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OUTPATIENT CLINIC
- Evaluation team (3.5 hours/week for 26 weeks), Cambridge Hospital
Campus
- Psychotherapy (individual, group and family, 10 hours/week for
52 weeks), Cambridge Hospital Campus
- Precepted psychopharmacology clinic
(3 hours/week for 52 weeks), Cambridge Hospital Campus
CONSULTATION/LIAISON
- 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)
FORENSIC CONSULTATION
PEDIATRIC NEUROLOGY
- Neurological evaluation, LADDERS, Lexington, MA
(4 hours/week for 10 weeks)
ELECTIVE/SCHOLARLY ACTIVITY
- Independent Clinical/Scholarly Activity Time
(1 day/week for 52 weeks)
I. OUTPATIENT CLINIC
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 conduct disorders,
Depression, Post-Traumatic Stress Disorder, Oppositional Defiant
Disorder, Attention Deficit 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 8,500 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, services are provided
within both school and neighborhood health centers.
Team Evaluation Clinic. Second-year fellows spend 3 1/2
hours weekly for 20 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 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. As in the first
year, second-year fellows spend approximately 3 hours a week all
year in a clinic for patients seeking psychopharmacology evaluations
and medication management. Dr. Debra Rosenblum and Dr. Nick Carson
are the clinic preceptors, and are available to see patients,
answer any questions, and discuss cases with the fellows.
Preceptors provide feedback on interviewing skills and documentation.
II. CONSULTATION/LIAISON1
The Cambridge and Somerville Public School systems serve
a diverse ethnic and socioeconomic community from kindergarten through
grade 12. Elementary to high school students, faculty, and families
are offered the benefit of psychiatric input from consultations
geared to support and enhance academic performance. This rotation
provides a unique opportunity for the child psychiatry fellows to
spend three hours per week for 9 months in consultation to a diverse
ethnic and cultural public student population.
Fellows consult at either an elementary school or high school location.
Their rotation consists of exposure to a variety of educational
experiences, potentially including: individual education meetings
for students receiving special education services; meeting on a
weekly basis with the teacher assistance team; co-leading a group
with school personnel; providing safety evaluations to the school
system; and providing consultation to the school administration.
The fellows will become more familiar with the barriers to learning
and how to translate psychiatric concepts into useful concrete strategies
for teachers.
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 located one mile from the Cambridge Hospital campus. 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
supervisor is Rebecca Pries, CAGS, LMHC.
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.
Educational activities include: Multiple diagnostic interview
sessions with the entire family and the referred youth;
Review of collateral documents; Completion of comprehensive report
(delinquency, Child in Need of Services, or Care and Protection
case) for the court, concluding with realistic recommendations;
introduction to the juvenile court setting and staff including
judges and probation officers; observation of juvenile court;
and, opportunity to give testimony.
The rotation supervisor is Barbara Hauser, LICSW.
IV. PEDIATRIC NEUROLOGY
Fellows spend one morning a week for 10 weeks at the Learning and
Developmental Disorder Evaluation and Referral Service (LADDERS)
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, tactile), and difficulties in perception
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,
balance), sensory, and mental status assessments. Pencil and paper
tasks include reading, writing, spelling, and math. 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 put
together an elective proposal and identify a mentor for their elective
time and scholarly project. 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
of treatment for weight gain in adolescents on neuroleptics, and
developing a school-based curriculum on cyberbullying. Projects
are due by June 1st.
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