The SYNCHRONY Project

Rotation Director: John Constantino MD

Other Faculty: Neha Navsaria PhD, Mini Tandon DO, Anne Glowinski MD, MPE, Eric Spiegel MD

Number of residents per rotation: One-two

Length of Rotation: 12 months, one afternoon per week

Time of Rotation: First and second year of training

Goal

To familiarize fellows with the comprehensive evaluation of the unmet mental health needs of infant/preschool children in foster care.

Objectives

To develop competence in the following areas:

Patient Care

  • Assessment of child functioning in the context of the child, parent and parent-child relationship
  • Differentiation of normative/at risk/disordered exams in infants, toddlers and preschoolers
  • Mental status examinations of infants- preschoolers
  • Detailed early developmental histories
  • Dyadic/relational approach to evaluation and care
  • Clinical observations with focus on aspects of parent-child relationship parameters
  • Diagnostic formulation of early onset emotional and behavioral problems
  • Careful weighing of risks and benefits of psychopharmacological interventions in the very young patient
  • Formulation of comprehensive recommendations for mental health intervention and support of child, caregiver and parent-of-origin as well as characterization of parameters of viable reunification.
  • Exposure to collaborative process with the St. Louis County Children’s Division and Family Court

 Medical Knowledge

The resident will gain medical knowledge through working in a multidisciplinary clinical team

  • Review of the degree to which a young foster child may be at-risk of new neglect, abuse and/or maltreatment should parent-child reunification occur.
  • Review of effective treatment strategies including psychopharmacological and psychotherapeutic approaches and strengths and limitations of approaches (combined or not combined with one another)
  • Review of formulation of reports to non-clinical settings (i.e. Children’s Division, Family Court)
  • Attendance (not mandatory) at monthly Trauma Case Conference to discuss complex cases.

Interpersonal/Communication Skills

The resident will effectively communicate with patients, their families, foster parents, members of the multidisciplinary treatment team and representatives of social services and the courts.

  • Family interviews for the evaluation of infant-preschool age children
  • Developmentally appropriate interviews of very young children
  • Conference calls with members of Children’s Division and Family Court

 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 an internationally known expert in infant-preschool psychiatry who leads a large interdisciplinary team

  • Review of evidence based literature
  • Observation of a role model who contributes significantly to the evidence based literature
  • Active case based learning in the clinic
  • This is an opportunity to evaluate a patient in tandem with another mental health professional (social workers, counselors, psychologists).

Professionalism

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.  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
  • Acknowledgement and remediation of errors
  • Intra-professionalism: ability to understand and remedy factors which interfere with one’s proper professional conduct
  • Respect of patients, colleagues, supervisors, supervisees and staff regardless of background
  • Review of professional conduct of colleagues if appropriate
  • Leadership role increasing with training level (e.g., 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 global system of care and where clinic care fits in it including appreciation of need to referral to other system of care vs. longitudinal monitoring of at risk youth 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

  • Direct clinical observations (use of one way mirrors)
  • Standard Program evaluations
  • Medical Records Review by Faculty
  • Clinical Skills Exams (focusing on use of interactive play assessment)

Description of Rotation

This is a second year rotation through a one of a kind clinic specializing in evaluation of the unmet mental health needs of children in foster care.  The fellows focus on evaluation and follow up of the mental health and emotional development of very young children as well as assessing risk factors related to the occurrence of abuse and neglect. The program’s mental health services focus primarily on helping children from infancy through the preschool period (up to age 6).

Children and families are referred to the SYNCHRONY Project by the Family Court of Saint Louis County or Children’s Division of the Missouri Department of Social Services for two primary reasons:

  1. Young children in or at risk of placement in foster care who are suspected of having behavioral or developmental problems that are not fully addressed by the resources of clinical care to which they have access.
  2. Young children in foster care who are likely to return to their parents-of-origin, but questions about the array of psychosocial supports necessary to ensure a successful reunification could be addressed by comprehensive child psychiatric consultation

Initial evaluations consist of a part A and part B, 2-hour assessments on consecutive weeks, followed by part C, a 30-60 minute teleconference on the third week with the Family Court and Children’s Division representatives.  Clinical Care Coordinators for the SYNCHRONY project are present for each evaluation and help coordinate interdisciplinary communication and implementation of treatment recommendations in concert with the lead clinician during and after the evaluation process. The SYNCHRONY Project will follow-up with most patients every three months for long-term monitoring.