Pivoting in the pandemic: a qualitative study of child and adolescent psychiatrists in the times of COVID-19

Abstract

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.

Neuroethics in the Era of Teleneurology

“…Especially in the context of the COVID-19 pandemic, virtual neurology encounters have been widely used to help facilitate equitable, safe, and reliable access to medical evaluation across a variety of geographic and clinical settings. [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Teleneurology-enabled hub-and-spoke model system design may also be used to democratize access to neurology expertise and to aid in appropriate triage of neurologically complex patients, including those with stroke and DoC. [59][60][61] Statements and resources made available by the American Medical Association (AMA), AAN, American Psychiatric Association, Centers for Medicare & Medicaid Services, American Academy of Physical Medicine and Rehabilitation, and other organizations have supported implementation of, and access to, telemedicine services, emphasizing themes of justice in their respective guidance and resources.…”

Qualitative methods in child and adolescent psychiatry: the time has come

“…One of us tried to address the shortcomings of the entirely numerical by co-editing two series soliciting qualitative and mixed methods submissions: one focused on the interface between CAP and the COVID-19 pandemic [ 7 ], another on that between psychiatry and medical education [ 8 ]. Qualitative research is sometimes the only available method to study discrete yet impactful phenomena, as exemplified by recent work from our group and others: patient and family perspectives about ADHD, anhedonia, or selective mutism [ 9 – 11 ]; stigma experienced by underrepresented minorities and their obstacles accessing mental health services [ 12 , 13 ]; barriers to science implementation in CAP [ 14 – 16 ]; the individual experience of child and adolescent mental health providers during the early days of the pandemic [ 17 , 18 ], or the experiences of medical students during their clerkship in adolescent psychiatry [ 19 ].…”