Psychiatry

The SickKids Ambulatory Psychiatry Clinic provides comprehensive psychiatric consultations, short-term treatment and follow-up to children and adolescents with complex mental health needs. Our areas of focus include treatment resistant ADHD, anxiety disorders, including Selective Mutism, Obsessive Compulsive Disorder (OCD), depression, as well as the management of psychiatric disorders in children and adolescents who also have significant physical health disorders, including somatic symptom and related disorders.

Typically, a child or adolescent and their caregivers attend an initial consultation, which is usually done in one visit; however, may be conducted over several visits. Several people may be involved in this first appointment, including learners (e.g. medical students, or residents). A typical assessment involves the clinician speaking with all who attend the appointment together. In addition, the clinician will speak with the child or adolescent on their own and will also speak with the parents or caregivers on their own.  

After completing the assessment, the clinician will discuss their assessment and make recommendations regarding the next steps. These recommendations may include connecting with local mental health services closer to home, or may include attending some form of short-term treatment offered through our Department.  Treatment recommendations may include various forms of talk therapy, such as cognitive behaviour therapy (CBT) or medication management. Sometimes recommendations about medications will be made to the referring physician while at times, short-term medication management or a course of short-term therapy may be offered within our Department. In general, our Department provides only short-term treatment. 

For anxiety disorders: 

For 4 to 7 year-old children and their caregivers, we offer the Taming Sneaky Fears CBT Group Sessions (8 caregiver sessions).   

For 8 to 12 year-old children and their caregivers, we offer group CBT sessions (10 sessions) where caregiver and child sessions run separately, at the same time; or alternatively for those who may require individual sessions, we offer individual therapy where the clinician meets with the child on a weekly basis followed by spending a few minutes with the parents or caregivers (total of 10 sessions).  

For older adolescents we offer individual CBT sessions (8 to 10 sessions).  

For OCD: 

We offer individual CBT for children 8 and older. 

For Somatization Disorder: 

We offer a Mind Body Together (MBT) group therapy for somatization disorder (6 weeks).

For 13- to 17-year-old adolescents with a variety of mental health illnesses, including severe anxiety or mood disorders and psychotic disorders, which may have interfered with their ability to function, we provide an intensive day-treatment program.   

The program uses primarily a cognitive behaviour therapy (CBT) approach. Patients typically attend the program for two to three months with the goal of having them transition back to school or other services. 

The Tics and Tourette Clinic is a provincial clinic at SickKids that works with children and adolescents to assess and treat Tourette Syndrome and associated symptoms such as tics. This is an outpatient clinic within the Department of Psychiatry. With a physician’s referral, child and adolescent patients will receive consultation on the diagnosis and management of symptoms, education about tics and Tourette Syndrome and related conditions, pharmacological management, and recommendations for home, school and other settings.

Referrals to the Tics and Tourette Clinic must be made by a physician through EpicCare. Learn more about how to refer a patient to SickKids. 

The Consultation-Liaison (CL) Psychiatry inpatient service at SickKids consists of an interprofessional team of psychiatrists, advanced practice nurses and behavioral specialists who provide comprehensive psychiatric assessment and integrated care to children and adolescents with complex physical health and mental health conditions across the hospital’s medical and surgical units.

The inpatient team works with the hospital's inpatient units to support patient care around a number of psychiatric disorders such as anxiety or depression, as well as acute psychiatric management after suicide attempts.  

The inpatient CL service also provides assessment and treatment of functional disorders and somatization (physical expression of emotional distress), and support around difficulties children and adolescents may have with medical or surgical treatment, as well as management of delirium (severe confusion due to medical reasons).   

The CL inpatient team provides education and support to staff across the hospital to enhance early recognition and identification of psychiatric concerns among physically ill children and adolescents and promotes early integrated care.  

In addition, CL Psychiatry provides out-patient assessments to assess and manage psychiatric concerns presenting in physically ill children and adolescents (as described via Ambulatory Psychiatry above). 

In both inpatient and outpatient settings, our CL team works as part of the child’s health care team and partners with medical/surgical teams with the goal of ensuring cohesive care from inpatient to outpatient at an individual level and hospital level.  

The SickKids inpatient psychiatry unit is a short-stay unit for children and youth ages 6 to 17 years with mental health issues that require an admission to hospital for acute safety concerns. Admission to the unit is via the SickKids Emergency Department or medical and surgical units at SickKids, on a voluntary basis.  

Children and adolescents are admitted for acute situations such as suicide attempts or for severe mental health symptoms such as psychosis. The focus of the unit is on assessment and stabilization of the mental health crisis and working with the child/adolescent and family on strategies to address safety concerns. The inpatient program is a family-based program and has caregivers participating in regular therapeutic meetings with staff and the child/adolescent.   

As the inpatient unit is a voluntary unit, children, adolescents, and caregivers must agree to the admission. If a doctor determines that an admission is required for mental health reasons and the child or adolescent is not in agreement, they will be transferred to a youth psychiatry unit at a local hospital that accepts involuntary admissions.   

This is a clinical research clinic within Ambulatory Psychiatry that recognizes the association between depression and the risk factors for heart disease. The CLIMB Clinic integrates physical health into the mental health assessment and treatment of patients with depression.   

Patients who are referred to this program undergo a thorough psychiatric and health assessment during their visit.  

The CLIMB Clinic accepts referrals for children and youth between the ages of 8-17. Referrals to the CLIMB clinic must be made by a physician through EpicCare. Learn more about how to refer a patient to SickKids.

This is a clinical research clinic within Ambulatory Psychiatry, that conducts detailed neurodevelopmental assessments for children with genetic disorders. The clinic team includes psychiatry, psychology, and psychometry, with experience in Applied Behaviour Analysis (ABA).  

The clinic’s main objective is to provide recommendations around family coping, behavioural strategies, safety, environment and activities, as well as principles of applied behavioral analysis (ABA).  

Referrals to the DAGSY program must be made by a physician through MHAP (referral.mhap@sickkids.ca)

Suneeta Monga MD, FRCPC  

Associate Psychiatrist-in-Chief & Medical Director, Ambulatory Psychiatry 

Associate Professor of Psychiatry, University of Toronto  

Darryl Yates RN, MHSc, CHE 

Executive Director, Brain and Mental Health Services, Garry Hurvitz Centre for Community Mental Health & Garry Hurvitz Centre for Brain and Mental Health

Research conducted through the neuropsychiatric research unit is dedicated to the understanding and treatment of neurodevelopmental disorders such as ADHD, OCD, Tics, and Tourette's Syndrome by examining both the genetics underlying these disorders, as well as the behavioural and cognitive traits that influence development. Our research uses a combination of behavioural, academic, genetic, and cognitive methods, and involves working with both typically-developing and clinical populations of children and youth.   

For more information please see Schachar-Crosbie Lab. 

From June 2019 to September 2021, we will invite 30,000 children and youth visiting the Ontario Science Centre to become Junior Scientists as part of our research project called Spit for Science. Children and youth will have the opportunity complete a computer game that will provide us with information about how they act and think. Using postal codes, we will also be able to estimate an understanding about different aspects of environment in which our Junior Scientists live in (e.g., how close they live to green space or exposure to air pollution). Finally, we will ask our Junior Scientists to spit in a small tube so that we can collect DNA. 

The aim of this study is to better understand how genes work with the environment to impact mental and physical health of children and adolescents. Learn more about Spit for Science. 

In collaboration with a national leader in medical engineering and technology, our team is creating novel virtual reality tools for assessment and intervention of cognitive trait (executive functions) common in neurodevelopmental and brain-based disorders.  

The POND Network brings together a multidisciplinary team of scientists, clinicians, engineers and community stakeholders who share the goal of improving the long-term outcomes for children with ASD, ADHD, OCD and ID.  

The POND Network hopes to: 

•  increase awareness and knowledge around neurodevelopmental disorders; 
• support Ontario’s health researchers, clinicians and policy-makers in their efforts to better understand and implement evidence-based treatments for these conditions; and 
• improve health outcomes and quality of life for children and youth with neurodevelopmental disorders in Ontario, Canada and around the world. 

The DAGSY clinic within Ambulatory Psychiatry provides comprehensive one-time consultations for children identified as carriers of genetic risk variants associated with neurodevelopmental and psychiatric conditions. The interdisciplinary clinic team conducts integrated psychiatric, psychological and developmental evaluations to obtain a detailed profile of strengths and weaknesses of the child. Following assessment, families receive recommendations that include information on the genetic condition relevant to behaviour and development, concrete strategies to address current behavioural or learning issues and strategies to minimize future mental health risks. If available, research opportunities are discussed with parents.

Research through the CLIMB Clinic is focused on understanding the link between depression and heart disease as children and adolescents with depression are more likely as adults to have serious heart disease. The focus of this research program is to understand why this happens and what we can do about it.  For example, as part of this clinical research program we are examining the ways in which diet and activity can affect inflammation, blood vessels, and mood.  

One tragic problem associated with depression is suicide. Suicide is a leading cause of death among youth in Canada, and we need better treatments that are more widely available. Currently SickKids is leading a large multi-site study to test a youth suicide prevention intervention that was developed at SickKids. The study is for adolescents who come or are brought to the emergency department due to a concern around their safety. 

We know that mental health outcomes (e.g., the results of treatment) to date are poorly defined with little standardization across both clinical practice and research, making it difficult to identify the best or most effective treatment for various mental health concerns. This is the case with adolescent depression. In other areas of healthcare, the development of a core outcome set (COS), which is a set of outcomes that should be measured and reported in all clinical trials, has led to better outcome selection and measurement across research studies and this has led to better understanding which treatments are best for which patients.   

The IN-ROADS Initiative is planning to develop a core outcome set for adolescent depression studies. With this goal, we will seek out input from stakeholders including active engagement of patients and their caregivers to ensure what outcomes matter most to patients and their caregivers are included in the final core outcome set for adolescent depression. 

Early research is underway to use smartphones as a tool to learn more about someone's behaviour. Think about it: A smartphone automatically collects all kinds of information, for example, how often you go outside and how often you communicate with others (texting, Instagram, Snapchat, etc). Our department in collaboration with others is looking to see if smartphones can help us see changes in behaviour that may tell us that someone has mental health problems and may need help. 

Our Department provides core child & adolescent psychiatry training for the University of Toronto Psychiatry clerkship block, which builds on the Foundations Curriculum.  

In addition, the Department offers elective experiences for medical students from the University of Toronto and elsewhere. Electives are typically two weeks in length but can be up to four weeks.   

Find more information around the process for U of T, and other Canadian and International medical students.

Our department is a core training site for general Psychiatry Residents in the University of Toronto Residency Program as well as a core training site for aspects of the Child & Adolescent Psychiatry Subspecialty stream.   

Given the diversity of clinics and expertise of our staff, we also regularly attract senior residents seeking further experiences such as electives in child & adolescent psychiatry as per the U of T Post-graduate Medical Education guidelines. We are also able to provide electives of 2 to 4 weeks for psychiatry residents across the province and country for elective opportunities.    

Our department also provides training in child & adolescent psychiatry to paediatrics residents and fellows from the University of Toronto Paediatrics training program. These training opportunities allow for collaborative and interdisciplinary learning with a focus on ensuring that interested pediatric trainees obtain the necessary skills to assess and manage common pediatric mental health presentations. These opportunities are open to pediatric residents in the general pediatric program as well as subspecialty pediatric fellows in Community Pediatrics, Developmental Pediatrics, and Adolescent Medicine Fellows. 

See application details for electives via University of Toronto PGME. 

Our department also offers fellowships in child and adolescent psychiatry in affiliation with the University of Toronto’s Psychiatry Fellowship Program. These clinical and/or research fellowships are typically 1 to 2 years and graduate child and adolescent sub-specialty residents or pediatric residents may apply.

We also offer fellowship opportunities to both national and international candidates.  Fellows work with a primary Supervisor to obtain skills and expertise in one or two specific clinical or research areas within the department and report to the Fellowship Director.   

All applicants must follow the application process through the Post-Graduate Medical Office (PGME) and they must meet The Hospital for Sick Children’s application requirements as well.     

For more information on Department of Psychiatry fellowship application requirements and how to apply for a fellowship, visit University of Toronto Fellowships. 

The Hospital for Sick Children (SickKids) is offering a unique training fellowship opportunity in Neurodevelopmental Child and Youth Psychiatry under the supervision of Dr. Jacob Vorstman and Dr. Louise Gallagher. The fellowship offers an exciting opportunity to work in an interdisciplinary clinical and research environment. The fellowship will provide training in:

• assessing children and youth with various degrees of intellectual disability and other neurodevelopmental conditions (e.g., autism, language disorders, etc.) in the context of rare genetic disorders
• diagnostic assessment of children at risk for neurodevelopmental and psychiatric conditions
• structured clinical interviewing and observational assessment (e.g., KSADS, ADI, DAWBA, ADOS)
• clinical research methods (e.g., eye tracking and EEG data acquisition)

Eligibility

We are seeking applications from physicians with at least 3 years of specialty training in any of the following areas:

• child and adolescent psychiatry
• general adult psychiatry
• other recognized subspecialties outside Canada (e.g., psychiatry of intellectual disability)
• paediatrics with a strong interest in neurodisability

Expected start date in September 2023

How to apply

Please email your cover letter and CV (including 1–2 recent references) to jacob.vorstman@sickkids.ca and louise.gallagher@sickkids.ca by March 25, 2023.

Learn more about the fellowship by reading the information sheet.

Download the Clinical Research Fellowship Information Sheet

This clinical research fellowship opportunity provides fellows with advanced training in Tourette syndrome (TS) and other tic disorders at the Tics and Tourette Clinic, a provincial clinic within the Department of Psychiatry at The Hospital for Sick Children (SickKids).

The goal of the fellowship will be to gain expertise in TS and tic disorders, working within the multidisciplinary stepped care model of the clinic by collaborating with colleagues in psychiatry, psychology and neurology.

Read the full description of the clinical research fellowship in Tics and Tourette Syndrome (PDF).

Duration

One year, with an optional second year following successful completion of the first year

Start date

Fellowship training should start on July 1 annually, if possible, to align with the new academic year.

Alternative start dates may be negotiated in consultation with the fellowship supervisor, Dr. Elia Abi-Jaoude, and the Psychiatry Fellowship Program (psych.fellows@utoronto.ca)

Stipend availability

Candidates selected for the CAP Fellowship at SickKids will receive a first-year fellowship stipend of C$92,767.48 per annum, comprised of available clinical program funds as well as fellow-sourced external funding if applicable.

Candidates are encouraged to explore external sources of funding towards their prospective training stipend and the SickKids Fellowship Office will work with selected candidates to ensure that they receive the full stipend amount listed above.

Sponsored candidates from the following countries whose governments have official postgraduate medical training agreements with the University of Toronto are eligible to apply:

• Bahrain
• Kuwait
• Oman
• Qatar
• United Arab Emirates
• Saudi Arabia

See Psychiatry Fellowship Program’s website for more information

How to apply

Candidates must review the University of Toronto Psychiatry Fellowship Program’s application requirements before starting an application. Internationally trained applicants will be asked to provide English proficiency results at the time of application.

Interested candidates must submit the following documents as part of their application:

• Updated CV
• Copies of their MD
• Copies of their certificate in psychiatry and/or child and adolescent psychiatry (or a letter of good standing, indiciated their anticipated graduation date)
• Letter of intent (detailing their interest in this opportunity and how it aligns with their career goals)
• Contact information for three references, one of whom should be their residency program director (references must be received before the end of the application period)

The recommended application period for a July 1, 2025 start date is June 1 to Sept. 1, 2024.

Applications for entry in the 2025–2026 year (July 1 academic session) will be accepted between Oct. 1 and Nov. 30, 2024 on the Psychiatry Fellowship Program’s application platform.

Contact

For any questions, contact Ashley Allen at ashley.allen@sickkids.ca