Jarrod M. Leffler

Integrated treatment teams are necessary to manage acute patient needs in an inpatient psychiatric hospital unit (IPHU). Teams often include psychiatrists, nurses, and social workers. Some IPHUs also include psychologists who may provide a range of activities that include providing therapy and testing, milieu management, treatment planning, and staff training, depending on the needs of the IPHU. Psychologists’ diverse skillsets and ability to adapt to fluid needs may in fact contribute to an inconsistent role definition on IPHUs. The current study, conducted on an 18-bed child and adolescent IPHU at a Midwestern tertiary medical center, sought to understand: (a) treatment team perceptions of the role of psychology; (b) stakeholder feedback on best ways to engage psychological services; and (c) stakeholder feedback on the implementation of eight-hour weekly psychology consultation service; and satisfaction with a weekly caregiver group for parents/guardians of inpatient youth. Fifty-two providers (i.e., registered nurses, advanced practice registered nurses, licensed clinical social workers, and psychiatrists) completed a survey regarding the role of and satisfaction with psychology on the IPHU , as well as satisfaction with the weekly caregiver group. The results suggest overall positive outcomes for an eight-hour IPHU psychology consultation model, with 17% of staff satisfied, 56% highly satisfied, and 27% extremely satisfied. Results showed mixed satisfaction with the amount of psychology time spent with the treatment team; 42% of staff reported overall satisfaction, while 38% reported overall dissatisfaction.

Psychology training concentrates on psychological theory, clinical assessment, diagnosis, intervention, research, interpersonal skills, diversity and ethics. Emphasis is on increasing scientific and professional knowledge about human behavior and psychologists learn to support behavioral change, form and maintain relationships, teach others to improve coping skills, promote decision-making and personal potential, while supporting individual development. It is rare that psychologists are provided education on the business aspects of psychology, which focuses on coding, billing, productivity expectations and understanding how our work translates into collections for our academic health centers. This article outlines ways in which productivity is measured, discusses reimbursement for services, outlines billing and coding challenges, puts forth recommendations on how to best utilize time for maximum benefit and discusses the importance of advocacy for psychologists and our work in academic health centers.

Dramatic shifts in state-level cannabis laws (CLs) and federal hemp regulations have resulted in increased availability and use of cannabis and cannabidiol (CBD) products throughout the US, with unknown implications for the youth. Youth with mood disorders represent a vulnerable population that is more likely to use cannabis and CBD and is at elevated risk for experiencing cannabis-related adverse health outcomes. This multisite study characterized attitudes, health perceptions, and behaviors related to cannabis and CBD use among US youth receiving mood disorder treatment and their parents, and assessed whether attitudinal differences varied as a function of respondent group and state-level CL status. Anonymous surveys were completed by 84 youths and 66 parents recruited from six child mood clinics providing care to patients living in eleven US states with variable CLs. Covariate-adjusted regressions were run using respondent group and state-level CL status as between-subject factors. Most youths (76% and 74%) and parents (65% and 68%) endorsed believing that cannabis and CBD, respectively, are safe and effective treatments for mental health conditions, and that regular use of these products reduces depression, anxiety, and suicidal behaviors. Intergenerational differences in cannabis-related attitudes and health perceptions were observed, with some associations varying as a function of state-level CL. Among the youth, male sex and positive cannabis expectancies and attitudes were associated with higher cannabis use intentions. Findings can inform prevention and public health messaging efforts.

The diagnosis of bipolar disorder (BD) in young children has been a topic of debate, in part owing to varied interpretation of manic-like symptoms. We examined how expert academic clinicians participating in the pediatric bipolar biobank varied in their interpretation and application of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and diagnoses. Study co-investigators reviewed 12 standardized narratives and for each marked a visual analog scale with their confidence in the presence of manic episodes and criteria. We analyzed raters’ confidence and inter-rater agreement using interclass correlation (ICC). Symptoms with good ICC ranging from 0.60 to 0.74 included inflated self-esteem/grandiosity and decreased need for sleep. Diagnoses and episodes with poor ICCs (< 0.4) included Hypomania and Bipolar Not Elsewhere Classified/Not Otherwise Specified. Despite efforts made to refine BD criteria with DSM-5, there was substantive variation in diagnostic interpretation among investigators working with children presenting with manic-like symptoms.

The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research. To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs. A multi-institutional research team conducted a nationwide (US) survey of child and adolescent IPU clinicians using snowball sampling. Recruitment emails were sent to IPU groups in the American Psychological Association and the American Academy Child and Adolescent Psychiatry. The study yielded data from 12 institutions with a total of 20 IPUs, representing over 23,000 admissions in the years 2019 and 2020. The results of the survey show wide variability in institutional definitions of key variables (such as readmissions and safety events) as well as large ranges in length of stay, restraints, seclusions, and safety events. This study reveals the importance of IPU clinical researchers taking steps to build a robust evidence base for IPU care, including developing consensus definitions of key variables and conceptualizing why high degrees of variability exist in important variables of IPU care. The survey results provide valuable insights for hospital systems, policymakers, and clinicians in the field of child and adolescent psychiatry.