In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry.

OBJECTIVE: To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry. METHOD: Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. RESULTS: Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. CONCLUSION: The world is a better place because Joe Biederman was here.

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.

Impact of a collaborative model on community clinician confidence in child and adolescent mental health care, wellbeing, and access to child psychiatry expertise.

BACKGROUND: The COVID-19 pandemic was associated with an increase in child and adolescent mental health disorders, with subsequent worsening of patient access to specialist mental health care. Clinicians working in the community were faced with increased demands to diagnose and manage pediatric mental health disorders, without always having the confidence and knowledge to do so. We therefore developed COnnecting Mental-health PAediatric Specialists and community Services (COMPASS)-a collaborative model designed to upskill community clinicians in child and adolescent mental health care and provide them with better access to child and adolescent psychiatry expertise. COMPASS comprises (1) an online Community of Practice (CoP) with fortnightly one-hour sessions covering: anxiety; aggression and challenging behaviours; depression; self-harm and suicidality; eating disorders; and autism spectrum disorder/complex cases and (2) primary and secondary consultations for general practitioners and paediatricians with an experienced child psychiatrist. We aimed to assess the impact of COMPASS on community clinician self-reported confidence in: managing common child and adolescent mental health disorders (Objective 1, primary outcome); navigating the mental health care system (i.e. knowing how services are organised, accessed, and how to refer patients, Objective 2); diagnosing conditions (Objective 3); prescribing psychotropic medications (Objective 4) as well as the impact on, clinician practice and wellbeing (Objective 5) and outcomes of patients referred by COMPASS clinicians to the child psychiatrist (Objective 6). METHODS: We evaluated COMPASS in its first year, with COMPASS running from March to July 2021. Participating clinicians completed pre-post surveys evaluating change in Objectives 1 to 4 above, using study-designed measures. A purposive sample of clinicians was then invited to a semi-structured interview to understand their experience of COMPASS and its impacts on practice and wellbeing (Objective 5). We adopted an inductive approach to the qualitative analysis using the Framework Method. This involved selecting five random transcripts which were double coded and categorized, to generate an initial framework against which all subsequent transcripts were analysed. Themes and subthemes were generated from the data set, by reviewing the matrix and making connections within and between clinicians, codes and categories One child psychiatrist completed a 2-week logbook of the nature and outcomes of primary and secondary consultations (Objective 6). FINDINGS: 51 (86%) clinicians attended CoP sessions and completed pre-post surveys, with 92% recommending COMPASS to peers. Clinicians reported increased confidence in the pharmacological and non-pharmacological management of all conditions, most notably for management of self-harm. They also reported increased knowledge of how to navigate the mental health system and prescribe medications. Qualitative analysis (n = 27 interviews) found that COMPASS increased clinician wellbeing and reduced feelings of professional isolation and burnout. Over the 2-week snapshot, the child psychiatrist consulted on 22 patients and referred all back to the community clinician. CONCLUSIONS: COMPASS is associated with improved clinician confidence to manage child and adolescent mental health concerns, navigate the mental health system, improved clinician wellbeing, and reduced need for ongoing mental health care by specialists.

[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.

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.

[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.

[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.

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 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.

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.

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.