Outpatient Diagnostic Evaluation
The task of outpatient diagnoses of child and adolescent psychiatric disorders challenges the child and adolescent resident to establish evidence of psychopathology, to recognize disturbances and strengths in development, to identify maladaptations in the family and surrounding environment, to estimate the degree of impaired function, to recommend ancillary physical, laboratory and/or psychological examinations, to arrive at recommendations for treatment and help arrange appropriate dispositions. For outpatients as well as inpatients, the residents use the diagnostic classification of the American Psychiatric Association, DSM IV TR, as well as careful attention to psychosocial difficulties that may not meet exact diagnostic criteria.
The diagnostic evaluation program is under the close supervision of the director of the outpatient clinic and Dr. Jaqueline Olds at MGH. In Year 1, residents will be scheduled for a new diagnostic evaluation every other week, though extended evaluations are sometimes necessary as dictated by clinical judgment. Evaluations are conducted as often as possible by a team consisting of a resident and a senior faculty member, both in the room together. Early in training, the evaluations are performed by the faculty member with the resident observing. After a few evaluations, the resident conducts the evaluation with the faculty member observing. The resident is then responsible for ordering additional psychological, educational, speech and language, laboratory, medical and family assessments, writing up the formal evaluation, developing a treatment plan, arranging disposition and providing necessary consultation to the family, schools, courts and/or social agencies. On the following week, two hours are set aside to be used for follow-up and supervision of the case seen. A year-long observational diagnostic evaluation seminar is conducted weekly by Dr. Olds. Residents are encouraged to pick up outpatient cases from their diagnostic assignments.