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OBJECTIVE Recruitment is one of the most important missions for the Child and Adolescent Psychiatry (CAP) Caucus of the American Association of Directors of Psychiatric Residency Training, the American Academy of Child and Adolescent Psychiatry, and the American Association of Directors of Child and Adolescent Psychiatry. A review of the National Resident Matching Program (NRMP) Match data is needed to inform current and future practices. METHODS The NRMP, Accreditation Council for Graduate Medical Education, and Association of American Medical College databases were queried from 1996 to 2021. RESULTS The NRMP data show that the number of programs participating in the Match has increased from 87 in 1996 to 106 in 2021 and that the percentage of programs that fill their positions in the Match is increasing and has increased from 41% in 1996 to 67% in 2021. However, each year, a percentage of programs do not fill their positions offered in the Match. The numbers indicate a surplus of positions for the number of applicants that appears to be increasing, and there are currently 49 more positions than applicants. CONCLUSIONS Trends in the CAP Match are encouraging, and importantly, more programs and applicants are using the Match. One concerning trend is the surplus of positions while there is a great need for child psychiatrists. More research is needed on the incentives for programs and applicants to participate in the Match and how to increase interest in child and adolescent psychiatry.

Health education has seen a surge of interest in active learning strategies like the flipped classroom. In response to the need for physical distancing in the age of COVID-19, schools are rapidly shifting to web-based and video technology, sometimes without being able to predict the outcomes of this change. The objectives of this pilot experiment were to (1) compare active learning (AL) methods versus traditional lecture for transmitting and retaining knowledge in the introductory pre-clinical medical school curriculum and (2) weigh whether the costs required to flip instruction were justified by learning gains. The authors took a 2 h lecture for first-year medical students and converted half of it into an AL format. In-person lecture and active learning groups were compared in terms of student knowledge at pre-intervention, immediately post-intervention, and 6months post-intervention. Costs for first-time delivery and anticipated costs for repeat delivery of each format were calculated. Students' gains in knowledge increased in both groups, though more by lecture (control) than via AL. Delivering a single hour of new AL costs 3.4 times that of a new lecture. Repeat offerings of the AL intervention were estimated to cost 5.4 times that of the repeat lecture. The 1 h AL session was less effective than the 1 h lecture for knowledge acquisition and retention at 6-month follow-up. The AL was more expensive to produce and to repeat. Future research needs to evaluate the impact of AL with a larger N, control group, structured faculty/resident procedures, and assessment of gaining and applying attitudes and skills in addition to knowledge.

Projects done in interprofessional groups can foster faculty development with minimal resources beyond what is already available at the university or medical center. Each project can yield multiple "wins" in individual faculty growth while meeting the needs of academic medical centers. These projects can build collaborative skills and a sense of community among faculty, trainees, and staff. The combination of low costs, high yields, and improvements in team skills make these approaches appealing and sustainable in resource-constrained medical centers. The authors describe 4 sample projects and their teams, needed resources, and outcomes.

The effectiveness of telepsychiatry video for clinical care is well established, and clinician and psychiatry resident interest in it is growing—particularly in light of the COVID-19 impact. Still, few residency programs in the United States have core curricula, rotations/electives available, and competencies, and many faculty have no experience. A survey was sent via national organization listserves for residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience and interest, and views/concerns, using Likert-like and yes/no questions. Descriptive statistics and other analyses compared the groups to assess impact of clinical experience on interest and views/concerns. Respondents (N = 270) have limited clinical experience with telepsychiatry (46% none), with trainees having less than others, and yet, most were very interested or interested in it (68%). Trainees (N = 123) have concerns about being prepared for future practice. Clinical experience with video in the range of 6–20 h appears to dramatically increase interest and reduce concerns, though less time has a positive effect. Respondents have concerns about connectivity, medico-legal issues, and clinical effectiveness (e.g., diverse populations, psychosis, and emergencies) with telepsychiatry. More research is needed to assess current clinical and curricular experience, interest, and concerns. Additional curricular interventions during residency and fellowship training could build skills and confidence, if this is feasible, and the benefits outweigh the costs.

Telepsychiatry’s effectiveness is well established, and interest in it is growing, despite few residency/fellowship core curricula and rotations. A link to a cross-sectional survey was sent via national organization listservs for psychiatry residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience, and views/concerns about telepsychiatry. Descriptive statistics and other analyses compared groups to assess the impact of amount clinical experience and psychiatric specialty (general vs. child and adolescent psychiatry), on interest, and views/concerns about the practice of telepsychiatry. All respondents (N = 270; child psychiatry N = 89) have limited clinical experience with telepsychiatry (46% overall; 49% of non-child had none versus 40% child). Trainees (N = 123; child N = 43) expressed less interest than others. All respondents expressed worry about ability to do a physical exam, connectivity, medico-legal issues, and fit for diverse populations. Child respondents expressed less concern than others, but they reported more worry about loss of nonverbal cues. Clinical experience with telepsychiatry in the range of 6–20 h appears to build interest and allay concerns, though 1–5 h also may have a positive impact. More research is needed to assess clinical experience, interest, and concerns for adult and child psychiatry trainees and clinicians. Replicable, curricular interventions appear to be indicated.

Achieving elimination of lymphatic filariasis (LF) as a public health problem requires a minimum of five effective rounds of mass drug administration (MDA) and demonstrating low prevalence in subsequent assessments. The first assessments recommended by the World Health Organization (WHO) are sentinel and spot-check sites—referred to as pre-transmission assessment surveys (pre-TAS)—in each implementation unit after MDA. If pre-TAS shows that prevalence in each site has been lowered to less than 1% microfilaremia or less than 2% antigenemia, the implementation unit conducts a TAS to determine whether MDA can be stopped. Failure to pass pre-TAS means that further rounds of MDA are required. This study aims to understand factors influencing pre-TAS results using existing programmatic data from 554 implementation units, of which 74 (13%) failed, in 13 countries. Secondary data analysis was completed using existing data from Bangladesh, Benin, Burkina Faso, Cameroon, Ghana, Haiti, Indonesia, Mali, Nepal, Niger, Sierra Leone, Tanzania, and Uganda. Additional covariate data were obtained from spatial raster data sets. Bivariate analysis and multilinear regression were performed to establish potential relationships between variables and the pre-TAS result. Higher baseline prevalence and lower elevation were significant in the regression model. Variables statistically significantly associated with failure (p-value ≤0.05) in the bivariate analyses included baseline prevalence at or above 5% or 10%, use of Filariasis Test Strips (FTS), primary vector of Culex, treatment with diethylcarbamazine-albendazole, higher elevation, higher population density, higher enhanced vegetation index (EVI), higher annual rainfall, and 6 or more rounds of MDA. This paper reports for the first time factors associated with pre-TAS results from a multi-country analysis. This information can help countries more effectively forecast program activities, such as the potential need for more rounds of MDA, and prioritize resources to ensure adequate coverage of all persons in areas at highest risk of failing pre-TAS., Author summary Achieving elimination of lymphatic filariasis (LF) as a public health problem requires a minimum of five rounds of mass drug administration (MDA) and being able to demonstrate low prevalence in several subsequent assessments. LF elimination programs implement sentinel and spot-check site assessments, called pre-TAS, to determine whether districts are eligible to implement more rigorous population-based surveys to determine whether MDA can be stopped or if further rounds are required. Reasons for failing pre-TAS are not well understood and have not previously been examined with data compiled from multiple countries. For this analysis, we analyzed data from routine USAID and WHO reports from Bangladesh, Benin, Burkina Faso, Cameroon, Ghana, Haiti, Indonesia, Mali, Nepal, Niger, Sierra Leone, Tanzania, and Uganda. In a model that included multiple variables, high baseline prevalence and lower elevation were significant. In models comparing only one variable to the outcome, the following were statistically significantly associated with failure: higher baseline prevalence at or above 5% or 10%, use of the FTS, primary vector of Culex, treatment with diethylcarbamazine-albendazole, lower elevation, higher population density, higher Enhanced Vegetation Index, higher annual rainfall, and six or more rounds of mass drug administration. These results can help national programs plan MDA more effectively, e.g., by focusing resources on areas with higher baseline prevalence and/or lower elevation.

Patient-centered care features quality and timely care in a variety of settings. Technology facilitates care and its use is common in the Digital Native (Z), Millenial (Y), and X Generations, particularly for adolescents and young adults. Social media/networking options like TwitterR and FacebookR are popular, as are text, e-mail, and mobile health apps. This paper proposes social media competencies and teaching methods based on the fields of healthcare, service delivery, education/androgogy, and evaluation. A brief review of the literature based on PubMed/Medline, Cochrane, Embase, and PsycINFO was performed using primary terms of social media, networking, technology, competency(ies), and other terminology. The social media/networking competencies are framed in contemporary competency-based frameworks. Teaching methods are aligned with competency outcomes, learning context, and program evaluation options. Case examples demonstrate ways to train residents/fellows/other mental health trainees in curricular settings. Novice/advanced beginner and competent/proficient competencies for social media/networking fit within a larger e-behavioral health curriculum, along with telepsychiatric competencies. Teaching methods for social media/networking competencies require additional planning, use of cases, and other in-time clinical activities for learners and teachers. Institutions must plan for clinical and educational elements, in order to support training, shift attitudes, and promote faculty and staff development. These competencies, their implementation, and impact need more research and institutions need an integrated approach to social media/networking, telepsychiatric, and other technology developments for this new era of care.

BackgroundDelivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors-the NTD front-line workers-to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers.Methodology/principal findingsWe reviewed data collected by USAID-supported NTD projects from national NTD programs from fiscal years (FY) 2012-2017 to assess availability of sex-disaggregated data on the workforce. What we found was sex-disaggregated data on 2,984,908 trainees trained with financial support from the project. We then analyzed the percentage of males and females trained by job category, country, and fiscal year. During FY12, 59% of these data were disaggregated by sex, which increased to nearly 100% by FY15 and was sustained through FY17. In FY17, 43% of trainees were female, with just four countries reporting more females than males trained as drug distributors and three countries reporting more females than males trained as trainers/supervisors. Except for two countries, there were no clear trends over time in changes to the percent of females trained.Conclusions/significanceThere has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.

This article identifies and describes key considerations toward the development of a clinical guideline intended to optimize telemental healthcare (TMH) of children and adolescents.The literature was searched with key terms and title words. Of 2824 articles that met primary or secondary key word search criteria, 326 met both criteria, and 118 thematically related directly to child and adolescent TMH. Only 44 studies met levels of evidence I-III and expert recommendation criteria used in clinical guidelines; review of their references found 8 additional studies (52 total). Data from adult, child, and adolescent in-person psychiatric care and adult TMH were applied to provide context in developing the key considerations.TMH guidelines for adults are well delineated, and TMH guidelines for children and adolescents are likely to closely overlap in terms of general clinical, technical, and administrative issues. However, for a child and adolescent focus, modifications of existing general guidelines appear necessary; for example, based on developmental status, family involvement, and patient-site modifications for space and sound. Additional clinical issues include specify who, exactly, is the "patient" (i.e., the patient, family, and /or other stakeholders), modalities of care (i.e., age-related psychotherapies such as play therapy or behavior management), and psychopharmacology.Specific clinical, administrative, and technical issues are key considerations - based on the nuances of established child and adolescent mental healthcare - and must be considered in developing a clinical guideline for TMH of these patients. Developing such guidance should proceed from a careful review of the growing evidence base, and through expert consensus processes.

Our current healthcare system in the United States is characterized by problems with access to timely and evidence-based care, particularly for mental disorders. e-Mental Health (eMH) improves access to care regardless of the point-of-service or barriers involved. Its effectiveness across age, population, and disorders is as good as in-person care, though adjustments for some populations in the approach are necessary. Early intervention is an example of “Cadillac” care or a best evidence-based approach that is easier to distribute via telemedicine. Cadillac care delivered via eMH has the potential to bring evidence-based early-intervention modalities to very young children and their families. However, early access to care is also critical for all populations, particularly those with cultural or medical disadvantages. It appears that eMH may be preferable or better than in-person care in some instances.

Objective: This chapter discusses the prioritization of outcomes and evaluation in the provision of synchronous telemedicine (i.e., videoconferencing, STM) services. Methods: This organizational approach may be a shift from seeing what happens with planned services to planning the outcomes and then designing the services—in advance. Results: Basic and advanced areas of evaluation (e.g., satisfaction, technology, cost, clinical and other outcomes) are suggested and involve the many participants in STM in a systematic framework. It also offers suggestions on how to do a needs assessment and how to adjust priorities based on specific needs and available resources in a program. Examples of project improvement apply ideas from theory to clinical and other associated outcomes. References and resources of information are provided for further review. Conclusion: The readers acquire knowledge, skill, and a framework to improve existing programs and help their many participants.

While the patient-centered healthcare movement, like traditional medicine movements, aims to deliver quality, affordable, and timely care in a variety of settings, the consumer movement on new technologies is passing it by with emerging technologies and new ways of communicating with others (text, e-mail, Twitter, Facebook). This chapter builds on what we know about e-Mental Health (eMH), technology and communication progress over the past 50 years in maintaining the tenets of “good” quality care, adjusting slightly to telemedicine models, and considering more significant adjustments for use of social media. The areas of challenges include privacy and confidentiality, health and personal practice, having “good” interpersonal/clinical boundaries, awareness of what information is out there about you, and discussing clear expectations about online communication between doctors and patients as part of the informed consent process. Guidelines, strategies, and tips for the clinician are offered.

“Integrated” behavioral health care most often refers to coordinated primary care and mental health care delivery at a co-located clinical site or psychiatric consultation service to a primary care clinical site. Women’s perinatal medical and mental health is an ideal target for integrated, patient-centered, and family-centered care. A three pronged approach is proposed to: 1) identify solutions for current barriers to mental health care delivery for pre- and postpartum women, 2) understand the relevance, steps toward and other thematic “how to” aspects of improving access to perinatal mental health services for the ongoing health of both mother and child, and 3) learn specifics of addressing maternal mental health, infant dyadic therapy, and enhanced parenting support. It borrows from the areas of stepped care, interdisciplinary teamwork, specific matching of treatments to disorders and stages of illness, and a range of individual, dyad, family and group treatments. These treatments are accessible, reduce stigmatization, and appropriate for dissemination using technology.

This chapter discusses the prioritization of desired outcomes and ongoing program evaluation in the provision of clinical videoconferencing (CV) services. It provides an overall organizing framework to consider program evaluation from the very early stages of planning. Emphasis is placed on crafting evaluation fitted to specific needs and available resources.

OBJECTIVE The authors demonstrate the value of reflective team supervision as part of the informal curriculum in an emergency psychiatry setting after a potentially traumatizing adverse event. METHOD The article gives a case presentation of a violent adolescent who eloped from his hospital Emergency Department and provides a description of team supervision sessions that facilitated informal learning for residents and medical students after this event. RESULTS Reflective team supervision sessions after this event resulted both in improved resident well-being and learning opportunities, as well as hospital quality improvement designed to prevent future elopements. CONCLUSIONS Reflective team supervision can be an essential component of trainee education to enhance residents' well-being and to promote both systems-based practice and practice-based learning. This can be an excellent forum to explore themes of humility, self-reflection, and professional growth. Language: en