ABSTRACT
Across the nation, each organization and every leadership team has become battle-tested during the coronavirus disease 2019 (COVID-19) pandemic. Health care has been impacted in every community, and the mental health toll of the pandemic continues to worsen each day. Key leadership and operational lessons learned during COVID are presented for a health system with 387 care sites, across 160 programs, serving 70,000 patients. General preparedness, maintaining access to care, staffing plan strategies, supporting our employees, and moving forward beyond the pandemic are presented.
Subject(s)
COVID-19 , Delivery of Health Care , Humans , Leadership , Pandemics , SARS-CoV-2Subject(s)
Adolescent Psychiatry , Child Psychiatry , Periodicals as Topic , Adolescent , Child , HumansABSTRACT
The issue of prescribing psychotropic medications is one that stirs much emotion and debate among parents and providers alike. This article is presented as a primer on the appropriate and judicious use of psychotropic medications in youth. Rather than focusing on any specific class of medications or on any clinical condition, the article presents best practices as well as key clinical pearls regarding the art and science of psychopharmacology in youth.
Subject(s)
Mental Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Adolescent , Child , Child Development , Humans , Mental Disorders/diagnosis , Psychiatric Status Rating Scales , Psychotropic Drugs/adverse effectsABSTRACT
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
Subject(s)
Adolescent Psychiatry , Child Psychiatry , Cognitive Behavioral Therapy , Adolescent , Child , Humans , North AmericaABSTRACT
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
Subject(s)
Child Health Services/organization & administration , Medical Records , Pediatrics/standards , Pediatrics/trends , Primary Health Care/organization & administration , Child , Delivery of Health Care/statistics & numerical data , Forecasting , Health Policy , Humans , Practice Patterns, Physicians'/organization & administrationABSTRACT
Aggressive symptomatology presents across multiple psychiatric, developmental, neurological and behavioral disorders, complicating the diagnosis and treatment of the underlying pathology. Anti-Epileptic Drugs (AEDs) have become an appealing alternative in the treatment of aggression, mood lability and impulsivity in adult and pediatric populations, although few controlled trials have explored their efficacy in treating pediatric populations. This review of the literature synthesizes the available data on ten AEDs - valproate, carbamazepine, oxcarbazepine, phenytoin, lamotrigine, topiramate, levetiracetam, zonisamide, gabapentin and tiagabine - in an attempt to assess evidence for the efficacy of AEDs in the treatment of aggression in pediatric populations. Our review revealed modest evidence that some of the AEDs produced improvement in pediatric aggression, but controlled trials in pediatric bipolar disorder have not been promising. Valproate is the best supported AED for aggression and should be considered as a first line of treatment. When monotherapy is insufficient, combining an AED with either lithium or an atypical anti-psychotic can result in better efficacy. Additionally, our review indicates that medications with predominately GABA-ergic mechanisms of action are not effective in treating aggression, and medications which decrease glutaminergic transmission tended to have more cognitive adverse effects. Agents with multiple mechanisms of action may be more effective.
Subject(s)
Sleep Wake Disorders/diagnosis , Sleep , Adolescent , Age Factors , Child , Child, Preschool , Humans , Infant , Reference ValuesSubject(s)
Feeding and Eating Disorders/psychology , Obesity/psychology , Adolescent , Child , HumansABSTRACT
OBJECTIVES: The ability to develop quality medical student exposures in child and adolescent psychiatry is critical to the professional development of these future physicians and to the growth of recruitment efforts into the field. This study identifies teaching perspectives among child and adolescent psychiatry faculty to determine whether there are optimal perspectives that positively influence medical student satisfaction. METHODS: Eighty-eight third- and fourth-year students at an allopathic U.S. medical school assessed teacher performance over a 1-year period using a standard internal teacher evaluation. Three experienced faculty members teaching the medical student seminars each completed a Teaching Perspective Inventory. The authors compared the different teaching perspectives with student satisfaction scores on the standard teacher evaluation instrument. RESULTS: All teachers had two dominant perspectives and one recessive perspective. Each teacher had a predominant developmental perspective but they differed in other dominant and recessive perspectives. The transmission perspective was associated with significantly less favorable scores on the standard teacher evaluation compared to the apprenticeship and nurturing perspective. CONCLUSION: The authors discuss the value of teaching perspective identification among child and adolescent psychiatry faculty for medical student education.
