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Objective A consortium of 8 academic child and adolescent psychiatry programs in the United States and Canada examined their pivot from in-person, clinic-based services to home-based telehealth during the COVID-19 pandemic. The aims were to document the transition across diverse sites and to present recommendations for future telehealth service planning. Method Consortium sites completed a Qualtrics survey assessing site characteristics, telehealth practices, service use, and barriers to and facilitators of telehealth service delivery prior to (pre) and during the early stages of (post) the COVID-19 pandemic. The design is descriptive. Results All sites pivoted from in-person services to home-based telehealth within 2 weeks. Some sites experienced delays in conducting new intakes, and most experienced delays establishing tele−group therapy. No-show rates and use of telephony versus videoconferencing varied by site. Changes in telehealth practices (eg, documentation requirements, safety protocols) and perceived barriers to telehealth service delivery (eg, regulatory limitations, inability to bill) occurred pre−/post−COVID-19. Conclusion A rapid pivot from in-person services to home-based telehealth occurred at 8 diverse academic programs in the context of a global health crisis. To promote ongoing use of home-based telehealth during future crises and usual care, academic programs should continue documenting the successes and barriers to telehealth practice to promote equitable and sustainable telehealth service delivery in the future.

Over the past decade telepsychiatry, and more broadly telemental health (TMH), services with children and adolescents have been implemented with diverse populations in many geographic areas across the United States. The feasibility and acceptability of child and adolescent TMH have been well demonstrated, but little research exists on the efficacy and effectiveness of TMH in improving the mental health care and outcomes for underserved youth. This article summarizes the state of research in child and adolescent telemental health TMH and examines studies in other areas of telemedicine that may inspire and guide child and adolescent telepsychiatrists to collect data on the process and outcomes of their own work.

This practice parameter discusses the use of telepsychiatry to provide services to children and adolescents. The parameter defines terms and reviews the status of telepsychiatry as a mode of health service delivery. Because many of the issues addressed are unique to telepsychiatry, the parameter presents principles for establishing a telepsychiatry service and optimizing clinical practice within that service. The principles presented are based on existing scientific evidence and clinical consensus. Telepsychiatry is still evolving, and this parameter represents a first approach to determining "best practices." The parameter emphasizes the integration of telepsychiatry within other practice parameters of the American Academy of Child and Adolescent Psychiatry. J. Am. Acad. Child Adolesc. Psychiatry , 2008;47:(12)1468–1483.

Objective This is the seventh in a series of 10-year reviews of rating scales. Here the authors present scales measuring functional impairment, a sequela of mental illness. The measurement of functional impairment has assumed importance with the recognition that symptom resolution does not necessarily correlate with functional improvement. Method The authors reviewed functional impairment from multiple sources over the past 20 years. Thus, this article includes a variety of scales ranging from those that have been subject to critical review with strong psychometric support to those that have not been critically reviewed but are in widespread use to those that are still finding their niche. Results These scales represent a continuum of constructs from symptoms to functional impairment to contextual factors that affect youths' functioning. Most older scales have focused on developmentally delayed youths. Newer scales strive to measure functional impairment separate from symptomatology. Some newer scales are also keyed to determination of level of service need. Conclusions Scales measuring functional impairment can elucidate the impact of illness on youths, identify targets for treatment, determine service needs, and monitor treatment effectiveness. These scales are widely used in community mental health and health service delivery. They can assist in providing evidence-based treatment.

Objective This is the sixth article in a series of 10-year reviews of rating scales. The current article reviews scales that assess externalizing behaviors such as disruptive behavior disorders and aggression. Method Relevant scales were found by searching popular electronic databases. The search was then broadened by a review of the references in selected articles. Due to the paucity of well-established scales, any such scales with potential utility for elucidating the functioning of youths with externalizing behaviors were selected. Results None of these scales is diagnosis-based, although some correlate with DSM-IV-defined disruptive behavior disorders. Most scales assessing disruptive behavior disorders have a solid normative base, good psychometric functioning, and high clinical utility. Scales assessing aggression comprise a bimodal group. Several have been adapted from the adult literature and are widely used in clinical practice, while others address theoretical aspects of aggression and are used predominantly in research. Empirical support for all of the scales assessing aggression varies widely, although several show potential for routine clinical practice. Conclusions Overall, these scales measure a variety of constructs with considerable utility for assessing youths’ externalizing behaviors, predicting outcome, and evaluating treatment effects. Many need further validation with youth.

Objective: This article summarizes scales assessing trauma and its effects on youths. Method: We sampled trauma-related articles published over the past 25 years, with an emphasis on the past decade, selected scales with at least several publications, and reviewed their properties. Those with minimally adequate psychometric properties and continued literature citations or a special niche are presented. Results: Most of trauma-related scales are relatively new, reflecting the evolving interest in juvenile trauma. Therefore, they do not have the depth of psychometric examination nor the breadth of applications described for previously reviewed scales. However, they have been applied to various traumatic situations. These scales assess a range of trauma-related symptoms and behaviors, including posttraumatic stress disorder, symptoms related to posttraumatic stress disorder, and dissociation. Additionally, several scales assess the trauma itself. Conclusions: Trauma-related scales show promise for research and clinical use in understanding youths’ responses to trauma. However, their utility for treatment planning and for accountability in practice is generally not as clear. The potential user must clearly define the goals of measurement and use these scales within their limited roles. With these caveats, trauma-related scales may assist our work with traumatized youths.

Objective This study examined the use of the collaborative care model in treating Hispanic children diagnosed with attention-deficit hyperactivity disorder (ADHD) living in underserved communities. Methods The study was implemented in two clinics, one in a rural and one in an urban setting. We evaluated model implementation and used standardized rating scales to assess pre/post-intervention changes in ADHD symptoms. All children were referred and treated by their pediatricians. A care manager conveyed medication recommendations from a child and adolescent psychiatrist to the pediatrician who in turn implemented recommendations. The care manager also provided psychoeducation regarding the causes and management of ADHD. Results The model was successfully implemented. Differences were observed across the two clinics. The urban clinic provided more sessions in the first 2 months of treatment, collected more rating scales, provided more psychoeducation, made more medication adjustments, and prescribed higher medication doses. However, children at both sites showed comparable reductions in ADHD symptoms. Parents were satisfied with the collaborative care model. Staff expressed the need for more administrative support in implementing the model. Conclusions Collaborative care appears feasible and acceptable for the treatment of Hispanic children with ADHD and shows preliminary evidence of effectiveness.

In the past decade, there has been a vast increase in the amount of gene sequence information that has the potential to revolutionize the way diseases are both categorized and treated. Old diagnoses, largely anatomical or descriptive in nature, are likely to be superceded by the molecular characterization of the disease. The recognition that certain genes drive key disease processes will also enable the rational design of gene-specific therapeutics. Antisense oligonucleotides represent a technology that should play multiple roles in this process.

Journal of the American Academy of Child & Adolescent Psychiatry - Vol. 42 - N° 2 - p. 257-259

Studies of the clinical course of depression in young people provide important information regarding the validity of mood disorders in youth and later psychopathology and psychosocial functioning. The most consistent finding is that mood disturbances during early development do not constitute a nonspecific prodrome to various later disorders but indicate a proclivity for recurrent difficulties with depressed mood. The course of recovery is much like that for adults, requiring weeks to months, with some youths developing chronic courses. Comorbidity appears important in determining overall impairment but not in altering the longitudinal course or psychopathologic outcome. Thus, the onset of depression in young people must be taken as a serious impediment to normal psychological development.

Family interactions appear to play an important role in the timing, intensity, and persistence of depressive disorders in adults. This article reviews the literature on the role of family interactions in depression in children and adolescents. Children’s reports of depressed affect have been associated with a variety of dysfunctional family attributes including maternal hostility, lack of cohesiveness, poor communication, and increased conflict. It is unclear, however, whether these patterns are specific to families of depressed youth or characterize the families of children with varied psychiatric psychosocial difficulties.

This investigation developed a hierarchical multiple regression model to assess the potential risk factors for suicidality in youths 7 to 17 years old. Variables were assessed in three domains: self-perceptions, demography and diagnosis, and home/environment. The model controlled for major depressive disorder (MDD), which has confounded previous investigations, by evaluating potential risks in a diagnostically heterogenous sample, and then evaluating these risks in a subsample with MDD. Conduct problems and depressive thinking emerged as the most powerful predictors in both samples. Hopelessness, life stress, and maternal psychopathology predicted suicidality only in the total sample. Separation anxiety protected MDD youths. These results suggest that suicidal MDD youths may comprise a distinct subgroup of depressed youths.

Journal of the American Academy of Child & Adolescent Psychiatry - Vol. 36 - N° 4 - p. 569-571