• Affiliated With

    • Beth Israel Deaconess Medical Center
    • MassGeneral Hospital for Children
    • Harvard Medical School Teaching Hospital

2nd Year Rotations

Content Overview of the Cambridge Health Alliance Child and Adolescent Psychiatry Training Program: Second Year

I. Outpatient Clinics

  • Outpatient Psychotherapy Clinic (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 and The Guidance Center
  • Urgent Evaluation Services (as needed, estimated 2 hours/month)

II. Consultation/Liaison

  • School consultation, Cambridge/Somerville public schools (3 hours/week for 40 weeks)
  • Forensic consultation, Middlesex Probate/ Family Court Clinic and Adolescent Consultation Services to the Middlesex Juvenile Court Clinic, Cambridge (4 hours/week for 26 weeks)

III. Elective/Scholarly Activity

  • Independent Clinical/Scholarly Activity Time (8 hours/week for 52 weeks)

Rotations: Second Year

I. Outpatient Clinics
The CHA Child and Adolescent Outpatient Service provides evaluation and treatment to children from ages three to 18, 60 percent of whom are male and 40 percent of whom are female. The clinic population is evenly split between children who are 12 or under, and half of whom are 13 or older. These children are most commonly diagnosed with attention-deficit/hyperactivity disorder, adjustment disorders, depressive disorders, posttraumatic stress disorder, anxiety disorders and oppositional defiant disorder. The clinic also treats youth with autism spectrum disorders, bipolar disorder, psychotic disorders and substance use disorders. School behavioral problems, learning disabilities, physical or sexual abuse and family disorganization are frequently part of the clinical picture. The cultural mix of patients includes Latino, Haitian and Portuguese, as well as a variety of other ethnicities.

The Child Ambulatory Service provides approximately ten thousand visits per year. Clinical services available at the Macht building on our main campus include a psychotherapy clinic, a psychopharmacology clinic, a neuropsychological and developmental testing program, a clinic for deaf and hard-of-hearing children, a family therapy clinic and a group therapy program.

In addition to the Macht outpatient service, children and adolescents are seen by our staff at local school-based health centers, at CHA community pediatrics and family medicine clinics in both co-located and integrated primary care models and at regional residential treatment and educational facilities. CHA providers also consult to the Cambridge Police Department (Safety Net Program) and to Cambridge preschool and daycare centers (Early Years Program).

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 each 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, at least one family therapy case, and at least one CBT case. Second-year fellows have 3-4 hours of weekly outpatient supervision. This includes 2 hours of individual supervision for psychotherapy in addition to family therapy supervision, group therapy supervision, and group CBT supervision.

Precepted Psychopharmacology Clinic
Second-year fellows spend approximately 4.5- 5 hours a week over two 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. Dr. Debra Rosenblum and Dr. Nicholas Carson are the CHA OPD clinic preceptors. Currently, the community site is The Guidance Center, where the rotation is precepted by their Medical Director, Dr. Tyrone Williams. Preceptors provide feedback on interviewing skills, treatment planning, coordination of care, coding and documentation. Time each week is devoted to supervision of cases and didactics focusing on the review of seminal articles in pediatric psychopharmacology.

Urgent Evaluation Service
Second-year fellows will spend approximately five months performing clinical assessments of youth who have been referred to the Macht Outpatient Clinic due to acute mental health problems that fall short of requiring an emergency room evaluation but are concerning for potential significant decline prior to a regular outpatient evaluation. Such referrals are seen within one week of referral. These evaluations are supervised by Sandra DeJong, MD, MSc. 

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II. Consultation/Liaison
The Cambridge Public School system serves a diverse ethnic and socioeconomic community from kindergarten through grade 12. Child psychiatry fellows spend three hours per week for nine months in consultation to a diverse cultural public student population.

Fellows either choose 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 school population is a highly culturally diverse population representing a broad range of socioeconomic backgrounds from Cambridge communities.

Fellows complete up to three evaluations of students with safety and/or mental health concerns (e.g. aggressive behavior) under close supervision. These assessments often clarify the diagnosis and help with understanding the treatment obstacles and how to manage a particularly challenging student.

This rotation is supervised by James Barrett, PhD, Director of School-Based Mental Health Programs for the Cambridge Health Alliance.

Forensic Consultation
Probate and Family Court: The Family Service Clinic is a department of the Middlesex Probate and Family Court, with 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 Mathilde Pelaprat, PsyD.

Educational activities include multiple diagnostic interview sessions with the entire family and the referred youth, review of collateral documents, completion of the comprehensive forensic report (Delinquency, Child Requiring Assistance, 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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III. Elective/Scholarly Activity

Independent Clinical/Scholarly Activity
Fellows have the equivalent of 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 making a 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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