We in the Department of Psychiatry at the Children’s Hospital Boston recognize that human development is shaped over time by ongoing dynamic transactions between biology and experience. We contend that both successful development and developmental psychopathology are best viewed as resulting from successes or failures in attachment and self-regulation; the latter occurring in one or more of the domains of affect, thought, and behavior. This vantage point provides useful scaffolding upon which to organize and integrate the biological, psychological, and social contributions to mental health and illness, within an overarching contextualized developmental framework.
In such a framework the child and adolescent psychiatrist with a holistic view of development and developmental psychopathology is able to appreciate the roles played by the broader social context that families live in, the contributions of families and caregivers themselves, and the risks presented by biological factors that can lead to adaptive and maladaptive outcomes in child development. The child and adolescent psychiatrist trained in this manner is able to consider a full complement of evidence-based interventions in order to address causal factors identified in each of these spheres of influence.
We want to train child and adolescent psychiatrists to help children achieve lasting self-regulation so that they may function better within themselves, with their families, with peers, in school, and in their communities. We want to provide this training in a broad range of settings – schools, community mental health centers, courts of law, and of course the hospital – so that residents have an opportunity to master the unique challenges posed by each service venue. Furthermore, we want to provide training in a full spectrum of intervention modalities – from prevention, to early intervention, to clinical treatment – so that residents are well prepared to provide services at each of these levels.
Our primary means of attaining these goals is an experiential teaching model that pairs fellows with faculty - whether in the acute inpatient psychiatric or consultation-liaison settings, the outpatient clinic, or community settings - so that clinical care and teaching are never separated from each other. With the proximity of experienced faculty, these diverse venues can provide innumerable opportunities for fellows to observe, to model, learn and to practice the core competencies that are central to the work of a well-trained child and adolescent psychiatrist: namely, patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice.
Quality of care
Finally, we believe that we must provide child mental health services that emphasize family centered and culturally competent care, increased accessibility, established practice parameters, outcome assessment, and community-based partnerships. We stress accountability and quality in our training program. We embrace research that informs clinical practice and that involves interdepartmental collaborations.
Ultimately, we expect that our graduates will improve the quality of life and reduce the burden of suffering for children and families that face disabling mental illnesses, and foster the successful development of all children they serve. We anticipate that our alumnae will work across the spectrum of clinical and research settings using existing evidenced based approaches or investigating new ones; and that they will work to empower patients, families, and communities through mental health advocacy at multiple levels.
Child and adolescent psychiatrists are facing a time of tremendous opportunity and challenge. There has been remarkable progress in behavioral science ranging from our expanded scientific knowledge base, to the introduction of new medications, to the development of manual-based psychosocial treatments. We have entered an era of neuroscience that will rewrite our understanding of development, mental health and mental illness, and change the very nature of our practice. We have come to realize the pivotal role that experience can have on developing brain architecture, and therefore the role preventive interventions can play in mental health and development.
>Yet, even with all this progress, the gap between “what we know” and “what we do” remains very wide. The stigma of mental illness lingers and continues to hamper advocacy efforts on behalf of accessible, quality mental health care for all. Our mental health system is characterized by fragmented care, service gaps, access problems, inadequate service payments, and insurance carve outs. We face significant challenges in the need to implement parity legislation and a national clinical trials registry, while responding to the critical shortage of qualified child and adolescent psychiatrists.
At Children’s, we believe that we must translate “what we know” into “what we do” across the entire spectrum of psychiatric illnesses, and in all the settings where children and their families seek care. We must bring “knowledge to children and families.” We must continue our mental health advocacy efforts on behalf of children and their families. We must emphasize community-based partnerships, such as those with educators and pediatricians who share our concerns about the mental health and well being of children and adolescents. It is in the context of these remarkable times that we must help prepare the next generation of leaders in child and adolescent psychiatry. We want to prepare leaders who can meet the present and future challenges in our field and take leadership roles in addressing them.
Eleni Maneta, MD
Associate Training Director