AACAP

A Publication of the News n May/June 2014 n Volume 45, Issue 3

Photo by Shubu Ghosh, MD Inside... Picking the Right Type of Treatment...... 109 Opportunities to Integrate BehavioralHealth and Primary Care in School-Based Clinics: A New Beginning...... 115 The Maori World – Words Matter...... 120

TABLE of CONTENTS

COLUMNS Jean Dunham, MD, Section Editor • [email protected] Clinical Vignettes: Picking the Right Type of Treatment • Martin J. Drell, MD, and Sylvia Worrell, MD...... 109

Psychotherapy: Unto the Third Generation: A New Development Textook for CAPs • Rachel Z. Ritvo...... 111

Diversity and Culture: Kurdish Immigrants and Mental Health • Sheinel J. Saleem, PhD, and Sala S. N. Webb, MD...... 113 COMMITTEES Ellen Heyneman, MD, Section Editor • [email protected] Schools Committee: Opportunities to Integrate Behavioral Health and Primary Care in School-Based Clinics: A New Beginning • Fareesh Kanga, MD, and Kimberly White, MD...... 115

Northern California Regional Organization of Child and Adolescent Psychiatry: What Our Patients Teach Us • Edmund C. Levin, MD...... 117

NEWS Stuart Goldman, MD, Section Editor • [email protected] News Updates • Stuart Goldman, MD, and Garrett Sparks, MD, MS...... 118

OPINION Christopher Varley, MD, Section Editor • [email protected] The Maori World – Words Matter • Hinemoa Elder, MBChB, PhD...... 120

FEATURES Debbie Carter, MD, Section Editor • [email protected] Poetry: Burst • Karie Evans...... 122

Media Page • Harmony Raylen Abejuela, MD...... 123

61ST ANNUAL MEETING Eva Szigethy, MD, Section Editor • [email protected] San Diego Preview...... 124

New Research Poster Call for Papers ...... 127

Medical Students and Residents: Attend the AACAP Annual Meeting and Get Involved! ...... 128

FOR YOUR INFORMATION Membership Corner...... 129

Upcoming Events...... 129

Staff Directory...... 130

AACAP Welcomes Carmen J. Head as the New Director of Research, Training & Education!...... 133

Thank You for Supporting AACAP!...... 132

Did You Know? ...... 134

COVER: The smiles on their faces looks like “Christmas came early” and that’s what I call that picture. The poverty level in Taki is high and the kids were genuinely excited with any my gift. It was my pleasure to give back. Taki is a village on the border between West Bengal (India) and Bangladesh by the Ichamati River. – Shubu Ghosh, MD MISSION STATEMENT MISSION OF AACAP NEWS Mission of AACAP: Promote the The mission of AACAP News includes: 1 Communication among AACAP members, components, and leadership. healthy development of children, 2 Education regarding child and adolescent psychiatry. adolescents, and families through 3 Recording the history of AACAP. 4 Artistic and creative expression of AACAP members. research, training, prevention, 5 Provide information regarding upcoming AACAP events. comprehensive diagnosis and 6 Provide a recruitment tool. treatment and to meet the EDITOR ...... Uma Rao, MD MANAGING EDITOR ...... Rob Grant professional needs of child and PRODUCTION EDITOR ...... Patricia J. Jutz, MA adolescent psychiatrists throughout COLUMNS EDITOR ...... Jean Dunham, MD COMPONENTS EDITOR ...... Ellen Heyneman, MD their careers. NEWS EDITOR ...... Garrett M. Sparks, MD OPINION EDITOR ...... Christopher Varley, MD Amended and Approved by Council, June 27, 2010 FEATURE EDITOR ...... Alvin Rosenfeld, MD ANNUAL MEETING EDITOR ...... Eva Szigethy, MD PHOTOGRAPHY EDITOR ...... Alvin Rosenfeld, MD FUNCTION AND ROLES OF THE CONTRIBUTING EDITOR ...... Diane K. Shrier, MD AMERICAN ACADEMY OF CHILD RESIDENT EDITOR: MEDIA PAGE ...... Harmony Raylen Abejuela, MD AND ADOLESCENT PSYCHIATRY OFFICERS COUNCIL MEMBERS The American Academy of Child and Paramjit T. Joshi, MD, President Mark S. Borer, MD Adolescent Psychiatry’s role is to lead its Gregory K. Fritz, MD, President-elect Debra E. Koss, MD membership through collective action, Deborah Deas, MD Martin J. Drell, MD, Past President peer support, continuing education, and Neal Ryan, MD mobilization of resources. The Academy Aradhana “Bela” Sood, MD, Secretary Steven J. Cozza, MD ■■ Establishes and supports the highest David G. Fassler, MD, Treasurer Joan Luby, MD ethical and professional standards of Warren Y.K. Ng, MD, Chair, Kayla Pope, MD clinical practice. Assembly of Regional Organizations Kaye L. McGinty, MD Jenna Saul, MD ■■ Advocates for the mental health and of Child and Adolescent Psychiatry Harsh Trivedi, MD public health needs of children, adolescents, and families. JERRY M. WIENER RESIDENT MEMBER Vandai X. Le, MD ■■ Promotes research, scholarship, training, JOHN E. SCHOWALTER RESIDENT MEMBER Marika Wrzosek, MD and continued expansion of the scientific base of our profession. ROBERT L. STUBBLEFIELD RESIDENT FELLOW Anita Chu, MD EXECUTIVE DIRECTOR Heidi Büttner Fordi, CAE ■■ Liases with other physicians and health care providers and collaborates with JOURNAL EDITOR Andrés Martin, MD, MPH others who share common goals. PROGRAM COMMITTEE CHAIR Gabrielle Carlson, MD

COLUMN COORDINATORS Ayesha Mian, MD, [email protected] Child Psychiatry Around the Globe Timothy Dugan, MD, [email protected] Clinical Vignettes Sala S.N. Webb, MD, [email protected] Diversity and Culture Arden Dingle, MD, [email protected] Ethics Stephen Zerby, MD, [email protected] Forensics Rachel Ritvo, MD, [email protected] Psychotherapy Sandra DeJong, MD, [email protected] Youth Culture Charles Joy, MD, [email protected] Poetry Coordinator Stuart Goldman, MD, Goldman, [email protected] News

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. © 2014 The American Academy of Child and Adolescent Psychiatry, all rights reserved COLUMNS

CLINICAL VIGNETTES Picking the Right Type of Treatment

see what was causing the sores before Charisse told us that it was due to her picking.”

“What makes you come now? It’s been going on her whole life.”

“It’s gotten worse in the last two years,” said the mom. ■■ Martin J. Drell, MD, and Sylvia Worrell, MD As the mom paused, Charisse added introduced me to her husband and softly, “I pick when I’m under stress.” Note: This column is a continuation 10-year-old son who were sitting on the of the previous column on opposite side of the waiting area. I noted “Well then, what’s stressing you?” supervision titled: Every July 1st, the seating arrangement and asked who I asked. There’s New Supervisees published was coming into the session with me. in the March/April issue of “Nothing,” said Charisse. “I’m laid back AACAP News. “Just Charisse and me,” Mom answered. just like my dad. Nothing bothers him.”

“What about them?” I replied point- “I’m confused,” I said. “You said you ontinuing the supervision, I told pick when you’re stressed, so I assumed the resident that I would like to ing at the men on the other side of the waiting room. if you are picking now, something is Ctell her about a case I saw the stressing you.” day before. It was a 13-year-old girl that was referred to me by her family “There’s things we don’t want Rusty [the son] to hear.” “I pick when I’m upset and do it without practitioner for “skin picking.” The family thinking,” Charisse responded. practitioner said that she had done “Well then, what about Dad?” I asked. what she felt comfortable doing. She “I can buy that, but to me, it still means had started the patient on a low dose of that something is bothering you, even an SSRI several weeks previously and “Rusty is hungry and Dad is going to take him out for something to eat.” though you may not know exactly what it referred her for CBT. The family practi- is. Did anything happen two years ago?” tioner suggested that the family consult with a child and adolescent psychiatrist. “Oh, ok.” I responded with some confusion. Both mom and Charisse said they did not know of anything. When the mom called, she asked me * * * * * * * * specifically about the SSRI. She said it “I will assume that something did hap- was not working and wanted to stop I then turned to the resident and talked pen, even though you can’t remember. it. I reminded the mom that I did not about the seating arrangement: Why not think about it?” I said to both know the case, but pointed out that the of them. I then added that it might SSRI was at a low dose and that her “I’d just met them, and judging by the be something that Charisse is upset daughter had not had an adequate trial, seating, and until proven otherwise, I about that she does not consciously as it had been prescribed for less than a suspect a split between the women and know about. month. She agreed to continue it. I asked the men, with some secrets to boot! her to negotiate that with her family I was intrigued.” I then returned to “Two years ago, I started a new school. practitioner who was still in charge. As describing what I did next. There was more school work and I scheduled the first appointment, I was drama,” said Charisse. anxious about what I could add. The * * * * * * * * combination of SSRI’s and CBT sounded “How can I help?” I asked the mom “What kind of drama?” fine to me. I planned to handle this as and Charisse. a consultation. “Catty girls that I didn’t like. You know The mom answered my question. She ‘messy’ girls.” As I entered the waiting area, I intro- explained that they wanted help for duced myself to Charisse, who was Charisse’s chronic skin picking, which “Any other changes?” sitting next to her mother on one side had been going on most of her life. “We of the waiting area. The mom then took her to several dermatologists to continued on page 110

MAY/JUNE 2014 109 COLUMNS

Picking the Right Type of Treatment continued from page 109

Mom then said, “I know what hap- “So mom, tell me more about your anger Turning to the resident, I noted that mom pened! My mother died of a heart and what triggers it?” and Charisse agreed to a family session attack. She was very important to the and scheduled a time for the next week. kids. She drove them to school and back “I’ve always been that way. I’ve been every day. She drove them to school that depressed and nervous for years since * * * * * * * * morning and had a heart attack and was I was in an abusive relationship with a “Now I ask you…,” I said to the resident, gone. The kids were very close to her.” past boyfriend. He made me nervous. “What would happen with this case if a I went for therapy and was put on an general resident saw Charisse?” “Tell me about that,” I asked. SSRI. It helped me, but I stopped it. I’m not sure why. I was depressed after my “She’d be put on meds,” said “They had a special thing going,” said mom died but I got over it. Didn’t I, the resident. the mom, at which point Charisse broke Charisse?” into tears. As she did, the mother looked “And if a starting child resident saw at Charisse and also began crying. Charisse nodded yes. her?” I asked. “After my mom died, I got depressed.” The mother continued: “A year ago, I “She’d be put on meds.” had some surgery and I’ve had some As this was unfolding, I noted that problems since. And my job isn’t the “Would they have gotten the information Charisse and her mother looked back easiest. I come home pretty frazzled. I I did?” at each other with what appeared to be have few problems with Charisse. She’s anxious concern. a doll. Now Rusty, my son, he’s another “Probably not.” story. He’s always pressing my buttons. The mother continued. “Charisse never He gets me going. It’s a good thing “And what makes sense for this case?” seemed to mourn.” my husband is so laid back. He knows how to make me feel better. He’s my “What you did,” said the resident. “She seems to be mourning now,” I comic relief.” interjected. “Actually, both of you. I note “Which included meds, but more,” that you keep looking at each other. I I then told the resident how I wrapped I added. see that a lot. I call the people who do up the session with Charisse and this, “lookers.” They tend to be very her mother. “Yes,” said the resident. “I want to learn sensitive and look at people who are how to do what you do.” important to them to check out how the “I’d like to see you back again and other person is feeling and whether what continue what we’ve talked about today. “So, let’s make that one of the goals for they said might have upset them.” Please continue the SSRI, noting for our supervision.” Charisse that the current dose is a fairly Mom responded to this by repeating small one and that it would probably “Sounds good to me.” n some of the past history. “When she take a few more weeks to work. From was younger, we took Charisse to many what I see today, I take Charisse at her dermatologists. She finally told us that word that she ‘picks’ when she’s stressed Dr. Drell is past-president of AACAP and she was picking at herself.” and I believe that there are things that head of the Division of Infant, Child, and are stressful to her and the whole fam- Adolescent Psychiatry at the Louisiana “Charisse, what was that about?” I asked. ily, including her grandmother’s death. State University Medical School in New I note that her problems are part of a Orleans, Louisiana. Dr. Drell may be “I didn’t want to disappoint my mom and larger family issue regarding how to deal reached at [email protected]. have her yell at me.” On cue, Charisse with feelings. The main issue is whether looked for her mother’s reaction. the family can talk about feelings when they are upsetting. And then there seems Mom instantaneously admitted, “I to be specific issues about how to deal have an anger problem… but I cool off with anger. Some show it and get angry quickly. I often have to give myself a and take ‘time outs.’ Others get over it ‘time out’ in my bedroom. My husband quickly, or are ‘laid back.’ Others push is real laid back.” people’s buttons. When things like this happen, it’s usually a family problem. “Like Charisse is laid back?” I retorted Can we have everyone at the next meet- with a tad of irony. ing so we can get some information from the guys?” “Yes,” said Charisse.

110 AACAP NEWS COLUMNS

PSYCHOTHERAPY Unto the Third Generation: A New Development Textbook for CAPs

psychology doctoral students, and psychoanalytic candidates for more than ten years. They found, as many instruc- tors in today’s child and adolescent psychiatry programs have found, that the textbooks available were from the 1990’s and could not possibly provide a 21st century synthesis of advances in psycho­­ analytic theory and the empirical studies of developmental cognitive psychology ■■ Rachel Z. Ritvo and neuroscience. Additionally, there were no texts that clearly explained th ACAP’s 60 anniversary celebra- our contemporary understanding of tion in 2013 marked the progres- the transactional and emergent nature Asion of child and adolescent of development. psychiatry into a third generation. As our profession matures, we are faced end of each chapter allow readers to with the challenge of conserving the go into greater depth on any topic that knowledge and skills that serve us well “Developmental thinking attracts their interest. While trainees while integrating new research into our may find that the references provide an theories and practice. Nowhere is this informs all aspects of child entrée into the psychoanalytic literature, more important than in our understand- and adolescent psychiatric they will also be helpful to psychody- ing of development. Development namic practitioners wishing to access the is a normal process of psychologi- practice but is critical to the neuroscience and empirical cognitive cal change and as such can teach us teaching and practice of developmental literature. much about how psychological change occurs. Developmental change can psychodynamic therapeutics, In the first generation of child and also destabilize individual and family both psychotherapy proper adolescent psychiatry, and well into psychological adaptations, bringing and psychodynamically the second generation, psychoanalytic children or adolescents to clinical atten- terminology was familiar and meaningful tion. Developmental progress can give a informed assessment or to fellows who were taught these terms youth new capacities to meet the chal- pharmacotherapy.” in their adult residencies. In the past lenges of life, making the support and decade, the psychoanalytic literature enhancement of development a useful has become less accessible to trainees approach to treatment. Developmental because of the length of the papers thinking informs all aspects of child Drs. Gilmore and Meersand’s book is and the unfamiliar terminology (jargon and adolescent psychiatric practice but a gem for teaching today’s fellows. It is to some). Drs. Gilmore and Meersand is critical to the teaching and practice barely 300 pages long. Ten chapters, retain relevant psychoanalytic language of psychodynamic therapeutics, both covering infancy through emerging while explaining the terms clearly. psychotherapy proper and psycho- adulthood, could be assigned in weekly Readers of this book will be better able dynamically informed assessment or installments to make a ten or twelve to digest the rich case material that is pharmacotherapy. week course. The writing is clear. There in the psychoanalytic literature if they are bullet point reviews at the end of should choose to explore it. APPI press has released this year Normal subsections, as well as summaries of Child and Adolescent Development: key points at the end of chapters. Video A balance is struck in this volume A Psychodynamic Primer authored clips illustrating normal development are between theoretical issues, e.g., devel- by Karen Gilmore, MD, and Pamela introduced in the text and conveniently opment as phasic versus non-linear, and Meersand, PhD, from the Columbia available on the APPI.org website. descriptions of the growth of mental University Medical School and Center Additionally, illustrative clinical vignettes capacities underlying developmental for Psychoanalytic Training. This volume enrich the text. Ideally, a course for fel- changes. To address the Oedipal phase, addresses the need for a third generation lows would take a more leisurely pace the authors have done this by having two textbook of development. Drs. Gilmore through the book, as there is much to and Meersand have taught human digest. The extensive references at the continued on page 112 development to psychiatry residents, MAY/JUNE 2014 111 COLUMNS

Unto the Third Generation continued from page 111 chapters. The first, “The Oedipal Phase been debated for years. Adolescence of self and of superego/conscience in and Emerging Capacities,” describes the was first described as a distinct period of each phase, so these can be followed as three- to six-year-old child’s advances life by G. Stanley Hall in 1904. Gilmore developmental lines by the reader. in language, both narrative capacities and Meersand note Hall’s choice of the and the use of conversation to develop decade from 14 to 24 marked the time Knowledge of normal child and ado- theory of mind and emotion regulation, from the median age of menarche to the lescent psychological development is imagination and symbolization, and typical age of marriage and parenthood an essential feature of our specialty. mentalization and self-regulation. The at the dawn of the twentieth century. Drs. Gilmore and Meersand have done second chapter, “The Oedipal Phase: “Chapter 10: The Odyssey Years” derives a brilliant job of updating psychoana- Psychosexual Development,” updates its name from a 2007 article by David lytic theory and integrating advances psychoanalytic theories of psychosexual Brooks in The New York Times. Brooks in the developmental sciences to give development and explores contempo- commented on the trend that entry into us a textbook that maintains a bridge rary views of sex differences, gender adulthood, defined as a time of finan- to the work of previous generations, identity and genital anxieties. cial independence, living away from Winnicott, Mahler, Blos, Fraiberg, and home, marriage and parenthood, has the Freuds, while building a bridge with Throughout the book, the authors pres- been pushed toward age thirty. Are the neuroscience and empirical develop- ent the body and brain changes that twenties a new developmental phase of mental psychology. n stimulate psychological development emerging adulthood? The authors note and also create symptoms. The chap- that this odyssey time is not in response Reference ter on “Preadolescence” is a masterful to a bodily change or maturation but description of the tweens’ experience more to economic and social trends and Gilmore KJ, Meerssand P (2014). Normal of gains in cognitive and social under- to the technology of contraception that Child and Adolescent Development, A ­Psychodynamic Primer. Arlington, VA: standing that give greater mental control allow for adult sexuality without pres- American Psychiatric Press while the tweens are simultaneously sures of parenthood. “Whether it is a challenged by the increasing hormonal true developmental phase or a transient levels of prepuberty and the first signs epiphenomenon of societal change Dr. Ritvo is assistant clinical professor of of sexual maturity. The effect of these remains a subject of debate” (Gilmore Psychiatry and Behavioral Sciences at the changes on peer and family relationships and Meersand 2014, p.284). George Washington University School are explored, drawing on empirical stud- of Medicine and Health Sciences, on ies as well as clinical observations. In Presenting development in phases is a the faculty of the Baltimore-Washington preadolescence, “the intimacy of earlier useful pedagogical approach. It allows Psychoanalytic Institute and Children’s parent-child bonds is slowly loosened; the student to jump off from the lay National Medical Center; and she has a roles and relationships are reorganized impressions of what is “age appropriate” private practice in Kensington, Maryland. and renegotiated. The preadolescent’s into the deeper streams of psychologi- Dr. Ritvo may be reached at loss of parental ego support during a cal development and the transactional [email protected]. time of increased inner confusion and nature of developmental change. In each Publication of articles does not in any vulnerability leads to deep feelings of phase the intricacies and interactive way constitute endorsement or approval separation and loneliness.” (Gilmore and matrix of the child’s relationship with the by the American Academy of Child and Meersand 2014, p.198). mother, and to a lesser degree father and Adolescent Psychiatry. siblings, are delineated by the authors. The influence of social factors on our Similarly, they present the development perception of developmental phases has

112 AACAP NEWS COLUMNS

DIVERSITY AND CULTURE Kurdish Immigrants and Mental Health

“Today, the Kurdish population in the United States is a heterogeneous community, whose members have experienced various types of trauma and where the ■■ Sheinel J. Saleem, PhD, and Sala S. N. Webb, MD consequent psychological impact remains evident.” o appreciate the consequences of chemical weapons were utilized to war and trauma among Kurdish kill thousands of Kurds; as well as the Timmigrants, one must at least Gulf War, the 1991 Rapareen Kurdish gain a superficial understanding of their Revolution, and massive exoduses where the consequent psychological history. Rooted deep in Mesopotamia, of Kurdish people to the mountains. impact remains evident. Each age group Kurdistan has seen many years of Subsequent to the establishment of the presents a unique pattern of emotional conflict and genocide since its fraction- “no fly zone,” Iraqi Kurdistan experi- distress and as such requires appropri- ation in 1920 under the Treaty of Sevres. enced several years of inter-fractional ately tailored interventions. Today, the Kurds stand as the largest civil strife. Consequently, many Kurds ethnic group without a country of their fled the country, escaping illegally to When analyzing the older generation own and are geographically divided Europe. Others were later brought over (age 50 years and above), one can among Iraq, Iran, Turkey, and Syria. to the United States in waves, with clearly see a spectrum of posttraumatic Each of these countries has subsequently the largest occurring in 1996 as part stress disorders (PTSD) that has become marginalized and attempted to eradicate of a resettlement program under then a pervasive component of daily life. This its Kurdish population via their own President Bill Clinton. is the result of this generation having unique methods. spent the majority of their lives in war Today, the Kurdish population in the and adhering to those values essential for Iraqi Kurdistan saw its darkest period United States is a heterogeneous basic human survival and preservation during the 1980s. This included Saddam community, whose members have of the Kurdish culture. Symptoms like Hussain’s Anfal Campaign, in which experienced various types of trauma and hyper-arousal, great distress upon event recall, severe anxiety, and distrust of oth- ers are regarded as part of normal life. Furthermore, no longer struggling to sus- tain life but rather meeting its emotional demands in a peaceful environment, this generation has also experienced a dysregulated perception of survival and preservation of culture. Life now in the United States, with no concurrent war, requires a different skill set that is focused more on prosperity. For many in the older Kurdish generation, this mental shift has been challenging to cultivate.

Perhaps the most severely affected are those who absconded from the war and immigrated as teenagers. This cohort, for the most part, represents a group of pre- cocious children who were forced into adulthood prematurely and served as forerunners for their families. This group

continued on page 114 A youthful Dr. Saleem with her brother, Botan Saleem.

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Kurdish Immigrants and Mental Health continued from page 113

occurred before and after their inter-con- tinental relocation. With this, they may become more susceptible to maladap- tive coping strategies such as substance abuse and other risky behaviors.

Perhaps even more frightening and requiring further investigation is the deleterious consequence of the chemi- cal weapons used on the Kurdish people and its genetic impact. While emerging data suggest such weapons have caused mutations that increase susceptibility to malformation and neoplastic progres- sion, little research has been conducted in the area of mental health.

The currently naturalized Kurdish Americans in the United States are in The Anfal Campaign dire need of mental health education and services. Much effort is still required to eradicate the cultural and social taboos of mental illness. Members of the Kurdish community require extensive effort and motivation to utilize all the now available supports and services. Parents need to be educated, not only about those disorders that commonly occur in children such as attention-def- icit hyperactivity disorder (ADHD) and autism spectrum disorders but also on the effects that their own unmet mental health needs are having on their chil- dren. Mental health screenings therefore need to be conducted at all age levels, and the impact on the third and subse- quent generations quantified.

Additionally, there is a great need for dedicated psychiatrists, psycholo- gists, social workers, and other mental health clinicians who can be trained to better appreciate the historical trauma of Kurdish people so they can pro- Photographers on the scene of Halabja vide highly personalized therapeutic interventions.­ n was not afforded the ability to properly rather severe manifestations of these transition though the stages of develop- conditions. It remains a cultural percep- ment. Consequently, individuals in this tion within the Kurdish community that Dr. Saleem is a first year medical student group not only experience intrapersonal mental health conditions should be at Virginia Commonwealth University conflicts related to immigration and “managed” at home and by the family. School of Medicine. She may be coming of age, such as identity develop- ­contacted at [email protected]. ment and perception of self, but they As a group, the younger generation also suffer from mental conditions such attempts to navigate life in America Dr. Webb is medical director, Webb as depressive disorders, PTSD, bipo- on their own accord; often experienc- Psychiatric Consulting, PLLC. She is lar disorders, and psychotic disorders. ing episodes of distress triggered by coordinator of the Diversity and Culture More often than not, when these youth unwanted intrusions of their traumatic Column. She may be contacted at do seek treatment, they present with childhood experiences, those that [email protected].

114 AACAP NEWS COMMITTEES

SCHOOLS COMMITTEE Opportunities to Integrate Behavioral Health and Primary Care in School-Based Clinics: A New Beginning

■■ Fareesh Kanga, MD, and Kimberly White, MD

urrently, the status of child and and the disparity in access to mental How does one grow a program? adolescent psychiatric involve- health care, there is also an effort to Fortunately, some groundwork had been Cment in schools ranges from examine force multiplication by maxi- implemented. In four schools, behav- the indirect to a direct and systematic mizing our leadership and consultative ioral health clinics existed within the school-based mental health service capabilities to other health care systems school medical clinics. Two licensed using evidence-based interventions. All and organizations. clinical social workers (LCSWs) and one too often, the only interaction between pediatrician with an interest in ADHD the child and adolescent psychiatrist One such model is school-based health and school health split their time among and school-based personnel occurs clinics, while another is integration into the schools. We also planned to expand with the exchange of information via the primary care setting. Many models into four more schools. Additionally, the a standardized rating scale report for of school-based mental health and/or LCSWs had concerns regarding isolation attention-deficit hyperactivity disorder primary care integration exist, but what and standardization between schools. I (ADHD). Additionally, there can be works in Los Angeles or Baltimore may had to finalize the expansion and move a significant disconnect between the not fit the culture and politics of other forward from there. practicing child and adolescent psy- locales. This piece documents an early chiatrist and the primary care provider. career child and adolescent psychiatrist’s I joined HealthFirst because its work, Recently, AACAP’s Back to Project odyssey as she implements a program establishing mental health clinics with Future (BTPF) delineated a plan to push that embraces both of the core principles medical clinics in schools, showed for better systems of care integration in previously articulated. Dr. Kanga’s lead- incredible foresight. This is also the the context of the emerging health care ership serves as a model of possibility. direction of modern medicine, and system driven by the Affordable Care meets the goals of the American Act (Drell 2014). Adapting New Models of Academy of Pediatrics’ (AAP) con- cept of the patient-centered medical Specifically, BTPF calls for collaboration Mental Health Care into home (PCMH). The 2007 AAP seven with primary care providers and allied School Clinics “Joint Principles” include a personal 1) health professionals across settings, A year following my residency training, provider, 2) a provider-directed medical including private and public sectors, I took a newly created position as “direc- practice (empanelment), 3) whole- such as community health centers, tor of Behavioral Health” for HealthFirst person orientation, 4) coordinated and/ schools, and accountable care organiza- Bluegrass, Inc., the co-applicant primary or integrated care, 5) quality and safety, tions (ACOs). The goal is to streamline care group with the Lexington-Fayette 6) enhanced access, and 7) payment and coordinate services in an efficient County Health Department. My tasks (California School-Based Health Alliance and cost effective manner. The AACAP included overseeing the behavioral 2014). Today, organizations like The Joint leadership emphasizes the need for each health component of the school-based Commission (formerly Joint Commission of us to play a role as formative partici- clinics in the county public elemen- on Accreditation of Healthcare pants in shaping change to bridge the tary schools. Truthfully, they lost me at Organizations) can bestow PCMH status service gap. Given the dearth of child “co-applicant.” and adolescent psychiatrists nationwide continued on page 116

MAY/JUNE 2014 115 COMMITTEES

Opportunities to Integrate Behavioral Health and Primary Care continued from page 115

References “School mental health requires simply putting in place what California School-Based Health Alliance we know from residency and then adapting it, sometimes to (2014). Patient Centered Medical Home. Available at: www.schoolhealthcenters.org/ a completely novel way of thinking, to provide the highest start-up-and-operations/patient-centered- quality care.” medical-home/. Accessed March 10, 2014 Drell M (2014). Back to Project Future: Plan for the Coming Decade. A Presidential Initia- tive of Martin J. Drell, MD. Washington, DC: to an organization if it meets specific relationship. At a recent meeting of the AACAP Available at: www.aacap.org/App_ criteria. HealthFirst Bluegrass is a major Kentucky Primary Care Association Themes/AACAP/docs/member_resources/ proponent of the PCMH, working inten- (where I was the only psychiatrist!), I back_to_project_future/BPF_Plan_for_the_ sively on the integration, quality, and was introduced to an emerging behav- Coming_Decade_2014.pdf. Accessed March enhanced access to care. The “shoulder- ioral health integration model, which 10, 2014 to-shoulder” collaboration of a child and includes the use of a Behavioral Health Greenberg JO, Barnett ML, Spinks MA, adolescent psychiatrist, LCSWs, pedia- Consultant. While we are unable to ­Dudley JC, Frolkis JP (2014). The “medical tricians, nurses and teachers, working implement this model now, it presents neighborhood”: integrating primary and as a team within schools, positions our an exciting new opportunity that could specialty care for ambulatory patients. JAMA patients to have accessible, coordinated, eventually be used both in our primary Intern Med 174: 454-457 and integrated quality care. care clinics and our schools. Sirlin S, Brownlee B (2014). “Patient- Centered Medical Home: What Is It and Quality, not quantity, is a cornerstone In addition to learning a new EMR and How Do SBHCs Fit In?” Available at: cshca. of the PCMH concept (Greenberg et al. embracing a new system of providing wpengine.netdna-cdn.com/wp-content/up- 2014). Objective evaluation is also para- mental health care, I learned new roles loads/2013/03/PCMH-What-Is-It-Where-Do- mount and requires frequent data input. including advocating, improving the SBHCs-Fit.pdf. Accessed March 10, 2014 HealthFirst Bluegrass strives to use these EMR, determining a school-based LCSW data to monitor quality improvement. scope of practice, and even refining the Dr. Kanga is director of Behavioral While I had certainly used scales in the referral process. Health, HealthFirst Bluegrass, Inc. She past to monitor an individual patient’s may be reached at fareesh.kanga@ improvement, I now reviewed scores We added monthly meetings to provide gmail.com. of rating instruments to identify scales supervision and promote communica- that could be used for an entire institu- tion. Recently, I started seeing patients Dr. White is program director, University tion. We opted to expand our use of the a half day in three of the school ADHD of Florida Division of Child and Vanderbilt Assessment Scale, which is clinics. In March 2014, the LCSWs Adolescent Psychiatry. She may be free, readily available to the LCSWs and started parent groups, and, by next reached at [email protected]. pediatricians and easy to use for parents school year, we hope to add formal and teachers. Since it is integrated into teacher education. Altogether, I have the electronic medical record (EMR), the gained new appreciation for being able data can be manipulated to demonstrate to prepare a department mission, follow trends in patient outcomes and provide productivity reports, and even write a benchmarks for improvement. Finally, grant. Turns out, understanding “co- to ensure quality progress notes and applicant” was just the tip of the iceberg. simpler peer evaluation, we included detailed note outlines designed in con- At the 2013 Annual AACAP meeting, I junction with the new EMR behavioral walked into the school committee hop- health note. ing for the key to a successful school program. I walked out of the committee Although more research is still forthcom- meeting with confidence, supportive col- ing, estimates show that PCMH may leagues… and this writing assignment! reduce hospitalization rates up to 19% The lesson learned was that school and ER visits up to 29%; and may also mental health requires simply putting reduce staff burnout and improve the in place what we know from residency patient experience (Sirlin and Brownlee and then adapting it, sometimes to a 2014). Moreover, with the Affordable completely novel way of thinking, to Care Act, there is an impetus on pri- provide the highest quality care. And, mary care to integrate with behavioral maybe leave the co-applicant part to health, which is generally a win-win someone else. n

116 AACAP NEWS COMMITTEES

NORTHERN CALIFORNIA REGIONAL ORGANIZATION OF CHILD AND ADOLESCENT PSYCHIATRY What Our Patients Teach Us

The evaluation consisted of my review- asked him why she was on an selective ing many pages of school and medical serotonin reuptake inhibitor (SSRI), he records, watching family videotapes, laughed and said, “Well, Doc, you know and reading emails exchanged between we’re all crazy.” mother and teachers. There were two sessions with the parents together, What I learned: These two patients four with the mother alone, three taught me lessons never forgotten. In with the father, and two with Ann. fact, they have since been reinforced There were multiple calls involving multiple times: a pediatrician, two psychiatrists, two ■■ Edmund C. Levin, MD neuropsychologists, a social worker, a ■■ The effects of trauma are easily school psychologist, a special educa- confused with major “biologic” “Nina”: Twenty-five years ago I per- tion teacher, and a community mental psychiatric disorders. formed a diagnostic evaluation at the health psychologist. ■ request of Nina’s therapist, a non- ■ With medications, sometimes less is more. medical colleague. Nina, at age 28, had ◗◗ Brief history: Beginning at least been diagnosed in the course of multiple by age 3, trauma was involved, ■■ Careful, intense evaluations can be hospitalizations as having schizoaffec- largely in the form of emotional worth their weight in lots of very tive disorder, bipolar disorder, borderline abuse and harsh physical confine- expensive pills. n personality disorder, and alcoholism. ment for perceived misbehavior. On multiple medications, she was still ◗◗ Psychotherapy: Little had been bouncing in and out of hospitals. When I Dr. Levin is chair of the AACAP done by way of therapy for Ann discovered that she was amnesic for the Mentoring Committee and an alternate and even less for the parents. first 12 years of her life, I suggested her delegate to the AACAP Assembly of therapist reconsider the patient’s diagno- ◗◗ Pharmacotherapy: At the begin- Regional Organization of Child and ses and listen carefully for evidence of ning of the evaluation, Ann was Adolescent Psychiatry. He may be trauma. It proved to be there, largely in taking 16 pills per day. Over a reached at [email protected]. the form of sexual abuse. Over time, the five and a half year period, a total patient’s symptoms remitted, she discon- of 86 prescriptions had been tinued her medications, and she made written for psychiatric, neuro- major life changes. Eventually, she quit logic, and/or behavioral reasons. therapy and moved away. The last her All told, mixed amphetamine therapist heard from her, about 10 years salts, atomoxetine, benztropine, later, indicated that she was doing well, buproprion, clonidine, divalproex in a stable relationship, and working. sodium, guanfacine, methylpheni- date, olanzapine, oxcarbazepine, “Ann”: Several years later I received a or risperidone had been dis- call from the mother of a 10-year-old pensed 103 times. who had been diagnosed with attention- Following the end of the evaluation Ann deficit hyperactivity disorder (ADHD) was off all medications. She no longer at age four and a half years and bipolar saw me, but worked with a non-medical disorder at age five. She was referred to therapist and a more appropriate school me when the family was able to recog- placement had been arranged. The diag- nize that she had been getting worse. noses she had from age four and a half Due to lack of time, I attempted to refer to age 10 were dropped. the case to a colleague. Possibly due to some telephone transference, my referral Occasional calls to the parents over did not work: The mother cried when I the years found Ann much improved, had said in our initial phone contact that though not “cured.” The father contin- I could appreciate how stressful life must ued to seek medications for her, though be for her family. She telephoned again not in the numbers or strengths previ- asking to be seen as soon as I could ously prescribed. In one call, when I manage. I agreed and a formal evalua- tion began two months later.

MAY/JUNE 2014 117 NEWS

News UPDATES by Stuart Goldman, MD, and Garrett Sparks, MD, MS

n each issue of AACAP News, we include brief commentary and a link to Cohort, was able to look at over 64,000 newsworthy items that the membership might have missed, or that merit repeating. live births between 1996 and 2002. IIf you have suggestions for this column, please send them to me at Controlling for a wide range of variables, [email protected]. they used mother reports for acetamino- phen usage and parent questionnaires, hospital diagnosis, and stimulant Why Systematic lipid profiles, etc., they conclude that the prescription usage to determine which lack of significant differences in weight children had ADHD, medication usage, Studies Matter gain is an important finding since these or ADHD-like behavioral problems. are the only two FDA approved agents With a lack of systematic studies for for irritability in ASD. While the prior Acetaminophen usage was associated many of our clinical interventions, we belief that aripiprazole is more “weight with an increase in the hazard ratio of often rely upon conventional wisdom or sparing” needs closer study, it should no 1.37 for ADHD, 1.29 for ADHD medica- clinical judgment to “inform” our clinical longer be assumed. tions, and 1.13 for ADHD-like behavioral practice. The two studies cited below problems. Researchers found that highlight the limitations and possible Wink LK, Early M, Schaefer T, Pottenger A, increases in usage and in the numbers of problems that “conventional wisdom” Horn P, McDougle CJ, Erickson CA (2014). trimesters involved both were associated may have missed. Body mass index change in autism spectrum with greater risk. While the findings are disorders: comparison of treatment with associative and not clearly causative, the Aripiprazole and risperidone and aripiprazole. J Child Adolesc size of the cohort, the statistical analysis, Psychopharmacol [epub ahead of print] and the relationship between dose, dose Risperidone: Impact online.liebertpub.com/doi/abs/10.1089/ timing, and occurrence all point towards on Weight Gain cap.2013.0099 advising pregnant women to minimize acetaminophen use. Risperidone and aripiprazole have both Acetaminophen been shown to be effective agents in the Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J (2014). Acetaminophen use during preg- management of children and adolescents and Pregnancy nancy, behavioral problems, and hyperkinetic who have Autistic Spectrum Disorder Almost all physicians and pregnant disorders. JAMA Pediatr [epub ahead of print] (ASD) and have received FDA approval mothers worry about medications during for usage. Conventional wisdom, with archpedi.jamanetwork.com/article. pregnancy. Clearly, the advice to avoid some supporting data, has suggested that aspx?articleid=1833486 usage is best, but conventional wisdom overall aripiprazole causes less weight has been that acetaminophen and most gain than risperidone. Given the long other over-the-counter (OCT) medica- Peer Victimization, term usage and concern about weight tions are safe to use when needed. gain, for many treating this patient Cyberbullying, Over 50% of pregnant women in the population, this “clinical truth” has United States and Denmark use OTC and Suicide dictated recent practice and teaching acetaminophen. However, recent animal (including us). Wink et al., in February’s The negative effects associated with studies have shown that acetamino- Journal of Child and Adolescent bullying have become increasingly phen can disrupt endocrine (thyroid Psychopharmacology, present an impor- clear over the past two decades. The and androgen) functions and impact the tant, albeit retrospective, head-to-head impact on both mental health and developing fetus. comparison of long-term weight gains in physical health have been extensively the ASD population. As part of a larger documented and there are many (but Liew et al. were interested in seeing if study, they looked at 70 children treated way too few and ineffective) efforts at there was any association between this with aripiprazole (11.8mg mean) and 72 both prevention and intervention for this widespread acetaminophen usage in with risperidone (2.2 mg mean). In both common problem that affects 5-20% of pregnancy and the increasing number of groups, there were changes in BMI of all children. In the last decade, this has children diagnosed with attention-deficit approximately 2 points over a 1-2 year also evolved into cyber-bullying both hyperactivity disorder (ADHD). Since period, but there was no statistically directly online and through social media. epidemiologists have determined that significant difference between the aripip- The toxicity of this type of peer victim- awareness and diagnostic criteria alone razole and risperidone treatment groups. ization is beginning to become ever could not account for the increases, While the authors acknowledge the limi- more clear as there have been several many suspect that there must be envi- tations of retrospective studies and the tragic examples of cyber-bullying leading ronmental factors contributing. Their need for closer examination, including to suicide. team, using the Danish National Birth

118 AACAP NEWS NEWS

Getting a clearer picture of the extent during adolescence. The effects were Booth JN, Tomporowski PD, Boyle JM, Ness and impact of bullying led van Geel more notable when age of onset and AR, Joinson C, Leary SD, Reilly JJ (2014). et al. to conduct a meta-analysis of 34 duration of exposure to stimulants Obesity impairs academic attainment in ado- studies that involved over 284,000 chil- were examined. lescence: findings from ALSPAC, a UK co- Obes (Lond) dren. They found that peer victimization hort. Int J [epub ahead of print] increased both the odds ratio for suicidal While somewhat confusing and counter- http://www.nature.com/ijo/journal/vaop/ ideation to 2.23 and for attempts to 2.55 intuitive, this study does improve upon naam/abs/ijo201440a.html with cyber-victimization being at least past cross-sectional data with a lon- as toxic. Clearly, inquiry into victimiza- gitudinal design. However, the study Tanning Bed Use tion has become increasingly part of was limited in its ability to control for the routine evaluation of children and confounds and for identifying the degree Associated with adolescents. These results suggest that to which children with ADHD that do Other Bad Ideas inquiry into cyber-victimization should or do not receive stimulant medica- be routine as well. tions may be very different populations Despite clear associations with later in a variety of ways. That said, such an melanomas, a sizeable minority of Van Geel M, Vedder P, Tanilon J (2014). association will be important for driving adolescents continue to get their beach Relationship between peer victimization, further research and allowing us to fur- tans in air-conditioned rooms, accord- cyberbullying, and suicide in children and ther focus our interventions on the most ing to the 2009 and 2011 national adolescents: a meta-analysis. JAMA Pediatr at-risk populations. [epub ahead of print] Youth Risk Behavior Surveys, which used a representative sample of 15.5 archpedi.jamanetwork.com/article. Schwartz BS, Bailey-Davis L, Bandeen-Roche million high school students each year. aspx?articleid=1840250 K, Pollak J, Hirsch AG, Nau C, Liu AY, Glass The study included more than 25,000 TA (2014). Attention deficit disorder, stimulant students who answered the indoor use, and childhood body mass index trajec- Could Stimulants tory. Pediatrics [epub ahead of print] tanning questions. be a Part of the pediatrics.aappublications.org/content/ Indoor tanners were more likely to be Obesity Epidemic? early/2014/03/11/peds.2013-3427 female, older, and Non-Hispanic White. Among the students 18-years-of-age or So often, we find ourselves discuss- Obesity Can Be the older, nearly 30% engaged in indoor ing with children and their families tanning. Among both female and male about how stimulants decrease appe- Difference Between students, indoor tanning was associated tite and how they might need to catch Passing and Failing for with increased binge drinking, unhealthy up on their calories on the weekends Adolescent Girls weight control practices, and having sex- or over the summer. Sometimes, we ual intercourse. Among just the female even prescribe medications to promote students, indoor tanning was associated Obesity has plenty of detrimental effects appetite in kids struggling to gain weight. with having sexual intercourse with four on children, though most of the research We have heard stories of adolescents or more persons and illegal drugs. Male on these effects has been limited to and young adults using stimulants to indoor tanners were more likely to use cross-sectional studies with small lose weight. ADHD has certainly been steroids, smoke cigarettes daily, and samples that are not able to control for associated with obesity. Could stimu- attempt suicide. other factors. Researchers at several lants actually be the driving factor with universities in the United Kingdom were this association? Given these associations, ques- able to follow almost 6,000 adolescents tions about indoor tanning should be from age 11 to 16 years. Achievement Electronic health record data from included among our risk assessments tests of English, math, and science were Geisinger Health System on over for teenagers. measured at ages 11, 13, and 16. After 160,000 children aged 3- to 18-years controlling for a multitude of factors, in central Pennsylvania identified more Guy GP, Berkowitz Z, Tai E, Holman DM, including socioeconomic status, mental than 13,000 children with ADHD. Everett Jones S, Richardson LC (2014). Indoor health, IQ, and age of menarche, obese Younger children with ADHD in general tanning among high school students in the girls at age 11 did much worse at 13 and had higher body mass index (BMI) United States, 2009 and 2011. JAMA Derma- 16 than their peers with normal weight. tol early on compared to those without [epub ahead of print] Researchers estimated the magnitude of ADHD, though this difference appeared archderm.jamanetwork.com/article. the effect to be about one letter grade, to disappear in adolescence. At the aspx?articleid=1833428 like getting a D instead of a C. The same time, children with ADHD who relationship was not nearly as clear for received stimulants were thinner early boys over the same time period. Such a on compared to those with ADHD who difference could have a significant effect were not treated with stimulants, the on whether an obese pre-teen girl would stimulant-treated children were actually be able to go to college after graduating. heavier than the children without ADHD or those not treated with stimulants

MAY/JUNE 2014 119 OPINION

The Maori World – Words Matter

colonization. However, when an institu- recognizing complex evolv- tion omits a dedicated principle about ing and context-specific indigenous peoples, we risk just that. My issues of identity both contention here is to highlight those risks within and across groups. from an indigenous perspective and look This involves us develop- for solutions. ing relationships with indigenous communities. The arguments for a principle dedicated to indigenous peoples are simple. We are Indigenous peoples first nations’ peoples and we are over- are over-represented in ■■ Hinemoa Elder, MBChB, PhD represented in populations with serious populations that we see. AACAP Corresponding Member and complex mental health issues. These For example in Aotearoa, aspects are now presented in more detail New Zealand, we know “He tao rakau, e taea te karo. He tao ki with the hope that constructive feedback that Maori psychiatric e kore e taea.” contributes to our collective understand- patients are more likely to ing, thereby improving our practice. be treated compulsorily, to The thrust of a weapon can be parried, a be secluded and in some lashing of the tongue cannot. Indigenous peoples are not defined by instances given higher colonization; we were on the planet doses of antipsychotic This proverb from Te Ao Maori (the long before that. Equally, we are not medication, even when Maori world) illustrates that Maori think an ‘emerging population’ (Pumariega diagnosis and severity are about the meaning and impact of words 2013). Many of our intergenerational accounted for (Elder & totally the opposite of the English saying experiences have come to be understood Tapsell 2013). Why does this “sticks and stones may break my bones in terms of what is called ‘historical happen? Is it because Maori but words will never hurt me.” trauma’(Walters 2011). This trauma mani- presentations are complex? fests in complex ways that can present Is it because psychiatrists These cultural differences are highlighted similarly to psychiatric conditions and make different decisions about these to emphasize the importance of cultural as a possible co-existing consideration. patients because they perceive them to competency documents making visible However, one of the problems with be more dangerous or more severely the range of cultures we work with via defining us solely by historical trauma unwell? Could this situation be changed the words that are chosen. is that it risks reinforcing that this is by improved cultural competency? We what solely defines us. This is not what need research to investigate these ques- As psychiatrists, we are arguably most indigenous communities are focused tions. What practice-based evidence comfortable and familiar with consider- on. Balancing cognition of what has tells us is that Maori patients and their ing ethnic cultural presentations rather gone before and how that needs to be whanau (extended families) are more than considering the culture of psy- attended to with the current and future comfortable and tell a different story to chiatry itself. Kleinman suggested that aspirations and successes are crucial for Maori psychiatrists and to psychiatrists “cultural analysis be applied to psy- indigenous peoples’ wellbeing. who use Maori cultural support work- chiatry’s own taxonomies and methods ers, Te Reo Maori (Maori language), and rather than just to indigenous illness Indigenous values and knowledge ensure adherence to cultural protocols. beliefs” (Kleinman 1987). Reflecting systems uphold the connectivity of all on that statement in the context of a things and have protocols for all aspects Our work with indigenous peoples must globally influential cultural practice of collective community relations. Our be done with particular care, mindful parameter that does not include a communities continue to work towards that we are at risk of being perceived as practice principle about working with healthy, self-determined cultural identity. yet another mode of colonization. This indigenous peoples has led to this paper It is, therefore, counterproductive for issue has particular tension for indig- about the worlds of indigeneity and medical specialists to risk re-traumatising enous child and adolescent psychiatrists psychiatry (Pumariega 2013). us with concepts that continue to define because of how the community inter- us by pathology and helplessness alone. prets the organization they represent. First, it is important to acknowledge that having cultural competencies is a great It would be the exception to find Quality research plays such a vital role step forward and vital in ensuring there practices where a child and adolescent in building our cultural competency. In are parameters to guide the complexity psychiatrist would never see indigenous the past, there has been limited rec- of working with different ethnic cultural peoples. Indigenous peoples are every- ognition of the reciprocity needed to groups. However, we can do better. where. We live in every community. ensure that research is culturally safe; As child and adolescent psychiatrists, and that indigenous communities have Child and adolescent psychiatrists we need to be culturally competent to their own research agendas. There are do not set out to become agents of work alongside indigenous peoples, now well-established relationships with

120 AACAP NEWS OPINION communities and researchers, includ- Many of us are in senior leadership Kleinman A (1987). Anthropology and psy- ing communities growing their own roles. How well do we serve the needs chiatry: the role of culture in cross-cultural researchers. Indigenous methods are of indigenous peoples when we pro- reserach on illness. The British Journal of being increasingly recognized as essen- vide guidance and advocacy? To what Psychiatry 151:447-454 tial in asking and answering research extent does the governance structure Pihama L (2010). He Kaupapa Korero: Maori questions in culturally meaningful ways of our institutions serve the needs of Health Research and Provider views on the (Pihama, 2010). indigenous peoples and what do we impact of Kaupapa Maori. A report for the do within our spheres of influence to Health Research Council for the Hohua Being counted is important. Many strengthen this? Tutengaehe Maori Health Fellowship epidemiological studies do not record Pumariega A ., Rothe E, Mian A, Carlisle indigenous peoples or group them When we do not write about indigenous L, Toppelberg C, Harris T, et al. (2013). together without concern for their het- peoples, we perpetuate a marginalized Practice parameter for cultural competency erogeneity. Those of us who participate position in society. If we make indige- in child and adolescent psychiatric practice. in decisions about research funding can nous cultural competency less valued by American Journal of Child and Adolescent insist on higher standards of ethnicity not including it, we discriminate against Psychiatry 52(10):1101-1115 data collection so that research findings this group. This is something none of us Walters K, Mohamed SA, Evans-Campbell T, are more useful to indigenous peoples want to do. Beltran RE, Chae DH, Duran B (2011). Bodies and to us. don’t just tell stories, they tell histories. Du My hope is that the new iteration of Bois Review 8(1):179-189 We need to know about rights. The United AACAP’s practice parameter for cultural Nations Declaration on the Rights of competence includes a principle about Dr. Elder, a Corresponding Member of Indigenous Peoples Article 22 describes indigenous peoples. Until then, indige- AACAP, is of Te Aupouri, Ngati Kuri, Te the rights of indigenous elders, women, nous families need us to ensure we think Rarawa, and Ngapuhi descent. She is a youth, children, and persons with dis- carefully about how we can practice in a Maori child and adolescent psychiatrist abilities. Article 24 describes the right to culturally competent way when working who has been a Fellow of the Royal health, and to use traditional medicines to serve their needs. n College of Australia and New Zealand and health care. Article 25 describes Psychiatry since 2006 who completed the right to spiritual relationships with Acknowledgement: Nga mihi ki a Dr. her PhD in 2012. She is currently the traditional land and resources. Indigenous Josh Sparrow and Moana Jackson for Health Research Council of NZ Eru scholars also emphasize recognition of commenting on an earlier draft. Pomare postdoctoral fellow, and visit- the humanity and visibility of indigenous ing associate professor of Indigenous peoples as critical (Jackson 2007). References Research at Te Whare Wananaga o Elder H, Tapsell R (2013). Maori and the Awanuiarangi. She is a deputy psychia- How well are we equipping medical trist member of the NZ Mental Health students, residents, and registrars for the Mental Health Act. In, New Zealand’s Mental Health Act in Practice, Dawson J & Gledhil K, Review Tribunal and a specialist medical challenges and rewards of working with eds. Wellington: Victoria University Press consultant under the NZ Intellectual indigenous peoples? For our indigenous Disability Compulsory Care and Jackson M (2007). Globalisation and the students who might feel drawn to child Rehabilitation Act 2003. and adolescent psychiatry, how do colonising state of mind. In Resistance: an we ensure that they are provided with indigenous response to neoliberalism, M. Bargh, ed. Wellington: Huia appropriate indigenous cultural support?

A gift in your will takes a simple designation and costs you nothing during your lifetime.

Join before October 31st 2014 and be honored as a Founding Member of the 1953 Society with special membership benefits.

To learn more, visit It is a “tomorrow” www.AACAP.org/1953_Society investment made today. Or call Stephen at 202.966.7300 ex.140

MAY/JUNE 2014 121 FEATURES FEATURES

As child and adolescent psychiatrists, we work with patients who put their feelings into actions. Poetry Often we are at a loss to find the words to describe the feelings the action conveys. Intentional self- harm in the form of cutting is one of those feeling-driven actions that we struggle to understand. Poetry provides a healthy vehicle for conveying the same feelings through metaphor and evoca- tive language. When Karie Evans, a college student from Kensington, MD, where I live and work, shared her poetry blog with me, I was struck by her poem “Burst.” Here Karie captures with words what so many of our patients, unfortunately, capture through action. Rachel Z. Ritvo, MD

Burst By Karie Evans

I just wanted to explode I wanted to cut my skin and bleed out not so I could feel, but so I could breathe, so I couldn’t think so I could transform

I wanted to rise up levitate above the earth with a trail of my blood behind me

I don’t need it I don’t need my heart to beat I don’t need my soul to feel Emotions are irrelevant here

I just want to float by the sun warm and safe no thoughts or worries

the absence of everything

Its hard to imagine but it’s like dreaming you’re just existing just moving just here

Individuals interested in submitting poetry should e-mail Poetry Coordinator Charles Joy, MD, at [email protected].

122 AACAP NEWS FEATURES Media Page ■■ Harmony Raylen Abejuela, MD, Resident Editor CHILD TEMPERAMENT: NEW THINKING ABOUT THE BOUNDARY BETWEEN TRAITS AND ILLNESS ■■ By Dr. David Rettew

W.W. Norton & Company, 2013 273 pages - $34.00 hardcover

Dr. David Rettew, a Harvard-trained child and adolescent psy- chiatrist who spent over a decade studying child temperament, has authored a well-written book about the increased interest into and continuing study of child temperament. He starts by discussing the history of temperament research particularly since Chess and Thomas’s seminal work. He thoroughly explores the neurobiological and genetic (nature) aspects that contribute to child temperament versus those that are societal and environmental (nurture). Then, Dr. Rettew delves into temperamental traits and their relationship to psychiatric ill- nesses. When does a child go from being considered “active” to “hyperactive”? At what point does temperamental shyness end and social anxiety disorder begin? When should sadness be considered depression? As the definitions of psychiatric disorders evolve, the boundaries between what are “just” graphs and tables summarizing each section’s main points and manifestations of temperament and personality and those that its lucid discussion of psychopharmacology, giving a reader are diagnosable conditions are increasingly debated in the a clear sense of the risks and benefits of prescribing psycho- professional and lay literatures. Risk factors that predispose a tropic medications for childhood disorders, justifying why no person to psychopathology and those that create the distinc- easy answers are available for questions and concerns regard- tion between normal child temperament and impairment are ing using medications to modify temperament. Dr. Rettew also discussed. succeeds in presenting essential information on the fascinating intersection of child temperament and psychiatric disorders. The book’s second part focuses on practical applications, His thoughtful book could help both adult and child and offering case vignettes in clinical settings. It discusses tem- adolescent psychiatrists, and other mental health providers, perament in relation to different parenting styles and in as well as other medical professionals, clinicians, parents, and educational settings. The book offers practical suggestions educators, to better treat, understand, teach, and raise children that clinicians, parents, and educators can use with children with different temperaments. with different temperaments. Readers will appreciate its clear, straightforward

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, Harmony Raylen Abejuela, MD, at [email protected].

MAY/JUNE 2014 123 61ST ANNUAL MEETING . OCT 20-25, 2014 . SAN DIEGO, CA FEATURES

San Diego Preview

AACAP’s 61st Annual Meeting is just 6 months away have scoped out the best that our destination has to offer and we’re excited! Whether you’re bringing the kids to and have highlighted some important information here! go to the famous San Diego Zoo, laser-focused on our For complete details about the Annual Meeting, visit high-quality programs, or somewhere in between, we www.aacap.org/AnnualMeeting/2014.

June 16 – Make your hotel reservations at the Manchester Grand Hyatt or Marriott Marquis and Marina in San Diego June 16 – Review the Annual Meeting programs online August 4 – Members Only Registration opens for the Annual Meeting August 11 – Registration opens to nonmembers

September 15 – Early Bird Registration Deadline

September 26 – Last day AACAP room rate guaranteed at hotel October 20 – First day of AACAP’s 61st Annual Meeting October 25 – Last day of AACAP’s 61st Annual Meeting October 31 – Look for the General Evaluation Survey in your e-mail inbox. CME certificate available upon completion of survey.

124 AACAP NEWS SAN DIEGO, CA . OCT 20-25, 2014 . 61ST ANNUALFEATURES MEETING

Hotel Hotel Policies: Manchester Grand Hyatt San Diego ✦✦When making your reservation, ask for the AACAP 1 Market Place ANNUAL MEETING GROUP RATE to qualify for the San Diego, CA 92101 reduced rate. Phone: 619.232.1234 ✦✦This rate is available until September 26, or until the www.manchestergrand.hyatt.com (for detailed hotel information) group block sells out, whichever comes first. We www.aacap.org/AnnualMeeting/2014 (to reserve your hotel room) recommend making your reservation early to secure Rate: $239 single/double per night your room. ✦✦A deposit equal to one night’s stay is required to hold The Manchester Grand Hyatt San Diego is the headquarter each individual’s reservation. Such deposit shall serve hotel for the Annual Meeting and the majority of educational to confirm the reservation for the date(s) indicated and, events will take place there. The best of San Diego is right upon check-in, shall be applied to the first night of outside their door! the reserved stay. This deposit is refundable if notice Take a walk along is received by September 15, 2014 and a cancellation the boardwalk number is obtained. All deposits shall be charged at the of beautiful San time the reservation is name. Diego Bay, pick up souvenirs in ✦✦Check-in is at 4:00 p.m. and check-out is at 12:00 p.m. Seaport Village, or walk to the bustling Gaslamp Quarter Travel for delicious food San Diego is served by the San Diego International Airport and drinks! (SAN). For more information about the airlines serving this airport, flight schedules, and ground transportation options, We will also have a small block of rooms at the San Diego visit www.san.org. The airport is just a 10 minute drive from the Marriott Marquis & Marina, located directly next door to Hyatt and Marriott and the average price for a taxi is $12-$15. the Grand Hyatt hotel. To reserve a room at the Marriott, please call 619.234.1500. The room rate and hotel polices at the Marriott are the same as the Grand Hyatt.

Residents, Trainees, and Medical Students ATTEND THE AACAP ANNUAL MEETING FOR FREE! Serve as a MONITOR for one full day or two half days of the meeting to receive free registration and half-price on most ticketed events.

For more information about the Monitor Program, visit the AACAP website at: www.aacap.org/AnnualMeeting/2014. Registration opens August 4 for AACAP members and August 11 for nonmembers. Become a member TODAY to get priority monitor scheduling!

MAY/JUNE 2014 125 61ST ANNUAL MEETING . OCT 20-25, 2014 . SAN DIEGO, CA FEATURES

✦✦Founded in 1916, the San Diego What to Do in San Diego! Zoo has been an icon in San Diego for nearly 100 years. ✦✦Balboa Park is a San Diego Located adjacent to downtown must-see, just minutes from San Diego in Balboa Park, the downtown, and ranked as Zoo is 100 acres in size and is one of the Best Parks in the home to more than 4,000 animals World. The Park is home representing more than 800 to 15 major museums, species from around the world. several performing arts Go to www.sandiegozoo.org for venues, lovely gardens and detailed information. many other cultural and recreational attractions, ✦✦Already been to the San Diego Zoo but still have a han- including the San Diego kering to see more animals?! Then check out the San Zoo. With a variety of Diego Zoo Safari Park! Located just 30 miles north of cultural institutions laid out downtown San Diego among its 1,200 beautiful in the San Pasqual and lushly planted acres, Valley, The Safari Balboa Park is the nation’s Park is an expansive largest urban cultural park. wildlife sanctuary that If you are planning on is home to more than visiting Balboa Park over the course of a few days, 2,600 animals repre- take advantage of the Passport to Balboa Park which senting more than 300 includes one admission to 14 museums over 7 con- species. Over half of secutive days. If you only have a day, visit the Visitors the Park’s 1,800 acres Center in Balboa Park for a Stay-for-the-Day pass that have been set aside as protected native species habitat. includes admission to 5 of the museums in one day. Visit www.sdzsafaripark.org for more information. Visit www.balboapark.org/parkpass for details. ✦✦The USS Midway Museum is a real aircraft carrier ✦✦With more than 70 craft breweries and several local and a once-in-a-lifetime memory for everyone! Create wineries, San Diego takes their beverage producing a lasting memory exploring the USS Midway, the seriously! Recently named the “Top Beer Town” in longest-serving U.S. Navy aircraft carrier of the 20th America, visitors can hop from breweries and pubs century! Imagine living aboard a floating city at sea to restaurants and local bars, tasting the best suds the with 4,500 shipmates by exploring galleys, officer’s region has to offer. And with a mild Mediterranean-like country, sleeping quarters, and the four acre flight deck. climate, it is no surprise that wine grapes grow well in Admission includes a self-guided audio tour to over 60 San Diego! San Diego wineries exist like hidden jewels locations from the engine room to control tower, nar- along the coast, tucked into the fertile North Country rated by Midway sailors who lived or worked in each farmland and amidst the rugged terrain of East County. area. Don’t forget to join us on the USS Midway for the Opening Reception on Wednesday night, included ✦✦Rising from in the cost of registration! Visit www.aacap.org/ the 16 square- AnnualMeeting/2014 for general registration informa- blocks are tion as well as details about the Opening Reception! Victorian-era buildings and modern skyscrapers that stand side by side, housing more than 100 of the city’s finest restaurants, pubs, nightclubs and retails shops, as well as offices and residential/work lofts. Downtown San Diego’s Gaslamp Quarter is a veritable playground, rich with cultural offerings that include theatres, art galleries, symphony halls, concert venues, and museums in addition to a variety of restaurants and night life.

For more information about other San Diego attractions, please visit: www.sandiego.org.

126 AACAP NEWS SAN DIEGO, CA . OCT 20-25, 2014 . 61ST ANNUALFEATURES MEETING

New Research Poster Call for Papers DON’T MISS OUT! AACAP’s 61st Annual Meeting takes place October 20-25, 2014, in San Diego, California. Abstract proposals are prerequisites for acceptance of all presentations given at the meeting. Topics may include any aspect of child and adolescent psychiatry including clinical treatment, research, training, development, service delivery, or administration.

Verbal presentation submissions were due February 18, 2014, and are Don’t miss this opportunity to save money! no longer being accepted. Abstract proposals for (late) New Research AACAP members who refer a new Annual Meeting Posters must be received by Monday, exhibitor receive a $100 discount on their 61st Annual June 16, 2014. Meeting registration. All Call for Papers applications must be All referrals must be first time AACAP exhibitors and must submitted online at www.aacap.org. purchase a booth for AACAP’s 61st Annual Meeting. Step-by-step instructions for how to use the online submission system Exhibitors can connect with more than 4,000 child and are available at www.aacap.org/ adolescent psychiatrists and other medical professionals or AnnualMeeting/2014. If you have advertise in several Annual Meeting publications. Typical AACAP exhibitors include recruiters, hospitals, residential questions regarding this process, treatment centers, medical publishers, and many more. please call 202.966.7300, ext. 2006 or email [email protected]. To review an Exhibitor Prospectus with more details on these opportunities, as well as forms to sign-up, please visit www.aacap.org/exhibits/2014.

Questions? [email protected] or 202.966.7300 ext: 155.

Show your support for AACAP and SAVE TODAY!

MAY/JUNE 2014 127 61ST ANNUAL MEETING . OCT 20-25, 2014 . SAN DIEGO, CA FOR YOUR INFORMATIONFEATURES

Medical Students and Residents: Attend the AACAP Annual Meeting and Get Involved!

The American Academy of Child and Adolescent get involved and attend AACAP meetings. Some of the Psychiatry (AACAP) offers numerous award programs current opportunities are listed below. and opportunities for medical students and residents to

Medical Students

Life Members Mentorship Grants for Medical Students – Award Deadline: July 11, 2014 The Life Members Mentorship Grants for Medical Students provides medical students with the opportunity to attend the 61st AACAP Annual Meeting in San Diego, CA, October 20-25, 2014. Partnered with the Mentorship Program, this program provides participants with networking opportunities, exposure to varying specialties, and interaction with Life Members. More information regarding this program can be found on the AACAP website at http://www.aacap.org/AACAP/Awards/Home.aspx or by contacting the Training and Education Department at [email protected].

Serving on Committees Residents

Resident members can get involved Educational Outreach Program – with national initiatives by serving Award Deadline: July 11, 2014 on one of AACAP’s committees. Serving on a committee is a The Educational Outreach Program (EOP) for both child and great way to network with senior adolescent psychiatry residents and general psychiatry residents members and experience how provides funding support for residents to attend the AACAP 61st AACAP members work together Annual Meeting, October 20-25, 2014 in San Diego, CA. The to address issues of national Annual Meeting provides residents with exposure to the field of concern. AACAP is now accepting child and adolescent psychiatry, including research and networking applications for residents to serve on committees. Below is a list opportunities. More information regarding the EOP program can of committees with open resident member positions. To apply, be found on the AACAP website at http://www.aacap.org/AACAP/ send an email with a statement of interest for your top three Awards/Home.aspx or by contacting the Training and Education committee choices and a copy of your CV to executive@aacap. Department at [email protected]. org by July 11, 2014. (Note: Residents are only permitted to serve on one committee.) Systems of Care Special Program Clinical Projects – Award Deadline: July 11, 2014 Open Committees: Child and adolescent psychiatry residents are encouraged to apply Art, Bylaws, Collaboration with Medical Professions, Medical for the 2014 Systems of Care Special Program Clinical Projects, Students and Residents, Community Based Systems of Care, which were created to give residents and fellows the opportunity Complementary and Integrative Medicine, Consumer Issues, to learn about treating children with mental disorders within the Continuing Medical Education, Development, Disaster community-based systems of care. The Clinical Projects includes and Trauma Issues, Early Career Psychiatrist, Ethics, Family, $1,000 plus shared funding from a training program or regional Financial Planning, Gifts and Endowments Oversight, Grants organization to be part of a learning community focused on Oversight, Health Promotion and Prevention, Healthcare system-based practice and attend the Systems of Care Special Access and Economics, History and Archives, HIV Issues, Program on Monday, October 20, 2014 at AACAP’s 61st Annual Infant and Preschool, International Relations, Juvenile Justice Meeting in San Diego, CA. Residents may apply to both the Special Reform, Media, Member Benefits, Membership, Military Issues, Program Clinical Projects and the Educational Outreach Program Native American Child, Physically Ill Child, Policy Statement (EOP); however, individuals cannot receive both awards at the Advisory Group, Program, Psychotherapy, Quality Issues, same time. For more information, please visit http://www.aacap. Religion and Spirituality, Rural Psychiatry, Schools, Sexual org/AACAP/Awards/Resident_and_ECP_Awards/2014_Systems_ Orientation and Gender Identity Issues, Substance Abuse and of_Care_Special_Program_Clinical_Projects.aspx or contact the Addiction, Telepsychiatry Clinical Practice Department at [email protected].

128 AACAP NEWS FOR YOUR INFORMATIONFEATURES

Membership CORNER

Congratulations Time is running out! Renew for 2014! to Graduating You can pay your dues in three easy AACA A Pu P blic ation of the

Ne ■ Marc h/Apri l 2014 ■ Vo lume ws45, Issu Residents and ways: online at www.aacap.org, by fax, e 2 or by mail. Contact AACAP Member Medical Students Services if you have any questions regarding your benefits or renewing When planning your your membership. Renew today and graduation ceremony Inside... Photo by Sandra Ne AACA ls P Execut on, MD Hi ive Dire storical Tr ctor & Pres AACAP News auma: A Pa iden keep your coming! t’ Update on nora s Messag the Back mic Pers e ...... CPT CO to Proj pective ...... DING ect Future CORNER Repo 65 ...... rt: The Plan s Unfold ...... 71 85 and after-party, be sure to include 86 AACAP! Please provide us with your updated contact and address information so you can put your AACAP member benefits to use for the next phase of Is Renewing Stressing You Out? your professional career. AACAP offers flexible payment solutions to meet Update your information online at www.aacap.org. your needs. Take advantage of our monthly installment payment program. Contact Member Services at 202.966.7300, ext. 2004, or email us at [email protected] to discuss your personalized payment plan options. Upcoming EVENTS

October 20-25, 2014 AACAP 61st Annual Meeting Manchester Grand Hyatt San Diego, California www.aacap.org December 25-26, 2014 Bangladesh Association for Child & Help Determine the Future of Adolescent Mental Health (BACAMH) 7th Annual Conference and General Meeting AACAP’s Educational Offerings! Child and Adolescent Psychiatric Disorder: AACAP is considering major changes to our edu- Connectivity cation program management, especially with our Dhaka,Bangladesh www.bacamh.org online CME programs and ability to track your CME [email protected] and Maintenance of Certification requirements. And, we need your help! October 26-November 1, 2015 AACAP 62nd Annual Meeting AACAP is conducting an educational needs assess- Henry B. Gonzalez Convention Center ment and asks for your input on how to best meet and Grand Hyatt your educational needs. Please look for an email San Antonio, Texas www.aacap.org in July for more information. Thanks in advance for your input!

MAY/JUNE 2014 129 FOR YOUR INFORMATION FOR YOUR INFORMATION Staff Directory

EXECUTIVE DEPARTMENT Heidi Buttner Fordi (Executive Director) [email protected] Earl Magee (Executive/Assembly Administrator) [email protected] Genifer Goldsmith (Executive Office Coordinator) [email protected]

FINANCE DEPARTMENT Executive Department Larry Burner (Comptroller) [email protected] Lynda Jones (Assistant Comptroller) [email protected] Naomi Franklin (Accounting Assistant) [email protected]

HUMAN RESOURCES & OPERATIONS Andrew Peters (Human Resources & Operations Director) [email protected] Danielle Jackson (Operations Coordinator/Receptionist) Finance Department [email protected]

INFORMATION SYSTEMS & WEB SERVICES Colleen Dougherty (Director of Information Systems and Web Services) [email protected] Te Erickson (Database Manager Contractor) [email protected] Andrew Kennedy (Help Desk/Network Technician) [email protected] Human Resources & Operations

GOVERNMENT AFFAIRS & CLINICAL PRACTICE Ronald Szabat, Esq. (Director Government Affairs & Clinical Practice) [email protected] Michael Linskey (Assistant Director, Federal Government Affairs) [email protected] Bryan Shuy (Assistant Director for Grassroots Advocacy) [email protected] Zachary Lee Kahan (Legislative Coordinator) [email protected] Jennifer Medicus (Assistant Director Clinical Practice) [email protected] Adriano Boccanelli (Clinical Practice Manager) Government Affairs & Clinical Practice [email protected]

130 AACAP NEWS FOR YOUR INFORMATION

COMMUNICATIONS & MEMBER SERVICES DEPARTMENT Rob Grant (Communications & Member Services Director) [email protected] Mona Noroozi (Communications & Marketing Coordinator) [email protected] Nicole Creek (Member Services Manager) [email protected] Nelson Tejada (Member Services & Registrar Assistant) [email protected] Stephanie Chow (Membership Marketing Coordinator) [email protected]

Communications & Member Services Department MEETINGS & CME Jill Brafford (Director of Meetings & CME) [email protected] Molly Moir (Assistant Director of Meetings) [email protected] Kate Bailey (Meetings and Exhibits Manager) [email protected] Brooke Schneider (Meetings Coordinator) [email protected] Elizabeth Hughes (Asst. Director of Education & Recertification)[email protected] Quentin Bernhard III (CME Coordinator) [email protected] Meetings & CME

RESEARCH, TRAINING & EDUCATION DEPARTMENT Carmen Jewel Head, MPH, CHES (Director of Research, Training, & Education) [email protected] Ashley Rutter, MPA (Assistant Director of Training & Education) [email protected] Elizabeth Goggin (Research Program Manager) [email protected] Cecilia Johnson (Research & Training Coordinator) [email protected]

Research, Training & Education Department

MAY/JUNE 2014 131 FOR YOUR INFORMATION FOR YOUR INFORMATION

DEVELOPMENT DEPARTMENT Alan Ezagui (Deputy Director of Development) [email protected] Stephen Major (Development Coordinator) [email protected]

JAACAP Mary Billingsley (Managing Editor) Development Department [email protected] Kristine Pumphrey (Editorial Coordinator) [email protected] Alyssa Murphy (Editorial Coordinator) [email protected]

JAACAP

AACAP Team

132 AACAP NEWS FOR YOUR INFORMATION

AACAP Welcomes Carmen J. Head as the New Director of Research, Training & Education!

s. Carmen J. Head is the new In Carmen’s role as Director of RTE at Director of Research, Training, AACAP, she oversees the implementa- Mand Education (RTE). She has tion and growth of AACAP’s research, been committed to helping health and training, and education portfolio that education professionals addressing child, includes a National Institutes of Health adolescent, and school health issues funded K12 grant for early career for eighteen years. She has worked on psychiatrists specializing in child and a number of federally and privately adolescent drug use and several fellow- Carmen J. Head funded programs impacting chronic ship and award programs. disease risks, HIV/AIDS prevention, health equity, and supporting youth Carmen has a special interest in the Bioethics Course. Carmen received with physical and learning challenges. well being of school age children. She a Bachelor of Science Degree in Ms. Head has worked at a number of also has interest in addressing social Community Health Education at Howard national organizations committed to justice issues that impact the mental University and a Master of Public Health both youth and health including the health of minorities and women. She has Degree from the George Washington National School Boards Association, the served as a keynote and plenary speaker University School of Public Health and Society for Public Health Education, the for Smithsonian Institution Lecture Health Services. She resides in Northern United Negro College Fund, and the Services on public health ethics and has Virginia. In her spare time, Carmen Spina Bifida Association. served as distinguished faculty for enjoys community service, volunteering, Tuskegee University’s Summer Institute and travelling. n

Share Your Photo Talents With AACAP News

The Editorial Board of AACAP News is soliciting photographs from AACAP members to be published on its front page, inside standing alone, or accompanying relevant articles or stories. The published photographs should— in some artistic way—illustrate themes pertaining to children, childhood, parents and children, parenting, or families. All AACAP members are invited to submit up to two photographs every two months for consideration.

A committee of five experienced photographers who are AACAP members—David Corwin, M.D., James Harris, M.D., Fred Seligman, M.D., Ludwig Szymanski, M.D., and Alvin Rosenfeld, M.D.—will select the photos to be used. Photos not selected will be included in the voting for the subsequent two issues, along with all newly submitted photos. Unused photos will be retained by the AACAP to be used if and when a story they might illustrate is to be published. The AACAP News may edit photos to enhance them or make them suitable for publication. If you would like your photo(s) considered, please send a high-resolution version to Dr. Rosenfeld, the AACAP News photo editor, at [email protected]. Please include a description, 50 words or less, of the photo and the circumstances it illustrates. n

MAY/JUNE 2014 133 FOR YOUR INFORMATION FOR YOUR INFORMATION Thank You for Supporting AACAP! AACAP is committed to the promotion of mentally healthy children, adolescents, and families through research, training, ­advocacy, prevention, comprehensive diagnosis and treatment, peer support, and collaboration. Thank you to the following donors for their generous­ financial support of our mission.

Gifts Received January 1, 2014 to February 28, 2014 We apologize that the donor list for the previous issue of AACAP News (Volume 45, Issue 2) was mislabeled. That list should have read “Gifts Received November 1, 2013 to December 31, 2013.”

$50,000 and Above $100 to $499 Sandra Boltax-Stern, MD International Fund Advocacy Robert Daehler, MD Paramjit T. Joshi, MD International Christopher Bellonci, MD in memory of my brother, Scholars Award Harinder Ghuman, MD Verne Daehler Paramjit T. Joshi, MD Jean Ying-Chang, MD Louise Desgranges, MD F. Rodney Drake, MD Pilot Research Award Campaign for America’s Kids David M. Ellis, MD Pfizer Inc. William Arroyo, MD Reza Feiz, MD Ryo Sook Chun, MD $5,000 to $9,999 Lois T. Flaherty, MD Martin J. Drell, MD Frank M. Gatti, MD Elaine Schlosser Lewis Fund Jorge E. Fernald, MD Richard L. Gross, MD Eric and Margot Egan Benjamin Goldstein, MD, PhD Nancy Haslett, MD The Brownington Foundation Michael S. Greenbaum, MD Bruce Henry, MD Jessica Hof, MD* Charles Huffine, MD $1,000 to $4,999 Anthony H. Jackson, MD Brian P. Jacks, MD Advocacy Donald Jacobs, MD* Clarice J. Kestenbaum, MD E. James and Virginia Anthony Neal Johnson Charles R. Korrol, DO* in Honor of Kristin Kroeger in Memory of Kate Joy Plaisier, MD in memory of Charles Brownfield PhD Ptakowski Peter Andrew Kahn, MD Harvey N. Kranzler, MD Life Members Fund Wajiha P. Karatela, MD Alvin B. Michaels, MD Alan A. Axelson, MD D. Richard Martini, MD Joan Stern Narad, MD John Schowalter, MD Joan Stern Narad, MD Joanne M. Pearson, MD Jack Obedzinski, MD* Cynthia R. Pfeffer, MD Virginia Q. Anthony Fund Vicente C. Pacheco, MD Ellen H. Sholevar, MD Robert Jay Reichler, MD James A. Parker, MD, MHA Herschel Rosenzweig, MD $500 to $999 Charles W. Popper, MD Carlos H. Salguero, MD, MPH Carlos H. Salguero, MD, MPH Eugene Parker Shatkin, MD Advocacy Endowment Fund Quentin Ted Smith, MD Gordon R. Hodas, MD in Memory of Reeves Warm, MD in Honor of Kristin Kroeger Joseph Drinka, MD Eric Steckler, MD Ptakowski International Fund in memory of Dr. Carl Steckler D. Richard Martini, MD Shashi K. Bhatia, MD Militza Stevanovic, MD Campaign for America’s Kids International Fund Carrie Sylvester, MD, MPH Mental Health Addiction and Ülkü Ülgür, MD International Emmanuel M. Tendero, MD Retardation Organizations of Scholar Award Research Initiative America Inc. Robert Spielmann* Jorge E. Fernald, MD Elaine Schlosser Lewis Fund Life Members Fund Virginia Q. Anthony Fund Richard P. Cohen, MD Thomas F. Anders, MD E. James Anthony, MD Eva Sperling, MD Life Members Fund Virginia Q. Anthony Workforce Development Alberto C. Serrano, MD Alfred M. Arensdorf, MD Summer Medical Student Fellowship John A. Traylor, MD in Honor of Irving Berlin, MD Teresa Hargrave, MD Where Most Needed William H. Beute, MD Virginia Ruth Heller, MD General Contribution in honor of Charles Keith, MD in Honor of James Allen, MD Randie Schacter, DO Shashi K. Bhatia, MD Quinton C. James, MD Barton J. Blinder, MD, PhD Where Most Needed in Honor of Salvidore Minuchin, General Contribution MD “Pioneer of Family Therapy and Philip Randall Frank, DO Valued Teacher” Michael S. Greenbaum, MD

134 AACAP NEWS FOR YOUR INFORMATION

Shannon Nicole Jap, MD* Kathleen Hughes-Kuda, MD International Fund Mohsin Riaz Khalique, MD Brian P. Jacks, MD Gregory Fernandopulle, MD Joey Lerner, MD, MPH Lara Jaradat, MD* Teresa M. Kohlenberg, MD Douglas A. Marcus, MD Parnjai J. Johnson, MD* in memory of Gerald Stechler, PhD Vishwas Mashalkar, MD Benjamin W. Jordan, MD Mrudula Rao, MD Judith R. Milner, MD Shashank V. Joshi, MD Life Members Fund Jane C. Smith, MD Joyce M. Kocher, MD* Andrew Cook, MD Sheree Krigsman, MD Up to $99 John E. Dunne, MD Corriene V. Kurz, MD Bernard Friedberg, MD Advocacy Timothy D. Landis, MD* Joseph B. Greene, MD Sharette Kirsten Gray, MD* Joseph S. Lee, MD* Frederick J. Stoddard, Jr., MD Kanchanamala Madhavan, MD* Stanley Leiken, MD Allan Thorburn, MD Andrew Peters* Annemarie K. Loth, MD* in Memory of Stuart Finch, MD Eileen Patricia Ryan, DO James F. Luebbert, MD Grant Hulse Wagner, MD Susan Lurie, MD Campaign for America’s Kids Research Initiative A. Reese Abright, MD Philip D. Malinas, MD* Ann Elizabeth Maloney, MD Dante Burgos, MD Ujwala S. Agharkar, MD Mrudula Rao, MD Denys E. Arrieta, MD* Gary Mart, MD Workforce Development David Axelson, MD* Ardis C. Martin, MD Summer Medical Student Fellowship Stephanie Axman, MD* Sharon Mason-Bell, MD* Loren Amdursky, MD Philip Luke Baese, MD* Catherine Lapp McCarthy, MD Stuart Bair, MD* Saran Mudumbi, MD Virginia Q. Anthony Fund Les Barrickman, DO* Anna E. Muelling, MD* Ralph Cohen, MD Raymond Behr, MD Marija D. Mutabdzic, MD Wun Jung Kim, MD, MPH Elizabeth V. Bernardino, MD Michael Neander, MD William Taylor, MD John Nicholson, MD Chester M. Berschling, MD Where Most Needed Anjali Nirmalani-Gandhy, MD* Miguel Angelo Boarati, MD* General Contribution Joan F. Poll, MD* Steven Brown, MD* Irmgard Borner, MD Tracy Protell, MD Deborah Carlson, MD in memory of my mother Charito V. Quintero-Howard, MD* Aurora M. Casta, MD Lorna J. Clark-Rubin, MD George Realmuto, MD Javed Choudhry, MD* Teresa M. Hargrave, MD Moira A. Rynn, MD* Nicole Christenson, MD* Robert H. Herrick, MD Erica Shoemaker, MD Gordon Richard Cohen, MD Arthur C. Jackson, MD Mustaq A. Siddique, MD* in honor of Kristin Kroeger Ptakowski Clarita N. Obleada, MD Eric Steckler, MD Edward J. Coll, MD Miriam L. Ornstein, MD* Colin Stewart, MD* Nancy Collins, MD Miriam K. Pizzani, MD* Frederick J. Stoddard, Jr., MD Stephen J. Cozza, MD Mrudula Rao, MD Dorothy E. Stubbe, MD Marc C. Cruser, MD Andrea Sorensen, MD* Melanie Suhr, MD Kim D. Dansie, MD in Memory of Jason Walenta, MD L. Read Sulik, MD* Dorothea L. DeGutis, MD Allan Ivan Stempler, MD Laine E. Taylor, DO* in honor of Adoptive Families Stephen E. Warres, MD Robert Paul Diamond, MD Dianne Thomas, MD* Lisa M. Donovan, MD Thomas J. Trannel, MD Raymond G. Troy, MD* Olimpia Dorries, MD *Indicates a first-time donor to AACAP Tom B. Vaughan, Jr., MD Stephen Fleming, MD* °Indicates honorarium donations Geraldine S. Fox, MD Rachel Waxman, MD* Teresa Frausto, MD Alexander Westphal, MD* Jean A. Frazier, MD* Timothy John Whalen, MD* John P. Glazer, MD Lloyda Broomes Williamson, MD Eleanor Gottesman, MD Susan Willis, MD Barbara Hamm, MD* Yuhuan Xie, MD Martin Hart, MD Linda Zamvil, MD* Francis F. Hayden, MD Adam D. Zavodnick, MD* Cheyenne X. He, MD* Manuela P. Zisu, MD* John Hertzer, 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.

MAY/JUNE 2014 135 FOR YOUR INFORMATION DID YOU KNOW YOU have the power to direct your donation WHERE MOST NEEDED to the AACAP initiative A donation “Where Most Needed” supports all of AACAP’s initiatives, and gives us the you care about most. greatest flexibility to direct your contribution where it will have the biggest impact.

INTERNATIONAL FUND CAMPAIGN FOR The international medical community has contributed significantly AMERICA’S KIDS (CFAK) to best practices in effectively treating children with mental illnesses. CFAK funds projects that promote By recognizing and investing in the work of our international quality mental health services and colleagues, your donation to the AACAP International Fund will help treatment for children and adolescents us tackle the biggest barrier to access to services: a global shortage of with mental illness through established child psychiatrists. CFAK priorities. They include: consumer education, access to It costs $2,500 to sponsor a travel scholarship for one treatment, professional education, international student or resident to attend the Annual and state/local government and Meeting and be mentored by an AACAP member. community coalitions.

ADVOCACY ELAINE SCHLOSSER VIRGINIA Q. ANTHONY As an essential part of professionalism, it is LEWIS FUND FUND imperative that child and adolescent psychiatrists The Elaine Schlosser Lewis (ESL) Fund Created to honor the service of AACAP’s advocate for their patients in all settings and with encourages innovative research in the areas retired Executive Director, the Virginia policymakers. To reduce stigma and to deepen of Attention Deficit Disorder/Attention Q. Anthony Fund underwrites the annual understanding, AACAP also helps to educate Deficit Hyperactive Disorder and learning Virginia Q. Anthony Outstanding Woman families and children on how telling their own disabilities. It is through this research that Leader Award, which celebrates the stories, when appropriate, can change public physicians and mental health experts can achievements of female CAPs who have opinion and inform the policymaking process improve the current diagnostic tools and had a profound impact on their field. through the sharing of the patient perspective. treatment options for ADHD. It costs $2,000 to sponsor a It costs $684 to enable one child or parent It costs $15,000 to sponsor one Virginia Q. Anthony Outstanding to attend Advocacy Day educational ESL Pilot Research Award. Woman Leader Award. training sessions in Washington, DC.

LIFE MEMBERS FUND WORKFORCE RESEARCH The Life Members Fund supports medical students and DEVELOPMENT It’s estimated that just 1% of child residents interested in a career as child and adolescent The average wait for a child to see a psychiatrists are researchers. We psychiatrists with travel scholarships to AACAP’s child and adolescent psychiatrist (CAP) is know that’s not nearly enough if we Annual Meeting. At the meeting, they are mentored seven and a half weeks; compared with are going to accelerate innovation by Life Members, our most senior members. Since two weeks for an adult to see a general and best-practice gains. Without 2010, 68 medical students and residents have been psychiatrist. This deficit in our workforce new researchers, we are facing the supported by your donations. has a devastating impact on children in very real possibility of not reaching our potential for new medicines It costs $1,325 to sponsor a travel grant to the need of treatment. The AACAP Medical Student Fellowship program helps and treatments that will have Annual Meeting for CAP Medical Students eliminate the CAP deficit by encouraging lasting benefits to children with and Residents. the best and brightest young medical mental illness. Your donation will minds to pursue careers in child and help us make more investments in adolescent psychiatry. promising new researchers. ENDOWMENT FUND It costs $7,500 to sponsor It costs $15,000 per year to A gift to the AACAP Endowment is a permanent one medical student in a launch one child psychiatry financial investment in the future and stability of 12-week fellowship. resident’s research career. AACAP. The AACAP Endowment funds important programs that support AACAP’s mission for current and future generations. Visit AACAP.org and direct your donation to any of the causes and funds listed and enjoy the freedom of targeting your gift exactly where you want it. To learn more about AACAP’s impact funds: Please contact the Office of Development at 202.966.7300 ext. 140 or [email protected]. FOR YOUR INFORMATION

DONATE YOUR BIRTHDAY! Make 2014 Special Celebrate your birthday and AACAP at the same time!

Set up a personal fundraising page, and ask friends and family to make a donation to AACAP in lieu of presents. To learn more, e-mail: [email protected] The setup process is simple and easy. Call Stephen at 202.966.7300 ext. 140. He will be happy to help you get started!

CHILD/ADOLESCENT PSYCHIATRIST Cook Children’s Medical Center Forth Worth, Texas

Cook Children’s is conducting a national search for a BC/ Children’s Health Care System, a pediatric system of care BE Child Psychiatrist to join our team of seven Child and where physician leadership is fostered and physicians actively Adolescent Psychiatrists. We have a well-established, out- participate in the strategic goals as well as the mission of patient and inpatient pediatric program, which provides a the organization. full range of early intervention, rehabilitation, medical, and mental health services for children. Our interdisciplinary team Knowing that every child’s life is sacred, it is the promise is comprised of child and adolescent psychiatrists, child psy- of Cook Children’s to improve the health of every child in chologists, developmental pediatricians, and speech, physical, our region through the prevention and treatment of illness, and occupational therapists. This is a unique position which disease and injury. offers a variety of clinical activities, including evaluation, ongoing treatment and follow-up, consultation, and education Physician candidates must be trained and board eligible/ in a stimulating atmosphere of close collaboration with other board certified in Child and Adolescent Psychiatry and able disciplines in the care of the child. to secure an unrestricted Texas Medical License.

Cook Children’s Medical Center is a non-academic, 457-bed Submit Applications To: tertiary care pediatric hospital. Cook Children’s physicians Debbie Brimer, Physician Recruiter enjoy a collegial relationship with more than 300 specialty Phone: 1-877-532-6657 and primary care associates. Cook Children’s Physician E-mail: [email protected] Network is the employed physician component of Cook Website Address: www.cookchildrens.org

MAY/JUNE 2014 137 FOR YOUR INFORMATION FOR YOUR INFORMATION

CHILD PSYCHIATRIST – FULL-TIME Spectrum Health Grand Rapids, MI

The Pediatric Neuroscience team at the Spectrum Health Medical Group affiliated with Helen DeVos Children’s Hospital seeks a Child Psychiatrist. The Pediatric Neurosciences team includes a pediatric CHILD PSYCHIATRIST – FULL-TIME behavioral medicine physician and three psychologists. The focus of pediatric psychiatry and behavioral Sendan Center services is on serving the needs of the tertiary and quaternary patient population, and on those who Bellingham, WA require acute care in the hospital setting. There is a current need for expanded services in pediatric If you envision... psychiatric and behavioral care with a focus on ... a stable, prosperous, and deeply fulfilling career consultative inpatient psychiatry and psychology, ... a relaxed and supportive work culture outpatient psychiatric and psychologic care for chronic ... a healthy work / life balance subspecialty patients, acute evaluation of specialized ... colleagues who love this work patient poulations presenting for complex care and ... living in an amazing place (one of Sunset behavioral medicine support of specializd patient Magazine’s 2014 “Best Places”) populations. The primary role of the new Child ... opportunities for mentorship from mid-career Psychiatrist will be inpatient consultation services, providers however he/she will also provide outpatient clinic visits If you believe your families deserve... to medically complex patients several times a week. ... the highest quality of mental and behavioral Primary academic partner of Michigan State University healthcare College of Human Medicine offering academic ... evidence-based treatment appointments for qualified candidates. Professional ... individualized diagnosis and treatment environment with support for clinical research exists. ... multiple specialists under one roof Helen DeVos Children’s Hospital is a 236-bed regional children’s quaternary referral center. Applicant should ... Then we welcome your employment application. be board eligible or board certified in Child Psychiatry. We are seeking another child psychiatrist (bc/be) AND child clinical psychologist (license-eligible in Position location is Grand Rapids, MI, the second Washington state) to join us. largest city in the state with a metropolitan population of 750,000. Grand Rapids is located just 40 minutes Please send letters of interest and curriculum vitae to: from beautiful Lake Michigan. Top-rated public and [email protected] private schools; seven colleges; variety of recreational activities, cultural opportunities and professional sports. Successful candidates will be outstanding clinicians Grand Rapids offers a vibrant downtown and family- with excellent interpersonal and communication skills. oriented neighborhoods. Visit hellowestmichigan.com; experiencegr.com and helendevoschildrens.org. Submit Applications To: Sati Mookherjee Submit Applications To: Sendan Center Diana Dieckman 1616 Cornwall Avenue, Suite 103 648 Monroe Avenue, NW Bellingham, WA 98225 Grand Rapids, MI 49503 Phone: 360-305-3275 Phone: 800-788-8410 E-mail: [email protected] Fax: 616-486-6655 Website Address: sendancenter.com E-mail: [email protected] Website Address: www.helendevoschildrens.org

138 AACAP NEWS FOR YOUR INFORMATION

MEDICAL DIRECTOR – FULL-TIME The Department of Psychiatry within the School of Medicine at UC San Diego is committed to academic excel- UC San Diego • San Diego, CA lence and diversity within the faculty, staff, and student body. The preferred candidate will have demonstrated The Department of Psychiatry http://psychiatry.ucsd.edu/ strong leadership or a commitment to support diversity, within the School of Medicine at UC San Diego is seeking equity, and inclusion in an academic setting. an experienced clinician educator who will provide leader- ship and direction as the Medical Director at the Child and Interested candidates should submit their application to the Adolescent Psychiatry Services Inpatient Unit (CAPS) at UCSD on-line application collection system, AP-On-Line Rady Children’s Hospital San Diego (RCHSD). The Medical Recruit, at: https://apol-recruit.ucsd.edu/apply/JPF00554. Director of the CAPS unit reports to the UCSD Department Applications should be addressed to Jeffrey Rowe, MD, of Psychiatry Chair, the Division Head of Child and Clinical Director of Child and Adolescent Psychiatry and Adolescent Psychiatry, and the Clinical Director of Child must include curriculum vitae, statement of research and and Adolescent Psychiatry. Candidates for Medical Director teaching interests and experience, evidence of teaching should have experience in inpatient evaluation, diagnosis, effectiveness (e.g., teaching evaluations), the names and and treatment of mental health problems of children and contact information of three to five referees, and a personal youth as well as administrative experience including super- statement summarizing past or potential contributions vision of trainees, program development, and collaboration to diversity (see http://facultyequity.ucsd.edu/Faculty- with other professionals on the unit, medical departments Applicant-C2D-Info.asp). Salary is commensurate with within RCHSD and outside institutions. qualifications and experience.

Candidate must be board eligible in Child and Adolescent Submit Applications To: Psychiatry and must have a current California medical Paula Smith license. Candidate is expected to have a track record in UCSD Department of Psychiatry clinical teaching, and evidence of clinical scholarship is 9500 Gilman Drive, MC 0603 desired. Candidate will be expected to perform required La Jolla, CA 92093-0603 services as outlined by medical staff bylaws, accreditation Phone: 858-534-3684 standards, standards of business conduct and professional Fax: 858-534-7653 practice standards for both UCSD and RCHSD. The specific E-mail: [email protected] academic appointment and rank will be determined based Website Address: http://psychiatry.ucsd.edu/ on the qualifications of the candidate but the Department will consider applicants ranging from the Assistant Professor level through Full Professor.

PSYCHIATRIST – PART-TIME Dynamic Interventions Warner Robins, GA

8-10 hours per week, diagnosis, treatment and prevention of mental health and SUD’s within a small C & A outpatient setting. Looking for Psychiatrist or Psychiatrist supported by PA or other mid-level professional. Practice Setting: CMHC, $150.00 per hour

Submit Applications To: Tammy Smith 524 South Houston Lake Road, Ste G100, Warner Robins, GA Phone: 941-845-4036 E-mail: [email protected] Website Address: http://www.dynamicinterventions.org/

MAY/JUNE 2014 139 Nonprofit Org. U.S. Postage PAID Merrifield, Va Permit No. 1693 3615 Wisconsin Avenue, NW Washington, D.C. 20016-3007

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