The Training Program in Child and Adolescent Psychiatry
Cambridge Health Alliance and Its Mission
Since 1964, the Cambridge Hospital (now Cambridge Health Alliance, or CHA) has provided a model of innovative community-oriented healthcare in which trainees from all psychiatric disciplines have developed their skills. The CHA mission is to improve the health of the Massachusetts communities we serve. As a safety-net healthcare system, CHA has been on the cutting edge of healthcare reform, and has received national recognition for its innovative work. In 1988, the Victims of Violence Program at CHA received the Gold Award from the American Psychiatric Association for innovative hospital and community service. In 1993, CHA was honored with the Foster G. McGraw Prize for service to the community; in 2001, CHA received three Safety Net awards for Open Access Patient Scheduling, Domestic Violence Programming, and Cultural and Linguistic Competency. In 2001, the Robert Wood Johnson Foundation selected CHA as one of seven healthcare systems for a “Pursuing Perfection” grant to transform healthcare delivery. In 2003, CHA was again honored with APA’s Gold Award, this time for its innovative work in providing a restraint-free environment on its child inpatient psychiatric unit. In 2007, the National Association of Public Hospitals and Health Systems presented the Chair Award to CHA for its integrated medical student clerkship program. And in 2009, CHA was selected as a national best practice site for team development by the Commonwealth Fund Safety Net Medical Home transformation initiative.
As part of its 2015-16 strategic planning process, CHA is poised to become an Accountable Care Organization. This “medical home” model would involve CHA receiving global insurance payments from private, state and federal insurers in exchange for providing integrated care to a community of patients. To this end, CHA developed an affiliation with the Beth Israel Deaconess Care Organization (BIDCO) in 2014. The integrated care model for adult patients is underway, and the model for child/adolescent integrated care is being rolled out, with services already in place at several pediatric clinics. This model will enhance our ability to focus on preventative care and well as treatment, and offer earlier interventions for the children and families we serve.
CHA Training in Child Psychiatry
Training and education are key elements of CHA’s mission. The CHA child psychiatry fellowship training program has its roots in psychodynamic and psychoanalytic therapies, and public sector, multicultural community based care. While continuing to nurture this tradition, the program also trains fellows in other evidence-based treatment modalities in the service of a comprehensive biopsychosocial model. Our values include training highly ethical, independent and responsible physicians who will give excellent psychiatric care to children and families using an integrative approach to child psychiatry that fits the needs of individual patients and their families.
The training experience is designed to develop and strengthen fellows’ abilities to develop a biopsychosocial formulation and treatment plan, and implement appropriate and effective treatments. Fellows are taught to consider different modalities of treatment based upon the family’s preferences for services, the efficacy and cost-effectiveness of certain methods for particular disorders, the capacity of a child and family to engage in treatment, and the level of supporting evidence. The range of psychotherapy techniques taught includes: intensive psychodynamic individual psychotherapy, intensive family therapy, brief and focused individual and family therapies, psychopharmacology, supportive psychotherapy, cognitive behavioral psychotherapy, psycho-educational interventions, and group therapy (including dialectical behavior group therapy).
The two-year training program includes a combination of didactics, clinical rotations, and independent scholarly work. Currently, eight to ten hours a week are protected for didactic learning. Weekly seminars cover a variety of topics pertinent to our field, including psychotherapy, psychopharmacology, human development, and scholarly activities. Clinical rotations occur throughout both years. The first year is divided into five 10-week blocks in Adolescent, Inpatient, Child Inpatient, Psychiatric Emergency and Residential Consultation, Consultation-Liaison, (including both inpatient and outpatient consultation), and Elective. In addition, briefer rotations within each block focus on issues such as developmental disorders, pediatric neurology, preschool-age development and consultation, early intervention observation, wrap-around care, and consultation to state agencies. Also in the first year, trainees begin their longitudinal outpatient experience in both psychotherapy and psychopharmacology. Finally, the first year fellows rotate through an interdisciplinary outpatient diagnostic evaluation team to learn the skills needed to conduct outpatient assessments.
The second year is focused on seeing a diverse outpatient population for a full range of outpatient treatments. In addition, second-year fellows learn about forensics in probate/family and juvenile court clinic settings, and school consultation. Eight hours a week throughout the second year is available for elective time and scholarly activity. All second-year fellows complete a Clinical Scholarship Project. Fellows in both years participate in quality improvement initiatives and case presentations.
The Training Program in Child and Adolescent Psychiatry at Cambridge Health Alliance recruits five fellows per year. Interested applicants should submit an application via ERAS by October 15, 2016. Interviews will be offered in September through November. The match list is submitted in mid-December and match results announced in January for the following training year. We accept fellows only after their PGY-III year of training (or beyond) who have passed USMLE III, completed required Clinical Skills Examinations (CESs), and met all ACGME requirements for general psychiatry. Our program participates in the NRMP match for fellows in Child and Adolescent Psychiatry. We are an equal opportunity employer and training program and seek to recruit minority trainees and faculty members who will assist us in providing services to minority groups in our community.