Responsive to the ACGME requirement for competency-based educational programs, the Psychiatry RRC implemented new program requirements for child and adolescent psychiatry training that broadly parallel the ACGME general competencies. For child and adolescent psychiatry training, the core competency areas are:

1. Patient Care,
   

2. Clinical Science
   

3. Practice-based Learning and Improvement,
   

4. Interpersonal Skills and Communication,
   

5. Professionalism and Ethical Behavior
   

6. Systems-based Care.
   

The core competencies for child and adolescent psychiatry training are outlined below:

Patient Care

For the purposes of this core competency category, Patient Care is divided into three areas: crisis intervention, psychotherapy and psychopharmacology. Each subgroup is described separately.

Core Competency for Crisis Intervention

Definition

Crisis intervention can be described as the use of a multiplicity of skills (psychotherapeutic, psychopharmacological, and mental health systems knowledge) to assist in the rapid stabilization of symptomatic children, adolescents, and/or their families, including crisis intervention skills in a variety of settings such as ambulatory care centers, emergency rooms, day treatment programs, residential treatment facilities, and inpatient psychiatric units.

Main Outcome

At regular intervals, the child and adolescent psychiatry resident should demonstrate progressive attainment of the knowledge, skills, and attitudes to intervene appropriately and effectively during child psychiatric emergencies. Upon graduation the resident should be able to independently manage acute clinical emergencies, implement crisis intervention strategies, and make appropriate referrals to intensive service settings.

Knowledge

By the end of training, the resident will be able to:

    * State pertinent information for adequate acute risk assessment

    * Plan and describe basic crisis intervention

    * Define cost-effective utilization of services

    * Define forensic issues related to commitment and emergency care

    * Itemize requisites for commitment of children and adolescents

Skills

By the end of training, the resident will be able to:

    * Demonstrate satisfactory acute risk assessment and effectively intervene during psychiatric emergencies with children, adolescents, and their families

    * Perform psychosocial interventions and illustrate use of medications in acute crises for purposes of acute stabilization and to avert more restrictive placements when clinically indicated

    * Perform clinically appropriate referrals to a variety of intensive service settings

    * Demonstrate assumption of emergency responsibility for patients, including commitment proceedings

    * Demonstrate application of forensic principles within intensive service settings, including acute utilization of medication, commitment procedures, and management of abuse and neglect allegations

Attitudes

The resident should demonstrate attitudinal behaviors such as:

    * Willingness to share clinical responsibility and relevant clinical data for patients with a variety of attending physicians

    * Openness to function within the mental health delivery system as a team player

    * Motivation to take advantage of didactic and clinical training opportunities in a variety of crisis intervention settings

Assessment

The resident’s competency will be assessed by:

    * Supervisor assessments through direct observation of resident activity (semiannually or at end of each rotation);

    * Chart review of clinical, administrative, and forensic services provided in intensive services settings (every two months);

    * Child PRITE (annually);

    * Participation in didactic seminars and clinical supervision (ongoing);

    * Participation in clinical team meetings (as per clinical rotation site);

    * Patient logs demonstrating numbers of cases, ages, genders, diagnostic groupings, and specific crisis interventions for patients treated (reviewed monthly by training director);

Deficiency Remediation

    * Specific tutorials to address knowledge deficiencies;

    * Additional focused clinical supervision;

    * Reassessment after deficiency remediation.

Core Competency in Psychopharmacology

Definition

Psychopharmacology can be described as the application of medical and neuroscience knowledge to the choice and utilization of psychopharmacological agents in the treatment of child and adolescent psychiatric disorders.

Main Outcome

At regular intervals, the child and adolescent psychiatry resident should demonstrate progressive attainment of the knowledge, skills, and attitudes to treat safely and appropriately childhood psychiatric disorders with medication. Upon graduation the resident should demonstrate competence in the safe and appropriate prescription and management of psychotropic medication treatment.

Knowledge

By the end of training, the resident will be able to:

    * Describe basic neuroregulatory mechanisms, neurotransmitter systems, and drug delivery systems specific to pediatrics

    * State and interpret medication dosages, interactions, and the relationship of dose to age, gender, and weight

    * Outline side effects and drug interactions for all psychotropic medications used in the treatment of psychiatric disorders in children and adolescents

    * Define medication management strategies using single and, whenever appropriate, multiple drugs

    * Classify methods to evaluate drug efficacy

Skills

By the end of training, the resident will be able to:

    * Demonstrate skills in diagnosing child and adolescent psychopathology and developing a treatment plan that includes psychopharmacology when indicated

    * Illustrate formulation of a case and anticipation how psychological and family issues may influence medication compliance

    * Identify target symptoms and their improvement as well as potential side effects and medication interactions

    * Demonstrate skills in the management of drug-abusing clients and the prescription of scheduled drugs

    * Perform psychopharmacology consultation and integrate psychopharmacologic interventions with treatment from a non-physician therapist or primary care provider

    * Demonstrate integration of psychopharmacology interventions skills within the context of an ongoing psychotherapy and other psychosocial interventions (i.e., inpatient hospital, community, or partial hospitalization program)

Attitudes

The resident should demonstrate attitudinal behaviors such as:

    * Motivation to review pediatric psychopharmacology literature and appropriately apply new research findings to medication management of child and adolescent psychiatry disorders

    * Openness to observing and inquiring about target symptom reduction, changes in impairment, compliance, impact of medication on family functioning, side effects, and potential medication interaction

    * Recognition that psychodynamic and family influences may have an impact on medication treatment processes

Assessment

The resident’s competency will be assessed by:

    * Supervisor assessment (in weekly meetings, at the end of each rotation, and semiannually);

    * Chart review to assess appropriate clinical record-keeping, indicating appropriate diagnoses and treatment planning, medication dosage, refills, patient/parent education, and appropriate informed consent (quarterly);

    * Child PRITE (annually);

    * Participation in case conferences (as scheduled);

    * Seminar attendance and participation (as scheduled);

    * Patient logs demonstrating numbers of cases, ages, gender, diagnostic groupings, and specific psychopharmacologic interventions for patients treated (discussed monthly with the training director);

Deficiency Remediation

    * Specific tutorials to address knowledge deficiencies;

    * Additional focused clinical supervision;

    * Reassessment after deficiency remediation.

Core Competency in Psychotherapy

Definition

Psychotherapy is a clinical intervention, which uses emotional, developmental, cognitive and systems principles to treat mental and emotional disorders in children and adolescents. Psychotherapeutic interventions may include such therapies as brief and long-term individual psychotherapy, family therapy, group therapy, supportive psychotherapy, psychodynamic psychotherapy, behavioral therapy, and cognitive-behavioral therapy.

Main Outcome

At regular intervals, the child and adolescent psychiatry resident should demonstrate progressive attainment of the knowledge, skills, and attitudes required to conduct clinically appropriate and effective psychotherapy with children, adolescents, and their families. Upon graduation the resident should demonstrate competence with the major techniques of psychotherapy and should be able to refer to psychotherapy subspecialists when clinically appropriate.

Knowledge

By the end of training, the resident will be able to:

    * Describe psychotherapeutic theories and their basic principles.

    * Outline and tabulate applied theories of development, including child, adult, parental, and family development issues

    * Define therapeutic techniques for individual children and adolescents, families, and groups

    * Demonstrate psychotherapy administration tasks including record-keeping, charting, and coding of psychosocial interventions

    * Describe ethics in psychotherapy including the understanding and maintaining of clinical boundaries

Skills

By the end of training, the resident will be able to:

    * Demonstrate the interview of a child or an adolescent, using techniques of play therapy, direct questioning, and empathic listening.

    * Perform interview of parents/family, using knowledge of systems theory, learning theory, and psychodynamic theories of family functioning

    * Formulate a case from an interview, mental status examination, historical material, and knowledge of development in multiple settings (i.e., clinic, inpatient unit, forensic environment, and medical units)

    * Develop and implement patient management plans

    * Engage in the variety of psychotherapies (short- and long-term, family, behavioral, cognitive-behavioral, and group psychotherapies), including formulating and implementing a treatment plan with the goal of relieving certain identifiable symptoms

    * Maintain a clinical record including psychotherapy notes, coding, and billing

    * Provide preventive health care services

Attitudes

By the end of training, the resident will be able to:

    * Demonstrate development of a therapeutic alliance with a child and caregivers and maintenance of appropriate clinical boundaries

    * Demonstrate effective communication of care and respect when interacting with patients and their families

    * Provide informed psychotherapy services, either directly or via appropriate referral, to all patients who present themselves for care

    * Participate in supervision in an open, revealing manner using detailed process notes, one-way mirrors, and/or videotaped sessions in addition to personal disclosure to develop increased therapeutic precision and ensure maintenance of appropriate boundaries

Assessment

The resident’s competency will be assessed by:

    * Active participation in related seminars and clinical supervision (as scheduled);

    * Supervisor assessment (in weekly meetings, at the end of each rotation, and semiannually);

    * Review of charts with supervising faculty (quarterly);

    * Patient logs demonstrating numbers of cases, ages, genders, diagnostic groupings, and specific therapeutic interventions for patients treated (discussed monthly with the training director);

    * Case conferences involving the resident’s interactions with peers and faculty;

    * Child PRITE;

Deficiency Remediation

    * Specific tutorials to address knowledge deficiencies;

    * Additional focused clinical supervision;

    * Assessment after deficiency remediation.

Clinical Science/Medical Knowledge

Definition

Clinical science is the knowledge base about established and evolving biomedical, clinical, and cognitive sciences and the application of this knowledge to clinical care. Residents are expected to demonstrate an analytical and investigatory approach to clinical situations. They are also expected to know and apply the basic and clinical sciences appropriate for the discipline of child and adolescent psychiatry.

Main Outcome

At regular intervals, the child and adolescent psychiatry resident should demonstrate progressive attainment of a knowledge base in clinical sciences and the ability to apply this knowledge to the care of children and adolescents with psychiatric disorders and their families. Upon graduation the resident should possess an adequate knowledge base of clinical sciences and should demonstrate competence in applying this knowledge in providing clinical care.

Knowledge

By the end of training, the resident will be able to:

General

Child and adolescent psychiatry trainees shall demonstrate the following:

    * Classify and described major disorders, including considerations relating to age, gender, race, and ethnicity, based on the literature and standards of practice.

    * Define systems of health care delivery

    * Outline and interpret ethical principles in delivering medical care

    * Demonstrate ability to reference and utilize electronic systems to access medical, scientific, and patient information

Specific to Child and Adolescent Psychiatry

    * Outline human growth and development, including normal biological, cognitive, and psychosexual development, including sociocultural factors

    * Itemize patient evaluation and treatment selection considerations, including diagnostic and therapeutic studies including:

    * Diagnostic interviewing

    * Mental status examination

    * Psychological and educational testing

    * Medical/laboratory testing

    * Imaging studies

    * Use of clinical rating scales

    * Treatment comparison and selection

    * Various therapies, including specific forms of psychotherapies, somatic treatments,

    * Emergency psychiatry

    * Substance abuse,

    * The resident will demonstrate knowledge of other psychiatric subspecialties and other areas of psychiatric endeavor, including:

          o Addiction psychiatry

          o Forensic psychiatry

          o Pain Medicine

    * The resident will demonstrate a knowledge of pediatric neurology and neurodevelopmental disabilities, including but not limited to defining the pathophysiology, epidemiology, diagnostic criteria, and clinical course of common neurological disorders.

    * The resident will demonstrate knowledge of pediatrics and relevant issues related to developmental behavioral pediatrics, adolescent medicine, genetics, and endocrinology

    * Employ principles of quality improvement in practice

    * Outline research ethics

    * Interpret considerations in psychopathology/classification/differential diagnosis

    * Define requisites to successful consultation

    * Outline issues common to clinical practice

    * Name common tools and techniques in psychiatric prevention

Skills

By the end of training, the resident will be able to:

    * Demonstrate effective dissemination of relevant data and knowledge about child and adolescent psychiatry

    * Apply knowledge of clinical science in the provision of care for children, adolescents, and families

    * Integrate up-to-date scientific evidence in decision-making about diagnostic and therapeutic interventions

Attitudes

The resident should demonstrate an analytic and investigatory approach to clinical situations that may include:

    * Active participation in didactic offerings by being able to discuss assigned readings and effectively present various topics in different forums, making relevant comments during discussions

    * Active participation in clinical rounds and clinically based conferences (for example Departmental Journal Club, Child Psychiatry Journal Club, Visiting *Lecture Series, and Clinical Case Conferences), bringing to these conferences literature and knowledge of the clinical sciences that are relevant to the clinical situation being discussed

    * Independent pursuit of knowledge as indicated by literature searches, other investigative work, and research

Assessment

The resident’s competency will be assessed by:

    * Objective measures—completion of CHILD PRITE annually and review of individual scores with training director; bi-annual documentation by clinical and teaching faculty of participation in didactic modules, case conferences and documentation of attendance

    * Supervision—documentation of resident performance in areas relevant to clinical science by supervising outpatient and on rotation faculty

    * Clinical skill evaluation

    * Direct observation of the individual resident’s clinical and didactic activities by the training director and/or designated faculty

    * “Mock Boards” (Annual ABPN Board style clinical examination)

    * Review of the clinical exam performance with the training director

    * Independent learning—demonstration of self-initiated as well as directed study through leadership of discussions in both didactic and clinical activities and through presentation to the residency program in various formats (e.g., departmental journal club, child psychiatry journal club, case conference)

Deficiency Remediation

    * Regular review of the various measures of performance and competence for each individual resident with the training director, identifying specific deficits

    * Development of specific remediation plans based on the particular deficiencies identified

    * Reassessment of specific deficiencies after remediation

Practice-Based Learning and Improvement

Definition

Practice-based learning and improvement is the process by which a child and adolescent psychiatrist continually expands his/her knowledge and skills and assesses his/her practice to ensure highly competent evaluation and treatment of psychiatric disorders in children and adolescents and their families. This process requires a willingness to develop new knowledge and skills, a recognition of knowledge and skill gaps, and an approach for continuously evaluating and improving one’s knowledge and skills through adherence to ‘‘best practices’’ and regular critical review of the scientific literature.

Main Outcomes

At regular intervals (e.g bi-annually), the child and adolescent psychiatry resident should demonstrate the progressive attainment of the knowledge, skills, and attitudes required to apply practice-based learning and improvement strategies to the assessment and treatment of child and adolescent psychiatric disorders. Upon graduation the resident should be able to investigate, evaluate, and improve his/her patient care practices.

Knowledge

By the end of training, the resident will be able:

    * Recognize and describe gaps in existing knowledge and emerging areas of future practice

    * Outline assessment procedures that identify learning opportunities

    * Describe relevant research design, statistics, and data interpretation

    * Define the skills and attitudes necessary for continued learning

Skills

By the end of training, the resident will be able:

    * Assess personal knowledge, clinical abilities, and practice style and perform practice-based improvement activities using a systematic methodology; examples of such an approach may include developing a learning and skill development program, as well as critical assessment of new knowledge and techniques and their applicability to one’s practice from a research oriented approach

    * Locate, appraise, and assimilate ‘‘best practices,’’ practice parameters and treatment guidelines that are relevant to the care of child and adolescent psychiatric disorders

    * Acquire and integrate information from a variety of sources, including electronic databases, scientific literature, presentations, and consultations, to support clinical in care, patient education, and one’s own education

    * Read the scientific literature critically, evaluating the impact of methodologies on reported findings

Attitudes

The resident should demonstrate attitudinal behaviors that foster lifelong learning, such as:

    * Recognition of the need for lifelong learning and monitoring of one’s own practice

    * Willingness to pursue continuing education and supervised experiences to keep one’s own practice commensurate with the community standard of care

    * Willingness to obtain information from electronic data bases and scientific literature in child and adolescent psychiatry and related fields, ensuring clinical practice consistent with scientific advances

    * Recognition that the scientific literature must be integrated in an evolutionary manner, realizing that no one study or theory is likely to address all clinical situations

Assessment

The resident’s competency will be assessed by:

    * Attendance at seminars and the departmental and child psychiatry journal clubs

    * By the end of Year 2, completion of a scholarly activity project evaluated by the departmental residency research committee (e.g. poster presentation, publication, etc.)

    * Demonstration of resident self-assessment, self-directed learning and skill development, and utilization of methods of gaining new knowledge and skills

    * Evaluation of the resident’s capacity to obtain and use new information for an assigned topic during a seminar

Deficiency Remediation

    * Specific tutorials to address knowledge deficiencies

Interpersonal Skills and Communication

Definition

Interpersonal and communication skills are the specific techniques and methods that facilitate effective and empathic communication between the psychiatrist, patients, colleagues, staff, and system. In addition to specific skill acquisition, interpersonal skills require an underlying set of attitudes involving the resident’s personal beliefs and values, self-understanding, opinions about other people, and understanding of the child and adolescent psychiatrist’s role as a consultant to patients and their contextual system. Development of interpersonal skills is enhanced by the acquisition of basic information about interpersonal communication.

Main Outcomes

At regular intervals the child and adolescent psychiatry resident should demonstrate progressive attainment of the knowledge, skills, and attitudes required to develop and maintain appropriate interpersonal therapeutic relationships and effectively communicate with patients and their families, colleagues, and the public. Upon graduation the resident will demonstrate competence in interpersonal and communication skills.

Knowledge

By the end of training, the resident will be able to:

    * Define effect of patient’s or family members’ emotional reactions and associations to the therapist (and vice versa) on psychiatric evaluation and treatment

    * Classify and contrast the structure and function of multidisciplinary treatment teams in various clinical settings

    * Interpret the contribution of cultural differences to treatment

Skills

By the end of training, the resident will be able to:

    * Illustrate effective communication through active listening and understanding of children, adolescents, adults, and families

    * Create and sustain a therapeutic alliance and an ethically sound relationship with patients and caregivers

    * Elicit and provide information using effective verbal, nonverbal, explanatory, interrogatory, interpretive, and writing skills as appropriate

    * Demonstrate use of negotiation to develop an agreed-upon health care management plan with patients and caregivers

    * Perform education of children, families, and professionals about medical, psychological, and behavioral issues in the life of children and families in a clear and effective manner

    * Illustrate self-observation and appropriate management of the physician’s own feelings and behavior in psychiatric interactions

    * Illustrate effective communication within multidisciplinary team structures as member, consultant, or leader

    * Exhibit culturally sensitive, professional, ethically sound behavior and attitudes in all patient and professional interactions

Attitudes

The resident should demonstrate attitudinal behaviors that facilitate interpersonal relationships, such as: Attitude of respect for others, irrespective of differing points of view or different professional or cultural backgrounds Desire to gain understanding of another’s position and reasoning Belief in the intrinsic worth of other human beings Wish to build collaboration and achieve mutual understanding Desire to share information in an open rather than a dogmatic fashion Willingness to continuously self-observe and confront one’s own biases and reactions Willingness to act as the patient’s advocate as indicated

Assessment

The resident’s competency will be assessed by: Oral clinical examinations with evaluation of observed interviews (e.g., mock boards, annually) Direct observation in clinical settings, videotape observation, chart review for written skills (i.e., in letters or evaluation reports) Supervisory evaluations from clinical rotations including a global rating from clinical personnel who work with the resident

Deficiency remediation

Specific tutorials to address knowledge deficiencies Additional focused clinical supervision Reassessment after deficiency remediation

Professionalism and Ethical Behavior

Definition

Professionalism and ethical behavior encompasses the resident’s commitment to professional responsibilities, including demonstration of respect, compassion, and integrity; responsivity to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and commitment to excellence and ongoing professional development. Adherence to ethical principles, including those pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, sensitivity to a diverse patient population, including sensitivity to a patient’s culture, age, gender, and disabilities, and the ethics of business practice are an integral part of professionalism and ethical practice.

Main Outcome

At regular intervals during subspecialty training, the child and adolescent psychiatry resident should demonstrate progressive attainment of the knowledge, skills, and attitudes to provide legal, ethical, and culturally sensitive care to children and adolescents with psychiatric disorders and their families. Upon graduation, the resident should demonstrate competency in the fundamental qualities of professionalism and ethical behavior.

Knowledge

By the end of training, the resident will be able:

    * Outline and interpret the AACAP code of ethics

    * Tabulate the legal and ethical principles of:

    * Confidentiality

    * The minor’s and guardian’s rights to receive and refuse treatment

    * Involuntary commitment

    * Compare assent and consent principles in research, to those in clinical settings

    * Define principles of cultural competence, such as:

    * Cultural diversity of the U.S. population and cultural differences in child development

    * Cultural influences on identification of mental health problems and help-seeking behavior

    * Ethnocultural influences in psychopharmacology and psychosocial interventions

Skills

By the end of training, the resident will be able:

    * Explain and discuss institutional and governmental ethical guidelines

    * Obtain and discuss treatment consent forms

    * Observe and participate in involuntary commitment procedures

    * Review and discuss research consent/assent forms

    * Provide culturally competent care as evidenced by the ability to:

    * Interview children and families from different ethnic groups with openness and sensitivity to cultural differences and communication

    * Demonstrate formulation of treatment plans that are culturally sensitive to the child’s and parents’ concept of mental illness

    * Provide clinical care with an understanding of possible cultural differences in treatment expectations

    * Work with health care systems professionals of diverse backgrounds

Attitudes

The resident should demonstrate attitudinal behaviors consistent with high professional and ethical standards, such as:

    * Respect and regard for and responsiveness to the needs of patients and society that supersedes self-interest

    * Commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, conflict of interest, and business practices

    * Capacity to know when and how to challenge/provide procedures and practices for the patient’s benefit, consistent with ongoing research and practice development in child and adolescent psychiatry

    * Sensitivity to cultural differences, including awareness of one’s own and the patient’s cultural perspective

Assessment

The resident’s competency will be assessed by:

    * Evaluation by clinical supervisors in relation to confidentiality, informed consent, and patients’ rights in providing assessment and treatment of children and adolescents

    * Observation of patient interviews and simulated oral board examination with regard to ethical principles and cultural competence (Seminar 11, continuous; mock boards, annually)

    * Monthly review of case log for diversity in terms of ethnic, racial, gender, age and socioeconomic backgrounds.

    * Evaluation of participation in case conferences, didactic seminars and Child PRITE performance in relation to ethical and forensic areas and cultural competence (ongoing and annual)

    * Overall review of professionalism, ethical standards, responsibility, and cultural competence in resident evaluation process in relation to program standards (semiannual reviews by program director)

Deficiency Remediation

    * Specific tutorials to address defined deficiencies in professionalism and/or ethics

    * Additional focused supervision to address issues of professionalism and ethical behavior

    * Reassessment after deficiency remediation

Systems-Based Care

Definition

Systems-based care refers to the treatment of children and adolescents with psychiatric problems within the context of multiple, complex systems.

Main Outcome:

At regular intervals, the child and adolescent psychiatry resident should demonstrate progressive attainment of systems-based care competencies such as working in a mutually respectful manner, displaying knowledge of the diverse systems involved in the treatment of children and adolescents, integrating multiple systems of care in treatment planning and collaborating in a shared treatment plan, and advocating for children and adolescents in various systems of care. The resident should demonstrate competence in child psychiatric treatment and consultation across multiple systems and agencies upon graduation.

Knowledge

By the end of training, the resident will be able:

Education

    * Define publicly and privately available resources for the treatment of learning disorders and psychiatric/behavioral problems affecting a child or adolescent’s ability to learn

    * Compare school-based mental health care to that in other settings

    * Outline legal aspects of education as they affect children and adolescents with psychiatric problems [e.g., the Individuals with Disabilities Education Act (IDEA)]

    * Demonstrate familiarity with Individual Education Plans (IEP) and the child and adolescent psychiatrist’s role in the process for determining the individual educational needs for particular patients (e.g., specialized classrooms or services for the learning disabled, the behaviorally challenged, the emotionally handicapped, and the otherwise health impaired).

    * Define school culture and state the roles and approaches of school personnel

Social Services

    * Describe the role of child welfare services, protective services, child welfare outreach services, and adoption and foster care

    * Itemize services for physically and developmentally disabled children and adolescents and the federal laws and regulations ensuring availability of the services

    * State the role of social services in the treatment system

    * Outline federal and state funding mechanisms for child-related social services

Medical

    * State public and private medical resources available in the community

    * Define the structure and function of primary care and subspecialty pediatrics and related specialties and health care professions frequently involved in the care of children and adolescents

    * Interpret the impact of patient-care practices and related actions on component units of the health care delivery system and the total delivery system, and how delivery systems affect provision of health care

    * Define systems-based approaches for controlling health care costs and allocating resources

    * Plan cost-effective health care and resource allocation that does not compromise quality of care

    * Analyze the advocacy role to ensure quality patient care and assist patients in dealing with system complexities

    * State methods for partnering with health care managers and health care providers to assess, coordinate, and improve health care and the impact these activities have on system performance

Mental Health System

    * Outline available services in the community, both public and private

    * Describe use of home, school, and other community-based treatments such as family preservation and intensive case management

    * Compare the methodologies to assess patients for the level and intensity of care required

    * Define the role of community-based treatment resources and their appropriate use

    * Describe the role of child psychiatrist in residential treatment facilities, group homes, and day treatment programs

    * Juvenile justice system

    * Describe the role of the child psychiatrist with courts and court personnel

    * Outline and tabulate consultation issues in work with detention facilities

Skills

By the end of training, the resident will be able: Elicit information from community systems involved in the care of a child or adolescent and use these data in the development of a treatment plan Interact with multiple systems in a consultation model Use community resources effectively Collaborate with community-based programs in the treatment of specific children or adolescents Explain the roles of various individuals and groups in community systems of care Understand the “social authority” of the mental health practitioner in advancing advocacy across policy, program, and practice sectors

Attitudes

The resident should demonstrate attitudes that reflect respect for the patient, family, and other caregivers, which may include: Maintenance of the focus on the “best interest” of the child and family Utilization of the concept of “least restrictive environment” Provision of treatment services as close to home as possible Collaboration with others to enhance a child or adolescent’s situation

Assessment

The resident’s competency will be assessed by:

    * Observation of resident performance in clinical activities (live or by audio or videotape, annually)

    * Performance on oral or written examinations or presentations

    * Supervisor reports

    * Supervised participation in an IEP meeting or a presentation to school personnel or parent groups affiliated with a school

    * Chart reviews documenting evidence of inclusion of systems of care in treatment planning

    * Resident folder

    * Satisfactory evaluations from collaborating professionals

Deficiency Remediation

    * Specific tutorials to address knowledge deficiencies

    * Additional focused supervision to address systems-based care issues

    * Reassessment after deficiency remediation