Objective To examine, through photo-elicitation, the personal and professional impact of the COVID-19 pandemic on mental health professionals working with children and adolescents around the globe. Methods We invited the submission of images collected about the pandemic between May and August 2020. We encouraged participants to yoke personal reflections or voice memos to their images. Using snowball sampling, we began with two invitations, including one to the graduates of a mentorship program continuously hosted since 2004 by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). We analyzed de-identified images and anonymized transcripts through iterative coding using thematic analysis informed by rich picture analysis and aided by NVivo software. Results We collected submissions from child and adolescent mental health professionals (n = 134) working in 54 countries spread across the five continents. We identified four overarching domains with component themes that revealed both the commonality and the uniqueness of the pandemic experience around the globe: (1) Place (adjusting to emptiness and stillness; shifting timeframes; blending of spaces); (2) Person (disruption to life rhythms; emotional toll; positives of the pandemic); (3) Profession (changing practices; outreach efforts; guild pride—and guilt); and (4) Purpose (from pandemic to syndemic; from lamenting to embracing; planning toward a better tomorrow). Conclusions Photo-elicitation provided a disarming and efficient means to learn about individual, regional, and global similarities and differences regarding the professionals charged with addressing the mental health needs of children and adolescents around the globe. These findings may help inform practice changes in post-pandemic times.
Objectives We examined the personal and professional impacts of the COVID-19 pandemic on the development, practice, and shifting values of child and adolescent psychiatrists (CAP), in order to inform how the field may move forward post-pandemic. Methods We conducted individual semi-structured interviews of child and adolescent psychiatrists (n = 24) practicing in the United States. Participants were selected as a diverse purposive sample of active members of the American Academy of Child and Adolescent Psychiatry (AACAP). We analyzed anonymized transcripts through iterative coding using thematic analysis aided by NVivo software. Results We identified three main thematic domains within participants’ response to the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These domains, paired with representative questions, include: (1) Unsettling, or “who have we been?” (identifying discontents such as daily inefficiencies and intraprofessional loss of trust); (2) Adaptation, or “who are we now?” (exploring affordances and limitations of virtual work, and the evolution of personal and professional identity); and (3) Reimagination, or “who will we become?” (renewing a commitment to psychiatry as advocacy). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested. Conclusion These three thematic domains, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in its next generation of practitioners.
Objectives We examined the personal and professional impacts of the COVID-19 pandemic on the development, practice, and shifting values of child and adolescent psychiatrists (CAP), in order to inform how the field may move forward post-pandemic. Methods We conducted individual semi-structured interviews of child and adolescent psychiatrists (n = 24) practicing in the US. Participants were selected as a diverse purposive sample of active members of the American Academy of Child and Adolescent Psychiatry (AACAP). We analyzed anonymized transcripts through iterative coding using thematic analysis aided by NVivo software. Results We identified three main thematic domains within participants’ response to the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These domains, paired with representative questions, include: 1) Unsettling, or “who have we been?” (identifying discontents such as daily inefficiencies and intraprofessional loss of trust); 2) Adaptation, or “who are we now?” (exploring affordances and limitations of virtual work, and the evolution of personal and professional identity); and 3) Reimagination, or “who will we become?” (renewing a commitment to psychiatry as advocacy). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested. Conclusion These three thematic domains, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in its next generation of practitioners.
Objective: Drug Story Theater (DST) is a peer-to-peer intervention that engages teenagers in the early stages of their recovery to develop shows about the seduction of, addiction to, and recovery from drugs and alcohol. Methods: We analyzed anonymous surveys completed by students before and after attending a DST performance, and transcripts of focus group interviews conducted with (1) program developers, (2) stakeholders, (3) performers, and (4) audience members. Results: Students (N = 871) from 5 schools attended one of 2 DST performances. Participants demonstrated increased knowledge on 5 fact-based questions (mean improvement range, 19%- 35%; p < .001 for all), and favorable changes on 10 items addressing perceptions regarding substance use risk (paired t test range, 3.9-9.4; p < .001 for all). Through iterative thematic analysis we developed an alliterative “7P” model spanning 2 domains: (1) Participants (Performers and Peers); and (2) Program (Partnerships, Practicalities, and Prevention). Conclusions: Exposure to a DST performance improved knowledge and risk perceptions about addiction among middle and high school students. It remains to be seen if those changes can have an effect on the prevention of substance use and dependence among vulnerable youth, and whether the active components of DST can be replicated in other school environments.
Introduction: Brazilian education follows an inclusion model of special education and utilizes school-based mental health centers, leading to the medicalization of student concerns and raising questions about the link between schooling and children’s psychopathology. How do professionals in the education sector define their roles regarding students’ mental health? Methods: Twenty-one semi-directive interviews were conducted between March and June 2018 in five schools and two universities in the state of Sao Paulo, Brazil. Transcripts were analyzed using a grounded theory approach. Results: We identified three overarching domains: 1) a reported increase in the number of students with a psychiatric diagnosis, 2) teachers’ discourse on the influence of inclusive education policies on their daily practice, and 3) how socioeconomic differences drive selective medicalization of student concerns. Conclusion: In Brazil, selective medicalization has evolved differently in the public and private school systems, reinforcing inequalities already present in care and education.
Background Unaccompanied refugee minors—or unaccompanied minors—are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients’ experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. Methods MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). Results Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one’s story can “set us free” if guided carefully by care providers. Conclusion This study suggests that MUCTUM therapy may efficiently support unaccompanied minors’ mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.
Objective There is a shortage of psychiatrists necessary to meet the clinical needs of children and adolescents. Efforts over the past decade to enhance the workforce have had a limited impact. This study sought to identify the critical components of a medical student mentorship network designed to increase recruitment into the subspecialty. Methods The authors conducted interviews via synchronized videoconferencing of network site leaders and medical students at 14 schools throughout the USA. In addition, they analyzed verbatim transcripts using a thematic-phenomenological qualitative approach. Results The authors interviewed thirty-eight program participants during seven focus group sessions: nine program directors and 29 medical students or graduates, a median of five participants per session. They constructed a framework consisting of two overarching domains, comprised of three themes each: (1) life cycle of a subspecialty mentorship network ( Origins , Initiation , and Continuity ); and (2) next steps to improve the program ( Refining goals , Increasing accessibility , and Defining a path forward ). Conclusion Preliminary data have already documented the positive impact of participation in this mentorship program on medical student match rates into psychiatry. The qualitative model of this study provides a blueprint to develop, maintain, and optimize this and similar efforts aimed at increasing the child and adolescent psychiatry workforce.
Objectives: As COVID-19 spreads around the globe, parents are being presented with new challenges to meet their children's needs. We investigated parental stress and its impact on their parenting practices alongside focusing on the impact on mothers of hospitalized children, during the COVID-19 outbreak in Lahore, Pakistan. Methods: Following IRB approval, using a web-based questionnaire and telephonic interviews, data were collected in April 2020. Symptoms of depression and anxiety were assessed by the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scale. Parents were also asked to report on their parenting practices as well as emotional and behavior changes noticed in their children in the last 1 month. In-depth semi-structured telephonic interviews were also conducted with 24 mothers of COVID-19positive children admitted at Mayo Hospital Lahore. Results: A total of 355 parents participated, with a mean age of 35.3 years AE 8.2, and 64.3% were mothers. The majority (55%) of the mothers had at least 1 child between the ages of 1 and 5 years, and 9% had children with special needs. The overall prevalence of depressive symptoms and anxiety were 25.6% and 21.6%, respectively. Mothers of hospitalized COVID-19positive children reported stress, anxiety, irritability, grief, and fear of death and infecting others. The most commonly identified sources of worry were problems experienced during the hospital stay, worry about the admitted child's physical and emotional health, care provision for children left at home, rumors, and stigma. Parental stress was affecting parenting, with at least 50% of parents reporting more than the usual consequences (shouting at children, taking privileges away, and slapping child) in the past 1 month. However, positive impacts-that is, parents spending more time in activities with their children (93%)-were also observed. Unhealthy eating and sleeping patterns (24.5%), irritability (21.1%), anxiety (16.3%), aggression (14.6%), and sleep difficulties (12.7%) were the most common problems noticed by parents in their children since the COVID-19 outbreak. Conclusions: Significant parental stress observed during the COVID-19 outbreak can adversely impact a child's physical and mental health outcomes. Provision of effective strategies to support parents to respond to and care for children are urgently needed.
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