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A mother's legacy

Yale Medicine Magazine, 2022 Issue 168 More than skin deep
by Hirschman, Rhea

Amber Childs’ mother provided an inspiring role model for the psychiatrist-to-be in childhood. This has shaped her professional interests, and a focus on at-risk adolescents.

Amber Childs, PhD, often thinks about a newspaper clipping in her mother’s scrapbook—a photo of her mother Fredia at 13, standing with a smiling young woman. The only child of a single parent who had to learn how to pay the bills because her own mother was unable to read or write, Fredia was determined to find herself a mentor. Big Brothers Big Sisters of America, a nonprofit organization dedicated since 1904 to providing mentors for youth, matched Fredia with the woman in the photo—an engineer in the armed forces who made it seem possible, even desirable, for a Black woman to be smart and good at math. They met for only a few sessions before the mentor was restationed, but Childs’ mother credits that brief connection for shaping a trajectory that led her to military service, college, graduate school, and a professional career. “I expect,” Childs said, “that my mother’s story gave rise to my hope that my work with youth might have that same potential.”

Childs, an assistant professor of psychiatry, began her clinical practice at Yale with a focus on young people. For the past five years, she has worked withadolescents and their families through Yale New Haven Psychiatric Hospital’s adolescent intensive outpatient program. The program’s interdisciplinary team provides comprehensive assessment of a teenager’s physical, psychological, and social issues;cognitive-behavioral group therapy; intensive family psychotherapy; and case management and care coordination for young people who have chronic and acute psychiatric illness.

“The teens we see come to us in a highly vulnerable state, and present with a complex set of concerns,” Childs said. Some are recently discharged from inpatient care, while others have received a psychiatric intervention through the emergency department with a discharge plan that includes a referral to the adolescent intensive outpatient program. Others may have had an escalating mental health crisis in the community and are referred for services by outpatient providers, schools, or other agencies as a preventive measure. Teens are in the adolescent intensive outpatient program for three and a half hours a day four days a week for six weeks. “We do a comprehensive baseline assessment, getting information from the teen and one of their caregivers,” Childs explained. “What are their challenges? Their strengths? What will we address in those six weeks, and what will they need after discharge? How overall do we best serve the youth coming into this program?”

Now, as the newly appointed co-director of the psychiatric hospital’s Division of Quality and Innovation, Childs is an institutional leader in the development and implementation of measurement-based care (MBC), an approach that uses ongoing patient-reported progress to track the effectiveness of care over the course of treatment. “MBC is a clinical process that is rooted in shared decision making and collaboration between patients and providers,” she said. “The patient’s voice as expressed through the data is central to guiding the treatment. And we look at what these data [tell us] to inform how we might improve quality of care for the individual and for the population being treated—with a special eye toward how we might reduce variability in outcomes for marginalized groups.”

Childs’ leadership and expertise regarding MBC has been foundational in keeping the Yale New Haven Psychiatric Hospital in alignment with national policies related to accreditation. In 2019, the Joint Commission cited her work as “the gold standard” for MBC and encouraged submission of Yale’s processes to the commission to serve as a model for other behavioral health care organizations.

An interest in using technology to improve access to care also led Childs to design and spearhead the implementation of group-based telehealth across all five of the psychiatric hospital’s ambulatory programs, including education, technical support, and consultation. She is also leveraging technology to support other interventions related to MBC and assessment data. Last year, she designed a telehealth intervention integrated into adolescent intensive outpatient program services, which includes a multidomain, multi-informant assessment using different psychological measures. The intervention is expected to increase a patient’s engagement and set the tone for shared decision making at the outset of treatment.

“Within a week after our initial intake, we set up a telehealth session with a patient and their family, and use the data to clarify the diagnosis, answer questions, and tailor treatment goals,” Childs said. “The resources of the families who come to us are already so taxed. A telehealth session is an additional opportunity for teens and their caregivers to communicate with us and with each other. We are also analyzing whether this intervention leads more patients to follow through with their treatment.”

Childs is director of training for the Doctoral Internship in Clinical and Community Psychology within the Yale Department of Psychiatry; co-chair of the internship’s Diversity, Equity, and Inclusion Committee; and co-chair of the education subcommittee of the Department of Psychiatry’s Antiracism Task Force. She oversees the final intensive year of training for about 15 psychology fellows from all over the country, working closely with them as they develop their professional skills. “My mission,” she said, “is helping to cultivate a generation of psychology leaders who have a deep and sophisticated understanding of diversity, equity, and inclusion as they relateto clinical service delivery, research, and education.”

Starting in the fall of 2021, a grant-funded curriculum called Getting Racism Out of Our Work (or GROW) that Childs co-developed will be delivered to internship faculty clinical supervisors. The focus will be on ways to discuss race and racism in supervision, and on such questions as: How do providers identify and contend with injustices in mental health care and research? What do faculty members need to know about themselves as cultural beings? And what practical skills do they need to best support those they are training?

“A core facet of my professional identity as a young African American woman psychologist is attunement to both the challenges and freedoms associated with change, growth, and development,” Childs said. “As I learned from my mother—even a relatively brief positive intervention can have a profound effect on someone’s life.”