Child and Adolescent Psychiatry Fellowship Training Program

Clinical Rotations

Infant Psychiatry/Therapeutic Nursery Program

This is a required clinical experience for second-year trainees and the trainee spends five hours weekly for 12 months. Trainees learn directly about the transactional nature of mother-infant interactions and ascertain whether it is the disorder in the parent, the infant, or in both that lies at the root of the maladaptive behavior patterns and resulting psychopathology. They also learn the range of therapeutic interventions derived from understanding the basis of the disordered relationship. There is a biweekly case conference in which all of the staff participates.

Faculty staff consists of one part-time child and adolescent psychiatrist with experience in Infant Psychiatry. One full-time social worker directs the one-and-a-half to three years-old nursery group and there is also a multidisciplinary team consisting of a special education teacher, speech and language therapist, occupational therapist, physical therapist, social worker, and attending psychiatrist.

Children are chiefly from minority and disadvantaged families with multiple problems. There are two nursery programs: one from 15 months to approximately two years-old and a second from two years to four years-old. There is also an afterschool group for patients aged three to five years. All of the programs are inclusion programs that require parent/caregiver participation.

The trainee is expected to be familiar with all of the children and parents in the nursery. Each trainee works with two specific parent-child dyads (or triad since occasionally a family will have both a preschooler and another member). In a 12-month rotation a resident will usually treat at least two dyads. A typical mix of cases might include one child with reactive attachment disorder and one child with developmental delays. The trainee serves as a medical and psychiatric consultant to non-medical staff therapists of other mother/child dyads. The trainee is also involved in the intake evaluation of new dyads including physical exams, psychiatric evaluation of the parent, observation and participation in psychological testing and developmental assessment. In addition to presenting clinical cases in conference, the trainee may also present didactic lectures on relevant topics (e.g., behavioral effects in infants and toddlers of prenatal exposure to psychoactive drugs).

Weekly supervision is twofold: nursery rounds and individual. The psychiatrist in charge gives active supervision based on their direct observation of the trainees with the child and parent in the nursery during rounds. Additionally, a community based voluntary faculty member with extensive infant experience supervises each trainee.

This experience with these severely disturbed infants and parents complements the Trainee's outpatient experiences with a more diverse group of early childhood patients. Also, it provides a unique opportunity to work with severely disturbed preschoolers as young as 18 months.