Thomas Jefferson UniversitySidney Kimmel Medical College

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Rotations

We are fortunate to have a variety of clinical settings through which our Child and Adolescent
Program Fellows rotate:

First Year Rotations

Fellows’ rotations occur at three sites during the first year of training: Belmont Behavioral Health, Einstein Crisis Response Center at Germantown Campus and at Thomas Jefferson University Department of Psychiatry and Human Behavior Outpatient offices.

Child Unit   Each fellow will spend three or four months on the Child Unit at the Belmont Center for Comprehensive Treatment. The children’s unit can admit up to twelve children between the ages of five and twelve. The Fellow rounds with the team, which consists of the attending, resident, medical student, nurse, two social workers, psychologist, teacher and BRIDGE representative. Generally, the fellows carry approximately eight patients. During the day, occupational therapy groups lead activities with the children that include constructive expression of emotion, creative activities and health education. Three to four nursing assistants also participate in the care of the children. A pediatric consultant is available regularly on weekdays. About once a month, “pet therapists” visit the unit with their trainers.

Adolescent Unit    Each fellow will spend three or four months on the Adolescent Unit at Belmont Behavioral Health. The adolescent unit can admit up to eighteen teens ages thirteen to eighteen. This team is led by Dr. El Gabalawi, and consists of two nurses per shift, three social workers, psychologist, four to five nursing assistants per shift, the teacher, residents, medical students, and BRIDGE representative. The fellow generally carries eight patients on this service and can oversee residents and medical students. In addition to activity groups, the teens also have group therapy, as well as unstructured free time. A pediatric consult is available regularly on weekdays.

Crisis Response Center    Einstein Crisis Response Center (CRC) at Germantown is the only psychiatric emergency service for youth designated by the County Office of Mental Health for Philadelphia. Adjacent to the adult crisis response center, the children’s CRC has considerable expertise in issues specific to the population.  A full-time social worker and mental health worker staff collaborate with the child psychiatrists to assess and plan for the disposition of patients presenting in crisis. A Family Advocate from the Parent’s Involved Network is available to meet with families and assist families in navigating the oftentimes complicated educational, child protective services, juvenile justice, and mental health systems.

At the CRC, the fellow works with an attending Child and Adolescent Psychiatrist who is present on the service with the fellow for the entire shift. The supervisory experience at the CRC can be individually tailored to the rotating fellow’s interests and requirements. At times, the fellow may evaluate patients with the attending, or if the Crisis Response center is busy, work independently yet side-by-side with the attending. In 2006, there were 3400 visits for children and teens to the Crisis Response Center. During this rotation, fellows’ exposure to the city-wide referral base (and often referrals from out of county) builds extensive experience. The CRC rotation provides hands on experience with legal and educational systems and the children’s protective services that impact the family. This results in fellows being adept at managing a variety of emergencies with consistent attending supervision, and without sleep deprivation.  The significant training advantages of this “day shift” crisis service rotation allows the Jefferson child and adolescent psychiatric fellowship  to avoid the use of overnight on call coverage in the CRC or  in other clinical settings. 

Second Year Rotations

As during the first year, four weeks of vacation may be taken. The fellow should distribute these evenly amongst the rotations, coordinating with attendings at the sites.

Council for Relationships    Here the second year fellow will take a class in family therapy, taught by Steven Treat, D.Min. Class occurs on Monday mornings from 9 – 12 pm from September through November. The class is open seminar format with readings.  The second year fellows have the opportunity to use their elective rotation block to pursue further work in family therapy in the clinical service at the Council for Relationships.  They also receive weekly group supervision at Jefferson’s child and adolescent outpatient psychiatric service with Matthew Wintersteen, Ph.D. - Dr. Wintersteen is a full time faculty member in the child division who is an expert in family therapy and has conducted funded research involving family therapy interventions.

Outpatient Clinic at Jefferson    Beginning in the first, year and continuing through the second year, the fellow will establish an outpatient caseload of child and adolescent patients and their families. Fellows are responsible for arranging new patient evaluations with the Intake Coordinator.
This rotation starts during the first year and continues the entirety of the second year. The fellow will maintain her/his own outpatient schedule. This permits child psychiatry fellows to cultivate a “private practice” experience and to develop the skills necessary to maintain such a practice after graduation. During this time, the fellows schedule and manage their own patients, adding as opening arise to their “continuity” outpatients accumulated during the first year of training. In addition to addressing HMO or private pay scale issues and managing the patient’s payment, fellows can determine which modality of treatment will best suit the patient and implement a long or short term treatment strategy, from cognitive therapy to family therapy to medication management to psychodynamic play therapy.  A continuous psychodynamic case conference at Jefferson and group supervision in family therapy directly support psychotherapeutic skills acquisition. 

Pediatric Neurology Clinic    During one block, fellows will participate in a pediatric neurology clinic at Jefferson. One morning a week, fellows rotate through the Pediatric Neurology clinic from 9 am – 12 noon. The Pediatric Neurology attending is Charles Brill, MD.  During the Pediatric Neurology clinic, the fellow will perform neurological exams on children and adolescents under the attending’s supervision and will work directly with the attending to establish neurological diagnoses and treatment interventions.  .

Child Psychiatry Consultation Liaison Service at duPont Children’s Hospital   During the entire second year, the fellow works 1-2 half days a week on the child psychiatric consultation liaison service at duPont Children’s Hospital.  duPont Children’s Hospital is a regional tertiary care facility with a strong reputation for its quality of pediatric care and service to the community, and has maintained a direct academic affiliation with Jefferson Medical College for decades.  The hospital is located in Wilmington, Delaware and is a fifty minute drive from Jefferson’s campus.  The fellow works directly with an attending consultation liaison child psychiatrist at duPont in providing clinical coverage to both inpatient and outpatient pediatric settings that include a wide range of subspecialties in pediatric medicine.

Terry Psychiatric Children’s Center- Day Hospital Program for Preschool and Early School Age Children   During the second year rotation blocks, the fellow spends 1-2 mornings per week at the Terry Psychiatric Children’s Center, a long term day hospital program located in New Castle, Delaware, which is a 50 minute drive from Jefferson’s campus.  The fellows work directly with a  volunteer child and adolescent psychiatric faculty member at the Terry Center, providing comprehensive psychiatric assessments and ongoing multidisciplinary treatment for preschool and early grade school children with psychiatric diagnoses that require more intensive community based treatment interventions.  The fellows attend the psychological testing evaluation sessions of at least one student during the rotation, including a team meeting in which the psychologist presents the testing results, diagnostic assessment, and clinical/educational recommendations.

Forensic Rotation at Philadelphia Family Court   During one of the second year rotation blocks, the fellow attends a forensic rotation based at Philadelphia Family Court one morning per week.  During this experience, the fellow works on site with an attending child and adolescent psychiatrist specializing in forensic issues.  The fellow on each day in attendance follows 1-2 cases presenting to Philadelphia Family Court for mental health assessment, interagency disposition planning conferences, or court hearings through either the dependency or juvenile justice sides of the court.  The fellow completes a forensic child and adolescent evaluation and composes a comprehensive clinical report under the attending psychiatrist’s supervision. 

Bache Martin Elementary School Rotation   During one of the second year rotation 4 month blocks, the fellow attends a school consultation rotation at Bache Martin Elementary School one morning every other week.  Bache Martin is a K-8 elementary school in teh School District of Philadelphia with a mix of students from an inner city minority background, as wellas from working  and middle class families from the surrounding gentrified neighborhood.  The fellow collaborates with a senior teacher at the school to observe classrooms and students of different grades in regular and various special education classroom settings.  The morning ends with an informal lunch meeting with a small group of teachers in which student observation discussion and specific consultation issues can be addressed.  The fellow receives weekly individual supervision from a core faculty member regarding the experience.

Child and Adolescent Intake Rotation   During one of the second year 4 month rotation block, the fellow works one afternoon per week directly supervising third and fourth year general psychiatry residents in completing 1-2 outpatient psychiatric evaluations of patients ages 6-17.  The fellow supervises appropriate clinical assessment, diagnosis, and treatment planning for the patient.