First-year fellows spend the majority of their clinical time on hospital-based services, including inpatient psychiatry, neurology, and consultation-liaison psychiatry. Given the value of longitudinally caring for children and families over the two-year fellowship, there are also outpatient expectations during the first year, including a weekly psychopharmacology continuity clinic and individual and/or family therapy cases.
- General Description
- Fellows spend two months on each one of the three child and adolescent units at Spring Harbor Hospital. During these rotations, fellows serve as the primary psychiatrist under the supervision of an attending psychiatrist. Fellows collaborate with social workers, pediatricians, occupational therapists, dieticians, and nurses to provide care that includes psychiatric evaluation, medication management, individual therapy, and family therapy. Supervision incorporates evidence-based practices and an appreciation of developmental theories and stages into the treatment planning for each child
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Inpatient Adolescent Psychiatry- 2 months
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Inpatient Child Psychiatry- 2 months
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Developmental Disorders Unit- 2 months
Hospital-based Programming at Maine Medical Center and The Barbara Bush Children’s Hospital
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Consultation & Liaison Psychiatry
- Location
- Duration- Four months
- Description
- The first-year consultation and liaison rotation orients fellows to the complexities of pediatric medical illnesses and their impact on the well-being of children and their families. Fellows learn about the roles of various providers on treatment teams, family dynamics in pediatric care, inpatient risk assessments, and the communication of diagnostic impressions and recommendations to patients, families and consulting providers.
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Pediatric Neurology
- Locations
- Duration- One month
- Description
- During this rotation, fellows engage with MMC pediatric neurologists as they provide inpatient consultative and outpatient services. They learn the fundamental principles of neurologic diagnosis in pediatric patients while becoming proficient in the neurologic examination of children of all ages and developmental stages.
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Systems of Care
- Locations
- Children’s Behavioral Health Services (CBHS) of the Department of Health and Human Services (DHHS)
- Child Protective Services (CPS) of DHHS
- Spurwink Residential Services
- Maine Behavioral Healthcare (MBH) Child and Adolescent Outpatient Community Services
- Palliative Care – Maine Medical Center
- InterMed Integrated Care
- Duration- One month
- Description
- This rotation helps strengthen fellows’ understanding of the multiple systems involved when children are in need of mental health treatment, including legal entities, DHHS, and the community as a whole. Maine is a complex state with respect to systems of care, and this rotation provides exposure to some of the state-mandated/supported levels of care.
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Scholarship/Quality Improvement
- Duration- One month
- Description
- This rotation allows first year fellows time to complete coursework in patient safety and quality improvement (PS/QI), to identify a scholarly project and quality improvement project which will completed by the end of the fellowship and to identify a mentor. There are many resources available at the institution and within the department to assist trainees in completing these projects including at the Maine Health Institute for Research.
Second-year fellows primarily learn and provide patient care in outpatient settings with an emphasis on consultation and increased time for longitudinal experiences and selective rotations.
Therapeutic School Observation & Consultation
- Location
- Duration- Two months
- Description
- Fellows have a unique opportunity to observe and engage in educational and therapeutic programming during their rotation at The Collaborative School, a private school serving students in grades K-12 who are eligible for out-of-district special education due to emotional and behavioral health needs.
Pediatric Forensic Psychiatry
- Locations Duration- Two months
- Description
- While at Long Creek Youth Development Center, fellows learn from staff clinicians , as well as specialists in corrections, special education, addiction services, and sexual abuse support and treatment. Through involvement in team meetings and observation of clinical interactions, fellows develop their skills in crisis intervention, risk assessment, and the multidisciplinary evaluation of an adjudicated adolescent.
- Fellows’ experience at the Spurwink Center for Safe and Healthy Families provides an education in inpatient and outpatient child abuse pediatrics (CAP) under the supervision of medical evaluators, forensic interviewers, psychologists, and other support staff throughout the state. Fellows observe and learn about parenting capacity evaluations and sexual behavior risk assessments.
Pediatric Emergency Psychiatry
- Location
- Duration- One month
- Description
- During this rotation, fellows provide psychiatric crisis evaluations and follow up assessments to aid in disposition planning to children and adolescents in the MMC Psychiatric Emergency Room.
Consultation to Outpatient Pediatrics Clinic
- Location
- Duration - twice monthly clinics, rotating schedule
- Description
- Fellows are available in pediatrics clinic for curbside questions or joint visits with pediatrics residents. The fellow develops consultative skills in this unique, embedded model. This integrated consultative model is supplemented by the Child Psychiatry/Pediatrics Resident Buddy System which pairs a child psychiatry fellow with several pediatrics residents to develop rapport and facilitate communication and curbside consultation over time.
Adolescent DBT
- Location
- Duration - 12 weeks
- Description
- Fellows co-lead an evidence based and manualized sixteen week adolescent DBT group for adolescents and their parent(s).
Child & Adolescent Substance Disorders
- Location
- Duration - one month
- Description
- Fellows have the opportunity to observe and consult to two adolescent residential substance use programs. Fellows learn from social workers and other staff at Day One, Maine’s leading agency in addressing teen substance use in residential, intensive outpatient, outpatient, school outreach, and homeless outreach programming.
Child & Adolescent Eating Disorders
- Location
- Duration - one month
- Description
- The NEED Program at Sweetser is the only comprehensive eating disorder treatment program in Maine. Partial hospitalization, intensive outpatient, and outpatient levels of care are available, and fellows learn about the development of treatment plans to meet the medical, psychological, social, and spiritual needs of patients of all ages.
Early Childhood Development
- Location
- Duration - one month
- Description
- Working with CDS, fellows participate in in-home assessments of children from birth to three years of age who have been referred with concerns that they may have special needs. They also spend time at a local preschool observing typically developing preschoolers and those identified as needing specialized services for learning, emotional, and/or behavioral problems.
Early-onset Psychosis
- Location
- Duration - two months
- Description
- The PIER program is nationally and internationally recognized for its interdisciplinary and family-centered model of early identification and intervention for psychosis in young people.
Selectives
Fellows can choose from the following one-month selective opportunities or work with supervisors to create a selective experience tailored to their specific clinical and/or research interests. Examples include:
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Gender Non-Conforming Youth
- Location
- Description
- Fellows observe and participate in specialized multi-disciplinary assessments of children and adolescents referred to the Gender Clinic. The Gender Clinic serves children of all ages with gender expansive behaviors in a family centered affirming model.
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Outpatient programming for children with autism and developmental disorders
- Location
- Description
- Fellows with an interest in developmental disorders may spend a month at the CADD Program, a comprehensive, multidisciplinary outpatient clinic and day treatment program with experts who are also involved in research and primary care consultation.
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Legislative advocacy
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College mental health
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Administrative psychiatry
Location
Description
- Throughout the two-year fellowship, our trainees serve as the primary psychiatrists for pediatric patients from toddlerhood through early adulthood. Fellows learn to serve various roles for patients and their families including medication management, combined treatment (medication and therapy), individual and family therapy. Additionally, fellows hone skills in outpatient consultation to primary care and pediatrics subspecialty physicians. Caseload expectations increase from the first year to the second year of the fellowship.
Department Philosophy on Supervision
- Fellows describe MMC Child & Adolescent Psychiatry Department faculty members as approachable, personable and knowledgeable. Faculty are invested and interested in the personal growth and development as well as the professional growth of each fellow. Though there are specific, scheduled supervision times detailed below, faculty members are open to questions as they arise and the culture is one of open doors and curbside questions.
Therapy & Psychopharmacology Supervision
- Each year, fellows are assigned two supervisors from our pool of faculty and adjunct community supervisors. Fellows meet with each of their supervisors once weekly. Fellows are provided with equipment and IT support to record their individual and family therapy sessions and are expected to receive feedback based on these recordings during their individual supervision.
Rotation Supervision
- Fellows often work alongside their rotation supervisors on a daily basis. At least once weekly, they are expected to have a more formal supervision time for clinical discussion and feedback.
On-call Supervision
- Fellows are on-call from home by pager, never more than five days in a month, with attending child psychiatrist back-up, for the Barbara Bush Children’s Hospital Consultation/Liaison Service and the Maine Medical Center Emergency Department Acute Psychiatric Unit (APU).
Summer Seminars
Every summer, fellows participate in our “summer boot camp” along with third-year general psychiatry residents. This serves as a helpful orientation for first-year fellows, an opportunity for review and teaching for second-year fellows, and a chance for fellows and residents from various years to become acquainted in a collegial environment. Specific courses include:
- Practice of Psychiatry
- Talking with Children Course
- Attachment and Infant Mental Health
- Developmental Psychopathology
- Pediatric Psychopharmacology
Year-Round Seminars
Fellows meet weekly to receive instruction in the following areas:
- Developmental Disorders and Psychopathology
- Pediatric Psychopharmacology
- Research Literacy, Patient Safety and Quality Improvement
- Systems-based Practice
- Patient Safety and Quality Improvement
- Transition to Practice
- History of Psychiatry
- Neuroscience
- Forensic Psychiatry
- Social and Cultural Psychiatry
- Therapy Training - fellows receive training in multiple modalities of psychotherapy including family therapy, Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH), Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), psychodynamic therapy and play therapy. Additionally, they receive introductions into working in other modalities and with specialized populations.
Family Therapy Seminar and Social and Cultural Psychiatry Course
The Child & Adolescent Psychiatry fellowship program aims for the recruitment and retention of a diverse and inclusive workforce.
The fellowship aims to incorporate principles of diversity, equity, accessibility and inclusion into everyday experiences from didactics and group discussions, to clinical work and supervision. As child psychiatrists, we work with marginalized patient populations and we must be aware of our own biases and our own intersectional identities including areas of privilege and marginalization. Faculty model and instruct fellows how to sensitively explore culturally ‘taboo’ topics such as poverty, domestic violence, substance use, gender and sexuality, race/racism, mental health stigma, etc. in our clinical work. These topics are explored in depth in the Family Therapy Seminar as well as in the Social and Cultural Psychiatry Course, a thirteen-session seminar including the following topics:
- Healthcare inequity
- The refugee experience
- Interpreter services as cultural brokers
- Assessing/addressing mental health needs in refugee/ethnic minority populations in Portland
- Working with gender and sexual identity minorities
- Working with racial and ethnic minorities
- Ability/disability- Deaf/deaf culture
- Art and antiracism with the Portland Museum of Art
- Spiritual issues in treatment
- MMC Department of Child & Adolescent Psychiatry Journal Club, monthly
- MMC Department of Psychiatry Grand Rounds, weekly
- MaineHealth Institute for Research "Introduction to Research" course
- MMC Pediatric Residency Program’s “Buddy System”
- Fellows engage in collaborative learning with pediatric and med-peds residents through a “Buddy System.” Pediatrics residents and child fellows are paired up to be available to one another to answer questions throughout the year. There are several shared learning sessions throughout the year.
- MMC Department of Psychiatry Annual Education Day/Visiting Professorship in Summer and Spring
- Completion of a Quality Improvement (QI) project
- Completion of a Scholarly Project
- Attendance at the Glickman conference, an annual child psychiatry conference
- Attendance at AACAP meetings and Legislative Advocacy day in D.C. is encouraged
Child & Adolescent Psychiatry Fellowship Diversity, Equity and Inclusion Mission Statement
The Department of Medical Education at Maine Medical Center is committed to actively pursuing and welcoming a wide range of perspectives and backgrounds. We believe that doing so will improve the academic environment, drive innovation, and enhance our ability to provide compassionate and patient-centered care to our patients and their families.
Our responsibility is to ensure a safe, inclusive culture, aligned with MaineHealth Diversity, Equity, & Inclusion policies, where each person has recognized value. We are committed to fostering a collaborative, respectful, and equitable environment where our learners, faculty, and teams can thrive in an ever-changing global community.
The Child & Adolescent Psychiatry fellowship program aims for the recruitment and retention of a diverse and inclusive workforce.
