Orientation to Child and Adolescent Psychiatry
- Introduce the resident to basic topics important to the safe, ethical, and competent practice of child and adolescent psychiatry.
- Impart a basic beginning skill set allowing the resident to begin seeing children and adolescents safely.
- Provide demonstration interview by experienced faculty to give residents guidelines for methods of interacting with children
- Create readiness and enthusiasm for learning the scientific, clinical, consultative, and administrative skills of a competent child and adolescent psychiatrist
- To introduce the resident to important clinical and educational resources they will be expected to use in their practice-based learning and improvement
- To introduce the core competencies and review how they will be evaluated during the residency
- To review general duties, expectations, and rotation descriptions of the residency
- The Orientation is required for residents in both years. It takes place in July and starts with an intensive daily series of lectures for the first week, followed by a weekly lecture series during the month of July.
- Clinical interviews of children will be conducted by clinical and academic faculty that residents will observe through a one-way mirror to demonstrate child /adolescent interviewing techniques
- Additional lecture topics include: Assessment, Treatment Planning, Ethics, Legal Issues in Practice, Emergency and Crisis Management, Introduction to Systems of Care, Introduction to Consultation-Liaison, Introduction to Psychopharmacology (covering the major classes of medication), Introduction to Normal Development, Psychosocial Treatment Modalities, and Educational Resources
- Residents participate in planning and teaching this program. They take a leadership role in the Orientation of general residents who start their child psychiatry rotation at the same time
Clinical Case Conference
- Provide a forum for all residents, students, and faculty in the Division to learn together about the practice and theory of child psychiatry through case discussion.
- Educating the residents in using a formal case presentation format, identifying child psychiatric literature relevant to the case, focusing the discussion on the relevant issues and leading the group discussion.
- Provide a regular forum for presentation of consult-liaison cases, clinic administration topics, and the clinic Morbidity and Mortality conference.
- Provide a forum for discussion of legal and systems issues relevant to cases seen in the clinic.
- Provide a forum for discussion of particularly challenging cases by both faculty and residents.
- This required weekly seminar takes place throughout the year. It is attended by Division faculty, child and adolescent psychiatry residents (first and second years), general psychiatry residents on year-long child psychiatry rotation, medical students on child psychiatry elective, and a pediatric resident on child psychiatry rotation.
- Fellows and Residents alternate presentation of cases. The presenter is asked to pose a particular clinical challenge or issue for consideration. The instructor asks participants to consider formulation from a biopsychosocial perspective. The presenter provides literature where appropriate for further self directed reading following the seminar.
- The chief resident gives the other residents a presentation format to use and helps them structure the presentation and discussion as needed during the seminar.
The psychotherapy seminar is a weekly two year 10 months a year comprehensive look at various psychotherapies via readings, didactics and video \ process note based discussion:
Interactive Therapy with Children
- Utilize group observations and thinking regarding non-verbal communication of children to develop “educated guesses” and hypotheses about the children’s psychological dynamics.
- Develop comfort in the use of one’s responses in formulating hypotheses about the child’s psychology.
- Communication in therapeutic interactions with young children.
- Demonstrate the ability to develop a therapeutic alliance with a child and family and develop a collaborative treatment plan.
- A foundation of psychodynamic theory is emphasized early in the training.
- Techniques of play therapy are emphasized early in the training.
- This is a required weekly seminar for eight months with an experienced dynamically oriented child psychiatrist.
- Residents and the seminar leader present continuing case material by verbal report and videotape, when available.
- The group uses its collective talents, experiences and speculations to develop hypotheses about the psychology of the patient. Use of the group allows for a richer collection of speculations and hypotheses, also normalizing the activity of hypothesis generation.
- These hypotheses are used as the basis of developing both behavioral and psychodynamic treatment strategies.
- The guiding principle is oriented towards helping the child develop a sense of self, a sense of competency, sense of belonging, and optimizing the child’s functioning.
- The seminar discusses development of therapeutic alliances and collaborative treatment planning with the child and parents.
- Integration of psychotherapy and pharmacotherapy are discussed.
Evidence Based Therapies
- To expose the residents to the existing evidence base regarding efficacy of psychosocial treatments for child psychiatric disorders.
- To familiarize the resident with specific evidence-based psychotherapies
- To develop beginning competence in conducting several evidence-based psychotherapies
- To learn indications for specific evidence-based psychotherapies, including patient selection criteria.
- To gain some familiarity with different applications of specific evidence-based psychotherapies (e.g. cognitive behavioral therapy) and how the model varies according to disorder
- Residents read a variety of articles, including review articles on evidence-based psychotherapies, and articles on research methodology to better understand the levels of evidence, articles on the foundations of some of the modalities
- The course discussion reviews the theoretical foundations for behavior modification, cognitive therapy (CBT), interpersonal therapy for depressed adolescents (IPT-A), Relational therapy with children and adolescents, Collaborative Problem Solving, and Parent Child Interactive Therapy.
- Cases are liberally used (both residents and seminar leader’s case material) to discuss how each method might be applied.
- Residents return to the seminar and report back on cases in which they have applied some of these evidence-based therapy techniques.
Family Therapy Seminar
- To learn the major theories and approaches in family therapy
- To understand issues of role definition and boundary functioning in families and identification of how families are dealing with developmental tasks of the family and environmental stressors.
- To recognize difficulties in family dynamics and functioning that may be indications for family therapy.
- To learn basic family interviewing and therapeutic techniques.
- To develop some level of competency as a family therapist, but also to know when to refer to a specialist in family therapy.
- This is a required course for both years that meets weekly for 7 months.
- The course is taught by a very experienced Psychologist, Ivan Inger, PhD who specializes in family therapy.
- The residents read major theorists in family therapy to become familiar with how to evaluate problems in family structure and functioning.
- The residents present their cases and bring in videotapes of cases to discuss the family dynamics and review possible family therapy approaches.
- During the seminar, the seminar leader does a live demonstration of a family interview with resident case in a co therapy manner.
- Residents are encouraged to take on family therapy cases in the clinic and are offered opportunities to do conjoint family therapy with other child psychiatry faculty in the Division.
- Increase residents’ observational skills by reflection on discrete aspects of a child or parent interview.
- Incorporate developmental assessments of children.
- Learn how to articulate observational and historical data and to synthesize this data into a developmental formulation, integrating constitutional, personality, family, and environmental factors.
- Learn how to generate an appropriate differential diagnosis and to collect data to support or rule out diagnoses in the differential.
- Increase the resident’s skill in interacting and interviewing children of diverse ages, cultural backgrounds and with a full range of psychiatric disorders.
- Increase the resident’s attunement of parent-child dynamics and psychodynamic themes in the play of children.
- This is a required seminar for residents in both years. It takes place weekly for twelve weeks each year.
- Patients new to the clinic are brought in for evaluation behind a one-way mirror. In the initial weeks of the seminar the faculty seminar leader conducts the interview, and subsequently residents rotate in conducting the evaluation interviews.
- The resident group observes the interview and discusses the interview as it is being conducted, focusing on developmental, behavioral, cognitive, psychodynamic, and interactional observations.
- At the midpoint of the evaluation interview the evaluator (faculty or resident) joins the observing group and discusses findings thus far. The observing group provides “consultation” to the interviewer as to how to proceed with the evaluation.
- At the conclusion of the interview the full group discusses the case, summarizing the findings, generating a differential diagnosis, and developing a preliminary plan for subsequent evaluation or treatment.
- Later in the year, resident do evaluations which are videotaped and serve as a measure of core competency in patient care and communication skills.
- To gain familiarity with research methodology, including experimental design, sample selection, outcome measurement, major statistical analytic methods, assessment of study results.
- To gain competence in critically reviewing the psychiatric literature
- To read important contemporary articles in the child psychiatric literature
- This is a required monthly lunch seminar throughout the year attended by both years. It is taught by Dr. William Sack, an Emeritus faculty member and former chair of the Division and Greg Clarke, PhD. Research psychologist working with Kaiser Health Systems.
- Review of basic research methodology at the beginning of the series and discusses how to critically review articles.
- Articles are selected with input from the residents for their importance in contributing to the child psychiatry literature and to illustrate methodologic issues or controversies.
- Establish a framework of developmental knowledge providing the resident with a foundation on which to use a developmental perspective in approaching diagnostic and therapeutic work with children and families.
- Establish basic knowledge of normal and abnormal development of biological and psychological functions in the child, including brain/cognitive, speech/language, motor, sensory, adaptive, sense of self, object relations, etc.
- Expose the resident to classic and contemporary theories of psychological development.
- Provide an exposure to historic literature in child and adolescent psychiatry that has been influential in shaping current views of human development.
- This is a required eight month course for both years taught by Dr. McKelvey
- Residents view videotapes of normal development concurrent with readings on normal development. To support their understanding of normal development, residents also will visit a day care center and do observations in elementary school classrooms during their school consultation.
- Residents read classic and contemporary literature on normal and abnormal psychological development.
- Residents read neurobiological literature on brain and cognitive development.
- Develop familiarity with the basic psychiatric disorders seen in children and adolescents.
- Gain an understanding of the phenomenology, epidemiology, etiology, differential diagnosis, course, outcomes, and prognosis of these disorders.
- To learn psychopathology and psychopharmacology in an integrated format.
- Gain an understanding of the evidence base for pharmacologic and psychosocial interventions for these disorders.
- Become familiar with different levels of evidence in the literature for psychotropic medication use, e.g. randomized controlled trials vs. open trials or anecdotal reports.
- Learn the essentials of safe use of medications and indications/ contraindications for different disorders.
- Learn to effectively communicate with children and families about risks, adverse effects, indications and alternatives to psychotropic medications.
- This is a required course for both years.
- Dr. Kyle Johnson is the course leader. He organizes course topics and invites speakers for different disorders. Each disorder is taught in a module, usually three to four sessions.
- Residents are given important literature to read on each disorder, usually emphasizing American Academy of Child and Adolescent Psychiatry Practice Parameters (if available) or Ten-Year Reviews, and other relevant articles on psychopharmacologic treatment of the disorder.
- Developmental disorders
- Mental retardation
- Learning disorders
- Communication/language disorders
- Disruptive behavior disorders
- Conduct disorder
- Oppositional defiant disorder
- Mood disorders
- Substance use disorders
- Sleep disorders
- Eating disorders
- Anxiety disorders
- Obsessive-compulsive disorder
- PTSD/dissociative disorders
- Personality disorders/traits
- Adjustment disorders
- Movement disorders
- Family psychopathology
- Somatoform disorders
- Co morbidity