UAB Synopsis, Vol. 27, No. 47, December 22, 2008

For 15 years UAB has been “quietly and consistently growing to be a major hub for child and adolescent psychiatry in the Southeast,” says child and adolescent psychiatrist Lee I. Ascherman, MD. This effort developed as a response to a nationwide shortage of child psychiatrists — a shortage felt keenly in Alabama, where, in 2006, there were only four practicing child and adolescent psychiatrists per hundred thousand youth.

In the early 1990s, Dr. Ascherman says, state health officials, the UAB Department of Psychiatry, and Children’s Hospital reached a consensus to help fill the growing void by starting a residency in child and adolescent psychiatry. The first two residents were enrolled in 1995, and to date the Accreditation Council for Graduate Medical Education program has graduated 28 child and adolescent psychiatrists. “Our goal was to retain these graduates in Alabama and the Southeast, and we’ve been largely successful. About 60% of our graduates stay in Alabama, and the majority remain in the region,” he says.

By growing the faculty to nine members, the department has strengthened its commitment to strong clinical services, training, and research. In 2004 a relationship with Children’s Hospital furthered those ends with the creation of a unified system of care involving the faculty of the Division of Child and Adolescent Psychiatry. “This partnership created a more coherent system and enabled us to serve greater numbers of children and families,” he says.

In addition to the 2-year residency program, the multifaceted division includes inpatient and outpatient services, the Engel Day Treatment Program and Engel Therapeutic Preschool, and an active consultation liaison service.

The division has 35 inpatient beds (24 at Children’s and 11 at UAB) and operates two outpatient clinics. One is located at UAB and the other at Children’s Hospital, but both medical staffs are faculty in the Division of Child and Adolescent Psychiatry. The division also functions as one of three community mental centers in Jefferson County for children younger than 19 years.

The inpatient population includes children and adolescents referred by schools, courts, agencies, and clinicians in the region, as well as those with presenting crises from emergency departments (EDs) at Children’s, UAB, or other regional hospitals that request transfer to the unit.

The division treats a broad range of difficulties, from adjustment to external stressors that move to a crisis level to concerns about emerging adult psychiatric profiles in adolescents, issues related to trauma, disruptive behaviors, mood disorders, psychotic illnesses, developmental disorders, and more. “Our goal is to stabilize the child and transition him or her to an appropriate outpatient service,” Dr. Ascherman says.

The consultation liaison service evaluates children and adolescents in UAB and Children’s EDs and in inpatient pediatric services. These patients may be referred for consultation because of psychiatric difficulties or significant challenges adapting to serious medical illness.

The Engel Day Treatment Program is a therapeutic school serving the educational and treatment needs of children in grade school through high school with significant difficulties functioning in their home public school. They are referred by their districts or are self-referred. An extension of the Day Treatment Program, the Engel Therapeutic Preschool focuses on early intervention and treatment of emotionally and behaviorally at-risk preschool and kindergarten children. Some of these children also are challenged with developmental difficulties and serious medical illnesses. Students receive individualized education services integrated with treatment needs.

The long-term program works toward the ultimate goal of reintegration into the school system. Support is provided during the transition, including future treatment and specialized educational planning. “We maintain a relationship with special education coordinators in the school districts and continue to provide help as it is needed,” Dr. Ascherman says.

Future goals of the division include expansion of research into childhood psychiatric disorders, improved collaboration with community resources, and residency program growth to address the continued shortage of child and adolescent psychiatrists in Alabama. Anyone interested in learning more may contact Dr. Ascherman at 205.934.5156.