General Outpatient Child and Adolescent Psychiatry Clinic at 4444

Rotation Director: T. Eric Spiegel, MD

Other Faculty: John Constantino, MD; Chad Sylvester, MD, PhD; Mini Tandon, DO; Cynthia Rogers, MD;  Ginger Nicol, MD; Bryan Sewing, DO; Alecia Vogel-Hammen, MD, PhD; Joan Luby, MD

Rotation Coordinator: Sundra Streibig

Number of Fellows per Rotation: 10

Length of Rotation: 24 months, 1 afternoon per week

Time of Rotation: First and second year

Location: Washington University Child and Adolescent Psychiatry Center
4444 Forest Park Ave. Suite 2600
St. Louis, MO 63108
(314) 286-1700

Goal
The overall goal is to provide fellows with in-depth exposure to the 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 clinic is physician-led relying on a team of physicians including the attending faculty and the fellow. It is expected that as the fellow advances through fellowship, especially into the second year of training, their team input will become progressively more prominent with a goal of autonomy at the end of fellowship and increased attention to teaching others, and an increased leadership role in the last months of fellowship.

Objectives

To develop competence in the following areas:

Patient Care

The fellow 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 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 needed frequency of clinic visits for optimum care
  • Advancing familiarity and competence with psychopharmacological and psychotherapeutic approaches to disorders

Medical Knowledge

The fellow will gain medical knowledge through working in a clinical team and accompanying mandatory divisional didactics and reading of the pertinent 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, 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 with one another)
  • Knowledge of outpatient care ethical standards of practice
  • Use of electronic systems to access the medical and scientific information

 Interpersonal/Communication Skills

The fellow 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 examinations on children and adolescents in outpatient settings
  • Effective communication with patients, attending physicians, 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 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 (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 (supervision, team supervision, journal club, psychotherapy seminar, core didactics, and special clinic conferences as applicable)
  • Active case-based learning in the clinic
  • A critical review of patient’s old records and outcomes
  • Research literacy (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 fellow will demonstrate sensitivity and compassion to children and adolescents affected by psychopathology and to their families or their caretakers and will continue to develop relationships 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
  • Acknowledgment and remediation of errors
  • Intra-professionalism; 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 professional conduct of colleagues if appropriate
  • Leadership role increases with training level (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 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

Measurement of Objectives

  • Feedback by others, including staff
  • Standard program evaluations
  • Medical records review by faculty
  • Clinical skills examinations

Description of Rotation

The General Outpatient Child and Adolescent Psychiatry 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 (preschool, medical and neurological comorbidity, autism, disruptive disorders, ADHD and comorbidity, depression, and suicidal behaviors). Fellows 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, and behavioral and cognitive approaches.