Child and Adolescent Psychiatry Fellowship
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Cambridge Health Alliance
Child and Adolescent
Psychiatry Fellowship
Program 2017-2018
Marshall Forstein, MD
Interim Chairman, Department of Psychiatry
Jacob Venter, MD, CPE
Division Chief, Child & Adolescent Psychiatry
Lee Robinson, MD
Training Director
1493 Cambridge Street,
Cambridge, Massachusetts 02139
(617) 575-5607
Sandra DeJong, MD
Senior Associate Training Director
1493 Cambridge Street,
Cambridge, Massachusetts 02139
(617) 665-1297
GR17_216
The CHA Training Program in Child & Adolescent Psychiatry Fellowship Table of Contents Cambridge Health Alliance and its Mission 2 CHA Training In Child Psychiatry 3 Child and Adolescent Psychiatry Training Program: First Year 4 Child and Adolescent Psychiatry Training Program: Second Year 10 Clinical and Research Leaders In The Division Of Child And Adolescent Psychiatry 15 Child and Adolescent Psychiatry Teaching Faculty – Cambridge Health Alliance 17 Faculty List – Division of Child and Adolescent Psychiatry 21
The CHA Training Program in
Child & Adolescent Psychiatry Fellowship
Cambridge Health Alliance In 2006, after Massachusetts passed its health
care reform law, CHA formed an Accountable Care
and Its Mission Organization (ACO). This means that CHA has
Since 1964, the Cambridge Hospital (now Cambridge been working to transition away from a fee-for-
Health Alliance or CHA) has provided a model of service payment model towards alternative payment
innovative, community-oriented healthcare in which arrangements, in which CHA receives global insurance
trainees from all psychiatric disciplines have developed payments from private, state and federal insurers
their skills. The CHA mission is to improve the health in exchange for providing high quality care to our
of the Massachusetts communities we serve. As a community of patients. To this end, CHA quickly began
safety-net healthcare system, CHA has been on the transforming its primary care centers into patient-
cutting edge of healthcare reform, and has received centered medical homes, and as of December 2016, all
national recognition for its innovative work. In 1988, 12 CHA primary care practices have been designated
the Victims of Violence Program at CHA received the as Level III Patient-Centered Medical Homes by the
Gold Award from the American Psychiatric Association National Committee for Quality Assurance (NCQA)
for innovative hospital and community service. In 1993, and have received the MA Health Policy Commission’s
CHA was honored with the Foster G. McGraw Prize for Patient Centered Medical Home PRIME Certification for
service to the community; in 2001, CHA received three behavioral health integration. Additionally, in 2014, CHA
Safety Net awards for Open Access Patient Scheduling, developed an affiliation with the Beth Israel Deaconess
Domestic Violence Programming, and Cultural and Care Organization (BIDCO). As these efforts continue
Linguistic Competency. In 2001, the Robert Wood to progress, and include specific planning for pediatric
Johnson Foundation selected CHA as one of seven integrated care models, CHA will be better able to
healthcare systems for a “Pursuing Perfection” grant focus on preventative care and population health for
to transform healthcare delivery. In 2003, CHA was the children and families we serve.
again honored with APA’s Gold Award, this time
for its innovative work in providing a restraint-free
environment on its child inpatient psychiatric unit. In
2007, the National Association of Public Hospitals and
Health Systems presented the Chair Award to CHA for
its integrated medical student clerkship program. And
in 2009, CHA was selected as a national best practice
site for team development by the Commonwealth Fund
Safety Net Medical Home transformation initiative.
page 2
CHA Training in Child Psychiatry Service Care, Consultation-Liaison, (including both
inpatient and outpatient consultation), and Residential
Training and education are key elements of CHA’s
Consultation. In addition, briefer rotations within each
mission. The CHA child psychiatry fellowship
block focus on issues such as developmental disorders,
training program has its roots in psychodynamic
pediatric neurology, preschool-age development
and psychoanalytic therapies and public sector,
and consultation, early intervention observation,
multicultural, community based care. While continuing
wrap-around care, pediatric primary care-mental
to nurture this tradition, the program also trains fellows
health integration, elective time, and consultation to
in other evidence-based treatment modalities in the
state agencies. Also in the first year, trainees begin
service of a comprehensive biopsychosocial model.
their longitudinal outpatient experience in both
Our values include training highly ethical, independent
psychotherapy and psychopharmacology. Finally, the
and responsible physicians who will give excellent
first year fellows rotate through an interdisciplinary
psychiatric care to children and families using an
outpatient diagnostic evaluation team to learn the skills
integrative approach to child psychiatry that fits the
needed to conduct outpatient assessments.
needs of individual patients and their families.
The second year is focused on seeing a diverse
The training experience is designed to develop
outpatient population for a full range of outpatient
and strengthen fellows’ abilities to develop a
treatments. In addition, second-year fellows learn
biopsychosocial formulation and treatment plan, and
about forensics in probate/family and juvenile court
implement appropriate and effective treatments.
clinic settings, and school consultation. Eight hours
Fellows are taught to consider different modalities
a week throughout the second year is available for
of treatment based upon the family’s preferences for
elective time and scholarly activity. All second-year
services, the efficacy and cost-effectiveness of certain
fellows complete a Clinical Scholarship Project. Fellows
methods for particular disorders, the capacity of a
in both years participate in quality improvement
child and family to engage in treatment, and the level
initiatives and case presentations.
of supporting evidence. The range of psychotherapy
techniques taught includes: intensive psychodynamic The Training Program in Child and Adolescent
individual psychotherapy, intensive family therapy, Psychiatry at Cambridge Health Alliance recruits five
brief and focused individual and family therapies, fellows per year. Interested applicants should submit
psychopharmacology, supportive psychotherapy, an application via ERAS by October 13, 2017. Interviews
cognitive behavioral psychotherapy, dialectical will be offered in September through November. The
behavior therapy, psycho-educational interventions, match list is submitted in mid-December and match
and group therapy. results announced in January for the following training
year. We accept fellows only after their PGY-III year
The two-year training program includes a combination
of training (or beyond) who have passed USMLE
of didactics, clinical rotations, and independent
III, completed required Clinical Skills Examinations
scholarly work. Currently, eight to ten hours a week
(CSEs), and met all ACGME requirements for general
are protected for didactic learning. Weekly seminars
psychiatry. Our program participates in the NRMP
cover a variety of topics pertinent to our field,
match for fellows in Child and Adolescent Psychiatry.
including psychotherapy, psychopharmacology, human
We are an equal opportunity employer and training
development, and scholarly activities. Clinical rotations
program and seek to recruit minority trainees and
occur throughout both years. The first year is divided
faculty members who will assist us in providing
into five 10-week blocks in Adolescent Inpatient,
services to minority groups in our community.
Child Inpatient, Psychiatric Emergency and Transition
page 3
CHA Child and Adolescent Psychiatry V. Walden Residential, Elective, Neurology,
Developmental Disorders, Integrated-Care
Training Program: First Year (WENDI)
The first year is divided into five blocks of ten weeks
• Residential Consultation (Walden Street School,
each. In addition, Wednesday and Thursday afternoons
Justice Resource Institute, 6 hours/week for 10
are devoted to a longitudinal outpatient experience
weeks)
throughout the year.
• Independent clinical and scholarly activity time
I. Child Assessment Unit (CAU) (8 hours/week for 10 weeks)
• Child Inpatient, Cambridge Hospital, 7th floor • Pediatric Neurology, Lurie Center for Autism
(27 hours/week for 10 weeks) (4 hours/week for 10 weeks)
II. Adolescent Assessment Unit (AAU) • Developmental disorders, office of Karen Levine,
PhD (2.5 hours/week for 10 weeks)
• Adolescent Inpatient, Cahill 3, Cambridge
Hospital (27 hours/week for 10 weeks) • Neuropsychological Testing observation (6 hours)
• Outpatient pediatrics primary care-mental health
III. Psychiatric Emergency and Transition
integration service, CHA Cambridge Pediatrics,
Service (PETS)
Cambridge (4 hours/week for 10 weeks)
• Psychiatric Emergency Services (Cambridge
Hospital ED, 8 hours/week for 10 weeks) VI. Longitudinal Outpatient Experience (Cambridge
Hospital, Macht Building)
• Psychiatric Transitional Service (Cambridge
Hospital Cahill 1, 3 hours/week for 10 weeks) • Psychotherapy (3 hours/week for 52 weeks)
• Evaluation team (3.5 hours/week for 10 weeks) • Precepted psychopharmacology clinic (3 hours/
week for 52 weeks)
• Early Intervention Observation (The Guidance
Center, 3 hours/week for 6 weeks)
Rotations: First Year
• Community Service Agency (Cambridge Youth
I. Child Assessment Unit (CAU),
Guidance Center, 5 hours/week for 10 weeks)
Cambridge Hospital - 10 weeks
IV. Consultation/Liaison This clinical experience gives fellows the
• Inpatient pediatrics consultation, Tufts Medical opportunity to work with multidisciplinary staff,
Center (16 hours/week for 10 weeks) gain experience negotiating with outside systems
such as the Department of Children and Families,
• Outpatient pediatrics consultation, MIT Pediatric
the Department of Mental Health, and the wrap-
Clinic, Cambridge (4 hours/week for 10 weeks)
around services of the Children’s Behavioral
• Consultation to State Agencies (Depts. of Health Initiative. Fellows develop assessment and
Mental Health and Children and Families, various treatment skills with oversight and supervision from
locations (3 hours/week for 10 weeks) inpatient psychiatric attendings and visiting faculty.
• Preschool Observation and Consultation, The Rotation Supervisor of the CAU rotation is Dr.
Peabody Terrace Children’s Center (2.5 hours/ Fida Hassan.
week for 5 weeks)
Patients range in age from 2 to 13; approximately
• Neuro/psychological Testing Review (1.25 hours/ 30 percent are from Cambridge and Somerville,
week for 5 weeks) while 70 percent are drawn from a wider
geographic area. The patients represent a diverse
page 4
socioeconomic, ethnic, and cultural mix and present disorders, psychotic disorders, substance abuse,
with a wide range of diagnostic problems, including ADHD and other disruptive disorders. Systems
post-traumatic, disruptive, mood, psychotic, work involves school and program (residential)
and developmental disorders. Clinical focus is consultation.
on accurate diagnostic assessment, including
individual and family evaluations, and broad-based Faculty on both inpatient units include child
treatment, including psychopharmacology, family and adolescent psychiatrists, social workers,
work and milieu therapy. The unit has received psychologists, nurse managers, staff nurses
recognition for its development of strategies to and milieu counselors. Faculty members are
reduce the use of restraint and seclusion. The unit experienced in assessment, psychotherapy,
has also developed a family-centered model of play therapy, behavior modification,
care. psychopharmacology, substance abuse and family
therapy.
Educational activities include weekly interview and
case formulations conference with outside faculty, Educational activities include weekly interview and
weekly family therapy case conference, weekly case formulations conference with outside faculty,
clinical supervision from outside faculty, weekly weekly family therapy case conference; weekly
supervision with an onsite supervisor and informal clinical supervision from outside faculty, weekly
supervision from psychiatric and psychology staff. supervision with an onsite supervisor and informal
supervision as needed. Teaching opportunities
Teaching opportunities include supervising include: supervising medical students, general
medical students, adult psychiatry and pediatric psychiatry residents and pediatric residents.
residents. Fellows also are expected to present and
implement evidence-based treatment plans in team III. Psychiatric Emergency and Transition
meetings. Service (PETS)
• The Cambridge Hospital’s Psychiatric
II. Adolescent Assessment Unit (AAU), Emergency Service (PES)
Cahill 3, Cambridge Hospital - 10 weeks
The PES is a consultation service based in the
The AAU rotation provides a rich clinical experience medical emergency room. It is the entry point for
with adolescents and their families involving close all acute psychiatric services, and also provides
work with multidisciplinary staff in a team format, evaluation and urgent treatment to children,
both as the primary clinician on cases and as the adolescents, adults, and families. Patients seen by
medication consultant. Fellows gain experience the PES team are children and adolescents aged
negotiating with outside systems and presenting 18 and under, though adolescents outnumber
evaluations in teams and to outside providers in latency age children, with an equal number
systems meetings. The Rotation Supervisor of the of male and female patients. The Rotation
AAU rotation is Dr. Fred Crow. Supervisor of the PES experience is Dr. Lee
Robinson, who provides weekly 1:1 supervision.
This unit has 14 inpatient beds. The population
Emergency assessments are directed at
ranges in age from 12 to 19, with approximately
determining patient needs for acute stabilization
50 percent of patients from the local Cambridge/
and appropriate/least restrictive level of care.
Somerville area and 50 percent from the greater
Fellows spend 8 hours a week for 10 weeks on
Massachusetts and New England regions.
this rotation.
Like the CAU, the patients represent a diverse
socioeconomic, ethnic and cultural mix. CHA • The Cambridge Hospital’s Psychiatry Transition
provides access to an award-winning interpreter Service (PTS)
service including ASL for deaf and hard-of- The PTS is a consultation service based in Cahill
hearing patients. The AAU serves a wide range of 1, next door to the medical emergency room.
adolescents with diagnoses including PTSD, mood It serves youth who were recently seen by the
page 5
PES team in the ER and are in need of urgent provides in-depth initial assessments of families
follow-up as a bridge to outpatient care or as a over two sessions. This setting provides an
means for supportive re-evaluation following the excellent opportunity for fellows to observe
acute presentation. As with the PES, patients senior faculty interview patients, to receive direct
seen in the PTS are youth aged 18 and under. feedback on their own interviewing skills, to
The Rotation Supervisor of the PTS experience practice in-depth biopsychosocial formulation
is Dr. Amy Mayhew, who provides supervision for skills (both written and in presentation to the
each case seen in weekly 1:1 supervision and staff team), to learn local resources and systems
meetings. available for families, and to work together
in a team setting to think through diagnostic
• The Community Service Agency (CSA) rotation formulations and treatment plans. The rotation
at The Guidance Center supervisor is Nicholas Carson, MD.
This rotation introduces fellows to wraparound
services offered in the setting of a community IV. Consultation/Liaison
mental health center. These services are offered
• Inpatient Consultation-Liaison
through the Massachusetts’ Child Behavioral
Health Initiative (CBHI), an innovative statewide The Floating Hospital for Children at Tufts
reform of public child mental health care Medical Center in downtown Boston is a 100-
emphasizing strengths-based, wrap-around bed pediatric tertiary care hospital within
community supports. Fellows participate in team Tufts Medical Center. CHA fellows rotate at the
evaluations of children and families, join the staff hospital performing inpatient consultations with
on home visits, and develop a comprehensive children and adolescents who have a wide range
treatment plan. Becoming more familiar with of concerns including psychological difficulties
community-based resources, working within a associated with pediatric illness, unexplained
multidisciplinary treatment team, and acting as a somatic symptoms, child abuse and neglect, pain
psychiatric consultant to CBHI service providers management and problems managing chronic
are also critical goals of this rotation. The rotation illness. In addition, fellows participate in more
supervisor is Allison Clark, LICSW. specialized inpatient consultation experiences
on both the Pediatric Intensive Care Unit and
• Early Intervention Observation the Bone Marrow Transplant Unit at the Floating
Fellows spend one morning per week with the Hospital. Fellows spend approximately 16
Early Intervention program at The Guidance hours per week over a 10-week period at Tufts
Center. This experience involves observation of performing clinical consultations, presenting
Early Intervention groups and of home based cases, attending a teaching conference, and
assessments under the supervision of Kathy Kelts, receiving supervision. The rotation supervisor
LICSW. Fellows learn how preventive strategies and C/L director is Dr. John Sargent, Chief of
are practiced in a state-supported program. Child and Adolescent Psychiatry at Tufts. Fellows
Fellows also deepen their theoretical and will also teach consultation psychiatry to Tufts
practical understanding of normal development Medical Students and have weekly supervision
at this stage of life and learn to distinguish it from with Dr. Sargent.
clinical pathology.
• Outpatient Consultation-Liaison
• Team Evaluation Clinic Massachusetts Institute of Technology (MIT)
First-year fellows spend 10 weeks during their Health Services provides pediatric care to
PETS rotation on a weekly 3.5-hour Evaluation the children of students, faculty and general
Team. The team is multidisciplinary (psychiatry, employees at the university. Fellows spend
psychology, social work, family medicine, one afternoon (4 hours) a week for 10 weeks
pediatrics, nursing, medical students) and seeing children and families referred by their MIT
pediatricians for a variety of psychiatric concerns.
page 6
They then discuss the case in supervision with Dr. provides updates about services and changes
Deborah Kulick, the rotation supervisor. Fellows in each of the participating state agencies as
learn about the consultative frame in general and well as a forum for consultation to high-risk and
consultation to pediatricians in particular. There underserved families who are in need of services
is also the opportunity to follow one MIT case from more than one agency.
for outpatient mental health treatment at the
Cambridge Hospital clinic. • Preschool Observation and Consultation
The Peabody Terrace Children’s Center is a
• Systems Consultation to State Agencies Harvard-affiliated preschool for healthy children
The MA Department of Mental Health (DMH) ranging in age from 2 months to 5 years who are
is a state agency that sets the standards for primarily children of Harvard University faculty,
the operation of mental health facilities and students, and staff. The children are divided into
community residential programs and provides several age-based “classes,” each of which is
clinical, rehabilitative, and supportive services for designed to meet the developmental needs of
adults and children with serious mental illness or its assigned group. Supervision is provided by
serious emotional disturbances. The Department Susannah Sherry, MD.
for Children and Families (DCF) is the child
welfare agency in Massachusetts. During this 10- Fellows spend 2.5 hours every second week for 10
week rotation, first-year child psychiatry fellows weeks on this rotation. The experience allows the
will spend 3 hours a week accompanying the fellows to observe preschool children who are,
faculty during weekly consultations to DMH and for the most part, on track developmentally in a
DCF at various sites within our catchment area. group setting while providing consultation to pre-
school staff on those children who present with
Fellows are supervised by Dr. Nandini Talwar, a developmental, social, emotional, communication,
DMH child and adolescent psychiatrist who has or other potential concerns.
extensive experience working with state and
community agencies. During the consultation, the • Neuro/Psychological Testing Review
trainees participate in discussions of complicated Fellows will spend 1.25 hours every second
cases presented by DCF case managers and week for 10 weeks reviewing psychological and
supervisors. Trainees learn about services and neuropsychological testing results, with our
opportunities provided by state agencies, criteria clinical psychologist, and neurodevelopmental
for eligibility for services from state agencies, testing expert, Laura Gaugh, PsyD. Throughout
the process of investigation and assessment the rotation, fellows will review testing results
for allegations of abuse and neglect, as well as offered by Dr. Gaugh, or from the fellow’s
the various dilemmas and limitations faced by outpatient caseload, with the goal of familiarizing
agencies when working with families and clients. the fellows with the types of tests they may
Fellows will also participate in monthly meetings encounter, and how best to interpret the testing
with the group of senior DMH child psychiatrists results in the context of the greater cultural
to discuss a variety of topics including high risk and linguistic clinical picture. Types of testing
and complicated cases, changes and trends in the may include tests of cognitive functioning,
mental health system in MA, and other important academic performance, adaptive functioning,
issues related to public mental health care for language, executive functioning, visuospatial and
children. In addition, the fellows will participate visuomotor functioning, learning and memory,
in a once a month interagency meeting with and social communication.
representation from DMH, DCF, DDS (Department
of Developmental Services), DYS (Department of
Youth Services), Department of Education and
the Department of Public Health. This meeting
page 7
V. Walden Residential, Elective, Neurology, children with Laura Gaugh, PsyD. Fellows observe
Developmental Disorders, Integrated-Care in-depth evaluations of cognition, emotions,
(WENDI) language and development with youth and
participate in feedback sessions with families.
• Residential Consultation rotation
The Walden Street School is a therapeutic • Developmental Disorders/Intellectual Disability
residential program of the Justice Resource Fellows spend approximately 2.5 hours a week for
Institute for young women offering a specialized 10 weeks observing evaluations at the office of Dr.
trauma-informed approach, known as Karen Levine, an award-winning developmental
Attachment, Self-Regulation, and Competency psychologist, in Lexington. The experience gives
(ARC). Fellows spend one day per week under fellows exposure to young children with a range
the supervision of Dr. Kerry-Ann Williams of developmental disorders including Autism
participating in treatment team, groups, and Spectrum Disorders, with or without intellectual
milieu treatment of students at the residential disability, and to various systems of care for
school. these children and adolescents. Uses of play in
assessment and treatment of this population are
• Elective/Scholarly Activity emphasized.
This rotation provides 8 hours per week for 10
weeks of elective time so that fellows can pursue • Primary Care Mental Health Integrated
scholarly activities or quality improvement in Consultation-Liaison
their own particular area(s) of interest, meet The Pediatric Primary Care - Mental Health
potential mentors, and prepare for their clinical Integration (PCMHI) Service at CHA Cambridge
scholarship and elective time in the second year. Pediatrics Clinic gives first-year fellows the
opportunity to work alongside an attending
• Pediatric Neurology child psychiatrist (Lee Robinson, MD) in an
The fellows spend one morning a week for integrated care model for 4 hours a week for 10
10 weeks at the Lurie Center for Autism in weeks. Fellows will learn how to consult to, and
Lexington, MA. They learn to take a pediatric and collaborate with, pediatricians and primary care
neurological history with a particular emphasis staff to address pediatric mental health needs
on birth and early development. School histories in the primary care setting. Fellows will learn
are also detailed. Areas addressed include the about pediatric primary care culture, workflows,
subtleties of abnormalities in processing and and staffing and what role pediatricians play in
modulating sensory input (auditory, visual, and the mental health care for many of our patients.
tactile), difficulties in perception and/or medical Fellows will learn how the child psychiatrist
conditions that are mistaken for psychiatric or on a PCMHI team can provide consultation to
behavioral disorders. Fellows review and perform pediatricians through indirect case consultations,
a neurological evaluation, including cranial nerves, direct “face-to-face” consultations and brief,
motor (fine motor, gross motor and balance) and urgent evaluations. Fellows will learn how to
sensory and mental status assessments. Fellows perform brief psychiatric interventions (both
are taught and expected to dictate a complete somatic and psychotherapeutic) for children and
report on the patients they have evaluated which families in the primary care setting, and how to
are then reviewed by the supervising neurologist, co-manage mental health care with pediatricians.
Dr. Ann Neumeyer. As health care nationally moves towards
an Accountable Care Model of delivery, this
• Neuropsychological Observation
innovative rotation is designed to prepare fellows
During the neurology rotation, fellows will spend for the future of integrated pediatric health care.
six hours observing neuropsychological testing of
page 8
VI. Longitudinal Outpatient Experience – First Year Program) and to Cambridge preschool and daycare
The Cambridge Hospital Child and Adolescent centers (Early Years Program).
Outpatient Service is located at the Macht Building • Outpatient Psychotherapy Clinic
and provides evaluation and treatment to children
Fellows spend their time learning and providing
from ages 3 to 18, approximately 60% of whom are
psychotherapy and psychopharmacology to
male and 40% of whom are female, with a relatively
diverse populations. The essential experience
even split between children and adolescents.
includes family work, individual psychodynamic
These children are most commonly diagnosed with
psychotherapy, supportive and cognitive/
disorders of adjustment or trauma, depression,
behavioral interventions, consultation with
anxiety and disruptive behaviors (ADHD, ODD).
community agencies and schools and general
School behavioral problems, learning disabilities,
clinical case management. Many cases will
physical or sexual abuse and family disorganization
involve combined treatment (both psychotherapy
are frequently part of the clinical picture. The
and medications) First-year fellows have at
cultural and ethnic mix of patients includes
least three therapy hours a week, primarily
Portuguese, Latino, and Haitian. Treatment of such
for psychotherapy, but also for evaluations,
families is facilitated by CHA’s excellent interpreter
family work and case management. First-year
services.
fellows receive a minimum of 2 hours of weekly
The Child Ambulatory Service provides outpatient supervision.
approximately ten thousand visits per year. Clinical
• Precepted Psychopharmacology Clinic
services available at the Macht building on our
main campus include a psychotherapy clinic, a The 3-hour psychopharmacology clinic is devoted
psychopharmacology clinic, a neuropsychological to the medication management of patients in
and developmental testing program, a clinic for a split treatment model. It is precepted by an
deaf and hard-of-hearing children, a family therapy attending child psychiatrist who is available to
clinic and a group therapy program. help fellows with diagnostic interviewing and
treatment planning, to answer any questions
In addition to the Macht outpatient service, the trainee may have, and to guide fellows’
children and adolescents are seen by our staff self-directed learning about evidence-based
at local school-based health centers, at CHA treatments in clinical practice. Preceptors
community pediatrics and family medicine clinics provide feedback on interviewing skills and
in both co-located and integrated primary care documentation. Current preceptors are Malak
models, and at regional residential treatment and Rafla, MD, Susan Walker, MD, Sandra DeJong, MD
educational facilities. CHA providers also consult and Lee Robinson, MD.
to the Cambridge Police Department (Safety Net
page 9CHA Child and Adolescent Psychiatry The Child Ambulatory Service provides
approximately ten thousand visits per year. Clinical
Training Program: Second Year services available at the Macht building on our
I. Outpatient Clinics main campus include a psychotherapy clinic, a
psychopharmacology clinic, a neuropsychological
• Outpatient Psychotherapy Clinic (individual,
and developmental testing program, a clinic for
group and family, 7.5 hours/week for 52 weeks),
deaf and hard-of-hearing children, a family therapy
Cambridge Hospital
clinic and a group therapy program.
• Precepted Psychopharmacology clinic (4.5-5
hours/week for 52 weeks), Cambridge Hospital In addition to the Macht outpatient service,
and The Guidance Center children and adolescents are seen by our staff
at local school-based health centers, at CHA
• Urgent Evaluation Services (as needed, estimated
community pediatrics and family medicine clinics
2 hours/month)
in both co-located and integrated primary care
II. Consultation/Liaison models and at regional residential treatment and
educational facilities. CHA providers also consult
• School consultation, Cambridge/Somerville
to the Cambridge Police Department (Safety Net
public schools (3 hours/week for 40 weeks)
Program) and to Cambridge preschool and daycare
• Forensic consultation, Middlesex Probate/ centers (Early Years Program).
Family Court Clinic and Adolescent Consultation
Outpatient Psychotherapy Clinic
Services to the Middlesex Juvenile Court Clinic,
Second-year fellows continue their work in
Cambridge (4 hours/week for 26 weeks)
evaluating and treating children and families.
III. Elective/Scholarly Activity The emphasis is on a flexible approach and
increasing each fellows’ breadth and depth of
• Independent Clinical/Scholarly Activity Time
treatment modalities. The fellows are expected
(8 hours/week for 52 weeks)
to have a minimum of eight clinical hours of
outpatient psychotherapy, including co-leading
Rotations: Second Year
a weekly outpatient group. Second-year fellows
I. Outpatient Clinics have 3-4 hours of weekly outpatient supervision.
The CHA Child and Adolescent Outpatient Service This includes 2 hours of individual supervision
provides evaluation and treatment to children from for psychotherapy in addition to group CBT
ages 3 to 18, 60 percent of whom are male and 40 supervision, group supervision for groups and
percent of whom are female. The clinic population group supervision for school consultation.
is evenly split between children who are 12 or under,
Precepted Psychopharmacology Clinic
and half of whom are 13 or older. These children
are most commonly diagnosed with attention- Second-year fellows spend approximately 4.5- 5
deficit/hyperactivity disorder, adjustment disorders, hours a week over two afternoons all year long
depressive disorders, posttraumatic stress disorder, performing psychopharmacology evaluations
anxiety disorders and oppositional defiant disorder. and medication management in a split-treatment
The clinic also treats youth with autism spectrum model. Fellows are primarily assigned either to the
disorders, bipolar disorder, psychotic disorders, Outpatient Department at CHA or to both CHA
and substance use disorders. School behavioral OPD and a CHA-affiliated site in the community.
problems, learning disabilities, physical or sexual Dr. Debra Rosenblum and Dr. Nicholas Carson
abuse and family disorganization are frequently are the CHA OPD clinic preceptors. Currently, the
part of the clinical picture. The cultural mix of community site is The Guidance Center, where the
patients includes Latino, Haitian and Portuguese, as rotation is precepted by their Medical Director, Dr.
well as a variety of other ethnicities. Tyrone Williams. Preceptors provide feedback on
interviewing skills, treatment planning, coordination
page 10of care, coding and documentation. Time each Forensic Consultation
week is devoted to supervision of cases and Probate and Family Court: The Family Service
didactics focusing on the review of seminal articles Clinic is a department of the Middlesex Probate
in pediatric psychopharmacology. and Family Court, with offices in Cambridge. The
clinic staff performs comprehensive evaluations
Urgent Evaluation Service
of families following parental separation in which
Second-year fellows will spend approximately five custody and visitation of minor children are
months performing clinical assessments of youth disputed issues. These evaluations focus on the
who have been referred to the Macht Outpatient needs, interests and welfare of the child in the
Clinic due to acute mental health problems that fall context of parental conflict. Children evaluated
short of requiring an emergency room evaluation range in age from under one year to 18 and
but are concerning for potential significant decline come from diverse socioeconomic and ethnic
prior to a regular outpatient evaluation. Such backgrounds. The rotation supervisors are Barbara
referrals are seen within one week of referral. These Hauser, LICSW and John Baker, Ph.D.
evaluations are supervised by Sandra DeJong, MD.
Educational activities include Introduction to the
II. Consultation/Liaison Probate and Family Court, including observation of
School Consultation court proceedings and the provision of testimony
during these proceedings, multiple diagnostic
The Cambridge Public School system serves a
interview sessions with the referred children and
diverse ethnic and socioeconomic community from
their parents, review of collateral documents and
kindergarten through grade 12. Child Psychiatry
completion of a comprehensive report for the
fellows spend 3 hours per week for nine months
court, concluding with recommendations.
in consultation to a diverse cultural public student
population Juvenile Court: Adolescent Consultation
Adolescent Consultation Services (ACS) is a private
Fellows either choose to work in an elementary/
non-profit agency which operates the Juvenile
middle school (kindergarten through eighth
Court Clinics for the Middlesex County Juvenile
grade) or high school according to their interest,
Courts. ACS offices are located in the Juvenile
exposure to different age groups and availability
Court in Cambridge. Upon order of the Judge,
of placement. The school population is a highly
Juvenile Court Clinic staff conduct comprehensive
culturally diverse population representing a
diagnostic evaluations of youth and families
broad range of socioeconomic backgrounds from
involved in the court. The rotation supervisor is
Cambridge communities.
Mathilde Pelaprat, PsyD.
Fellows complete up to three evaluations of
Educational activities include multiple diagnostic
students with safety and/or mental health concerns
interview sessions with the entire family and the
(e.g. aggressive behavior) under close supervision.
referred youth, review of collateral documents,
These assessments often clarify the diagnosis and
completion of the comprehensive forensic
help with understanding the treatment obstacles
report (Delinquency, Child Requiring Assistance,
and how to manage a particularly challenging
or Care and Protection case) for the court,
student.
including a dynamic formulation and realistic
This rotation is supervised by James Barrett, PhD, recommendations. Introduction to the juvenile
Director of School-Based Mental Health Programs court setting and staff including judges and
for the Cambridge Health Alliance. probation officers includes observation of juvenile
court and the opportunity to give testimony.
page 11III. Elective/Scholarly Activity These are:
Independent Clinical/Scholarly Activity 1. Introduction to Scholarly Activities Seminar,
Fellows have the equivalent of one day a week Summer Seminar in the first year.
in the second year to pursue clinical activities 2. Clinical Scholarship Seminar, Sept-June, both
according to their particular interests, and to years; critical evaluation of the literature to
complete a scholarly project. Fellows are expected answer a clinical question in the first year;
to either create an elective proposal or choose presentation for scholarship requirement in the
from a variety of electives currently offered by second year.
our faculty. Either of these options will require
3. Presentations during Preschool Observation
the fellow to choose a mentor or supervisor to
Rotation, Community Service Agency rotation,
work with during the elective. In addition, fellows
Neurology rotation and Harvard Consolidated
complete a scholarly project by the end of the
Seminar in the first year.
second year. The elective may or may not pertain
to the same material as the scholarly project. In 4. Option of preparing a poster for Mysell Research
the past, fellows have chosen a wide range of Day and CHA Poster Day.
projects, including making a video about toddler 5. Completion of a scholarly project during the
and preschool development, conducting a pilot second year elective time.
research project on pharmacological treatment of
weight gain in adolescents on neuroleptics, and Seminars and Didactics
developing a school-based curriculum on cyber- A defining feature of our didactics is the Harvard
bullying. Consolidated Program. In this program, all first-year
fellows in the Harvard-affiliated child psychiatry
Clinical Scholarship Expectations training programs (MGH/McLean, Children’s
The Accreditation Council of Graduate Medical Hospital and Cambridge Health Alliance) come
Education (ACGME) requires that all training together to participate in a 3-hour didactic session
programs meet standards in the area of scholarship. made up of two core seminars: Child Development
According to the guidelines, faculty is responsible and Child Psychopathology. Internationally
for ensuring there is an environment of inquiry and renowned Harvard faculty are guest lecturers on
scholarship. Scholarship is required of both faculty a variety of topics in child mental health research,
and fellows. In the Department of Psychiatry at assessment and treatment. The seminars are
Cambridge Health Alliance and at Harvard Medical coordinated by CHA faculty Maria Sauzier, MD and
School, scholarship is defined broadly and may Karlen Lyons-Ruth, PhD.
include the scholarship of discovery, the scholarship
of integration, the scholarship of teaching and First-Year Summer Seminars
the scholarship of application. Guidance and Scholarly Activities – Nick Carson, MD and
technical support should be provided to fellows by second-year fellow Sol Adelsky, MD
faculty. The scholarship requirement of the Child Systems Issues – Joel Goldstein, MD
Psychiatry Fellowship program is designed to meet
the ACGME requirements and provide flexibility Normal Development – Susannah Sherry, MD
for Fellows to pursue special scholarly interests. Introduction to Child Psychiatric Illness – Malak Rafla,
While all clinical service experiences, supervision MD and second-year fellow Kevin Coughlin, MD
and seminars are an integral part of developing Pragmatics of Child Psychiatry –Lee Robinson,
scholarship, specific components are intended to MD and CHA Faculty Introduction to Pediatric
address the development of attitudes, skills and Psychopharmacology – Sandra DeJong, MD
behaviors that lead to a potential academic career.
page 12First-Year Seminars: September–June Psychodynamic Psychotherapy – Jennifer Harris, MD
Clinical Scholarship (with second-years) - and Theodore Murray, MD
Nick Carson, MD and John Hamilton, MD, MSc Play Therapy – Neal Kass, MD
Harvard Consolidated Program: Neuroscience of Addictions – Sandra DeJong, MD
Child Development – Maria Sauzier, MD, Transitions to Practice – Joel Goldstein, MD
Karlen Lyons-Ruth, PhD (Course Directors)
Cognitive-Behavioral Therapy – Jeanne Strassburger,
Child Psychopathology – Maria Sauzier, MD PhD , Lauren Krumholz, PhD
and Harvard faculty
Trauma-Focused CBT – Sandra DeJong, MD
Inpatient Clinical Case Conference – Tim Dugan, MD
Family Therapy (elective) – Jill Harkaway, EdD
and Judy Tsafrir, MD
In addition to the above seminars, first- and second-
Inpatient Family Therapy Case Conference –
year fellows have twice-monthly training meetings with
John Sargent, MD
the program directors to discuss training issues, and
Family Therapy Seminar – Jill Harkaway, EdD also meet monthly with a facilitator Jeanne Heiple, MD,
Introduction to Child Evaluation – CHA Faculty for a peer support group.
School C/L – Nancy Rappaport, MD Family Therapy Training, CHA
Medical C/L – Amy Mayhew, MD, MPH Family Therapy is often a core component of
Neuropsychological Evaluation – Laura Gaugh, PsyD any successful psychiatric treatment of a child or
adolescent. The guidelines of the Accreditation
Forensics – Barbara Hauser, LICSW, Council of Graduate Medical Education, the Practice
Adam Rosen and JD, PhD Parameters of the American Academy of Child and
Parenting – Susannah Sherry, MD, and Ann Hess, MD Adolescent Psychiatry and the recommendations
Pediatric Psychopharmacology – Lee Robinson, MD of the Group for the Advancement of Psychiatry
and visiting faculty Committee on the Family all underscore the role
of working with families. To this end, the CHA child
Second-Year Summer Seminars psychiatry fellowship offers a very strong grounding
Administration and Leadership – Lee Robinson, MD in Family Therapy training opportunities. These
opportunities aim to provide fellows with a basic
Learning How to Teach – Sandra DeJong, MD
conceptual understanding of family therapy as well as
Integrated Psychiatric Assessment – a range of experiences across treatment settings with
Allison Warshof, LICSW and visiting faculty different kinds of families and family issues
Child Psychotherapy – Jennifer Harris, MD
In the first year, fellows participate in a year-long
and Theodore Murray, MD
seminar that introduces Family Therapy Theory,
Culture and Society – Xenia Johnson, MD assessment, and intervention. The seminar consists of
Infancy and Attachment: Clinical Implications – didactics and observation of family consultations using
Ayelet Barkai, MD, and Ann Epstein, MD a one-way mirror, with a daylong “Family Therapy
Retreat” to wrap-up the academic year. The focus of
Gender and Sexuality – Cindy Telingator, MD
this seminar is on acquiring basic knowledge, skills and
and John Wechter, EdD
attitudes in working with family systems. This seminar
Second-Year Seminars: September-June is taught by Jill Harkaway, EdD. In the second year, an
Clinical Scholarship (with first-years), Nick Carson elective advanced seminar is available. This seminar,
MD and John Hamilton MD, MSc taught by Jill Harkaway and Elizabeth Brenner, LICSW,
provides clinical training in Family Therapy through
School Supervision – Nancy Rappaport, MD case consultation and/or live supervision using a
Integration and Special Topics – Don Condie, MD, one-way mirror. Case supervision is also offered by all
and Sandra DeJong, MD members of the faculty.
page 13Fellows also participate in inpatient Family trainees to meet and talk with others who have
Consultations, conducted on both the Child transitioned into this unique academic setting. Second-
Assessment Unit and the Adolescent Assessment Unit, year trainees and current faculty who are former
and participate in a Family Therapy Case Conference, CHA trainees will also be present to offer support
precepted by John Sargent, MD. and their valuable insights to acclimating to CHA,
to Harvard Medical School and to New England (for
Program in Psychodynamics those who are spending their first year here in the
The Program in Psychodynamics is an elective Boston metropolitan area). This initiative is led by Dr.
opportunity for fellows in both years across all three Treniece Lewis-Harris, the Director of Child Psychology
Harvard Child Psychiatry Fellowship programs. Its goal Outpatient Training at CHA.
is to foster the career development of fellows with an
interest in psychodynamics, psychodynamic research,
psychoanalysis and psychodynamic psychotherapy.
Training Office:
The core activity is a monthly dinner meeting at the Lee Robinson, MD
home of program faculty to discuss relevant topics Training Director
defined by the program participants. The program 1493 Cambridge Street,
offers a flexible set of opportunities for enrichment Cambridge, Massachusetts 02139
in the fellowship and two years post fellowship. (617) 575-5607
In collaboration with the Boston Psychoanalytic
Society and Institute (BPSI), the Program in Sandra DeJong, MD
Psychodynamics allows fellows to enhance and Senior Associate Training Director
deepen their psychodynamic interests and to integrate 1493 Cambridge Street,
psychodynamic scholarship into the rigorous clinical Cambridge, Massachusetts 02139
training provided to all CHA child psychiatry fellows. (617) 665-1297
Teaching during Child Training Lee Robinson, MD
All our fellows are encouraged to teach during their Instructor in Psychiatry,
child training. Fellows have a hands-on, interactive Harvard Medical School
“Learning to Teach” seminar in the summer of their Training Director Division of Child
second year. Fellows are then assigned teaching and Adolescent Psychiatry
responsibilities based on their interests. In the past, Staff Psychiatrist, Pediatric Primary
fellows have co-taught seminars, taught medical Care Mental Health Integration
students and general psychiatry residents on the Dr. Robinson completed his general psychiatry
inpatient units and outpatient evaluation teams, given residency training at Columbia University – New York
lectures as part of standing seminars, developed State Psychiatric Institute, and his child and adolescent
curricula for public education, given talks in community psychiatry fellowship training at Cambridge Health
settings and helped organize and teach an onsite Alliance. He has worked in primary care-mental
Harvard Medical School course on interviewing health integration, providing psychiatric consultation
patients. to primary care providers for children and adults,
Minority Trainee Mentoring Alliance (MTMA) has provided consultation to the Department of
Mental Health (DMH) around issues of developmental
Multidisciplinary first-year trainees (i.e. nursing,
disorders, and works in private practice. Dr. Robinson’s
psychology, psychiatry, social work) in the Department
current academic interests include autism and
of Psychiatry at CHA who self-identify with a minority
neurodevelopmental disorders, primary care-mental
group or groups (e.g. ethnic, racial, sexual, religious)
health integration, addressing social determinants of
are invited to the Minority Trainee Mentoring Alliance
mental health, and education. He was a past PRITE
(MTMA). This program is sponsored by the Diversity
Fellow, and a recent graduate of the Kraft Center for
Task Force at CHA as an opportunity for first-year
Community Health Practitioner Program, in which he
page 14studied healthcare utilization patterns for children with Editor of the Child Psychiatry Resident In-Training
autism. Dr. Robinson has been a Team Leader on the Examination (PRITE). She will be stepping into the
Thursday Child Evaluation Team, has supervised and Senior Associate Training Director role in July 2017.
taught adult psychiatry residents in psychotherapy
and acute child assessment, has taught the fellows on Roopali Bhargava, BA
topics of autism and healthcare reform, and supervised Training Coordinator
them for psychopharmacology, psychotherapy, and Division of Child & Adolescent Psychiatry
scholarly electives. He was the Associate Training Roopali Bhargava graduated from McGill
Director for 2016/2017 training year, and will be University with a degree in Psychology.
assuming the role of Training Director in July 2017. She joined CHA in December 2012
bringing with her many years of experience in
Sandra DeJong, MD, MSc program/project management and administration.
Assistant Professor of Psychiatry, Roopali’s recent positions include Global Operations
Harvard Medical School Manager at an international nonprofit educational
Senior Associate Training Director, organization, Regional Program Director for
Division of Child and Adolescent Earthwatch Institute and Event Manager at the
Psychiatry New England Aquarium. In addition to being the
Dr. DeJong trained in pediatrics and General Psychiatry Coordinator for the training program she is also the
at the University of Massachusetts Medical Center in administrative coordinator for the Child Psychiatry
Worcester, MA, and in Child and Adolescent Psychiatry Division leadership team at Cambridge Health Alliance.
at Massachusetts General and McLean Hospitals.
She has worked in an outpatient community hospital Clinical and Research Leaders
setting providing consultations and medication
management to patients referred from pediatricians, The field of child and adolescent psychiatry has seen
as well as inpatient child psychiatry consultation tremendous growth recently in areas of epidemiology,
and private practice. In addition, she served as co- diagnosis, neurobiology, treatment and health services
Investigator with Dr. Jean Frazier on an NIMH-funded research. The Department of Psychiatry at CHA is
multi-site research project in the treatment of early- particularly committed to advancing the scientific
onset psychosis, and has written about the use of knowledge base regarding the mental health of
antipsychotic medications in children. children living in culturally diverse community settings,
and in training mental health professionals in clinical
In the fall of 2004, Dr. DeJong assumed the position of excellence, research investigation and academic writing
Associate Training Director in the Division of Child and for the promotion of this knowledge.
Adolescent Psychiatry and became Training Director
in July, 2013. Current academic interests include Cambridge Health Alliance is a health care system with
neurodevelopmental disorders, e-professionalism strong clinical, academic and research programs and
and integrating technology into clinical practice, diverse faculty interests. The training program and the
ethics in child psychiatry, and psychiatric education. faculty are committed to providing top educational
She is the author of Blogs and Tweets, Texting and opportunities for our fellows within the Cambridge
Friending: Social Media and the Internet in Health Health Alliance, as well as at affiliated Harvard teaching
Care published by Elsevier in 2014. She serves on the hospitals.
Steering Committee and the Executive Council of Jacob Venter, MD, CPE
the American Association of Directors of Psychiatry Instructor in Psychiatry, Harvard Medical
Training (AADPRT), and is the current AADPRT School Chief, Division of Child and
President. She currently also serves on the Ethics Adolescent Psychiatry
Committee of the American Association of Child and
Adolescent Psychiatry. She participated in the 2014 Dr. Venter hails from South Africa and
ACGME Subspecialty Milestones Taskforce to develop completed his Child and Adolescent
Milestones for Child/Adolescent Psychiatry and as Psychiatry training at CHA and a child and adolescent
neuropsychiatry research fellowship at Harvard
page 15Medical School. He has held a number of positions Benjamin Cook, Ph.D., M.P.H.
at CHA including Director of Intensive Services. His Assistant Professor, Department
clinical interests include autism, trauma, early-onset of Psychiatry, Harvard Medical School
psychosis and mitochondrial disorders. Most recently Director, Center for Multicultural Mental
he has served as Division Chief of Psychiatry at Barrow Health Research and Health Equity
Neurological Institute, Phoenix Children’s Hospital, Research Lab
Arizona. He obtained his certification as a physician Dr. Cook holds a Ph.D. in Health Policy from Harvard
executive in 2013, and stepped into the role of Division University and is a health services researcher
Chief of Child Psychiatry at CHA in 2016. focused on reducing and understanding underlying
Nicholas Carson, MD, FRCPC mechanisms of racial/ethnic disparities in health and
Instructor in Psychiatry, mental health care. He has been principal investigator
Harvard Medical School on several major R01 grants from the NIMH and AHRQ
Medical Director, Child and Adolescent investigating mechanisms underlying disparities in
Outpatient Psychiatry Services episodes of mental health care, a R01 Supplement
Clinical Research Associate, Center for developing state by state report cards on mental
Multicultural Mental Health Research health care disparities, and a Milton Foundation grant
supporting research on tobacco use and mental
Dr. Carson is a graduate of the child psychiatry health. His methodological work focuses on improving
fellowship at Cambridge Health Alliance and statistical methods for the measurement and tracking
completed residency training in psychiatry at the of healthcare disparities, and he has received awards
University of Pennsylvania in the Clinical Research from NIMH and AcademyHealth for this work. His other
Scholars Program. His research in mental health research interests include improving mental health
services for multicultural communities has explored of immigrant populations, comparative effectiveness
the quality and social determinants of mental health research and its influence on healthcare disparities,
treatment among Haitian youth at CHA. He is co- substance abuse treatment disparities, and healthcare
investigator on several major NIH-funded grants at equity. Dr. Cook assists with the Scholarly Activities
the Center for Multicultural Mental Health Research on seminar for first-year fellows and provides mentorship
topics of patient provider communication, mechanisms on research methods and analysis to fellows and
of health care disparities, and intervention research to faculty interested in pursuing quantitative research
improve patient participation in treatment. Dr. Carson studies.
also studies the effects of mass media and technology
on the mental health and development of youth, Katherine E. Grimes, MD, MPH
including an on-going, trainee-initiated survey of media Associate Clinical Professor of
use among inpatients on the adolescent unit at the Psychiatry, Harvard Medical School
Cambridge Hospital. Director, Children’s Health Initiative,
He also serves on the Media Committee of the Cambridge Health Alliance
American Association of Child and Adolescent Dr. Grimes is the Director of the Children’s
Psychiatry. Dr. Carson teaches the summer Scholarly Health Initiative, a health services research group
Activities seminar for first-year fellows, co-leads the focused on improving mental health access and
Clinical Scholarship (Journal Club) seminar for first treatment quality for children and adolescents,
and second-year fellows, precepts the second-year particularly those at greatest risk for health disparities.
psychopharmacology clinic, and is a Team Leader on Dr. Grimes is currently the co-principal investigator of
the Friday Evaluation Team. He was the Associate a 4-year, $4 million grant from the Substance Abuse
Training Director of the Child Psychiatry Fellowship and Mental Health Services Administration (SAMHSA)
Program from July 2013-June 2016 before assuming titled “Enhancing Systems of Care: Supporting Families
the role of Medical Director for the Child and and Improving Youth Outcomes ‘E-SOC,’” which aims
Adolescent Outpatient Psychiatry Services in to integrate services for children with, or at-risk of,
July of 2016.
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