Starting Child Psychiatry Inpatient Job

[shoomer]

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Hi all,

Just looking for any specific resources/tips/strategies/things you learned along the way for those who have worked in a child (5-12 y/o) inpatient setting. I have experience from fellowship but that's a relatively small portion of time compared to a full-time job, and it's also not as much experience as I have in adult inpatient work.

I will be in a community hospital in the southwest, so expecting less resources than I'm used to from my training in the northeast.

It's a broad topic but appreciate any insights from the more experienced people here.

 

[Sushirolls]

Pray. Sacrifice something. Light a candle. Get some holy water.
Whatever your thing is...
So that your SW and RN support on unit is good.

 

[Merovinge]

Figure out local RTCs/PHPs/IOPs for stepdown and what insurances they take. They are your best bet for a liability heat shield (and to actually get patients better). I would try and find some mentors who have done some of this work in the past to discuss medications with. Usually no standing orders so prepare for call to suck depending on the acuity and number of beds you are covering. If you are covering medicaid population, get to know patient's well since you will be seeing them regularly.

 

[comp1]

oh right, you have to get surrogate approval for all meds, most often from court appointed guardians! It was horrible. I remember covering as a moonlighter in residency. Definitely wish the OP luck! Someone has to do this....

 

[shoomer]

Figure out local RTCs/PHPs/IOPs for stepdown and what insurances they take. They are your best bet for a liability heat shield (and to actually get patients better). I would try and find some mentors who have done some of this work in the past to discuss medications with. Usually no standing orders so prepare for call to suck depending on the acuity and number of beds you are covering. If you are covering medicaid population, get to know patient's well since you will be seeing them regularly.

In my fellowship inpatient unit, we were able to get PRN consents to some extent. It was definitely variable with some parents not wanting any meds, some parents saying Benadryl is fine but don't give my kid Ativan/thorazine, some parents agreeing completely with the standard consent sheet we provided them. Is this atypical?

 

[clozareal]

You will really want to beef up your psychotherapy skills, particularly in family therapy and parent management training. I found that a bulk of child inpatient was focused on helping the parents understand what happened, making meaning out of it, helping the child make meaning out of their situation, and really focusing on interventions related to the parenting/family structure at home. The Kazdin Method works well here in my opinion and you have a book you can give to parents to teach them how to deal with their kiddos behaviors.

The BETA workgroup has guidelines on pediatric aggression in the ER which can be helpful for inpatient as well.

 

[Merovinge]

In my fellowship inpatient unit, we were able to get PRN consents to some extent. It was definitely variable with some parents not wanting any meds, some parents saying Benadryl is fine but don't give my kid Ativan/thorazine, some parents agreeing completely with the standard consent sheet we provided them. Is this atypical?

I think it's very state dependent, but I'll admit that I have very little geographic diversity in my medical training. There may be some hospital specific regulations as well that I would suggest anyone look into before doing CAP IP work.