- Email: [email protected]
8.5 New Technologies, New Laws, New Childhood
CLINICAL PERSPECTIVES 8.4 — 9.0
8.4 WORKING WITH FAMILIES OF ADOLESCENTS AROUND MEDIA USE AND LIMITS Erin L. Belfort, MD, Maine Medical Center, erin.belfort@ gmail.com Objectives: The goals of this session are 1) to review the importance of taking a media history with adolescent patients; and 2) to demonstrate how to work with families around discussing, setting, and maintaining media limits. Methods: A literature search was performed about the uses of social media among adolescents. The author’s experience in working with adolescents and their families around media use will be incorporated into the presentation. Clinical examples will be shared to illustrate basic tenets of family therapy to help families develop media plans in a collaborative way. Results: Recent data from Common Sense Media suggest that adolescent use of social media is ubiquitous. Teenagers use nine hours of media a day, on average, not including for school or homework. Likewise, their parents use almost eight hours a day of personal screen media, and 78 percent of parents believe they are good media and technology role models for their children. The author’s clinical experience suggests that conflicts around media use are a frequent source of tension, arguments, and distress in families. Increasingly, conflict around media use is a precipitating factor for entry into the mental health system, with conflicts resulting in crisis, emergency, or outpatient settings. Often problems arise in families with either rigidly strict limits or no limits at all around adolescent media use. Using family therapy techniques to facilitate conversation can help parents restore their authority, thus allowing them to set and reinforce limits, yet also to enlist some engagement and support from the adolescent in the planning process. Often communication in families has become so hostile and polarized that facilitating a different kind of conversation can be powerful. This conversation recognizes the good intentions of the parent, acknowledges the hope for a better future with less family conflict, and encourages the adolescent to consider how their media use may be problematic personally and in their family life. Developing a media plan based on this different conversation leads to better outcomes. Conclusions: Use of media is ubiquitous among both adolescents and their parents. Arguments about media use are common in families with teenagers and lead to significant distress. Using family therapy techniques to facilitate a different conversation to find middle ground and to agree to a media plan is helpful.
ADOL, FAM, MED http://dx.doi.org/10.1016/j.jaac.2017.07.048
8.5 NEW TECHNOLOGIES, NEW LAWS, NEW CHILDHOOD Kristopher Kaliebe, MD, University of South Florida, [email protected] Objectives: The goals of this session are to 1) outline the legal and regulatory framework that allows or prohibits the actions, including minors, on the internet; 2) be aware of the civil and criminal avenues available when minors are victims of cyber-crimes; and 3) introduce how child psychiatrists can work as consultants, advocates, and forensic experts weighing potential harms and benefits of various media regulations and interventions. Methods: Legal, regulatory, and economic trends regarding the use of the internet by minors are reviewed, in particular, the Children’s Online Privacy Protection Act (COPPA). COPPA determines the limits of marketing to and contracting with minors. Notable forensic cases involving minors and the internet will also be presented. Results: Children and adolescents tend to be heavy users of the internet but are vulnerable because of their still developing physical, cognitive, and emotional abilities. The COPPA provides some protection for children under age 13 years, but adolescents aged 13 to 17 years have little legal protection. Corporate interests tend to drive what is available on the internet, with little oversight of how minors use the internet. Potential risks to minors on the internet include cyberbullying, online harassment, unauthorized release of private information, data mining, and targeted selling and advertising of harmful products. Child and adolescent psychiatrists may become involved with these legal issues in a variety of arenas. They often treat patients victimized on the internet and should be
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
familiar with possible civil and criminal avenues that families may pursue after these incidents. Child and adolescent psychiatrists may serve as forensic expert witnesses, weighing harms from the internet-related incidents. Child and adolescent psychiatrists can also serve as advocates for legislative endeavors to increase oversight and improve legal protections for children and adolescents online. Conclusions: The legal and forensic issues related to internet use have been underexplored in the mental health literature but have important ramifications for child and adolescent psychiatrists. Increased education regarding these issues is critical to minimizing harm.
FCP, MED, PUP http://dx.doi.org/10.1016/j.jaac.2017.07.049
8.6 ETHICAL ISSUES AND E-PROFESSIONALISM Sandra M. DeJong, MD, Cambridge Health Alliance / The Cambridge Hospital, [email protected] Objectives: The goals of this session are as follows: 1) to briefly review and update participants on potential legal and ethical problems in the use of electronic media in our work as child psychiatrists, with reference to the extant literature and the media (“e-Professionalism”); 2) to introduce participants to resources available to help guide child psychiatrists in their use of electronic media in clinical practice; and 3) to apply ethical principles and guidelines to specific situations through the discussion of clinical vignettes. Methods: This presentation is based on an ongoing review of the literature and media since 2008 and the work of the American Association of Directors of Psychiatric Residency Training (AADPRT) Taskforce on Professionalism and the internet in providing teaching resources on this topic. Results: Use of electronic media by adolescents, parents, and psychiatrists is widespread according to recent surveys and has entered the realm of clinical care, offering the potential to broaden access to care. Use of electronic media in practice with adolescents raises significant ethical and legal issues, such as boundary violations and permeability, potential conflicts of interest, questions regarding our duty to warn, patient confidentiality, psychiatrist privacy, liability, and libel. Increasingly, child psychiatrists must assess the suitability of “apps,” wearable sensors, and other electronic devices and media for use in treatment. Few guidelines exist regarding use of media in the clinical practice. Child psychiatrists need to learn to be sensitive to these potential issues to be able to practice good clinical judgment about media use. Through the use of clinical vignettes, psychiatrists can learn to apply the ethical principles outlined in AACAP’s Code of Ethics to specific situations involving electronic media with patients. Conclusions: As with many ethical dilemmas, the best that a child psychiatrist as a user of electronic media may do is ensure that s/he is sensitive to the potential ethical issues, has weighed the pros and cons of different courses of action, and has sought consultation when appropriate. In the use of electronic media, child psychiatrists need to be informed about the technological issues with different media. Because of the unique features of electronic media, such as speed, range of dissemination, and permanence, particular care is warranted as we brave this new frontier.
ETH, MED, REST http://dx.doi.org/10.1016/j.jaac.2017.07.050
CLINICAL PERSPECTIVES 9 ENGAGING YOUTH IN PREPARATION FOR AND RECOVERY FROM DISASTERS AND TRAUMATIC EVENTS Linda Chokroverty, MD, The Albert Einstein College of Medicine at Yeshiva University, [email protected]; Margaret E. Tompsett, MD, Private Practice, Chatham, MA, [email protected] Objectives: The goals of this session are as follows: 1) to learn about disaster preparedness activities done by teenagers as facilitated by professional partnerships; 2) to learn how to help communities recover from trauma by working with emerging-age youth, especially those from vulnerable ethnic groups; 3) to learn about best practices in helping young people and families after traumatic events and learn about a novel
www.jaacap.org
S13
8.4 WORKING WITH FAMILIES OF ADOLESCENTS AROUND MEDIA USE AND LIMITS Erin L. Belfort, MD, Maine Medical Center, erin.belfort@ gmail.com Objectives: The goals of this session are 1) to review the importance of taking a media history with adolescent patients; and 2) to demonstrate how to work with families around discussing, setting, and maintaining media limits. Methods: A literature search was performed about the uses of social media among adolescents. The author’s experience in working with adolescents and their families around media use will be incorporated into the presentation. Clinical examples will be shared to illustrate basic tenets of family therapy to help families develop media plans in a collaborative way. Results: Recent data from Common Sense Media suggest that adolescent use of social media is ubiquitous. Teenagers use nine hours of media a day, on average, not including for school or homework. Likewise, their parents use almost eight hours a day of personal screen media, and 78 percent of parents believe they are good media and technology role models for their children. The author’s clinical experience suggests that conflicts around media use are a frequent source of tension, arguments, and distress in families. Increasingly, conflict around media use is a precipitating factor for entry into the mental health system, with conflicts resulting in crisis, emergency, or outpatient settings. Often problems arise in families with either rigidly strict limits or no limits at all around adolescent media use. Using family therapy techniques to facilitate conversation can help parents restore their authority, thus allowing them to set and reinforce limits, yet also to enlist some engagement and support from the adolescent in the planning process. Often communication in families has become so hostile and polarized that facilitating a different kind of conversation can be powerful. This conversation recognizes the good intentions of the parent, acknowledges the hope for a better future with less family conflict, and encourages the adolescent to consider how their media use may be problematic personally and in their family life. Developing a media plan based on this different conversation leads to better outcomes. Conclusions: Use of media is ubiquitous among both adolescents and their parents. Arguments about media use are common in families with teenagers and lead to significant distress. Using family therapy techniques to facilitate a different conversation to find middle ground and to agree to a media plan is helpful.
ADOL, FAM, MED http://dx.doi.org/10.1016/j.jaac.2017.07.048
8.5 NEW TECHNOLOGIES, NEW LAWS, NEW CHILDHOOD Kristopher Kaliebe, MD, University of South Florida, [email protected] Objectives: The goals of this session are to 1) outline the legal and regulatory framework that allows or prohibits the actions, including minors, on the internet; 2) be aware of the civil and criminal avenues available when minors are victims of cyber-crimes; and 3) introduce how child psychiatrists can work as consultants, advocates, and forensic experts weighing potential harms and benefits of various media regulations and interventions. Methods: Legal, regulatory, and economic trends regarding the use of the internet by minors are reviewed, in particular, the Children’s Online Privacy Protection Act (COPPA). COPPA determines the limits of marketing to and contracting with minors. Notable forensic cases involving minors and the internet will also be presented. Results: Children and adolescents tend to be heavy users of the internet but are vulnerable because of their still developing physical, cognitive, and emotional abilities. The COPPA provides some protection for children under age 13 years, but adolescents aged 13 to 17 years have little legal protection. Corporate interests tend to drive what is available on the internet, with little oversight of how minors use the internet. Potential risks to minors on the internet include cyberbullying, online harassment, unauthorized release of private information, data mining, and targeted selling and advertising of harmful products. Child and adolescent psychiatrists may become involved with these legal issues in a variety of arenas. They often treat patients victimized on the internet and should be
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
familiar with possible civil and criminal avenues that families may pursue after these incidents. Child and adolescent psychiatrists may serve as forensic expert witnesses, weighing harms from the internet-related incidents. Child and adolescent psychiatrists can also serve as advocates for legislative endeavors to increase oversight and improve legal protections for children and adolescents online. Conclusions: The legal and forensic issues related to internet use have been underexplored in the mental health literature but have important ramifications for child and adolescent psychiatrists. Increased education regarding these issues is critical to minimizing harm.
FCP, MED, PUP http://dx.doi.org/10.1016/j.jaac.2017.07.049
8.6 ETHICAL ISSUES AND E-PROFESSIONALISM Sandra M. DeJong, MD, Cambridge Health Alliance / The Cambridge Hospital, [email protected] Objectives: The goals of this session are as follows: 1) to briefly review and update participants on potential legal and ethical problems in the use of electronic media in our work as child psychiatrists, with reference to the extant literature and the media (“e-Professionalism”); 2) to introduce participants to resources available to help guide child psychiatrists in their use of electronic media in clinical practice; and 3) to apply ethical principles and guidelines to specific situations through the discussion of clinical vignettes. Methods: This presentation is based on an ongoing review of the literature and media since 2008 and the work of the American Association of Directors of Psychiatric Residency Training (AADPRT) Taskforce on Professionalism and the internet in providing teaching resources on this topic. Results: Use of electronic media by adolescents, parents, and psychiatrists is widespread according to recent surveys and has entered the realm of clinical care, offering the potential to broaden access to care. Use of electronic media in practice with adolescents raises significant ethical and legal issues, such as boundary violations and permeability, potential conflicts of interest, questions regarding our duty to warn, patient confidentiality, psychiatrist privacy, liability, and libel. Increasingly, child psychiatrists must assess the suitability of “apps,” wearable sensors, and other electronic devices and media for use in treatment. Few guidelines exist regarding use of media in the clinical practice. Child psychiatrists need to learn to be sensitive to these potential issues to be able to practice good clinical judgment about media use. Through the use of clinical vignettes, psychiatrists can learn to apply the ethical principles outlined in AACAP’s Code of Ethics to specific situations involving electronic media with patients. Conclusions: As with many ethical dilemmas, the best that a child psychiatrist as a user of electronic media may do is ensure that s/he is sensitive to the potential ethical issues, has weighed the pros and cons of different courses of action, and has sought consultation when appropriate. In the use of electronic media, child psychiatrists need to be informed about the technological issues with different media. Because of the unique features of electronic media, such as speed, range of dissemination, and permanence, particular care is warranted as we brave this new frontier.
ETH, MED, REST http://dx.doi.org/10.1016/j.jaac.2017.07.050
CLINICAL PERSPECTIVES 9 ENGAGING YOUTH IN PREPARATION FOR AND RECOVERY FROM DISASTERS AND TRAUMATIC EVENTS Linda Chokroverty, MD, The Albert Einstein College of Medicine at Yeshiva University, [email protected]; Margaret E. Tompsett, MD, Private Practice, Chatham, MA, [email protected] Objectives: The goals of this session are as follows: 1) to learn about disaster preparedness activities done by teenagers as facilitated by professional partnerships; 2) to learn how to help communities recover from trauma by working with emerging-age youth, especially those from vulnerable ethnic groups; 3) to learn about best practices in helping young people and families after traumatic events and learn about a novel
www.jaacap.org
S13