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 applicants.
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 treated.
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 most efficient.
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 towards wellness.
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 Achenbach System 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 languages.
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 and age.
- 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 addressed.
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 assessment.