“We need our own clinics”: Adolescents’ living with HIV recommendations for a responsive health system

Adolescents living with HIV comprise a significant patient population in sub Saharan Africa but are poorly retained in care with consequent increased mortality and morbidity. We conducted in-depth interviews with 25 adolescents living with HIV engaged in care from five clinics in Johannesburg regarding their recommendations for the healthcare system. Findings included advocating for adolescent clinics, recognizing the importance of clinic-based support groups, valuing the influence lay counselors have in providing healthcare to adolescents, improving widespread education of vertical HIV transmission and meaningfully linking clinics to the community. Our study offers guidance to the differentiated care model recommended for adolescent treatment highlighting that a positive youth development approach and use of lay and peer counselors may act as cornerstones of this model. Serving the mental health needs of adolescents living with HIV in a responsive manner may strengthen their use of the system and elevate it to a source of resilience.

Intervenções para casos de crianças e adolescentes com mutismo seletivo

O objetivo do presente artigo é apresentar uma revisão integrativa de literatura com vistas à identificação dos tratamentos psicoterapêuticos, farmacológicos ou que utilizaram a comunicação alternativa como intervenção para os casos de crianças com mutismo seletivo. Para este fim, considerou-se o levantamento bibliográfico em base de dados virtuais como método de análise. Foram selecionados os descritores nas versões português e inglês (“mutismo seletivo”, “crianças”, “adolescente”, “tratamento”, “intervenção”, “escola”, “comunicação alternativa e ampliada”, “selective mutism”, “children”, “adolescent”, “treatment”, “intervention”, “augumentative and alternative communication”) e utilizados, isoladamente ou combinados entre si, por meio do operador boleano “and” de acordo com a particularidade de cada base de dados. Como resultado, foram identificados 27 estudos, entre eles: artigos na íntegra, teses, dissertações publicadas em português e inglês nas bases de dados Google Acadêmico, ERIC, PubMed, Scielo, Web of Science, bibliotecas virtuais de universidades públicas nacionais e uma biblioteca virtual de uma universidade americana. Para a seleção final dos estudos foram definidos parâmetros de inclusão, conforme os três itens a seguir: a) estudos empíricos que mostrassem efeitos de intervenções, publicados entre os anos de 2006 a 2017; b) participantes com até 18 anos de idade e com o diagnóstico de mutismo seletivo, de acordo com os critérios do DSM 4 e 5; c) intervenções psicoterapêuticas, farmacológicas ou que utilizassem a comunicação alternativa. Foram excluídas as publicações que não atendessem aos critérios acima. Concluiu-se que intervenção terapêutica predominantemente utilizada é a cognitiva comportamental, sem indicar um tempo de intervenção específico.

The Psychoanalytic-Interactional Method (PiM) for Adolescents with Borderline Personality Disorder

Background: Studies have shown the practicality of diagnosing borderline personality disorder (BPD) in children from the age of 12 years (cf. ICD-11, DSM-5). Research in the psychodynamic therapy of adolescents with BPD has been rare to date, however, there do exist some studies on the efficacy and effectiveness of psychodynamic therapy in adults with borderline personality disorder. Methods: We adapted the psychoanalytic-interactional method (PiM), originally developed in the treatment of severely disturbed adults, to the conditions of adolescents diagnosed with borderline personality disorder or structural deficits. Randomized controlled trial in an inpatient setting (Salzer et al., 2013; Salzer et al., 2014) showed that PIM is efficacious for adolescents with BPD symptoms. We describe the approach to treatment in detail. Results: The results of the therapeutic study and the short case vignette show that PiM is a useful method in both inpatient and outpatient treatment and meets the specific requirements of adolescent treatment.

Rapid design and deployment of intensive outpatient, group-based psychiatric care using telehealth during coronavirus disease 2019 (COVID-19)

COVID-19 has demanded unprecedented actions in the delivery of outpatient psychiatric services, including the rapid shift of services from in-person to telehealth in response to public health physical distancing guidelines. One such shift was to convert group-level intensive outpatient psychiatric (IOP) interventions to telehealth. Historically, telehealth in psychiatric care has been studied in provider-patient interactions, but has not been as well studied for group telehealth service delivery. During the COVID-19 outbreak, providing group-based interventions was important in order to care for high-risk individuals who needed structured psychotherapy group support. However, the delivery of services via telehealth led to special challenges that were unable to be fully accommodated by the preexisting telehealth infrastructure. Rapid feasibility testing and adoption of technology was needed to support IOP services to minimize infectious spread while delivering group services to high-risk psychiatric patients. This article describes the processes and workflows for service delivery and early results of telehealth for IOP services in 2 adolescent treatment programs. In addition, the article highlights early observations around safety and quality and the role of telehealth policy and payment.