University of New Mexico Health Sciences Center

NB:  Please refer to the clinical program descriptions for further information about each of these rotation sites.  This section concentrates specifically on the educational experiences during these rotations.

Inpatient and Fellowial Care - UNM Children’s Psychiatric Hospital (CPH)

Child psychiatry fellows at CPH will encounter the full range of child/adolescent psychopathology.  As well, they will have the opportunity to care for children and families from a broad range of socioeconomic and cultural backgrounds.  Experience and training are provided in interviewing, assessment, diagnosis, and formulation; coordination and delivery of multimodal treatment; various psychotherapeutic interventions, including psychodynamic, cognitive-behavioral, client-centered, milieu, experiential, family, focused, supportive, and behavioral therapies, especially as these apply to child and adolescent patients; pediatric psychopharmacology; emergency evaluation and crisis management; inpatient milieu management; court commitments and legal issues; and  working as a member of a multidisciplinary team.

During their first year of training, fellows spend the full time equivalent of four and a half months in acute inpatient psychiatry.  They are assigned for three months in an acute child cottage (4-9 year olds or 9-12 year olds) and three months in an adolescent cottage (14-18 year olds).  Each rotation constitutes 70% of the fellow’s weekly time.  Fellows customarily assume responsibility for 3-4 inpatients, and assist the attending in the psychopharmacologic management of other patients.

Fellows customarily receive approximately 15-30 minutes of daily supervision and one full hour of weekly individual supervision with the cottage attending.  As well, fellows are frequently involved with the other members of the patient’s clinical team.

Additional specific learning experiences may be arranged depending upon the fellow’s interests, available time, and available opportunities.

Outpatient Experiences - Cimarron Clinic
The fellows spend time at Cimarron and PFCA during both fellowship years.  During the first year, fellows join a psychopharmacology clinic ½ day/week for the entire year, and also see 1-2 children for longer-term psychotherapy.  During a 70% three-month rotation in the first year, fellows are assigned to the Rapid Assessment Program (RAP), a clinic designed to develop skill in crisis management, evaluation, family dynamics, and short-term focused intervention strategies.

During the second year of their training, fellows serve as child psychiatric consultants ½ day/ week to an Albuquerque public school as part of UNM’s school-based health program.  The clinic multidisciplinary teams include family practice and pediatric faculty and housestaff, fellows, nurses and social workers.  Fellows also add a second psychopharmacology clinic, participating in each ½ day/week.  As well, fellows are psychotherapists for several outpatients, and participate in selected therapy groups.

Fellows receive one hour of individual supervision for each long-term psychotherapy case.  The Rapid Assessment Clinic is supervised by an attending child psychiatrist and staff social worker who are present for the entire experience (either in the room working collaboratively or observing behind a one-way mirror) and who provide ongoing supervision during the session behind the mirror and during breaks.  Supervisory activities during psychopharmacology clinic include direct observation, individual and group supervision, and case reviews.  The final hour of each clinic is reserved for wrap-up, charting, and didactics.  Child psychiatry faculty also provide specific supervision for the school-based experience, both on-site and at UNM.

Community Consultation (Rural and School-Based Mental Health Care)

UNM child psychiatry fellows serve as consultants to a wide range of community programs.  Some of these rotations are part of the regular curriculum, and some are elective.

As noted above, fellows participate in multidisciplinary school-based clinics.  In addition to the school clinic rotation, second year child fellows provide rural community consultation.  Some of this consultation is provided in clinics serving local pueblos or the Navaho Nation.  Such consultation to Native American populations has been provided in a number of settings, including Head Start preschool programs, clinics, and Public Health Service hospitals.  A large percentage of New Mexico medical care is provided in a rural setting, and many of these sites are connected to tribal entities.

As well, much rural and frontier care is provided in public health clinics.  Fellows may provide child psychiatric care and consultation at a variety of rural or frontier sites.

By consulting in rural and school sites, the child fellow learns how to help the programs and institutions in which children actually live much of their lives.  By providing expertise in child development and psychopathology to these non-clinical settings, child psychiatry fellows enable them to provide more developmentally-informed service to children, and to better identify children at risk and arrange for appropriate treatment.  Fellows also gain insight into the everyday lives of children in their schools and communities.

Forensic Psychiatry

In the second year of training, fellows spend one-half day/week for 6 weeks at the Bernalillo County Juvenile Detention Center (BCJDC) and at the Bernalillo County Court Clinic (Court Clinic).  BCJDC is a locked facility housing juvenile offenders, and is located approximately two miles from the UNM campus.  The clinical population at the BCJDC is approximately 90% male and presents with the multiple psychiatric and psychosocial problems typical of a conduct-disordered population.  The patients are referred by the BCJDC medical or social work staff for assessment of acute psychiatric syndromes (depression, psychosis, etc.) and/or behavioral problems on the unit.  Assessments include diagnostic impressions, development of focused treatment interventions, and the initiation of pharmacotherapy.  Fellows see patients both with the attending and independently, and receive one hour of supervision weekly during the rotation.

The New Mexico State Second Judicial District Court Clinic is housed in the Municipal Court Building in downtown Albuquerque, one mile from the UNM campus.  Second year fellows spend four hours per week for 6 weeks in the Court clinic, under the supervision of a licensed clinical psychologist who is Clinical Director of the Court Clinic.  The Court Clinic serves both adults and children, commonly for issues related to child custody and child-related divorce mediation.  Fellows are involved in direct assessments, interventions and observation of court hearings.  The caseload is typically between four and eight cases per half day of service.  Fellows receive an hour of supervision per half day of service.

Pediatric Neurology

During their first year, fellows participate in a 4-6 week experience conducted by the behavioral pediatrician at the Children’s Psychiatric Hospital.  This experience focuses on the pediatric neurologic exam, interpretation of the MRI and EEG findings, and diagnostic signs of genetic syndromes.  During their second year each fellow spends ½ day/week for three months in a UNM outpatient pediatric neurology clinic and at the neuropsychology clinic of Carrie Tingley Hospital.  Carrie Tingley Hospital, located ~1/4 mile from the UNM HSC main campus, is UNM’s pediatric rehabilitation service.  The general pediatric neurology clinic conducts approximately 2000 clinic visits per year.

Typically, fellows conduct two new patient visits and four follow-up visits during each week of service.  Supervision includes individual and group supervision, as well as direct observation.

Child Psychiatry Consultation / Liaison Service

This rotation consists of a three month, 16 hour/ week rotation in the first year at the Children’s Hospital of New Mexico and Carrie Tingley Hospital.  Dr. Carol Larroque, the current chief of service, is a triple-boarded pediatrician and child psychiatrist.  Didactics include ~30 hours in the consultation/liaison seminar.  A faculty member is always available for supervising emergencies or management difficulties.  Faculty regularly interview patients and families with the fellow, as well as observing the fellow’s interviews.

Fellows customarily see patients from infancy to age 18.  These children and adolescents are being treated as inpatients for medical or surgical problems, or are being seen as urgent outpatients in the emergency room, pediatric clinics or teen OB clinic.  Children, adolescents, and some young adult patients are also seen at Carrie Tingley Hospital.  A large number of inpatients meet criteria for acute stress disorder for medical procedures, accidents, or burns.  Most of the patients seen in the emergency room have made a suicide attempt and also may show signs of depression and/or substance abuse.  Other problems frequently evaluated on the inpatient unit are poor parent/child interactions, failure to thrive, youngsters with chronic illness who are not compliant with treatment, and head injured or delirious youngsters.  The fellow will conduct psychiatric evaluations of these children, typically including interviews with the family and the treating pediatric team.  The child psychiatry fellow works closely with pediatric, nursing and Child Life staff to coordinate the best care for child patients.  In addition, the child fellow may conduct short-term crisis intervention, play therapy with traumatized children, supportive care for siblings and parents of injured or burned children, and psychopharmacotherapy for various psychiatric and behavioral difficulties.

An average caseload for a child fellow is three new consults per week and follow-up treatment of three children and their families per week.  The child fellow receives supervision on each case, averaging two hours per patient.  In addition to the C/L seminar, the chief of service conducts a three-month seminar devoted to infancy and infant assessment.  The rotation also includes visits to the Intensive Care Nursery, and the opportunity to interview pregnant adolescents and adolescent mothers.