Serving the Next Generation as a Child Adolescent Psychiatrist

Session 189

Dr. Kimberly Gordon-Achebe is a Child and Adolescent Psychiatrist and program director. She talks about providing care in dangerous areas and her daily, clinical duties.

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:18] Interest in Child and Adolescent Psychiatry

Kimberly went into medical school thinking she was going to be a psychiatrist. And at this time, her family members didn’t think psychiatry is real medicine.

She was a premed at a historically black college university, which is number one in the nation for getting African-Americans into medical school.

Kimberly enjoyed abnormal psychology. And she got a better understanding of this seeing how their church would skip the customary laying of hands on people with bipolar or schizophrenia. People would also be scared of manic women for instance. And so, she thought the church could do everything. It also got her to question how health meant for communities. And abnormal psychology explained all of that.

Torn between wanting to be a psychologist and fulfilling her parents’ dream for her to be a doctor, Kimberly decided that psychiatry was the best of both worlds. And so, she had to grapple with attending four years of medical school and doing all the biological sciences.

[04:20] The Biggest Myth or Misconception Around Child and Adolescent Psychiatry

Oftentimes, when young people develop symptoms like anxiety and depression, people just feel like they’re going to outgrow it so give them a little bit more time. But it could be too late to address some of the things that will prevent those symptoms from getting worse.

'A lot of people don't understand that kids can have psychiatric illnesses. Most people probably think of it as just a behavioral thing.'Click To Tweet

Another myth is that childhood psychiatrists just want to prescribe medications like ADHD medications and they just want to drug up kids.

But many childhood psychiatrists work with psychologists and social workers and other professionals and educators. They get kids engaged in their communities and schools. And they do not prescribe medications as the mainstay, although that is something they could also do very well, safely and effectively.

Medication is not the first go-to in childhood psychiatry because they have to consider other things. But when medication is indicated, they would prescribe.

[05:47] The Most Important Trait to Be a Child and Adolescent Psychiatrist

Kimberly thinks you have to be close to the community and the patients you serve. Have an understanding of what their school systems are and what their communities may face to engage in mental health treatment. Although these are things you learn in medical school.

Today, we’re learning a lot about social determinants of mental health, and understanding that people are a product of where they work, live, play, worship, etc. Especially when parents fail or when systems fail, how do you engage people and correct them in a way that is safe and great for kids?

“You really have to understand the nature of development and what it requires to have healthy development, healthy attachments and healthy relationships.”Click To Tweet

[07:22] Interacting with Families

Kimberly explains that when you meet a kid for the first time who suffers from anxiety, for instance, part of the battle is getting the parents to engage in treating their own anxiety. They probably haven’t known better yet or understand that the kid is not being oppositional or just not refusing to go to school – and they’re really just suffering.

That’s why Kimberly stresses the importance of being pretty clear from the beginning with the parents that they’re going to guide them through the process.

A lot of times, parents come in when their kids are having struggles and feel demoralized. They’ve been told by many people that their kid is bad or there’s something wrong with them, or they’re not smart enough or whatever. Imagine the weight this has on a parent who’s meeting you for the first time to tell you that they’re not doing a good job as a parent.

That’s how they feel but Kimberly certainly doesn’t think that’s the case. And so, it’s important for childhood psychiatrists to make them feel that they’re not going to be judged.

[09:24] Typical Day

Kimberly’s clinical work is going to people’s homes. She’s considered a community psychiatrist that works for a community treatment program. They go to people’s homes and provide psychiatric services and medication management in addition to counseling. And so, she gets to see how these people live and see the challenges that young people have to face in their communities.

[11:02] Taking Calls

She takes calls supervising medical students and residents when they’re called to see difficult cases, particularly in an inpatient or emergency room setting.

'You see just about everything. You may see a youth who has been abused physically or sexually, or you may see someone who has had a meltdown.'Click To Tweet

For instance, you may see someone who’s destructive or aggressive at home. Then the mom called the cops and the cops brought them to the emergency room to be evaluated. And it may be the first time they’ve actually had psychiatric services or have seen a psychiatrist.

She may also get to see kids who have organic things going on, and not necessarily for psychiatric reasons, but a metabolic problem. However, because they’re having behavioral disturbances, psychiatry is called to assist in managing their behaviors while getting their medical treatment.

[12:17] The Training Path

After medical school, you apply to residency programs through the match process. Not only do these programs interview you, but you also get to interview them. That way, you would be able to figure out if you’re the right fit and they’re the right fit for you as well.

The psychiatry residency program is four years if you’re just interested in general psychiatry. It’s basically the bread and butter of psychiatry. Most people are general psychiatrists, and they can practice with children and adolescents. They may also practice with geriatric adults, or the whole gamut of addiction psychiatry, forensics, and whatever you may want to specialize.

Public and community psychiatry is a fellowship program that’s not board-certified. Many people decide in their third year of residency in general psychiatry whether they want to go into child adolescent psychiatry. This is an additional two years. And you can fast track into Child and Adolescent Psychiatry and complete your training in five years.

[14:56] Life Outside of the Hospital

Kimberly says she still gets to have a life outside of the hospital. There would be days she would come late, but more often than not, it’s nine to five. For some psychiatrists, particularly those who work in communities, the clinic is closed at 4:30 – 5pm.

For some psychiatrists, particularly those who work in communities, the clinic is closed at 4:30 – 5pm. If you’re in academic psychiatry, this may vary from eight to seven, depending on what you do. And if you have your own private practice, you can make your own hours. It really is completely up to you.

'Psychiatry is a field that has so many options.”Click To Tweet

There are psychiatrists who do mostly clinical work and others do mostly administrative work. Some people also do a gamut of clinical and administrative work. There are some people who actually decide to use their psychiatry background to consult. There’s a lot of things you can do in your career.

Kimberly usually tells people to not be discouraged about their options because options for psychiatry are endless in many ways.

[15:36] Opportunities to Sub-specialize

If you’re a child psychiatrist, but you’re really interested in infant mental health, there is extra training you can do to work with those youth zero to five. If you’re a child adolescent psychiatrist, but you’re really interested in adolescents, then you can focus on adolescents.

There’s Addiction Medicine where you work with youth who may have substance use disorder, or just have problematic substance use. If you’re a psychiatrist and have had exposure to Addiction Medicine, you could study on your own and work underneath someone who has additional training so you can become an expert.

You may also be somebody interested in youth detained in juvenile detention centers, or who’ve had issues with problematic behaviors. These require other systems to be involved such as the Department of Social Services or Department of Juvenile Services.

There’s also forensic work in terms of evaluation for youth who may have difficult circumstances and their parents may be engaged in legal systems.

'There's a lot of opportunity and channels in psychiatry outside of the bread and butter – ADHD management, depression, and anxiety.'Click To Tweet

Additionally, there are psychiatrists who work just for youth who have severe mental illnesses like schizophrenia and early onset psychosis. As psychiatrists, sometimes, things could get a little demanding so you have the opportunities to move around if you want to.

[18:58] Message to Future Primary Care Physicians

Kimberly thinks that because of the way medicine is set up, there’s so much red tape with keeping your documentation and making sure people get the proper care and insurance paperwork.

“Preventive medicine should be a mainstay for kids.”Click To Tweet

If a pediatrician sees a kid for the first time and notices some challenges either with the kid or in the family, that is the time to intervene. That intervention may not only affect that young person’s life, but it may also change the trajectory of the family. Because if that parent got the appropriate support they needed, it may prevent other things from happening.

'Preventive medicine prevents the cascade of events that happen when things go untreated.'Click To Tweet

It’s also an opportunity to look at some of the social determinants of mental health. For example, an exposure to lead can lead to intellectual disabilities, as well as exposure to drugs and alcohol in utero. These are some things pediatricians often document, but they don’t always hook people into services that can prevent the negative outcomes related to things beyond the control of families.

Pediatricians can’t do it alone. Ultimately, Kimberly hopes we’re creating doctors who are also playing a big part of efficacy and health equity.

[23:26] Advocacy in Medical School Curriculum

Kimberly believes advocacy should be embedded in the curriculum so people understand more about how healthcare systems work from different perspectives. Whether that’s billing, insurance and payers, or hospital systems and their mission or values, communities and what resources are available.

[26:31] What She Wished She Knew Before Getting Into the Field

Kimberly says she wished she had known that it’s okay to take breaks and that it’s okay to ask for help. It’s okay to be transparent about that. If you’re feeling tired or burned out, take a break. Breaks don’t necessarily mean you go on a vacation.

'When life challenges happen, it's really important for medical students to feel comfortable asking for help.'Click To Tweet

Kimberly wishes to tell students that at the end of the day, take advantage of the time you have in medical school. Grab those opportunities to travel if there are. This is the time in your life where you get to learn not just about medicine, but about yourself. You learn about what type of doctor you want to be. And so, don’t waste time worrying about things that will take care of itself.

[28:35] The Most and Least Liked Things

What she loves most about her specialty are the kids. She loves how they’re so resilient, funny, and they teach you things about life that you just don’t get otherwise. Even with the most horrendous stories, you can see that glimmer of hope that you don’t always see with adults. For her, kids remind her that it’s really important to stay youthful, which is what keeps her going.

Kimberly explains that if you have 30 people in your classroom, and it’s hot and the AC doesn’t work and you have ADHD, that can be your worst nightmare. Or when someone’s telling you over and over again to sit down, but then you’re not comfortable. Now, those are easy fixes.

But oftentimes what happens is the kid is labeled and it becomes a spiraling theme. And so, this kid who used to be happy about going to school doesn’t like to go to school anymore because of the zero tolerance and practice of suspending and expelling kids for misbehavior.

'Every kid doesn't learn the same way. And because kids learn differently, we have to do different things.'Click To Tweet

That being said, what she hates most about child psychiatry is battling systems to get it right so we don’t lose the kids opportunity.

[32:0] How to Get Involved

Kimberly encourages students who might be interested in Child and Adolescent Psychiatry to learn from her experience as an educator and as a clinician. And so, she created a health equity firm to engage people in medicine, but also people who are in communities as community leaders to understand how you can bring justice in diversity and health equity.

[33:07] Final Words of Wisdom

If you’re interested in learning more about what Kimberly does, look her up on Twitter and Instagram.

Finally, she encourages students to look up Dr. Chester Pierce, who was a huge inspiration for Kimberly. He was a huge advocate for mental health, particularly for African Americans, and he coined the term microaggressions.