Child and Adolescent Psychiatry Outpatient Clinic
Child and adolescent psychiatry residents at University of Florida gain diverse outpatient experience throughout their two years of training. The primary objective of outpatient training is to help the trainees achieve competence in assessing and treating children and adolescents with developmental and psychiatric problems in an outpatient setting. During the second year of training, in addition to the general outpatient cases, subspecialty clinics are also emphasized.
A. Required during both years of training, at Shands at University of Florida. Some outpatients will be followed throughout the two years of residency. When on the inpatient services, the resident may decrease the number of patient contact hours, but he/she should never have less than six outpatient contact hours per week. When on the outpatient service full-time, 18 patient contact hours per week will be expected.
B. Faculty consists of seven full-time child psychiatrists, one full-time child psychologist, and one full-time advanced registered nurse practitioner.
C. Faculty provides supervision in multiple treatment modalities including pharmacotherapy, cognitive and behavioral therapy, supportive therapy, psychodynamic psychotherapy, and family therapy. The clinic director and the training director review caseloads of individual residents periodically to assure each trainee has an optimal case mix.
D. The clinic population is comprised 33% females and 67% males in the age range of 2 to 17 years, with an average age of 11.7 years. About 65% are Caucasian, 25% African American, 5% Hispanic and the remainder of other racial descent. Diagnostic categories represented included: attention deficit hyperactivity disorder or other disruptive disorders (58%), adjustment disorders (4%), affective disorders (33%), eating disorders (4%), and a small percentage (less than 1% each) with schizophrenia, psychotic disorder not otherwise specified, organic personality disorder, sleep disorder, reactive attachment disorder, and others. Frequently, learning disorders are co-morbid with other diagnoses. Treatments provided in the outpatient clinic include various forms of individual therapy (such as psychodynamic therapy, cognitive behavior therapy, brief and supportive therapy); parent training; family therapy and medication therapy. In most cases combinations of treatment modalities are used.
E. Residents provide psychotherapy and pharmacotherapy with most cases, and typically have 5 to 10 cases in long-term psychotherapy. All residents provide family therapy for many cases. Most cases are treated with psychotropic medications and individual or family therapy with follow-up visits at 1 to 4 week intervals.
F. All residents are assigned to faculty for weekly supervision and may arrange for more if they wish. Each resident has at least two supervisors and is expected to have one hour of supervision per week with each supervisor. These hours are in addition to the teaching conferences, rounds, and seminars. Additionally one faculty member is always present in the clinic and provides on-site supervision. Faculty with different theoretical points of view and areas of expertise are available as 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.
Objectives:
Knowledge: The resident will demonstrate an adequate fund of knowledge related to the evidence-based clinical management of outpatient children and adolescents with psychiatric disorders and their families, including the following areas:
- Child and family interview techniques
- Psychological testing procedures
- Inclusion of school information for evaluative purposes
- Appropriate use of outpatient laboratory tests and other clinical assessment procedures
- Child psychopathology
- Pediatric psychopharmacology
- Evidence-based psychosocial treatment
- Legal and ethical issues related to outpatient psychiatric care for children
Skills: The resident should demonstrate the ability to
- Synthesize pertinent clinical information from multiple informants (i.e., family, teachers, social service providers) in the child outpatient psychiatric assessment.
- Develop multi-axial differential diagnoses and rationale for priority.
- Develop treatment plan that integrates biological, psychotherapeutic, and social interventions appropriately.
- Communicate effectively with patients and family members in outlining the goals of evaluation and treatment.
- Apply the psychotherapeutic skills necessary to manage outpatients.
- Start and monitor psychotropic medications, including the use of standardized rating scales completed by the patients and/or teacher.
- Apply the principles and basics of family therapy.
- Communicate with physicians in other fields of medicine.
- Master ethical and legal issues surrounding the psychiatric care of children and adolescents in an outpatient setting.
- Proficiently discuss, complete, and write evaluations.
Attitudes: The resident will demonstrate
- Professionalism by arriving in a timely and prepared manner for outpatient clinic, with appropriate dress and demeanor, by seeking timely coverage for his/her leave periods, and by complying with training program and clinic policies.
- Timeliness in completing daily assignments regarding all aspects of patient care, including the prompt dictation of initial evaluations, the charting of telephone calls.
- Respect for others while participating in clinical activities.
- Commitment to learning how to provide the highest standard of patient care.
- Commitment to act as the patient’s advocate when clinically indicated.
- Commitment to legal and ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices.
- Commitment to training requirements, such as keeping an updated log of all patient contacts and submitting them to the residency office at the end of every month.
