School Consultation SSD-CAP2

superintendent working with student

Rotation Director: Natasha Marrus MD, PhD

Other faculty: Angela Reiersen, MD, MPE

Number of residents per rotation: One

Length of Rotation: 10.4 weeks during SUD Disorders Block, 2 mornings per week (Mondays with Dr. Marrus and Thursdays with Dr. Reiersen.)

Time of Rotation: Second year of training

Location: Schools of the St. Louis County Special School District (1 morning per week) and 4444 (1 morning per week)

Please contact both Dr. Marrus and Dr. Reiersen at least two weeks before the beginning of this rotation.


The goal is to provide the CAP resident with an understanding of the factors impacting a consultation in a school setting or related to optimizing child function in a school environment. Adequate consultation in a school setting hinges on understanding the uniqueness of the school environment.


To develop competence in the following areas

Patient Care

The resident will learn consulting skills at various schools within the St. Louis Special School District and at the Montclair clinic with up to two weekly consultations to the SSD.

  • Understanding presentations of functional impairment in school settings including behavioral and educational difficulties
  • Observing and interpreting family relationships and teacher-child relationships and their relevance to presenting problem
  • Understanding how psychiatry symptomatology can be exacerbated or moderated by the school environment
  • Work effectively with the professionals involved in teaching

Medical Knowledge

The resident will gain medical knowledge through a combination of supervised clinical activities, mandatory divisional didactics, supervised reading of the pertinent CAP or related literature.

  • Understand specific learning disabilities and their relationships to behavioral disorders
  • Develop concepts of psychiatric presentations in a school context
  • Understand the academic and social implications of various psychiatry disorders including ADHD and depression

Practice Based Learning

In addition to supervised clinical activities and self initiated and suggested readings, the resident will participate in supervision including 1:1 supervision by attending faculty and other divisional supervision including individual and team supervision

  • Continuing to appraise oneself of current knowledge concerning the pathogenesis and etiology of psychiatric disorders in particular as they relate to school functioning and outcomes
  • Becoming familiar with models of school consultations
  • Understand the structural and organizational aspect of the school or school systems
  • Gaining knowledge of special education laws
  • Appreciate pros and cons of 504 plans and IEPs


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.

  • Developing intra-professionally by managing adaptively their own emotional reactions to youth psychopathology and to the attitudes of other professionals towards youth psychopathology
  • Convey information both written and especially oral as clearly as possible without the use of jargon
  • Demonstrating a commitment to continued professional development
  • Perform a consultation which respectfully addresses the specific questions paused by the school teacher, school counselor, or school administrator
  • Appreciate the professional role of the consultant versus primary provider

Interpersonal/Communication Skills

The resident will effectively communicate with patients, their families and school teachers, counselors or administrators.

  • Talking with and obtaining a history from school personnel
  • Tailoring communication to the needs of school professionals
  • Respectfully appreciate that the teaching of children with psychopathology can be anxiety provoking to non mental health professionals

System Based Care

  • Understanding the roles of other professionals including teachers, special education teachers, aides, school psychologists, school counselors, school nurse, principals
  • Understanding the constraints of the systems within which these other professionals operate
  • Understanding the limitation of community mental health care for children and its impact on psychiatric presentations in a school setting

Measurement of Objectives

  • 360 evaluations
  • Standard Program evaluations
  • Feedback by other professionals

Description of Rotation

The fellow will observe and participate in the evaluation of children referred by the special school district for psychiatric evaluations.