Inpatient Psychiatry

New York City Children’s Center ‐ Queens Campus Inpatient Service

The Queens Campus of the New York City Children’s Center (NYCC-QC) in the teaching unit, 556, which also serves as the admissions unit. This is a 12- to 13-bed acute unit for male and female adolescents, ages 12 to 18 years, who present with a severe and disabling psychopathology including anxiety, psychosis, aggression, impulsivity, hyperactivity, mood disorders, and developmental delay and deviance. Frequently, these patients have severe forms of treatment-resistant psychotic and mood disorders or they might be in the category of complex, multi-dimensionally impaired youth who had many hospitalizations and placements prior to arriving at 556. Most patients, but not all, come from underserved backgrounds, many with histories of abuse, removal from biological parents, and current guardianship through community agencies.

Fellows have a broad educational experience, including utilizing different interviewing techniques required for these complex youth, including multiple informants; reviewing extensive treatments in other facilities; using the range of psychometric instruments available to complement the clinical exam; and using ancillary laboratory, medical, psychological, and educational testing. Fellows have a chance to see many aspects of psychopathology in children and to learn how to sort out symptoms and behaviors in the context of disrupted, normal, or deviant development. Fellows are involved, not only in psychopharmacological treatment, but also in individual, family, and group therapy for their patients. Fellows learn how to evaluate and manage acute psychiatric emergencies and how to help with problem-solving skills and social skills on a day-to-day basis, both individually and in groups. Fellows gain experience tracking outcomes utilizing standardized instruments. Fellows work within a multidisciplinary treatment team and are actively involved in the multimodal treatment planning of these youngsters, with major emphasis on diagnostic assessment and formulations that utilize biological, sociocultural, and psychological factors to help the team derive short- and long-term treatment planning.

Working with individual supervisors, fellows are also expected to participate in meetings and projects related to diverse areas of child and adolescent public psychiatry, including community site visits. Fellows have a chance to develop an understanding of public child psychiatry and to understand systems of care, not only in the setting of an inpatient state hospital for children, but also within the broader context of systems of care for public pediatric psychiatry patients. Fellows will be able to identify systems of care in public child psychiatry, including outpatient services, acute psychiatry, state hospitalization, and residential treatment centers and facilities and name the organizations designed to span these systems of care, including ACS, PINS, c-SPOA, advocacy groups, and wraparound services. Fellows will also identify the different professions (and their training and scope of practice) involved in the care of children, including social workers, recreational therapists, special-education teachers, case managers, and court-appointed advocates. Fellows will learn to identify the implications diagnostic uncertainty has on the chronic care of complex, multi-dimensionally impaired youth. Further, fellows will be able to identify special-needs populations and the impact of culture, race, ethnicity, sexual orientation, gender, and socioeconomic status on psychiatric illness, as well as the challenges posed by treating these children.

Fellows have a chance to see the results of their work with their patients in longer-term settings of six months, and they will have a chance to get involved in different projects with the help of their supervisors. During this rotation, fellows are involved in different academic activities, including monthly grand rounds and biweekly psychopharmacology and child-neurology rounds/consultations. Fellows have specialized supervision for trauma-specific CBT, group therapy for youth with substance-use problems, mindful group psychotherapy for the management of weight, and other specialized psychotherapies for severely ill youth. At times, fellows have a chance to be involved with the legal system regarding their patients, and they have a chance to get specialized supervision by our forensic child psychiatrist.

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