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.

Child and adolescent Liaison-Consultation Psychiatry and Psychosomatic Medicine in a Clinical-Teaching Hospital. / Psiquiatría de Enlace y Medicina Psicosomática Infanto Juvenil en un Hospital Clínico-Docente.

Psychosomatic medicine explores the psychological, behavioral, and social elements that influence people's health and quality of life. This discipline develops skills and knowledge used in the evalua tion and management of psychosocial elements interfering in the process of illness and healing. The Child and Adolescent Consultation-Liaison Psychiatry (CACLP) is a discipline that has been empi rically installed in order to favor adherence to treatments and recovery of children and teenagers du ring the process of illness. There is a need for developing this discipline in Chile, but so far there are limited national and international records and literature dedicated to it. The objective of this article is to update the concepts of structure and describe how a CACLP unit in a high complexity teaching hospital works in general, discussing the clinical challenges involved in these issues.

[The Eyes Movement Desensitization and Reprocessing for children with traumatic traumatic stress disorder: A Tunisian experience]. / L'Eyes Movement Desensitization and Reprocessing auprès des enfants avec Trouble Stress Post-Traumatique : une expérience tunisienne.

OBJECTIVES: Evaluate the effectiveness of the Eyes Movement Desensitization and Reprocessing psychotherapy for children with Post-Traumatic Stress Disorder. METHODS: A retrospective study was conducted in the Child Psychiatry Department of CHU Mongi Slim, Marsa (Tunis, Tunisia). All Outpatients with a Post-Traumatic Stress Disorder diagnosis and who had Eyes Movement Desensitization and Reprocessing psychotherapy during the period from July 2016 to May 2018 were included. They were evaluated according to DSM 5 criteria in pre and post therapy. RESULTS: The sample consisted of sixteen children with a sex-ratio of 1.6. Their age ranged from 3 to 17 years old with a mean age of 9.5±4.6 years. Five patients were less than six years old. Our patients were exposed to a sexual assault (4 cases), a death of a family member (3 cases), a road accident (3 cases), a physical assault (4 cases), an arrest of the father (1 case) and burglary of the house (1 case). In 15 cases, the traumatic event was unique while it was repeated in one sexual assault case. The total number of follow-up sessions ranged from one to seven sessions with an average of 3±2.4 sessions. The average number of sessions for preschool children was 2.6±0.5 sessions. Bilateral tactile stimulations were used with thirteen children in our population, including the five children younger than six years old. At the end of the therapy all patients no longer met the criteria for Post-Traumatic Stress Disorder diagnosis. All the preschool patients and eight children older than 6 years did not respond to any of the four Post-Traumatic Stress Disorder criteria. The difference between the scores of the DSM 5 criteria in pre and post EMDR was statistically significant. We found P=10-3 for children over six years and P<0.05 for children under six years old. CONCLUSION: Eyes Movement Desensitization and Reprocessing is a therapy that has several advantages. First, it is effective in Post Traumatic Stress Disorder in children. Second, its protocol is flexible and adaptable to all ages and developmental level of the child. Third, the number of sessions is usually reduced, which is a great advantage over other trauma-focused psychotherapies.

Utilization of Child Psychiatry Consultation Embedded in Primary Care for an Urban, Latino Population.

OBJECTIVE: In a novel model of embedded primary care child psychiatry serving an urban Latino population, we examined determinants of successful referral and relationship between clinical need and service intensity. METHODS: We conducted a chart review of referred patients from July 2013-March 2015. We used multiple logistic regressions controlling for confounders to identify determinants of successful referral. We examined the relationship between service intensity and clinical need using Poisson regression, adjusting for exposure time, age, sex, ethnicity, and language. RESULTS: Seventy-four percent of patients completed an evaluation. Younger children (p=.0397) and those with a history of therapy (p=.0077) were more likely to make initial contact. The markers of clinical need included PSC-35 Global Scores (p=.0027) and number of psychiatric diagnoses (p=.0178) predicted number of visits. CONCLUSIONS: Our findings support early referral to improve engagement, and provide initial evidence that embedded child psychiatry consultation is feasible and may increase access to care.

Family-Based Integrated Care (FBIC) in a Partial Hospital Program for Complex Pediatric Illness: Fostering Shifts in Family Illness Beliefs and Relationships.

The heuristic model of family-based integrated care (FBIC) was developed from 1998 to 2016 in the context of the development of the Hasbro Children's Partial Hospital Program (HCPHP) along with the development of a family therapy training program for Brown University child psychiatry and triple board residents. The clinical experience of the HCPHP team in treating more than 2000 patients and families in combination with the authors' experience in training residents for diverse practice settings highlights the usefulness of the FBIC paradigm for interdisciplinary family-based treatment for a broad range of illnesses and levels of care.

Integrated Behavioral Health Care in Pediatric Subspecialty Clinics.

Comorbid behavioral and physical health conditions are accompanied by troubling symptom burden, functional impairment, and treatment complexity. Pediatric subspecialty care clinics offer an opportunity for the implementation of integrated behavioral health (BH) care models that promote resiliency. This article reviews integrated BH care in oncology, palliative care, pain, neuropsychiatry, cystic fibrosis, and transplantation. Examples include integrated care mandates, standards of care, research, and quality improvement by child and adolescent psychiatrists (CAPs) and allied BH clinicians. The role of CAPs in integrated BH care in subspecialty care is explored, focusing on cost, resource use, financial support, and patient and provider satisfaction.

Comparing Two Models of Integrated Behavioral Health Programs in Pediatric Primary Care.

This study examined how to design, staff, and evaluate the feasibility of 2 different models of integrated behavioral health programs in pediatric primary care across primary care sites in the Bronx, NY. Results suggest that the Behavioral Health Integration Program model of pediatric integrated care is feasible and that hiring behavioral health staff with specific training in pediatric, evidence-informed behavioral health treatments may be a critical variable in increasing outcomes such as referral rates, self-reported competency, and satisfaction.

The Use of Health Information Technology Within Collaborative and Integrated Models of Child Psychiatry Practice.

There is a consistent need for more child and adolescent psychiatrists. Despite increased recruitment of child and adolescent psychiatry trainees, traditional models of care will likely not be able to meet the need of youth with mental illness. Integrated care models focusing on population-based, team-based, measurement-based, and evidenced-based care have been effective in addressing accessibility and quality of care. These integrated models have specific needs regarding health information technology (HIT). HIT has been used in a variety of different ways in several integrated care models. HIT can aid in implementation of these models but is not without its challenges.

Tactile massage as a nursing intervention in child and adolescent psychiatry: nurses' experiences.

WHAT IS KNOWN ABOUT THE SUBJECT?: There is little research on the implementation of tactile massage in child and adolescent psychiatry that describes children's and adolescents' experiences and outcomes. There is also limited knowledge of providing tactile massage in child and adolescent psychiatry. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper describes 10 nurses' experiences of tactile massage as a nursing intervention in child and adolescent psychiatry. The nurses considered tactile massage a non-verbal nursing intervention that could complement other available treatments. It reveals their reflections on the impact of tactile massage on their nursing and on themselves as a person, including the belief that they had developed deepened self-reflection and attentiveness. The nurses highlighted the importance of providing a trusting environment and collaborating with the children and adolescents. They both experienced and observed that tactile massage triggered various physical and mental processes in the children and adolescents, such as improvement in sleep disturbances, an ability to relax in body and mind and a deeper connectedness with their own bodies and feelings. The nurses described instructing next of kin in the use of tactile massage, which they believed could serve as a tool at home, mainly as a way for next of kin to help their children to relax, fall asleep more easily and to deepen connectedness. However, the nurses stressed the need to consider if it was appropriate or desired by the children and adolescents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Tactile massage addresses the individual's emotional and physiological responses and could therefore bring holistic nursing to child and adolescent psychiatry. It could also help nurses in child and adolescent psychiatry to develop their attentiveness and sensitivity in acknowledging the needs of children and adolescents in psychiatric care. ABSTRACT: Introduction There is limited research on tactile massage in child and adolescent psychiatry and no studies investigating experiences of providing tactile massage in child and adolescent psychiatry were found. Aim The aim was therefore to describe nurses' experiences of providing tactile massage as a nursing intervention in child and adolescent psychiatry. Method Ten nurses trained in tactile massage and employed at five different child and adolescent psychiatry clinics in Sweden participated in a qualitative study. Semi-structured interviews were conducted, transcribed verbatim and analysed by qualitative content analysis. Results Three categories emerged from the analysis. 'Confirming body and mind', 'Building a trusting relationship' and 'Instructing next of kin in tactile massage'. Attentiveness to and respect for the integrity of the children and adolescents were essential for creating a trusting relationship with them. Tactile massage was found to trigger various physical and mental processes in the children and adolescents. The nurses reflected on the impact of tactile massage on their nursing and on themselves as a person, stating that it had led to the development of self-reflection and attentiveness. Implications for practice Tactile massage addresses the individual's emotional and physiological responses and could therefore bring holistic nursing to child and adolescent psychiatry. It might also enhance attentiveness and sensitivity on the part of child and adolescent psychiatry nurses when acknowledging the needs of children and adolescents in psychiatric care.

Predictors of diagnosis of child psychiatric disorder in adult-infant social-communicative interaction at 12 months.

To establish which social interactive behaviours predict later psychiatric diagnosis, we examined 180 videos of a parent-infant interaction when children were aged one year, from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Sixty of the videos involved infants who were later diagnosed with a psychiatric disorder at seven years, and 120 were a randomly selected sex-matched control group. Interactive behaviours for both the caregiver and the one year old infant were coded from the videos according to eight holistic categories of interpersonal engagement: Well-being, Contingent Responsiveness, Cooperativeness, Involvement, Activity, Playfulness, Fussiness, and Speech. Lower levels of adult activity and speech in interaction at one year significantly predicted overall diagnosis of child psychiatric disorder.

Hypnotherapy in child psychiatry: the state of the art.

Children are more easily hypnotized than adults, and hypnotherapy as a method responds to the general developmental needs of children by addressing their ability for fantasy and imagination. Hypnotherapy and self-hypnosis are tools with which to assess and develop protective factors, and enhance positive adjustment. Meta-analyses and overviews have demonstrated the effect of hypnotherapy in paediatric disorders like asthma, chronic and acute pain, and in procedure-related distress in cancer patients. We wanted to examine the use and benefits of hypnotherapy when applied to child psychiatric disorders. A review of a literature search from PubMed, PsychINFO and the Cochrane databases revealed 60 publications, mostly case reports based on 2-60 cases, addressing the use of hypnotherapy in various child psychiatric conditions. Findings indicate that hypnotherapy may be useful for a wide range of disorders and problems, and may be particularly valuable in the treatment of anxiety disorders and trauma-related conditions. In conclusion, knowledge of hypnosis is useful in clinical practice and hypnotherapy may play an important role as an adjunctive therapy in cognitive-behavioural treatment and family therapy. Additional qualitative and quantitative studies are needed to assess the place for hypnosis/hypnotherapy in child psychiatry.

Mindfulness with children and adolescents: effective clinical application.

Mindfulness interventions within adult populations are becoming increasingly popular. Research suggests that mindfulness can deliver lasting improvements in self-awareness and emotional stability to adults with severe and chronic conditions. As yet, research within child and adolescent populations is in its initial stages, although mindfulness shows great clinical promise for young people. This article aims to provide an overview of mindfulness to professionals who are working in child or adolescent settings. Initially, it will provide the reader with some orientation to and definitions from the field, before summarizing the current evidence for the utility of the approach. The article recommends specific clinical modifications for mindfulness with children and adolescents, as well as reviewing how to monitor and enhance the development of this skill. Finally, it highlights important differences among mindfulness, relaxation and other meditative techniques.

Using dance/movement therapy to augment the effectiveness of therapeutic holding with children.

PROBLEM: Therapeutic holding is a commonly used tool for the containment of aggressive behavior in children. Although often effective, the intervention has inherent physical and emotional safety risks. Can a body-based therapy be used to limit these risks? METHODS: Research was conducted incorporating dance/movement therapy techniques (D/MT) before and after therapeutic holding to investigate this question. Volunteer residential treatment center staff participated in a 4-hour D/MT-based training workshop integrating the techniques with the intervention. Children participated via self-report. FINDINGS: D/MT training increased adult awareness, sensitivity, perspective shifting ability, and confidence in the intervention while decreasing the necessity for physicality. CONCLUSION: Integrating D/MT therapy training with therapeutic holding decreased the threat of trauma to adult participants. Further research into the integration of D/MT techniques with safe holding procedures may prove helpful in the challenge of making restraints safer for both children and adults.

Healing traumatized children: creating illustrated storybooks in family therapy.

In this article we describe the therapeutic practice of creating illustrated storybooks in family therapy with traumatized children. Illustrated stories offer a predictable structure to sessions and facilitate engagement and participation of children in therapy. The therapeutic emphasis of storybooks can be adjusted to take into account a child's life story, verbal capacity, level of anxiety, and traumatic hyperarousal. The creation of storybooks is an active process that embraces important aspects of trauma-specific interventions, including expression of trauma-related feelings; clarification of erroneous beliefs about the self, others, or the traumatic event; and externalization of traumatic stimuli into artwork, allowing for exposure and habituation of the arousal response. A focus on visual images together with narrative takes advantage of children's developmental capacities and spontaneous pleasure in the creation of art, thus minimizing anxiety and enhancing feelings of mastery, competence, and hope. The creation of storybooks is compatible with family interventions that foster a safe family context, strengthen attachment relationships, insure appropriate structure and boundaries, and enhance parenting capacity as well as those interactions that facilitate understanding and dialogue between family members.

That place where we live: the discovery of self through the creative play experience.

TOPIC: The origin and meaning of play in relation to D.W. Winnicott's (1971) conceptualization of the intermediate area of experience and transitional object, and transitional phenomena formation. PURPOSE: To demonstrate how the nurse therapist can enhance the child's discovery of self and healthy development through creativity and play. SOURCES: Clinical experiences with children in a school-based mental health program and literature support. CONCLUSIONS: By providing "good enough" mothering and a holding environment to enhance the development of a creative play experience, the nurse allows the child to find meaning through self-expression and, ultimately, health.