Consultation & Liason
This is a required six-month rotation for first-year child and adolescent psychiatry trainees. Faculty consists of a child and adolescent psychiatrist who supervises the trainees and interviews children on the service with the trainee. Three pediatric neurologists also supervise the trainees in the Pediatric Neurology Clinic. The Trainees spend one hour per week in structured conferences.
There is extensive on-site teaching through clinical experience on a variety of services, as follows:
Pediatric Inpatient units
Fellows see all new inpatient consultations with the attending. They examine and interview patients, acquire information from charts, ward personnel and family, learn to organize this information and integrate it with their own findings to make a diagnosis. They learn to discuss the case findings with pediatric house staff and to educate them on behavioral issues. They learn to formulate a treatment plan and to discuss patient management with the nurses and other ward personnel. They learn to write a psychiatric evaluation that is informative and appropriate for inclusion in the public record of a pediatric chart. Trainees evaluate their cases in a biopsychosocial framework and manage cases with appropriate combinations of behavioral, pharmacological, supportive, brief dynamic, and family therapies. All new cases are presented and discussed in the weekly conference.
Pediatric Emergency Room
The consult service covers consultations to children age 12 and under brought to the Pediatric Emergency Room between 9:00 A.M. and 4:00 P.M. Between 4:00 P.M. and 9:00 A.M., and on holidays and weekends, children 12 years and under are seen in the pediatric emergency room by the on-call trainees. Patients are initially evaluated by the trainee, and then attending support and supervision are provided for each consult. The experience includes triaging patients from the ER to the Outpatient Department for crisis or routine intake appointments. There is also the opportunity for liaison with referring agencies, providers, and schools. The trainees must be able to present their assessment and recommendation to the patient and their family as well as to the ER staff. Trainees tend to evaluate suicidal and aggressive patients with a variety of diagnoses including mood disorders, anxiety disorders, disruptive behavior disorders, PTSD, substance use/abuse, and family dysfunction.
Child Protection Committee
Trainees have the option of attending the weekly meeting of the hospital Child Protection Committee, with the attending, and provide indirect consultation on the cases discussed. They also occasionally provide direct consultation on cases that require further intervention (e.g., evaluation of child abuse). Trainees may present difficult or confusing cases to the committee when they need advice or guidance regarding mandated reporting or other legal issues. They may also refer cases to the committee for further evaluation.
Pediatric Liver and Small Bowel Transplantation
All pediatric cases being evaluated for transplantation are seen for psychiatric evaluation and/or consultation, and follow-up care is provided on selected cases. Often assessments include evaluation of development, assessment of family dynamics, and identification of psychopathology and/or risk factors.
Child Life Conference
Trainees have the option of attending the weekly meeting of the Child Life service. Child life specialists, art therapists, and music therapist review behavioral interventions utilized with hospitalized medically ill children. Art, music, medical play and group interventions are reviewed. Cases shared by the consult service are reviewed and coordinated treatment plans are established.
The Pediatric C/L population is roughly 50 percent male and 50 percent female, about 33 percent African American, 33 percent White, and 33 percent Latino, with a few Asian children. Age range is from one to 25 years; infants and toddlers are particularly common on the Transplant Services. The majority of pediatric inpatients are adolescents. Patients from a wide range of socio-cultural backgrounds are seen; Mount Sinai draws both from affluent and indigent populations throughout New York City.
Occasional patients from more rural locations are admitted for transplantation. A full range of major psychiatric disorders is seen, including psychosomatic conditions, mood and anxiety disorders, schizophrenia, PTSD and adjustment disorder, non-organic failure to thrive, eating disorders, delirium and dementia, child abuse and drug abuse-related conditions. A broad range of pediatric conditions are seen with heavy emphasis on oncology, HIV/AIDS, transplant patients, asthma, and congenital cardiac disorders.
Treatment includes triage, rapid stabilization, brief and more extended psychotherapy, family intervention, pharmacotherapy, and behavioral therapy. Other important interventions include consultation to medical and non-medical personnel (i.e., intervention at the level of the milieu), and teaching of psychiatric concepts to the pediatric team.
Trainees see one to three new pediatric inpatient consultations each week during the rotation; the average caseload is three to five patients. The assignments are monitored to provide each trainee with cases spanning a variety of ages, as well as pediatric and psychiatric diagnoses. Trainees see several pediatric neurology patients each week under the supervision of the pediatric neurologists. They also provide Psychiatric Consultation when necessary on these and other cases. Teaching of pediatric house officers and collaboration with the entire pediatric staff in the psychiatric care of patients is an essential aspect of consultation activity. Fellows function as team leaders in this capacity.
Child and adolescent psychiatry fellows may participate in relevant pediatric conferences, such as the pediatric neurology clinical conference, which focuses on difficult differential diagnostic cases. Trainees may also pursue special Pediatric and/or Psychiatric interests while on this service, for example, pain management, hypnosis, and crisis intervention.
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