AACAP

A Publication of the News n May/June 2016 n Volume 47, Issue 3

Photo Credit: MAY IS MENTAL HEALTH Marc Sandrolini, MD AWARENESS MONTH Inside... President’s Message: Working on Workforce...... 113 Mentorship Matters: Klingenstein Third Generation Foundation Wins Again!...... 117 Child and Adolescent Psychiatry: Can We Provide Comprehensive Care in a Changing Health Care Environment?....129 AACAP’S 63rd Annual Meeting New York Preview...... 134 100% Club Photos...... 140

TABLE of CONTENTS

COLUMNS Jean Dunham, MD, Section Editor • [email protected] President’s Message: Working on Workforce • Gregory K. Fritz, MD ...... 113 Becoming a Statewide Collaborative Care PAL (Partnership Access Line) • Robert J. Hilt, MD ...... 114 Clinical Vignettes: Hanging in There • Cody Roi, DO, MPH...... 115

COMMITTEES Ellen Heyneman, MD, Section Editor • [email protected] Residents and Medical Students: Mentorship Matters: Klingenstein Third Generation Foundation Wins Again • Corey Horien, BA, and Bernie Mulvey, BS...... 117 Telepsychiatry Committee: Telepsychiatry Practice: Technological Consideration • Nicole Gloff, MD, and the Telepsychiatry Committee...... 120 New Mexico Council of Child and Adolescent Psychiatry: New Mexico Truth: Child Advocacy Campaign Sheds Light on Our National Child Poverty Crisis • Ramnarine Boodoo, MD, Alison Duncan, MD, Dyani Loo, MD, and Shawn S. Sidhu, MD...... 122 Update on Advocacy Committee 2016: AACAP Has a New Advocacy Committee Co-chaired by Debra E. Koss, MD, and Karen Pierce, MD • Debra Koss, MD, and Karen Pierce, MD...... 123

NEWS Garrett M. Sparks, MD, Section Editor • [email protected] New Updates...... 124

FEATURES Alvin Rosenfield, MD, Section Editor • [email protected] Poetry: Madeline • John Pruett, MD, and Commitment • Daisy Bassen, MD ...... 127

OPINIONS Christopher Varley, MD, Section Editor • [email protected] Letter to the Editor • Kim J. Masters, MD...... 128 Child and Adolescent Psychiatry: Can We Provide Comprehensive Care in a Changing Health Care Environment? • Henry Gault, MD, and Jennifer Yen, MD...... 129 Motherhood, Medicine and Mentoring • Desiree Shapiro, MD...... 131

MEETINGS Jon (Jack) McClellan, MD, Section Editor • [email protected] AACAP’S 63rd Annual Meeting New York Preview ...... 134 Why I ♥ NY!...... 137 New Research Call for Papers...... 137 FOR YOUR INFORMATION 2016 AACAP Election Now Open!...... 116 AACAP Distinguished Fellowship It’s Time That You’re Recognized for Your Efforts...... 128 Membership Corner...... 139 In Memoriam ...... 139 100% Club Photos ...... 140 Welcome New AACAP Members...... 142 Thank You for Supporting AACAP!...... 143 Transgender Youth in Juvenile Justice and Other Correctional Systems ...... 144 Policy Statements ...... 145 Classifieds...... 147

Cover Photo: The picture titled “Mexico” is from 2009, taken in the city of León, in central Mexico. My wife and I were visiting friends of her family, and we found ourselves in a house bustling with three generations of extended family. The three girls are cousins (several other children were playing around us). The beaming woman in the background is the mother of the girl on the left. The stern-looking man in the corner is their grandfather, who later confided to my wife that his children and grandchildren are very precious to him. ~Marc Sandrolini, MD MISSION STATEMENT MISSION OF AACAP NEWS The Mission of the American The mission of AACAP News includes: 1 Communication among AACAP members, components, and leadership. Academy of Child and Adolescent 2 Education regarding child and adolescent psychiatry. Psychiatry is to promote the 3 Recording the history of AACAP. 4 Artistic and creative expression of AACAP members. healthy development of children, 5 Provide information regarding upcoming AACAP events. adolescents, and families through 6 Provide a recruitment tool. advocacy, education, and research, EDITOR ...... Uma Rao, MD MANAGING EDITOR ...... Rob Grant and to meet the professional needs PRODUCTION EDITOR ...... Patricia J. Jutz, MA of child and adolescent psychiatrists COLUMNS EDITOR ...... Neera Ghaziuddin, MD COMPONENTS EDITOR ...... Ellen Heyneman, MD throughout their careers. NEWS EDITOR ...... Garrett M. Sparks, MD OPINION EDITOR ...... Harmony Abejuela, MD – Approved by AACAP Membership FEATURE EDITOR ...... Alvin Rosenfeld, MD December 2014 ANNUAL MEETING EDITOR ...... Jon (Jack) McClellan, MD PSYCHOPHARMACOLOGY EDITOR ...... Gabrielle A. Carlson, MD RESIDENT EDITOR: MEDIA PAGE ...... Erik Loraas, MD FUNCTION AND ROLES OF THE AMERICAN ACADEMY OF CHILD AACAP EXECUTIVE COMMITTEE COUNCIL President AND ADOLESCENT PSYCHIATRY Gregory K. Fritz, MD, Gabrielle A. Carlson, MD Karen D. Wagner, MD, PhD, President-elect Cathryn Galanter, MD The American Academy of Child and Shashank V. Joshi, MD Tami D. Benton, MD, Secretary Adolescent Psychiatry’s role is to lead its Debra E. Koss, MD membership through collective action, Yiu Kee Warren Ng, MD, Treasurer Douglas A. Kramer, MD peer support, continuing education, and Mark S. Borer, MD, Chair, Kaye L. McGinty, MD mobilization of resources. The Academy Assembly of Regional Organizations Melvin D. Oatis, MD of Child and Adolescent Psychiatry ■■ Establishes and supports the highest Kayla Pope, MD ethical and professional standards of Marian A. Swope, MD clinical practice. Jose Vito, MD ■■ Advocates for the mental health and public health needs of children, JERRY M. WIENER RESIDENT MEMBER Aaron J. Roberto, MD adolescents, and families. JOHN E. SCHOWALTER RESIDENT MEMBER Jennifer Creedon, MD ■■ Promotes research, scholarship, training, ROBERT L. STUBBLEFIELD RESIDENT FELLOW George “Bud” Vana IV, MD and continued expansion of the scientific base of our profession. EXECUTIVE DIRECTOR Heidi Büttner Fordi, CAE JOURNAL EDITOR Andrés Martin, MD, MPH ■■ Liases with other physicians and health care providers and collaborates with PROGRAM COMMITTEE CHAIR Boris Birmaher, MD others who share common goals. COLUMN COORDINATORS Ayesha Mian, MD, [email protected] International Relations Timothy Dugan, MD, [email protected] Clinical Vignettes Sala S.N. Webb, MD, [email protected] Diversity and Culture Arden Dingle, MD, [email protected] Ethics Rachel Ritvo, MD, [email protected] Psychotherapy Charles Joy, MD, [email protected] Poetry Coordinator Kim Masters, MD, [email protected] Acute Care Psychiatry Mark Chenven, MD, [email protected] Systems of Care

AACAP News is an official membership publication of the American 3615 Wisconsin Avenue, N.W. Academy of Child and Adolescent Psychiatry, published six times annually. Washington, D.C. 20016-3007 This publication is protected by copyright and can be reproduced with the permission of the American Academy of Child and Adolescent Psychiatry. Publication phone 202.966.7300 • fax 202.966.2891 of articles and advertising does not in any way constitute endorsement or approval by the American Academy of Child and Adolescent Psychiatry. © 2016 The American Academy of Child and Adolescent Psychiatry, all rights reserved PRESIDENT’S MESSAGE

PRESIDENT’S MESSAGE Working on Workforce

■■ Gregory K. Fritz, MD

t the recent AACAP Legislative Conference in Washington, D.C., A(April 14 and 15, 2016), 250 AACAP members, patients, and families fanned out on Capitol Hill to lobby for children’s mental health. Each year this event gets bigger and better, but you can guarantee that one persistent topic, level. At the Legislative Conference, this move, retire, etc. I would like to provide sure to be high on our priority list, is new resource proved to be extremely special thanks to AACAP’s Research and the nationwide shortage of child and helpful in engaging and educating Training Education Department, espe- adolescent psychiatrists. Although the legislators and their staffers about the cially Mona Noroozi, Lisell Perez-Rogers, reduction in stigma and wider recogni- workforce shortage issues facing child and Carmen Head for their leadership, tion of the effectiveness of psychiatric and adolescent psychiatry. management, and coordination of this treatment have changed the conversa- project, as well as Wun Jung Kim, MD, tion some, our numbers remain far too The new maps provide a much clearer, for serving as AACAP’s workforce expert small to approach meeting the need for more defined view of the child and ado- and consultant. My deep appreciation child and adolescent psychiatry ser- lescent psychiatry workforce shortage also goes to AACAP’s Government vices. The length of training required to than did previous editions. Journalists, Affairs Department—Michael Linskey, become a child and adolescent psychia- legislators, and families had provided Ronald Szabat, Zachary Kahan, and trist, the increasing debt burden that feedback to improve the comprehensi- Emily Rohlffs—and to AACAP’s IT most medical students graduate with, bility of the data; asking, for example, Department, especially Don Kenneally and the small number of “stretched-to- how we defined degrees of the shortage and Peter Plourd. Creating these maps their-limit” academic child and adoles- and what the source for such definitions was a team effort by a very dedicated cent psychiatrists appear to conspire, were. Highlighted changes include: and talented group of AACAP staffers. along with other variables, to keep our ■■ User-friendly, interactive maps of the numbers low. What we as workforce It is my hope that these maps will be entire nation by county advocates have needed is a tool that used in future years to evaluate, educate, instantly dramatizes the shortage of child ■■ Demarcated areas of “no child psy- and advocate on the need for greater and adolescent psychiatrists on a very chiatrists,” “extreme shortage” and pediatric mental health services nation- local level; a tool that can be used to “serious shortage” wide and the need for integrated care. tailor the tale of our national shortage to I strongly encourage AACAP members ■■ References used for the shortage the individual interests of our targeted to go the AACAP website to view and calculations audience. The participants at this year’s download your own state map to share Legislative Conference were thrilled to ■■ An easy-to-read, downloadable with local policy leaders and col- have just such a tool at their disposal state snapshot leagues—or even for personal use as and the results were gratifying. you consider future career moves. At Some of these features are illustrated in the very least, have some fun exploring I am referring to the recently released the above graphic. these interactive maps to see how your 2016 AACAP Workforce Shortage Maps. own practice area stacks up. m While AACAP has had such maps for a Remarkably, these maps were produced long time, the new and much improved entirely “in house” at AACAP using version specifically shows the average publicly available statistics from the number of practicing child and adoles- American Medical Association, which— cent psychiatrists per 100,000 children like the maps themselves—are constantly aged 0-17 years at the state and county updated as physicians start practice, MAY/JUNE 2016 113 Becoming a Statewide Collaborative Care PAL (Partnership Access Line)

metaphorically sitting side-by-side with three years of combined PAL/Second the prescriber, focusing our attention on Opinion consult services Washington’s helping them with the care of their most pre-existing rapid increase in child anti- challenging cases rather than just playing psychotic use reversed course, and then the role of authorizer. This might seem decreased by 17%. like a subtle distinction, but it makes a huge difference in the provider reported Collaborative care systems need to be value of the program. For instance, last explicitly tailored to local needs. In year’s mandatory second opinion review working with Wyoming Medicaid we feedback from prescribers rated their learned that children in their foster care reviewers as a mean of 6.0 on a seven ■■ Robert J. Hilt, MD system had particular challenges with point scale regarding the statement, “The getting timely access to child psychiat- consultant offered appropriate and help- ric assessments, and this lack of access hild psychiatrists are a rare ful treatment suggestions for my patient.” negatively impacted overall treatment commodity, such that if we planning. So we created a path for rapid Call only worked in traditional The second program that we created access and in depth system collabora- models of care then most community was for all primary care providers to be tion televideo patient consultations for mental health care needs would go able to receive elective, on-demand, their foster care system. An analysis of unaddressed. AACAP describes this telephone-based consultations with the whole package of Wyoming col- eloquently within the advocacy section a child and adolescent psychiatrist. laborative care (PAL, medication second of aacap.org, for instance pointing out This Partnership Access Line (PAL) is opinion, and foster care consults) found that about 80 percent of children with a staffed in such a way that primary care there were desirable outcomes beyond mental illness do not currently receive providers can expect to nearly always positive provider feedback. There were treatment in the existing care system. get directly connected to a child and 42% fewer children under five years of adolescent psychiatrist when they call. age receiving psychotropic medications, A collaborative care goal would be to They also receive access to a social 52% fewer children receiving >150% of leverage child and adolescent psychia- worker helping with care coordination, the adult FDA maximum dose psy- trist’s expertise to support other care access to televideo patient consultations, chotropics, and, by reducing clinically providers and positively impact the locally hosted continuing medical edu- inappropriate residential care place- lives of whole populations of children. cation education events, and a treatment ments, the collaborative care system Specifically how this collaboration guide designed for primary care men- saved money with a 1.8 to 1 return on should best occur is still being inves- tal health services. Provider feedback investment. (Hilt et al. 2015) tigated. “Collaborative care” might for this service has consistently been currently describe referral support, overwhelmingly positive. This collab- Based on all of these experiences, I screening programs, telephone consult orative care support service was made encourage others to consider working access programs, face-to-face patient available by both Washington State and with one of the many types of develop- consultations, care coordination, co- Wyoming Medicaid for all of the primary ing collaborative care systems in their location, educational support, care care providers in those states, and was own areas, as it can be highly rewarding reviews, electronic medical record created because primary care provid- work. m integration, and fully integrated mental/ ers kept asking for a support like this. behavioral health services. More details of the PAL elective primary care consultation service have been References In Washington State, our Medicaid divi- described elsewhere (Hilt et al. 2009, Hilt R, McDonell MG, Rockhill C, Golombek sion, almost a decade ago, created two 2013, and 2015), and at palforkids.org A, Thompson J (2009). The partnership access different consult service programs that and ­wyomingpal.org. line: establishing an empirically based child are now operated together as a single psychiatry consultation program for Washing- collaborative-care support service. The Early on in the PAL program develop- ton state. Report on Emotional and Behavioral first of these programs was doctor to ment process, we learned that we Disorders in Youth 9(1):9-12 doctor mandatory second opinion medi- needed to functionally combine the cation reviews for state defined “outlier” elective PAL consultation and mandatory Hilt RJ, Romaire MA, McDonnell MG, Sears prescribing, such as doses over twice the secondary opinion review consultation JM, Krupski A, Thompson JN, et al. (2013). adult Federal Drug Administration (FDA) programs into a single service. Doing The partnership access line: evaluating a child max or more than five concurrent psy- this provided for greater staffing flexibil- psychiatry consult program in Washington chotropic medications. These mandatory ity (difficult to always have a child and state. JAMA Pediatrics 167(2):162-8 reviews were initially unpopular with adolescent psychiatrist “available”) and Hilt RJ, Barclay RP, Bush J, Stout B, Ander- the prescribing community, and started helped us to ensure fidelity of message son N, Wignall JR (2015). A statewide child out focused just on authorization versus regardless of the door of entry for collab- telepsychiatry consult system yields desired denial recommendations rather than on oration assistance. The consultants work health system changes and savings. Telemedi- providing a forum for care collabora- as a team, discuss challenging scenarios cine and e-Health Journal 21(7):533-7 tion. Over time however we learned to reach a best consensus approach, to do a second opinion review while and formally audit the consultations provide for consistency of best practice Dr. Hilt can be reached at messaging. System outcomes have been [email protected]. 114 AACAP NEWS notable. For instance, in just the first COLUMNS

CLINICAL VIGNETTES Hanging in There

Teddy was keeping up his end of the therapy – he was playing – and encour- “It was a significant challenge aged me to allow the play to unfold. for me to allow the play to Teddy was consistently successful at bringing enthusiasm and directing play. continue to be directed by I, on the other hand, found myself con- Teddy. It required my full stantly being challenged by an evolving set of tensions. reserve of patience to avoid the impulse to revert to asking him At first, the play was aggressive and ■ direct questions about his life.” ■ Cody Roi, DO, MPH disorganized. We would kick balls back and forth, throw foam blocks, and jump s a beginning child and adoles- around. I found myself getting distracted final victim in the Blare Witch Project, cent fellow there are no short- by calculating how much it would cost standing there, bored and lifeless. Often, Aage of challenging and anxiety to replace the large glass window in I used those moments in the corner to provoking situations. My first psychody- my office every time a block or toy car stretch my toes or rest my head on the namic play therapy case has proven to would bounce off of it. For a short time, cold cement wall. In supervision, I was be no exception. my anxiety surrounding the aggression encouraged to consider that hide-and- subsided when the theme changed to seek is often a way to master separation Teddy, a 6-year-old male, was handed cooperatively chasing bad guys, only and individuation conflicts. I was also off to me by a graduating fellow. He to return when he began shooting me advised that I was making a common was being treated for attention-deficit/ repeatedly with the toy guns, ramming beginner’s error of expecting outcomes hyperactivity disorder (ADHD), opposi- police cars into my fingers, and sawing too quickly. Regardless of the advice, tional defiant disorder, and parent-child off my legs with a toy saw. I wondered I desperately hoped that Teddy would relational problems. He had a history if I was going to get hurt. I wondered master the conflict quickly. Personally, I of witnessing frequent physical alterca- if I was modeling bad behavior when was astounded at how much less toler- tions between his parents. When the I pretended blood was spraying out of able to me the boredom was than my patient presented to me, he had already my various bullet and saw wounds. My anxiety of the aggression. Then, one day, failed an extended course of trauma- supervisor challenged me to consider if seemingly out of nowhere, he asked to based cognitive behavioral therapy, the aggression was within the play or if it play with the toys in the sand box. He reportedly because “he wouldn’t say had traveled beyond what was safe, not- casually said that he was “bored” with anything,” and a course of parent-child ing that my fears about getting hurt had hide-and-seek. interactional therapy, because he and not actually happened. Suddenly, it all his mother “wouldn’t stop yelling at stopped—all the aggression and violent In the sandbox, we had battles with each other when they played Connect themes—for no reason that was appar- dinosaurs and pirates. His unit of armed Four.” His mother’s primary complaints ent to me. My supervisor suggested that soldiers guarded secret treasure against to me focused on oppositional behavior, Teddy had worked through the issue he my invading zoo animals. Playing with aggression, and sleep issues. was dealing with and was ready to move the toys in the sandbox was certainly on. So was I. more tolerable than being a victim of a Consistent with previous reports, Teddy handsaw or counting in the corner, but refused to answer any questions about Next, my anxiety turned to boredom. a new sensation arose in me—a nagging his history, symptoms, or feelings. It was For six weeks straight, Teddy wanted to sense that nothing was happening—the not that he was being overtly opposi- play hide-and-seek in my office. After sense that someone, somewhere, was tional; rather, it was as if my questions hiding behind the plant, the dry erase paying for me to provide skilled babysit- passively floated over him like clouds board, and finally, the cabinet, the only ting. I recognized this thought as one – like he did not hear the questions at space left was under my desk. This is that had been expressed to me by the all. “How was your week?” “What do where he continued to hide every time, previous fellow. It was a significant you do for fun?” “Tell me about your every session, week after week. I was challenge for me to allow the play to house?” None of my questions appeared ordered to stand in the corner count- continue to be directed by Teddy. It to be even subtlety acknowledged. ing to 10 then 20, then 120 while he required my full reserve of patience to However, Teddy was excellent at play, repositioned himself—just right. While avoid the impulse to revert to asking him and engaged easily in this form of com- banished to my corner, I found myself direct questions about his life. Questions munication, as I found out on our first trying to sneak peeks at my phone or I very much wanted answered: “Why meeting when he requested a soccer position myself to stare out the win- won’t you sleep in your bed?” “How’s match. My supervisor would remark that dow. I imagined that I looked like the continued on page 116

MAY/JUNE 2016 115 COLUMNS

Hanging in There continued from page 115 your mood?” “Has an adult ever hurt boys moved into our boy’s home. Then, interpretations of my supervisor, I had you?” A few times I did ask questions he began to allow girls. First a single trouble trusting the natural evolution like this. He instantly became guarded mom for all the boys, then more female of the process. At present, Teddy and I and sullenly returned to playing inde- roles were allowed into the play. Next, appear to both be pleased and engaged pendently. But Teddy was tolerant of my he began choosing to play with figures in the play. Reports from home are that intrusions. He always allowed me back that parallel the makeup of his family. he is improving his ability to toler- into the play, and kept up his end of the Most recently, he is choosing to play as ate stress, behavioral issues at school bargain each week by actively participat- his parents with me as a child – throwing have been reduced, and that his broad ing in his therapy. In supervision, I was tantrums. We are redirectly reenact- oppositional behavior has improved. His assured that the play was progressing. ing his home conflicts (as described to academic performance has significantly me by his mother) with the dolls. Each improved across multiple academic After many sessions playing in the week, the play picks up exactly in the domains. However, he still continues sandbox, Teddy, much to my surprise, place it left off the week before. The first to exhibit oppositional behavior toward began choosing to play specifically with thing he says when he comes in is, “I his mother, and I am interested to see the dollhouses and people figurines – wonder what is going to happen with the how the tension in this relationship will toys he had expressed explicit disinterest family today,” or “lets do the same things continue to manifest in the play. in just a few months before. At first, as last time.” He is effectively working he played in front of the houses with through conflicts and demonstrating a I am not sure what the next challenge trucks, army men, and animals, using confidence and mastery I had not wit- in our play will be, but if the pattern the people figurines as an audience to nessed in him before. He is consistently continues, it will likely be a challenge watch the play. Next, he started using empathetic and demonstrating a strong within me. I can, however, take some the people to work directly through theory of mind. comfort in trusting a few principles that issues that sounded familiar to those have proven their efficacy – supporting he had been having at home. To me, Over the six months I have been work- a child-directed space, trusting Teddy, this is where the play made a dramatic ing with Teddy, the play has evolved checking in with supervision, and simply shift into something that more closely from disorganized and aggressive with allowing the process of play to unfold resembled the direct themes I was used diffuse displacements, to organized organically. m to working with in my adult training. The and cooperative, with specific conflict play was becoming less abstract and resolution. Throughout, I have been less displaced. He investigated themes constantly wondering what the hell I am Dr. Roi is a child and adolescent psychia- of gender when we made a boy’s house doing and feeling anxious about a thera- try fellow at Louisiana State University and piled all the girl dolls far away. He peutic trajectory I had no experience in New Orleans, Louisiana. He may be was challenged with managing interper- with—child-directed play. Even with the reached at [email protected]. sonal relationships as more and more constant positive assurances and rational

2016 AACAP Election Now Open!

AACAP’s 2016 Election is open! This year’s election positions include two Councilors-at-Large and two Nominating Committee members. All votes must be received by 11:59:59 pm EST on May 31, 2016.

AACAP Members, sign in and check out the candidates online (www.aacap.org/bios.pdf).

116 AACAP NEWS COMMITTEES

RESIDENTS AND MEDICAL STUDENTS: MENTORSHIP MATTERS Klingenstein Third Generation Foundation Wins Again

regarding a health outreach program It is through the generosity, and the continuing support, of the Klingenstein Third they developed to help incarcerated Generation Foundation that AACAP can bring medical students and faculty from youth, Danielle Mohabir (University of medical schools across the United States together to foster student interest in, North Carolina) on structural barriers to and understanding of, the field of child and adolescent psychiatry. The number mental health in college students, and of medical schools involved in this mentorship program has grown over the Ronnye Rutledge (Yale) on the role of years to 15. The ongoing activities at these institutions culminate in the annual cultural spaces in constructing alterna- “Games,” which have been the highlight of this program since 2006. This year, tive health narratives. To conclude the we have the pleasure of looking at the “Games” through the eyes of both a morning, James Comer, MD, (Yale) member of the team from the host school and one from a school that accepted spoke about the need for inclusion and a the invitation to “compete.” It is a competition where everyone is a winner! sense of belonging for the mental health of children. But where are the “Games”?! John E. Schowalter, MD, (Yale School of Medicine), former president of AACAP, Lunch was next, with plenty of time A Summary of the 2016 give a moving lecture about how to have allowed for mingling among students Klingenstein Third Generation an impact in medicine. (Dr. Schowalter and faculty. Nevertheless, the allotted Foundation Games at the also turned heads with his flashy green- 70 minutes for food and conversa- tion seemed too little, as many lively Yale School of Medicine and red checkered trousers). This was followed by six outstanding medical discussions were still occurring as the ■■ Corey Horien, BA student presentations, with contribu- next activity began (a delightful prob- Yale School of Medicine tions from Emily Olfson (Washington lem to have for the conference planning University) on the non-medical use of committee). Once everyone was For the past ten years, individuals prescription pain relievers in adoles- reassembled, they were treated to 30 attending the annual Klingenstein cents, Nikhil Patel (Mayo Clinic) on research posters presented by students, Third Generation Foundation Games, cannabis and the developing brain, with topics ranging from differential an annual conference for medical Cordelia Y. Ross (Vermont) on autism methylation sites in genes implicated in students interested in child and adoles- and gender identity, Jeannine Rider and eating disorders, to work describing the cent psychiatry generously supported Matthew Santos (Brown University) continued on page 118 by the Klingenstein Third Generation Foundation, have come to expect a certain number of experiences. These include meaningful conversations with other students, inspiring presentations from child and adolescent psychiatrists concerning their personal journey through medicine, and, last but not least, “The Games” – a mix of spirited, often bizarre contests designed to foster a sense of camaraderie among attendees. Those who travelled to Yale on February 27, 2016, were able to enjoy conversa- tions, lectures, and research. The actual Games, however, were nowhere to be found. What gives? Was the most important part of the conference simply forgotten? Or was this an elaborate scheme devised by the Yale planning committee, intended to ensure The Games trophy remains permanently in New Haven?

The conference started early Saturday with 162 attendees from 15 medical Over 120 meetings attendees participated in the Feb. 27th Klingenstein National Medical Student Conference schools gathering in the Donald J. Cohen at Yale School of Medicine. Auditorium where they listened to

MAY/JUNE 2016 117 COMMITTEES

Klingenstein Third Generation Foundation Wins Again continued from page 117 use of mobile technologies as a means late 20s, spoke about his experiences of large scale mental health interventions with the healthcare system and what he to the probable DSM diagnoses of comic wished people knew about the disorder. book superheroes. His family members also discussed their own experiences and struggles as they The afternoon session began with engag- watched Paul develop, start a job, and ing presentations from three faculty become more independent. The session members, all of whom are leaders in served as a touching way to end the child and adolescent psychiatry. Hanna day’s classroom activities. Stevens, MD, (Iowa) shared how experi- ences from her time as a student have To cap the day, Anne Glowinski, MD, shaped her work today, studying the and her colleagues from Washington molecular and cellular aspects of brain University showed a brief video development as it relates to psychi- highlighting the child and adolescent atric disorders. Robert Althoff, MD, psychiatry department “Wash” and (Vermont) discussed his journey as a what conference-goers can look for- child psychiatrist, and, through descrip- ward to next year when Wash U hosts. tions of his own work, detailed the many Attendees then made the short trek to exciting challenges awaiting future child BAR, a New Haven favorite for food and adolescent psychiatrists. Margaret and drink. Over mashed potato bacon John E. Schowalter, MD, from Yale School of Stuber, MD, (University of California pizza and a beer, students and faculty Medicine, shared personal incites with medical Los Angeles) provided helpful tips about alike rehashed the day’s events, explored students work-life balance and how one can have the finer points of the research posters it all, though not necessarily at the same presented, and made plans to reconnect time. Linda Mayes, MD, chair of the Yale next year at the conference. Child Study Center, wrapped up the fac- changed? Will there be no more wacky ulty presentations by detailing her career So what about the “Games”? Well, it competitions? You’ll have to read Bernie path, highlighting the history of the Child was apparent to the conference planning Mulvey’s essay and be in St. Louis next Study Center, and describing the many committee from Yale that the day was year to find out… ways child and adolescent psychiatry going to be (wonderfully) packed, with involves a patient’s family. all the excellent student presentations, Corey wishes to thank the entire the scores of stimulating posters, and the Yale Klingenstein Third Generation As the conference drew to a close, many faculty members who graciously Foundation conference planning com- attendees had the phenomenal oppor- agreed to share their personal stories. mittee, Dr. Andres Martin and Bernie tunity to hear from a patient and his So to allow time for everything, this year Mulvey for helpful comments regarding family about what it is like to live with we cut the “Games” from The Games the manuscript, and the Klingenstein autism. In poignant detail, Paul, who has – as simple as that. Does this mean The Third Generation Foundation for making grown up with autism and is now in his Games as we know them are forever The Games possible.

Anne Glowinski, MD Washington University at St. Louis, Andres Martin, MD Andy Klingenstein, Patricia Klingenstein, and Sally Klingensten Martell, attending Yale School of Medicine, and Linda Mayes, MD Yale School of Medicine the Student Poster Session at the Klingenstein Conference attending the Klingentsen Conference Medical Student Poster Session

118 AACAP NEWS COMMITTEES

disorders in underserved and minor- ity populations. Like most clinical research, autism is studied largely in the context of Caucasian populations. Joshua’s work represents a step for- ward in understanding autism spectrum disorders as a global and ethnically- unbiased phenomenon.

First-year medical students Anna Arnaud, Mary Chavarria, and Erin Klein presented a poster on an exciting new program they have started in their short time at Wash U, in which students travel to nearby juvenile detention facilities to discuss mental health awareness and interpersonal support. The initiative and compassion shown by this group in start- ing up a service-oriented mental health Poster Presentations at the Klingenstein National Medical Student Conference program so early in their medical careers has been quite impressive to all of us. Bringing the Games Back research into disorders of all types. Wash U is thrilled about hosting the (Or, How I Learned to Stop The Klingenstein Third Generation Foundation has been a major hit with Games next year. Students and faculty Worrying and Love the students in this program, including two alike will gather to discuss basic sci- Conference) presenters who traveled to Yale. Emily ence research, clinical practice, and Olfson, a fourth-year medical student in social justice in child and adolescent ■■ Bernie Mulvey, BS the program—whom recently matched psychiatry—and we are confident that Washington University in to Yale for her residency in psychia- Wash U’s strengths in this area will give St. Louis School of Medicine try—gave a brief talk, “Non-Medical members throughout Klingenstein Third Use of Prescription Pain Relievers in Generation Foundation new ideas to Medical students from Washington Adolescents.” Her talk was quite timely, take back to their home institutions, and University (Wash U) in St. Louis made as the Federal Drug Administration will help to create new collaborations their second visit to the Klingenstein released stronger guidelines on the and friendships with in the child and Third Generation Foundation’s Games in prescription and use of opioid drugs adolescent psychiatry community. February 2016. This young Klingenstein just a few weeks later. A first-year Third Generation Foundation chapter graduate student in the program, Bernie As for Games that are actually played, has seen a huge amount of growth since Mulvey, presented a poster on sexu- there is no question that they will be its establishment last year; while sending ally dimorphic gene expression in the brought back in grand fashion in 2017. eight students to the Games—and win- locus coeruleus (LC), the norepinephrine Wash U’s Klingenstein Third Generation ning the coveted trophy—at Mayo Clinic center of the brain. His work with Joe Foundation chapter did not mind there in 2015, Wash U sent 15 students to the Dougherty, PhD, in Wash U’s psychia- not being Games at Yale—as we got Games at Yale this spring! Such rapid try department indicated that between to hold onto the trophy for another growth is a testament to the school’s 60-200 genes are expressed in a sex- year by default! While what games strong reputation in child and adolescent specific manner in the LC. Soon after will be played is confidential, I will psychiatry, as well as to the previously the Games, a mini-grant co-written by share this much: there will be 15-seater latent interest in the field among Wash U Bernie and Dr. Dougherty was accepted vans involved, and not for reasons medical students. The posters and brief for funding. of transportation. talks presented by Wash U students at this year’s Games are a microcosm of Joshua Page, first-year medical stu- Bernie would like to thank Yale’s the strengths in the school’s child and dent, presented a poster demonstrating Klingenstein Third Generation adolescent psychiatry department, and that quantitative measures of autistic Foundation program for hosting an provide a preview of the clinical and traits are predictive of the presence of unprecedented large and intellectu- research environments Wash U will be genetic risk factors for autism among ally stimulating round of Games; Anne sharing with over a dozen other insti- Hispanic populations. Joshua’s work Glowinski, MD, for getting Wash U tutions when they host the Games in represents two major areas of focus involved with the Klingenstein Third S p ring 2017. at Wash U—understanding the bio- Generation Foundation program; and logical underpinnings of psychiatric Corey Horien (Yale), and Andres Martin, Wash U boasts one of the largest disease, as well as advancing research MD (Yale), for their suggestions in writ- MD-PhD programs in the country, on—and identification of—psychiatric ing the presented article. m which drives both clinical and laboratory

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TELEPSYCHIATRY COMMITTEE Telepsychiatry Practice: Technological Considerations

signals using satellite or fiber optic Future technological innovations systems. Data are transmitted may overcome this limitation in over digital subscriber lines (DSL). the future. Despite these potential Typical DSL broadband capaci- limitations, consumer-grade plat- ties are often small (< 12 mbps); forms are considered acceptable however, this speed is guaranteed for clinical work and widely used. at all times as these systems use a ■■ Network Connection. Bandwidth is static IP address, which ensures a the rate at which data is transmitted stable image (Roth webpage). They over an online connection. Video provide excellent telepresence. ■ teleconferencing can require large ■ Nicole Gloff, MD, and the A limitation to standards-based Telepsychiatry Committee amounts of bandwidth to operate systems is that they are relatively smoothly, without breaks in audio immobile and require technical or video transmission (Chou et al., rograms using telemental health expertise/IT support to set-up 2015). The general guideline is for (TMH) to deliver mental health and maintain, thus making them a VTC platform to have the ability Pservices directly to children and impractical for use in the home to operate at a bandwidth of 384 families are developing rapidly. Many and in clinics with few supports Kbps or higher (Myers, Cain 2008; institutions are pushing for the use of (Chou et al. 2015). Additionally Yellowlees et al. 2010). Having communications technology in mental they are associated with a higher a seamless network connection health service provision for all ages. overall cost, which may be limit- allows the telepsychiatrist to observe Fortunately, there has been a decrease in ing in certain settings. subtleties in a child’s speech, facial the cost of video teleconferencing (VTC) ◗◗ Consumer-grade. Consumer- expression, and movements. It also systems over the past decade, which grade platforms allow for VTC allows the provider to respond fluidly allows for greater acceptability and over the Internet using software to the child and family during a ses- feasibility of such programs (Chou et al. that encrypts the transmission. sion. This is important for effective 2015). In this second article, the AACAP Subscriptions to these platforms expression of empathy and emo- Telepsychiatry Committee presents key are sold based on the number tional tone (Glueck 2013). technological considerations for a tele- of users/accounts and the soft- ■■ Video. Display resolution and screen psychiatry practice. ware can be readily loaded onto size can impact the telepsychiatrist’s personal computers, tablets, ability to adequately observe a child When implementing a TMH program, an and smartphones (Chou et al. during a TMH visit. High definition important step is to select the appropri- 2015; Roth webpage). This is also displays allow for transmission of a ate technology for the services being known as cloud-based comput- crisp image as long as the bandwidth provided. The chosen technology should ing. Accessing the software usually is great enough to support this. It be appropriate to the clinical setting and involves downloading an applica- is optimal to have a frame rate of the model of care. Quality of service, tion or utilizing a link to a website 30 frames per second. There is no reach, and accessibility need to be to join a session. Major advan- guideline as to the appropriate size balanced with the costs of purchas- tages to consumer-grade platforms of the display, so the clinician must ing equipment, training clinicians, and are that they are easily accessible, consider the patient population and necessary technical support (Chou adaptable, consumer friendly, and resolution to make this determination et al. 2015). available at a lower cost. They can (Chou et al. 2015). be installed wherever broadband ■■ Video Teleconferencing (VTC) is available. Limitations include a A camera with pan-tilt-zoom func- Software Applications/Platforms. highly variable connection speed, tionality is considered to be the gold There are two basic applications/ which can be affected by fac- standard in TMH (Chou et al. 2015; platforms that are available to use tors such as high local Internet Glueck 2013; Myers, Cain 2008; in telepsychiatry. These include traffic, inclement weather, and Yellowlees et al. 2010). However, this standards-based applications and network failures. This ultimately capability may not be possible with consumer-grade applications. impacts the quality of streaming consumer-grade applications (Gloff ◗◗ Standards-based. Standards-based audio and video (Roth webpage). 2015). Pan-tilt-zoom functionality platforms, sometimes referred to Additionally, these systems gener- allows for close examination of the as “legacy hardware,” allow for ally do not allow for the addition child and the ability to follow his or secure point-to-point transmission of external features such as a her movements throughout the exam of high bandwidth (> 1.5 mbps), remote stethoscope or camera that room. Zooming in allows for closer high-definition video and audio is operated by the provider site. examination of facial expression,

120 AACAP NEWS COMMITTEES

a VTC system for a TMH practice. Technological advances continue to occur and providers and institutions must stay current. It is important to choose VTC technology that is appro- priate to the clinical service, financially sustainable, and matches the available technical support at the patient site. Appropriate technology selection and implementation ensure the quality and security of TMH care for children and their families. m

References Chou T, Comer JS, Turvey C L, Karr A, Spargo G (2015). Technological considerations for the delivery of real-time child telemental healthcare. Journal of Child and Adolescent Psychopharmacology [online ahead of print October 22, 2015] affect, nonverbal cues, subtle move- particularly important to investigate Gloff NE, LeNoue SR, Novins DK, Myers K ments and dysmorphia. Zooming out prior to purchasing a consumer- (2015). Telemental health for children and allows for observation of the child’s based platform, as some do not meet adolescents. International Review of Psychia- play and gross motor skills while HIPAA standards. try 27(6):513-524 simultaneously talking to the care- ■■ Technical support. The level of giver (Gloff et al. 2015; Glueck 2013). Glueck D (2013). Establishing therapeutic rap- IT support required to install and port in telemental health. Telemental Health: ■■ Audio. Some clinicians consider maintain a VTC system within an Clinical, Technical, and Administrative Foun- having crisp seamless audio during a institution largely depends upon the dations for Evidence-Based Practice, Myers K, TMH visit to be even more important complexity of the system, resources Turey CL, eds. London: Elsevier than a strong video signal, thus it available at both the patient and Myers KM, Cain S (2008). Practice parameter is important to use an appropriate provider site, and the abilities and for telepsychiatry with children and adoles- microphone (with the correct place- availability of existing administrative cents. J Amn Acad Child Adolesc Psychiatry ment) during a TMH visit (Chou et al. and technical staff in troubleshoot- 47(12): 1468-1483 2015; Roth webpage) It is generally ing potential issues. Prompt IT Roth, DE. Mind and Body Works, Honoulu, HI. recommended that TMH visits utilize support may reduce the number www.mind-bodyworks.com/telehealth-.html audio at 7 kHz full duplex with of TMH sessions that fail to occur Yellowlees P, Shore J, Roberts L (2010). echo cancellation (eliminates room or are prematurely terminated due Practice guidelines for videoconferencing- return audio echo) and the ability to to equipment failures (Chou et al. based telemental health. Telemedicine mute and adjust volume (Yellowlees 2015). In addition to having adequate Journal and E-Health, 16(10): 1074-89 et al. 2010). IT support, it is also useful to have brief provider trainings in order to American Telemedicine Association: ■■ Privacy. Privacy is an important issue www.americantelemed.org familiarize clinicians with the VTC in TMH and decisions regarding the equipment and ways to quickly Health Resources and Services Administration selection of VTC equipment should troubleshoot issues. If technical (HRSA): www.hrsa.gov/healthit/telehealth/ be made with patient confidential- difficulties occur, it is important to glossary.html ity, privacy, and security in mind have a back-up plan in place, e.g., Telehealth Resource Center: (Chou et al. 2015). Institutions should telephone, in order to complete www.telehealthresourcecenter.org ensure that their VTC systems and a session if deemed appropriate data storage are in compliance with (Myers, Cain, 2008). Additionally, the Health Information Portability Dr. Gloff is assistant professor in the when negotiating with a cloud-based and Accountability Act (HIPAA) Division of Child and Adolescent vendor, it is important to ask about (Chou et al. 2015; Myers, Cain 2008; Psychiatry at the University of Maryland their typical response time and the Roth webpage; Yellowlees et al. School of Medicine. She may be reached services provided by their company 2010). Encryption alone does not at [email protected]. to assist with troubleshooting techni- ensure compatibility with the HIPAA. cal difficulties. This can vary widely Software vendors with platforms that between vendors. are HIPAA compliant have signed a Business Associate Agreement There are several considerations to be (BAA) attesting that they are in made regarding the purchase, instal- compliance with HIPAA. This is lation, and ongoing maintenance of

MAY/JUNE 2016 121 COMMITTEES

NEW MEXICO COUNCIL OF CHILD AND ADOLESCENT PSYCHIATRY New Mexico Truth: Child Advocacy Campaign Sheds Light on Our National Child Poverty Crisis

■■ Ramnarine Boodoo, MD, Alison Duncan, MD, Dyani Loo, MD, and Shawn S. Sidhu, MD

ew Mexico True (www. increased risk for chronic disease in Annie E. Casey Foundation (2014). newmwcico.org) is a highly adulthood (Schickendanz et al. 2015). Kids Count Data Center. Children in Nsuccessful $2 million campaign Food insecurity is associated with higher Poverty. Accessed W Mach 2, 2016. created by the state of New Mexico rates of depression, anxiety, aggressive datacenter.kidscount.org/data/ in an effort to generate tourism. The behavior, inattention, and hyperactivity Map/43-children-in-poverty-100- advertisements depict happy families in children, as well as depression and percent-poverty?loc=1&loct=2#2/any/ enjoying expansive sunlit skies and anxiety in parents (Cook et al. 2013). false/869/any/322/Orange/ snow topped mountain resorts. In 2015, New Mexico Voices for Children used a Social well-being in children is also Brooks-Gunn J, Duncan GJ (1997). virtually identical media platform entitled significantly impacted by poverty. Child The effects of poverty on children. The New Mexico Truth (www.mexicotruth. poverty is a strong predictor of all Future of Children 7(2):55-71 Princeton org) to highlight the very troubling plight of types of child abuse and maltreatment University: Brookings Institution children in the state. New Mexico has the (Lee and George 1999). Low socioeco- highest rate of child poverty in the country nomic status in youth is associated with Cook JT, Black M, Chilton M, Cutts D, (31%) and ranks 49th for child well-being. decreased school achievement, juvenile Ettinger de Cuba S, Heeren TC, et al Moreover, an astounding 79 percent of justice involvement, early substance (2013). Are food insecurity’s health children are not proficient in reading by abuse initiation, and lower future earn- impacts underestimated in the U.S. fourth grade and 77 percent of eighth ings (Nikulina et al. 2011, Fite et al. population? Marginal food security graders are not proficient in math, resulting 2009). The timing (early development) also predicts adverse health outcomes in low high school graduation rates. and duration of poverty can significantly in young U.S. children and mothers. exacerbate these effects. Advances in Nutrition 4(1):51-61 The child poverty mark of 31 percent is especially telling when compared to Child poverty has a profound and Fite PJ, Wynn P, Lochman JE, Wells other rural states such as Utah (13%), pervasive impact on our patients and (2009). The influence of neighborhood Wyoming, (13%), and Idaho (13%) their families (Brooks-Gunn and Duncan disadvantage and perceived disap- (Annie E. Casey Foundation 2014). 1997). Child and adolescent psychiatrists proval on early substance use initiation. However, this issue is not unique to need to be at the forefront of advocacy Addictive Behaviors 34(9):769-71 New Mexico. The national child poverty efforts aimed at confronting this prob- average is a striking 23.1% (by contrast, lem, as even incremental improvements Kakinami L, Seguin L, Lambert M, the Netherlands is at 6.1%), placing the could result in a substantially greater Gauvin L, Nikiema B, Paradis, G (2014). United States at 34 out of 35 developed quality of life for millions of youth across Poverty’s latent effect on adiposity dur- countries (Adamson 2012). the country. m ing childhood: evidence from a Québec birth cohort. J of Epidemiology and Child poverty profoundly affects both References Community Health 68(3):239-45 short- and long-term quality of life (Schickedanz et al. 2015). Children Adamson P (2012) Measuring Child Lee BJ, George RM (1999). Poverty, early raised in poverty not only endure higher Poverty: New League Tables of Child childbearing, and child maltreatment: a rates of asthma, obesity, developmen- Poverty in the World’s Rich Countries. multinomial analysis. Children and Youth tal delay, failure to thrive, trauma and Florence, Italy: UNICEF Office of Services Review (10):755-780 prematurity (Schickedanz et al. 2015, Research Innocenti Report Kakimani et al. 2014), but are also at continued on page 123

122 AACAP NEWS COMMITTEES

UPDATE ON ADVOCACY COMMITTEE 2016 AACAP Has a New Advocacy Committee Co-chaired by Debra E. Koss, MD, and Karen Pierce, MD

s a national organization, AACAP adolescent psychiatrists within their policies impacting child and adolescent aims to influence decision respective ROCAPs to become psychiatry, as well as the need to create Awithin political, economic, and involved in advocacy, using advo- new opportunities for positive change. social systems and institution to a much cacy training materials developed Past agendas have included psychologist greater degree with the establishment by the AACAP Department of prescribing, foster care and psychotro- of the AACAP Advocacy Committee. Government Affairs and the AACAP pic medications, and scope of practice. Advocacy long has been a part of Advocacy Committee; AACAP staff, who are also AACAP’s AACAP’s mission, and an activity which registered lobbyists in Washington, D.C., ■■ Organize grassroots advocacy efforts all child and adolescent psychiatrist support participants in their advocacy within their ROCAP with the use of need to be a part of--for and with their efforts by providing information on AACAP Advocacy resources (e.g., patients and their patient’s families. As a materials, strategies, and tactics that have Voter Voice) and policy resources national organization, AACAP now aims been helpful in other states. In addition identified by the AACAP Department to have greatly influence on decision to the calls, AACAP has membership in of Government Affairs and the new made within institutions and political, Voter Voice, which is a proprietary grass- AACAP Advocacy Committee; economic, and social systems with the roots advocacy system that helps track establishment of the AACAP Advocacy ■■ Help engage child and adolescent what bills and legislation are moving in Committee. This committee has been psychiatrists, including members in each respective state. formally created to coordinate the grass- training, and local youth and families roots activity of all of AACAP’s regional to participate in the annual AACAP The committee will spend this year organizations of child and adolescent Legislative Conference; identifying a small number of high psychiatry (ROCAPs), as well as work on profile issues to help to develop and ■ issues that are on AACAP’s federal and ■ Find and work jointly with collabora- focus corresponding toolkits to advance regulatory agenda. The goal is to mobi- tive partners and organizations to AACAP’s legislative goals. Currently, lize all ROCAPs to designate member advocate for and promote the mental child and adolescent psychiatry loan each to act as the advocacy liaison in its health care of youth in their reagion; forgiveness and comprehensive men- state or region. Advocacy Liaisons will ■■ Participate in the new AACAP tal health reform are at the top of our be child and adolescent psychiatrists Advocacy listserv with members of federal agenda. We also are developing acting as the eyes and ears on legislative the AACAP Advocacy Committee. advocacy programming for the AACAP’s and regulatory affairs in their ROCAP’s 63rd Annual Meeting. Working with area. Advocacy Liaisons will: Come join us and keep AACAP updated AACAP-PAC, the Advocacy Committee on what is happening in your state or is educating members to become active ■■ Participate in monthly calls reagion! The Advocacy Committee Association members, so they can where they will receive updates monthly call-in is on the first Monday become active in all phases of legisla- on AACAP’s latest federal and of each month at 8:00 pm EST. You will tive activity and the political process. state legislative and regulatory unite with other child and adolescent AACAP “Advocacy Updates” are excit- priorities, share news from their psychiatrists across the country who ing and information filled emails that respective states and regions, and are working to achieve optimal physi- come to you twice a month. brainstorm about key issues impact- cal, mental, and social well-being for ing the subspecialty of child and infants, children, adolescents, and young Come join us—monthly calls are on the adolescent psychiatry; adults, and to improve the practice of first Monday of the month at 8:00 pm child and adolescent psychiatry. You EST, and tell us about your state’s ■■ Develop local efforts to recruit, inform others and learn from your peers. issues! m train, and mentor child and Each of us struggle with new laws and

New Mexico Truth continued from page 122

Nikulina V, Widom CS, Czaja S (2011). Schickedanz A, Dreyer BP, Halfon N For more information, please contact The role of childhood neglect and (2015). Childhood poverty: understand- Shawn S. Sidhu, MD, president of the childhood poverty in predicting men- ing and preventing the adverse impacts New Mexico Council of Child and tal health, Academic achievement and of a most-prevalent risk to pediatric Adolescent Psychiatry, at shawnsidu@ crime in adulthood. American Journal of health and well-being. Pediatric Clinics gmail.com. Community Psychiatry (3-4):309-21. of North America 62(5):1111-35

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News UPDATES by Garrett Sparks, MD, MS

n each issue of AACAP News, I include brief commentary and links to newsworthy transgender children will not scar or items that the membership might have missed, or that merit repeating. If you have confuse their children by allowing them Isuggestions for this column, please send them to me at [email protected]. to change their name, their pronouns, their haircut, and their wardrobe. Transgender Kids Who prepubescent children (n=73, aged 3-12 years) along with a control group of 73 Olson KR, Durwood L, DeMeules M, McLaughlin KA (2016). Mental health of Are Supported in Their cisgender (nontransgender) age- and transgender children who are supported in Transition Have Better gender-matched community controls as their identities. Pediatrics 137(3):1-8. Mental Health well as 49 cisgender siblings of the trans- gender children. The mean age for all Transgender children who have socially of the children was around eight years Glutamate-modulating transitioned to living as their identified of age. Parents completed anxiety and Supplement May Be Helpful gender rather than their natal gender are depression measures on all the children. becoming much more common in soci- for Skin-Picking ety, and correspondingly more common There was no difference among the N-acetylcysteine (NAC) is most in the child and adolescent psychia- groups on depressive symptoms. known by medical professionals as trist’s clinic. Parents who support their Transgender children had slightly Mucomyst, the standard treatment for children in their social transition to their elevated anxiety symptoms com- acetaminophen overdoses in emer- identified gender often allow children to pared to controls, though the mean gency departments. It is also a common dress and wear their hair in a way more anxiety ratings were not in a clinical or supplement sold with claims of anti- consistent with their gender identity. preclinical range. oxidant and liver protecting properties. Children and parents may choose a In addition to its mucolytic or antioxi- new name more consistent with their Notably, these children were mostly dant properties, NAC is an amino acid gender identity and request that others white and relatively affluent; more than cysteine prodrug that increases extracel- use pronouns consistent with the child’s 70% of each sample was white, 81-90% lular levels of glutamate in the nucleus gender identity. of the families made more than $75 accumbens (NA), reducing synaptic thousand, and 38-51% made more than release of glutamate. Glutamatergic Previous research found high rates of $125 thousand. Families who allow or activity in the NA may be important in anxiety and depression among children promote the social transition of their many compulsive or habitual behaviors with gender identity disorder (DSM-IV; transgender prepubescent child may and reward-seeking behaviors. The now gender dysphoria in DSM-5), have other unique characteristics as well. administration of NAC has been shown though most of these children were typi- Interactions between expression of gen- to reduce cannabis use in dependent cally still living as their natal sex. Past der identity, socioeconomic status, and adolescents (Gray 2012). research also suggested that elevated rates of psychopathology will hopefully rates of depression, anxiety, suicide, and be explored in future research. There are currently no FDA-approved substance abuse experienced by those treatments for skin-picking disor- with gender dysphoria often resulted Though important clinical populations, ders. A few studies in adults suggest from years of prejudice, discrimination, the researchers did not include in this mixed results with SSRIs, and a study and stigma; conflict between appear- study non-binary gender identities or of lamotrigine did not show ben- ance and identity; and general rejection agender (without a gender) identities, efit over placebo. Skin-picking often by others, including their families. As and it is not clear how these children presents by itself or comorbid with societal trends change to allow more might compare to children with binary obsessive-compulsive disorder and transgender children to make the social gender identities. other anxiety disorders, and is not so transition to their identified gender, we uncommon among children treated find that we really don’t know much Like many scientific studies, this one with stimulants for attention-deficit/ about the mental health of transgender does not answer all the questions we hyperactivity disorder. children who are supported in living as would like to inform us on how we their identified gender. counsel our patients and families. While A randomized, double-blind trial transgender identities are becoming was conducted at the University of As part of the TransYouth Project more socially accepted, family and even Minnesota and the University of Chicago (https://depts.washington.edu/tran- provider acceptance of transgender in 66 adults with skin-picking, with 35 syp/), researchers at the University of identities may have some ways to go. participants randomized to receive NAC Washington recruited a community- However, at least one well-executed and 31 randomized to receive placebo based national sample of transgender, study suggests that families of young treatment. Fifty-three subjects completed

124 AACAP NEWS NEWS the study. At the end of the 12-week Service Foundation Trust between 2006 use is challenging even in those who do study, 15 of the 32 (47%) individuals and 2013. SLaM serves a large catch- not have comorbid psychotic disorders, who received NAC were “much” or ment of around 1.2 million residents in with few evidence-based psychosocial “very much improved,” compared to South London. The researchers used treatments and even fewer psychophar- only four of the 21 (19%) of those receiv- Natural Language Processing (NLP) macologic approaches. Developing ing placebo. Of note, 10 of those in the software to scour the anonymized medi- further treatment for this comorbidity placebo group were lost to follow-up, cal records to identify marijuana use. might have a substantial effect on the compared to only three in the NAC Treatment data were followed for up to treatment course of early psychosis. group; all those who failed to complete five years to look at the course of illness the study did so due to an inability to following FEP. Patel R, Wilson R, Jackson R, Ball M, Shetty adhere to the study schedule. H, Broadbent M, et al. (2016). Association Marijuana use was found in 46.3% of of cannabis use with hospital admission and Doses of NAC were started at 1200 mg/ the sample on initial presentation and antipsychotic treatment failure in first episode psychosis: an observational study. BMJ Open day, increased to 2400 mg/day by week was particularly common in single males 6(3). Published online March 3, 2015 three, and increased to 3000 mg/day by aged 16-25 years. Marijuana use at the week six. The authors stated that they time of FEP was associated with a 50% chose these doses because 2400 mg/day increase in the frequency of hospital Another Study of had been so well-tolerated in a previ- admission (incidence rate ratio 1.50, Attention-Deficit/ ous similar study on trichotillomania. In 95% CI 1.25-1.80) and a 55% increase in the previously mentioned study of NAC the likelihood of an involuntary com- Hyperactivity Disorder in cannabis-dependent adolescents a mitment (OR 1.55, 1.16-2.08). Initial Finds Higher Rates of dosage of 2400 mg/day (1200 mg twice marijuana users spent an average of 35 Diagnosis in the Youngest daily) was used, suggesting this dose more days in the hospital total over five might be well-tolerated in adolescents. year follow-up compared to those who Children in Their Grade did not present with marijuana use at the Over the past several years, research- Grant JE, Chamberlain SR, Redden SA, time of FEP. ers studying children in a variety of Leppink EW, Odlaug BL, Kim SW (2016). N- countries, including Iceland, Canada, acetylcysteine in the treatment of excoriation Those who used marijuana at the time of Spain, Israel, Sweden, and now Taiwan, disorder: a randomized clinical trial. JAMA FEP were also more likely to have more have found that the younger a child is Psychiatry. Published online March 23, 2016 failed antipsychotic trials and more use compared to his peers in his grade, the Gray KM, Carpenter MJ, Baker NL, DeSantis of clozapine, suggesting that one way more likely he will receive a diagnosis SM, Kryway E, Hartwell KJ, et al. (2012). A in which marijuana use may mediate of, and be treated for, Attention-Deficit/ double-blind randomized controlled trial of these negative outcomes is through Hyperactivity Disorder (ADHD). The N-acetylcysteine in cannabis-dependent ado- interference with the effectiveness of one exception has been a study in lescents. Am J Psychiatry 169(8):805-12 antipsychotic medication. Denmark, a country where the age of entry to school is more flexible than in Marijuana Use Portends This was a large retrospective study many other countries. In Taiwan, the cut- Negative Outcomes in First that was not able to assess how much off birthdate for entry to school is August marijuana was being used at the time 31, such that children born in August are Episode Psychosis of FEP. Information about whether the typically the youngest in their grades. While research linking marijuana use to individual may have stopped or con- an increased risk of developing a psy- tinued to use marijuana following FEP Using longitudinal data from the large chotic disorder continues to accumulate, was also not available. Given that these National Health Insurance database, not much has been written about the large effects were found even without nearly 400,000 children aged 4-17 longitudinal clinical course of mari- those important pieces of information, years were followed from the time of juana-smoking youth who present with the effect of marijuana on FEP might entry into the study up until their 18th first-episode psychosis (FEP). Previous actually be underestimated. Individuals birthday or the end of the study period. studies that have attempted to ask ques- who smoked very little or who stopped Among those diagnosed with ADHD, tions about how marijuana use would smoking after FEP may have had more the diagnosis was given at least twice affect various longitudinal outcomes in favorable clinical courses than those by board-certified psychiatrists during psychosis have been small and incon- who persistently smoked more, leading the follow-up. Use of methylphenidate sistent. Does marijuana use increase to conservative estimates of the hospital- and atomoxetine were recorded, and rates of relapse? Of hospitalization? Of ization and treatment data. variables around level of urbanization treatment resistance? and income of the family were used This research highlights the likely as confounders. To investigate the effects of marijuana importance of marijuana use in pre- use on FEP, researchers from King’s dicting negative outcomes in early The initial diagnosis of ADHD was made College London identified 2026 indi- psychosis, particularly increased days in most often in grade school (60.3%), viduals with FEP accepted at an early the hospital and increased numbers of followed by preschool (22.7%) and the intervention service in the South London antipsychotic trials, a proxy for treat- and Maudsley (SLaM) National Health ment resistance. Treatment of marijuana continued on page 126

MAY/JUNE 2016 125 NEWS

News Updates continued from page 125 teenage years (17.0%). The prevalence of smart, thoughtful doctors, inadvertently to capture this particular dysfunction. It subjects receiving an ADHD diagnosis imply these exact same things. should not be surprising that an evi- or being treated with medication steadily dence-based treatment would be offered increased with each birth month from What these analyses ignore is the fact to treat the disorder. September (1.8% had the diagnosis, that psychiatric diagnoses are conditions 1.2% received medication) to August of dysfunction. The fact that the envi- Depending on the study you read, some (2.9% and 2.1%, respectively). The ronment affects the development and children “grow out” of ADHD, and trends were similar in boys and girls, presentation of a psychiatric condition others maintain clinically significant though boys (September 2.8%, 1.9%; is not a bug in the system. It is a feature. levels of symptomatology throughout August 4.5%, 3.3%) were more likely Childhood psychiatric conditions are adulthood. We do not say that the to be diagnosed and treated than girls often descriptions of developmental former group was misdiagnosed and (September 0.7%, 0.5%, August 1.2%, delays that result in difficulties accom- just immature because eventually their 0.8%). This effect was true in preschool plishing the tasks that others think you executive functioning “caught up” with and grade school children, but disap- should be able to do. Oppositional the demands of their environments. The peared by the teenage years. defiant disorder (ODD) is basically a question about ADHD is not whether condition of difficulty with flexibility, it is real or not real, but what we are The main reason for covering this study transitioning, and mood regulation. going to do about it. We can change the in the AACAP News is not that the ADHD is basically a condition of dif- environment, we can teach skills and results are somehow surprising; they are ficulty with being able to direct attention implement psychosocial interventions, not. More significant, however, is the and control impulses. Whether a child or we can prescribe medications. Only way these studies are often presented can do these things is not a yes or no two of those three things can happen in popular media. In the best-case question. The question is whether the in a psychiatrist’s office. If children are scenario, popular media presents these child is able to do these things as well going to have demands placed on them studies as evidence that psychiatrists as the environment demands that they that are not individualized and scaled to and pediatricians diagnosing ADHD are do them. It should not be surprising that their abilities, it is inevitable that some really bad at distinguishing pathology a younger child may not be as good at will have dysfunction. And what is a psy- from immaturity. At worst, the news these tasks as an older child, regardless chiatric diagnosis other than an attempt coverage can imply that the diagnosis of of an ADHD diagnosis or not. It also to describe dysfunction? ADHD is a myth, and the ADHD diag- should not be that surprising that more nosis itself is just evidence of a medical of the younger children will not be able Chen MH, Lan WH, Bai YM, Huang KL, Su establishment intent on pathologiz- to meet the demands of the environment TP, Tsai SJ, et al. (2016). Influence of relative ing and medicating normal childhood in which they find themselves and that age on diagnosis and treatment of Attention- behavior. I have heard other child and they will be referred for an ADHD evalu- Deficit Hyperactivity Disorder in Taiwanese children. J Pediatr. March 2, 2016 [Epub adolescent psychiatrists, otherwise ation and meet criteria that are designed ahead of print]

ATION PUBLIC A JAACAP JAACAP Connect is an online companion to the Journal of the American Academy of Child and Adolescent Psychiatry

ISSUE 1 VOLUME 3 t• promoting the development of translational skills and 16 • JAACAP ConnecWINTER 20 y publication as education. The field of child and adolescent

Special Issue: The Intersection of Child Psychiatr and Sociocultural Issues psychiatry is rapidly changing, and translation of scientific d ity to Understan n Cultural Ident Tilling Our Ow tion 3 literature into clinical practice is a vital skillset that takes Sociocultural Evolu ...... years to develop. Connect engages clinicians in this process Michelle S. Horner, DO s Greater Than ity (or, the Whole I al Intersectional g the Sociocultur arts): Informin ities the Sum of Its P tal Health Inequ by offering brief articles based on trending observations by nd Improving Men 5 Formulation a peers, and by facilitating development of lifelong learning MD ...... e. Patrice Janell Holmes, hink About Rac esidency Race to T 9 Too Busy in the R skills via mentored authorship experiences. We work with ...... Jerome H. Taylor, MD nd ender Identity a Conceptualizing G students, trainees, early career, and seasoned physicians, nformity 12 Gender Nonco regardless of previous publication experience, to develop brief MD...... Dalia N. Balsamo, art 1: Development Models From Biracial Identity P on 16 science-based and skill-building articles. DeŠ cit to Integrati ...... Cortlyn Brown, BA orking With art 2: Tips for W Biracial Identity P 21 www.jaacap.com/content/connect Biracial Families ...... Cortlyn Brown, BA [email protected]

ATION PUBLICATION AS EDUC ANSLATIONAL SKILLS AND VELOPMENT OF TR PROMOTING DE 126 AACAP NEWS OPINIONSFEATURES

Poetry Madeline By John Pruett, MD

My heart’s entwined with Madeline Baby angel, eyes of blue A cherub and an imp combined Her face lights up with all that’s new Commitment Again, Again she shouts for more, By Daisy Bassen, MD And throws herself without a care From my shoulders to the floor He has smashed everything, Knowing that my arms are there Torn the corners from squares, Broken the world the best he could. Unconsciously she flirts with me He reached to wrest the moon A soft caress, a touch that lingers Her cheek turned to him, Knowing how instinctively But he was too late. He’d succeeded To wrap me round her little fingers In making poison from cure And he died and died and died She claims her place curled at my side Until they distilled his blood Arm and head upon my chest Into a simple syrup, its gloss Relaxed she signs a double sigh Obscured in the tubing. Now all is well and she can rest

The following week, they want to rescue him. Dr. Pruett is associate professor and director of Child and Adolescent Psychiatry at the They are afraid it will be worse. University of Mississippi Medical Center. He may be reached at [email protected]. They hope it will be worse, perhaps This was not annihilation.

Dr. Bassen is a child and adolescent psychiatrist in Providence, Rhode Island, and is associated with Butler Hospital. She may be reached at [email protected].

MAY/JUNE 2016 127 OPINIONS

ETTER TO THE EDITOR

To the Editor of AACAP News

April 13, 2016

I thought the article by Dr. Shrier and Dr. Pope about jobs in the March/April 2016 issue of AACAP News was quite interesting. It did not mention the option of jobs in the Public Health Service, particularly the Indian Health Service (IHS). I spent two years in the IHS in Zuni, New Mexico, after my internal medicine internship, as a Family Doctor, it was a great experience. The IHS also employs child and adult psychia- trists and provides either a short-term or a career experience. I believe that there was a recruiter at the AACAP Annual Meeting in San Antonio last fall. There are also careers in branches of the armed forces.

I think they compare favorably with those in the private sector, especially for clinicians who do not want to be in business management, and they provide special insights and service opportunities.

Kim J. Masters, MD

We always look forward to hearing from members! Letters to the Editor of 250 words or less may be submitted through the National Office to Rob Grant, director of Communication and Member Services at [email protected].

AACAP Distinguished Fellowship It’s Time That You’re Recognized for Your Efforts! Distinguished Fellow status is the highest membership honor AACAP bestows upon members. It’s a symbol of your dedication, enthusiasm, and passion for our specialty. It also serves as a reflection of your commitment to the Academy.

The criteria for eligibility include: 1. Board certified in child psychiatry 2. AACAP General member for at least 5 consecutive years 3. Made (continue to make) outstanding and sustained contributions in any 3 of the 5 areas noted below: ■■ Scholarly publications ■■ Outstanding teaching ■■ 5 years of significant and continuing contribution to patient care ■■ Organizational or social policy leadership at community, state, or national levels ■■ Significant contributions to AACAP for at least 5 years in one or more of the following: ✦✦ AACAP Committee/Component ✦✦ AACAP Assembly of Regional Organizations ✦✦ An AACAP Regional Organization

Distinguished Fellowship Nomination Package Requirements: ■■ Current copy of Curriculum Vitae ■■ Copy of Child Psychiatry board certificate ■■ 3 recommendation letters written by AACAP Distinguished Fellows If you have any questions, or would like more information, please contact Nicole Creek, Supervisor, Member Services directly via email at [email protected] or by phone at 202.966.7300, ext. 134. We’re here to help!

128 AACAP NEWS OPINIONS

CONSUMER ISSUES COMMITTEE Child and Adolescent Psychiatry: Can We Provide Comprehensive Care in a Changing Health Care Environment?

community agencies. I feel it balances what I do by allowing me to work with a socioeconomically disadvantaged population. My private practice is a fee-for-service practice where I sub- mit a statement to my patients who pay me directly and then submit it to their insurance company for whatever reimbursement they provide. I am not on any insurance panels. I realize this ■■ Henry Gault, MD, and Jennifer Yen, MD model would need to be modified in AACAP’s Consumer Issues Committee residents. I enjoyed my hospital work, most areas of the country and could provides personal insights into the evolu- and my private practice quickly grew. not work in a less affluent area. It does, tion of and the changing role of child Over the next three years the hospital however, allow me to utilize all the skills and adolescent psychiatry today. administration pushed me to see more I was trained in and follow the path that and more patients and do less teach- led me into psychiatry in the first place. The Classic Career Path ing. I spoke with my chair, who told me (Henry Gault, MD) he would love for me to teach more, Like most of us, I had several wonderful but he would pay me less. After a frank The Early Career Path mentors during my psychiatry train- discussion, I decided to leave and go As with many passionate psychiatry ing. They were also role models for into full-time private practice. At that residents completing their training, I different career options. I enjoyed my time, many people could afford private had a mental image of what kind of experiences with teaching, consulting to practice fees as insurance frequently a child and adolescent psychiatrist I schools and community agencies, doing would pay up to 50 percent of fees up to would like to be. I felt as though my pediatric liaison, and, especially, seeing 50 sessions per year. patients, i.e., working with individuals, general and child and adolescent psychiatry residency programs pre- families, and couples. At that time, my My practice today is what many describe pared me for all aspects of the job, therapeutic tools were almost exclu- as an “old fashioned” psychiatric including preparing the formulation of sively the talking therapies and behavior practice. One of my pediatrician friends a biopsychosocial model for treatment, modification. I was fortunate to have describes me as a “dinosaur.” Currently, experience with various psychotherapy many consultation experiences including I see about 35 patients per week, all modalities, and a good foundation on spending a day a week in school consul- for 45 minutes each. About a third are pharmacological treatment. tation as a second year fellow. children and adolescents and the rest are adults. Almost 100 percent are ongo- Unfortunately, it was not long after grad- Medications played a minor role in child ing psychotherapy patients who I treat uation that I became aware of several and adolescent psychiatry in the late with medications, as indicated. For my issues that changed my understanding 1970’s. There were the antipsychotics child and adolescent patients, I work of the practice of psychiatric medicine and stimulants. Antidepressants and closely with family members and school today. First, I had to come to grips with anti-anxiety agents were of limited help. personnel as needed, sometimes doing the fact that unlike all the years before, Upon completing training, my initial parent management. I will frequently my choice of the type of practice I desire was to have a half-time academic make school visits for which I am wanted would have to take into account position and spend half time in private reimbursed, through insurance or private multiple factors. This included financial practice. That was frequently done and pay. I also have a cancellation policy to considerations, such as buy-in costs and seemed ideal. My chair told me he protect my time from last minute can- overhead (for private or group practice), would love to have me join the faculty, cellations. I do almost no “medication loan repayment, paid leave, benefits, but only full time. I took a position at a management,” except for former therapy automatic administrative support, pay local university affiliated hospital and patients or when psychotherapy was not potential, scheduling, and staff require- started a private practice on the side. indicated initially. I worked on a multidisciplinary team ments for training or supervision (for academics). Second, my duties and doing diagnostic work, saw patients in The rest of my time I consult to schools, ongoing therapy, did pediatric liai- special education programs, and continued on page 130 son, and lectured and taught pediatric MAY/JUNE 2016 129 OPINIONS

Can We Provide Comprehensive Care continued from page 129 responsibilities would be to some degree and adolescent psychiatry primarily communication to obtain vital dictated by the managed care systems due to the appeal of being able to treat information (such as life changes or that my patients are a part of. the whole patient. That would include psychosocial stressors) before mak- a thorough evaluation of the genetic, ing treatment decisions. physical, psychological, and environ- These factors played an increasingly 5. The great variability in com- mental factors affecting each patient. prominent part as I settled into a 50/50 munication between the With children and adolescents, that private practice and academic posi- psychiatrist prescribing medications includes work with the individual child, tion. The private practice offered me and the therapist providing the family, school, other professionals, or the financial growth that I would need ongoing therapy. as time goes on, along with flexibility outside agencies. in schedule and patient population. The 6. The ever increasing view by patients academic position covered much of my Unfortunately, the role of child and ado- and families that psychiatrists professional expenses, such as liability lescent psychiatrists today is becoming are solely medication special- insurance, medical dues, and benefits, as increasingly narrow, with the result that ists without experience in use of well as offering paid leave. I did my best for many child and adolescent psychia- non-pharmacological modalities to balance medication visits with brief trists, their involvement is marginalized or understanding of the multiple psychotherapy where I could, carried a while psychologists and social workers psychosocial factors that impact few weekly or biweekly therapy patients, are the primary providers. Many psychia- mental health. and reached out regularly to therapists, trists, especially those recently trained, 7. Push for cost-saving and quickest school teachers, and school counsel- are focusing more on evaluations and options to be the standard of care ors. Despite running into some barriers, medication management and less on for treatment. including patients (or parents) requesting ongoing regular therapy with patients fewer visits to avoid time off from work and families. Much of the transition has 8. Training future generations of or school, difficulty collaborating with been dictated by financial concerns and psychiatrists to provide compre- other providers due to scheduling, and restrictions on psychiatric practice based hensive assessments, including changes in insurance coverage for care upon policies of the insurance industry. the family, genetic, physical, and medication, I managed to be fairly Individual practitioners have little power psychological, social and environ- successful in my endeavor to provide against a now well-entrenched system. mental factors as well as to provide comprehensive care. Many questions arise as to whether or effective psychotherapy. not these changes are in the best interest 9. The possibility that child and ado- In the recent months, however, I was of patients and the impact it will have on lescent psychiatry may become less surprised to find myself heading toward psychiatry as a specialty. relevant because of the narrowness an unexpected outcome. After spending of our roles and a diminution in the four years working within the current How do we cope with the challenge of breadth of our knowledge. construct of managed care, I made a life- providing good psychopharmacological changing decision. I have joined a group treatment to the many in need without Child and adolescent psychiatrists are of psychiatrists who have transitioned to giving up on the advantages of a psy- historically experts in development, and a fee-for-service practice. Although my chiatrist doing both kinds of treatment? are trained in talking therapies, includ- choice was difficult and I still struggle Some specific concerns are: ing family therapy and behavior therapy, with the guilt of leaving some patients 1. Increased focus on medication to medications, individual and family psy- behind, it allowed me the chance to the neglect of other therapies that chodynamics, and managing a treatment improve my ability to provide quality may be needed alone or in con- team. Patients have the advantage of patient care. Despite my initial reserva- junction with medical treatment. working with a well-trained professional tions and worries, so far my patients that provided well-rounded care. With have responded warmly and positively 2. Minimization of individual and fam- the new challenges that are faced by to the change. My stress level has ily dynamics as major factors in a child and adolescent psychiatrists today, decreased significantly, and I feel more child’s problems, and more focus on it will be important to consider all of confident that the care my patients are biological factors with medication these concerns in order to produce solu- receiving is the best that I can provide. as the primary treatment modality. tions that will allow for the continuation I am hopeful that as time passes, I will 3. Loss of the learning acquired from of quality patient care. m find the personal and professional satis- long-term interactions with patients faction that I seek. (Jennifer Yen, MD) and families, and the deficiency of knowledge that could result from Jennifer Yen, MD, is on AACAP’s Future Concerns for Child only providing brief and problem- Consumer Issues Committee and can be and Adolescent Psychiatry focused treatment. reached via email at [email protected]. and Its Practice 4. Emergence of 15-20 minute patient Henry J. Gault, MD, is an AACAP interviews as the norm due to insur- Many of us chose to become psychia- Distinguished Life Fellow and can be ance reimbursement policies and its reached via email at [email protected]. trists and ultimately to specialize in child negative impact on effective patient

130 AACAP NEWS OPINIONS

Motherhood, Medicine and Mentoring

days faded those seemingly unforget- table memories away. 10 Tips to surviving Looking back, nothing could have pre- parenthood in residency pared me for the magnificent adventure or fellowship: that becoming a new mother brought. I am not in any way claiming to simplify ➤➤Embrace every extraordinary the experience of parenthood for read- moment with your baby. These ers; rather I am humbly sharing my story seconds go by fast! and what I learned to be helpful to me ■ ■ Desiree Shapiro, MD along the way. ➤➤Be kind to yourself. ➤➤It is okay to put family first. t 4:05 AM on January 11, 2016, my little bundle of joy entered ➤➤Appreciate the lessons your Athe world. My life changed newborn is teaching you about instantly and I was surprisingly shocked development, compassionate at the transition. Despite past pediatric care, and parenting. rotations, being an aunt, being a current child and adolescent psychiatry fellow, ➤➤Consult with mentors on and spending the past few months navigating and balancing making preparations and complet- difficulties of being a trainee and ing the nursery, I felt scared, excited, a parent. clueless, and humbled. My family and ➤ friends reassured me that I simply had ➤Reach out to your colleagues for to use my common sense and follow support. my motherly instinct—all of which was Even after carrying my baby for months, ➤➤Schedule time with your partner only minimally reassuring when trying it was not until the moment I held each day to check-in. to master the car seat, feedings, and my newborn that I sincerely felt like a ➤➤Each family has a different story inconsolable meltdowns. mother, guardian, and caretaker. I added a new role to my many other roles and a different journey. Make My idealistic expectations of how life including wife, sister, daughter, friend, decisions best for you and your would be after birth did not exactly and child psychiatry trainee. I was now family. equate to the reality of taking my a parent. In this new position, I learned ➤➤It will get easier. newborn home. I imagined I would be many tasks of basic caretaking and I well prepared for sleepless nights given experienced feelings of all-consuming ➤➤Laugh, play, and be present. the many “on calls” I had conquered; love and a desire to protect. This gave however, I soon realized that taking care me an overwhelming sense of apprecia- of a newborn did not come with the tion for my parents who had given so deprivation or concerns about the over- glorious and rejuvenating post call, unin- much of themselves to love, nurture, and flowing dishes, my inability to leave the terrupted, deep sleep. I imagined my protect me. Thomas Berry Brazelton, house because of my girl’s intense car husband and I would take long walks, MD, said it best: “A grandchild is a seat aversion, and my endless to-do list. cook delicious meals, and watch movies miracle, but a renewed relationship with I had read about oxytocin, complicated while our bundle of joy slept like an your own children is even a greater one.” neurohormonal systems, the neurobiol- angel. However, after diapering, feeding, ogy of mothering, reward processing, soothing, swinging, singing, shushing, As a parent, I also experienced a wide psychoanalytic theories of early attach- and swaddling, there was no thought of range of emotions in response to my ment, brain activation sites involved in walks, meals, or movies. newborn. When I heard my baby this attachment, empathy, and emotional crying, my heart sunk and I would do bonding, and now all of these articles I imagined I would become an arts and anything to soothe her. I wondered took on a new meaning as my baby crafts mom (no history of these skills) what was going on in my brain and stared back at me. This was real. I had and create decorative albums of the first in my body to generate such a strong become a mother, but how was I going days of my sweet girl’s life. I promised response. I had heard babies cry before, to continue on at the same pace in medi- to write one memory down each day but this sensation was different. When cine? Thankfully, I looked to my mentors in a baby book, but the blank entries I witnessed my little one smiling, I was for guidance. outnumbered the completed ones. Each joyous and ecstatic. In sync, we stared day I missed I thought, “I will never at one another lovingly with sparking continued on page 132 forget today, I will catch up later,” but eyes. It was those magical moments of course the whirlwind of the following that immediately cured me of any sleep

MAY/JUNE 2016 131 OPINIONS

Motherhood, Medicine, and Mentoring continued from page 131

Mentoring has always been incredibly Others had been terrified and over- and worked full time—each making important and valuable to me, but it whelmed as well? This comment was her decision fit for her family. These was not until I became a mother that unbelievably therapeutic. Laura Dunn, stories inspired me, notwithstanding I fully appreciated the preciousness of MD, from Stanford University provided my own doubt and uncertainty. It can my mentors and supervisors. While at immense support while I struggled with be easy to compartmentalize mentor- the AACAP Annual Meeting in October balancing work and family. She told me ing as solely clinical in nature: patient 2016, members of all ages generously about raising her own little “koala” (as management, psychopharmacology, and shared their advice and stories about I am writing these thoughts, my baby is psychotherapy; however, mentoring may being a mother or a father. I benefited wrapped around me like a little koala be the most beneficial when you are from the experiences of mentors at my leaving my hands free to type) and gave struggling with a personal transition such institution and those from various profes- me reassurance and hope. as parenthood. Navigating this journey sional organizations across the country. in motherhood and medicine, I will The two most common pieces of infor- In addition to my mentors, fellow continue to look to wise mentors who mation I received included: 1) Time AACAP trainees who are new parents have survived and thrived as parents and would pass much too fast (This I found and soon-to-be parents provided a psychiatrists. I encourage others to reach to be extremely true as I sadly look at network of support and encouragement out and seek insight and knowledge those newborn outfits that no longer fit); that I appreciate greatly. Knowing that from their mentors as well! m and 2) Family is most important. Hearing others in the field welcomed my ques- the emphasis on family life from my pro- tions and understood my situation was fessional organization was heartwarming priceless for my survival in those first Dr. Shapiro is the executive chief and motivational. I knew I had chosen few weeks. I heard the powerful stories fellow for the University of California, the right career for myself. Dorothy of those who had done this before me. I San Diego, Child and Adolescent Stubbe, MD, offered a statement, pro- listened to the challenges and the beauty Psychiatry Fellowship Program. She foundly resonating with my experience: of being a mother in medicine, and how serves on the AACAP Adolescent “newborns are the most wonderful, attitudes and expectations had evolved Committee. She may be reached at joyous, terrifying, and overwhelm- over time. I learned from mothers who [email protected]. ing creatures alive.” I felt understood! had stopped working, worked part time,

Life Members Reach 140!

No, not 140 years old. But, 140 lives you have impacted. Impact. Since 2010, the Life Members Fund has made an investment in 75 residents and 65 medical students. That’s potentially 140 next generation child and adolescent psychiatrists. And, future Owls! Donate. This achievement is remarkable. We are at a time of health care change when our skills have never been more important, but the deficit of available child and adolescent psychiatrists is growing. Life Members can, and are, closing this gap. Let’s keep it up. To donate, visit www.aacap.org/donate.

NEW: There is another way you can donate and do more to close the gap. Learn about the 1953 Society. It’s a tomorrow investment, made today. Visit www.aacap.org/1953_Society to learn more.

Stay involved. Stay connected to all Life Members activities, programs, and photos by reading the Life Members Owl eNewsletter.

2016 Owl Pin. Remember, if you donate $450 or more to the Life Members Fund by October 31, 2016, you will receive a limited edition 63rd Anniversary OWL PIN!

132 AACAP NEWS

63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

AACAP’s 63rd Annual Meeting New York Preview

AACAP’s 63rd Annual Meeting is just five months away, destination has to offer and have highlighted important and we’re excited! Whether you’re bringing the family, information here! For complete details about the Annual laser-focused on our high-quality programs, or some- Meeting, visit www.aacap.org/AnnualMeeting/2016. where in between, we have scoped out the best that our

Attendee To-Do List ❑ June 15 – Review the Annual Meeting programs online ❑ June 15 – Make your hotel reservation ❑ August 1 – Members Only Registration opens for the Annual Meeting ❑ August 8 – Registration opens to nonmembers – Early Bird Registration Deadline ❑ September 15 ❑ October 3 – Last day AACAP room rate guaranteed at hotels ❑ October 24 – First day of AACAP’s 63rd Annual Meeting ❑ October 29 – Last day of AACAP’s 63rd Annual Meeting ❑ November 4 – Look for the General Evaluation Survey in your email inbox. CME certificate available upon completion of survey.

134 AACAP NEWS 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

otels When making your reservation, ask for the AACAP ANNUAL H MEETING GROUP RATE to qualify for the reduced rate. New York Hilton Midtown Both the New York Hilton Midtown and the Sheraton New 1335 Avenue of the Americas York Times Square will host scientific sessions for AACAP’s New York, NY 10019 Annual Meeting. Located directly across the street from each Phone: 212.586.7000 other, both hotels sit in heart of non-stop excitement in mid- http://www3.hilton.com/en/ town Manhattan. After attending AACAP’s stellar educational hotels/new-york/new-york-hilton- offerings, you will be steps from Times Square, Broadway, midtown-NYCNHHH/index. Radio City Music Hall, Central Park, the Museum of Modern htmlAnnualMeeting/2016/hotel Art, and hundreds of restaurants with cuisines ranging from (to reserve your hotel room) Austrian to West African and everything in between! Rate: $375 single/double per night Check-in is at 3:00 pm and check- out is at 12:00 pm. T ravel Sheraton New York Times Square Plane 811 7th rd Avenue 53 St. New York City is served by three airports, the John F. Kennedy New York, NY 10019 International Airport (JFK), LaGuardia Airport (LGA), and Phone: 212.581.1000 Newark Liberty International Airport (EWR). For more informa- www.sheratonnewyork. tion about the airlines serving these airports, flight schedules, com and ground transportation options, visit www.panynj.gov. (for detailed hotel information) www.aacap.org/ Train AnnualMeeting/2016/ New York City is served by two main rail stations: Grand hotel (to reserve your Central Terminal and Penn Station. Both are served by numer- hotel room) ous bus and subway lines, including Metro-North Commuter Railroad, Long Island Railroad (LIRR), Amtrak, New Jersey Rate: $375 single/double per night. Transit, and PATH (Port Authority Trans Hudson). Early Bird Rate (limited quantities): $345 single/double per night, but must be pre-paid in full with a non-refundable deposit. Check-in is at 3:00 pm and check-out is at 12:00 pm. Don’t miss this opportunity to save money!

AACAP members who refer a new Annual Meeting exhibitor can receive a $100 discount on their 63rd Annual Meeting registration. All referrals must be first time AACAP exhibitors and must purchase a booth for AACAP’s 63rd Annual Meeting.

Exhibitors can connect with more than 5,000 child and adolescent psychiatrists and other medical professionals or advertise in several Annual Meeting publications. Typical AACAP exhibitors include recruiters, hospitals, residential treatment centers, medical publishers, and much more. To review an Invitation to Exhibit with more details on these opportunities as well as forms to sign up, please visit www.aacap.org/exhibits/2016.

Questions? Contact [email protected] or 202.966.9574 Show your support for AACAP and save today!

MAY/JUNE 2016 135 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

hat to Do in New York! New York City has an abundance of concert halls, but none is W quite so storied as Carnegie Hall. Musicians of all walks and genres have entertained crowds in the venerable space; indeed, Central Park is a visual masterpiece created by landscape playing the venue looms as something of an unspoken bench- designer Frederick Law Olmsted and architect Calvert Vaux. mark in many artists’ careers. The Italian Renaissance–style It has gone through major developments and restoration over building—with a brick-and-terra-cotta facade and, in its main time to carry on its initial purpose as an open-air oasis for a auditorium, plush red seats, impeccable acoustics and open metropolitan city. No matter the season or reason for your visit, design (there’s no curtain, for a start)—has also hosted politi- this national historic landmark is a setting for enjoying many cians, authors, comedians, and religious leaders for more than pursuits. For more information, visit www.centralpark.com. a century. For more information, visit www.carnegiehall.org.

Forever at the forefront, the Museum of Modern Art (MoMA) is not only devoted to presenting the best in contemporary art, There’s no better place to experience the excitement of New but also to promoting the understanding of modern art and York than Times Square. Surrounded by neon lights, giant expanding the definition of what is considered “art” in the first billboards, Broadway theaters, electronic ticker tape, and televi- place. Whether it is showing you something you have never sion studios. Times Square is truly the heart of Midtown. The seen before, or showing you how to see something familiar in TKTS Discount Booth (where theater tickets are sold at up to a new way, the MoMA is always an eye- and mind-opening 50% off face value) is topped with a giant red staircase, open experience. For more information, visit www.moma.org. to visitors daily until 1:00 am. Walk to the top of the steps and you will be rewarded with a sweeping view of the area, including the site of the annual New Year’s Eve Ball Drop. Elsewhere in Times Square, the City has created several new pedestrian-only zones furnished with tables and chairs, perfect for people-watching. The neighborhood is central to Midtown West, located near the Theatre District and Broadway shows. For more information, visit www.timessquarenyc.org.

For more information about other New York City attractions, please visit: www.nycgo.com. 136 AACAP NEWS 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

Why I ♥ NY! The Local Arrangements Committee is excited to welcome AACAP back to New York!

Scott M. Palyo, MD: I ♥ NY because New York is Melvin D. Oatis, MD: I ♥ NY for the opportunity a fantastic city, and its diversity makes it appealing of adventure just by walking down the street. Sans to everyone. Whatever your interests – food, parks, your distracting devices, you will be afforded the theatre, music, art, shopping, people watching – New possibility of taking in culture by listening to the York has it all. Our subway system (as well as the easy multitude of languages, the rhythm and fashion of access to cabs and Uber drivers) makes our meeting Gotham by watching the residents walk the runway of site easy to go wherever you want to go. Besides the our pedestrian friendly city streets and the aesthetic newer sites such as One World Trade Center, New beauty of the historical buildings surrounding you. Museum, and the Highline, there is also much to see in Times Square, Central Park, the fashion district, several the other boroughs. Feel free to explore; there is always museums, Columbus Circle, Rockefeller Center, and something to see wherever you end up. Radio Center Music hall are all within walking distance of AACAP’s Annual Meeting.

New Research Call For Papers AACAP’s 63rd Annual Meeting takes place October 24-29, 2016, in New York, NY. Abstract proposals are prerequisites for acceptance of all presentations given at the meeting. Topics may include any aspect of child and adolescent psychiatry including clinical treatment, research, training, development, service delivery, or administration.

Verbal presentation submissions were due February 16, 2016, and are no longer accepted. Abstract proposals for (late) New Research Posters must be received by Wednesday, June 15, 2016. All Call for Papers applications must be submitted online. The online Call for Papers submission form is available at www.aacap.org/AnnualMeeting/2016 in mid-April 2016. Questions? Contact AACAP’s Meetings Department at 202.966.7300, ext. 2006 or [email protected].

MAY/JUNE 2016 137 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

Residents, Trainees, and Medical Students ATTEND THE AACAP ANNUAL MEETING FOR FREE! Serve as a MONITOR for one full day or two half days of the meeting to receive free registration and half-price on most ticketed events. October 24-29, 2016 New York Hilton Midtown and Sheraton New York Times Square New York, NY

For more information about the Monitor Program, visit www.aacap.org/AnnualMeeting/2016/Monitors. Registration opens August 1 for AACAP members and August 8 for nonmembers. Become a member TODAY to get priority monitor scheduling!

Will You Join? Make a gift to AACAP in your will. Ensure AACAP’s Future! Visit www.aacap.org/1953_Society to learn more!

138 AACAP NEWS FOR YOUR INFORMATION

Membership CORNER

Congratulations Is Renewing Stressing You Out? to Graduating AACAP offers flexible payment solutions to meet Residents and your needs. Medical Students Take advantage of our monthly installment payment When planning your program. Contact Member Services at 202.966.7300, graduation ceremony ext. 2004, or email us at [email protected] to discuss your and after-party, be sure personalized payment plan options. to include AACAP! Please provide us with your updated contact and address information so you can put your AACAP member benefits to use Errata: In the March/April 2016 issue of AACAP News, for the next phase of your professional career. the Media Page review of the movie “Inside Out” and Dr. Mina Dulcan’s book “Dulcan’s Texbook of Child and Update your information online at www.aacap.org. Adolescent Psychiatry: Second Edition” were incorrectly credited to Erek Lorras, MD. It was in fact the last Media Page written by Harmony Abejuela, MD, as outgoing resident editor.

In Memoriam

Barbara Fish, MD Los Angeles, CA

Joel Ganz, MD Rockville, MD

Marla Warren, MD Mason, MI

We would like to amend the attribution of the March/April cover from Alvin Rosenfeld, MD, to Kathryn Massie. The photo features the granddaughter of Henry Massie, MD, (on left) and her friend (on right). Thank you Dr. Massie for contributing the great picture and following up on the correct acknowledgement.

MAY/JUNE 2016 139 FOR YOUR INFORMATION

100% CLUB Photos We’re incredibly proud of our 100% Club members!

All of your efforts and enthusiasm in your involvement with AACAP are much appreciated, and we want to give you the recognition you deserve. Plus, it’s always great for our community to see our future leaders.

If your program is in the 100% Club, thinks it is, or wants to be, please contact [email protected].

A big thank you to the 100% Clubs pictured here Institute of Living-Hartford Hospital 100%for sharing your photos! 100% 100% 100% 100% 100% 100% 100% 00%

University of Tennessee

100%Yale Child Study Center 100% 100% 100% 100% 100%

University of Massachusetts 100% 100% 100% 100% 140 100%AACAP NEWS 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% FOR YOUR INFORMATION

Tripler 100% 100% 100%Ponce Health Sciences University 100% 100% 100% 100% 100% 00% 100% 100% 100% 100%Palmetto Health-USC SoM Child Psychiatry 100% 100%

100% 100% Ann & Robert100% H. Lurie Hospital of Chicago-McGaw Medical Center of Northwestern University100% 100% MAY/JUNE 2016 141 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% FOR YOUR INFORMATION

Welcome New AACAP Members Himanshu Agrawal, MD, Minneapolis, MN Yasamaer Hemmat, Iowa City, IA Johanna F. Paulino-Woolridge, DO, Yusuf Ali, MD, Gainesville, FL Douglas Hess, DO, Sioux Falls, SD Laurel, MD Joseph Aloi, Omaha, NE Taman Hoang, Sacramento, CA Ian Peters, DO, Philadelphia, PA Yasser Al-Qahtani, MD, Daniel Hosker, MD, Rochester, MN Vincent Placido, DO, Mesa, AZ Toronto, ON, Canada Shani Isaac, MD, San Francisco, CA Rachel Anne Pontemayor, Mount Vernon, WA Hetal Amin, MD, O Fallon, IL Syed H. Jaffery, MD, Elmira, NY Kevin Quinby, Kansas City, MO Dallas Argueso, Philadelphia, PA Ather Sajjad Jafri, MD, Al Khoud, Diana Back, Minneapolis, MN Muscat, Oman Amer Qureshi, MD, Apex, NC Amanda Bailey, Chicago, IL Liisa Johnston, MD, Halifax, NS, Canada Mitchell Raymond, Owasso, OK Manpreet K. Bassi, Sacramento, CA Khushbu Joshi, Florence, NJ Laura Reale, MD, Milan, Italy Jessica Bayner, MD, Ridgewood, NJ Ayotunde Kafi, MD, Grande Prairie, Hilary Renaldy, Chicago, IL Stuti Bhandari, MD, Omaha, NE AB, Canada Kyley Roberts, Corpus Christi, TX Apurva Bhatt, Kansas City, MO Heather Kaminsky, West Orange, NJ Claudia Rocha, Sacramento, CA Emeric Bojarski, MD, Carlisle, MA Mitchel G. Katz, MD, Rocky Hill, CT Danielle Rome, New York, NY Rachel Bokelman, MD, Dearborn, MI Simreet Khaira, MD, Boston, MA Samer Roumani, Riverside, CA Xenia Borue, MD, PhD, Pittsburgh, PA Kristen Kim, Ridgefield Park, NJ Callum J. Rowe, Sacramento, CA Rosemarie Anne Boyle, Matthew S. Koval, MD, Schnecksville, PA John-Lloyd Santamarina, Sacramento, CA Center Moriches, NY Andrew Kuhle, DO, Rockville, MD Dana Sarvey, MD, Belmont, MA Kateland Branch, MD, Winston Salem, NC Alison Larson, DO, Little Falls, NJ Shimon Schwartz, MD, Somerville, MA Soledad Cabrera, MD, Moon Soo Lee, MD, Seoul, Jessica E. Shabo, MD, Paramus, NJ Montevideo, Uruguay Republic of Korea Suhal Shah, Middletown, NY Omar Canosa, MD, Morristown, NJ Elizabeth Lisi Leung, DO, Brooklyn, NY Susan Sharp, DO, Kansas City, KS Andrea Carlsen, MD, Huntington, NY Kimberly S. Lin, Pittsburgh, PA Andrew Silva, MD, Sterling Heights, MI Jennifer Chaffin, DO, Portland, OR Maria Jose Lisotto, MD, Philadelphia, PA Evita Singh, Powell, OH Catherine Chan, Arcadia, CA Yee Lo, Sacramento, CA Lindsey M. Smith, MD, Papillion, NE Julia Chung, MD, Tucson, AZ Vincent J. Lumsden, MD, Paramaribo, Kyle Stephens, MD, Tampa, FL Paramariabo, Suriname Lea DeFrancisci Lis, MD, Maya Strange, MD, Reno, NV Southampton, NY Irene Ly, Elk Grove, CA Rachel Sullivan, MD, Steilacoom, WA Alexander J. Demand, Tulsa, OK Neetu Malhi, Fresno, CA Christina Tolbert, MD, Charleston, SC Michael A. Donath, Sacramento, CA Martin Manoukian, Sacramento, CA Eloisa H. R. Valler Celeri, MD, Kim Drever, MD, Cotham, VIC, Australia Mohammad Mertaban, Campinas, Brazil South Burlington, VT Kristen Eckstrand, MD, Pittsburgh, PA Joshua Valverde, Jr., Peoria, IL Fortunata Grace Milano, MD, Medina, MN Mahmoud Ahmed El Wasify, MD, Nina Vasan, MD, Palo Alto, CA Mansoura Dakahlia, Egypt Andrew Miller, MD, Indianapolis, IN Sergey Veretennikov, Sacramento, CA Eyup Sabri Ercan, MD, Istanbul, Turkey Lorin Mowrey, Phoenix, AZ Ashaki Warren, MD, Cincinnati, OH Gretchen Ferber, Amherst, OH Hahit Mukaddes, MD, Istanbul, Turkey Sarah Weatherall, Providence, RI Luis A. Fernandez, Sacramento, CA Bernard Mulvey, Saint Louis, MO John Webber, MD, Little Rock, AR Kara Foster, MD, Kansas City, MO Anandhi Narasimhan, MD, Emily S. Weibel, Sacramento, CA Shannon Friedbacher, Muskego, WI Los Angeles, CA Rebecca Nkrumatt, Sacramento, CA Bernhard Weidle, MD, PhD, Itzayana Garcia, Los Angeles, CA Trondheim, Norway Roya Noorishad, MD, Brooklyn, NY Anisha Garg, MD, Philadelphia, PA James Welle, Atlanta, GA Katie Norris, Scottsdale, AZ Bahar Gokler, MD, Ankara, Turkey Alexa Whatmough, Saint Louis, MO Leah R. Grengs, Rochester, MN Nkechi Nwanolue-Abayomi, MD, Edmonton, Abm Canada Agnes Whitaker, MD, New York, NY Nihit Gupta, MD, Minneapolis, MN Hannah Oliver, DO, Bel Aire, KS Brady Yates, MD, Chevy Chase, MD Linda Halldner Henriksson, MD, Ghazal Zahed, MD, Tehran, Iran Taby, Stockholm, Sweden Patrick O’Malley, El Paso, TX Rachel Zambrowicz, Sleepy Hollow, NY Georgina Hartzell, MD, Atlanta, GA Ozgur Oner, MD, Ankara, Turkey Cristian Zeni, MD, PhD, Sugar Land, TX Matthew Heard, Philadelphia, PA Charles Oseroff, MD, Towson, MD Blaire Ashley Heath, Placentia, CA Keiho Owada, MD, Tokyo, Japan

142 AACAP NEWS FOR YOUR INFORMATION

Thank You for Supporting AACAP! AACAP is committed to the promotion of mentally healthy children, adolescents, and families through research, training, ­advocacy, prevention, comprehensive diagnosis and treatment, peer support, and collaboration. Thank you to the following donors for their generous­ financial support of our mission. Gifts Received February 1, 2016 to March 31, 2016 $100,000 – $249,999 Ravinder Bhalla, MD Frances Gottfried, PhD*, James C. Harris, MD Developmental Jennifer Bowden, MD* in memory of Joel Ganz, MD Neuropsychiatry Forum Stephen Brown, MD Peter Gray*, in memory of Joel Ganz, MD Sharon Burey, MD Stanley and Judith Gray*, James C. Harris, MD and Brady G. Case, MD in memory of Joel Ganz, MD Catherine DeAngelis, MD, MPH Tracy Das, MD* Susan S. Gullo*, in memory of Joel S. Ganz, MD $1,000 – $2,499 Alice L. Del Rosario, MD Michael Kahn*, in memory of Joel S. Ganz, MD Break the Cycle Peter Deschamps, MD, PhD Jimmie Leleszi, DO The Empathy Fund, in honor of Andres Martin Jana Kaye Dreyzehner, MD Deborah and Scott Mayster*, Nancy A. Durant, MD in memory of Joel S. Ganz, MD $500 – $999 Sarah Edwards, DO Boris Rubinstein, MD♥ AACAP Endowment Kathryn Flegel, MD Faye and Norm Seltzer*, Nancy Collins, MD Cara M. Fosdick, MD in memory of Dr. Joel Ganz George Alex Fouras, MD Marni Shapiro*, in memory of Joel S. Ganz, MD $100 to $499 Sarah Frazier, MD Arnold and Janet Sperling*, Barbara Gracious, MD♥ in memory of Joel Ganz, MD AACAP Endowment Alfreda Grosrenaud, MD* George L. Wing, MD Joseph Drinka, MD Olayinka R. Harding, MD* Elizabeth Hay, MD* Research Initative Campaign for America’s Kids Steven P. Cuffe, MD♥ Erum Ali, MD* Shamina J. Henkel, MD Martin J. Drell, MD♥ Brigitte Hristea, MD* Virginia Q. Anthony Fund Megan E. Jones* Mariflor S. Jamora, MD Alice R. Mao, MD♥, Brian Keyes, MD Ashok Khushalani, MD in honor of Rob Grant and Stephanie Chow Mark D. Kilgus, MD, PhD* Kristie Ladegard, MD Where Most Needed Marie-Josephe Viard, MD Tia R. Konzer, DO* Jack Levine, MD* General Contribution International Initiative Jocelyn Lluberes, MD A. Scott Dowling, MD* Teresa M. Hargrave, MD Thomas L. Lowe, MD Ryan Herringa, MD, PhD♥ Elizabeth DeRose Kowal, MD Life Members Fund Ghada Lteif, MD Linda Lundin, MD Adam Lucas* Virginia Q. Anthony Pamela Marinchak, MD* Joseph R. Mawhinney, MD Ellen and George Bahtiarian*, Jose M. Marrero, MD Clinton Y. Montgomery, MD* in memory of Joel Ganz, MD Sanjay Masson, MD* Richard Nightingale, MD Ronald Borchardt, MD Michael B. Mefford, MD* Miguel Cardosa Silva* R. Barkley Clark, MD J.Richard Navarre, II, MD* Mini Tandon, DO♥ John E. Dunne, MD Peter D. Nierman, MD Lois Fried*, in memory of Joel Ganz Workforce Development Charles Oseroff, MD* Joseph B. Greene, MD Summer Medical Student Fellowship Muralikrishnan Parthasarathy, MD Merle Haberman*, in memory of Joel S. Ganz, MD Paula Marie Smith, MD♥ Yann Poncin, MD Susan Haberman*, in memory of Dr. Joel Ganz Richard G. Pugliese, MD 1953 Society Members Bruce Hauptman, MD Ann E. Saunders, MD Anonymous (4) Marie T. House*, in memory of Joel Ganz Laura Schafer, MD* Steve and Babette Cuffe Steven Janowitz*, DDS, Susan M. Scherer, MD James C. Harris, MD and in memory of Joel Ganz, MD Sonia Thomas, MD* Catherine DeAngelis, MD, MPH Lenore McKnight, MD Raymond G. Troy, MD Paramjit T. Joshi, MD Militza Stevanovic, MD Dominique Vo, MD, MPH Joan E. Kinlan, MD Jeffrey Sverd, MD Kai-ping Wang, MD Dr. Michael Maloney & Dr. Marta Pisarska Paramjit Toor Joshi, MD International Robyn Leigh Wechsler, MD Jack and Sally McDermott Scholars Award Deborah Marcia Weisbrot, MD (Dr. Jack McDermott, in memoriam) Reeba Chacko, MD Yvette Yvette Westlake, MD* Patricia A. McKnight, MD Timothy John Whalen, MD Scott M. Palyo, MD Where Most Needed Thomas P. Williams, MD, PhD The Roberto Family General Contribution Lloyda Broomes Williamson, MD Diane H. Schetky, MD Sarah Carroll* Ross A. Yaple, IV, MD Gabrielle L. Shapiro, MD Victor Fornari, MD Diane K. Shrier, MD and Adam Louis Shrier, Gregory K. Fritz, MD International Initiative D.Eng, JD Quinton C. James, MD James Jenson, MD Michael Kahn* * Indicates a first-time donor to AACAP ♥ Life Members Fund Matthew N. Koury, MD, MPH Wafaya Abdallah*, in memory of Dr. Joel Ganz ° Indicates an honorarium donation Amazon Smile Harold and Ruth Baskin*, ♥ Indicates a Hope Maker recurring monthly Sheila Sontag, MD in memory of Dr. Joel S. Ganz donation Jeffrey Sverd, MD Eileen Bazelon, MD Up to $99 Joseph J. Colella*, in memory of Joel S. Ganz, MD Every effort was made to list names correctly. Campaign for America’s Kids Geraldine Dubit*, in memory of Dr. Joel S. Ganz If you find an error, please accept our Alan Mark Ezagui, MHCA♥ Dejene Abebe, MD apologies and contact the Development Reza Feiz, MD James C. Ashworth, MD Department at [email protected] or Ashley Finke*, in memory of Joel S. Ganz Terrence C. Bethea, MD 202.966.7300 ext. 130. Sol Goldstein, MD* MAY/JUNE 2016 143 FOR YOUR INFORMATION

AACAP Policy Statement

Transgender Youth in Juvenile Justice and Other Correctional Systems Approved by Council on March 16, 2016

Research demonstrates that transgender youth are at increased risk for being bullied, harassed and physically assaulted. They also have a higher incidence of suicide attempts. For these reasons, transgender youth face particular challenges in juvenile justice and other correctional systems.

The American Academy of Child and Adolescent Psychiatry opposes all discrimination based on gender identity. Consistent with this position, AACAP recommends that detention and corrections staff classify and house all youth consistent with their gender identity, as the youth defines it. Based on individualized risk assessments, facilities should take the necessary precautions to ensure the safety of every youth in their custody, including transgender youth.

AACAP further recommends that transgender youth should be referred to by their preferred pronoun and name. AACAP also believes that transgender youth must have access to all educational and recreational programs and services available to the general youth population. Absent serious short term safety concerns, it is inappropriate, discriminatory and dangerous for transgender youth to be segregated, isolated or placed in solitary confinement due to resource limitations or the absence of an appropriate setting. Finally, AACAP believes that transgender youth in correctional systems are entitled to access to comprehensive psychiatric and other medical care consistent with prevailing national standards and guiidelines.

American Academy of Child and Adolescent Psychiatry (2009). Policy Statement on Sexual Orientation, Gender Identity, and Civil Rights

Hunt J and Moodie-Mills A (2012, June). The Unfair Criminalization of Gay and Transgender Youth, Center for American Progress

Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents. (2012). Journal of the American Academy of Child and Adolescent Psychiatry 51(9):957-974

World Professional Association for Transgender Health (WPATH) (2012). Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People (Version 7).

Shannan Wilber (2015) Lesbian, Gay, Bisexual, and Transgender Youth in the Juvenile Justice System, A Guide to Juvenile Detention Reform. The Annie Casey Foundation

For more information or to review AACAP’s Policy Statements visit www.aacap.org.

144 AACAP NEWS FOR YOUR INFORMATION

POLICY STATEMENTS AACAP Policy Statement Requirements Policies should: 1) be a statement regarding an important policy issue, 2) be a well-written statement, as brief as possible, 3) identify the target audience, 4) have the potential of having some specific impact, and 5) include ideas for distribution.

Platitudinous statements supporting “Apple Pie and Motherhood” or condemning the multitude of actions, behaviors, social events, or cultural patterns which may have some negative effect on children and families are not likely to serve the AACAP well and may, ultimately, undermine the credibility of AACAP efforts in other areas.

The final draft policy statement should be submitted by the author(s) or body (e.g., component or Assembly) to the Policy Statement Advisory Committee via the National Office. In formulating the policy statement, the authors should keep in mind the criteria as stated above. Statement must include ideas for distribution. If the author(s) wishes to have the statement reviewed by the next Executive Committee or Council, they must have the draft statement to the National Office eight weeks in advance. e f Policy Statement Procedures

»» Once a final draft policy statement is submitted by an individual author(s) or body (e.g., component orAssembly) to the Policy Statement Advisory Group (PSAG) via the National Office, the Policy Statement Advisory Group Chair directs that: •• the author(s) is told what major revisions or minor edits are necessary. After the author(s) has revised the statement, they may resubmit to the PSAG; OR •• The author(s) is informed that the statement does not meet the criteria for a policy statement.

»» If the PSAG recommends it, the Executive Committee reviews the statement to decide whether it should be e-mailed to Council or placed on Council’s meeting agenda. If the Executive Committee decides not to advance the statement, the author(s) may be contacted to resolve the issue(s).

»» If emailed, Council members have a two-week discussion period in which to convey concerns and ask questions. After this period, a one-week voting period begins.

»» If Council approves the statement, the author(s) is notified. The statement is printed inAACAP News and distributed to the recommended sources then placed on the AACAP website.

»» If Council does not approve the statement, the author(s) may be requested to rewrite and resubmit to the PSAG with an explanation of what changed.

»» Every two years, the PSAG reviews all policy statements for necessary revisions or updates. Revisions are made by the original author(s), if available, or by known specialists in that area of expertise. The revising author(s) is given a 3-month period to make changes and resubmit to the PSAG for final approval.

»» Annually, committee chairs are asked to review policy statements online and update if necessary.

*revised 10/2012

MAY/JUNE 2016 145 FOR YOUR INFORMATION AACAP News ADVERTISING RATES ADVERTISING DEADLINES Inside front, inside back or back cover . . $4,000 July/August 2016 ...... May 27 Full Page ...... $2,000 September/October 2016 ...... July 27 Half Page ...... $1,600 November/December ...... September 27 Third Page ...... $1,100 January/February 2017 ...... November 27 March/April 2017 ...... January 27 Quarter Page ...... $700 DISCOUNTS CLASSIFIED ADVERTISING RATES ✦✦ AACAP members and nonprofit entities receive ✦✦ $12 per line (approximately 6-8 words per line) . a 15% discount . ✦✦ Classified ad format listed by state . Typesetting ✦✦ Advertisers who run ads three issues in a row receive by AACAP . a 5% discount . ✦✦ Commission for advertising agencies not included . ✦✦ Advertisers who run ads six issues in a row receive a 10% discount .

For any/all questions regarding advertising in AACAP News contact [email protected].

146 AACAP NEWS FOR YOUR INFORMATION CLASSIFIEDS CALIFORNIA A devoted team of clinicians, support LOUISIANA and administrative staff are there to FULL-TIME AND PART-TIME CHILD CHILD AND ADOLESCENT assist in any way to ensure a comfort- AND ADOLESCENT PSYCHIATRIST able, respected and balanced work/ PSYCHIATRIST Malibu, CA life environment. On Call Schedule: ER New Orleans, LA Paradigm Malibu is currently seeking phone call 5-6 days with 1 weekend per OCHSNER HEALTH SYSTEM is seeking a part- and full-time Board Certified month. No in-house call, coverage by a BC/BE CHILD AND ADOLESCENT Child and Adolescent Psychiatrist to join phone. Patient population is a wonder- PSYCHIATRIST to practice at OCHSNER our compassionate and expert clinical ful payor-mix blend. 1-2 average patient MEDICAL CENTER in NEW ORLEANS. services at Paradigm Malibu. We offer a admissions per call. Our Child and Adolescent Psychiatry warm and inviting team atmosphere, a Section offer outpatient consultation, highly competitive salary and excellent Please forward CV and detailed cover evaluation, testing and treatment for benefits package. Please submit ques- Letter to: Nancy Mathieu Nancy. children and adolescents with prob- tions or your curriculum vitae/resume [email protected] lems related to behavior, feelings, and we provide a timely response. emotions, thinking and learning. The Please visit www.advocatechild- approach involves teams of social work- Job Requirements: renshospital.com/ach/ and www. ers, psychologists and psychiatrists, in • Board certified child and adolescent amgdoctors.com/about-us/ for more close collaboration with educational psychiatrist detailed information. specialists, primary care pediatricians • Ability to see client in Malibu, and pediatric specialists. Opportunities California CHILD AND ADOLESCENT exist for teaching through our combined PSYCHIATRIST Ochsner-LSU psychiatry residency ILLINOIS Chicago, IL program. Salary offered will be competi- Northwestern Medicine Central Dupage tive and commensurate with experience INPATIENT (WITH OPTIONAL Hospital and Northwestern Medicine and training. OUTPATIENT) CHILD AND Delnor Hospital is seeking a BE/BC Child ADOLESCENT PSYCHIATRIST and Adolescent Psychiatrist. This posi- Ochsner Health System is Louisiana’s Suburban Chicago tion would be based primarily at Central largest non-profit, academic, healthcare Advocate Childrens Medical Group at Dupage Hospital, outpatient clinic and system. Driven by a mission to Serve, Advocate Childrens Hospital in Park potentially a mix of inpatient consults Heal, Lead, Educate and Innovate, Ridge, Illinois seeks a full time flexible and partial hospitalization program. This coordinated clinical and hospital BE/BC Child and Adolescent Psychiatrist is an outstanding opportunity for a new patient care is provided across the with excellent interpersonal skills and or experienced psychiatrist to build your region by Ochsner’s 28 owned, man- a passion for improving the lives of career with the premier health provider aged and affiliated hospitals and more children. Come join an outstanding in the western suburbs of Chicago. than 60 health centers. Ochsner is the multidisciplinary team to provide care only Louisiana hospital recognized by for and an opportunity to lead one of the • Employed position with Northwestern U.S. News & World Report as a “Best few and truly unique child and adoles- Medicine Regional Medical Group. Hospital” across six specialty categories cent inpatient psychiatry units in the • Full-time Opportunity. caring for patients from all 50 states and more than 99 countries worldwide each Chicagoland area! • Competitive compensation and year. Our medical school, the Ochsner outstanding benefits. This would be primarily an inpatient Clinical School, in partnership with the • EPIC electronic health system. role providing services to patients in the University of Queensland in Australia, 12-bed C/A inpatient psychiatric unit, • Outstanding 24/7 nursing enrolls 130 medical students each year. partial hospitalization program, and support staff. We also have the largest graduate medi- patients on the general medical floors • Great Location – Western Suburbs cal educational (GME) program in the through consultative work. (Outpatient of Chicago, easy access by Metra/ state. Ochsner employs more than 1,000 work would be optional.) Assist in being expressway. physicians in over 90 medical specialties part of an extraordinary and nationally and subspecialties and conducts more renowned hospital network focused Job Requirements: than 900 clinical research studies. For on development of its child behavioral • BE/BC in Child and Adolescent more information, please visit www. health services. There are opportunities Psychiatry ochsner.org. New Orleans is one of for growth and leadership and additional • Illnois licensure in good standing the most exciting and vibrant cities in responsibilities may include hospital America. Amenities include multiple uni- staff education, community education versities, academic centers, professional and partnerships, and assisting in the sports teams, world-class dining, cultural supervision and teaching of a wonder- interests, renowned live entertainment ful group of dedicated psychiatry and and music. pediatric residents.

MAY/JUNE 2016 147 FOR YOUR INFORMATION

Please e-mail CV to profrecruiting@och- to: Wun Jung Kim, MD, MPH wunjung. predictable and stable compensation sner.org or call 800-488-2240 for more [email protected] plan as well as bonus compensation A information. Reference # CAPSYC-5. comprehensive benefit package Akron Job Requirements: Children’s Hospital is set in the beautiful Sorry, no opportunities for J1 Fellowship training in child and adoles- Cuyahoga Valley, just minutes south of applications. cent psychiatry is required. Cleveland. From major league attractions to small-town appeal, the greater Akron Ochsner is an equal opportunity area has something for everyone. The employer and all qualified applicants OHIO area is rich in history and cultural diver- will receive consideration for employ- CHILD AND ADOLESCENT sity, and provides a stimulating blend of ment without regard to race, color, PSYCHIATRIST outstanding educational, cultural and religion, sex, national origin, sexual Akron, OH recreational resources. This four-season orientation, disability status, protected community will have outdoor enthusi- Ohio based Akron Children’s Hospital veteran status, or any other characteristic asts thrilled with over 40,000 acres of seeks a Weekend Child and Adolescent protected by law. Metro Parks for year round enjoyment. Psychiatrist to join its mental health Northeast Ohio has become a premiere team. Akron Children’s Hospital is the destination to work, live, play, shop and largest pediatric healthcare system in NEW JERSEY dine! Interested candidates may submit Northeast Ohio and was recently named ACADEMIC CHILD AND their CV to Jane Hensley, via e-mail to by Modern Healthcare as the fastest ADOLESCENT PSYCHIATRIST – [email protected]. To learn more, growing children’s hospital in the nation! ASSISTANT/ASSOCIATE PROFESSOR visit our website at www.akronchild- Akron Children’s Hospital is nation- New Brunswick, NJ rens.org or call 330-543-3015. ally ranked by US News and World Rutgers Robert Wood Johnson Medical Report in seven pediatric specialties Job Requirements: School Cancer Institute of New Jersey and is an integrated healthcare delivery Requirements include MD or DO The Division of Child and Adolescent system that includes: Two free-standing degree, board eligibility/certification in Psychiatry at Rutgers Robert Wood pediatric hospitals 700 providers, who Child and Adolescent Psychiatry and Johnson Medical School (RWJMS) has manage over 850,000 patient visits the ability to obtain an active medical an opening for a full time CA Psychiatrist annually A network of 80 primary and license in the state of Ohio. to work both with patients with can- specialty care locations Robust research cer at Cancer Institute of New Jersey and innovation endeavors Over 5,000 DIRECTOR OF CHILD AND (CINJ), and with outpatients in one of employees, nurses and healthcare ADOLESCENT PSYCHIATRY our general child and adolescent clinics professionals The successful candidate Dayton, OH at University Behavioral Health Care will join a well-established team of (UBHC). The position is at the Assistant/ 10 Child and Adolescent Psychiatrists The Psychiatry Department at WRIGHT Associate Professor level and includes and 5 Advanced Practice Nurses, who STATE’s Boonshoft School of Medicine protected teaching time. Responsibilities provide comprehensive mental health is seeking a proven academic and include direct patient care as well as services. Inpatient care is provided in a research leader to become the Director teaching medical students and resi- 14 bed inpatient which will be expanded of Child and Adolescent Psychiatry dents from multiple services and CAP to a 24 bed unit by the end of 2016. (CAP). The CAP Director is one of Fellows. Teaching is an integral part of Outpatients are treated in the 20 bed the key faculty members involved in the service and time is protected for partial hospitalization unit and through growing and maintaining the academic, formal didactic teaching. Research is intense outpatient service programs. In research and clinical presence of the encouraged and the successful can- addition, the Psychiatric Intake Response entire department by delivering effec- didates will be expected to develop Center, co-located in the Emergency tive administration, leadership and an area of scholarly focus. Fellowship Department at Akron Children’s Hospital mentorship. All faculty members enjoy training in child and adolescent psychia- provides access to behavioral health the opportunity for clinical contract and try is required. The Division of Child services 24 hours a day, 7 days per private practice through the auspices and Adolescent Psychiatry is based at week. This position offers opportuni- of WRIGHT STATE PHYSICIANS. Robert Wood Johnson Medical School ties for: Weekend only responsibilities Candidates should be board eligible or in the Department of Psychiatry which affording exceptional work-life balance certified in Psychiatry. offers a range of training programs, Partnership with an established team Job Requirements: including a fellowship in CAP, as well as of child and adolescent psychiatrists • MD or DO degree clinical services and multiple research Active involvement in medical student, opportunities. The Rutgers Robert Wood resident and fellowship education; • Board Certification (ABPN) Johnson Medical School (RWJMS) is academic appointment at Northeast • Ohio Medical License or eligible. a vibrant medical school located on Ohio Medical University is available and • 2-5+ years combined aca- the campus of Rutgers University in commensurate with experience Research demic, research and/or medical New Brunswick, New Jersey – mid and innovation available through the administration experience. way between New York City and Rebecca D. Considine Research Institute Assistant Professor level candidates must Philadelphia. This is a great opportunity and partnerships with NEOMED and fulfill all the requirements listed above. for someone interested in psychoso- local university-based scientists with Associate Professor level candidates matic medicine and an academic career. a variety of interests and expertise in must fulfill all the requirements of Please email your CV and cover letter clinical and translational research A

148 AACAP NEWS FOR YOUR INFORMATION assistant professor along with at least 5 CMHC, clinical contracts and Job Requirements: years’ experience at the assistant profes- office hours – Patient care. (or more Successful completion of an ACGME sor level with an exemplary scholarly time attributed to grants, scholarly accredited psychiatry residency portfolio and supervisory experience. and teaching) Successful completion of an ACGME Full Professor level candidates must accredited child & adolescent fellowship fulfill all the requirements of Associate Serve as liaison between the Chair, WSU Eligiblity to obtain a PA medical license Professor along with at least 5 years’ Boonshoft School of Medicine and other Eligibility to obtain a DEA license experience at the associate professor community and state agencies. level with an exemplary scholarly portfo- lio and leadership experience. QATAR PENNSYLVANIA DIVISION CHIEF – CHILD AND Preferred Qualifications: CHILD AND ADOLESCENT ADOLESCENT PSYCHIATRY • Proven knowledge of grant writing, PSYCHIATRIST Sidra, Qatar reporting and processes. York, PA • Proven leadership and ability to Reporting to the Chair of Psychiatry, Child and Adolescent Psychiatrist Take function in a professional, collab- the Division Chief provides clinical, Advantage of Our Educational Loan orative manner with community education, research and executive Repayment Plan! Wellspan Health, a stakeholders, faculty peers, medical management leadership in Child and progressive medical community in York, students and psychiatry residents and Adolescent Psychiatry. The Division PA, is seeking a successful candidate fellows. Excellent human relations Chief is a clinical and managerial leader who will provide Child and Adolescent skills, independent judgment, initia- working with the Sidra executive team outpatient behavior health care. This is tive, planning capability and ability to develop and deliver strategy and an opportunity to join a large Behavioral to serve as a model for excellent business plans and is accountable for Health department with strong support in research and clinical care. Track resources and performance in Child and from leadership. WellSpan Health is a record of research and other schol- Adolescent Psychiatry and integrates top-rated, integrated health system with arly activities. Knowledge of relevant research and education priorities into a focus on a high-quality patient care. clinical skills applicable to research or a program of excellent clinical ser- About the Practice Join a team of 6 practice settings. vice delivery. It is anticipated that the fellowship-trained child and adolescent Division Chief will be able to continue psychiatrists Excellent daily schedule with personal clinical, educational and Essential Functions and Percentage with no weekend appointments Typically research activities albeit in a reduced of Time manage 15 patients per shift Call is and modified manner, and will have a Division Direction – Direct, strategize limited Must have PA medical license full-time appointment with Weill Cornell and organize the activities of the divi- and be a BC/BE Psychiatrist Must be a Medical College – Qatar and hold the sion. Formulate current and long-term graduate of accredited school of medi- position of Vice Chair in the Department program plans with related policies. cine with Doctor of Medicine degree of Psychiatry at Sidra. Participate in departmental strategic plus completion of residency training planning. Prepare and present informa- program in Psychiatry Be a member of Key Role Accountabilities: tion in facilitating these interactions for our large Behavioral Health Department decision making. Direct the revision of with over 20 Psychiatrists and 60 • Identifies and articulates the vision, rules, regulations, and procedures to licensed therapists Benefits Competitive strategic direction, and growth of meet changes in law, policy or accredita- salary, sign on bonus and educational the Division of Child and Adolescent tion. Participate in the hiring of relevant loan repayment Health, life and dis- Psychiatry and collaborates on the faculty and staff. Maintain records, ability insurance Retirement savings implementation of strategies to prepares reports and composes cor- plan with employer automatic contri- achieve them. respondence relative to the division and bution and employer match Medical • Leads clinical service plan- its activities. Direct the overall program malpractice insurance and tail coverage ning, service development and of clinical activities. Mentor division Continuing Medical Education time off capacity planning for the clinical members. Supervise and participates in and stipend Relocation Physician-led activities of Child and Adolescent residency recruitment efforts. medical group Lifestyle Conveniently Psychiatry services. located 45 minutes north of Baltimore • Promotes leadership and direction Research & Scholarly – Investigate and 90 minutes west of Philadelphia for the development of strategies to and facilitate funding opportunities for Abundant outdoor and cultural activi- promote the recruitment, retention, the program and/or related research. ties including restaurants, theatre, golf and direct mission of excellence for Expected to publish regularly on pro- courses, hiking, water sports, farmers the medical staff, and collaborates gram and project related topics. markets and downtown access to a with the Division Chiefs to execute 42-mile recreation trail Family oriented the strategies. Teaching – Teach and supervise fel- community, with excellent schools, low • Recommends clinical privileges, lows, psychiatry residents and medical cost of living and low crime rates. appointment, reappointment and students. Collaboration with the training corrective action for each member of directors is essential. the Division of Child and Adolescent Administer current division relationships, Psychiatry as well as promoting support, grants and funding.

MAY/JUNE 2016 149 FOR YOUR INFORMATION

mentorship and academic career requiring medical care from the Child treatment procedures, services development for these staff members. and Adolescent Psychiatry Division and resources. • Responsible for all administrative (including emergency care). • Promotes and evaluates physician related activities of the Child and • Ensures all members of the Child community outreach programs Adolescent Psychiatry Division and Adolescent Psychiatry Division as appropriate. unless otherwise provided for by the optimize the use of electronic • Develops, manages and sup- hospital, and serves on all requested medical records. ports physician and community committees including medical execu- • Sets and achieves targets for programs relationships, coordinating and tive committee, and appointing such and procedures for confidentiality of disseminating information to all stake- committees as necessary to conduct all patient information in accordance holders to solicit ongoing support the function of the department. with hospital policy and the privacy from the State of Qatar for Child and • Develops and implements policies laws of the State of Qatar. Adolescent Psychiatry. and procedures that guide support • In conjunction with the Service Chief, • Promotes outreach and communica- provision of services to the Child and ensures the implementation of robust tions with non-Sidra to providers of Adolescent Psychiatry Clinic services. clinical governance structures and Child and Adolescent Psychiatry care • Continues surveillance of the processes to ensure patient safety. to help Sidra function as the pre- professional performance of all indi- • In conjunction with the Chief mier regional Child and Adolescent viduals in the Child and Adolescent Research officer and division heads Psychiatry Center of the Gulf Region. Psychiatry Division who have of research, ensures a program of • Identifies and coordinates resolution delineated clinical privileges, includ- clinical and translational research is of problems to improve physician ing performance, and ongoing and developed and promoted and deliv- utilization and patient satisfaction. focused professional practice evalua- ered within the Child and Adolescent • Develops and maintains appropriate tions (OPPE and FPPE). Psychiatry Division. systems of communication between • Continues surveillance of patient care • In conjunction with the Dean of Sidra and other providers of primary and the professional performance Weill Cornell Medical College – and advanced Child and Adolescent of all individuals in the Child and Qatar ensures there is an active and Psychiatry services in Qatar for the Adolescent Psychiatry Division who continuous program of undergradu- purpose of individual patient care have defined clinical privileges. ate teaching within the Child and and systemic safety and quality • Ensures that the staff of the Child and Adolescent Psychiatry Division to improvement Adolescent Psychiatry Division pro- ensure an effective learning environ- • Supports the development of Sidra as vides services that are in compliance ment for students, residents, and a world class regional center. with all applicable standards and medical staff. • Adheres to Sidra’s standards as they requirements of the Joint Commission • Is actively involved in research, appear in the Code of Conduct and International, Qatar Supreme Council graduate teaching, and publication Conflict of Interest policies. of Health, and all other applicable in higher impact journals, advis- regulatory bodies. ing of students and participation in Scope of clinical responsi- • Accountable for the financial academic services. bilities for Division Child and performance and management of • Ensures effective communication with Adolescent Psychiatry: all budgets within the Child and and involvement of all staff within • Screening consultations for diag- Adolescent Psychiatry Division. the Child and Adolescent Psychiatry nostic and therapeutic procedures • Implements the clinical service strate- Division in regards to key decisions as indicated. gies and business plan for the Child and initiatives. • Coordination of care for com- and Adolescent Psychiatry Division. • Works collaboratively with other plicated Child and Adolescent • Makes recommendations for the pur- service chiefs, chief officers, and Psychiatry cases. chase of capital and other equipment executive directors to achieve broad • Coordinates appropriate referrals and participates in the evaluation of Sidra objectives. and transfers under standard and products for use by different mem- • Conducts other duties as may be emergency situations. bers of the Child and Adolescent directed by the Clinical Service Chief Psychiatry Division to ensure their of Psychiatry, Chief Medical Officer Sites of practice: safety and efficacy. and / or Chief Executive Officer. • Outpatient clinic building at Sidra and Sidra hospital building. • Sets and achieves targets to drive con- • Initiates, implements and over- tinuous assessment and improvement sees programs designed to foster • Telemedicine consultation when of the quality of care and services positive relations between Child and developed and appropriate. provided and initiates actions for Adolescent Psychiatry physicians and • Procedure rooms in the clinic suites necessary improvements according to other Child and Adolescent Psychiatry (and in hospital when needed Sidra Board initiatives. Division staff, and the hospital opera- and appropriate) • Works with the Service Chief to tions and administration. • Site visits to referring and affiliated establish and update the work week • Assists with marketing strategies hospitals and clinics when requested standards for all physicians on staff to inform physicians and their staff and appropriate. and assures that there is appropri- of Sidra’s clinical diagnostic and ate clinical coverage for all patients

150 AACAP NEWS FOR YOUR INFORMATION

SELECTION CRITERIA: accredited by the Accreditation Council youngsters with a variety of serious Education: for Graduate Medical Education. It is psychiatric and behavioral difficul- • MD degree (or equivalent) a four year program and currently has ties from across the Commonwealth. 15 residents. Emphasis is on general Treatment is provided in a relationship- • Residency Training in Psychiatry psychiatry supported by departmental based, collaborative, trauma-informed (or equivalent) and community resources in specialized treatment model of care. The mission of • Subspecialty Fellowship in Child and care areas. Residents participate in a CCCA is to provide high quality acute Adolescent Psychiatry (or equivalent progression of experiences which blend psychiatric evaluation, crisis stabilization, training or certification) inpatient and outpatient care responsi- and intensive short-term treatment that bilities with a series of didactic seminars. empowers children and their families Experience: Research activities are encouraged to make developmentally appropriate • 10+ years post-residency clinical through opportunities in ongoing clinical choices and that strengthens children’s experience in the relevant field from and basic science studies. Junior and hope, resilience and self esteem. a North American Academic/ Health senior medical students rotate through care Institution or equivalent in UK, the department and resident have an As psychiatrist, you will be responsible Republic of Ireland, Australia or opportunity to participate in their educa- for providing high quality psychiatric New Zealand. tion. The Texas Tech University Health evaluations and treatment services to • 5+ Plus years in academic leadership Sciences Center has been a leader in assigned child and adolescent clients in child and adolescent psychiatry education and patient care in the West and their families. You will function • Expertise in Child and Adolescent Texas area for over 40 years. Since 1969, as a member of a collaborative, multi- Psychiatry the organization has grown into a seven- disciplinary team providing diagnostic evaluations, medication management, • Presentations at National / school university. Lubbock is a family and individual therapy for children International level (Preferred) friendly community offering a mild cli- mate, low cost of living, and high-quality and adolescents with significant psy- • Peer Reviewed publications public and private schools. Lubbock and chiatric, emotional, behavioral, and (Preferred) the surrounding communities comprise a environmental challenges. population of over a quarter of a million Certification and Licensure: For further requirements and to apply, • Active license to practice year round residents plus patients from New Mexico. With multiple universi- please visit the Virginia Jobs at medicine in home country (or https://virginiajobs.peopleadmin.com. equivalent certifications) ties and professional schools, there are diverse entertainment and leisure Professional Membership: opportunities to accommodate any • American Academy of Child And tastes. Qualified candidate will enjoy a Adolescent Psychiatry or Similar very competitive compensation package including production incentives after TEXAS first year, sign on bonus, minimal call, relocation expenses up to $10K, CME/ ACADEMIC CHILD AND Professional Development, exceptional ADOLESCENT PSYCHIATRIST benefits package, i.e. vacation and sick Lubbock, TX leave, retirement, malpractice insurance. Texas made the 2015 list on the best Interested applicants should apply states for physicians. Why? No state online through Texas Tech Jobs http:// income tax. Fewer malpractice lawsuits. jobs.ttuhsc.edu/child-adolescent- Excellent medical community. The Texas psychiatrist-psychiatry-dept-lbk-genl/ Tech University Health Sciences Center job/5542046 or contact sarah.harris@ School of Medicine is seeking a BE/ ttuhsc.edu for questions! BC psychiatrist to join busy academic practice. We are open to all levels of Job Requirements: experience including 2016/2017 fel- MD/DO BE/BC Fellowship Trained lows. Clinical opportunities abound throughout the community including: Outpatient Service – TTUHSC Psychiatry VIRGINIA Clinic Consultation/Liaison Service University Medical Center (https:// CHILD AND ADOLESCENT www.umchealthsystem.com/) Covenant PSYCHIATRIST – PART TIME Medical Center – Lakeside (http:// Staunton, VA www.covenanthealth.org/view/default) The Commonwealth Center for Children Child-Adolescent Psychiatry Service and Adolescents (CCCA) invites you TTUHSC Psychiatry Clinic Lubbock to consider a child and adolescent Independent School District Community psychiatry position in the beautiful Psychiatry Student Wellness Center at Shenandoah Valley. CCCA is Virginia’s Texas Tech University The Department only public acute psychiatric hospital for of Psychiatry’s residency program is fully children and adolescents. CCCA serves

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