During the first year of the Child and Adolescent Psychiatry fellowship, residents are required to participate in this program to attain familiarity and exposure to the school system, its resources, and the interaction of the system and staff with the child within the school environment. Two experiences are provided:
I. School consultation
II. Shadowing a school psychologist/observation in the classroom
I. School consultation is performed on-site in several schools in Alachua, Levy, and Gilchrist county schools. The students served are provided services with parental permission. The exception to this rule is in cases of emergency such as threat of harm to self or others. Multidisciplinary teamwork and realistic feedback and treatment planning are emphasized. The residents meet with the school personnel to determine their concerns about the student and then meet with the student and student’s family. We are partnered with CARD (Center for Autism Related Disabilities) who is consulted by schools. The resident is assigned to a CARD-associated UF faculty member and they work together as a team to provide the consultation. Multidisciplinary teamwork and realistic feedback and treatment planning are emphasized. After the evaluation is complete, the resident may prepare a report for the school and refer the case to the appropriate agency or therapist for treatment.
II. The school rotation also consists of shadowing a credentialed Alachua County Public School Psychologist and observation time in a Title I local school to gain exposure to the Response to Intervention (RTI) tier system in practical application and attend Individualized Education Program (IEP) meetings to observe normal classroom behaviors of early elementary school children.
A. Required rotation occurring in the first year and allowing the resident exposure.
B. Faculty consists of two full-time PhD Faculty from the University of Florida for the school consultation in concert with school guidance counselors and teaching staff. For the school shadowing experience; staffing includes the school psychologist at Title I school.
C. Residents spend a full day at the schools with Ann-Marie Orlando, PhD, or Greg Valcante, PhD, or Art Wallen, MS/BCBA, or Danielle Liso, PhD which consists of separate interviews with student, family, teachers and related school staff and classroom observations. Faculty is available for consultations. The school psychology shadowing experience consists of 1 or 2 partial mornings which may include classroom observation.
D. The children seen during this rotation are about 80% males and 20% females; 50% are Caucasian, 25% African American and 25% Hispanic. Ages range from 4 to and including 17 years; the majority are between 6 and 12 years of age. Approximately 70% have school behavioral problems, 20% anxiety disorders, 20% learning disorders, 20% mood disorders, and 80% are intellectually disabled, at least 20% are responding to stressful environments, i.e., family disruption, death in the family, abuse. The recommendations also focus on the identification and prevention of risk factors for such problems. There are NO recommendations made at the school shadowing experience.
E. An average caseload would be one to three one-time consultations for a resident. The school shadowing experience does not entail a caseload.
F. All new and follow up consultation patients are discussed with the UF faculty onsite. The school shadowing experience provides an opportunity for discussion with the school psychologist but neither treatment recommendations nor any opinions are rendered by the resident.
G. Following are the goals and objectives for this rotation:
Goal: To provide child psychiatric consultation proficiently in school settings.
- Reviews limits of confidentiality with patients when providing school based psychiatric evaluation and treatment.
- Gather and integrate information obtained from the student, parents, and school personnel to formulate a differential diagnosis.
- Apply an understanding of school resources and limitations to treatment planning.
- To learn about Child Psychiatrist roles in school settings and about different consultation techniques.
- To learn about the influence of the school on children’s cognitive, social and emotional development.
- To learn about the influence of different socioeconomic and cultural factors on children’s school performance.
- To observe and learn parameters of development and behavior of children and adolescents within the school setting.
- To become familiar with school-based mental health services for children and adolescents.
- To become familiar MTSS, Multi-Tiered System of Supports (formerly known as Response to Intervention or RtI).
- To become familiar with the qualification process for special education programs.
- To become aware of new developments in school policies and structures, particularly as they apply to the mental health needs of students.
- Demonstrate knowledge of federal and state education laws.
- Familiarize with resources provided by the FL Department of Education and listed on their website.
- Review AACAP resources and practice parameter for psychiatric consultation to schools.
Skills: The resident will demonstrate the ability to
- Display familiarity with the role of a child psychiatrist as consultant to mainstream and special education programs.
- Conduct assessment and formulate treatment plans for youths from various cultural and socioeconomic backgrounds in a culturally sensitive manner while in the consultant’s role.
- Act as spokesperson for the needs of children and to relate them to school personnel while performing consultation but maintain the observer’s role for the Title I school experience.
- Increase partnerships within the school and community that promote emotional health.
Attitudes: The resident should demonstrate:
- Awareness and sensitivity of cultural differences among children and their families.
- Respect for the roles of professionals from multiple disciplines in the school setting.
- Appreciation for the influence of system and organizational factors on decision-making process related to psychiatric care of children and adolescents
- Commitment to child advocacy, particularly in the areas of improving care for underserved youth
- Professionalism as evidenced by timeliness of consultations, reports and phone calls; availability to answer any questions school/family may have during regular hours and observance of the shadowing role as an observer.