Child and Adolescent Psychiatry Curriculum

During the first year, emphasis is placed on mastering clinical care in the inpatient setting. Inpatient rotations where fellows are exposed to acute care include the Adolescent Psychiatry unit at Valleywise Behavioral Health Center – Mesa as well as a Specialized Needs Unit for children and adolescents with developmental disabilities at Aurora Behavioral Healthcare. Fellows also participate in a residential treatment center program at Devereux Arizona and a child neurology rotation at Phoenix Children's Hospital. The outpatient experience begins in the first year as well at the Valleywise Behavioral Health Center – Mesa Outpatient Clinic where the aim is to provide a longer-term treatment experience with a variety of patients, including those that are uninsured and underinsured, exposing fellows to the evolution of therapeutic progress in their patients. After the successful completion of Year 1, fellows will be eligible to take the Psychiatry ABPN exam, contingent on the successful completion of ABPN and ACGME requirements for psychiatry training prior to fellowship.

During the second year, fellows master outpatient treatment and consultation in various settings. Fellows are trained and supervised in a variety of treatment modalities, including individual child psychotherapy (psychodynamic, cognitive-behavioral, supportive, and play therapy), parent guidance, crisis intervention, and pharmacological treatments. The outpatient experience started in the first year continues at the Valleywise Behavioral Health Center – Mesa Outpatient Clinic with additional DMG/Valleywise Health outpatient experiences at the Valleywise Community Health Center-Mesa, and Children’s Rehabilitative Services. Fellows also rotate through community settings for a wide range of clinical experiences. Off-site rotations include Childhelp Children’s Advocacy Center of Arizona (an integrated investigation and treatment center addressing child maltreatment), Southwest Human Development (a non-profit agency specializing in treating children from birth to five years of age), and Hu Hu Kam Memorial Hospital (a healthcare setting within the Gila River Indian Community). In addition to outpatient treatment and consultation, fellows participate in a rotation teaching child psychiatry to general psychiatry residents, as well as an Administrative Psychiatry rotation at MercyCare. After completion of Year 2, graduates of the program will be eligible to take the ABPN child psychiatry exam.

Fellows are assigned by the chief fellow. There is no in-hospital call, only at-home call for fellows’ continuity clinics at Valleywise Behavioral Health Center-Mesa. Calls rotate on a weekly basis, meaning an anticipated frequency of about every 8th week. Backup is provided by an on-call attending.

Note: any required rotations may be scheduled as electives after the required rotation is completed.

1. Outpatient Practice Elective-Private or Hospital
a. Redemption Psychiatry
b. Serenity Psychiatry
c. Lighthouse Psychiatry

2. Community Outpatient Elective
a. Gila River Indian Community - Clinics in Sacaton or Laveen
b. Southwest Behavioral Health Autism Center of Excellence
c. First Episode Center

3. Telemedicine
a. Serenity Psychiatry

4. Psychotherapy Electives
a. . Family & Group Therapy Elective – Valleywise Behavioral Health-Mesa Campus
b. Southwest Human Development – Infant & Preschool Home Therapy observation

5. Administrative Psychiatry Elective
a. Administrative Elective at Valleywise Behavioral Health Center-Mesa

6. Teaching Elective
a. Medical student teaching opportunities at Valleywise Behavioral Health-Mesa, Creighton, Mayo, etc.

7. Forensic Elective
a. Forensic Counseling and Evaluations, P.L.L.C.

8. Non-Clinical Electives (4 hours per week)
a. Academic Elective
b. Career Development Elective
c. Board Review Elective

The didactic schedule is designed to meet the unique needs of both first- and second-year fellows. While some classes are specifically for select years, such as introductory inpatient and practice parameter courses for first years and transition to independent practice classes for second years, most didactics combine first and second year fellows. This class size of eight allows for significant fellow interaction, useful in therapy role plays and other group learning activities, as well as promoting cohesion within the program. Second year fellows often participate in teaching concepts to first year fellows, sharing their experience and knowledge, solidifying their identity as child psychiatrists committed to life-long learning. Classes meet biweekly for a total of seven hours of didactics per week, including child psychiatry grand rounds. Time to attend classes is protected. The curriculum is designed to ensure a comprehensive training experience, exposure to the major theories of child development and psychiatry and integration of different models of care in an evidence-based framework.

This series covers child development from conception to early adulthood. Topics include physical development, CNS development, cognitive development, and gender differences. Classic papers are presented. Theories of personality, social, and intrapsychic development are discussed. Common childhood problems are addressed (e.g., fears, sleep, parental divorce and death, sibling relationships, peer relationships, eating problems, etc.). This course is held weekly over a 6-month period each year.

During each clinical case conference, one case is reviewed with a focus on diagnoses, formulation, data gathering, and therapeutic recommendations. Fellows and staff present the cases, with discussion among faculty and fellows. Legal and ethical issues are discussed when pertinent. Psychological evaluations and school observations may also be reviewed. Conferences generally occur weekly, as needed.

This seminar integrates teaching about the range of childhood psychiatric disorders as well as contextual presentations of child patients (i.e., family interaction challenges, school difficulties) with their psychopharmacologic management. Sessions are taught using case-based, evidence-based and problem-solving approaches. Skills in evaluating children and adolescents at different developmental stages are taught, with an emphasis on learning board-style presentation skills. Assessment and treatment planning, as well as legal issues and ethics, are discussed. This seminar is held weekly over the course of two years.

Initially, a review of different types of treatment and psychotherapy techniques is conducted. Related reading is assigned, including presentations on different methods of psychotherapy. Readings and video presentations are supplemented with discussion of specific cases. Utilization of webcam recordings of therapy sessions helps fellows to refine therapy skills. Models discussed in conference include psychodynamic, play therapy, cognitive-behavioral, family therapy, parent guidance, supportive therapy, group therapy, interpersonal process and behavioral approaches. This seminar is held weekly over two years and led by an attending psychiatrist and a clinical psychologist.

Current articles in child and adolescent psychiatry are assigned. Fellows present on varied topics with discussion by fellows and faculty. Critical evaluations of papers, studies and research are conducted. Evidence-based practice is emphasized. This seminar occurs monthly.

This seminar is held for one hour every month. Cases with additional learning opportunities are identified from the Consult-liaison or Inpatient services. A systems-based approach is utilized for analysis of cases with learning goals including identification of potential quality improvement projects.  Modalities include chart review or case-based learning sessions from any site/case a fellow has been involved in personally. Confidentiality and professionalism are core features of this seminar and a confidentiality statement protected under peer review is signed at the beginning of each session.

This seminar includes 12 one-hour sessions per year reviewing anatomical structures and pathways related to behavior, neurotransmitters and mechanisms of signaling, and commonly occurring neuro-psychiatric disorders. Fellows will develop a theoretical neuro-psychiatric framework for understanding and explaining psychiatric symptoms and disorders. Interactive learning techniques from the National Neuroscience Curriculum Initiative are utilized.

The following mini courses are also presented in a two-year rotation

• Administrative Psychiatry
• Child Neurology
• Consultation-Liaison Psychiatry
• Cross-Cultural Child Psychiatry
• Ethics in Child and Adolescent Psychiatry
• Forensic Child Psychiatry
• Psychiatric Advocacy
• Systems-Based Practice
• Integrative Medicine (Five sessions yearly)
• Research Design and Analysis (Seven sessions at the start of each year)