University of Maryland Medical System (UMMS)
The University of Maryland Medical System, is a 700 bed facility, and is the primary teaching hospital of the University of Maryland. The hospital provides primary care services to the surrounding community as well as specialized tertiary care services to a broad socioeconomic population from the city and state. The School of Medicine and the University Hospital are functionally integrated to provide training for students in the professional schools, primarily for medical students, residents and fellows, and for the provision of medical services to the residents of the State of Maryland. In addition to the School of Medicine, the Schools of Law, Nursing, Pharmacy, Allied Health Sciences, Social Work and Community Planning, and Dentistry are also located on this campus. The close proximity of these schools facilitates interaction and sharing of resources in areas of common concern.
Child Psychiatry Inpatient Service
The Child Psychiatry Inpatient Service, located in the University Hospital (UMMS), consists of a 12-bed unit, school and offices for professional and administrative staff. It provides intensive evaluation and short term therapy for children aged 6 - 12, with an average length of stay of 13 days.
The program is designed to provide services for children whose emotional, mental, neurological, or behavioral problems have not responded to the customary outpatient or Day Hospital services, and/or who are in need of crisis intervention. Included are those children whose behavioral disturbances are of such a magnitude that treatment on an outpatient basis does not provide adequate protection against their destructive tendencies to themselves or to others. The program also provides diagnostic services for children whose problems preclude the use of outpatient diagnostic techniques. Admissions average 150 per year. The most frequent psychiatric diagnoses are affective disorders. Approximately 50% of the total number of patients are found to be learning disabled. Although the majority of the patients return to their families upon discharge, about 15 % are recommended for placement in long term residential treatment settings, and 25% are recommended for level five educational placements for severely educationally handicapped students.
Teaching on this unit is performed by two full time child psychiatrists and social workers. Family therapy training is taught and supervised by a doctoral level psychologist. Trainees include child psychiatry residents, medical students and social work students. The resident is assigned to one of two treatment teams with each team being responsible for half of the patients. Residents do admission work-ups, treatment planning and psychotherapy with patients and their families. The social worker is responsible for family therapy and discharge planning. Live family therapy supervision is provided as part of the training experience.
The school is staffed by a Masters level teacher with a special education concentration and is accredited by the Maryland State Department of Education. The educational staff, in collaboration with other staff members provide a multi-disciplinary approach to the educational and diagnostic evaluation and educational service provision for children.
The inpatient service provides individual intensive psychotherapy, milieu therapy, various forms of family therapy, behavioral therapy, psychopharmacological treatment, and remedial programs for children with cognitive deficiencies and disturbances.
Child Psychiatry Day Hospital
This 12 patient unit provides hospital diversion, hospital stepdown and intensive day treatment services. All modalities of treatment are utilized and child residents provide medical psychiatric services.
Child And Adolescent Psychiatry Outpatient Clinic
This clinic, with over 5000 patient visits per year, offers services for children and adolescents ages 4 to 18, with emotional, behavioral, developmental or learning problems. Services include evaluation, consultation, and brief or long-term therapy, utilizing all of the currently accepted treatment modalities including psychodynamic, cognitive and behavioral approaches. Group therapy includes specialized groups for latency children, young adolescents, older adolescents, and parents. Psychopharmacological medications are used when indicated. Specialty clinics include Mood Disorders, Attention Deficit Hyperactivity Disorder, Traumatic Disorders and Complex Disorders. Collaborative working relationships are developed with schools, physicians, and other professionals in the community. Residents perform diagnostic evaluations, individual, group and family treatment and medication management co-lead a group.
Walter P. Carter Community Mental Health Center (WPCC)
The Walter P. Carter Center Community Mental Health Clinics are located within the Baltimore campus and functionally incorporated into the medical school complex. The Center has two child and adolescent outpatient clinics, each serving a different geographic area and sociocultural background, offering a comprehensive training experience. Services include diagnostic evaluations, individual, group and family therapies, psychopharmacology and in-home and school interventions. A specialized program for conduct disorder - juvenile delinquents is situated at WPCC.
Sheppard Pratt Health System (SPHS)
The Division of Child and Adolescent Psychiatry at Sheppard Pratt, offers the following programs; a short term inpatient program for children and adolescents, a managed care adolescent evaluation and treatment unit, an outpatient program, a Child and Adolescent Day Treatment Program, an after school program, extended day school program, a respite program, and a special education program, the Forbush School. In addition, the health system operates NORCOM and Northwest Community Mental Health Centers which are community mental health centers serving Northern and Northwestern Baltimore County. Several outpatient satellite clinics in Bel Air, Owings Mills and Annapolis are operated by the Health System. All of these centers provide child and adolescent psychiatry services.
The inpatient program consists of 3 eighteen bed, coed units. The short term program, with an average length of stay of twenty days, includes the Childrens Unit for patients ages 5 through 12 and two adolescent units for patients ages 13 to 18. There are also two short-term managed care programs with an average length of stay of 5 - 12 days. The outpatient program provides a comprehensive array of psychotherapeutic and related services to individuals under 18 years of age and their parents and families.
The Forbush School is an on-site level V psychoeducational day treatment school for the education and treatment of severely emotionally handicapped children adolescents, preschool K through 12, for approximately 190 students from Baltimore City and surrounding counties.
First year residents assigned to Sheppard Pratt work in the inpatient programs and Child and Adolescent Day Hospitals for six months. Each resident is assigned to either the adolescent units, or to the Children's Unit for three months at a time. The resident carries 8 patients at any one time and is responsible for the complete medical and psychiatric diagnostic assessment, treatment plan and prescription of medication when indicated. The residents follow their patients from the inpatient units to the Day Hospital and provides individual, group or family psychotherapy, and participates in ward milieu therapy.
Second year residents may work in the outpatient clinic, the Forbush School and/or the Northwest Community Mental Health Center, where they are responsible for diagnostic assessments, consultations, crisis intervention and long term intensive psychotherapy.
Regional Institute For Children And Adolescents (RICA) - Baltimore
The Catonsville Educational Center, the Day Program of RICA, is a Level V psychoeducational day treatment program designed for the treatment of severely emotionally handicapped adolescents age 13 to 21. This program is structurally integrated with the RICA Residential Program in beautiful new buildings approximately three miles from the division's downtown campus. The program staff is composed of personnel from the Department of Health and Mental Hygiene, the Baltimore County Board of Education and the Baltimore City Board of Education. Additional services are provided by a consulting psychiatrist, psychiatric residents and several clinical interns (graduate and undergraduate level) from the University of Maryland and Catonsville Community College, as well as an educational intern in the area of speech and language.
The adolescents in the day school represent a heterogeneous grouping of inner city youth and lower middle class youth from suburban Baltimore County, many of whom are "school drop-outs" and who are experiencing emotional disorders that prevent them from learning in a regular classroom setting. The majority of the students in the day program are diagnosed with attention deficit disorder, conduct disorder, oppositional disorder or depression. In addition, a high percentage of the students are also diagnosed as learning disabled, generally in the areas of language and reading. The average length of stay in this program is two years.
The day treatment program serves as a training site for child psychiatry residents in the second year of training. Second year residents are assigned to this site one and a half days per week, providing diagnostic and evaluation services and participating in team planning and individual treatment. On site supervision is provided by the Child and Adolescent Psychiatry Medical Director, and a staff child and adolescent psychiatrist.
Child Psychiatry - Pediatric Liaison Service
This service, under the direction of Murray Kappelman, M.D., provides consultation to the general pediatric inpatient and ambulatory areas and pediatric emergency room at University Hospital as well as providing an active teaching program through the liaison teaching rounds and didactic conferences. Weekly liaison rounds provide a focal point for discussion of consultation cases. These rounds are attended by the pediatric house staff, medical students, nursing students, nursing and child life staff, pediatric psychology interns, child psychiatry residents, and behavioral pediatric fellows assigned to the Liaison Service. An interdisciplinary approach is emphasized. A weekly seminar is given which covers important topics in liaison psychiatry. Murray Kappelman, M.D. and Richard M. Sarles, M.D. co-lead the seminar and rounds.
Approximately 300 consultations are completed each year for problems covering the entire range of childhood disorders and total of 600 - 700 patient hour visits. Second year residents are assigned to this service for a four or six month block rotation. Supervision is by Richard M. Sarles, M.D.
The Center For Infant Study
The Center for Infant Study at the University of Maryland is a unique program that provides assessment and early intervention for infants and young children who are at high risk for serious mental disorder, or who already manifest signs of disorder. The Center is under the direction of David B. Pruitt, MD and includes an interdisciplinary staff of psychiatrists, psychologists, nurses and social workers.
The Center includes three programs:
- The Infant Mental Health Clinic evaluates and treats infants and children (to three years of age) and their families. Included in the Clinics target population are children with failure to thrive, attachment disorders of infancy, those who have experienced physical abuse or neglect and infants of severely mentally ill mothers.
- The Sexual Abuse Treatment Program treats children who have experienced sexual abuse, up to the age of five, as well as their families.
- The Therapeutic Nursery, associated with the Coldspring Head Start program, treats children enrolled in the Head Start Program who demonstrate behavioral problems. The Therapeutic Nursery offers individual therapy, family assessment and therapy and consultation with the Head Start teachers.
First year Child and Adolescent Psychiatry fellows are assigned to the Center for Infant Study. Extensive use is made of the Center's excellent facilities for videotaping and live observation of therapy sessions.
School Mental Health
The Division of Child and Adolescent Psychiatry provides mental health services, in 20 inner city community schools, elementary through high school. The school mental health program is also one of two sites to be awarded federal multi-million dollar grants to provide national consultation and resources to other programs.
Didactic seminars are part of the mental health consultation seminar along with a month case conference/supervision by Doctors Weist, and Shingleton.
Baltimore City Juvenile Court
The Juvenile Court is one of the major branches of the justice system in Baltimore City. It is located in the Court House in downtown Baltimore and serves a primary population of youth adjudicated as being children in need of supervision (CINS) or delinquent.
In this setting, which is one of the community consultation experiences for second year residents, the child psychiatry residents provide diagnostic and evaluation services for the court. The residents receive on-site supervision and teaching by Tonya Tuggle, M.D., a child and adolescent psychiatrist with special interest and expertise in the juvenile justice system. In coordination with this training site, a series of seminars on delinquency, runaway behavior and substance abuse, custody and other forensic issues are integrated into are the Therapeutic Modalities Seminar and the Mental Health Consultation Seminar at the Division of Child and Adolescent Psychiatry.
Each second year child resident attends the pediatric neurology clinic and evaluates patients under the direct supervision of one of the pediatric neurologists. A weekly teaching conference utilizing video tape examples of various clinical conditions is included in this rotation.
The curriculum for child psychiatry residents has been designed to provide them with the knowledge and skills necessary to function effectively in a variety of roles and settings. Seminars are given on two days during the week, during which time residents are excused from clinical responsibilities. Tuesday seminars are held at Sheppard Pratt and UMMS; Thursday seminars are at UMMS. Many seminars are multidisciplinary, i.e., the residents participate together with interns in Child Psychology and fellows in Behavioral Pediatrics.