Consultations to Alachua County Schools
During the second year of the child psychiatry residency, residents are required to participate in this program to attain familiarity with the school system, its resources, and the interaction of the system and staff with the child within the school environment. School consultation is performed on-site in several schools in Alachua County District. The School Board’s head nurse calls in the referral by faxing the consultation and consent forms to us. 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. After the evaluation is completed, the resident prepares a report for the school. If repeat visits are needed, the resident may provide follow-up or refer the case to the appropriate agency or therapist for treatment.
A. Required 4 months rotation occurring in the second year at institution 3 and requiring 10% of the resident’s time.
B. Faculty consists of 1 full-time child psychiatrist from the University of Florida; staffing from the Alachua County School District includes the director of health services who coordinates the consultation requests and guidance counselors at schools seeking consultations.
C. Residents spend 2-4 hours for new evaluations, which consist of separate interviews with student, family, teachers and related school staff and classroom observations. Faculty is available for consultations.
D. The children seen during this rotation are about 65% males and 35% females; 40% are Caucasian, 30% African American and 30% Hispanic. Ages range from 5 to and including 17years; the majority are between 6 and 12 years of age. Approximately 30% have school behavioral problems, 20% anxiety disorders, 10% learning disorders, 20% mood disorders, and 10% are developmentally disabled, 10% are responding to stressful environments, i.e., family disruption, death in the family, abuse. During 2003-4, this service provided consultations on 24 students. They all had comprehensive initial evaluation and few required follow up at the school. Residents learn to manage academic and behavioral problems of individual students in a multidimensional treatment approach, which sometimes includes pharmacotherapy and behavior therapy. The recommendations also focus on the identification and prevention of risk factors for such problems.
E. An average caseload for a resident would consist of 5 to 7 patients that are seen for medication management and psychotherapies.
F. All new and follow up patients are discussed with the faculty on an individual basis before any recommendations are made to school. Faculty is also available by phone while the residents perform these evaluations in the school.
G. Following are the goals and objectives for this rotation:
Goal: To provide child psychiatric consultation proficiently in school settings .
Objectives:
Knowledge :
- 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 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.
Skills: The resident will demonstrate the ability to
- Display familiarity with the role of a child psychiatrist as consultant to regular and special education programs.
- Conduct assessment and formulate treatment plans for youths from various cultural and socioeconomic backgrounds in a culturally sensitive manner.
- Act as spokesperson for the needs of children and to relate them to school personnel.
- Increase partnerships within the school and community that promotes 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 are as 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.
