COVID-19 and Immunization: Reflections and Rationale on Why Child and Adolescent Psychiatry Should Help.

The COVID-19 pandemic has resulted in widespread reflection in medical communities about the role of professional stakeholders in public health interventions. Health professionals, including mental health clinicians, should question how, when, and why they should intervene to address the obstacles and objections to these interventions.

COVID-19 vaccine hesitancy of adolescents with psychiatric disorders and their parents: data from a child psychiatry outpatient clinic.

BACKGROUND: Vaccinating adolescents and determining the factors influencing their vaccination status are critical in the event of a pandemic. One of the factors affecting vaccination is vaccine hesitancy, which is an increasing problem worldwide. Vaccine hesitancy and the vaccination rates of some special groups, such as psychiatric patients and their families, may differ from the general population. The purpose of this study was to identify any vaccine hesitancy to the coronavirus disease 2019 (COVID-19) vaccination in adolescents evaluated in a child psychiatry outpatient clinic, as well as to determine the factors influencing vaccination in these adolescents and their families. METHODS: Two hundred forty-eight adolescents examined in the child psychiatry outpatient clinic were evaluated using a semi-structured psychiatric interview, strengths and difficulties questionnaire (SDQ), the fear of COVID-19 scale, and a form about coronavirus vaccine hesitancy. The parents completed the vaccine hesitancy scale and answered the vaccine hesitancy questions. RESULTS: The vaccination rate was higher in patients with anxiety disorders. The patient`s age (odds ratio [OR]:1.59; 95% confidence interval [CI]:1.26, 2.02), the parent`s vaccine hesitancy (OR: 0.91; CI:0.87-0.95), the status of chronic disease in a family member (OR: 2.26; CI:1.10, 4.65), and the vaccination status of the adolescent`s parents (OR:7.40; CI:1.39, 39.34) were found to be predictive for adolescent vaccination. While 2.8% of the adolescents said that they were definitely against getting vaccinated, 7.7% were undecided. While the rate of undecided parents was 7.3%, those who were against vaccination was 1.6%. CONCLUSIONS: Age, parental vaccine hesitancy, and parental vaccination status can affect the vaccination of adolescents admitted to a child psychiatry clinic. Recognizing vaccine hesitancy in adolescents admitted to a child psychiatry clinic and in their families is beneficial for public health.

Editorial: The Impact of the COVID-19 Pandemic on Racial Disparities in Pediatric Mental Health.

The COVID-19 pandemic has resulted in a devastating impact on youth mental health concerns, with rates of anxiety, depression, and suicidality doubling.1 With 1 in 5 youth now experiencing a mental health disorder, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the Children's Hospital Association, and the US Surgeon General have all declared a national state of emergency in child and adolescent mental health.2,3 Although youth mental health has declined overall since the onset of the pandemic, racial minority youth have been disproportionately negatively impacted. Unfortunately, racial disparities in youth mental health have been a long-standing concern, and the impact of COVID-19 has only served to worsen this gap.2 This is consistent with broader population health trends observed throughout the pandemic across age groups, where a higher proportion of racial and ethnic minorities have experienced poverty, violence, educational and vocational disruptions, and poorer health outcomes, including COVID-19-related hospitalizations and deaths.3,4.

Editorial: The times they are a-changin': paradigm shifts in child and adolescent psychology and psychiatry.

The world is a different place than it was more than 2 years ago, at the start of the COVID-19 pandemic. The times are always changing, but events of the recent past have radically shifted how we work, when and how we interact with each other, and how we understand our history. The papers in the current issue echo this spirit of change, challenging us to fundamentally re-think how we conceptualize psychopathology, where we define boundaries between 'normal' and 'abnormal' (and, who gets to define those boundaries), and whether our current conceptual models are generalizable to ever more diverse groups. These challenges represent healthy and timely critiques of dominant paradigms. Collectively, the authors who contributed to the current Annual Research Review make the case that these new frameworks will have big pay-offs in terms of improving clinical practice and policy.

Impact on Child Psychiatry.

The American pediatric mental health system is in crisis; the COVID-19 pandemic highlighted and exacerbated existing gaps. All youth were affected by the pandemic, an impact medicated by mental illness, the closing of schools, reduced access to mental health services, loss and bereavement, and financial and emotional stress on families. The pandemic's fallout is likely to be felt for years to come as today's youth move through successive developmental stages. Improvements in health care systems for youth, innovations in how care is delivered, and ongoing community support for recovery and resilience are needed moving forward.

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.

A National Pediatric Telepsychiatry Curriculum for Graduate Medical Education and Continuing Medical Education.

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.

E-mental health in child psychiatry during COVID-19: an initial attitudinal study.

OBJECTIVE: COVID-19 propelled e-mental health within the Australian health system. It is important to learn from this to inform mental healthcare during future crises. METHOD: A lexical analysis was conducted of clinician reflections during COVID-19 as they delivered psychiatry services to children and families in New South Wales (n = 6) and transitioned to e-mental health. RESULTS: E-mental health can extend the reach of, and access to psychiatry services, particularly for individuals disadvantaged by inequity. Yet e-mental health can be problematic. It is partly contingent on technological prowess, equipment, internet access as well as space and privacy. Relatedly, e-mental health can hinder clinician capacity to conduct examinations, monitor child development as well as assess risk and the need for child protection. CONCLUSIONS: Given the benefits and limitations of e-mental health, a model that supports face-to-face mental healthcare and e-mental health may be of value. This model would require practical, yet flexible policies and protocols that protect the privacy of children and families, safeguard them from harm, and respect the needs and preferences of children, families and clinicians.

Debate: Child and adolescent mental health services in Pakistan; Do we need in-patient mental health facilities for children and young people?

Depression and anxiety are leading causes of morbidity in children and adolescents worldwide. In Pakistan, young people are exposed to many chronic adversities including violence, social and economic inequalities, and are at greater risk of developing mental health problems. Yet there is a lack of trained human resources, in-patient child and adolescent mental healthcare facilities, and training opportunities in child and adolescent psychiatry and mental health in Pakistan. Given the poor economic condition of the country, which has been made even worse by the COVID-19 pandemic, it is very unlikely that dedicated resources will be made available in near future to develop specialist child and adolescent mental health services in Pakistan. To bridge this treatment gap, we propose a multitiered, transdiagnostic, task-shifting strategy-based model for child and adolescent mental health services in Pakistan.

Identification and Management of COVID-19 Related Child and Adolescent Mental Health Problems: A Multi-Tier Intervention Model.

Nepal is a low and medium-income country (LMIC), situated in South-east Asia, with a population of 29 million, of which, 40-50% are children and adolescents. The Coronavirus Disease 2019 (COVID-19) pandemic has affected the lives of people around the world, including Nepal. The child and adolescent mental health (CAMH) needs and services in Nepal have a significant gap. CAMH in Nepal suffers from lack of specialized training in this field as well as scarcity of human resources and services. There is only one full-time child and adolescent psychiatry (CAP) out-patient clinic in the country. Some recent activities have focused on CAMH in Nepal but the COVID-19 pandemic has produced new challenges. Access to mental health services for children and adolescents (C&A) across Nepal has been adversely affected. Factors such as closure of schools, confinement at home, lockdown, transportation problems, uncertainty, loss of usual routine and fear of infection have affected the mental health of C&A. This has highlighted a need to build capacity of available local human resources, enhance community support, teach measures of coping with stress and improve CAMH service delivery by strengthening the referral system, but these have to be addressed overcoming problems of travel restrictions and limited resources. To address these needs, online platform can be a suitable approach. With this view, a multi-tier CAMH intervention model was developed, which utilizes online platform for training mental health professionals across Nepal, who would then facilitate sessions for C&A, teachers, parents and caregivers; and link them to CAMH services locally, and remotely through teleconsultation. This started as a pilot from June 2020 and will continue till end of February 2021, with the aim to reach 40,000 C&A, parents, teachers and caregivers. As of Nov 2020, this model has been used to successfully conduct 1,415 sessions, with 28,597 population reached. Among them, 16,571 are C&A and 12,026 are parents, teachers and caregivers, across all 7 provinces of Nepal. In this paper, the multi-tier intervention to address the COVID-19 related CAMH problems has been discussed as a feasible framework for resource limited settings and LMICs like Nepal.