|Child and Adolescent Psychiatry Residency Training: Clinical Services|
1. Child and Adolescent Inpatient Unit and Day Treatment Program: Aurora Chicago Lakeshore Hospital
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 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 (CARTS) is an intensive treatment program serving the psychiatric needs of DCFS wards. The Medical Director/Coordinator are Michael Naylor, M.D. and Kathleen Kelley, 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 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. 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, Ph.D., 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.
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.
6. 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.
7. Pediatric Neurology: Rush University
The rotation coordinator (Peter Heydemann, 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.
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.