Shashank V Joshi, MD

Abstract

We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures.Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.

View details for DOI 10.1007/s11920-023-01431-x

View details for PubMedID 37470928

View details for PubMedCentralID 8979602

View details for DOI 10.3928/00485713-20230613-02

Abstract

The purpose of this study is to examine the impact of an online virtual human role-play simulation in teaching high school educators and staff to identify, talk to, and if necessary, refer students in psychological distress to support services. High school educators (N=31,144) from 43 US states and 5 American territories completed a baseline survey and then randomly assigned to a wait-list control or treatment group. Participants in the treatment group completed the training simulation which included active learning strategies to teach evidenced-based communication strategies such as motivational interviewing to build skills and shift attitudes. Immediately after the training, treatment group participants completed a post-survey and then a 3-month follow-up survey. Baseline and post-surveys included the validated gatekeeper behavior scale measures which assess attitudinal constructs that predict helping behaviors. Self-reported helping behaviors were collected at baseline from both groups and at the 3-month follow-up for the treatment group. The treatment group participants' post and follow-up data were compared to the control group's baseline measures. The treatment group post-training scores were significantly higher (p<.001) than the control group's baseline scores for all gatekeeper behavior scale attitudinal constructs of preparedness, likelihood, and self-efficacy to engage in helping behaviors. A teacher subsample reported significant increases (p<.001) in the number of students referred to mental health support services when compared to baseline measures of the control group. Role-play simulations hold promise in teaching educators to become the "eyes and ears" of student mental health by empowering them to identify students in psychological distress, engage them in effective conversations about their concerns, and if necessary, make a referral to behavioral health support services. Future studies need to implement measures that document students entering counseling as a result of self-reported referrals and examine the impact of the training on the overall mental health culture within schools. Such studies could lead to simulations being widely adopted to support public health initiatives that address student mental health and wellness.

View details for DOI 10.1007/s41347-022-00243-9

View details for PubMedID 35372668

Abstract

Research suggests that media adherence to suicide reporting recommendations in the aftermath of a highly publicized suicide event can help reduce the risk of imitative behavior, yet there exists no standardized tool for assessing adherence to these standards. The Tool for Evaluating Media Portrayals of Suicide (TEMPOS) allows media professionals, researchers, and suicide prevention experts to assess adherence to the recommendations with a user-friendly, standardized rating scale. An interdisciplinary team of raters constructed operational definitions for three levels of adherence to each of the reporting recommendations and piloted the scale on a sample of articles to assess reliability and clarify scale definitions. TEMPOS was then used to evaluate 220 news articles published during a high-risk period following the suicide deaths of two public figures. Post-hoc analyses of the results demonstrated how data produced by TEMPOS can be used to inform research and public health efforts, and inter-rater reliability analyses revealed substantial agreement across raters and criteria. A novel, wide-reaching, and practical approach to suicide prevention, TEMPOS allows researchers, suicide prevention professionals, and media professionals to study how adherence varies across contexts and can be used to guide future efforts to decrease the risk of media-induced suicide contagion.

View details for DOI 10.3390/ijerph19052994

View details for PubMedID 35270688

Abstract

Psychiatrists need to create a partnership that doesnt lean on psychiatric jargon or an encyclopedic list of side effects, but instead on measured candor, vulnerability, andmost importantlytime.

View details for DOI 10.1037/aap0000294

Abstract

OBJECTIVE: Recruitment is one of the most important missions for the Child and Adolescent Psychiatry (CAP) Caucus of the American Association of Directors of Psychiatric Residency Training, the American Academy of Child and Adolescent Psychiatry, and the American Association of Directors of Child and Adolescent Psychiatry. A review of the National Resident Matching Program (NRMP) Match data is needed to inform current and future practices.METHODS: The NRMP, Accreditation Council for Graduate Medical Education, and Association of American Medical College databases were queried from 1996 to 2021.RESULTS: The NRMP data show that the number of programs participating in the Match has increased from 87 in 1996 to 106 in 2021 and that the percentage of programs that fill their positions in the Match is increasing and has increased from 41% in 1996 to 67% in 2021. However, each year, a percentage of programs do not fill their positions offered in the Match. The numbers indicate a surplus of positions for the number of applicants that appears to be increasing, and there are currently 49 more positions than applicants.CONCLUSIONS: Trends in the CAP Match are encouraging, and importantly, more programs and applicants are using the Match. One concerning trend is the surplus of positions while there is a great need for child psychiatrists. More research is needed on the incentives for programs and applicants to participate in the Match and how to increase interest in child and adolescent psychiatry.

View details for DOI 10.1007/s40596-021-01546-4

View details for PubMedID 34854071

Abstract

Since the early 1900s when school-based health services were first introduced, models of school-based health have evolved toward comprehensive and integrated models that include mental health. New and innovative models of Comprehensive Mental Health Systems offer a range of prevention and intervention strategies that are delivered across collaborative systems of community and school-based mental health. Studies of school-based health services indicate positive outcomes in health, mental health, and education. Child and adolescent psychiatrists can work with schools by providing direct service, consultation, and technical assistance to increase access, improve health equity, and optimize mental health outcomes for all youth.

View details for DOI 10.1016/j.chc.2021.07.004

View details for PubMedID 34538446

Abstract

Children and adolescents should be included in exercises and drills to the extent that their involvement advances readiness to meet their unique needs in the event of a crisis and/or furthers their own preparedness or resiliency. However, there is also a need to be cautious about the potential psychological risks and other unintended consequences of directly involving children in live exercises and drills. These risks and consequences are especially a concern when children are deceived and led to believe there is an actual attack and not a drill and/or for high-intensity active shooter drills. High-intensity active shooter drills may involve the use of real weapons, gunfire or blanks, theatrical makeup to give a realistic image of blood or gunshot wounds, predatory and aggressive acting by the individual posing to be the shooter, or other means to simulate an actual attack, even when participants are aware that it is a drill. This policy statement outlines some of the considerations regarding the prevalent practice of live active shooter drills in schools, including the recommendations to eliminate children's involvement in high-intensity drills and exercises (with the possible exception of adolescent volunteers), prohibit deception in drills and exercises, and ensure appropriate accommodations during drills and exercises based on children's unique vulnerabilities.

View details for DOI 10.1542/peds.2020-015503

View details for Web of Science ID 000562996900041

View details for PubMedID 32839245

View details for DOI 10.1542/peds.2020-0127

View details for PubMedID 32434762

Abstract

A pilot survey was created to sample early career child and adolescent psychiatrists (CAPs) and fellows to identify factors contributing to recruitment, satisfaction, and general practice trends.A 44-item survey was developed based on a previous study of early career CAPs and discussion at an early career forum. Participants were recruited at a professional meeting and through emails sent to all 125 US training program directors.Only 184 out of 2209 responses were received. Approximately two-thirds were female and one-third had completed fellowship. Most decided to pursue a career in child psychiatry during medical school and expected full time salaries between $175,000 and $250,000 after fellowship. Forty-five percent owed more than $150,000 in educational debt. The top reasons for pursuing a career in child psychiatry included the following: working with children, working in an interesting field, and helping society. Males (x=85.7, SD 22.9) compared with females (x=77.5, SD 25.3) were more interested in pursuing full time work. A higher proportion of participants were confident in prescribing medications (x=79.9, SD 17.1) compared with providing psychotherapy (X=63.3, SD 23.9).The vast majority of early career CAPs were recruited during medical school, motivated by altruistic reasons, and rated high confidence in their career choice despite significant student loan debt. Training directors should consider increasing competency in psychotherapeutic skills. Early child psychiatry exposure and a means of addressing physician debt are needed to improve recruitment to this specialty.

View details for DOI 10.1007/s40596-019-01167-y

View details for PubMedID 31900876

Abstract

Projects done in interprofessional groups can foster faculty development with minimal resources beyond what is already available at the university or medical center. Each project can yield multiple "wins" in individual faculty growth while meeting the needs of academic medical centers. These projects can build collaborative skills and a sense of community among faculty, trainees, and staff. The combination of low costs, high yields, and improvements in team skills make these approaches appealing and sustainable in resource-constrained medical centers. The authors describe 4 sample projects and their teams, needed resources, and outcomes.

View details for DOI 10.1016/j.psc.2019.05.011

View details for PubMedID 31358121

Abstract

The American Academy of Pediatrics has created recommendations for health appraisal and preparation of young people before participation in day, resident, or family camps and to guide health and safety practices at camp. These recommendations are intended for parents and families, primary health care providers, and camp administration and health center staff. Although camps have diverse environments, there are general guidelines that apply to all situations and specific recommendations that are appropriate under special conditions. This policy statement has been reviewed and is supported by the American Camp Association and Association of Camp Nursing.

View details for DOI 10.1542/peds.2019-1355

View details for Web of Science ID 000479007500048

View details for PubMedID 31209160

Abstract

Psychiatric training for medical students, residents, and fellows can integrate well-being principles to improve mental health. From preschool to college, principles of wellness and health promotion are increasingly prevalent and are showing promising results. Courses on happiness and well-being have been embraced at colleges and universities. Well-being is now a required component of child and adolescent psychiatry training. Training residents and fellows in emotional and behavioral well-being requires incorporation into clinical supervision and the overall culture and infrastructure of the training program.

View details for PubMedID 30832957

View details for DOI 10.1007/s40596-018-1007-2

View details for Web of Science ID 000459533100019

Abstract

More than 6.5 million children in the United States, approximately 13% of all students, miss 15 or more days of school each year. The rates of chronic absenteeism vary between states, communities, and schools, with significant disparities based on income, race, and ethnicity. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes. Pediatricians and their colleagues caring for children in the medical setting have opportunities at the individual patient and/or family, practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities. Although this policy statement is primarily focused on absenteeism related to students' physical and mental health, pediatricians may play a role in addressing absenteeism attributable to a wide range of factors through individual interactions with patients and their parents and through community-, state-, and federal-level advocacy.

View details for DOI 10.1542/peds.2018-3648

View details for Web of Science ID 000457458700053

View details for PubMedID 30835245

View details for DOI 10.1016/j.psc.2019.05.008

View details for Web of Science ID 000550988100017

Abstract

Adolescence is a time of remarkable growth and development. It is also a time of great vulnerability. According to national indicators of adolescent health and well-being, the most significant health issues young people face are related to mental health. When a young person is supported to develop the skills and habits associated with robust mental health and their mental health needs are effectively diagnosed and treated, they are more likely to experience positive outcomes associated with their physical, social, emotional, and cognitive development as well as overall quality of life. Conversely, when a young person is not supported to develop the skills and habits associated with robust mental health and their mental health needs are left undiagnosed or untreated, they are more likely to experience a wide range of negative outcomes including, but not limited to, an acute mental health crisis. The Center for Disease Control and Prevention and The National Institute of Mental Health have reported that suicide, often considered to be an indicator of acute mental health distress, was the second leading cause of death for American youth ages 10-24 in 2017. In San Mateo County, a recent report on adolescent health frames the prevalence of mental health needs among public school students as staggering. Both locally and nationally, To address these challenges in Northern Californias San Mateo County, San Mateo Union High School District, Peninsula Health Care District, and Stanfords Department of Psychiatry & Behavioral Sciences Center for Youth Mental Health and Wellbeing have been collaborating to strengthen mental health supports for youth in both the high school district and its K-8 partner districts. To better understand which efforts have the greatest potential for impact, we joined their collaborative to conduct a mixed methods study to examine three questions: 1. How do students, parents, teachers, and providers perceive mental health needs and student supports throughout middle and high school? 2. What predictive factors appear to be related to positive transitions, high school readiness, or risk indicators of later mental health challenges? 3. What are the opportunities for intervention and support to improve teen mental health? schools are grappling with the challenges of students mental health needs, and the resulting demand it places on them not only to respond to students experiencing acute mental health distress, but to more effectively promote the mental health and well-being of all students. Key Findings Schools are experiencing earlier onset, increased prevalence, and greater complexity of student mental health needs across all ages (K-12) and across the socio-economic spectrum. Student mental health is affected by a wide range of school and non-school factors. Student mental health needs are often difficult to detect until they manifest as crisis. Resources to address student mental health needs vary across schools and districts, primarily focus on crisis management, and rest heavily on individual responses rather than a comprehensive or integrated system of support. Most students and families navigate transitions between grades, schools, and districts with relatively little guidance, leaving them vulnerable to gaps in services and support. Information regularly collected by public school districts provides little insight into students mental health strengths/challenges and the effectiveness of mental health supports; available data do not yield any predictive factors related to mental health challenges. There are many opportunities with high potential for transforming how participating schools and districts support student mental health and well-being. Opportunities The research findings point toward four opportunities for schools and districts to transform their approach to supporting mental health and well-being: 1. Situate student mental health in the broader context of comprehensive development and well-being that is cultivated over the course of a lifetime 2. Shift from an individual view of the problem and solution to a systems view 3. Strengthen continuity of care across grades, schools, and districts 4. Expand data systems to include meaningful measures of well-being These opportunities are accompanied by a tri-level framework for comprehensive change which emphasizes an integrated approach to innovation that simultaneously addresses the system (district/cross-district), setting (school site), and the individual (student/family). The Research Brief includes concrete examples of strategies that can be used to address each of the opportunities at each of these levels, across the K-12 continuum. In so doing, it offers multiple entry points for activating a more comprehensive and coordinated approach to supporting student mental health and well-being.

Abstract

In this article, the authors make a compelling case that all clinicians who treat youth with depressive disorders should embrace strategies to engage with school staff to best serve their patients in the classroom. Because these disorders have a high incidence in the school population (13% of US teens experienced at least 1 major depressive episode in 2016), this can affect learning, social interactions, and classroom engagement. Several approaches are highlighted for assessment of depressive symptoms, intervention and treatment in school settings, and prevention strategies, including depression education curricula and programs promoting subjective well-being, such as positive psychology and mindfulness.

View details for PubMedID 31076113

View details for DOI 10.1037/aap0000134

View details for Web of Science ID 000453232100003

View details for DOI 10.1007/s41347-018-0061-7

Abstract

(2018). , in , . : American Society of Clinical Psychopharmacology.

View details for PubMedID 29437126

View details for DOI 10.1007/s40596-015-0484-9

View details for Web of Science ID 000376248800036

View details for PubMedID 27020935

View details for DOI 10.1016/j.chc.2014.12.003

View details for DOI 10.1007/978-1-4939-1686-3_3

Abstract

Joshi SV (Contibutor, 2014). California Dept of Education, Placer Co. Office of Education and Minnesota Association for Childrens Health: A Guide to Student Mental Health and Wellness in California. 2014 (90 pages): St. Paul, (I contributed as part of the California School Mental Health Policy Workgroup, appointed by State Superintendent of Schools Tom Torlikson)

Abstract

OBJECTIVE There is a critical shortage of child and adolescent psychiatrists in the United States. Increased exposure, through mentorship, clinical experiences, and research opportunities, may increase the number of medical students selecting child and adolescent psychiatry (CAP) as a career choice. METHOD Between 2008 and 2011, 241 first-year participants of a program to increase exposure to CAP, funded by the Klingenstein Third-Generation Foundation (KTGF) at 10 medical schools completed baseline surveys assessing their opinions of and experiences in CAP, and 115 second-year participants completed follow-up surveys to reflect 1 year of experience in the KTGF Program. RESULTS Students reported significantly increased positive perception of mentorship for career and research guidance, along with perceived increased knowledge and understanding of CAP. CONCLUSIONS Results suggest that the KTGF Program positively influenced participating medical students, although future studies are needed to determine whether these changes will translate into more medical students entering the field of CAP.

View details for Web of Science ID 000323916200007

View details for PubMedID 24026370

Abstract

Ojakian V, Joshi SV, et al. (2012). Suicide Prevention Initiative, 2nd Annual Report. (24 pages); San Jose: County of Santa Clara.

Abstract

Research indicates that the therapeutic alliance between therapist and pediatric patient is most effective in the context of a productive supporting alliance--an alliance encompassing the network of relationships among therapists, parents and teachers. In this essay, we develop a model of the supporting alliance, arguing that the child's primary relationships with various parties (therapists, teachers, and parents) imply a set of secondary relationships among those parties (parent-therapist, therapist-teacher, parent-teacher). We review the literature on these secondary relationships, focusing on their nature and discussing the benefits of and obstacles to establishing productive collaborations in each case. We also describe three sorts of pathology that can afflict the supporting alliance as a whole, and discuss the importance of patient autonomy and therapist-patient confidentiality relative to the supporting alliance. Finally, we identify directions for future research and highlight implications for practice.

View details for PubMedID 20131741

Abstract

Delirium in adult populations of hospitalized patients has been well characterized into hyperactive, hypoactive, and mixed subtypes. The degree to which these subtypes apply to pediatric populations has yet to be fully demonstrated. In this case report, the authors present two cases of delirium that serve as examples of the hyperactive and hypoactive/mixed types and then discuss treatment. They find marked differences in the response of different delirium subtypes to haloperidol and risperidone and theorize as to the neurochemical pathways by which these pharmacological agents might work. This framework provides an algorithm for the treatment of pediatric delirium.

View details for Web of Science ID 000246210400010

View details for PubMedID 17478595

Abstract

Currently our field is actively involved in developing new ways to characterize and treat children and adolescents with psychiatric disorders and in evaluating the effects of our therapies. We also are beginning to examine the effectiveness of our teaching methods. This article presents evidence for, ideas about, and a philosophy to guide individuals who are privileged to train child psychiatrists in psychotherapies. Specifically, it discusses the issues of the evidence base for diagnosis and for nonspecific and specific active elements of child psychotherapy. Evidence for methods of training is presented. The article addressed the need for supervising psychiatrists to keep abreast of developments in teaching methods so that we can best train competent, curious, and compassionate child psychiatrists.

View details for DOI 10.1016/j.chc.2006.09.004

View details for Web of Science ID 000243016300012

View details for PubMedID 17141124

Abstract

All child psychiatrists' interactions with patients and families have important potential meanings, and the act of prescribing medication is no exception. As psychopharmacologic practice has increased in child psychiatry, facility with psychotherapeutic skills, such as establishing an alliance, identifying and treating symptoms, and promoting adherence must follow to enhance clinical outcomes. This article addresses the role of the therapeutic alliance in pediatric work, the psychologic implications of administering medications, developmental issues altering psychopharmacologic efforts, the role of the dual alliance (allying both patients and parents), and recommendations for clinical practice and further research.

View details for DOI 10.1016/j.chc.2005.08.004

View details for Web of Science ID 000234522400013

View details for PubMedID 16321733

Abstract

This cross-sectional survey determined the prevalence of motherhood among severely mentally ill women hospitalized in an inner-city facility and examined the demographic characteristics and perceived needs of the 32 mothers who were identified. Slightly less than one-quarter of these mothers had seen their children within the last week, and only about 20 percent maintained full custody of their children. However, none of the respondents reported feeling that it was unimportant whether they continued mothering their children. Approximately half described needing help in dealing with their sadness about their children. The pilot data presented in this paper suggest that motherhood is common among severely mentally ill and hospitalized women and that issues relevant to mothering remain important to them.

View details for Web of Science ID 000082941600017

View details for PubMedID 10506308

View details for DOI 10.1542/pir.2022-005715

View details for PubMedID 37122041

View details for DOI 10.1016/j.jaac.2022.07.828

View details for Web of Science ID 000873567900083

View details for DOI 10.1016/j.jaac.2022.07.119

View details for Web of Science ID 000873567900101

View details for DOI 10.1016/j.jaac.2022.07.303

View details for Web of Science ID 000873567900251

View details for DOI 10.1016/j.jaac.2019.07.134

View details for Web of Science ID 000518857300109

View details for DOI 10.1016/j.chc.2010.08.001

View details for Web of Science ID 000284507200002

View details for PubMedID 21056339

View details for PubMedID 11826259

View details for DOI 10.1016/j.jaac.2016.09.488