This is a required six-month rotation occurring during the first year for child and adolescent psychiatry fellows and triple board residents. Trainees spend equal amounts of time on both units for a total of three months of child and three months of adolescent exposure. Faculty consists of two full-time child and adolescent psychiatrists, a psychologist, two social workers, special education teachers, milieu therapists, and support staff. The social workers provide supervision of family work on the unit and the attending psychiatrists provide supervision of group therapy. All fellows assigned to this service treat patients under the close supervision of faculty. There is a unit case conference in which clinical work is presented and discussed in detail with the entire interdisciplinary staff and attending psychiatrist. Cases are reviewed immediately upon admission by the unit director, and are discussed weekly at the interdisciplinary team meeting. A comprehensive treatment plan is developed and monitored.
The Child Psychiatry Inpatient Unit is a 15-bed unit that serves children aged five to 12 years old with a wide range of severe psychopathologies. The Adolescent Psychiatry Inpatient Unit has eight beds for adolescents aged 13 to 18. The distribution of patients is approximately 60 percent male and 40 percent female. Children are accepted from all geographic areas in and around New York City. However, as one of only a few general hospital Child and Adolescent Psychiatry inpatient units in Manhattan, the service is principally responsive to the needs of the surrounding community. The patient population is approximately 40 percent Latino, 45 percent African American, and 15 percent Caucasian.
The majority of children and adolescents treated on the inpatient unit have severe behavior disorders, such as conduct disorder, attention deficit-hyperactivity disorder, or both (45 percent); approximately 75 percent of them have co-morbid learning and/or communication disorders. Other diagnoses include spectrum disorders (30 percent), anxiety disorders (15 percent), schizophrenia and psychotic disorders (5 percent), and pervasive developmental disorders and mild mental retardation (5 percent), depressive. Most of the children are raised in chaotic and stressful environments; many are in foster care. A variety of treatment modalities are employed, including individual, family and group psychotherapies, milieu and behavioral treatments, recreational therapies, psychopharmacologic, and psycho-educational interventions. The unit is organized to follow a behavioral schedule focusing on pro-social behavior.
Each trainee carries a caseload of approximately five to six patients for whom they provide all psychiatric services including individual therapy, family therapy, milieu and behavioral treatment, and all medical evaluation and treatment interventions. Children are seen at least three times weekly and their family is seen one to two times weekly. The trainee has administrative responsibility for the interdisciplinary treatment team under the direct supervision of the unit attendings. Each trainee has the opportunity to lead a psychotherapy group under the supervision of the attending psychiatrist and also participate in the supervision and teaching of the third and fourth year medical students during their psychiatry rotation and/or elective, and assist in supervision and teaching of non-medical personnel.
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