On Demand Grand Rounds: Thinking about Prescribing: What the Therapeutic Alliance, Evidence-based Psychotherapy and Relational Principles Teach Us about Psychopharmacology with Diverse Youth and Families

This presentation was originally reviewed on December 13, 2023, and broadcast live online on December 13, 2023, from 12:00 PM – 1:00 PM ET. 

The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.

This presentation will explore the relational aspects of psychopharmacological work with youth and families. While technical and scientific knowledge can be taught and examined during medical education, the therapeutic skills also known as “nonspecific” treatment factors or “common factors” are more elusive and harder to describe.

Differences in culture between the prescriber and the patient often lead to differing perspectives and, if not explored, can interfere with the treatment alliance and subsequently with treatment adherence and/or resistance. Cultural concordance is crucial to teach physicians how to appreciate the cultural background unique to each patient in a way that values and honors our similarities and our differences. In keeping with the adage, The formulation must always precede the prescription, recent work has highlighted the use of the DSM-5 Cultural Formulation Interview as an important tool to more fully understand a young person in the context of their daily life, as part of comprehensive treatment planning.

We propose that the term ‘med check’ is not only a misnomer that simply doesn’t exist in child and adolescent psychiatric treatment (as if the patient just comes to us wanting to ‘talk about their meds’), but more importantly it is a disservice to the nature and intention of our work with youth and families. For such time-limited visits where the medication issues are a primary focus, we propose the term, ‘brief pharmacotherapy visits’, which allows us to retain our role as therapists (as an inextricable part of psychopharmacology). An effective pharmacotherapy appointment necessitates the appreciation of many things that inform treatment, and thus pharmacotherapy decisions, including the intricacies of an individual’s culturally informed, biopsychosocial story. It has consistently been shown that strong therapeutic alliances between a patient and their mental health provider, as well as empathy demonstrated by the latter, lead to more positive clinical and functional outcomes- and thus to the primary goal of evaluating and promoting mental health and well-being.

Target Audience

This activity is intended for physicians, nurses, psychologists, social workers and other mental health professionals. 

Learning Objectives

At the conclusion of this activity, attendees will be able to:

    • Describe the essential features of the Y-model of psychotherapy and how relational aspects of pharmacotherapy are key to child & adolescent psychiatric practice, even for brief visits. 
    • Identify techniques, adapted from evidence-based psychotherapies, to enhance medication adherence in diverse youth populations. 
    • List strategies to cultivate a pharmacotherapeutic alliance when engaging with patients and families via telehealth, including in the school setting. 
    • Define how to best utilize the 30-minute Brief Pharmacotherapy Visit (BPV), so that the alliance is nurtured and time is most efficiently utilized. 
    Course summary
    Available credit: 
    • 1.00 AMA PRA Category 1 Credit™
    • 1.00 Category II credits for Social Workers
    • 1.00 Psychologists
    • 1.00 MNA Contact Hours for Nurses
    • 1.00 Participation
    Course opens: 
    01/12/2024
    Course expires: 
    01/09/2026

    Sheppard Pratt’s Professional Education Program is pleased to provide Wednesdays at Sheppard Pratt free of charge as a public service to the mental health community.  Your tax-deductible donations will help maintain the outstanding quality of this service. 

    Sheppard Pratt is dedicated to improving quality of life through mental health, special education, and addiction services for children, adolescents, adults and older adults.  Our patient-centered treatment approach, combined with our legacy of clinical excellence, sets us apart from other health systems on both a local and national level.  We have been ranked among the nation’s top psychiatric hospitals for 24 consecutive years by U. S. News & World Report.  Founded in 1853 by philanthropist Moses Sheppard, Sheppard Pratt Health System still abides by its Quaker traditions and values.

    Sheppard Pratt regularly hosts renowned speakers from across the country at our headquarters in Towson. We provide educational opportunities on subjects including psychiatric disorders, issues of behavioral health, systems-based change, mental and somatic co-morbidities, psychiatric effects on health and health outcomes, advances in neurobiology, and clinical developments in concepts underlying drug treatment of psychiatric disorders. We are accredited by the Accreditation Council of Continuing Medical Education, the Maryland Nurses’ Association, the Maryland Board of Psychology, the Maryland Board of Social Work, and the National Board of Certified Counselors.

    Please send your contributions to:

    Sheppard Pratt Professional Education Program
    Grand Rounds Fund
    6501 North Charles Street, Baltimore, Maryland 21204

    Professional Education Program: 410.938.4593
    Conference Center at Sheppard Pratt: 410.938.3900

    There is no commercial support for this activity.

    About the speaker

    Dr. Shashank Joshi is Professor and Director of Training in Pediatrics, General Psychiatry and Child & Adolescent Psychiatry at the Stanford University School of Medicine. He also serves as Director of School Mental Health at Lucile Packard Children’s Hospital Stanford and Senior Associate Vice Provost for Academic Wellbeing at Stanford University.

    He is a Distinguished Fellow of the American Academy of Child & Adolescent Psychiatry (AACAP) and a member of the Student Mental Health Policy Workgroup for the State of California. He serves on the advisory boards of the Jed Foundation and the National Center on School Mental Health.

    Dr. Joshi's publications focus on interprofessional collaboration, cultural aspects of pediatric health, wellbeing promotion in youth and young adults, and suicide prevention in school settings. He is the lead author of the K12 Toolkit for Mental Health Promotion and Suicide Prevention used by the California Department of Education. His current book, Thinking About Prescribing: The Psychology of Psychopharmacology with Diverse Youth & Families (American Psychiatric Press 2022), examines the relational and psychotherapeutic aspects of medication treatment.

    Disclosure Statements

    Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she has with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt, and if there will be discussion of any products, services, or off-label uses of product(s) during this presentation.

    Shashank V. Joshi, MD, FAAP, DFAACAP, reports receiving royalties from APA Publishing during the last 24 months.  He will not discuss any products, services, or off-label uses in this presentation.

    Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months: Todd Peters, MD, Deepak Prabhakar, MD, Elizabeth Ryznar, MD, MSc, Louis Marino, MD, Ehsan Syed, MD, Devi Bhuyan, PhD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Stacey Garnett, RN, MSN, Stephanie M. Robinson, MSN, RN, PMH-BC, NPD-BC, NE-BC , Heather Billings, RN, Lisa Illum, MLIS, MEd, and Jennifer Tornabene.

    Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity.  Sheppard Pratt designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.0 contact hours for nurses.

    Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity.  Sheppard Pratt designates this educational activity for a maximum of 1.0 contact hours for Psychologists.

    Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. This activity is approved for 1.0 contact hours in Category II credits for Social Workers.

    Counselor Statement:  No NBCC Credit Available.

    Available Credit

    • 1.00 AMA PRA Category 1 Credit™
    • 1.00 Category II credits for Social Workers
    • 1.00 Psychologists
    • 1.00 MNA Contact Hours for Nurses
    • 1.00 Participation
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    ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME

    Grand Rounds: Thinking about Prescribing: What the Therapeutic Alliance, Evidence-based Psychotherapy and Relational Principles Teach Us  about Psychopharmacology with Diverse Youth and Families

    Shashank V. Joshi, MD, FAAP, DFAACAP

    Professor of Psychiatry, Pediatrics, and Education, Stanford University School of Medicine

    Senior Associate Vice Provost for Academic Wellbeing, Stanford University

    Director of School Mental Health Services, Lucile Packard Children's Hospital Stanford

    Stanford, CA

    Originally reviewed December 13, 2023.
    Originally broadcast live December 13, 2023, from 12:00 PM – 1:00 PM ET
    Enduring Activity Credit Expiration Date: January 9, 2026.

    Activity Time: One hour webinar lecture with a 15-minute evaluation process. Total Time: 1:15.

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    After the video follow the prompts to complete the posttest, evaluation and attestation of credit. 
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