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Residency Training - Child and Adolescent Psychiatry

Clinical Rotations

Overview

4 months at Payne Whitney Manhattan
Clinical time is divided as follows:

• 80% Adolescent Inpatient Service
• 20% Pediatric Consultation-Liaison Service/Pediatric Neurology & Neonatal Follow-up Clinics

4 months at Payne Whitney Westchester
Clinical time is divided as follows:

• 90% Inpatient Services (Nichols Cottage, 7 North, and Bard House)/Evaluation Center
• 10% Social-Skills Group Therapy (Outpatient Department)

4 months at NewYork-Presbyterian Morgan Stanley Children's Hospital
Clinical time is divided as follows:

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

Description of Clinical Rotations

Adolescent Inpatient Service: Greenberg 11 North (Payne Whitney Manhattan)

First-Year Residents
The Adolescent Inpatient Service is a 10-to-12 bed acute unit for adolescents from 13 to 19 years of age. Diagnoses include affective disorders, psychotic disorders, disruptive behavior disorders, pervasive developmental disorder, and severe personality disorders. Social class and ethnicity vary broadly. Residents have a broad educational experience, including individual and family therapy, psychopharmacology and ECT in adolescent populations, involvement in a multidisciplinary team, and management of acute psychiatric emergencies. Major emphasis is placed on diagnostic assessment and both short and long-term treatment planning. Residents are actively involved in formulating and implementing dispositions.

Pediatric Consultation/Liaison Service (Komansky Center for Children's Health/Payne Whitney Manhattan)

First-Year Residents
The service provides consultation to children and adolescents admitted to any inpatient service or the emergency room. The Pediatric Psychiatry Consult resident spends, on average, 15 hours a week in consultations to the pediatric services and the emergency department. Each consultation is reviewed with the supervising child psychiatrist. Additionally, residents gain experience teaching pediatric residents, both informally on the inpatient services and formally during the pediatric morning report.

Neonatal Follow-Up Clinic/0-3 Infant Psychiatry Experience (Komansky Center For Children/S Health)

First-Year Residents
The 0-3 Infant Psychiatry Experience at PWM includes a one-month observation in the Neonatal Follow-Up Clinic, didactic series on early development, and participation in the Infancy Seminar. The Neonatal Follow-Up Clinic evaluates all infants discharged from the Neonatal Intensive Care Unit (NICU). A multidisciplinary team of pediatricians, a physical therapist, and a nutritionist completes developmental assessments at regular intervals up to age 3 years of age. The Pediatric Psychiatry Consult resident observes and participates in these assessments with special focus on the mother-infant relationship. The Consult resident will present one mother-infant assessment during the Infancy Seminar.

Pediatric Neurology Clinic (Komansky Center For Childrens Health)

First-Year Residents
Residents rotate through the Pediatric Neurology Clinic, under the direction of the Pediatric Neurology Service, while on the Pediatric Consultation/Liaison Service at Payne Whitney Manhattan. 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.

Child Inpatient Service: Nichols Cottage (Payne Whitney Westchester)

First-Year Residents
Nichols Cottage is a 17-bed acute inpatient unit for children age 4 to 12 years old, with an average length of stay of 30 days. Residents care for patients with a wide range of psychopathologies. Residents function as part of a multidisciplinary team, working alongside psychiatrists, social workers, and nursing staff. They are involved in formulating treatment and discharge plans, as well as managing psychiatric emergencies.

Adolescent Inpatient Service: 7 North (Payne Whitney Westchester)

First-Year Residents
7 North is an 18-bed acute inpatient unit for adolescents age 13 to 17 years old, with a length of stay averaging two weeks. Residents care for patients with a wide range of psychopathologies and discharge needs. Residents function as a part of a multidisciplinary team, working closely with psychiatrists, social workers, and nursing staff. They are involved in formulating treatment and discharge plans, as well as managing psychiatric emergencies.

Children's Day Hospital: Bard House (Payne Whitney Westchester)

First-Year Residents
Bard House is a year-round intensive day-treatment program for children, ages 5 to 12, providing a nurturing educational setting for fragile youngsters with psychiatric disorders and often chaotic psychosocial situations. Educational and clinical services are all provided onsite, and outreach is done to families and community agencies. Residents will work as part of a multidisciplinary team and will have the opportunity to participate in Committee on Special Education meetings, home visits to the families, and network meetings, where they will help families to access services and supports available in the community. While on the Bard House rotation, residents also provide emergency assessment of children, ages twelve and under, in the Evaluation Center at Payne Whitney Westchester and facilitate their admissions when necessary.

Social Skills Group Therapy (Payne Whitney Westchester)

First-Year Residents
Residents participate in a social skills group therapy program on a weekly basis, under supervision, throughout their four-month rotation 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.

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

First-Year Residents
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 Residents
The Comprehensive Emergency Service (CES) rotation is half time for four 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 Neurology (NewYork-Presbyterian Morgan Stanley Children's Hospital)

First-Year 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.

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

First-Year Residents
Each child psychiatry fellow 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 Rotations

Overview

2 days a week at NewYork-Presbyterian Morgan Stanley Children's Hospital
Clinical time is divided as follows:

• 30% Subspecialty Clinics
• 7.5% Evaluation Clinic/Nursery/Caring

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

• 15% Child and Adolescent Outpatient Department
• 15% Pediatric Psychopharmacology Clinic
• 7.5% Evaluation Clinic/Public School Consultation

Research selective/scholarly activity (multiple sites) - 25%

Description of Clinical Rotations

Subspecialty Clinics (NewYork-Presbyterian Morgan Stanley Children's Hospital)

Second-Year Residents
The Pediatric Psychiatry outpatient clinics at NewYork-Presbyterian Morgan Stanley Children's Hospital are organized around specific diagnoses. Residents rotate through the several of these subspecialty clinics, including the Children's Anxiety & Depression Clinic (CADC) and the Disruptive Behavior Disorders Clinic (DBDC) or the Neuropsychiatry Clinic (NPC). In the CADC residents care for children and adolescents diagnosed with Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder with Depressed Mood, Panic Disorder, Separation Anxiety, and Post Traumatic Stress Disorder. The DBDC patient population carries diagnoses of Attention-Deficit/Hyperactivity Disorder and/or Oppositional-Defiant Disorder, as well as Adjustment Disorder with Disturbance of Conduct or Conduct Disorder. Most of the children seen in the Neuropsychiatry Clinic (NPC) clinic have developmental disorders, and the majority of these have some degree of mental retardation with or without autistic features. A minority of NPC patients have histories of normal development compromised by neurological problems (e.g., epilepsy, brain tumor) or other neuro-psychiatric problems. Each resident receives individual supervision for their respective subspecialty clinic patients. The combination of individual supervision and small group technique supervision teach the resident how to employ a wide range of treatments including individual psychodynamic or play therapy, behavior therapy, interpersonal therapy, family therapy, social skills group therapy and psychopharmacology.

Nursery Observation (Columbia University Medical Center Nursery School)

Second-Year Residents
Residents observe children in routine nursery school programs under supervision. Time is provided for discussion of child observations.

Caring At Columbia (Columbia University Medical Center)

Second-Year Residents
The target population consists of community children living in the Washington Heights area of upper Manhattan and adolescents attending the Children's Day Unit (CDU). The community group are middle school children and adolescents who are exposed to a series of family, social, and school stresses that place them at risk to develop or complicate mental health issues. These children, although at risk, do not meet criteria for a formal diagnosis. Adolescents attending the CDU carry a range of psychiatric diagnoses, most commonly anxiety and mood disorders.

Evaluation Clinic (NewYork-Presbyterian Morgan Stanley Children's Hospital and Payne Whitney Campuses)

Second-Year Residents
Residents perform psychiatric evaluations of children and adolescents under direct supervision. 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 Campuses)

Second-Year Residents
Residents 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 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 Campuses)

Second-Year 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. The population is approximately 65 percent male and 35 percent female, with ethnic and socioeconomic diversity. The ages range from 3 to 18 years old and into adulthood for people with developmental disabilities (at PWM only). Patients are seen a minimum of every three months and, on average, every six weeks.

Public School Consultation (Payne Whitney Campuses)

Second-Year Residents
This rotation provides an experience in a mainstream education setting. 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 Residents spend one morning a week for three months on this rotation during the school calendar year.

Cognitive Behavioral Therapy Techniques

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

Family Therapy Techniques

Second-Year Residents
Small groups of residents receive ongoing instruction in family-therapy techniques using their own clinical cases.

Parent Training/Parent Child Techniques

Second-Year Residents
Small groups of residents received expert supervision in parent child interaction and parent training using their own clinical cases.

Download the Child and Adolescent Psychiatry Clinical Schedule.