University of Washington Seattle Children's
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Fellow Dan Yang, MD, Attending Lauren Boydston, MD and with patient family

Child & Adolescent Psychiatry Training Sites

The principal training site is Seattle Children's Hospital. There are several other facilities in the program, including Child Study and Treatment Center, the state's hospital for long-term hospitalization of children and adolescents.

Seattle Children’s Hospital (SCH) Sites

Seattle Children’s Hospital (SCH) is the primary training site, located in Seattle’s Laurelhurst neighborhood. It is a private, 250-bed, regional, not-for-profit hospital affiliated with the University of Washington. SCH has an international reputation for excellence in clinical care, research and teaching and serves as the primary tertiary facility for pediatric care in the Pacific Northwest. It is the largest provider of mental health services for children in the region. Patients are regularly referred from Washington, Alaska, Montana Wyoming, and Idaho. The Division of Child and Adolescent Psychiatry has a commitment to provide services for and conduct research in populations of under-served, acutely ill children and adolescents treated in the public sector. Child and Adolescent Psychiatry Residents complete rotations on the 20-bed inpatient unit at SCH, the Consultation/Liaison Service, and the hospital's Outpatient Psychiatry Clinic. The hospital is currently undergoing a significant expansion, which will double the number of overall hospital beds and inpatient psychiatric beds. The new building is expected to be completed in April 2013.

SCH Inpatient Psychiatric Unit

The inpatient psychiatric unit (IPU) is a comprehensive diagnostic and treatment center for children and adolescents with acute psychiatric disorders. Over 600 patients are admitted each year with a wide range of diagnoses, including Attention Deficit/Hyperactivity Disorder, Disruptive Behavior Disorders, Depression, Bipolar Disorder, Developmental Disorders, Psychotic Disorders, Eating Disorders, and Organic Mental Disorders. Currently there are 20 beds, with a mean length of stay of 9 days. There are specialized treatment programs for youth with depression, disruptive behavior disorders, eating disorders, med/psych patients, and youth with autism spectrum disorders. The unit is staffed by two multidisciplinary teams, each with an attending psychiatrist, child psychiatry resident, teacher, and case managers. As part of the clinical teams, residents have the opportunity to work with professionals and trainees from a variety of different backgrounds, including psychology residents, general psychiatry residents, medical students, ARNPs, and licensed mental health counselors.

SCH Outpatient Psychiatry Clinic

SCH offers outpatient services at the Laurelhurst (main) campus as well as at two satellite clinics in the greater Seattle area: Children's Bellevue, east of Seattle, and Odessa Brown Children's Center in central Seattle. The outpatient clinic at SCH is the primary outpatient training site and serves over 1600 children and families each year, totaling more than 12,000 visits. Services include diagnostic evaluations, routine and complicated psychopharmacological evaluation and management, cognitive-behavioral therapies, individual, family, and group therapy, patient and parent education groups, and school consultation. Children served are between the ages of 0-21 with diverse ethnic, economic, and social backgrounds, representing the entire spectrum of psychiatric diagnoses. Many of these children have comorbid developmental and medical disorders. Training of child psychiatrists occurs within the context of a community model implemented by a multidisciplinary team including psychologists, nurse practitioners, and crisis and support staff.

Psychiatry Consultation/Liaison Service and Emergency Services

The child psychiatry consult service is composed of a multidisciplinary team of psychologists and psychiatrists consulting to various medical services within SCH. The medical illnesses experienced by youth referred to the Psychiatry Consultation-Liaison Service are diverse, requiring flexibility and initiative to meet the requests of pediatrics teams. Common referrals include challenges in coping with chronic illnesses such as Crohn's Disease and diabetes, untoward reactions to medical care, such as delirium or prednisone-induced mood disorders, eating disorders, safety evaluations following suicidal behaviors or significant noncompliance, and consultation to our emergency room mental health staff. Psychiatric disturbances predominantly include mood and anxiety disorders associated with medical illness. Behavioral disturbances are also common as youth act out psychological disturbances through lack of adherence to their medical care, thereby challenging their providers in both the hospital and outpatient settings. Clinical work includes assessment, short-term psychotherapy, medication management, behavioral management, safety planning, and liaison with medical, nursing, and social work teams.  Demographic variables follow SCH patient statistics. Proportions of patient referrals are roughly even by sex; 80% Caucasian; full spectrum of DSM-IV child and adolescent diagnostic categories in youth with medical illnesses and those with psychosomatic illnesses.

SCH Autism Center

The Seattle Children’s Autism Center is a multidisciplinary outpatient diagnostic and treatment clinic for children with autism spectrum disorder (ASD), comprised of developmental pediatricians, child psychiatrists, pediatric neurologists, psychologists, nurse practitioners, and speech-language pathologists. It is one of our busiest clinical sites, serving over 2,500 children and families each year.  The Autism Center offers diagnostic testing for ASDs using standardized assessment methods, treatment for co-morbid psychiatric conditions and disruptive behaviors using both psychopharmacological and behavioral approaches, treatment of co-morbid medical/neurological conditions, social skills group treatment programs, and school consultation. There is also an adult transitional program for helping individuals with ASD make the transition to adulthood, as well as a dedicated Family Resources staff providing education, individual and group support.

Residential Sites

Child Study and Treatment Center (CSTC)

Child Study and Treatment Center is Washington State's long term psychiatric hospital for children and adolescents. CSTC is located in Lakewood, 40 miles south of Seattle. Long-term, residential-level treatment is provided for 47 children and adolescents with persistent and severe psychosocial distress and mental illness. In addition to primary and specialty medical (including psychopharmacologic) care, treatment modalities at CSTC include milieu and group (including dialectical behavioral and adventure-based) therapies, as well as individual therapies such as narrative, motivational, and trauma-focused cognitive behavioral therapy. The average length of patient stay is eight months. During the first year of training, Child and Adolescent Psychiatry Residents spend 2 .5 months at CSTC as an essential part of a multidisciplinary team providing care for five to eight of the adolescent patients.  This training site provides a unique opportunity for "in-vivo" appreciation of the lives, challenges, and developmental pathways of youth with very complex biopsychosocial challenges.

Echo Glen

Echo Glen Children’s Center is a juvenile justice residential rehabilitation center for boys (ages 11-16) and girls (ages 11-21). Located in Snoqualmie Ridge, near exit 25 off Interstate 90, the Echo Glen census typically runs between 150 to 190 youth. Youth may present with complex histories and multiple risk factors. Common mental health concerns include disruptive behavior disorders, attention-deficit/hyperactivity disorder, substance use disorders, anxiety disorders, post-traumatic stress symptoms and mood disorders. Echo Glen staff members are trained in cognitive-behavioral treatment techniques, including motivational enhancement, behavior analysis, behavior modification, and skills training based on aggression replacement training and dialectical behavior therapy. Child psychiatry and general psychiatry residents provide psychiatric evaluations, psychiatric medication management and psychotherapy. Additional training experiences include engaging youth and families, collaborating with health care and cottage staff, and addressing system of care issues. A year-long didactic covers child psychiatry and effective juvenile justice practices.

Community Consultation Sites

Several community-based sites are available, in addition to the sites named. These include rural community mental health centers, Native American mental health agencies, ethnic minority mental health centers, therapeutic foster care programs, intensive community support programs, specialized daycare programs for preschoolers, and child abuse programs. Consultation opportunities related to state mental health legislation are also available.

School-Based Consultation

The School-Based Health Clinics/Reaching for Excellence Project collaborates with King County Public Health. We provide monthly on-site consultation to clinics that are located in a dozen Seattle-area public schools, in addition to providing continuing education to the staff of all of the school-based clinics in the district.

Odessa Brown Children's Mental Health Clinic

This clinic is associated with the Odessa Brown Children’s Clinic (OBCC) and is affiliated with Children's Hospital. It is housed in the Central District Community Health Center that also houses a family practice clinic, an adult dental clinic, a WIC clinic and some public health services. The mental health clinic serves children who receive pediatric and/or dental services in the same building or who are referred from other SCH clinics, as well as children from all over King County referred by private pediatricians, family practitioners or other clinics. The clinic serves an ethnically, culturally and socio-economically diverse clientele. Special programs focus on treating children with ADHD and teaching Parent-Child Interaction Therapy.

Harborview Medical Center (HMC)

Harborview Medical Center's Pediatric Clinic, with 8,400 visits per year, serves a population that includes indigents without third-party coverage, the non-English speaking poor, children in foster care, and many recent immigrants to the state of Washington. The current child psychiatry rotation is a half-day a week, with a focus on consultation to the HMC Pediatric Clinic. Patients usually are first seen by their pediatric primary care clinicians, who then coordinate with social work staff to arrange referrals to the child psychiatry attending and resident.  The subsequent child psychiatry evaluations typically include an initial assessment and treatment recommendation phase.  Then, depending on the needs of the patient and family, either ongoing treatment is provided or the family is given information and assistance regarding referral to other community services. This is one of the most culturally diverse populations of the clinical sites of the Division of Child Psychiatry.

Asian Counseling and Referral Service (ACRS)

This agency is located in the International District of Seattle. The rotation is one half-day per week for one year. Residents learn from the ACRS staff about the relevant cultural aspects of cases under discussion and the ACRS staff offer consultation to the resident around cultural issues. Residents see patients for diagnostic evaluations, medication evaluations, and medication management sessions.

Childhaven

Childhaven is a non-profit early therapeutic child care agency with 3 locations in King County (in Seattle, Burien, and Auburn) dedicated to early intervention, from 1 month to 5 years of age. The organization is most renowned for its therapeutic daycare program which serves children and families referred by Child Welfare Services, public health providers and crisis nurseries. The Childhaven team consists of pre-school educators, social workers, nurses, OT, PT, and speech and language therapists.   Residents who rotate at Childhaven have the opportunity to consult with the Childhaven team and observe highly special needs children in a structured and therapeutic setting. Child psychiatry residents may also spend additional elective time at Childhaven observing and consulting with the Parent-Child Interaction  Therapy (PCIT) team.