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Residency Training - Child and Adolescent Psychiatry

Clinical Rotations - CAP Track

First Year Cap Track Rotations

Overview

6 months at Queens Children's Psychiatric Center
Clinical time is divided as follows:

• 90% Inpatient Service
• 10% Research Selective/Scholarly Activity

6 months at NewYork-Presbyterian Morgan Stanley Childrens Hospital
Clinical time is divided as follows:

• 50% Comprehensive Emergency Service (CCPEP, HBCI, and ITC)
• 40% Pediatric Consultation/Liaison Service
• 10% Pediatric Neuropsychiatry/Pediatric Neurology & Pediatric Pain Clinics

Description of Clinical Rotations

Inpatient Psychiatric Service (Queen's Children's Psychiatric Center)

First-Year CAP Track Residents
The training service treats patients ages twelve to eighteen years who present with severe and disabling psychopathology including anxiety, psychosis, aggression, impulsivity, hyperactivity, mood disorders, and developmental delay and deviance. The CAP Track residents are active members of the service. They participate in the evaluation, diagnosis, as well as individual, family and milieu therapy, and psychopharmacological management of hospitalized children and adolescents. Residents are responsible for up to 4 patients during their 6 month rotation, seeing each patient individually twice weekly, co-leading a group, as well as participating in team meetings, administrative unit meetings and therapeutic community meetings. Child and adolescent residents from another training program, psychology interns and social work interns may also participate.

Pediatric Consultation/Liaison Service (NewYork-Presbyterian Morgan Stanley Children's Hospital)

First-Year CAP Track Residents
Residents rotate on the Consultation Liaison service at NewYork-Presbyterian Morgan Stanley Children's Hospital at the Columbia University Medical Center campus for six months. Clinical activities include consultation to medically ill children on inpatient and, less often, outpatient pediatric services. Liaison services to selected subspecialty teams include cardiac transplant, ICU, pain management, hematology/oncology, neurology, and renal. Psychiatric diagnoses include adjustment disorder, acute stress disorder, patients admitted following suicide attempts, anxiety disorders, PTSD, affective disorders, neuropsychiatric disorders, and brain syndromes secondary to medical illness. Types of treatment provided include preoperative evaluations before organ transplantation, brief behavioral interventions, acute psychopharmacological management, parent education, and family counseling. Cognitive-behavioral interventions include hypnosis and pain management techniques. Interdisciplinary teamwork with pediatric staff is an intrinsic component of this rotation.

Comprehensive Emergency Service (NewYork-Presbyterian Morgan Stanley Children's Hospital)

First-Year CAP Track Residents
The Comprehensive Emergency Service (CES) rotation is half time for six months. The CES is divided into three components: The Children's Comprehensive Psychiatric Emergency Program (CCPEP), the Home-Based Crisis Intervention (HBCI), and the Immediate-Treatment Clinic (ITC). The CCPEP is subdivided into an ambulatory evaluation service and the extended-observation unit. The most common presenting problems are suicidal thoughts and actions, disruptive behavior disorders, anxiety and depressive disorders, child abuse and neglect, and school problems. The types of treatment provided include crisis-oriented interventions, psychopharmacological management, supportive therapy, family therapy, and referrals for psychosocial support services. All cases are discussed with the attending on an individual basis prior to disposition.

Pediatric Neuropsychiatry (NewYork-Presbyterian Morgan Stanley Children's Hospital)

First-Year CAP Track Residents
Most of the children seen in the Neuropsychiatry clinic have developmental disorders, and the majority of these have some degree of mental retardation with or without autistic features. A minority of patients have histories of normal development compromised by neurological problems (e.g., epilepsy, brain tumor) or neuropsychiatric problems. The most common types of behavioral and emotional problems addressed by the clinic include aggression, sleep problems, depression, mood lability, anxiety, and repetitive behaviors.

Pediatric Neurology Clinic (NewYork-Presbyterian Morgan Stanley Children's Hospital)

First-Year CAP Track Residents
Residents rotate through the Pediatric Neurology Clinic, under the direction of the Pediatric Neurology Service, while on the Pediatric Consultation/Liaison Service at NewYork-Presbyterian Morgan Stanley Children's Hospital. The clinic population is culturally diverse, with a variety of neurological disorders, including neuromuscular disorders, seizure disorders, tumors, movement disorders, degenerative neurological diseases, strokes, and other neurological syndromes. Many disorders are complicated by neuropsychiatric problems or include a differential diagnosis of a conversion disorder, somatization disorder, or psychiatric factors complicating a neurological condition.

Pediatric Pain Clinic (NewYork-Presbyterian Morgan Stanley Children's Hospital)

First-Year CAP Track Residents
Each child psychiatry resident rotates for four weeks in the outpatient Pediatric Pain Management Center at NewYork-Presbyterian Morgan Stanley Children's Hospital. The fellow participates in the evaluation of children and adolescents with diagnoses such as functional abdominal pain, chronic daily headache, complex regional pain syndrome type I (reflex sympathetic dystrophy), and chronic pain associated with life-threatening illness.

Second Year Cap Track Rotations

Overview

2 days a week at Payne Whitney Westchester
Clinical time is divided as follows:

• 20% Child and Adolescent Outpatient Department
• 15% Pediatric Psychopharmacology Clinic
• 10% Evaluation Clinic/Public School Consultation
• 5% Social Skills Group Therapy

2 days a week at Queens Childrens Psychiatric Center (QCPC)/New York State Psychiatric Institute
Clinical time is divided as follows:

• 25% Community Based School Mental Health
• 25% Research Selective/Scholarly Activity

Description of Clinical Rotations

QCPC/Community-Based School Mental Health

Second-Year CAP Track Residents
This rotation provides an experience in a range of structured and therapeutic special education classroom settings. The target population varies with school site but includes children ages 5 to 18 who are receiving or are in need of special education services though. These students often have significant behavioral and learning issues in school or/and at home. The range of diagnosis includes Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Learning Disorders, Anxiety and Mood Disorders, and Pervasive Developmental Disorder, NOS. Residents observe children in the classroom, consult with teachers about normal vs. deviant development, behavioral management, and provide psychiatric assessment and treatment when indicated. Second Year CAP Track Residents spend one day a week over throughout the year rotating through select QCPC Community Services schools.

Public School Consultation (White Plains Public School)

Second-Year CAP Track Residents
This rotation provides an experience in mainstream education setting in White Plains, New York. Residents observe children in the classroom, consult with teachers about normal vs. deviant development and behavioral management, and provide psychiatric assessment when indicated. Second Year CAP Track Residents spend one morning a week for four months during the calendar school year while at Payne Whitney Westchester.

Evaluation Clinic (Payne Whitney Westchester)

Second-Year Cap Track Residents
Residents perform psychiatric evaluations of children and adolescents under direct supervision for six months. Evaluations include interview with the child, as well as parents/caretakers, and acquisition of collateral history. Differential diagnosis, risk assessment, and disposition of patients are done with a supervisor.

Child & Adolescent Psychiatry Outpatient Department (Payne Whitney Westchester)

Second-Year CAP Track Residents
Residents evaluate and treat children and adolescents up to age 18 at these general pediatric psychiatry clinics. Patients present with a variety of diagnoses: disruptive behavior disorders, depression/anxiety disorder, adjustment disorders, pervasive developmental disorder or psychosis, and mental retardation. Child psychiatry residents participate in routine evaluations and manage a caseload of patients in both long-term and short-term treatment modalities, which include psychodynamic psychotherapy, play therapy, family therapy, parent guidance and CBT, under the supervision of senior faculty members. Patients requiring medication are referred and monitored in the psychopharmacology clinic.

Pediatric Psychopharmacology Clinic (Payne Whitney Westchester)

Second-Year CAP Track Residents
The diagnostic breakdown of patients referred to the psychopharmacology clinics includes ADHD, affective disorders, pervasive developmental disorder and/or mental retardation, schizophrenia and other psychotic disorders, and anxiety disorders, including OCD. The population is approximately 75 percent male and 25 percent female, with ethnic and socioeconomic diversity. The ages range from 3 to 18 years old. Patients are seen a minimum of every three months and, on average, every six weeks.

Social Skills Group Therapy (Payne Whitney Westchester)

Second-Year CAP Track Residents
Residents participate in a social skills group-therapy program on a weekly basis, under supervision, for 6 months at Payne Whitney Westchester. These groups vary with regard to age range and diagnosis, but all provide the residents with valuable exposure to the principles and practice of social skills training.

Cognitive Behavioral Therapy Techniques

Second-Year CAP Track Residents
Small groups of residents receive ongoing instruction in cognitive-behavior techniques using their own clinical cases.

Download the Child and Adolescent Psychiatry Track Clinical Schedule.