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Child and Adolescent Psychiatry Fellow Rotations (Year 1)

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 2nd 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 2nd 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.

Sample First Year Rotation Schedule

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

* 2nd 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

* 2nd 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

* 2nd 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

 

 

Child and Adolescent Psychiatry Fellow Rotations (Year 2)

Intensive Community Based Acute Treatment (ICBAT/CBAT)

The YOU, Inc. Wetzel center is an acute residential treatment setting that is dedicated to latency age children.  Fellows will integrate into the multi-disciplinary team and provide psychiatric care for youth aged 5-12 under the supervision of the medical director, Dr. Allison Beckler.  The Wetzel Center rotation will focus on pharmacologic and behavioral management of these youth and the fellow will carry their own caseload of 4 patients.  The fellows will be leading the multidisciplinary team in formulating a treatment plan involving the family and systems of care in Central MA.

Addictions Block/Group Therapy – Motivating Youth Recovery (MYR)

CAP fellows will work at MYR which is one of only two residential substance abuse programs in the state that support adolescents with substance use disorders.  It is a 24-bed acute detox and treatment center that provides comprehensive assessment, diagnosis, and treatment with after care planning utilizing a multidisciplinary team.  Responsibilities include delivering psychiatric care for patients under the supervision of Dr. Abita Raj and facilitation of group psychotherapy involving patients/families with their multidisciplinary staff.

Mood and Psychosis Clinic

This is a subspecialty clinic within the CANDO clinic that focuses on multisystem involved youth with complex mood and/or psychotic disorders.  Supervised by our division chief, Dr. Yael Dvir, fellows will have the opportunity to participate and eventually lead consultations for these youth.  These evaluations take place over the course of two weeks with 2-hour sessions each week to allow for review of records, obtaining collateral information from current and past providers, and examining the youth with their families/guardians.

Neurodevelopmental Disorders Clinic (NDCC)

The NDCC is another sub specialty clinic offered through CANDO.  Fellows will consolidate knowledge of developmental disabilities in children and adolescents and participate in a multi-disciplinary team assessment that includes psychiatry, occupational therapy, and speech and language pathology over the course of 2 visits.  An initial visit consists of an extensive multidisciplinary examination followed by collection of collateral from relevant providers, PCPs, schools, and community service agencies to generate a comprehensive treatment plan that is provided in a face to face visit at the subsequent visit followed by a written report.  Fellows will participate in multiple assessments over a 4-month period and gain experience in performing these complex consultations and authoring these comprehensive treatment plans.

CANDO Bridging Clinic

This clinic is designed to provide short term stabilization and treatment for youth that have previously had consultations completed either through MCPAP or our Child Psychiatry Consult/Liaison Service.  Fellows will have their own panel of patients and provide psychopharmacologic treatment and management under the supervision of Dr. David Cochran with plan to transfer care back to the primary care provider or a psychiatrist in the community after 4 visits.

Juvenile Justice Residential Unit

Fellows will work alongside Dr. Matt Lahaie who has a J.D. in addition to being trained as an adult and child psychiatrist.  They will develop knowledge of the criminal court systems, the range of dispositions offered, court commitments, and the probation services.  CAP trainees will integrate into a multidisciplinary team which consists of social workers, medical providers, corrections officers, and psychiatry and will have increasing responsibility in psychiatric management throughout the rotation.

Adolescent Medicine Integrated Care

The Adolescent Medicine clinic is a combination of primary care and subspecialty practice that includes primary care providers, Ob-Gyn, and behavioral health.  Patients are referred for complex medical and behavioral issues that include eating disorders, substance use, PTSD, and multi-system involvement.  Fellows will work alongside these providers providing consultation and short-term stabilization with indirect supervision from Dr. Brian Skehan.  They will gain experience in managing these youth in an integrated care setting as well as systems-based practice supervision for this model.

School Rotation

Led by Dr. Kimberlee Kusiak, fellows will have the opportunity to work in two different school districts in the region, advising educators and support staff about trauma focused support for students struggling in the educational setting.  The rotation will include visits to the Assabet Valley Collaborative School which serves as a regional school for youth that struggle in traditional academic settings.  This program utilizes DBT and Positive Based Incentive Support (PBIS) to help youth reach their potential.