Community Mental Health


Andres Pumariega

Andres Pumariega M.D.




Chrysalis Family Services

During this rotation residents gain experiences in treating children in the community mental health system as part of multidisciplinary treatment team.

A. This is a new elective rotation implemented in 2016.

B. Faculty consists of one Child Psychiatrist from the Division of Child and Adolescent Psychiatry who is available on-site for supervision. Other staff consists of case managers, therapists, mentors, and an LPN.

C. Residents see new and follow-up patients for evaluation, diagnosis and treatment in the outpatient setting. Although psychopharmacology is the main treatment modality for the resident, each patient has an assigned therapist and a mentor who regularly communicate with the resident. Residents meet with the multidisciplinary team in the morning for 2-3 hours to discuss each patient’s case. The patient appointments begin after the multidisciplinary meeting is completed.

D. Sinfonia’s Community Action Team (CAT) is a grant-funded program. It serves individuals between the ages of 10 and 21 years-old who have a mental health diagnosis and have one or more of the following characteristics:

  • At risk for out-of-home placement as demonstrated by repeated failures at less intensive levels of care;
  • Has had two or more periods of hospitalization or repeated failures;
  • Has had involvement with DJJ or multiple episodes involving law enforcement;
  • Has poor academic performance or suspensions.

Patients seen during this rotation are largely referred from the Florida Department of Children and Families and the Florida Department of Juvenile Justice. Age ranges are from 8 to 21 years, about 52% are male and 48% female, about 49% are African American, 35% are Caucasian, 12% are multiracial, and 3% are Hispanic. Diagnoses, including comorbidities, are disruptive behavior disorders (62%), ADHD (45%), depressive disorders (29%), substance use disorders (29%), bipolar spectrum disorders (22%), anxiety disorders (7%) and autism spectrum disorders (7%). The patients remain with the CAT team for an average of 6 to 9 months. Residents learn pharmacotherapy and behavioral therapy in a multidisciplinary team approach.

E. Residents 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 UF faculty member who is present on-site or by telephonic consultation. Additional faculty members are also available by phone to provide back up if needed.

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.


Patient Care

  • Review court paperwork regarding a child’s custody, guardianship, and parental rights.
  • Identify the parties authorized to provide informed consent/assent for Telepsychiatry evaluations and treatment.
  • Interview the child in a sensitive manner appropriate for the developmental level.
  • Collect collateral information from foster parents, biological parents, school, case worker and other healthcare providers as clinically indicated.
  • Select and order appropriate diagnostic tests.
  • Incorporate knowledge of social determinants of health into a comprehensive biopsychosocial formulation.
  • Apply evidence-based guidelines in the assessment and treatment of children in the welfare system.
  • Appropriately prescribe psychotropic medications and monitor for adverse effects.


  • Review the American Academy of Child and Adolescent Psychiatry (AACAP) practice parameter or clinical guidelines for the assessment and management of youth in the child welfare system.
  • Describe the effect of adverse childhood experiences (ACEs) on child development.
  • Recognize the similarities and differences in presentation of attachment disorders, trauma and stress related disorders, and neurodevelopmental disorders in children in the welfare system.
  • Describe the different types of out of home placements for children in foster care.
  • Summarize the patterns of psychotropic medication prescriptions in children in the welfare system and how they differ from those with children in the general population
  • 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.

Practice-based Learning and Improvement

  • Self-identify gaps in their knowledge of the welfare system and develop a self-improvement plan.

Interpersonal and Communication Skills

  • Keep accurate and timely records of the child’s evaluation and treatment.
  • Communicate with children and caregiver in a sensitive manner especially with regards to traumatic experiences.
  • Cover professional duties for colleagues when needed.
  • 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.


  • Recognize and manage ethical conflicts in the treatment of children in the welfare system, such as confidentiality, parental rights, and child rights.
  • Demonstrate respect and compassion toward the child in the welfare system and the child’s caregivers.

System-based Practice

  • Work collaboratively with the welfare worker responsible for the child’s case management.
  • Communicate with guardian ad litem and other court-appointed personnel.
  • Complete the FL physician’s medical report (5339) and other legal paperwork for psychotropic medications as mandated by state laws.
  • Participate in planning care with welfare agency, community mental health agencies, and schools.


The resident 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, documentation completion and return of phone calls, and by appropriate physical appearance and demeanor.
  • Commitment to learning how to provide the highest standard of patient care, including the use of the literature to guide treatment and quality parameters to evaluate treatment.

Telepsychiatry/Telemedicine for the Children’s Home Society

A.   This is a required rotation in the second year of the fellowship, occurring at institution 1, requiring 0.2 FTE of the residents’ time for 12 months.

B.   Faculty consists of 1 child psychiatrist from the University of Florida.

C.   Residents see new and follow up patients for evaluation, diagnosis and treatment in the Telepsychiatry setting.

D.   Supervision is available on-site by a UF child psychiatrist faculty when needed by the resident.

Goals: To provide outpatient care to children and adolescents via telepsychiatry.

Patient Care

  • Evaluate, diagnose and treat children within a Telepsychiatry system of care for children and adolescents with serious emotional and behavioral disorders

Medical Knowledge

Practice Based Learning: The resident will

  • Operate equipment and software (cameras, recording, audio, etc.), optimizing use of their unique capabilities and trouble-shooting technical problems.
  • Manage both the EHR and telemedicine technology without damaging patient interactions. 

Systems based Practice

  • Use telepsychiatry as a delivery system for patient care.
  • Communicate with case managers and other health providers for comprehensive care of patients
  • Adhere to HIPAA, legislative, and professional regulatory standards when treating patients using Telepsychiatry.
  • Familiarize themselves with reimbursement models for Telepsychiatry.

Interpersonal and Communication Skills

  • Effectively communicate clinical information using Telepsychiatry
  • Complete clinical documentation in a timely manner

Professionalism: The resident will

Utilize Telemedicine to deliver psychiatric care in a professional manner.

Demonstrate sensitivity to cultural variation in the assessment and treatment of psychiatric disorders among children and families from various racial and ethnic backgrounds.