According to experts at Bradley Hospital, it’s common for children to feel anxious about the unknown and they will look to their parents to provide support and comfort. “Children follow their parents’ cues, so if mom or dad seem stressed or are constantly talking about how worried they are, a child will pick up on that. But if parents cope well, their child will also cope better,” says Henry T. Sachs, MD, medical director at Bradley Hospital.

The key to helping children manage their anxiety is to address and acknowledge their fears without causing alarm or panic. “Reassure your child that everyone in the family is fine and that you will all work together to stay healthy. Being calm and confident will do wonders in helping a child feel safe and secure,” says Sachs.

He suggests parents proactively ask their children what they have heard about H1N1, which will indicate whether there are any rumors or misinformation that need to be addressed. Information and knowledge can help children feel a sense of control, so parents should also be prepared to provide some simple, age-appropriate facts about H1N1.

“Younger children will need equal amounts of fact and reassurance, but older kids and teens will likely have more specific questions or may need help separating fact from fiction,” Sachs says. “Although we want to shelter our children, it’s important to be honest and accurate about the situation.”

Sachs points out that these conversations also provide a good opportunity to remind children that good hygiene – particularly frequent hand-washing and covering coughs or sneezes – is the best way to stay healthy and avoid spreading disease, including H1N1.

Other ways parents can help ease their child’s H1N1 anxiety and help them stay healthy include:

• Make sure you are up to the date on the latest information on H1N1, including symptoms, vaccinations and how the disease spreads. The RI Department of Health website, http://www.health.ri.gov/, and www.flu.gov are good resources.
• Allow your children to express their feelings and let them know it is okay to be afraid or upset. Keep in mind that when children are uncertain about situations and feel frightened, they may need even more affection and attention.
• Even if the family’s normal routine is disrupted due to school or work closures, try and keep activities as consistent and normal as possible. Children are most comfortable when they can stick with their routines.
• Encourage healthy behaviors – such as eating well, getting a good night’s sleep, and playing outside – that can help children build a strong immune system.
• Remind your children not to share their food or drinks with others.
• Try to limit your child’s exposure to media coverage about the H1N1 virus.
• If your children are being vaccinated, remind them why this is important and how the vaccine will help keep them safe and healthy.
• Keep your children home when they are sick. They should remain out of school until they are free of fever for 24 hours without the use of a fever-reducing medication.

NOTE: Some information provided by the National Association of School Psychologists and the Centers for Disease Control and Prevention.

Wall, who has led Bradley Hospital for the past 16 years, is being honored for his longstanding commitment to the families of Rhode Island and the thousands of children who are treated at Bradley each year. He also is recognized for his day-to-day leadership and his steadfast support of Bradley’s groundbreaking research initiatives and academic mission. Bradley is a major teaching hospital for The Warren Alpert Medical School of Brown University.

Peers who nominated Wall specifically cited his leadership in guiding Bradley’s ambitious campus-wide revitalization project – which includes the recent opening of the hospital’s new state-of-the-art inpatient addition – as an example of his tireless determination to enhance the care and comfort of patients and their families.

“Dan is a model president and CEO who has dedicated his professional life to supporting academic child psychiatry and our clinical programs,” said Gregory K. Fritz, MD, academic director, Bradley Hospital. “Under his leadership, Bradley Hospital has become a national leader in children’s mental health treatment, education and research. On behalf of the entire Bradley family, I congratulate him on this well-deserved award.”

The Robert Cancro Academic Leadership award recognizes a currently serving general psychiatry training director, medical school dean, CEO of a training institution, chair of a department of pediatrics or chair of a department of psychiatry for his or her contributions to the promotion of child and adolescent psychiatry. The award is named in honor of Robert Cancro, MD, chairman at New York University.

“Our mission at Bradley Hospital is to provide high-quality, family-focused care to children with emotional disorders and developmental disabilities,” said Wall. “I am extremely fortunate to have a world-class medical team and clinical staff who fully embrace that mission and help keep us on the forefront of innovative patient care, research and medical education. It is a privilege and a pleasure to lead these efforts and I thank the American Academy of Child and Adolescent Psychiatry for this great honor.”

A graduate of Providence College with a degree in accounting, Wall began his career in children’s mental health as a milieu counselor on psychiatric inpatient units. He was appointed president and chief executive officer at Bradley in 1993 after serving the previous five years as the hospital’s chief operating officer and chief financial officer. Prior to joining Bradley, Wall was the vice president of finance at the Hospital Association of Rhode Island and held various financial positions in health care settings. A native of Rhode Island, Wall currently resides in Pawtucket.

AACAP is the leading national professional medical association dedicated to treating and improving the quality of life for children, adolescents, and families affected by these disorders. Established in 1953, it is a membership-based organization composed of more than 7,500 child and adolescent psychiatrists and other interested physicians.

“We’re grateful to Bank of America and the Bank of America Foundation for their generosity and commitment to children’s mental health,” said Daniel J. Wall, president and CEO, Bradley Hospital. “Their support is essential, particularly during these challenging economic times, and will help us achieve our mission of providing high-quality, family-focused care to children with emotional disorders and developmental disabilities.”

“This grant is a reflection of our commitment to providing improved access to high-quality health care, particularly for the underserved or those facing unique challenges” said Bill Hatfield, market president, Bank of America Rhode Island. “We are extremely proud of our partnership with Bradley Hospital, and applaud their leadership in the children’s mental health community.”

Bank of America’s workforce development funding will support on-site, competency-based education and training for direct care providers – the hospital’s largest group of employees – which includes approximately 700 milieu therapists, residential care counselors, social workers, nurses, psychologists, psychiatrists and other clinical specialists. The program is administered by Bradley’s Department of Behavioral Education.

Bradley Hospital is halfway through a multiphase, campus-wide revitalization that will significantly increase and modernize the hospital’s patient, visitor and research space. The centerpiece of the project – a new, state-of-the-art, 44,000-square-foot inpatient addition – opened in April 2009. The entire project, which also calls for renovating existing space on campus, is scheduled to be complete by early 2010.

Most recently, Rennie was associate director in the Brown University Office of Development, where she was instrumental in setting new records for raising unrestricted gifts through the university’s annual fund campaign. Previously, she was a partner with Synthesis Partnership, where she provided strategic planning services for non-profit organizations, including Save the Bay and the Providence Public Library.

Rennie has also held several volunteer leadership positions at The Wheeler School in Providence, including vice president of the board of trustees and chair of the advancement committee and campaign cabinet. A graduate of the University of California at Berkeley, Rennie earned her MBA from Columbia University.

“Diane is a seasoned professional whose experience, creativity and guidance will be critical as we continue with our campaign to build the future of Bradley Hospital,” said Daniel J. Wall, president and chief executive officer, Bradley Hospital. “We welcome Diane to the Bradley Hospital community and look forward to her enthusiastic leadership at this very exciting time.”

Bradley Hospital is halfway through a multiphase, campus-wide revitalization that will significantly increase and modernize the hospital’s patient, visitor and research space. The centerpiece of the project – a new, state-of-the-art, 44,000-square-foot inpatient addition – opened in April 2009. The entire project, which also calls for renovating existing space on campus, is scheduled to be complete by early 2010.

As part of the public phase of the Uniquely Bradley: Advancing Children’s Mental Health campaign, friends of Bradley Hospital are invited to purchase bricks to “pave the way” to a bright future for Bradley patients. Bricks, which will be placed in the courtyard, can be purchased for $100 (uninscribed) and $200 (inscribed). Susan and David Brown, chairman of the board of trustees of Bradley Hospital, will match all brick purchases up to $100,000. To purchase a brick, please visit: http://www.lifespan.org/bradley/donors/brick.htm

“It’s normal for children to be anxious or fearful about any new situation, whether it’s starting a new school, riding the bus for the first time, or meeting a new teacher,” says child psychologist Abbe Garcia, PhD, of the Pediatric Anxiety Research Clinic at the Bradley Hasbro Children’s Research Center (BHCRC). “Older children may be nervous about academic performance or making new friends. The most important thing parents can do is acknowledge the child’s anxiety, find out exactly what it is that he or she is worried about, and offer reassurance.”

Other ways parents can help ensure a smooth back-to-school transition include:

· Emphasize the positive things about going back to school: seeing old friends, meeting new classmates and participating in sports and other school activities.

· Have your child help with back-to-school preparations, such as picking out a new backpack, lunchbox, notebooks or other school supplies.

· If your child is starting a new school, contact the school before the first day to arrange a visit.

· Try to transition children into a consistent school-night routine at least a week or two before school starts, including earlier bedtimes.

· Use a wall calendar or white board to keep track of when assignments are due, tests will be given, extracurricular practices and rehearsals will be held, etc.

· Be enthusiastic – parental anxiety can be contagious and affect a child’s mood.

How can parents tell if it’s something more than just back-to-school jitters?

For most children, back-to-school anxiety will improve as they get back into the swing of things. However, some children may continue to complain of vague physical ailments, such as a stomach ache, headache or nausea, that often appear just before it’s time to leave for school and improve once the child is allowed to stay home. Others may have severe tantrums when being forced to go to school or may exhibit clingy or defiant behavior. And a small percentage of children may refuse to go to school altogether.

“If your child’s school anxiety persists or worsens over time and is impacting his or her ability to function on a daily basis, it may actually be a sign of a deeper problem, such as separation anxiety disorder, social anxiety disorder or school refusal. It’s probably time to seek help from your child’s pediatrician or a mental health professional,” Garcia says.

NOTE: Some information provided by the Nemours Foundation.

“The benefits of a combined health care system are even more compelling today, given the significant change in the economic environment since we first announced our intent to affiliate,” said George A. Vecchione, president and CEO of Lifespan. “In fact, our ability to continue to offer high quality, cost-effective care, provide and enhance good jobs and maintain a stable health system is more important than ever to help Rhode Island’s economy move into recovery and growth.”

More about the affiliation:

• Read the executive summary of the affiliation application (PDF)
• Learn more about its benefits
• Ask a question online

“Rhode Islanders want and deserve high quality care, which will only remain in the state if we are able to compete with hospitals in Boston that have expanded their reach into Rhode Island,” said John J. Hynes, Esq., president and CEO of Care New England. “Our first commitment is to ensure that the affiliation moves forward in a way that improves health care in our state so that patients stay in Rhode Island for care, and that enhances our ability to continue to attract federal research dollars into Rhode Island in an even more competitive environment.”

If approved, an affiliation will also place Lifespan, Care New England, and their member hospitals in a better position to withstand the challenging financial environment and anticipated additional changes with health care reform. A stronger financial footing through greater economies of scale and efficiency will allow member hospitals to focus anew on their missions, including continuing to invest in their communities to improve health status and health care access.

Commenting on the importance of the affiliation, Edward J. Wing, MD, dean of The Warren Alpert Medical School of Brown University, said, “Lifespan and Care New England hospitals are important partners with Brown in fulfilling our academic and research missions. The coming together of these two systems will go a long way to enhance research activities and develop academic programs in our state.”

The Federal Trade Commission (FTC) has twice successfully cleared the federal regulatory requirements regarding the Lifespan and Care New England affiliation. The FTC’s authority is to look at whether mergers violate federal anti-trust standards. If the FTC believes that a merger may substantially lessen competition in a given marketplace, it can block the merger while it pursues a deeper investigation. In 2007 and in 2008, the parties filed for pre-merger clearance, and each time the affiliation was cleared following an intensive investigation that included analysis of competitive data.

The application to affiliate contains nearly 110,000 pages. The next step in the Hospital Conversions Act application process is for the Attorney General and Department of Health to review the application during the next 30 calendar days to determine if it is complete. If there are questions, Lifespan and Care New England have 30 business days to respond. The two state offices then have 10 business days to determine if the application is complete. If accepted, the Attorney General has up to 30 additional business days to rule on any confidentiality issues. Within 180 days, the state will hold public hearings and make a determination on the affiliation.

“We welcome the opportunity to discuss the benefits of this affiliation with the public and to work with state regulators and elected officials to complete this process,” said Vecchione and Hynes.

About Lifespan
Lifespan, a not-for-profit organization, is Rhode Island’s largest health care system. Formed in 1994, it includes Rhode Island Hospital and its Hasbro Children’s Hospital; The Miriam Hospital; Bradley Hospital and Newport Hospital. Lifespan (www.lifespan.org) is the state’s largest private employer, with more than 11,800 employees, and is affiliated with The Warren Alpert Medical School of Brown University. Lifespan hospitals are among the top recipients in the country of research funding from the National Institutes of Health. The hospitals received nearly $74 million in total research funding in fiscal 2008. All Lifespan-affiliated hospitals are charitable organizations that depend on support from the community to provide programs and services.

About Care New England
Care New England, located in Providence, was founded in 1996 by Butler Hospital, Kent Hospital and Women & Infants Hospital. Care New England is a not-for-profit health care system that offers a continuum of quality care. Our system includes two teaching hospitals affiliated with The Warren Alpert Medical School of Brown University, Butler and Women & Infants; a community hospital, Kent; a visiting nurse and home care/hospice agency, Care New England Home Health; and one Care New England Wellness Center. Care New England has 6,612 employees, 1,573 physicians, 613 licensed beds and 162 infant bassinets (FY08). For more information about Care New England, please visit www.carenewengland.org.

Following a similar model, the AWCR is looking for teens in Rhode Island and across the country between the ages of 14 and 20 who have lost more than 10 pounds and maintained that weight loss for at least one year. Researchers are interested in learning from teens about how they achieved their weight loss success. Participants in the AWCR are asked to complete questionnaires and an interview that may be done either in person at the Weight Control and Diabetes Research Center (WCDRC) at The Miriam Hospital or through mail and telephone contact.

“The major challenge in treating obesity for teens and adults is not only losing weight but keeping it off. There is very little research on effective weight control strategies for teens, and the research that has been done has focused on the actual weight loss itself, not the strategies that help teens successfully maintain that weight loss and avoid regain,” said Rena Wing, PhD, who will serve as one of the primary investigators. She is director of the WCDRC and is a professor of psychiatry and human behavior at Alpert Medical School. Elissa Jelalian, PhD, will co-direct the study. She is a child psychologist with the Bradley Hasbro Children’s Research Center and the WCDRC who has conducted research on weight regulation and behavioral interventions for overweight children and adolescents.

“We’re hoping the Adolescent Weight Control Registry will shed some light on what weight management tools and strategies work for this specific population, who are often dealing with additional stressors such as peer pressure, teasing and low self-esteem,” said Jelalian, who is also an associate professor of psychiatry and human behavior at Alpert Medical School. “This information could ultimately lead to improved and more effective obesity treatment programs for adolescents.”

To learn more about the AWCR, please call (401) 793-8931 or visit: http://www.weightresearch.org/AWCR.html

Reporting in the July issue of the Journal of the American Academy of Child & Adolescent Psychiatry, researchers say a small percentage of children with bipolar disorder experience manic episodes without extreme elation – one of the hallmarks of the disorder – and are diagnosed based on irritable mood alone.

“Diagnosing children with bipolar disorder is challenging. One of the chief controversies is whether irritability should be included among the criteria for this diagnosis because it can also overlap with a number of other psychiatric disorders, such as attention deficit hyperactivity disorder,” says lead author Jeffrey Hunt, MD, a child psychiatrist and training director at Bradley Hospital. “Our findings confirm that while irritable-only mania is uncommon, it does exist – particularly in younger children – and should be considered in a bipolar diagnosis.”

Bipolar disorder is characterized by dramatic mood swings from euphoria, elation and irritability – the manic phase of the disorder – to severe depression. Bipolar disorder often begins in late adolescence or early adulthood, although it can develop as early as the preschool years. Recent studies have shown that the number of children and teens being treated for bipolar disorder has grown dramatically in the last decade. Although it is unclear what has caused this increase, experts believe it may be due in part to more aggressive diagnoses by physicians and a greater awareness of pediatric bipolar disorder in the medical community.

Hunt and colleagues studied 361 children between the ages of 7 and 17 with bipolar disorder participating in the multi-site Course and Outcome of Bipolar Illness in Youth (COBY) study at Bradley Hospital and Alpert Medical School, the University of Pittsburgh and the University of California-Los Angeles. COBY is the largest and most comprehensive study of children and adolescents with bipolar disorder to date.

Researchers quantified the frequency and severity of manic symptoms of each participant, including whether irritability and elation were present. Based on this data, the group was then reclassified into three subgroups: elation-only, irritable-only and both elated and irritable.

Approximately 10 percent of children fell into the irritable-only category, while elated-only constituted about 15 percent. Nearly three-quarters experienced both elation and irritability. The irritable-only participants were significantly younger in age than the other two groups; however, there were no other sociodemographic differences between the groups. There were also no significant differences in terms of bipolar subtype, rate of psychiatric comorbidities, severity and duration of illness, and family history of mania and other psychiatric disorders. However, depression and alcohol abuse in second-degree relatives occurred more frequently in the irritable-only subgroup.

“The fact that the irritable-only and elation-only subgroup had similar clinical characteristics and family histories of bipolar disorder provides support for continuing to consider episodic irritability in the diagnosis of pediatric bipolar disorder,” says Hunt, who is an assistant professor of psychiatry and human behavior at Alpert Medical School. Hunt is also training director of the child and adolescent fellowship and triple board residency programs.

The authors say continual, long-term follow-up of this study sample will help clarify whether the presence or predominance of elation or irritability at baseline will predict future clinical outcomes.

The research was funded by a grant from the National Institute of Mental Health. Study co-authors include Jennifer Dyl and the late Henrietta Leonard from Bradley Hospital and Alpert Medical School; Christianne Esposito-Smythers, Martin Keller, Lance Swenson and Robert Stout from Alpert Medical School; Boris Birmaher, David Axelson, Neal Ryan, Benjamin Goldstein, Tina Goldstein, MaryKay Gill and Mei Yang from the University of Pittsburgh Medical Center; and Michael Strober from the David Geffen School of Medicine, University of California at Los Angeles.

Founded in 1931, Bradley Hospital, located in East Providence, RI, was the nation’s first psychiatric hospital devoted exclusively for children and adolescents. It remains a nationally recognized center for children’s mental health care, training and research. Bradley Hospital is a member of the Lifespan health system and is a teaching hospital for The Warren Alpert Medical School of Brown University. For more information, please visit www.bradleyhospital.org

If patients’ family members or friends have flu-like symptoms, including fever and runny nose and/or sore throat and/or cough, please do not visit. If a visit is absolutely necessary, visitors should wear a mask and limit their time in the hospital.

We also provide Purell hand sanitizer dispensers throughout the hospital and encourage their frequent use to kill germs.

Again, we stress these are precautionary measures to provide the best care to all of our patients, and to protect families and staff.

Learn more about the swine flu on our website.