West Hills Hospital

PGY-1: Six Month Block A

Residents will rotate at West Hills Hospital for 0.7 FTE during a six-month block of their PGY-4 year. West Hills Hospital is a private, free-standing acute psychiatric facility which contains a 35-bed child and adolescent psychiatric unit. During this rotation, residents will manage 4-8 inpatients and will perform psychiatric evaluations, medication evaluations, medication management, individual and group psychotherapy, family therapy and participate in multi-disciplinary treatment sessions. The overall goal of this rotation is for residents to learn how to manage child and adolescent psychiatric patients in the inpatient setting. To reach this goal, the following objectives will be met:

Knowledge objectives:

  1. Inpatient admission criteria which warrant referral to an acute child and adolescent psychiatric unit.
  2. Risk factors for suicide and homicide in children and adolescents.
  3. DSM criteria for the major diagnostic categories seen in an inpatient child and adolescent psychiatry setting.
  4. Strategies for management of acute agitation of children and adolescents in the inpatient setting.
  5. Involuntary treatment standards and procedures.
  6. Legal requirements for compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations.
  7. Standards and procedures for mandated reporting of child abuse.
  8. Criteria and provisions for safely discharging a patient to a less restrictive setting.

Skills objectives:

  1. To perform an adequate assessment of a child or adolescent in crisis, that includes diagnostic interviewing of both the child and family in order to determine the chief complaint, history of present illness, past medical history, review of systems, family history, social history, substance history and developmental history.
  2. To perform a comprehensive mental status exam and physical and neurological evaluations (when appropriate) of children and adolescents as they present for admission and during the course of their inpatient stays.
  3. To develop a complete multi-axial differential diagnosis for children and adolescents who present for inpatient admission.
  4. To utilize appropriate evaluation tools including medical, laboratory, radiological and psychological testing
  5. To develop a comprehensive formulation and inpatient treatment plan that includes the biological, psychological, spiritual and social domains.
  6. To work with multi-disciplinary teams (including social workers, psychologists and nursing staff) in formulating an inpatient treatment plan.
  7. To adequately obtain informed consent for psychiatric treatment from parents, and informed assent from minors, including the ability to discuss risks, benefits and alternative treatments in language understandable to families.
  8. To conduct therapeutic interviews (using supportive interventions, exploratory interventions and clarifications) as a tool for evaluation and treatment in the inpatient setting.
  9. To conduct brief individual therapy, group therapy and family therapy in the context of inpatient treatment of children and adolescents.
  10. To evaluate the need for specific psychopharmacological treatments and to implement them based on AACAP practice parameters and other standards of practice.
  11. To monitor and evaluate response to treatment of children and adolescents in the inpatient setting.
  12. To produce appropriate clinical records in the inpatient setting which document pertinent historical data, clinical formulation, treatment plan and response to treatment.
  13. To participate in utilization review communications and, when appropriate, advocate for quality patient care with managed care organizations or third-party payers.
  14. To participate in quality assurance and peer review processes designed to improve performance.
  15. To network with community systems in planning appropriate outpatient referrals for discharge planning.

Attitudes objectives:

  1. Awareness of personal reactions and counter-transference (both in self and other staff members), and how these dynamics can influence patient care.
  2. Understanding of how the inpatient milieu environment works to positively or negatively influence the treatment of individual children or adolescents.
  3. Advocacy for the patient's best interests with inpatient staff, family and third-party payers.
  4. Understanding of the limited nature of available resources and commitment to using them wisely.
  5. Sensitivity and responsiveness to the cultural differences of self and others.
  6. 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: #1, 4, 5, 8, 9, 10, 11, 12, 13, 16, 17, 18, 19, 25
  • Medical Knowledge: #2, 3, 4, 5,
  • Interpersonal and Communication Skills: 14, 15, 16, 24, 26, 28, 29
  • Professionalism: #6, 20, 24
  • Practice-Based Learning and Improvement: #22
  • Systems-Based Practice: #1, 5, 6, 7, 8, 18, 21, 23, 25, 26, 27