Ayame Takahashi, MD

Ayame Takahashi, MD
Child Psychiatry Fellowship Director

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Rotation Descriptions

Child and Adolescent Inpatient

The Child and Adolescent Inpatient rotation will take place at Lincoln Prairie Behavioral Health Center (LPBHC), a state of the art, child and adolescent psychiatric hospital. The hospital currently has 80 beds, including some longer term residential beds. LPBHC also provides intensive outpatient services as well as partial hospital and or day treatment services. Currently they have a 24-hour walk-in assessment service. LPBHC is the largest child and adolescent psychiatric hospital in central and southern Illinois, as such; children come from all over the state due to shortages of services in this area. Children admitted range in age from 4 to 17 years.

Trainees will spend the first year "half time" doing inpatient work under the supervision of the medical director of the facility. Caseload will be capped at five to seven cases at any one time. There will be opportunity to do crisis family work as well as individual and group therapy.

Hospital Consultation Rotation

This rotation will take place at both St. John's Hospital and Memorial Medical Center. These are two community hospitals affiliated with SIU School of Medicine. The majority of the consults will come from the Carol Jo Vecchie Center, a Women and Children's Hospital located at St. John's. This rotation takes place for the first year and the trainee will gain experience in consulting to various medical professionals and also in discerning the interface between physical and behavioral/psychological illness. The majority of the consultation requests tend to be for suicidal adolescents.

Family Medicine Consultation Clinic Rotation

This service provides weekly child psychiatry consultations to patients receiving primary care from the residents and attending physicians of the SIU Department of Family and Community Medicine program. After the cases referred by the family practice physicians are seen, they are presented and discussed in a monthly group case consultation. Child psychiatry residents will also be involved in educational programming for the family and community medicine residents.

The Family and Community Medicine clinic serves the general population of Springfield, Illinois and surrounding areas with a full range of child psychiatric disorders seen. The racial mix of the patients reflects the demographic of the surrounding area (approximately 80% Caucasian, 15% African-American, and 5% Other). The socioeconomic background of those patients seen in the Family and Community Medicine clinics tend to be from the lower socioeconomic strata. The child and adolescent psychiatrist will act as the consultant to the family medicine physicians and will see patients 18 years old and younger.

The school age and adolescent observations will take place in two public schools in the Springfield school district; Enos Elementary School and Springfield High School. Enos Elementary School has early intervention programs through 5th grade. The early intervention children come in as young as three years of age, and are placed there with an individualized education plan (IEP). Residents will have the opportunity to observe children in these classes as well as in the regular classes, lunchroom and recess.

Springfield High School has grades 9-12, with a student population of about 1,400. During this rotation, the resident will have the opportunity to observe regular classrooms as well as the gifted classes, inclusion classrooms, and special education classes. In addition, residents will be asked to teach one health class on a topic to be determined between the resident and the health class instructor.

Pediatric Neurology Rotation

SIU's Pediatric Neurology rotation provides expertise in common and specialty areas in pediatric neurology – epilepsy, headaches, intellectual and developmental disabilities, movement disorders, neuroimmunologic disorders, neuromuscular diseases and neuro-intensive care.

The pediatric neurology outpatient services are arranged into specific specialty clinics. The residents will rotate through the Headache clinic, the Epilepsy clinic and the Movement Disorders clinic for two months each for a six month block. Children of all ages are seen from all over central and southern Illinois as this is the only pediatric neurology specialty clinic for this region. Ethnic and socioeconomic mix of clients is representative of the ethnic and socioeconomic of the surrounding region. Typically five to eight patients are seen during a morning with a mix of new and established patients. Overall, the pediatric neurology clinics serve approximately 250 patients per month. Residents will attend pediatric neurology case conferences once a month. This is a multidisciplinary case conference that is also televised to rural sites to include practitioners from remote areas.

School Consultation Rotation

The School Consultation rotation is arranged through Springfield School District #186 Department of Special Education. All schools in District #186 are within one to five miles of the primary site and are easily accessible within minutes by car. The focus of this rotation will be to identify at-risk students early so that appropriate referrals and services can be set into place. The hope is to prevent worsening behaviors and compromise of education in the schools and to ensure that children and families who do need mental health services are at least given a path for seeking those services.

Telepsychiatry Rotation

Telepsychiatry consultation services are offered to large rural areas in central and southern Illinois. This is an area that is under-served for both adult mental health and in child and adolescent mental health.

Consultation services are provided to a general practice clinic in Carbondale, Illinois once a month and one to two other times a month to rural clinics in central and southern Illinois. Children ages 18 or younger are referred by a variety of multidisciplinary providers responsible for primary care or mental health services for these children. Currently the majority of the teleconferencing sessions consist of presentations by the primary care provider. Arrangements for patient observation via teleconferencing are currently being developed. Cases discussed tend to run diagnostically within the disruptive behavioral disorders spectrum, and pervasive developmental disorders spectrum. The racial mix is predominantly Caucasian, and socioeconomically in the lower range.

Community Psychiatry Rotation

The Children's Center is an outpatient child and adolescent program. It is situated at the on the second floor of Noll Medical Pavilion. The center provides psychiatric care to children ages 3 to 18, who suffer from severe mental illnesses and who do not have other treatment options within the community.

The clinic population is 71% Caucasian, 14% African-American, and 15% other racial background. The majority of the patients are from impoverished backgrounds and have severe mental illness, and psychosocial issues requiring an intensive interdisciplinary approach. Case management services are provided to the majority of the clients served. Referrals to the Center come from the hospital inpatient unit, primary care physicians, hospital emergency room, the school district and other community based agencies. Coordination and communication with these various professionals and agencies is essential. Over 1,000 clients are served yearly in this program.

Developmental Disabilities Rotation

The Developmental Disabilities rotation is based at The Hope Institute for Children and Families, a residential program and day school for children with intellectual and developmental disabilities. The Hope Institute for Children and Families provides residential, health, and educational services to more than 100 children residing on campus and in community homes. It also provides assessment, treatment, and consultation through The Autism Program to over 500 children and families annually. The Hope Institute does this by employing 470 professional and direct service staff, linking eight Illinois universities and collaborating with four out-of-state research institutions. In collaboration with university partners and families, The Hope Institute serves more than 115 children (ages 5-21) with multiple disabilities including autism. Although there are numerous day students, most of the children live and receive residential services through the Hope Center for Residential Services year-round and attend either the on-grounds accredited school or are enrolled at local public schools. Each child has an individualized living and learning program.

The primary experience will be participation in and direction of a bi-weekly behavioral clinic for residents of the school. During this clinic, participants include behavior analysts, teachers, staff, and program coordinators for each student. The clinic operates under the direction of a psychologists and a behavioral neurologist. The process consists in review and analysis of behavioral data, anecdotal reports and educational reports as relate to the use of psychotropic medications within the context of a behavioral and educational program plan. Plans are developed, followed and analyzed within the context of bests-practice for psychotropic use in persons with IDD, including the development of diagnostic hypotheses and/or neuropharmacologic targets. Appropriate clinical and standardized assessments are used to identify and track potential medication side-effects. Typically up to about six children are seen in each morning clinic.

There will be additional experiences offered in work with behavior analysis, data development and collection, validation of data, and the process of developing operationalized behavior criteria (OBC) for supporting specific psychiatric diagnoses. There will be opportunities to work with specific standardized assessments for psychiatric illness in IDD, including the DASH and PIMRA, administered and scored by PhD psychologists at the School. Work within teams to identify and validate specific behavioral hypotheses will be especially encouraged. It is anticipated that through the early part of the process, one particular student with difficult behavioral issues will be identified and that the full experience of evaluation and validation could be pursued.

Outpatient Department

The Outpatient Psychiatry clinic has a catchment area covering Sangamon, Cass, Calhoun, Christian, Greene, Jersey, Logan, Macoupin, Mason, Menard, Montgomery, Morgan, and Scott counties of central and southern Illinois with a population in this area of about 450,000. Services provided for children and adolescents include consultations to other mental health and primary care providers, family, individual and group therapy and medication management.

In the first year during the six months of inpatient experience, the resident will be expected to see one new evaluation per week and then approximately four to five psychopharm patients per week seen during the psychopharm clinic. Individual/family therapy cases will be limited to two ongoing cases for the first year. During the six months off inpatient, the resident will be expected to see two new evaluations per week and in addition to the ongoing psychopharm and individual therapy cases. During the second year, the case load will increase to 10-12 psychopharm cases per week, five to six individual/family cases per week, and two new evaluations per week (the new evaluations in the second year will preferentially be focused on providing second opinions and consultations to other health care providers). All residents will have live, on-site supervision during their new evaluation and psychopharm clinics as they will be observed via video camera by the supervisor and will be provided with immediate feedback. For the individual and family cases, they will be assigned a supervisor from the either the core faculty or the voluntary faculty to meet with them one hour per week. They will also receive one hour of individual supervision per week for the group therapy.

Residents will also have the opportunity to observe portions of psychological testing of their own patients as the need arises. Individual therapy cases will be monitored to ensure that residents receive training in psychodynamic, supportive and cognitive behavioral approaches, in brief and longer term treatments.

Substance Abuse Rotation

The substance abuse rotation will occur at The Gateway Foundation in Springfield, which is located approximately four miles from the primary site. The Gateway Foundation is a non-profit organization specializing in the treatment of adolescents and adults with substance abuse disorders. They provide intensive outpatient and residential services. The focus of the rotation will be on the adolescents in the residential program. At any one time there are up to 60 adolescents (ages 13-18) in the residential program with approximately two thirds needing psychiatric intervention. The length of stay ranges from three to six months.

About the Department of Psychiatry

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