Rotation Director: Mona Dreier, PhD, LCSW
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 and staff consist 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-year-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 fellow 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.
Parent Infant Clinic (PIC)
Rotation Director: Wendie Klapper, PhD
This rotation takes place one morning weekly on an outpatient basis for six months. The main components of the PIC rotation will include conducting evaluations of parent infant interaction and attachment, administering developmental screenings, writing up evaluations and screenings and conducting a Family Forum. During this rotation, fellows will acquire knowledge of normal infancy and early childhood development and normal parent-infant interactions. They will understand the stages of parent development and the emotional/behavioral disorders of infancy and toddlerhood in the DSM–IV–TR. They will develop knowledge of attachment classifications and the impact of parental risk factors (e.g. maternal depression, trauma) on the attachment relationship. They will be able to recognize the risk factors for child abuse and neglect and identify parental behaviors and child risk factors than can place an infant at risk. Fellows will develop skills in identifying attachment classifications and patterns, an ability to observe parent-infant and toddler interactions and understand how one member of the dyad impacts the other. He/she will diagnose disorders of infancy and toddlerhood, conduct an infant mental status assessment, obtain a thorough developmental history and observe and interpret non-verbal forms of communication. The fellow will conduct and write up a comprehensive evaluation of a parent-infant dyad and developmental screening, read a developmental screening with a critical eye and provide feedback to parents regarding the screening results and intake evaluation. He or she will have an awareness and sensitivity towards cultural factors that impact assessment and intervention, an understanding of the importance of a therapeutic stance to observation, assessment and intervention and an empathic understanding of the struggles of parents and their young children.
One Gustave L. Levy Place
New York, NY 10029