Rotations
YEAR 1
4 months: Acute Child & Adolescent Psychiatry- Psychiatric Residential Treatment Facility (LCCA)
4 months: Consultation/Liaison Psychiatry (CHOG)
The above experiences are longitudinal. Remaining time is devoted to didactics, research,
outpatient continuity clinic, group therapy modalities (DBT, autism social skills
group), and experiences in pediatric neurology, sexual abuse evaluations, gender clinic,
palliative care, and HemeOnc.
YEAR 2
The majority of the second year consists of outpatient clinic with exposure to various
settings, typically for three month blocks a half-day a week including:
- Community Psychiatry (Transitional Family Services)
- Forensic psychiatry (Augusta RYDC)
- Pediatrics Enhanced Primary Care Clinic
- School Consultation (McDuffie & Richmond Counties)
- Student Health (Augusta University)
Additional elective time for research, QI projects, or other treatment modalities
is available
Goals and Objectives
The clinical rotations for the child and adolescent psychiatry training program at
the MCG are organized to provide the resident intense and focused experiences to develop
the comprehensive skills necessary for the diagnosis and treatment of the full scope
of child, adolescent and family psychopathology. Experiences are tailored to train
the resident to function as a leader of and collaborator with multidisciplinary teams
in a variety of settings (inpatient, outpatient, pediatric hospital, schools, juvenile
justice center, community systems of care, etc.). While goals and objectives for each
rotation have been developed, it is recognized that clinical learning takes place
in every encounter and cannot be totally qualified or quantified by specific goals
within the core rotations.
Clinical Rotation 01: MCG Hospital Child and Adolescent Inpatient Service
The goal of this rotation is to provide the resident with an opportunity to evaluate
and treat a wide range of child and adolescent inpatients and their families in a
multidisciplinary setting under the close supervision of a child and adolescent psychiatrist.
A. Knowledge - At the end of this rotation the resident should be able to:
- Recognize the components of a comprehensive inpatient assessment and treatment plan
as well as the criteria for inpatient admission.
- Understand the role of a child and adolescent psychiatrist as an inpatient treatment
team member and case manager.
- Understand the roles of the nurse, psychologist, social worker, occupational therapy,
and education members of the inpatient team and how they complement the total treatment
approach to the patient and family.
- Recognize the value of consultants in the hospital setting.
- Discuss the range of diagnoses for children and adolescents in the inpatient setting.
- Recognize the teaching role of the child and adolescent psychiatrist in an inpatient
milieu.
- Learn about a number of specific areas such as child protective services, juvenile
court and probation issues, parent training and family therapy, group therapies, individual
and play interventions, approach to reactive attachment disorder issues, criteria
for commitment or hold proceedings, etc.
- Learn about managed care reviews, quality assurance, performance improvement strategies.
B. Skills - The resident should be able to:
- Admit, write orders, conduct an assessment, develop a treatment and discharge plan
for patients across the developmental spectrum from preschool to adolescence.
- Implement the psychiatric components of the assessment and treatment plans in a comprehensive
and efficient manner.
- Utilize the milieu staff and available consultants appropriately in the management
of patients and families.
- Work with children/adolescents in groups and individually in a therapeutic manner.
- Set up behavior management plans for patients with the milieu staff.
- Communicate findings and treatment plans to referring physicians and mental health
providers.
- Communicate effectively within the utilization review process.
- Serve as an advocate for children and adolescents with mental illnesses.
C. Attitudes - The resident should demonstrate:
- An interest in learning about the inpatient treatment of children and adolescents.
- A non-prejudicial approach to patients and staff.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- The resident will be the case manager for 4-7 patients at any one time, integrating
and orchestrating all ongoing evaluation and therapeutic interventions and directing
the team meetings on his/her patients.
- The resident will also have some cases where he/she is the solo manager of the case,
participating in both the child and family evaluations and treatments.
- The resident will attend all team meetings, presenting ongoing cases and developing
treatment and discharge plans for all cases.
- The resident will participate in pre-admission evaluations for crisis management and
interagency conferences as appropriate.
- The resident will be expected to participate in family sessions with the social worker
as time allows but minimally weekly.
- The resident will be expected to participate in group therapies as time allows
- Resident record keeping is monitored daily by the attending psychiatrist and reviewed
with the resident as necessary.
- The resident will have weekly individual supervision with the attending child and
adolescent psychiatrist to review all ongoing cases.
- All experiences are reviewed in the context of the Core Competencies.
Clinical Rotation 02: MCG Hospital Outpatient Child and Adolescent Mental Health Clinic
The goal of this rotation is to provide the child and adolescent psychiatry resident
with numerous opportunities to evaluate and treat, under close supervision, a variety
of children, adolescents and their families in an outpatient setting, both on a scheduled
basis and occasionally for crisis or emergency assessment and treatment and with the
range of therapeutic modalities available. This rotation runs throughout the residency
and provides the opportunity for continuity of care over a two year period.
A. Knowledge - At the end of this rotation, the resident should be able to:
- Recognize the various approaches to evaluation and treatment in the child and adolescent
psychiatry outpatient setting.
- Discuss the components necessary for formulating a diagnosis, biospychosocial formulation
and treatment plan for each case.
- Recognize the broad spectrum of severity of disorders in children and adolescents.
- Recognize the developmental influences on the presentation, evaluation and treatment
of psychiatric disorders in children from preschool through adolescence.
- Discuss the collaboration necessary between the child and adolescent psychiatrist
in the outpatient clinic and the family, school, and other community agencies to insure
the best treatment outcome for the patient.
- Recognize the influence that culture and religion may have on the presentation of
mental health issues as will as the psychological accessibility to various interventions.
- Recognize the contributions of other mental health providers within the outpatient
setting.
- Discuss interventions, including a variety of psychotherapies as well as psychopharmacological
interventions.
B. Skills - At the end of this rotation, the resident should be able to:
- Evaluate and treat children and adolescents of various developmental levels with the
full range of psychiatric disorders to include all of the diagnoses listed in the
description of the clinical rotation.
- Complete an initial evaluation, request appropriate collateral information, use appropriate
rating scales, request appropriate consultation, etc., to allow the resident to reach
a diagnosis, develop a formulation of the case, and recommend appropriate comprehensive
intervention strategies.
- Demonstrate competency in a variety of therapeutic modalities and at least a knowledge
of the indications for those for which competency has not yet been achieved.
- Evaluate and triage to the appropriate level of care emergencies which may present
for intake.
- Demonstrate the ability to integrate community resources into the comprehensive treatment
of children, adolescents and their families.
- Demonstrate clinical proficiency in the outpatient diagnosis and treatment of children,
adolescents and families.
- Keep up-to-date and complete records.
- Maintain ethical standards in the outpatient setting.
- Communicate effectively with families and patients and educate them appropriately
about their disorders as well as their treatments.
- Participate in QA monitoring and performance improvement activities within the outpatient
setting.
C. Attitudes - The resident should demonstrate:
- An interest in learning about the outpatient treatment of children and adolescents.
- A non-prejudicial approach to patients, families and other mental health providers.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- Each resident will have an intake appointment time on a regular basis.
- Each intake will be supervised on-site by a child and adolescent psychiatrist, with
the resident presenting the chief complaint, history, a formulation and treatment
plan.
- Intakes will be triaged appropriately and may be followed into therapy with the resident.
- Residents may follow inpatient cases from their inpatient rotations or from other
rotations in the outpatient clinic.
- The resident case load will be monitored by the supervisor and/or the clinic medical
director to assure adequate numbers, diagnostic and age diversity, cultural diversity,
and the full range of treatment modalities. When a resident does not have enough diversity
in the case load, the supervisor will work with the resident and the intake coordinator
to facilitate a broader range of patients.
- Case loads are monitored by using departmental software that allows for the supervisor
and resident to access the resident's case load. Occasionally residents maintain their
own case log but this is seldom necessary.
- Resident charting is monitored regularly by the supervisor at the time of the visit
and usually signed by the supervisor after review.
- In addition to on-site supervision on almost all cases, the resident also participates
in at least one hour of individual supervision weekly with a child and adolescent
psychiatrist. Specific therapies may also be supervised by other professional disciplines
with demonstrated expertise in the therapy being employed.
- All experiences are couched in the Core Competencies.
Clinical Rotation 03: Pediatric Neurology
The goal of this rotation is to expose child and adolescent psychiatry residents to
the outpatient practice of pediatric neurology and to facilitate an understanding
of the collaboration between these two specialties.
A. Knowledge - At the end of this rotation, the resident should be able to:
- Discuss the major disorders seen by the pediatric neurologist.
- Outline an approach to the diagnosis and treatment of these disorders.
- Recognize the frequent overlap between neurological and psychiatric disorders.
- Recognize the benefits of neuropsychological testing for pediatric neurology patients.
- Understand the use of specialized lab testing, EEG, CT and MRI.
B. Skills - At the end of this rotation, the resident should be able to:
- Take a neurological history and perform an adequate neurological exam on children
and adolescents and present an organized case to the neurology attending.
- Develop a differential diagnosis for the presenting problem.
- Identify further assessment methodologies appropriate to the findings in the history
and physical.
- Implement a basic treatment plan for the most common pediatric neurology problems.
- Communicate findings and recommendations to the patient and family as well as to referral
sources.
C. Attitudes - The resident should demonstrate:
- An interest in learning about the pediatric neurology.
- A non-prejudicial approach to patients, families and other medical providers.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- The resident will see 1-5 complicated new or return patients per clinic afternoon
and review these cases with the pediatric neurology faculty on-site.
- The resident will participate in any team discussions of particularly interesting
or complicated cases and may present the case if it is their clinic patient.
- The resident will do neurological examinations under the supervision of the pediatric
neurologist or the neurology resident.
- The resident will be exposed to various treatment modalities such as medication management,
patient and family education, and collaborative with clinic team and coordination
with community resources.
Clinical Rotation 04: MCG Pediatric Consultation/Liaison Service
The goal of this course is to provide a clinical experience in pediatric consultation
and liaison, helping the resident to integrate clinical the didactic material presented
in the C/L course. Emphasis is on working with the pediatric team, assuming the role
of consultant rather than treating physician, and working with patients and their
families with chronic pediatric illnesses, acute catastrophic illness and patients
with suicide attempts.
A. Knowledge - At the end of the rotation, the resident should be able to:
- Discuss the process of pediatric consultation and how it differs from primary psychiatric
assessment and treatment.
- Identify appropriate liaison functions for the child and adolescent psychiatrist in
a pediatric setting.
- Recognize the staff as well as family issues cogent to psychiatric consultation.
- Discuss common emotional issues relevant to specific medical diagnoses.
- Discuss the assessment of suicidal behavior in children and adolescents.
- Recognize issues for patient, family, and staff in palliative care and terminal illness.
B. Skills - At the end of the rotation, the resident should be able to:
- Undertake a consultation on any patient in the pediatric setting.
- Undertake the role of a consultant appropriately depending on the consultation questions.
- Write a concise consultation report with practical recommendations for intervention
that can be implemented in the pediatric setting.
- Work with staff to deal with physician/staff or family/staff issues that may interfere
with care.
- Assess a suicidal patient.
- Work with a dying child or adolescent and his/her family.
C. Attitudes - The resident should demonstrate:
- An interest in learning about the pediatric consultation and liaison.
- A non-prejudicial approach to patients, families and other medical providers.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- Integrated into the Child Psychiatry Residency Lecture series will be the following
core consultation/liaison lectures:
- Evaluation and Triage of Suicidality
- Pain Management
- Physical Trauma/PTSD
- Somatoform Disorders in Children
- Dealing with Chronic Illness.
- Death and Dying
- Residents will see all pediatric consultations requested in a timely manner.
- Each case will be presented to and most will actually be seen by the attending consultant
(either psychologist or child and adolescent psychiatrist) and discussed in depth
prior to final assessment and recommendations are formulated.
- Residents are monitored closely for competency in consultation issues and evaluated
on at least four pediatric disease-related categories as to competence to implement
interventions independently.
- Supervision on each case is intensive and includes case review of resident's initial
evaluation, modeling of assessment/treatments by the attending, case formulation discussion
and supervision of case follow-ups.
- Handouts and articles are provided on various topics relevant to the specific consultations.
- All experiences are assessed in the context of the Core Competencies.
Clinical Rotation 05: Residential Treatment Rotation - Lighthouse
The goal of this rotation is to provide residents with an continuous experience working
with in a long-term treatment facility for adolescents. The resident will have opportunities
to evaluate adolescents as they enter the program and follow them within the program
over several months in the program. The resident will also gain experience in working
with the multidisciplinary team and observ ing the various facets of the residential
treatment program at work.
A. Knowledge - At the end of this rotation, the resident should be able to:
- Discuss differentiation between the indications for home based, intensive, acute inpatient
and residential care for children and adolescents.
- Discuss aspects of advocacy for adolescents and families within this setting.
- Recognize the contributions of the various members of the multidisciplinary treatment
team and the psychiatrist's role within this setting.
- Recognize the myriad of disorders and potential psychiatric and social interventions
that may be used within the residential setting including psychopharmacology and psychosocial
therapies.
B. Skills - At the end of this rotation, the resident should be able to:
- Function comfortably in the residential treatment setting.
- Participate in the admission process that brings adolescents to the residential treatment
setting.
- Provide psychiatric services to the multidisciplinary team through direct assessment
and treatment recommendations to the team, and through actual provision of direct
psychopharmacology, diagnostic, and group and individual therapies.
- Work with the treatment team to develop intensive behavioral interventions for youth
with serious and complicated behavior problems.
- Work with the treatment team to develop comprehensive discharge plans for youth with
severe mental health problems.
C. Attitudes - The resident should demonstrate:
- An interest in learning about youth with severe mental illness.
- A non-prejudicial approach to patients, families and providers within the juvenile
justice setting.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- The resident will work within the setting for 6 months to allow continuity and facilitate
membership in and contributions to the treatment team.
- The resident will carry a caseload of patients with serious and complicated psychiatric
morbidity.
- The resident will observe patients in residential treatment facility milieu and work
with staff to develop behavioral, individual and group interventions as well as provide
psychopharmacology consultation when appropriate.
- The resident will provide education regarding the provision of services to youth with
severe emotional and behavioral disturbances.
- The faculty supervisor will supervise the resident in all of these endeavors on an
individual basis.
- The resident will be evaluated in the context of the Core Competencies.
Clinical Rotation 06: School Consultation
The goal of this rotation is to expose residents to the role of the child and adolescent
psychiatrist in the regular and psychoeducational school setting through didactics
that define the consultant's role and boundaries, school visits where residents work
collaboratively with teachers, social workers, school psychologists, and school administration
to develop and implement educational strategies that optimize academic performance
and decrease problematic classroom behavior, and participation in formal educational
meetings to formulate individualized educational treatment plans.
A. Knowledge - At the end of this rotation the resident should be able to:
- Define the models of school consultation and the role of the child and adolescent
psychiatrist under each model of service.
- Understand the role of the child and adolescent psychiatrist in a non-medical setting.
- Understand the role of school collaboration in the comprehensive treatment of a child
or adolescent.
- Discuss the components of an individualized educational plan and the process for development
of such a plan.
- Understand the legal issues related to children in schools.
- Recognize teaching methods effective for children with severe cognitive, emotional
and behavioral impairments.
- Discuss behavioral and social skills interventions effective in working with children
in schools.
- Appreciate that information presented to non-medical professionals differ from presentations
to medical professionals.
B. Skills - At the end of this rotation the resident should be able to:
- Conduct a school consultation, including classroom observations and discussions with
teachers and other personnel to communicate behavioral approaches to optimizing the
child's function in the academic setting.
- Collaborate with a parent, school teachers, and school administration to develop an
individualized educational plan.
- Actively participate in a student support team or individualized educational plan
meeting.
- Advocate for the child within the school system based on federal laws governing the
child's rights.
- Present information on mental health topics to social workers and school personnel
that is appropriate for non-medical professionals.
C. Attitudes - The resident should demonstrate:
- An interest in learning about children and adolescents within the school setting.
- A non-prejudicial approach to patients, families and educators within the school setting.
- Professionalism by active participation, regular attendance and preparation for didactics
and school visits related to school consultation.
- Motivation to work in as many different educational systems and with patients with
as many different educational needs as possible.
- Responsible and ethical approach to all aspects of the experience.
D. Strategies
- The resident will receive a minimum of four hours of didactics exploring models of
consultation, educational rights of students with disabilities including “other health
impaired”, educational strategies effective for specific diagnostic categories (i.e.
ADHD, autism, oppositional defiant disorder, psychosis), and obstacles that may impede
effective school consultation.
- The resident will work closely with the psychoeducational school system over a period
of time that allows for continuity of care and facilitates a process for becoming
a part of the educational team.
- The resident will spend time observing children in the psychoeducational school, focusing
on the challenges that emotionally disturbed children and/or autistic students have
in the academic setting.
- The resident will work with the school staff to develop behavioral and social skills
interventions for the children for whom consultation is requested. It is expected
that the resident will consult on at least one case or classroom every two weeks.
- The resident will attend monthly multidisciplinary team meetings where he/she will
facilitate the discussion of a clinical case or present a mental health topic to teachers,
school administrators, and social workers.
- The resident will visit and observe at least one child or classroom in a regular education
setting.
- The resident will be assigned a formal review of an individualized treatment plan.
- The resident will attend at least one student support team or individualized educational
plan meeting during the rotation.
- The faculty supervisor will supervise the resident in all of these endeavors on an
individual basis.
Clinical Rotation 07: Forensic Consultation/Juvenile Justice Rotation
The goal of this rotation is to provide residents with an in-depth continuous experience
working with a system of care within the juvenile justice system. The resident will
have opportunities to observe the juvenile justice system at work, to consult on very
complicated cases within the system, and to provide education to and team input into
the multidisciplinary team working with these troubled youth.
A. Knowledge - At the end of this rotation, the resident should be able to:
- Discuss the legal process that brings adolescents to a juvenile justice facility.
- Discuss aspects of advocacy for adolescents within this system.
- Understand the milieu within which psychiatric consultation and treatment occurs.
- Recognize the contributions of the various members of the juvenile justice treatment
team.
- Recognize the myriad of disorders and potential psychiatric and social interventions
within the juvenile justice system including psychopharmacology and psychosocial therapies.
- Differentiate between "corrections" and interventions for treatment.
B. Skills - At the end of this rotation, the resident should be able to:
- Function comfortably in the juvenile justice setting.
- Participate in the legal process that brings adolescents to the juvenile justice setting.
- Work with youth and families regarding transition from YDC back into the community,
facilitating improvement around parenting issues and consistent limit setting and
identifying community resources to help.
- Provide psychiatric consultation to the multidisciplinary team in team meetings, through
direct assessment and treatment recommendations to the team, and through actual provision
of direct psychopharmacology, diagnostic, and group and individual therapies.
- Work with the treatment team to develop intensive behavioral interventions for youth
with serious and complicated behavior problems.
C. Attitudes - The resident should demonstrate:
- An interest in learning about adolescents within the juvenile justice setting.
- A non-prejudicial approach to patients, families and providers within the juvenile
justice setting.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- The resident will work within the setting for 6 months to allow continuity and facilitate
membership in and contributions to the treatment team
- The resident will carry a caseload of patients with serious and complicated psychiatric
morbidity
- The resident will observe patients in the incarcerative facility milieu and work with
staff to develop behavioral, individual and group interventions as well as provide
psychopharmacology consultation when appropriate
- The resident will attend multidisciplinary team meetings during which the cases with
whom he/she is involved are discussed
- The resident will provide education regarding the provision of services to adjudicated
youth with severe emotional and behavioral disturbances
- The faculty supervisor will supervise the resident in all of these endeavors on an
individual basis as well as on-site on a weekly basis
Clinical Rotation 08: Community Rotation Experience - Transitional Family Services
The goal of this rotation is to provide residents with an experience that exposes
them to children and families that are being served in the community by intensive
in home family based services. On this rotation the resident, working with and child
and adolescent psychiatry faculty member will provide psychiatric evaluations and
medication management services to children and adolescents who have had intake evaluations
by transitional family services staff. Then the resident will have an opportunity
to participate in team meetings where the ongoing care and treatment planning for
these children, adolescents and their families along with other clients are discussed
over a period of time as well as have some opportunities to accompany in home service
delivery staff as they provide services for a number of times during the rotation.
A. Knowledge - At the end of this rotation, the resident should be able to:
- Discuss the indications for referral to home based, intensive outpatient mental health
interventions for children, adolescents and their families.
- Identify the components of intensive in home mental health interventions for children,
adolescents and their families.
- Recognize the contributions of the various members of the multidisciplinary treatment
on this team.
- Recognize how in home interventions can serve as the least restrictive alternative
intervention for many seriously mentally ill children and adolescents and prevent
unnecessary hospitalizations or out of home care.
B. Skills - At the end of this rotation, the resident should be able to:
- Refer outpatients and inpatients ready for discharge appropriately to intensive in-home
and wrap around services in the community.
- Serve as a psychiatric consultant to community agencies that provide intensive outpatient
and in-home services to families with children and adolescents with serious mental
illness problems.
- Provide psychiatric services to the multidisciplinary team through direct assessment
and treatment recommendations to the team, and through actual provision of direct
psychopharmacology and diagnostic services.
- Work with the treatment team to develop intensive behavioral interventions for youth
with serious and complicated behavior problems.
- Work with the treatment team to develop comprehensive discharge plans for youth with
severe mental health problems.
C. Attitudes -The resident should demonstrate:
- An interest in learning about youth with severe mental illness.
- A non-prejudicial approach to patients, families and providers within community mental
health setting.
- Active participation, regular attendance and preparation.
- Motivation to work with as many different patients and families as possible.
- Responsible approach to all aspects of the experience.
- Professional and ethical approach to all aspects of the experience.
D. Strategies
- The resident will work within the setting for 4 months to allow continuity and facilitate
membership in and contributions to the treatment team.
- The resident will carry a caseload of patients with serious and complicated psychiatric
morbidity.
- The resident will observe patients in community setting and work with staff as appropriate
to facilitate treatment.
- The resident will provide education regarding the provision of services to youth with
severe emotional and behavioral disturbances.
- The faculty supervisor will supervise the resident in all of these endeavors on an
individual basis.
- The resident will be evaluated in the context of the Core Competencies.
Clinical Rotation 09: Elective Rotation
The goal of this rotation is to provide residents with opportunities to choose some
of their educational experiences, either to expand or improve their knowledge and
skills in a certain area or to explore a new area not specifically covered in the
training program. Electives are planned individually between the resident and the
PD and may involve any number of possibilities.
