CHILD AND ADOLESCENT PSYCHIATRY PORTAL |
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CAPP Line: 1-800-253-2103 | capp.ucsf.edu | Connecting for Care
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The leaves are changing colors, which means autumn has officially arrived in California! Children are settling into their school routines and before we know it, Thanksgiving will be right around the corner. In this newsletter we share some exciting updates about new partnerships, and recent and upcoming training opportunities. |
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Upper: Shelly Nakaishi PNP, Petra Steinbuchel MD
Lower: Joan Jeung MD MPH, Anne Glowinski MD, MPE, Yanni Rho MD MPH
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CAPP & Fresno Madera Medical Society host
Pediatric Mental Health Bootcamp for Primary Care
On September 24th, the Fresno Madera Medical Society and CAPP hosted a live, interactive training with Central Valley PCPs.We began with important reflection on the impact of stigma, vicarious trauma and unaddressed burnout, and then we enjoyed animated discussion questions and complex presentations of ADHD, depression, anxiety and common co-morbidities including trauma, learning problems and substance use. During both the formal sessions and informal discussions over lunch, we were so impressed with attendee's passionate commitment to addressing their pediatric patients complex mental health needs.
Special thanks to our partner colleagues at United Health Centers for hosting the event at their very welcoming Fresno Administration building.
Our team is looking forward to doing more in-person CME events and trainings. Let us know if you are interested in an in-person training in your area by emailing CAPP@UCSF.edu.
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SCHOOL BASED MENTAL HEALTH UPDATE |
Since 2020, our CAPP team has been strengthening relationships with California school and School Based Health Center (SBHC) partners to support student and staff mental health, wellness, and resilience. Our efforts to-date have focused on: 1) understanding the needs of our partnering school communities, 2) facilitating training and consultation opportunities, and 3) curating psychoeducational resources and social-emotional learning toolkits.
- Informed by input from our partners, we held several workshops focused on staff experiences of grief, vicarious trauma, and burnout, and tools for enhancing resilience, wellbeing and mental health.
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As a next step, we are expanding our training/consultation model into a Project ECHO live interprofessional tele-mentoring and consultation model with school teachers, administrators & staff, as well as school-based health center staff. Applications for our 2022-2023 school ECHO series are open with an extended deadline of October 28th!
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Our psychoeducational resource efforts to-date include a series of newsletters, as well as toolkits co-developed with partnering schools. The initial ADHD & Trauma Newsletter was created with contribution from CAPP’s SF Change intern (a high school student interested in a career in mental health) and the follow-up newsletter focused on Eating Disorders.
- Toolkits include strategies for leading supportive check-ins, facilitating distress tolerance and mindfulness skills practice, strengthening relationships between teachers and students, providing teachers a framework for understanding student behavior, with strategies to de-escalate and redirect students towards more effective behavior.
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If you would like to sign up for our newsletter series or have an idea for a future edition topic, or if you are interested in co-developing a toolkit for your school community, please contact us at capp@ucsf.edu.
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CAPP Project ECHO is a monthly, virtual continuing medical education (CME) activity that seeks to improve pediatricians' knowledge, skills, and confidence in diagnosing and managing commonly occurring mental health conditions in children. After a brief didactic, all participating PCPs discuss a peer-presented case and consult question, with input also from subject matter experts. Project ECHO’s motto is "Democratizing Knowledge" through an “All teach; all learn” process, in order to iteratively build skills, capacity, and confidence. Peer discussion and connection help all participants learn from one another, and also helps to mitigate the impact of caring for complex patients in our often stressful current collective context.
Note: There will be no November meeting since the standing time falls right before Thanksgiving. December’s meeting (topic=PTSD) is on December 7, in order to avoid the winter holidays. Registration for the next cohort will open in early December, with the new cohort starting in January 2023. The series is monthly for 1 year. Please look for an email flyer in December with registration details.
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Upcoming Webinars (with CME)
CAPP also offers a virtual monthly webinar series occurring on the second Thursday of each month, with occasional special topics offered on other days. The registration link, along with links to recordings of recent webinars, can be found here: https://capp.ucsf.edu/node/1306. Both webinars and Project ECHO participation are free.
November 10, 2022
SSRI's
Petra Steinbuchel, MD
December 8, 2022
Suicidality & Self-harm
Hohui Wang, MD & Shelly Nakaishi, NP
January 12, 2023
Early Childhood Mental Health
Sally Cantrell, PhD
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Case Example: 6-year-old with Autism Spectrum Disorder |
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A 6 year-old boy with a diagnosis of autism spectrum disorder is brought to his pediatrician by his mother. He has been exhibiting worsening emotional and behavioral dysregulation. He started ABA (Applied Behavioral Analysis) a few months ago, and also receives speech therapy and occupational therapy through school. Tommy has been having a difficult time with changes and daily transitions, leading to significant meltdowns, running away, screaming, intermittent self-injurious head-banging and biting. School and therapists note difficulty paying attention during sessions, difficulty sitting still, and requiring frequent redirection.
Clinical pearl: In patient with ASD, there is frequent co-morbid anxiety and ADHD symptoms, which may present as externalized behaviors (e.g. aggression), especially when there is a speech delay and children are unable to verbalize there needs/wants appropriately. These behaviors can interfere with a child’s ability to learn, and engage appropriately with therapy.
Recommendation: When there is a large transition, for children with autism it may be helpful to consider doing a “Social Story”, which includes visuals and simple explanations to help prime the child for what is to come/what they can expect. This may also include practice, such as driving to the school, and practicing the steps such as walking to the classroom. Parents may ask teachers for photos of the classroom, and what the daily schedule may look like.
Clinical pearl: When addressing self-injurious behaviors, of course the child’s safety comes first, however also important to observe and try to understand the function of the behavior. This is called the “ABC’s”: A (antecedent), B (behavior), C (consequence). In example, an Antecedent may be the TV being turned off by the parent before dinner, Behavior may then be the child head-banging, and then Consequence may then be the child gaining access to the remote and turning TV back on. In this example the self-injurious behavior becomes reinforced. So although we want to ensure the child’s safety, we want to avoid reinforcing these behaviors.
Recommendation: The pediatrician should work with this patient’s ABA provider to obtain collateral regarding identifying if certain challenging behaviors are happing in discrete settings, and for feedback once medications are started.
Medication pearl: A non-stimulant medication such as Guanfacine may help address this combination of symptoms which include hyperactivity, focus difficulties, irritability/aggression, impulsivity, and anxiety- a cluster of symptoms/behaviors we often see within the autism population.
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CAPP Line: 1-800-253-2103| capp.ucsf.edu |
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