Introduction and Rationale:
Child and Adolescent Psychiatrists are in short supply. The U.S. Federal Bureau of Health Professions has named Child and Adolescent Psychiatry as the most underserved of all medical subspecialties. The current workforce consists of approximately 6300 Child and Adolescents Psychiatrists, whereas the need is estimated at over 30,000 (AACAP, 2001). While clinical care is crucial, however, it is not the sole source of the deficiency.

Our country lacks qualified and skilled Child and Adolescent Psychiatrists who are also effective leaders and administrators. The field is in dire need of individuals who can develop new paradigms for service delivery, manage existing programs and develop new programs, and effectively supervise a clinical and administrative staff. All fields of medicine have been guilty to a greater or lesser extent of not adequately developing leaders and encouraging visionaries amongst their ranks. Child and Adolescent Psychiatry, however, demands effective leaders perhaps even more fervently than other disciplines because the field has long faced a potentially crippling trifecta—first, children represent an underserved and disenfranchised group with no voice of their own when it comes to policy and organizational decision making; second, although our society has taken great strides, there remains significant stigma attached to those with mental illness and to families with a child who is ill; and finally, within the medical establishment itself, psychiatry (and particularly child psychiatry) suffers an undeserved reputation as an ineffectual and weak discipline couched within soft science. The active recruitment and training of Child and Adolescent Psychiatrists who will be groomed for administrative positions of leadership upon graduation is of vital need to the field and our society.

We are particularly fortunate at the NYU School of Medicine to have a number of Child and Adolescent Psychiatrists with strong track records in administration, program development, and leadership. Furthermore, NYU houses one of only two Departments of Child and Adolescent Psychiatry in the country and is, therefore, uniquely situated to design such a training program. Finally, the Department's recent affiliations with the Rockland Children's Psychiatric Center (RCPC) and the Nathan Kline Institute (NKI), along with recognition by the State of New York as the first mental health Center of Excellence, have impressed upon us more than ever before the need to nurture and support the careers of visionary and effective leaders who are capable of managing such institutions and creating similar growth elsewhere.

Program:
The one-year non-accredited training program (fellowship) in Administrative Child and Adolescent Psychiatry was launched in July of 2007. The program offers focused training in administrative management in a variety of clinical settings, including inpatient, outpatient, and research clinics. Clinical rotations are held at RCPC and NKI with supervision held at RCPC and the New York University Child Study Center (Department of Child and Adolescent Psychiatry). The program is supervised by participating faculty from each of these institutions. New York University School of Medicine serves as the sponsoring institution.

Goals:
The goals of the Administrative Child and Adolescent Psychiatry fellowship are to train fellows in:

1. The administrative management of inpatient and outpatient psychiatric facilities;
2. The development, implementation, and evaluation of mental health programs;
3. The clinical and administrative supervision of nursing, social work, and medical staff; and
4. The importance of public policy and how to build effective links to city and state political bodies.

Upon graduation, fellows will be qualified for employment as Medical and Clinical Directors of state, community, and other social service and public mental health institutions.

Accreditation:
As administrative psychiatry fellowships are not formally recognized and accredited by the ACGME, the fellowship is non-accredited. The program does, however, adhere to all ACGME common program requirements.

Candidate Qualifications:

1. Board Certification or eligibility in Child and Adolescent Psychiatry
2. A valid New York State license to practice medicine
3. Possession of a valid and unrestricted DEA certificate
4. Satisfactory completion of an ACGME-approved training program in General Psychiatry and Child and Adolescent Psychiatry
5. Applicants must meet credentialing requirements of the State of New York Office of Mental Health and the House Staff Affairs Office of the NYU School of Medicine

Administrative Faculty:

• Jess P. Shatkin, MD, MPH; Program Director, NYU Child Study Center and Nathan Kline Institute
• Raul Silva, MD; Site Director, RCPC
• Harold Koplewicz, MD; Chair, Department of Child & Adolescent Psychiatry, and Executive Director, Nathan Kline Institute
• Zoe Scott; Residency Program Coordinator, NYU Child Study Center and Rockland Children's Psychiatric Center

Facilities and Resources:
RCPC is currently undergoing many internal changes under the directorship of Raul Silva, MD. Dr. Silva has sharpened the focus of the facility and is making it a more academic training site than it had been previously. In addition, the New York State Governor's Office has committed $35 million to build a new edifice for RCPC, which is scheduled to open in 2009. The opportunities that these internal and external changes present in terms of clinical service redesign and program development are monumental, and we believe that this restructuring provides unprecedented learning opportunities for Administrative Child and Adolescent Psychiatry Fellows. The Fellows are given key roles in many of the following activities:

1. Establishment of new policies for internal review of research protocols (e.g., IRB);
2. Physical plant design of the new facility;
3. Review of medical/legal policies;
4. Supervision of Child and Adolescent Psychiatry Fellows on rotation at RCPC and NKI;
5. Review and redesign of quality assurance measures; and
6. Development of research clinics at NKI.

Additionally, the Fellows are given a seat on various hospital committees (e.g., pharmaceutical, safety, peer review, etc.). Finally, the Fellows work with the Director to address the local mental health needs of the residents of Rockland County through the development of needs assessments, public education projects, and clinical interventions. The Fellows also have opportunities to work with local legislators in the design of these county programs.

Fellow Complement:
Up to four Fellows per year may be enrolled in this program. The program begins as a one-year commitment but may be extended an additional year for select candidates.

Curriculum:
A key organizing principle for the Fellowship is the examination of the many boundaries, juxtapositions, and dichotomies in service delivery systems. Particular attention in the didactic curriculum is paid to these contrasts, including inpatient vs. outpatient, mental health vs. substance abuse programs, somatic vs. psychiatric illness, traditional treatment models vs. non-traditional and rehabilitation models, administrative vs. clinical roles, and physician vs. allied mental health and administrative staff roles.

The core class for the Fellowship, The Director's Seminar, meets daily from 12–1 p.m. Monday through Thursday and is designed to meet the aforementioned program goals. Topics such as budgeting, human resources, program development, and quality management, form the essence of the material reviewed. The Fellows learn about the "trade offs" which go into administrative decision-making and are groomed to take increasing responsibility for clinical administration. This seminar is supplemented by one hour of weekly individual supervision with faculty from the Child Study Center and attendance at weekly Grand Rounds at the Child Study Center. Additional activities, including a mentored scholarly project and a Grand Rounds presentation at RCPC, serve to promote academic curiosity and maintain a high level of academic inquiry during the Fellowship.

The goals of the scholarly project are to: (1) Help Fellows to develop an area of expertise within Child and Adolescent Psychiatry Administration; and (2) promote Fellows' academic curiosity. The final product must be written in publishable form, regardless of whether or not it is intended for submission. The project itself may be a program evaluation, a research project, a new program proposal, a review of the literature with examples from the Fellow's experience in the Fellowship, or another project approved by the Director of the Fellowship Program. The scholarly project forms the basis of the RCPC Grand Rounds presentation at the close of the Fellowship year.

On-Call Duties:
Fellows in the program may be required to stay overnight on call periodically at RCPC from 5 p.m. in the afternoon until 8 AM the next morning. During this time, the Fellows maintain administrative responsibility for the hospital. They may also occasionally admit patients and respond to patient emergencies and staff concerns.

Policies:
The program follows all policies of the Graduate Medical Education Committee at the NYU School of Medicine and the participating institutions (e.g., NYU Child Study Center, Rockland Children's Psychiatric Center, and the Nathan Kline Institute). Written program policies cover all ACGME common program requirements and include:

• Duty Hours
• Moonlighting
• On Call
• Vacation
• Conference Leave
• Leave of Absence
• Performance Evaluations
• Grievance and Review Procedures
• Advancement and Graduation

Evaluation:
Formal evaluations of clinical and administrative activities and didactics are completed by the Fellows twice annually. Likewise, Fellows meet with the Program Director twice annually for performance reviews. Summative evaluations, 360-degree evaluations, faculty evaluations, and program evaluations are also utilized. Both faculty and Fellows are counseled on the basis of these evaluations, and program improvements follow from these reviews.

Funding:
Salary support and benefits for Fellows and all expenses related to program operations, administration, staff support, office availability, computer access, travel, and appropriate incidentals derive from RCPC and the State of New York Office of Mental Health. Fellows are paid at the appropriate PGY level. The current state pay rate for a PGY-6 is $82,140.00 per year. Full benefits, including health, dental, vision, disability, and life insurance are covered by the State as well.

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