65: Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health

Dr. Mette Ødegaard Nielsen (Unit for Complicated Schizophrenia, Glostrup, Denmark) joins Dr. Dixon and Dr. Berezin to discuss patient motivations and experiences of antipsychotic medication tapering at a clinic in Denmark. Transcript 01:02     Nielsen interview 02:22     Tapering medication 04:09     Controversies around tapering 07:07     Debilitating effects of side effects 09:09     The tension between medication and side effects for the clinician 12:47     Top line findings 15:28     Psychotic symptom relapse 17:38     Differences by medication 19:43     Expectations from patients 21:47     Shared decision making 24:44     Mixed expectations and reality 27:20     Relapse 29:50     Close contact between patients and clinic staff Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Maggi A. Price, Ph.D., M.A. (School of Social Work, Boston College) joins Dr. Dixon and Dr. Berezin to discuss gender-affirming psychotherapy (GAP), a comprehensive, evidence-informed, and human-centered set of practices focusing on the treatment of transgender youth developed by Dr. Price and colleagues. The training discussed in the podcast is available to the public at a reduced cost at https://www.affirmlab.org/gaptraining with the discount code “psychserv50." Transcript 01:27     How did you end up on this project? 04:20     Gaps in care for transgender youths 05:47     Methods 08:47     Human-centered design 09:28     Stakeholders and focus groups 12:32     Domains 15:22     Key themes 18:17     Can you separate out gender identity from other goals of therapy? 20:38     Bringing in providers who are less supportive of potentially hostile 23:40     Providers who work in areas of transgender discrimination 26:03     First steps Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Dr. Sharon Hoover (University of Maryland School of Medicine, Baltimore) joins Dr. Dixon and Dr. Berezin to discuss the provision of mental health services in schools: why it matters, who it touches, how it’s funded, and how it’s doing. 01:15     Background 02:46     Provision of school mental health 09:56     How mental health services differ between ages and grades 11:08     COVID pandemic and youth mental health 15:29     Federal funding mechanisms 18:39     Using the funding while it’s still available 22:10     Partnerships in school mental health 23:00     Medicaid 27:11     Medicaid billing and complications for school systems 28:47     Technical assistance for schools 30:07     Data systems 33:49     Temperature check Transcript Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Simon Graham, M.B.Ch.B., M.R.C.Psych., and Kathy Curtis (Spring House Psychotherapy and Personality Disorder Service) join Dr. Dixon and Dr. Berezin to discuss the use of a local case management team and a combined day treatment and crisis service for patients with borderline personality disorder in Liverpool, United Kingdom. Transcript Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]  

Elizabeth Bromley, M.D., Ph.D. (University of California, Los Angeles) joins Dr. Dixon and Dr. Berezin to discuss the use of outpatient conservatorship in the effort to address mental health disability among unsheltered homeless persons in Los Angeles County, California. 00:00    Introduction 03:04     Homelessness in Los Angeles County, California 09:04     The paper and services 11:39     Lanterman-Petris-Short (LPS) conservatorship 13:44     Outpatient conservatorship (OPC) pilot program 15:54     Skepticism 18:48     Beyond conservatorship: other aspects of the program 22:34     Initial evaluation 25:21     Quantitative measures 28:33     Coordination Transcript   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Gregory E. Simon, M.D., M.P.H. (Kaiser Permanente Washington Health Research Institute, Seattle) join Dr. Dixon and Dr. Berezin to discuss the use of machine learning models to analyze electronic health records to predict antidepressant treatment response. 00:00     Introduction 02:31    Focus on practical research 04:55    Population studied 05:57    Predicting outcomes 07:20    Using diagnostic codes, not personalized notes 08:04    What three data items might be more helpful? 08:49    What key indicators are we missing in clinical care? 11:35    A billing tool, not a clinical tool 12:57    Is suicide a predictable event based on electronic health record data? 14:48    “Machine learning and artificial intelligence”  16:15    Methods 18:59     Can we do a better job clarifying what we mean by depression? 22:32    How can we use a predictive model in clinical practice? 28:20    Predictive models, probability, the weather, and communicating  Transcript Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Misty C. Richards, M.D., M.S. (University of California, Los Angeles), and Nicole Kozloff, M.D. (University of Toronto), join Dr. Dixon and Dr. Berezin to discuss the need to remodel our systems and provision of mental health services for children and adolescents. 00:00     Introduction 01:18     Impetus 05:45     What constitutes a mental health crisis? 11:14     “Remodeling” 16:21     Differences by location 18:28     Remodeling primary care 21:25     Virtual care 27:19     New service models 32:19     Are we moving in the right direction?   Transcript   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Andrew D. Carlo, M.D., M.P.H. (Northwestern University Feinberg School of Medicine, Chicago) joins Dr. Dixon and Dr. Berezin to discuss the insurance acceptance rates of psychiatric practitioners compared with other medical disciplines. 00:00     Introduction 01:04     Background and Motivation 02:46     Data Set and Methodology 05:12     Restricted Data Set and Privacy Concerns 06:08     Research Questions and Goals 10:04     Findings: Insurance Acceptance Rates 11:29     Factors Influencing Insurance Acceptance 14:23     Magnitude of the Gap in Insurance Acceptance 15:44     Factors Affecting Insurance Acceptance for Psychiatrists 18:08     Challenges in Enforcing Mental Health Parity 19:27     Market Power of Psychiatrists 22:48     Impact on Other Mental Health Professionals 24:16     Importance and Implications 25:11     Potential Solutions and Policy Changes 29:31     Conclusion   Transcript   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Eliza Hallett, M.S., (Oregon Health & Science University, Portland, Oregon) joins Dr. Dixon and Dr. Berezin to discuss the challenges faced by staff and behavioral health service providers, including low wages, traumatic work environments, low wages, and physical and administrative infrastructure. Workforce crisis in behavioral health care [01:33] How representative of the country is Oregon? [03:45] Who were you talking to? [05:32] A figure on radio [06:30] Generating a theoretical framework from the responses [08:01] Qualitative methods [09:30] The five factors [10:33] Wages [14:05] Infrastructure [14:40] Are these issues unique to behavioral health services? [19:11] Legislative changes in Oregon [21:25] Feeling supported matters [23:39] Did the pandemic exacerbate the problem? [27:04] Take home [29:08] Access the complete Behavioral Health Workforce Report to the Oregon Health Authority and State Legislature here. Transcript   Figure 1.  Factors influencing turnover and attrition in the public behavioral health system workforce in Oregona a Interviewees identified factors across three levels—system, organizational, and individual—that contribute to the direct drivers of workforce turnover and attrition.   https://ps.psychiatryonline.org/pb-assets/podcasts/transcripts/PS/PS_Chung_August_2023_transcript.pdf   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Henry Chung, M.D., (Albert Einstein College of Medicine, Bronx, New York City) joins Dr. Dixon and Dr. Berezin to discuss the differences between the collaborative care model and the colocation model, and the impact on Medicaid costs and utilization, for the treatment of patients with depression. Chung interview [00:58] A bridge between clinical and research work [02:32] The colocation model and the collaborative care model [03:44] What populations are you working with? [07:21] Differences in service utilization and cost [10:25] Methodology [10:47] Concentration on depression instead of other psychiatric disorders [13:59] Findings [15:11] Choosing between models [20:21] Impact of COVID [24:06] Final thoughts [28:21] Transcript   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]