Year one

• This is a required rotation at the UC Davis Psychiatry Outpatient Clinic of two days per week during the first year and a one half day per week during the second year.
  
  
• The faculty in this clinic consists of one full-time child psychiatrist.  The clinic is also staffed by other attending psychiatrists who treat adult and geriatric patients.
  
  
• In the first year, each resident is individually supervised weekly by a faculty child psychiatrist, and additionally by another child psychiatrist from either the volunteer or full-time clinical faculty.  In the second year, residents are supervised in a group for an hour every other week by a faculty child psychiatrist and for an hour individually by another child psychiatry faculty (either volunteer or full-time clinical faculty).  Residents may attend a monthly child psychiatry case conference which is chaired by a faculty child psychiatrist and also attended by general psychiatry residents rotating through the child psychiatry service.
  
  
• The clinic population is approximately 58% male, 42% female; 63.8% Caucasian, 16.2% Hispanic, 15.2% African American, and 4.8% Asian.  The age range is 3-18 years, with approximately 35% from lower socioeconomic groups and 65% from middle socioeconomic groups.  The age distribution is as follows:  12% 3-6 year olds, 42% 7-11 year olds, 19% 12-14 year olds, 27% 15-18 year olds.

  Diagnoses in the clinic vary and many children have multiple diagnoses:  attention deficit hyperactivity disorder/disruptive behavior disorders 31%, mood disorders 37%, psychotic disorders 4%, anxiety disorders 12%.  Other disorders (including pervasive developmental disorders, Tourette's disorder, mental retardation, substance related disorders, learning disorders, enuresis/encopresis, and attachment disorders) account for 16%.

  Treatment modalities include individual psychotherapy (brief, long-term, psychodynamic, cognitive-behavioral, supportive and crisis-oriented), family therapy, and psychopharmacologic interventions.  This is a managed care clinic.
  
  

• First year residents are scheduled approximately four new patient evaluations per month and approximately sixteen follow-up patient appointments a month.  Second year residents are scheduled approximately 12-16 follow-up patient appointments per month.  The average case load by the end of the first year and throughout the second year is approximately 16-20 patients.  Residents assume responsibility for all aspects of patient care in this clinic, including psychotherapeutic interventions, psychopharmacologic interventions (if indicated), family therapy, and any consultation to or collaboration with school or outside agencies.  Residents are expected to develop a caseload of four cases in long-term psychotherapy.
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• This is a required rotation at the UC Davis M.I.N.D. Institute of 2.5 days per week for four months during the first year and one half day per week for four months during the second year.
  
  
• Staff and faculty at this site who work with child psychiatry residents include one attending child psychiatrist, two pediatric neurologists, one neuropsychologist, four clinical psychologists, two developmental pediatricians, a social worker, a speech and language specialist, and an occupational therapist.
  
  
• Residents receive direct, on-site supervision from attending faculty for all casework in the two major clinics through which they rotate at this site-the psychopharmacology and pediatric neurology clinics.  In the psychopharmacology clinic, feedback is also provided and cases discussed by the team.  There are a number of conferences, seminars, and topical meetings that residents may attend on this rotation.  Medical students and other trainees provide opportunities for teaching.
  
  
• Patients seen in these clinics range in age from 3 months to 18 years.  The majority of the patients seen in the clinics treating pervasive developmental disorder (PDD) spectrum disorders are male.  Patients represent a broad range of ethnicities and cultural backgrounds.  The majority of patients treated in the psychopharmacology clinic are diagnosed with some form of PDD and/or mental retardation.  Patients in this clinic may also be diagnosed with mood disorders, anxiety disorders, disruptive behavior disorders, and occasionally psychotic disorders.  Many patients also have other medical and developmental disorders, including seizure disorder, Down Syndrome, metabolic disorders, asthma, Fragile X and other genetic disorders.  Residents perform psychopharmacologic, educational and behavioral interventions in this clinic.  In the pediatric neurology clinic, presenting concerns and diagnoses often include seizure disorder, headache, cerebral palsy, genetic syndromes, PDD spectrum disorders, and concerns regarding infant hypotonia or developmental delays.
  
  
• During this rotation, residents function as members of multidisciplinary teams in the evaluation of children with a range of developmental disorders in both clinical and research settings.  The residents directly evaluate and treat patients in both the psychopharmacology clinic and the neurology clinics.  In these settings, they receive on site supervision by faculty who observe their clinical work from behind a one-way mirror, or who confirm findings and discuss the case with the resident.  Residents then dictate evaluations and progress notes for faculty review.  Other clinics through which residents rotate include the parent-toddler intervention clinic, infant-sibling study clinic, and the parent-child interactional treatment (PCIT) clinic, as well as speech and language, occupational therapy, and neuropsychological testing clinics.  In the psychopharmacology clinic, residents evaluate one new patient per week, and may follow several others until they are stabilized and referred back to community providers.  In the pediatric neurology clinic, residents evaluate 2-4 new cases per week and also see patients for follow-up.
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• This is a required rotation at the UC Davis Children's Hospital of three days per week for two months during the first year.
  
  
• The faculty consists of a board-certified child and adolescent psychiatrist who is also a board-certified pediatrician.
  
  
• Pediatric consultation liaison rounds are held regularly and include medical students and psychology interns.  All team members have an opportunity to present at weekly journal club and multidisciplinary case conference at the M.I.N.D. Institute.
  
  
• Services provided include psychiatric evaluation of children, adolescents and families with associated treatment recommendations; working with the primary treatment team to facilitate their understanding and management of a range of emotional, behavioral, and systems issues affecting the child; ongoing treatment including recommendations for medication management and behavioral interventions; and provision of short-term and cognitive behavioral therapy.  Services are coordinated with the Child Life Program and Pediatric Social Services, along with the primary consulting medical/surgical team.  Medical conditions for which psychiatric consultation is sought are of a great variety but include: suicide attempts, accidents, victims of violence and abuse, cancer, cystic fibrosis, delirium, pulmonary, endocrine, infectious disease, cardiology, and renal problems.  The population is approximately 58% male and 42% female; ages range from infancy to 18 years.  The population is approximately 51% Caucasian, 32% Hispanic, 9% African American, and 8% Other.  Approximately 32% of the psychiatric diagnoses made are mood disorders, 22% adjustment disorders, 16% ADHD and disruptive behavior disorders, 12% PTSD and other anxiety disorders.  The remainder represents a range of disorders including psychotic disorders, delirium, and mental retardation.
  
  
• The service receives approximately 16-24 new consultations a month.  A typical caseload for a child psychiatry resident is 2-5 cases.  The short-stay nature of some of the pediatric services means that an evaluation and disposition often needs to be provided in one to three days, although some of the consults may come from services with longer lengths of stay.  Consultations are often requested by trauma surgery, pediatric intensive care, obstetrics (maternal competency), and emergency services.  Cases are worked up and managed primarily by the resident, but are reviewed concurrently with the faculty supervisor.  The supervisor often observes the resident interviewing a child and his/her family and interacting with pediatric residents and other members of the treatment team, and so is able to provide supervision to residents around these interactions.
  
  
• Individual supervision is available daily when the resident is on the service.  Group supervision is scheduled twice a week and includes medical students.  The resident is also expected to provide at least one hour a week of teaching to the medical student in addition to the usual clinical supervision.
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• This is a required rotation at Shriners Hospital for Children-Northern California of three days per week for two months during the first year .
  
  
• The faculty consists of a full-time faculty child psychologist and part-time psychiatrist.
  
  
• Educational experience includes a weekly multidisciplinary case conference and journal club attended by the child psychiatry resident, attending psychologist and psychiatrist, psychology trainees, and medical students.
  
  
• The clinical population at this site ranges in age from infancy to 21 years old.  The population reflects the diverse population in northern California, as well as the large number of patients that are transported to the hospital from other countries (including Mexico, Korea, Honduras, Turkey, American Samoa, and Romania).  Patients are referred from one of four primary treatment teams:  Orthopedics, Burns, Plastic Surgery or Physical Medicine and Rehabilitation (PM&R).  Services provided include psychiatric evaluation of children, adolescents and families with associated treatment recommendations; consultation to the primary treatment team and school staff in order to facilitate their understanding and management of a range of emotional, behavioral, and systems issues affecting the child; ongoing treatment including recommendations for medication management and behavioral interventions; and provision of brief, supportive, and cognitive-behavioral therapy.  Medical conditions for which treatment is sought often include burns, spina bifida, cerebral palsy, juvenile rheumatoid arthritis, spinal cord injury, meningiococcemia, and injuries due to violence and childhood physical abuse.  The psychiatric diagnoses most often encountered include:  delirium, PTSD and other anxiety disorders, mood disorders, adjustment disorders and ADHD.
  
  
• Cases are managed primarily by the resident with concurrent supervisor review.  The resident attends weekly multidisciplinary burn team and rehabilitation team rounds (participating services include surgery, PM&R, nursing, social work, child life, occupational therapy, physical therapy, recreational therapy, vocational counseling and education).  Residents also participate in multidisciplinary family conferences.  Resident caseload is between 3-5 cases.  Given the extended length of stay required by many patients, the resident may follow several patients for the duration of the rotation.
  
  
• Supervision is often "live" in that the supervisor observes the resident interviewing a child and his/her family and interacting with the multidisciplinary team, both on the floor and during medical service rounds.  Individual supervision is provided daily.  Group supervision is scheduled once a week and often includes medical students and psychology interns.
  
  
• Shriners Hospital for Children is on site at the UC Davis Medical Center.
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• This is a second year required rotation of two days per week at the River Oak Center for Children residential treatment program and 90-day diagnostic unit.
  
  
• The faculty consists of one half-time board-certified child and adolescent psychiatrist.
  
  
• Educational activities include conjoint child evaluations with supervisor; direct consultation with supervisor, as needed; classroom observations; art therapy observations; psychological testing observations; psychologist review of psychological testing results with resident; individualized education plan (IEP) observation and participation; weekly multidisciplinary child, family, and team meetings; weekly case review conference; and biweekly one hour seminar addressing topics in consultation to community systems of care.
  
  
• Children treated at this site are aged 5-12; 70% male, 30% female; 42.5% African American, 35% Caucasian, 22.5% multi-racial.  Diagnoses include all axis I diagnoses for children with an emphasis on mood disorders, PTSD, disruptive behavior disorders, and learning disorders. Approximately 70% of referred children have been either physically or sexually abused.  The majority of parents have a history of substance use disorders; 71% have mental illness.  Treatment modalities include: psychopharmacological, individual, group, art, behavioral, milieu, and family therapy; parent support groups, parenting classes, and parent advocacy.  Specialized behavioral services and wraparound services are also available, as needed.  Most of the children attend an on-site school geared to treat children with emotional disturbances.  A full-time nurse works on site and helps to coordinate pediatric and sub-specialty (including neurological) care for all patients.  Psychological testing with neuropsychological screening is available on-site, as is speech and language assessment and treatment.  A dietician provides regular on-site consultation.
  
  
• Residents: provide psychiatric evaluations and psychopharmacological treatment and consultative services to individual staff and treatment teams; participate in weekly multi-disciplinary treatment planning meetings and case reviews; provide on-call telephone availability for consultation regarding psychiatric emergencies; and evaluate children in crisis and facilitate psychiatric hospitalization, if needed.  Residents carry five cases:  three within the 90-day diagnostic unit and two in the long-term (12 to18 months) residential program.  All patients are seen weekly.  Residents treat two children in individual psychotherapy and co-lead a time-limited psychotherapy group.
  
  
• One hour of individual supervision is provided per week.
  
  
• Because this training site offers a continuum of mental health services for children, residents learn about the "wraparound" philosophy of care and "continuum of care" concepts and are provided with opportunities to work with and learn from a wide range of mental health workers.
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• Residents undertake a required rotation of ten hours per week through the Sacramento County Health and Human Services Child and Adolescent Psychiatric Services during their second year of training, spending one half day per week for three months evaluating and assessing children and adolescents in crisis on the Minor Emergency Response Team (MERT).
  
  
• The outpatient clinic is staffed by four faculty child psychiatrists, two faculty psychologists, a pediatrician, a full-time nurse, and several Master's level clinicians.  The crisis unit is staffed by two part-time  faculty child psychiatrists, a psychiatric nurse, and several bachelor's and master's level clinicians.
  
  
• Medical students, general psychiatry residents and psychology trainees provide the child residents with opportunities for teaching at this site.  Residents have weekly individual supervision with faculty child psychiatrists, and meet with an attending clinical child psychologist for one hour per month to discuss issues in psychological testing.   Finally, residents on this rotation participate in a weekly multidisciplinary assessment conference (Rapid Assessment Team Conference or "RAT") in which children and adolescents treated within the community mental health setting are comprehensively assessed over 4-5 ninety minute sessions.  Assessment includes a review of records, interview with caregiver, interview with child, report of school observation, psychological testing, and family assessment.  This conference is attended by child psychiatry residents, child psychology post-doctoral students, child psychiatry and child psychology faculty and staff, a faculty pediatrician, medical students, social workers, and bachelor or masters level therapists.  The conference focuses upon assessment, diagnosis, formulation, and development of a comprehensive biopsychosocial treatment plan.
  
  
• The county child/adolescent mental health population is approximately 60% male, 40% female, 47% Caucasian, 24% African American, 12% Hispanic, 3% Asian, and 14% Other.  The age range is 3-18 years.  The county serves the Medi-Cal and indigent child/adolescent population.  Child protective services is involved in approximately 37% of cases; 6% are involved with probation and 2% are involved with the California Department of Developmental Services Regional Centers for the developmentally disabled.  6.4% are enrolled in "26.5 services" (which designate them as eligible for the most intensive educational services due to their emotional/educational difficulties).  Non-ADHD disruptive behavior disorders account for 22% of the cases seen, ADHD 11%, depressive disorders 13%, bipolar disorder 5%, adjustment disorders 16%, anxiety disorders 14%, with the remaining carrying other diagnoses.  Many children at these sites carry multiple psychiatric diagnoses.

  In the outpatient clinic, many of the cases involve fairly complex biopsychosocial treatment planning.  Residents work as part of a multidisciplinary team within a continuum of care, and work both individually with patients, as well as with families. They consult to mental health coordinators around diagnostic assessment, recommendations regarding level of care and specific interventions, and make recommendations for any pediatric follow-up, parental referral for services, or social service interventions.  At this site, consultation is often provided to other community agencies as well, including foster agencies, group homes, probation, protective services, and wrap-around programs.  

  In the crisis unit, most patients are on involuntary holds.  Risk assessments are performed with particular attention paid to assessment of medical stability and identification of medical issues related to psychiatric concerns.  The basic treatment mode is crisis intervention. Residents manage acutely agitated, and sometimes violent or psychotic patients.  Residents generate multiaxial diagnoses and develop an appropriate disposition and treatment plan, based on direct interviews of the patients and their caretakers, collaboration with other crisis clinicians, and collateral information.  If patients are to be discharged from the crisis unit, residents make recommendations regarding the child or adolescent's needs in the community.
  
  

• In the outpatient clinic residents are typically scheduled for one intake per week and maintain an ongoing caseload of approximately 10-20 patients.  In the crisis unit, residents evaluate one to four patients per week.
  
  

• Residents receive one hour per week of supervision by faculty child psychiatrists at the outpatient clinic.  Residents in the crisis unit are supervised on site by a faculty child psychiatrist.
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• This is a required rotation of 26 hours per week for four months at the Sacramento County Health and Human Services inpatient adolescent unit at Heritage Oaks Hospital.
  
  
• Three faculty child psychiatrists staff this site.  Additionally, residents work with hospital-based social workers, nursing staff, internists, and mental health workers.
  
  
• Direct on-site supervision is provided.  Residents round daily with the attending child psychiatrist, medical student, and an occasional general psychiatry resident.  Hence, significant opportunities for teaching are available at this site.
  
  
• This is an adolescent unit.  The county child/adolescent mental health population is approximately 60% male, 40% female, 47% Caucasian, 24% African American, 12% Hispanic, 3% Asian, and 14% Other.  Cases of major mood disorders and psychotic disorders are frequently seen.  Most adolescents treated on this service are diagnosed with multiple co-morbid disorders as well, including anxiety disorders, substance use disorders, disruptive behavior disorders, and parent-child relational problems.  A significant number of children treated on this service have histories of abuse and/or neglect; many reside in foster or group homes.  Treatment provided in hospital includes milieu, group therapy, individual psychotherapy, family therapy, psychopharmacology, art therapy, and recreation therapy.
  
  
• Residents carry 3-4 cases during this rotation.  They are responsible for performing comprehensive initial assessments under direct supervision of the attending psychiatrist, and generating an appropriate differential diagnosis and biopsychosocial treatment plan.  Individual psychotherapy and psychopharmacologic management is provided by the resident, under supervision.  The resident works directly with social work staff to assess and treat the family.  The resident also conducts a bi-weekly psychoeducation group for the patients.  Residents collaborate closely with county social workers, foster agency workers, child protective services, children's attorneys, and others in the provision of care.
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• Sacramento County Health and Human Services' Sacramento Assessment Center (SAC) is a required rotation in the first year of child and adolescent psychiatry training, providing experience in forensic child psychiatry.  The rotation is one half day per week for two months.
  
  
• Supervision is provided by a faculty child psychiatrist.  The resident also works directly with a number of other professionals.
  
  
• The resident participates in a multidisciplinary assessment team conference, comprised of psychologists, education staff, substance abuse counselors, social workers, probation staff, nursing, and mental health workers.  The team meets weekly to discuss findings and develop recommendations, which are provided to the child's probation officer in a written report for use by the court.
  
  
• The primary purpose of youth placement in this site is comprehensive assessment.  SAC is a group home affiliated with Juvenile Hall whose purpose is to assess these juveniles for mental illness and to make treatment and placement recommendations to the probation officer and court.  The assessment is a team-based process in which multiple aspects of the child's functioning are assessed, including family, educational, psychological, current functioning, medical and psychiatric.  The population at this site is approximately 61% male and 39% female.  Approximately 42% of the population is African American, 35% Caucasian, 17% Hispanic and 5% Asian.  A preponderance of the population is from lower socioeconomic groups.  The age range is between 12 and 18 years old, with the majority following within the 15-18 year old age range.  All patients treated at this site have a criminal history and most of them are repeat offenders.  Diagnoses in the clinic vary and many children have multiple diagnoses. Common diagnoses include disruptive behavior disorders and substance use disorders.  A significant number of children with attention deficit/hyperactivity disorder, mood disorders and anxiety disorders are also seen.  Intellectual problems and learning disabilities are frequently identified.
  
  
• Residents work directly with on-site attending child psychiatrist to assess 3-4 cases during their two month rotation.  The resident is expected to perform comprehensive psychiatric evaluations of juveniles placed in the juvenile justice system; present and discuss their assessment and recommendations at the team meeting; and prepare a detailed report for use by the court.
  
  
• The resident works closely with and is directly supervised by the attending child psychiatrist in the evaluation of patients, presentation skills, and report-writing.
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• This is a first year required rotation of one half day per week for two months at Kaiser Permanente's Chemical Dependency Recovery Program.
  
  
• Staffing is provided by a clinical psychologist, a clinical social worker, and a drug and alcohol counselor.
  
  
• Educational activities on the service include one hour of weekly supervision by the supervising psychologist; directed readings and discussion; and the opportunity to observe and discuss detoxification treatment with the internist.
  
  
• This clinic treats patients ages 13-17; 70% male, 30% female; approximately 90% of whom are Caucasian; 10% Asian, Hispanic, African American or of mixed race.  Patients with a range of substance use disorders are treated in this clinic; co-morbid psychiatric diagnoses may include mood disorders, anxiety disorders and disruptive behavior disorders.  The primary treatment modalities used in this clinic are group and behaviorally-oriented individual psychotherapy.
  
  
• Residents co-lead either the weekly girls group or the boys group; work directly with the treating psychologist in the assessment and provision of individual psychotherapy for 2-3 cases per week; and present cases which they have assessed to the team.
  
  
• One hour of individual supervision is provided weekly.
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• This is a required rotation of one half day per week during the second year at St. Hope Academy in Sacramento .
  
  
• A faculty child psychiatrist serves as site director.
  
  
• Individual supervision occurs approximately once per month, with more frequent supervision available as needed.
  
  
• Approximately 1600 students are enrolled in this co-ed high school.  The student body is composed of 31% African American, 28% Hispanic, 20% Caucasian, 13% Asian, 3% Native American/Alaskan Native, and 5% "Other" students.  Students of families speaking 18 different primary languages attend this school.  Fifty-five percent of students qualify for the federally funded free or reduced fee lunch program.  The majority do not have a mental health history.
  
  
• At this site, residents gain practical experience in consultation to school administrators, teachers, counselors, and other school professional staff in the areas of program development, mental health education and prevention, behavioral support plans, and classroom management.  Residents are also able to directly observe and informally interact with students outside of the mental health system.
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