Stigma as a Source of Stress for Adolescent Mothers and Their Babies.

ABSTRACT: Adolescent pregnancy and the babies of teen mothers have been a focus of attention and concern for many years. The literature on the health of pregnant and parenting teens, however, is largely silent about the impact of stigma on them and their children. Stigma is a pervasive cultural attitude, which leads us to overlook potentially good outcomes for this vulnerable population and contributes to poor outcomes for these mothers and babies. Stigma is a cause of stress leading to well-known adverse effects on health and development for both mothers and babies. This article reviews manifestations of social stigma in our communities, in the offices of professionals, and in policies that embed bias in our social systems. The impact of inequity has been vividly revealed over the course of the global pandemic. We review findings related to interventions associated with better outcomes and offer suggestions for more humane care and policies.

Toward Evaluation in Public Services: Getting Past the Barriers.

Evaluation of public programs in mental health and in other fields is often blocked when "reasons not to" are cited. These include "HIPAA," "IRB," "not my job," "it's already evidence based," "we know what's right," "we don't know enough," "we don't have baseline data," and "there's too much to do." Examining these reasons, the values thought to justify them, and possible ways to respond will facilitate evaluation research.

Being with the patient: the use of "clinical evidence," reconsidered.

Our objective was to review the use in psychiatry of data arising from interaction with the patient, here called "clinical evidence." We conducted a clinical and historical review. Data from interactions with patients are increasingly marginalized in psychiatry, even as interactional data have an increasing role elsewhere in healthcare. Recommendations for training, clinical care, and administration are made.

Child and adolescent mental health policy: promise to provision.

Mental health policy enables the translation of the knowledge base of 'how' to help children and families into the actual 'provision' of help. Amid competing pressures to leave the allocation of services to the market, policy is required to define needs, select priorities, match resources with need, and to measure what has been accomplished. Crafting policy requires balancing contrasting goals and approaches, here spelled out. Public mental health policy can be compared to other forms of continuous quality improvement (CQI).

Case study: the internet as a developmental tool in an adolescent boy with psychosis.

The Internet has become an increasingly important part of teen culture; however, there still remains little in the medical/psychiatric literature pertaining to the impact of the Internet on adolescent development. Despite the potential problems associated with communication online, the Internet offers a variety of positive opportunities for teens. In this report, we present a case study that illustrates the Internet as a helpful tool in a 15-year-old adolescent boy with a history of chronic neurological illness accompanied by refractory psychosis. Although the case emphasizes some of the ways in which the Internet may have a positive impact on adolescent development, further research is indicated to evaluate the contexts in which the Internet serves healthy developmental processes and those in which its influence is potentially deleterious.

Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care.

OBJECTIVE: To reduce the use of restraint and seclusion with children and adolescents in psychiatric inpatient units by promoting a preventive, strength-based model of care. METHOD: The State Mental Health Authority used data analysis, quality improvement strategies, regulatory oversight, and technical assistance to develop and implement system change over a 22-month period. No changes in regulation or policy were undertaken. RESULTS: Comparative data collected before and after the interventions demonstrated substantial reductions in the use of restraint and seclusion. Child units (age 5-12) decreased from 84.03 to 22.78 episodes per 1,000 patient days (72.9%), adolescent units from 72.22 to 37.99 episodes (47.4%), and mixed child/adolescent units from 73.37 to 30.08 episodes (59%). CONCLUSIONS: The use of restraint and seclusion in child and adolescent inpatient settings can be reduced through a systems approach, which may have applicability to other settings and systems.

Alliance formation with parents: limit-setting and the effect of mandated reporting.

The ability of parents to cooperate in their children's treatment is not fixed, but is a potential that evolves in a clinical relationship. Such clinical work includes a hierarchy of limit-setting, ranging from education to legal intervention. The experience of an inpatient child psychosomatic service indicates that such limit-setting was relevant in more than 50% of cases, and served to enhance the alliance with parents and children.