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Objective: Asynchronous technologies such as mobile health, e-mail, e-consult, and social media are being added to in-person and synchronous service delivery. To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. This study sought out competencies for asynchronous technologies and/or an approach to define them. Methods: This 6-stage scoping review of Pubmed/Medline, APA PsycNET, PsycINFO and other databases was based on a broad research question, “What skills are needed for clinicians and trainees to provide quality care using asynchronous technologies for children and adolescents, and how can they be made measurable to implement, teach and evaluate?” The search focused on key words in 4 concept areas: (a) competencies; (b) asynchronous technology; (c) synchronous telepsychiatry, telebehavioral or telemental health; and (d) clinical. The screeners reviewed the full-text articles based on inclusion (mesh of the key words) and exclusion criteria. Results: From a total of 5,877 potential references, 2 authors found 509 eligible for full text review and found 110 articles directly relevant to the concepts. Clinical studies discuss clinical, technical and administrative workflow rather than competencies, though behavioral health professions’ position statements advise on adapting care and training. Existing technology competencies for video, social media, mobile health, and other asynchronous technologies were used to build a framework. Training, faculty development, and organizational suggestions are suggested. Conclusions: Research is needed on how to implement and evaluate asynchronous competencies to ensure quality clinical care and training, which is a paradigm shift for participants.

Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs).Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country.Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with “awkward” and “uncomfortable” the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each).Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

Purpose of Review Bipolar disorder is highly familial and has a protracted and diagnostically confusing prodrome. This review critically evaluates recently published literature relevant to the treatment of psychiatric symptoms in high-risk offspring of parents with Bipolar Disorder. Recent Findings Non-pharmacological treatment options including psychotherapy, resilience promotion through good sleep, diet, and exercise hygiene, and omega-3 fatty acid supplementation are important first line interventions for high-risk offspring. There has been some success in treating this population with open-label trials with mood stabilizers and atypical antipsychotics; however, these results have not been replicated in randomized controlled trails. Summary Despite some progress in early identification of symptoms in offspring of parents with Bipolar Disorder, there is scarce evidence supporting the treatment of these high-risk youth to prevent psychiatric symptoms from progressing to threshold bipolar or other psychiatric disorders. There is a need for prospective and randomized trials and research that identifies reliable biomarkers to individualize treatments for these youth.

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KEYWORDS: antidepressant-induced mania, family history of bipolar disorder, pediatric depression and anxiety, pharmacotherapy, psychotherapy, treatment | C A S E"John" is a 14-year-old boy who presents with symptoms of depressed mood and anxiety. His mother describes him as a sociable child who participates in several extracurricular activities. However, over the past 2 years, he has become increasingly socially withdrawn. In the past 6 months, other symptoms developed, including difficulties falling asleep, academic decline, and feelings of worthlessness. During this time, John's family reports significant psychosocial stressors: John's brother is diagnosed with schizophrenia, and his father, who has lived with bipolar I disorder for years, is hospitalized for a suicide attempt.Indeed, John's symptoms significantly interfere with his social and academic functioning. With these concerns, he initially presents to his pediatrician seeking treatment for sustained depressive symptoms lasting at least 2 weeks for most of the day, every day.He shares with his pediatrician that he had been experiencing daily challenges trying to fall asleep due to low mood and worries, some anhedonia, decreased energy, difficulty concentrating in school, and psychomotor retardation. He also reports several weeks of hypersomnia, increased appetite, and eating, especially during times of stress, like studying for exams. Though he endorses passive suicidal thoughts in dark moments of hopelessness, he denies any specific plans, means, or intent to harm himself, and does not report a history of any prior suicide attempts or self-injurious behaviors.Importantly, John denies any current or lifetime manic or psychotic symptoms. After being diagnosed with major depressive disorder, it is recommended that he receive psychotherapy to address his mood symptoms. John completes 4 months of family focused therapy (FFT) for youth at risk for bipolar disorder, after which he reported mild improvement in anxiety but no significant improvement of his mood symptoms. His baseline and 4-month depression and mania severity scores are as follows: Children's Depression Rating Scale-Revised Raw score went from 59 to 52 and the Young Mania Rating Scale score went from 1 to 0.Given the persistence of his mood symptoms in spite of FFT, John's therapist recommends that he speak to his pediatrician about the possibility of starting an antidepressant. After reviewing risks, benefits, and alternatives, his pediatrician starts John on 5 mg of escitalopram. Within hours, John notices that his mood had improved.However, on the third day of treatment on 5 mg of escitalopram, John's experiences increased anxiety to a level of a full-blown panic attack. While he was sitting in class, he reports suddenly feeling restless, a sense of doom, and palpitations. He worries that these intense symptoms were due to escitalopram so he discontinues the medication the next day with full resolution of his anxiety and agitation. A life chart illustrating his transition from psychotherapy t...