Invited Addresses

Presented by:

Jennifer F. Havens, M.D., Arnold Simon Professor and Chair, Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine; Director of Child and Adolescent Behavioral Health Strategy and Growth, Office of Behavioral Health, NYC Health and Hospitals

Participants earn 1 continuing education credit

Categories: Health Care System/Public Policy, Trauma and Stress Related Disorders

Keywords: Evidenced-Based Practice, Public Health, Health Care System

Dr. Havens is the Arnold Simon Professor and Chair of the Department of Child and Adolescent Psychiatry at NYU Grossman School of Medicine, Director of the Child Study Center at Hassenfeld Children’s Hospital, and Director of Child and Adolescent Behavioral Health Strategy & Growth in the Office of Behavioral Health at NYC Health and Hospitals. Until October 2018, she was the Director and Chief of Service of the Department of Child and Adolescent Psychiatry at Bellevue Hospital Center, where she oversaw New York City’s most comprehensive continuum of mental health services for children and adolescents.

There, she opened New York State’s only dedicated Children’s Comprehensive Psychiatric Emergency Program, expanded Bellevue’s inpatient child psychiatric service to 45 beds, and opened NYC’s only Partial Hospital Program serving both children and adolescents. She also established and oversees a public psychiatry initiative providing mental health services at the NYC Administration for Child Services’ Secure & Non-Secure Juvenile Detention sites. Dr. Havens is an expert in the treatment of behavioral and mental health issues in children and adolescents who have experienced complex trauma. She has been active in public psychiatry innovation since the early 1990s, when she founded and led NYC’s first mental health clinic serving children and families affected by HIV. Dr. Havens serves on numerous public sector committees and is active is many of New York State’s major child mental health initiatives.

Dr. Havens will review the growth in knowledge and evidenced based treatments in child and adolescent psychiatry over the last 30 years, as well as the challenges the field has experienced in integrating the effects of trauma exposure into current diagnostic and treatment formulation; will explicate the history of financing of behavioral health services and its impact on our current capacity to address the mental health needs of children and families and will review potential solutions for increasing access to mental health services for children and families, with emphasis on early intervention and enhanced secondary prevention strategies.

 Outline:

1. Progress
   1. Growth of Knowledge
   2. Development of Evidence-Based Practice
   3. Diagnostic and Treatment Confusion in Traumatized Youth
2. Challenges
   1. Steady increases in child and adolescent mental health burden
   2. Failed business model for fiscal support of mental health services
3. Solutions
   1. Transformation of perinatal care models to support healthy development
   2. Investing in Child and Family Mental Health Services
   3. Implementing Effective Secondary Prevention
   4. Advocacy – A New York State Case Study

At the end of this session, the learner will be able to:

• Describe the growth in knowledge and evidenced based treatments in child and adolescent psychiatry over the last 30 years, as well as the challenges the field has experienced in integrating the effects of trauma exposure into current diagnostic and treatment formulation
• Appreciate the history of financing of behavioral health services and its impact on our current capacity to address the mental health needs of children and families
• List potential solutions for increasing access to mental health services for children and families, with emphasis on early intervention and enhanced secondary prevention strategies

Long-term Goals:

• More systemic integration of trauma-informed care within child and family mental health services.
• More effective ambulatory mental health and wrap around services that reach children and families as early as possible.
• More effective secondary prevention services that reach children and families as early as possible.

Recommended Readings:

1. Havens JF, Marr M, Hirsch E. Editorial: From Bipolar Disorder to DMDD: Challenges to Diagnostic and Treatment Specificity in Traumatized Youths. Journal of American Academy of Child Adolescent Psychiatry. 2021 Aug 4; S0890-8567(21)00485-8. doi:10.1016/j.jaac.2021.07.012.
2. 2. Kimberly Eaton Hoagwood, Ph.D., Shira Richards-Rachlin, B.S., Meaghan Baier, L.M.S.W., et al. Implementation Feasibility and Hidden Costs of Statewide Scaling of Evidence-Based Therapies for Children and Adolescents. Psychiatric Services 2024; 75:5, 461-469.
3. 3. McCord, M, Fierman A, Sisco S, Canfield C, et al. A Two-Generation, Early Childhood Advanced Primary Care Model. American Academy of Pediatrics, 2024 Mar 6:e2023062567. doi: 10.1542/peds.2023-062567.

Presented by:

Cathy Creswell, Ph.D., Professor of Developmental Psychology, University of Oxford

Participants earn 1 continuing education credit

Categories: Child/Adolescent Anxiety, Parenting/Families, Technology/Digital Health

Keywords: Anxiety, Child, Early Intervention

Basic to moderate level of familiarity with the material.

Cathy Creswell is Professor of Developmental Clinical Psychology at the University of Oxford, an Honorary Consultant Clinical Psychologist in Oxford Health NHS Foundation Trust, an NIHR Senior Investigator and a Fellow of the Academy of Medical Sciences. She leads The Oxford Psychological Interventions in Children and adolescents (TOPIC) research group which aims to improve outcomes from and access to psychological therapies for common mental health problems in children and young people. Her research particularly focuses on the development, maintenance and treatment of anxiety disorders in children.

Across the world demand for effective mental health care, and evidence-based psychological therapies in particular, far exceeds the available supply. Digitally augmented approaches provide a potential mechanism to increase the efficiency of CBT delivery but it is critical that we do this without compromising accessibility, engagement and outcomes. In keeping with the convention focus on opening our doors through innovation to advance CBT, this talk will draw on examples from a programme of mixed method studies to develop, evaluate, and implement digitally-augmented treatment in which parents are supported to help their children overcome anxiety problems.

Throughout the talk I will illustrate the potential of digitally augmented approaches, the challenges that they present (in particular in relation to implementation in routine practice) and how we have overcome them so far. While the focus will be on treatments for anxiety in the child mental health settings, the lessons learned will be widely applicable to practitioners in, and researchers focused on, any mental health setting where demand outstrips supply.

Outline:

• Introduction:
  • Overview of digital transformation in child mental health
  • The need to balance efficiency with accessibility, engagement, and outcomes
• Benefits of Digitally Augmented CBT:
  • Enhancing access to therapy
  • Improving efficiency without compromising treatment quality
• Challenges of Implementation:
  • Barriers in routine practice (clinics, schools)
  • Addressing accessibility and engagement
• Research Findings:
  • Mixed method studies
  • Case examples of success and lessons learned
• Future Directions:
  • Application of findings across different mental health settings

At the end of this session, the learner will be able to:

• Explain key benefits of integrated digitally augmented treatment approaches into routine mental health care settings
• Identify potential barriers and facilitators for successful implementation of digitally augmented psychological therapies (through clinics and schools)
• Describe examples of successful implementation

Long-term Goals:

• Participants will learn ways to integrate digitally augmented treatment approaches to increase access to psychological therapies while maintaining treatment efficacy and engagement.

Recommended Readings:

Hill, C., Reardon, T., Taylor, L., & Creswell, C. (2022). Online Support and Intervention for Child Anxiety (OSI): development and usability testing. JMIR Formative Research, 6(4), e29846.
https://formative.jmir.org/2022/4/e29846/

Creswell, C., Taylor, L., Giles, S., Howitt, S., Radley, L., Whitaker, E., … & Yu, L. M. (2024). Digitally augmented, parent-led CBT versus treatment as usual for child anxiety problems in child mental health services in England and Northern Ireland: a pragmatic, non-inferiority, clinical effectiveness and cost-effectiveness randomised controlled trial. The Lancet Psychiatry, 11(3), 193-209.
https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(23)00429-7.pdf

Creswell, C., Chessell, C., & Halliday, G. (2023). Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment. Behavioural and cognitive psychotherapy, 51(6), 512-532.
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/95E025DF1C39213BC65DE31C117DBE55/S1352465822000546a.pdf/parentled_cognitive_behaviour_therapy_for_child_anxiety_problems_overcoming_challenges_to_increase_access_to_effective_treatment.pdf