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I. OUTPATIENT ROTATIONS
The CHA Child and Adolescent Ambulatory 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 3½ 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 six clinical hours of
outpatient psychotherapy, including co-leading a weekly outpatient
group. Second-year fellows have 3-4 hours of weekly outpatient supervision,
including both psychodynamic and cognitive-behavioral therapies.
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, is the
clinic preceptor, and is available to see patients, answer any questions,
and discuss cases with the fellows.
II. SCHOOL CONSULTATION
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 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, 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 Dr. Nancy Rappaport, Director
of School Programs.
III. FORENSICS 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 afternoon a week for 10 weeks at 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 neurologist, Dr. Margaret Bauman.
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. In the past, fellows have chosen a wide
range of projects, including a video presentation, preparing a paper
for publication, and putting together public education materials.
By June 1st of the second year, regardless of how elective time
is spent, all fellows are expected to turn in a scholarly project.
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