First Year Rotations

Worcester Recovery Center and Hospital – Continuing Care Units

The WRCH opened in 2012 and the two inpatient adolescent CCU’s provide inpatient level of care to 60 adolescents. The CCUs serve as the highest level of care available to adolescents in the state. Fellows integrate into the multi-disciplinary teams and provide psychiatric care for adolescents aged 13-18 under the supervision of Dr. Boris Lorberg. The fellows carry a caseload of 3-4 adolescents focusing on pharmacologic and behavioral management. The fellows gain experience in formulating treatment plans involving the multi-disciplinary team members, family, and systems of care within the state of MA.

Pediatric Consultation-Liaison Service

CAP fellows work closely with the pediatric floor on medical and surgical patients with psychiatric illness under supervision from Dr. Brian Skehan. CAP fellows will evaluate medical and surgical patients for the presence of psychiatric illness by means of a developmentally based psychiatric interview. Residents will diagnose mental illnesses, as well as psychiatric symptoms due to medical conditions or adverse responses to medication. They will hone their ability to efficiently construct a sophisticated biopsychosocial formulation on a busy clinical service. They will develop short-term interventions and long-term treatment plans, including referrals to psychiatric services in the community when appropriate. They will develop proficiency in interviews of families and evaluating family issues, practice teaching parent-training skills, and develop knowledge of what collateral information is important to obtain in child psychiatry consultations. They also will gain experience in understanding the interplay between mental illness and various presenting medical conditions.

Child Behavior Clinic (Infant Psychiatry)

The fellows work closely under supervision of Dr. Wynne Morgan and Dr. Peter Metz seeing preschool aged children and their parents/caregivers. CAP fellows will gain competence in child psychiatric evaluation and formulation of emotional and behavioral disturbances of preschool children and in the use of short-term behavioral strategies in this population such as time-outs, sticker charts, and special time. The resident will gain knowledge in the use of rating scales (CBCL, TRF) in assessing young children. Lastly, residents gain competence in coordination of care with systems relevant to this population including pediatricians, schools, day-care providers, child protective services, etc. An average caseload for a resident in the clinic would be 1-2 cases at any given time. Supervision is provided on an immediate basis within the context of the clinic involving direct observation of play with the child (via a one-way mirror), parent interviews, and feedback by Dr. Metz and Dr. Morgan.

Families and Communities Together Consultation

The fellows work closely under supervision of Dr. Peter Metz providing consultation to the CBHI wrap-around service team to patients and their families, including the Intensive Care Coordinators, Family Partners, and therapeutic mentors. These complex cases provide ample opportunity to better understand the role of available community wrap-around services and the integral role they provide in supporting families and patients.

Pediatric Neurology

The fellows work closely with Dr. Brenda Wong, who has over 20 years of experience providing collaborative care within the DMD population, in the multi-disciplinary Duchenne Muscular Dystrophy clinic at UMass. The fellow gains experience with the comprehensive evaluations and examinations conducted in this clinic, understanding the importance of active coordination amongst various specialists, and the mental health issues that can present in this unique population. The fellows also spend time in the general pediatric neurology clinic with Dr. Patrick Mabray gaining experience with other common and complex outpatient neurological conditions. The fellows gain an understanding of specific neurodiagnostic tools, laboratory values, MRIs, and CTs in formulating a differential diagnosis and in reviewing the treatment options available.

Longitudinal Outpatient Psychopharmacology Clinic

The clinic will begin on the first Friday in July with orientation to the clinic and EMR. The fellow will acquire the skills to assess and diagnose patients in the outpatient setting, develop a biopsychosocial formulation, and initiate psychopharmacological treatments and/or make appropriate referrals for additional modalities of treatment. The minimum caseload is approximately 15-19 patients during a 5 hours per week period seeing psychopharmacology patients. The fellow will begin to accumulate cases with one new intake per week as the caseload develops. 90 minutes will be allotted for initial interviews, allowing for Dr. Rangsun Sitthichai to provide supervision as needed in the office. The remainder of clinic time will be used for follow-up visits and any additional supervision from Dr. Sitthichai or the 2^nd year fellows. The fellow will continue to develop skills in child and family assessment and learn to treat patients in a strength-based and culturally competent manner. The resident will maintain ongoing communication with the child’s primary care and other important providers. The fellows caseload will carry forward and continue into 2^nd year for a maximum allotted 2 year longitudinal experience.

Longitudinal Outpatient Psychotherapy Clinic

Fellows will develop skills in multiple modalities of psychotherapy with children and families including psychodynamic therapy/play therapy, cognitive behavioral therapy, and family therapy. A minimum of 2 patients a week from a combination of these three modalities should be selected or assigned. The fellow will meet with one supervisor for for approximately one hour per week, to review their clinic patients. The treatment should include medication management if it is indicated. The clinic is held at Community Healthlink Youth and Family Services and each fellow is responsible for setting, maintaining, and rescheduling appointments (with assistance from Beth Baldwin) as needed with their therapy patients during the half-day in the weekly schedule allotted for this clinic.

Pediatric Consultation-Liaison Block

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	C/L Service	C/L Service	C/L Service	Didactics	Administration Time*§‡
PM	C/L Service	Outpatient Therapy	C/L Service	C/L Service	Outpatient Psychopharm Clinic

* 2^nd Friday of each month Solution-Focused Therapy seminar with Dr. Anne Lutz

§ Mid July-early September Parent Management Training seminar led by Dr. Alisha Jaquith

‡ Late August through October Day Care seminar and experience with Dr. Ciottone

Community Psychiatry Block

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	DMH with Dr. Haynes	Families and Communities Together (FCT) consultation with Dr. Metz	Pedi Neuro	Didactics	Administration Time*§‡
PM	DMH with Dr. Haynes ¶	Outpatient Therapy	Pedi Neuro	Child Behavior Clinic with Dr. Metz and Dr. Morgan	Outpatient Psychopharm Clinic

¶ Will perform up to two separate, two-visit 90 minute consultations for the FCT teams/families

* 2^nd Friday of each month Solution-Focused Therapy seminar with Dr. Anne Lutz

§ Mid July-early September Parent Management Training seminar led by Dr. Alisha Jaquith

‡ Late August through October Day Care seminar and experience with Dr. Ciottone

Worcester Recovery Center and Hospital
(Adolescent Inpatient block)

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Worcester Recovery Center and Hospital Continuing Care Unit (WRCH-CCU)	WRCH-CCU	WRCH-CCU	Didactics	Administration Time*§‡
PM	WRCH-CCU	Outpatient Therapy	WRCH-CCU	WRCH-CCU	Outpatient Psychopharm Clinic

* 2^nd Friday of each month Solution-Focused Therapy seminar with Dr. Anne Lutz

§ Mid July-early September Parent Management Training seminar led by Dr. Alisha Jaquith

‡ Late August through October Day Care seminar and experience with Dr. Ciottone