First Year Rotation Clinics

Inpatient Psychiatry Rotation 

The inpatient units at the Children Pavilion have a capacity for 60 beds which are under the medical directorship of Jennifer King, MD, who is board-certified in Psychiatry and Child and Adolescent Psychiatry.  Patients are admitted not only from the local Hampton Roads area but also as far as Richmond, VA, in the north and North Carolina in the south. First-year fellows will spend one month on each of the following four inpatient rotations.

Pre-Adolescent Inpatient Rotation 
This unit provides inpatient care to patients ages 6 through 13. Common psychiatric diagnoses seen on this unit include ADHD, trauma and stressor related disorders, and mood and anxiety disorders.

Fellows work with a multidisciplinary team with psychiatry, pediatrics, psychology, social work, utilization management, pharmacy, and behavioral technicians. The medical director of this unit is Dr. Jeffrey Wilson, who is triple boarded in Psychiatry, Child and Adolescent Psychiatry, and Addiction Medicine.

Adolescent Inpatient Rotation
This unit provides inpatient psychiatric care to patients ages 14 through 17. Fellows work with a multidisciplinary team with psychiatry, pediatrics, psychology, social work, utilization management, pharmacy, and behavioral technicians.  Common diagnoses seen on this unit include mood disorders, trauma and stressor related disorders, psychotic disorders, and borderline personality disorder.

Patients are hospitalized for an average of 7 days. The medical director of this unit is Dr. Michael Shapiro, who is board-certified in Child and Adolescent Psychiatry.

Psych-Med Unit
This unit provides inpatient psychiatric care to patients ages 13 through 17 who have chronic or complex medical conditions (e.g. autoimmune diseases, T1DM, epilepsy, chronic pain, somatic symptom disorders) that affect their mental health.

Fellows works in a multidisciplinary team that is integrated with pediatrics so both medical and psychiatric treatment can be provided effectively. The length of stay is roughly 7-10 days. The medical director of this unit is David Meyer, MD, who is board-certified in Psychiatry and Child and Adolescent Psychiatry.

Neurodevelopmental Disorders Track
This unit provides inpatient psychiatric care to patients with Level 1 Autism Spectrum Disorder. In addition to the usual multidisciplinary team, fellows also work closely with board certified behavior analysts on this rotation. 

Faculty

Jennifer King, MD, Inpatient Mental Health Service Line Chief
Michael Shapiro MD,  Associate Professor, Medical Director
Jeffrey Wilson, MD, Associate Professor, Medical Director
David, Meyer, DO, Assistant Professor, Medical Director

Partial Hospitalization Program, PHP

First year fellows spend 1-2 months on this rotation which is housed in the Children’s Pavilion.

The Partial Hospitalization Program provides an opportunity to care for youth with impairing and severe psychiatric symptoms who do not require inpatient care. There are three different tracks designed to meet the patients’ developmental needs according to their age. Common conditions seen on this service include depressive disorders, anxiety disorders, and non-suicidal self-injury.

The fellow is part of an interdisciplinary team dedicated to family-centered care and supporting emotional regulation with milieu and therapeutic approaches.  Fellows participate in diagnostic process, treatment planning that includes pharmacologic, child and family therapeutic interventions, and planning levels of care and community services needed after discharge.  

Faculty

Jennifer Moran, PsyD, Clinical Director
Samuel Scott, MD, Medical Director

Consultation Liaison (CL)

First year fellows spend 2-3 months on this rotation which is housed in the Children’s Hospital, a Level 1 trauma center.

The Consultation Liaison (CL) rotation offers fellows an opportunity to provide consultation to patients admitted to the general or subspecialty pediatric floors, intensive care units, and the medical-psychiatric unit of children’s hospital. Working with an interdisciplinary team, the fellow supports the pediatric hospitalist team and pediatric specialty teams caring for the patients whose clinical presentation highlights the interface between physical health and psychiatric concerns.

The rotation also offers an opportunity to develop the skills necessary to offer effective consultation, including maintenance of the consultative stance, efficient communication, and an awareness of systems and inter-team dynamics. 

Faculty

Jana Elliker, DO, Assistant Medical Director
Jack, Fanton, MD, Assistant Professor
Anisha Garg, MD, Assistant Professor

Emergency Psychiatry Clinic

First year fellows spend 1 month on this rotation which is housed in the ED (Emergency Department) attached to the children’s hospital.

This rotation offers an opportunity to assess acute psychiatric presentations of children and adolescents in the pediatric ED (Emergency Department). The fellow is part of a multi-disciplinary team offering clinical assessment, level of care assessments, and acute interventions as a consultative service to the Emergency Department.

The rotation supports the fellow in developing skills in brief assessment and emergency management, using milieu, behavioral, and pharmacologic interventions.  Generally, consults are about patients with safety concerns or acute psychosis or mania but may also include assessment of patients with acute mental status changes, or management of psychiatric issues in a patient with a physical health emergency.

Faculty

John (Jack) Fanton, MD, Assistant Professor, Medical Director

Neurology Clinic

First year fellows spend 1 month on this rotation which is housed at CHKD and across the street on the South Campus also known as NDC.

The neurology rotation offers an opportunity to care for children with neurologic issues in the inpatient and outpatient settings.  The outpatient experiences offer longitudinal care for children with common neurologic issues including seizures, movement disorders, headaches, tics, inherited metabolic disorders, as well as sleep medicine.  

In the inpatient experience, Fellows participate in assessment of these disorders, management of the disorder and secondary sequelae. Fellows learn to identify the presentations in which neurologic and psychiatric disorders may be considered, as well as the co-occurrence of neurologic and psychiatric disorders. 

Selective (2 months)

First year fellows have 2 months of selective rotation, which can be spent on any of the inpatient units or PHP.

Exposures

Forensic consultation at the Child Advocacy Center

In this rotation, Fellows will gain experience in forensic pediatrics and direct interactions with elements of the legal system and child protection system. Fellows will observe forensic interviews and participate in multidisciplinary case conferences with law enforcement and child protection services.

Through the rotation, Fellows become familiar with the Virginia Child Protection System and learn skills of reviewing records through a forensic lens, learn principles of forensic interviews related to child maltreatment, and become familiar with the common physical examination findings (and lack thereof) in validated cases of child maltreatment, and evidence-based therapies for maltreated children and adolescents. Fellows will also offer psychiatric input related to the cases they observe or discuss. 

School consultation

First year fellows spend a1-2 days on site at the Yellowhab school in downtown Norfolk. Yellowhab is a unique, tuition-free, private school for 4th and 5th grade children. The school is geared toward families who receive state or federal financial assistance. The school offers a supportive learning ecosystem with family and community involvement.  

Each child has personalized educational experiences with an explicit goal of “evening the odds” and “nourishing youth” in a holistic and innovative manner.   The fellow’s experience includes classroom observation, and they also develop a familiarity of effective interventions for addressing educational disparities and creating supportive classroom environments for a population of children with engaged families and high exposure to ACES. 

Community engagement experiences 

Psychotherapy Clinic

First year fellows have outpatient psychotherapy clinic for half-day a week for six months, in the second half of their first year. This is the only outpatient experience in the first year of fellowship.
Second year fellows have outpatient psychotherapy clinic for half-day a week for the entire second year.

This clinic is housed at the Children’s Pavilion Fellows are supervised by the Director of Psychotherapy Training, Dr. Rajesh Mehta, who is board-certified in Psychiatry and Child and Adolescent Psychiatry, and by Dr. Michael Shapiro, who is board-certified in Child and Adolescent Psychiatry.

Fellows start the afternoon with group supervision, followed by seeing two weekly psychotherapy patients, one adolescent and one pre-adolescent. Therapy modalities are determined by patient need, but include elements of psychodynamic, parent management training, cognitive behavioral therapy, family therapy, and dialectical behavioral therapy.

The therapy clinic begins in the second half of the CF 1 year and offers Fellows a series of didactics focused on therapy an opportunity to offer evaluations and provide psychotherapy to children and families across the age range from early childhood to transitional age youth.

Fellows will have access to real time supervision during the clinic and will progress from co-therapy with a supervisor to observed therapy to independent therapy.  Fellows will have direct supervision and indirect time for feedback in every session.  Faculty may include psychiatry, psychology, and social work professionals.

Faculty

Rajesh Mehta, MD, Assistant Professor, Director of Psychotherapy Training
Michael Shapiro, MD, Associate Professor, Medical Director