DAY THREE
On the third day of working in the Wexford offices I shadowed Dr. Schlesinger exclusively on her clinical day with patients that were non-TiPS and were coming to the offices under Children's. The patients that we saw on this day were all ones that she had been seeing for some time now and these appointments were all follow ups or check-ups for these kids. Since Dr. Schlesinger is a child psychiatrist all of her cases deal with some sort of need for medication, but always with a side of therapy. The cases she works with range from the more simple cases where the patient was diagnosed easily and placed on an effective medication plan, these patients are coming in for routine check ups; to cases that have new problems popping and need their treatment adapted each time they come in.
A recomandation that Dr. Schlesinger often gave was to have her patients to go on medication holidays during these summer months. This recomendation can be scary for some parnets who still strugle with their kids while they are ona consistant medication. In the end though going off of a regular dosage will benefit the pateint in the long run becuase their body will not become used to the medication and require dosage changes they longer they would be on the medication as fast as when they wouldnt have taken the medication holiday.
DAY FOUR
On day four here in the Wexford offices, Dr. Schlesinger was out of the offices so I got to work with her care coordinators and shadow some of the behavioral health therapist that work for just Children's pediatrics. The care coordinators of the TiPs program are very important because they are the first line when it comes to outside requests from all pediatric offices sending kids in to see Dr. Schlesinger or Colleen Gianneski. The care coordinator that I was able to sit down with for a little before the team meeting happened was with Nechama, Splaver. The care coordinators follow the cases through their time interacting with the TiPS offices and make sure that the patient's parents have given a release of information otherwise Dr. Schlesinger is not allowed to make changes to the patient's medical charts nor would she be allowed to write her recommendations on the chart. They also are in charge of getting all basic information from the families themselves, such as the medical back ground and any special accommodations the patient may need. Once all the information is acquired, the care coordinators would inform Colleen or Dr. Schlesinger of the new patient and set up a time for an appointment or their opinion on a consult. It is important that the care coordinators record all the information down on the chart so all parties involved are able to see the notes taken from each interaction with the patient and their medical background. The patient's that the care coordinators work with can have really quick follow through and have the patient be seen and sent back to the PCP or they can play phone tag with patents for two to three weeks trying to get all the information they need to send the patient's information to Dr. Schlesinger or Colleen. The clinical workers that are working for Children's TiPs are all licensed social workers, they are working on recording enough hours to get their certification for clinical social work. Once they have the clinical social work certification they would be allowed to do counseling in the office.
The next item on today's agenda was a team meeting call, this was something that the team that works under the TiPS name completed every week just to keep everyone up to date on any changes or reminders needed. This conference call lasts just under an hour and they quickly run through the topics such as, reminding everyone to get a release of information from the family to share the information from the TiPs doctor back to the family's pediatrician; and trying to keep these patients referred to them to go back to their original PCP (primary child care provider), to keep these kids in established relationships with their pediatricians.
The final activity that I followed along with today was the chance to shadow Stephanie Azarcon, LCSW. Stephanie was not in the TiPS program but was just a behavioral health therapist for Children's. I had the chance to view a case of anxeity with an extreme presentation of executive functioning disorder. THis disorder needs to be waatched carefully to make sure there is not a comorbidity with major deppresion disorder or psychosis eidsodes. If this would be the case the severity of the treatment for that kind of patient would need to be increased.
On the third day of working in the Wexford offices I shadowed Dr. Schlesinger exclusively on her clinical day with patients that were non-TiPS and were coming to the offices under Children's. The patients that we saw on this day were all ones that she had been seeing for some time now and these appointments were all follow ups or check-ups for these kids. Since Dr. Schlesinger is a child psychiatrist all of her cases deal with some sort of need for medication, but always with a side of therapy. The cases she works with range from the more simple cases where the patient was diagnosed easily and placed on an effective medication plan, these patients are coming in for routine check ups; to cases that have new problems popping and need their treatment adapted each time they come in.
Selective Serotonin Inhibitors are used to treat depression and anxiety in children and adolescents. They need to be taken every day to be effective. Depression and anxiety can make it hard to fall asleep or stay asleep, and sometimes a sign that depression or anxiety is not adequately treated is the need to use melatonin every night. Melatonin can be quite useful to promote sleep, and is often used at the beginning of treatment, or intermittently throughout treatment, but the need to use melatonin every day is a sign that more aggression therapy and/or medication management of depression or ADHD is needed.
Goal setting is an important part of behavioral health treatment. Dr. Schlesinger talks to every single patient that she sees about their goals. They often talk about short term goals and long term goals. The ability of patients to attain their short term goals and/or long term goals is one way to assess whether or not treatment is adequate. Also, as one component of anxiety is avoidance, talking about goals is a mechanism to make sure that a patient is actively working on coping skills rather, than accidentally giving in to the avoidance that can come with depression, anxiety or ADHD.
I also had the opportunity to meet a transgender male. There are many unique concerns that come with being transgendered. I learned that depression, anxiety and other behavioral health conditions are actually more common in transgendered youth. Some believe that by helping youth transition these behavioral health conditions can decrease. It is also clear that treatment of behavioral health concerns –with therapy and medication- is essential in order to assure that transgendered youth can live up to their potential.
A recomandation that Dr. Schlesinger often gave was to have her patients to go on medication holidays during these summer months. This recomendation can be scary for some parnets who still strugle with their kids while they are ona consistant medication. In the end though going off of a regular dosage will benefit the pateint in the long run becuase their body will not become used to the medication and require dosage changes they longer they would be on the medication as fast as when they wouldnt have taken the medication holiday.
DAY FOUR
On day four here in the Wexford offices, Dr. Schlesinger was out of the offices so I got to work with her care coordinators and shadow some of the behavioral health therapist that work for just Children's pediatrics. The care coordinators of the TiPs program are very important because they are the first line when it comes to outside requests from all pediatric offices sending kids in to see Dr. Schlesinger or Colleen Gianneski. The care coordinator that I was able to sit down with for a little before the team meeting happened was with Nechama, Splaver. The care coordinators follow the cases through their time interacting with the TiPS offices and make sure that the patient's parents have given a release of information otherwise Dr. Schlesinger is not allowed to make changes to the patient's medical charts nor would she be allowed to write her recommendations on the chart. They also are in charge of getting all basic information from the families themselves, such as the medical back ground and any special accommodations the patient may need. Once all the information is acquired, the care coordinators would inform Colleen or Dr. Schlesinger of the new patient and set up a time for an appointment or their opinion on a consult. It is important that the care coordinators record all the information down on the chart so all parties involved are able to see the notes taken from each interaction with the patient and their medical background. The patient's that the care coordinators work with can have really quick follow through and have the patient be seen and sent back to the PCP or they can play phone tag with patents for two to three weeks trying to get all the information they need to send the patient's information to Dr. Schlesinger or Colleen. The clinical workers that are working for Children's TiPs are all licensed social workers, they are working on recording enough hours to get their certification for clinical social work. Once they have the clinical social work certification they would be allowed to do counseling in the office.
The next item on today's agenda was a team meeting call, this was something that the team that works under the TiPS name completed every week just to keep everyone up to date on any changes or reminders needed. This conference call lasts just under an hour and they quickly run through the topics such as, reminding everyone to get a release of information from the family to share the information from the TiPs doctor back to the family's pediatrician; and trying to keep these patients referred to them to go back to their original PCP (primary child care provider), to keep these kids in established relationships with their pediatricians.
The final activity that I followed along with today was the chance to shadow Stephanie Azarcon, LCSW. Stephanie was not in the TiPS program but was just a behavioral health therapist for Children's. I had the chance to view a case of anxeity with an extreme presentation of executive functioning disorder. THis disorder needs to be waatched carefully to make sure there is not a comorbidity with major deppresion disorder or psychosis eidsodes. If this would be the case the severity of the treatment for that kind of patient would need to be increased.
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