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Child & Adolescent Psychiatry Advanced Training

The Bristol Training Scheme

 

Key Features

  •  Tight organisation to ensure trainees are able to complete CAPSAC’s Learning Objectives and Core Experiences  in the time  allotted.
  •  Excellent clinical opportunities.
  • A well organised and stimulating academic seminar programme.
  • A history of supporting flexible training.
  • A small nurturing scheme that prioritises your training and development as a Child and Adolescent Psychiatrist.
  • Range of placements located over a relatively small geographical area.

Key people:

Training Programme Director  

   Dr Philip Shoebridge

Research Co-ordinator

   Dr Melanie Merricks

Academic Co-ordinator  

   Dr Cara Maiden

                        

                          

Introduction to the Scheme


This scheme provides comprehensive Advanced training in Child and Adolescent Psychiatry with opportunities for placements in most of the sub-specialities.

The Scheme provides a rich and varied clinical experience through in-patient, day-patient and out-patient placements offering a diversity of perspectives ranging from the biological, the psychodynamic and systemic. There are currently 4 full time posts and 5 placements located in United Bristol Healthcare Trust (UBHT) and North Bristol Trust (NBT).  Other placements are possible in adjacent schemes (Bath and Swindon) and additional core placements have recently been developed to increase the flexibility of the scheme by offering options for additional community training, further hospital-based out-patient work, forensic and drug misuse experience.

The scheme welcomes part time trainees who wish to train flexibly.

Trainees will be placed according to their training needs primarily at the recommendation of the Training Programme Director and the Trainers’ Committee.

There is a regional training structure under the aegis of the Postgraduate Dean linking the 3 rotations in the South West. There is formal appraisal of ST4-6 training progress on an annual basis (ARCPs).

 

 Structure of Training

The training takes place over three years and contains three core placements during this period. 

  • Two core placements of 12 months each will be Community Child & Adolescent Multi-disciplinary teams.  During these placements Specialty Trainees will have involvement in more specialist service provisions according to training needs and level of experience.
  • Six months will be spent in the Riverside Adolescent Unit.
  • Two Sessions are allocated weekly throughout the three years for research/scholarship
  • One session a week throughout the three years is allocated to study (through the formal academic teaching programme).

In addition to the core placement experience, training is provided over the three years in a number of therapeutic modalities (CBT, Individual Psychotherapy, Family Therapy, and Pharmacotherapy) monitored with “competency” protocols that satisfy (and exceed) CAPSAC guidelines.  The training in each area is overseen by a member of the Trainer’s Committee (Lead Therapists) in association with placement supervisors.

 

 Additional specialised training

This can be  provided in the following areas: -

  • Group therapy- This experience is available in at least three of the placements.

  • Consultation- Liaison -There is an emphasis within the departments in both Trusts on consultation and liaison to a wide range of professionals.  Specialty Trainees will be involved in this and will have experience of providing formal consultation to a professional group.  Consultation-liaison is a particular focus of the work done by the Lumsden Walker House Children’s Service. Paediatric Liaison experience will be gained both in the community through contact with Community Paediatricians, and in hospital settings through liaison with the Paediatric Teams and through deliberate self-harm assessment.

  • Developmental Paediatric Clinics -Are held in both Trusts providing experience for trainees in assessment of learning disability and developmental problems including autism.  Further experience of the Child Psychiatry aspects of Learning Disabilities is available through contact with Learning Disability Nurses and Psychologists.  Locally Consultants in Learning Disability provide sessional input for children.

  • Experience in the legal aspects of Child & Adolescent Psychiatry -will be provided to all trainees through exposure to child protection issues in clinical work, attendance at child protection training, and an apprenticeship over the three years in providing assessments and writing reports for the Court.  Trainees with a special interest can be provided additional experience in forensic child psychiatry and drug misuse services.

 

Location of Services

The services provided in both Trusts are Tier 3 Child & Adolescent Mental Health Services.  Each provides a comprehensive multi-disciplinary service for the assessment and treatment of children, adolescents and their families.  There is a common philosophy across the services of the provision of Community Child Mental Health Services close to the population.  The population served is those aged 0 – 16 years, and those 16 – 18 years who remain in secondary school education. This age cut-off is currently under review as part of a national drive to ensure that all children up until their 18th birthday are covered by CAMHS.

Lumsden Walker House Young People’s Service (currently in redevelopment), and Riverside Adolescent Unit, provide Tier 4 services for the whole area.

Paediatric services are located at Bristol Children’s Hospital, Frenchay Hospital, and Southmead Hospital.


Opportunities for teaching others

The CAMHS service at UBHT, as part of the Department of Child Health, provides regular teaching to medical students of the University of Bristol. The Department of  Psychiatry organises post-graduate teaching for psychiatrists in training (MRCPsych Part I and II courses). The Specialist Registrar will be encouraged to undertake teaching in these settings appropriate to their skills and interests. Opportunities arise from time to time to teach within a multi-disciplinary setting and the Specialist Registrar will be encouraged to take these up when they arise.

 

On-Call requirement:

All posts include the expectation of joining the first on-call rota providing an out of hours emergency service for which there is Consultant cover.  This is a 1:6 first on rota covering emergency hours for Child and Adolescent Psychiatry emergencies. The post would not exceed the maximum hours of duty agreed nationally for Trainees


01

Child & Adolescent Psychiatry

Bristol

Dr Melanie Merricks

Administrative Base & Clinic Setting:        
CAMHS, Knowle Clinic, Broadfield Road, Knowle, Bristol, BS4 2UA Tel: 919 0330

Specific Features

Dr Merricks, has particular interests in the assessment and treatment of children with neuro-developmental disorders, Systemic Family Therapy and Cognitive Behaviour Therapy. Within the multi-disciplinary team there are opportunities to gain experience in Infant Mental Health and Group Parent Programmes (Webster-Stratton and 1-2-3 Magic). There are opportunities for special interest sessions with the liaison, forensic and substance misuse teams within the UBHT CAMHS service. Other possibilities include attachment to the Learning Disability Team, who hold regular clinical sessions at Knowle Clinic and the Bristol-wide service for Looked After Children (“Thinking Allowed”).

Facilities

The service is situated in the heart of its catchment area, on the first floor of the Knowle Clinic. The building is shared with a number of other services, including community child health, health visitors and psychiatry for older age adults. The CAMHS part of the building has separate, dedicated clinical space, but shares use of certain facilities such as photocopying and staff room.

The Specialist Registrar will have dedicated office space, with use of a computer. Along with all other members of the team the Specialist Registrar will be required to book rooms for clinical work.

Population Served

The catchment area of the team has a population of approximately 19 000 children (0 to 16 yrs old). This is a predominantly urban area with high levels of deprivation.

Details of Multi-Disciplinary Team

Currently the team consists of the following staff: 1.0 WTE Consultant Child Psychiatrist (Dr Melanie Merricks) WTE Community Psychiatric Nurse 1.0 WTE Family Therapist 0.9 WTE Clinical Psychologists 1.1 WTE Child Psychotherapists WTE Primary Mental Health Worker (under 5’s) WTE Primary Mental Health Worker (adolescents) 0.4 WTE Primary Mental Health Specialist  We have the following additional staff on a sessional basis: WTE Family Therapist for Eating Disorders WTE Psychiatric Nurse for Looked After Children 0.1 WTE Occupational Therapist We currently also have a child and adolescent mental health worker (0.6 WTE) undertaking a waiting list initiative, on a temporary basis.

The clinic also provides training placements to Clinical Psychology Trainees.

 

Research/Special Interests:

The development of research methodologies within the clinical setting, including developing methods for outcomes research. Neurodevelopmental disorders.

 

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02

Child & Adolescent Psychiatry

Bristol

Dr Philip Shoebridge

Administrative Base:  
CAMHS/CFCS, Monks Park House, Southmead Hospital, Bristol BS10 5NB. Tel: 0117 959 5802 or 5800

Facilities:

The Department of Child & Family Psychiatry is based on the site of a large District General Hospital, Southmead Hospital.  Adequate office space and clinical facilities are available including the use of a one way screen, group and individual therapy facilities.  The Department has personal panic alarms for security purposes.  A mobile phone is available.  Southmead Hospital has excellent information technology, library and post-graduate facilities.

Population Served:

The catchment area of the Bristol North CAMHS team has a population of approximately 35,000 0-16 year old children, 9.3% of whom are likely to suffer from a mental health disorder at any one time (ONS 1999).  It is a predominately urban catchment area encompassing areas of affluence, social deprivation and mixed ethnicity. The Southmead based CAMH team covers North-West Bristol.

Details of Multi-Disciplinary Team:

1.9 WTE Family Therapists.  2.0 WTE Community Psychiatric Nurses.  1.0 WTE Occupational Therapist (with expertise in play therapy).  1.0 WTE Art Therapists.  3.1 WTE psychologists. 3.0 Primary Mental Health Specialists (infant, primary school aged and secondary school aged)  1.0 WTE ST2s and 1.0 WTE ST4-6 in Child Psychiatry. 

There are two WTE Consultant Child and Adolescent Psychiatrists providing a service within this catchment area, Dr Stevens 0.6 WTE, Dr Short 0.4 WTE and Dr Shoebridge 1.0 WTE.

Opportunities for Teaching Others:

Medical students visit the department each academic term and there are also opportunities to teach disciplines allied to Child Psychiatry.  Supervision and teaching for the SHO trainees would be available.

Specific Features:

The service has a Consultant Family Therapist (Susie Essex) who is a lead trainer for SpR Family therapy training and is a tutor / trainer for Family Therapy courses at Bristol University.  Her particular clinical interests are Child Protection, Eating Disorders, and OCD.

Dr Shoebridge is the local SpR/ST4-6 Training Programme Director.  He has research experience, publications, and special interests in.

Dr Helen Stephens has particular interests in ASD services and Eating Disorder services. 

Dr Clare Short has interests in Learning Disability, models of joint working, and Liaison Psychiatry.

The service has developed teams addressing the needs of Looked After Children, Webster-Stratton programmes (Parent Management Training), Child Protection, CBT approaches and Eating Disorders.

Research/Special Interest:

Cognitive Behaviour Therapy, Attachment Theory and its application therapeutically, ADHD (combined Complex ADHD clinic with paediatricians), Clinical Evaluation, Evidence Based Practice and Group Parent Support Programmes (Webster-Stratton)

 

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Consultant New/Patient Clinic

 

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CAMHS Referral Meeting

Multidisciplinary Team Clinical Meeting

Family Therapy Outpatient Clinic

Thursday

Webster-Stratton Basic Group (when running)

 

Friday

Academic Programme or Outpatient Clinic (alternate weeks)

Academic Programme or CPD/Neurology Clinic (alternate weeks)


 

03

Child & Adolescent Psychiatry

Bristol

Dr Ian Skeldon

Administrative Base:  
Riverside Adolescent Unit, Blackberry Hill Hospital, Stapleton, Bristol BS16 2EW. Tel: 0117 975 4878

Main Training Opportunities

The Riverside Adolescent In-Patient and Day Patient Unit offers experience in working with adolescents with severe psychiatric disorder.

§  Day to day involvement in the psychological and physical care of adolescents, either admitted to or attending the Unit as day patients.

§  The trainee will work as part of a large multi-disciplinary team of psychiatrists, nurses, therapists, family therapists, psychologists and teachers.

§  Training opportunities in the management of complex cases requiring intensive input from the Unit’s multi-disciplinary team.

Main categories of severe mental disorder treated by the unit are :psychosis and eating disorders, but also severe forms of neurotic disorder including: obsessive compulsive disorder; anxiety disorders; depression; psychosomatic disorders; somatic conditions involving severe stress reactions; disorder presenting as deliberate self harm; some adolescents with solvent, alcohol and drug abuse problems; disorders resulting from physical and emotional problems and sexual abuse and neuropsychiatric disorder.

§  The trainee will have experience of the referral and assessment process and will be a fully integrated member of the multi-disciplinary team.

§  The trainee will regularly attend in-patient and day patient ward rounds and take on responsibility as case co-ordinator for a specified number of young people on the Unit. 

§  The trainee’s role will involve being an integral part of the running of the Unit with regular involvement in making management decisions about cases. 

§  Involvement in the referral and assessment process will give the trainee experience of making judgements about the suitability of different forms of day and residential treatment and it’s potential advantages and disadvantages. 

§  This role involves working closely alongside members of the therapy and nursing teams, to co-ordinate and deliver the care for young people at the Unit.

§   The trainee will have experience of the use of legislation such as the Children Act and the Mental Health Act as applied to young people with severe mental disorders.

The trainee will also have the opportunity to take part in the general therapeutic activity of the Unit and will have the opportunity to gain experience in working in a range of group therapy situations under supervision.

§  The trainee will also have the opportunity to take the lead in offering individual therapy to a small number of selected cases under supervision.

§    Opportunities will be made available for the trainee to visit other in-patient and day patient units as part of their experience to offer contrasting experiences of Tier 4 services.

The range of treatments offered at the Unit include: multi-disciplinary assessment; individual psychotherapy; group psychotherapy; social skills and other developmental groups; cognitive behavioural therapy/family therapy; administration and monitoring of psychotropic medication.

Other specific training experiences

§  Family Therapy :Supervised training and exposure to work with in-patient and day patient unit families under the supervision of a trained family therapist with MSc qualification.

§     Cognitive Behaviour Therapy : There is opportunity for supervised practice including cases of severe obsessive compulsive disorder and eating disorder.

§     Psychopharmacology : Experience in the use and monitoring of psychotropic medication in severely ill adolescents, including those with psychotic disorders.

Special Experiences Available

§     The opportunity to shadow the Unit Consultant in his role as manager of The Riverside Adolescent Unit in the North Bristol NHS Trust and  in his strategic role in commissioning Tier 4 services with the local health authority.

Research/Special Interest:

Early Intervention in Psychosis

 

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04

Child & Adolescent Psychiatry

Bristol

Dr Deborah Judge

Administrative Base: Young Peoples Drug Treatment Service, 38 Southwell Street, Bristol BS2 8EJ

Description of Service

The Young Peoples’ Drug Treatment Service (YPDTS) has been in operation for 5 years. It offers specialist assessment and intervention to young people aged 18 and under in Bristol, South Gloucestershire, Bath and North East Somerset and North Somerset. The service has links with local Tier 3 Substance Misuse Services, Youth Offending Teams and with non-statutory services. It is an out patient service only

The service provides specialist assessment and interventions to young people (18 and under) misusing drugs. We offer trainees the experience of specialist prescribing of substitute medication and community detoxification. There are opportunities for other therapeutic modalities and supervision for CBT is available from the team’s psychologist.

The service also provides clinical input to outlying areas in accommodation shared with Social Services (South Gloucestershire), the Youth Offending Team (Weston super Mare) and non-statutory services (Bath). The Specialist Registrar would have the opportunity to do home and community based visits with members of the multi-disciplinary team. This is a specialist Tier 4 service covering Bristol, South Gloucestershire, Bath and North East Somerset and North Somerset.

The team works with individuals and families. The vast majority of cases involve close working with other agencies, including YOTs, Connexions, Social Services, etc.

The workers offer extremely intensive (2-3 appointments per week) work with a small caseload.

Facilities

The service has stand-alone premises in central Bristol. The accommodation comprises 2 large shared offices, 2 consulting rooms, a group room and a clinical area. There is a separate waiting area, a kitchen and a shower.

The Specialist Registrar has a dedicated workspace and computer in a shared office. The Specialist Registrar would have access to bookable clinical space.

YPDTS has one part time (6 sessions) consultant. UBHT overall has Community CAMHS Consultants 2.0 wte

Forensic CAMHS Consultants 1.0 wte

Multidisciplinary Team

Consultant in Substance Misuse in Young People: 0.6WTE  Staff Grade Doctor: 0.5 WTE Lead Nurse 1.0 WTE; Specialist Drug Workers: Total 2.5 WTE; Specialist Nurse 1.3 WTE; B Grade Psychologist: 0.2 WTE; Medical Secretary: 1.0 WTE

Research/Specialist interests

 

 

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05

Child & Adolescent Psychiatry

Bristol

Dr Cara Maiden

 

 

 

 

 

 

 

INFORMATION TO FOLLOW

 

 

 

 

 

 

 

 

 

 

 

Research/Specialist interests

 

 

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Last updated at 16:50, 18 March 2009