As I write this column, I am en route from Northern California to Washington, D.C. to attend a meeting of AACAP Task force for Training and Education. In reviewing our agenda, which includes several discussions about bringing teaching and learning into sharper focus within the Academy, I have a moment to consider the current “outcome” of my own training—the roles for which I was well-prepared and the complexities of working within a new system.

Heading three thousand miles away from the Youth and Family Services Clinic where I work, I reflect on the successes and challenges that I have seen after six months in my first position out of training. After enjoying many positive experiences during residency as a member of an interdisciplinary team, I have deliberately chosen to work within a county mental health system where I am one of four child and adolescent- trained psychiatrists working alongside social workers and therapists. Together we serve the public child mental health needs for a county with a population of approximately 466,477.

My clinical role in the outpatient clinic has been defined clearly in the system. As a staff psychiatrist evaluating and treating children and teens, I bring my skills in assessment, diagnosis, treatment planning, and psychotherapeutic and psychopharmacologic treatment to the team. As in many public systems, the formal individual, family, and group psychotherapy is typically provided by non-MD therapists, while children are referred to me when larger questions of diagnosis or a possible indication for medication treatment emerges. This division of labor leaves me with a narrower role than I often had in training, but also with opportunities to bring my training in psychotherapy to bear within the setting of our “medication support services” sessions. My long-range career planning includes additional work in a private practice office where I might once again provide more intensive psychotherapy myself. In the meantime, I am exploring the extent to which this work is possible and realistic within our public system and the ways that I can support and consult with children’s therapists within my role.

In parallel with this clinical work within the walls of my office, I am identifying wider opportunities to advocate for children and families in the educational, juvenile justice, and social service systems in our community. Our skilled case managers and my more senior colleagues have served as guides while I map out the terrain of these intersecting systems. Through this process, I hope to continue to discover where I can act as an advocate for the families, children and teens who entrust me with their stories, but whose own voices may not always be heard without such support.

While budget realities threaten our existing services and new funding is sought to support innovative programs for prevention and for innovative delivery of mental health care to children and families, I observe how the political process can directly affect who gets what care for childhood emotional and mental disorders. With all there is yet to learn, I am grateful for the firm foundation I received in my formal training programs and, as ever, aware of the importance of continued connections with colleagues and mentors in this phase of my professional development.

Through the work of the AACAP Committee on Medical Students, Residents, and Early Career Psychiatrists we continue several initiatives intended to foster career development of Child and Adolescent Psychiatrists through these earliest and critical years:

• Plans are underway to build on ideas sprouted at the San Diego Early Career Psychiatry focus group including the support of grass-roots connections between ECP members and local RO-CAPs.
• We propose, again, to present a full schedule of Annual Meeting events next October in Boston, including a continuation of our Annual Meeting Mentorship program for students and residents.
• Dr. Anne Frederickson, John Schowalter Resident Representative to Council, has embarked on a revision and assessment of the Resident Rep Program for CAP Residents.
• Finally, we continue collaboration with the Steering Committee on Workforce Issues and the Workgroup on Training and Education to address broader projects within AACAP affecting our constituency.

As always please be in touch so that I may represent your views and ideas and help connect you with potential mentors within our Academy.

Susan Milam Miller, M.D., is a staff psychiatrist with the Sonoma County Mental Health Division in Santa Rosa, CA and a member of the volunteer clinical faculty of the UC Davis Child and Adolescent Psychiatry Program; she can be reached by email at susan.milam@stanfordalumni.org and by phone at 707-217-3347.