A JAACAP PUBLICATION

JAACAP ConnectSPRING 2020 • VOLUME 7 • ISSUE 2

We Cannot be Silent: Using Our Voice to Be Anti-Racist ...... 3 Justin Schreiber, DO, MPH Lab to Smartphone: How Residencies Became Competitive Again ...... 4 Christopher Chamanadjian, MD, David Rettew, MD Anticipating the Mental Health Effects of COVID-19 in Youth: Social Isolation in a Digital Age ...... 8 Kyle Rutledge, DO, PhD Hurricane Harvey: A Psychiatry Resident’s Perspective ...... 12 Anastasia Klott, MD Knowledge of Child Refugee Experiences Through Non-Fiction Texts . . . 15 Mary C. Chavarria, MD Developing Successful Mental Illness Prevention Efforts on University Campuses: A Local Look Based on the CARES Program at ...... 19 Vishnu Shankar, MS, Ronald C. Albucher, MD Reaching Across the Table: Conflict Resolution Skills for the Child Psychiatrist ...... 25 Lisa Hutchison, MD, Elizabeth Menefee, MD, Neha Sharma, MD, Martine Solages, MD Effective Interdisciplinary Medicine: Psychiatric Care in Children and Adolescents With Type 1 Diabetes ...... 30 Amy Lynn Meadows, MD, MHS, Sonya Jayaratna, MD, Victoria Vorholt, MA, Alba Morales Pozzo, MD Bringing Psychiatry and Oncology Together Through Case-Based Learning ...... 35 Zheala Qayyum MD, MMSc, Asher Marks MD, Gerrit van Schalkwyk, MD Corner: Adventures in Fortnite ...... 39 Connect Paula Wadell, MD, Anne McBride, MD, Erik Youngdale, MD, Shreesh Prasad, MD

PROMOTING DEVELOPMENT OF TRANSLATIONAL SKILLS AND PUBLICATION AS EDUCATION JAACAP Connect A JAACAP PUBLICATION

Welcome to JAACAP Connect!

What is JAACAP Connect? mentors when necessary, and work as a team to create All are invited! JAACAP Connect is an online companion the final manuscripts. to the Journal of the American Academy of Child and What are the content requirements for Adolescent Psychiatry (JAACAP), the leading journal JAACAP Connect articles? focused exclusively on psychiatric research and treat- JAACAP Connect is interested in any topic relevant to ment of children and adolescents. A core mission of pediatric mental health that bridges scientific findings JAACAP Connect is to engage trainees and practi- with clinical reality. As evidenced by our first edition, the tioners in the process of lifelong learning via readership, topic and format can vary widely, from neuroscience to authorship, and publication experiences that emphasize teen music choices. translation of research findings into the clinical practice of child and adolescent psychiatry. How can JAACAP Connect help with my educational requirements? Why do we need JAACAP Connect? Motivated by the ACGME/ABPN Psychiatry Milestone The field of child and adolescent psychiatry is Project©, JAACAP Connect aims to promote the devel- rapidly changing, and translation of scientific liter- opment of the skillset necessary for translating scientific ature into clinical practice is a vital skillset that takes research into clinical practice. The process of science- years to develop. JAACAP Connect engages clini- based publication creates a vital set of skills that is rarely cians in this process by offering brief articles based acquired elsewhere, and models the real-life thought on trending observations by peers, and by facilitating process of translating scientific findings into clinical development of lifelong learning skills via mentored care. To bring this experience to more trainees and authorship experiences. providers, JAACAP Connect aims to enhance mastery of translating scientific findings into clinical reality by Who reads JAACAP Connect? encouraging publishing as education.

All students, trainees, and clinicians who are interested JAACAP Connect combines education and skill acqui- in child and adolescent mental health will benefit from sition with mentorship and guidance to offer new expe- reading JAACAP Connect, available online at www. riences in science-based publication. We will work jaacap.com/content/connect. AACAP members will with students, trainees, early career, and seasoned receive emails announcing new quarterly issues. physicians, regardless of previous publication experi- ence, to develop brief science-based and skill-building Who writes JAACAP Connect? articles. Opportunities for increasing knowledge and You do! We seek highly motivated students, trainees, skills through publishing as education will be available early career, and seasoned clinicians and researchers through continued contributions and direct involve- from all disciplines with compelling observations about ment with the JAACAP Connect editorial team, using an child and adolescent psychiatry. We pair authors with apprenticeship model.

Start Thinking About Authorship With JAACAP Connect What trends have you observed that deserve a closer look? Can you envision reframing key research findings into clinical care? Do you want to educate others on a broader scale, thereby improving the health of children around the country, the world? We encourage all levels of practitioners and researchers, from students to attendings, to join in and participate. All are welcome, and you are invited.

2 Spring 2020 www.jaacap.com/content/connect JAACAP Connect A JAACAP PUBLICATION

We Cannot be Silent: Using Our Voice to Be Anti-Racist

s I began writing this introduction, a piece typically To start, JAACAP Connect is a journal intended to be meant to tie the various Connect articles together, available for writers at all levels to start the process of AI reflected on the stark changes in our country writing. The papers and ideas we receive often do not since authors began writing their articles for this issue. reflect the diversity of our profession and our patient First, a pandemic brought substantial change to the population, so we will actively solicit articles from overall mental health of the country, including the way diverse authors and encourage anyone reading this to that psychiatric services are provided, accessed, and reach out to start the process of writing. We also know taught. The changes that COVID-19 has brought to the that to really strive to be anti-racist, we recognize the state of mental health in the country and the way that need to diversify our editorial board, so we ask anyone psychiatric services are provided and taught has been interested in editing to reach out and we will be actively a whirlwind that nobody was prepared for. COVID-19 working to identify editors. further exposed the racial disparities in services due to systemic racism that have existed long before the JAACAP Connect will also have 2 upcoming themed pandemic, leading to significant differences in the issues, the first on COVID-19 and the second on morbidity and mortality of the illness towards people of systemic racism, which will include an examination of color. In addition, the killings of Black men and women systemic changes that need to occur to change current exemplified in George Floyd having his breath taken practices. For the issue on systemic racism, we will from him, Breonna Taylor shot while sleeping in her feature a guest lead editor, recognizing the importance home, and Ahmaud Arbery shot while simply jogging, of bringing in an expert in the field to ensure that as an awoke the need to identify the systemic racism that is, editorial board, we are taking steps to be anti-racist in and has been killing Black people. As child and adoles- our editorial work. We will also have a continued call cent psychiatrists, we see the impact of racism daily in for papers on systemic racism, beyond just this specific the lack of access to services, the difference in treat- theme issue. ment provided to children in school, and the fear and When writing, authors will be encouraged to think crit- anxiety that Black youth and parents experience doing ically about how racism might have had an impact on what should be mundane tasks because of the poten- the topic. For example, when looking at differences in tial life-changing consequences. We are taking the outcomes related to race, we can consider the impact of following initial steps to change our journal. racism, rather than race, on differing outcomes and what It is with great humility that we acknowledge our failure can be done to address this disparity. As editors we will as editors in ensuring these issues receive the coverage develop guidance questions to improve our approach and discussion they deserve. As editors, writers, and and our reviews by remaining conscious of racism. readers, we can no longer be silent bystanders to racism. We need to do better, and as writers, editors, child We must take an active stance to be anti-racist. As an psychiatrists, and physicians, we must use our powerful editorial board, we are working with our colleagues voice and respond to our duty to actively address at JAACAP and are in the process of identifying the racism. And we need your help. We want your feedback, steps we need to take to ensure that our journal is no your writing, and your help in editing. We look forward to longer a part of the problem and that we are instead hearing from you at [email protected]. changing the way scientific writing and editing occurs. We acknowledge that this is a work in progress for the Justin Schreiber, DO, MPH foreseeable future. Editor

3 Spring 2020 www.jaacap.com/content/connect JAACAP Connect A JAACAP PUBLICATION

Lab to Smartphone How Psychiatry Residencies Became Competitive Again

Christopher Chamanadjian, MD, and David Rettew, MD

hen I started medical school in 2014, the field of Neuropsychiatric Research Advancements. For psychiatry was considered a “layup” residency centuries the mind was a longstanding mystery in Wto match into. I recall one professor saying, medicine. However, recent discoveries continue to “You all must excel in your academics to give yourself unveil previously unknown neurobiological complexi- the best chance in matching, because it is incredibly ties contributing to mental health. Neuroimaging, brain competitive—unless you want psychiatry.” mapping, and genetic sequencing research studies reveal key insights into the neurophysiologic processes Don’t look now, but psychiatry is becoming one of the underlying many psychiatric disorders. Alongside other more competitive categorical residency programs. In related medical fields, such as sleep and pain medicine, the past 5 years, matching in psychiatry “increased both we continue to understand the multiple factors affecting modestly and consistently”.1 The National Residency psychiatry. As we slowly unravel some of the mysteries Matching Program (NRMP) reports that in 2016, the of our “home” organ, psychiatry’s parallels with other proportion of total US seniors matching into psychiatry specialties becomes more apparent. was 5.0%.2 In 2020, the proportion increased to 6.3%. Furthermore, the number of positions offered in psychi- Reduced Stigma. Mental health stigma remains a significant problem but has been falling, thanks in part to atry continues to steadily grow each year. In 2020, social media. With the emergence of innovative commu- psychiatry positions offered (1,858) was the highest nication technologies, we enter an era of unprecedented recorded and represented a 34.2% (474) increase access to people. From celebrities to key public figures, from 2016 (1,384) and 74.0% (789) increase from 2008 social media has provided a platform for many people (1,069).1 What might be behind this increased popularity to openly share their personal struggles with mental of psychiatry? Nobody knows for sure, and different health. Some pop culture influencers have also deliber- people obviously choose the specialty for different ately aimed to break the stigma in specific campaigns reasons. Here, however, are a few of the possibilities. such as #YouAreNotAlone. These efforts have demon- Prevalence. The Centers for Disease Control and strated how common mental illness is in the United Prevention estimate that approximately 1 in 6 US children States. Through the use of hashtags, public figures, and nationwide campaigns, social media helped spread the has a mental, behavior, or developmental disorder.3 A importance of mental health to millions. recent report by the American Psychological Associ- ation estimates a 71% increase in adolescents expe- Work-Life Balance. Psychiatry can bring a healthy riencing serious monthly psychological distress from balance between work and lifestyle. The work envi- 2008 to 2017 (an increase from 7.7% to 13.1%).4 As the ronment of psychiatrists can include an office setting prevalence increases, so does the likelihood of knowing with regular working hours, fewer emergencies, and someone suffering from a mental health condition. This less on-call obligations, although recent events with increase in the number of struggling youths is attracting COVID-19 have shown that these qualities are not guar- increased media attention and may be inspiring some anteed. Nevertheless, this schedule allows more time medical students to answer the call. for family, hobbies, or any non-work activities which in

4 Spring 2020 www.jaacap.com/content/connect Lab to Smartphone

turn can reduce the risk of future burnout. Quality of life Maintaining a healthy diet, getting regular exercise, and is becoming a growing priority for students choosing a practicing meditation all improve one’s physical and medical specialty. mental health. As these bidirectional influences become more and more apparent, the value of psychiatrists and Physician-Patient Relationship. The physician-pa- other mental health professionals in healthcare settings tient relationship is a sacred partnership. However, the of all kind is being fully appreciated with there being current health care system overwhelms physicians with growing opportunities for collaboration. paperwork, billing literacy, and documentation. I fell in love with medicine for the connections between the Because of these factors, and others, psychiatry is now physician and the patient. But now, the overwhelming in much more demand. While this may lead to some logistical duties sacrifice time spent conversing with extra challenges for those wishing to enter the field, the patient, requiring attention to their electronic docu- such a shift is a positive development both for those mentation instead. While psychiatry also struggles with doing psychiatric work and the people whom we serve. these encumbrances, the true art of medicine still lives. Spending more time getting to know your patient, a References psychiatrist can use their knowledge and authentic 1. National Resident Matching Program. Results and Data communication to not only understand the diagnosis 2020 Main Residency Match. Washington, DC; 2020. http://www.nrmp.org/main-residency-match-data/. but more so the human being sitting across from them. Accessed May 7, 2020. 2. National Residency Matching Program. Results and Data: Job Opportunity. Psychiatry career opportunities 2016 Residency Match. Washington, DC; 2016. www. are wide and various. There has remained a persistent nrmp.org/report-archives/. Accessed May 10, 2020. disparity between decreased supply of psychiatrists 3. Cree RA, Bitsko RH, Robinson LR, et al. Health care, and increased demand of mental health services. The family, and community factors associated with mental, National Institute of Mental Health (NIMH) reported only behavioral, and developmental disorders and poverty among children aged 2–8 Years—, 2016. 7.5 of the 11.2 million (66.7%) of US adults suffering from MMWR Morb Mortal Wkly Rep. 2018;67(50):1377-1383. serious mental illness received necessary services.5 As http://dx.doi.org/10.15585/mmwr.mm6750a1 a result, employment opportunities are abundant in 4. Twenge JM, Cooper AB, Joiner TE, Duffy ME, Binau both rural and urban areas. Regarding specialization, SG. Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally numerous psychiatry fellowships offer subspecial- representative dataset, 2005–2017. J Abnorm Psychol. ties in addiction, child and adolescent, forensic, geri- 2019;128(3):185-199. https://www.apa.org/pubs/journals/ atric, liaison consulting, and many more. With so many releases/abn-abn0000410.pdf branches to choose from, each psychiatry resident is 5. Substance Abuse and Mental Health Services Administra- more likely to find their niche interest. tion. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. HHS Publ No PEP19-5068, NSDUH Integrative Medicine. It is increasingly clear that Ser H-54. 2019;170:51-58. https://www.samhsa.gov/data/ mental health is a foundation for general health, and how sites/default/files/cbhsq-reports/NSDUHNationalFind- your body influences your mental health and vice versa. ingsReport2018/NSDUHNationalFindingsReport2018.pdf

5 Spring 2020 www.jaacap.com/content/connect JAACAP Connect A JAACAP PUBLICATION

About the Authors Christopher A. Chamanadjian, MD, is a recent medical school graduate from St. George’s University School of Medicine, Grenada, aspiring to pursue psychiatry. His interests include child and adolescent psychi- atry, healthcare innovation technologies with digital therapeutics for mental health, artificial intelligence, inte- grated behavioral healthcare, and student mental health. He is a member of the AACAP regional organization Southern California Society of Child and Adolescent Psychiatry and several APA caucuses including the College Mental Health and Integrative Psychiatry Caucus.

David C. Rettew, MD, is an associate professor of psychiatry and pediatrics at the University of Vermont Larner College of Medicine and the Medical Director for the Child Division of the Vermont Department of Mental Health. He is author of the book Child Psychiatry: New Thinking About the Boundary Between Traits and Illness and the “ABCs of Child Psychiatry” blog on the Psychology Today website. You can follow him on Twitter at @PediPsych.

The authors have reported no funding for this work.

Dr. Chamanadjian thanks David Rettew, MD, of University of Vermont Larner College of Medicine of Vermont, and Justin Schreiber, DO, of Children’s Hospital of Pittsburgh, Pennsylvania, for their mentorship and guidance in writing and editing this piece, both inspiring and encouraging me through constructive criticism bringing out my creativity into becoming my reality.

Disclosure: Dr. Rettew has received royalties for his blog for Psychology Today and from Guilford Press. Dr. Chamanadjian has served as Sr. Medical Science Liaison & Medical Affairs Consultant at Cognoa, Inc.

Correspondence to Christopher Chamanadjian, MD; e-mail: [email protected]

To Participate in the Lab to Smartphone Column To suggest a topic for this column or to inquire about co-writing a Lab to Smartphone column with Dr. Rettew or another child psychiatry mentor, please send an email to [email protected].

6 Spring 2020 www.jaacap.com/content/connect ACADEMY & ASSOCIATION 101

What is the American The American Association of Child and Adolescent Psychiatry was formed in 2013 as an affiliated Association of Child organization of the Academy as a way for CAPs to and Adolescent increase their advocacy activities. Activities such as AACAP’s Legislative Conference, federal lobbying, Psychiatry, and how grassroots, and state advocacy are all under the umbrella of the Association. It also allows for the does it differ from existence of AACAP-PAC, but no dues dollars fund the Academy? our PAC.

The mission of the Association is to engage in health policy and advocacy activities to promote mentally healthy children, adolescents, and families and the profession of child and adolescent psychiatry.

How does the Your dues remain the same whether you choose to be an Association member or not. On your Association affect yearly dues statement, you have the option to opt me as a dues out of the Association. If you opt out and choose not to be an Association member, a portion of paying Academy your dues will no longer go towards our advocacy Member? efforts.Regardless, your dues will be the same, but you will miss out on crucial advocacy alerts, toolkits, and activities.

For any further questions, please contact the Government Affairs team at [email protected]. JAACAP Connect A JAACAP PUBLICATION

Anticipating the Mental Health Effects of COVID-19 in Youth: Social Isolation in a Digital Age

Kyle Rutledge, DO, PhD

e have entered unusual times. As of this writing, and experience with COVID-19, paying special attention the pandemic of COVID-19 is continuing to grow to our more vulnerable populations. exponentially. New cases arise, policy changes W Currently, there are no formal, standardized assessment quickly, and the entire world has become unified against a common enemy. In the United States, schools have tools available that would allow us to systematically been closed, recreational gatherings cancelled, and determine who may face the greatest psycholog- states locked down. Within medical education, students ical impact from a pandemic. However, the themes of have been pulled off rotations, residents and attending the Psychological Preparedness for Disaster Threat physicians have found themselves reassigned to “the Scale (PPDTS)—created to assess the response to the front lines,” and clinics have begun more liberally cyclones in Australia—may be extrapolated for use in 3,4 adopting telehealth systems. Social media is buzzing evaluation of COVID-19 response. Psychological about the disease, with videos of quarantine-inspired preparedness, as operationalized as a score on the novelties, memes cataloguing fears and reactions, PPDTS, is related to mental health through the course and several posts even questioning the legitimacy of of disaster experience and response. The themes of the the threat. In psychiatry, we find ourselves working to questionnaire may be simplified into 3 parts: 1) insight anticipate how the fallout will land in the realm of mental into one’s own psychological response to the event, 2) health, and questioning what we can do about it. capacity and confidence to psychologically and socially cope with this response, and 3) ability and confidence Attempts to predict and mitigate negative outcomes of in managing external effects of the situation. Therefore, the pandemic may be informed by prior pandemics as our own open-ended assessments of how individuals well as literature of “disaster mental health,” a branch of may be mentally responding to COVID-19 may include research which delves into the psychological outcomes questions to gauge the individual’s perception of their of large-scale catastrophes. While this field often own internal response, any coping skills they utilize (in focuses on the effects of regional natural disasters such particular if they are turning to alcohol or substances), as earthquakes, tornadoes, and floods, the themes apply and to what degree they feel hopeless or in control 1 to pandemics as well. This research has shown there regarding their role in the current pandemic. Based on to be an increased incidence of certain mental health our own clinical judgement as we gather more infor- diagnoses following disasters, including posttraumatic mation, it may become clearer which individuals are stress disorder, major depressive disorder, and general- struggling more than others with the pandemic and may ized anxiety disorder. Some subpopulations have been require an increase in services and closer follow-up. found particularly vulnerable, including individuals with low socioeconomic resources, substance use issues or In the case of assessing children and adolescents, premorbid mental disorders, and children.2 Therefore, it we must pay particular attention to the many ways is fair to anticipate the development of more psychiatric the family may have been disrupted by the pandemic. illness during the current pandemic, with some individ- Effects of COVID-19 impacting the family are not only uals at greater risk than others. Considering this risk in limited to contracting the illness, but may also include: our own patient populations, a first step is to evaluate occupational stressors, marked alteration to routine each of our patients with respect to their own responses of child supervision, decreased access to medical

8 Spring 2020 www.jaacap.com/content/connect Anticipating the Mental Health Effects of COVID-19 in Youth

care for family members and children, and difficulty on social media are associated with higher perceived acquiring goods and home essentials.5 While a child social isolation, while positive experiences do little to may be in tune to these changes, these stressors can decrease these feelings.9 These findings underscore also lead to indirect effects through the response of the importance of balancing social engagement online family members. Evidence from previous disasters to limit over-exposing oneself to negative or deceptive indicate that these pandemic-generated woes may social media. elicit maladaptive responses from caregivers or other members of the home, which could lead to deteriora- The magnitude of impact of COVID-19 each individual tion of a caregiver’s own mental health or increased faces will differ, with some children and adolescents at alcohol or substance use. During prior economic crises, higher risk than others and therefore requiring different multiple correlations have been found which link unem- responses. For those facing a milder form of distress, ployment, debt, and difficulty with housing payments practices including reassurance, normalization, and to alcohol use, family violence, child maltreatment, and recommendations for stress reduction may be suffi- 10 neglect.6 Accordingly, with other pandemics, there have cient. When patients share feelings, we can validate been reports to suggest school closures may lead to them and help them challenge any cognitive distor- 11 increased reports of child abuse.7 While the family may tions exaggerating the assessment of risk by a patient. be a source of strength and support for a child during a We may direct our attention to reducing stress in the global crisis, we must also be aware of the many ways family and home, while promoting resilience practices new stressors in the family can negatively impact the in all children and adolescents. Some suggestions may child in this pandemic. be generalized for most patients, such as maintaining routines and limiting exposure to stress provoking Outside of the immediate family, it is important to pandemic-related media, intentionally setting aside time note the additional threat on mental health that comes for relaxation, and promoting mindfulness and positive with social isolation during quarantine and associated thinking.11,12 We may direct patients to resources and over utilization of social media. Brooks et al. provide a recommendations from the Centers for Disease Control timely piece regarding ways to reduce the psycholog- and Prevention (CDC) and World Health Organization ical impact of quarantine and social distancing specif- (WHO) as summarized in Table 1.13,14 For individuals 8 ically. Among the authors’ suggestions for mitigation facing more significant distress and impairment, these of risk from quarantine is ensuring ongoing access to practices remain appropriate, but may be insufficient, information, improving communication, and reducing and increase in offered services such as more frequent monotony. Further advice that may be especially therapy and follow-up may be necessary. Individuals important for adolescents is praising the altruism of in more acute scenarios undergoing such stress may choosing to keep others safe through quarantine, while benefit from Psychological First Aid, a manualized taking the focus off the loss of liberty from mandated approach to disaster response in children to foster short- sequestration. Although children and adolescents have term and long-term adaptation to trauma.15 The practice been restricted from physically interacting with friends includes steps of engagement, providing safety and or large groups, their phones, tablets, and other screens comfort, stabilizing overwhelming emotions, sharing allow them to continue to socially and emotionally resources for practical assistance with immediate connect with friends and family on a daily basis. Also, needs, providing information on coping, and connecting with social media, the population is able to commiserate to collaborative services and social supports. through their similar experience in real time, perhaps reducing the sense of loneliness. However, social media The role of the child psychiatrist at this time of uncer- access during social isolation does not come without tainty remains at its core focused on improving patient risk. It has also been found that negative experiences care. During COVID-19, beyond our typical duty to

9 Spring 2020 www.jaacap.com/content/connect JAACAP Connect A JAACAP PUBLICATION

Table 1. Summary of Recommendations From the of social media to mitigate social isolation and maintain Centers for Disease Control and Prevention (CDC) connections without over exposure to negative experi- 13,14 and World Health Organization (WHO) ences stands as a challenge to our patients that should Domain Recommendations not be underestimated, and an area to explore during Physical 7 Schedule well balanced meals patient encounters. Beyond the patients we see daily, health 7 Maintain sufficient sleep we may also disseminate basic information promoting 7 Prioritize regular exercise mental health in patients for front-line medical workers 7 Avoid alcohol and other substances to share with patients as well, reaching a greater number Routines 7 Keep consistent sleep and wake times of individuals. The recommendations from the CDC and 7 Maintain personal hygiene WHO for decreasing stress during this time may also 7 Structure time for both work and rest be circulated to patients and families, shared in offices, 7 Set aside time for enjoyable activities or posted in common areas of medical centers. Finally, Relaxation 7 Practice deep-breathing exercises we must not underestimate the power of every action 7 Practice stretching to stop the spread of the illness, including informing 7 Practice meditating parents about safe practices, as marginal reductions Information 7 Stay informed on the pandemic in the disease burden of the pandemic will translate to 7 Know where and how to get treatment decreased risk for mental health sequelae. 7 Avoid over-exposure to the news 7 Take breaks from social media 7 Correct misinformation when Take Home Summary encountered COVID-19 will leave a lasting impression on our Connections 7 Connect with individuals for emotional youth. This article applies lessons from disaster support mental health literature and prior pandemics to 7 Connect with community and faith- based organizations anticipate child and adolescent mental health struggles, and shares suggestions for patient Help 7 Offer help to others interactions during the pandemic. 7 Seek help when needed

References conduct assessments and manage treatment plans, 1. Douglas PK, Douglas DB, Harrigan DC, Douglas KM. we may also begin addressing concerns as they arise Preparing for pandemic influenza and its aftermath: mental health issues considered. Int J Emerg Ment Health. related to the pandemic while we anticipate more to 2009;11(3):137-144. come. A comprehensive assessment of the child or 2. Roudini J, Khankeh HR, Witruk E. Disaster mental adolescent during a pandemic would include ques- health preparedness in the community: A systematic tions into the psychological preparedness, social and review study. Heal Psychol Open. 2017;4(1). https://doi. org/10.1177/2055102917711307 behavioral consequences on the family, prior mental 3. Zulch H. Psychological preparedness for natural health status, illness threatening life of the self or a hazards-improving disaster preparedness policy and family member, bereavement, separation from family, practice. Glob Assess Rep Disaster Risk Reduct. 2019. and socioeconomic status. Questions on the perceived Accessed May 15, 2020. personal effects of COVID-19, coping behaviors and 4. Zulch H, Morrissey S, Reser J, Creed P. Psychological Preparedness For Natural Disasters. First Int Conf Urban ability to adapt, as well as effects on members of the Sustain. 2012:25. https://hazards.colorado.edu/uploads/ household can be incorporated seamlessly into evalua- basicpage/Zulch.pdf. Accessed May 15, 2020. tions of patients in order to uncover higher risk individ- uals and inspire targets for management. Balancing use

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5. Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges 10. Pfefferbaum B, North CS. Mental Health and the and burden of the Coronavirus 2019 (COVID-19) pandemic Covid-19 Pandemic. N Engl J Med. April 2020. https://doi. for child and adolescent mental health: A narrative review org/10.1056/nejmp2008017 to highlight clinical and research needs in the acute phase 11. Ho CS, Chee CY, Ho RC. Mental Health Strategies and the long return to normality. Child Adolesc Psychi- to Combat the Psychological Impact of COVID-19 atry Ment Health. 2020;14(1):20. https://doi.org/10.1186/ Beyond Paranoia and Panic. Ann Acad Med Singapore. s13034-020-00329-3 2020;49(1):1-3. 6. Wahlbeck K, McDaid D. Actions to alleviate the 12. Shah K, Kamrai D, Mekala H, Mann B, Desai K, Patel RS. mental health impact of the economic crisis. Focus on Mental Health During the Coronavirus (COVID-19) World Psychiatry. 2012;11(3):139-145. https://doi. Pandemic: Applying Learnings from the Past Outbreaks. org/10.1002/j.2051-5545.2012.tb00114.x Cureus. 2020. https://doi.org/10.7759/cureus.7405 7. International P. REPORT: Ebola: Beyond the Health Emer- 13. World Health Organization. #HealthyAtHome - Mental gency; 2015. http://plan-international.org/ebolareport. health. 2020:1-19. https://www.who.int/campaigns/ Accessed June 17, 2020. connecting-the-world-to-combat-coronavirus/healthy- 8. Brooks SK, Webster RK, Smith LE, et al. The psycho- athome/healthyathome---mental-health. Accessed June logical impact of quarantine and how to reduce it: rapid 17, 2020. review of the evidence. Lancet. 2020;395(10227):912-920. 14. Centers for Disease Control and Prevention. Mental Health https://doi.org/10.1016/S0140-6736(20)30460-8 and Coping During COVID-19 | CDC. Centers for Disease 9. Primack BA, Karim SA, Shensa A, Bowman N, Control and Prevention. https://www.cdc.gov/coronavi- Knight J, Sidani JE. Positive and Negative Experi- rus/2019-ncov/daily-life-coping/managing-stress-anxiety. ences on Social Media and Perceived Social Isola- html. 2020. Accessed June 17, 2020. tion. Am J Heal Promot. 2019;33(6):859-868. https://doi. 15. Brymer M, Jacobs A, Layne C, et al. National Child Trau- org/10.1177/0890117118824196 matic Stress Network and National Center for PTSD. Psychological First Aid: Field Operations Guide. 2nd Edition. 2006

About the Author Kyle Rutledge, DO, PhD, is in his second year of the child and adolescent psychiatry fellowship at Central Michigan University College of Medicine. Before medical school, he completed his PhD in human development at the University of California, Davis. His research interests broadly span child development, though most recently have been focused on epigenetics, trauma, and resilience.

The author has reported no funding for this work.

Dr. Rutledge would like to thank Anne Haley, MS, Hannah Sydney, DO, and James Harvey, MD, of Central Michigan University College of Medicine, for their discussions while preparing this manuscript.

Disclosure: Dr. Rutledge has reported no biomedical financial interests or potential conflicts of interest.

Correspondence to Kyle Rutledge, DO, PhD; e-mail: [email protected]

This article was edited by Justin Schreiber, DO, MPH.

11 Spring 2020 www.jaacap.com/content/connect JAACAP Connect A JAACAP PUBLICATION

Hurricane Harvey: A Psychiatry Resident’s Perspective

Anastasia Klott, MD

ver