Dorothy E. Stubbe

Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective Inpatient Study

OBJECTIVE This study examined usage patterns of restraint and seclusion before and after the implementation of collaborative problem solving (CPS), a manualized therapeutic program for working with aggressive children and adolescents. METHODS The clinical setting was a 15-bed psychiatric inpatient unit for school-age children. A total of 755 children were hospitalized for a total of 998 admissions from fiscal years 2003 to 2007 (median age=11 years; 64% boys). Data were collected for three years before and 1.5 years after the six-month implementation of the CPS model of care. RESULTS There were 559 restraint and 1,671 seclusion events during the study period. After implementation of the CPS model there was a reduction in the use of restraints (from 263 events to seven events per year, representing a 37.6-fold reduction, slope [beta]=-.696) and seclusion (from 432 to 133 events per year, representing a 3.2-fold reduction, beta=-.423). The mean duration of restraints decreased from 41+/-8 to 18+/-20 minutes per episode, yielding cumulative unitwide restraint use that dropped from 16+/-10 to .3+/-.5 hours per month (a 45.5-fold reduction, beta=-.674). The mean duration of seclusion decreased from 27+/-5 to 21+/-5 minutes per episode, yielding cumulative unitwide seclusion use that dropped from 15+/-6 to 7+/-6 hours per month (a 2.2-fold reduction; p for trend .01 or better for all slopes). During the early phases of implementation there was a transient increase in staff injuries through patient assaults. CONCLUSIONS CPS is a promising approach to reduce seclusion and restraint use in a child psychiatric inpatient setting. Future research and replication efforts are warranted to test its effectiveness in other restrictive settings.

A Survey of Early-Career Child and Adolescent Psychiatrists: Professional Activities and Perceptions

OBJECTIVE To assess the career paths and work perceptions of early-career child and adolescent psychiatrists in the United States. METHOD Analysis of survey data of 392/797 (49.2%) of all U.S. child and adolescent psychiatrists graduating from training in 1996-1998 and on the mailing list of the American Academy of Child and Adolescent Psychiatry. RESULTS Slightly more than half of those surveyed were women, and most were in their late thirties, white, married, and living in the geographic area in which they trained, with a median income for full-time workers between

A Comparison of Correctional and Mental Health Referrals in the Juvenile Court

121,000 and

Individual differences in exploratory behavior in the second year of life

150,000. Those with educational debt owed an average of

Improving child and adolescent psychiatry education for medical students: An inter-organizational collaborative action plan

69,741. The sample was generally very satisfied with their work. They identified clinical work, variety, autonomy, and making a difference as the best aspects, and managed care, paperwork, and overwork as the least desirable aspects. The bulk of hours worked were in solo private practice, public sector, and group practice, with children and adolescents making up 73% of patients treated. The most common treatment modality was medication management. CONCLUSIONS The present study uses a database approach to defining current practice and workforce issues among early-career child and adolescent psychiatrists. These data may facilitate objective discussion about public policies concerning workforce priorities, barriers, and facilitators to recruitment in this understaffed field.

A 2-year Progress Report of the AACAP-Harvard Macy Teaching Scholars Program

This article presents the results of the first study to compare only court-referred adolescents in the mental health and criminal justice systems. The study reviewed the files of all 93 adolescents whom the Connecticut juvenile courts referred from July 1, 1993, to June 30, 1994, to Connecticuts only state-run psychiatric hospital for adolescents, and the files of all 241 adolescents whom the same courts referred that same year to the states only juvenile correctional facility. The study analyzed the relationship between seven independent variables—gender, age, race, severity and other aspects of the alleged criminal offense, the court making the referral, family constellation, and the population size of the subjects home town—and referral for a mental health evaluation. Four of the independent variables—race, whether the subject was charged with a sex offense, age, and severity of the alleged offense—were significantly related to referral.

Psychosocial interventions. Individual psychotherapy with the child, and family interventions.

For children in their second year, exploration is an inherently social phenomenon with fundamental implications for learning about the animate and inanimate world. This article examines how 15-month-old children spontaneously involve their mothers in their exploration of a novel task in an unstructured setting. Forty-six 15-month-olds were presented with a novel exploration task with their mothers present but uninvolved. The task consisted of a box with 15 clear plastic drawers each containing a novel toy. Types of bids to mothers, childrens affect, and exploratory behaviors were coded. In the absence of active maternal cues, 15-month-old children quickly and frequently involved their mothers in their exploratory efforts, and at least half of the bids were accompanied by positive affect. Active bids to mother (walking or extending a toy) were associated with more manipulation of novel toys, whereas passive bids such as looking were related to less active exploration of toys and more visual inspection of the task stimuli. Furthermore, the earlier any type of bid to mother, the quicker children approached novel toys. Finally, there were notable sex differences both in childrens bids to their mothers and in their approach to the task. While exploring, girls made more active bids for physical contact with their mothers. On the other hand, girls spent more time than boys visually examining the box itself without touching, but boys spent more time than girls exploring and touching the box. These results are discussed in terms of how mothers and children mutually contribute to childrens interest in novel exploration.

Model Curriculum for Academic Child and Adolescent Psychiatry Training

ObjectiveA new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the longstanding dearth of CAP training for medical students.MethodThe CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP’s CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies.ResultsThe authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

Social Media and Networking Competencies for Psychiatric Education: Skills, Teaching Methods, and Implications

ObjectiveThe American Academy of Child and Adolescent Psychiatry (AACAP) has partnered with the Harvard Macy Program for Healthcare Educators so that selected child and adolescent psychiatry academic faculty might enhance their teaching expertise in order to possibly enhance recruitment of medical students into child and adolescent psychiatry.MethodsThirteen child psychiatry faculty have graduated from the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). There are 10 additional child and adolescent psychiatry faculty members in the process of completing the program. A survey was created to broadly assess the effect of the AACAP-HMTSP training on the first 13 graduates of the program as a pilot to guide future study of the program. Three teaching scholars who are the first authors of this article (JH, DS, MH) conducted this survey and the data interpretation for this study.ResultsThirteen of the scholars submitted responses to the survey. All participants indicated a high degree of satisfaction with the HMTSP and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness. The scholars reported increased teaching of medical students (9 of 13) and psychiatry residents (6 of 13) after the HMTSP.ConclusionThe AACAP-Harvard Macy Teaching Scholars reported high levels of satisfaction with the overall program. Whether the reported increase in medical student and psychiatry resident mentoring and teaching will eventually lead to increased medical student recruitment into child and adolescent psychiatry remains to be determined.

Diagnostic specificity of a brief measure of expressed emotion: a community study of children.

Research concerning ADHD and cost-effective and efficacious treatments of the core deficits and concomitant functional impairments is burgeoning. Substantial gains have been made in elucidating effective treatment modalities for the complex neuropsychiatric disorder of ADHD. Much remains to be investigated in order to gain a more thorough understanding of the differential contributions of psychosocial and medication treatments to the long-term outcome of this complex disorder.