Tag Archive for: behavioral health
Expanding access to pediatric mental health care: Q&A with Justine Larson, MD
In this interview, Dr. Larson shares her journey into pediatric psychiatry, her passion for increasing access to mental health care and her goals for advancing services at Children’s National.
Justine Larson, MD, recently joined Children’s National Hospital as the new associate chief of Psychiatry and Behavioral Sciences. A board-certified psychiatrist specializing in child and adolescent mental health, Dr. Larson has extensive experience in clinical practice, research and policy development. Her work focuses on improving systems of care, integrating behavioral health and expanding mental health services for vulnerable populations.
In this interview, Dr. Larson shares her journey into pediatric psychiatry, her passion for increasing access to mental health care and her goals for advancing services at Children’s National.
Q: Why did you choose Children’s National?
A: I chose Children’s National because I see an incredible opportunity to provide high-quality behavioral healthcare to children, especially in the DMV. A big part of my career and passion revolves around increasing access to care for underserved children. Children’s National offers a platform where I can make a significant impact, especially given its potential to create a broad footprint in this crucial area — that was the primary reason behind my decision.
Q: How did you decide to pursue a career in pediatric psychiatry?
A: I initially thought I would pursue OB/GYN because I was drawn to the field’s focus on women’s advocacy, but I realized I wanted to develop deep, long-term relationships with my patients. Psychiatry allowed me to do that, as it offers a unique combination of sociocultural, philosophical, psychological and biological variables, variables that interact in ways I find fascinating.
Additionally, my connection to children’s health was solidified years ago when my son, now 16, was hospitalized at Children’s National for 10 days as an infant. He had RSV and was in the ICU, and I’ve always felt that Children National saved his life. That positive association with the hospital played a role in my decision as well.
Q: What are some of your goals while serving as associate chief of psychiatry at Children’s?
A: One of my primary goals is to explore and implement alternative models of care that can help more children access mental health services. With the nationwide shortage of mental health providers, particularly pediatric psychiatrists and therapists, it’s crucial to think outside the box. I’m particularly interested in developing care models that provide services in pediatric settings or schools. Increasing access to care is at the core of my focus and interest as I work toward making these services more available to those in need.
Q: How do you spend your free time when you aren’t at the hospital or with patients?
A: Outside of work, I spend a lot of time with my family. I have three children — an 18-year-old, a 16-year-old and a 7-year-old — and a Great Pyrenees dog. My son, the one who was hospitalized as a baby, is really passionate about music. He plays guitar and piano, and I love supporting him by attending his shows and encouraging his musical journey. My oldest son is passionate about the outdoors and dreams of becoming a park ranger, so he often drags the family on hiking and camping trips, which I thoroughly enjoy. My littlest one loves nature and reading. My husband is a health economist, but we try not to talk shop too much!
Mindfulness-based interventions boost teens with Type 1 diabetes
A team of experts at Children’s National Hospital, using the input of teens with Type 1 diabetes from our Children’s National clinics, adapted a six-week virtual group diabetes education program and mindfulness-based intervention. In their new study published in Journal of Pediatric Psychology, the team described how the intervention might work to support teens with Type 1 diabetes experiencing anxiety or depression.
The findings showed that both the mindfulness-based intervention and the diabetes education program were successfully implemented and valued by the participating teens. While the study was limited in scope, focusing primarily on assessing the programs’ acceptance and perceived value among adolescents, preliminary results suggest participation in the programs may also contribute to improvements in mood, diabetes-related distress and glycemic control.
Molly Basch, Ph.D., and Eleanor Mackey, Ph.D., both psychologists and authors of the study, shared more about their learnings.
Q: What’s been the hold-up in the field?
A: Many adolescents with Type 1 diabetes experience symptoms of anxiety and depression, yet it can be hard to access care to relieve some of these symptoms. Group-based, brief virtual care may be a way to provide more access to necessary support. Testing whether such programs are desired and useful by teens and their families, and whether they show promise for improving symptoms of depression and anxiety, is an important step in addressing this gap in care.
Q: How does this work move the field forward?
A: This study helped us to use the input of the teens we hope to serve to create and adapt programs that they were enthusiastic about and test them to see if they were helpful. We used these findings to obtain a second grant from the National Institutes of Health to do a larger scale study to see whether these programs help with depression, anxiety, eating, stress and diabetes management.
Q: What’s the goal and how will this work benefit patients?
A: Our ultimate goal is to create easy to access programs which help improve anxiety, depression and diabetes management in teens with Type 1 diabetes. We are trying to ensure that these programs are feasible and accessible and could be translated into our clinics if they prove to be beneficial. We hope to improve the ways we identify teens experiencing anxiety and depression and provide them the option for this brief group-based care in our clinics.
Q: What did you find that excites you and what’s next?
A: We were very excited to find that teens were interested in enrolling in these programs and found them useful. We were also excited to see that our very preliminary data indicates that mindfulness-based interventions may improve depression and even possibly glycemic control.
Children’s National is the first institution that we know of to use teen feedback to adapt a mindfulness-based intervention specific to teens with Type 1 diabetes. Our team is now preparing to embark on a five-year project in collaboration with the Barbara Davis Center in Colorado to evaluate the effectiveness of these programs with a larger group of teens.
Additional authors from Children’s National include: Katherine Patterson Kelly, Ph.D., R.N.; Randi Streisand, Professor, Ph.D., CDCES; and Jack Vagadori.
Pilot program improves well-being of families during advanced care planning
Children with life-limiting rare diseases and their caregivers face tremendous stress and anxiety about the heart-breaking decisions before them. A new intervention – designed at Children’s National Hospital to support the palliative needs of these families – improved their spiritual and emotional well-being, according to new research published in the journal, Pediatrics.
Called FACE Rare (FAmily CEntered Pediatric Advance Care Planning Intervention for Rare Diseases), the counseling tools were found to be safe, effective and increased feelings of peace among families in this underserved population.
“Seventy-four percent of the families in that intervention group reported feelings of sadness, yet 100% reported our pilot intervention was a worthwhile experience,” said Maureen Lyon, Ph.D., a clinical psychologist and principal investigator at the Center for Translational Research at Children’s National. “If you’re talking about the possibility that the worst thing in the world would happen to you – that your child might die, and what you would want for them – the families found that our intervention helped. They had a place to process their feelings and consider what would be important to their child.”
The big picture
A rare disease is defined as any condition affecting fewer than 200,000 people in the United States. In pediatrics, these diseases often require constant caregiving and require families to face the cruel reality that the diagnosis may be life-limiting. In such cases, clinical teams often decide that conversations about advanced care planning (ACP) are needed.
The pilot-phase, randomized trial enrolled patients from Children’s National between 2021 and 2023. Research nurses underwent two days of training to be certified in the new intervention. Families assigned to the new approach received three, weekly 60-minute sessions and were evaluated using evidence-based assessment tools, including the Carer Support Needs Assessment Tool/Action Plan and the Next Steps: Respecting Choices Pediatric ACP Conversation. Measures of anxiety and spiritualization were tracked, and families returned after three months for follow-up.
Patients had a range of diagnoses that put tremendous strain on the caregivers, including complex digestive disorders, white-matter diseases and rare forms of epilepsy. Yet the caregivers expressed similar challenges: having time for themselves during the day, knowing what to expect in the future for their child’s care, and managing financial, legal and work issues.
What we found
Reinforcing the need to improve engagement and support for these families, the investigative team found that those who received the FACE Rare intervention reported higher levels of spiritual meaning and peace than those who received “treatment as usual.” All families living below the poverty line reported greater anxiety, and noteworthy to the team, black caregivers were less likely to report caregiver distress than non-black caregivers.
Dr. Lyon said future research needs to understand better how families respond to the challenges of rare diseases and unique social determinants of health that can change the approach to care.
“In some cultures, and families, having strong feelings is discouraged,” Dr. Lyon said. “We want to give families and caregivers space to have these emotions and think about what would be important for their child, if the worst were to happen. They appreciated that they participated in the program and had the space to consider these difficult questions.”
Read the full study, “Advance Care Planning for Children with Rare Diseases: A Pilot RCT,” in Pediatrics.
Changing the game in pediatric psychopharmacology
“I realized adequate treatment in youth can prevent many of the harmful outcomes in adults who were never treated properly for their symptoms,” says Adelaide Robb, M.D.
Over three decades ago, Adelaide Robb, M.D., sat in her office with a clear goal in mind: follow a career in adult psychiatry. Her patients displayed all sorts of symptoms: generalized anxiety, depression, bipolar disorder, autism, schizophrenia.
“In the early 1990s, my patients would tell me other doctors didn’t believe in their children having bipolar disorder,” she says.
These adult patients had been sick for 5, 10 and even 15 years but had not been diagnosed or treated properly. Eventually, they started bringing their children with them, who also had similar symptoms.
“I realized adequate treatment in youth can prevent many of the harmful outcomes in adults who were never treated properly for their symptoms,” Dr. Robb says.
She soon came to another realization: there was a massive gap in the health care world – pediatric psychopharmacology. She felt the need to bridge this gap and help children, motivating her to change the course of her career. Since joining Children’s National Hospital in 1994, she’s been an unstoppable force in the pediatric psychopharmacology world, quickly changing the rules of the game.
The big picture
Pediatricians in the United States continue to grapple with a mental health crisis that was exacerbated by the COVID-19 pandemic and declared a national emergency in 2021.
Mental health plays a key role in a child’s mental, emotional and behavioral well-being. It affects the way they think, feel and act while also impacting how they handle stress, relate to their peers and make choices.
According to the Centers for Disease Control and Prevention, attention deficit hyperactivity disorder (ADHD), anxiety, behavior problems and depression are the most commonly diagnosed mental health disorders in children. While available treatments vary, over the years, data has proven how medications can play a role in improving most mental health conditions.
Children’s National leads the way
For decades, Dr. Robb has led research focused on pediatric psychopharmacology with more than 80 clinical trials. Children’s National is one of only a few sites nationwide to participate in federally funded mental health clinical trials. Major trials she has led include:
- Lexapro for major depression in youth
- Prozac for obsessive compulsive disorder
- Abilify for pediatric bipolar and schizophrenia
- Latuda for pediatric bipolar depression
- Concerta for ADHD
Dr. Robb also co-chaired the American Academy of Child and Adolescent Psychiatry’s Pediatric Psychopharmacology Initiative Committee for more than 8 years. She has also been active for more than 15 years in the American Academy of Pediatrics Committee on drugs (pharmacology).
“Since its inception in the ‘90s, pediatric psychopharmacology has changed in two major ways: First, we started to do regular testing of new medications in children and not just adults. Second, there’s been congressional and FDA mandates for testing of all medications that can be used in kids,” says Dr. Robb. “It’s no longer a guessing game – we have an evidence-based approach to children with mental illness using psychopharmacology.”
Currently, Dr. Robb is the principal investigator on several open clinical trials at Children’s National, including a study that compares the effectiveness of treating a parent with ADHD medication plus behavioral parent training (BPT) versus BPT alone on their child’s ADHD related symptoms.
Moving the field forward
Earlier this year, Dr. Robb moderated a panel on mental health and precision genomics which touched on what we know about depression, anxiety and other disorders and the future of pediatric behavioral health care.
“The goal is to give people with depression and other mental health illnesses the opportunity to go to school and function, whether they have depression, ADHD or any other disorder. This can make a huge difference in someone’s life,” Dr. Robb says.
Children’s National is uniquely positioned with a dedicated pharmacokinetic clinical team – which has greatly aided its ADHD and Learning Differences Program and most recent Addictions Program.
“We changed how ADHD was treated because our patients had early access to new trialed drugs,” says Dr. Robb. “This makes a big difference and gives children the opportunity to have better control of their symptoms so they’re paying attention and learning in school.”
Read more about our advances in Behavioral Health.
New intervention program can help children with food allergies
Kids with food allergies can experience stress related to daily food allergy management.
Adolescence is a challenging developmental period associated with risky food allergy behaviors. Kids with food allergies can experience stress related to daily food allergy management. In fact, some kids report that they have anxiety about allergic reactions and get bullied for their allergies.
The big picture
In a new study published in the Annals of Allergy, Asthma and Immunology, a team of experts developed the Food Allergy Mastery Program (FAM), a six-session telehealth program led by a counselor that promotes food allergy self-management and adjustment for youth ages 10-14 years.
“We then conducted focus groups with families in our food allergy clinic to get their opinions on the program, made changes and conducted a pilot study with additional food allergy families,” said Linda Herbert, Ph.D., director of Psychology Research and Clinical Services for Allergy and Immunology and psychologist at Children’s National Hospital and author of the study. “When we compared kids’ food allergy knowledge, self-efficacy and social support before and after completing the FAM Program, we saw improvements in food allergy knowledge, greater self-efficacy and more social support after the program.”
What’s been the hold-up in the field?
To date, there are no behavioral interventions that promote food allergy self-management and adjustment for youth. However, Herbert said such an intervention is critically needed because adolescence is a higher-risk period for allergic reactions.
“Adolescents are typically diagnosed when they are young and may not have sufficient food allergy knowledge about how to engage in food allergy self-management,” Herbert said.
They also spend an increasingly greater amount of time with peers, so they are more responsible for their food allergy, she added.
What’s exciting about the findings?
Youth who completed all six sessions rated the FAM Program as relevant and enjoyable on the post-program evaluation. They also reported having better knowledge related to allergen avoidance, allergic reaction symptom recognition and allergic reaction treatment.
“The FAM Program is a promising intervention for youth with food allergies,” the authors wrote.
What’s next?
From here, the team is conducting a large-scale randomized clinical trial to fully evaluate the FAM Program’s impact on kids funded by the National Institute of Allergy and Infectious Diseases. This trial is evaluating the impact of the FAM Program on primary outcomes of interest, such as food allergy knowledge, skills, behavior and psychosocial functioning, and distal outcomes of interest, such as healthcare utilization.
TikTok could be causing rising cases of tic-like behaviors
Many teenagers who viewed a high number of Tourette syndrome TikTok videos during the COVID-19 pandemic started portraying similar tic-like behaviors.
The impact of social media on children is once again front and center. During the pandemic, experts noticed the increase in functional tic-like disorders and suggested an association with the rise in popularity of social media videos on TikTok. Many teenagers who viewed a high number of Tourette syndrome (TS) TikTok videos during the COVID-19 pandemic portrayed similar tic-like behaviors.
In a new study published in Pediatric Neurology, experts analyzed the 100 most-viewed videos under #tourettes on the media platform. The authors found the symptoms portrayed as TS on viewed TikTok videos are an inaccurate representation of TS and are more consistent with functional tic-like behaviors.
“Tourette syndrome symptoms portrayals on highly-viewed TikTok videos are predominantly not representative or typical of Tourette syndrome,” says Alonso Zea Vera, M.D., neurologist at Children’s National Hospital and lead author of the study.
“Although many videos are aimed at increasing Tourette syndrome awareness, I worry that some features of these videos can result in confusion and further stigmatization,” Dr. Zea Vera says. “A common cause of stigmatization in Tourette syndrome is the exaggeration of coprolalia (cursing tics) in the media. We found that many videos portrayed this (often used for a comedic effect) despite being a relatively rare symptom in Tourette syndrome.”
There have been recent discussions about the accuracy of current social media videos of TS. This study highlights the importance of mentioning the source of the medical information and providing guidance. Children’s National has one of the largest movement disorders teams in the U.S. that is trained to differentiate TS from functional tic-like disorders.
“This differentiation can be challenging but important since the treatment is different,” Dr. Zea Vera adds. “Both of these conditions can be very impairing for patients.”
You can read the full study ‘The phenomenology of tics and tic-like behavior in TikTok” here.
Randi Streisand, Ph.D., appointed Chief of Psychology and Behavioral Health at Children’s National Health System
Children’s National Health System announces that Randi Streisand, Ph.D., will become the chief of Psychology and Behavioral Health within the Center for Neuroscience and Behavioral Medicine. Dr. Streisand is a behavioral scientist, child health researcher and certified diabetes educator. She is a tenured professor of Psychology and Behavioral Health, and Pediatrics at The George Washington University School of Medicine and Health Sciences, and serves as the director of Psychology Research for Children’s National Health System.
“Dr. Streisand’s acceptance of this leadership position will play an integral role in our approach to improve research methods and providing comprehensive approaches to psychological treatments” says Roger J. Packer, M.D., senior vice president of the Center for Neuroscience and Behavioral Medicine.
As chief, Dr. Streisand will lead our team of nationally recognized educators, research leaders and specialists who are experts in the care of children and teens with emotional and behavioral disorders. She will also continue to lead an extensive research portfolio, focusing on parent-child adjustment to chronic disease, behavioral interventions to prevent and control disease and treatment complications and adherence to pediatric medical regimens.
Before joining the faculty at Children’s National in 2000, Dr. Streisand received her doctorate in clinical psychology from the University of Florida, completed her internship at Brown University and a fellowship at the Children’s Hospital of Philadelphia. She has written numerous publications in the areas of child health and serves on several grant review committees through Children’s National, NIH and the American Diabetes Association. At Children’s National, she is an active participant in the psychology training program, and mentors undergraduates, graduate students, interns, fellows and junior faculty members.
Using text messages and telemedicine to improve diabetes self-management
Maureen Monaghan, Ph.D., C.D.E., clinical psychologist and certified diabetes educator in the Childhood and Adolescent Diabetes Program at Children’s National Health System, awarded nearly $1.6 million grant from American Diabetes Association.
Adolescents and young adults ages 17-22 with Type 1 diabetes are at high risk for negative health outcomes. If fact, some studies show that less than 20 percent of patients in this population meet targets for glycemic control, and visits to the Emergency Department for acute complications like diabetic ketoacidosis peak around the same age.
The American Diabetes Association (ADA) awarded Maureen Monaghan, Ph.D., C.D.E., clinical psychologist and certified diabetes educator in the Childhood and Adolescent Diabetes Program at Children’s National Health System, nearly $1.6 million to evaluate an innovative behavioral intervention to improve patient-provider communication, teach and help patients maintain self-care and self-advocacy skills and ultimately prepare young adults for transition into adult diabetes care, limiting the negative adverse outcomes that are commonly seen in adulthood.
Dr. Monaghan is the first psychologist funded through the ADA’s Pathway to Stop Diabetes program, which awards six annual research grants designed to spur breakthroughs in fundamental diabetes science, technology, diabetes care and potential cures. Dr. Monaghan received the Accelerator Award, given to diabetes researchers early in their careers, which will assist her in leading a behavioral science project titled, “Improving Health Communication During the Transition from Pediatric to Adult Diabetes Care.”
“Behavior is such a key component in diabetes care, and it’s wonderful that the American Diabetes Association is invested in promoting healthy behaviors,” says Dr. Monaghan. “I’m excited to address psychosocial complications of diabetes and take a closer look at how supporting positive health behavior during adolescence and young adulthood can lead to a reduction in medical complications down the road.”
During the five year study, Dr. Monaghan will recruit patients ages 17-22 and follow their care at Children’s National through their first visit with an adult endocrinologist. Her team will assess participants’ ability to communicate with providers, including their willingness to disclose diabetes-related concerns, share potentially risky behaviors like drinking alcohol and take proactive steps to monitor and regularly review glucose data.
“The period of transition from pediatric to adult diabetes care represents a particularly risky time. Patients are going through major life changes, such as starting new jobs, attending college, moving out of their parents’ homes and ultimately managing care more independently,” says Dr. Monaghan. “Behavioral intervention can be effective at any age, but we are hopeful that we can substantially help youth during this time of transition when they are losing many of their safety nets.”
Study leaders will help participants download glucose device management tools onto their smartphones and explain how to upload information from patients’ diabetes devices into the system. Participants will then learn how to review the data and quickly spot issues for intervention or follow-up with their health care provider.
Patients also will participate in behavioral telemedicine visits from the convenience of their own homes, and receive text messages giving them reminders about self-care and educational information, such as “Going out with your friends tonight? Make sure you check your glucose level before you drive.”
At the study’s conclusion, Dr. Monaghan anticipates seeing improvements in psychosocial indicators, mood and transition readiness, as well as improved diabetes self-management and engagement in adult medicine.
