Implementing COVID-19 Mitigation in the Community Mental Health Setting: March 2020 and Lessons Learned.

In March 2020, at the beginning of the COVID-19 pandemic, state-funded community mental health service programs (CMHSP) in Michigan, organized into 10 regions known as a "Prepaid Inpatient Health Plan" (PIHP), grappled with the task of developing a modified plan of operations, while complying with mitigation and social distancing guidelines. With the premise that psychiatric care is essential healthcare, a panel of physician and non-physician leaders representing Region 5, met and developed recommendations, and feedback iteratively, using an adaptive modified Delphi methodology. This facilitated the development of a service and patient prioritization document to triage and to deliver behavioral health services in 21 counties which comprised Region 5 PIHP. Our procedures were organized around the principles of mitigation and contingency management, like physical health service delivery paradigms. The purpose of this manuscript is to share region 5 PIHP's response; a process which has allowed continuity of care during these unprecedented times.

Caring for the Transgender Adolescent: It Takes a Village.

CASE: Christa is a 15-year-old male-to-female (MTF) transgender patient who comes to your Developmental-Behavioral Pediatrics office for consultation on attention deficit/hyperactivity disorder (ADHD) management and concerns about worsening anxiety. Review of medical history included mild persistent asthma managed with steroid inhaler and leukotriene antagonist. She was diagnosed with ADHD at 12 years and has been placed on methylphenidate and clonidine over the years with little improvement. She struggles in school, with barely passing grades, and feels that she cannot focus on her assignments.She was diagnosed with MTF transition gender dysphoria, social anxiety disorder, and depressive disorder at 13 years by a psychiatrist and was treated with sertraline with some mood improvement. More recently, she reports having thoughts of wanting to hurt people and "wanting to watch them wither away." She expressed being terrified by these thoughts, which lasted for a couple of days but have since resolved. She denied any suicidal thoughts recently and gives credit to her "best girlfriend" for her overall improved mood, improved sleep pattern, and increased energy level. She expressed having deepening feelings for this girlfriend but admitted to not having acted on these feelings as she is afraid of the consequences. She currently uses the pronouns she/her/hers.Family history is pertinent for paternal bipolar disorder. There is considerable psychosocial stress as Christa is estranged from her father, who is not supportive of her transition, although mother is. Unfortunately, she is dependent on her father for medical insurance coverage, and he is refusing to give authorization to proceed with the evaluations and diagnostic workup for the transformation. Christa has been repeatedly encouraged to seek counseling but has declined because of previous poor experiences with counselors. Her primary care clinician in Family Medicine has been administering hormonal replacement therapy because she cannot access the regional center of excellence because of above-mentioned insurance issues. She presents to you now with her mother for management suggestions and diagnostic clarification. What is your next step?

Understanding the use of psychotropic medications in the child welfare system: causes, consequences, and proposed solutions.

Recent studies have highlighted the progressively increasing number of children prescribed psychotropic medication, while findings have illustrated significantly greater usage among child welfare-involved children. These findings have raised serious concerns among mental health and child welfare professionals as well as the general public. To address this issue, the authors explore the factors that may contribute to the higher incidence of psychotropic medication usage among child welfare-involved children and the unintended negative consequences for these children and the public health system. They propose methods to effectively address this problem.