Infant-Preschool Clinic-Site-CAP 2

Rotation Director: Joan Luby MD

Other Faculty: Neha Navsaria PhD

Number of residents per rotation: Three

Length of Rotation: 9 months, one afternoon per week

Time of Rotation: Second year of training

Goal

To familiarize fellows with the comprehensive evaluation and follow up of earliest onset mental and behavioral problems.

Objectives

To develop competence in the following areas:

Patient Care

  • Differentiation of normative/at risk/disordered exams in infants, toddlers and preschoolers
  • Mental status examinations of infants- preschoolers
  • Detailed early developmental histories
  • Dyadic/relational approach to evaluation and care
  • Clinical observations with focus on aspects of parent-child relationship parameters
  • Diagnostic formulation of early onset emotional and behavioral problems
  • Careful weighing of risks and benefits of psychopharmacological interventions in the very young patient
  • Exposure to Parent Child Interaction Therapy and to Emotion Developmental treatment models

Medical Knowledge

The resident will gain medical knowledge through working in a clinical team and participating in a weekly pre-clinic multidisciplinary noon case conference

  • Presentations of clinic cases with relevant correlation to salient literature
  • Review of effective treatment strategies including psychopharmacological and psychotherapeutic approaches and strengths and limitations of approaches (combined or not combined with one another)

Interpersonal/Communication Skills

The resident will effectively communicate with patients, their families and all other members of the treatment team

  • Family interviews for the evaluation of infant-preschool age children
  • Developmentally appropriate interviews of very young children

Practice Based Learning

The fellow will develop competence in continuous learning and improvement through practice and related activities including, in the clinic setting, close supervision by an internationally known expert in infant-preschool psychiatry who leads a large interdisciplinary team

  • Review of evidence based literature
  • Observation of a role model who contributes significantly to the evidence based literature
  • Active case based learning in the clinic

Professionalism

The resident will demonstrate sensitivity and compassion to children and adolescents affected by psychopathology and to their families or their caretakers and will continue to develop in relationship with other professionals or professionals in training, including supervisors, colleagues, students and allied professionals.  In the clinic, major aspects of professional development will include:

  • Developing intra-professionally by managing adaptively their own emotional reactions to youth and families seen in the clinic
  • Responsibility for patient care as demonstrated by timely response or communication with families, attending(s), and other health professionals
  • Arranging for coverage during absences including illness or vacation
  • Acknowledgement and remediation of errors
  • Intra-professionalism: ability to understand and remedy factors which interfere with one’s proper professional conduct
  • Respect of patients, colleagues, supervisors, supervisees and staff regardless of background
  • Review of professional conduct of colleagues if appropriate
  • Leadership role increasing with training level (e.g., improvement in problem solving, providing resources and advice to others, becoming a role model)

System Based Care

  • Development of outpatient care skills including time management, clinic scheduling management, and communication with referral sources
  • Familiarity with outpatient billing procedures
  • Understanding of global system of care and where clinic care fits in it including appreciation of need to referral to other system of care vs. longitudinal monitoring of at risk youth if more adequate for patient care
  • Utilization of appropriate consultation and referral
  • Communication with referring providers and education of other providers within the system of care

Measurement of Objectives

  • Direct clinical observations (use of one way mirrors)
  • Standard Program evaluations
  • Medical Records Review by Faculty
  • Clinical Skills Exams (focusing on use of interactive play assessment)

Description of Rotation

This is a second year rotation through a one of a kind clinic specializing in the identification and treatment of early onset mental disorders. The fellows focus on evaluation and follow up of the mental health and emotional development of very young children. The program’s mental health services focus primarily on helping children from infancy through the preschool period (up to age 6) and receive on-going referrals from local, and national sources.