- Email: [email protected]
15.1 Neurocognitive Challenges Facing Refugee Children
CLINICAL PERSPECTIVES 14.4 — 15.1
variability across providers, poor classification rates, and the overwhelmed provider. Methods: Flaws in current approaches, such as difficulty detecting deception, are avoided through the RISC approach. The RISC process yields a hypothesized pathway to violence, classifies aggression type, and assesses 11 risk domains. The semistructured interview assesses both the specific threat as well as the germane risk domains. Data integrity is confirmed via complementary patient/collateral interview and independent psychological/neuropsychological test data. Report writing and therapeutic dissemination of findings will be discussed, as well as “how to” adapt to the RISC framework for unique environments. Results: In addition to using cases to teach the RISC technique, data from our first 100 cases will be used to highlight issues salient to the attendee, including rates of congruence between sources, impact of various psychiatric disorders on risk level, and suicide risk as it co-varies by level of threat. Implications of these findings in general clinical practice will be discussed. Conclusions: By using a systematic, risk-management approach, RISC shifts focus to the identification of factors that increase the risk of carrying out specific threats. Confidence in findings is increased because of collateral information and a reliance on convergent data. Information from this comprehensive approach guides our therapeutic feedback sessions with patient, family, and treatment team.
AGG, ICP, SII http://dx.doi.org/10.1016/j.jaac.2017.07.084
14.4 CHILDREN AND ADOLESCENTS WITH HOMICIDAL IDEATION: RISK FACTORS AND THE MENTAL STATUS EXAMINATION Mirela Loftus, MD, PhD, Institute of Living at Hartford Hospital, [email protected] Objectives: Child and adolescent psychiatrists are often faced with assessing patients who express homicidal thoughts. These assessments occur in various settings as an inpatient or an outpatient; emergency departments or schools need to ultimately determine whether patients can return safely to the community. Although there seems to be some consensus regarding the assessment of potential suicide, such a consensus is lacking when it comes to the assessment of homicide. To date, clinicians are offering estimates of likelihood for acting on homicidal thoughts while taking into account various factors such as risk factors, type of violence, and risk level. However, with the development of the Virginia Student Threat Assessment Guidelines (VSTAG) and subsequent Review of Interpersonal Safety Concerns (RISC) model of assessment of violence, which use an evidence-based, risk management focused approach to assess individual threats, we developed a semistructured approach to screen patients. Methods: Through a case example, the crucial domains that need to be explored to determine the level of risk will be presented. This will include a review of the risk and protective factors that mitigate the potential risk of acting on homicidal thoughts. A structured mental status exam developed in conjunction with the RISC assessment will also be presented. Results: This semistructured approach will serve as a guide in determining further exploration of risk as well as helping in categorizing the underlying pathology as belonging to one of three pathways to violent behavior: psychotic, antisocial, or conflicted. The advantages and disadvantages of using a screen versus a comprehensive threat assessment will be explored. Conclusions: Because of the high variability of clinical presentations of youth with homicidal ideations and the lack of consensus in the assessment of such youth, it is difficult to determine the level of risk and ensuing clinical recommendations. With the development of the VSTAG and subsequently of the RISC assessment model, we have incorporated certain aspects of risk assessment into the review of risk and protective factors of such patients. In addition, we expanded the mental status exam to incorporate certain domains known to be relevant in predicting future acts of violence.
AGG, PRE, RF http://dx.doi.org/10.1016/j.jaac.2017.07.796
S22
www.jaacap.org
CLINICAL PERSPECTIVES 15 PSYCHIATRIC, COGNITIVE, LEGAL, AND PUBLIC HEALTH CHALLENGES FACING REFUGEE CHILDREN: AN INTEGRATED APPROACH Dorothy E. Stubbe, MD, Yale Child Study Center, Dorothy. [email protected] Objectives: Refugee children and families present with special health and mental health concerns. Cultural and religious factors, language barriers, traumas, and the potential for discrimination are all salient issues. This interdisciplinary presentation addresses issues critical to understanding and treating the needs of refugee children and families. Methods: 1) Interviews of recently settled refugee children convey the struggles and resilience factors displayed by displaced children. 2) Chris George discusses the work of the Integrated Refugee and Immigrant Services (IRIS) in resettling refugees from war-torn countries to Connecticut. IRIS assists refugees in acclimating to and accessing services, with successful outcomes. 3) John Thomas presents an international comparison of immigration laws that affect refugees, including the impact of President Trump’s January 27, 2017 Executive Order banning the entry into the United States of individuals from seven primarily Muslim countries. 4) Caleb Thomas reviews the psychiatric sequelae, neuroimaging changes, and epigenetic evidence on the impact of psychic trauma. 5) Dorothy Stubbe discusses factors related to needs assessment, culturally sensitive engagement, and treatment effectiveness for this population of vulnerable individuals. Results: Legal research reveals that legal status and immigration possibilities vary dramatically among countries and across time. Refugees are at high risk for a variety of mental disorders, and DNA alterations in those suffering from psychological trauma may be epigenetically transferred to offspring. Identifying culturally sensitive supports and meeting basic needs improves outcomes. Engagement through an understanding of beliefs and values and joint goal setting forms the basis for therapeutic interventions. Conclusions: Use of an integrated formulation to characterize resilience, as well as the psychiatric, cognitive, and legal risk factors facing refugee families, may lead to a more collaborative multidisciplinary approach to supporting the needs of recently immigrated children and families. Healers must also be aware of the political climate and form strong alliances and support systems to advocate for these families and maintain a safe environment for them to heal and thrive.
PUP, DS, EC http://dx.doi.org/10.1016/j.jaac.2017.07.089
15.1 NEUROCOGNITIVE CHALLENGES FACING REFUGEE CHILDREN Caleb N. Thomas, Brown University, Caleb_Thomas@ brown.edu Objectives: This presentation reviews the existing literature concerning the neuroscience implications for children in families who experience forced immigration. Methods: Neuroimaging studies, neuropsychological testing findings, epigenetic studies, and psychiatric diagnostics suggest that children and adolescents with chronic and severe stress, such as fleeing from a war-torn area, trauma, loss, and displacement, may result in significant differences between these populations and control youth. Results: Children and adolescents with histories of trauma, including forced migration, demonstrate a variety of psychiatric and neurocognitive deficits. Studies suggest that refugees, populations in need of and seeking asylum, and those undergoing refugee application processes present a much higher variety of mental disorders, including MDD and PTSD. Many of these disorders exhibit great levels of comorbidity among refugee populations. Hyperreactivity of the amygdala and limbic system is seen with neuroimaging. Memory accuracy is frequently impaired. Epigenetic studies have correlated
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
CLINICAL PERSPECTIVES 15.2 — 16.1
chronically highly stressful life events with changes in DNA structures, which may then be passed to offspring. Conclusions: Memory accuracy and mental health have been shown to be correlated with the rights granted (work, school, living, etc.) and asylum acceptance—rejecting refugees, or denying them certain rights, has been suggested to decrease average mental health levels and quality of life.
IMAGS, NEPSYC, PTSD http://dx.doi.org/10.1016/j.jaac.2017.07.090
fact, studies show that immigrants are more likely than native-born Americans to start their own businesses. Conclusions: Refugees, and especially refugee children, face daunting challenges. As Viet Thanh Nguyen wrote in a September 2016 op-ed article in the New York Times, “[R]efugees are the zombies of the world, the undead who rise from dying states to march or swim toward our borders in endless waves.” They may “remain scarred by their history,” but resettlement efforts, properly executed, can minimize the damage.
COPI, DS, PUP
15.2 LEGAL AND PUBLIC HEALTH CHALLENGES FACING REFUGEE CHILDREN
http://dx.doi.org/10.1016/j.jaac.2017.07.092
John Thomas, JD, Quinnipiac University School of Law, john. [email protected]
CLINICAL PERSPECTIVES 16
Objectives: This presentation seeks to illuminate the legal challenges facing refugee children and their families. Methods: This member of our panel presents an international comparison of immigration laws, with a particular focus on laws that affect refugees. The presentation begins with the 1951 United Nations Refugee Convention and its related 1967 United Nations Protocol. It then surveys the laws in regions with the greatest refugee crises, including those of Europe, the Middle East, and the United States. With respect to the United States, the presentation emphasizes the impact of President Trump’s January 27, 2017 Executive Order, “Protecting the Nation from Foreign Terrorist Entry into the United States,” which banned entry of people living in Iran, Iraq, Syria, Sudan, Libya, Yemen, and Somalia into the United States. Results: Our legal research reveals that legal status and immigration possibilities vary dramatically from country to country and from time to time. Although most countries’ legal codes embrace the United Nations definition of “refugee,” related laws implement this charge in very different manners, resulting in unpredictable immigration outcomes. In the United States, in particular, the vicissitudes of politics also generate unpredictable outcomes. Conclusions: This presentation concludes by observing that refugee expectations are often incompatible with available legal solutions and public health resources. This tension has particular consequences for refugee children, which our other panel members will address.
BEYOND THE PRESCRIPTION PAD: PSYCHOTHERAPY INTERVENTIONS FOR PARENTS/CAREGIVERS OF YOUTH WITH SERIOUS MENTAL ILLNESSES AND TREATMENT NONADHERENCE
DS, ETH, FCP http://dx.doi.org/10.1016/j.jaac.2017.07.091
15.3 THE PRACTICAL CHALLENGES FACING REFUGEE CHILDREN Chris George, Integrated Immigration and Refugee Services (IRIS), [email protected] Objectives: This presentation seeks to illuminate the practical challenges facing refugee children and their families. In doing so, it uses video recordings of interviews of recent refugee children who have settled in the United States, discusses the hardships that they have endured, and discusses the life’s challenges they face and the demands involved in settling in a new environment. Methods: This panel member describes the work of Integrated Refugee and Immigration Services (IRIS) in New Haven, Connecticut. IRIS has settled refugees from a wide range of war-torn countries, including Sudan, the Democratic Republic of the Congo, Afghanistan, Iraq, and Syria. Their needs are significant, and IRIS is their primary resource as they begin to rebuild their lives after years of persecution and displacement. IRIS helps refugees on the road to self-sufficiency by providing lifesaving support during their transition to life in the United States. IRIS case managers greet refugees and take them to apartments, rented by IRIS and furnished with donated furniture. Results: Refugee resettlement is a demanding, self-help program, with only modest funding from the federal government, but with support from the staff at IRIS. Together with the community, most refugees quickly adjust to their new country and become self-sufficient. Just as quickly, these new Americans add value to our community through cultural enrichment, diversity, and economic growth. We have found that refugees make wonderful neighbors. In
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Mary S. Ahn, MD, University of Massachusetts Medical School, [email protected] Objectives: Youth with serious mental illness (SMI) adhere poorly to the recommended medications and other treatments, with prevalence of nonadherence ranging between 30 and 60 percent. Medication nonadherence is multifactorial, but the root causes can be both analyzed and minimized by a strong therapeutic alliance and understanding of the psychological and social factors. Parent/caregivers can be both a supportive, but also an obstructive force in addressing engagement of the youth to treatment. Therefore, child psychiatrists are in a unique position to introduce components of evidence-based psychotherapies targeted toward parents/caregivers into their clinical practice to address treatment nonadherence, even in settings outside of the traditional psychotherapy encounter. This session will introduce strategies based on evidence-based psychotherapies that may be used to address this common problem, specifically in skills addressing engagement of the parent/caregiver. Methods: A review of the rationale for intervening with the family of SMI youth will be provided. Dr. David Miklowitz will present his work on familyfocused therapy for bipolar and psychotic disorders, with a specific focus on interventions for the parents/caregivers. Dr. Anne Lutz will present her work on solution-focused therapy in youth with substance use disorders (SUD), including stimulus videos that demonstrate the impact of intervening with the parents. Dr. Victor Fornari will bridge behavioral and interpersonal psychotherapy interventions for eating disorders (ED) with psychodynamic-informed strategies for ED (once medical stabilization is established) and other maladaptive eating behaviors. Results: With translation of both research and innovative clinical approaches, this session uses different psychotherapeutic strategies that can be used to address treatment nonadherence in youth with SMI. Dr. Mary Ahn will be our expert discussant to lead and moderate the panel to will allow for audience participation and questions. Conclusions: Child psychiatrists working with SMI youth can use modular psychotherapy techniques for the parent/caregiver in a variety of treatment settings to address treatment nonadherence in youth.
PAT, P, TREAT Sponsored by AACAP's Psychotherapy Committee and Early Career Psychiatrist Committee http://dx.doi.org/10.1016/j.jaac.2017.07.094
16.1 FAMILY-FOCUSED THERAPY David J. Miklowitz, PhD, University of California, Los Angeles David Geffen School of Medicine, dmiklowitz@mednet. ucla.edu Objectives: Adolescents or young adults with bipolar disorder (BD) are often nonadherent with medication regimens and behavioral prescriptions (e.g.,
www.jaacap.org
S23
variability across providers, poor classification rates, and the overwhelmed provider. Methods: Flaws in current approaches, such as difficulty detecting deception, are avoided through the RISC approach. The RISC process yields a hypothesized pathway to violence, classifies aggression type, and assesses 11 risk domains. The semistructured interview assesses both the specific threat as well as the germane risk domains. Data integrity is confirmed via complementary patient/collateral interview and independent psychological/neuropsychological test data. Report writing and therapeutic dissemination of findings will be discussed, as well as “how to” adapt to the RISC framework for unique environments. Results: In addition to using cases to teach the RISC technique, data from our first 100 cases will be used to highlight issues salient to the attendee, including rates of congruence between sources, impact of various psychiatric disorders on risk level, and suicide risk as it co-varies by level of threat. Implications of these findings in general clinical practice will be discussed. Conclusions: By using a systematic, risk-management approach, RISC shifts focus to the identification of factors that increase the risk of carrying out specific threats. Confidence in findings is increased because of collateral information and a reliance on convergent data. Information from this comprehensive approach guides our therapeutic feedback sessions with patient, family, and treatment team.
AGG, ICP, SII http://dx.doi.org/10.1016/j.jaac.2017.07.084
14.4 CHILDREN AND ADOLESCENTS WITH HOMICIDAL IDEATION: RISK FACTORS AND THE MENTAL STATUS EXAMINATION Mirela Loftus, MD, PhD, Institute of Living at Hartford Hospital, [email protected] Objectives: Child and adolescent psychiatrists are often faced with assessing patients who express homicidal thoughts. These assessments occur in various settings as an inpatient or an outpatient; emergency departments or schools need to ultimately determine whether patients can return safely to the community. Although there seems to be some consensus regarding the assessment of potential suicide, such a consensus is lacking when it comes to the assessment of homicide. To date, clinicians are offering estimates of likelihood for acting on homicidal thoughts while taking into account various factors such as risk factors, type of violence, and risk level. However, with the development of the Virginia Student Threat Assessment Guidelines (VSTAG) and subsequent Review of Interpersonal Safety Concerns (RISC) model of assessment of violence, which use an evidence-based, risk management focused approach to assess individual threats, we developed a semistructured approach to screen patients. Methods: Through a case example, the crucial domains that need to be explored to determine the level of risk will be presented. This will include a review of the risk and protective factors that mitigate the potential risk of acting on homicidal thoughts. A structured mental status exam developed in conjunction with the RISC assessment will also be presented. Results: This semistructured approach will serve as a guide in determining further exploration of risk as well as helping in categorizing the underlying pathology as belonging to one of three pathways to violent behavior: psychotic, antisocial, or conflicted. The advantages and disadvantages of using a screen versus a comprehensive threat assessment will be explored. Conclusions: Because of the high variability of clinical presentations of youth with homicidal ideations and the lack of consensus in the assessment of such youth, it is difficult to determine the level of risk and ensuing clinical recommendations. With the development of the VSTAG and subsequently of the RISC assessment model, we have incorporated certain aspects of risk assessment into the review of risk and protective factors of such patients. In addition, we expanded the mental status exam to incorporate certain domains known to be relevant in predicting future acts of violence.
AGG, PRE, RF http://dx.doi.org/10.1016/j.jaac.2017.07.796
S22
www.jaacap.org
CLINICAL PERSPECTIVES 15 PSYCHIATRIC, COGNITIVE, LEGAL, AND PUBLIC HEALTH CHALLENGES FACING REFUGEE CHILDREN: AN INTEGRATED APPROACH Dorothy E. Stubbe, MD, Yale Child Study Center, Dorothy. [email protected] Objectives: Refugee children and families present with special health and mental health concerns. Cultural and religious factors, language barriers, traumas, and the potential for discrimination are all salient issues. This interdisciplinary presentation addresses issues critical to understanding and treating the needs of refugee children and families. Methods: 1) Interviews of recently settled refugee children convey the struggles and resilience factors displayed by displaced children. 2) Chris George discusses the work of the Integrated Refugee and Immigrant Services (IRIS) in resettling refugees from war-torn countries to Connecticut. IRIS assists refugees in acclimating to and accessing services, with successful outcomes. 3) John Thomas presents an international comparison of immigration laws that affect refugees, including the impact of President Trump’s January 27, 2017 Executive Order banning the entry into the United States of individuals from seven primarily Muslim countries. 4) Caleb Thomas reviews the psychiatric sequelae, neuroimaging changes, and epigenetic evidence on the impact of psychic trauma. 5) Dorothy Stubbe discusses factors related to needs assessment, culturally sensitive engagement, and treatment effectiveness for this population of vulnerable individuals. Results: Legal research reveals that legal status and immigration possibilities vary dramatically among countries and across time. Refugees are at high risk for a variety of mental disorders, and DNA alterations in those suffering from psychological trauma may be epigenetically transferred to offspring. Identifying culturally sensitive supports and meeting basic needs improves outcomes. Engagement through an understanding of beliefs and values and joint goal setting forms the basis for therapeutic interventions. Conclusions: Use of an integrated formulation to characterize resilience, as well as the psychiatric, cognitive, and legal risk factors facing refugee families, may lead to a more collaborative multidisciplinary approach to supporting the needs of recently immigrated children and families. Healers must also be aware of the political climate and form strong alliances and support systems to advocate for these families and maintain a safe environment for them to heal and thrive.
PUP, DS, EC http://dx.doi.org/10.1016/j.jaac.2017.07.089
15.1 NEUROCOGNITIVE CHALLENGES FACING REFUGEE CHILDREN Caleb N. Thomas, Brown University, Caleb_Thomas@ brown.edu Objectives: This presentation reviews the existing literature concerning the neuroscience implications for children in families who experience forced immigration. Methods: Neuroimaging studies, neuropsychological testing findings, epigenetic studies, and psychiatric diagnostics suggest that children and adolescents with chronic and severe stress, such as fleeing from a war-torn area, trauma, loss, and displacement, may result in significant differences between these populations and control youth. Results: Children and adolescents with histories of trauma, including forced migration, demonstrate a variety of psychiatric and neurocognitive deficits. Studies suggest that refugees, populations in need of and seeking asylum, and those undergoing refugee application processes present a much higher variety of mental disorders, including MDD and PTSD. Many of these disorders exhibit great levels of comorbidity among refugee populations. Hyperreactivity of the amygdala and limbic system is seen with neuroimaging. Memory accuracy is frequently impaired. Epigenetic studies have correlated
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
CLINICAL PERSPECTIVES 15.2 — 16.1
chronically highly stressful life events with changes in DNA structures, which may then be passed to offspring. Conclusions: Memory accuracy and mental health have been shown to be correlated with the rights granted (work, school, living, etc.) and asylum acceptance—rejecting refugees, or denying them certain rights, has been suggested to decrease average mental health levels and quality of life.
IMAGS, NEPSYC, PTSD http://dx.doi.org/10.1016/j.jaac.2017.07.090
fact, studies show that immigrants are more likely than native-born Americans to start their own businesses. Conclusions: Refugees, and especially refugee children, face daunting challenges. As Viet Thanh Nguyen wrote in a September 2016 op-ed article in the New York Times, “[R]efugees are the zombies of the world, the undead who rise from dying states to march or swim toward our borders in endless waves.” They may “remain scarred by their history,” but resettlement efforts, properly executed, can minimize the damage.
COPI, DS, PUP
15.2 LEGAL AND PUBLIC HEALTH CHALLENGES FACING REFUGEE CHILDREN
http://dx.doi.org/10.1016/j.jaac.2017.07.092
John Thomas, JD, Quinnipiac University School of Law, john. [email protected]
CLINICAL PERSPECTIVES 16
Objectives: This presentation seeks to illuminate the legal challenges facing refugee children and their families. Methods: This member of our panel presents an international comparison of immigration laws, with a particular focus on laws that affect refugees. The presentation begins with the 1951 United Nations Refugee Convention and its related 1967 United Nations Protocol. It then surveys the laws in regions with the greatest refugee crises, including those of Europe, the Middle East, and the United States. With respect to the United States, the presentation emphasizes the impact of President Trump’s January 27, 2017 Executive Order, “Protecting the Nation from Foreign Terrorist Entry into the United States,” which banned entry of people living in Iran, Iraq, Syria, Sudan, Libya, Yemen, and Somalia into the United States. Results: Our legal research reveals that legal status and immigration possibilities vary dramatically from country to country and from time to time. Although most countries’ legal codes embrace the United Nations definition of “refugee,” related laws implement this charge in very different manners, resulting in unpredictable immigration outcomes. In the United States, in particular, the vicissitudes of politics also generate unpredictable outcomes. Conclusions: This presentation concludes by observing that refugee expectations are often incompatible with available legal solutions and public health resources. This tension has particular consequences for refugee children, which our other panel members will address.
BEYOND THE PRESCRIPTION PAD: PSYCHOTHERAPY INTERVENTIONS FOR PARENTS/CAREGIVERS OF YOUTH WITH SERIOUS MENTAL ILLNESSES AND TREATMENT NONADHERENCE
DS, ETH, FCP http://dx.doi.org/10.1016/j.jaac.2017.07.091
15.3 THE PRACTICAL CHALLENGES FACING REFUGEE CHILDREN Chris George, Integrated Immigration and Refugee Services (IRIS), [email protected] Objectives: This presentation seeks to illuminate the practical challenges facing refugee children and their families. In doing so, it uses video recordings of interviews of recent refugee children who have settled in the United States, discusses the hardships that they have endured, and discusses the life’s challenges they face and the demands involved in settling in a new environment. Methods: This panel member describes the work of Integrated Refugee and Immigration Services (IRIS) in New Haven, Connecticut. IRIS has settled refugees from a wide range of war-torn countries, including Sudan, the Democratic Republic of the Congo, Afghanistan, Iraq, and Syria. Their needs are significant, and IRIS is their primary resource as they begin to rebuild their lives after years of persecution and displacement. IRIS helps refugees on the road to self-sufficiency by providing lifesaving support during their transition to life in the United States. IRIS case managers greet refugees and take them to apartments, rented by IRIS and furnished with donated furniture. Results: Refugee resettlement is a demanding, self-help program, with only modest funding from the federal government, but with support from the staff at IRIS. Together with the community, most refugees quickly adjust to their new country and become self-sufficient. Just as quickly, these new Americans add value to our community through cultural enrichment, diversity, and economic growth. We have found that refugees make wonderful neighbors. In
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Mary S. Ahn, MD, University of Massachusetts Medical School, [email protected] Objectives: Youth with serious mental illness (SMI) adhere poorly to the recommended medications and other treatments, with prevalence of nonadherence ranging between 30 and 60 percent. Medication nonadherence is multifactorial, but the root causes can be both analyzed and minimized by a strong therapeutic alliance and understanding of the psychological and social factors. Parent/caregivers can be both a supportive, but also an obstructive force in addressing engagement of the youth to treatment. Therefore, child psychiatrists are in a unique position to introduce components of evidence-based psychotherapies targeted toward parents/caregivers into their clinical practice to address treatment nonadherence, even in settings outside of the traditional psychotherapy encounter. This session will introduce strategies based on evidence-based psychotherapies that may be used to address this common problem, specifically in skills addressing engagement of the parent/caregiver. Methods: A review of the rationale for intervening with the family of SMI youth will be provided. Dr. David Miklowitz will present his work on familyfocused therapy for bipolar and psychotic disorders, with a specific focus on interventions for the parents/caregivers. Dr. Anne Lutz will present her work on solution-focused therapy in youth with substance use disorders (SUD), including stimulus videos that demonstrate the impact of intervening with the parents. Dr. Victor Fornari will bridge behavioral and interpersonal psychotherapy interventions for eating disorders (ED) with psychodynamic-informed strategies for ED (once medical stabilization is established) and other maladaptive eating behaviors. Results: With translation of both research and innovative clinical approaches, this session uses different psychotherapeutic strategies that can be used to address treatment nonadherence in youth with SMI. Dr. Mary Ahn will be our expert discussant to lead and moderate the panel to will allow for audience participation and questions. Conclusions: Child psychiatrists working with SMI youth can use modular psychotherapy techniques for the parent/caregiver in a variety of treatment settings to address treatment nonadherence in youth.
PAT, P, TREAT Sponsored by AACAP's Psychotherapy Committee and Early Career Psychiatrist Committee http://dx.doi.org/10.1016/j.jaac.2017.07.094
16.1 FAMILY-FOCUSED THERAPY David J. Miklowitz, PhD, University of California, Los Angeles David Geffen School of Medicine, dmiklowitz@mednet. ucla.edu Objectives: Adolescents or young adults with bipolar disorder (BD) are often nonadherent with medication regimens and behavioral prescriptions (e.g.,
www.jaacap.org
S23