The Child Study Center’s quarter century partnership with academic leaders and advocacy organizations in Brazil

Building on the shared goal to improve the lives of the families and children across the globe, Yale Child Study Center has had a longstanding relationship with our colleagues in child mental health in Brazil. One line of collaboration dates back to 1995 and began with a shared interest in pediatric-onset Obsessive-compulsive disorder (OCD), Tourette’s syndrome and Autism Spectrum Disorders (ASD). However, since that first connection, the common work in child psychiatry shared across our two countries has widened to include a broad range of activities such as approaches to clinical education, research in systematic literature review and innovative outreach programs for adolescents. Important aspects of the work between Yale CSC and Brazilian children’s mental health advocates are: (1) an ongoing exchange of faculty and trainees with some staying at Yale for as long as two to three years; (2) many joint endeavors ranging from collaborative scientific research to the development of nation-wide programs; and (3) close ties to advocacy organizations including Autismo e Realidade (AeR). AeR is the first parent advocacy organization of its kind in Brazil devoted to advancing knowledge and reducing the stigma associated with ASD.

At present several of these initiatives are a direct out growth of the National Institute for Developmental Psychiatry (INPD). Founded in 2008, INPD is an ambitious nation-wide effort in Brazil lead by Prof. Euripedes C. Miguel at the Institute of Psychiatry in São Paulo and Prof. Luis A. Rohde at the Federal University of Rio Grande do Sul in Porto Alegre to improve the knowledge-base concerning childhood onset disorders. This Institute involves a set of initiatives and research projects designed to promote the healthy development of children and adolescents. One of the major initiatives is to use telemedicine to advance understanding in child mental health nationwide. Experts work remotely with public school teachers, family doctors, pediatricians, as well as trainees in psychiatry and psychology to help these professionals recognize and address the mental health needs of children and families. In the other major component of the institute, research projects range from a population-based birth cohort study to early intervention efforts to prevent the onset of a number of neuropsychiatric disorders (ASD, schizophrenia, mood and anxiety disorders, OCD, Attention Deficit Hyperactivity Disorder). A number of state-of-the-art clinical trials are also underway using novel therapeutic approaches. For example, the Equilibrium Project led by Prof. Sandra Scivoletto intervenes with street children in Sao Paulo by engaging them in a sports club, yoking their involvement with the desirable and adaptive activities in sports with engagement in foster care which many are initially reluctant to do. For many of these initiatives, they are also partnering with government officials in order to monitor the costs and benefits of these initiatives that can then be used in the planning and management of mental health programs.

Recently, a colleague from Brazil, Prof. Maria Conceição do Rosáriofrom theFederal University of São Paulo (USP) and an active participant in the INPD visited the Child Study Center to work with Pia Britto, Walter Gilliam, and James Leckman. Their work together in November of this year was aimed at implementing a day care based mother-child education program in a poor district of São Paulo, based on what has been developed in Turkey with some of our other global partners.

Also in November, assistant professor Michael Bloch traveled to São Paolo to begin work with some members of the Institute of Psychiatry in how to use systematic reviews to advance the field of child psychiatry, particularly in better understanding whether treatments show evidence of efficacy across multiple trials.

In September of this year, Kara Bagot, a third year resident in the Solnit Integrated program also visited the USP Institute of Psychiatry. During her time there, she shadowed child psychiatry fellows in their sub-specialty clinics and met with research faculty to discuss ongoing and upcoming research projects within the department. She also visited the Equilibrium Project, the program that integrates homeless, adjudicated and victimized youth into their communities and schools through comprehensive psychiatric and pediatric care. She was interested in how the Equilibrium Project engages youth in a sports and recreation club as part of the initial contact with these high risk youth and predictive factors for good outcomes in these youth. Dr. Bagot continues to work to publish findings based on data collected from this program.

For 3 months this fall, the Child Study Center hosted Mauro Medeiros Filho, a psychiatry resident at USP, to work on the Winchester-1 child psychiatry inpatient unit and to collaborate with psychiatry researchers including Bob Rosenheck at Yale on how to best analyze the data from the Equilibrium Project. He was able to learn recent approaches to completing this type of community intervention work and made many close connections with Child Study Center faculty and trainees while here. Another visitor this winter is Elisa Mesquita, another Brazilian trainee in psychiatry, who is working on the Winchester-1 inpatient unit. Dr. Mesquita is also pursuing research with Michael Bloch. Dr. Mesquita is interested in studying the efficacy of web-based interventions in the treatment of OCD.

In April of 2012, Tom Fernandez, recent graduate of the Solnit Integrated Training Program was hosted by Dr. Miguel in Sao Paolo. While at USP, Dr. Fernandez consulted with several research programs on the approach to research questions about child mental health and on the potential for including genetics in ongoing studies. During this productive visit, several potential collaborations arose from the contacts that were made, particularly in the area of Tourette’s and OCD genetics family studies. Dr. Fernandez was one of Matt State’s team that had previously hosted a Brazilian PhD student, Carolina Cappi, at Yale. Carolina’s work had included exome sequencing of Brazilian children with OCD looking for single nucleotide variants.

In 2011, Dorothy Stubbe, the Director of Child Psychiatry Training at the Yale Child Study Center, visited USP as a consultant to their psychiatry and child and adolescent psychiatry training programs. As in all countries, in Brazil, there are very few child psychiatrists and recruiting talented trainees into the field is a challenge. To encourage physicians to do more extensive training in child psychiatry, Dr. Stubbe was helping to implement curricular changes at USP and national changes in clinical child psychiatry that motivate early career physicians to stay in training longer.

Among the faculty at the Child Study Center, James Leckman is a visiting professor at the University of São Paulo and the Federal University of São Paulo. He also was involved in the initial conceptualization of the INPD and currently serves as one of their international advisors. Other Child Study Center faculty who have made visits to Brazil include Paul Lombroso who visited USP to provide teaching in the molecular biology of childhood psychiatric disorders hosted by Marcos Mercadente, Flora Vaccarino who worked with researchers interested in analysis of post-mortem brain tissue donated by patients with OCD, and Fred Volkmar. Profs. Miguel and do Rosario both serve on the voluntary faculty of the Child Study Center.

This article was submitted by Liz Pantani on January 10, 2013.