Implementation of problem-based learning in child and adolescent psychiatry: shared experiences of a special-interest study group.

BACKGROUND/OBJECTIVE: Problem-based learning (PBL) represents a major development and change in educational practice that continues to have a large impact across subjects and disciplines worldwide. It would seem that child and adolescent psychiatry, because of its inherently integrative, bio-psycho-social nature and emphasis on teamwork and collaboration, would be a specialty learned optimally through PBL. Thus, there was a need to establish an international group where experiences in implementing PBL in child and adolescent psychiatry could be shared. This article reports on the first meeting and plans of the Problem-Based Learning in Child and Adolescent Psychiatry (CAP) Special Interest Study Group (SISG), held at the annual meeting of the American Academy of Child and Adolescent Psychiatry. METHODS: Through international collaboration and information-sharing, the SISG aims to promote knowledge among Child and Adolescent Psychiatrists on PBL, to explore evaluation methods of PBL in CAP, and to discuss development of PBL-based curricula. RESULTS: Problem-based learning (PBL) represents a major change in education that has had a large impact across disciplines worldwide. CONCLUSION: The core steps in PBL are the following: presentation of the initial problem; discussion of the problem, and development of learning objectives; independent learning focused on the objectives; and discussion, exploration of new ideas, and discovery of solutions in the reconvened group. Different from the traditional teacher's role, the PBL tutor is an active facilitator who guides learners to identify issues and ways to learn, rather than a "content expert" who provides facts.

Curricular adaptations in inpatient child psychiatry for the 21st century: the Flexner model revisited.

OBJECTIVE: The authors describe curricular modifications created in response to the changing culture of medical education, health care systems, academic medicine, and generational differences. The authors propose a model child psychiatry inpatient curriculum that is sustainable within a community teaching hospital in the 21st century. METHODS: The authors built upon the existing literature in health care financing, academic medicine, effective leadership, and the collective clinical, educational and administrative experience of its faculty to design a model inpatient curriculum that should be portable to other training programs. RESULTS: An innovative training model was developed, implemented, and improved over a 5-year period without any additional fiscal resources. CONCLUSION: This training model has the potential to improve patient care, resident training, interdisciplinary functioning, and resident satisfaction.

The National Center on Indigenous Hawaiian Behavioral Health study of prevalence of psychiatric disorders in native Hawaiian adolescents.

OBJECTIVES: The prevalence rates of disorders among a community-based sample of Hawaiian youths were determined and compared to previously published epidemiological studies. METHOD: Using a two-phase design, 7,317 adolescents were surveyed (60% participation rate), from which 619 were selected in a modified random sample during the 1992-1993 to 1995-1996 school years: 590 selected randomly and 29 at risk (i.e., Center for Epidemiologic Studies-Depression score of >or=35 and suicidal risk) from grades 9-12. The Diagnostic Interview Schedule for Children-Version 2.3, was used to determine DSM-III-R diagnoses. Prevalence rates, weighted for ethnicity, Center for Epidemiologic Studies-Depression scores, and suicide attempts, were calculated for any diagnosis and various disorders. Meta-analyses compared the Hawai'i sample to four community-based studies (randomly selected youths from community populations) and two high-risk studies (homeless, low-income, or high unemployment communities). RESULTS: Hawaiian females had the highest rate for any diagnosis (37.7%; 95% confidence interval [CI] 28.4%-48.0%) and non-Hawaiian males had the lowest rate (19.6%; 95% CI 14.8%-25.5%). Hawaiian males (26.8%; 95% CI 18.2%-37.5%) and non-Hawaiian females (27.9%; 95% CI 22.2%-34.4%) had intermediate and comparable rates. Overall, Hawaiians had significantly higher rates (32.7%; 95% CI 26.1%-40.1%) than non-Hawaiians (23.7%; 95% CI 19.9%-28.0%) when controlling for gender, and girls had significantly higher rates (30.8%; 95% CI 25.8%-36.3%) than boys (21.1%; 95% CI 16.8%-26.1%) when controlling for ethnicity. These findings were primarily the result of the significant differences in rates regarding anxiety disorders. Meta-analyses showed the Hawaiian youth rate for any diagnosis was comparable to high-risk studies and nearly three times higher than the community studies. CONCLUSIONS: Hawaiian youths, especially females, are at high risk. Research on the sociocultural factors that underpin both the genesis of and protection from psychopathology is imperative for Hawaiian and non-Hawaiian mixed-ethnicity youths.

Resilience, family adversity and well-being among Hawaiian and non-Hawaiian adolescents.

BACKGROUND: Minorities and indigenous peoples are likely to have poor mental health and physical outcomes. This study examines resiliency indicators in Hawaiian adolescents. AIMS: Multiple resiliency indicators were examined across different domains including individual, family and community in relation to increased psychological well-being. METHODS: Existing data from the Native Hawaiian Mental Health Research Development Program (NHMHRDP) were used. These data included information from a community sample of five high schools on three islands from the state of Hawai'i. The sample included 1,832 students, where 64% were Native Hawaiian and 36% were non-Hawaiian. RESULTS: This study found that Native Hawaiian youth experienced more family adversity compared with non-Hawaiians, but Native Hawaiians were also more likely to have higher levels of family support. For internalizing symptomatology, the most robust resiliency factors were family support and physical fitness/ health for Native Hawaiian and non-Hawaiian adolescents. For externalizing symptomatology, achievement and family support were consistently strong resiliency factors. The indicator for physical fitness and health was more influential among Native Hawaiians than non-Hawaiians for externalizing symptoms, while academic achievement was more influential among non-Hawaiians than for Native Hawaiians for the protection against internalizing symptoms. CONCLUSIONS: Our findings support the need for intervention programs designed to promote resilience in adolescents, including highlighting the importance of the family. Further research is needed to design and evaluate programs that promote well-being, enhance resilience and improve mental health in culturally appropriate ways.

Demographic and clinical characteristics of adolescents in Hawaii with obsessive-compulsive disorder.

BACKGROUND: A high prevalence rate of obsessive-compulsive disorder (OCD) among Hawaiian adolescents, particularly Native Hawaiians, has been reported. Because Native Hawaiian and other Polynesian youth are at an increased risk for rheumatic fever, caused by an autoimmune response to group A beta-hemolytic streptococci, we hypothesized that the genetic and environmental risk factors for streptococcal infections and their autoimmune sequelae potentially may be associated with the presence of OCD and may partially explain this high OCD prevalence. OBJECTIVE: To describe, among the adolescents in Hawaii diagnosed as having OCD through a previous study, OCD prevalence by ethnicity, household crowding and other measures of socioeconomic status, various measures of physical health and health-seeking behavior, and comorbid psychopathologic features. DESIGN: Six hundred nineteen adolescents from 5 high schools in the state of Hawaii were interviewed from April 15, 1993, to May 7, 1996. Interview instruments included the Diagnostic Interview Schedule for Children and other measurements of psychopathology. Obsessive-compulsive disorder diagnoses, based on current and past 6-month symptoms elicited via structured interview of the adolescents, were reported. RESULTS: Relative to other ethnicities, Native Hawaiians had a 2-fold higher risk (odds ratio = 2.03) for OCD. Degree of Polynesian ancestry correlated positively with OCD prevalence. Obsessive-compulsive disorder prevalence also correlated positively with crowding in the household; measures of physical illness; and measures of depression, anxiety, aggression, and illicit substance use. CONCLUSIONS: The characteristics of OCD in this sample suggest the need to consider the possibility of a streptococcal origin and the need for further studies to clarify the genetic and environmental risk factors for OCD in Hawaiian and other Polynesian youth.