Normal Child Observation Rotation
The normal child observation rotation will take place at 3 different sites, all located within a 2 mile radius of the SIU Dept. of Psychiatry Building. For preschool age children, the rotation will take place at Memorial Child Care.  This daycare has the capacity of up to 160 children ages 6 weeks- 6 years, and at any one time tends to have about 140 children. Residents will be spending time with each age group

The school age and adolescent observations will take place in 2 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 3 years old, and are placed there with an IEP (individualized education plan). Residents will have the opportunity to observe children in these classes as well as in the regular classes, lunchroom and at recess.

Springfield High School has grades 9-12, with a student population of about 1400. 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 group 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 Head Ache clinic, the Epilepsy clinic and the Movement Disorders clinic for 2 months each for a 6 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 5-8 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 1 x monthly. 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 1-5 miles of the primary site and are easily accessible within minutes by car. The focus of this rotation will be to try and 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 underserved for both mental health and in particular child and adolescent mental health.

Consultation services are provided to a general practice clinic in Carbondale, Illinois once a month and 1-2 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 on the campus of Memorial Hospital in Springfield, IL. 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.  Co-ordination and communication with these various professionals and agencies is essential.  Over 1000 clients are served yearly in this program.


Developmental Disabilities Rotation
The Developmental Disabilities rotation is based primarily at the Hope Institute for Children and Families, a residential program and day school for children with intellectual and developmental disabilities. The Hope Institute 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 Institute does this by employing 470 professional and direct service staff, linking 8 Illinois Universities, and collaborating with 4 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 biweekly 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.  In addition appropriate clinical and standardized assessments are used to identify and track potential medication side-effects. Typically up to about 6 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 OBC (operationalized behavior criteria) 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.


Forensic Psychiatry Rotation
The Forensic psychiatry rotation will take place at the McFarland Mental Health Center in Springfield, Illinois. McFarland is a state mental health hospital, with a specialized adolescent forensics unit (this is the only such unit in this state). The adolescents are referred for forensic evaluation through the juvenile justice system, and the length of stay on the unit ranges from 3 to 6 months. The resident will rotate one afternoon a week for 3 months at this site. The resident will also observe one private forensic evaluation arranged with a full time faculty member in the department.

Outpatient Department
The SIU psychiatry outpatient clinic has a catchment area covering Sangamon, Cass, Calhoun, Christian, Greene, Jersy, Logan, Macoupin, Mason, Menard, Montgomery, Morgan, and Scott counties of central and southern Illinois.  The total population in this area is 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 6 months of inpatient experience the resident will be expected to see one new evaluation per week and then approximately 4-5 psychopharm patients per week (seen during the psychopharm clinic). Individual/family therapy cases will be limited to 2 ongoing cases for the first year. During the 6 months off inpatient, the resident will be expected to see 2 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, 5-6 individual/ family cases per week and 2 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 1 hour per week. They will also receive 1 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.


Residential TreatmentCenter Rotation
This rotation will be involve fellow’s active participation in consultation, treatment planning, and pharmacologic management of children and adolescents ages 10-18 at a residential treatment center. Children are generally referred to the residential treatment setting because they have failed in less restrictive settings due to problematic behaviors generally involving aggression or harm to self or others.

Most children will be under the guardianship of the Department of Children and Family Services (DCFS), however, a smaller percentage of children will be referred by the juvenile justice system, special education programs, and occasionally the Department of Mental Health on an individual care grant.  Kemmerer Village residential treatment center has approximately 50 beds, divided in five treatment cottages where children live and receive psychiatric and psychological treatment. The children at Kemmerer Village are 50% male, and 50% female, racial/ethnic backgrounds are 50% African American and 50% Caucasian. Most of the children have experienced some abuse and neglect, and disrupted family lives. Most commonly seen diagnoses are ADHD, Mood and Anxiety disorders (depression, bipolar disorder, PTSD), and Reactive Attachment disorder. As this is a longer term residential facility, the average length of stay is 1 year. Residents will do new evaluations of children recently admitted to the facility and will also continue to follow a number of children for psychopharm management.


Substance Abuse Rotation
The substance abuse rotation will occur at the Gateway Foundation in Springfield, Illinois, which is located approximately 8 miles from the primary site. Gateway 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 2/3’s needing psychiatric intervention. The length of stay ranges from 3-6 months.