Child Psychiatry
Child and Adolescent Psychiatry Training
at Harbor-UCLA Medical Center
OVERVIEW
Who We Are
The Child and Adolescent Psychiatry Fellowship at Harbor-UCLA provides a two-year program of specialized training in child and adolescent psychiatry. Harbor-UCLA is a joint venture of the Los Angeles County Department of Health Services, the Los Angeles County Department of Mental Health and the University of California at Los Angeles. As one of the 3 public hospital in Los Angeles County, Harbor-UCLA is the community safety-net hospital for nearly 3 million people. Our public mission is to provide the highest quality care for our main patient population: low income, underserved minorities.
Who we treat and where you train
Child and adolescent psychiatry fellows gain experience with a wide variety of patient populations, diagnoses, and treatment settings. Although at Harbor-UCLA, the main patient population are youth with public insurance or no health insurance, in your rotations in at UCLA Westwood and during your elective time, you will work with more middle-class, insured groups. Both at UCLA Westwood and at Harbor-UCLA, fellows will gain experience with the variety of systems that care for our youth: school, foster care, juvenile justice, and the Regional Centers (developmental disability) that are key partners in improving the mental health outcomes and functional status of our patients.
Our vision of training
The Harbor-UCLA Child and Adolescent Fellowship is designed to offer fellows a well-balanced clinical experience with broad exposure to children and families who need assessment, treatment, and the prevention of psychopathology.
What you learn
Fellows are taught to view patients and their families from a developmental perspective using a variety of orientations: psychodynamic, psychosocial, biologic, behavioral and cognitive. Both competence and compassion are stressed. Fellows are taught to think rigorously about diagnosis, as well as to be conversant in evidence-based treatment in child mental health.
Fellows are expected to gain experience following patients longitudinally in preparation for practice after fellowship. There are multiple opportunities for trainees to develop growing competence in a variety of domains: clinical service, consultation, teaching, and administration.
What we hope for you when you graduate
Upon successful completion of the program, fellows will be qualified for competent independent practice in both child and adolescent psychiatry and adult psychiatry, and will be eligible for examination by the respective specialty and subspecialty Boards for certification. They will be equipped to begin careers of leadership in service, teaching, and administration, particularly in public sector child and adolescent psychiatry. Upon completion of the program, the fellows are expected to exhibit the core competentencies of patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice.
Specifically, upon graduation our fellows should be able to:
1. Understand normal child and adolescent development and have developed the skill to differentiate normal from abnormal development
2. Conduct a comprehensive psychiatric evaluation that takes into consideration biological, psychological, behavioral and socio-cultural dimensions of children, adolescents and families
3. Demonstrate both diagnostic and treatment planning skills
4. Be comfortable evaluating and treating a broad spectrum of psychopathology, including neurologic and other organic disorders, mental retardation, developmental disabilities, learning disorder, the full range of DSM-IV Axis I and Axis II conditions including but not limited to substance use and alcohol disorders and psychosomatic disorders
5. Recognize and manage acute crises, including suicidal and homicidal behavior. Feel comfortable and competent functioning as a part of a multidisciplinary evaluation and treatment team that includes pediatricians and other medical specialists, clinical psychologists, social workers, nurses, speech and language therapists, audiologists, teachers and representatives of community and social service agencies
6. Provide the major treatment modalities, including long-term and time-limited individual psychotherapy, psychodynamic psychotherapy, play therapy, supportive therapy, family therapy, pharmacotherapy, crisis intervention, cognitive behavior therapy, and combined psychotherapy and psychopharmacology. The fellow should be able to carry out these treatments in a wide range of settings, including outpatient clinics, legal settings, schools, pediatric inpatient units and within a general hospital emergency department
7. Work with patients and families in a logitudinal manner, addressing needs as they are identified, referring to other specialists or community resources as needed and terminating with patients as appropriate
8. Target treatment modalities to a child’s diagnosis
9. Function as a consultant to other medical and non-medical professionals in pediatric settings, courts, schools and a wide range of social and community health centers and agencies
10. Teach trainees in other disciplines, parents and staff of community and social agencies
11. Use research methodology and knowing how to critically evaluate the child mental health literature
TRAINING
CAP I Training
CAP I Rotations
Inpatient/Partial Hospitalization
During the first year, fellows rotate for 4 months at the Semel Institute on the UCLA Westwood Campus. During this rotation, the are supervised by Dr. De Antonio on the inpatient unit and by Dr. Suddath when they follow patients in the partial hospitalization program. The fellows follow their inpatients into the partial hospitalization program. Fellows work closely with the psychologists, educational experts, social workers and other clinicians to care for their patients and thus, learn about multi-disciplinary treatment. Fellows attend case discussions and lectures on the eating disorders unit.
Consultation/Liaison
CAP I fellows not rotating on inpatient and partial hospitalization at UCLA Westwood Campus are responsible for consultation to the pediatric unit and the emergency rooms three days a week. These experiences are supervised by Drs. Grob and Chung.
Outpatient Treatment
CAP I fellows treat children and transitional age youth in the Harbor-UCLA outpatient clinic. They provide medication treatment services for patients in treatment with other clinicians and see new assessments in Dr. Grob’s assessment clinic and in intake clinics with Drs. Lee and Yagoubi. Fellows are encouraged to have a variety of ages and diagnoses represented in their practices. They are encouraged to have a variety of kinds of involvement in their cases: shared cases with other clinicians, patient for whom they provide both medication and therapy and, when indicated, patients for whom they only provide therapy.
Intake Clinics
CAP I fellows assess new patients once a week with Dr. Grob and several times a month with child psychiatrists Dr. Lee or Dr. Yagoubi. This offers fellows the opportunity to see experienced child psychiatrists assess children and to receive individual feedback and teaching.
CAP I Didactics
CAP I fellows receive three to four hours of didactics at UCLA Westwood Campus one morning a week. Each week they also have two hours of didactics at Harbor-UCLA. Fellows are encouraged to work on one to two cases with Dr. Tangeman in his behavioral assessment program. Fellows can go with Dr. Tangeman to the child’s school and home and learn how to develop and implement an expert behavior plan for oppositional children. Didactics at Harbor-UCLA are taught by both full-time, visiting, and volunteer faculty.
CAP I SUPERVISION
All CAP I fellows are supervised individually and weekly by Dr. McKenna and also receive weekly individual supervision with Dr. Lee and Dr. Yagoubi during intake appointments.
CAP II Training
CAP II Rotations
TIES for Families
Fellows work with TIES for Families, a program that focuses on young children and enhancing adoption experiences for families, a day a week for six months. At TIES for Families the fellows are supervised by Karen Rathburn, Ph.D. They observe assessments of young children, occasionally provide psychopharmacology consults, and participate as part of a multi-disciplinary team. They also attend lectures and learn evidence-based approaches to parenting such at Parent-Child Interaction Therapy.
Sub-Specialty Clinic
Fellows work for six months with Dr. McKenna, developing a clinic within the Harbor-UCLA clinic that serves four purposes: 1) to provide further assessment of children seen in the emergency room at Harbor-UCLA, 2) to provide prompt follow up for children in the Harbor-UCLA catchment area who have recently been dicharged from a psychiatric hospital, 3) to provide teaching of child psychiatry to residents in pediatrics, child neurology and family medicine who must have child mental health training as part of their residency curriculum, and 4) to provide opportunities for CAP II fellows to mature in teaching, consulting and supervising under the supervision of Dr. McKenna.
Outpatient Treatment
During the second year, fellows continue to follow their outpatients. They provide medication management to patients in the Dialectical Behavior Therapy service. The do fewer initial evaluations than the CAP I fellows.
Elective Rotations
At the end of the first year, fellows meet with Dr. McKenna to plan their elective time. Fellows may broaden or deepen their interest areas by taking advantage of established electives or working to develop a new elective when possible. Current fellows are rotating at the UCLA Westwood Campus in the Anxiety, OCD and Tourette’s program, the Couples and Family Therapy program, the partial hospitalization program for young children, and the Parenting and Friendship program for children with autism spectrum disorders. There is a Child Maltreatment, Advocacy and Forensic elective established at Harbor-UCLA in conjunction with pediatrics in which a child fellow can join the multidisciplinary team of pediatricians and psychologist to provide mental health assessment and consultation, teaching and liaison to community services while learning from the other members of the team. On this elective, fellows have the chance to attend multidisciplinary conferences regarding medical aspects of child maltreatment and to watch one-way mirror interviews of children who may have experienced abuse. There are other electives at Cedars Sinai and at USC and additional electives are in the process of being developed.
CAP II Didactics
Fellows have 6 months of specialty training with Dr. Berk, two hours a week, to learn Dialectical Behavior Therapy and are part of the DBT team. Each fellow co-leads at least one DBT group. They receive an hour and a half a week training from Dr. Shelby in Cognitive Behavior Therapy. Fellows have a weekly seminar on the Harbor campus in which they read about and discuss more advanced topics in child and adolescent psychiatry.
CAP II Supervision
CAP II fellows receive half an hour DBT supervision from Dr. Avina and group supervision in the DBT program. The fellows have supervisors while rotating on required and elective rotations and have one additional individual supervisor.
Additional Information
Call
CAP I and II fellows provide evening telephone consultation to residents in the ER who are evaluating children or adolescents. There is always faculty back up. Fellows do not need to come into the hospital in the evening.
Meals
Three free meals a day are provided by the cafeteria. When fellows rotate off campus, they may claim reimbursement for up to $25 a day.
Parking
Parking is free on the Harbor-UCLA campus but is difficult to find after 9:30. Parking is available on surrounding streets. At the UCLA Westwood campus, parking is $9-$11 a day. This is offset by the opportunity to buy groceries with the meal stipend.
Additional educational opportunities
The Child and Adolescent Division has Grand Rounds on the second and fourth Wednesday of the month. Outside speakers, faculty and trainees present topics and cases. Periodically, there are case conferences in which particularly interesting or difficult cases are discussed from a multi-disiplinary perspective. General Psychiatry Grand Rounds are held every week.
Moonlighting
Moonlighting is permitted on an individual basis after the first six months. Fellows who have transferred from the Harbor residency program may apply to moonlight Friday or Saturday nights before six months into the child psychiatry fellowship. If residents from other programs are interested in doing this, they may talk to the director of the ER to see how to qualify for moonlighting.
Accreditation
Harbor-UCLA is accredited by the Joint Commission for Accreditation of Hospitals. The Training Program is approved by the Accreditation Council of Graduate Medical Education’s Residency Review Committee for two years of training. The fellowship is accredited through the Accreditation Council of Graduate Medical Education (ACGME).
Salary and Benefits
See www.harbor-ucla.org for full details. Currently, PGY IV salary is $4784.95/month and PGY V is $5120.20/month. The county offers generous vacation, sick leave, disability insurance, medical and dental insurance and a pension savings plan.
For further information, please contact:
Kathleen McKenna, M.D., Director, Child and Adolescent Psychiatry Education