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Clinical Rotations

Inpatient Rotations

Adolescent Inpatient Service: Greenberg 11 North (Payne Whitney Manhattan)

First-Year Residents
The Adolescent Inpatient Service is a 10-to-12 bed acute unit for adolescents from 13 to 21 years of age. Diagnoses include affective disorders, psychotic disorders, disruptive behavior disorders, pervasive developmental disorder, and severe personality disorders. Social class and ethnicity vary broadly. Residents have a broad educational experience, including individual and family therapy, psychopharmacology and ECT in adolescent populations, involvement in a multidisciplinary team, and management of acute psychiatric emergencies. Major emphasis is placed on diagnostic assessment and both short and long-term treatment planning. Residents are actively involved in formulating and implementing dispositions.

Pediatric Consultation/Liaison Service (Komansky Center for Children's Health/Payne Whitney Manhattan)

First-Year Residents
The service provides consultation to children and adolescents admitted to any inpatient service or the emergency room. Residents spend, on average, 10 hours a week in a variety of activities, including consultations to the pediatric services and the emergency department, and participation in a weekly lecture/case conference. Each consultation is reviewed with the supervising child psychiatrist. Additionally, residents gain experience teaching pediatric residents, both informally on the inpatient services and formally during the pediatric morning report.

Child Inpatient Service: Nichols Cottage (Payne Whitney Westchester)

First-Year Residents
Nichols Cottage is a 17-bed acute inpatient unit for children age 4 to 12 years old, with an average length of stay of 30 days. Residents care for patients with a wide range of psychopathologies. Residents function as part of a multidisciplinary team, working alongside psychiatrists, social workers, and nursing staff. Residents also provide emergency assessment of children twelve and under in the Evaluation Center at Payne Whitney Westchester and facilitate their admissions to Nichols Cottage when necessary.

Adolescent Inpatient Service: 7 North (Payne Whitney Westchester)

First-Year Residents
7 North is an 18 bed acute inpatient unit for adolescents age thirteen to eighteen years old, with a length of stay averaging two weeks. Residents care for patients with a wide range of psychopathologies and discharge needs. Residents function as a part of a multidisciplinary team, working closely with psychiatrists, social workers, and nursing staff. They are involved in formulating treatment and discharge plans, as well as managing psychiatric emergencies.

Children's Day Hospital: Bard House (Payne Whitney Westchester)

First-Year Residents
Bard House is a year-round intensive day-treatment program for children, ages five to twelve, providing a nurturing educational setting for fragile youngsters with psychiatric disorders and often chaotic psychosocial situations. Educational and clinical services are all provided onsite, and outreach is done to families and community agencies. Residents will work as part of a multidisciplinary team and will have the opportunity to participate in Committee on Special Education meetings, home visits to the families, and network meetings, where they will help families to access services and supports available in the community.

Pediatric Consultation/Liaison Service (Morgan Stanley Children's Hospital)

First-Year Residents and First-Year CAP Track Residents
Clinical activities include consultation to medically ill children on inpatient and, less often, outpatient pediatric services. Liaison services to selected subspecialty teams include cardiac transplant, ICU, pain management, hematology/oncology, neurology, and renal. Psychiatric diagnoses include adjustment disorder, acute stress disorder, patients admitted following suicide attempts, anxiety disorders, PTSD, affective disorders, neuropsychiatric disorders, and brain syndromes secondary to medical illness. Types of treatment provided include preoperative evaluations before organ transplantation, brief behavioral interventions, acute psychopharmacological management, parent education, and family counseling. Cognitive-behavioral interventions include hypnosis and pain management techniques. Interdisciplinary teamwork with pediatric staff is an intrinsic component of this rotation.

Inpatient Psychiatric Service (Queen's Children's Psychiatric Center)

First-Year CAP Track Residents
The training service treats patients ages 12 to 18 years who present with severe and disabling psychopathology including anxiety, psychosis, aggression, impulsivity, hyperactivity, mood disorders, and developmental delay and deviance. The resident is an active member of the service. They participate in the evaluation, diagnosis, as well as individual, family and milieu therapy, and psychopharmacological management of hospitalized children and adolescents. Residents are responsible for up to 4 patients during their 6 month rotation, seeing each patient individually twice weekly, co-leading a group, as well as participating in team meetings, administrative unit meetings and therapeutic community meetings. Child and adolescent residents from another training program, psychology interns and social work interns may also participate.

Outpatient Rotations

Comprehensive Emergency Service (Morgan Stanley Children's Hospital)

First-Year Residents and First-Year CAP Track Residents
The Comprehensive Emergency Service (CES) rotation is half time for four months. The CES is divided into three components: The Children's Comprehensive Psychiatric Emergency Program (CCPEP), the Home-Based Crisis Intervention (HBCI), and the Immediate-Treatment Clinic (ITC). The CCPEP is subdivided into an ambulatory evaluation service and the extended-observation unit. The most common presenting problems are suicidal thoughts and actions, disruptive behavior disorders, anxiety and depressive disorders, child abuse and neglect, and school problems. The types of treatment provided include crisis-oriented interventions, psychopharmacological management, supportive therapy, family therapy, and referrals for psychosocial support services. All cases are discussed with the attending on an individual basis prior to disposition.

Pediatric Neurology (Morgan Stanley Children's Hospital)

First-Year Residents and First-Year CAP Track Residents Residents rotate through the Pediatric Neurology Clinic, under the direction of the Pediatric Neurology Service, while on the Pediatric Consultation/Liaison Service at MSCH. The clinic population is culturally diverse, with a variety of neurological disorders, including neuromuscular disorders, seizure disorders, tumors, movement disorders, degenerative neurological diseases, strokes, and other neurological syndromes. Many disorders are complicated by neuropsychiatric problems or include a differential diagnosis of a conversion disorder, somatization disorder, or psychiatric factors complicating a neurological condition.

Pain Clinic (Morgan Stanley Children's Hospital)

First Year Residents and First-Year CAP Track Residents
Each child psychiatry fellow rotates for four weeks in the outpatient Pediatric Pain-Management Center at the Morgan Stanley Children's Hospital. The fellow participates in the evaluation of children and adolescents with diagnoses such as functional abdominal pain, chronic daily headache, complex regional pain syndrome type I (relfex sympathetic dystrophy), and chronic pain associated with life-threatening illness.

White Plains Public School Consultation

First-Year Residents
This school consultation provides an experience in mainstream education setting. Residents observe children in the classroom, consult with teachers about normal vs. deviant development, behavioral management, and provide psychiatric assessment when indicated. First Year Residents spend one morning a week for two months during their rotation at Payne Whitney Westchester.

QCPC/ Robert F. Kennedy School Clinic

First-Year Residents and Second Year CAP Track Residents
This school consultation provides an experience in specialized education in a fairly restrictive day program setting. Residents observe children in the classroom, consult with teachers about normal vs. deviant development, behavioral management, and provide psychiatric assessment and treatment when indicated. First Year Residents spend one morning a week for two months during their rotation at Payne Whitney Manhattan. Second Year CAP Track Residents spend one day a week over a 6 month period.

QCPC/Children's Intensive Day Treatment Program

Second-Year CAP Track Residents
This is a sixty day program that provides children with a structured and therapeutic special education classroom setting. The clinical team is involved in the evaluation and treatment of the children and their parents and coordinates and integrates their needs for additional social services. The target population is children ages 5 to 12 who are receiving or are in need of special education services though District 75. They often have significant behavioral and learning issues in school or/and at home. The range of diagnosis includes Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Learning Disorders, Anxiety and Mood Disorders, and Pervasive Developmental Disorder, NOS. The CAP Track residents attend this program one day a week for 6 months in their second year of training.

Social-Skills Group Therapy (Payne Whitney Westchester)

First-Year Residents and Second Year CAP Track Residents
Residents participate in a social-skills group-therapy program on a weekly basis, under supervision, throughout their four-month rotation at Payne Whitney Westchester. These groups vary with regard to age range and diagnosis, but all provide the residents with valuable exposure to the principles and practice of social-skills training.

Children's Anxiety & Depression Clinic (Morgan Stanley Children's Hospital)

Second-Year Residents
The Children's Anxiety & Depression Clinic (CADC) population is 60 percent Hispanic, 20 percent African American, and 20 percent Caucasian. Diagnoses include Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder with Depressed Mood, Panic Disorder, Separation Anxiety, and Post Traumatic Stress Disorder. A variety of treatments are offered and include individual psychodynamic or play therapy, behavior therapy, interpersonal therapy, family therapy, social-skills group therapy for adolescent girls and for prepubertal girls, and psychopharmacology.

Disruptive Behavior Disorders Clinic (Morgan Stanley Children's Hospital)

Second-Year Residents
The Disruptive Behavior Disorders (DBD) Clinic population is approximately 75 percent Hispanic, 20 percent African American, and 5 percent other. The majority of patients are diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or Oppositional-Defiant Disorder (ODD); other diagnoses include Adjustment Disorder with Disturbance of Conduct or Conduct Disorder (CD). The clinic offers advanced multi-modal treatment for ADHD and behavior problems in children, including pediatric psychopharmacology, evidence based behavioral therapy, parent training, and cognitive-behavioral therapy (CBT). Child and adolescent psychiatry residents are assigned families for supervised family therapy.

Pediatric Neuropsychiatry (Morgan Stanley Children's Hospital)

First-Year CAP Track Residents and Second-Year Residents
The clinical population is 40 percent Hispanic, 30 percent African American, and 30 percent Caucasian, and includes all ages up to and including age 17. Most of the children seen in this clinic have developmental disorders, and the majority of these have some degree of mental retardation with or without autistic features. A minority of patients have histories of normal development compromised by neurological problems (e.g., epilepsy, brain tumor) or neuropsychiatric problems (e.g., Obsessive Compulsive Disorder, Tic Disorder, or psychotic disorders). The most common types of behavioral and emotional problems addressed by the clinic include aggression, sleep problems, depression, mood lability, anxiety, and repetitive behaviors.

Evaluation Clinic (Morgan Stanley Children's Hospital)

Second-Year Residents
Residents perform psychiatric evaluations of children and adolescents under direct supervision. Evaluations include interview with the child, as well as parents/caretakers, and acquisition of collateral history. Differential diagnosis, risk assessment, and disposition of patients are done with a supervisor.

CARING at Columbia (Columbia University Medical Center)

Second Year Residents
The target population consists of community children living in the Washington Heights area of upper Manhattan and adolescents attending the Children's Day Unit (CDU). They are middle-school children and adolescents who are exposed to a series of family, social, and school stresses that place them at risk to develop or complicate mental health issues. The children in the community are at risk, and, even though they indicate some symptoms of distress, do not meet criteria for a formal diagnosis. The CDU group of adolescents has a variety of diagnoses according to the research incentives of the unit.

Child & Adolescent Psychiatry Outpatient Department (Payne Whitney Campuses)

Second-Year Residents and Second-Year CAP Track Residents
Residents evaluate and treat children and adolescents up to age 18 at these general pediatric psychiatry clinics. Patients present with a variety of diagnoses: disruptive behavior disorders, depression/anxiety disorder, adjustment disorders, pervasive developmental disorder or psychosis, and mental retardation. Child psychiatry residents participate in routine evaluations and manage a caseload of patients in both long-term and short-term treatment modalities, which include psychodynamic psychotherapy, play therapy, family therapy, and CBT, under the supervision of senior faculty members. Patients requiring medication are referred and monitored in the psychopharmacology clinic.

Pediatric Psychopharmacology Clinic (Payne Whitney Campuses)

Second-Year Residents and Second Year CAP Track Residents
The diagnostic breakdown of patients referred to the psychopharmacology clinics includes ADHD, affective disorders, pervasive developmental disorder and/or mental retardation, schizophrenia and other psychotic disorders, and anxiety disorders, including OCD. The population is approximately 75 percent male and 25 percent female, with ethnic and socioeconomic diversity. The ages range from 3 to 18 years old and into adulthood for people with developmental disabilities (at PWM only). Patients are seen a minimum of every three months and, on average, every six weeks.

Cognitive Behavioral Therapy Techniques

Second-Year Residents and Second-Year CAP Track Residents
Small groups of residents receive ongoing instruction in cognitive-behavior techniques using their own clinical cases.

Family Therapy Techniques

Second-Year Residents and Second-Year CAP Track Residents
Small groups of residents receive ongoing instruction in family-therapy techniques using their own clinical cases.

Parent Training/Parent Child Techniques

Second Year Residents and Second Year CAP Track Residents
Small groups of residents received expert supervision in parent child interaction and parent training using their own clinical cases.

Nursery Observation (Columbia University Medical Center Nursery School)

Second-Year Residents
Residents observe children in routine nursery-school programs under supervision. Time is provided for discussion of child observations.