University of Nevada School of Medicine - Post-Graduate Residency & Fellowships

Child/Adolescent Psychiatry Fellowship

Rotation Site Descriptions

PGY-1: Six Month Block A
WEST HILLS HOSPITAL

Residents will rotate at West Hills Hospital for 0.7 FTE during a six-month block of their PGY-4 year. West Hills Hospital is a private, free-standing acute psychiatric facility which contains a 35-bed child and adolescent psychiatric unit. During this rotation, residents will manage 4-8 inpatients and will perform psychiatric evaluations, medication evaluations, medication management, individual and group psychotherapy, family therapy and participate in multi-disciplinary treatment sessions. The overall goal of this rotation is for residents to learn how to manage child and adolescent psychiatric patients in the inpatient setting. To reach this goal, the following objectives will be met: Knowledge objectives:

Inpatient admission criteria which warrant referral to an acute child and adolescent psychiatric unit.
Risk factors for suicide and homicide in children and adolescents.
DSM criteria for the major diagnostic categories seen in an inpatient child and adolescent psychiatry setting.
Strategies for management of acute agitation of children and adolescents in the inpatient setting.
Involuntary treatment standards and procedures.
Legal requirements for compliance with HIPPA (Health Information Portability and Protection Act) regulations.
Standards and procedures for mandated reporting of child abuse.
Criteria and provisions for safely discharging a patient to a less restrictive setting.

To perform an adequate assessment of a child or adolescent in crisis, that includes diagnostic interviewing of both the child and family in order to determine the chief complaint, history of present illness, past medical history, review of systems, family history, social history, substance history and developmental history.
To perform a comprehensive mental status exam and physical and neurological evaluations (when appropriate) of children and adolescents as they present for admission and during the course of their inpatient stays.
To develop a complete multi-axial differential diagnosis for children and adolescents who present for inpatient admission.
To utilize appropriate evaluation tools including medical, laboratory, radiological and psychological testing
To develop a comprehensive formulation and inpatient treatment plan that includes the biological, psychological, spiritual and social domains.
To work with multi-disciplinary teams (including social workers, psychologists and nursing staff) in formulating an inpatient treatment plan.
To adequately obtain informed consent for psychiatric treatment from parents, and informed assent from minors, including the ability to discuss risks, benefits and alternative treatments in language understandable to families.
To conduct therapeutic interviews (using supportive interventions, exploratory interventions and clarifications) as a tool for evaluation and treatment in the inpatient setting.
To conduct brief individual therapy, group therapy and family therapy in the context of inpatient treatment of children and adolescents.
To evaluate the need for specific psychopharmacological treatments and to implement them based on AACAP practice parameters and other standards of practice.
To monitor and evaluate response to treatment of children and adolescents in the inpatient setting.
To produce appropriate clinical records in the inpatient setting which document pertinent historical data, clinical formulation, treatment plan and response to treatment.
To participate in utilization review communications and, when appropriate, advocate for quality patient care with managed care organizations or third-party payers.
To participate in quality assurance and peer review processes designed to improve performance.
To network with community systems in planning appropriate outpatient referrals for discharge planning.

Awareness of personal reactions and counter-transference (both in self and other staff members), and how these dynamics can influence patient care.
Understanding of how the inpatient milieu environment works to positively or negatively influence the treatment of individual children or adolescents.
Advocacy for the patient’s best interests with inpatient staff, family and third-party payers.
Understanding of the limited nature of available resources and commitment to using them wisely.
Sensitivity and responsiveness to the cultural differences of self and others.
Sensitivity to the dependent status of children and the ramifications of this in the treatment alliance, particularly with respect to confidentiality and consent issues.

The above knowledge, skills and attitudes address competencies in each of these areas:
Patient Care: #1, 4, 5, 8, 9, 10, 11, 12, 13, 16, 17, 18, 19, 25
Medical Knowledge: #2, 3, 4, 5,
Interpersonal and Communication Skills: 14, 15, 16, 24, 26, 28, 29
Professionalism: #6, 20, 24
Practice-Based Learning and Improvement: #22
Systems-Based Practice: #1, 5, 6, 7, 8, 18, 21, 23, 25, 26, 27

WILLOW SPRINGS CENTER

Residents will rotate at Willow Springs Center for 0.4 FTE during a six-month block of their PGY-4 year. Willow Springs Center is a private, free-standing psychiatric child and adolescent residential treatment center which has a census of about 70 patients. During this rotation, residents will manage 4-8 residential inpatients including performing psychiatric evaluations, medication evaluations, medication management, individual and group psychotherapy, family therapy and participate in multi-disciplinary treatment sessions. The overall goal of this rotation is for residents to learn how to manage child and adolescent psychiatric patients in a residential treatment setting. To reach this goal, the following objectives will be met:

Knowledge objectives:

Admission criteria which warrant referral to a child and adolescent residential treatment center.
Understanding of the types of problems typically requiring residential treatment, including severe family discord, maladaptive coping such as parasuicidal behavior, and adolescent substance abuse.
DSM criteria for the major diagnostic categories seen in a residential child and adolescent psychiatry treatment setting.
Strategies for management of agitation of children and adolescents in a residential treatment center
Mechanisms for creating therapeutic systems of behavioral change within a milieu setting (such as dialectical behavioral therapy or functional behavioral analysis with contingency management).
Treatment strategies for adolescent substance abuse
Legal requirements for compliance with HIPPA (Health Information Portability and Protection Act) regulations.
Standards and procedures for mandated reporting of child abuse
Criteria and provisions for safely discharging a patient to the community

To perform an adequate assessment of a child or adolescent in crisis, that includes diagnostic interviewing of both the child and family in order to determine the chief complaint, history of present illness, past medical history, review of systems, family history, social history, substance history and developmental history.
To perform a comprehensive mental status exam and physical and neurological evaluations (when appropriate) of children and adolescents as they present for admission and during the course of their residential stays.
To develop a complete multi-axial differential diagnosis for children and adolescents who present for residential admission.
To utilize appropriate evaluation tools including medical, laboratory, radiological and psychological testing
To develop a comprehensive formulation and residential treatment plan that includes the biological, psychological, spiritual and social domains.
To adequately obtain informed consent for psychiatric treatment from parents, and informed assent from minors, including the ability to discuss risks, benefits and alternative treatments in language understandable to families.
To work with multi-disciplinary teams (including social workers, psychologists and nursing staff) in formulating a residential treatment plan.
To conduct therapeutic interviews (using supportive interventions, exploratory interventions and clarifications) as a tool for evaluation and treatment in the residential setting.
To conduct brief individual therapy, psychodynamic psychotherapy, group therapy and family therapy in the context of residential treatment of children and adolescents.
To evaluate the need for specific psychopharmacological treatments and to implement them based on AACAP practice parameters and other standards of practice.
To monitor and evaluate response to treatment of children and adolescents in the residential setting.
To produce appropriate clinical records in the residential setting which document pertinent historical data, clinical formulation, treatment plan and response to treatment.
To participate in utilization review communications and, when appropriate, advocate for quality patient care with managed care organizations or third party payors.
To participate in quality assurance and peer review processes designed to improve performance.
To network with community systems in planning appropriate outpatient referrals for discharge planning.

Awareness of personal reactions and counter-transference (both in self and other staff members), and how these dynamics can influence patient care.
Understanding of how the residential milieu environment works to positively or negatively influence the treatment of individual children or adolescents.
Advocacy for the patient’s best interests with residential staff, family and third-party payers.
Understanding of the limited nature of available resources and commitment to using them wisely.
Sensitivity and responsiveness to the cultural differences of self and others.
Sensitivity to the dependent status of children and the ramifications of this in the treatment alliance, particularly with respect to confidentiality and consent issues.

The above knowledge, skills and attitudes address competencies in each of these areas:
Patient Care: #1, 4, 6, 9, 10, 11, 12, 13, 14, 16, 17, 18, 19, 20, 25
Medical Knowledge: #2, 3, 4, 5, 6,
Interpersonal and Communication Skills: 15, 16, 17, 25, 27, 29, 30
Professionalism: #7, 21
Practice-Based Learning and Improvement: #23
Systems-Based Practice: #1, 7, 8, 9, 19, 22, 24, 26, 27, 28,

WASHOE COUNTY SCHOOL DISTRICT

Residents will rotate in the school system for 0.2 FTE during a six-month block of their PGY-1 year. The Washoe County school district serves a total enrollment of more than 60,000 students. Residents will see a variable number of consultations per week to include performing psychiatric evaluations and consultations, medication evaluations and consultations, multi-disciplinary treatment sessions, and participation in psychological and educational planning sessions. The overall goal of this rotation is for residents to learn how to evaluate children and adolescents in the school setting, and make recommendations to school staff. To reach this goal, the following objectives will be met:

Knowledge objectives:

Normal cognitive, physical, emotional and social development for children ages five to eighteen.
The school system structure and how various members (such as teachers, administrators, school nurses, school psychologists and guidance counselors) work within it.
The mechanism for referral within the school system for children with learning and behavioral problems.
The range of educational accommodations from least restrictive (integrated classroom) to most restrictive (therapeutic school) for children with learning and behavioral problems.
The legal rights of parents and children to obtain evaluation for learning disabilities within the school system as well as the implementation of these rights in the development of individual education plans.
DSM criteria, epidemiology and phenomenology of the major diagnostic categories seen in a cross-section of children and adolescents.
Standards and procedures for mandated reporting of child abuse

To effectively interface with school staff by defining the consultation question and providing the requested feedback in terms understandable to non-clinicians.
To approach children of different ages in a manner appropriate to the child’s developmental level.
To perform an adequate assessment of a child or adolescent within their school context, that could include diagnostic interviewing of the child and family, classroom observation, review of school records, and consultation with school personnel.
To interpret typical educational testing used in school educational assessment, such as the WISC and WRAT, and to use these in informing overall assessment and educational planning.
To work within a school team to generate behavioral solutions appropriate to the school environment.
To develop appropriate recommendations regarding educational accommodations for psychiatrically affected children and adolescents.
To provide classroom teachers with education about how each of the major childhood psychiatric disorders may present in the classroom, and how they may be managed in the classroom.
To give appropriate advice to schools about how to respond to crises, such as world events or local tragedies.
To conduct brief play therapy in conjunction with school psychologists or adjustment counselors.
To help the school in accessing community resources for mental health.

Awareness of personal reactions and counter-transference (both in self and other staff members), and how these dynamics can influence the treatment of children within the school setting.
Understanding of how the cultural contexts of school (for example, gang presence or extent of bullying) can affect individuals.
Advocacy for the children’s best interests with regards to being provided with adequate education.
Sensitivity and responsiveness to the cultural differences of self and others.
Sensitivity to the dependent status of children and the ramifications of this in the treatment alliance, particularly with respect to confidentiality and consent issues.

The above knowledge, skills and attitudes address competencies in each of these areas:
Patient Care: #10, 11, 13, 16,
Medical Knowledge: #1, 6,
Interpersonal and Communication Skills: #8, 9, 12, 14, 15, 18, 20, 21, 22
Professionalism:
Practice-Based Learning and Improvement:
Systems-Based Practice: #2, 3, 4, 5, 7, 14, 15, 17, 19, 20,

PGY-4: six-month block rotation.
RENO-SPARKS TRIBAL HEALTH SERVICES – INDIAN HEALTH SERVICE

Residents will rotate in the tribal health services for 0.05 FTE during a six-month block of their PGY-4 year. Residents will see and manage a variable number of diverse patients per week including performing psychiatric evaluations, medication evaluations, medication management, individual, group and family psychotherapy. The overall goal of this rotation is for residents to learn how to evaluate and treat child and adolescent psychiatric patients within their unique cultural context.

PGY-4: Six-month block rotation
WASHOE COUNTY JUVENILE SERVICES: JAN EVANS JUVENILE CENTER

Residents will rotate at Jan Evans Juvenile Center for 0.1 FTE during a six-month block of their PGY-4 year. Residents will see and manage a variable number of patients per week including psychiatric evaluations, medication evaluations, medication management, individual and group psychotherapy, and participate in planning sessions with probation personnel and interdisciplinary support staff. The overall goal for this rotation is for the residents to learn how to evaluate child and adolescent psychiatric patients in a forensic setting and offer treatment recommendations to court personnel.