Clinical Rotations

Rotation: Longitudinal Outpatient Psychotherapy Clinic

Duration: 24 Months, 0.5 days per week (CAP 1), 1 day per week (CAP 2)

Description: Required two-year part-time rotation in both the first and second years at Georgetown University Hospital’s Department of Psychiatry Outpatient Clinic. First-years have one half-day per week in clinic and second-years have two half-days per week in clinic. Fellows spend two to five hours weekly in case conferences and supervision. Faculty is on site and reviews each patient with the fellow to provide appropriate supervision and ensure breadth and variety of caseload. In the first year, the average caseload for fellows consists of one new diagnostic evaluation per week under direct faculty supervision, and longitudinal care of three to four ongoing psychotherapy cases and one to two medication management cases. The focus for first-year fellows is on diagnostic assessment and implementation of core psychotherapeutic treatment modalities. In the second year, fellows conduct longitudinal care with approximately five to seven psychotherapy cases and fifteen to twenty medication management cases. Fellows will gain experience with longitudinal assessment and formulation, treatment planning, and individual treatment utilizing multiple treatment modalities including psychodynamic psychotherapy, cognitive behavioral therapy, dialectical-behavioral therapy, behavior modification, collaborative problem-solving, parent psychotherapy, family therapy, school-based interventions, and psychopharmacology.

Faculty: CAP 1 Clinic - Swati Chanani, MD; Olivia Hamrah, MD; CAP 2 Clinic - Nauf Azad, DO; Sean Pustilnik, MD

Rotation: Adolescent Inpatient Unit, ED and inpatient Consultation-Liaison, Group Psychotherapy

Duration: 4 Months, 4 days per week

Description: During this four-month, 4 days-per-week rotation at MedStar Montgomery Medical Center, fellows spend mornings on a five-bed adolescent inpatient unit learning about the evaluation and management of acutely ill adolescents and their families. Afternoons are a mix of general outpatient evaluation and treatment, evaluations of CAP patients in the ED and on the pediatric inpatient floors, and co-leading substance abuse and depression groups for adolescents. During this rotation, fellows will learn to approach the care of children and adolescents from a multidimensional perspective, including the creation of a comprehensive formulation for each case utilizing a biopsychosociocultural x 4P’s model. Fellows will take a leadership role in the treatment of each case including deciding (in consultation with supervisors) treatment priorities, foci of individual, family, and group therapies, appropriate use of medication, and coordination of care with outpatient providers and schools.

While fellows are rotating at MMMC, they will choose one weekend per each two-month block (two weekends total) to provide on-call coverage for the adolescent inpatient unit as well as CAP patients in the ED and on the pediatrics floors. Fellows will round on the adolescent unit inpatients Sat/Sun morning, then provide home call overnight Saturday (fellow covers all CAP psych patients on units and in the ED), and then home call ends at 4pm Sunday. These two weekends are the only “on-call” experiences during the training program.

MedStar Montgomery Medical Center is located in Olney, Maryland, in the north-eastern corner of Montgomery County. It has been a cornerstone of the community, with a long and rich history dedicated to serving the citizens of Montgomery and surrounding counties. The hospital views itself as a community health resource and states that its mission is “enhancing our community's health & well-being by offering high-quality, compassionate and personalized care.”

Faculty: Jacob Swartz, MD

Rotation: Consultation/Liaison Psychiatry & Integrated Care - Inpatient and Outpatient

Duration: 3 Months, 4 days per week

Description: Required three-month rotation in the first year at MedStar Georgetown University Hospital. During this rotation, fellows provide consultation to child and adolescent patients hospitalized on the pediatrics units at MedStar Georgetown University Hospital, including Transplant, Neurology, ICU, Hematology/Oncology, and general Pediatrics units. The rotation includes weekly supervision and multidisciplinary treatment rounds. Under the supervision of faculty, fellows conduct comprehensive evaluations and ongoing psychiatric treatment of children, adolescents and families with co-occurring medical and psychiatric illnesses. Fellows interact with ancillary professionals including nursing, social workers, art therapists, physical/occupational/speech therapists, clergy, and child life therapists.

Additionally, fellows have a number of other weekly, half-day experiences in outpatient consultation, including:

• Experiential Child Development Rotation: Additionally, fellows spend one half-day every other week at the Hoya Kids Learning Center, a preschool and pre-kindergarten school for typically developing children located on campus at Georgetown University. At Hoya Kids, fellows have no direct clinical obligations, but instead focus on observing typical developmental milestones and characteristics of the cognitive and social development of young children [please note Hoya Kids has not been open during the pandemic but is scheduled to reopen summer of 2021, and we hope to have fellows back there during the 2021-2022 academic year]. Fellows also spend one half-day every other week in the multidisciplinary Developmental Evaluation Clinic with Dr. Kathy Katz, one of our staff psychologists. This clinic focuses on assessment and treatment planning for infants with suspected developmental disorders, most of whom spent time in the NICU.
• Pediatrics Experience: Fellows spend one half day per week in the following Georgetown University pediatrics clinics: neurology, and integrated care clinic. During these “mini rotations”, fellows are directly supervised by Georgetown University School of Medicine faculty members and observe and participate in clinical assessments and treatment. Fellows also learn about providing integrated care consultation to pediatricians.

Faculty: C/L Rotation Director and Integrated Care Supervisor – Sean Pustilnik, MD; Child Development Rotation – Kathy Katz, PhD and Jane Banister, MA; School-Based Integrated Care Clinics – Swati Chanani, MD and Jessica Ouyang, MD; Pediatrics rotations - Neurology: Alexander Andrews, MD; Jessica Martin, NP; Paola Pergami, MD

Follow the links for further information:

http://www.medstargeorgetown.org/our-services/psychiatry/treatments/child-and-adolescent-psychiatry-program

http://www.medstarwise.org/

https://hoyakids.georgetown.edu/about

https://gucchd.georgetown.edu/DEC.php

Rotation: CAP 1 Assessment Clinic

Duration: 12 months, 1.5 hours per week

Description: Weekly, 12-month clinic experience during the CAP 1 year. Fellows conduct comprehensive evaluations of patients presenting with a variety of concerns with the structured guidance of Dr. Jeff Bostic as part of the CAP Division’s Center for Children and Families. The clinic uses a systems-based, family-centered positive psychiatry assessment approach that explicitly assesses the strengths of the identified patient, the family system, and the systems they are connected with and utilizes these strengths in treatment planning. Caregivers are also evaluated and provided with appropriate referrals as part of the family-based approach of the clinic. Families also fill out a comprehensive set of screening and diagnostic tools online prior to their initial visits using the CHADIS web-based patient data collection system, which allows fellows to focus more on developing a therapeutic alliance and deeply connecting with families as opposed to having to focus solely on information-gathering.

Faculty: Olivia Hamrah, MD

Rotation: Adolescent and Young Adult Intensive Outpatient Programs

Duration: 4 months, 4 days per week

Description: During this 4-month, 4 days per week rotation during the CAP 1 year, fellows work as an integral team member of both the MGUH Adolescent Intensive Outpatient Program and the MGUH Young Adult Intensive Outpatient Program. Fellows both co-lead and observe group psychotherapy sessions, conduct new patient intake visits, and see program participants for psychiatric care follow-up visits.

The intensive outpatient program for adolescents is for patients ages 13-17 who need more support than traditional once-a-week outpatient therapy can provide. The program’s mission is to inspire a pathway to wellness by teaching healthy coping skills, exploring identity, and building community through diverse, fun, and engaging programming in an open and accepting space.

The Young Adult Intensive Outpatient program is for patients ages of 18-26 and is designed to provide a higher level of care and support to help young people build the skills they need to manage their symptoms and navigate the transition to adulthood. The team includes experienced psychiatrists, psychologists, social workers, and care coordinators.

Example therapies fellows get exposure to include:

• Cognitive behavioral therapy
• Dialectical behavioral therapy
• Executive function skills group
• Mindfulness
• Movement-based therapy
• Development of coping and problem-solving skills
• Music and art therapy
• Nature-focused therapy
• Nutrition counseling
• EMDR

Faculty: Adolescent IOP - Michael Brachfeld, PhD; Swati Chanani, MD; Olivia Hamrah, MD;; Marika Martin-Coleman, PhD, LCMFT, CFLE; Rachel Neurohr, LGPC, NCC; Xiaoxi Ouyang, MD; Michelle Sobon, PsyD, MBA, ABSNP; Travis Spencer

Faculty: Young Adult IOP - Nauf Azad, DO; William Cohen, MD; Shyneice Porter, PhD, LMFT; Rachel Neurohr, LGPC, NCC; Xiaoxi Ouyang, MD

Rotation: Outpatient community mental health & integrated care

Duration: 12 Months, 2 days per week

Description: Required twelve-month, two full days-per-week rotation in the second year at Mary’s Center, a Federally Qualified Health Center that provides mental health care, primary care, sub-specialty medical services, and a range of social services to a primarily low-income and culturally diverse patient population in Washington, D.C. The majority of the patients seen have emigrated from Central America due to gang violence and/or lack of economic opportunity Other populations served include African-American/Black families, families from Northeast Africa, families from South America, and families local to Ward 5 and NE Washington, DC. Families are provided access to health care services regardless of their ability to pay.

Mary's Center, founded in 1988, is a Community Health Center that provides health care, family literacy and social services to individuals whose needs too often go unmet by the public and private systems. Mary's Center uses a holistic, multipronged approach to help each participant access individualized services that set them on the path toward good health, stable families, and economic independence. The Center offers high-quality, professional care in a safe and trusting environment to fellows from the entire DC metropolitan region, including individuals from nearly 50 countries, through 8 locations.

The fellows rotate in a clinic embedded within the primary care pediatrics clinic in the NW DC neighborhood, Petworth, where most of the patients attend school. Fellows spend one to two hours weekly in multidisciplinary case conferences and consultation team meetings with either the primary care team or the school-based mental health team. Fellows also spend two hours per week providing direct consultation to both primary care providers and the psychotherapy team. Faculty is on site and reviews each patient with the fellow to provide appropriate supervision and to ensure breadth and variety of caseload. During this rotation, fellows conduct comprehensive diagnostic assessments, provide psychotherapy and psychopharmacology treatment for patients in their own caseload, as well as provide consultation to pediatricians and social workers on a school-based mental health team. All patients must be seen for psychotherapy either by a social worker or by the fellow, and the Mary’s Center psychotherapy team provides a variety of evidence-based psychotherapies, including Parent-Child Interaction Therapy (PCIT), Child-Parent Psychotherapy (CPP), Dialectical Behavioral Therapy, CBT, Trauma-Focused CBT (TF-CBT), systemic family therapy, and Theraplay, as well as many expressive therapies, such as art and music therapy. Mary’s Center also has an active research division, and there are many opportunities for fellows to get involved with community systems of care research.

Faculty: Colin Stewart, M.D.

Follow the link for further information: http://www.maryscenter.org/

Follow the link for Mary’s Center’s 30th Anniversary Video:

https://www.youtube.com/watch?v=-vEWf-RR3w4&feature=youtu.be

Follow the link for a video about Mary’s Center from the United Way:

https://www.heroeffect.com/episodes/episode-4-marys-center/

Follow the link for a podcast about health care for Latino youth in DC featuring Mary's Center's Director of School-Based Mental Health, Marisa Parrella, LCSW:

https://thekojonnamdishow.org/shows/2018-04-12/for-latino-youth-health-is-about-much-more-than-just-healthcare

Rotation: Outpatient Infant and Early Childhood clinic

Duration: 12 Months, 0.5 days per week

Description: 12-month second-year rotation for one fellow one half-day per week. In this clinc, the fellow works alongside Dr. Emily Aron who is specially trained in early childhood mental health and has recently developed an early childhood mental health training program. Dr. Aron is certified in Parent-Child Interaction Therapy (PCIT), Child-Parent Psychotherapy (CPP), and Circle of Security, and fellows have the opportunity to gain their own certification in these therapies. The fellow will see patients ages 0-8 years old and mostly provide psychotherapy services to young children and/or their caregivers.

Faculty: Emily Aron, MD

Rotation: Clinical Neuroscience Elective

Duration: 6 Months, 0.5 days per week

Description: Six-month second-year elective opportunity for one half-day per week. Fellows meet with Haniya Raza, D.O., MPH, Deputy Chief of the Psychiatry Consultation Liaison Service at the NIMH, to learn about opportunities to get connected to a Principal Investigator (PI) who they can work with during an elective rotation. Fellows then work with their PI to set both clinical and scholarly goals. The NIMH is the lead federal agency for research on mental disorders. NIMH is one of the 27 Institutes and Centers that make up the National Institutes of Health (NIH), the largest biomedical research agency in the world. This rotation focuses on building up fellows’ understanding of both clinical research and clinical neuroscience.

Faculty: Joyce Chung, MD.; Maryland Pao, MD.; Haniya Raza, D.O., MPH

Previous Principal Investigators:

• Pedro Martinez, MD, Chief of the NIMH Reproductive Psychiatry Clinic
• Argyris Stringaris, MD, PhD, FRCPsych, Chief of the Mood Brain & Development Unit
• Kenneth Towbin, MD, Chief, Clinical Child and Adolescent Psychiatry, NIMH Emotion and Development Branch
• Audrey Thurm, PhD, Director, Neurodevelopmental & Behavioral Phenotyping Service

Please follow the link for further information: https://www.nimh.nih.gov/research/index.shtml

Rotation: School-Based Mental Health/Autism Spectrum Disorder/Intellectual Disability

Duration: 6 Months, 0.5 days per month

Description: Required rotation for second-year fellows, who spend one half day per week for two months at the Ivymount School in Rockville, Maryland. Fellows are under the direct supervision and teaching of Dr. Lance Clawson, an experienced volunteer faculty member who consults directly with the school. Ivymount is a nationally recognized school for children from preschool through early 20's who have autism spectrum disorders and/or intellectual disability.

For more than 55 years, Ivymount School has been a leader in special education, supporting independence and achievement for a diverse student population with complex learning needs. Currently serving over 200 students from the Washington DC metro area with developmental disabilities including autism spectrum disorders and other related disabilities, Ivymount School has a long tradition of providing innovative services to fulfill their mission. They offer a model and creative learning environment where all students can achieve their highest level of development. As leaders in the community and in the field of special education, their highly trained staff supports families in their efforts to make thoughtful, informed choices with their children so that progress and growth can be maximized.

Faculty: Lance Clawson, M.D.

Follow the link for further information: http://ivymountschool.ss11.sharpschool.com/

Follow the link to watch a video about Ivymount: https://youtu.be/3WQT2z0MRz4