In their first year of training, fellows spend three months rotating on the psychiatry and behavioral health consultation 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.
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, autism spectrum disorders, attention disorders, disruptive disorders, and co-morbid illnesses. The inpatient unit 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.
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, autism spectrum 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 a weekly multifamily activity group that includes a parent training session and a child recreational activity group. Fellows may also have the opportunity to supervise medical students with an interest in psychiatry who rotate through PHP for monthly elective rotations.
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 psychiatry and behavioral health consultation 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 location for a major medical school's pediatric services, a wide range of pediatric problems across the full 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. General psychiatry residents also rotate on this service, which allows the fellows to participate in supervision and teaching during the rotation.
For 1.5 hours every other week on Mondays for the first year of training, each CAP 1 fellow participates in this rotation where direct supervision and guidance is provided to foster skill building in diagnostic assessments. Through this rotation, fellows gain experience and confidence in evaluating new patients through the general intake clinic process. The objective of this rotation is to develop proficiency in the evaluation and treatment of the wide range of non-emergent psychiatric problems at the point of entry into psychiatric services. Fellows are expected to gather and integrate clinical information and collaborate with schools and other providers with the goal of formulating each case to provide initial treatment recommendations and initiate treatment planning. Fellows benefit from direct supervision and/or by use of the one-way mirror video suite. New cases seen by the fellows will be incorporated into their longitudinal treatment caseload.
In both years of training, fellows gain experience in building and managing an outpatient caseload. Fellows also take call from home approximately every eighth night, gaining essential skills in emergency assessment and triage management, crisis intervention, and treatment planning.
Through this experience, fellows learn to provide efficient, expert child and adolescent psychiatric emergency assessments, interventions and treatment planning. They also gain experience in collaborating with community agencies and hospital staff including nurses, social workers, pediatric specialists, abuse team workers, and other health care professionals in crisis situations. A faculty attending is also on call every night to supervise all cases and provide clinical assistance as needed.
Psychiatric social workers provide first-line assessment and case coordination for patients presenting to the hospital’s Emergency Department during most evening/night hours Sunday through Saturday. When a psychiatric social worker is on duty, he or she evaluates each patient and involves the on-call fellow only if the patient is being admitted to the inpatient unit, if the case is complex or acute, or if the case is a complicated medical case requiring child and adolescent psychiatry expertise. If a psychiatric social worker is not on duty, the fellow provides first-line evaluation and management of all cases on call. General psychiatry residents also take some first-line call with direct supervision by fellows. Patients are seen within one hour to allow the fellow time to travel from home. Fellows who prefer to avoid commuting can request a private call room at the hospital for the night.
Fellows called in to see a case are actively involved in both patient assessment and disposition planning. Decisions for inpatient hospitalization, partial hospital admission, and outpatient referrals are made in consultation with faculty supervisors. With the assistance of psychiatric social workers and other staff, fellows gain valuable experience in negotiating with third-party payers, child protective services, community services, and government agencies when formulating a treatment plan. The Chicago metropolitan area has ample child and adolescent psychiatry beds, so finding a hospital for admission is rarely a problem. Most admissions go directly to the hospital’s on-site inpatient program.
Fellows who work on call past 10 p.m. are considered to be post-call, and are required to take off the following afternoon to ensure adequate time for rest and personal activities. Fellows are not expected to carry their beepers after hours when they are not on call.
Through this experience, fellows develop proficiency in the evaluation and longitudinal treatment of a wide variety of psychiatric problems in scheduled outpatient appointments. Fellows also learn valuable office management and organizational strategies for maintaining an outpatient practice in preparation for clinical careers.
Families from all ethnic groups and children from infancy through adolescence are seen in the outpatient program, including youth in foster placements. The approach to evaluation and treatment is systematic and comprehensive, with an emphasis on interdisciplinary consultation and collaboration.
Fellows see cases that require the comprehensive or consultative attention of a child and adolescent psychiatrist after being screened by an experienced intake staff member. Case assignments are monitored by the outpatient medical director and the program director to ensure rounded caseloads over the two years of training. In the first year, fellows are assigned sufficient numbers of evaluations to establish an active caseload of at least three contact hours per week. In the second year, caseloads are increased to seven patient contact hours per week, and additional patients are also seen in subspecialty and diagnostic clinics.
Year 1 fellows receive an hour of individual supervision for every three hours of outpatient visits from a hospital-based faculty attending. Year 2 fellows receive supervision from three supervisors given the higher caseload. At least two supervisors are hospital-based faculty attendings, and the third supervisor is typically a volunteer community faculty member. Fellows have access to additional special consultative supervision within the department if expertise in a particular area would be helpful.
In their second year of training, fellows spend time in a variety of subspecialty clinics. In addition to these required rotations, one to two days per week are also set aside for fellows to pursue electives in areas of individual clinical, teaching, or research interest.
Through this rotation, fellows gain experience and knowledge in court proceedings, which complements the experience fellows gain throughout their training in evaluating children for whom custody, home, or educational placement is an issue.
In the Juvenile Division of the Cook County Office of the Public Guardian (OPG), fellows review client files and records and discuss the appropriateness of mental health treatment options with attorneys, as well as custody, residential, or educational placement issues. Fellows also observe contested trials, motions, and depositions, including direct and cross-examinations of opinion witnesses, and discuss observed cases with attorneys to gain perspective on legal professional opinion testimony. In addition, fellows provide an informal training seminar on a forensic-related mental health issue to the attorneys and staff of the OPG.
Through this rotation, fellows gain experience in clinical pediatric neuropsychiatry and advance their pharmacological expertise. Fellows also gain increased confidence and competence in providing complex pharmacological consultation to other medical colleagues, including neurologists and primary care physicians. Fellows work directly with subspecialized attending faculty to learn comprehensive multidisciplinary psychiatric evaluation and treatment of youth with neurological and medical disorders. Boys and girls of all age groups with a variety of neurological and medical disorders requiring psychiatric diagnostic and treatment evaluations are seen. Patients may be referred either from within the hospital or by practitioners in the community. During each half-day clinic, fellows will typically conduct one new psychiatric diagnostic or medication evaluation and two to four follow-up visits.
In this rotation, fellows gain experience in pediatric neurology, providing a foundation for the evaluation and treatment of complex psychiatric problems at the interface of psychiatry and neurology. Fellows see patients from infancy through age 20 with neurological problems such as seizure disorders, headaches, cerebral palsy, developmental delay, hydrocephalus, tumors, and behavioral presentations of neurological disorders. Treatment includes anticonvulsant and other medications and recommendations for a variety of further evaluations and rehabilitative approaches including occupational, physical, speech, and psychiatric services. Fellows see both new and returning patients in each clinic and are expected to request and review electroencephalogram reports and neuroimaging studies. Fellows can also choose to participate in morning neurological team rounds on the intensive care unit with neurology attendings to gain additional experience in the evaluation and management of the full range of severe neurologic conditions requiring intensive care treatment, including traumatic brain injury, altered mental status, stroke, epilepsy, metabolic disorders, cancer and other illnesses. Fellows may also choose to attend a weekly EEG rounds to complement the intensive care unit rounds.
Through this rotation, fellows gain experience in treating preschool-aged children referred by a variety of hospital and community/school providers for specialized early childhood assessments and treatment. Fellows directly observe patient evaluations by highly experienced psychologists with expertise with early childhood and developmental psychopathology. Fellows will fine-tune their diagnostic skills using a specialized assessment tool to evaluate early-onset disruptive behavior disorders, feeding and sleep difficulties, attachment and anxiety syndromes, and other psychiatric disorders presenting in early childhood ranging from the uncomplicated to the complex/co-morbid. By use of the one-way mirror video suite, trainees will benefit from direct, on-site clinical supervision of cases. Treatment modalities in this clinic include both psychopharmacology and psychotherapy, encompassing family, parenting, and group therapy.
During this clinical experience, fellows work with a multidisciplinary staff and faculty to gain specialized training in using semi-structured interviews, such as the Anxiety Disorders Interview Schedule (ADIS) and the Schedule for Affective Disorders and Schizophrenia for School-Aged Kids (K-SADS), and other assessment scales to evaluate the full range of childhood mood and anxiety disorders. Fellows become experienced not only in thorough diagnostic processes, but also in using empirically-based treatments including cognitive behavioral therapy techniques and up-to-date psychopharmacologic interventions. Additionally, fellows receive in-depth supervision with the use of the one-way mirror video suite, allowing for direct observation of mood and anxiety assessments. An emphasis is placed on complex treatment planning, including individual, family, group, and combination treatments.
Through this rotation, fellows gain opportunities to observe normal development in school-age children, and to gain consultation experience in demographically diverse schools and community recreational and youth development programs. Fellows have the opportunity to observe normal child development and behavior in classrooms, lunchrooms, playgrounds, and after-school activities in the Chicago Public School District. Fellows also partner with the hospital’s faculty and staff to provide education and consultation to teachers, staff, and parents about mental health issues, social/emotional skills training, and behavioral plan development. Fellows may also provide on-site assessment of students with social/emotional problems and triage to appropriate treatment services. They may also become involved in other administrative, consulting, or advocacy/outreach projects related to mental health issues in the community.