Ethical Considerations for Mental Health Clinicians Working with Adolescents in the Digital Age.

PURPOSE OF REVIEW: Adolescents' use of digital technologies is constantly changing and significantly influences and reflects their mental health and development. Technology has entered the clinical space and raises new ethical dilemmas for mental health clinicians. After an update on this shifting landscape, including a brief review of important literature since 2014, this article will demonstrate how core ethical principles may be applied to clinical situations with patients, using vignettes for illustration. RECENT FINDINGS: The vast majority of adolescents (95%) across all demographic groups can access smartphones (Anderson et al. 2018•). Technology use in mental health is also expanding, including a proliferation of "apps." While qualitative data from technology experts reports overall positive effects of technology (Anderson and Rainie 2018), concern about its potential negative impact on youth mental health remains high, and an association between technology use and depression is strong. Internet addiction, online sexual exploitation, and accessing illicit substances through the "dark net" pose additional clinical and legal concerns. In this context, clinicians have an ethical responsibility to engage in education and advocacy, to explore technology use with teen patients and to be sensitive to ethical issues that may arise clinically, including confidentiality, autonomy, beneficence/nonmaleficence, and legal considerations such as mandated reporting. New media and digital technologies pose unique ethical challenges to mental health clinicians working with adolescents. Clinicians need to stay abreast of current trends and controversies about technology and their potential impact on youth and engage in advocacy and psychoeducation appropriately. With individual patients, clinicians should watch for potential ethical dilemmas stemming from technology use and think them through, with consultation as needed, by applying longstanding core ethical principles.

Between-week reliability of the cervical range of motion (CROM) device for upper cervical rotation.

Background: The Cervical Range of Motion (CROM) device is a valid and reliable clinical tool used to measure full cervical rotation, however, its reliability for measuring upper cervical rotation is unknown.Objectives: Assess between-week test-retest reliability of the CROM device in measuring upper cervical rotationMethod: Thirty students participated in this test-retest reliability study. The CROM device was used to measure left and right cervical rotation in both a seated neutral and fully flexed head-neck position. Interclass correlation coefficient (ICC) was calculated for all motions. Measurement error was determined using standard error of measurement (SEM) and minimal detectable change (MDC).Results: The CROM device demonstrated moderate to good reliability (ICCs 0.65-0.9) of full and upper cervical rotation. The SEMs and MDCs of this study are small and suggest that the chance of repeated measurement error was relatively minimal for the between-week trials.Conclusions: The CROM device is a reliable outcome tool for measuring upper cervical rotation. The clinical implications of these findings suggest that therapists can utilize the CROM device to more completely examine all planes of upper and full cervical mobility. It may also assist in identifying upper cervical ROM limitations associated with underlying cervical pathology or motion dysfunction.

Use of Manifest Injustice in the Washington State Juvenile Rehabilitation Administration.

In the Washington State Juvenile Code, the Manifest Injustice (MI) provision allows judges to sentence youth outside of the standard guidelines. We compared rates of Juvenile Rehabilitation Administration (JRA) involvement and MI between racial minority youth and Caucasian youth. Although not statistically significant, there was a trend toward African American and multiracial youth having MI used to decrease their sentence less frequently than Caucasian youth. African American youth were about half as likely to have MI used to intensify their sentence compared with Caucasian youth (rate ratio = .49, p = .002), whereas multiracial youth were 42 percent less likely (rate ratio = .58, p = .04). More African American youth reside in urban and liberal parts of the state where judges may be more progressive and less likely to use MI to intensify sentences. More diversion programs targeting minority youth exist in urban areas of Washington, and more African American youth are transferred to adult court; both reduce the likelihood of minority youth receiving MI. Judges in rural areas of the state, which have fewer treatment resources, may be using MI to access services only available to court-involved youth. It is imperative that community behavioral health services are available so that youth and families can be justly served.