Second Year Clinical Services

Transcription

1 Second Year Clinical Services 1. High Risk Child Clinic The High Risk Child Clinic (HRCC) provides second-year child psychiatry residents with intensive clinical training in the assessment and treatment of children with multiple risk factors for serious psychiatric disorders. Unlike the other specialty mental health clinic rotations, HRCC is a full-day clinic for 6 months. Located in the Willowbrook area of Los Angeles, a region of marked poverty, the clinic serves predominantly children from minority ethnic backgrounds that are on Medi-Cal or uninsured. Emphasis is placed on the care of childhood psychiatric diagnoses with co-morbid psychosocial complexities, such as parental severe mental illness, substance abuse or incarceration, exposure to community and domestic violence, physical and/or sexual abuse, prenatal drug and alcohol exposure, foster care placement and homelessness. Faculty: Erica Shoemaker, M.D., Karen Lee, M.D. Visiting expert clinical consultants from UCLA Semel Institute and the County of Los Angeles Department of Mental Health Mondays 8:30-5:00 6 months 1. Participate in clinic weekly 2. Attend group supervision Schedule 8:30-9:00 Patient assignments 9:00-10:30 New patient evaluations 10:30-11:15 Group supervision 11:15-12:00 Reserve for urgent follow-up case 12:00-1:00 Lunch 1:00-4:00 On-going patient care 4:00-5:00 Administrative follow-up, service linkage, collateral information, etc. Didactic format Individual and group supervision

2 2. Child OCD, Anxiety, and Tic Disorders Clinic The Child OCD, Anxiety, and Tic Disorders Clinic provides second year fellows with intensive training in the evidence-based treatment (psychosocial and psychopharmacological) of childhood anxiety and related disorders. For six months, the residents receive training in general use of manualized therapies including habit reversal therapy, behavioral therapy and CBT for the full spectrum of pediatric anxiety disorders. In addition to providing these therapies with real-time supervision behind a one-way mirror, fellows also learn cognitive-behavior theory, clinical indications for CBT and evidence-based psychopharmacology. Faculty: John Piacentini, Ph.D., Joan Asarnow, Ph.D., Jim McCracken, M.D., R. Lindsey Bergman, Ph.D., Susanna Chang, Ph.D. Mondays 2:00-6:00 6 months 1. Participate in clinic weekly 2. Attend a weekly group supervision 1. Lectures 2. Mentored clinical observation 3. Group supervision 3. Child Evaluation and Treatment The Child Evaluation and Treatment program provides clinical training in the assessment and treatment of children and adolescents with psychiatric disorders and their families in an outpatient setting. Emphasis is placed on increasing the breadth of child psychiatry patients seen by the senior resident as well as further refining outpatient clinical skills for common child psychiatric disorders (i.e., ADHD). Residents conduct initial evaluations and psychiatric interviews from behind a one-way mirror, and then follow-up with patients as indicated. On average, residents conduct one new intake every other week. Parents and families are included in the assessment of the child, and collateral information is obtained as clinically indicated (i.e. schools, general health care provider, caseworker). Treatment planning meetings and group supervision with academic and clinical faculty enhance each resident s training and clinical experience. Group supervision also allows the fellows to practice boards style presentations to faculty members. Opportunities to teach medical students and general psychiatry residents are provided. Faculty: Andrew Russell, M.D., Sheryl Kataoka, M.D., Martha Jura, Ph.D., and Erika Bath (to start in October 2007)

3 Tuesdays 12:15-5:00 1. Participate in clinic weekly 2. Attend group supervision from 2:00-3:00 Schedule 12:15-12:30: Assignment of new cases 12:30-2:00: Evaluations of new cases 2:00-3:00: Group supervision 3:00-5:00: Follow-up visits with patients Didactic format 1. Group supervision 4. Child and Adolescent Psychopharmacology The Child and Adolescent Psychopharmacology Clinic is dedicated to providing secondyear residents with intensive clinical training in the psychopharmacological treatment of childhood psychiatric disorders. Emphasis is placed on safety of psychotropic medication use, including appropriate selection, anticipated interaction effects, and proper monitoring over time. Residents are taught to develop a scientific rationale for selection and management of psychopharmacologic treatments. They will learn how to conduct an evaluation for psychotropic medication that includes a thorough history of earlier psychopharmacologic trials, family history of medication treatment response, and general medical history pertinent to the psychopharmacologic medication use. A weekly one-hour seminar is taught in conjunction with the Child and Adolescent Psychopharmacology Clinic. It utilizes problem-based teaching methods and critical reviews of the medical literature as a basis for rational pharmacotherapy in children and adolescents. A major focus of the seminar is development of a clinical decision-making process given the available scientific evidence supporting pharmacological practice in the field. In addition to covering psychopharmacology for all of the major childhood psychiatric disorders, residents will also present on a topic of their own choosing relevant to cases followed in the clinic. Faculty: James McGough, M.D., Susan Friedland, M.D., Jennifer Levitt, M.D. Wednesdays 12:30-5:00

4 1. Participate in clinic weekly 2. Attend group seminar weekly Didactic format 1. Group supervision 2. Seminar 3. Lectures 5. School Consultation This rotation provides training in psychiatric consultation to the schools. It combines didactic presentations, mentored visits to school-based settings during the school year, and participation in the Educational Advocacy clinic. UCLA law students also participate in seminar, enriching the discussion in the areas of legal precedents and statutes relating to provision of equitable care for children with mental health problems and developmental disabilities (i.e., IDEA). Faculty: Esther Sinclair, Ph.D., Maureen Graves, attorney, Martha Jura Ph.D. Thursday 8:00-10:30 8 months (Aug-Apr) 1. Attend all scheduled clinics. Each child fellow is expected to attend 4-6 clinic meetings throughout the year. 2. Within the clinic setting, work with interdisciplinary team to determine appropriate school setting and supports for children with psychiatric illnesses 3. Complete supervised site visits to alternative educational programs 6. Pediatric Neurology This 4 month clinical rotation provides combined training in pediatric neuropsychiatry (3month), as well pediatric neurology (1 month) at the UCLA Pediatric Neurology Clinic. Residents will gain exposure to the assessment and treatment of children with epilepsy/seizure disorders, head injury/trauma, non-electrical seizures and other conversion reactions, Tourette s syndrome and other tics disorders, other movement disorders, with and without co-morbid developmental delays and psychiatric disorders. This rotation is enriched by six weekly lectures by Dr. Derek Ott in the Consultation- Liaison seminar series. Faculty: Derek Ott, M.D., Raman Sankar, M.D., Ph.D., W. Donald Shields, M.D., Rebecca Hanson, M.D., Christopher Giza, M.D.

5 Thursday 1:00-5:00 4 months 1. Attend Pediatric Neurology Clinic weekly for 1 months 2. Attend Pediatric Neuropsychiatry Clinic for 3 months. 3. Individual supervision with Dr. Ott weekly for 3 months. 4. Completion of psychiatric consultations to pediatric neurology team during the 4 month rotation with supervision by Dr. Ott 5. Attend 6 weekly lectures in the Consultation-Liaison seminar series 6. Attend selected lunch/noon seminars in Pediatric Neurology 1. Mentored clinical observation 2. Individual clinical supervision 3. Lectures 4. Seminars 5. Pediatric Neurology Case Conference/Journal Club (Thursday noon) 7. Forensic Child Psychiatry This 8-week rotation provides forensic training on-site at the Edelman Children s Court and other Juvenile Court related facilities including both the Dependency and Delinquency branches of the Juvenile Court. During this time, fellows have the opportunity to observe legal procedures in one of the busiest juvenile justice systems in the country. They also will work as consultants to the court, performing psychiatric evaluations of children who are wards and dependents of the court and writing reports of their evaluations. Fellows also may have the opportunity to testify in court, depending on the nature and timing of the case they are working on. This rotation is enriched by six to eight didactic sessions in the Consultation-Liaison seminar led by Drs. Sara Latz (an attorney and child psychiatrist) and Roxanne Szeftel (board certified forensic and child psychiatrist). Faculty: Michael Malkin, M.D., Director, Juvenile Court Mental Health Services, County of Los Angeles; Sara Latz, M.D., J.D. Edelman Children s Court Thursdays 1:00-5:00 8 weeks 1. Report to Edelman Children s Court for eight weeks of rotation, which may also entail visits to other Juvenile Court related facilities 2. Complete at least one forensic evaluation 3. Complete at least one written report of evaluation

6 4. Attend the 6-8 week forensic seminar 1. Individual supervision 2. Faculty feedback on forensic evaluation and consultations with Court personnel 3. Seminar 8. Community Child Psychiatry This 4-month clinical rotation provides intensive clinical training in the assessment and treatment of children and adolescents in a community mental health center. The patient population is children and adolescents from predominantly low-income families, most of which are from an ethnic minority background (African-American, Latino). Emphasis is placed on clinical training in the areas of care of high-risk youth, psychiatric sequlae of exposure to violence, comorbid substance abuse, child abuse, foster care, culturally competency, and systems of care. The residents learn to provide psychiatric care in a community mental health treatment model. In addition to clinical care, the rotation provides opportunities to visit other community-based mental health care settings, including residential treatment facilities, group homes, and therapeutic foster care. Faculty: Charles Sophy, D.O., Medical Director, County of Los Angeles Department of Child and Family Services Edmund D. Edelman Mental Health Center Thursdays, 1:00-5:00 4 months 9. Child Psychiatry Elective One half-day (or 5 hours) per week is protected time for second-year residents to pursue additional clinical training in an area of special interest or do research. During the spring of the first year, the resident is expected to identify a special area of interest, elective plan and faculty mentor. The faculty mentor is expected to meet at least monthly with the fellow during the year. Final approval from the training director is required. Topics for the elective vary widely. Residents may do additional clinical training in college student psychiatry, eating disorders, developmental disorders, medical student education, forensic psychiatry, school consultation, community mental health, administration, and inpatient psychiatry. There is also a breadth of research opportunities at UCLA Neuropsychiatric Institute. Residents are encouraged to develop a research project under the mentorship of academic faculty, in the areas of genetics, neuroimaging, learning disorders, subsyndromal psychosis, affective disorders, anxiety disorders, ADHD, psychopharmacologic clinical trials, psychotherapeutic intervention trials, child mental health services research, and quality of care. Residents are encouraged to develop their

7 grand rounds presentation and write their graduation paper on their elective topic, and to seek additional supervision from their mentor for these scholarly activities. Faculty: Bonnie Zima, M.D. (coordinator), Child and Adolescent Psychiatry Faculty One-half day/week or 5 hours/week Individual supervision 10. Long Term Outpatient Care/ Resident s Psychotherapy Clinic Described in the first year clinical services section.

8 Second Year Didactics 1. Advanced Child and Adolescent Psychopathology and Psychopharmacology This hour and a half seminar meets throughout the year, and is also known as the second year core seminar. The seminar is dedicated to advanced topics related to the assessment and treatment of childhood psychiatric disorders in children, adolescents and their families. In addition to advanced child psychopathology and psychopharmacology, there are also didactic sessions on administrative/legal issues relating to the practice of child and adolescent psychiatry (informed consent, quality assurance), and child mental health services research. Resident learning is enriched by a variety of approaches including journal club, lectures, case presentations, and videotaped clinical interviews. Faculty: Andrew Russell, M.D. (coordinator) Friday 8:30-10:00 1. Lecture 2. Journal club 3. Mentored clinical observation (videotape) 4. Interactive sessions for research paper review (i.e., round table debate) 2. Child Psychiatry Consultation This year-long seminar is dedicated to instruction in the practical and theoretical aspects of the role of child psychiatric consultant-liaison to schools, forensic and community settings. The teaching formats include lectures, journal club, interactive discussion, and clinical presentations as well as special presentations from public agency leaders and clinical faculty with expertise in provision of care within particular care sectors. Faculty: Margaret Stuber, M.D., Brenda Bursch, Ph.D., Esther Sinclair, Ph.D., Bonnie Zima, M.D., Sara Latz, M.D., J.D. (coordinators) Friday 10:30-12:00

9 1. Lectures 2. Group discussion 3. Journal club 4. Clinical case presentation 3. Child Psychiatry Grand Rounds Described in the first year courses and seminars section