CHILD AND ADOLESCENT PSYCHIATRY RESIDENCY PROGRAM
Director, Education & Training: Emily Frosch, M.D.
Each year of training is designed to provide the resident with both breadth and depth of experiences. The first year is based on a block rotation design for hospital services while the second year is a series of longitudinal outpatient placements.
YEAR 1
Click here for Sample Rotation Schedule (PDF)
The first year of training focuses on the principles of diagnosis and treatment of children, adolescents, and their families who present primarily in the hospital setting; specific interview techniques in working with children, adolescents, and their families; adaptation of the principles of psychopharmacology to children and adolescents; and an appreciation for the system of care that surrounds children.
First year clinical rotations include:
• 6 months on the 12-bed General Child and Adolescent Psychiatry Inpatient Unit
• 2 months on the 4-bed Adolescent Affective Disorders Inpatient Unit
• 2 months in the 6-patient Day Hospital
• 2 months on the Pediatric Consultation Liaison Service
• Resident Continuity Clinic
• On-Call Coverage
A full-time faculty member directs each rotation and provides supervision and oversight for all the clinical work.
The General Child & Adolescent Psychiatry Inpatient Unit serves seriously emotionally disturbed youngsters and their families. The unit is designed to assess and stabilize acute psychiatric dysfunction through pharmacologic, behavioral, and systems oriented interventions. Nearly 400 children are treated annually on this service with an average length of stay of 8 days. Knowledge, skills, and attitudes necessary for the assessment, diagnosis, case formulation, and treatment planning for youth with serious emotional disturbance, and interdisciplinary team leadership are developed through daily faculty supervision and work with severely disordered children and their families.
The Adolescent Affective Disorders Unit serves teenagers with serious affective illness in need of intensive inpatient services. This service is led by faculty with particular experience and expertise in working with these patients and their families. Knowledge, skills, and attitudes necessary for the optimal management of adolescents with severe affective illness requiring inpatient care is the focus of this rotation. Individual and family work, therapeutic groups, and psychopharmacological management all contribute to the milieu treatment approach.
The Day Hospital provides “step-down” care from the inpatient service and “step-up” care from outpatient programs for children aged 6-17 years. Length of stay ranges from 1-3 weeks, and ongoing medication management, family work, individual treatments, and coordination of services is offered. Knowledge, skills, and attitudes necessary for optimal management of youth needing intensive outpatient programming is the focus of this rotation.
The Consultation Liaison Service provides clinical assessments, treatment, and referral resources for any child hospitalized in the Johns Hopkins Children’s Center. The service focuses on the collaborative relationship with Pediatrics and on the process of consultation, helping residents to understand their role as a consultant. Daytime consultation is also provided to the Pediatric Emergency Department. In addition, each resident spends one afternoon a week in Pediatric Neurology Clinic seeing children with a range of neurological disorders with Pediatric Neurology faculty.
The Division has an active research program with a large emphasis on clinical treatment research.The Research Clinic provides an opportunity for trainees to participate in a variety of research protocols. Residents learn about study design and methodology and provide pharmacotherapy to patients enrolled in specific studies. All of this is conducted under the supervision of senior faculty and the research coordinator staff.
The Resident Continuity Clinic provides an opportunity for trainees to work in a longitudinal outpatient setting with patients and families. All cases are assigned by the Training Director and attention is paid to balancing age, gender, and diagnoses. These cases are supervised by longitudinal supervisors for the year, each of whom meets weekly with the resident.
On-Call experiences provide an opportunity for residents to develop competency and confidence at rapid assessment and triage of youth presenting for emergency consultation. Emphasis is placed on safety, and all cases are staffed by faculty to ensure supervision and discussion of the case and disposition plan.
YEAR 2
Click here for Sample Rotation Schedule (PDF)
The second year focuses upon the diagnosis and treatment of children, adolescents and their families who present primarily in the outpatient setting. Residents develop greater knowledge of and skill with a variety of therapeutic interventions, and address issues in community, court, and school consultation. There are opportunities to develop research skills and participate in ongoing research with faculty support and guidance. The second year of training is comprised of several outpatient experiences in a longitudinal design. Each resident spends approximately a day a week for the year in a variety of clinical programs including:
• Specialty Clinics
• Community Psychiatry Program
• Kennedy Krieger Institute’s Developmental Disabilities Programs
• Resident Continuity Clinic
• Adolescent Substance Abuse Treatment Program
• Preschool Intensive Outpatient Program
• Varied elective opportunities
The Specialty Clinics at Hopkins include Affective Disorders, Anxiety Disorders, OCD & Tic Disorders, Psychopharmacology Consultation, Developmental Neuropsychiatry, and Disruptive Behavior Disorders including ADHD. All of these clinics provide both evaluations and ongoing care for children, adolescents, and their families. Faculty direct these clinics that reflect their individual expertise and see every patient at every visit with the residents. Emphasis is placed on comprehensive diagnostic evaluations, careful differential diagnoses, and intensive treatment planning. These clinics often provide second opinions or consultation to community clinicians, and effective communication is critical.
The Johns Hopkins Pediatric Psychiatry Community Programs provide extensive community-based care through collaboration with schools, courts, and social agencies. Clinical programs include a Children’s Mental Health center, a School -Based Consultation Program, and a Family Resource Coordination Unit comprised of case management and home-based services. Each second year resident completes diagnostic assessments and provides ongoing treatment to patients and families in the Community Mental Health Center in addition to providing on-site consultation to full-time clinicians in two schools over the course of the year. At both sites, emphasis is placed on the knowledge, skills, and attitudes necessary to be an effective Child and Adolescent Psychiatrist in a community care setting.
The Kennedy Krieger Institute offers training in the diagnosis and treatment of children with autism and pervasive developmental disorders, mental retardation, and other developmental disabilities. Second year residents work side by side with full time faculty members in specialty clinics that include preschool aged children, children with genetic syndromes such as fragile X, and behavioral teratology. Residents also participate in the Autism Diagnostic Center, a comprehensive multidisciplinary program for children with autism. Emphasis is placed on the knowledge, skills, and attitudes necessary to work effectively with developmentally disabled youth and families in need of mental health services.
Residents continue to follow their own outpatients in Continuity Clinic in Year 2 and develop their skills in individual therapy, cognitive-behavioral therapy, family therapy, parent management training, and pharmacologic therapy.
Mountain Manor Treatment Center is an Adolescent Substance Abuse Treatment Program located in Baltimore, MD providing services over a continuum of residential to outpatient settings. Second year residents rotate through this program under the mentorship of a full time faculty member. The objective of this experience is to become familiar with the differential diagnosis and management of the various substance use disorders and co-occurring psychiatric disorders. Residents will also gain experience in engaging and motivating the patients to change, interacting with the multidisciplinary treatment team, involving family in treatment and coordinating associated agencies and/or systems in developing and implementing a suitable treatment plan during treatment and after-care plans for post-discharge.
The Preschool Intensive Outpatient Program provides residents with the opportunity to learn skills in the assessment, diagnosis and treatment of children under age 5. Second year residents rotate through this service one half day/week for four months and work closely with a senior faculty member and a treatment team dedicated to this population. Over the course of the second year, residents participate in a longitudinal elective experience in conjunction with specific clinical or research settings and/or specific faculty members. Throughout the fellowship, there is a comprehensive didactic program that links clinical experiences and theoretical knowledge.
