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Child
and Adolescent Psychiatry Residency Training Outline
1. Child and Adolescent Inpatient Unit and Day Treatment Program: Lutheran General Hospital Lutheran General Hospital is a 608 bed tertiary care medical center which has been named one of the top 100 hospitals in the country for two consecutive years. Lutheran General is a Level I Trauma Center and Level III Perinatal Center. LGH is the largest independent academic medical center in Illinois. In addition to a full spectrum of psychiatric services, LGH also has a large pediatric service, including the Yacktman Children's Pavilion with a broad range of pediatric subspecialty services. The continuum of child/adolescent psychiatric services includes a ten bed inpatient unit (soon to be twelve beds), two TOPS slots, the Day Treatment Program, the Laureate Day School (therapeutic day school for elementary-aged children with emotional disorder), the Eating Disorder Program, Substance Abuse Program for Youth, and Outpatient Services. Lutheran General Hospital has a General Psychiatry residency with three residents per year. There is also a Pediatrics residency with about ten residents per year. For three months in the first year, the fellow will rotate through the Child and Adolescent Psychiatry Inpatient Unit and in the Day Treatment program. The coordinator of the rotation is a Board-certified child and adolescent psychiatrist, Norman Chapman, M.D., Chief of the Division of Child and Adolescent Psychiatry at Lutheran General Hospital. The fellow will pick up cases from the point of initial evaluation and follow them through the continuum of care, mostly as inpatient admissions who then step down to the day treatment program or an intensive alternative
2. Pediatric Consultation-Liaison: University of Illinois at Chicago The child and adolescent psychiatry consultation/liaison service is run by Cyrus Solhkhah, M.D., a child and adolescent psychiatrist and full-time faculty member. First-year fellows rotate through the C/L service for three months at 80% time. The service provides a combination of inpatient, outpatient, an 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 and adolescent patients hospitalized on the psychiatric 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 and the Center for Handicapped Children, genetics clinic, and psychosocial clinic. The C/L team provides back up to the social worker 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. Finally, the C/L service provides short term follow-up in our Monday afternoon clinic for patients who are medically ill or seen as outpatients or inpatients by our service.
3. DCFS Adolescent Assessment Unit: University of Illinois The
Comprehensive Assessment and Treatment Unit (CATU)/Response Training
System (RTS) is an intensive treatment program serving the psychiatric
needs of DCFS wards. The Medical Director/Coordinator is Michael W.
Naylor, M.D and Associate Director, Tanya R. Anderson. 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
11 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. 4. Residential Treatment: Allendale Association Allendale is a residential and educational treatment setting that treats 255 children, ages 6-20, average age 14 y/o, 70% male: 30% female, 50% black: 50% white. The units are not locked, and provide treatment to chronically troubled children who are not acutely suicidal or homicidal. Diagnostic categories include PDD, childhood psychosis, school refusal, PTSD, dissociative disorders, primary affective disorders, and disruptive disorders. Mental retardation is represented as a secondary diagnosis. Children with a primary substance abuse problem are not accepted into the residential setting. Funding includes DCFS, DHS (Individual Care Grants), private insurance (20%), Illinois State Board of Education, and Wisconsin counties. The campus includes residential treatment cottages, school, and gymnasium on 120 acres on Cedar Lake. In addition to the 125 residential beds, the Stepping Stone Day Education Treatment Center also serves 70 children who are bused in from surrounding communities. Also, a satellite location in Woodstock, IL serves 30 children. The school is approved by the Illinois State Board of Education. In the residential program, the average length of stay is 12-18 months. The Bush and Shumway cottages focus on a unified behavioral approach for street-wise attentionally-disordered children. The Shelter, Lehmann, and Cramer cottage house those children with more acute Axis I disorders such as psychosis and affective disorders. St. Armand's provides a transitional setting. The two Becker/Cherry Group Homes in nearby Waukegan provide a transitional setting for fifteen children, and there are sheltered workshop and community vocational experiences available for this population. A third group home in Highland Park, serves 10 adolescent girls of varied diagnostic backgrounds. Allendale's Benet Lake Facility, opened in 1994, is located just across the state line in Benet Lake, Wisconsin. This is a 20-bed residential unit. Allendale also has approximately 45 foster homes and the community-based Bradley Child and Family Counseling Centers, as well as providing transition services, aftercare follow-up and support after the child returns home. The BCC is APA accredited and serves as an APA approved intern site. The Independent Living Program currently serves about forty 18-20 y/o. Allendale has been JCAHO accredited since 1981 and serves as a training site for social workers and psychologists as well as psychiatrists. There are 380 employees at Allendale. There are 45 professional staff, including 6 part-time M.D. child/adolescent psychiatry consultants, 4 full-time R.N.'s, M.S.W.'s, Ph.D.'s, Psy. D.'s, and 120 bachelor's level mental health workers. The school program has 27 special education teachers and 44 T.A.'s, or 1.5 aides and 1 teacher per class of 8-10 pupils. Local neurologists see Allendale cases. Comprehensive medical services are available at St. Therese Hospital (15 miles away). Allendale utilizes a range of treatment approaches, including behavior modification, psychopharmacology (approximately 75% of the children currently receive psychotropic medication) family work, group therapy (sexual abuse, children of divorce, substance abuse prevention), pre-vocational therapy, recreational therapy (gym on premises), parent and sibling groups, etc. UIC/IJR
is one of the only programs in the country that include training on
a residential unit as part of a fellowship. The child/adolescent psychiatry
resident rotating at this site should develop competence in the role
of a psychiatric consultant to a residential treatment and day educational
treatment setting. Generally, trainees will be expected to be primary
therapists for 2 children, and perform several diagnostic evaluations
or consultations each week. Trainees will also be co-therapist in one
on-going group, and provide one in-service educational lecture during
their rotation. Supervision in the full range of assessment and treatment
modalities is provided on-site by Norm Chapman, M.D. (rotation coordinator)
, Ray Wilkerson, M.D.,and Dr Teich.
5. Outpatient Clinic: University of Illinois at Chicago/Institute for Juvenile Research (UIC/IJR) 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 caseload 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 spend one afternoon a week either in
the Metropolitan Family Services MHC (see below), or in our own Pediatric
Mood Disorders clinic, under the supervision of Mani Pavuluri, M.D.,
and Julie Carbray, DNSc. Additionally, residents rotate through the
Pediatric Anxiety and Trauma Disorders clinic under the supervision
of Sucheta Connolly, 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.
6. Community Mental Health Consultation: Metropolitan Family Services Founded in 1857, Metropolitan Family Services (formerly United Charities) is the oldest and largest non-sectarian family service organization in metropolitan Chicago. Each year, more than 100,000 families and individuals receive direct services at 25 neighborhood based centers throughout Chicago and the suburbs. Services available through the agency include family development, family support, mental health services, senior services, consumer credit counseling, community development, social policy, legal services, camp and education center, employee assistance program and managed care. There is a strong focus on developing families' strengths to aid in development of self-sufficiency. The rotation takes place year round, one day a week, at the South Chicago center, where second-year fellows are the child/adolescent psychiatric consultants. At this site the patient population is predominantly urban African-American and Hispanic with a smaller percentage of other groups. There are a broad range of diagnoses including many patients with developmental disabilities. This center is involved with intake, crisis intervention, short and long-term outpatient services, case management and community education. Therapists are social workers who can provide outpatient child and adolescent services as well as SASS services. There is a consulting psychologist who provides testing and evaluations on a monthly basis. A psychiatric nurse is scheduled to join the center and work closely with the residents. Services provided by therapists include assessment, individual and family treatment, linkage/consultation with schools and community providers. Therapists often provide services directly in the families' homes. Therapists also participate in staffings at school as well as during inpatient hospitalization and day treatment. In the past six months there has been a significant increase in children and adolescents who need psychiatric intervention at this center, especially youth at risk for immediate psychiatric hospitalization or those just discharged from the hospital. Many of the cases seen by the trainees tend to be fairly disturbed. Service is also prioritized for low income families who live in the neighborhood or catchment area. Educational
activities include on-site supervision, team discussions and conferences.
Child and adolescent psychiatrist, Scott Feldman, M.D. is the rotation
coordinators and on-site supervisor. The trainee may participate in
community educational mental health programs or attend staffings with
therapists. Participation in psycho-educational groups may develop over
the course of this year. The resident is asked to provide psychiatric
consultation to the non-medical staff, diagnostic evaluations, ongoing
pharmacotherapy, and emergency evaluations. The trainee is also the
psychiatric consultant at weekly interdisciplinary team meetings where
many cases are often discussed. Residents will have the opportunity
to follow patients over time and negotiate continuity of care with a
variety of treatment providers and systems. Building skills needed to
work in a multidisciplinary team setting will be emphasized.
7. 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. 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.
8. Pediatric Neurology: University of Illinois at Chicago The rotation coordinator (Michelle Melyn, M.D.) is the Director of Pediatric Neurology. The patient population is the same as that already described for the University of Illinois Medical Center. 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. 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. The trainee will be given gradually increasing levels of responsibility during the rotation based on the faculty's assessment of the trainee's level of expertise. The trainee will be expected to evaluate patients in both the inpatient/consultation and outpatient settings, to actively participate in rounds, and accompany the service when possible to look at CT scans and other diagnostic tests. The
trainee is expected to participate in the outpatient clinic, where s/he
usually is responsible for one or two new diagnostic evaluations, and
several follow-ups, each week. The trainee also sees hospital inpatients
on service and consult, averaging several per week. In addition, the
trainee may be asked to provide psychiatric consultation to patients
on the pediatric neurology service.
9. Forensic Consultation: Parenting Assessment Team The primary supervisor for this training site will be Teresa Jacobsen, Ph.D. with secondary supervision by Laura Miller, M.D. The Parenting Assessment Team (PAT) was formed for the purpose of assisting the Illinois department of Children and Family Services (DCFS) and the Juvenile Court in evaluating parenting capabilities of parents with serious mental illnesses who are alleged perpetrators of child abuse or neglect. The PAT consists of a psychiatrist, child psychologist, a coordinator, and outreach workers. The team has both service and research components. Service - The PAT primarily provides a service to DCFS, although its evaluations are also designed to be of use to the Juvenile Court also. The cases that DCFS is having the most trouble evaluating are the top priority cases for the PAT. The assessments performed by the PAT include structured and clinical psychiatric interviews, pediatric evaluations of the children, including interviews and standardized tests, assessment of parent child attachment quality, evaluations in the home setting, structured and clinical assessment of social support, collateral history from significant others, assessment of the home environment, urine drug screens of the parent, and review of pertinent mental health, pediatric, and criminal records. The fellow will spend 2-3 hours one morning a week for two months observing and participating in the evaluation of these families. In addition, the fellow will be available by page over a designated period of time to go with their supervisor when they testify at court. It is unlikely that an individual fellow will actually have to testify but it is hoped t that they could observe the process 2-3 times during their rotation. Additionally, it
is anticipated that IJR will open in Spring 2001 a large clinical service
program in forensics, providing primary services, including evaluation
and treatment to the Cook County Juvenile Court, the largest juvenile
court program in the nation. This will be under the direction of Louis
Kraus, M.D.
Second-year trainees spend a month part-time observing contested custody evaluations performed by two psychiatrists in private practice (one specially trained in forensics who is also an attorney, and the other a child and adolescent psychiatrist). The site coordinators are Phyllis Amabile, M.D., J.D., and Rachelle Miller, M.D. The goals of the rotation are to observe the process of custody evaluations, to learn about divorce, its effects on the family, the judicial system, and the role of the child/adolescent psychiatrist in the evaluation procedure.
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. A wide range of opportunities are available. Many trainees elect to become part of the Parenting Assessment Team with Teresa Jacobsen, Ph.D., and Laura Miller, M.D., which evaluates chronically mentally ill mothers who have been found to have problems parenting, in order to predict future risk for abuse or neglect. 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. |
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