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Two-Person Relational Psychotherapy of a High School-Age Adolescent: Integrating Intersubjectivity and Neuroscience in Clinical Work
1–4 1. Suicidal Cognitions and Behaviors in Early Childhood: Why Does It Arise and What Does It Mean? 2. 2016 AACAP Rieger Psychodynamic Psychotherapy Award 3. The Cultural Formulation and Academic Psychiatry 4. Leveraging Partnerships to Strengthen Local Child and Adolescent Psychiatry Resources and to Improve Outcomes 5. Prevention of Callous-Unemotional Traits in Early Adolescence Following Early Deprivation 6. Brain-Gut-Axis as a Therapeutic Target for Psychotherapy 7. Impact of a Mental Health Curriculum on Knowledge and Stigma Among High School Students: A Randomized Controlled Trial 9. The Tarjan Legacy of Prevention: An Update
HONORS PRESENTATION 1 SUICIDAL COGNITIONS AND BEHAVIORS IN EARLY CHILDHOOD: WHY DOES IT ARISE AND WHAT DOES IT MEAN? Joan L. Luby, MD, Early Emotional Development Program at Washington University, 4444 Forest Park Ave Ste 2100 # 8511, St. Louis, MO 63108-2212 Objectives: Increasing clinical consensus in the context of a growing empirical database has established the clinical importance of the identification of depression as early as age 3. However, whether children this young also experience suicidal ideation, and if so whether they understand the meaning of death and the potentially dangerous consequences of self-harm, remains much less clear. Further, the psychosocial correlates of these alarming early expressions remain unexplored. The objective of this study was to examine these issues in a sample of depressed and healthy children ages 4-7. Methods: This lecture will present new data on the expression of suicidal ideation and behaviors based on parent report on the K-SADS-PL as well young children’s understanding of death from an age appropriate narrative measure in a sample of depressed preschoolers enrolled in a psychotherapy treatment study and a group of healthy controls. Associations with exposure to harsh parenting and violent media and these early ideations will be explored. Results: The demographic and clinical characteristics of young children who express suicidal cognitions will be presented as well as variation in their understanding of death. Conclusions: The clinical and public health implications of the finding of suicidal ideation and behaviors in young children will be discussed. Guidelines for clinician about the assessment and treatment of suicidal cognitions and behaviors in early childhood will be reviewed.
DDD PSC S http://dx.doi.org/10.1016/j.jaac.2016.09.481
HONORS PRESENTATION 2 TWO-PERSON RELATIONAL PSYCHOTHERAPY OF A HIGH SCHOOL-AGE ADOLESCENT: INTEGRATING INTERSUBJECTIVITY AND NEUROSCIENCE IN CLINICAL WORK Sergio V. Delgado, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3026 Objectives: This is a broad review of the main differences that exist between traditional one-person and two-person relational psychotherapeutic approaches. Methods: A 16-year-old adolescent female who has difficulties negotiating her psychosocial development within the context of a critical and dismissive mother and the abandonment by her father. Results: Much of what transpires that promotes changes and moves along the process occurs at an implicit nonverbal level and is strongly influenced by the patient’s and psychotherapist’s tone of voice, posture, and nonverbal expressions in the here-and-now moments. Conclusions: This is a case conceptualization from a pluralistic traditional oneperson model and we follow this with a detailed description of the work that transpired from a contemporary two-person relational psychotherapeutic
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
HONORS PRESENTATIONS approach, with attention paid to the patient’s and her mother’s temperament, cognitive and affective flexibility, and internal working models of attachment within the context of the psychotherapist’s intersubjective experiences.
FAM P TR http://dx.doi.org/10.1016/j.jaac.2016.09.482
HONORS PRESENTATION 3 THE CULTURAL FORMULATION AND ACADEMIC PSYCHIATRY Cheryl S. Al-Mateen, MD, Psychiatry, Virginia Commonwealth University, 5306 Clipper Cove Rd, Midlothian, VA 23112-6235 Objectives: The participant will explore and discuss the use of the DSM-5 Outline for Cultural Formulation and the Cultural Formulation Interview and reflect on its use in clinical practice, including its use in working with trainees. Methods: Case examples will be utilized to model the use of the cultural formulation in children and adolescents. Methods for utilizing the formulation in teaching both beginning and advanced learners will also be discussed. Results: The participant will have an increased understanding of how the Outline for Cultural Formulationcan be utilized in clinical as well as clinical teaching. Conclusions: The recognition and inclusion of relevant cultural factors is key in assessment, diagnosis and treatment in an increasingly diverse society. This presentation will focus on utilization of the Cultural Formulation in work with a child and adolescent clinical practice, with recommentations for clinical teaching.
AC DIAG ETHN http://dx.doi.org/10.1016/j.jaac.2016.09.483
HONORS PRESENTATION 4 LEVERAGING PARTNERSHIPS TO STRENGTHEN LOCAL CHILD AND ADOLESCENT PSYCHIATRY RESOURCES AND TO IMPROVE OUTCOMES Lisa Ann Durette, MD, Psychiatry, University of Nevada, 1701 W. Charleston Blvd, Suite 290, Las Vegas, NV 89101 Objectives: The intersection of the CAP workforce shortage, and the practice limitations imposed by state Medicaid systems is where foster care youth with psychiatric morbidities fall. The 2009 Casey Family Program’s review exposed concerns with Clark County, NV’s system: inappropriate funding structures and service array and an absence of quality control and oversight. System redesign, a more flexible funding mechanism, outcome driven standards of care, and evidenced based clinical interventions were recommended. In 2011, the NV legislature provided funding flexibility between Medicaid and child welfare budgets for the creation of a pilot program, to infuse comprehensive, evidence-based mental health care for the youth served, with formal integration of the CAP into overall care. The University of Nevada, Las Vegas CAP fellowship program was accomplished in parallel with the pilot, with the immediate goal to expand access to CAP resources for youth involved in the child welfare system, and to expand the overall professional capacity in the community. Methods: We treated 797 foster children (ages 1-17) and their families, employing a treatment model founded in multi-systemic therapy and traumafocused interventions. Data was collected from state and county sources on four objective variables independent of provider, patient, or parent survey: inpatient psychiatric hospitalizations, psychotropic medications, unfavorable placement disruptions, and DFS case closures. Analyses consisted of descriptive statistics, pairwise mean comparisons, and analysis of variance (ANOVA). Results: Treatment was associated with significant decreases in the rates of psychiatric hospitalizations, psychotropic medications, and placement disruptions: 28 percent, 12 percent, and 27 percent, respectively; family services closed the child’s case for 47 percent of the patients.
www.jaacap.org
S81
HONORS PRESENTATION 1 SUICIDAL COGNITIONS AND BEHAVIORS IN EARLY CHILDHOOD: WHY DOES IT ARISE AND WHAT DOES IT MEAN? Joan L. Luby, MD, Early Emotional Development Program at Washington University, 4444 Forest Park Ave Ste 2100 # 8511, St. Louis, MO 63108-2212 Objectives: Increasing clinical consensus in the context of a growing empirical database has established the clinical importance of the identification of depression as early as age 3. However, whether children this young also experience suicidal ideation, and if so whether they understand the meaning of death and the potentially dangerous consequences of self-harm, remains much less clear. Further, the psychosocial correlates of these alarming early expressions remain unexplored. The objective of this study was to examine these issues in a sample of depressed and healthy children ages 4-7. Methods: This lecture will present new data on the expression of suicidal ideation and behaviors based on parent report on the K-SADS-PL as well young children’s understanding of death from an age appropriate narrative measure in a sample of depressed preschoolers enrolled in a psychotherapy treatment study and a group of healthy controls. Associations with exposure to harsh parenting and violent media and these early ideations will be explored. Results: The demographic and clinical characteristics of young children who express suicidal cognitions will be presented as well as variation in their understanding of death. Conclusions: The clinical and public health implications of the finding of suicidal ideation and behaviors in young children will be discussed. Guidelines for clinician about the assessment and treatment of suicidal cognitions and behaviors in early childhood will be reviewed.
DDD PSC S http://dx.doi.org/10.1016/j.jaac.2016.09.481
HONORS PRESENTATION 2 TWO-PERSON RELATIONAL PSYCHOTHERAPY OF A HIGH SCHOOL-AGE ADOLESCENT: INTEGRATING INTERSUBJECTIVITY AND NEUROSCIENCE IN CLINICAL WORK Sergio V. Delgado, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3026 Objectives: This is a broad review of the main differences that exist between traditional one-person and two-person relational psychotherapeutic approaches. Methods: A 16-year-old adolescent female who has difficulties negotiating her psychosocial development within the context of a critical and dismissive mother and the abandonment by her father. Results: Much of what transpires that promotes changes and moves along the process occurs at an implicit nonverbal level and is strongly influenced by the patient’s and psychotherapist’s tone of voice, posture, and nonverbal expressions in the here-and-now moments. Conclusions: This is a case conceptualization from a pluralistic traditional oneperson model and we follow this with a detailed description of the work that transpired from a contemporary two-person relational psychotherapeutic
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
HONORS PRESENTATIONS approach, with attention paid to the patient’s and her mother’s temperament, cognitive and affective flexibility, and internal working models of attachment within the context of the psychotherapist’s intersubjective experiences.
FAM P TR http://dx.doi.org/10.1016/j.jaac.2016.09.482
HONORS PRESENTATION 3 THE CULTURAL FORMULATION AND ACADEMIC PSYCHIATRY Cheryl S. Al-Mateen, MD, Psychiatry, Virginia Commonwealth University, 5306 Clipper Cove Rd, Midlothian, VA 23112-6235 Objectives: The participant will explore and discuss the use of the DSM-5 Outline for Cultural Formulation and the Cultural Formulation Interview and reflect on its use in clinical practice, including its use in working with trainees. Methods: Case examples will be utilized to model the use of the cultural formulation in children and adolescents. Methods for utilizing the formulation in teaching both beginning and advanced learners will also be discussed. Results: The participant will have an increased understanding of how the Outline for Cultural Formulationcan be utilized in clinical as well as clinical teaching. Conclusions: The recognition and inclusion of relevant cultural factors is key in assessment, diagnosis and treatment in an increasingly diverse society. This presentation will focus on utilization of the Cultural Formulation in work with a child and adolescent clinical practice, with recommentations for clinical teaching.
AC DIAG ETHN http://dx.doi.org/10.1016/j.jaac.2016.09.483
HONORS PRESENTATION 4 LEVERAGING PARTNERSHIPS TO STRENGTHEN LOCAL CHILD AND ADOLESCENT PSYCHIATRY RESOURCES AND TO IMPROVE OUTCOMES Lisa Ann Durette, MD, Psychiatry, University of Nevada, 1701 W. Charleston Blvd, Suite 290, Las Vegas, NV 89101 Objectives: The intersection of the CAP workforce shortage, and the practice limitations imposed by state Medicaid systems is where foster care youth with psychiatric morbidities fall. The 2009 Casey Family Program’s review exposed concerns with Clark County, NV’s system: inappropriate funding structures and service array and an absence of quality control and oversight. System redesign, a more flexible funding mechanism, outcome driven standards of care, and evidenced based clinical interventions were recommended. In 2011, the NV legislature provided funding flexibility between Medicaid and child welfare budgets for the creation of a pilot program, to infuse comprehensive, evidence-based mental health care for the youth served, with formal integration of the CAP into overall care. The University of Nevada, Las Vegas CAP fellowship program was accomplished in parallel with the pilot, with the immediate goal to expand access to CAP resources for youth involved in the child welfare system, and to expand the overall professional capacity in the community. Methods: We treated 797 foster children (ages 1-17) and their families, employing a treatment model founded in multi-systemic therapy and traumafocused interventions. Data was collected from state and county sources on four objective variables independent of provider, patient, or parent survey: inpatient psychiatric hospitalizations, psychotropic medications, unfavorable placement disruptions, and DFS case closures. Analyses consisted of descriptive statistics, pairwise mean comparisons, and analysis of variance (ANOVA). Results: Treatment was associated with significant decreases in the rates of psychiatric hospitalizations, psychotropic medications, and placement disruptions: 28 percent, 12 percent, and 27 percent, respectively; family services closed the child’s case for 47 percent of the patients.
www.jaacap.org
S81