Faculty: Mathew Nguyen, MD (Inpatient Medical Director)
Shands Vista is a general Child and Adolescent Psychiatry inpatient unit and partial hospitalization program for children 5 through 17 years old with mental disorders severe enough to require a secure, structured hospital environment. On this unit, the fellow will learn to serve as a member of the multidisciplinary therapeutic team with increasing responsibility over time to eventually assume the leadership role of the team. The therapeutic milieu provides behavioral therapies, group therapy, family therapy, individual therapies, and pharmacotherapy as appropriate to the patient’s individual treatment plan, and also includes an onsite school.
A. This is a required 4 months rotation occurring in the first year at Institution 1, requiring 70-80% of the fellow’s time.
B. Faculty consists of a full-time Child and Adolescent Psychiatrist. Other staff include a full time social worker/case manager and a full-time special educator/occupational/recreational therapist, and nursing staff.
C. Fellows spend two to three hours in attending treatment rounds and team meetings everyday. Faculty is available on-site for supervision and monitors the case loads for breadth and variety of experience. Fellows also participate as therapists and/or co-therapists in group therapy and family therapy sessions three to four hours per week.
D. This program serves on average 7 inpatients and up to three partially hospitalized (PHP/IOP) children and adolescents. The unit usually has about equal proportions of male and female patients and serves children 5 to 17 years of age, with one-third of patients below the age of 11. The patient mix consists of approximately 80% Caucasian, 14% African-American and 6% of various other racial backgrounds. Average length of stay is 5 to 7 days. The main problems requiring admission are: affective disorders, including bipolar depression (50%), post traumatic stress disorder (20%), disruptive disorders (40%), eating disorder (5%), and schizophrenia or other psychotic disorders (5%). In excess of 50% of teenage patients have comorbid substance use disorders. Treatments include milieu and group therapy, family therapy, occupational and recreational therapy, individual therapy, medication treatment, and onsite educational services. Focus is on a Dialetical Behavioral Therapy model aimed at improving the patient’s self-awareness and coping skills.
E. Average caseloads range from 5 to 8 inpatients at any given time. Fellows direct the multidisciplinary team, which consists of representatives from psychology, social work, nursing, occupational and recreational therapy, in addition to medical, psychology, and nursing students. They also participate in individual, family, and group therapies with children adolescents and their families.
F. Fellows have at least two hours of weekly individual supervision with the faculty, in addition to daily case supervision. These hours are in addition to the teaching conferences, rounds, and seminars.
G. Following are the goals and objectives for this rotation:
Goal: To become capable to provide basic inpatient clinical care, in the areas of assessment and inpatient treatment, to children and adolescents with a range of psychiatric disorders, at a level consistent with his/her first year training.
Knowledge : The fellow should demonstrate knowledge underlying the basic clinical approaches to the assessment and inpatient treatment of children and adolescents with psychiatric disorders and their families, including the areas of
- Exposure to a broad range of severe child and adolescent psychopathology as well as appropriate therapeutic modalities as indicated.
- Didactic and practical discussion regarding formal psychological assessment.
- To serve as the primary psychiatrist for his/her patients from admission to discharge, with a focus on comprehensive diagnosis, crisis management, and appropriate multimodal treatment. This will include collaboration with other physician and allied health professionals.
- Exposure to the fundamentals of inpatient family assessment and family crisis management with sensitivity to cultural issues and diversity.
- Exposure to the principles of nursing and milieu management of psychiatrically hospitalized children and adolescents (including behavioral intervention).
- Supervised involvement in core legal issues as they apply to psychiatrically hospitalized children and adolescents (e.g., abuse, custody, informed consent, confidentiality, intent to leave, involuntary commitment, and Department of Children and Families involvement).
Skills: The fellow should demonstrate ability to
- Perform an inpatient admission interview, with focus on the development of rapport, interview structure, diagnostic skills, and the comprehensive Mental Status Examination.
- Work effectively with children, adolescents and families in crisis.
- Formulate a differential diagnosis and a multi-disciplinary treatment plan tapered to the individual needs of the patient, i.e., crisis intervention, evaluation and diagnosis, stabilization on medication, and/or preparation for long-term residential psychotherapy placement, or treatment of emotional or behavioral disorders.
- Conduct a family interview and assessment.
- Formulate and present a case history concisely.
- Work collaboratively and effectively with a multi-disciplinary team.
- Attend and participate in family therapy sessions of their patients with social worker/co-therapists
- Attain exposure to group therapy with adolescents.
- Interact with utilization management personnel related to issues in managed care.
- Teach medical and other students how to evaluate and treat inpatients as well as understand the psychopathology and psychodynamics of the patients and their families, because an important part of the learning process is teaching others.
Attitude: The fellow should demonstrate
- Professionalism by arriving in a timely and prepared manner for daily rounds and unit meetings, with appropriate dress and demeanor.
- Timeliness in completing daily assignments regarding all aspects of patient care, including the prompt dictation of discharge summaries within hospital guidelines.
- Willingness to learn from treatment team members from multiple disciplines.
- Respect for others while participating in clinical activities.
- Commitment to learning how to provide the highest standard of patient care.
- Commitment to act as the patient’s advocate when clinically indicated.
- Commitment to legal and ethical principles pertaining to the provision or with holding of clinical care, confidentiality of patient information, informed consent and business practices.
- Sensitivity and responsiveness to cultural differences, including awareness of their own cultural perspectives.
- Experience and appreciate the strength and diversity of the various perspectives of the multidisciplinary team in providing comprehensive care to the patients.
- Appreciate the strengths/weaknesses and challenges of each patient and develop creative ways to capitalize on the various resources available.
- Recognize the psychiatrist’s own strengths/weaknesses as a physician and to identify and anticipate issues of transference/counter-transference across domains (patient, family, group, team dynamics).