While covering all the required features of a standard child and
adolescent training program, this fellowship places emphasis on
some specific areas that might be of particular interest to some
The Family Based Approach
Research has increasingly shown that child psychopathology is the
result of multiple interacting genetic and environmental factors.
Furthermore, it is well known that most psychiatric disorders
tend to run in families. Recent studies have also shown benefit
in child behavior when parents with psychiatric disorders are
Given this knowledge, this training program emphasizes a Family
Based Approach to assessment and treatment. Evaluations in this
clinic include screenings of psychiatric illness in family
members, measures of family environment, and appraisals of
specific environmental factors such as television and computer
time, sleep, and structured activities.
Much of this information is gathered in questionnaire form prior
to the appointment in order to make face time with the clinician
Treatment plans that arise from this approach typically include
not only medication suggestions when appropriate but also
suggestions for specific types of psychotherapy, school based
interventions, referrals for parents themselves, and
recommendations for changing specific environmental factors that
might be exacerbating symptoms and impeding a child's trajectory
Fellows in this program are taught this approach and this way of
thinking not only for their outpatient rotation but as a
foundation for all of their clinical endeavors.
Learn more about the Vermont Family Based Approach.
Despite the term "mental health" that is commonly used in
psychiatry departments, most programs focus nearly all of their
education on mental illness rather than true mental health. Here
at the University of Vermont, we believe strongly that our
graduates should be experts not only in how to help those who are
sick but also in how to help children thrive.
We believe that emotional behavioral wellness is squarely within
the domain of our field and incorporate this attitude into our
training program. As an example, the fellowship includes a
seminar called Child Behavioral Wellness that is given to the
second year fellows. Both the training director and the child
psychiatry division chief are members of AACAP Preventions and
Health Promotion committee (Dr. Hudziak is chair). Please see the
chapter "Positive Child Psychiatry," written by the Program
Director, in the new book Positive Psychiatry which was published
by American Psychiatric Publishing.
Access to a child psychiatrist is a national problem, and efforts
are underway to utilize technology to help remove obstacles from
children and their families in receiving effective and timely
child psychiatry services.
One such tool is using videoconferencing technology to enable
patients and families to be seen from more remote locations while
the clinician performs an evaluation from his or her regular
office. The VCCYF currently has installed high-quality and secure
connections between it and several Federally Qualified Health
Centers. With the help of case managers, consultive evaluations
to state primary care physicians and mental health professionals
take place using this technology.
Fellows will participate in telepsychiatry evaluations as part of
their Consult/Liaison and Outpatient Rotations. These experiences
will not only equip trainees in delivering service through novel
mechanisms but will also provide experience in working with media
and public relations.
Empirically Based Assessment
The current DSM-based classification system of psychiatric
disorders has been a tremendous advance to our field. Fellows in
this program are taught to become proficient diagnosticians under
this conceptual framework.
At the same time, additional classification structures exist that
offer additional and complementary information in clinical and
research assessment. This program trains fellows in the most
widely used child behavioral assessment system in the world - the
of Empirically Based Assessment (ASEBA). This system was
developed here at the University of Vermont by Dr. Thomas
Achenbach and colleagues and has now been translated in over 70
The ASEBA system classifies emotional and behavior problems in a
number of ways that can augment the DSM.
- Symptoms are grouped together according to how they naturally
cluster together in children rather than by committee decision.
For example, one problem area is anxious/depressed. This area is
considered a single dimension of problems rather than two
separate domains because research has shown that these types of
symptoms tend to cluster naturally in children and adolescents.
- Symptoms are scored quantitatively rather than in a yes/no
format. This provision allows the clinician to consider levels of
problems that might be important in specific circumstances. For
example, "subclinical" levels of attention problems might require
treatment in a child with borderline intelligence but maybe able
to be overcome in another child with higher intellectual ability.
- Furthermore, the quantitative levels of symptoms are
standardized according to both age and gender. Output from these
scales, for example, allows one to see what percentile a reported
level of problem lies compared to other children of that gender
- Symptoms from multiple informants can be easily summarized
and compared, adding invaluable information to the clinician.
Agreement and discrepancies between a child and his or her
parents or teachers, for example, can be readily seen and
In this way, the ASEBA system becomes more than a simple rating
scale and instead is viewed as an important alternate conceptual
framework that can compliment the DSM system. Fellows in this
program will become "fluent" in both DSM and empirically based