Clinical Rotations

In their first year, fellows complete a rotation on this high-acuity, locked inpatient unit with patients ages 12 to 17 years. The unit serves a diverse demographic with a rich diagnostic pool, providing exposure to virtually all major DSM diagnoses.

During the rotation, fellows gain expertise in acute stabilization, pharmacotherapy, brief psychotherapy and comprehensive work-up of newly presenting mental illness.

Fellows assume a leadership role in a multidisciplinary team and work with social workers and case managers to develop disposition plans, engage families in education and coordinate with outside providers and schools. This rotation also provides an excellent opportunity for fellows to work as educators with rotating PGY-2 residents and medical students.

The partial hospitalization program is a day program that incorporates group, individual, allied and family therapy with medication management for children and adolescents ages 12 to 17 years. Fellows rotate here during their first year and participate in assessment, treatment planning, medication management, therapy and family education.

A unique opportunity for continuity of care is provided, in that many partial hospital patients step down from the inpatient unit and ultimately follow up with the fellows in the outpatient clinic, allowing fellows to observe their patients and adjust their treatment strategies in these different settings.

The intensive outpatient program incorporates group and individual therapy with medication management for children and adolescents ages 12 to 17 years. It is held three times per week in the late afternoons for three hours.

A unique opportunity for continuity of care is provided, in that many patients step down from the inpatient unit or the partial hospital program and ultimately follow up with the fellows in the outpatient clinic, allowing fellows to observe their patients and adjust their treatment strategies in these different settings.

Fellows gain experience in conducting emergency evaluation, crisis intervention, safety assessment and triage in the ER. Fellows provide consultation to the emergency room physicians and become experts at determining level-of-care needs. As this rotation runs concurrently with the inpatient and partial hospitalization rotations, fellows are often able to follow the patients they evaluate in the ER.

In their first year, fellows rotate on this high-acuity, locked inpatient unit with patients mainly ages 12 years and under. This unit also serves a diverse demographic with a rich diagnostic pool, providing exposure to virtually all major DSM diagnoses in young patients.

During the rotation, fellows gain expertise in acute stabilization, pharmacotherapy, brief psychotherapy and comprehensive work-up of newly presenting mental illness.

Fellows assume a leadership role in a multidisciplinary team and work with social workers and case managers to develop disposition plans, engage families in education and coordinate with outside providers and schools. 

During this rotation that spans the first and second years, fellows gain experience in providing consult and liaison services at Orange County’s state-of-the-art and nationally renowned children’s hospital.

Fellows are supervised by an attending physician who is quadruple-boarded (general psychiatry, child psychiatry, pediatrics and psychosomatic medicine) and receive valuable training in all facets of pediatric psychosomatic medicine. At Children's Hospital of Orange County (CHOC), fellows are supported by a well-established psychology department, whose members actively manage disposition and psychosocial issues, allowing fellows to focus on psychiatric issues and questions. 

During the consultation rotation, first-year fellows are embedded in specialty outpatient clinics at Children's Hospital of Orange County (CHOC).

In the bulimia anorexia nervosa (BAN) clinic, fellows work with attending pediatricians, dietitians, social workers and a supervising psychiatrist in a team-based approach toward treating eating disorders.

When their patients are admitted from the clinic, fellows can follow them as consultants in the hospital, where they are essentially provided the services of an inpatient eating disorder unit, including the use of NG tubes, psychological services, dieticians and weekly interdisciplinary team rounds. Fellows learn several psychosocial interventions, as well as appropriate psychiatric treatment of this population during this rotation.

In the CHOC outpatient psychopharmacology clinic, fellows have the opportunity to work exclusively with underserved patients with co-occurring medical conditions. This clinic also provides a teaching opportunity for psychologists in the treatment of patients with pharmacotherapy. Fellows also gain training in and exposure to the use of various psychotherapeutic modalities in the medically ill population.

Fellows have a half-day clinic in their first year and three half-day clinics in their second year, allowing them the opportunity to experience a full two years of continuity of care with their outpatients. Cases are diverse and range from preschool-aged children to teenagers. Fellows engage in comprehensive assessment, treatment planning, medication management and coordination of care while receiving individual supervision on each case. 

The clinic utilizes an evidence-based model of treatment, with relevant research/articles pertaining to cases or clinical questions discussed. Fellows are provided with 90 minutes for new cases and 30 minutes for follow-ups. Graduating fellows are given the opportunity to retain patients if they choose to practice in the area.

This second-year rotation occurs at the Orange County Juvenile Hall, two juvenile day schools, and the county’s primary group home for children who have been abused, abandoned and/or neglected. Fellows provide psychiatric evaluation and treatment to youth who are incarcerated or on probation while learning about forensic issues in child and adolescent psychiatry.

Fellows work with an interdisciplinary team in these settings, including case managers, social workers, therapists and probation officers. Fellows have the opportunity to attend drug court and family court, and to interact with judges for adjudicated youth. They are also exposed to challenges inherent to these populations and learn strategies to improve their systems-based practice.

Fellows provide psychiatric care to those children who may have PTSD, depression or other psychiatric disorders as a result of experiencing abuse or neglect.

In this second-year rotation, fellows see child and adolescent patients weekly for individual psychotherapy. The attending psychologist provides supervision, with both a biopsychosocial and psychodynamic formulation considered, followed by weekly group supervision for fellows. 

Fellows also seek input from their individual supervisors, who are voluntary faculty typically in a private practice setting in the community. Fellows develop a treatment plan and are encouraged to consider a variety of possible therapeutic modalities.

FOCUS is a county-funded program specializing in the treatment of sexually abused children and their families. FOCUS offers individual, group, family, parenting and pharmacotherapy treatment to patients and families referred by Orange County Social Services for sexual abuse. 

Fellows rotate at FOCUS during their second year of training. During this rotation, fellows’ caseload and treatment modalities are monitored to ensure breadth of experience and supervision. 

FOCUS provides a unique opportunity to practice long-term individual psychotherapy with children of all ages, both victims and family members of victims of sexual abuse. Play therapy is frequently employed, with close supervision by therapists with extensive experience in this modality. Fellows are also given the opportunity to participate in family and group therapies, parenting classes and medication management. 

This second-year rotation occurs at The Craig School. The faculty consists of a full-time child psychologist, teachers, behaviorists, graduate students and research associates. 

The UCI Craig School, in association with the Orange County Department of Education, operates a model school-based treatment program for children with behavioral and academic problems in first through sixth grades (with planned expansion to eighth grade). The program includes daily social skills for children in the program and parent participation through parent training and multiple family groups. 

Fellows participate in all aspects of care, working with educators, therapists, students and their families. They also assist in developing a behavioral plan to transition children from specialty school back to mainstream classes. 

During this rotation, fellows have the opportunity to participate in community outreach by engaging parent groups in education on general child psychiatry topics. They are exposed to a highly integrated token economy system.

During this second-year rotation, fellows work alongside world-renowned neurologists with a variety of subspecialty experience at the Children's Hospital of Orange County (CHOC) outpatient pediatric neurology clinic to gain exposure to the treatment and management of childhood neurological disorders. 

Assigned readings and individual instruction occur with a pediatric neurology attending, and fellows learn to perform a comprehensive neurological exam.

Fellows provide outpatient psychiatric consultation for a wide range of neurological conditions, allowing them the opportunity to become comfortable with the various anti-epileptic medications, as well as common and rare neurological conditions.

The overall goal of this outpatient rotation in the second year is to help the fellow build on skills gained in the first year of consultation-liaison training and become more sophisticated in evaluation and treatment of patients with comorbid neurological disorders. 

The fellow is exposed to pediatric patients with complex medical problems, epilepsy, developmental disorders and psychiatric co-morbidities. They demonstrate competence in managing these complex patients in an integrative outpatient setting. Fellows see new patients for 60- to 70-minute visits and follow-up visits for 20 minutes. 

The fellow then discusses evaluations with the attending psychiatrist utilizing a biopsychosocial formulation. The attending physician sees all patients after the fellow has first evaluated and staffed the patients. Fellows are expected to develop a treatment plan, which should include psychological treatment recommendations, as well as medication recommendations, if indicated. 

This second-year rotation occurs at the Center for Autism at Children's Hospital of Orange County (CHOC), where fellows gain increased exposure to patients with developmental disabilities and become more proficient in medication management of this population with unique challenges and needs.

There are also opportunities to learn about various other modalities utilized in the treatment of this population, as the center houses specialists in developmental and behavioral pediatrics and occupational therapy, among other professionals.

Training incorporates learning about how the various modalities of treatment apply to each patient’s individualized treatment plan, whether it is applied behavioral analysis, medication management or social skills training.

Compass Behavioral Health’s dialectical behavior therapy (DBT) program allows fellows to gain experience in working with complex psychiatric co-occurring conditions at a residential level of care. Residents are 12 to 18 years of age, have a history of multiple inpatient hospitalizations, and due to their acuity, require 30 to 90 days in a 24-hour supervised-care setting. Fellows are supervised by a board-certified child and adolescent psychiatrist trained in DBT, integrative medicine and nutritional psychiatry. Learn more about Compass Behavioral Health’s residential program.

Fellows carry a residential caseload and gain experience in assessment, treatment planning, medication management, DBT skills and nutritional psychiatry interventions while participating on a multidisciplinary treatment team consisting of psychiatrists, registered dietician/eating disorder specialists, primary care/eating disorder specialists, psychologists, nurses, clinical social workers, family therapists and milieu staff. Additionally, fellows gain experience participating in a Compass-Duke University Clinical Research study, exploring the treatment of identity dysregulation in suicidal and self-harming adolescents. Learn more about Compass Behavioral Health’s research outcomes. 

Fellows have the option to treat a Compass resident, providing individual DBT therapy under the supervision of a DBT-LBC certified clinician. Fellows also have the option of participating in a DBT multi-family skills training group. 

Learning objectives for this rotation include a deep understanding of the behavioral analysis of suicide attempts, self-harm and eating disorders. Fellows learn to identify functions of behaviors, missing emotional regulation skills and when treatment calls for DBT skills training, MAT or contingency management of the environment. Fellows develop expertise in the differential diagnosis of borderline personality disorder versus frequently co-occurring mood disorders. Additionally, fellows are taught nutritional psychiatry and develop expertise in providing psychoeducation to families on how to stabilize mood through food.