Search

Psychiatric boarding in pediatric emergency departments is a predictable outcome of escalating psychiatric acuity and inadequate mental health services in hospital systems and the community at large. Guidelines are offered to support initiating treatments in nonpsychiatric hospital settings to reduce pediatric boarding. Treatments call for interdisciplinary approaches, care coordination, and addressing systemic disparities in access and quality of care. Telemental health interventions offer a promising means of reducing inequalities in access. Creating a crisis continuum of care will help minimize strict reliance on inpatient settings, which are increasingly challenging to access and only sometimes fully address the crises, even when used., Competing Interests: Disclosure The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work completed in this publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The US child mental health care system requires a revival and reimagination. We need to shift toward healing-centered models of care and prioritize access to high-quality mental health care through policy changes and resource allocation. Funding community-based programs that provide culturally responsive, antiracist, and equitable (CARE) systems is essential. Policies must be implemented to reduce barriers to accessing mental health services for underresourced communities. By prioritizing (CARE) over control, we can build a just workforce that is equipped to address the needs of a growing diverse population and ensure that all children and families can heal and thrive., Competing Interests: Disclosure The authors have no disclosures nor conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Pediatric mental health needs are currently on the rise across all levels of care. The COVID-19 pandemic accentuated concerns within our mental health system, not only for those requiring care, but also for care providers. One particular area of concern is access to care for those that require acute care or crisis stabilization (eg, emergency department visits or stays on crisis stabilization units). The Attachment, Regulation, and Competency (ARC) approach, a flexible trauma-informed treatment framework, provides equitable and effective treatments for youth as well as systems to support health care professionals caring for these youth. Trauma-informed care, particularly that which incorporates restorative practices, increases equity for racially and ethnically minoritized youth and informs the creation of upstream, midstream, and downstream policy interventions., Competing Interests: Disclosure There are no conflicts of interest to report and no funding related to this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Amidst a national youth mental health crisis, comprehensive school mental health systems offer an opportunity to promote positive mental health for all students. To advance health equity, schools benefit from a culturally responsive, antiracist, and equitable (CARE) framework to address the youth mental health crisis. This article describes how to integrate CARE practices within a multi-tiered system of support for mental health in schools. The strategies align with a trauma-informed approach and aim to enhance the capacity of comprehensive school mental health systems to promote positive mental health and well-being for all students., Competing Interests: Disclosure There are no conflicts of interest to report and no funding related to this article., (Published by Elsevier Inc.)

Introduction: Understanding the legacy of slavery in the United States is crucial for engaging in anti-racism that challenges racial health inequities' root causes. However, few medical educational curricula exist to guide this process. We created a workshop illustrating key historical themes pertaining to this legacy and grounded in critical race theory., Methods: During a preclinical psychiatry block, a second-year medical school class, divided into three groups of 50-60, attended the workshop, which comprised a 90-minute lecture, 30-minute break, and 60-minute small-group debriefing. Afterwards, participants completed an evaluation assessing self-reported knowledge, attitudes and beliefs, and satisfaction with the workshop., Results: One hundred eighty students watched the lecture, 15 attended small-group debriefings, and 132 completed the survey. Seventy-six percent (100) reported receiving no, very little, or some prior exposure to the legacy of slavery in American medicine and psychiatry. Over 80% agreed or strongly agreed that the workshop made them more aware of this legacy and that the artwork, photographs, storytelling, and media (videos) facilitated learning. Qualitative feedback highlighted how the workshop improved students' knowledge about the legacy of slavery's presence in medicine and psychiatry. However, students criticized the lecture's scripted approach and requested more discussion, dialogue, interaction, and connection of this history to anti-racist action they could engage in now., Discussion: Though this workshop improved awareness of the legacy of slavery, students criticized its structure and approach. When teaching this legacy, medical schools should consider expanding content, ensuring opportunities for discussion in safe spaces, and connecting it to immediate anti-racist action., (© 2023 Legha et al.)

This article illuminates the color of child protection by exposing the risks of racist and white supremacist harm intrinsic to the child welfare, public education, and juvenile injustice systems, specifically when they intersect with the child mental health system. Relying on bold and radical frameworks, such as abolition, critical race theory, and decolonization, it positions child mental health providers to confront the color of child protection while protecting minoritized children against these systems of harm. These frameworks inspire a daily antiracist practice whereby child mental health providers challenge racist inequities and the historical arcs driving them; protect minoritized children and families against the systems of care designed to harm them; and work toward the longer-term goal of abolishing these systems altogether. In a white supremacist society, child mental health providers have no choice but to engage in such antiracist practices in order to uphold their fundamental oath to first do no harm. The failure to do so amounts to negligence and malpractice., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This paper unpacks the legacy of racism and white supremacy in American child psychiatry, connecting them to current racist inequities, to reimagine an antiracist future for the profession, and to serve all children's mental health body and soul. History reveals how child psychiatry has neglected and even perpetuated the intergenerational trauma suffered by minoritized children and families. By refusing to confront racial injustice, it has centered on white children's protection and deleted their role in white supremacist violence. An antiracist future for the profession demands a profound historical reckoning and comprehensive reimagining, a process that this paper begins to unfold., Competing Interests: Disclosure The authors have no conflicts of interest to disclose. They collectively contributed hundreds of hours and centuries of lived experience. In the process, they endured retraumatization while confronting white supremacist violence and risking censure from their employers and institutions for their unapologetic, transparent approach. The emotional, intellectual, and physical toll of this labor on their bodies cannot be quantified. The only remuneration they received for their free labor was support from one another. While invaluable, this is also unacceptable. The motivation for their unpaid contribution is that it serves as an impetus and mandate to fund long overdue and desperately needed anti-racism initiatives in American child psychiatry., (Copyright © 2021 Elsevier Inc. All rights reserved.)