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Community Mental Health

During this rotation, fellows gain experiences in treating patients in a community mental health setting as part of multidisciplinary treatment team.

A. This required rotation is in the second year of training and requires 20% of the fellow’s time

B. Faculty consists of one Child Psychiatrist from the Division of Child and Adolescent Psychiatry and an assigned supervisor from community mental health agency.

C. Fellows see new and follow up patients for evaluation, diagnosis and treatment in the outpatient setting. Although psychopharmacotherapy is the main treatment modality, fellows can recommend individual psychotherapy and request for a therapist be assigned to his/her patient. The fellow and the therapists work very closely and many times therapists accompany patients for their appointments with the fellow.

D. Patients treated during this rotation are largely from families of low socioeconomic status. The clinic population consists of about 60% males and 40% females; 45% are Caucasian, 40% African American and 15% Hispanic. Ages range from 4 years up to and including 17 years -the majority are between 5 and 12 years of age. Approximately 50% are treated for disruptive and school behavioral problems, 15% for mood disorders, 10% for developmental disability & pervasive developmental disorders, 5% for psychosis, and 10% for adjustment disorders, i.e., family disruption, death in the family, abuse; During the years 2003 – 4 , the Clinic maintained a case load of approximately 400 active cases at any time. There were 125 new cases seen during that year. Fellows learn pharmacotherapy and behavioral therapy in a multidisciplinary team approach.

E. Fellows provide Child Psychiatry evaluation and medication management for children and adolescents and work in conjunction with assigned counselors and treatment plans that are school-based, home-based or on-site.

F. Supervision is provided by the assigned supervisor who is present on-site. This supervision is in addition to the two hours of weekly supervision by assigned supervisors and seminars. Faculty is also available by phone to provide back up. Additional supervision can also be arranged by mutual understanding.

G. Following are the goals and objectives for this rotation:

Goal: To provide outpatient care to children and adolescents with psychiatric disorders that is of high quality, with priority on safety and use of interventions with established effectiveness.

Objectives

Knowledge:

  • To learn the role of a Child Psychiatrist within a community-based system of care for children and adolescents with serious emotional and behavioral disorders through working as a member of a multidisciplinary team in a community-based mental health system and through interfacing with child protective agencies.
  • To learn ways to increase mental health awareness in underserved populations.
  • To become familiar with commonly encountered assessment and management problems and their possible solutions by community psychiatrists.

Skills: The fellow will demonstrate

  • Proficiency in the assessment and management of emotional and behavioral problems of children, adolescents and their families in rural settings
  • Understanding of the role of a Child Psychiatrist within a community-based system of care for children with serious emotional and behavioral problems through:
  • working as a member of a multidisciplinary team in a community-based treatment setting, which includes individual case managers and therapists.
  • interfacing with child protective agencies (emergency, at risk for or in out-of-home placements)
  • interfacing with school-based services and the foster care program.

Attitudes: The fellow will demonstrate

  • Sensitivity to cultural variation in the assessment and treatment of psychiatric disorders among children and families from various racial and ethnic backgrounds.
  • Respect for the roles of professionals from multiple disciplines in child-serving public agencies.
  • Professionalism by timeliness in appointments, dictations and return of phone calls, and by appropriate physical appearance and demeanor