The Residency Training Program in Child and Adolescent Psychiatry at UMDNJ – New Jersey Medical School understands that trainees arrive for training as competent general psychiatrists with varied backgrounds and differing professional goals. The Program, under the guidance of the Division Chief and Training Director intends to elicit and elaborate each trainee’s individual goals and objectives, providing each with the tools for full professional realization. The program is further guided by efforts of the Accreditation Council for Graduate Medical Education (ACGME), the Psychiatry Residency Review Committee (RRC) and other organizations seeking training excellence in child and adolescent psychiatry. As such, the program has adopted the ACGME “General Competencies” as described in the “ACGME Outcome Project”.

Stated briefly, the six general competencies as described by the ACGME are:

    * Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health;

    * Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care;

    * Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care;

    * Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals;

    * Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population;

    * Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

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 a) clinical science (replacing “medical knowledge”, b) interpersonal skills and communication, c) patient care, d) practice-based learning and improvement, e) professionalism and ethical behavior, and f) systems-based care.

Overview

The Child and Adolescent Residency training program at UMDNJ – New Jersey Medical School offers a wide variety of clinical experiences in diverse settings and in collaboration with faculty of differing backgrounds and training. Graduates can expect a well-rounded experience in clinical, research, and academic child and adolescent psychiatry. The program aims to expose each trainee to mentally ill, as well as healthy children and adolescents and their families, while emphasizing the honing of skills in assessment, prevention and treatment. A biopsychosocial model of formulation and care is promoted that emphasizes collaboration between families, systems, and other mental health professionals (including psychologists, social workers, guidance counselors, teachers, and case managers). In parallel with the clinical experience, the curriculum offers the knowledge and skills to successfully implement interventions in a variety of settings, such as inpatient units, partial hospitalization settings, outpatient settings, schools, and emergency settings.

The successful graduate will be able to propose, develop, and implement care for children and adolescents with mental disorders, be it individually or as part of a team in varied settings and formats. The graduate is expected to demonstrate excellent communication skills as a consultant to other professionals. His/her compassionate care will be guided by evidence-based practices and delivered with the highest ethics, minding the best interest of the child or adolescent. The graduate will demonstrate a passion for continuous learning and improvement, not only of themselves, but also the communities or spheres in which they serve. He/she will show leadership and administrative aptitude in child and adolescent psychiatry in the typical settings of practice from direct care facilities and community-based settings, to academic settings.

Knowledge, skills and attitudes specific to child and adolescent psychiatry are further described for each clinical and didactic experience.

Goals and Objectives – Year One

The first year of training includes didactic and clinical components that emphasize the acquisition of skills, knowledge and attitudes central to child and adolescent psychiatry. The six-month rotation at Trinitas Hospital serves as the core inpatient experience where close supervision is offered for acute psychiatric presentations of children and adolescents. A small caseload of outpatients at University Behavioral Health Center (UBHC) establishes cases for long-term follow-up so the resident develops a longitudinal experience that affords observation of both development and care over time. A forensic psychiatry rotation provides hands-on experiences with a veteran forensic psychiatrist in an intimate supervisory environment, as well as a structured rotation (the Children of Violence (COV) Clinic). The rotation to the UBHC partial hospitalization program offers an interface to varied clinical presentations and opportunities for collaboration with other mental health professionals. The first year trainee will also consult to the pediatric inpatient units, provide coverage to the emergency room and participate in specialty clinics, such as the Autism Center. Time is reserved for scholarly activity, allowing each trainee to develop his or her own interests and competencies. The didactic curriculum familiarizes the trainee with all aspects of childhood psychopathology and its treatment. The curriculum emphasizes the development of core competencies as outlined.

Knowledge

By the end of the first year, the resident will be able to:

    * Define normal biological and psychosocial human development from infancy to adulthood

    * Define psychopathology on a developmental time line

    * Classify and compare child, adolescent and family assessment methods, including unstructured, semi-structured, and structured assessment tools

    * Describe ancillary services as used in inpatient, outpatient and emergency room settings

    * Define the role and functions of other professionals collaborating with psychiatrists, such as pediatricians, psychologists, social workers, case managers, teachers, and guidance counselors

    * Outline the educational goals of each clinical or didactic experience for the first year of training

    * Classify and compare a range of treatment modalities employed in child and adolescent psychiatry, including psychopharmacological, psychodynamic, behavioral and cognitive modalities as appropriate to various care settings and clinical presentations

    * Define principles of preventive medicine as it pertains to child and adolescent psychiatry

    * Interpret variations in individuals and families with varied ethnic, cultural, and socioeconomic backgrounds

Skills

By the end of the first year, the resident will be able to:

    * Comprehensively assess the mental status of a child or adolescent in the context of developmental status and varied settings, including the inpatient unit, partial hospitalization program, outpatient clinic and emergency room

    * Explain the underpinnings of a comprehensive assessment and treatment plan

    * Formulate, document and discuss cases in respect to health, psychopathology, and proposed interventions

    * Demonstrate assessment of health and psychopathology in children across developmental stages in the settings of the clinical rotations

    * Select and offer standard treatments to children, adolescents and their families, including psychodynamic, somatic, behavioral, and cognitive interventions

    * Perform emergency interventions in a range of settings, including outpatient clinics, pediatric inpatient floors, the emergency room, inpatient and partial hospitalization settings

    * Comprehensively assess, discuss, document and intervene concerning the patient’s potential for self-harm of harm to others

    * Conduct multidimensional clinical interviews with children, adolescents, and families

    * Demonstrate understanding of ancillary services in psychiatry.

    * Perform as a member of a team of multidisciplinary providers in delivering care

    * Perform consultation and liaison services for typical presentations of children and adolescents

    * Explain forensic dimensions of child and adolescents presenting at the interface of law and psychiatry

    * Recognize signs of abuse and neglect in children and adolescents and the determine the appropriate response

    * Demonstrate all skills in individuals and families with varied ethnic, cultural, and socioeconomic backgrounds.

    * Discuss scientific articles relevant to child and adolescent psychiatry in terms of research methods employed, validity, and implications for practice

Attitudes

By the end of the first year, the resident will be able to:

    * Offer openness to learning as demonstrated by a curious and questioning attitude

    * Respect mental health providers in varied settings and with varied backgrounds

    * Understand and value the role and contribution of each provider in a multidisciplinary care setting

    * Advocate for the rights of the child and adolescent

    * Assess self for compliance with individual ethical standards

    * Evaluate his/her own practice performance and challenge self for further learning

    * Seek and utilize supervision

    * Actively participate in learning

Goals and Objectives – Year Two

The second year of training provides further clinical experiences in the partial hospitalization, outpatient, emergency room and pediatric consultation settings, as well as a rotation to the pediatric neurology clinic. School consultation is also offered this year. Further opportunities for individuation exist in elective time. The didactic curriculum offers advanced topics in psychopharmacology and other therapies, as well as an emphasis on administration and leadership. Seminar 11, Advanced Assessment in Child Psychiatry aims to enhance analytic thinking in assessment, while promoting the use of evidenced-based assessment methods. Seminar 12, Integrated Therapeutics: Specific Disorders focuses on an assimilation of knowledge and skills as a competent clinician.

Knowledge

The 2nd year trainee is expected to build upon the knowledge base of Year 1. In addition, by the end of training, the 2nd year resident will be able to:

    * Administer advanced child, adolescent, and family assessment methods, including semi-structured, and structured assessment tools used in inpatient, outpatient, consultation, and emergency room settings

    * Describe and compare collaborative intervention methods in child and adolescent psychiatry, such as with psychologists, social workers, case managers, teachers, and guidance counselors

    * Outline the educational goals of each clinical or didactic experience for the second year of training

    * Competently administer a range of treatment modalities employed in child and adolescent psychiatry, including psychopharmacological, psychodynamic, behavioral and cognitive modalities as appropriate to each care setting and clinical presentation

    * Demonstrate administrative and leadership methods, including the teaching of medical students, psychiatric residents, other physicians and allied professionals, parents, and the public regarding normal and abnormal development, psychopathology, methods of intervention and prevention

    * Describe and analyze principles of consultation to community systems of care

    * Define community-based educational and preventive techniques

    * Analyze and interpret variations in individuals and families with varied ethnic, cultural, and socioeconomic backgrounds

Skills

The 2nd year trainee will build upon the skills mastered in Year 1. In addition, by the end of training, the 2nd year resident will be able to:

    * Comprehensively assess the mental status, health and psychopathology of a child or adolescent in the context of developmental status and varied settings

    * Conduct assessments of children, adolescents, or their caregivers that incorporate elements of therapeutic technique

    * Develop and implement a comprehensive assessment and treatment plan for children and adolescents in partial hospitalization settings and outpatient settings

    * Interpret ancillary assessments, such as those provided by psychologists, occupational therapists, speech and language pathologists, social workers, or school personnel

    * Concisely and efficiently formulate, document and discuss cases in respect to health, psychopathology, and proposed interventions

    * Appropriately select and deliver standard and specialized treatments to children, adolescents and their families, including psychodynamic, somatic, behavioral, and cognitive interventions

    * Practice as a member or leader of a team of providers in delivering care

    * Perform consultation and liaison services for atypical presentations of children and adolescents

    * Illustrate discussion of a forensic case as an expert witness, such as in custody evaluation

    * Demonstrate all skills in individuals and families with varied ethnic, cultural, and socioeconomic backgrounds

Attitudes

By the end of the second year, the resident will be able to:

    * Offer openness to learning despite developing competence, as demonstrated by an interest in and knowledge of current research and publications

    * Embrace advanced and complex methods of assessment and care as typically described in treatment guidelines published by the American Psychiatric Association (APA) or American Academy of Child and Adolescent Psychiatry (AACAP)

    * Seek supervision for a range of issues from treatment choices to ethical considerations

    * Participate in learning as demonstrated by active discussion

    * Evaluate one’s own performance and competence

    * Practice self-directed learning in biological, social and clinical sciences related to child and adolescent psychiatry

    * In a team environment, challenge team members to practice with the highest ethical and professional standards

    * Assume genuine responsibility as a teacher of students in medicine and psychiatry

    * Develop individual professional goals that reflect his/her competencies and attitudes in training