Stanford, CA 94305
University of Wisconsin School of Medicine & Public Health, Madison, WI, 06/30/2001
Northshore Medical Center-Salem Hospital, Salem, OR, 06/30/2002
Massachusetts General Hospital Dept of Psychiatry Program, Boston, MA, 06/30/2004
Massachusetts General Hospital Dept of Psychiatry Program, Boston, MA, 06/30/2006
Child & Adolescent Psychiatry, American Board of Psychiatry and Neurology
Psychiatry, American Board of Psychiatry and Neurology
View details for DOI 10.1016/j.jaac.2020.07.300
View details for Web of Science ID 000579844100234
View details for DOI 10.1016/j.jaac.2020.07.528
View details for Web of Science ID 000579844100442
View details for DOI 10.1016/j.jaac.2020.07.517
View details for Web of Science ID 000579844100431
View details for DOI 10.1016/j.jaac.2020.07.080
View details for Web of Science ID 000579844100060
The 2019 novel coronavirus disease (COVID-19) pandemic has forced many eating disorder medical stabilization units to consider adjustments that uphold both the quality of care delivered to patients while also observing social distancing public health directives for patients and staff. To date, inpatient facilities for eating disorders (both medical stabilization units and higher level of care facilities) have not needed to consider how to translate services to electronic platforms, given that most of these programs have in-person staff. We outline our transition to telehealth broadly, emphasizing some unexpected benefits of using telehealth services that we plan on integrating into our work-flow post COVID-19. These may be useful for other higher level of care eating disorder programs, including medical stabilization units, residential, partial hospitalization, and intensive outpatient programs. We also highlight aspects of transition that have been more challenging for this particular patient population, warranting the need for in-person services.
View details for DOI 10.1002/eat.23348
View details for PubMedID 32715512
View details for Web of Science ID 000506637300120
View details for DOI 10.1016/j.jaac.2019.07.338
View details for Web of Science ID 000518857300154
View details for DOI 10.1016/j.jaac.2019.07.569
View details for Web of Science ID 000518857301127
View details for DOI 10.1016/j.jaac.2019.07.572
View details for Web of Science ID 000518857301130
View details for DOI 10.1016/j.jaac.2019.07.339
View details for Web of Science ID 000518857300155
View details for DOI 10.1016/j.jaac.2019.07.574
View details for Web of Science ID 000518857301132
View details for DOI 10.1016/j.jaac.2019.07.570
View details for Web of Science ID 000518857301128
Time flies. Young people grow up and are off to college. It's exciting. Yet even for the most well-adjusted student, it is fraught with uncertainty. It is a time of tension. Young people take on greater academic responsibility, are more independent in tasks of daily living, must navigate mature relationships, and must take charge of their own health care. In years past, transitional age youth with mental illness may have had inadequately controlled symptoms, functional impairment, or faced stigma preventing them from going to a college or university. Their academic paths and career options were limited. Changing attitudes and improvements in identifying mental health conditions have allowed an increasing number of young people to access appropriate treatment, and this has led to improvements in educational achievement. However, although students with mental illness may enjoy improved access to college, they struggle more than others when making the transition. Stress can exacerbate symptoms and make attending class regularly or completing projects difficult.2.
View details for DOI 10.1016/j.jaac.2019.06.011
View details for PubMedID 31445622
View details for DOI 10.1016/j.chc.2019.02.008
View details for Web of Science ID 000471090500008
View details for DOI 10.1002/eat.22994
View details for Web of Science ID 000466426100013
Transitional age youth with a history of mood disorders, such as major depressive disorder, are uniquely vulnerable to clinical destabilization and relapse in the context of life transition. Moving from a structured adolescence to a more independent and potentially more demanding young adult life can result in worsening symptoms and barriers to effective help-seeking. Transitional age youth newly diagnosed are exposed to their first course of treatment of a potentially chronic condition. This article describes the challenges inherent in navigating this life transition, and also offers strategies to promote a successful "launch" into adulthood.
View details for PubMedID 31076114
Eating disorders are common in children and adolescents, and may continue, resurface, or present anew in young people making the transition to adulthood. This may affect the young person's academic or occupational trajectory, and patients and parents/families need to recognize the supports that may be necessary to allow the emerging adult to be successful in navigating independent living, increased work or educational autonomy, and adult relationships. Colleges and universities are able to provide some support, but patients, families, and clinicians must be aware of limitations and must be thoughtful about options available to promote successful transition wherever possible.
View details for DOI 10.1016/j.chc.2019.05.010
View details for PubMedID 31443875
Many eating disorder patients are successfully treated in outpatient settings. Family-based treatment allows youth to recover at home. Higher levels of care may be necessary for medical or psychiatric stabilization, or to provide added structure. Historically, hospital lengths of stay were long. Currently, insurance limitations encourage intermediate care levels to support patients not requiring inpatient treatment but not ready for outpatient care. Options include inpatient medical stabilization, locked units for individuals with suicidal ideation, and outpatient programs offering daily meal support and group therapy. Outpatient teams and families collaborate to determine the appropriate level of care.
View details for DOI 10.1016/j.chc.2019.05.006
View details for PubMedID 31443876
View details for DOI 10.1016/j.chc.2019.06.001
View details for PubMedID 31443883
OBJECTIVE: This article uses three brief case reports to illustrate how family-based treatment (FBT) can be used to treat pre-adolescents with avoidant/restrictive food intake disorder (ARFID).METHOD: We present case material illustrating how FBT can be used in three different clinical presentations of ARFID: (1) low appetite and lack of interest; (2) sensory sensitive eaters; and (3) fear of aversive consequences eaters-all without shape or weight concerns.RESULTS: This case material illustrates that the main principles of FBT-agnosticism as to the cause of the illness, externalization, emphasizing the seriousness of ARFID, parental empowerment, behavioral consultation, and practical behavioral focus-are applicable for a range of ARFID clinical presentations. Common challenges in this patient group include (1) promoting urgency; (2) challenging long term behavioral accommodation; (3) lack of parental alignment, parental fatigue, (4) and co-morbid psychiatric problems in the patients. Strategies to address these problems are described.CONCLUSION: FBT can be adapted for children with ARFID using the main principles of the approach.
View details for PubMedID 30578635
View details for PubMedID 29047075
Child and adolescent psychiatrists (CAP) care for high school students preparing to enter college. They also may continue to see students while on school vacations and may care for college students in various settings (emergency room, inpatient hospital unit, private practice, college student health service, or counseling center). As increasing numbers of students with mental health diagnoses pursue secondary education, CAP need to be knowledgeable about campus systems of care, principles of transition, and privacy and educational laws affecting college students. This article describes an informal needs assessment of general CAP members of the American Academy of Child and Adolescent Psychiatry and details the results of a survey of CAP program directors on training opportunities in college student mental health (CSMH). The authors present a sample curriculum for a clinical rotation in CSMH, as well as providing ideas for core didactic lectures, and proposing the development of online resources to reduce the burden of creating new lectures and standardize experiences among training programs.
View details for DOI 10.1007/s40596-015-0307-z
View details for PubMedID 25895628
The purpose of this article is to determine the effectiveness of a hands-on continuing education program for practicing child and adolescent psychiatrists (CAPs) with a focus on best practices in transitioning psychiatric patients to college. The plan was to build on the unique knowledge and skill set of CAPs, use audience and facilitator feedback from prior programs to inform program content, structure, and format, and incorporate findings from the evolving literature.A 3-h interactive workshop was designed with an emphasis on audience participation. The workshop was divided into three main segments: didactics, whole group discussion/brainstorming, and small group discussion of illustrative case vignettes.Improvements and changes in knowledge, skills, and attitudes related to transition planning were identified by program participants. Quantitative feedback in the form of course evaluations, pre- and posttests, and a 6-month follow-up questionnaire indicate that the use of interactive teaching techniques is a productive learning experience for practicing CAPs. Qualitative feedback was that the discussion of the case vignettes was the most helpful.The use of a workshop format is an effective strategy to engage practicing CAPs in learning about and implementing best practices to support the transition of their patients to college and into young adulthood. Comprehensive and proactive transition planning, facilitated by clinicians, should promote the wellness of college-bound patients and help to reduce the potential risks in the setting of an upcoming transition.
View details for DOI 10.1007/s40596-015-0347-4
View details for PubMedID 26077008
View details for DOI 10.1016/j.jaac.2013.03.003
View details for PubMedID 23702442
View details for Web of Science ID 000283647900002
View details for PubMedID 21041462
View details for Web of Science ID 000281675700001
View details for PubMedID 20833897