Child and Adolescent Psychiatry Outpatient Clinic

Rotation Director: Anne Glowinski MD, MPE

Other Faculty: John Constantino MD, Chad Sylvester MD, PhD, Mini Tandon DO, Brooke Ayden MD, Cynthia Rogers MD,  Eric Spiegel MD, Ginger Nicol MD, Dehra Harris, MD

Rotation Coordinator: Michelle Rodgers

Number of residents per rotation: 9

Length of Rotation: 24 months, 1 afternoon per week

Time of Rotation: First and Second Year

Location: 4444 Forest Park Avenue

Goal

The overall goal is to provide CAP residents with an in-depth exposure to care of children and adolescents in both short term collaborative care models with other physicians and longitudinal aspects of outpatient child psychiatry care in an academic clinic setting, where complex or tertiary referrals are common.  The nature of patient care at the 4444 Forest Park Ave clinic is physician-led relying on a team of physicians which includes an attending faculty and the fellow.  It is expected that as the fellow advances through fellowship and especially advances into the second year of training, her of his team input will become progressively more prominent with a goal of autonomy at the end of fellowship and increased attention to teaching of others and an increased leadership role in the last months of fellowship.

Objectives

To develop competence in the following areas:

Patient Care

The resident will learn comprehensive longitudinal provision of clinical care in the Child And Adolescent Psychiatry Clinic. This includes:

  • Refinement of child and family therapeutic interviewing skills
  • Conducting patient and family centered evaluations of common and less common presentations of CAP disorders.
  • Sophisticated observations and interpretations of  family relationships and their pertinence to the child’s presenting problems
  • Deeper appreciation of the role of the family in the assessment and treatment regardless of the age of the patient
  • Assessment of risk and appropriateness of outpatient (vs. more intensive) treatment
  • Prevention of self-harm and harm to others
  • Assessment of needed frequency of clinic visit for optimum care
  • Advancing familiarity and competence with psychopharmacological and psychotherapeutic approaches to CAP disorders

Medical Knowledge

The resident will gain medical knowledge through working in a clinical team and accompanying mandatory divisional didactics and reading of the pertinent CAP or related literature.  Knowledge developed in the clinic will include:

  • Outpatient presentation of major child psychiatric disorders including knowledge of epidemiology, known etiological or risk factors, disorder phenomenology, diagnostic criteria, predictive value of diagnosis
  • Understanding the appropriate use of laboratory testing and adjunctive data collection in child psychiatric outpatient care
  • Understanding the appropriate use of adjunct medical consultation
  • Critical knowledge of effective treatment strategies including psychopharmacological and psychotherapeutic approaches and strengths and limitations of approaches (combined or not combined with one another)
  • Knowledge of outpatient care ethical standards of practice
  • Use of electronic systems to access medical and scientific information

 Interpersonal/Communication Skills

The resident will effectively communicate with patients, their families and all other members of the treatment team

  • Conducting age appropriate interview techniques, as well as comprehensive mental status examination on children and adolescents in outpatient settings
  • Effective communication with patients, attending physician and clinic staff including verbal, non-verbal and written communication
  • Ability to efficiently summarize new cases and progress in a manner conducive to the timely pace of clinical care in the clinic
  • Develop and maintain longitudinal therapeutic alliances with patients and families and ability to troubleshoot difficulties encountered in the maintenance of therapeutic alliances
  • Clear transmission of information to patients and families of varying ages and backgrounds
  • Education of others (e.g., neurology residents, medical students, general psychiatry residents, school professionals, allied professionals, primary care providers, public) as needed to advocate for patients.
  • Clear and timely maintenance of electronic medical records including written prescriptions and all communications related to patient care
  • Providing preventive education related to patient’s prognosis
  • Conflict management

Practice Based Learning

The fellow will develop competence in continuous learning and improvement through practice and related activities including, in the clinic setting, close supervision by a physician with advanced training in CAP

  • Appreciation of one’s strengths and weaknesses related to child psychiatric outpatient care and willingness and ability to address one’s own limitations with learning
  • Active participation in didactics which are particularly salient to practice in the clinic (e.g., supervision, team supervision, journal club, psychotherapy seminar, core didactics and special clinic conferences as applicable)
  • Active case based learning in the clinic
  • Critical review of patient’s old records and outcomes
  • Research literacy (e.g., develop an understanding of common methods used in child psychiatry and related research)
  • Integration of literature findings into patient care and/or communication with others including families
  • Ability to research and troubleshoot complexities and difficulties that arise in patient care

 Professionalism

The resident will demonstrate sensitivity and compassion to children and adolescents affected by psychopathology and to their families or their caretakers and will continue to develop in relationship with other professionals or professionals in training, including supervisors, colleagues, students and allied professionals.  In the clinic, major aspects of professional development will include:

  • Developing intra-professionally by managing adaptively their own emotional reactions to youth and families seen in the clinic
  • Responsibility for patient care as demonstrated by timely response or communication with families, attending(s), and other health professionals
  • Arranging for coverage during absences including illness or vacation
  • Acknowledgement and remediation of errors
  • Intra-professionalism: ability to understand and remedy factors which interfere with one’s proper professional conduct
  • Respect of patients, colleagues, supervisors, supervisees and staff regardless of background
  • Review of professional conduct of colleagues if appropriate
  • Leadership role increasing with training level (e.g., improvement in problem solving, providing resources and advice to others, becoming a role model)

System Based Care

  • Development of outpatient care skills including time management, clinic scheduling management, and communication with referral sources
  • Familiarity with outpatient billing procedures
  • Understanding of global system of care and where clinic care fits in it including appreciation of need to referral to other system of care if more adequate for patient care
  • Utilization of appropriate consultation and referral
  • Communication with referring providers and education of other providers within the system of care.

Measurement of Objectives

  • Feedback by others including staff
  • Standard Program evaluations
  • Medical Records Review by Faculty
  • Clinical Skills Exams

Description of Rotation

This outpatient clinic experience emphasizes the thorough and comprehensive evaluation of patients referred for difficulties ranging from common to very complex and the ongoing longitudinal treatment vs. referral back to community care of these patients.  This rotation involves sharing patient care with program faculty, some of which have specialized areas of clinical and/or research (e.g., preschool, medical and neurological comorbidity, autism, disruptive disorders, ADHDand comorbidity, depression, suicidal behaviors). Residents will evaluate and follow a variety of patients throughout the years under supervision typically integrating multiple treatment modalities for outpatient clinical care including pharmacotherapy, psychotherapy, family therapy, parent training, behavioral and cognitive approaches.