Crista E. Wetherington, Ph. D, Gabriela Reed, Ph. D, Julie N. Germann, Ph. D, Jamie A. Grollman, Ph. D, Jami N. Gross, Ph. D, Mary C. Lazarus, Psy. D, & Corinne E. Fribley, MD The Center for Pediatric Psychiatry, Children’s Medical Center Dallas & The Department of Psychiatry, UT Southwestern Medical Center • This poster describes the process for conceptualizing an integrated program for psychology and psychiatry training within a pediatric teaching hospital NEEDS ASSESSMENT The Consults: Average Monthly Consults by Discipline in 2008 • A hospital based psychiatry consultation liaison (C/L) service that is well integrated across mental health disciplines can offer rich and unique opportunities for psychiatry and psychology trainees, as well as benefit patients and families • With one of the busiest pediatric emergency departments (EDs) in the country and 360, 000 patient visits per year, the demand for mental health services is significant • Through its affiliation with UT Southwestern Medical Center, Children’s has a strong commitment to training and serves an urban area with a diverse population • The development of an integrated training program, its implementation, challenges faced, and future directions are discussed NEEDS ASSESSMENT • Recent growth in patient volume and staff has increased the importance of examining the training model on the C/L team and encouraging cross discipline collaboration The Consult Team: • 3. 5 psychiatry attendings • 6 psychologists • 1 consult nurse • 2 half time clinical therapists • 5 ED psychiatric social workers (LCSWs) • 3 half time predoctoral psychology interns • 1 full time psychology postdoctoral fellow • 2 child psychiatry fellows (10 week rotations) • 2 adult psychiatry residents (4 week rotations) • 1 2 medical students (3 week rotations) CHALLENGES • Implementation did not meet expectations and raised unforeseen challenges, but yielded accomplishments Generated discussion about training/clinical needs Consult Grand Rounds positive experience for team New shared office space for trainees completed Synthesis of Clinical Demands & Training Priorities: • Inherent differences in nature of clinical responsibilities Psychology and play therapy • Outpatient appointments, clinics, and consults to medical floors Psychiatry • Medical floor/ED consults primary responsibility during consult rotation • Team members felt fragmented Triaging calls became more complicated Difficult for consult nurse to stay informed Variability in how different teams carried out rounds • The psychiatry C/L team within the Center for Pediatric Psychiatry at Children’s Medical Center Dallas offers an environment for this type of cross discipline training • Children’s Medical Center is a private, not for profit academic healthcare facility Licensed for 483 beds More than 50 subspecialty programs Only Level I trauma center for pediatrics in Texas RESULTS • After a few months, consult team drifted back toward more traditional one team model The Training: • Goal of providing quality training opportunities within a rich and unique environment for cross training Weekly individual supervision for all trainees Weekly didactics and group supervision for psychology interns and postdocs Monthly professional development seminar for psychology postdoctoral fellows Weekly didactics for psychiatry fellows Consult rounds 4 x/week Consult grand rounds 1 x/week • Meeting clinical needs while ensuring quality training • Team members surveyed recently to understand perception of rounding model and attitudes on team Like 1 team model: 100% agree or strongly agree Prefer 2 team model: 10% agree, 50% disagree or strongly disagree; 30% neither agree nor disagree Consult Team Survey The Need: • Increased volume of patients, increased number of individuals on team, and decreased time for discussion of cases • Began planning a 2 team rounding strategy IMPLEMENTATION • Primary Goals: Cross discipline collaboration on individual patients Briefer, but more in depth rounds More teaching opportunities during rounds Increased discussion and case conceptualization • The Model: Plan implemented in Fall 2008 Divided into two teams comprised of representatives from each discipline on the service Teams met simultaneously but in different rounding rooms New consults divided between teams when triaged DISCUSSION & FUTURE DIRECTIONS • Fewer psychiatry fellows in 2009 2010 will affect responsibilities of team members and division of labor Psychiatry attendings will complete more consults Social workers will complete most ED evaluations Psychology trainees will need to adjust schedule to accommodate more new consults Likely more opportunities for psychology trainees to work with psychiatry attendings on cases • Revisit idea of a team model Round and see patients as two teams; meet as an entire team weekly for in depth case presentations Strengthen role of each discipline on the service Scheduling monthly meetings focused on continued improvements Question INTRODUCTION % of team members endorsing rating CHALLENGES Team Members: • Model difficult for those without a counterpart; teams missed input of disciplines attending only one rounds • Appreciated social aspect of meeting as a single team • Transitions in leadership (e. g. , new medical director, new psychologists and psychiatry attendings) Increased Volume: • Growth in staff more need for mental health services • Necessary to “divide and conquer” to work efficiently • Development of a successful model should consider: Goals of training Clinical needs Team members’ roles Buy in and investment from team members Education and explanation regarding changes and the rationale for them Building team’s cohesiveness across disciplines Emphasizing strengths of disciplines and inter connectedness of skill sets • Implementing a model that effectively integrates psychology and psychiatry training while addressing significant clinical demands can be challenging, but has the potential to yield enriching cross discipline collaboration that can benefit trainees, patients, families, and other team members
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