile detention facilities (JDFs) serve as important settings for intervention. Detained youth in JDFs present with a variety of charges/offenses, from truancy to murder and vary with regard to their history of contact with the system and the length of their detainment. The present study provides an overview of a brief skills-based intervention implemented in a group-based format with detained adolescents in a JDF, in an effort to examine youths' engagement, buy-in, and perceived obstacles in such settings. Preliminary findings from our pilot intervention effort informed our understanding of youths' engagement, buy-in, and perceived relevance and utility of the intervention.

A pilot study of the efficacy of a mindfulness program for children newly diagnosed with Attention-Deficit Hyperactivity Disorder: Impact on core symptoms and executive functions

Mindfulness has emerged as a new approach for treating mental disorders. The aim of this study is to investigate preliminary efficacy of group-based mindfulness meditation training for children on core symptoms, executive functioning and comorbidity symptoms in a children naïve Attention-Deficit Hyperactivity Disorder (ADHD) sample. Five children aged 7-12 years newly diagnosed with ADHD received an eight-week group-based mindfulness treatment. The program consisted of once-per-week sessions lasting 75 minutes and daily homework assignments. The study assessments included pre-and posttest measure of psychiatric symptoms and cognitive functioning. Data were analyzed using Wilcoxon signed-rank test. Pre-post improvements in ADHD symptoms and test performance on tasks measuring executive functioning were noted. Significant results were observed in total ADHD symptoms (p= .042), anxiety symptoms (p= .042), cognitive inhibition (p= .042) and processing speed (p= .043). In summary, although the sample size was small, our pilot study suggests that mindfulness training for children is a feasible intervention in at least a subset of ADHD children and may improve behavioral and neurocognitive impairments (AU)

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Beneficios del masaje infantil. Percepción de las madres en un centro de Atención Primaria / Benefits of the infant massage noticed by mothers in a Primary Care

OBJETIVOS. El objetivo principal del estudio fue confirmar los beneficios del masaje infantil (MI) que perciben las madres. Como objetivos secundarios se planteó conocer datos sociodemográficos de las madres que realizan el MI en casa y el tipo de lactancia predominante. MATERIAL Y MÉTODOS. Estudio descriptivo longitudinal que incluyó a las madres que acudían al taller de masaje infantil de un centro de Atención Primaria de la provincia de León, con una muestra final de 49 madres. El periodo de recogida de datos fue de febrero de 2014 a febrero de 2015. Se entregó una encuesta diseñada para este estudio que recogía: tipo de lactancia, variables sociodemográficas (edad materna, estudios y etnia), los beneficios del masaje, si lo realizan en casa y si acuden acompañadas por su pareja. Para el análisis estadístico se utilizó el programa SPSS.13. RESULTADOS. Los beneficios más percibidos por las madres son el aumento del vínculo materno filial y la relajación, con un 95.9 % de respuesta positiva, seguido del aumento de la calidad del sueño en un 65.3 %. La disminución del llanto y la reducción de los cólicos tuvieron un 63.3 %. El 93.3 % de las madres realizan el masaje en casa. El tipo de lactancia predominante es la materna, con un 53.1 %. CONCLUSIONES. Las madres perciben los beneficios del masaje infantil en sus bebés y realizan la técnica en casa (AU)

OBJECTIVES. The main objective of the study was to confirm the infant massage benefits noticed by mothers. As for secondary objectives, the aim was to establish the sociodemographic characteristics of the mothers who practice the infant massage at home and the main type of feeding. MATERIAL AND METHODS. Longitudinal descriptive study which included the mothers who came to the infant massage workshop in a Primary Care Centre in León, with a sample composed of 49 mothers. Data were collected from February 2014 to February 2015. A questionnaire designed for this study was given, which contained: sociodemographic characteristics (mothers’ age, studies and ethnic group), benefits of the infant massage, if they did it at home and if the couple came to the workshop. For the statistical analysis, the software manager SPSS.13. was used. RESULTS. The main noticed benefits were increasing mother-child bond and relaxation, with a 95.9 % of positive answer, followed by the increasing of the sleep quality, in a 65.3 %. Less crying and decreasing of the colic had a 63.3 %. Most of the mothers, 93.3 %, did the massage at home. The main type of feeding was breast-feeding, 53.1 %. CONCLUSIONS. Mothers noticed the benefits of the infant massage and they do it at home (AU)

Commentary: Integrated Pediatric Primary Care: Moving From Why to How.

Whether to address behavioral health issues in pediatric primary care is no longer debated; instead, we are challenged to determine "how" and who can best deliver services in an effective and sustainable manner. This commentary explores how pediatric psychology can contribute to this discussion by developing and evaluating innovative clinical models (such as a hybrid Collaborative Care/Primary Care Behavioral Health model) and expanding workforce and teaching initiatives.

What would Batman do? Self-distancing improves executive function in young children.

This experimental research assessed the influence of graded levels of self-distancing - psychological distancing from one's egocentric perspective - on executive function (EF) in young children. Three- (n = 48) and 5-year-old (n = 48) children were randomly assigned to one of four manipulations of distance from the self (from proximal to distal: self-immersed, control, third person, and exemplar) on a comprehensive measure of EF. Performance increased as a function of self-distancing across age groups. Follow-up analyses indicated that 5-year-olds were driving this effect. They showed significant improvements in EF with increased distance from the self, outperforming controls both when taking a third person perspective on the self and when taking the perspective of an exemplar other (e.g., Batman) through role play. Three-year-olds, however, did not show increased EF performance as a function of greater distance from the self. Preliminary results suggest that developments in theory of mind might contribute to these age-related differences in efficacy. These findings speak to the importance of psychological distancing in the expression of conscious control over thought and action from a young age and suggest a promising new avenue for early EF intervention.

Creación de una técnica psicoterapéutica para niños / A new Psychotherapeutic technique device for children

Se realizó un estudio experimental aplicado en el cual se introdujo una técnica psicoterapéutica de Imaginería escrita para niños cubanos. La muestra estudiada quedó formada por 25 niños que reciben tratamiento en el Centro Provincial de Retinosis Pigmentaria de la ciudad de Camaguey. La técnica consiste en un relato de un viaje con representaciones de paisajes terrestres, marinos y aéreos, reforzando esta imaginería con recursos de respiración y cromoterapia, para lograr estados afectivos placenteros en los niños. Al finalizar la sesión los pacientes dibujaron las visualizaciones vivenciadas. Los resultados reflejaron que todos los niños aceptaron la técnica y sus representaciones pictóricas y se ajustaron al tema ofertado. Los temas mas representados fueron árboles y palmas, cielo y nubes, aeropuerto, avión y montañas (AU)

An experimental study in which it was introduced a psychotherapeutic technique devised for a Cuban child was applied. The studied sample was formed by 25 children that receive treatment in the Night Blindness Provincial Center in the city of Camagüey. The technique consists of a story about a trip with representations of marine and terrestrial landscapes, reinforcing this imagery with breathing resources and chromotherapy, to achieve pleasant affective states in children. When concluding the session the patients drew the visualizations. The results reflected that all children accepted the technique and their pictorial representations and that they adjusted to the topic. The topics the students represented the most were trees and palms, sky and clouds, airports, airplanes and mountains (AU)

Modeling the interplay of multilevel risk factors for future academic and behavior problems: a person-centered approach.

This study identified profiles of 13 risk factors across child, family, school, and neighborhood domains in a diverse sample of children in kindergarten from four US locations (n = 750; 45% minority). It then examined the relation of those early risk profiles to externalizing problems, school failure, and low academic achievement in Grade 5. A person-centered approach, latent class analysis, revealed four unique risk profiles, which varied considerably across urban African American, urban White, and rural White children. Profiles characterized by several risks that cut across multiple domains conferred the highest risk for negative outcomes. Compared to a variable-centered approach, such as a cumulative risk index, these findings provide a more nuanced understanding of the early precursors to negative outcomes. For example, results suggested that urban children in single-parent homes that have few other risk factors (i.e., show at least average parenting warmth and consistency and report relatively low stress and high social support) are at quite low risk for externalizing problems, but at relatively high risk for poor grades and low academic achievement. These findings provide important information for refining and targeting preventive interventions to groups of children who share particular constellations of risk factors.

The Huichol offering: a shamanic healing journey.

An American transcultural psychiatrist, and a Mexican engineer deeply involved with the Huichol Indians, build a team that heals a decade-long epidemic caused by sorcery. Huichol children in boarding schools became possessed by demonic witchcraft that transformed them into aggressive animals. Many local shaman had been called in to treat the illness but had been unsuccessful. The team found a way to incorporate traditional belief and ritual, with modern psychological principles to weave a healing story. This article represents the ultimate integration of mind/body/spirit medicine to heal across cultures.

Pediatric psychosomatic medicine: an annotated bibliography.

This annotated bibliography is intended to be a resource in the essentials of pediatric psychosomatic medicine for the psychosomatic-medicine fellow. The publication list provides practical references for multiple clinical issues relevant to children and adolescents with medical illness and includes major developmental considerations, familial interactions, diagnostic categories, and pharmacologic concerns. Although it encompasses a range of topics, the proposed bibliography is not an exhaustive resource for fellowship training, but rather a first step toward developing a standard curriculum in pediatric psychosomatic medicine.

[Using fairy tales and narrative strategies with the help of a sandpit with children suffering from conduct disorders]. / L'utilisation des contes de fées et du travail narratif à l'aide d'un bac à sable auprès d'enfants présentant des troubles de la conduite.

Our research, focussed on art therapy with primary school children, guided us to the footsteps of women pioneers in the research about children's psyche, like Anna Freud, Melanie Klein, Margaret Loewenfeld, Dora Kalff. We have been inspired by their very personal but nevertheless somehow similar type of research, to work with the children in a blue sand pit, where they could construct and play their personal fairy tales. Thus they share with us their momentary preoccupations, without being forced to talk about them. They are revealing their internal structures, and are integrating, by narration and projection on those figurines in action, their deficient defense mechanisms as well as their negative tendencies. Based on this approach, we expect that there will by an amelioration of their social skills, an enhancement of their intrinsic motivation, and a diminution of their conduct disorders. The analyze will be done by questionnaires and rating scales constructed especially for this research, as well as by sociograms, with the help of descriptive non parametric statistics.

Believing is seeing: how rumors can engender false memories in preschoolers.

This study examined how an erroneous rumor circulated among preschoolers can influence their memory. One fourth of the children overheard a rumor from an adult conversation in which it was alleged that an event the children had not experienced themselves had occurred. A second fourth were the classmates of those who overheard the rumor. A third group had no exposure to the rumor. The remaining children actually experienced the event suggested by the rumor. One week later, the children were interviewed in either a neutral or a suggestive manner. Results from a second interview after a 2-week delay revealed that under both interview conditions, children who overheard the rumor, either from the adult conversation or during naturally occurring interactions with classmates, were as likely to report experiencing the rumored but nonexperienced event as were those who actually experienced it. Most reports of the rumored but nonexperienced event were in children's free recall and were accompanied by high levels of fictitious elaboration.

Empirically supported treatments in pediatric psychology: constipation and encopresis.

OBJECTIVE: To review the empirical research examining behavioral and medical treatments for constipation and fecal incontinence. METHOD: Sixty-five articles investigating intervention efficacy were identified and reviewed. Twenty-three of the studies were excluded because they were case studies or were less well-controlled single-case designs. The intervention protocol for each study was identified and coded, with studies employing the same interventions matched and evaluated according to the Chambless criteria. RESULTS: From the literature base to date, no well-established interventions have emerged. However, four probably efficacious treatments and three promising interventions were identified. Two different medical interventions plus positive reinforcement fit the criteria for the probably efficacious category (one with fiber recommendation and one without). Three biofeedback plus medical interventions fit efficacy category criteria: one probably efficacious for constipation with abnormal defecation dynamics (full medical intervention plus biofeedback for paradoxical contraction), and two fit the promising intervention criteria for constipation and abnormal defecation dynamics (full medical intervention plus biofeedback for EAS strengthening, correction of paradoxical contraction and home practice; and biofeedback focused on correction of paradoxical contraction, medical intervention without fiber recommendation, and positive reinforcement). Two extensive behavioral interventions plus medical intervention also met efficacy criteria for constipation plus incontinence (medical intervention without laxative maintenance plus positive reinforcement, dietary education, goal setting, and skills building presented in a small-group format fits criteria for a promising intervention; and positive reinforcement and skills building focused on relaxation of the EAS during defecation, but without biofeedback, plus medical intervention meets the probably efficacious criteria). CONCLUSIONS: A discussion of the current weaknesses in this research area follows. Specific recommendations for future research are made including greater clarity in treatment protocol and sample descriptions, reporting cure rates rather than success rates, utilization of adherence checks, and investigation of potential differential outcomes for subgroups of children with constipation and incontinence.

[Model of residential psychoanalytic integrative parent-child therapy]. / Modell einer stationären psychoanalytischen integrativen Eltern-Kindtherapie.

Deriving from an integrative psychoanalytic concept for single grownup patients treatment in a psychotherapeutic clinic based on the integrative model of P. Janssen the author tries to apply this model and to expand it to the treatment of families in a similar context. This setting mainly relies on three columns: 1. the psychoanalytic group therapy of the parents (or the mother resp. father), 2. the psychoanalytic psychotherapy of the child (resp. children) and 3. the psychotherapy sessions with the family, resp. the single therapy sessions of the grown up patients. This clinical model offers the opportunity to distinguish between accompanying children and children as patients in a stricter sense. The psychodynamic processes of transference, countertransference and resistance are integrated in and by regular team sessions. This paper discusses the parallel processes in the different applied therapeutic methods and their positive mutual influences on each other centered around a detailed case vignette of a family (a mother with two boys) that underwent psychotherapeutic treatment in the described manner for 12 weeks.

Empirically supported treatments for children with phobic and anxiety disorders: current status.

Reviews the empirically supported status of behavioral and cognitive-behavioral interventions in the treatment of childhood phobias and anxiety disorders. For childhood phobias, it is concluded that imaginal desensitization, in vivo desensitization, filmed modeling, live modeling, and cognitive-behavioral interventions that use self-instruction training are probably efficacious and that participant modeling and reinforced practice are well established. For anxiety disorders, only cognitive-behavioral procedures with and without family anxiety management (FAM) were found to be probably efficacious. However, much of the support for these procedures comes from analogue studies conducted in research laboratory or school settings, delivered in small-group format and, not infrequently, with nonclinically referred children. Additional research that examines high-strength interventions with clinic-referred children is recommended. Furthermore, research that examines the pathological processes involved in the onset and maintenance of phobic and anxiety disorders as well as the change processes used to treat these disorders is called for.