First year of fellowship: Acute and Inpatient Psychiatry

In the first year of the fellowship, clinical training is focused on acute presentation of psychiatric illness in children and adolescents. Fellows rotate in blocks between rotations at Vanderbilt Psychiatric Hospital and Vanderbilt Children’s Hospital.   The rotations include inpatient psychiatry, Adolescent Partial Hospitalization Program, Consultation/Liaison Psychiatry and Pediatric Neurology. The fellows have opportunities to teach medical students or residents on all services.

Our inpatient team of Child and Adolescent Psychiatrists includes Child Psychiatry faculty members Dr. Aaron Jeckell and Dr. Yasas Tanguturi. Fellows will have the opportunity to work directly with each of our team members.

Our inpatient adolescent services serve the acute psychiatric needs of children and adolescents with a wide range of disorders, including psychotic disorders, severe mood disorders, anxiety disorders (including post-traumatic stress disorder),disruptive behavior disorders, dual diagnosis of substance use disorders, and ADHD. The fellow on the unit provides leadership for the team including working with the children, families, and staff with opportunities to participate in group process and therapy. The fellow also provides teaching to a first-year resident on the service as well as medical students. The treatment team includes the nursing staff, social workers, and a teacher from the unit’s accredited special education school. The service has medical students assigned throughout the year.

The consultation-liaison service serves the Vanderbilt Children’s Hospital. The leaders of the Consultation Liaison (CL) team are Dr. Allyson Cundiff and Dr. Catherine Fuchs. The CL team at Vanderbilt has been on the forefront of research and clinical treatment of delirium under the leadership of Dr. Fuchs, working closely with the PICU and other teams in the hospital.

The adolescent Partial Hospital Program serves adolescents from 13-18 with impairment from disorders of mood, anxiety, thought and other areas. The fellow works with the vibrant team of social workers, psychologists, nurses and staff to provide psychiatric care in this intensive outpatient setting.

Second year of fellowship

Outpatient Clinics

The second year of training is focused upon an outpatient experience and leadership opportunities for the fellows. All second year fellows have continuity clinics - managing their own groups of patients throughout the year. The continuity clinic includes children and adolescents of all ages, with a wide variety of diagnoses, and includes opportunities for both medication management and psychotherapy cases. The fellows have supervision of their outpatient cases with individual supervisors as well as availability of a child and adolescent psychiatrist on site for review of cases. The director of the outpatient clinic is Dr. Cheryl Cobb, and other supervisors include Dr. Edwin Williamson, Dr. Meg Benningfield and Dr. Michael Sherman.

Education-Based Psychiatry

Our child psychiatry fellowship has a particular strength in Education Based Psychiatry.

School-Based Clinics

Each second-year fellow spends one half-day per week in a school-based clinic. Each fellow is assigned either two elementary schools, or an elementary school and a middle school, and works with Vanderbilt school-based therapists at each school. Fellows have the opportunity to provide evaluation and psychiatric services to children, consultation to schools and families, and coordination of care within the system. This embedded placement provides a unique perspective on the workings of schools and how our patients interface with the system.

Electives

Fellows have the opportunity to work in elective clinics for exposure to a range of disorders. They all have an opportunity to work with children identified to have anxiety disorders. These children and adolescents are seen with an attending child psychiatrist who has expertise in anxiety disorders.

Elective clinic options include an Eating Disorder clinic coordinated by Dr. Bradley Freeman and located in a primary care adolescent clinic. The child psychiatry team works closely with the adolescent medicine team in a multidisciplinary clinical setting.

Fellows may work in the Autism Spectrum Disorders (ASD) clinic at Vanderbilt’s Kennedy Center for intellectual and developmental disabilities. This is a clinic that provides the opportunity to work with children with ASDs and their families in a clinical setting or in a clinical research setting. In the clinical setting they learn about assessment, pharmacotherapy, and behavioral management. Fellows also have the opportunity to work with a PhD psychologist specialized in structured assessment of children using standardized assessment tools for autism spectrum disorders.

Second-year fellows have the option of working with our Center of Excellence with Dr.s Jon Ebert and Tarah Kuhn where they gain exposure to children at risk of going into state’s custody. This provides opportunities to learn about systems of care throughout the state as well as learning about the importance of advocacy for children experiencing neglect or abuse. The fellows have a multidisciplinary seminar with Dr. van Eys at the Center of Excellence where they have the opportunity to learn about therapy and systems of care in collaboration with other disciplines.

An additional elective option is the Vanderbilt Center for Integrative Health where fellows can work with therapists to participate in group therapy. Patients seen at the VCIH have significant psychiatric needs co morbid with significant medical disorders. The fellows learn about alternative methods for dealing with pain.

Child Psychiatry and the Law

Second-year fellows gain experience in forensic psychiatry by working with various members of the Forensic team to assess adolescents in the juvenile justice system. Fellows spend one half-day per week with Dr. Mary Elizabeth Wood for at least three months of the year. During this time, the fellow participates in juvenile assessments using structured clinical interviewing, psychological assessment measures and records reviews, and writes formal reports for the juvenile court with Dr. Wood’s guidance. Fellows may occasionally have the opportunity to testify as expert witnesses regarding the assessments they have conducted. Fellows who are particularly interested in forensic psychiatry have the opportunity to use elective time to continue their participation in these assessments beyond the required three month interval.

All second-year fellows work with children, adolescents, and their families using a range of therapy techniques. Fellows are taught family therapy with a rigorous seminar that includes working with families while observed behind a mirror. They also work with children and adolescents using a range of individual therapies.

Second-year fellows have up to two half-days per week of elective time. This time may be used to participate in research studies within the department, to initiate a research project in the fellow’s area of interest, or to gain additional clinical exposure in an area of special interest.