Clinical Training Program

Application Criteria:

Completed Adult Psychiatry Residency in good standing at ACGME accredited institution Adult Psychiatry Board certification eligible/board certified New York State license required.

Application process:

Please email training@themotherhoodcenter.com the following documents:

• Cover letter

• CV

• Statement of interest

• 2 letters of recommendation

Please email all materials together. The application deadline is November 15, 2021. Interviews will be conducted throughout the fall.

Length of program & time commitment: 1-year, full-time position (40 hours per week) or part-time position (24 hours per week). The start date is projected for July 2023. Start dates can be flexible for off-track trainees.

Salary: The position has a standard base salary of $100,000+ per year for a full-time position, in addition to benefits provided to all Motherhood Center staff.

Description of setting: The Motherhood Center is a unique combination of an OMH-licensed Partial Hospital Program and an outpatient practice, co-located in a warm, modern setting in mid-town Manhattan. The Mother Center serves women with a wide range of psychiatric disorders who come from different age groups, and socioeconomic and ethnic backgrounds. The Motherhood Center is pleased to extend its commitment to excellence in academic training to fellowship applicants interested in learning how to treat perinatal women in both an acute, and partial hospital setting as well as in brief and long-term outpatient psychotherapy.

The Motherhood Center is an equal-opportunity employer and is deeply committed to maintaining a diverse and inclusive community amongst its staff, trainees, and clients. We seek to increase diversity across race, ethnicity, national origins, gender and gender identity, sexual orientation, disability, and socioeconomic background. We host monthly didactics that are dedicated to educating our entire staff and addressing clinical issues related to diversity and inclusion.

Description of agency mission: The Motherhood Center provides supportive mental health services for new and expecting moms, including a range of treatment options for women suffering from perinatal mood and anxiety disorders (PMADs). Staffed by experienced professionals, we take an interdisciplinary approach to evaluating and treating women before, during, and after pregnancy.

Description of standard fellowship experience: The Motherhood Center Women’s Mental Health Psychiatry Fellowship is a unique training experience that bridges women’s mental health in the perinatal period with an emphasis on attachment and dyadic work with the infant.

• Conduct psychiatric intakes with diagnosis, treatment planning, and coordination of care.

• Provide individual medication management.

• Assess early childhood development and the quality of the mother-infant dyadic attachment in our on-site nursery.

• Conduct and hone skills in individual psychotherapy for partial hospitalization programming in a number of modalities, with a specific focus on optimizing treatment for perinatal patients. Individual psychotherapy may be psychodynamic, behavioral, and/or dyadic in orientation.

• Develop group psychotherapy skills in IPT, DBT, and/or Dyadic in orientation. Five groups run daily for partial hospitalization program patients. Fellows will have the opportunity to either co-lead and/or independently run group therapy sessions each week.

• Learn family and couples therapy. Intensive supervision, with an expert in the field, focusing on various techniques addressing the management of current stressors, communication patterns, adjustment to new roles, and addressing adaptive and maladaptive intergenerational patterns in the family.

• Receive supervision: Supervision will be provided for medication management, psychotherapy, group therapy, and psychiatric intakes. Weekly group medication management supervision with Dr. Catherine Birndorf/Dr. Albertini

• Attend and participate in daily rounds with an interdisciplinary team of psychologists, psychiatrists, social workers, and medical practitioners.

• Collaborate with all members of The Motherhood Center staff and interact with patients in both the partial hospitalization day program and outpatient program.

Outpatient experience: The fellow will treat pregnant and postpartum women who require treatment due to perinatal mood and anxiety symptoms, attachment/bonding issues, traumatic birth experiences, or acute psychiatric crises. Fellows will carry a full caseload of individual medication management +/-psychotherapy cases, conduct weekly psychiatric intakes, co-lead one group therapy session per week, and participate in dyadic and family/couples’ treatment in both the partial hospitalization program and the outpatient program.

Seminars & conferences: The fellowship position will include access to ongoing didactics and case conferences to help deepen the clinician’s knowledge in the following topics: perinatal psychiatry, short-term psychodynamic psychotherapy, dyadic therapy, dialectical behavior therapy, trauma, personality disorders, psychopharmacology, couples/family therapy, systems of care, case formulation and professional development. Additionally, fellows will participate in weekly didactics conducted by the National Curriculum for Reproductive Psychiatry.

Scholarly project: Over the course of the one-year fellowship, the fellow will be mentored in the development of a scholarly project of their choice, related to PMAD’s. This can include an independent research project, review article, case study, or book chapter. It may also include a presentation at a professional conference.

Supervision arrangements/ratio: The fellow will be provided with at least 4 hours of the following weekly supervision: Medication management, case formulation, individual psychotherapy, and group psychotherapy with Drs. Catherine Birndorf, Elizabeth Albertini, and Nicole Van Nortwick as well as other members of the team.

Site Director/Host: Nicole Van Nortwick, PhD: Director of Outpatient Services & Clinical Training: nvannortwick@themotherhoodcenter.com Elizabeth Albertini, MD: Associate Director of Medical Training: ealbertini@themotherhoodcenter.com Catherine Birndorf, MD: Medical Director: cbirndorf@themotherhoodcenter.com Description of Rotation: During the Women’s Health elective, residents will be exposed to a unique treatment setting that provides services for new and expecting mothers and their partners, including a range of treatment options for women experiencing perinatal mood and anxiety disorders. The resident will ultimately be expected to assess and manage these patients using various biological and psychosocial treatment modalities under general supervision from the Center’s staff. This rotation will include evaluating new and acute perinatal patients, seeing follow-up cases for medication management and some psychotherapy, participating in specialized evaluations such as pre-conception consultations, and co-leading groups in the perinatal partial hospital program. There will be an orientation for the resident at the outset of their rotation, weekly supervision, and participation in didactics. There are currently two “tracks” being offered that would cater to different interests of trainees. PHP track: Residents would elect to come for 5 days a week for 4-6 weeks, from 9 am until approximately 3 pm. They would participate in evaluations of new patients, manage a caseload of 2-3 PHP patients, co-lead groups, and participate in daily rounds. Outpatient track: A one-day-a-week rotation for a 6-month commitment (4 months would be considered on a case-by-case basis) from 9 am-5 pm. Emphasis would be on conducting evaluations, offering medication management, and utilizing psychotherapy interventions. Trainees would also have the opportunity to participate in weekly group therapy in the PHP program in order to gain knowledge of behavioral interventions used in this population. The knowledge, associated skills, and attitudes to be acquired during this elective, as part of the PGY-4 year of residency in order to demonstrate progress toward achievement of the core competencies are: Patient Care – residents will be expected to:

• Refine their performance of the psychiatric interview and of the mental status examination to incorporate special attention to the issues pertinent in women in the peripartum period. They will be expected to integrate this information into a bio-psycho-social formulation that is specific to each patient’s illness and presentation.
• Formulate and document appropriate diagnoses utilizing the criteria in the DSM-5, including but not limited to depressive disorders, anxiety disorders, OCD, PTSD, and bipolar disorders.
• Recognize any co-occurring psychiatric, psychological, interpersonal, and medical, disorders which may occur in women during their pre-conception or peripartum periods.
• Identify and recommend appropriate pharmacological treatment for diagnosed psychiatric disorders and be able to properly consent the patient for their use, including, at a minimum, the indications, side effects, risks and benefits. The resident must be able to participate in an informed and compassionate conversation about the indication of medications in this patient populations.
• Collaborate with the patient’s obstetrical providers when appropriate and when consented to by the patient.
• Recognize the necessity of inpatient psychiatric referral when present.

Medical Knowledge – residents are expected to:

• Refine their knowledge of the DSM-5 criteria for peripartum mood and anxiety disorders, sexual dysfunctions, relationship distress with a spouse or intimate partner, spouse or partner abuse or violence, phase of life problems, problems related to unwanted pregnancies or multiparity, and other conditions that are diagnosed.
• Understand the unique impact that hormones in the peripartum period can have on a patient’s mental state and /or mood.
• Be sensitized to the presentation of postpartum psychosis, infanticidal fantasies, or suicidal ideations.
• Understand the difference between the “baby blues” (i.e., normal adjustment to childbirth) and PMADs.
• Understand the changes that may be necessary with psychopharmacologic medication dosing before, during, and after childbirth as a result of the changes in the volume of distribution of the mother.
• Recognize the signs and symptoms of any substance use disorders in the mother or the newborn.
• Be introduced to concepts of Attachment Theory and Dyadic Treatment.
• Become familiar with the concept of Adverse Childhood Events (ACE’s) and how to identify them in the context of the new mother.

Practice-Based Learning and Improvement – residents are expected to:

• Use information technology to access online medical information related to treatment of illnesses and conditions that affect women.
• Refine their skills in collaborating with other healthcare professionals in the fundamentals of supportive therapy for perinatal conditions.
• Evaluate, measure, and utilize at least three measures of clinical effectiveness during the rotation. The resident would be expected to work with their supervisor to devise possibilities.
• Be able to function independently with minimal supervision from the attending.

Interpersonal and Communication skills – residents are expected to:

• Refine their communication skills with female patients and their partners about their ongoing treatment and goals for the future.
• Empathize with patients suffering from perinatal mood disorders so as to understand the effect of the illness/condition on their lives.
• Communicate with other treatment providers, both at the Center and on the patient’s healthcare team.
• Work with the Center’s staff to determine the best discharge plan for the patient.
• Write clear, legible, well-organized, accurate and appropriately detailed psychiatric notes, evaluations and consults when necessary in a timely manner.

Professionalism – residents are expected to:

• Arrive on time to perform the psychiatric evaluations, see follow up patients, and participate in other modalities of care of the Center.
• Inform the supervising attending at the beginning of the month of the times that the resident will be unavailable due to meetings, vacation, patient care responsibilities, etc.
• Relate to patients, their family and concerned others with compassion, respect, and professional integrity
• Develop the necessary objectivity, initiative, judicious decision making, and foresight inherent in the role of more complex and responsible patient care and administrative positions.

Systems-Based Practice – residents are expected to:

• Gain experience and understanding of the frequently complex medical, vocational, financial, and psychosocial needs of families during this time in their lives.
• Gain experience and understanding of different women’s health programs available to patients in the community.
• Gain experience in placement of patients in aftercare programs in both the inpatient and outpatient setting.
• Be familiar with different insurance issues that may arise during care.
• Be familiar with resources available through groups such as:
  • The Office of Women’s Health: https://www.womenshealth.gov/mental-health
  • The National Institute of Mental Health: https://www.nimh.nih.gov/health/ topics/women-and-mental-health/index.shtml
  • The World Health Organization: https://www.who.int/mental_health/maternalchild/en/
  • The American Psychiatric Association: https://www.psychiatry.org/ psychiatrists/practice/professional-interests/women
  • Postpartum Support International: www.postpartum.net
  • MGH Center for Women’s Mental Health: www.womensmentalhealth.org

Teaching Methods

• Clinical Teaching
• Role Modeling
• Individual Supervision
• Reading Material Provided

Assessment Methods (of residents)

• Resident’s Global Performance Evaluation - by Attending

Assessment Methods (of program)

• Evaluation of Teaching Faculty
• Evaluation of Clinical Rotation
• Annual Psychiatry Residency Program Evaluation

Measures of Clinical Effectiveness or Data used to demonstrate clinical effectiveness:

• Rating scales and interval comparison
• Patient Surveys
• Clinical Interviews
• Discharge criteria

Level of supervision

• Resident receives daily supervision from the service attending. All cases seen by resident are supervised by the attending. This supervision includes discussion of diagnosis and treatment plan for the patient. There is also time allocated separately to discuss any other questions that arise in the context of substance use not necessarily related to the patients seen that day.

Elective Requirements

• At least one case conference or journal article presentation during didactic hour

Suggested Reading:

• Relevant literature to be provided