Clinical services
Year 1
In their first year of training, fellows spend three months rotating on the consultation-liaison service, three months with the partial hospitalization (day treatment) program, and a total of six months (usually broken into two 3-month rotations) with the inpatient program.
Inpatient service
Through this rotation, fellows gain experience and competence in the diagnostic assessment and intensive treatment of acutely ill children and adolescents who typically have comorbid psychiatric, developmental, social, and medical problems.
Male and female patients from ages 3-17 years are admitted to the program for the full range of psychiatric disorders including affective disorders, psychoses, anxiety disorders, eating disorders, pervasive developmental disorders, attention disorders, disruptive disorders, and co-morbid illnesses. The IPU has an excellent reputation for the management of complex medically ill children, developmentally delayed children, and preschoolers. Patients are discussed in daily multidisciplinary rounds and treatment planning meetings. Primary case assignments include individual psychotherapy, family therapy, medication management, and consultation to the unit staff about milieu issues including behavior therapy and discharge planning. Fellows participate in medical and subspecialty pediatric service collaboration indicated for patients with medical issues. Fellows have ample opportunities to observe and interact with the youth in the structured school program and recreational therapy program. Group therapy experience is available, and sessions are conducted with an experienced master's level therapist. Medical students and general psychiatry residents frequently rotate on this service, which allows the fellows to participate in supervision and teaching during the rotation.
Partial hospitalization program
Through this rotation, fellows learn sophisticated pharmacology skills and brief, intensive psychotherapy modalities including behaviorally-based individual therapy and family interventions, and group therapy in this intensive and day treatment program. This rotation lays the groundwork for leadership positions in a variety of interdisciplinary community settings.
Patients from 4 to 14 years are admitted to the partial hospitalization program (PHP) with a range of psychiatric disorders including disruptive behavior disorders, ADHD, affective disorders, anxiety disorders, pervasive developmental disorders, learning disabilities, and complex co-morbidities. Patients frequently exhibit comorbid developmental disabilities and pediatric medical problems. The typical length of stay is 7 to 10 days. Each fellow follows three patients as the primary clinician, providing diagnostic evaluation, individual and family therapy, medication management, and consultation to the unit staff about milieu issues, behavioral programming, and discharge planning. Fellows participate in and eventually co-lead a weekly multifamily activity group that includes a parent training session and a child recreational activity group. Fellows are provided with an opportunity to gain familiarity with group therapy by participating as a co-therapist with a senior clinician in cognitive-behavioral group sessions twice a week, and then progress to being lead group therapist. Fellows may also have the opportunity to supervise medical students with an interest in psychiatry who rotate through PHP for monthly elective rotations.
Pediatrics consultation-liaison service
Through this rotation, fellows learn to function as consultants in a tertiary care pediatric setting, in the context of an experienced multidisciplinary team.
The psychiatry fellow participates in daily rounds on the consultation-liaison service with a multidisciplinary team that includes psychiatry and psychology attendings and trainees, reviewing new and active cases. Because this program is in a free-standing metropolitan children's hospital that serves as the primary site for a major medical school's pediatric services, a full range of pediatric problems requiring routine or emergent consultative attention across the pediatric age span is seen. The fellow generally sees four to six new consultations per week, including emergency cases, and provides follow-up care to those patients who remain in the hospital. Brief outpatient follow-up, under supervision of the service faculty, occasionally takes place as the fellow's schedule permits. Medical students and general psychiatry residents frequently rotate on this service, which allows the fellows to participate in supervision and teaching during the rotation.