Content Overview of the Cambridge Health Alliance Child and Adolescent Psychiatry Training Program: SECOND YEAR
- Evaluation team (3.5 hours/week for 26 weeks), Cambridge Hospital
- Psychotherapy (individual, group and family, 7.5 hours/week for 52 weeks), Cambridge Hospital
- Precepted psychopharmacology clinic (4.5-5 hours/week for 52 weeks), Cambridge Hospital
- School consultation, Cambridge/Somerville public schools (3 hours/week for 40 weeks)
- Forensic consultation, Middlesex Probate/Family Court and Middlesex Juvenile Court Clinic, Cambridge (4 hours/week for 26 weeks)
- Neurological evaluation, Lurie Center for Autism in Lexington, MA (4 hours/week for 10 weeks)
- Independent Clinical/Scholarly Activity Time (7 hours/week for 52 weeks)
ROTATIONS: SECOND YEAR
The CHA Child and Adolescent Outpatient Service provides evaluation and treatment to children from ages 3 to 18, 60% of whom are male and 40% of whom are female. Half the children are 12 or under, half are 13 or older.
These children are most commonly diagnosed with attention-deficit/hyperactivity disorder, adjustment disorders, depressive disorders, post-traumatic stress disorder, anxiety disorders, and oppositional defiant disorder. School behavioral problems, learning disabilities, physical or sexual abuse, and family disorganization are frequently part of the clinical picture. The cultural and ethnic mix of patients includes Latino, Haitian, and Portuguese.
The Child Ambulatory Service handles approximately 10,466 visits per year. Among the components of the service are a psychotherapy clinic, a psychopharmacology clinic, and a unique clinic for deaf and hard-of-hearing children. In addition, services are provided within both school-based health clinics and neighborhood health centers.
Team Evaluation Clinic
Second-year fellows spend 3.5 hours weekly for 26 weeks as senior members of the Evaluation Team providing outpatient evaluations. The clinic provides an opportunity for fellows to consolidate their skills in diagnostic interviewing, treatment planning, and working within a team setting. It also provides increased opportunity for fellows to teach and mentor first-year fellows, general psychiatry residents, and medical students.
Outpatient Psychotherapy Clinic
Second-year fellows continue their work in evaluating and treating children and families. The emphasis is on a flexible approach and increasing fellows’ breadth and depth of treatment modalities. The fellows are expected to have a minimum of eight clinical hours of outpatient psychotherapy, including co-leading a weekly outpatient group. Second-year fellows have 3-4 hours of weekly outpatient supervision. This includes 2 hours of individual supervision for psychotherapy in addition to group CBT supervision, group supervision for groups, and group supervision for school consultation.
Precepted Psychopharmacology Clinic
Second-year fellows spend approximately 4.5-5 hours a week over 2 afternoons all year long performing psychopharmacology evaluations and medication management in a split-treatment model. Fellows are primarily assigned either to the Outpatient Department at CHA or to both CHA OPD and a CHA-affiliated site in the community. Currently the community sites are Cambridge Youth Guidance Center, where the rotation is precepted by Dr. Tyrone Williams
, and the Anna May Powers community clinic in Everett, precepted by Dr. Deborah Kulick
. Dr. Debra Rosenblum
and Dr. Nick Carson
are the CHA OPD clinic preceptors. Preceptors provide feedback on interviewing skills and documentation. Time each week is devoted to supervision of cases and didactics focusing on the review of seminal articles in pediatric psychopharmacology.
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II. School Consultation
The Cambridge and Somerville Public School systems serve a diverse ethnic and socioeconomic community from kindergarten through grade 12. Child psychiatry fellows spend three hours per week for 9 months in consultation to a diverse cultural public student population.
Fellows either chose to work in an elementary/middle school (kindergarten through eighth grade) or high school according to their interest, exposure to different age groups and availability of placement. The elementary school age group is from five years old to fourteen years old and the high school population is from fourteen years old to eighteen years old. The school population is a highly culturally diverse population representing a broad range of socioeconomic backgrounds from Cambridge communities.
Fellows participate on a “Teacher Assistant Team” one hour per week. This is a multidisciplinary team where strategies are generated to support students who are struggling and is an effort also to reduce referral of students to special education. Fellows also provide one hour a week of consultation to the staff that work with the “wrap around” classrooms in their school. The students in the separate “wrap around” classroom have “severe emotional disturbances” (bipolar, PTSD or ADHD for example) and often have learning disorders. They will often run a psychotherapy group with a school psychologist that are either adjustment groups or provide practical social skills to students. Once a year they do an extensive evaluation of a student under close supervision by request of the Office of Special Education. These assessments often clarify diagnosis and help with understanding the treatment obstacles and how to manage a particularly challenging student.
This rotation is supervised by Nancy Rappaport, MD
, Director of School Programs.
III. Forensic Consultation
Probate and Family Court: The Family Service Clinic
is a department of the Middlesex Probate and Family Court. It has offices in Cambridge. The clinic staff performs comprehensive evaluations of families following parental separation in which custody and visitation of minor children are disputed issues. These evaluations focus on the needs, interests, and welfare of the child in the context of parental conflict. Children evaluated range in age from under one year to 18 and come from diverse socioeconomic and ethnic backgrounds. The rotation supervisors are Barbara Hauser, LICSW
and John Baker, Ph.D
Educational activities include:
Introduction to the Probate and Family Court, including observation of court proceedings and the provision of testimony during these proceedings; Multiple diagnostic interview sessions with the referred children and their parents; review of collateral documents; and completion of a comprehensive report for the court, concluding with recommendations.
Juvenile Court: Adolescent Consultation Services (ACS)
is a private non-profit agency, which operates the Juvenile Court Clinics for the Middlesex County Juvenile Courts. ACS offices are located in the Juvenile Court in Cambridge. Upon order of the Judge, Juvenile Court Clinic staff conduct comprehensive diagnostic evaluations of youth and families involved in the court. The rotation supervisor is Rebecca Pries, CAGS, LMHC
Educational activities include:
Multiple diagnostic interview sessions with the entire family and the referred youth; review of collateral documents; completion of comprehensive forensic report (Delinquency, Child in Need of Services, or Care and Protection case) for the court, including a dynamic formulation and realistic recommendations. Introduction to the juvenile court setting and staff including judges and probation officers includes observation of juvenile court and the opportunity to give testimony.
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IV. PEDIATRIC NEUROLOGY
The Fellows spend one morning a week for 10 weeks at the Lurie Center in Lexington, MA. They learn to take a pediatric and neurological history with a particular emphasis on birth and early development. School histories are also detailed. Areas addressed include the subtleties of abnormalities in processing and modulating sensory input (auditory, visual, and tactile), difficulties in perception and/or medical conditions which could potentially be confused or mistaken for psychiatric or behavioral disorders. Fellows review and perform a neurological evaluation, including cranial nerves, motor (fine motor, gross motor, and balance), and sensory and mental status assessments. Fellows are taught and expected to dictate a complete report on the patients they have evaluated which are then reviewed by the supervising neurologists, Dr. Margaret Bauman
and Dr. Ann Neumeyer
V. INDEPENDENT CLINICAL/SCHOLARLY ACTIVITY
Fellows have approximately one day a week in the second year to pursue clinical activities according to their particular interests, and to complete a scholarly project. Fellows are expected to either create an elective proposal, or choose from a variety of electives currently offered by our faculty. Either of these options will require the fellow to choose a mentor or supervisor to work with during the elective. In addition, fellows complete a scholarly project by the end of the second year. The elective may or may not pertain to the same material as the scholarly project. In the past, fellows have chosen a wide range of projects, including a making video about toddler and preschool development, conducting a pilot research project on pharmacological treatment of weight gain in adolescents on neuroleptics, and developing a school-based curriculum on cyber-bullying.
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