Search

Background: The MedZou Community Health Clinic at the University of Missouri School of Medicine is a student-run free clinic (SRFC) providing primary care and specialty services to uninsured patients of Missouri. Little is published about the relationship of volunteerism in SRFCs and residency match results. This study evaluated the association of SRFC volunteering on residency placement. We hy-pothesized that there would be an increased likelihood of medical students matching into specialties correlating with specialty clinics they volunteered with as students. Methods: We analyzed data on volunteers who graduated from the University of Missouri School of Medicine between 2010-2019 in this retrospective study. Selection criteria included students who per-mitted publishing their residency match results publicly and actively volunteered for MedZou (at least five volunteer shifts). Odds ratios (OR) were calculated with Fisher exact tests using a confidence in-terval (CI) of 95% to assess whether volunteering in a specialty clinic was associated with matching in that specialty. Clinics with at least five volunteers during the study period were analyzed (Dermatol-ogy, Musculoskeletal [MSK], and Neurology). Results: Twenty-nine percent of the MedZou volunteers that fit the inclusion criteria volunteered for the Dermatology, MSK, or Neurology Clinic. We found significant associations between those who volunteered in a specialty clinic and those who matched in a related specialty for Dermatology (OR = 4.25, 95% CI = 1.37, 12.13), Musculoskeletal (OR = 3.49, 95% CI = 1.45, 7.98), and Neurology Clinics (OR = 10.89, CI = 1.71, 50.39). Additionally, 51% of MedZou volunteers that fit inclusion criteria volunteered for Primary Care Clinic. These students were also found to have a significant association with matching into a related primary care specialty (OR= 2.01, CI= 1.14, 3.62). Conclusions: The results of this study indicated that clinical exposure at a SRFC specialty clinic was associated with residency match into related specialties.

To provide access to timely youth psychiatric care, the Bridge Program: School-Based Psychiatry provides interim, school-based psychiatric services by child psychiatrists and psychiatric nurse case...

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.

One in 5 youth experience a psychiatric disorder in any given year, but fewer than half of these youth receive mental health services. This lack of service utilization is often attributed to structural and perceptual barriers, and school-based mental health programs have been proposed as a means of addressing these barriers and increasing youths' access to services. While universal prevention programs and targeted treatments may benefit most youth receiving services in schools, collaborations between schools and child psychiatry may benefit youth with the most severe symptoms and the greatest impairment. This article describes the Bridge Program, a school-based psychiatric program funded by a county-wide mental health tax initiative designed to provide psychiatric services in local schools without any out-of-pocket expenses for youth and families within 10 days of referral. Two case reports provide a description of the delivery of psychiatric services through the Bridge Program. Future research is needed to compare the feasibility and effectiveness of different approaches to increasing access to youth psychiatric care.

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.

Schizophrenia is a neurodevelopmental disorder with a multifactorial etiology. Pediatric schizophrenia consists of early-onset schizophrenia (onset prior to age 18 years) and childhood-onset schizophrenia (onset prior to age 13 years). Adolescence has been established as a critical period for neuronal pruning; hence, with earlier the onset of symptoms, there may be disruption in the normal process of neuronal development, causing impairments with memory, abstract thinking, and emotion regulation. Although the lifetime prevalence of schizophrenia is 1% in the general population, the incidence of pediatric schizophrenia is rare. Therefore, it is important to effectively evaluate the cause of any psychosis of a child or an adolescent. An accurate history and physical, including a detailed neurological examination, are vitally important, as are pertinent laboratory and imaging tests to rule out the many alternative differential diagnoses that also present with psychotic symptoms. The antipsychotics continue to be significantly more effective than placebo in treating pediatric schizophrenia in combination with psychotherapy, as evidenced by the recent Recover After an Initial Schizophrenia Episode (RAISE) study. However, further study is still needed to better understand causality, improve assessment, and develop a definitive treatment algorithm.

This study compared University of Missouri child and adolescent telepsychiatry services patients’ specific zip codes to child and adolescent psychiatrists’ practice locations to learn if telehealth was an appropriate option for this group of patients. In demographically and geographically diverse state such as Missouri, patients in rural areas may have limited or no access to timely, affordable and quality care. Many large urban health-care institutions have turned to telehealth as a means of providing equal access to care for all population, no matter where they choose to live. The management analyst system Cognos/Analyzer was used as a data source. Patient- and provider-specific zip codes were processed using GeoKettle software, and ArcGIS explorer was used for map visualization. While patients utilizing child and adolescent telepsychiatry services come from various parts of the state, providers are mostly clustered in urban locations along the Interstate 70. This greatly limits access to specialty care for rural and other vulnerable populations. Telehealth provides adequate and timely access to child and adolescent psychiatry services for the youth that may otherwise not be able to get needed care. Barriers such as mental health crisis and access to care for rural population have been more or less successfully addressed by telehealth for several decades now. However, the shortage of specialty physicians adds an additional layer of complexity to this issue. Health-care organizations with informatics tools such as telemedicine need to focus their efforts on maximizing usage to allow more access for the underserved population.

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.

The abuse of “bath salts” is a fairly new trend amongst teenagers and young adults. These substances, which are sold under various brand names, contain any one, or mixtures of, several synthetic cathinones such as 3,4-methylenedioxypyrovalerone (MDPV). The users of these substances may present with delusions, hallucinations, severe psychomotor agitation, and various other physiological effects. Special screens are required to detect these substances in users. Management is mostly supportive and has involved the use of benzodiazepines, antipsychotics, and general anesthesia in extreme cases. The use of beta blockers in users with elevated blood pressure is contraindicated as it may cause dangerous paradoxical increase in blood pressure.

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