Washoe County School District

Department of Psychiatry and Behavioral Sciences

Residents will rotate in the school system for 0.2 FTE during a six-month block of their PGY-1 year. The Washoe County school district serves a total enrollment of more than 60,000 students. Residents will see a variable number of consultations per week to include performing psychiatric evaluations and consultations, medication evaluations and consultations, multi-disciplinary treatment sessions, and participation in psychological and educational planning sessions. The overall goal of this rotation is for residents to learn how to evaluate children and adolescents in the school setting, and make recommendations to school staff. To reach this goal, the following objectives will be met:

Knowledge objectives

  1. Normal cognitive, physical, emotional and social development for children ages five to eighteen.
  2. The school system structure and how various members (such as teachers, administrators, school nurses, school psychologists and guidance counselors) work within it.
  3. The mechanism for referral within the school system for children with learning and behavioral problems.
  4. The range of educational accommodations from least restrictive (integrated classroom) to most restrictive (therapeutic school) for children with learning and behavioral problems.
  5. The legal rights of parents and children to obtain evaluation for learning disabilities within the school system as well as the implementation of these rights in the development of individual education plans.
  6. DSM criteria, epidemiology and phenomenology of the major diagnostic categories seen in a cross-section of children and adolescents.
  7. Standards and procedures for mandated reporting of child abuse

Skills objectives

  1. To effectively interface with school staff by defining the consultation question and providing the requested feedback in terms understandable to non-clinicians.
  2. To approach children of different ages in a manner appropriate to the child's developmental level.
  3. To perform an adequate assessment of a child or adolescent within their school context, that could include diagnostic interviewing of the child and family, classroom observation, review of school records, and consultation with school personnel.
  4. To interpret typical educational testing used in school educational assessment, such as the WISC and WRAT, and to use these in informing overall assessment and educational planning.
  5. To work within a school team to generate behavioral solutions appropriate to the school environment.
  6. To develop appropriate recommendations regarding educational accommodations for psychiatrically affected children and adolescents.
  7. To provide classroom teachers with education about how each of the major childhood psychiatric disorders may present in the classroom, and how they may be managed in the classroom.
  8. To give appropriate advice to schools about how to respond to crises, such as world events or local tragedies.
  9. To conduct brief play therapy in conjunction with school psychologists or adjustment counselors.
  10. To help the school in accessing community resources for mental health.

Attitudes objectives

  1. Awareness of personal reactions and counter-transference (both in self and other staff members), and how these dynamics can influence the treatment of children within the school setting.
  2. Understanding of how the cultural contexts of school (for example, gang presence or extent of bullying) can affect individuals.
  3. Advocacy for the children's best interests with regards to being provided with adequate education.
  4. Sensitivity and responsiveness to the cultural differences of self and others.
  5. Sensitivity to the dependent status of children and the ramifications of this in the treatment alliance, particularly with respect to confidentiality and consent issues.

The above knowledge, skills and attitudes address competencies in each of these areas:

  • Patient Care: #10, 11, 13, 16
  • Medical Knowledge: #1, 6
  • Interpersonal and Communication Skills: #8, 9, 12, 14, 15, 18, 20, 21, 22
  • Professionalism:
  • Practice-Based Learning and Improvement:
  • Systems-Based Practice: #2, 3, 4, 5, 7, 14, 15, 17, 19, 20