Child Adolescent Psychiatry Curriculum

Inpatient at Nationwide Children’s Hospital

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Nationwide Children’s Hospital has three inpatient units where youth are admitted for varying issues, for an average length of stay of 8-10 days. 7B is structured mainly for child/younger patients, while 8A is structured more for adolescent patients. 7A is called the neurobehavioral unit and is designed for those with intellectual disability, Autism Spectrum Disorder or severe aggression as patients are typically on one-to-one staffing and facilities are designed differently than typical units (e.g., padded walls)..

Youth Crisis Stabilization Unit (YCSU)

The YCSU provides an alternative to psychiatric inpatient hospitalization with an average length of stay of under three days. The YCSU is a 10 bed unit that provides assessment by both a psychiatrist and a masters-level clinician, as well as brief individual and family psychotherapy with multiple daily sessions. The goals of the unit are to provide a family-centered care approach to help youth and families understand what led to the crisis event, to identify and develop healthy coping skills to decrease future crises or need for psychiatric inpatient hospitalization and to improve commitment to ongoing mental health counseling in the community. Follow-up sessions are available to help bridge while families wait to link with ongoing treatment. Fellows will participate in initial assessment and treatment during the patient’s brief stay, with the option to follow them as an outpatient provider in the bridge clinic and beyond.

Consultation Liaison Psychiatry Service

Consultations at Nationwide Children’s are managed in a collaborative fashion with the Department of Psychology. Mental health assessment, treatment and assistance with referral to outpatient care are provided to any child cared for in the hospital. Fellows also rotate through the various outpatient clinics in the Department of Psychology. In these clinics, there is concentration of care in specialty areas such as cardiology, transplant, gastroenterology, weight management, oncology and pulmonary. Clinics provide extensions of behavioral interventions offered to children and their families after discharge from the hospital. 

Child Development Center / Center for Autism Spectrum Disorders

Together the Child Development Center (CDC) and the Center for Autism Spectrum Disorders (CASD) at Nationwide Children’s Hospital provide comprehensive, multidisciplinary care focusing on evidence-based treatment, education, research, and advocacy for children with the diagnosis of an Autism Spectrum Disorder and Intellectual Developmental Disorders/Developmental Delays. Fellows participate in the evaluation of children and adolescents as a member of the treatment team. They see patients for whom the diagnosis of Autism Spectrum Disorder has not yet been established and children whose families are struggling with symptom management.

The Center for Family Safety and Healing (TCFSH)

In 2011, the Center for Child and Family Advocacy at Nationwide Children's (founded in 2002) and the Columbus Coalition Against Family Violence (founded in 1998) merged into one organization, becoming The Center for Family Safety and Healing (TCFSH). TCFSH fully addresses all aspects of family violence, including child abuse and neglect, teen dating abuse, domestic violence and elder abuse. The center houses a multi-disciplinary team of exerts including mental health, child protective services and areas of the law. Fellows have the opportunity to participate in the range of services provided at the center including individual assessment, evidence-based trauma focused therapy both on-site and in the community, and group therapy for children and adolescents that have been traumatized. 

Adolescent Eating Disorders Clinic

In March 2009, Nationwide Children’s launched the multidisciplinary Eating Disorders Program, which provides eating disorder assessment and treatment services in the outpatient setting, including intensive outpatient and partial hospitalization program options. The program includes staff in adolescent medicine, psychiatry, psychology, social work, nursing and nutrition, with additional linkages to occupational, massage and recreational therapy. The program emphasizes care for adolescents with eating disorders and includes younger children on a case-by-case basis. The team also provides inpatient care for those adolescents requiring medical stabilization. At this time, fellows participate in the assessment of the adolescents that come to the clinic and are engaged as co-leaders in running groups.

Mood and Anxiety Program (MAP)

The Mood and Anxiety Program serves youth by providing psychiatry, outpatient therapy services and intensive outpatient services. Psychiatrists, counselors, social workers, psychologists and nurses work together to provide families with targeted therapy, including DBT. Fellows will be a part of this multidisciplinary team.

Psychiatric Crisis Department (PCD)

Nationwide Children's Psychiatric Crisis Department (Emergency Department) operates 24/7/365. The PCD in the Behavioral Health Pavilion is staffed by psychiatrists, nurses, licensed master’s level social workers, professional counselors, and marriage and family therapists. The goal is to provide family-centered trauma-informed care to patients, families, and our community through assessment, education, linkage to resources and crisis intervention. In addition, the PCD supports patients and families to maintain safety in the least restrictive environment, navigate the behavioral health system, and empower caregivers to manage their child's symptoms and treatment.  Trainees will provide initial assessments and care for children and families presenting primarily during the evening hours.

Family Therapy

Family Based Intensive Treatment (FBIT)and Integrative Family and systems treatment (I-FAST) are two treatment teams that provide community-based family therapy. The teams use a combination of case consultation and live supervision to ensure adherence to the program models. Fellows are able to join clinicians in the community to provide these intensive services and participate in weekly supervision

Forensics

The Behavioral Health Juvenile Justine Program (BHJJ) is a collaborative effort among Franklin County Juvenile Court, the Franklin County ADAMH Board and Nationwide Children’s. The program is located within the Probation Department at the Juvenile Court. BHJJ is responsible for completing diagnostic assessments (including juvenile sex offender assessments using the ERASOR tool), developing recommendations for level of care and evidence-based treatment programs, providing behavioral health consultation and training with juvenile court staff on mental health symptoms and resources and advocating for families during the court process, which includes attendance at case reviews and court hearings. Fellows will be a part of this dynamic team.

School Consultation and Observation

With an attending psychiatrist, fellows are expected to not only provide psychiatric assessment for identified children within the 15+ Columbus City Public Schools that have partnerships with Nationwide Children’s, but also to participate in student observations, IEP and 504 meetings and teacher conferences. The population served primarily consists of youth who are experiencing non-academic barriers to school success. In 2013, the School-Based Program implemented the PAX Good Behavior Game (GBG), a teacher-driven evidence-based universal prevention model for the classroom. In 2015, Nationwide Children’s clinicians also began providing the Signs of Suicide Curriculum to local schools.

Training is enriched by rotation experience at the Nationwide Children’s Daycare Center. Fellows are oriented through a didactic experience; the philosophy of the center, needs of children from infancy, through the preschool years and the cognitive, social and emotional development of typically developing children is reviewed. Lastly, fellows will have the opportunity to visit local high schools which involves meeting with the faculty and directly observing students. This experience introduces fellows to various academic settings allowing them to make recommendations regarding educational programs. This observational opportunity increases awareness of independent, public and private schools in Columbus, specifically academic and mental health supports available in those schools.

Early Childhood Mental Health Program (ECMH)

ECMH is a multidisciplinary team with specialized training and experience in early childhood development and mental health who provides developmentally sensitive screening, assessment and intervention (as well as make referrals for other services critical to development) for families with children ages birth through six. In addition, ECMH clinicians provide Parent-Child Interaction Therapy, Incredible Years groups and trauma-informed ECMH classroom consultation for selected preschools/childcare centers in Franklin County as part of the Healthy Neighborhoods Healthy Families initiative. Fellows may choose to do this as an elective in their second year.

Partial Hospitalization Program (PHP)

The Child and Adolescent Partial Hospitalization Program is an intensive and interdisciplinary outpatient treatment program that aims to help 12–18-year olds struggling with primary mental health concerns. The program creates an individualized treatment plan for each person that is delivered in a structured daily program that provides a highly supportive environment that allows patients and their families to practice the necessary skills for working towards greater stability. The clinical staff is comprised of a child and adolescent psychiatrist and APRN, master-level therapists, nursing, recreational therapists, and mental health support staff. The average length of patient participation is 3 to 4 weeks.

Pediatric Neurology

Fellows will rotate through the following outpatient clinics; epilepsy, psychogenic non-epileptic seizure (PNES), movement disorders, headache and postural orthostatic tachycardia syndrome (POTS).

General Psychiatry Outpatient Clinic at Nationwide Children’s Hospital

In the second year of training, a large portion of the fellow’s time will be spent in the general outpatient clinic at Nationwide Children’s, with direct and indirect supervision immediately available depending upon the specific type of appointment. Fellows will provide both initial assessments and follow-up psychiatric care. This will involve both psychopharmacologic management as well as other evidence based psychotherapeutic techniques. The outpatient clinic serves families with all types of insurance, socioeconomic status, race, ethnicity and religion, making it an exciting environment to practice child and adolescent psychiatry.

Scholarly Project

Each fellow must complete a scholarly project in order to successfully graduate from the program. The goals of the scholarly project are to help fellows develop an area of expertise in child and adolescent psychiatry and to promote fellows’ academic curiosity. Fellows will be taught about the departmental structure and various ongoing projects early on in training, so they can select a project in the first six months of training. The Ohio State GME office in conjunction with Nationwide Children’s Research Institute will provide education and support. Fellows will be provided with a mentor and spend 20 percent of their second year of training working on this scholarly project. The project will result in a research paper, conference poster, book chapter, course or an intervention at a systemic-level, for example.

In addition, fellows are required to actively participate in at least one Quality Improvement project approved by Ohio State, Nationwide Children’s or an ABMS Board. Fellows may select from projects:

1. Within their specialty
2. Hospital-wide initiatives
3. National projects

Trainees must demonstrate knowledge of key components of an aim statement, identify major causes (key drivers) that influence the aim, implement at least one test of change (intervention) and use data to determine if the changes have led to improvement.