Patient Care

Definition and Goals
The child and adolescent psychiatrist must have a thorough understanding of the development, assessment, multimodal treatment and prevention of psychopathology as it appears from infancy through adulthood. He or she must be able to differentiate normal development from deviations in development. He or she must demonstrate the knowledge, attitudes and skills to care for children, adolescents and families in a wide range of settings including: inpatient and partial hospital units, emergency departments, outpatient clinics and in other settings that include pediatric wards, juvenile court and school clinics and community health centers. Residents are expected to develop comprehensive formulation of cases and implement a multimodal treatment plan. The competent resident must be able to integrate the knowledge, attitudes and skills learned through clinical rotations and didactic seminars in the care of his or her patients.

Knowledge
In each year of training, the resident must demonstrate increasing knowledge of the following areas related to patient care:

1. Techniques of conducting therapeutic interviews in a wide range of settings including outpatient clinics, pediatric wards, emergency departments, inpatient and partial hospital units, court clinics, schools and community health centers
   
   
2. Techniques of developing therapeutic alliances
   
   
3. Methods of taking comprehensive histories
   
   
4. Methods of using ancillary means for patient assessment, including laboratory tests, psychological tests and medical and neurological examinations
   
   
5. Biological Therapies, including psychopharmacological agents and other somatic therapies
   
   
6. Psychological Therapies, including brief and long-term individual therapy, family therapy, group therapy, crisis intervention, supportive therapy, psychodynamic psychotherapy, cognitive-behavioral therapy and the combination of psychotherapy with psychopharmacology
   
   
7. Social Interventions, such as community-based, school-based and home-based care
   
   
8. Methods Assessment and Treatment Methods for the full range of psychopathology, including developmental and substance use disorders
   
   •Methods Assessment and Treatment of patients from diverse cultural backgrounds and varied socioeconomic levels

Skills
In each year of training, the resident must demonstrate increasing skill in each of the following areas related to patient care:

1. Ability to perform and document a comprehensive psychiatric history and examination of children, adolescents, adults and families including:
   • a complete present and past psychiatric history
   
   • a developmental history
   
   • a social and educational history
   
   • a family history
   
   • a substance abuse history
   • a medical history and review of systems
   
   • a pediatric neurological examination
   
   • a comprehensive mental status examination including the assessment of cognitive functioning
   
   
2. Based on a comprehensive psychiatric assessment (see #1), ability to develop and document
   
   • a complete DSM multiaxial differential diagnosis
   
   • a case formulation and evaluation plan, including appropriate laboratory, medical and psychological examinations
   
   • a comprehensive treatment plan addressing biological, psychological and social domains
   
   
3. Ability to comprehensively assess, discuss, document and intervene concerning the patient’s potential for self-harm or harm to others. This shall include:
   
   • an assessment of risk based on known risk factors
   
   •knowledge of involuntary treatment standards and procedures
   
   • effectively intervening to minimize risk
   
   • implementing prevention methods for self-harm and harm to others
   
   
4. Ability to conduct therapeutic interviews with children, adolescents and families, e.g., the ability to collect and use clinically relevant material, through supportive interventions and exploratory interventions and clarifications
   
   
5. Ability to conduct a range of therapies effectively including:
   
   •biological therapies, including psychopharmacological interventions
   
   •psychological therapies including: brief and long-term individual psychotherapy, family therapy, group therapy, crisis intervention, supportive therapy, psychodynamic psychotherapy, cognitive-behavioral therapy and combined psychotherapy and psychopharmacology
   
   •social therapies, including court, school and community-based interventions
   

The therapies noted above should be evidence-based and integrated into multimodal treatment plans.

Attitudes
In each year, the resident must demonstrate the following attitudes related to patient care:

1. Desire to increase medical and psychiatric knowledge based on current literature and standards of practice
   
   
2. Interest in seeking appropriate supervision regarding patient care
   
   
3. Desire to maintain the highest standards of ethical and professional behavior in the care of patients