Child and Adolescent Inpatient Rotation

By the end of the Child and Adolescent Inpatient Rotation, the resident will be able to:

Knowledge:

    * Classify and compare child, adolescent and family assessment methods, including unstructured, semi-structured, and structured assessment tools

    * Describe ancillary services as used in inpatient settings

    * Classify and compare a range of treatment modalities employed in child and adolescent psychiatry, including psychopharmacological, psychodynamic, behavioral and cognitive modalities as appropriate to various care settings and clinical presentations

Skills:

    * Comprehensively assess the mental status of a child or adolescent in the context of developmental status in the setting of the inpatient unit

    * Explain the underpinnings of a comprehensive assessment and treatment plan

    * Formulate, document and discuss cases in respect to health, psychopathology, and proposed interventions

    * Select and offer standard treatments as delivered in inpatient settings to children, adolescents and their families, including psychodynamic, somatic, behavioral, and cognitive interventions

Attitudes:

    * Advocate for the rights of the child and adolescent

    * Assess self for compliance with individual ethical standards

Partial Hospitalization (Challenge) Program

By the end of this rotation, the resident will be able to:

Knowledge:

    * Describe and compare collaborative intervention methods in child and adolescent psychiatry as defined in a partial hospitalization program

    * Competently administer a range of treatment modalities employed in child and adolescent psychiatry, including psychopharmacological, psychodynamic, behavioral and cognitive modalities as appropriate to each care setting and clinical presentation

Skills:

    * Assess, discuss, document and intervene in cases of children and adolescents presenting with non-acute, but sustained impairment

Attitudes:

    * Evaluate his/her own practice performance and challenge self for further learning

    * Seek and utilize supervision

Child and Adolescent Outpatient Services

At the end of this rotation, the resident will be able to:

Knowledge:

    * Define child, adolescent, and family assessment methods in the outpatient setting

    * Describe common unstructured and semistructured assessment methods

    * Describe basic neuroregulatory mechanisms, neurotransmitter systems, and drug delivery systems specific to pediatrics

    * Describe psychotherapeutic theories and their basic principles.

    * Define therapeutic techniques for individual children and adolescents, families, and groups

    * Describe ethics in psychotherapy including the understanding and maintaining of clinical boundaries

Skills:

    * Collaborate with other professionals, such as psychologists, social workers, case managers, teachers, educational specialists, and guidance counselors who participate in the treatment of children and adolescents in the outpatient setting

    * Assess, discuss, document and intervene in cases of children and adolescents presenting to outpatient settings

    * Assess children, adolescents, and their families in the context of developmental, socioeconomic, and cultural variables.

    * Interpret ancillary assessments, such as those provided by psychologists, occupational therapists, speech and language pathologists, social workers, or school personnel

    * Develop a treatment plan that includes psychopharmacology when indicated

    * Illustrate formulation of a case and anticipation how psychological and family issues may influence medication compliance

    * Identify target symptoms and their improvement as well as potential side effects and medication interactions

    * Demonstrate skills in the management of drug-abusing clients and the prescription of scheduled drugs

    * Perform interview of parents/family, using knowledge of systems theory, learning theory, and psychodynamic theories of family functioning

    * Formulate a case from an interview, mental status examination, historical material, and knowledge of development in multiple settings (i.e., clinic, inpatient unit, forensic environment, and medical units)

    * Develop and implement patient management plans

    * Maintain a clinical record including psychotherapy notes, coding, and billing

    * Demonstrate development of a therapeutic alliance with a child and caregivers and maintenance of appropriate clinical boundaries

Attitudes:

    * Evaluate his/her own practice performance and challenge self for further learning

    * Offer openness to learning as demonstrated by a curious and questioning attitude.

    * Participate in supervision in an open, revealing manner using detailed process notes and personal disclosure to develop increased therapeutic precision and ensure maintenance of appropriate boundaries

Pediatric Consultation-Liaison

At the end of Pediatric Consultation-Liaison rotation, the resident will be able to:

Knowledge:

    * Describe considerations in the evaluation children and adolescents on a pediatric unit for primary psychiatric illness including diagnoses such as depression, anxiety disorders, disruptive behavioral disorders, and psychosomatic illnesses

    * Outline psychological factors that affect a medical illness and adjustment to medical illness

    * State the roles and experiences of each member of a multidisciplinary team

    * Define determinants of a child‚ need for psychiatric support on discharge from the pediatric unit.

Skills:

    * Communicate effectively with the requesting party to refine the consultation question

    * Maintain the role of consultant

    * Ability to perform a psychiatric assessment of a child, adolescent or family on a pediatric unit

    * Gather the necessary information about a child‚ premorbid functioning in order to understand the current style of coping and to communicate this information to the team in a way that increases empathy for the child

    * Write an appropriate assessment note in the hospital chart and appropriate daily chart notes

    * Communicate clear and specific recommendations

    * Arrange an appropriate psychiatric disposition at discharge from the pediatric unit

Attitudes:

    * Demonstrate sensitivity and empathy while interacting with children and families on the inpatient service

    * Promote openness to ethnic and cultural issues that may affect the child and family‚ hospital experience

    * Demonstrate willingness to work collaboratively with members of the multidisciplinary medical team

    * Respect the knowledge and expertise of the requesting professionals to educate patients, their families, and professionals about medical, psychosocial, and behavioral issues

Pediatric Emergency Room

At the end of the Pediatric Emergency Room rotation, the resident will be able to:

Knowledge:

    * Define child psychiatric presentations that necessitate emergency service.

    * Itemize skills necessary to assess and manage the potential for suicidality or homicidality

    * Plan for suspected abuse or neglect intervention

    * Define resources available at the state and local level for inpatient and outpatient follow-up care

    * Describe appropriate procedures in consulting with a junior resident over the telephone, including reviewing the case, formulating a diagnosis and validating a treatment plan together with the junior resident.

Skills:

    * Take a swift yet comprehensive psychiatric history and generate a complete differential diagnosis

    * Recommend the administration of necessary medications that are relevant in the emergency room setting

    * Assess potential for suicidality and/or homicidality in child patients

    * Access outpatient or inpatient services when necessary, with the assistance of the crisis intervention staff

    * Work collaboratively with members of the pediatric staff, to facilitate further medical evaluation when necessary

Attitudes:

    * Vigilance in considering the potential for abuse/neglect of children

    * Sensitivity to cross-cultural issues in emergency child psychiatry

    * Respect for the needs of family members in the assessment and treatment of children and adolescents presenting to the Emergency Room

    * Attention to the needs and questions of junior psychiatric residents and respect for their level of understanding of a case.

The Autism Center

At the end of The Autism Center clinical rotation, the resident will be able to:

Knowledge:

    * Describe the DSM-IV diagnostic criteria of all the Pervasive Developmental Disorders

    * Describe how to appropriately diagnose comorbid psychiatric conditions in this population

    * Define the different roles that each specialist plays in the care of individuals on the autism spectrum

Skills:

    * Conduct a diagnostic evaluation, which includes a developmental history from the parent/caregiver and a play based evaluation of the child/adolescent

    * Accurately diagnose the type of pervasive developmental disorder as well as the comorbid psychiatric conditions

    * Formulate an individualized biopsychosocial treatment plan that integrates the information gained from the evaluation and from other systems in the child‚ environment (school, pediatrician, therapists, etc).

    * Utilize community resources and autism advocacy groups in the care of the patient

Attitudes:

    * Show an increased level of comfort in dealing with children and families affected by this neurodevelopmental disorder

    * Demonstrate respectful, compassionate and systematic approach to giving feedback to the family regarding diagnosis and treatment

    * Demonstrate awareness of the many, varied interventions available to families and the role of the biomedical/psychiatric perspective within this larger network

The Specialty Clinic

At the end of The Specialty Clinic rotation, the resident will be able to:

Knowledge:

    * Describe the DSM-IV diagnostic criteria for Tourette’s Disorder and other disorders encountered at the Specialty Clinic

    * Describe how to appropriately diagnose comorbid psychiatric conditions in each population

    * Define the different roles that each specialist plays in the care of individuals with Tourette Syndrome and other encountered disorders

Skills:

    * Conduct a diagnostic evaluation, which includes a parent/caregiver and child/adolescent component

    * Accurately diagnose Tourette Syndrome and comorbid psychiatric conditions

    * Formulate an individualized biopsychosocial treatment plan that integrates the information gained from the evaluation and from other systems in the child‚ environment (school, pediatrician, therapists, etc).

    * Utilize community resources in the care of the patient

Attitudes:

    * Show an increased level of comfort in dealing with children and families affected by this neurodevelopmental disorder

    * Demonstrate respectful, compassionate and systematic approach to giving feedback to the family regarding diagnosis and treatment

    * Demonstrate awareness of the many, varied interventions available to families and the role of the biomedical/psychiatric perspective within this larger network

Pediatric Neurology

At the end of the Pediatric Neurology rotation, the resident will be able to:

Knowledge:

    * Outline the common neurological disorders of infants and children in a hospital setting

    * Differentiate neurological deficits of the central and peripheral nervous system

    * Describe available treatments and techniques used with epilepsy, CNS infections, and other neurological diseases.

    * Compare and contrast pediatric psychiatry and neurology clinical presentations

Skills:

    * Take an accurate history and perform a neurological examination of a child and adolescent

    * Integrate clinical findings with other investigations to make a differential diagnosis and formulate a treatment plan.

    * Provide information to patients and families about the nature of therapeutic and diagnostic procedures and the nature of the disorder and intervention options

    * Write concise consultation notes regarding the neurological evaluation

Attitudes:

    * Demonstrate empathic and sensitive approach to working with patients with neurological disorders, and their families

    * Consider the needs of patients and families to be fully informed regarding medical options both in the acute and chronic phases

    * Show a respectful and collaborative approach in working with other healthcare professionals in the neurological outpatient clinics.

School Consultation

At the end of school consultation rotation, the resident will be able to:

Knowledge:

    * Distinguishing responsibilities of teacher, principal, social worker and other school staff and their roles within the multidisciplinary team.

    * Define school culture and state the roles and approaches of school personnel

    * Define publicly and privately available resources for the treatment of learning disorders and psychiatric/behavioral problems affecting a child or adolescent‚ ability to learn

    * Compare school-based mental health care to that in other settings

    * Outline legal aspects of education as they affect children and adolescents with psychiatric problems [e.g., the Individuals with Disabilities Education Act (IDEA)]

    * Demonstrate familiarity with Individual Education Plans (IEP) and the child and adolescent psychiatrist‚ role in the process for determining the individual educational needs for particular patients (e.g., specialized classrooms or services for the learning disabled, the behaviorally challenged, the emotionally handicapped, and the otherwise health impaired).

    * Outline developmentally appropriate models that are used by staff to successfully address the behavioral and developmental difficulties that impede learning

    * Itemize psychiatric symptoms within the school population

    * Describe the interaction between psychopathology and learning difficulties

    * Define the process of initiating, monitoring and evaluating behavioral plans for children with learning and developmental disabilities

Skills:

    * Observe a child within the classroom in a discrete and objective manner, and then succinctly and systematically describe the play activities and behavioral patterns

    * Describe the interaction between learning disabilities and emotional and behavioral difficulties

    * Design a behavioral plan for a child that has been observed as well as discussed in team meetings

Attitudes:

    * Respectfully interact with school staff who provide different services

    * Show awareness of the impact of the developmental disability on the family system and of the associated stresses experienced by the family

    * Foster appreciation of the cultural diversity of the parent body and the socioeconomic circumstances experienced by the children that attend the school

Child and Adolescent Outpatient Continuity Clinic (ChOC; UBHC)

At the end of this rotation, the resident will be able to:

Knowledge:

    * Define the role and functions of other professionals collaborating with psychiatrists, such as psychologists, social workers, case managers, teachers, educational specialists, and guidance counselors

    * State and interpret medication dosages, interactions, and the relationship of dose to age, gender, and weight

    * Outline side effects and drug interactions for all psychotropic medications used in the treatment of psychiatric disorders in children and adolescents

    * Define medication management strategies using single and, whenever appropriate, multiple drugs

    * Classify methods to evaluate drug efficacy

    * Outline and tabulate applied theories of development, including child, adult, parental, and family development issues

    * Demonstrate psychotherapy administration tasks including record-keeping, charting, and coding of psychosocial interventions

    * Describe ethics in psychotherapy including the understanding and maintaining of clinical boundaries

Skills:

    * Collaborate with other professionals, such as psychologists, social workers, case managers, teachers, educational specialists, and guidance counselors who participate in the treatment of children and adolescents in the outpatient setting

    * Competently administer a range of treatment modalities employed in child and adolescent psychiatry outpatient settings, including psychopharmacological, psychodynamic, behavioral and cognitive modalities as appropriate

    * Concisely and efficiently formulate, document and discuss cases in respect to health, psychopathology, and proposed interventions

    * Develop a treatment plan that includes psychopharmacology when indicated

    * Illustrate formulation of a case and anticipation how psychological and family issues may influence medication compliance

    * Identify target symptoms and their improvement as well as potential side effects and medication interactions

    * Perform psychopharmacology consultation and integrate psychopharmacologic interventions with treatment from a non-physician therapist or primary care provider

    * Demonstrate integration of psychopharmacology interventions skills within the context of an ongoing psychotherapy and other psychosocial interventions (i.e., inpatient hospital, community, or partial hospitalization program)

    * Develop and implement patient management plans

    * Engage in the variety of psychotherapies (short- and long-term, family, behavioral, cognitive-behavioral, and group psychotherapies), including formulating and implementing a treatment plan with the goal of relieving certain identifiable symptoms

    * Maintain a clinical record including psychotherapy notes, coding, and billing

    * Demonstrate development of a therapeutic alliance with a child and caregivers and maintenance of appropriate clinical boundaries

Attitudes:

    * Evaluate his/her own practice performance and challenge self for further learning

    * Offer openness to learning as demonstrated by a curious and questioning attitude.

    * Participate in supervision in an open, revealing manner using detailed process notes and personal disclosure to develop increased therapeutic precision and ensure maintenance of appropriate boundaries