Number of Fellows per Rotation: 1
Length of Rotation: 2 blocks of 5.2 weeks
Time of Rotation: First-year
You will be the provider for a group of acute inpatients between the ages of 5 – 17 with serious
psychiatric crises. We help stabilize these patients so they may return home. While stabilizing the crisis, we focus on clarifying the diagnosis, beginning psychopharmacologic treatment, and setting up outpatient follow-up after the hospital. While hospitalized, our patients learn Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT) based skills like distress tolerance, emotional regulation, communication, social skills, and relaxation. There is also Recreational Therapy Groups, Art Therapy Groups, Music Therapy Groups, and other groups that are available based on facilitator availability (e.g., Yoga Groups). Each patient collaborates with a therapist who may collaborate with their families as needed. You can also get the opportunity to hone skills in brief crisis-focused Supportive Psychotherapy, Motivational Interviewing, and Introductions to CBT. You will work with multiple types of therapists, nurses, physicians, Advanced Practice Practitioners, and other trainees.
Objectives
To develop competence in the following areas:
The fellow will learn the provision of clinical care at SLCH PBHU. The nature of patient care is inter-disciplinary and focused on crisis stabilization, rapid recruitment of community resources into a treatment plan, and discharge back into the community. Disposition planning begins on the day of admission, and the average length of stay is 5-7 days per patient. The fellow will:
- Assess patients admitted from the emergency room setting or the consultation service. This will allow the fellow a full, longitudinal perspective of care for patients who arrive at SLCH for behavioral health needs in conjunction with other clinical rotations.
- Conduct patient and family-centered evaluations of severe CAP disorders.
- Assess the patient’s needs, current resources, and support systems to develop the
assessment into an effective treatment and disposition plan. - Observe and interpret family relationships and their pertinence to the child’s presenting
problems. - Appreciate the role of the family in the assessment and treatment, regardless of the patient’s age.
- Produce differential diagnosis and dynamic case formulation of psychiatric
symptomatology and appreciate the importance of biologic, psychological, and socio-
cultural aspects of symptoms. - Become familiar with psychopharmacological and psychotherapeutic approaches to severe CAP disorders.
The fellow will gain medical knowledge through supervised clinical activities, mandatory divisional didactics, and supervised reading of the pertinent CAP or other related literature. The fellow will:
- Develop the appropriate knowledge of effective medication modifications for acute hospitalization.
- Bolster psychotherapy skills geared towards crisis-intervention supportive
psychotherapy, cognitive behavioral approaches, and motivational interviewing. - Know the strengths and limitations of the current DSM diagnostic criteria.
- Understand the appropriate use of laboratory testing.
- Understand the appropriate use of adjunct medical consultation and effectively communicate the answers to medical questions to the medical consultant.
In addition to supervised clinical activities and self-initiated and suggested readings, the fellow will participate in supervision. This will include one-on-one supervision by the faculty at SLCH PBHU. The fellow will:
- Continue to appraise oneself of current knowledge concerning the pathogenesis and etiology of psychiatric disorders.
- Become familiar with the appropriate use of psychological testing, types of psychological testing available, and their availability in the community.
- Gain administrative experience in ward management.
- Appreciate the historical, cultural, legal, and ethical aspects of inpatient child and
adolescent psychiatry.
The fellow will demonstrate sensitivity and compassion to children and adolescents affected by serious psychopathology, and to their families, or their caretakers. Fellows will continue to
develop relationships with other professionals, including supervisors, colleagues, professionals in training, students, and allied professionals. The fellow will:
- Develop intra-professionally by managing their emotional reactions to severe youth psychopathology.
- Demonstrate the ability to function as a cooperative member of a multi-disciplinary therapeutic team.
- Demonstrate a commitment to continued professional development.
The fellow will effectively communicate with patients, their families, and all other members of
the treatment team. The fellow will:
- Conduct age-appropriate interview techniques, as well as comprehensive mental status examinations on children and adolescents.
- Talk with and obtain a history from patients, family members, and all others involved in the caretaking system of the patient (DFS social worker, case worker, teacher, etc.).
- Present cases succinctly and accurately.
- The fellow will understand the roles of other mental health professionals including nursing staff, social workers, art therapists, music therapists, recreational therapists, and mental health coaches.
- Interact with social and legal agencies in the management of child and adolescent
psychiatric disorders.
Measurement of Objectives
- Standard Program evaluations
- Multisource feedback
- Clinical Skills Exams