Child & Adolescent Psychiatry Fellowship

Schedule

Training Sites

• Queen’s Family Treatment Center:  The Family Treatment Center (FTC) is part of Queen’s Medical Center, which is a general medical facility with a 500-bed capacity.  The FTC consists of (approximately, when capacity is full) 16 beds for 5-18-year-old males and females.  There are acute and sub-acute inpatient programs as well as an outpatient component.  Fellows have the opportunity to follow their inpatients post-discharge in the outpatient clinic. There is significant ethnic diversity among the patients.  At least 1/3 of the patients have associated substance use disorders.  Fellows have ample opportunities to learn and perform comprehensive evaluations and various therapies, including individual psychotherapy, group therapy, family therapy, and psychopharmacotherapy.  Fellows also participate in multidisciplinary treatment meetings and learn to collaborate amongst multiple agencies to promote positive outcomes for children and families.  

• Queen’s Youth Partial Hospital Program/Youth Intensive Outpatient Program (YPHP/YIOP):  Gives CAP fellows an opportunity to experience working with patients who are at a mid-level acuity of care.  Patients are referred from outpatient clinics who may require a higher level of care as well as from inpatient and residential settings as a step-down transition from higher levels of care.  The YPHP program is an in-person day treatment setting while the YIOP program is provided through telehealth services.  Fellows will work directly with patients, being able to follow-up with them in a more continuous, long-term setting since many of the patients remain in the programs anywhere from 8-12 weeks or longer.  Fellows may also have an opportunity to utilize various modalities with specific patients they work with either in the in-person or telehealth setting.

• Queen’s Counseling Service:
  • Outpatient Clinic:  Categorical Child & Adolescent Psychiatry fellows (12 months) spend approximately 4-6 hours per week providing supervised long-term psychotherapy for young children, school-age children and adolescents. 

• Queen’s Clinically Integrated Physician Network (QCIPN):  The Queen’s Clinically Integrated Physician’s Network (QCIPN) Mental Health Integration (MHI) Collaborative Care Model (CoCM) is an outpatient program servicing QCIPN’s Primary Care Physician (PCP) and specialist network.  The program offers an evidence-based approach to a patient’s integrated mental health care by focusing on patient populations identified by the physician and supported by the MHI team – creating improvements in patient’s access to care, capacity for the mental health provider communities, and workflows for PCP and psychiatrists.  Fellows will learn to work in an interdisciplinary team which consists of the care managers and PCPs, functioning in a consultative capacity in providing both medication and behavioral interventions for patients.  Fellows will focus on working directly with care managers on how to best serve patients and navigate systems, including working with PCP and other specialists, rural health, and other local mental health resources.

• State of Hawai‘i Department of Health, Child and Adolescent Mental Health Division, Family Court Liaison Branch (FCLB):  There are two sites for FCLB: Hawai‘i Youth Correctional Facility (HYCF) and the Detention Home (DH).  Disruptive behavior problems, adjustment disorders, learning disorders, and/or substance abuse are commonly addressed.  Most youth have been exposed to stressful environments, including parental substance abuse, domestic violence, neglect, and/or physical or sexual abuse.  HYCF is under the state Office of Youth Services, and houses adolescent males and females incarcerated for a period of a few weeks to a few years.  The majority of youth are incarcerated for criminal offenses.  DH is a shorter-term detention facility under the Hawai‘i State Family Court. For many youth this is their entry into the mental health system of care. Fellows spend two days per week during their four-month community rotation seeing youth in these settings.  

• School-Based Behavioral Health: The UH JABSOM Child/Adolescent Psychiatry Fellow(s) will be part of an interprofessional collaborative (IPC) practice team at Olomana School on the HYCF campus.   

• Tripler Army Medical Center: the largest hospital in Hawai‘i is a major teaching center that provides graduate training in General Psychiatry, Child & Adolescent Psychiatry, Pediatrics, and various other specialties.  Child & Adolescent Psychiatry fellows have the following rotations at Tripler Army Medical Center (TAMC):

• Child Study Group (CSG): held in the Child & Adolescent Psychiatry Service, is a multi-disciplinary evaluation clinic for preschool children.  The evaluation team includes a supervising child and adolescent psychiatrist, a speech pathologist, an occupational therapist, a developmental//behavioral pediatrician, an educational coordinator, a psychologist and a social worker.  Each month, an average of 14-15 children are evaluated in two groups: one consisting of 4-5-year-old children, and the other consisting of 2-3-year-old toddlers.  Children referred to the CSG are assigned a primary physician responsible for patient interview, chart keeping and follow-up.  The evaluation begins with history-taking interview with one or both parents.
  
  After the initial interview, the child is seen in the appropriate age group while the parents are seen in a group setting with a social worker for 3 sequential weeks.  Through these sessions, each child is evaluated in the areas of motor development, language development, adaptive and cognitive development.  After each session, team members gather to synthesize the information.  At the end of the third session, each child is discussed by the team members to formulate a diagnosis according to the DSM and to offer recommendations based on the needs of each child.  Parents are usually seen again a week later for feedback, at which time the results of the CSG evaluations are shared with them.
  
  Fellows have the opportunity to follow these young children in their continuity clinics their 1^st and 2^nd years of training.  Fellows on rotation are expected to be on-site from 8:15 am to 12 noon every Tuesday during their four-month community rotation.  On non-Child Study Group Tuesdays, you will evaluate preschool-age patients for an individual intake prior to seeing the same children in the group setting.

• Observation of Normal Preschool Children: Seminar includes assigned readings, discussion and observation of children at the Fort Shafter Child Development Center. The fellow will learn to accurately observe and record the behaviors of children in the day care setting. The fellow will be introduced to normative scales, descriptions, and developmental models to use as guidelines in observing and rating children.
  
• Pediatric Neurology occurs in the outpatient Pediatric Neurology Clinic (Kapiolani Medical Center for Women & Children during the CL rotation), where children of all ages, genders, and ethnicities are evaluated and treated.  Under supervision, fellows learn to take a detailed neurodevelopmental history, perform a thorough neurological examination, and develop a differential diagnosis for children who present with neurological symptoms.  During this rotation, the supervising pediatric neurologist provides informal lectures on common neurology topics such as seizures, non-epileptic “spells,” evaluation of the child with developmental delay, pediatric headache, tics and Tourette syndrome, neurocutaneous disorders, and organic conditions presenting as psychiatric disease.   

• Kapi‘olani Behavioral Health Service (KBHS) consists of two major components:
  • The KMCWC inpatient pediatric consultation-liaison service provides:
    • Experience in inpatient pediatric consultation/liaison at the premier pediatric and perinatal medical center of Hawai‘i and the entire Pacific Basin.
  • The outpatient portion of KBHS complements the inpatient consultation-liaison service at KMCWC and provides:
    • Experience in longitudinal outpatient care for children and adolescents, including those with medical illnesses needing pediatric specialty care, and
    • Exposure to the day-to-day realities of outpatient practice.
      
• Straub Medical Center Honolulu Clinic (Outpatient Program):  Straub psychiatrists and psychologists offer a full range of clinical services to adults, adolescents, children and families who are experiencing emotional, personal or social difficulties.  They treat mood disorders, stress-related problems, phobias, panic and anxiety disorders and serious mental illness.  They provide individual, couple and family therapy to treat mood disorders, psychosomatic complaints, depression, stress-related problems, phobias, anxiety, panic disorders and serious psychiatric illness.  Medicine is prescribed when required.  Straub’s staff offers psychological testing, behavior modification, cognitive therapy, relaxation training and hypnosis.  This rotation will focus on community mental health and in the future a collaborative care type model.