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As pediatric mental health needs continue to rise across the country, there is an escalating deficit of child and adolescent psychiatric specialists. In an effort to meet this increasing need, many health systems have explored multiple innovative options to expedite and expand care delivery. The bridging model of care is a burgeoning area of care delivery in child and adolescent psychiatry nationwide. As a model, it improves efficiency of and access to care and is therefore able to reduce systemic stress by providing pressure release at various points across the continuum of care.
The Core Concepts of Childhood Trauma and the curriculum devised to teach them, have been created by the National Child Traumatic Stress Network. These are meant to provide a conceptual framework as clinicians and other professional approach children and adolescents exposed to traumatic events. The Core Concepts provide a background, not replace evidence-based therapies. In this paper we present the Core Concepts, in brief and in detail, and describe how they can be used in understanding a variety of situations. Training in the Core Concepts of Childhood Trauma curriculum is now widely available for trainees of many professions.
Exposure to trauma in childhood is common. Trauma can affect brain development and have lasting physical health, emotional health, behavioral and social consequences. Symptoms related to traumatic exposure are often transdiagnostic and impact multiple dimensions of life functioning. Understanding the neurobiological, psychosocial, and structural underpinnings of trauma exposure and traumatic stress is critical to diagnosis and appropriate treatment of trauma-related symptoms. In this article, we will review trauma exposure and associated psychopathology. We will discuss current assessment approaches and identify areas for improvement.
Childhood trauma is a critical public health issue with cascading deleterious developmental and clinical outcomes. This study provides definitions of related terms and provides an overview of the prevalence and burden of trauma and its identified root causes. Additionally, it reviews theoretical frameworks used to guide the study of prevention of childhood trauma, summarizes extant literature on trauma prevention efforts, and describes specific examples of empirically-based prevention models grounded in these frameworks. The article concludes with applications for psychiatrists in the field.
Complex trauma is multiple and/prolonged interpersonal trauma occurring during vulnerable developmental periods that can lead to complex clinical presentations characterized by significant deficits in attachment, regulation, and self-image. Behavioral and biological interventions for complex trauma focus on ameliorating these key deficits and have been shown to reduce a range of mental health symptoms and increase child and family functioning across a variety of settings and implementation methods. Although there are no approved psychotropic medications for the treatment of complex trauma, several symptoms of complex trauma are mediated by neurobiological changes that can be targeted by pharmacologic and nonpharmacological interventions.
Children and adolescents experiencing behavioral health crises and their families often rely on emergency systems, including 911, law enforcement, and emergency medical services. Health care systems are increasingly partnering with emergency systems to ensure that youth and families are connected with urgent behavioral health care in the community, avoiding unnecessary emergency department visits and interactions with law enforcement. This article describes the pediatric behavioral health crisis care continuum developed at Boston Medical Center, the largest safety-net hospital in New England, and situates this model within the existing evidence base on youth crisis response.
Trauma-specific cognitive behavioral therapies (CBTs) have several common components and have the strongest evidence for improving children's symptoms of posttraumatic stress disorder (PTSD) and other trauma-related mental health problems. The model with the strongest empirical support for improving children's PTSD and related symptoms, TF-CBT, has been tested in more than 2 dozen randomized controlled trials, modified for many specific populations, and widely disseminated. The TF-CBT components and modifications for complex PTSD; Black children who experience racial trauma; and children with parental substance use are described, and brief examples of other child trauma CBTs are provided.
The early period of life form pregnancy to preschool is often overlooked in discussions of the impact of trauma. Early childhood is a period of high sensitivity to experience, both positive and negative. Young children may be at higher risk of experiencing potentially traumatic events (PTEs) AND the possibility- but not destiny- of long-term negative implications. This article describes patterns of exposure to PTEs, the associated clinical presentations, and the opportunities for health care systems to deliver effective, trauma-informed care and protect against potential secondary traumatization in clinical settings.
Youth with disabilities are over-represented in school discipline and the juvenile legal system. Studies examining this over-representation often overlook the unique needs and behaviors of cognitively diverse girls. System-impacted cognitively diverse girls hold a range of unique needs and qualities and are deserving of individualized, culturally competent, and evidence-based care. This article presents the unique risk factors for girls impacted by the legal system in disaggregated summaries of the literature, and as illustrated by 2 case studies, to better understand the clinical needs of system-impacted girls.
Trauma occurs when an event or series of events overwhelms an individual's capacity to cope, invoking feelings of fear, terror, or powerlessness. Girls have higher prevalence rates of traumatic experiences and subsequent posttraumatic stress disorder, depression, and anxiety compared to boys. The authors reviewed these prevalence rates within a socioecological context using a social constructions of gender framework to understand mechanisms of risk, best practices of measurement in research, and identification of targets for intervention. Clinical care points include promotion, prevention, and treatment strategies for mental health that are gender sensitive.
The development of racial identity in Black boys is a critical aspect of their overall mental health and well-being. This article explores the unique societal and cultural challenges faced by Black boys in the context of identity formation and mental health outcomes. It critiques the one size fits all approach in clinical settings and advocates for an equitably tailored approach that emphasizes cultural competence, cultural responsiveness, and the importance of understanding the lived experiences of Black youth. By integrating these elements into clinical practice, mental health professionals can provide more effective and compassionate care promoting their mental health and resilience.
Pediatric mental health-related emergency department (ED) visits have increased, though EDs are often ill-equipped to deliver timely, developmentally appropriate care, leading to repeated utilization. In response, Northwell Health launched a pediatric Behavioral Health Urgent Care (BHUC) in 2017 as an intermediate level of care providing same-day assessment, crisis intervention, care coordination, and short-term bridging services for youth not requiring ED care. Evaluation showed effective ED diversion, improved follow-up and care coordination, and high parent satisfaction, supporting BHUCs as a model to reduce preventable ED use and improve access to crisis-focused mental health care.
This article will review the literatureregarding the impact of trauma and violence on boys and young men, includingthose who identify as Gay, Bisexual, Transgender, and Queer. Currently males under18 make up roughly half of the 73.1 million children in the US-about 22% of theUS population. The child and adolescent mental health clinician must be awareof and able to recognize how violence affects trans, nonbinary, andgender-nonconforming people who are targeted for defying gender norms andexpressions.
Historically, there is a dramatic overrepresentation of males involved in the juvenile legal system as compared with their female counterparts with males representing 71.3% of all criminal offenses committed by juveniles in 2022. Through decades of research, it has become clear that there is no single risk factor that predicts antisocial or delinquent behavior, but rather a perfect storm of risk factors that interacts to contribute to a complex constellation of behaviors. Child and adolescent psychiatrists and other medical and mental health professionals have responsibility of breaking this intergenerational cycle by advocating for system reform.
Our current scan of the digital health and intervention programming spaces for girls online well-being will provide an overview of current clinical-based, community-based, and school-based programs that emphasize the unique needs of girls from the preteen and adolescent years. Sections will include digital health interventions (eg, sleep and body image), girls' youth development programs, and a case study of the development and implementation of a digital well-being workshop for girls and allies with girls. We will offer current trends and recommendations for stakeholders to utilize resources that are available and forthcoming in the field of girls digital well-being.
Asian American boys benefit psychologically from a well-integrated bicultural identity, supported by bilingualism and same-ethnic or mixed-ethnic friendships. They face higher risks of peer discrimination than girls, leading to depressive symptoms. While pop culture has challenged traditional masculinity in America, many Asian American boys still adhere to these masculine norms, causing internal conflict. Family values of collectivism and respect influence parenting, with bicultural and supportive approaches fostering better developmental outcomes in children, while "tiger parenting" may cause stress and anxiety. Acculturation gaps between parents and children can strain their relationships. Future research should consider ethnic diversity and immigration context.
Global forced displacement remains at an all-time high, with current estimates nearing 120 million people. Despite elevated rates of depression, anxiety, and traumatic stress among forcibly displaced communities, mental health service utilization remains low. In this manuscript, we describe community-level psychosocial factors necessary to build and sustain programs for refugee and immigrant youth and families and introduce the Trust and Engagement Axis Framework. We then examine organizational factors that support successful implementation and sustainment of refugee-serving programs and introduce the Bowl and Soup Framework.
The dramatic rise in pediatric mental health visits to emergency departments that started in the 1990s continues, reflecting an ongoing youth mental health crisis. There is an urgent need for a comprehensive care continuum with accessible outpatient services capable of identifying and supporting the mental health needs of children regardless of acuity, payor, and geographic setting. A fully realized child mental health continuum of care meets children where they are; adequately funds services from the outpatient clinic to the inpatient unit; delivers evidence-based treatments targeted to reduce mental health symptoms; and supports the development of a skilled behavioral health workforce.
Sexual and gender minority (SGM) girls face unique challenges in school, child welfare, and legal settings due to identity-linked discrimination, stigma, and marginalization. Inequities in school harassment, school discipline, and family support are especially harmful, given they increase the risk of homelessness and legal contact. Black and Latinx SGM girls are particularly impacted given the compounding inequities they face in today's society. Despite these tremendous inequities, providers in different settings can make positive impacts for systems-involved SGM girls by creating a safe and affirming environment, building on well-established protective factors, and increasing agency.
The article explores the complex relationship between social media use and the mental health of adolescent girls. It discusses the negative impacts, such as increased anxiety, depression, and self-objectification, while also acknowledging positive aspects like social connection and creative expression. Gender differences in social media behavior are noted as adolescent girls face unique challenges in online spaces reflective of larger societal pressures and expectations on girls. Parental involvement, educational initiatives, policy change, and clinical guidance for those working with teen girls may help them effectively navigate the complexities of social media.