Maddy, Youssef and Andrew discuss a case presented by Noah and share their approach to bradycardia.

View the bradycardia schema here.

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Episode description

RR discusses a case of dysphagia

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Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Sebastian presents a case of confusion to Aye.

Aye Chan Moe Thant ( @AyeThant94 )

Aye is a physician from Myanmar and now working as a clinical research team member at the Department of Neurology, Washington University in Saint Louis. Throughout her career in Myanmar, she worked closely and received training from her mentor neurologist, one of only three neurologists available for the whole upper Myanmar of 23 million population. Witnessing the challenges faced by the patients from underserved areas, she is dedicated to advancing health equity, research, and global neurology. Aye is also very passionate about medical education and has been deeply involved in Clinical Problem Solvers mainly in neurology with the mentor Dr. Aaron Berkowitz. She is going to apply for neurology residency and very excited about the journey ahead!

Dr. Sebastian Green ( @sebfgreen )

Dr. Sebastian Green is a neurology resident at the University of California, Los Angeles (UCLA). He was born and raised in London, England. He has degrees in Medicine from the University of Bristol and Neuroscience from the University of Oxford. He has published on neuroimaging, memory, sleep, epilepsy, and more. He is passionate about medical education in neurology, and using EEG to answer big questions about the brain. 

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Episode description: Seyma presents a case of persistent cough and fatigue that ends up in an unexpected place.

Featuring: 

Priyanka Athavale

Anna Fretz

Kirtan Patolia

Seyma Yildirim

Schemas:

Syncope

Pulmonary renal syndromes

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Click here to view the weekly episode recap email!

CPSolvers: Anti-Racism in Medicine Series

Episode 26 – Racial and Gender Health Disparities in Youth Suicide: Part 1

Show Notes by Alec J. Calac

March 14, 2025

Summary: In this first half of a two-part series, we discuss the growing rates of suicide amongst child and adolescent populations in the United States, with a focus on historically underserved groups. In particular, our guests, Dr. Tami Benton and Dr. Kevin Simon, elucidate the disturbing rises in suicidality—suicide attempts and suicidal ideation—and suicide fatality amongst Indigenous and Black youth. Drs. Benton and Simon recount the pervasive nature of the suicide crisis impacting Black and Indigenous youth and offer insights into how we may begin ameliorating these harrowing inequities. 

Episode Learning Objectives

After listening to this episode, learners will be able to:

1. Identify barriers and facilitators to establishing care with a child and adolescent psychiatrist
2. Explain the shifting visibility of racial and gender health disparities in the academic literature
3. Describe the importance of cultural humility and racial concordance in health care

Credits

• Written and produced by: Ashley Cooper, Sudarshan Krishnamurthy, Asya Pitre, and Team
• Hosts: Ashley Cooper and Sudarshan Krishnamurthy
• Infographic and Audio Edits: Ashley Cooper
• Show Notes: Alec J. Calac
• Guest: Dr. Tami Benton and Dr. Kevin Simon

Time Stamps

0:00 Opening and Guest Biographies

3:15 Personal Guest Introductions (Dr. Simon)

6:50 Personal Guest Introductions (Dr. Benton)

13:08 Youth Suicide Crisis Discussion, “Ringing the Alarm”

20:10 Shift in Issue Framing in the Literature 

24:31 The Network Begins with Primary Care

28:42  Diversifying your Outreach

30:54 Cultural Humility

Speaker Biographies

Dr. Tami Benton, MD, is the Frederick Allen Professor of Psychiatry at the University of Pennsylvania. She is the Psychiatrist-in-Chief and Chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia (CHOP). She is the President of The American Association of Directors of Child and Adolescent Psychiatry (AADCAP) and the President of The American Academy of Child and Adolescent Psychiatry (AACAP). She served on the National Institute of Mental Health Advisory Council and the APA’s Council for Research. Dr. Benton mentors clinical and research physicians, fellows, and postdoctoral trainees. She was awarded the Society of Biological Psychiatry Humanitarian Award and the Community Outreach Award by the American Foundation for Suicide Prevention. Dr. Benton’s career has been dedicated to developing leadership for a diverse child psychiatry workforce. Her mission — preparing the next generation of diverse physician leaders in pediatric healthcare and mental health and creating partnerships between communities and academic centers — will be critical for eliminating disparities among minority populations.

Dr. Kevin M. Simon, MD, MPH, is Boston’s inaugural Chief Behavioral Health Officer, appointed by Mayor Michelle Wu. He is a physician-scientist, health policy expert, inspirational teacher, and a gifted writer. Dr. Simon is a pediatric addiction medicine psychiatrist at Boston Children’s Hospital; an assistant professor in psychiatry at Harvard Medical School; a recent Commonwealth Fund fellow in health policy at Harvard University; and the medical director of Wayside Youth & Family Support Network. Clinically, he cares for youth and families through the Department of Psychiatry & Behavioral Sciences and the new Division of Addiction Medicine at Boston Children’s Hospital. Academically, he has won multiple awards for research on structural violence, health equity, and mental health. Additionally, he consults with federal agencies on mental health system design and practices. Dr. Simon’s writings on health equity are in notable journals like the American Journal of Public Health and the New England Journal of Medicine. National audiences regularly seek his perspectives on mental health through trusted outlets. 

Episode Takeaways

• Community health centers play an important role in access to evidence-based psychiatric care rooted in community values. They are often the first interface for patients experiencing mental health crises, not academic medical centers. 

• The youth suicide crisis is disproportionately shouldered by Indigenous and Black and African American communities. Historical challenges include inadequate data surveillance and reporting systems and “hidden” trends brought to the attention of academics by Dr. Jeffrey Bridge, a leading researcher at the Nationwide Children’s Hospital. Among these groups, youth suicide is particularly more prominent at younger ages when compared to other racial and ethnic groups.

• Groups experiencing severe morbidity and mortality–due to any psychiatric cause–often do not reflect the demographics of inpatient hospital censuses. Comprehensive mental health interventions are often beyond reach of those uninsured and underinsured.

• Resources are often directed to the largest group by number, not necessarily the group with the highest incidence and prevalence per capita. This can have devastating effects on public health and impede timely policy and program development. Literature has also shown that youth beneficiaries in Medicaid are not prioritized for mental health services when compared to other programs, which impedes continuity of care.

• There are a growing number of Child Psychiatric Access Programs, including one in Massachusetts, which provide quick access to psychiatric consultation and facilitates referrals for accessing ongoing behavioral health care. These programs recognize the increasing difficulties in having to first see a community-based primary care provider before seeing a specialized psychiatrist.

• Diversifying your mental health outreach goes hand in hand with diversifying your providers. This is directly related to the importance of cultural humility in mitigating health disparities among racial and gender minority youth, as well as literature highlighting the benefits of racial concordance between providers and patients.

• According to a 2019 study published by Price and Khubchandani, the suicide rate among Black girls increased by a striking 182% over the course of 2001 to 2017. Despite these increases there remains a paucity of literature addressing this critical disparity. 

• Language plays an important role in obtaining a thorough mental health history. Youth are often not familiar with medical jargon on questionnaires and intake forms, which can work against important conversations and opportunities for shared decision-making. 

• Large language models and artificial intelligence technologies are likely biased by the documentation we place in the electronic health record, which may reinforce youth health disparities.

Disclosures 

The hosts and guests report no relevant financial disclosures.

References

1. Benton TD, Boyd RC, Njoroge WF. Addressing the Global Crisis of Child and Adolescent Mental Health. JAMA Pediatr. 2021;175(11):1108–1110. doi:10.1001/jamapediatrics.2021.2479
2. Benton T, Njoroge WFM, Ng WYK. Sounding the Alarm for Children’s Mental Health During the COVID-19 Pandemic. JAMA Pediatr. 2022;176(4):e216295. doi:10.1001/jamapediatrics.2021.6295
3. Benton TD. Suicide and Suicidal Behaviors Among Minoritized Youth. Child and Adolescent Psychiatric Clinics of North America. 2022;31(2):211-221. doi:10.1016/j.chc.2022.01.002
4. Benton TD. A Culturally Informed Approach to Supporting Suicidal Minoritized Patients. Focus. 2023 Apr;21(2):166-7.
5. Brent DA, Goldstein TR, Benton TD. Bridging Gaps in Follow-up Appointments After Hospitalization and Youth Suicide: Mental Health Care Disparities Matter. JAMA Netw Open. 2020;3(8):e2013100. doi:10.1001/jamanetworkopen.2020.13100
6. Bridge JA, Asti L, Horowitz LM, et al. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465
7. Fontanella CA, Hiance-Steelesmith DL, Bridge JA, Lester N, Sweeney HA, Hurst M, Campo JV. Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders. Psychiatr Serv. 2016 Mar;67(3):324-31. doi: 10.1176/appi.ps.201500104. Epub 2015 Dec 1. PMID: 26620293.
8. King, C. A., Brent, D., Grupp-Phelan, J., Shenoi, R., Page, K., Mahabee-Gittens, E. M., Chernick, L. S., Melzer-Lange, M., Rea, M., McGuire, T. C., Littlefield, A., & Casper, T. C. (2020). Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use. Journal of the American Academy of Child & Adolescent Psychiatry, 59(9), 1058-1068.e5. https://doi.org/10.1016/j.jaac.2019.10.015
9. Lindsey MA, Sheftall AH, Xiao Y, Joe S. Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017. Pediatrics. 2019;144(5):e20191187. doi:10.1542/peds.2019-1187
10. Lindsey MA, Brown DR, Cunningham M. Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal of Orthopsychiatry. 2017;87:377-383. doi:10.1037/ort0000198
11. Price JH, Khubchandani J. The Changing Characteristics of African-American Adolescent Suicides, 2001–2017. J Community Health. 2019;44(4):756-763. doi:10.1007/s10900-019-00678-x
12. Sheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(5):662-675. doi:10.1016/j.jaac.2021.08.021
13. Sheftall AH, Miller AB. Setting a Ground Zero Research Agenda for Preventing Black Youth Suicide. 2021;175(9):890-892. doi:10.1001/jamapediatrics.2021.1112
14. Simon KM. Daughters’ Keeper—The Care and Treatment of Black Girls in America. New England Journal of Medicine. 2022 Jun 2;386(22):2067-9.
15. Simon KM. Mitigating the Negative Mental Health Impact of Racism on Black Adolescents—A Preventive Perspective. JAMA Netw Open. 2023;6(11):e2340577. doi:10.1001/jamanetworkopen.2023.40577
16. Simon KM. Them and Me – The Care and Treatment of Black Boys in America. N Engl J Med. 2020 Nov 12;383(20):1904-1905. doi: 10.1056/NEJMp2022606. PMID: 33176082.
17. Congressional Black Caucus: Emergency Task Force on Black Youth Suicide and Mental Health. Ring the Alarm. The Crisis of Black Youth Suicide in America. U.S. Congress. Published December 17, 2019. Accessed 2024. https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf 

Citation

Benton T, Simon K, Cooper A, Krishnamurthy S, Calac A, Pitre A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Khazanchi R. “Episode 26: Racial and Gender Health Disparities in Youth Suicide: Part 1” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. March 14, 2025.

Show Transcript

Download CPSolvers App here

RLRCPSOLVERS

CPSolvers: Anti-Racism in Medicine Series

Episode 26 – Racial and Gender Health Disparities in Youth Suicide: Part 1

Show Notes by Alec J. Calac

March 14, 2025

Summary: In this first half of a two-part series, we discuss the growing rates of suicide amongst child and adolescent populations in the United States, with a focus on historically underserved groups. In particular, our guests, Dr. Tami Benton and Dr. Kevin Simon, elucidate the disturbing rises in suicidality—suicide attempts and suicidal ideation—and suicide fatality amongst Indigenous and Black youth. Drs. Benton and Simon recount the pervasive nature of the suicide crisis impacting Black and Indigenous youth and offer insights into how we may begin ameliorating these harrowing inequities. 

Episode Learning Objectives

After listening to this episode, learners will be able to:

1. Identify barriers and facilitators to establishing care with a child and adolescent psychiatrist
2. Explain the shifting visibility of racial and gender health disparities in the academic literature
3. Describe the importance of cultural humility and racial concordance in health care

Credits

• Written and produced by: Ashley Cooper, Sudarshan Krishnamurthy, Asya Pitre, and Team
• Hosts: Ashley Cooper and Sudarshan Krishnamurthy
• Infographic and Audio Edits: Ashley Cooper
• Show Notes: Alec J. Calac
• Guest: Dr. Tami Benton and Dr. Kevin Simon

Time Stamps

0:00 Opening and Guest Biographies

3:15 Personal Guest Introductions (Dr. Simon)

6:50 Personal Guest Introductions (Dr. Benton)

13:08 Youth Suicide Crisis Discussion, “Ringing the Alarm”

20:10 Shift in Issue Framing in the Literature 

24:31 The Network Begins with Primary Care

28:42  Diversifying your Outreach

30:54 Cultural Humility

Speaker Biographies

Dr. Tami Benton, MD, is the Frederick Allen Professor of Psychiatry at the University of Pennsylvania. She is the Psychiatrist-in-Chief and Chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia (CHOP). She is the President of The American Association of Directors of Child and Adolescent Psychiatry (AADCAP) and the President of The American Academy of Child and Adolescent Psychiatry (AACAP). She served on the National Institute of Mental Health Advisory Council and the APA’s Council for Research. Dr. Benton mentors clinical and research physicians, fellows, and postdoctoral trainees. She was awarded the Society of Biological Psychiatry Humanitarian Award and the Community Outreach Award by the American Foundation for Suicide Prevention. Dr. Benton’s career has been dedicated to developing leadership for a diverse child psychiatry workforce. Her mission — preparing the next generation of diverse physician leaders in pediatric healthcare and mental health and creating partnerships between communities and academic centers — will be critical for eliminating disparities among minority populations.

Dr. Kevin M. Simon, MD, MPH, is Boston’s inaugural Chief Behavioral Health Officer, appointed by Mayor Michelle Wu. He is a physician-scientist, health policy expert, inspirational teacher, and a gifted writer. Dr. Simon is a pediatric addiction medicine psychiatrist at Boston Children’s Hospital; an assistant professor in psychiatry at Harvard Medical School; a recent Commonwealth Fund fellow in health policy at Harvard University; and the medical director of Wayside Youth & Family Support Network. Clinically, he cares for youth and families through the Department of Psychiatry & Behavioral Sciences and the new Division of Addiction Medicine at Boston Children’s Hospital. Academically, he has won multiple awards for research on structural violence, health equity, and mental health. Additionally, he consults with federal agencies on mental health system design and practices. Dr. Simon’s writings on health equity are in notable journals like the American Journal of Public Health and the New England Journal of Medicine. National audiences regularly seek his perspectives on mental health through trusted outlets. 

Episode Takeaways

• Community health centers play an important role in access to evidence-based psychiatric care rooted in community values. They are often the first interface for patients experiencing mental health crises, not academic medical centers. 

• The youth suicide crisis is disproportionately shouldered by Indigenous and Black and African American communities. Historical challenges include inadequate data surveillance and reporting systems and “hidden” trends brought to the attention of academics by Dr. Jeffrey Bridge, a leading researcher at the Nationwide Children’s Hospital. Among these groups, youth suicide is particularly more prominent at younger ages when compared to other racial and ethnic groups.

• Groups experiencing severe morbidity and mortality–due to any psychiatric cause–often do not reflect the demographics of inpatient hospital censuses. Comprehensive mental health interventions are often beyond reach of those uninsured and underinsured.

• Resources are often directed to the largest group by number, not necessarily the group with the highest incidence and prevalence per capita. This can have devastating effects on public health and impede timely policy and program development. Literature has also shown that youth beneficiaries in Medicaid are not prioritized for mental health services when compared to other programs, which impedes continuity of care.

• There are a growing number of Child Psychiatric Access Programs, including one in Massachusetts, which provide quick access to psychiatric consultation and facilitates referrals for accessing ongoing behavioral health care. These programs recognize the increasing difficulties in having to first see a community-based primary care provider before seeing a specialized psychiatrist.

• Diversifying your mental health outreach goes hand in hand with diversifying your providers. This is directly related to the importance of cultural humility in mitigating health disparities among racial and gender minority youth, as well as literature highlighting the benefits of racial concordance between providers and patients.

• According to a 2019 study published by Price and Khubchandani, the suicide rate among Black girls increased by a striking 182% over the course of 2001 to 2017. Despite these increases there remains a paucity of literature addressing this critical disparity. 

• Language plays an important role in obtaining a thorough mental health history. Youth are often not familiar with medical jargon on questionnaires and intake forms, which can work against important conversations and opportunities for shared decision-making. 

• Large language models and artificial intelligence technologies are likely biased by the documentation we place in the electronic health record, which may reinforce youth health disparities.

Disclosures 

The hosts and guests report no relevant financial disclosures.

References

1. Benton TD, Boyd RC, Njoroge WF. Addressing the Global Crisis of Child and Adolescent Mental Health. JAMA Pediatr. 2021;175(11):1108–1110. doi:10.1001/jamapediatrics.2021.2479
2. Benton T, Njoroge WFM, Ng WYK. Sounding the Alarm for Children’s Mental Health During the COVID-19 Pandemic. JAMA Pediatr. 2022;176(4):e216295. doi:10.1001/jamapediatrics.2021.6295
3. Benton TD. Suicide and Suicidal Behaviors Among Minoritized Youth. Child and Adolescent Psychiatric Clinics of North America. 2022;31(2):211-221. doi:10.1016/j.chc.2022.01.002
4. Benton TD. A Culturally Informed Approach to Supporting Suicidal Minoritized Patients. Focus. 2023 Apr;21(2):166-7.
5. Brent DA, Goldstein TR, Benton TD. Bridging Gaps in Follow-up Appointments After Hospitalization and Youth Suicide: Mental Health Care Disparities Matter. JAMA Netw Open. 2020;3(8):e2013100. doi:10.1001/jamanetworkopen.2020.13100
6. Bridge JA, Asti L, Horowitz LM, et al. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465
7. Fontanella CA, Hiance-Steelesmith DL, Bridge JA, Lester N, Sweeney HA, Hurst M, Campo JV. Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders. Psychiatr Serv. 2016 Mar;67(3):324-31. doi: 10.1176/appi.ps.201500104. Epub 2015 Dec 1. PMID: 26620293.
8. King, C. A., Brent, D., Grupp-Phelan, J., Shenoi, R., Page, K., Mahabee-Gittens, E. M., Chernick, L. S., Melzer-Lange, M., Rea, M., McGuire, T. C., Littlefield, A., & Casper, T. C. (2020). Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use. Journal of the American Academy of Child & Adolescent Psychiatry, 59(9), 1058-1068.e5. https://doi.org/10.1016/j.jaac.2019.10.015
9. Lindsey MA, Sheftall AH, Xiao Y, Joe S. Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017. Pediatrics. 2019;144(5):e20191187. doi:10.1542/peds.2019-1187
10. Lindsey MA, Brown DR, Cunningham M. Boys do(n’t) cry: Addressing the unmet mental health needs of African American boys. American Journal of Orthopsychiatry. 2017;87:377-383. doi:10.1037/ort0000198
11. Price JH, Khubchandani J. The Changing Characteristics of African-American Adolescent Suicides, 2001–2017. J Community Health. 2019;44(4):756-763. doi:10.1007/s10900-019-00678-x
12. Sheftall AH, Vakil F, Ruch DA, Boyd RC, Lindsey MA, Bridge JA. Black Youth Suicide: Investigation of Current Trends and Precipitating Circumstances. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(5):662-675. doi:10.1016/j.jaac.2021.08.021
13. Sheftall AH, Miller AB. Setting a Ground Zero Research Agenda for Preventing Black Youth Suicide. 2021;175(9):890-892. doi:10.1001/jamapediatrics.2021.1112
14. Simon KM. Daughters’ Keeper—The Care and Treatment of Black Girls in America. New England Journal of Medicine. 2022 Jun 2;386(22):2067-9.
15. Simon KM. Mitigating the Negative Mental Health Impact of Racism on Black Adolescents—A Preventive Perspective. JAMA Netw Open. 2023;6(11):e2340577. doi:10.1001/jamanetworkopen.2023.40577
16. Simon KM. Them and Me – The Care and Treatment of Black Boys in America. N Engl J Med. 2020 Nov 12;383(20):1904-1905. doi: 10.1056/NEJMp2022606. PMID: 33176082.
17. Congressional Black Caucus: Emergency Task Force on Black Youth Suicide and Mental Health. Ring the Alarm. The Crisis of Black Youth Suicide in America. U.S. Congress. Published December 17, 2019. Accessed 2024. https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf 

Citation

Benton T, Simon K, Cooper A, Krishnamurthy S, Calac A, Pitre A, Pierce G, Essien UR, Fields NF, Lopez-Carmen V, Nolen L, Onuoha C, Watkins A, Williams J, Tsai J, Khazanchi R. “Episode 26: Racial and Gender Health Disparities in Youth Suicide: Part 1” The Clinical Problem Solvers Podcast – Antiracism in Medicine Series. https://clinicalproblemsolving.com/antiracism-in-medicine/. March 14, 2025.

Show Transcript

Download CPSolvers App here

RLRCPSOLVERS

Noah, Mark, and Debora received Rabih Geha for a fantastic case discussion in this episode.

Embark on this diagnostic journey with us! 

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Episode description

Reza interviews his mentor and master clinician Dr. Elmer Holzinger

Title  – Distention – why?

Episode description

RR discusses 2 cases of abdominal distention

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IMG discount

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Maddy, Youssef and Andrew share their approach to neuropathy and frequent falls as they discuss a case presented by Sharmin.

Polyneuropathy Framework

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