Child and Adolescent Psychiatry Fellowship Curriculum

group of fellowship students working with playdoh

Didactics by the Numbers

  1. Fellows have 6-7 hours weekly of protected didactics time.
  2. Summer didactics are split into 2 - each class has didactics that are tailored to meet that group’s unique learning needs at the start of the year.
  3. Core didactics are on a 2-year schedule with experts leading our classes - this includes our large faculty group comprised of psychiatrists, psychologists, and social workers.
  4. 360 holistic didactic experiences - experts are asked to create lectures that review a topic from multiple perspectives to ensure a thorough understanding that includes cultural awareness, fairness, systemic influences, and evidence-based and evidence-informed data. Topics - too many to count!
  5. 10 psychotherapeutic interventions are covered including:
    1. Cognitive behavioral therapy
    2. Family therapy
    3. Interpersonal therapy
    4. Applied behavioral analysis
    5. Psychodynamic psychotherapy - Mentalization Based Theory and Practice
    6. Dialectical behavioral therapy
    7. Parent management training
    8. Exposure and response prevention
    9. Eye movement desensitization and reprocessing
    10. TF-CBT
  6. 4-5 hours weekly of psychotherapy training
    Psychotherapy is a skill set that requires active participation in both clinical cases and in didactic sessions. Our program is designed to allow fellows to carry psychotherapy cases at both their primary clinical sites as well as in their 24-month continuity clinic.
    1. Fellows use a Psychotherapy Passport to track their patients and their therapy modality.
    2. Trainees are expected to develop basic competencies in several forms of psychotherapy for children and adolescents including Time Limited, Supportive, Cognitive Behavioral, Family, Psychodynamic, and Play Therapy.
    3. Psychotherapy supervision occurs weekly with clinical faculty.
    4. Fellows who wish to delve deeper into psychotherapeutic theories and techniques may apply for the two- or four-year program at the Houston-Galveston Psychoanalytic Institute in Psychodynamic and Psychoanalytic Programs respectively.
    5. The ability to develop an effective therapeutic alliance with children, adolescents, and their parents is an invaluable skill set that is essential to all aspects of care provided by a child psychiatrist.
  7. 6 Journal Clubs annually
    Journal Club occurs every other month during the first hour of didactics and is supervised by Dr. Chadi Calarge.
    1. Fellows will learn how to evaluate psychiatric literature critically and become familiar with emerging research in the field.
    2. Each fellow is assigned to present an article. The designated fellow works with Dr. Calarge in choosing an article to review and how best to present the critical analysis of the topic to the group.
    3. Dr. Calarge moderates and facilitates the discussion to ensure the fellows understand the core concepts and conclusions of the article.
  8. 6 seminal article reviews annually
    Seminal article review is an activity that occurs every other month during the second hour of didactics and is supervised by Drs. Sohail Nibras and Anh Truong.
    1. Fellows will dissect clinically pertinent articles in the field of pediatric mental health that have helped guide diagnostic formulations and evidence-based treatment plans.
    2. The discussion serves to solidify the fellow’s rationale for treatment and what therapeutic modalities are most appropriate.
    3. Each fellow is assigned to present an article. The designated fellow works with Dr. Nibras or Truong in choosing an article to review and how best to present the critical analysis and conclusion of the article to the group.
    4. Dr. Nibras or Truong moderates and facilitates the discussion to ensure the fellows understand the study and conclusions of the article.
  9. 12 monthly Transition to Practice lectures
    The Transition to Practice lecture series occurs during the first Monday of every month. Fellows discuss various aspects of career development, employment opportunities, and clinical practice considerations in pediatric psychiatry that are otherwise not covered in a formal didactic series. This is where fellows can candidly ask their questions on:
    1. financial planning
    2. coding and billing
    3. contract negotiations
    4. introduction to private practice
    5. community mental health
    6. licensure and maintenance of certification
    7. intensive outpatient psychiatry
    8. telemedicine
    9. locum tenens
    10. legal and ethical considerations in outpatient practice
    11. consultation and liaison psychiatry
    12. job opportunities within the Houston area
  10. Weekly Texas Children’s Hospital conferences
    During the Texas Children’s Hospital (TCH) rotation, fellows participate in
    1. A monthly multidisciplinary developmental behavioral pediatrics and psychiatry
      conference
    2. Discussion of complicated cases with Drs. Maldonado and Shah
    3. Dr. Havel’s conference with a focus on psychotherapy

Training Sites

Texas Children's Hospital is a tertiary care pediatric facility and is Baylor College of Medicine’s primary affiliate for the program. This site is a key training site for other medical personnel and mental health students, contributing to a useful and exciting environment. It is located inside the Texas Medical Center and is in easy walking distance from Baylor College of Medicine. Fellows typically spend six months full-time during the first year at Texas Children’s Hospital, a required rotation focused on ambulatory clinic activities that includes rotating with the TCH Pediatric Neurology and Developmental Pediatric Clinic. Fellows in their second year work full time for 2 months on the consultation and liaison service, 2 months with the mood disorder clinic, and 2 months on special populations (includes Child Psychiatry Access Network, Texas Child Health Access Through Telemedicine Substance Abuse Clinic, Mind Body Clinic and Complex Care Clinic, Harris Health Substance Abuse Clinic, and Harris Center rotations in forensic and Dual Diagnosis Clinic for individuals with intellectual disabilities). Finally, second year residents have a 2-month Elective Rotation where they focus on a maximum of two specialty areas within children’s mental health at TCH (Mood Disorders, Autism, Attachment, Integrated Care, Eating Disorders, etc.).

The Menninger Clinic is a specialty inpatient psychiatric hospital. Its primary focus is the treatment of patients who have failed multiple previous treatments known as the Adolescent Treatment Program Track A with an average length of stay 4-6 weeks. Track B is a partnership with TCH providing short-term stabilization for adolescents seen in the TCH emergency room with an average length of stay 2 weeks. The site provides training for psychologists, social workers, and psychiatry residents. Fellows spend 3 months during their second year of fellowship at The Menninger Clinic on ATP Track A, a required rotation. An average case load is 6-8 patients. Fellows can select to spend an additional month exclusively working with youth and families in the short-term stabilization program referenced above.

The HHS system has several community clinics and its premier flagship hospital, Ben Taub General Hospital. BTGH is a county hospital providing medical, surgical, and psychiatric care to a predominantly indigent population. It is located inside the Texas Medical Center and is within easy walking distance from Baylor College of Medicine and Texas Children's Hospital. The Pediatric Psychiatry Ambulatory Clinics (KIDS Clinic within Ben Taub and Pasadena Clinic) provide an opportunity for residents and fellows to learn psychiatric management, including medication evaluation, prescription, and follow-up, as well as the provision of eclectic individual and family therapy for a wide range of psychiatric disorders.

The The Harris Center for Mental Health and Intellectual and Developmental Disabilities (IDD) provides high-quality, efficient, and cost-effective services so that persons with behavioral health needs may live with dignity as fully functioning, participating, and contributing members of our community. Both first- and second-year fellows work within the Harris Center. In the first year, each first-year resident will have ½ day for 6 months focusing on specific populations of care: Forensics and Quality Improvement Projects. Each second-year fellows will spend two half days for 2 months within clinics that are for patients with Intellectual Disability in addition to Mental Health Disorders and Providing Competency Evaluations for court.

As a Federally Qualified Health Center, Legacy provides essential preventive and primary healthcare services at low or no cost. Legacy’s 11 clinics, located in Houston, Baytown, and Beaumont, served 85,430 patients through 256,108 patient visits in 2013. Legacy offers adult primary care, pediatrics, dental care, vision services, behavioral health services, OB/GYN and maternity, vaccinations and immunizations, health promotion and community outreach, wellness and nutrition, and comprehensive HIV/AIDS care to all Texans, including those who have traditionally faced barriers to care. The mental health clinics where the fellows work are located outside the Texas Medical Center within a 20-mile radius. The Legacy mental health clinics provide an opportunity for fellows to learn psychiatric management, including medication evaluation, prescription, and follow-up, and the provision of eclectic individual and family therapy for a wide range of psychiatric disorders.

Sun Behavioral Hospital is an acute care inpatient psychiatric facility designed to assess, diagnose, and treat children ages 6-12 years of age with acute psychiatric emergencies. Fellows can select Sun Behavioral for a 1-month rotation in their second year of training. The fellows will be assigned 6-8 patients and provide assessment, management, and psychoeducation to the patients and their families. The fellows will work within the multidisciplinary team.

The Continuity Clinic is the program’s primary site for ambulatory continuity training for fellows (and other trainees) and specializes in the provision of psychotherapies; continuous care for children, adolescents, and families; and practice management knowledge and skills. Fellows are assigned to one of the following for the entirety of their fellowship: TCH Clinic locations, HHS KIDS clinic, or the Legacy Clinic for one ½ day on Monday afternoons. These activities are part of a fellow’s week regardless of primary rotation site and are coordinated with primary attendings. In addition to the child psychiatry fellows, there are social work fellows/interns and psychology trainees who are assigned to these clinics.