CAP I Child and Adolescent C/L (University of Chicago)

The ability to comprehensively assess, discuss, document, and intervene in situations concerning patients who have psychiatric illness interfering with medical or surgical illness, or who have psychiatric illness presenting with physical symptoms, e.g. somatoform illness. The resident will be able to:

  • Evaluate procedures including review of physical and neurologic findings, laboratory and radiologic findings, medications and treatments.
  • Manage crisis/ emergencies of acutely disturbed children and adolescents with medical or surgical illness from outpatient practice.
  • Discuss consultation liaison treatment standards, procedures, psychopharmacolgy and the differences from outpatient
  • Effectively intervene to implement methods to minimize risk of harm to self or others including psychopharmacolgic and mechanical restraints
  • Choose the most appropriate psychotherapeutic treatment for different each consultation.

Medical Knowledge

Residents will demonstrate a solid understanding and grasp of core concepts and knowledge in the following areas:

  1. Understanding of the psychological impact of, and adjustment to, acute and chronic illness in children and their families
  2. Understanding how developmental level affects response to treatment and treatment approaches.
  3. Define the consult process (calling a consult, defining the consult question, evaluation the child and family, working with the medical team.)
  4. Understand the role of the Consult-liaison psychiatist in the medical/ surgical team
  5. Define differences in presentation of common pyschiatric disorders in the medical/ surgical setting.
  6. Describe developmentally appropriate understanding of and responses to death in both children and adolescents, and describe how to identify when supportive or treatment interventions are needed.

Interpersonal and Communication Skills

Upon completion of the CL rotation, residents will be able to demonstrate the following interpersonal and communication skills:

  1. Help the referring physician articulate and define a practical, useful and answerable consult question.
  2. Help children/ adolescents communicate in developmentally appropriate ways.
  3. Communicate effectively with every member of the family bot individually and in groups to form an effective working alliance.
  4. Form effective working relationships with the entire pediatric treatment team, including generalists and specialists, physicians, nurses, social workers, nutritionists, psychologists, physical/occupational therapists, etc.
  5. Be able to deliver "bad news" effectively, compassionately, and therapeutically; and model this for other members of the team.
  6. The ability to work effectively within a multidisciplinary team structure as a team member and consultant. Be able to lead the team when called for.

Professionalism

Residents will be sensitive to the sociocultural, socioeconomic, educational issues that arise in the therapeutic relationship. In addition:

  1. Residents will evaluate children and families with sensitivity, empathy and clinical acumen, while being sensitive to feelings of anger, guilt, anxiety and hopelessness, or to denial of feeling .
  2. Residents will use developmentally appropriate, comprehensible language in communicating with children and families with physical illness and comorbid psychiatric illness.
  3. Use culturally and socially appropriate language in communicating with children and families.
  4. Wear appropriate professional attire on the C/L service, including an understanding of how the consultant's attire may affect children based on their trauma and medical histories and past experience with medical care.

Practice-based Learning and Improvement

The resident will evaluate caseload and practice experience in a systematic manner. Daily rounds are held to review the patient's treatment and informal feedback is given. Residents will identify areas of strengths and weakness, and work with the attending to make a performance improvement plan.

In addition, the resident will:

  1. Know when to update knowledge of pediatric illnesses and treatment.
  2. Identify when to seek additional supervision.
  3. Be able to discuss transference and countertransference with patients and families and identify when this is interfering with treatment.

Systems-based Practice

The resident will:

  1. Learn how to advocate for optimal patient care within the limits of the health care delivery system by understanding the resources available for increased outpatient services or residential care including community and school based resources.
  2. Learn how to consult with emergency doctors and other specialist including state agencies around inpatient admissions
  3. Learn how to be the leader in a psychiatric emergency, keeping the patient and staff safety as priority
  4. Review cases with supervisors and other staff in ER/ C-L Rounds, and when appropriate, in quality improvement rounds (M&M)
  5. Understand the different levels of care in acute inpatient, partial hospitalization, intensive outpatient, 23-hour crisis evaluation and management units and be able to define the typical symptomatology that can be best managed in each treatment environment.
  6. Understand what is meant by "systems of care" and use a system of care approach in addressing the comprehensive bio-psycho-social and spiritual needs of physically ill children with psychiatric needs.
  7. Be able to work effectively with all of the relevant care-providers involved in a given case, potentially including pediatricians, nurses, OT/PT, nutritionist, educators, child life specialists, psychologists, patient advocates and others.