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As a second-year Child and Adolescent Psychiatry fellow (PGY5), my weeks are filled with various outpatient clinics and therapy sessions as well as opportunities for independent learning and projects. 

Child and Adolescent Psychiatry PGY 5: A Day in the Life with You Na Kheir

By: You Na Kheir, MD

As a second-year child fellow (PGY5), my weeks are filled with various outpatient clinics and therapy sessions as well as opportunities for independent learning and projects. 

In the morning, I have the Disruptive Mood Disorder clinic with David Dunn, MD. I started his clinic as a PGY3 and kept going for 2 years. I really enjoy his clinic population and his teaching. He is a wonderful teacher, a mentor, and a skilled physician who makes even the most shy and awkward child speak up and talk about his or her feelings. Patients have various diagnoses, including ADHD, oppositional defiant disorder, various co-morbid mood and anxiety disorders, and complex medical conditions. 

In the afternoon, I see my weekly therapy patients. I currently have one long-term psychodynamic psychotherapy patient who I see weekly while I also manage his medications at the same time for his depression and ADHD. I carry two ENCOMPASS therapy patients who I see for dual diagnoses (substance use and mood disorder). The ENCOMPASS therapy modality utilizes individual cognitive behavioral therapy with motivational incentives to encourage treatment compliance and abstinence, reinforced by regular urine drug screenings. These therapy patients are supervised by either psychiatrists or psychologists who are faculty members in our department. 

I work with Leslie Hulvershorn, MD and Zachary Adams, PhD in their ENCOMPASS dual diagnosis clinic on Tuesdays. Clinic starts with an hour-long multidisciplinary meeting where we review clinic patients (intake and established patients), review their progress with objective screening measures, discuss challenging clinical scenarios, and collaborate with other team members, including psychologists, psychology interns, psychiatry residents and fellows, social workers, therapists, and support clinicians. Patients generally have substance use disorders of varying duration and severity with co-morbid mood and/or anxiety disorders. Initial assessment of each patient requires a 3-4 hour-long exhaustive and intense diagnostic assessment using Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), a semi-structured interview to measure current and past symptoms of mood, anxiety, psychosis, and disruptive behavior disorders in youth ages 6-18 years old. We manage these patients with evidence-based medication and dual-diagnoses focused therapy. 

I work with Dr. Shelton at Midtown clinic on Wednesday mornings. Midtown is a community mental health clinic and sees many patients facing multigenerational trauma, violence, poverty, and various psychiatric illnesses, including ADHD, ODD, mood/anxiety, PTSD, and other trauma-related disorders. We work closely with school-based and clinic-based therapists, updating and providing feedback to the child’s Individual Education Plan (IEP), giving guidance to therapists with treatment plans, and working with multiple family members to help the child’s well-being and growth. Many patients struggle with their psychosocial factors and family dynamics, so you really get to appreciate the complexity of Child and Adolescent Psychiatry in real community settings. 

In the morning I work with Martin Plawecki, MD in his Developmental Disorder clinic. Most patients have diagnoses of Autism Spectrum Disorder and/or Intellectual disability of known or unknown etiologies. Many patients have difficulty with communication, complex medical needs, aggression, social challenges, and academic impairments. We work closely with psychologists in our department who provide behavioral interventions and therapy to patients and their families. I just started the clinic a few weeks ago, but it’s already been a great learning experience so far. 

In the afternoon, I work with Rachel Yoder, MD, Gabriela Rodriguez, PhD, and Valerie Scislowicz, LCSW in their Family-Based Treatment clinic. In this uniquely designed clinic, we see both caregivers and youth for their individual psychiatric needs. Currently we are limiting our clinical focus to concerns for depression or anxiety in caregivers, and anxiety, depression, or behavioral problems in their children. Psychiatrists, including Dr. Yoder and myself, see patients for medication management, and parents follow up with Dr. Rodriguez for parent management training. Parents also see Valerie for their individual therapy addressing their needs. We are often able to find many missing pieces and causes of problems as we provide family-based assessment and treatment. 

Fridays are focused educational days. We have weekly Grand Rounds organized by the department of Psychiatry at Indiana University. Afterwards, we join the rest of the psychiatry residency program for our resident business meeting and journal club, which is followed by child fellow didactics. Child fellow lecture topics for the first 6 months of 2019 include, but are not limited to, normal development, psychopharmacology, behavioral interventions for ADHD, ODD, sleep disorders, autism etiology and genetics, and many more.