Department of Psychiatry and Human Behavior

Department of Psychiatry and Human Behavior

BradleyHospital

Adolescent Inpatient Psychiatry
Overview of Rotation
Date of Revision: 8/19/11
The inpatient adolescent psychiatry rotation at BradleyHospital is a core training experience within the Brown Child and Adolescent Psychiatry fellowship and the Triple Board program. During this rotation fellows/residents gain knowledge, skills and practice in the care of adolescents hospitalized for psychiatric illness. The rotation requires a high degree of organization and efficiency, as well as, a strong commitment to professionalism. Additionally, the role of development in the understanding and management of their patients is emphasized.

Description of Rotation

Fellows in their first year are provided with adolescent inpatient unit assignments. The assignment consists of a 10 week long rotation on the adolescent inpatient unit. Each fellow’s assignments are scheduled in order to provide broad clinical experience in all areas of inpatient and crisis psychiatry, including variation in diagnosis, age, and ethnic background of patients and their families.
BradleyHospital
The unique aspects of the BradleyHospital experience derive from the broad range of diagnostic categories seen at the hospital, and from the full range of psychosocial treatment modalities available. BradleyHospital is a major child and adolescent inpatient psychiatric facility in Rhode Island. Founded in 1931, BradleyHospital is the nation's first psychiatric hospital devoted exclusively to children and adolescents. Today it remains the only such hospital in Rhode Island. As a psychiatric center, BradleyHospital is recognized as a national resource for the treatment of troubled children. It provides a full continuum of care for young people from infancy to age 22. As an affiliate of BrownMedicalSchool, Bradley has established itself as the national center for training and research in Child and Adolescent Psychiatry. It is a private, not-for-profit hospital and operates the BradleySchool, a fully certified special education school. There are about 800 admissions per year on the adolescent unit.
Diagnostic groups treated at BradleyHospital include mood disorders, developmental disorders, schizophrenia, PTSD, anxiety states, attachment disorders, disruptive behavior disorders, adjustment disorders, and personality disorders.
Treatment modalities available to patients at BradleyHospital include various psychopharmacologic treatments, as well as established programs in milieu therapy, family therapy, group therapy, and individual therapies. BradleyHospital also has specialized programs in developmental disorders, adolescent risk taking, and crisis management.
This patient population offers residents opportunities to evaluate and treat the full range of primary psychiatric disorders, including the impact on the family. BradleyHospital has an active family therapy program, thereby providing fellows with an excellent opportunity to learn family assessment and the role of the family in mental illness. There is about a 1:1 gender split throughout the year. Various ethnic groups are represented with Caucasian, Hispanic, African-American and Asian groups predominating.
BradleyHospital’s role as the principal child and adolescent psychiatric hospital in Rhode Island permits fellows to develop a perspective on the entire mental health system of Rhode Island.
I. GENERAL INFORMATION
Name of Rotation / Inpatient Adolescent Psychiatry
Unit Psychiatry Attendings / Laura Ruoff, MD (Adolescent Program Director)
Elizabeth Taylor, MD , Jamison Rogers, MD, April Cambre, MD
Contact Information / Laura Ruoff, MD –
Residency Coordinator / Marsha Spirito, 444-3762
II. FACULTY
Psychiatry: Drs. Ruoff, Taylor, Rogers, Cambre; Psychology: Drs. Alday and Kreth.
III. TOPICS/TEACHING METHODS/MATERIALS USED DURING THIS ROTATION
Topics to be covered are based upon:
The patient population cared for by the team over the course of the rotation
Cases selected for presentation
Principal teaching methods:
Daily Attending Rounds and treatment team
Individual supervision (one hour per week minimum)
Educational materials provided/referred to fellows/residents:
Reading: Each attending fellow and resident is expected to utilize current medical literature in the planning of therapeutic and diagnostic interventions.
Computer-assisted educational materials: All housestaff have access to full-text literature search and retrieval capacity through the hospitals’ computer networks. Terminals are located on all floors and in the residents’ offices.
Other: Fellows/Residents may be given articles as part of their weekly supervision.

V. EVALUATIONS

Evaluation of the fellow’s/resident’s successful completion of the above goals will be carried out by the attending.
Evaluation of the attending's successful completion of the above goals will be carried out by the fellow/resident.
Evaluation of the rotation will be completed as part of the annual child psychiatry fellows’ retreat report.

VI. RESPONSIBILITIES OF ATTENDING ON ROTATION

The attending assigned will see all patients within 24 hours of admission and will supervise the care of the patient by the housestaff, offering guidance but allowing for autonomy.
The attending will be available for or be present at all activities where their involvement is needed.
The attending will conduct attending rounds daily. Each attending rounds includes interaction with the patient under discussion as part of the educational session and discussion of the patient from a diagnostic and therapeutic perspective.
Attending will schedule individual supervision for one hour per week for each trainee.
VII. RESPONSIBILITY OF RESIDENT ON ROTATION
Fellow serves as primary treatment provider in conjunction with the attending for all patients assigned to him/her. Fellow is responsible for initial evaluation of the newly hospitalized patient, documenting a full admission history and physical examination.
Fellow/Resident:
will discuss the diagnostic and management strategy with the attending on all new patients.
is responsible for examining and monitoring the progress of their patients on a daily basis, noting all laboratory and other data in a timely manner, discussing the management plans with the team, and writing daily progress notes.
is responsible for collecting all relevant information on the patient, including reviewing old medical records.
is responsible for working collaboratively with the multidisciplinary team working with the patient.
is responsible for helping the assigned social worker manage the family and patient communication.
is responsible for the discharge summary for assigned patients to be completed no more than 30 days following the discharge of each patient.
will be responsible for the on-going care of not more than 5 patients at a given time (4 if Triple Board or adult resident).
will submit an online evaluation of the attending upon completion of the rotation.
must attend weekly afternoon seminars, educational experience that are site-specific and Grand Rounds.

VIII. SCHEDULE DURING THIS ROTATION

Morning Rounds daily beginning at 8:45 for inpatient service walk rounds
Grand Rounds1st Wednesday of each month, 11:00, Ray Hall, Butler Hospital Campus and 2nd Wed of month at Bradley
Interviewing Course Every Monday, Noon, LauferBuilding, 2nd floor
Family Therapy Seminar 1st Tuesday of each month, 11:00, LauferBuilding, 2nd floor

IX. GENERAL EDUCATIONAL OBJECTIVES

Objectives - By the end of this rotation, the resident will be able to:
Conduct a comprehensive diagnostic interview of adolescent inpatients and present integrated formulation. PC, IPCS, MK, P
Conduct a comprehensive family assessment. PC, IPCS, P
Prepare and present case presentations to include pertinent history, MSE, formulation, differential diagnosis, and treatment plan. PC, IPCS
Assess severity of illness and develop prioritization skills necessary to make diagnostic and therapeutic interventions in a timely manner. PC, MK, PBL
Understand the diagnosis, prognosis and management options for the major psychiatric illnesses encountered. MK, PC
Understand role of development in diagnosis and management of patient. PC, MK
Develop an appreciation for cost-efficient care, proper utilization of resources, the importance of after-hospital care planning, and patient autonomy. SBP
Work in a coordinated fashion within a multi-disciplinary team. PC, IPCS, P, SBP

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