AACAP

A Publication of the News n July/August 2016 n Volume 47, Issue 4

Photo: U.S. Representative Brad Ashford (D-NE) Inside... President’s Message: Making the Rounds and Making a Difference...... 157 Psychopharmacology Corner: Atypical or Second-Generation Antipsychotics... 161 60th Congress of AEPNYA in San Sebastian: A Shared Initiative with AACAP!...164 My Introduction to The Life: Domestic Minor Sex Trafficking...... 169 2016 AACAP Legislative Conference Recap – Successfully Advancing Children’s Mental Health...... 174 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY...... 188

TABLE of CONTENTS

COLUMNS Neera Ghaziuddin, MD, Section Editor • [email protected] President’s Message: Making the Rounds and Making a Difference • Gregory K. Fritz, MD...... 157 President’s Initiative: Implementing Integrated Care Models in Clinical Programs • Khyati Brahmbhatt, MD. . . . 159 PSYCHOPHARMACOLOGY Gabrielle A. Carlson, MD, Section Editor • [email protected] Psychopharmacology Corner: Atypical or Second-Generation Antipsychotics • Gabrielle A. Carlson, MD, Harold E. Carlson, MD, and Christoph U. Correll, MD ...... 161 AEPYNA AND AACAP 60th Congress of AEPNYA in San Sebastian: A Shared Initiative with AACAP! ...... 164 COMMITTEES Ellen Heyneman, MD, Section Editor • [email protected] AACAP Schools Committee: An Innovative Model for Integrating Substance Use Treatment in Schools • Kristie Ladegard, MD, Amanda Ingram, LCSW, CAC III, and Meg Benningfield, MD...... 167 Consumer Issues Committee: My Introduction to The Life: Domestic Minor Sex Trafficking • George (Bud) Vana, MD. . 169 Telepsychiatry Committee: Integrating Telemental Health with the Patient-Centered Medical Home Model • Jennifer K. McWilliams, MD, MS, and the Telepsychiatry Committee ...... 170 Regional Organizations of Child and Adolescent Psychiatry: How Can We Increase Access to Care? – A Letter From a Busy Child and Adolescent Psychiatrist to a Primary Care Physician • Mark S. Borer, MD ...... 172 LEGISLATIVE RECAP 2016 AACAP Legislative Conference Recap – Successfully Advancing Children’s Mental Health • Ronald Szabat, Esq., Michael Linskey, Emily Rohlffs, and Zachary Kahan...... 174 AACAP Resident Scholars • Justin Schreiber, DO, and Laura Willing, MD...... 176 Legislative Conference Recap Photos...... 177 NEWS Garrett M. Sparks, MD, Section Editor • [email protected] News Updates ...... 181 FEATURES Alvin Rosenfield, MD, Section Editor • [email protected] Media Page • Erik Loraas, MD ...... 183 OPINIONS Harmony Raylen Abejuela, MD, Section Editor • [email protected] Honors Presentation: Sidney Berman Award “Where There’s a Will, There’s a Way” • John T. McCarthy, MD . . . . . 184 63RD ANNUAL MEETING Jon (Jack) McClellan, MD, Section Editor • [email protected] Check It Out! ...... 188 Why I ♥ NY!...... 190 Wellness Initiative...... 191 Integrated Care Programs ...... 192 FOR YOUR INFORMATION Congratulations! Highest Rated Speakers...... 194 Membership Corner...... 195 In Memoriam ...... 195 Welcome New AACAP Members...... 196 Beneficiary Designations: A Gift to AACAP that Costs Nothing Now...... 197 Thank You for Supporting AACAP!...... 198 Classifieds...... 200

Cover Photo: U.S. Representative Brad Ashford (D-NE) and a very ambitious, energetic, and enthusiastic AACAP Legislative Conference family member. Congressman Ashford was more than accommodating in letting our young “advocate” sit in his chair. Mr. Ashford sat on his desk the entire meeting! 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 Jeffrey Hunt, MD, [email protected] Clinical Case Reports and 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 Making the Rounds and Making a Difference

Regional organizations typically wax a system in which 60 to 80 percent of and wane in terms of energy, initiative children with psychiatric disorders get for projects, and member involvement, no treatment at all. Integrated care – at and I was told this was the beginning least conceptually – improves access of a period of rejuvenation for their by involving primary care providers in organization. If so, they are well on their children’s mental health assessment and way. The attendance was excellent, treatment. When I speak to groups of enthusiasm was high, and the camara- child and adolescent psychiatrists on the derie seemed to be enjoyed by all. I led topic, the responses to my enthusiasm a discussion on the pros and cons of are typically mixed, with some skepti- ■ ■ Gregory K. Fritz, MD electronic medical records for child and cism balancing positive views. Such was adolescent psychiatrists. As is usually the the case in Wisconsin, and it made for ne of the pleasures of being case, the topic provoked a lively give- lively interactions. AACAP President is that I and-take that only partially fell along Ohave the opportunity to visit generational lines. I also got the chance In May, I had the pleasure of speaking a number of Regional Organizations of to talk about my favorite topic and the to members of the New York Council Child and Adolescent Psychiatry and focus of my Presidential Initiative – pedi- on Child and Adolescent Psychiatry meet with members on their home turf. atric integrated care. (NYCCAP) about my Presidential I have been doing this quite a bit this Initiative at its End of the Year event spring (enough that I have been sent I am an unabashed proponent of at the invitation of Scott Palyo, MD. reminders a couple of times that I also integrated care, with my enthusiasm With most of its child and adolescent have a day job), and it has been very admittedly exceeding the existing psychiatrists in the New York City area, enlightening, interesting, and rewarding. evidence supporting its effectiveness. NYCCAP is the largest and most active However, unless we find a way to of AACAP’s regional organizations. At the invitation of William J. Swift, dramatically enlarge the number of The highlight of this event was Victor III, MD, the President of the Wisconsin professionals who are interested in and Fornari, MD, receiving the Wilfred Council of Child and Adolescent competent to deal with some — if not C. Hulse Award for his outstanding Psychiatry, I traveled to Wisconsin in all — pediatric mental health prob- contributions to the field of child and early April for their annual meeting. lems, we will continue to be a part of continued on page 158

Left to right: Doug A. Kramer, MD, past president of WCCAP; Bill Swift, MD, president of the Wisconsin Council of Child and Adolescent Psychiatry; Gregory K. Fritz, MD, AACAP President; Kathleen Koth, MD, secretary, Jay O’Grady, MD, treasurer, and Peter Lake, MD, medical director of Rogers Memorial Hospital

JULY/AUGUST 2016 157 President’s Message continued from page 157 adolescent psychiatry. Heartfelt testimo- nials from colleagues attesting to Victor’s commitment and dedication to patients and their families, and his effective men- toring, were only outshined by Victor’s moving acceptance speech.

I also spoke at the annual meet- ing of the Regional Council of Child and Adolescent Psychiatry of Eastern Pennsylvania and Southern New Jersey in Philadelphia in early June. This event was the 22nd Annual Herman Staples Memorial Lecture and Dinner, at which it has become a tradition to have the AACAP president speak. Another part of this great tradition is to recognize the child and adolescent psychiatry gradu- ates from the training programs in the region, many of whom were in atten- Scott Palyo, MD, Gregory K. Fritz, MD, Victor Fornari, MD, and Laurence Greenhill, MD dance. I enjoyed this special chance to welcome our newest colleagues into our community.

The response to my presentation on integrated care was especially animated in this crowd, as many in the regional council are themselves involved in inte- grated care projects. Others underlined the challenges – financial, educational, and clinical – that need to be faced and resolved if integrated care is ever to make a large-scale difference in chil- dren’s mental health.

It is eye opening to see the differences Gregory K. Fritz, MD, and Victor Fornari, MD that exist around the country in mental health resources, systems of pediatric mental health care delivery, and the activities and philosophies of regional DID YOU KNOW? organizations. The one thing that is consistent wherever I have been is the evident passion and commitment to our profession. The corollary to that is the energy with which we embrace and defend our opinions. We are a lively, at times opinionated, but always respect- ful group with great ideas about how to improve children’s mental health.

I am convinced that AACAP, our profes- sional home, reflects the diversity of opinion, practicality, and commitment of its members, and I am finding it very gratifying to be AACAP President. m The first pizzeria in the United States was opened in NYC in 1895.

158 AACAP NEWS PRESIDENT’S INITIATIVE Implementing Integrated Care Models in Clinical Programs

accountable care. Programs that inte- and leverages increased coordination of grate mental health into primary care are services. PPACT is a multi-disciplinary underway, including in pediatrics. team that includes developmental behavioral pediatricians, child and Pediatric ACOs employ medical homes adolescent psychiatrists, nurse practi- and health care teams that utilize tioners, as well as trainees from diverse stepped care and 4-Quadrant clinical programs. PPACT clinics offer multidis- integration as common concepts to ciplinary consultative assessments of structure services provision (Collins et children and adolescent in Quadrants al. 2010). The 4-Quadrant model of II/III. Specialized clinics within PPACT ■■ Khyati Brahmbhatt, MD, Deputy care takes into account the physical and are being setup to see patients referred Director Pediatric Psychiatry mental health needs of the population from subspecialty areas such as Cystic Consultation-Liaison Service / served. We have adapted this model Fibrosis, Cochlear Implants, etc. Associate Training Director, CAP in designing the services provided within pediatric settings as illustrated in For patients who fall within Quadrant s healthcare systems across the Figure 1. IV, improved coordination between nation transition to a population intensive mental and physical health Ahealth model, measuring and Embedding child and adolescent psy- services can address some of their improving outcomes becomes increas- chiatry in primary care clinics (pediatrics needs. However, barriers to accessing ingly important. Unmet psychiatric and adolescent medicine) has been care remain. There might be a role for needs present a significant barrier to instrumental in expanding mental health special programs to address the needs improving physical health and impact services for patients that fall within of these patients; e.g., seizure disorder, outcomes negatively (Asamow 2015). Quadrants I/III. Patients are seen in oncology, etc. Children with epilepsy are A proactive and systematic approach the same physical space and in close known to have three to nine times the to mental healthcare is key to success- coordination with pediatric providers burden of mental illness when compared fully improving health outcomes within (co-located and coordinated care). to the general population, especially for Accountable Care organizations (ACOs). depression and anxiety disorders, includ- Several models with varying levels of Patients too complex to be managed ing suicide (Dunn and Austin 2004). In integrated mental healthcare have been within primary care and/or those with partnership with the Pediatric Epilepsy proposed to achieve this. A significant specific chronic medical illnesses lie clinic, we are pioneering one such pro- portion of the evidence for these models in Quadrants II/III. The Pediatrics- gram, CCoPE. Utilizing the 4-Quadrant comes from adult care settings, though Psychiatry Assessment and Consultation model, we proposed a stepped care there is reason to believe that they Team (PPACT) is modelled on ‘medi- program utilizing the building blocks would be effective within pediatrics cally provided behavioral health care’ mentioned earlier: (Asamow 2015). Figure 1: 4-Quadrant model and its application to service structures at UCSF Irrespective of the model used, the building blocks for integrating care into Quadrant II: Quadrant IV: pediatrics primary care include: 1) use High Behavioral Health High Behavioral Health of screening to systematically assess mental health needs, 2) appropriate Low Physical Health High Physical Health interventions being put into place based PPACT* (General Pediatrics) CCoPE# on the screening, 3) care coordina- Quadrant I: Quadrant III: tion, 4) access to child and adolescent psychiatry (CAP) consultation in various Low Behavioral Health Low Behavioral Health forms when appropriate, 5) access to Low Physical Health High Physical Health CAP specialty services when indicated, and 6) ability to assess outcomes of the Primary Care/Adolescent Medicine Primary Care /Adolescent Medicine services provided (AACAP 2012). At our PPACT* (Subspecialty Pediatrics) organization, the formation of ‘UCSF Health’ signaled the transition to a *PPACT: Pediatrics/Psychiatry Assessment and Consultation Team patient-centered, effective, and afford- #CCoPE: Care Collaboration in Pediatric Epilepsy able care delivery system for providing continued on page 160

JULY/AUGUST 2016 159 Implementing Integrated Care Models continued from page 159

1) Use of systematic screening: The collaborative team includes a volunteered to participate in the formation ■■ Quality of Life Childhood child and adolescent psychiatrist, nurse of the ‘Pathways in Clinical Care (PaCC)’ Epilepsy (QOLCE) and Behavioral practitioner, social workers, neu- workgroup. Our mission is to create and Assessment System for Children- rologists, neuropsychologist, and clinic disseminate consensus based pathways in 3rd edition (BASC-3) administered coordinator. The resources required to clinical care for commonly encountered yearly successfully implement such a program psychiatric/behavioral challenges in a can be significant. These patients are pediatric hospital setting to guide care ■■ Specific illness category scales as often seen within systems with several within a multidisciplinary context. We indicated (e.g.: CYBOCS, PHQ-9, pre-existing resources and the ability to have outlined the structure and process of GAD-7, SCARED, Vanderbilt) reorganize or optimize them can impact developing CPs for topics that include self- their feasibility. harm, psychosomatic illness, and delirium. 2) Appropriate interventions being put Work is underway to gather available into place: In parallel with integrating services within evidence to inform these CPs. We aim to ■■ Predetermined scale score cutoffs outpatient settings, there has been an define outcome measures to gauge their use to assign to Quadrants I-IV increasing interest in outcomes driven effectiveness. Collaboration across sites, ■■ Reassessment of Quadrant mental health care in inpatient hospital as in the PaCC workgroup, can facilitate assignments conducted yearly or settings. There is evidence for clinical designing and testing models for effective as needed pathways (CPs) that use available research systems of care. m to guide practice patterns within local ■■ Care coordination in monthly systems, improving outcomes in those References team meetings settings (Kinsman et al. 2010). CPs are already being used for various physi- AACAP (2012). Principles for Integration of 3) Access to CAP consultation: cal health conditions including asthma, Child Psychiatry into the Pediatric Health See Figure 2 Home. diabetes, etc. (Camphel et al. 1998). While 4) Access to CAP specialty services: this practice is not common in CAP, Asarnow JR, Rozenman M, Wiblin J, Zeltzer See Figure 2 there may be a role for developing CPs L (2015). Integrated Medical behavioral care compared with usual lprimary care for child 5) Ability to assess outcomes: Pilot Data for mental health care in the inpatient hospital setting. Several members (34) of and adolescent behavioral health: a meta an- to be collected nalysis. JAMA Pediatrics 169(10):929-937 the Physically Ill Child Committee have Campbell H, Hotchkiss R, Bradshaw N, Porteous M (1998). Integrated care pathways. Figure 2: 4-Quadrant model and its application to clinical programs BMJ 316(7125):133-137 Quadrant II: Quadrant IV: Collins C, Hewson, DL, Munger R, Wade T Evolving Models of Behavioral Health High Behavioral Health/ High Behavioral Health/ (2010). Integration in Primary Care. New York, NY: Low Physical Health High Physical Health Milbank Memorial Fund Interventions: Interventions: Dunn DW, Austin JK (2004). Differential di- 1) Psychiatry Referral for Evaluation 1) See Psychiatrist and Neurologist agnosis and treatment of psychiatric disorders in children and adolescents with epilepsy. 2) Transfer to Nurse practitioner (NP) 2) NP to help coordinate Epilepsy & Behavior 5(S3):10-17 when stable 3) Once stable consider transfer to NP Kinsman L, Rotter T, James E, Snow P, Willis J 3) Social Work (SW) Involvement AND/OR (2010). What is a clinical pathway? Develop- 4) Neuropsychiatric Testing as needed ment of a definition to inform the debate. Refer to Psychiatry Outpatient services BMC Medicine 8:31-31 4) SW Involvement 5) Neuropsychiatric Testing as needed Dr. Brahmbhatt is an Assistant Clinical Quadrant I: Quadrant III: Professor at the UCSF School of Medicine in the Department of Psychiatry. Low Behavioral Health/ Low Behavioral Health/ Dr. Brahmbhatt is the Deputy Director Low Physical Health High Physical Health for Child and Adolescent Psychiatry Interventions: Interventions: Consultation-Liaison Service (PPACT). She completed her general psychiatry 1) Websites 1) See NP and Neurologist residency from Albert Einstein Medical 2) Books 2) Discuss as needed with Psychiatrist Center in Philadelphia and her child psychiatry training from Massachusetts 3) Educational videos 3) Neuropsychiatric Testing as needed General Hospital in Boston. She has 4) Prevention Strategies previously served as the director of 5) Neuropsychiatric Testing as needed pediatric consultation-liaison psychiatry at U.C Davis. 160 AACAP NEWS PSYCHOPHARMACOLOGY

PSYCHOPHARMACOLOGY CORNER Atypical or Second-Generation Antipsychotics

■■ Gabrielle A. Carlson, MD, Harold E. Carlson, MD, and Christoph U. Correll, MD

typical or second-generation everyone, but more than half. The aver- adds 50-120 kcal (depending on antipsychotics (SGAs) are effec- age weight gain on olanzapine can be the size) to the daily calorie intake, Ative at reducing irritability and up to two pounds per week, while it whereas three cookies would likely aggression, whether those symptoms is about one pound or so per week for add 160 to 300 kcal (depending on occur during an episode of mania or risperidone and quetiapine, and only the cookie). other mood disorders, psychosis, or a little less per week for aripiprazole. as part of autism spectrum disorder or Moreover, weight gain occurs both early Other suggestions: attention-deficit/hyperactivity disorder. and is continuous until it levels off, often ■■ Drink water instead of soft drinks Unfortunately, the medications are asso- many months and many pounds later. ciated with significant weight gain and, ■■ Eat breakfast every day with it, increased cardiometabolic risk In order to gain this amount of weight, ■■ Serve small portions as measured by alterations in glucose, the olanzapine-treated patient has to triglycerides and cholesterol. be eating about an extra 1,000 calories ■■ Eat foods with low glycemic index per day, the risperidone-treated patient (www.glycemicindex.com) and If we assume that the child’s condition about 500 calories more per day and the eat slowly is not better addressed by a lower risk aripiprazole-treated patient about 250 ■■ Reduce/avoid saturated fat intake intervention, and that the SGAs need extra calories per day, at least for the first to be used, the question arises, how do month or two. ■■ Eat at least 25-30 g of soluble you inform parents/children about the fiber daily associated weight gain plus metabolic We all know that we should try to avoid ■ risk, and is there anything that can done the drugs that are associated with the ■ Avoid snacking when full to prevent it? greatest weight gain (olanzapine and clo- ■■ Limit fast foods to less than 1 zapine) and use the lowest effective dose meal per week I have asked two colleagues of whichever drug we choose. Beyond who often speak at the AACAP that, we recommend healthy diet and There are some useful educational Psychopharmacology Institute to weigh exercise to prevent and treat weight gain websites that families can access to in (forgive the pun) on the subject. associated with SGAs: help them with meal planning: Harold E. Carlson, MD, professor of www.youtube.com/ Medicine and Head of Endocrinology 1) Enlist the support of the entire family, watch?v=cVPmEao0NTU at Stony Brook University School of not just the child, in promoting good Medicine and Christoph U. Correll, MD, dietary choices and eating habits in The University of Cincinnati has professor of Psychiatry and Molecular ALL family members; e.g. structured information in English Medicine at Hofstra Northwell School meal times (not just grazing in the med.uc.edu/docs/default-source/ of Medicine and Medical Director, refrigerator when anyone wants), fam- default-document-library/healthy- Recognition and Prevention (RAP) ily participation in meal planning and eating-and-physical-activity-plan. Program; Department of Psychiatry, the decision about what kind of food to pdf?sfvrsn=0) and Spanish (med. Zucker Hillside Hospital. have around (it is hard to tell a child uc.edu/docs/default-source/ not to eat cookies for a snack when default-document-library/ They provided the following information: the cupboard is full of cookies and healthy-eating-and-physical-activity- everyone else is eating them). Always, plan-(spanish).pdf?sfvrsn=0); or Drs. H. Carlson and Correll: Second- fruits and vegetables are better snack www.eatright.org/resources/for-kids/ generation antipsychotics often cause choices than sweets. For example, rapid weight gain in children – not a snack of one apple or one banana continued on page 162

JULY/AUGUST 2016 161 PSYCHOPHARMACOLOGY

Atypical or Second-Generation Antipsychotics continued from page 161

Some recent studies, mostly in adults, 2 diabetes in children down to age 10). hyperprolactinemia and gynecomastia. have suggested that snacking after Our advice is, if the child is already sig- Could you clarify that for us? dinner is particularly likely to lead to nificantly overweight and is to be started weight gain, so evening snacks should on an SGA, metformin should be started Drs. H. Carlson and Correll: True be minimized or eliminated. either at the same time or at the first gynecomastia is defined as male breast clinical visit after starting the SGA when enlargement due to the proliferation of 2) Both child and adult studies have relevant early weight gain is observed. If glandular breast tissue. Male breasts may clearly shown that sleep deprivation the child’s BMI is normal, one can wait also enlarge due to increases in adipose plays an important role in weight and see if weight gain becomes an issue tissue, not glandular tissue. This is called gain, since not getting enough sleep (children with the most weight gain note pseudogynecomastia or lipomastia, both stimulates appetite and alters increased appetite and food consump- which can be distinguished from true metabolism, therefore, assuring that tion immediately with concomitant gynecomastia by palpating the breast. the child gets a good night’s sleep weight gain). Glandular breast tissue (true gyneco- may help minimize weight gain on mastia) is characterized by a palpable, the antipsychotic. Metformin is generally started at a firm plate or button of subareolar tissue, 3) Strongly encourage 30-60 minutes of dose of 500 mg/day (one tablet) of the while the breast in pseudogynecomastia exercise per day (maybe starting off sustained release preparation, known as feels the same as subcutaneous adipose with a lower goal in youth not used metformin ER. There may be gastroin- tissue elsewhere on the body. By virtue to exercising). Encourage parents testinal side effects (nausea, cramping, of their ability to cause generalized to exercise together with the child, diarrhea) for the first few days, but these weight gain, SGAs can result in pseu- like going for a brisk walk, “running” symptoms usually resolve spontaneously dogynecomastia, while their ability to errands or playing sports together. and are minimized when administering raise serum prolactin can result in true Increasing activity should be accom- the metformin together with a meal. gynecomastia. YOU CANNOT TELL panied by limiting screen time to After about one to two weeks, the met- THE DIFFERENCE JUST BY LOOKING! <2 hours/day (including television, formin dose can be gradually increased A knowledgeable clinician needs to computer, texting, video games) in 500 mg increments every one-to- palpate the tissue. www.youtube.com/watch?v=dRQf3 two weeks until the total daily dose is yFXO1Y&list=PLi%E2%80%907CrjH 1,500 mg for those weighing <50 kg and Data from clinical trials suggest that Wbqicvpg_NC8N7RVCnrRAMnmV 2,000 mg/day in those weighing ≥50 only about five percent of boys taking or www.letsmove.gov/kids kg. With each dose increase, there may risperidone will develop true drug- be a transient return of gastrointestinal induced gynecomastia. Those data do Dr. G. Carlson: To emphasize the side effects. Remember that metformin not clarify how the diagnosis was made importance of limited snacking, some should not be given to patients with or the pubertal status of the subjects. years ago when we kept children (ages significant renal impairment, since there Importantly, the development of true 5-12) longer on our inpatient unit, a is a risk of lactic acidosis when metfor- gynecomastia is gradual. It starts with couple of our residents and I looked at min is given to such patients. Therefore, breast tenderness, so that should be weight changes for those who had been always check creatinine and make sure it reported as soon as it occurs, as should in hospital and treated with SGAs (2/3 is <1.3 mg/dL before starting metformin. any enlargement or nipple discharge had been prescribed risperidone) longer (“galactorrhea”); drug-induced gyneco- than five weeks (n=70). Twenty-nine Dr. Correll added: In case that met- mastia is more likely to be reversible if it (41%) lost weight, 16 (22.9%) gained formin is either not tolerated or only has been present for only a few months. >7% of their body weight. The remaining insufficiently reduces antipsychotic were in neither category. The differ- related weight gain, consider adding While we do not really understand ence? Children could order whatever topiramate. Start at 25 milligrams and the mechanism for developing drug- they wanted for meals but few and only increase the dose in weekly intervals by induced gynecomastia, we speculate healthy snacks were served in hospital. 25 milligrams using bid dosing up to 100 that risperidone can cause gynecomastia Those who gained more weight had milligrams twice daily. However, make via hyperprolactinemia, which occurs more pass-time home where they ate a sure to monitor the potential for cogni- because it blocks the D2 dopa- good deal more. tive impairment mine receptor in the pituitary gland. Hyperprolactinemia may then sup- Next question to Drs. Carlson and Dr. G Carlson: There has been lots of press gonadotropins (LH, FSH), which Correll: What do you do if the above publicity about risperidone causing boys causes testosterone suppression in some strategies are ineffective or unfeasible? to develop breasts (gynecomastia). The patients (and drawing testosterone levels impression one gets is that with the first is unlikely to help because there is much Drs. Carlson and Correll: We suggest dose of risperidone or its metabolite, inter-individual variability in these endo- administration of metformin, which is paliperidone, a boy will wake up as well crine effects), thus disturbing the balance the best studied augmentation option endowed as Dolly Parton. In addition, of testosterone and estrogen that pro- in kids (it has FDA indication for type there is considerable confusion about tects men from breast development. This

162 AACAP NEWS PSYCHOPHARMACOLOGY mechanism, however, does not operate such as testicular or adrenal tumors, in prepubertal boys who have low levels hypogonadism, hyperthyroidism, hemo- of gonadotropins and testosterone. True dialysis treatment, or liver disease. It is gynecomastia in this age group is there- really difficult to distinguish medication- fore very rare. associated gynecomastia from pubertal gynecomastia. To differentiate medi- Nearly all boys receiving risperidone cation associated gynecomastia from will have an elevated serum prolactin pubertal or other causes, make sure to level, at least in the first few months of establish a time line of the breast tissue drug administration; with the passage changes related to risperidone treatment. of time (months), the serum prolactin If in doubt, and if you and the patient/ levels tend to gradually diminish, and family want to continue risperidone may in some patients eventually return or paliperidone, consider referring the to normal, even though the drug is patient to a pediatrician or pediatric continued. Since some level of hyperp- endocrinologist, providing all necessary rolactinemia is nearly universal in boys information. m taking risperidone, finding an elevated serum prolactin in such a patient is not helpful in predicting the occurrence of Dr. Gabrielle Carlson is professor of gynecomastia. Ninety-five percent of Psychiatry and Pediatrics at Stony Brook boys with hyperprolactinemia due to University School of Medicine. She risperidone will NOT develop drug- may be reached at Gabrielle.carlson@ induced gynecomastia. Bottom line: lab stonybrook.edu. tests do not predict gynecomastia, so it is necessary to frequently ask the patient Dr. Harold Carlson is professor of about breast symptoms. Medicine and head of Endocrinology at Stony Brook University School of In patients who do develop true gyneco- Medicine. He may be reached at mastia while taking risperidone, lowering [email protected]. the serum prolactin level to normal should help. This can be accomplished Dr. Christoph U. Correll is professor of by switching from risperidone to a more Psychiatry and Molecular Medicine at prolactin-neutral drug, such as quetiap- Hofstra Northwell School of Medicine ine, lurasidone or aripiprazole, or by and medical director of the Recognition adding aripiprazole (2-10 mg) on top of and Prevention (RAP) Program in the the risperidone regimen; aripiprazole is Department of Psychiatry at the Zucker a partial dopamine receptor agonist, and Hillside Hospital. He may be reached at counteracts the prolactin-raising effect [email protected]. of risperidone, even when risperidone is continued.

Most importantly, a very common cause DID YOU KNOW? of true gynecomastia is pubertal gyne- comastia, which occurs in 60-70 percent of normal teenage boys (usually around 13-14 years of age), and has nothing to do with drugs or prolactin. It lasts one to two years and then most often resolves on its own; however, it may not resolve in all cases, and about 10-20 percent of boys without any antipsychotic treatment history may have persistent pubertal gynecomastia at age 20 years. Additionally, teenage boys may abuse other substances, which can cause true gynecomastia, including marijuana and anabolic steroids, and the physician About 1 in every 38 people should inquire about this possibility. living in the United States Much less commonly, true gynecomastia can be due to other medical problems, resides in New York City.

JULY/AUGUST 2016 163 AEPYNA AND AACAP

60th Congress of AEPNYA in San Sebastian: A Shared Initiative with AACAP!

AEPNYA’s 60 th Congress, June 1-4, 2016 in Donostia / San Sebastian, Spain, was a shared initiative with AACAP. Leading the meeting were AACAP members Joaquin Fuentes, MD, President, and Bennett L. Leventhal, MD, Vice President. From the world-class programming, picturesque views, and gastronomic adventures, the meet- ing was a great success!

PEOPLE REGISTERED FOR THE CONGRESS. 637 They are classified as follows: 32 COUNTRIES 349 155 78 55 WERE REPRESENTED From Spain From USA From the From Other (103 identified (102 identified European Union Countries IN TOTAL as AEPNYA as AACAP (excluding Spain) (13 identified members) members) as AACAP members)

AACAP in Spain

164 AACAP NEWS AEPYNA AND AACAP

Apart from the wealth of new things I learned, from lunch breaks with local delicacies and fresh juices to a Pintxos tour in the old city of Donostia, the organization went to great lengths to provide the possibility of tasting the local culture in its purest form. All of this set in the beautiful city of Donostia, with its stunning architecture and relaxed atmosphere, made this congress a great experience. – Frank van der Boom, MD

JULY/AUGUST 2016 165 AEPYNA AND AACAP

166 AACAP NEWS COMMITTEES

AACAP SCHOOLS COMMITTEE An Innovative Model for Integrating Substance Use Treatment in Schools

■■ Kristie Ladegard, MD, Amanda Ingram, LCSW, CAC III, and Meg Benningfield, MD

ince legalization of marijuana in categories: knowledge-based curricula, clinics in Denver Public Schools. The Colorado, youth marijuana use social competence curricula, social clinics consist of a nurse practitioner, Sincreased by 20 percent which is 74 norms approaches, and combined social worker (who offers mental health percent higher than the national average methods. Social competence based- treatment), nurse, health educator, (National Survey on Drug Use and Health prevention programs have been best psychiatrist, and medical assistant. In [NSDUH] 2014). According to this same studied. These curricula provide benefit August of 2015, Denver Health received survey, the top 20 states with the highest by increasing the knowledge regarding a grant to fund three full-time substance rate of marijuana use for youth ages 12 the risks of drug use, decision-making abuse therapists in these clinics as well to 17 years of age are those that have skills, self-esteem, and resistance to peer as a part-time child and adolescent medical marijuana or have legalized pressure. These programs have shown to psychiatrist (CAP) who subspecialized recreational marijuana. Substance abuse reduce drug use, however, effect sizes in addiction psychiatry. When the first continues to be a significant problem are typically small and benefits diminish substance abuse therapist set foot in the for American youth and is quite pro- over time (Faggiano et al. 2013). school clinic, the school social worker nounced in certain areas of the country. already had a list of 20 students for her An estimated 1.3 million adolescents (5%) Schools offer an ideal setting to pro- to see. These were students with mul- endorsed symptoms of a substance use vide not only prevention services, but tiple challenges including: failing grades, disorder (SUD) as defined by DSM-IV; also treatment to address the mental poor attendance, several suspensions for however, these data may underestimate health and substance abuse needs of fighting, drug use on school grounds, the need for treatment in adolescents. underserved youth. Screening and brief and disrespectful behaviors. The According to an analysis of 2011 NSDUH intervention models have also been substance abuse therapist and CAP com- data, 13.6% of youth in school ages 12-18 explored in school-based settings. pleted diagnostic evaluations of each years, met the DSM-V revised criteria These interventions typically comprise of these students. Consistent with what for a substance use disorder, with 4.6% one to three sessions of motivational is known about this group of patients, endorsing mild SUD (2-3 symptoms), 4% interviewing. For youth with less severe most of them had several comorbid moderate SUD (4-5 symptoms), and 4.9% substance use, the opportunity to reflect diagnoses’ including depression, anxiety, severe SUD (6-11 symptoms). Fewer than on the consequences of their use in this conduct disorder, and psychosis. Nearly 4% of these youth received substance context can significantly decrease the all of these students reported symptoms abuse or mental health treatment and harm related to substance use. However, consistent with complex posttraumatic fewer than 8% received any interven- systematic studies of brief interventions stress disorder (PTSD). In every case, tion including being seen in a medical in adolescents have found these treat- students had a comorbid mental illness office or emergency department, juvenile ments to have medium-to-small effects in addition to their substance use. detention, or self-help group (Dennis et that decay over time (Carney et al. 2010). al. 2014). These figures illustrate a huge Due to the high volume of students gap in treatment availability that could Youth with more severe substance abuse needing substance use treatment and be addressed by co-locating services require more robust and comprehen- to the severity of their conditions, the in schools. sive treatment. In Denver, investigator substance use therapist was quickly Christian Thurstone, MD, has part- filled to her capacity of 35 clients with a Substance abuse prevention in schools nered with clinicians in the schools to wait list of 10. About 90 percent of the has a long history. Generally provided provide evidence-based treatment for clients aged 11 to19 years were using in the middle school setting, programs SUDs. Denver Health and Hospital marijuana, and a small number reported can be divided into the following four Authority have about 17 school-based continued on page 168

JULY/AUGUST 2016 167 COMMITTEES

An Innovative Model continued from page 167 using alcohol, cocaine, ecstasy, mush- externalizing symptoms—potentially Dennis ML, Clark HW, Huang LN rooms, and LSD. All clients volunteered resulting in greater difficulty in achiev- (2014). The need and opportunity to for treatment and parental consent ing remission of symptoms. In addition, expand substance use disorder treat- was obtained for youth under 15 years engagement with the juvenile justice ment in school-based settings. Advances of age. system intensifies stigma as well as in School Mental Health Promotion other potential negative consequences 7(2):75-87 Treatment followed an evidence-based for these youth. In the Denver school- protocol, consisting of at least eight based model, students did not have to Faggiano F, Minozzi S, Versino E, weeks of 60-minute individual therapy be placed on diversion or probation Buscemi D (2014). Universal school- sessions. Therapy included components to access services. The team was able based prevention for illicit drug use. of motivational interviewing, contin- to provide preventative care instead of Cochrane Database of Systematic gency management, cognitive behavioral being reactive. Students can now walk Reviews 12:Art. No.: CD003020 therapy, and acceptance and commit- into a clinic, knock on the door, and ask ment therapy. In addition, some patients for help, without getting involved with Substance Abuse and Mental Health also received components of dialectal the “system” first. Services Administration (2012). National behavioral therapy, eye movement Survey on Drug Use and Health, 2011 desensitization reprocessing, animal Providing treatment in the schools has [ICPSR34481-v1]. Ann Arbor, MD: Inter- assisted therapy, somatic experiencing, the benefit of reaching the most vulner- university Consortium for Political and and family therapy, which was tailored to able students who lack the resources Social Research their needs. During each session, clients to access care in community clinics. provided an instant urine drug screen. These students can receive treatment Substance Abuse and Mental Health Using a contingency management model, on-site during their school day allow- Services Administration (2014). Results they earned the ability to draw for gift ing for significantly increased access to from the 2013 National Survey on cards from a fishbowl for negative drug care. Another population that benefits Drug Use and Health: Summary of screens and for engagement in pro-social greatly from co-location of services in National Findings (NSDUH Series H-48, behaviors. Clients rated symptoms at the schools is the group of students who HHS Publication No. (SMA) 14-4863). beginning of each session using standard- lack the motivation to seek out treat- Rockville, MD: Substance Abuse and ized instruments (Child PTSD Symptom ment. These students may be willing to Mental Health Services Administration Scale, PHQ-9-A for depression, ADHD engage when treatment is convenient checklist, and the SCARED for anxiety). and quite literally meet them where they After four therapy sessions, symptoms are. In Denver, school staff reported that Dr. Ladegard is assistant professor in reduced from severe to mild in intensity. students they had been trying to get into the Department of Psychiatry at the Within the first eight weeks of treatment, treatment for years were finally willing University of Colorado. She may be 50% of clients were completely abstinent to participate. The preliminary positive reached at [email protected]. from all substances. About 25% were outcomes of this program are exciting reducing their substance use by 50%. and promising for our field, and highlight Ms. Ingram graduated from the The remaining 25% had maintained the the importance of child and adolescent University of Denver Graduate School of same level of substance use and did not psychiatrists collaborating with schools social work in 2007. Since then she has progress to harder substances. to help provide care to a vulnerable and practiced animal assisted therapy with underserved population. m children, families, and adults. She is an The program was viewed positively by adjunct professor at Denver University Graduate School of Social Work and students as well as teachers and other References school staff. Students began to self-refer runs her own business teaching animal for treatment after hearing how their Carney T, Myers, B (2012). Effectiveness assisted therapy workshops. peers valued the program. Teachers of early interventions for substance-using noticed that the students were calmer, adolescents: findings from a systematic Dr. Benningfield is medical director of participated more in class, and had review and meta-analysis. Substance Vanderbilt School Based Mental Health higher grades and attendance rates after Abuse Treatment, Prevention, and Policy and assistant professor psychiatry at participating in treatment. 7(1):25 Vanderbilt University Medical Center.

Across the United States, the major- Center for Behavioral Health Statistics ity of substance abuse treatment and Quality (2015). Behavioral Health currently provided for adolescents is Trends in the United States: Results court-mandated and accessed through from the 2014 National Survey on Drug the juvenile justice system. Youth Use and Health. (HHS Publication No. therefore experience delays in receiv- SMA 15-4927, NSDUH Series H-50). ing treatment, which promote greater Retrieved from www.samhsa.gov/data/ severity of substance use as well as other

168 AACAP NEWS COMMITTEES

CONSUMER ISSUES COMMITTEE My Introduction to The Life: Domestic Minor Sex Trafficking which can act as brands for their pimps. with their trafficker, making disclosure and Frequently, they will turn 18 years of age identification difficult and re-victimization and be arrested in prostitution rings. common. The systems approach must be collaborative, informed, and multidis- The Aubin Center, along with vari- ciplinary to meet the complex needs of ous agencies in the state of Rhode this poorly understood and marginalized Island, is working on ways to address patient population.” DMST. It was clear that coordination was needed and Dr. Kaplan reports, For this patient, I asked her if she had “I began working to develop a medi- someone she could trust whom she ■ ■ George (Bud) Vana, MD cal protocol to respond to victims of could call. She mentioned a name of a DMST in order to better address the social worker she had worked with. It hile on call in the hospital as specific needs of this patient popula- was about 6:30 pm on a Friday, and I a triple board senior resident tion.” Treatment of these children’s had doubts as to whether she would be in pediatrics, I was called to W mental health problems is complicated able to get through. I discussed the plan evaluate a 17-year-old girl in blue paper because they have often been in and with the nurses who brought a phone scrubs who was agitated and pacing out of foster care and have had irregu- into her room. I hovered around the around the room. Upon seeing me lar mental health and primary medical general section of the hospital where approach her room she remarked, “Who care. At the Aubin Center, the child her room was located, busying myself are you? What do you want?” and, then, protection doctors sometimes become with other tasks, all the while preparing “I’ll wipe that look off your face.” As I the closest thing to a medical home for what might happen if the receiver on approached her, she quickly interrupted for these patients. Katherine Liebesny, the other end did not pick up the phone. to say, “DCYF doesn’t care about me. MD, a second year child and adolescent When I snuck a glance back at her They’re just going to send me back to a psychiatry fellow at Bradley Hospital room 20 minutes later, she was happily group home, then I’m going to run. They has spent time working at the Aubin reclined in her hospital bed watching can’t keep me there.” Center. She said, “As their placements television. It reassured me that this was are often unstable, [their] mental health going to be an okay night for her. She Her remarks and agitation made sense, treatment can be equally fragmented. was discharged the next day to a group especially given her history as a victim A child [and adolescent] psychiatrist in home where she stayed for a period of domestic minor sex trafficking and the team can serve to liaise with outside of time, and then she turned 18 and that she was in the hospital for DCYF systems to advocate for continuity of entered the adult world unlikely to return (the Department of Children, Youth and care or become a branch of this ‘child to the pediatric hospital. She might have Families). Domestic minor sex traffick- safe primary care’ model and serve as a left the pediatric world, but she made ing (DMST) was poorly recognized at stable mental health provider for these an indelible mark on my training and Hasbro Children’s Hospital before a few patients.” She describes the need to use showed me how much more needs years ago. Dana Kaplan, MD, a child creative interventions working with these to be learned about how best to help abuse fellow at Aubin Child Protection patients. She has had the most success these patients. m Center said, “Two years ago in my first incorporating motivational enhancement year of fellowship, our institution began and interpersonal therapy techniques I would like to acknowledge Anish Raj, to see an influx of patients who dis- with critical attention to disruptions of MD, First Year Triple Board Resident at closed involvement in DMST, which is attachment and trauma. She has found Hasbro Children’s Hospital who also another form of child sexual abuse.” these techniques useful for medically contributed to this article. focused conversations, such as starting The population is extremely difficult to long-acting birth control. study but has attracted more interest in Dr. Vana is a triple boarder at Brown academic centers and the child protec- The work of the Aubin Center, Hasbro University who just finished his second tion field recently. Children in DMST Children’s Hospital, and the state of Rhode year of residency. He is interested in have a difficult time getting away from Island has made it clear that these patients the intersection between medical and the life, their term for living as a victim of need an inclusive team for the best psychiatric care for children with autism DMST. They are at high risk for being vic- outcomes. Amy Goldberg, MD, a child spectrum disorder and learning dis- tims of violence and also of returning to protection pediatrician and researcher abilities, foster children, and victims of DMST when they try to leave it. Providers in this field said, “Through a perpetual child abuse and exploitation. He may be describe seeing these patients start to state of physical, sexual and/or emotional reached at [email protected]. receive expensive items like smartphones abuse, DMST victims form traumatic and get new tattoos and other body art, bonds and strong emotional attachments JULY/AUGUST 2016 169 COMMITTEES

TELEPSYCHIATRY COMMITTEE Integrating Telemental Health with the Patient-Centered Medical Home Model

has since been generalized to different are to provide comprehensive, coor- patient populations. In order to qualify dinated care, and improve outcomes, as a PCMH, primary care practices must this integration makes logical sense for provide comprehensive care and be PCMH teams. responsible for the majority of patients’ care. Inevitably, patients will require spe- The Role of Telemental Health cialty care outside of the medical home and care coordination between provid- Despite the need for PCMHs to integrate ers in the healthcare system becomes mental health care into their prac- essential. As such, multidisciplinary tices, the shortage of qualified mental ■ ■ Jennifer K. McWilliams, MD, MS, teams form the backbone of PCMH health providers, particularly in rural and the Telepsychiatry Committee model. The members of these teams may and impoverished areas, significantly be a part of the actual practice itself or limits access to care. By using technol- ogy, mental health providers can join Introduction be providers and resources in the com- munity. In addition to the coordination as remote team members. The mod- The United States healthcare system is in of care between team members, the els for integrating telemental health a time of dramatic change. As emerging PCMH model requires the implementa- into primary care generally fall into technologies and medical advancements tion of quality and safety programs and three categories. become a reality, the healthcare system encourages the use of evidence-based faces increased demands to curb costs practices and the measurement, assess- Direct Service Models. Mental health and improve outcomes. Developing a ment, and improvement of its processes providers can provide direct care for strong primary care system is necessary and outcomes (AHRQ 2014). patients. Patients are evaluated and for reforms and the patient-centered managed by mental health providers via medical home model (PCMH) has been Mental and Behavioral telehealth technology. If the telemental promoted to address the necessary sys- health site is located within the PCMH’s tem changes (Jackson 2013). The PCMH Health Care Integration clinical space and the mental health model recognizes the interdependence As the body of research supporting the provider is an active participant in the of mental health and physical health. efficacy of PCMHs grows, so does the PCMH team, the provider helps the Access to an expert mental health care recognition that mental health care must PCMH meet the goals of offering com- workforce is limited in many parts of the be integrated with physical health care. prehensive care using a multidisciplinary country however, making the integration Approximately 26 percent of American team and improving access to services. of mental health into the PCMH difficult. adults suffer from diagnosable mental Telemental health is one approach to health disorders in any given year (NIMH Multiple benefits exist for providing achieving integration and is one of the 2008) and many of these disorders direct care through telemental health. most active telemedicine applications develop in childhood and adolescence. Patients may be more comfortable used in the United States. Both psycho- The majority of patients seek treatment being seen by a specialist, but within therapy and medication management with their primary care physicians (PCPs) the familiar environment of their PCMH are provided via telemental health with rather than mental health providers. clinic. Patients may be more willing to increasing evidence of their effectiveness The high rate of mental health disorders seek mental health care if the care is not in improving care and outcomes (Hilty et in primary care has a profound impact associated with the stigma of going to al. 2013). on patients’ physical health. Patients a mental health setting. Finally, patients with chronic physical health conditions are often seen closer to their homes, lim- Patient-Centered frequently have more medical complica- iting travel and the costs associated with time off work or school (Loh et al. 2013). Medical Homes tions if their co-morbid mental health conditions are not adequately treated. Many patients, providers, and Patients with mental health disorders One limitation of telemental health in policymakers have only a limited under- frequently present to their PCPs with this model is that it does not actually standing of what differentiates PCMHs physical health complaints rather than expand the access to mental health ser- from other types of clinical practice. The mental health complaints, which can vices. While it may be more convenient American Academy of Pediatrics (AAP) lead to unnecessary tests and proce- for patients to be seen at the PCMH introduced the “medical home” concept dures. Mental and physical health care site, they may have to wait just as long in 1967 to centralize the care of and must be integrated to optimize patient to see a provider via telemental health the medical records for children with outcomes. Given that the PCMH goals as they would in person. Telemental special healthcare needs. The concept

170 AACAP NEWS COMMITTEES health may only redistribute the mental comprehensive care by using a multidis- patient-centered medical home: a systmatic health workforce. ciplinary team approach. Not only does review. Ann of Int Med 158:169-178 a shared treatment plan help ensure care Loh P, Sabesan S, Allen D, Caldwell P, Mozer Consultation Models. Consultation coordination, but tracking and monitor- R, Komesaroff P (2013) Practical aspects of care can be used to integrate telemen- ing patients through a care manager telehealth: financial considerations. Int Med J tal health services into the PCMH. In leads to quality and safety measures. 43:829-834 this model, the mental health pro- National Instiute of Mental Health (NIMH) vider does not offer ongoing care of Much like the consultation model, (2008): The numbers count: mental disorders the patient, but instead evaluates the reimbursement in traditional fee- in America. Available at www.nimh.nih.gov/ patient via telehealth and provides for-service environments does not health/publications/the-numbers-count- the PCP with treatment recommenda- support the collaborative care model. mental-disorders-in-america/index.shtml tions. Alternatively, the mental health Furthermore, extensive work must be provider may discuss the case with the done to establish the relationships, build Dr. McWilliams is a child and adolescent PCP as a “curbside” consult. Several the clinical processes, and support the psychiatrist at Children’s Hospital and programs employing either one or both care manager’s role for this model to be Medical Center in Omaha, Nebraska. of these methods have been developed. successfully implemented. She completed her training at the Regardless of how these relationships are University of Iowa and has a master’s structured, the consulting mental health Conclusion degree in Health Care Delivery Science provider can fill the need for mental from Dartmouth College. She has been health integration in the PCMH either as While it is widely recognized that the United States healthcare system faces providing telemental health care to a remote team member or as a specialist rural Nebraskans and Iowans for the with whom the team coordinates care. incredible change, no one can predict what form the evolving system will past six years. She may be reached at Most models also incorporate training for [email protected]. the primary care teams with the goal of ultimately take. Patients, providers, PCPs becoming more confident in man- and policymakers demand a system aging common psychiatric problems, that improves access to care, improves while the psychiatrist assists with more outcomes, and reduces total health care challenging cases. The didactics can be costs (Berwick 2008). PCMHs have an instrumental component in quality been accepted as a standard of care and safety programs within PCMHs. for patients with chronic and complex medical problems and are being pro- Reimbursement is a limitation of consul- moted for general patient populations. tation models. While consulting mental Including mental health care will be vital health providers can be reimbursed on to the success of expanding PCMHs. a fee-for-service basis for consults in Telemental health is uniquely poised which the patient is seen, subsequent to address the limited access to mental DID YOU KNOW? follow-up discussions or other “curb- health services that many patients in side” consults with PCPs often cannot PCMHs face. The improved accessibil- be billed. Payment reform models may ity to mental health care that is created address this limitation in the future, but via telemental health will strengthen are not yet readily available. the approaches to population health and team-based care implemented in Collaborative Care Models. Finally, the PCMHs, making telemental health and mental health provider can treat patients PCMHs ideal partners. m collaboratively with the PCP, primarily by providing supervision to an on-site References care manager and maintaining a shared Agency for Healthcare Research and Quality: treatment plan. The collaborative care Patient Centered Medical Home Resource model relies on a care manager who Center. Accessed at pcmh.ahrq.gov on 1 administers screening tools, tracks treat- June 2014 ment response and adherence, monitors Berwick D, Nolan T, Whittington J (2008). The Annual New York City patients to ensure adequate follow-up, The triple aim: care, health, and cost. Health Marathon takes place on and identifies patients who may need Affairs 27:759-769 a referral to the consulting mental November 6, only one week health provider. Hilty D, Ferrer D, Parish M, Johnston B, after our Annual Meeting ends! ­Callahan E, Yellowlees P (2013) The effective- This marathon will draw up ness of telemental health: a 2013 review. Of the three models, the collaborative Telemed J E Health 19:444-454 to 50,000 runners and travel care model is most consistent with the through all five boroughs. principles of the PCMH. By definition, Jackson G, Powers B, Chatterjee R, Bettger the collaborative care model provides J, Kemper A, Hasselblad V, et al. 2013. The

JULY/AUGUST 2016 171 COMMITTEES

REGIONAL ORGANIZATIONS OF CHILD AND ADOLESCENT PSYCHIATRY How Can We Increase Access to Care? – A Letter From a Busy Child and Adolescent Psychiatrist to a Primary Care Physician

s child and adolescent psychia- the integrated care team, and may also trists, we can be leaders, as the be the distributor of reimbursement in Aevidence base is showing, in that setting. effective care delivery within integrated care settings. Our leadership must be As we were reminded at our ROCAP nuanced, and for access to child and Spring Assembly meeting, as physi- adolescent psychiatry in a time of short- cians—psychiatrists and child and age of child and adolescent psychia- adolescent psychiatrists—we continue to trists, our service delivery may include owe a duty to the individual patient, and increased access through multidisci- this duty must resonate with our efforts ■ ■ Mark S. Borer, MD, plinary and collaborative teams moving to contribute to population health. Our Chair, Assembly of Regional toward integrated care. Psychiatric lead- presence to patients and families in the Organizations of Child and ership in the patient centered medical PCMH and other integrated care centers Adolescent Psychiatry home (PCMH) must also recognize will reverberate throughout the networks that the primary care physician is often of care. m the clinical and contractual head of

Dear Dr.______,

I have enjoyed consulting with you regarding your patients and have appreciated your referrals to my practice (clinic).

As you know, child and adolescent psychiatrists are in short supply in the community, and we are trying to remain as available as possible to those who need us. As we continue to recruit and retain more child and adolescent psychiatrists to practice locally and be available to you, I would like to offer you some additional child and adolescent psychiatry-led and child and adolescent psychiatry-informed options to help your practice get your kids and families assessed, help you get them linked to various community services, and improve your patient outcomes.

First, I work with several advanced practice psychiatric nurses (in my office/in my community) with whom I collaborate (consult) who may be able to help us with assessment of some of your kids and families. They are available not only in their own offices, but may also be available on site with you weekly, in collaboration with my office, to help with case reviews, talk with your in-office medical and mental health professionals, do warm handoffs, meet with your care manager to help coordinate care, and be available to consult regarding your integrated treatment plans. They are in close contact with me, and to manage both my time and your costs, I will be available to your practice on site (monthly/biweekly)—and by phone or telemedicine in between times—to review with your team and the psychiatric advanced practical registered nurse (APRN) the most complex cases, including those you may be having assessed through a telemedicine service. All these services will help improve access to care for your patients and practice professionals, and will lead to better treatment, less need for outside referrals, less referrals to high level care, and, thus, lower cost to your practice.

If your practice has a psychologist, social worker, or counselor consulting with your medical team or embedded in your practice, I can bring the same expertise you expect when you make referrals to my office to consultation with your mental health professionals. I am not here to duplicate their work, but to enhance the accuracy of complex diagnostic pictures, medication regimens, and medication-treatment coordination. Through our meetings, on site and through telemedicine (provided by our office/provided by an outside service) our hope is to increase your and your team’s comfort with dealing with children with psychiatric difficulties within your own office, and increasing your comfort with prescribing for some of these children, particularly those who have already been assessed and stabilized by a child and adolescent psychiatrist.

You may be approached by a number of different mental health professionals and other prescribers offering to help in your practice; some may offer slightly lower cost per hour services. The question to ask is who is their team and who do they turn to for complex diagnostic, treatment, and prescribing issues? How do they coordinate a full range of mental health professionals, support your medical approaches with your dually diagnosed patients and those with substance use disorders, and will they bring the same value and cost savings to your practice?

172 AACAP NEWS COMMITTEES

I am able to value each member of your team, while bringing child and adolescent psychiatry expertise that the evidence shows is critical to your patient outcomes.

My office is still able to work with some of your patients on a referral basis, as we always have. But, if you want to reduce those wait times and get the same kind of team approach that you take with your medical team in your own practice, then know that I am available to you as you face these big changes in approach to treatment and payment reform, especially value-based reimbursement plans. Together, we can work toward achieving the Triple Aim, one patient and family at a time.

Sincerely yours,

Your name?

Dr. Borer is a child and adolescent psy- Economics Committee. He is also How do you envision your practice chiatrist practicing in central Delaware. the AACAP Delegate to the PCPCC five or ten years from now? He is currently Delaware’s Delegate (The Patient Centered Primary Care to the AACAP Assembly, where he Collaborative). He may be reached at Are you sharing your vision with serves as Chair, as well as a member [email protected]. your ROCAP? Let your Delegate of AACAP’s Health Care Access and know your thoughts for our Fall Assembly Meeting.

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!

JULY/AUGUST 2016 173 LEGISLATIVE RECAP

2016 AACAP Legislative Conference Recap – Successfully Advancing Children’s Mental Health

■■ Ronald Szabat, Esq., Michael Linskey, Emily Rohlffs, and Zachary Kahan

pwards of 240 AACAP members and family advocates came Utogether on April 14-15, 2016, to unite for positive change in children’s mental health. Overall, this year’s attend- ees had over 40 scheduled face-to-face meetings directly with Members of Congress, hundreds of meetings with Congressional staff, and over 50 family and youth advocates ready to lobby for change. All this set a new AACAP record!

The well-organized conference opened on Thursday, April 14, 2016, with an hour-long Resident, Newcomer, and Family Orientation. Those attending AACAP Government Affairs: [left to right] Emily Rohlffs, Zachary Kahan, Michael Linskey, and the orientation learned everything from Ronald Szabat, Esq. the layout of Capitol Hill to the basics of the legislative process. Everyone was recipients. Throughout 2016, these two pediatric subspecialists, including child duly impressed with how quickly and incredible individuals have demonstrated and adolescent psychiatrists, to be eli- smoothly the presentation progressed their desire, knowledge, and passion for gible for the NHSC loan relief program. from the simple to the complex. By improving our nation’s mental health It would also list children and adoles- design, the session achieved its goal of system. Rep. Collins introduced H.R. cents as an underserved population. As making everyone comfortable in convey- 1859, the “Ensuring Children’s Access to Legislative Director to Rep. Murphy, Mr. ing AACAP’s issues to lawmakers. Specialty Care Act,” which would make Dziengelski was principally responsible surgical corrections to the National for technical drafting negotiations sur- Taking their new found advocacy Health Service Corps (NHSC) to allow rounding the Congressman’s landmark background to the next level, attend- mental health reform bill. ees then participated in a two-hour Special Advocacy Training. Led by On Friday morning, attendees were AACAP Director of Government Affairs deeply versed in the details of the and Clinical Practice Ronald Szabat, legislative goals for improving children’s participants learned real-time advocacy mental health. Conference participants strategies and mastered new skills (e.g., focused on specific ways in which bridging to a topic at hand) through a federal law must change to address the series of audience-participation mock current shortage of child and adolescent congressional visits. Laughter and real psychiatrists. Right now, nearly every learning were hallmarks of this fun and state has a severe shortage of child interactive session. and adolescent psychiatrists, with the majority of counties in the United States This exciting day was capped off by having zero. Conference attendees also AACAP’s annual Legislative Conference learned and stressed the importance Reception where AACAP lead- of including key federal regulatory ers recognized Representative Chris language, such as “serious emotional Collins (R-NY) and Scott Dziengelski disturbance” and specific references of Representative Tim Murphy’s (R-PA) to “child and adolescent psychiatrists” office as AACAP’s 2016 Friends of in all major mental health reform Children’s Mental Health Award Rep. Ryan Costello (R-PA) and AACAP member bills. Without these simple key terms, Randy Gurak, MD children, and child and adolescent

174 AACAP NEWS LEGISLATIVE RECAP

Attendees also made a plea for co-spon- adolescent psychiatrist references, and sorship and support of Rep. Murphy’s NHSC workforce provisions to ensure H.R. 2646, the “Helping Families in that children and child and adolescent Mental Health Crisis Act.” Among a psychiatrists have access and eligibility series of policy changes to fix America’s to programmatic activity. As attendees broken mental health system, this learned, not all comprehensive men- comprehensive mental health legislation tal health bills are comprehensive, as would establish a new assistant secretary some do not have the needed word- for Mental Health and Substance Abuse ing to guarantee that programs and Disorders. The bill aims to immediately funds flow to children and child and address intergovernmental coordination adolescent psychiatrists. of mental health services and programs, which is badly needed. In large part AACAP is very proud of its advocacy by due to AACAP’s successful Legislative members, family, and youth. The con- Conference and effective advocacy, the ference was tremendously productive House of Representatives overwhelm- and successful in advancing children’s ingly passed H.R. 2646 on July 6 by a mental health. If you wish to review vote of 422-2. AACAP’s 2016 Legislative Priorities Rep. Chris Collins (R-NY) in more depth, contact a member of H.R. 2646, H.R. 1859, and S. 2782 all AACAP’s Government Affairs team at psychiatrists would not be eligible for or have the requisite key wording of “seri- [email protected]. m included in federal funding and pro- ous emotional disturbance,” child and grammatic activities through needed legislative change.

H.R. 1859 and S. 2782, the “Ensuring Children’s Access to Specialty Care Act,” are imperative for improving America’s child and adolescent psychiatrists work- force. Heads were nodding in agreement as attendees learned that the average wait-time to see a child and adolescent psychiatrist is over 7.5 weeks and that the actual need for child and adoles- cent psychiatrists almost quadruples the current supply. The goals of this legisla- tion are to bring pediatric subspecialty fellows or trainees within the NHSC loan relief eligibility, list children as an under- served population for needed medical services, and ensure that pediatric subspecialty training sites and programs meet NHSC loan relief criteria. Scott Dziengelski, Legislative Director for Rep. Tim Murphy (R-PA), and AACAP President Gregory K. Fritz, MD

Missed the conference this year or ready for the next AACAP wave to take our messages to Capitol Hill? Then mark your calendars now to attend next year’s Conference – May 11-12, 2017!

JULY/AUGUST 2016 175 LEGISLATIVE RECAP

AACAP Resident Scholars

■■ Justin Schreiber, DO, and Laura Willing, MD

n residency, we learn a lot about med- The time at AACAP was ication management, psychotherapy, spent not only reading though Iand building rapport with our patients, complex legislation, it also but rarely do we learn about the legisla- included a wide-range of tion or regulations that can either expand responsibilities that included or restrict the work we do and the access attending collaborative our patients have to the mental health meetings with other physi- care they need and deserve. According cian organizations, legislative to a study in 2007, physicians voted less meetings with Congressional than the general population. In addition, staff, political events with out of 435 members of Congress, only Members of Congress, and 14 physicians currently serve in the U.S. policy-focused events around House of Representatives (only one of Washington, DC. One meeting them, Jim McDermott, MD, is a child that stood out was working and adolescent psychiatrist)—a total of with other pediatric groups to three percent. In the Senate, there are develop legislative strategies to three physicians and no psychiatrists, ensure children have increased again only representing three percent access to child and adolescent of the total voting body. It is clear that psychiatrists by making CAPs child and adolescent psychiatrists (CAPs) eligible for the National Health need to increase their collective voice Service Corps. It was also clear and receive the necessary training to that as child and adolescent play a more active role in shaping policy psychiatry trainees, we served and the political process. With this in as a resource to the AACAP mind, we decided to work with AACAP’s office and provided valuable Zachary Kahan, Laura Willing, MD, Justin Schreiber, DO, and Government Affairs and Clinical Practice clinical insight. Important also Emily Rohlffs director, Ron Szabat, to initiate the was that during meetings with Resident Scholars program at AACAP. federal legislators we could tell our stories, and the stories It was clear from day one in the of our patients, to emphasize Government Affairs and Clinical Practice why we need legislation, such as mental Reference Department how little we knew, and health reform. Grande D, Asch DA, Armstrong K (2007). how much we would gain while at Do doctors vote? Journal of General Internal AACAP. For example, we learned that if We hope that other trainees will see the Medicine 22(5):585-589 the term “serious emotional disturbance” value in this unique training that comes is not included in federal legislation, the from spending a month at the AACAP Laura Willing, MD, just completed legislation would not apply to children national office in Washington, DC. It her fifth year as a child fellow and the and adolescents from birth up to the age is our hope that with more opportuni- advocacy chief resident at the University of 18-years-old. We would have thought ties like this, trainees can increase their of North Carolina in Chapel Hill. Next from our medical training that using the voice and the voice of their patients in year she will serve as the APA Jeanne term “serious mental illness” could refer advocating for increasing access, reduc- Spurlock Congressional Fellow in to a person of any age with a mental ing stigma, reducing debt burden, and Washington, DC. health disorder, but we quickly realized much more. Please do not hesitate to that legislative language and medical contact either AACAP’s Government Justin Schreiber, DO, MPH, FAAP, just language are not congruent. Another Affairs team or one of us if you want completed service as a fifth year triple example of what we learned was finding more information about the program or board resident and co-triple board chief out that the term “psychiatrist” in a bill our experiences. at the Children’s Hospital of Pittsburgh does NOT include “child and adolescent and Western Psychiatric Institute and psychiatrists.” In our time at the AACAP We want to thank Ronald Szabat, Esq., Clinic in Pittsburgh, PA. Next year he office, we saw how the Government Michael Linskey, Emily Rohlffs, Zach will remain in Pittsburgh to work as a Affairs team would carefully dissect leg- Kahan, and the rest of the AACAP staff child and adolescent psychiatrist and islation, looking for these small wording for their hospitality during our month. As pediatrician. differences to make sure that child and AACAP members, we are very lucky to adolescent psychiatrists and our patients have such a highly qualified and hard- are not left out. working staff. m

176 AACAP NEWS LEGISLATIVE RECAP

JULY/AUGUST 2016 177 LEGISLATIVE RECAP

178 AACAP NEWS LEGISLATIVE RECAP

JULY/AUGUST 2016 179 LEGISLATIVE RECAP

180 AACAP NEWS NEWS

News UPDATES by Garrett Sparks, MD, MS

n each issue of AACAP News, I include brief commentary and links to newsworthy Health Records Study. JAMA Psychiatry [Epub items that the membership might have missed, or that merit repeating. If you have ahead of print] Isuggestions for this column, please send them to me at [email protected]. FDA Issues New More Evidence Lithium the results of improved mood stabili- Warnings on Olanzapine, zation or from a separate decrease in Decreases Self-Harm and impulsive aggression and risk taking. The Aripiprazole Suicide in Bipolar Disorder lower rates of unintentional self-injury The Food and Drug Administration (and previous research on lithium and Adults with bipolar disorder receiving (FDA) released two significant warnings suicide) may point towards the idea of maintenance treatment with lithium regarding two commonly used atypical lithium decreasing impulsive aggression. were not only less likely to [demonstrate antipsychotics in May 2016 after wor- suicidality], they were also less likely to risome cases were identified using the Of course, these are adult data, but commit self-injury than those receiving FDA Adverse Event Reporting System child and adolescent psychiatrists are valproate, quetiapine, or olanzapine, (FAERS), the database that supports the no strangers to having to rely on (or according to a study published in JAMA FDA’s post-marketing safety surveil- at least consider) adult treatment data Psychiatry by British researchers using lance system by collecting information given the relative dearth of studies in data from electronic health records col- on adverse events and medication children compared to adults. Given lected between 1995 and 2013 in the error reports submitted to the FDA. concerns about heterogeneity in the United Kingdom. Such warnings describe events that are bipolar diagnosis across study sites in extremely rare but nonetheless of ade- pediatric bipolar studies, the pediat- Of the 6,671 individuals aged 16 and quate clinical importance for prescribing ric bipolar treatment data are already over with bipolar disorder who were psychiatrists to educate and monitor complicated to interpret. Available data included in the cohort (meaning they their patients for these conditions. have tended to favor the use of atypi- had received a bipolar disorder diagnosis cal antipsychotics over more traditional and were treated with one of the four Aripiprazole mood stabilizers in pediatric popula- drugs listed above for at least two filled On May 3, 2016, the FDA issues a tions, though this might point to a more prescriptions), 2,148 received lithium, warning that aripiprazole use may be general trans-diagnostic tranquilizing 1,670 valproate, 1,477 olanzapine, and associated with an increased risk for effect from antipsychotics rather than 1,376 quetiapine. compulsive or uncontrollable urges actual superior effectiveness in children to gamble, binge eat, shop, and have with episodic hypomania or mania. Rates of self-injury were expressed per sex. A search of the FAERS database However, the recent publication of the 10,000 person-years at risk (10K-PYAR). identified 184 case reports (167 in the long-awaited Collaborative Lithium Self-harm rates were 205 per 10K-PYAR United States, including both adults and Trials (CoLT) study supports the use of (95% CI 175-241) for those prescribed children) of impulse-control problems lithium as a well-tolerated and relatively lithium; 392 (95% CI 334-460) for those since November 2002 when aripipra- weight-neutral agent for reducing manic prescribed valproate; 409 (95% CI 345- zole was first approved by the FDA. Of symptoms in pediatric patients with rig- 483) for those prescribed olanzapine; the 184 case reports, 167 were from orously defined type-1 bipolar disorder. and 582 (95% CI 489-692) for those the FAERS and 17 were available in the prescribed quetiapine. medical literature. We sometimes find ourselves prescrib- ing for our sickest and most impaired The overall suicide rate in the study was The most common behaviors were patients with our best intentions rather 14 per 10K-PYAR, and while the rate of pathological gambling (N=164), but also than with a tremendous evidence suicide was lower for those prescribed included compulsive sexual behavior base. At the same time, further stud- lithium, the suicide rate was low enough (N=9), compulsive eating (N=3), and ies strengthening past suggestions that that rates could not be statistically multiple problems with impulse-control lithium may reduce suicidality, as well compared. The authors also measured (N=4). None of these conditions were as self-injury, may inform our treatment rates of unintentional self-injury (like present prior to aripiprazole. None had choices when little else than our experi- falls or car accidents), which were also concurrent substance use disorder or ence guides our hands. lower for lithium compared to valproate symptoms of mania at the time they and quetiapine, though not necessarily Hayes JF, Pitman A, Marston L, Walters K, developed impulse-control problems. for olanzapine. Geddes R, King M, et al. (2016). Self-harm, Each condition resolved shortly after unintentional injury, and suicide in bipbolar discontinuing aripiprazole. In four of What is not entirely clear is whether disorder during maintenance mood stabilizer the cases in the medical literature, these better outcomes with lithium are treatment: A UK Population-Based Electronic continued on page 182

JULY/AUGUST 2016 181 NEWS

News Updates continued from page 181 compulsive behaviors went away with Biomarkers for the presence of MMTBI, intracranial discontinuing aripiprazole, and reap- lesions on CT exam, and the need for peared when aripiprazole was resumed. Concussion Getting Closer neurosurgical interventions and would to Clinical Utility be expected to be used to separate those FDA Warns About New Impluse- with and without these outcomes. While psychiatrists generally are not Control Problems Associated With the ones seeing patients in the emer- Mental Health Drug Aripiprazole Given these properties, the authors gency room following a closed head (Abilify, Abilify Maintena, Aristada). speculate that UCH-L1 might be most injury, biomarkers for mild or moderate May 3 2016. useful very early on as a point-of-care traumatic brain injury (TBI) may not be test in settings such as in the ambulance, so far away from clinical use, as several Olanzapine on the playing field, or on a battlefield. companies are trying to commercial- They speculate that GFAP may help On May 10, 2016, the FDA issued a ize biomarkers for FDA approval. Two predict outcomes in both acute and sub- warning that olanzapine use may be such promising biomarkers include glial acute settings and for those who do not associated with an increased risk of a protein glial fibrillary acidic protein present immediately to the Emergency rare but serious skin reaction known as (GFAP) and neuronal protein ubiquitin Department. These markers may even- DRESS (Drug Reaction with Eosinophilia C-terminal hydroxylase L (UCH-L ). Both 1 1 tually be able to predict other longer and Systemic Symptoms) Syndrome. A of these proteins are present in serum term outcomes and may help physi- search of the FAERS database identified less than an hour after a mild TBI and cians decide whether a patient should 23 cases of DRESS Syndrome reported are able to distinguish between patients be discharged from the Emergency with olanzapine since 1996. Only with mild TBI and other trauma patients Department or admitted to the hospital cases that are reported to the FDA are without acute brain injury and can for further monitoring or intervention. included in the FAERS, so there is no also help distinguish patients who will way to know how many other cases may have intracranial lesions on computed Papa L, Brophy GM, Welch RD, Lewis LM, have occurred and were not reported. tomography (CT) scans and which might Braga, CF, Tan CN, et al. (2016). Time course One patient reportedly died from DRESS require neurosurgical intervention. and diagnostic accuracy of glial and neuronal Syndrome, though this patient was tak- blood biomarkers GFAP and UCh-L1 in a ing multiple medications in addition to A recent study in JAMA Neurology went large cohort of trauma patients with and olanzapine that may have contributed to further and explored the time course and without mild traumatic brain injury. JAMA the death. diagnostic accuracy of the serum glial Neurol 73(5):551-60 and neuronal biomarkers for detecting DRESS Syndrome, also known as drug- mild-to-moderate traumatic brain injury induced hypersensitivity syndrome, is (MMTBI), traumatic intracranial lesions an idiosyncratic drug reaction that can on CT, and neurosurgical interven- affect both the skin and various organs. tion for brain trauma. Trauma patients It typically includes a long latency (N=584) with or without MMTBI were period between initiation of the drug followed over 7 days with a total of and onset of the rash (more than two 1,831 blood samples collected. Of the DID YOU KNOW? to three weeks) and may be associ- 325 patients with MMTBI, 97.8% scored ated with fever, rash, and involvement a 13-15 on the Glasgow Coma Scale, as of at least one organ system. DRESS the study focused mainly on milder TBI. Syndrome is different from Stevens- Intracranial lesions were found in 35 of Johnson Syndrome or Toxic Epidermal the 325 patients with MMTBI and none Necrolysis, though DRESS Syndrome of the controls. Neurosurgical interven- is also associated with use of carbam- tions were performed in 7 patients with azepine and lamotrigine. Management MMTBI and none of the controls. involves withdrawal of the offending medication and sending patients to the GFAP was detectable within one hour emergency room for further evaluation. of injury and peaked at 20 hours while Systemic corticosteroids are frequently concentrations steadily decreased over the first line treatment. Mortality rate 72 hours. GFAP levels were still detect- may be up to 10%. able seven days after injury. UCH-L1 was also detectable within an hour and Since 2005, New York City has Olanzapine: Drug Safety peaked around eight hours with further Communication – FDA Warns About decreases over the next 48 hours. There the lowest crime rate of the 25 Rare But Serious Skin Reactions. were small peaks and troughs over the largest U.S. cities and is one May 10 2016. next seven days. While the statistical of the safest cities in the U.S. results are beyond the scope of this sum- overall. Dermatological Emergencies, mary, both proteins strongly predicted Cleveland Clinic.

182 AACAP NEWS FEATURES

Media Page ■■ Erik Loraas, MD Resident Editor

Youth Substance Abuse and co-occurring psychiatric dis- Co-occurring Disorders orders, first exploring barriers in current clinical practice and Edited by Yifrah Kaminer, MD, MBA then outlining effective delivery American Psychiatric Association 2016 of evidence-based treatments. Paperback: 316 pages – $65.00 Chapter 3 covers screening, Youth Substance Abuse and assessment, and treatment Co-occurring Disorders is a newly pub- options for adolescents with lished book that presents key biological, SUDs. General screening tools psychosocial, and clinical topics pertain- and comprehensive assess- ing to the understanding and treatment ment instruments are reviewed. of psychiatric comorbidity in adolescents Treatment options considered with substance use disorders (SUDs). As include brief interventions, cog- 70-80% of adolescents with SUDs have nitive behavioral interventions, a comorbid psychiatric disorder, this is brief motivational interventions, an important topic for child and ado- 12 step programs for adoles- Chapter 13 considers youth gambling, lescent psychiatrists. This book is well cents, family therapies, contingency whereas chapter 14 explores patho- suited for clinicians, clinical researchers, managing, and adaptive treatment logical preoccupation with the Internet. and students of mental health, public and aftercare. health, and medicine. Though not official DSM-5 diagnoses, these conditions represent important, Chapters 4-12 look at major co- prevalent non-substance-related addic- The book contains 14 informative and occurring disorders, such as conduct tive disorders in adolescents. While well-organized chapters. Each chapter is disorder and delinquency, attention- offering a helpful review of current comprehensive in its review, with easy- deficit/hyperactivity disorder (ADHD), literature, these chapters also highlight to-navigate sections and helpful “Key depressive disorders, bipolar disorders, the importance of ongoing work in these Points” at the end of the chapter. anxiety disorders, posttraumatic stress emerging areas. disorder (PTSD), suicide and self-harm, Chapters 1 and 2 introduce co-occurring schizophrenia, and eating disorders. Youth Substance Abuse and disorders in adolescents. Chapter 1 pays Each chapter reviews the epidemiology, Co-occurring Disorders is a well- particular attention to developmental etiology, assessment, prevention, and organized and accessible review of key pathways and patterns in developing treatment options for each co-occurring concepts in the assessment and manage- SUDs, looking closely at how psycho- disorder. For convenient reference, ment of SUDs in adolescents. It offers logical regulation is acquired during complete diagnostic criteria for DSM-5 a valuable launching point in our effort development and the clear relationship disorders are provided. Important con- to address the “worldwide public health between psychological dysregula- cepts and key data are also summarized challenge” of SUDs in youth. m tion and SUDs. Chapter 2 expands on using figures and tables. the relationships between SUDs and

AACAP members who would like to have their work featured on the Media Page may send a copy and/or a synopsis to the Resident Editor, Erik Loraas, MD, 3811 O’Hara Street, Pittsburgh, PA 15213, or by e-mail to [email protected].

JULY/AUGUST 2016 183 OPINIONS

Honors Presentation: Sidney Berman Award “Where There’s a Will, There’s a Way”

someone else will respond. He elabo- rates: “If someone collapses and needs CPR, you don’t vaguely yell, ‘Call 911!’ BUT RATHER You (a specific person) call 911’.” In schools, this means that all personnel (principal, guidance coun- selor, teacher, etc.) must know exactly what their responsibilities are, and what they will be held accountable for in helping students under their care. Each ■■ John T. McCarthy, MD member of the team will thereby feel valued for his or her contributions to creating an optimal school environment. William (Will) Dikel, MD “Creating a School Mental The school principal must establish an open-door, two-way-street atmosphere Health Plan that meets the within the school among staff, teachers, needs of Students who have parents, and, yes, students. A princi- Dr. McCarthy has been a member of pal must encourage honest feedback AACAP’s Schools Committee since 2002. Psychiatric Disorders” with an Ed Koch’s “How am I doing?” He is a retired associate clinical profes- —William Dikel, MD demeanor. Toward that end, regular staff sor of Child and Adolescent Psychiatry meetings must be convened to identify of the New York University School of potential problems early and proactively Medicine’s Child Study Center, where implement solutions. he ran the School-based Mental Health illiam (Will) Dikel, MD, a Program for the child psychiatry fellows proud Minnesotan child and For those students with clearly diag- and directed the Consultation-Liaison adolescent psychiatrist, has W nosed mental health problems, the Program. devoted his entire career to creating a principal must foster open commu- mentally healthy school environment nication with the treating child and where kids of all ages can thrive. A man adolescent psychiatrist and teacher after on a mission, he has traveled far and obtaining parental consent in order wide, well beyond the confines of his to enhance outcomes. For example, a DID YOU KNOW? home state to provide useful, common- youngster diagnosed with attention- sense consultation to schools that want deficit/hyperactive disorder (ADHD) to do better for their students. In recog- who is on medication will greatly benefit nition for his outstanding contributions from an integral approach in monitoring to School Mental Health, the AACAP treatment that involves a child and ado- Schools Committee unanimously lescent psychiatrist. I personally know selected Dr. Dikel as the 2015 recipient how valuable feedback from my patient’s of AACAP’s Sidney Berman Award for teacher can be in optimizing treatment. the School-Based Study and Treatment Treatment in a vacuum is never good. of Learning Disorders and Mental Illness. In summary, each and every person on Dr. Dikel uses an individualized the educational team, from principal on approach with each school consultation. down, needs to understand his/her spe- He starts at the top to insure there is a cific role and the importance of honest, real commitment to change, endorsed free, and unhindered interaction within The New York subway system and followed through at every level. the school milieu to improve students’ is the largest mass transit Clarifying roles becomes a critical education and, ultimately, their men- ingredient toward success. He wants system in the world with 468 tal health. As the saying goes, “When schools to avoid the “Kitty Genovese stations and 842 miles (1355 there’s a Will (pun intended), there’s Syndrome” in which everyone who a way.” m km) of track. hears a cry for help ignores it assuming

184 AACAP NEWS

Please consider a gift in your will, and join your colleagues and friends:

1953 Society Members Anonymous (4) Steve and Babette Cuffe, MD James C. Harris, MD, and Catherine DeAngelis, MD, MPH Paramjit T. Joshi, MD Joan E. Kinlan, MD Dr. Michael Maloney and Dr. Marta Pisarska Jack and Sally McDermott (Dr. Jack McDermott, in memoriam) Will You Join? Patricia A. McKnight, MD Make a gift to AACAP Scott M. Palyo, MD in your will. The Roberto Family Ensure AACAP’s Future! Diane H. Schetky, MD Visit Gabrielle L. Shapiro, MD Diane K. Shrier, MD, and www.aacap.org/1953_Society to learn more! Adam Louis Shrier, D.Eng, JD

JULY/AUGUST 2016 187 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

Check It Out! AACAP’s 63rd Annual Meeting in New York City is Right Around the Corner! Join us October 24-29, 2016, for the world’s largest gathering of child and adolescent psychiatrists. Start planning today!

Reserve Your Hotel Room Sheraton New York Times Square ✔ 811 7th Avenue 53rd St. New York, NY 10019 AACAP’s 63rd Annual Meeting takes place at the New York Phone: 212.581.1000 Hilton Midtown and the Sheraton New York Times Square in www.sheratonnewyork.com (for detailed hotel information) New York, NY. Make your reservation TODAY! www.aacap.org/AnnualMeeting/2016/hotel (to reserve your hotel room) Hotels Rate: $375 single/ New York Hilton Midtown double per night 1335 Avenue of the Americas New York, NY 10019 Early Bird Rate Phone: 212.586.7000 (limited quanti- www3.hilton.com/en/hotels/ ties): $345 single/ new-york/new-york-hilton-mid- double per night, but town-NYCNHHH/index.html must be pre-paid (for detailed hotel information) in full with a non- www.aacap.org/ refundable deposit. AnnualMeeting/2016/hotel (to reserve your hotel room) Check-in is at 3:00 pm and check-out is at Rate: $375 single/double per night 12:00 pm.

Check-in is at 3:00 pm and check- When making your reservation, ask for the AACAP ANNUAL out is at 12:00 pm. MEETING GROUP RATE to qualify for the reduced rate.

Both the New York Hilton Midtown and the Sheraton New York Times Square will host scientific sessions for AACAP’s Annual Meeting. Located directly across the street from each other, both hotels sit in heart of non-stop excitement in mid- town Manhattan. After attending AACAP’s stellar educational offerings, you will be steps from Times Square, Broadway, Radio City Music Hall, Central Park, the Museum of Modern Art, and hundreds of restaurants with cuisines ranging from Austrian to West African and everything in between!

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

Review the Hundreds of Register for the Annual Meeting ✔ Annual Meeting Programs at ✔ Starting in August www.aacap.org/AnnualMeeting/2016. Registration for the Annual Meeting will open on August 1, You can count on AACAP to provide the latest research 2016, for AACAP members and August 8, 2016, for in child and adolescent psychiatry with a wide variety of nonmembers. Be sure to register early to secure all of your programs to meet all of your educational needs. Get up to preferred events. Save $25 by registering online at date on all of the changes in the field, including Healthcare www.aacap.org/AnnualMeeting/2016. Reform, CPT Codes, the effects of marijuana use on kids, emergency room medicine, and international perspectives on child and adolescent psychiatry. Plus, earn up to 50 CME credits! Check AACAP’s website for a complete list of programs and speakers or download the Registration Magazine in August.

Book Your Travel to ✔ New York City

New York City is served by three airports, the John F. Kennedy International Airport (JFK), LaGuardia Airport (LGA), and Newark Liberty International Airport (EWR). For more information about the airlines serving these airports, flight schedules, and ground transportation options, visit www.panynj.gov.

New York City is served by two main rail stations: Grand Central Terminal and Penn Station. Both are served by numerous bus and subway lines, including Metro-North Commuter Railroad, Long Island Railroad (LIRR), Amtrak, New Jersey Transit, and PATH (Port Authority Trans Hudson).

JULY/AUGUST 2016 189 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!

Richard R. Pleak, MD: I ♥ NY for our panoply of cultural, civic, Iliyan Ivanov, MD: I ♥ NY: Travel North – visit part of food, and nature opportunities. This October, AACAP meeting Manhattan that your tourist guide will not tell you about. West attendees can listen to great music in Carnegie Hall (4 blocks Harlem and Upper Manhattan host a number of art galleries and away: Danish String Quartet, American Composers Orchestra), music venues that showcase authentic New York feel, art, and Lincoln Center with the New York Philharmonic, or Radio City culture. Travel is easy – take the 1 train north from Columbus Music Hall (3 blocks away); go see terrific art at MoMA (1/2 circle for a short 30-minute ride depending on your destination. block away), the Museum of Design (7 blocks away), the new Whitney, and the Metropolitan Museum; visit the World Trade Plan A – A day trip to the Spanish Society of America (155th Center memorial fountains; and walk or bike up and into Central St. and Broadway) that houses original Goya and Velasquez Park (5 blocks away) for a great escape from the skyscrapers! paintings; then stroll down Broadway by the historic Trinity And of course, there is wonderful food from the street vendors cemetery to the newest gallery on the block “Gitler & …” on to some of the highest rated restaurants in the world. Local 149 th St. The gallery started a public art project of murals of birds Arrangements will have suggestions to all these and more. endangered by climate change to raise awareness and honor the memory of one of America’s greatest (and New York’s own) Scott M. Palyo, MD: I ♥ NY because New York is a fantastic artists John James Audubon. So, while in the neighborhood look city and its diversity makes it appealing to everyone. Whatever for the bird murals and also check out the New York Times story your interests-food, parks, theatre, music, art, shopping, people on this project. watching -New York has it all. Our subway system (as well as the easy access to cabs and Uber drivers) makes our meeting site You can finish it off with a late lunch at Harlem Public – the best easy to go wherever you want to go. Besides the newer sites such burger joint in town – on 148th St. and Broadway, or stroll further as One World Trade Center, New Museum, and the Highline, south and take pictures of the most incredible sample of Gothic there is also much to see in the other boroughs. Feel free to architecture when you visit the campus of City College on 137th explore, there is always something to see wherever you end up. St. and Amsterdam Avenue.

Gabrielle L. Shapiro, MD: I ♥ NY because of its energy and Plan B – A night out – take the 1 train to 125th St. Just a couple of multicultural identity. New York has something for everyone blocks from the station is the new location of the Gavin Brown and the best of everything! Enterprise – world renowned gallery that has presented the most recognized contemporary artists (the 2015 solo show of Alex Katz was a must and a true cultural landmark). The gallery in located on 126th St. and Amsterdam Avenue in the historic Mink Building (an ex-factory turned art hub where “Uptown meets Downtown”). Late afternoon arrival will give you enough time to enjoy the art and prepare for dinner with music. Two blocks away to the east is “Showman’s” – New York’s most authentic jazz club featuring mostly Harlem based artists and offering home-made dishes. For BBQ stroll west to the end of 125th St. to find “Dinosaur BBQ” – excellent brisket and blues. If you are in a mood for an adventure you can visit the historic “Cotton Club,” which is free standing on the south side of 125th St., just 100 feet east from Hudson River.

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

W ellness Initiative In an effort to encourage the personal good health and wellness Thursday, October 27 of our AACAP members, the Program Committee is infusing 6:30 am–7:30 am a wellness theme into the Annual Meeting this year. Special Yoga Class activities include: Bike Ride in Central Park A morning run, walk, and bike in Central Park Join JAACAP Editor-in-Chief Andres Martin, MD, MPH, for a bike ride in Central Park as Dr. Martin prepares for his Yoga classes each morning cross-country ride in 2017 for Break the Cycle. Meet in the Lobby of the New York Hilton Midtown at 6:30 am. AACAP Meditation classes each afternoon/evening will provide up to 30 bikes complimentary on a first-come, first-serve basis. Scientific CME sessions on wellness for your patients 2:00 pm–5:00 pm Healthier food selections at our special events Clinical Perspectives 27: TED Talks Meet Perspectives: (Clinical) Ideas Worth Spreading We hope attendees take advantage of these opportunities to improve their own wellbeing. These events are open to all 5:30 pm–6:15 pm attendees and their spouse/significant other. See below for Meditation Class scheduling details. Friday, October 28 Tuesday, October 25 6:30 am–7:30 am 4:30 pm–5:15 pm Yoga Class Meditation Class Meditation sessions will last for 45 minutes at the end of Run in Central Park each day. There will be a 30-minute practice with various Join Douglas K. Novins, MD, JAACAP Editor-Elect, and your techniques of focusing the mind. Time will also be given to fellow attendees for a run in Central Park and start your day discussing meditation postures, barriers to meditation, and off right! Meet in the Lobby of the New York Hilton Midtown cultivation of a personal practice. These meditation sessions at 6:30 am. are designed for all levels of practice. 8:30 am–11:30 am Wednesday, October 26 Workshop 26: CARING at Columbia Head Start: 6:30 am–7:30 am Promoting Resilience Through Creative Art and Play Yoga Class and a Prevention Model for At-Risk Preschool Children Sivananda Yoga is a classical approach to the practice of and Families yoga. Classes consist of physical yoga postures, breathing exercises and relaxation techniques. Classes are designed 1:30 pm–04:30 pm for all levels of practices from beginner to advanced. All are Workshop 36: The Buddha in Therapy: Integrating welcome, but space is limited and will be on a first come- Mindfulness Into the Treatment of Children, Adolescents, first served basis. Mats will be provided. and Their Families

Walk in Central Park 7:00 pm–7:45 pm Join Angel A. Caraballo, MD, President of the Meditation Class New York Council on Child and Adolescent Psychiatry and member of the Program Committee, as well as fellow attend- Saturday, October 29 ees for a brisk walk through Central Park to start your day off 6:30 am–7:30 am on the right foot! Meet in the Lobby of the New York Hilton Yoga Class Midtown at 6:30 am.

10:00 am–1:00 pm Symposium 12: Health Prevention and Promotion: More than Common Sense?

6:30 pm–7:15 pm Meditation Class

JULY/AUGUST 2016 191 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

Integrated AACAP President Gregory K. Fritz, MD, has made integrated care the focus of his two-year presidential initiative. Part of that Care Programs initiative involves educating child and adolescent psychiatrists about models for integrated care and how best to collaborate with others in primary or specialty medical care. Here is a sampling of the programs on the Annual Meeting schedule dedicated to this topic.

Systems of Care Special Program: Meeting Workshop 9: Collaboration With Primary Special Interest Study Group 8: the Needs of Children and Youth With Care: Developing Clinical Skills and Integrating Clinical Pathways into the Complex Behavioral Health Problems in Overcoming System Challenges Management of Psychiatric Disorders an Integrated Healthcare World Wednesday, October 26, Within Pediatric Settings Monday, October 24, 3:00 pm–6:00 pm (ticket) Friday, October 28, 8:00 am–4:30 pm (ticket) Chair: Barry Sarvet, MD 5:00 pm–6:30 pm (ticket) Chairs: Justine Larson, MD, MPH Speaker: Read Sulik, MD Chairs and Speakers: Lisa B. Namerow, Mark Chenven, MD Sponsored by AACAP’s Committee on MD, Khyati Brahmbhatt, MD, Nasuh Speakers: Gregory K. Fritz, MD, Paige Collaboration With Medical Professions Malas, MD, MPH, Tyler Pirlot, MD, Pierce, Gary Blau, PhD, Ruth Stein, MD, and Healthcare Access and Economics FRCPC, Claire M. De Souza, MD, FRCPC, Robert J. Hilt, MD, Lisa R. Fortuna, MD, Committee Ilana Waynik, MD MPH, Joyce N. Harrison, MD, Kaye L. Sponsored by AACAP’s Physically Ill McGinty, MD, Lisa Amaya-Jackson, MD, Clinical Perspectives 26: Life Members Child Committee D. Richard Martini, MD, Terry G. Lee, MD, Wisdom Clinical Perspectives on Integrated William Arroyo, MD, Sheryl H. Kataoka, MD Care, Health, Resilience, and the Future of Institute 8: Practical Pediatric Psycho— Sponsored by AACAP’s Community-Based Child and Adolescent Psychiatry pharmacology for the Primary Care Systems of Care Committee Thursday, October 27, Practitioner and Early Career Psychiatrist 2:00 pm–5:00 pm (open) Saturday, October 29, Clinical Perspectives 4: The Integrative Chair: Douglas A. Kramer, MD, MS 8:30 am–4:00 pm (ticket) Child and Adolescent Psychiatrist: Novel Discussants: Marilyn B. Benoit, MD, Chair: Adelaide S. Robb, MD Models of Perinatal Mental Health Care Yiu Kee Warren Ng, MD Speakers: Boris Birmaher, MD, Adelaide S. to Improve Maternal-Infant Outcomes Speakers: Margaret Cary, MD, MPH, Robb, MD, Martine M. Solages, MD, John Tuesday, October 25, T. Walkup, MD, Timothy E. Wilens, MD 9:00 am–12:00 pm (open) Gregory K. Fritz, MD, James J. Hudziak, MD, Michelle L. Rickerby, MD Sponsored by AACAP’s Research Committee Chair: Celeste St. John-Larkin, MD Sponsored by AACAP’s Family Committee Discussant: Kimberly Kelsay, MD and Life Members Committee Workshop 38: How to Succeed or Fail Speakers: Anilla Del Fabbro, MD, in Implementing an Integrated Pediatric Rhapsody Mason, LCSW, Diane M. Misch, Symposium 29: Simon Wile Symposium: Behavioral Health Program MD, Jennifer Paul, PhD, Screening, Adhering, and Dying: Saturday, October 29, Celeste St. John-Larkin A Collaboration With Subspecialty 8:30 am–11:30 am (ticket) Sponsored by AACAP’s Infant and Pediatrics Chair: Rahil Briggs, PsyD Preschool Committee Thursday, October 27, Speakers: Diane Bloomfield, MD, 2:00 pm–5:00 pm (open) Jason Herrick, MD, Susan Weinstein, MD Karl Menninger, MD Plenary: A Common Chair: Sourav Sengupta, MD, MPH Struggle: A Personal Journey Through the Speakers: Beth A. Smith, MD, Eyal Training Child and Adolescent Past and Future of Mental Illness Shemesh, MD, David Buxton, MD, Read Psychiatrists to Work in Integrated Care and Addiction Sulik, MD Saturday, October 29, Wednesday, October 26, 8:30 am–4:00 pm (open) 8:00 am–9:45 am (open) Sponsored by AACAP’s Committee on Collaboration With Medical Professions Speakers: Anna Ratzliff, MD, PhD, Chair: Gregory K. Fritz, MD Barry Sarvet, MD Speaker: The Honorable Patrick J. Kennedy Working Together in 21st Century Pediatrics: Collaborative Care in Action Lawrence A. Stone, MD Plenary: Clinical Perspectives 12: Pediatric with Experts in Anxiety and Depression Child Psychiatry: Population Health’s Medicine Updates for the Child Thursday, October 27, Reluctant Driver Psychiatrist: Headache, Concussion, and 6:00 pm–10:00 pm (ticket) Saturday, October 29, 11:45 am–1:15 pm (open) Child Physical Abuse Chair: Rachel Zuckerbrot, MD Wednesday, October 26, Chair: Gregory K. Fritz, MD 10:00 am–1:00 pm (open) Speakers: Boris Birmaher, MD, Diane Bloomfield, MD Speaker: Kelly J. Kelleher, MD Chairs: Kristi Kleinschmit, MD and Mary T. Gabriel, MD Symposium 34: Community Crisis and Clinical Perspectives 49: Evaluating and Speakers: David W. Dunn, MD, Community Resilience: The Children of Implementing Complex Psychosocial Pam Esperanza, MD, Kelly Irons, MD Flint, Michigan Interventions for Children and Youth Sponsored by AACAP’s Physically Ill Friday, October 28, Saturday, October 29, Child Committee, Training and Education 8:30 am–11:30 am (open) 1:30 pm–4:30 pm (open) Committee, and Triple Board and Post Chairs: Sheila M. Marcus, MD, Chair: Amy Cheung, MD, MS Pediatric Portal Programs Committee Dayna LePlatte, MD Discussant: Gregory K. Fritz, MD Speakers: Anne Kramer, MSW, Dayna Speakers: Nicole Kozloff, MD, Joan R. LePlatte, MD, Lauren O’Connell, MD, MSC Asarnow, PhD, Amy Cheung, MD, MS, Sponsored by AACAP’s Infant and Laurence Y. Katz, MD 192 AACAP NEWS Preschool Committee 63RD ANNUAL MEETING ♥ OCT 24-29, 2016 ♥ NEW YORK, NY

Residents, Trainees, and Medical Students ATTEND AACAP’S 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. Registration opens August 1 for AACAP members and August 8 for nonmembers. Become a member TODAY to get priority monitor scheduling!

Promote Your Book at This Year’s Annual Meeting!

Join us at our “Meet the Author” booth in the Exhibit Hall. All attendees are welcomed to participate. Sign up for a one-hour time slot to promote your book. Limited time slots are available beginning on Wednesday, October 26 and ending on Friday, October 28. The cost is $300 per hour for each book, which defrays costs of booth rental. Be the first author to sign up!

More information can be found at: www.aacap.org/exhibits/2016.

JULY/AUGUST 2016 193 FOR YOUR INFORMATION Congratulations!

AACAP wants to acknowledge the hard work and success of all the speakers who presented at our 2016 Spring Meetings.

The following speakers received the highest average ratings on evaluations from the 2016 Psychopharmacology Update Institute: Translating Evidence-Based Studies Into Clinical Practice. This Institute was chaired by Melissa P. DelBello, MD, and Laurence L. Greenhill, MD, and held at the Sheraton New York at Times Square, January 29-30, 2016.

Timothy E. Wilens, MD: John T. Walkup, MD: Clinical Psychopharmacological Strategies Studies That Shape the for Adolescent Substance Use Psychopharmacological Treatment Disorders (4.8 on a 5 point scale) for the Child With Anxiety Disorder (4.87 on a 5 point scale)

Be sure to look for the latest installment of the Psychopharmacology Update Institute at AACAP’s 63rd Annual Meeting in New York, NY, and in San Francisco, CA, January 20-21, 2017!

The following speakers received the highest average ratings on evaluations from AACAP’s Douglas B. Hansen, MD, 41st Annual Review Course. This Institute was chaired by Gabrielle A. Carlson, MD, and James J. McGough, MD, and held in Long Beach, CA, March 12-14, 2016.

Eraka Bath, MD: Forensic Issues John T. Walkup, MD: Generalized (4.84 on a 5 point scale) Anxiety Disorder, Social Phobia, Separation Anxiety, Obsessive Compulsive Disorder, Movement Disorders, and Posttraumatic Stress Disorder (4.80 on a 5 point scale)

Thanks to all of the chairs, presenters, and participants of these valuable meetings!

194 AACAP NEWS FOR YOUR INFORMATION

Membership CORNER

In Memoriam

Jose Marrero, MD Palm City, FL

Nelli Mitchell, MD Rochester, NY Congratulations to Graduating Residents and Medical Students Herman Spater, MD Larchmont, NY Please provide us with your updated contact information after graduation.

You can update your information online at www.aacap.org.

This Could Be Your Last Issue! AACAP A Pu blication of the

■ Ju Nely/A ugust 2016 ■ Volume ws47, Issue 4 Renewed for 2016? If not, you DID YOU KNOW? could be holding your last issue of AACAP News! Logon to www.aacap.org and renew today. Contact Member Services at 202.966.7300,

Photo: In Congressman Brad ext. 2004 to renew by phone. side... Ashford (D -NE) Presiden t’s Message: Making Ps the Roun ychopharmacolo ds and Maki gy: At ng a Di ypical or Second fference ...... My Introd -G uction to The L eneration Anti 157 ife: Domest psychotics 2016 AACA ic Minor ...... 16 P Legislat Sex Traffi ckin 1 Children ive Conference g ...... ’s Mental Recap – Su Health ...... ccessf 166 60th ully Advancin Congress of AEPN g YA RD in San Sebast 63 ANNU ian: A Sh 17 AL MEET ared Init 1 ING ♥ OC iative with T 24-29, 2016 AACAP! .. ♥ NEW YO 180 RK, NY ...... 188

New York City’s 520-mile coastline is longer than those of Miami, Boston, Los Angeles, and San Francisco combined.

JULY/AUGUST 2016 195 FOR YOUR INFORMATION

Welcome New AACAP Members Hetal Amin, MD, O’Fallon, IL Joel Kestenbaum, MD, Belle Harbor, NY Lauren Provini, New Haven, CT Kammarauche Asuzu, MD, Durham, NC EunHye Kim, MD, Seoul, Saumya Rachakonda, MD, Brooklyn, NY Republic of Korea Alan Atkins, La Canada Flintridge, CA Manivel Rengasamy, MD, Pittsburgh, PA Kodjovi Kodjo, Elkridge, MD Manpreet K. Bassi, Sacramento, CA Monica Rettenmier, MD, Nashville, TN Bishoy Kolta, MD, Atlantic City, NJ Emeric Bojarski, MD, Carlisle, MA Juan A. Rivolta, MD, Brooklyn, NY Jordan Koncinsky, Salt Lake City, UT Celeste Brown, Charlotte, NC Kyley Roberts, Corpus Christi, TX Hal Kronsberg, MD, Somerville, MA Hector Sam Cardiel, West Orange, NJ Claudia Rocha, Sacramento, CA Reena Kumar, DO, Milwaukee, WI Sara Chun, Washington, DC Nicole Christina Rouse, Riverside, CA Lauren Kwan, Sacramento, CA Un-Sun Chung, MD, PhD, Deagu, Callum J. Rowe, Sacramento, CA Republic of Korea Svante Niklas Langstrom, MD, Gabriela Sanchez, MD, Pasadena, CA Stockholm, Sweden Esther Currie, MD, Sacramento, CA Kevin Sanders, MD, Nashville, TN Grace Lee, DO, Tampa, FL Eva Diaz, MD, Denver, CO John-Lloyd Santamarina, Sacramento, CA Rachel Leidner, MD, Dallas, TX Michael A. Donath, Sacramento, CA Anna Scandinaro, Hummelstown, PA Kimberly S. Lin, Pittsburgh, PA Justine L. Ellis, MD MBBS, Annandale, Hannah Schroeder, Christiansburg, VA NSW, Australia Yee Lo, Sacramento, CA Meryam Sheriaty, MD, Baldwin, NY Veronica Faller, North Reading, MA Erica Lubliner, MD, Bakersfield, CA Jeonwon Shin, MD, Morton, IL Luis A. Fernandez, Sacramento, CA Gabriel Lugo, MD, Lakewood Ranch, FL Kevin Mauclair Simon, MD, Atlanta, GA Brittany Furrow, New York, NY Irene Ly, Elk Grove, CA Ramon Solhkhah, MD, Neptune, NJ Itzayana Garcia, Los Angeles, CA Ramkrishna Makani, MD, Absecon, NJ Maya Strange, MD, Reno, NV Tracy Grabman, MD, Knoxville, TN Neetu Malhi, Fresno, CA Evan Trager, MD, Corona, CA Ronald Graveland, MD, Wezep, Lauren Manning, Portland, ME Jalia Tucker, Chicago, IL Netherlands Martin Manoukian, Sacramento, CA Jack Turban, III, New Haven, CT Olivier Halfon, MD, Lausanne, Vaud, Noah Matilsky, MD, Tampa, FL Switzerland Marcia Unger, MD, Sacramento, CA Morgan Anne McCoy, Philadelphia, PA Shariq Haque, MD, Parsippany, NJ Olivetta Uradu, Washington, DC Megan McLeod, MD, Buffalo, NY Blaire Ashley Heath, Placentia, CA Codie Vassar, Milwaukee, WI Nadia Mendiola, MD, San Antonio, TX Renea Henderson, DO, Little Rock, AR Sergey Veretennikov, Sacramento, CA Carlos Molina, MD, Cleveland, OH Benjamin Hines, MD, Morgantown, WV Richa Vijayvargiya, Melbourne, FL Lorin Mowrey, Phoenix, AZ Taman Hoang, Sacramento, CA Benjamin Weger, Rockford, IL Megan Mroczkowski, MD, Julia Hoang, MD, Huntington Beach, CA New York, NY Emily S. Weibel, Sacramento, CA Kali Hobson, MD, Portland, OR Kathy Mu, DO, Houston, TX Matthew Weingard, MD, MPHTM, Alexandria, VA Daniel Hosker, MD, Rochester, MN Kristin Nguyen, Rochester, MN Alison Weiss, MD, Chicago, IL Iyantta Howell, MD, Livonia, MI Daniel Nicoli, MD, Portland, OR Alexa Whatmough, St. Louis, MO Lance Irons, Norfolk, VA Rebecca Nkrumatt, Sacramento, CA Jorge A. Zapatel, MD, Solana Beach, CA Brett Johnson, MD, Chula Vista, CA Kristine Olivier, MD, New Orleans, LA Alexandra Junewicz, MD, New York, NY Sameeraa Pahwa, New Orleans, LA Mitchel G. Katz, MD, Rocky Hill, CT Shivani Patel, Temple, TX Jasmine Kaur, MD, Wichita, KS

196 AACAP NEWS FOR YOUR INFORMATION

Beneficiary Designations: A Gift to AACAP That Costs Nothing Now

■■ Alan Mark Ezagui, MHCA, designation form to complete. You still Deputy Director of Development retain complete ownership of your AACAP account to spend during your later t is never too early to consider using years and any leftover funds will go your retirement assets to make a to A AC AP. Idifference. Many of our members have IRAs, 401(k)s, 403(b)s, or another You can even name multiple benefi- qualified plan, yet these assets are often ciaries: AACAP can be a full or partial overlooked when considering how to beneficiary of any portion of those help AACAP do more to help children assets. Another option is to name with mental illnesses. A beneficiary AACAP as a contingent beneficiary to designation on a retirement plan costs inherit those assets should your primary making an even bigger difference for nothing now, and at the same time beneficiary not survive you. children with mental illnesses, helping allows you to include AACAP in your them achieve their life’s full potential. future charitable giving without having to Also, naming AACAP as a beneficiary consult an attorney. of your retirement plan will help you Finally, other assets you can use with save on estate and income taxes. How? beneficiary designations are life insur- And, in making such a gift, you also Retirement plan assets that are left to ance policies, investment accounts, and become a member of AACAP’s heirs other than a spouse are taxed; bank accounts. 1953 Society. however, a tax exempt organization (i.e., a 501(c)(3), such as AACAP does not pay For more information on how you can It is also one of the easiest estate gifts to taxes. Furthermore, taxes on retirement make a difference for these children, make. Your plan administrator at your assets must be paid at death which please contact AACAP’s Development hospital, Human Resources Department leaves less money for heirs. Thus, if you Office 202.966.7300, ext. 140 or by at your academic institution or other plan on making a gift to charity in your email at [email protected]. You employer, or the financial institution estate plan, giving retirement assets tax- can also find more information in the that holds your (IRA) assets can provide free is a great way to maximize the value 1953 Society section of our website, you with the necessary beneficiary of your estate for your heirs, while also www.aacap.org/1953Society. m Lifelong Learning Module 10 Expires August 31, 2016

AACAP’s Lifelong Learning Module 10: Abuse and Neglect, Adoption and Foster Care, Custody and Divorce, Dissociative It’s not too late to Disorders, Personality Disorders, Reactive Attachment Disorder, buy a copy of Lifelong and Relevant Updates for Child and Adolescent Psychiatrists Learning Module 10. expires on August 31, 2016. Be sure to complete your module The deadline to order exams before the deadline to earn a total of 38 AMA PRA Category 1 Credits (8 of which can be used towards the ABPN’s Module 10 is July 31, self-assessment requirement for MOC). 2016. Visit our online publication store at If you currently have Module 10, complete your exams online or mail in your answer form before August 31st to receive credit www.aacap.org (complete instructions are included within your module). Exams to place your order. cannot be submitted for grading after August 31.

JULY/AUGUST 2016 197 FOR YOUR INFORMATION

Thank You for Supporting AACAP! AACAP is committed to the promotion of mentally healthy children, adolescents, and families through research, training, pre- vention, comprehensive diagnosis and treatment, peer support, and collaboration. Thank you to the following donors for their ­generous financial support of our mission. ♥

Gifts Received April 1, 2016 to April 30, 2016

$2,500 to $4,999 R. Andrew Harper, MD* 1953 Society Members Break-the-Cycle Atsuko Ishikawa, MD* Anonymous (4) (supporting Campaign for Karen Joan Kraus, MD Steve and Babette Cuffe America’s Kids initiatives) Marissa C. Leslie, MD James C. Harris, MD and Andrés Martin, MD, MPH Justine Sarah McCarthy, MD* Catherine DeAngelis, MD, MPH $100 to $499 Nadine Schwartz, MD* Paramjit T. Joshi, MD Campaign for America’s Kids Cynthia Sortwell, MD Joan E. Kinlan, MD Martin J. Drell, MD♥ Jim Tucker, MD* Dr. Michael Maloney and Andrea Eisner, MD Dr. Marta Pisarska Amy Ursano, MD Jack and Sally McDermott Geetika Verma, MD* Life Members Fund (Dr. Jack McDermott, in memoriam) Joan Caggiano*, Patricia A. McKnight, MD in memory of Joel Ganz, MD Life Members Fund Scott M. Palyo, MD Brenda Dixon*, Alan Mark Ezagui, MHCA♥ in memory of Joel Ganz, MD Boris Rubinstein, MD♥ The Roberto Family Joan Stern Narad, MD Karen Simat*, in memory of Diane H. Schetky, MD Dr. Joel Ganz Gabrielle L. Shapiro, MD Marc Amaya Fund Diane K. Shrier, MD, and Kaye L. McGinty, MD Research Initative Adam Louis Shrier, D.Eng, JD Jacqueline Nicole Smith, MD Steven P. Cuffe, MD♥ * Indicates a first-time donor to AACAP Where Most Needed Virginia Q. Anthony Fund ° Indicates an honorarium donation General Contribution Alice R. Mao, MD♥, in honor of Rob Grant and Stephanie Chow ♥ Indicates a Hope Maker recurring Shamal S. Beltangady, MD monthly donation David Dunn, MD* Where Most Needed Matthew N. Koury, MD, MPH♥ General Contribution Margaret Klitzke, DO Brigitte Bailey, MD Stephen J. Cozza, MD♥ Up to $99 Ryan Herringa, MD, PhD♥ Campaign for America’s Kids Kelly N. Botteron, MD* Michelle Marwitz♥ William Burleson Daviss, MD Mini Tandon, DO♥ Robert J. Edleman, MD Workforce Development Andrea Eisner, MD Summer Medical Student Fellowship Ken A. Ensroth, MD Paula Marie Smith, MD♥ Barbara Gracious, MD♥

Every effort was made to list names correctly. If you find an error, please accept our apologies and contact the Development Department at [email protected] or 202.966.7300 ext. 130.

198 AACAP NEWS

FOR YOUR INFORMATION CLASSIFIEDS AUSTRALIA Enquiries: ILLINOIS Dr. Maree Ploetz 07 4226 5273 SENIOR STAFF SPECIALIST OR HEAD OF CHILD AND STAFF SPECIALIST (CHILD AND Job Ad Reference: CA207135 ADOLESCENT PSYCHIATRY YOUTH PSYCHIATRIST) www.smartjobs.qld.gov.au Chicago, IL Cairns The Northwestern University Feinberg Mental Health and Alcohol, Tobacco School of Medicine (NUFSM) and Ann and Other Drugs Service, Division of CALIFORNIA & Robert H. Lurie Children’s Hospital Family Health and Wellbeing, Cairns, ADOLESCENT INPATIENT AND of Chicago are seeking an outstand- Cairns and Hinterland Hospital and OUTPATIENT OPPORTUNITY ing child and adolescent psychiatrist to Health Service. San Francisco, CA hold the Osterman Endowed Chair as Head of the Department of Child and Remuneration value up to $394 542 Adolescent and Adult Inpatient/ Adolescent Psychiatry at Lurie Children’s p.a., comprising salary between $194 Outpatient Opportunity Practice Near and Division Head at NUFSM. An 686 - $206 416 p.a. (L25-L27) or Golden Gate Park in San Francisco energetic and forward-thinking leader is Remuneration value up to $360 771 Dignity Health Medical Group – Saint sought for this multidisciplinary program p.a., comprising salary between $162 Francis/St. Mary’s, a service of Dignity with missions of clinical care, education, 802 - $189 106 p.a. (L18-L24), employer Health Medical Foundation, is a research, and advocacy in a nationally contribution to superannuation (up to dynamic and growing group provid- ranked freestanding state-of-the art chil- 12.75%), annual leave loading (17.5%), ing high quality medical services dren’s hospital located on the medical communications package, professional to patients. We are affiliated with school campus in the heart of Chicago, development allowance, motor vehicle St. Mary’s Medical Center, dignity- overlooking Lake Michigan. Funding allowance, professional development health.org/stmarys/medical-services/ is available for research and faculty leave 3.6 weeks p.a., professional adolescent-psychiatric-services. development. Successful application indemnity cover, private practice requires leadership and administrative We are seeking a BE/BC Adolescent arrangements plus overtime and on-call experience in an academic medical Psychiatrist who is energetic and allowances. (Applications will remain center, preferably including a children’s thrives on the opportunity of expand- current for 12 months). hospital, a sustained record of academic ing our existing Adolescent services in accomplishments, excellent skills in San Francisco! Leadership experience/ Duties/Abilities: Cairns is in the heart collaboration, and leadership in national interest is a plus for a possible Medical of the tropical north and is the pri- professional organizations. Current Director Opportunity. mary gateway to northern Australia. certification by ABPN in child and Cairns is an ideal base to explore the Opportunity Highlights: Adolescent adolescent psychiatry is required. This wider region with front door access to and Adult Psychiatrist Practice at the Associate or full Professor position is a the Great Barrier Reef, rainforests and hospital’s McAuley Institute, the only full-time continuing faculty appointment. outback locations with an International dedicated adolescent inpatient program Airport located only several minutes’ Rank, track, and salary are commensu- in San Francisco Also practice outpa- drive north of the city centre. This rate with qualifications and experience. tient/inpatient adult psychiatry Growth position will require the provision of Hiring is contingent upon eligibility to to a Medical Director role Practice with excellent, specialist child and adoles- work in the United States and medical established community Psychiatrists cent psychiatric knowledge and skills licensure in Illinois. Applications will be In-House Hospitalists available 24/7/365 to facilitate the delivery of quality child evaluated as received. Anticipated start for medical H & P and management of and adolescent mental health care to date is December 2016. acute medical conditions. Our Medical children, young people and support- Foundation is aligned with one of the ing their families in recovery model of Send your CV with a letter describing largest health systems in the nation and care. This role will provide diversity, relevant experience and interests to the largest hospital system in California. challenges and rewards, combined with Alexis Puzon ([email protected]). the opportunity to contribute to new For more information, please contact Northwestern University and the initiatives and the enhancement of an and send your CV to: integrated, developmentally appropriate Lurie Children’s Medical Group are Equal Opportunity, Affirmative Action model of care for children and youth Dignity Health Medical Foundation Employers of all protected classes, and their families across the continuum. Lori Hart, Physician Recruiter including veterans and individuals with Cairns and Hinterland Hospital and Email: [email protected] disabilities. Women and minorities are Health Service will not be accepting Phone: 888-599-7787 encouraged to apply. Hiring is con- applications submitted through recruit- www.dignityhealth.org/physician-careers ment agencies. Medical Practitioners are tingent upon eligibility to work in the encouraged to apply online or directly to Company: Spin Recruitment Advertising United States. Recruitment Services. (876472) Mkd 111715 Job ID: 8212638 http://jobsource.aacap.org/jobs/8212638

200 AACAP NEWS FOR YOUR INFORMATION

INPATIENT (WITH OPTIONAL evidence based, compassionate care. 104 psychologists), the Department of OUTPATIENT) CHILD AND Advocate Children’s Hospital is the Psychiatry’s active and diverse programs ADOLESCENT PSYCHIATRIST largest network provider of pediatric in clinical services, education, and Park Ridge, IL services in Illinois and among the top research encompass all aspects of the 10 in the nation. Through a special, field of child and adolescent behavioral Inpatient (with optional outpatient) Child holistic approach, Advocate Children’s health. The Department is seeking lead- and Adolescent Psychiatrist Suburban Hospital combines some of the coun- ership from a gifted mid- to senior level Chicago Advocate Childrens Medical try’s most respected medical talent with academic child psychiatrist or psycholo- Group at Advocate Childrens Hospital exceptional and compassionate care. gist with an active research program in Park Ridge, Illinois, seeks a full time Compensation package is available that promotes the mission of the Tommy flexible BE/BC Child and Adolescent through Advocate Medical Group, one Fuss Center to advance understanding Psychiatrist with excellent interpersonal of the largest physician-run organizations of developmental pathways leading to skills and a passion for improving the in the state. Candidtaes with strong ties major neuropsychiatric disorders. lives of children. Come join an outstand- to the area are welcomed! This is a full ing multidisciplinary team to provide time postiton. Job Requirements: care for and an opportunity to lead one The successful candidate will dem- of the few and truly unique child and Company: Advocate Health Care / adolescent inpatient psychiatry units in onstrate scholarly excellence through Advocate Childrens Medical Group research productivity and a record of the Chicagoland area! This would be (931977) primarily an inpatient role providing successful competition for external Job ID: 8198731 funding, a strong record of mentoring, services to patients in the 12-bed C/A http://jobsource.aacap.org/jobs/8198731 inpatient psychiatric unit, partial hospi- and excellent leadership skills. A strong talization program, and patients on the collaborative nature will be required general medical floors through consulta- MASSACHUSETTS to sustain and build partnerships both tive work. (Outpatient work would be within and outside the hospital set- RESEARCH DIRECTOR, FUSS optional.) ting. The proposed position will be at CENTER FOR NEUROPSYCHIATRIC either the rank of Professor or Associate Assist in being part of an extraordi- DISEASE AND PROGRAM IN Professor at Harvard Medical School. nary and nationally renowned hospital BEHAVIORAL SCIENCE network focused on development of Boston, MA Company: Boston Children’s Hospital (881542) its child behavioral health services. Boston Children’s Hospital Department Job ID: 8201241 There are opportunities for growth and of Psychiatry is seeking a Director for http://jobsource.aacap.org/jobs/8201241 leadership and additional responsibili- its newly created Tommy Fuss Center ties may include hospital staff education, for Neuropsychiatric Disease Research community education and partner- (Tommy Fuss Center). The successful MINNESOTA ships, and assisting in the supervision candidate will also assume leadership and teaching of a wonderful group of all Psychiatry research in the dual CHILD AND ADOLESCENT of dedicated psychiatry and pediatric role as Director of the Department’s OPPORTUNITY residents. A devoted team of clinicians, Program in Behavioral Science (PBS). St. Paul/Minneapolis, MN support and administrative staff are there The current PBS research portfolio Growing Psychiatric Healthcare System to assist in any way to ensure a comfort- spans Developmental Neuroscience, Seeks Psychiatrists PrairieCare, a able, respected and balanced work/ Developmental Psychopathology, physician-owned psychiatric health- life environment. On Call Schedule: ER Health Psychology, and Community care system in the Minneapolis/St. Paul phone call 5-6 days with 1 weekend per Psychology. The Tommy Fuss Center metropolitan area, is recruiting child, month. No in-house call, coverage by is an exciting new opportunity that adolescent and adult psychiatrists for its phone. Patient population is a wonder- significantly enhances the PBS research Brooklyn Park, Chaska, Edina, Maple ful payor-mix blend. 1-2 average patient portfolio by targeting the understanding Grove, Maplewood and Rochester admissions per call. Regreatably J 1 Visas of the developmental pathways lead- sites. Child/Adolescent clinical duties are not available. ing to major neuropsychiatric disorders. may include treating youth in inpatient, The primary goals of the Center will be partial hospital, intensive outpatient, res- Please forward CV and detailed cover to develop strategies to identify young idential and clinic settings. Adult patients Letter to: Nancy Mathieu children at risk for anxiety, depressive, are served in intensive outpatient [email protected] and psychotic disorders along with programs and busy outpatient clinics Please visit www.advocatechild- innovative approaches to therapy that with therapist, social work and nursing renshospital.com/ach/ and www. could limit the progression of these dis- support on site. Opportunities to consult amgdoctors.com/about-us/ for more orders, thereby promoting more positive with primary care clinicians through an detailed information. developmental outcomes. The Center innovative “integrated health and well- will be highly interdisciplinary and Job Requirements: ness” model available as well. Academic translational and will provide for both appointment on the adjunct faculty of Qualified applicants will have completed innovative research by scientists at all the University of Minnesota Medical an American Board of Pediatrics (ABP) levels and training of the next generation School possible for interested candi- accredited fellowship and be BE/BC by of talented researchers to carry these dates. Reports to Chief Medical Officer. the ABP in this subspecialty. Consider efforts forth into future. With over 140 Requires BC/BE in Psychiatry and an joining our team committed to providing faculty members (42 psychiatrists and

JULY/AUGUST 2016 201 FOR YOUR INFORMATION unrestricted license to practice medi- to have an incredible impact on the Company: ADHD, Mood and Behavior cine in Minnesota. With multiple sites youth in a community, this is where Center (980325) across Minnesota, PrairieCare is rapidly you want to be! About the Community Job ID: 8215592 growing and boasts one of the region’s According to Forbes, Lincoln is the 7th http://jobsource.aacap.org/jobs/8215592 largest groups of psychiatric physicians. Best Place in the country for Business Our organization is focused on offering and Careers! Lincoln, Nebraska, has dedicated clinicians the opportunity to earned a reputation as one of the VIRGINIA practice high quality psychiatric care Midwest’s most beloved cities. Home CHILD AND ADOLESCENT in a supportive, team-based group to fine culinary and artistic treasures, a PSYCHIATRIST practice. The Twin Cities metro area has budding live music scene, breath-taking Shenandoah Valley approximately 3.5 million people, over parks, numerous golf courses, miles of thirty institutions of higher learning, an biking trails, and a friendly Midwestern The Commonwealth Center for Children outstanding K-12 school system, multiple attitude, Lincoln offers the exhilara- & Adolescents (CCCA) invites you professional sports teams and a thriv- tion of a large city and the serenity of a to consider a Child and Adolescent ing fine arts community. Minnesota has smaller town all in one place. Suburban Psychiatry position in the beautiful four beautiful seasons and is consistently living offers charming family neighbor- Shenandoah Valley. CCCA is Virginia’s ranked as one of the healthiest states hoods, top-notch public and private only public acute psychiatric hospital with some of the most enjoyable ameni- K-12 schools, and a cost of living 10.2% for children and adolescents. CCCA is ties. PrairieCare provides an excellent below the national average! Downtown 48-bed hospital serves youngsters with compensation and benefits package. Lincoln is a vibrant, growing “urban a variety of serious psychiatric disor- oasis” evidenced by the resurgence of ders from across the state of Virginia. View us online at www.prairie-care. young professionals choosing to live and Treatment is provided in a relationship- com. play in the city. Lincoln offers something based, collaborative, trauma-informed for every lifestyle! treatment model of care, in which the Send CV and letter of interest to: psychiatrist is the head of the child’s Kait Semon, Medical Staff Coordinator; Contact in Confidence: treatment team on a 12-bed unit. PrairieCare; 9400 Zane Ave N; Brooklyn Brenda McGinn Park, MN 55443; or [email protected] As Psychiatrist, you will direct a via email to [email protected]. 402-481-4526 multidisciplinary treatment team www.bryanhealth.com/careers/ multidisciplinary team consisting of a Company: PrairieCare (878184) physician-opportunities psychologist, social worker, nurse, sub- Job ID: 8057401 stance abuse counselor, direct care staff, http://jobsource.aacap.org/jobs/8057401 Company: Bryan Health (912612) and teachers, providing treatment for Job ID: 8137891 children and adolescents with complex, http://jobsource.aacap.org/jobs/8137891 co-morbid, and severe mental illnesses. NEBRASKA Expertise in psychiatric evaluation and CHILD AND ADOLESCENT treatment, including psychopharmacol- PSYCHIATRIC HOSPITALIST NEW JERSEY ogy, is essential. Lincoln, Nebraska PRIVATE OUTPATIENT CHILD CCCA serves as the inpatient child psy- Bryan Physician Network, the employed AND ADOLESCENT PSYCHIATRY chiatry training center for the University medical group of Bryan Health, has OPPORTUNITY of Virginia Department of Psychiatry & a Child and Adolescent Psychiatric Cedar Knolls, Millburn and Neurobehavioral Sciences child psy- Hospitalist opportunity. Average Daily Montclair, NJ chiatry fellows and general psychiatry Census of 13-22 28 bed child and Child/Adolescent Psychiatrist posi- residents, and abundant education and adolescent unit provides acute crisis tions are available for our Cedar Knolls, supervision opportunities are available, stabilization for youth 3-18 Wide range Millburn and Montclair, NJ, locations, to including a clinical faculty appointment of diagnoses treated The 7 days on and join our private upscale fee-for-service at the University of Virginia for eligible 7 days off schedule allows for travel and comprehensive child, adolescent and candidates. time with family that few other jobs can adult psychotherapy Centers. Candidate accomodate Dedicated team of expe- will be part of a multi-disciplinary team For further requirements and to apply, rienced social workers and therapists, and will provide psychiatric evaluation, please visit the Virginia Jobs at http:// psych pharmacists and other profession- medication management and, if desired, jobs.virginia.gov/. The position offers a als work closely with our Psychiatric psychotherapy, in a supportive collegial competitive salary with full state benefits Hospitalists Competitive compensation atmosphere. Salary and benefit pack- including vacation and educational con- and benefits package Bryan Health is age is generous, and includes excellent ference time, retirement plan, medical the regional leader in providing mental medical and dental insurance benefits, and dental insurance, disability plan, life health services and offers 66 inpatient generous vacation and CME time, retire- insurance, etc. mental health beds, a dedicated mental ment plan and more. Candidate must be health emergency department, drug board certified or board eligible in child/ Please contact our Human Resource and alcohol treatment facility, partial adolescent psychiatry. office at (540) 332-2116 for further ques- hospitalization, individual and family tions. CCCA is an equal opportunity, counseling, biofeedback, and many E-mail cv to [email protected]. affirmative action employer. other outpatient services. If you desire

202 AACAP NEWS Gabrielle A. Carlson, MD, and Manpreet Kaur Singh, MD, MS, Co-Chairs The Westin St. Francis San Francisco – San Francisco, CA

Register by December 7 at www.aacap.org/psychopharm/2017. Questions? E-mail [email protected]. Nonprofit Org. U.S. Postage PAID Merrifield, Va Permit No. 1693 3615 Wisconsin Avenue, NW Washington, D.C. 20016-3007

AACAP News

ADVERTISING RATES ADVERTISING DEADLINES Inside front, inside back or back cover . . $4,000 September/October 2016 ...... July 27 Full Page ...... $2,000 November/December ...... September 27 Half Page ...... $1,600 January/February 2017 ...... November 27 Third Page ...... $1,100 March/April 2017 ...... January 27 Quarter Page ...... $700 May/June 2017 ...... March 27

CLASSIFIED ADVERTISING RATES DISCOUNTS ◗◗ $12 per line (approximately 6-8 words per line) . ◗◗ AACAP members and nonprofit entities receive ◗◗ Classified ad format listed by state . Typesetting a 15% discount . by AACAP . ◗◗ Advertisers who run ads three issues in a row receive ◗◗ Commission for advertising agencies not included . a 5% discount . ◗◗ 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].