Child & Adolescent Psychiatry Residency Program

The Child and Adolescent Psychiatry Residency Program at the University of Washington is an ACGME-accredited, two-year program based at Seattle Children’s Hospital, one of the top-ranked pediatric hospitals in the country. The Fellowship is the only child and adolescent psychiatry training program in the entire WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region.


Fellowship Type(s):
ACGME Fellowship, Clinical Fellowship, Psychiatry Fellowship

Related Research Centers/Programs:

Supervision
Supervisors include both academic and clinical faculty, who represent a wide variety of perspectives. They supervise residents in psychodynamic, cognitive-behavioral, and other psychotherapies, as well as psychopharmacology and the integration of different treatment modalities. A large number of clinical faculty (see list below), most of whom are in private practice, complement supervision provided by the academic faculty.

All residents in their first year of child/adolescent psychiatry (CAP) training receive at least 1 hour of supervision per week from their attending while rotating on the inpatient, residential, and consultation/liaison services. Additionally, there is an hour of caseload supervision per week in the outpatient clinic, as well as an hour a week of supervision by clinical faculty, which usually takes place off-site. Residents on their first-year outpatient block and those in their second year of CAP training also receive regular supervision from their various attendings at the clinical sites where they are rotating.

Mentoring
Each resident in the program is matched with a faculty mentor. Residents may choose their mentors if they have a preference, or they can enlist the Program Director’s assistance in being assigned a mentor who will complement their interests. The mentor advises the resident in choosing rotations, in identifying opportunities in his or her area of interest, and in career planning. The mentor also serves as an advocate for the resident. Residents are required to meet with their mentors on at least a bi-annual basis.

First Year

The 1st year of the 2-year Child and Adolescent Psychiatry Residency is divided into five blocks of either 10 or 11 weeks each. The rotations are as follows:

  • Seattle Children’s (SCH) Psychiatry and Behavioral Medicine Unit (PBMU), our Inpatient Psychiatric Unit: Two rotations are spent on the PBMU
    • The first PBMU rotation emphasizes learning how the unit operates, the roles of each team member, and working with children and their families.
    • The second PBMU rotation emphasizes development of medical decision-making skills required for an inpatient attending child psychiatrist.
  • SCH Consult/Liaison Service
  • Child Study and Treatment Center (CSTC): Mondays, Tuesdays, and Thursdays. On Wednesday you will be in the SCH Outpatient clinic (see below). Friday morning is Didactics and Friday afternoon is SCH Outpatient Clinic.
  • Outpatient Rotation: One block is spent in a variety of outpatient settings
    • Monday: Eating Disorders Clinic
    • Tuesday: Mornings at a daycare center doing observation of normative development, and afternoons are spent doing co-therapy with an experienced psychologist.
    • Thursday: Autism Center
    • Friday: Afternoon Pediatric Neurology Clinic
  • CH Outpatient Psychiatry Clinic: Wednesdays throughout both years of training. Offers chance to experience long term continuity care with both weekly therapy patients and medication management cases that are seen less frequently.

Second Year
During the 2nd year, residents continue their outpatient care clinic with an emphasis on long-term care. The second year is divided into two 6-month long blocks. Approximately 2 days per week are used for elective time, which is designed to further enhance or develop their skills in areas consistent with their career goals. Required rotations include:

  • Addictions Clinic: Half a day per week for 6 months. (May elect to do a full year.)
  • Community Consultation Selective: Half a day per week for 1 year.
    • Choices include Asian Counseling and Referral Services, Harborview Medical Center Pediatrics Clinic, or the Odessa Brown Children’s Clinic.
  • Echo Glen Children’s Center: 1 day per week for 6 months.
  • Early Childhood Clinic: Half a day per week for 6 months.
  • School-Based Consultations: Residents provide 1 morning a month of consultation to two or more of over a dozen Seattle school-based mental health clinics.
  • Elective Opportunities: Electives include research activities, additional outpatient or inpatient clinical training, administration and teaching opportunities, or community consultations. Generally, two of the residents are chosen as Chief Residents in the 2nd year.

Criteria For Graduation

  • Complete, in a satisfactory manner, all required clinical rotations, as well as sufficient elective rotations to total 24 months of training.
  • Be approved for graduation by the Division’s Resident Education Steering Committee (RESC). In considering residents for graduation, the RESC considers clinical competence, interpersonal skills, ethical standards, and professional conduct.

The principal training site is Seattle Children’s Hospital. There are several other facilities in the program, including the 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.

Psychiatry and Behavioral Medicine Unit (PBMU)
The Psychiatry and Behavioral Medicine Unit (PBMU), our inpatient psychiatry unit, is a comprehensive diagnostic and treatment center for children and adolescents from ages 3 to 18 with acute psychiatric disorders. The average stay is 5 days. 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 Autism Spectrum Disorder.

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.

SCH Autism Center
The Seattle Children’s Autism Center is a multidisciplinary outpatient diagnostic and treatment clinic for children with autism spectrum disorder (ASD) and/or neurodevelopmental disorders, 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.

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.

Echo Glen
Echo Glen Children’s Center is a juvenile justice residential rehabilitation center for boys (ages 11-16) and girls (ages 11-21). The census typically runs between 110 to 150 youth. Youth may present with complex histories and multiple risk factors. Common behavioral concerns include disruptive behavior disorders, attention-deficit/hyperactivity disorder, substance use disorders, anxiety disorders, post-traumatic stress symptoms and mood disorders. 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 general 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. The current Child Psychiatry rotation is for 2 trainees to each provide care for one half-day per week.

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. HMC also provides integrated care for ADHD patients involving psychiatric consultation to primary care providers with the aid of a care manager.

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.

Throughout the residency program, all residents have a didactic program of lectures and seminars each Friday morning. There is also an hour-long didactic series on Wednesdays focusing on clinical skills and therapies, as well as a monthly Journal Club that is held jointly with the child psychology trainees. In addition, Division Grand Grounds are held every month during the academic year. The Department of Psychiatry and Behavioral Sciences and Seattle Children’s Hospital also offer additional weekly or monthly grand rounds that the residents are encouraged to attend.

Both years attend the Growth and Development/Psychopathology Seminar, which extensively and carefully integrates growth and development with childhood and adolescent psychopathology. There are additional didactic seminars that include a Psychotherapy Seminar, Family Assessment/Therapy, CBT, and a quarterly Community Psychiatry Seminar.

The 1st year didactic seminars include: Orientation Seminar, Assessment Seminar, Parent Training Seminar.
The 2nd year didactic seminars include: Transition to Practice, Forensics and Ethics.

Psychotherapy Training
The training program emphasizes evidence-based therapeutic modalities, such as cognitive-behavioral therapy and parent training (e.g. PCIT) to target disruptive behaviors. During the first year, residents on their outpatient rotations participate in co-therapy with an experienced psychologist, and also help run a group for parents with anxious children. In addition, residents have the opportunity to participate in a wide variety of other groups, targeting issues such as eating disorders, disruptive behaviors, and emotion regulation/coping skills.

The didactic curriculum covers additional modalities of therapy, such as psychodynamic and family psychotherapy. Residents interested in those therapeutic modalities may seek specific supervision in those areas. Seattle has two psychoanalytic institutes (the Seattle Psychoanalytic Society and Institute and the Pacific Northwest Psychoanalytic Society) for those interested in pursuing psychoanalytic training after residency.
Residents can also attend seminars and receive training for dialectical behavior therapy (DBT) and trauma-focused cognitive behavioral therapy (TF-CBT). The University of Washington offers training in these therapeutic modalities on a yearly basis to trainees in psychiatry and psychology. Residents are especially encouraged to participate in the DBT seminar.

Educational Leave
Residents have one week per year of educational leave, which they may use at their discretion. They are especially encouraged to attend the Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Residents may apply for funding to offset some of the expenses of this meeting.

Each year, we offer 5 first-year positions for residents who have successfully completed at least three years of an ACGME-accredited residency in Psychiatry. Applicants for the first-year positions must have successfully completed their PGY-3 year prior to entry into the Child and Adolescent Psychiatry (CAP) Residency.

All applicants for 1st year (PGY-4 or 5) CAP positions should submit the following materials through ERAS:

  1. Completed ERAS application form.
  2. Personal statement regarding your interest in Child and Adolescent Psychiatry. Please include special areas of interest you may have so that if selected to interview we can schedule you to meet faculty and residents with similar interests.
  3. Current Curriculum Vitae (CV).
  4. A photo.

All applicants for 1st year (PGY-4 or 5) CAP positions should arrange to have the following materials submitted through ERAS via the authorized parties as detailed on the ERAS website:

  1. One Letter of Recommendation from your General Psychiatry Training Director which includes:
    • A completed Program Director’s Verification Form Attesting to Child & Adolescent Psychiatry (CAP) Fellowship Eligibility
    • A statement that the applicant has satisfied the training objectives for reaching the level of training indicated in the application; any deficiencies must be stated
    • A statement regarding the residents performance (fund of knowledge, clinical judgment)
    • A statement regarding professional integrity (empathy towards patients, professional interactions, motivation to learn)
      (Note: Our Program Director or a member of our Admissions Committee may speak directly with the applicant’s Program Director. If any questions are raised, further verbal or written evaluation is requested.)
  2. Two to three Letters of Recommendation (LoRs) from Faculty in your program.
  3. A Medical Student Performance Evaluation (MSPE)
  4. An official Medical School Transcript
  5. USMLE and/or COMLEX Transcripts. (Completion of USMLE Step 3 is required prior to starting the CAP Residency program)

Applications are only accepted through the Electronic Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP). We start interviewing in mid to late August and usually finish prior to the Thanksgiving holiday.

For additional information, please contact Charisa Lantin, Program Coordinator, by email (preferred) at charisa.lantin@seattlechildrens.org or by phone at (206) 987-3268.