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Because of significant shortages in the behavioral health workforce, primary care providers (PCPs) have become the de facto mental health providers to address poor access to mental health care. Child psychiatry access programs (CPAPs) could support PCPs through case consultations. This column describes the innovative Missouri Child Psychiatry Access Project, highlighting the unique enhancements to existing CPAPs and the partnership between community and academic settings to support behavioral health access in primary care. Using an implementation science approach, the authors applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to disseminate replicable steps for other systems; they also discuss future directions for expanding utility and scope.

Early childhood teachers are a unique population of teachers and it is important to determine amendable factors that contribute to their stress. According to available research, challenging child behavior is associated with teacher stress and burnout in school-aged teachers. Given the lack of formal and coordinated in-service education and varied qualifications, early childhood teachers are particularly vulnerable to stress. Further, young children are more likely to have challenging behavior given their social-emotional developmental levels. The purpose of this study was to explore teacher characteristics and perceptions related to their stress, commitment, support, and challenging child behavior in their classrooms. Participants included 100 early childhood professionals. A teacher survey was utilized to determine their perceptions related to key variables. Regression analyses documented teacher commitment and challenging behavior in the classroom uniquely predicted variance in teacher ratings of stress and burnout. Commitment to their job was also a significant predictor to their perceptions of challenging behavior. However, only teacher stress/burnout predicted ratings of challenging behavior; thus, relationships among variables may be more complex. Teachers’ years of experience and education level were not related to other variables. For exploratory purposes, teacher professional development perceptions were also surveyed and results indicated that the vast majority of early childhood educators felt professional development was a good use of their time and that they wished more opportunities were available; however, most also indicated they felt training covered information they already knew.

The authors evaluated whether Maintenance of Certification (MOC) Performance-in-Practice products in training increases trainee knowledge of MOC processes and is viewed by trainees as a useful activity.Six child and adolescent psychiatry fellowships used MOC products in continuity clinics to assess their usefulness as training tools. Two surveys assessed initial knowledge of MOC and usefulness of the activity.Forty-one fellows completed the initial survey. A majority of first-year fellows indicated lack of awareness of MOC in contrast to a majority of second-year fellows who indicated some awareness. Thirty-five fellows completed the second survey. A majority of first- and second-year fellows found the activity easy to execute and would change something about their practice as a result.Using MOC products in training appears to be a useful activity that may assist training programs in teaching the principles of self- and peer-learning.

13-year-old white male was admitted to the child and adolescent psychiatry unit at our institution. He was referred to us by his outpatient therapist. He had become increasingly aggressive (both verbally and physically), agitated, unable to sit still, and was pacing and talking incessantly. His speech was pressured, rapid, and mumbled. He was acting out sexually by masturbation. He also had auditory hallucinations (was hearing a “good voice”) but no visual hallucinations. He had paranoid ideations that someone was breaking into his home, and he was talking to himself and responding to internal stimuli. His sleep and concentration were reduced but his appetite was adequate. Suicidal and homicidal ideations were absent. His symptoms had been getting worse in the weeks prior to