Infants & Preschoolers Clinic

Rotation Director: Joan Luby, MD

Other Faculty: Neha Navsaria, PhD

Number of Fellows per Rotation: Three

Length of Rotation: 9 months, one afternoon per week

Time of Rotation: Second year

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 and preschoolers
  • Detailed early developmental histories
  • Dyadic/relational approach to evaluation and care
  • Clinical observations with a 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 fellow 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 fellow will effectively communicate with patients, their families, and all other members of the treatment team.

  • Family interviews for the evaluation of infant and 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 close supervision by an internationally known expert in infant and 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 fellow will demonstrate sensitivity and compassion to children, adolescents, and to their families/caretakers affected by psychopathology and will continue to develop relationships 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 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
  • Acknowledgment and remediation of errors
  • Intra-professionalism; ability to understand and remedy factors that interfere with one’s proper professional conduct
  • Respect for patients, colleagues, supervisors, supervisees, and staff regardless of background
  • Review of professional conduct of colleagues if appropriate
  • Leadership role increases with training level (improvement in problem-solving, providing resources and advice to others, and 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 the global system of care and where clinic care fits in it including appreciation of the need for referral to other systems 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 examinations (focusing on the 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 the 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 ongoing referrals from local, and national sources.