The Infant, Child and Adolescent Psychiatry Fellowship, headed by Dr. Martin J. Drell, began in 1987. The Division was envisioned and remains “public sector” oriented, and has been continuously associated with the State of Louisiana Office of Behavioral Health (formally the Office of Mental Health) via a number of public/academic initiatives. The Division was conceptualized with the systemic, developmentally oriented biopsychosocial model of Dr. George Engel in mind, and strives to deliver the best in evidence based and evidence informed care to the citizens it serves. Its faculty is multidisciplinary, which allows for a diversity of approaches and skills, especially in the areas of inpatient care, infant psychiatry, autism spectrum disorders, foster care, pediatric psychopharmacology and responses to violence. It has evolved with the times and has weathered unique circumstances, such as Hurricane Katrina and the BP oil spill. It has remained resilient and viable throughout. The fellowship is now adapting to the increasing pace of change under the Affordable Healthcare Act and Managed Care.