Community Mental Health


Andres Pumariega

Andres Pumariega M.D.



Children’s Home Society Rotation

Fellows provide psychiatric evaluations and psychopharmacological treatment for children in the foster care system all over Florida via Telehealth. This rotation provides them an interface with the legal system as they review court paperwork regarding a child’s custody, guardianship, and parental rights to ensure that informed consent is obtained from the appropriate parties. They also work collaboratively with therapists and child protective services.


Patient Care

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

  • Review court paperwork regarding a child’s custody, guardianship, and parental rights
  • Identify the parties authorized to provide informed consent/assent for Telepsychiatric evaluation 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


Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

  • 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

Practice-based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

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

Interpersonal and Communication Skills

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

  • 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


Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

  • 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

Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

  • 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

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.