Outpatient Child and Adolescent Psychiatry Continuity Clinic

The fellow will learn comprehensive longitudinal provision of clinical care in the Outpatient Child and Adolescent Psychiatry Continuity Clinic. This includes:

• Refinement of child and family therapeutic interviewing skills.
• Conducting patient and family-centered evaluations of common and less common presentations of disorders.
• Sophisticated observations and interpretations of family relationships and their pertinence to the child’s presenting problems.
• A 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 the needed frequency of clinic visits for optimum care.
• Advancing familiarity and competence with psychopharmacological and psychotherapeutic approaches to child and adolescent disorders.

The fellow will gain medical knowledge through working in a clinical team, attending mandatory divisional didactics, and reading the pertinent child and adolescent psychiatry-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, and 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).
• Knowledge of outpatient care ethical standards of practice.
• Use of electronic systems to access medical and scientific information.

The fellow will develop competence in continuous learning and improvement through practice and related activities, including close supervision by a physician with advanced training in child and adolescent psychiatry. This includes:

• Appreciation of one’s strengths and weaknesses related to child psychiatric outpatient care and the willingness and ability to address one’s limitations with learning.
• Active participation in didactics that are particularly salient to practice in the clinic (e.g., supervision, team supervision, journal club, psychotherapy seminar, core didactics,
  and special clinic conferences).
• Active case-based learning in the clinic.
• Critical review of the 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.

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

• Developing intra-professionally by managing adaptively their emotional reactions to youth and families seen in the clinic.
• Responsibility for patient care as demonstrated by a 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.
• The ability to understand and remedy factors that interfere with one’s proper professional conduct.
• Respect for patients, colleagues, supervisors, supervisees, and staff regardless of background.
• Review of the professional conduct of colleagues, if appropriate.
• Leadership role increases with training level (e.g., improvement in problem solving, providing resources and advice to others, and becoming a role model.

The fellow will effectively communicate with patients, their families, and all other members of the treatment team. This includes:

• Conducting age-appropriate interview techniques, as well as comprehensive mental status examination on children and adolescents in outpatient settings.
• Effective communication with patients, the attending physician, and the 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 have the 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, and primary care providers) 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 a patient’s prognosis.
• Conflict management.

• Development of outpatient care skills, including time management, clinic scheduling management, and communication with referral sources
• Familiarity with outpatient billing procedures.
• Understanding of the global system of care and where clinic care fits in it, including appreciation of the need to refer to other systems 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.