WELCOME

Thank you for your interest in the Icahn School of Medicine at Mount Sinai St. Luke’s and Mount Sinai Roosevelt hospitals program. For over half a century, the Division of Child and Adolescent Psychiatry (CAP) has been an integral part of the Department of Psychiatry. Beginning in the late 1940s, before Child and Adolescent Psychiatry was even a recognized field, St. Luke's (SL) and Roosevelt (RH) Hospitals were providing care to children and their families afflicted by mental illness. The skilled, multidisciplinary mental health professionals in the Division provide diagnostic and therapeutic services for children, adolescents, and their families whose problems range from mild behavioral difficulties to severe psychiatric illness.


PROGRAM LENGTH

To complete the residency requirements and be board eligible in Child and Adolescent Psychiatry, each candidate must complete two years of training in an ACGME-accredited Child and Adolescent Psychiatry Residency Training Program. The Icahn School of Medicine at Mount Sinai St. Luke’s/Roosevelt Hospital Center program is ACGME accredited to provide training for two post-graduate years in child and adolescent psychiatry. At the time of recruitment, the program contracts with the applicants for a single year of training with the option to complete a second year provided that an acceptable performance was rendered in the first year of training.


TRAINING SITES:

Mount Sinai St. Luke's and Mount Sinai Roosevelt hospitals
Mount Sinai St. Luke's and Roosevelt Hospitals are full-service community and tertiary care hospitals. These sites provide a sophisticated clinical and academic environment in which physicians can practice superior medicine, train more than 480 residents and fellows in 40 clinical specialties and carry out innovative research. Each is widely respected for high quality clinical care and its contribution to research in cardiology, gastroenterology, metabolic disorders, psychiatry and many other areas. Throughout their histories, these hospitals have placed a strong emphasis on responding with compassion and sensitivity to the unique needs of the communities they serve, including areas whose residents have multiple social and economic challenges. Much of the inpatient, outpatient, and emergency medical care for more than half a million residents of the West Side of Manhattan, as well as for patients throughout the New York Metropolitan region, is provided at these sites.

Mount Sinai Beth Israel
Mount Sinai Beth Israel is an 899-bed, full-service tertiary teaching hospital. Beth Israel has two hospital divisions: the Milton and Carroll Petrie Division in Lower Manhattan; and the Kings Highway Division in the Midwood section of Brooklyn. Founded on Manhattan's Lower East Side before the turn of the 20th century, Beth Israel originally was dedicated to serving vulnerable populations in that community. A century later, the Medical Center serves individuals and families throughout New York City and beyond—while retaining its traditional strong sense of mission. Beth Israel has been cited for excellence in many clinical areas, including AIDS and HIV-related disorders, breast cancer and other cancer specialties, such as head and neck, lung, skin, gynecological, urological, colorectal and neurological cancer, cardiology, chemical dependency, neurological disorders, brief psychotherapy, geriatric psychiatry, neuroimaging, and neurobehavior.

The Mount Sinai Hospital
Founded in 1852, The Mount Sinai Hospital is a 1,171-bed, tertiary-care teaching facility acclaimed internationally for excellence in clinical care. The Mount Sinai Hospital was named to the U.S. News & World Report Honor Roll in its 2014-2015 edition, ranking 16th out of nearly 5,000 hospitals nationwide. Icahn School of Medicine at Mount Sinai is internationally recognized as a leader in groundbreaking clinical and basic science research and is known for its innovative approach to medical education. With a faculty of more than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai ranks among the top 20 medical schools in receipt of National Institutes of Health grants. In its 2012 "America’s Best Graduate Schools" issue, U.S. News & World Report ranks the Icahn School of Medicine 18th out of 126 medical schools nationwide.

GENERAL EDUCATIONAL GOALS AND OBJECTIVES

  • The goal of this training program is to produce the highest quality of child and adolescent psychiatrists who will demonstrate high ethical standards, excellent clinical skills and knowledge in child and adolescent psychopathology, psychotherapy, psychopharmacology, consultation, teaching, research and administration.
  • Our ambition is to help a fellow build up his or her professional identity as a child and adolescent psychiatrist, ready to be a leader in the field of child mental health, an advocate for children and their families, an educator for professionals and community, an academic psychiatrist and researcher and above all a mindful and integrative clinician.
  • Our program utilizes clinical experience as well as a formal curriculum covering major areas of child and adolescent psychiatry, individual and group supervision, conferences and seminars to educate trainees on the theoretical and practical principles of our field in a comprehensive manner. Upon completion of the program, the fellow will be competent in the core areas of patient care, medical knowledge, interpersonal and communication skills, practice-based learning, professionalism and systems-based practice.
  • The fellow will be well trained in understanding normal development and, with this framework in mind, will become an expert in differentiating normal from abnormal behavior and in development of psychopathology.
  • At the end of training, the fellow will demonstrate broad knowledge of child and adolescent psychopathology, including the full range of DSM 5 diagnoses. He or she will demonstrate competency in working with culturally, ethnically and educationally diverse population.
  • The fellow will become proficient in conducting comprehensive diagnostic and therapeutic evaluations of children, adolescents and their families within a framework of biological, psychological, social and cultural influences, with the ultimate outcome of becoming an expert in formulating comprehensive and integrative diagnostic impressions and treatment plans.
  • The fellow is expected to demonstrate diagnostic and treatment skills in a wide range of clinical settings, including outpatient, inpatient, day treatment programs, crisis clinic and emergency room. The fellow is expected to become a competent consultant to the pediatric medical specialty clinics, schools, various community health centers and agencies or courts. He or she will become a confident and competent team leader as well as a valuable team participant and collaborator.
  • The fellow is expected to become proficient in major treatment modalities: a) psychotherapeutic clinical skills such as behavioral and cognitive therapy, motivational interviewing, dialectic behavioral therapy skills; psychodynamic psychotherapy and play therapy, dyadic parent-infant therapy; group therapy, family therapy; individual and family crisis work, b) pharmacotherapy and c) combined psychotherapy and pharmacotherapy
  • The fellow will have ample experience in supervising and teaching other trainees including medical students, general psychiatry fellows, and psychology and social work trainees.
  • Upon completion of this program, the fellow will be a competent clinical administrator in any clinical setting including outpatient, inpatient, day treatment or acute care. The fellow will be adept at consulting and critically apprising medical literature as well as understanding research methodology and processes. We promote academic development and encourage fellows to engage in their independent scientific research projects and scholarly activities, and we provide mentorship and time for fellows to do so.

CLINICAL ROTATIONS:
FIRST YEAR

First year fellows rotate through five blocks as detailed below. An attending psychiatrist is available to supervise on site for all rotations. One date per week is protected for didactics, Grand Rounds, fellows’ lunch meeting, Journal Club, Clinical Case Conference, Dialectical Behavioral Therapy (DBT) Practicum, and PRITE review. Didactics in the first year include Psychopharmacology, Psychotherapy and Psychopathology. First year fellows participate in a crash course in child and adolescent psychiatry topics through July and August.

Block 1
Mount Sinai Beth Israel, Outpatient Child Psychiatry Clinic
The fellow rotates to our affiliated outpatient clinic at Mount Sinai Beth Israel, located in the Lower East Side of Manhattan. We anticipate that the exposure to CAP services at Mount Sinai Beth Israel, including outpatient treatment and consultation services, will increase the depth and breadth of training and exposure for CAP fellows. Another educational benefit for our CAP fellows is within the extensive and well-respected family therapy program. The CAP fellow will be able to receive more intensive didactics, supervision, and clinical experience in this important treatment modality. Educational activities on this rotation consist of weekly supervision, journal club and participation in multidisciplinary ward rounds and team meetings.

Block 2
Crisis Service
Rotation Director: Phintso Bhutia, MD
Location: 1090 Amsterdam Avenue, 17th floor

Crisis Service: During this component, the child and adolescent psychiatry fellow will be part of a multidisciplinary team that works with children and families in a crisis. Patients will be referred from our emergency room consultation service. The fellow is expected to provide brief diagnostic evaluations, short term individual and family crisis work, provide acute pharmacological stabilization, and appropriately refer patient for further care in our outpatient clinic. Work is directly supervised by an attending. 

Block 3
Emergency Room Consultation
In this component, the fellow will help serve as a consultant to the staff of the pediatric emergency and general psychiatry emergency rooms. The fellow is expected to learn how to interview patients, family members and other involved persons in emergency situations in order to accurately assess the diagnosis, the immediateness of the situation and develop the most appropriate treatment and disposition. The evaluation of child abuse and neglect is also of paramount importance as well as learning when to make a report to the State Central Registry (SCR) for evaluation by the Administration for Children’s Services (ACS). Goals include making a time-limited assessment and synthesizing findings into a cogent presentation.

Finally, the fellow should learn the consultative aspects of work in an emergency room, in order to help the staff in the pediatric and adult psychiatry emergency rooms deal with children and adolescents presenting with psychopathology.

Block 4
Comprehensive Adolescent Rehabilitation and Education Service (CARES)
The fellow divides their time on two services during this block. The first is the Adolescent Alternative Day Program (AADP), and the other is the Comprehensive Addictions Program for Adolescents (CAPA). Both programs function in a unique partnership with the New York City Department of Education. This day treatment setting provides for an intensive school consultation experience in collaboration and consultation with the on-site teachers and staff of the New York City Department of Education. AADP serves adolescents with primary psychiatric diagnoses, while CAPA is directed towards adolescents who are dually diagnosed with both substance abuse and psychiatric disorders. Fellows are responsible for providing a comprehensive psychiatric evaluation, meeting with families, stabilizing their illness and collaborating with appropriate associated services. The therapeutic modalities include milieu, behavior modification, psychopharmacology, individual, small group, family therapy and DBT. The expectation for this rotation will be the management of seriously emotionally disturbed adolescents in order to stabilize emergent problems and help them transition back to their communities in a functional manner.

Block 5
Inpatient Child Psychiatry
Educational activities on this rotation consist of weekly supervision and participation in multidisciplinary ward rounds, as well as team meetings. The multidisciplinary staff consists of pediatricians, social workers, and child-life therapists. Evaluation of acute and/or severe mental illness is discussed. The fellow is expected to understand the phenomenology and course of severe psychiatric disorders in adolescents. They should also learn how to conduct a risk assessment for suicidal and homicidal patients. While on this rotation, the fellow will be responsible for evaluating patient’s conditions, meeting with families, stabilizing their illness, and determining appropriate medication treatment.

CLINICAL ROTATIONS:
SECOND YEAR

Second year fellows rotate trough several subspecialty clinics in addition to working with their individual caseload. One day per week is protected for clinical instruction in family therapy, parent child dyadic therapy, Grand Rounds, fellows’ lunch meeting, Journal Club, Case Conference, MD and PRITE review. In addition, fellows have courses in Neuropsychological Testing, Development, Therapeutic Interventions, Cognitive Behavioral Therapy (CBT) and Special Topics in Child and Adolescent Psychiatry. Clarice Kestenbaum, MD, the 1999 – 2001 president of the American Academy of Child and Adolescent Psychiatry, teaches a year-long course in The Classics of Child and Adolescent Psychiatry. Second year fellows also complement didactics in CBT and DBT from their first year with cases and group supervision this year.

Fellows spend most afternoons at the outpatient clinic providing patient care. Each fellow is assigned psychotherapy cases using the following modalities: psychodynamic psychotherapy, CBT, DBT, family therapy, group therapy and dyadic therapy in addition to a psychopharmacology case load. The fellow’s caseload is closely monitored to ensure a diverse patient population and extensive experience in various psychotherapeutic and pharmacological interventions. As in the first training year, both psychopharmacologic and psychotherapy supervision continues this year.

In their second fellowship year, trainees have ample opportunity to learn about supervision. Fellows are involved in supervision of medical students and general psychiatry fellows throughout their training. This includes both psychopharmacology as well as psychotherapy supervision.

Forensic Child and Adolescent Psychiatry
This seminar will be held in various locations in Manhattan Family Court or an adjacent NYC Health and Hospitals Corporation (HHC) building in July and August. The program will include observation of Family Court proceedings, introduction to family law, and a particular emphasis on juvenile delinquency and child protection. A mock trial illustrating the role of the expert witness will be included. Following these three seminars, fellows will have a practicum experience, consisting of observing a clinician conducting interviews. Extensive reading material will be provided to supplement this educational activity.

Child and Adolescent School Based Health Clinic Rotation
This rotation takes place one morning weekly for six months. Fellows will acquire training and knowledge about the dynamics of working in a school-based health clinic that serves predominantly inner city high schools in the heart of New York City. Fellows will see patients as recommended by the school-based clinic staff, school counselors and teachers. The three facets of the rotation will be psychopharmacological management for appropriate students, school consultation, and presentations to school staff and parents. Fellows will have the opportunity to acquire skills in school consultation.

Pediatric Developmental Disability Clinic
This rotation takes place one afternoon weekly on an outpatient basis for three months and it is complementary to the pediatric neurology rotation. It consists of diagnosing, treatment planning and treatment implementation of children with developmental disorders in a multidisciplinary setting and under direct supervision of a child psychiatry attending. The activities include the observation of children during the process of evaluation by a pediatric neurologist and a multidisciplinary team including social workers, psychologists, and neuropsychologists. The attending child psychiatrist and child psychiatry fellows provide assessments, medication evaluation and brief behavioral psychotherapeutic interventions for children ages 0-18 with pervasive developmental delays. Fellows provide medication management for complex and treatment resistant behavioral disturbances. Child psychiatrists collaborate with the DDC social worker and Medicaid Service Coordinator (MSC) to ensure that children and families receive appropriate services such as respite services, appropriate school placement and accommodations, etc.

Parent Infant Clinic (PIC)
This rotation takes place one morning weekly on an outpatient basis for six months. The main components of the PIC rotation will include conducting evaluations of parent infant interaction and attachment, administering developmental screenings, writing up evaluations and screenings, and conducting a Family Forum. During this rotation, fellows will acquire knowledge of normal infancy and early childhood development and normal parent-infant interactions. They will understand the stages of parent development and the emotional/behavioral disorders of infancy and toddlerhood in the DSM 5. They will develop knowledge of attachment classifications and the impact of parental risk factors (e.g., maternal depression, trauma) on the attachment relationship. The fellow will conduct and write up a comprehensive evaluation of a parent-infant dyad and developmental screening, read a developmental screening with a critical eye and provide feedback to parents regarding the screening results and intake evaluation.

Children’s Community Mental Health Services (CCMHS)
This rotation takes place one afternoon weekly on an outpatient basis for two months. Fellows will acquire training and knowledge about the dynamics of working in a system of care model that is geared towards working with patients with the Severely Emotionally Disturbed (SED) categorization. This is a very unique opportunity in that only seven states in the United States have Waiver programs that are geared towards serving the SED population. Children’s Center of Mental Health Services (CCMHS) is composed of three programs: Home and Community – Based Services Waiver Program (HCBS), Blended Case Management (BCM), and Children’s Single Point of Access (CSPOA). Fellows will have the opportunity to acquire skills in working in a wrap around service and learning about the role that a physician can play in such a structure. The fellow will conduct home visits and school visits with the attending psychiatrist and the patients assigned to an intensive care coordinator (ICC) worker.

Comprehensive Assessment Center
This rotation takes place one morning weekly on an outpatient basis throughout the academic year. Fellows will conduct a comprehensive diagnostic interview of a child or adolescent and their family, taking into account developmental stages, cultural backgrounds and psychological needs. The case will then be discussed with the child and adolescent psychiatry attending, and a bio-psycho-social formulation and treatment plan will be prepared. At the end of this rotation, fellows will be able to conduct and complete a thorough evaluation, including a complete differential diagnosis, and to deal with and guide families facing psychosocial stressors. They will learn about proper documentation, ethical and medico-legal issues, systems of care, and different cultural, religious and socio-economical issues in families.

Clinical Research
Fellows have the opportunity to spend at least one half day per week working with a faculty mentor on a scholarly or research project of their choice for the duration of one academic year. Examples of research or scholarly product outcomes would include original literature review, a poster presentation or a journal article depending on the fellow's interests.

Pediatric Neurology
This rotation takes place one afternoon weekly on an outpatient basis for two months. It consists of direct observation of pediatric neurological examinations, learning neurologist recommended work-ups, and differential diagnoses for assigned cases. Patient cases will be both initial contacts, as well as case follow-ups. This clinical work will be supplemented by a Pediatric Neurology Seminar. Cases are evaluated and monitored under direct supervision of the attending pediatric neurologist. Techniques of routine neurological exam, EEG readings, history taking, diagnosis, differential diagnosis and current treatments are covered in this rotation. 

EVALUATIONS
Performance evaluations on all fellows are requested from all supervisors on a semi-annual basis and upon completion of a rotation. These evaluation forms are returned to the Director of Training who reviews them and meets with the fellows twice yearly. At the end of each year of training, the Director of Training fills out an end-of-year evaluation that incorporates the feedback from personal observations and interactions, written evaluations, and feedback from staff. These are also reviewed with the trainees. At the end of training, final written evaluations and ethical moral conduct forms are completed, which are also reviewed with the trainees. All anonymous evaluations are included in the New Innovations online software and include course and supervisory evaluations. Issues regarding the trainees’ evaluations are discussed during the educational committee meetings and, when appropriate, modifications are made to curriculum and feedback is offered to supervisors.

PROMOTIONS
Promotions are made from one year to the other based on the final end of year evaluations. In general these are based on the compilation of scores given in service areas and courses. Receiving a score of “fair” or higher in all areas of service and courses is associated with promotion. A score of "poor" in any area of service and courses requires that the evaluation be reviewed by the Residency Educational Committee of the Division of Child and Adolescent Psychiatry. The results of the meeting will yield specific recommendations to be made in writing and verbally to the trainee. Those recommendations will be made in terms of concrete goals and objectives of course work or service requirements. There will be a time frame associated with the achievement of those goals and objectives. If the deficiencies continue or are such that remediation is needed, there exists the possibility of extending the period of training for the fellow or taking more formal steps. Any decision that requires formal disciplinary action, probation or extension of training will first be discussed with the Director of General Psychiatry Residency Training, the Chairman of the Department of Psychiatry and the appropriate members of the Medical Staff Office and Continuing Medical Education Office. The trainee will have the formal steps involved in the due process involved in arguing any decisions made by the Hospital Center.

Salaries and other conditions of employment including paid time off are disclosed on contracts and are set by the collective bargaining agreement between the medical center and the Committee for Interns and Residents (CIR).

APPLICATION
The Icahn School of Medicine at Mount Sinai St. Luke’s and Mount Sinai Roosevelt hospitals program participates in the Electronic Residency Application Service (ERAS #4053531166) and National Resident Match Program (#2070405).

For further information and questions, please call 212.523.5089. Applications are accepted from July 1 through October 15 for each academic year. Applications are only accepted through ERAS.

Our interview and selection process begins in early September and runs through mid-November. Because of the large number of applications, we are not able to interview all applicants. After receipt and processing of your completed application, your materials will be reviewed.

Inquiries concerning the program should be forwarded to:

Jacqueline Rivas
Education Coordinator
Department of Psychiatry
Mount Sinai St. Luke's and Mount Sinai Roosevelt 
1090 Amsterdam Avenue, Suite 16A
New York, New York 10025
Tel: 212.523.5089
Fax: 212.523.3642
jarivas@chpnet.org


Thank you again for your interest in our program.  We hope to meet you during the interview process in order to answer any other questions while you make your decisions about your child and adolescent psychiatry training.

 

Best,
 

Georgia Gaveras, DO
Director of Education and Training

Division of Child and Adolescent Psychiatry
Icahn School of Medicine at Mount Sinai
Mount Sinai St. Luke’s and Mount Sinai Roosevelt


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