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Child Assessment Unit (CAU)
- Child Inpatient, Cambridge Hospital Campus
(30 hours/week for 10 weeks)
Adoelscent Assessment Unit (AAU)
- Adolescent Inpatient, Cahill 3, Cambridge Hospital Campus
(30 hours/week for 10 weeks)
OUTPATIENT (Cambridge Hospital
Macht Building)
- Evaluation team
(3.5 hours/week for 10 weeks during the Elective Block)
- Psychotherapy
(individual, group and family, 3 hours/week for 52 weeks)
- Precepted psychopharmacology clinic
(2.5 hours/week for 52 weeks
PSYCHIATRIC EMERGENCY SERVICES
(PES)
- Emergency room, Cambridge Hospital Campus
(19 hours/week for 10 weeks)
- Community Service Agency
(Cambridge Youth Guidance, 5 hours/week for 10 weeks)
- Neuropsychological testing observation
(Cambridge Hospital, 3 hours/week for 10 weeks)
CONSULTATION/ LIAISON
- Inpatient consultation, Shriners' Hospital, Boston
(19 hours/week for 10 weeks)
- Outpatient consultation, MIT Pediatric Clinic, Cambridge
(4 hours/week for 10 weeks)
- Preschool consultation, Soldier's Field Park Children's Center,
Cambridge (2.5 hours/week for 10 weeks during the Elective Block)
- Consultation to State Agencies (Depts. of Mental Health and
Children and Families, various locations (3 hours/week for 10
weeks)
ELECTIVE AND SCHOLARLY ACTIVITY
- Independent clinical and scholarly activity time (site and hours
vary, 8 weeks)
- Developmental disorders, office of Karen Levine, PhD (2.5 hours/week
for 10 weeks)
- Preschool Children: Clinical Issues and Normal Development (1.5
hours/week for 8 weeks)
- Eating disorders, Cambridge Eating Disorder Center (11.5 hours/week
for 2 weeks)
I. INPATIENT
- Child Assessment Unit (CAU), Cambridge Campus - 10 weeks
This clinical experience gives fellows a chance to work with multidisciplinary
staff, gain experience negotiating outside systems such as the
Department of Children and Families, Department of Mental Health,
and the newly-developed services under the umbrella of the Children's
Behavioral Health Initiative. Fellows are offered opportunities
to develop assessment and treatment skills with oversight and
supervision, both in a "split-treatment" model and as
the primary provider. The Cambridge Hospital CAU opened in 1989
and houses 13 acute inpatient beds. Patients range in age from
2 to 13; approximately 30% are from Cambridge and Somerville,
while 70% are drawn from a wider geographic area. The patients
represent a diverse ethnic and cultural mix and present with a
wide range of diagnostic problems, including post-traumatic, mood,
psychotic, and developmental disorders. Clinical focus is on accurate
diagnostic assessment, including individual and family evaluations,
and broad-based treatment, including psychopharmacology, family
work and milieu therapy. The unit has been involved in a major
research project with Ross Greene, PhD, using his Collaborative
Problem Solving approach to manage aggressive behavior and eliminate
the use of restraint and seclusion. The unit has also has developed
a family-centered model of care.
Educational activities include: Weekly interview and case formulations
conference; weekly family therapy case conference; clinical
and psychopharmacology supervision from faculty; weekly supervision
with an onsite supervisor; and informal supervision as needed.
Teaching opportunities include supervising medical students,
adult psychiatry and pediatric residents.
- Adolescent Assessment Unit (AAU), Cahill 3, Cambridge Campus
- 10 weeks. The rotation provides a rich and diverse clinical
experience and a chance to work with multidisciplinary staff in
a team format, both as primary provider on the case and as the
medication consultant. Fellows gain experience negotiating outside
systems and presenting evaluations in teams and to outside providers
in systems meetings.
This unit has 14 inpatient beds. The population ranges in age
from 12 to 19, with approximately 50% of patients from the local
Cambridge/Somerville area and 50% from further away. The patients
represent a diverse ethnic and cultural mix. We have access
to many kinds of translators including ASL for deaf patients.
Like the CAU, this unit serves a wide range of adolescents with
diagnoses including, but not limited to: PTSD, ADHD, mood disorders,
psychotic disorders, substance abuse, and disruptive disorders.
Systems work involves school and program (residential) consultation.
Faculty on both inpatient units include child and adolescent
psychiatrists, social workers, psychologists, nurse managers,
staff nurses, and milieu counselors. Faculty members are experienced
in assessment, psychotherapy, play therapy, behavior modification,
psychopharmacology, substance abuse, and family therapy.
Educational activities include: Weekly interview and case formulations
conference; weekly family therapy case conference; clinical
and psychopharmacology supervision from faculty; weekly supervision
with an onsite supervisor; and informal supervision as needed.
Teaching opportunities include: Supervising medical students,
adult psychiatrists and pediatric residents.
II. OUTPATIENT
The CHA Child and Adolescent Outpatient Service is located
at the Macht Building and provides evaluation and treatment to children
from ages 3 to 18, approximately 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 conduct
disorders, depression, Post-Traumatic Stress Disorder, Oppositional
Defiant Disorder, Attention Deficit Hyperactivity Disorder, and
adjustment disorders. 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 13,600 visits
per year. Among the components of the service are a psychotherapy
clinic, a psychopharmacology clinic, and a small clinic for deaf
and hard-of-hearing children.
In addition to the Macht outpatient service, children and adolescents
are seen by our staff at local schools and in neighborhood health
centers. Fellows have an opportunity to view this experience first-hand
during the Community Service Agency rotation during the PES block.
The educational experience on the outpatient service includes:
- Team Evaluation Clinic. First-year fellows spend 10 weeks
during their Elective rotation and second-year fellows spend 26
weeks attending a weekly 3- hour Evaluation Team meeting. The
team is multidisciplinary and provides initial assessments to
patients new to the clinic. This setting provides an opportunity
for fellows to watch senior faculty interview patients; to be
observed interviewing patients; and to work together in a team
setting to think through diagnostic formulations and treatment
plans.
- Outpatient Clinic. Fellows spend their time learning
and providing psychotherapy and psychopharmacology to diverse
populations. The essential experience includes family work, individual
psychodynamic psychotherapy, supportive and cognitive/behavioral
interventions, consultation with community agencies and schools,
and general clinical case management.
First year fellows carry three therapy hours a week primarily for
psychotherapy but also for evaluations, family work, and case management.
First-year fellows receive a minimum of 2 hours of weekly outpatient
supervision.
- Precepted Psychopharmacology Clinic. The 2.5-hour psychopharmacology
clinic is devoted to the medication management of patients in
a split treatment model. It is precepted by an attending child
psychiatrist who is available to help fellows with diagnostic
interviewing and treatment planning, to answer any questions the
trainee may have, and to guide fellows' self-directed learning
about evidence-based treatments in clinical practice. Preceptors
provide feedback on interviewing skills and documentation. Current
preceptors are Sandra DeJong, MD, Michele Deneys, MD, and Susan
Walker, MD.
III.
PSYCHIATRIC EMERGENCY SERVICE
The CHA's Psychiatric Emergency Service is the entry point
for all acute psychiatric services, and also provides evaluation,
urgent treatment, and community outreach to children, adolescents,
adults, and families. Patients are children and adolescents aged
18 and under. Adolescents outnumber latency age children, with an
equal number of male and female patients.
Evaluations/assessments are directed at determining patient needs
for acute stabilization and appropriate/least restrictive level
of care. Fellows spend 19 hours a week for 10 weeks on this rotation.
Cases in this rotation are supervised by a child and adolescent
attending psychiatrist who interacts with the Medical Director and
Staff Psychologists, social workers and other experienced clinicians
in Emergency Services. Faculty supervision is available for each
case seen.
Christine Wittmann, MD, is the rotation supervisor for the PES
rotation.
The Community Service Agency (CSA) rotation at The Cambridge
Youth Guidance Center introduces fellows to working in a community
mental health center. The CSA rotation aims to introduce residents
to the Massachusetts' Child Behavioral Health Initiative (CBHI),
a statewide reform of public child mental health care. Residents
participate in evaluating children and families, and developing
a comprehensive treatment plan using the concept of wraparound services.
Becoming more familiar with community-based resources, working within
a multidisciplinary treatment team, and acting as a psychiatric
consultant in a community setting are also critical goals of this
rotation. Rotation Supervisor is Carol Murphy, LICSW.
- Neuropsychology. During the PES block, fellows spend
one morning a week learning about neuropsychological testing of
children with Laura Gaugh, PhD. They observe her perform neuropsychological
testing with children and adolescents and participate in the feedback
sessions with families.
IV. CONSULTATION/LIAISON
- Inpatient C/L. Shriners Hospital for Children in Boston
is an international referral center for burn injuries and a major
center of research on burn injuries in children and adolescents.
The patient population commonly includes neglected or abused children,
and children of parents with PTSD, depression, or alcoholism.
Many children and families have survived near-death experiences
due to burns or have grieved the loss of a loved one. Children
from all over Latin America, Asia, Europe, the U.S., and Canada
travel to this center for treatment. The center provides opportunities
for child and adolescent psychiatric research. In addition, it
offers the opportunity for training in acute or postoperative
pain management problems.
Fellows spend approximately 19 hours a week over a 10-week
period at Shriners performing clinical consultations, attending
a teaching conference, and receiving supervision. All fellows
have individual, once weekly supervision with Dr. Frederick
Stoddard, with additional supervision provided by Drs. David
Chedekel and Atilla Ceranoglu.
- Outpatient C/L. The outpatient pediatric clinic at the
Massachusetts Institute of Technology (MIT) Health Services provides
pediatric care to the children of students, faculty and general
employees at the Institute. Fellows spend one afternoon (4 hours)
a week for 10 weeks seeing children and families referred by their
MIT pediatrician for a variety of psychiatric concerns. Fellows
have an opportunity to learn about the consultative frame in general
and consultation to pediatricians in particular, and to pick up
one case for outpatient follow-up at their Cambridge Hospital
clinic. The rotation supervisor is Dr. Sherry Bauman.
- Preschool Consultation. The Soldiers Field Park Children's
Center in Cambridge is attended by 73 healthy children ranging
in age from 2 months to 5 years. They are primarily children of
Harvard University faculty and staff. The children are divided
into seven classrooms, each of which is designed to meet the developmental
needs of its assigned group. This consultation is supervised by
a child psychiatrist, Jeanne Heiple, MD, PhD.
Fellows spend 2 hours a week for 10 weeks on this rotation.
The experience allows the fellows to observe "normal"
preschool children in groups. In addition, it provides an opportunity
to act as a consultant in a preschool setting and to consider
the issues involved in acting as a consultant. Fellows spend
one hour weekly in observation of one of two preschool toddler
or infant classrooms and one hour weekly consulting with teachers
and the center director.
During this rotation, the fellow functions as a consultant
without any direct clinical responsibility. In addition, fellows
provide a 1-hour in-service teaching session to staff at some
point during the rotation.
- Systems Consultation to State Agencies. The MA Department
of Mental Health (DMH) is a state agency that sets the standards
for the operation of mental health facilities and community residential
programs and provides clinical, rehabilitative, and supportive
services for adults and children with serious mental illness or
serious emotional disturbances. The Department for Children and
Families (DCF) is the child welfare agency in Massachusetts.
During this 10-week rotation, first year child psychiatry Fellows
will spend 3 hours a week accompanying the faculty during weekly
consultations to DMH and DCF at various sites within our catchment
area.
Fellows will be supervised by Dr. Nandini Talwar, a child and
adolescent psychiatrist who has extensive experience working
with state and community agencies. During the consultation,
the trainees will hear about complicated cases presented by
DCF case managers and supervisors. Trainees learn about services
and opportunities provided by state agencies, criteria for eligibility
for services from state agencies, the process of investigation
and assessment for allegations of abuse and neglect, as well
as the various dilemmas and limitations faced by agencies when
working with families and clients. Fellows will also participate
in a once a month meeting with the group of Massachusetts DMH
child and adolescent psychiatrists to discuss a variety of topics
including high risk and complicated cases, changes and trends
in the mental health system in MA, and other important issues
related to public mental health care for children. In addition,
the fellows will participate in a once a month Interagency Meeting
with representation from DMH, DCF, DDS (Department of Developmental
Services, formerly known as Department of Mental Retardation),
DYS (Department of Youth Services), Department of Education
and the Department of Public Health. This meeting will serve
to provide updates about services and changes in each of the
participating state agencies as well as a forum for consultation
to high-risk and underserved families who are in need of services
from more than one agency.
V. ELECTIVE/SCHOLARLY ACTIVITY
- Independent clinical/scholarly activity. This rotation
provides 10-15 hours per week for 10 weeks of undesignated time
so that fellows can pursue clinical or scholarly activities in
their own particular area of interest(s).
- Eating Disorders. The Cambridge Eating Disorders Clinic
(CEDC) is an intensive outpatient and residential treatment
center for adolescents with a variety of eating disorders. Treatment
consists primarily of group therapy. The clinic is run by Seda
Ebrahimi, PhD, and a staff of clinicians specially trained in
eating disorders.
Fellows spend 11.5 hours over 2 weeks working on an adolescent
partial hospitalization unit as well as an adolescent residential
program. The rotation includes doing assessments, working with
individual patients and participating in groups. Marc Libman,
MD, is the rotation supervisor.
- Developmental Disorders/Mental Retardation. Fellows spend
approximately 2.5 hours a week for 10 weeks during the Elective
rotation observing evaluations at the office of Dr. Karen Levine,
a developmental neuropsychologist, in Lexington. The experience
gives fellows exposure to a range of developmental disorders,
with or without mental retardation, and to various systems of
care for these children and adolescents.
- Preschool Children: Clinical Issues and Normal Development.
Fellows spend one morning a week with child psychiatrist Margaret
"Polly" Gean, MD, doing consultations with preschoolers
and their families. Fellows deepen their understanding of normal
development at this stage of life, and learn to distinguish it
from clinical pathology.
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