Erica Z. Shoemaker

The Next Big Thing in Child and Adolescent Psychiatry: Interventions to Prevent and Intervene Early in Psychiatric Illnesses

The last two decades have marked tremendous progress in our ability to prevent and intervene early in psychiatric illnesses. The interventions described in this article range from established, empirically-supported treatments to creative interventions early in their development and deployment. Some of these interventions are low-technology programs delivered in social settings (such as schools), and some rely on sophisticated emerging technologies such as neuroimaging. This article reviews 4 preventative interventions: 1) The use of structural brain imaging to identify children at risk for familial depression who are most likely to benefit from preventative cognitive behavioral therapy 2) The Good Behavior Game, a school based program that, when implemented in 1st grade classrooms, cut the incidence of substance use disorders in students in half when those students were 19 years old, 3) The SPARX video game, which has the potential to be an accessible, appealing, and cost-effective treatment for the thousands of teens affected by mild to moderate depressive disorders, and 4) Intensive psychosocial treatments which can reduce the progression of from the ultra high risk state to the first episode psychosis by 50% over 12 months. All of these interventions have tremendous potential to reduce the suffering and disability caused by psychiatric illness to both children and adults.

Integrated Care for Women, Mothers, Children and Newborns: Approaches and Models for Mental Health, Pediatric and Prenatal Care Settings

“Integrated” behavioral health care most often refers to coordinated primary care and mental health care delivery at a co-located clinical site or psychiatric consultation service to a primary care clinical site. Women’s perinatal medical and mental health is an ideal target for integrated, patient-centered, and family-centered care. A three pronged approach is proposed to: 1) identify solutions for current barriers to mental health care delivery for pre- and postpartum women, 2) understand the relevance, steps toward and other thematic “how to” aspects of improving access to perinatal mental health services for the ongoing health of both mother and child, and 3) learn specifics of addressing maternal mental health, infant dyadic therapy, and enhanced parenting support. It borrows from the areas of stepped care, interdisciplinary teamwork, specific matching of treatments to disorders and stages of illness, and a range of individual, dyad, family and group treatments. These treatments are accessible, reduce stigmatization, and appropriate for dissemination using technology.

Reflective Team Supervision After a Frightening Event on a Psychiatric Crisis Service

ObjectiveThe authors demonstrate the value of reflective team supervision as part of the informal curriculum in an emergency psychiatry setting after a potentially traumatizing adverse event.MethodThe article gives a case presentation of a violent adolescent who eloped from his hospital Emergency Department and provides a description of team supervision sessions that facilitated informal learning for residents and medical students after this event.ResultsReflective team supervision sessions after this event resulted both in improved resident well-being and learning opportunities, as well as hospital quality improvement designed to prevent future elopements.ConclusionsReflective team supervision can be an essential component of trainee education to enhance residents’ well-being and to promote both systems-based practice and practice-based learning. This can be an excellent forum to explore themes of humility, self-reflection, and professional growth.

Social Media and Clinical Practice: What Stays the Same, What Changes, and How to Plan Ahead?

While the patient-centered healthcare movement, like traditional medicine movements, aims to deliver quality, affordable, and timely care in a variety of settings, the consumer movement on new technologies is passing it by with emerging technologies and new ways of communicating with others (text, e-mail, Twitter, Facebook). This chapter builds on what we know about e-Mental Health (eMH), technology and communication progress over the past 50 years in maintaining the tenets of “good” quality care, adjusting slightly to telemedicine models, and considering more significant adjustments for use of social media. The areas of challenges include privacy and confidentiality, health and personal practice, having “good” interpersonal/clinical boundaries, awareness of what information is out there about you, and discussing clear expectations about online communication between doctors and patients as part of the informed consent process. Guidelines, strategies, and tips for the clinician are offered.

e-Mental Health Improves Access to Care, Facilitates Early Intervention, and Provides Evidence-Based Treatments at a Distance

Our current healthcare system in the United States is characterized by problems with access to timely and evidence-based care, particularly for mental disorders. e-Mental Health (eMH) improves access to care regardless of the point-of-service or barriers involved. Its effectiveness across age, population, and disorders is as good as in-person care, though adjustments for some populations in the approach are necessary. Early intervention is an example of “Cadillac” care or a best evidence-based approach that is easier to distribute via telemedicine. Cadillac care delivered via eMH has the potential to bring evidence-based early-intervention modalities to very young children and their families. However, early access to care is also critical for all populations, particularly those with cultural or medical disadvantages. It appears that eMH may be preferable or better than in-person care in some instances.

Program Evaluation and Modification: Supporting Pragmatic Data-Driven Clinical Videoconferencing (CV) Services

This chapter discusses the prioritization of desired outcomes and ongoing program evaluation in the provision of clinical videoconferencing (CV) services. It provides an overall organizing framework to consider program evaluation from the very early stages of planning. Emphasis is placed on crafting evaluation fitted to specific needs and available resources.

How to Build, Evaluate, and Increase Your e-Mental Health Program Efficiency

Objective: This chapter discusses the prioritization of outcomes and evaluation in the provision of synchronous telemedicine (i.e., videoconferencing, STM) services. Methods: This organizational approach may be a shift from seeing what happens with planned services to planning the outcomes and then designing the services—in advance. Results: Basic and advanced areas of evaluation (e.g., satisfaction, technology, cost, clinical and other outcomes) are suggested and involve the many participants in STM in a systematic framework. It also offers suggestions on how to do a needs assessment and how to adjust priorities based on specific needs and available resources in a program. Examples of project improvement apply ideas from theory to clinical and other associated outcomes. References and resources of information are provided for further review. Conclusion: The readers acquire knowledge, skill, and a framework to improve existing programs and help their many participants.