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Objective: To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement.Method: The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students 'perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated.Results: The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI).Conclusions: Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.

Objectives: To examine the dilemmas for children, family, and mental health professionals posed by the presence of a delusional parent in a family, including someone with induced psychotic disorder (IPD); to identify frequently unrecognized problems; and to propose practical suggestions for professionals.Method: The pertinent literature on the effects of delusional parents on children, families, and professionals is reviewed. By way of 3 case vignettes, the dilemmas are identified and discussed.Results: Delusional disorders are underdiagnosed, resulting in poor anticipation of their implications. Unanticipated family factors, such as “pursuit of isolation” and the related heightened risk of violence, contribute to the failure of professional interventions, which has been described as “therapeutic systems paralysis.”Conclusions: These cases are complex, often requiring multisystemic involvement to reduce the risks of flight, violence, psychosis, posttraumatic stress disorder, and other psychiatric sequelae to children and other family members. The critical features of the innovative collaboration (“therapeutic consensus”) required between professionals for successful therapeutic interventions with these families are described.

Objectives: To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted.Method: Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined.Results: Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder.Conclusions: Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.