1. Child and Adolescent Inpatient Unit: Ingalls Memorial Hospital
2. Pediatric Consultation-Liaison: University of Illinois
3. DCFS Adolescent Assessment Unit: University of Illinois
4. Outpatient Clinic: UIC/IJR
5. School Consultation: SEDOL, and Chicago Public Schools
6. Forensic Consultation: Circuit Court of Cook County, Juvenile Division
1. Child and Adolescent Inpatient Unit and Partial Hospital Program: Ingalls Memorial Hospital
Fellows will spend 4 months practicing inpatient psychiatry on the busy 22 bed inpatient child and adolescent psychiatry unit at Ingalls Hospital where they encounter a diverse patient population with problems across the spectrum of psychiatric pathology. While fellows work under an attending physician they are granted a wide berth of independence allowing them to make patient management decisions commensurate with their burgeoning knowledge and skill sets. Fellows will also be working with and at times leading a team of nurses, psychologists and social workers in formulating and implementing treatment protocols specific to each patient and their psychosocial needs. In addition to caring for patients admitted to the hospital the fellow will have responsibility for managing patients in the partial hospital program at Ingalls as well.
2. Pediatric Consultation-Liaison: University of Illinois at Chicago
The child and adolescent psychiatry consultation/liaison service is run by Elizabeth Charney, M.D., a triple boarded child and adolescent psychiatrist and full-time faculty member. First-year fellows rotate through the C/L service for four months. The service provides a combination of inpatient, outpatient, and emergent consultation to pediatric patients who have been referred by other physicians at UIC. Consults to inpatients include medically ill patients hospitalized on the pediatric unit. The pediatric unit consists of 40 general pediatric beds, a Pediatric Intensive Care Unit, and a step down unit. Outpatient consultation involves consults to general pediatric patients as well as patients in specialty clinics including pediatric neurology, hematology/oncology, nephrology, endocrinology, surgery, infectious disease, cardiology genetics clinic, and psychosocial clinic. The C/L team provides back up to the social worker and general adult psychiatry residents in the ER for pediatric patients requiring psychiatric consultation. This may involve seeing patients in the ER or arranging for next day outpatient evaluation for these patients. In addition to these roles the fellow on the C/L service will function in the Peds-embedded clinic, a psychiatric evaluation and management clinic within the pediatric clinic, providing direct consultation and evaluation for patients seen within the pediatric clinic. Fellows on this rotation also take phone consultation from primary care providers throughout the state of Illinois as part of the stated funded Doc Assist program, of which UIC IJR is the only consultation site. Rounding out the rotation, fellows rotate in the busy UIC neurology clinic. The goals and objectives of the rotation are: to learn the fundamentals of the neurological history and physical examination, neurological diagnostic tests, report interpretation, when to refer to a neurologist, differential diagnosis, when to suspect an underlying neurological condition in a child with a behavior problem, typical behavioral problems of common neurological conditions, knowledge of basic neurological medications and their side effects. Diagnostic categories include seizure disorders, developmental delay, mental retardation with behavioral dysfunction, learning disability, headaches, gait disorders, post-infectious neurological sequelae, motor disorders, tumors, toxic encephalopathies, prenatal and perinatal trauma sequelae, chromosomal anomalies, and metabolic diseases. The clinic sees children between 0 to 21 years of age, with the majority between 7 and 16 years of age.
3. DCFS Adolescent Assessment Unit: University of Illinois
The Comprehensive Assessment and Treatment Unit (CATU)/Response Training System (CARTS) is an intensive treatment program serving the psychiatric needs of DCFS wards. The Medical Director/Coordinator is Michael Naylor, M.D.. The program is the result of a contract between the Department of Children and Family Services and the University of Illinois at Chicago. The patients treated are adolescents between the ages of 12 and 18 years with severe psychopathology who have failed numerous hospitalizations, residential treatment center placements, or group or foster home placements. The inpatient component of the program, the CATU, strives to provide comprehensive evaluations, crisis stabilization, acute treatment, and linkage to intensive community-based treatment programs, including wrap - around services. The CATU is an 10 bed unit housed in the University of Illinois at Chicago Hospital. Diagnoses represent the full range of psychopathology, with high percentages of post-traumatic stress disorder, affective disorders, disruptive behavior disorders, and learning disabilities. Services offered include psychological, neuropsychological, and educational testing; speech and language evaluation; behavioral analysis and behavioral treatment; individual psychotherapy; pharmacotherapy; milieu and group therapy; case management; occupational therapy; group therapy for adolescents who have been sexually and physically abused; group therapy for offenders; and substance abuse treatment. Given the chronicity and severity of psychopathology in this population, the average length of stay is expected to be approximately 21 days.
The CARTS follows the patients from the hospital into the community, providing direct clinical services and providing consultative and educational services to care-givers involved in the patient's care in the community.
First year fellows rotate for 4 months on the CATU/CARTS. Fellows will be assigned patients at the time of admission to the unit and will be responsible for day to day patient care under the supervision of the attending physician.
The UIC/IJR outpatient clinic maintains an active caseload. The clinic population is approximately 60% male and 40% female. Approximately 60% are black, 20% are white, and 20% are Hispanic. Fifty-five percent are elementary school-age children, 35% are adolescents, and 10% are preschoolers. Typical diagnoses include depressive or anxiety disorders, sexual or physical abuse, family conflict, disruptive disorders, learning disorders, developmental disability/mental retardation, psychotic disorders, and specific symptom disorders such as enuresis and encopresis. Referral sources include schools, community agencies, private practitioners, Department of Children and Family Services, Department of Corrections, the University of Illinois complex, Department of Mental Health inpatient units, City of Chicago Mental Health Clinics, and self-referrals. Services include consultation, diagnostic assessment, and treatment. Treatment provided may be either short- or long-term. Treatment modalities include an overall eclectic biopsychosocial approach, supportive psychotherapy, psychodynamic psychotherapy, psychopharmacology, group therapy, individual and family systems (including occasional larger group therapy and marital therapy), and cognitive-behavioral therapy.
Residents maintain an ongoing outpatient medication management and psychotherapy caseloads throughout the two years of training. Weekly individual supervision of outpatient treatment is provided by several supervisors for each resident, in addition to special group practicum supervision in family work. In keeping with our philosophy of teaching our trainees to become excellent teachers, supervisors, and administrative leaders, we give special responsibilities to our second-year trainees. They become outpatient group leaders, under supervision. They also supervise general psychiatry residents on their outpatient cases and are given supervision in this activity. They give lectures to third-year medical students, and are given feedback on their lecture style. Second-year trainees also rotate in our own Pediatric Mood Disorders clinic, under the supervision of Mani Pavuluri, M.D., and Julie Carbray, Ph.D., DNSc and the Pediatric Stress and Anxiety clinic under the supervision of Meghann Hennelley, M.D. These UIC/IJR subspecialty outpatient clinics use a multidisciplinary team approach to assessment and treatment, and trainees are taught how to run outpatient groups as part of this clinic.
5. School Consultation: Special Education District of Lake County
A Board-certified child and adolescent psychiatrist who is on our faculty and in private practice, Henry Gault, M.D., is the rotation coordinator and supervisor. SEDOL (Special Education District of Lake County) is a special education cooperative with a school population base of 67,000 students being served by 40 individual small suburban districts. Of these, 8000 have special education needs, and 2000 are within self-contained classrooms. The Lake County population tends to be middle-class, non-minority, and the school resources are excellent. At SEDOL, we consult to both regular and special education classrooms. Ages seen range from the Parent-Infant Center (0-3 years) to 21-year-old handicapped young adults. Diagnostic categories seen include autism, developmental disability/mental retardation, disruptive disorders, learning disability, physically handicapped, and mood disorders.
Trainees perform client-centered, consultee-centered, and program consultation. They do classroom observation, consult to nursing staff about medication issues, consult to teachers about behavorial techniques, work with classroom groups on selected issues, meet with parents, evaluate individual children, and participate in staffings. They coordinate and perform crisis intervention, and conduct various groups. Supervision occurs on-site at SEDOL for the entire day with Dr. Gault.
Interested trainees may elect to become involved in ongoing research and clinical projects at UIC/IJR involving the Chicago Public Schools. The Chicago Public Schools serve 400,000 students in mainstream education. There is a large proportion of minority, low income, socially disadvantaged students. William McMiller, M.D., MPH, offers an elective working in the community in the Oak Park/River Forest High School.
6. Forensic Consultation: Circuit Court of Cook County, Juvenile Division, Juvenile Detention Center
The rotation at the Juvenile detention center entails completing psychiatric evaluations of adolescents upon admission to the facility and working with a multidisciplinary team to establish treatment plans for them during their stay. Fellows also have the opportunity to observe first hand the process by which youth residents of the facility carry out their term. Under the direct supervision of Dr. Lynelle Thomas, a Child and Adolescent Psychiatrist, one will also learn about and become part of the necessary careful and structured mental health interventions provided by the facility.
The training director helps each resident entering the second year of training to develop areas of interest into personally designed electives. The trainee's initial ideas are explored and refined. The training director acts as a networking resource to match trainee interests with faculty and sites. The electives are then formalized, with written goals, objectives, methods, time estimates, supervising faculty, end product (paper, presentation, etc.), and evaluation criteria. There are approximately 260 hours available in the second year set aside for the pursuit of elective interests.
Trainees may choose to design or join an ongoing research project with a research mentor within the Division. Some residents choose to expand involvement within the IJR Outpatient Clinic Rotation or other clinical sites listed above, focusing on a particular therapeutic approach, or diagnostic subgroup. Trainees may also spend time involved in learning disability evaluations, infant psychiatry, abuse prevention and intervention, substance abuse treatment, local community mental health projects or literature reviews on specific topics.
Examples of past electives include: working in community mental health at a Hispanic community center, family systems program, doing in-depth school consultation in the Chicago Public Schools and Lake County, doing the medical student teaching within the medication clinic, doing additional consultation-liaison work, working with homosexual adolescents at risk for AIDS at a community organization, preparing a presentation on managed care for AACAP, observing normal development in preschool and school settings, doing psychopharmacological research, co-leading multiple family groups, working with sexually abused children and abusers, working with patients with eating disorders, working on a normal development videotape, differential diagnosis of psychosis in children, running a therapy group for pregnant teenagers, Melanie Klein reading tutorial, advanced psychodynamics' tutorial and clinical work with senior analysts, infant assessment, substance abuse treatment, research in dissociative disorders and PTSD, research in anxiety disorders among music students, abuse prevention and intervention, and administrative psychiatry electives. Topics of book chapters and articles have included gender identity disorder, paraphilia, education and normal development, psychopharmacology of disruptive disorders, emergency child/adolescent psychiatry, normal development of music from birth to six years, and reviewing placebo effects in child and adolescent psychopharmacology.