An interview with the training program

Craigan Usher, MD, Karina Espana, MD, & Mariah Racicot, MD
Craigan Usher, MD, Karina Espana, MD, & Mariah Racicot, MD

Craigan Usher, MD, Program Director

What do you think is unique about the OHSU Child & Adolescent Psychiatry Training Program?

Nestled in a rain forest in the West Hills of Portland, Oregon, at OHSU you’ll find a core group of child psychiatrists who value the unique subjectivity of every young person and family we meet. The group here wrestles with questions like: “what’s preventing this child, teen or family from engaging with the world, from enjoying the nature that surrounds us, the company of others, or of feeling agentive—like they can make an impact—and alive? And more importantly, what can we do to help and what role might others play in this?” 

This kind of questioning helps us transcend simply saying: “use X medicine or offer Y evidence-based psychotherapy” and focus on formulation and functional outcomes. In order to facilitate our asking and answering deeper questions, we offer an array of rotations—from examinations of typical child development at the Helen Gordon Child Development Center to rotations on advocacy and policymaking to pediatric sleep medicine.

What books do you recommend to residents?

I invite residents to lean into pathographies like Esmé Weijun Wang’s The Collected Schizophrenias, The Center Cannot Hold by Elyn Saks, and Marbles by Ellen Forney or Rachel Aviv’s examination of the mental health field, Strangers to Ourselves. These are not about childhood per se, but really train our lens on development and growth over time. Reading these books helps us consider that how we address the needs of someone (of any age) who is in a mental health crisis may have a long-lasting impact on that person’s sense of hope and possibility. Reading these books might make us kinder and less hurried.

What are some of your specific interests in child and adolescent psychiatry?

I’m interested in psychodynamic psychiatry and the role that unconscious limitations play on how big all of us (young and old) are willing to dream and on how interested in and interesting we allow ourselves and others to be. These unconscious limitations (things that are sometimes right in front of us that our minds don’t less us see, that simply don’t register) lead to personal dissatisfaction and many of the major problems society faces in terms of inequality and discrimination. This ties in well with my passion for the humanities, graphic medicine, family therapy, and early psychosis intervention.

Karina España, MD, Associate Program Director

Why train with us?

This program is about heart. We lean into knowing and celebrating who you are as a person to then support you in your professional development. We encourage you to dream big about who you are and what your impact will be.

We teach how to be innovative and masterful in your approach when working with children and families affected by mental illness. Our fellowship ensures that as you navigate your own journey as a child psychiatrist, you are both well-trained and well-supported. We offer you a breadth of experiences so that you leave training feeling equipped to help diverse communities in need of your expertise in a variety of settings. And, we want you to have fun!

What should I read to prepare for fellowship?

The Boy Who Was Raised as a Dog by Bruce Perry

What is your vision for what a child and adolescent psychiatrist ought to be?

Child and adolescent psychiatrists lead their field with curiosity, compassion, imagination, and humility. They should be curious about the developing narrative of each young person they encounter and the nature of one’s authorship over their story. A child and adolescent psychiatrist must hold compassion for the unique strengths and vulnerabilities of the individual with whom they’re working. Having humility in applying expertise enables a thoughtful and collaborative approach to improving the lives of young people and their families. This translates to thinking critically about natural supports and intersecting systems, and the role of child and adolescent psychiatrists as change agents for community-driven initiatives.

What are some of your specific interests in the field?

Health equity, juvenile justice, child welfare, crisis response and intervention, community mental health, graphic medicine, narrative therapies.

Mariah Racicot, MD, Associate Program Director

Why train with us?

Our program endeavors to think about children and adolescents holistically - both as individuals and within their family and community systems - and to consider our patients first as people with rich, complex lives outside of our diagnostic impressions.

This sense of respecting that we are only one small part of someone’s life and that our lens is necessarily narrow lends itself to clinical curiosity from a psychiatric and psychodynamic perspective, and leads to lively, interesting discussions within the program and with colleagues across medicine.

We encourage psychiatrists in our program to take the time to question assumptions, to wonder about previous diagnoses and the appropriateness of treatment modalities, and to really get to know patients and their families in a broader sense while thinking creatively about our recommendations and treatment strategies.

What are some of your specific interests in the field?

As I imagine anyone interested in CAP is aware – there are not enough psychiatrists let alone enough child psychiatrists in North America (the world?) and this dearth of providers leaves many, many youth without appropriate access to care. I grew up in communities without adequate access to many types of healthcare and services, and I am passionate about finding creative ways to improve access while also advocating for an increase in training spots and reasonable changes to our healthcare delivery system to meet this need. I believe that as child and adolescent psychiatrists we have a unique expertise and knowledge that we both can and should be sharing broadly and in a myriad of ways.

I am passionate about bi-directional learning and continuing to question my own biases and perspectives and those that prevail in our field.

Specifically I am interested in the way psychiatric diagnoses are understood and used practically (in schools, in organizations like child services and/or disability services, in literature, in media and social media, etc.) and to that end I have a special interest in ADHD and bipolar disorder.

Finally, though I tend to work with the pre-adolescent and adolescent age groups more frequently in my own practice, I am interested in finding ways for CAP to promote parenting strategies, systems change, and early childhood interventions that build a healthy psychiatric foundation for life – in essence, a preventative, up-stream approach that encompasses both individual factors and much larger systemic issues.

Elisa Ross, CAP Program Coordination + Coffee
Elisa Ross, BFA, Program Coordinator

Elisa Ross, BFA, Program Coordinator

What role do you play in the lives of fellows and faculty? 

As the program training coordinator, I listen to the fellows and faculty to create a successful, smooth, unique & collaborative, training experience in child and adolescent psychiatry. As an artist, I bring in collaborators to teach the fellows how art can shift perspective and allow them to become engaged, playful, and holistic thinkers. 

Contact the Program Coordinator, Elisa Ross :