Outpatient Child and Adolescent Community Mental Health Psychiatry Clinic

Number of Fellows per Rotation: 5

Length of Rotation: 52 weeks

Time of Rotation: Second-year

Goal

The Outpatient Child and Adolescent Psychiatry Community Mental Health Clinic rotation provides longitudinal exposure to the care and outcomes of community children and adolescents who come from very high-risk backgrounds. This rotation allows observation of developmental change and therapeutic change over time. Fellows will join a multidisciplinary team dedicated to providing high-quality,
longitudinal community mental health care to children and adolescents in our region.

Objectives

To develop competence in the following areas:

Patient Care
  • The fellow provides longitudinal treatment of children and their families or children in foster care.
  • The fellow provides longitudinal efforts to modify key child risk factors for poor psychiatric outcomes, including non-adherence, loss to follow-up, and familial or environmental risks, including severe parental psychopathology.
  • The fellow develops psychotherapy skills necessary to manage outpatients, their family members, and their caretakers.
  • The fellow provides longitudinal medication regimens, adjustments, and changes.
  • The fellow provides ongoing outpatient psychoeducation.
Medical Knowledge

  • The fellow gains medical knowledge through a combination of supervised clinical activities, mandatory divisional didactics, and supervised reading of pertinent literature.
  • The fellow understands stability and change in functional impairments associated with various child psychiatric disorders and the ongoing dynamic influence of other risk factors on course, prognosis, and outcomes.
  • The fellow understands the use of standardized rating scales completed by patients, parents, and/or teachers to document incremental changes in symptoms.
  • The fellow provides longitudinal monitoring of the side effects of psychopharmacology, especially poly-psychopharmacology.
  • The fellow understands appropriate and necessary use of laboratory testing, including how to safely maintain patients on psychopharmacological regimens.
  • The fellow gains an appreciation of adherence and compliance issues.
Practice-Based Learning

  • The fellow participates in clinical activities, self-initiated and suggested readings, and one-on-one and team supervision by faculty.
  • The fellow demonstrates the ability to incorporate lessons learned from supervision into new knowledge, professional attitudes, and skills.
  • The fellow continuously apprises oneself of current knowledge concerning community mental health.
  • The fellow reflects on longitudinal courses and managing their clinic.
  • The fellow gains an appreciation of how community mental health patients may, or may not, differ systematically from patients studied more intensively in child psychiatry research.
  • The fellow gains an understanding of the strengths and limitations of evidence-based treatments in understudied populations.
Professionalism

  • The fellow demonstrates compassion, integrity, respect, and sensitivity to patients, families, and caregivers, considering age, cultural background, disabilities, ethnicity, gender identity and expression, race, sexual orientation, and socioeconomic status.
  • The fellow demonstrates a commitment to ethical principles such as confidentiality, non-maleficence, and informed consent.
  • The fellow continues to develop relationships with all non-physicians and physicians involved in patient care.
  • The fellow adaptively manages their emotional reactions to severe child and adolescent psychiatry.
  • The fellow demonstrates an ability to function as a cooperative member of a multidisciplinary therapeutic team.
  • The fellow demonstrates a commitment to continued professional development.
  • The fellow completes documentation of patient encounters in a timely fashion.
Interpersonal/Communication Skills

  • The fellow demonstrates an ability to effectively communicate with patients, families, caregivers, and providers from different disciplines.
  • The fellow demonstrates the ability to present findings and treatment options to patients, families, and caregivers.
  • The fellow effectively communicates and coordinates care with all non-physicians and physicians involved in providing patient care.
  • The fellow presents cases accurately, succinctly, and timely.
System-Based Care
  • The fellow develops an understanding of the roles of other mental health professionals, including but not limited to art therapists, mental health coaches, music therapists, nursing staff, recreational therapists, and social workers.
  • The fellow interacts with social and legal agencies in the management of child and
    adolescent psychiatric disorders.
  • The fellow deepens their understanding of the limitations of community mental health care for children and its impact on psychiatric presentations. The expectation is to form ideas about improvements to systems of care.
  • The fellows provide an ongoing team approach for managing outpatients, including clinic and outreach therapists.

Measurement of Objectives

  • Feedback from other professionals
  • Standard program evaluations
  • Medical records review by faculty
  • Clinical Skills Examination