The Triple Board Philosophy

Will the Triple Board Residency at IU School of Medicine really train me to board and work in all three disciplines?

Absolutely. One of the biggest areas of concern that triple board applicants express is about training in pediatrics. At IU School of Medicine, there is a wide range of exposure and training opportunities. You will care for “bread and butter” conditions to the most specialized/complex diagnoses in all three disciplines. While in each discipline, the goals and expectations of your training and work will be equivalent to peers in the other disciplines.

 

Most states are under-resourced in mental health services. How is IU School of Medicine addressing this challenge?

IU Health is the largest health care system in Indiana and supports the only triple board residency and child psychiatry fellowship. Our organization considers the entire state population to be our responsibility. Many innovative programs have been developed as a way to tackle gaps in services:        

 

• Multiple mechanisms for integrated behavioral health in primary care settings, designed to deliver integrated behavioral health in primary care settings.

• The Department of Psychiatry has a long-standing and close-working relationship with the Indiana State Division of Mental Health and Addiction, with faculty members serving on various government task forces and committees addressing child and adolescent mental health. Residents are able to participate and obtain solid advocacy experiences and skills through the residency advocacy elective.
• Indiana Behavioral Health Access Program for Youth (Be Happy) – A service available to primary care and specialty providers throughout the state to “phone a friend”/consult a child psychiatrist on the mental health care of a patient in need. The goal of the service is to improve evidence-based practice throughout Indiana.

• Psychotropic Consultation Program: an initiative launched by IU School of Medicine Department of Psychiatry, Department of Child Services (DCS), Office of Medicaid Policy and Planning, Division of Mental Health and Addiction, Family Social Services Administration for overseeing the care of DCS involved youth who are prescribed psychotropic medications. A multidisciplinary team reviews best practice guidelines, monitors prescription patterns, provides education, and consultation.

• Project ECHO: Project ECHO (Extension for Community Healthcare Outcomes) is a movement to connect local primary care teams with inter-disciplinary specialist teams via technology to improve treatment for complex and chronic health conditions. State-supported Project ECHOs include topics in general psychiatry, child psychiatry, and addiction psychiatry. Many interesting options available, including a series on LGBTQ health care.

• IU Health “Virtual Hub”: Behavioral health clinicians located in a “virtual hub” evaluate patients who have presented in crisis to IU Health ERs throughout the state.

• Cross Teaching between Specialties: Opportunities for faculty, residents, and fellows to provide didactics on psychiatric topics for the medical school and other residency programs (e.g., general pediatrics program, emergency medicine program, child protection, developmental behavioral pediatrics program).

• Psychiatry Outpatient Clinic for Categorical Pediatrics: A clinic option in the IU Child and Adolescent Psychiatry Outpatient for pediatricians who plan to practice primary care pediatrics, to gain more comfort in diagnosing and treating psychiatric conditions.

• Neurodevelopmental Hubs: The Neurodevelopmental Hubs are a well-integrated, statewide system of care for children with neurodevelopmental and behavioral conditions to improve access to care.
  
  
  
  

What programs does IU offer that provide care for children with autism and intellectual disabilities?

• Developmental Pediatrics Complex Care Service: Residents work on an inpatient pediatric rotation with Complex Care, a multidisciplinary team caring for children with neurodevelopmental and genetic conditions.
• Outpatient Developmental Pediatrics.
• The Center for Youth & Adults with Conditions of Childhood (CYACC): CYACC is a nationally known program that helps youth ages 11 to 22 with chronic health conditions transition successfully from childhood to adulthood.

• Neurodevelopmental Hubs: The Neurodevelopmental Hubs are a well-integrated, statewide system of care for children with neurodevelopmental and behavioral conditions to improve access to care.
• Developmental-Behavioral Pediatric Fellowship.
• IU Psychiatry and Christian Sarkine Autism Center: The Christian Sarkine Autism Center, through multiple clinics (including Down Syndrome and Catatonia Clinic, Child Autism and Neurodevelopmental Disorders Clinic, and Adult Neurodevelopmental Disorders Clinic), provides psychiatric care to children with neurodevelopmental conditions and autism.

• Neurodiagnostic Institute (NDI) Autism and Neurodevelopmental treatment: This cutting edge inpatient unit at the state hospital residential facility is designed to take care of youth with neurodevelopmental conditions. Residents rotate through the Adolescent Autism unit.

• Hands in Autism: Hands in Autism is a state-wide training and resource center providing evidence-based behavioral and educational practices for providers and other stakeholders across settings (educational, medical/clinical, home/community).

What does IU School of Medicine offer that provides training to care for children with chronic medical conditions, the medical/psychiatric interface, and/or in consultation liaison?

• Riley Hospital for Children: Riley Hospital for Children is the only tertiary care hospital in Indiana, is ranked among the top children’s hospitals in the country by U.S. News & World Report.
• Robust specialty pediatric services: Riley Hospital provides care for several specialty services, including oncology, stem cell, sickle cell, gastroenterology, rheumatology, nephrology, cystic fibrosis and pulmonology, cardiology, , pediatric intensive care unit, neonatal intensive care unit, and heart/kidney/multivisceral transplants.
• Riley Child and Adolescent Psychiatry Consultation-Liaison (C/L) Team: The Riley C/L Service is an interdisciplinary team of psychiatrists, pediatric psychologists, and 2 LCSW therapists. On the team, there is a potential mix of triple board and general psychiatry residents, child psychiatry fellows, residents in neurology/developmental behavioral pediatrics/general pediatrics, psychology interns, and medical students. Trainees have opportunities to participate in “bread and butter” C-L evaluation and diagnosis, diagnostic conundrums, treatment with medications and psychotherapies, care conferences, working with many specialty teams in clinical care, and in addressing systems problems.
• The Center for Youth & Adults with Conditions of Childhood (CYACC): CYACC is a nationally known program that helps youth ages 11 to 12 with chronic health conditions make a successful transition from childhood to adult medical care.

• Opportunities to work with pediatric psychologists: Pediatric psychologists are embedded on the c/l service and in multiple specialty, interdisciplinary clinics: Headache Clinic, Conversion Clinic, Oncology Clinic, Pain Clinic, GI Clinic, Sleep Clinic.
• Inpatient Pediatric Rehabilitation Unit: The Riley Inpatient Rehabilitation Unit cares for patients with spinal cord injuries, burns, chronic pain conditions, trauma, etc. Trainees have opportunities to work on the unit as consultants while on the Riley Consultation and Liaison Service.
• Charis Center for Eating Disorders: The Charis Center offers a multidisciplinary team providing outpatient and partial hospitalization to patients dealing with eating disorders.
• Integrated behavioral health in primary care settings.
• Indiana University Department of Psychiatry Consultation-Liaison Fellowship

• Interhospital C/L Rounds: During interhospital C/L rounds, teams from Riley, University, Eskenazi, and Methodist Hospitals meet weekly for didactics and case presentations.
  
  

Are there settings at IU School of Medicine that will allow me to work with specialty or underserved populations that don’t often seek psychiatric treatment due to multiple barriers or complicated by other medical needs?

• Eskenazi Pecar Health Center:  Eskenazi Pecar Health Center is a medical home where families can receive comprehensive care (e.g., pediatrics, adolescent, substance, mental health) and access to food pantry, social services, WIC and many other services.
• Spanish speaking pediatrics clinic at Eskenazi Pecar Health Center and 38th Street Clinics.
• Opportunities to work with Spanish speaking attendings and populations.
• The Academic Model Providing Access to Healthcare (AMPATH): AMPATH is a partnership between North American academic health centers, led by Indiana University, and Moi University and Moi Teaching and Referral Hospital in Eldoret, Kenya.

• Global Health Track: Interdisciplinary Global Health Track with four-five half-day educational conferences per year, support through mentorship and individual projects, global health-related experience. This is an internationally recognized partnership through which many Triple Board residents have rotated in Eldoret, Kenya. This program enables residents the opportunity to work on the pediatric wards at Shoe 4 Africa Children’s Hospital and various psychiatry experiences through Moi Teaching and Referral Hospital in Eldoret, Kenya for up to two months. In addition to learning about international medicine, there is ample time for travel and learning about other cultures. Residents may also pursue global health rotations elsewhere as a pediatric elective, with the most popular being Kenya, the China elective or Honduras.
• Eskenazi Gender Health Program: Provides primary care and specialty services for older adolescent and adult transgender patients of all gender identities.
• Riley Gender Health Program: This comprehensive team consists of adolescent medicine doctors, pediatricians, pediatric urologists, pediatric endocrinologists, psychologists and social workers and provides care to children, teens, and young adults who may experience gender dysphoria.

• LGBTQ Project ECHO (Extension for Community Healthcare Outcomes): LGBTQ Project ECHO is a movement to connect local primary care teams with inter-disciplinary specialist teams via technology to improve treatment for complex and chronic health conditions specific to LGBTQ care.

• The Dr. Alan & Diane Breier Prevention and Recovery Center (PARC) for Early Psychosis: PARC is a full-service center for young people, ages 16–35, who are at high risk for, or are currently experiencing, the earliest stages of a psychotic disorder.
• Psychotropic Consultation Program – an initiative launched by IU School of Medicine Department of Psychiatry, Department of Child Services (DCS), Office of Medicaid Policy and Planning (OMPP), Division of Mental Health and Addiction (DMHA), Family Social Services Administration for reviewing evaluation and treatment of DCS involved youth who are on multiple psychotropic medications. A multidisciplinary team reviews best practice guidelines, monitors prescription patterns, provides education, and consultation.
• Child Protection Services.

• Pediatric Center of Hope: This service provides comprehensive medical evaluation for children alleged to have been sexually abused. Children are referred primarily by Child Protective Services, law enforcement, and health care providers. Patients are seen for both scheduled and acute examinations (often involving forensic evidence collection). Additional Center of Hope rooms in the Emergency Department for acute evaluations.
• IU School of Medicine Department of Pediatrics Child Abuse Pediatrics Fellowship.
  
  
• Riley Pediatric Palliative Care: The Riley Pediatric Palliative Care team provides inpatient and outpatient services.