Psychiatrist

Volume 39, Number 1

When writing our personal statements to get into medical school and residency, most of us cite connection with others and a desire to help on an individual and community basis as the reason we are drawn to this field. Approaching these patients, whose needs are more social in nature, with this desire to connect and help would better align with our goals of becoming physicians. People who are unhoused, unemployed and Black are more likely to be labeled as "malingering" than other populations, and people previously given this label are more likely to be discharged from a hospital on subsequent presentation (Park et al., 2021). The most common reason for "malingering" is often unmet clinical needs. Changing our terminology and directing our anger towards the system as opposed to the patient may help shift the culture in medicine. Trainees approaching our broken system with compassion, empathy and humility are going to be better equipped to provide accessible, appropriate care for our patients. We will be more passionate about lobbying for funding for housing resources, substance use treatment and comprehensive outpatient support and quicker to engage with the communities we serve to understand the unique struggles they encounter. Inpatient psychiatric hospitalization may not be indicated for someone whose main concern is lack of housing. When I hear people using denigrating or insensitive language, I speak up and try to rephrase what they are saying in hopes that it will help combat this culture of “catching malingerers.”

Spring 2023

Volume 39, Number 1

Innovative Community Program for Children with Autism Spectrum Disorder

Kelly (Chase) Greeson, MD, MPH (she/her/hers )

Psychiatry Resident, Medical University of South Carolina

The increasing prevalence of Autism Spectrum Disorder (ASD) calls attention to the urgent need for effective treatments. According to the Centers for Disease Control and Prevention, the prevalence of ASD in the United States in 2010 was 1 in 68 children, while in 2020 it rose to 1 in 36 children (CDC, 2023) To date, there are no curative pharmacotherapy options for ASD and medical treatment has focused on targeting symptom management and incorporating behavioral therapy techniques.

The goal of behavioral therapy treatment is to identify what occurs before and after a certain behavior and employ techniques such as applied behavior analysis (ABA) and discrete trial training to modify the specific behavior. Given the rising prevalence of ASD, barriers to access to care, and increased financial burdens, we as a field must consider innovative community-based models that are high quality and cost friendly. High quality cost effectiveness analysis of early intensive behavioral intervention (EIBI) is still relatively lacking; several studies have nonetheless shown that EIBI is a cost effective treatment (Sampaio et al., 2021) This report presents one such program, the Meredith Autism Program (MAP) at Meredith College in Raleigh, North Carolina. Programs like the MAP are critically needed as our current system of care demonstrates socioeconomic disparities. Children who are members of minority groups receive diagnoses and access to interventions and treatment less often and at an older age. For example, non-Hispanic Black children (0.67 absolute odds ratio (AOR); 95% CI, 0.54-0.84) and Hispanic children (0.77 AOR; 95% CI, 0.63-0.93) have lower odds of participating in EIBI, when compared to non-Hispanic White children (Shenouda et al., 2022) In addition, children living in affluent areas have been shown to have a greater odds of participation in EIBI programs. These socioeconomic status disparities manifest the importance of ensuring programs are working to improve care for all children regardless of race/ethnicity or financial standing.

Spring 2023