Willow Springs Center

Department of Psychiatry and Behavioral Sciences

Residents will rotate at Willow Springs Center for 0.4 FTE during a six-month block of their PGY-4 year. Willow Springs Center is a private, free-standing psychiatric child and adolescent residential treatment center which has a census of about 70 patients. During this rotation, residents will manage 4-8 residential inpatients including performing 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 a residential treatment setting. To reach this goal, the following objectives will be met:

Knowledge objectives

  1. Admission criteria which warrant referral to a child and adolescent residential treatment center.
  2. Understanding of the types of problems typically requiring residential treatment, including severe family discord, maladaptive coping such as parasuicidal behavior, and adolescent substance abuse.
  3. DSM criteria for the major diagnostic categories seen in a residential child and adolescent psychiatry treatment setting.
  4. Strategies for management of agitation of children and adolescents in a residential treatment center
  5. Mechanisms for creating therapeutic systems of behavioral change within a milieu setting (such as dialectical behavioral therapy or functional behavioral analysis with contingency management).
  6. Treatment strategies for adolescent substance abuse
  7. Legal requirements for compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations.
  8. Standards and procedures for mandated reporting of child abuse
  9. Criteria and provisions for safely discharging a patient to the community

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 residential stays.
  3. To develop a complete multi-axial differential diagnosis for children and adolescents who present for residential admission.
  4. To utilize appropriate evaluation tools including medical, laboratory, radiological and psychological testing
  5. To develop a comprehensive formulation and residential treatment plan that includes the biological, psychological, spiritual and social domains.
  6. 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.
  7. To work with multi-disciplinary teams (including social workers, psychologists and nursing staff) in formulating a residential treatment plan.
  8. To conduct therapeutic interviews (using supportive interventions, exploratory interventions and clarifications) as a tool for evaluation and treatment in the residential setting.
  9. To conduct brief individual therapy, psychodynamic psychotherapy, group therapy and family therapy in the context of residential 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 residential setting.
  12. To produce appropriate clinical records in the residential 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 payors.
  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 residential milieu environment works to positively or negatively influence the treatment of individual children or adolescents.
  3. Advocacy for the patient's best interests with residential 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, 6, 9, 10, 11, 12, 13, 14, 16, 17, 18, 19, 20, 25
  • Medical Knowledge: #2, 3, 4, 5, 6
  • Interpersonal and Communication Skills: 15, 16, 17, 25, 27, 29, 30
  • Professionalism: #7, 21
  • Practice-Based Learning and Improvement: #23
  • Systems-Based Practice: #1, 7, 8, 9, 19, 22, 24, 26, 27, 28