Primary Admitting Diagnosis for this population is as follows:

Bipolar Disorder                 35%

Mood Disorder                   29%

Major Depressive Disorder   24%

Psychotic Disorder              5%

Depressive Disorder NOS      4%

Schizoaffective Disorder       3%

Conduct Disturbance NOS     2%

All Other                            1%

• Caseload is not expected to exceed six inpatients per trainee.

• Individual supervision with the attending is scheduled outside the time spent in teaching rounds and is required to occur at a minimum of two hours per week. Residents may choose to participate in unit group therapy, with supervision available immediately after group sessions.

• The unit has been designed to accommodate clinical and research interests, with each new patient being assessed using a standardized diagnostic research interview and receiving a state of the art clinical work-up. Residents participate in the inpatient assessment and synthesize available information to produce a diagnostic formulation and treatment plan with the supervision of the attending child and adolescent psychiatrist, then direct and monitor treatment across the hospitalization. There are many opportunities for residents to continue to follow patients in the outpatient setting after discharge. 

02. OSU (Outpatient Child and Adolescent Psychiatry; Nisonger Center; Forensics)

Required 18-month rotation beginning the second half of the first year and continuing through the second year of the fellowship.

• Faculty supervision by a fully trained child and adolescent psychiatrist or general psychiatrist is required on site. Outpatient care is team based and multidisciplinary, including faculty psychologists and social workers. 

• Educational activities, besides scheduled individual supervision, include refinement of assessment skills, longitudinal practice with psychotherapeutic modalities, acquisition of consultative skills, application of psychotropic medication interventions, and exposure to research.  

• The clinical population served is quite broad and diverse, and residents have opportunities to see patients in OSU outpatient child and adolescent psychiatry and at the OSU-Nisonger Center. The OSU outpatient child and adolescent psychiatry clinic had approximately 5,281 visits from July 2004 – June 2005. The gender ratio showed a very slight male preponderance. When patient age was examined, 81% of patients were adolescents and 19% were children. Caucasians made up 82% of visits, followed by 12% African American, and 6% other. Mood disorders accounted for the majority of primary diagnoses (42%), but many patients suffered from multiple disorders. Residents are exposed to youth with substance abuse disorders in this experience, with patients suffering from drug/alcohol dependence accounting for nearly one-third of the primary diagnoses reported (30%). Other prominent diagnoses seen in the clinic include attention deficit disorder, disruptive behavioral disorders, impulse control disorders, anxiety disorders, and obsessive compulsive disorder, and residents also see patients presenting with psychotic disorders and eating disorders at this site. The clinical rotation in forensics is conducted at juvenile justice facilities operated by the Ohio Department of Youth Services. The Department of Psychiatry at OSU has contracted to provide comprehensive services to adjudicated youth in their custody in five different facilities within a fourteen to sixty mile radius of OSU. The system serves youth younger than 21 years, with most adjudicated youth being between the ages of 15 to 18 years. Many youths have preexisting psychiatric diagnoses, while others demonstrate emergence of severe psychiatric disturbances, including psychosis, suicidality, and aggression when confined. The intensive mental health unit at Marion serves youth in need of intensive mental health services, while the units in Circleville and Mohican specialize in sexual offenders and substance abuse, respectively. The resident is involved in the assessment, treatment, and continuity of care provided to incarcerated youth, and participated in multidisciplinary team meetings that include parole officers, court officials, psychologists, social workers, correctional officers, families, educators, and other medical and non-medical personnel. The placement at the OSU-Nisonger Center provides exposure to a clientele of primarily mentally retarded and developmentally delayed youth with behavioral and/or emotional problems. The gender ratio is approximately equal. There are numerous patients with comorbid physical disorders that are important considerations in the process of assessment and intervention (e.g., epilepsy). Resident activities may vary from being a participant observer in a comprehensive assessment conducted by a multidisciplinary team to taking the lead in providing ongoing treatment services involving psychoeducation, psychotropic medication, psychotherapy, and parent guidance with faculty supervision. 

• The clinical caseload is measured in terms of the amount of time spent in clinical activities. The expectation is that residents will devote approximately 50 to 80% of their time to patient care services. Patient logs are maintained and reviewed to help ensure an adequate and instructive case mix. Residents are responsible for conducting initial assessments and ongoing management for selected cases with faculty supervision.

•  Individual supervision is scheduled and provided to residents each day they are at the site.

03. Columbus Children’s Hospital (Outpatient; Consultation-Liaison; Neurology; School Consultation)

The rotation is in the second training year and is required. 

• Faculty supervision is provided on-site by a fully trained child and adolescent psychiatrist and is required. Residents working in pediatric neurology are required to be directly supervised by a board certified pediatric neurologist.
• In addition to scheduled individual supervision, residents participate in clinical conferences and multidisciplinary team meetings with other mental health professionals. Educational opportunities include:  refinement of assessment skills; longitudinal practice with psychotherapeutic modalities; development of consultative skills relevant to the care of youth with physical illness who are being cared for by pediatricians and other medical specialists in the general medical setting; application of psychotropic medication interventions; and, exposure to research.

• Columbus Children’s Hospital (CHI) is the largest provider of outpatient mental health services for youth in central Ohio. A large proportion of the clinical population is referred from CHI pediatric clinics, both primary care and specialty services. Accordingly, a considerable portion of cases seen by residents at CHI suffer from comorbid medical conditions and require collaboration and consultation with referring pediatricians and specialists. CHI also serves a significant number of children and adolescents from outlying and rural areas. About 7,000 patients are seen annually and 90,000 hours of care are provided in the outpatient psychiatry clinic.  The gender distribution is 60% male and 40% female. Racial distribution is 65% Caucasian, 27% African-American, and 8% other. Outpatient counseling/psychotherapy, psychological assessment, and psychiatric services are available at the main hospital and at eight CHI Close to Home Centers in the metro area. Intensive community-based and school-based services are available for severely emotionally disturbed children and youth. Consultation-liaison psychiatry experiences are available for CHI inpatients and during the outpatient rotation, where consultations may be requested from psychiatry by community pediatricians and hospital based specialists. School consultation experience is gained by residents through relationships between CHI and public schools in the community. The current multi-disciplinary staff at CHI includes approximately 3 FTE psychiatrists, 3 FTE developmental-behavioral pediatricians, .5 FTE nurse practitioners, 30 FTE psychologists and trainees, and 65 social workers, counselors and aides. The top diagnoses treated are: ADHD, disruptive disorders, mood disorders, anxiety disorders, adjustment disorders, psychological factors affecting medical condition, somatoform disorders, and stress related disorders such as post-traumatic stress disorder (PTSD). Residents at CHI gain experience with youth from divorced and separated families, as well as those who have experienced neglect, physical and sexual maltreatment, and family violence. Residents are also exposed to the evaluation and management of preschool children with common emotional and behavioral difficulties and developmental delays. Residents also rotate through the pediatric neurology specialty clinic at CHI, where there are nine board certified pediatric neurologists and several nurse practitioners. Patients range in age from infancy to young adulthood, and the full range of socioeconomic spectrum is represented, with approximately one fourth of patients and families receiving public assistance.

• The clinical caseload is measured in terms of the amount of time spent in clinical activities. The expectation is that residents will devote approximately 50 to 80% of their time to patient care services. Patient logs are maintained and reviewed to help ensure an adequate and instructive case mix. Residents are responsible for conducting initial assessments and ongoing management for selected cases with faculty supervision.

• Individual supervision is scheduled and provided to residents each day they are at the site.

04. Moundbuilders Guidance Center

The rotation is available in the first and second years.

•  Faculty supervision is provided on-site by a fully trained child psychiatrist and is required. 
•   In addition to scheduled individual supervision, educational opportunities include: refinement of assessment skills, practice with psychotherapeutic modalities, consultative skills, and the application of psychotropic medication interventions.

•  Moundbuilders Guidance Center is the main agency for mental health services for Licking County and Knox County in Central Ohio. Moundbuilders is a non-urban behavioral health care center and offers a comprehensive array of outpatient services for all ages, designed to identify and treat a wide range of mental health and behavioral problems. The most current data notes that over 6,000 patients are seen yearly, with approximately one-third of the entire patient population at Moundbuilders being 18 years old or younger. Gender distribution is 60% male and 40% female.  Racial distribution of the patient base is 91% Caucasian, 3% African-American, and 6.0% other. Twenty-seven percent of the patient base is self-pay, 25% is worker’s compensation, 20% managed care, and 28% other. The majority of referrals are self-referrals, followed by family and private physicians. The top diagnoses treated are affective disorders (53%), behavioral problems (6.3%), ADHD (5.5%), severely mentally disabled (5.0%) and other (30%).

• The clinical caseload is measured in terms of the amount of time spent in clinical activities. The expectation is that residents will devote approximately 50 to 80% of their time to patient care services. Patient logs are maintained and reviewed to help ensure an adequate and instructive case mix. Residents are responsible for conducting initial assessments and ongoing management for selected cases with faculty supervision.

•   Individual supervision is scheduled for each fellow each day they are at the site.

• This affiliation affords the fellow an opportunity to observe an array of psychiatric problems within an entire community and to observe how resources are prioritized to meet the community’s need. The importance of collaborative efforts with school juvenile justice and other community systems is stressed. Fellows observe and participate in a holistic view of community resources and networking, including county government, with a first hand view of the impact of community mental health in a non-urban setting.