Child Track Clinical Training

Metropolitan Human Services District Children and Youth Services Clinic

The Metropolitan Human Services District Children and Youth Services Clinic, located at 719 Elysian Fields Avenue in New Orleans, is a community-based, outpatient mental health clinic. The Clinic serves children, adolescents, and their families who reside in the city of New Orleans and the surrounding areas. Individuals, ages 0 to 21 years, are seen at the Clinic for behavioral, emotional, psychological, and/or psychiatric difficulties. This licensed community mental health center provides an array of services: screening and assessment; emergency crisis care; individual evaluation and treatment; medication administration and management; clinical casework services; specialized services for children and adolescents; and individual, dyadic, family, and group psychotherapy. The Clinic serves clients who are Medicaid-eligible.

Staff at the Clinic includes Tulane University School of Medicine faculty members from the Department of Psychiatry and Behavioral Sciences, Section of Child Psychiatry. The mental health disciplines represented at the Clinic include social work, psychology and psychiatry. Trainees from psychology and psychiatry rotate through the Clinic. The Clinic offers a continuum of care for various levels of acuity. Comprehensive evaluations are conducted once a patient is referred to one of the services offered by the Clinic. The Clinic is open Monday through Friday, and services are provided by appointment only. The interns conduct various interventions at the clinic. Depending upon the needs of the patient, these may include intake evaluations, psychological testing, consultation, and psychotherapy, including evidence-based approaches. The Clinic is comprised of a general clinic, which serves primarily youth with histories of trauma and/or diagnosis of ADHD, and two specialty clinics, one which offers Infant Mental Health services for children under 6 years of age, and one which offers intervention and assessment services to young adults ages 18-21 years in the Transition Age Youth Clinic. The interns can see clients with any presenting problem, including Infant Mental Health needs. The emphasis is on the provision of therapy services, although interns may conduct psychological assessments depending on availability and need.

As part of this clinical training experience, the interns will:

• Evaluate and recommend appropriate treatment for the child and family presenting to the Metropolitan Children and Youth Services Clinic.
• Develop competence in the intake process. This includes defining the presenting problems, making the first contact, ascertaining commitment on the part of parents or caregivers, helping promote a firm commitment from the patients and family, planning the evaluation, and identifying and addressing mental health emergencies.
• Develop competence in the evaluation process. This includes involving all significant parents or caregivers, if possible, taking complete individual and relationship histories, as appropriate, recording the child's developmental history, and formulating a working diagnosis and case conceptualization.
• Develop an understanding of the importance of family dynamics in psychopathology.
• Discuss the use of conjoint approaches, family therapy approaches, and the referral of family members to other therapists, if appropriate.
• Develop developmentally appropriate skill in the use of play techniques to facilitate emotional expression and contribute to the therapeutic process.
• Develop skills to evaluate children and families and young adults in an outpatient clinical setting, formulate reasonable differential diagnoses and recommendations for treatment and/or follow up information, and convey results of evaluations to mental health or allied professionals also assigned to the cases.
• Develop the ability to competently perform the treatment and other intervention services the child, caregivers, and/or other family members or young adults require for symptom remediation and improvement in functioning.
• Develop skills to effectively and cooperatively function in a multidisciplinary team, including participating in team staff meetings and providing case consultation when requested by other team members.
• Document all work according to State and accreditation standards.

Interns on the Child Track with the Infant Mental Health major area of study spend two days a week here all year.

Primary Supervisor: Dr. Valerie Wajda-Johnston

Tulane Comprehensive Assessment and Treatment Team

The Tulane Comprehensive Assessment and Treatment Team (T-CATT) provides intensive intervention for maltreated children, birth to age 17 years, and their caregivers in Jefferson, Orleans, and other parishes in Southeast Louisiana. The team works collaboratively with a variety of systems to provide assessment and treatment for this high-risk population. All referrals to the team come from the Department of Children and Family Services (DCFS, the state Child Protection Agency) and involve cases of suspected or validated abuse and neglect of children. Children who are referred for T-PEP services may remain in their homes. For these families, intervention is provided to assist in preserving the placement with biological parents. Alternatively, when safety issues are of significant concern, DCFS places children in non-family foster homes or with relative caregivers while the biological parents address the impediments to their safe, effective parenting. T-CATT is located at 1340 Poydras Street, near the New Orleans Superdome, about one-half mile from Tulane University Medical Center.

The Tulane Comprehensive Assessment and Treatment Team is staffed by a multidisciplinary group of faculty and trainees from Tulane University School of Medicine, including child psychiatrists, clinical and developmental psychologists, clinical social workers, pediatricians, parent educators, and paraprofessionals, all of whom have knowledge of infant and child development and developmental psychopathology. There is a weekly clinical case conference, which includes the entire T-CATT team and, at times, DCFS caseworkers and supervisors, Bureau of General Counsel attorneys, and DCFS senior administrators. Clinicians present a case to the group, sometimes including video excerpts selected for the illustration of individual, dyadic, and family characteristics. This conference is used to develop specific recommendations about what will be required to intervene in a culturally responsive manner with a child and his or her biological and/or foster parents. Clinical decision-making skills are modeled at the weekly case conference. Interns are also exposed to the forensic process and, on very rare occasions, may have the opportunity to testify in Juvenile Court. All children are referred due to prior maltreatment and many display a range of behavioral, social-emotional, psychiatric, and relationship-based difficulties. In the last year, for example, the traumatic effects demonstrated by the infants and young children referred for services ranged from clinical diagnoses of Post-Traumatic Stress Disorder and Disinhibited Social Engagement Disorder to a variety of subclinical manifestations, including sleep disturbances, hypervigilance, concentration difficulties, distressing memories, irritable behavior, disturbed social relatedness, toileting difficulties, sexualized behavior, aggressive outbursts, and social withdrawal. Regarding ethnicity, the population served is 6% Hispanic/Latinx and 94% non-Hispanic/Latino. Regarding race, the patient base is 52% Caucasian, 42% African American, and 6% Hispanic/Latinx. Approximately 6% speak Spanish primarily. Fifty-five percent are female. The majority of families are low-income and most parents have low levels of education.

The T-CATT faculty specializes in assessment and intervention with children under age 6 years and interns receive specialized Infant Mental Health training at this site. Interns may treat 1-2 selected cases of children older than age 6 years. Interns receive weekly individual supervision, in addition to weekly group consultation with the entire team. Hands-on-training in the procedures used by the team occurs on a regular basis.

As part of this clinical training experience, the interns will:

• Acquire skills in the evaluation techniques used by the team, including intake interviews, caregiver-child interaction procedures, caregiver perception interviews, possible home visits to biological parents', relatives' and foster parents' domiciles, possible visits to schools/childcare centers, and various ancillary assessments.
• Develop skills in various therapeutic interventions, which may include individual play therapy with children, individual psychotherapy with caregivers, dyadic caregiver-child psychotherapy, couples psychotherapy, group therapy and family therapy. Evidence-based and evidence-informed therapies may be provided when indicated, including Parent-Child Interaction Therapy, Child-Parent Psychotherapy, Cognitive Behavioral Therapy for PTSD, and Circle of Security Intervention.
• Learn to work on a multidisciplinary team.
• Gain experience collaborating or consulting with professionals from other agencies including DCFS, Court-Appointed Special Advocates (CASA), substance abuse counseling, developmental and special education services, and adjunctive therapies to strengthen family functioning.
• Document all work according to State and accreditation standards and produce reports for forensic and legal consumers.

The Child Track interns with the Infant Mental Health concentration work here two days a week all year.

Primary Supervisors: Dr. Julie Larrieu and Dr. Devi Miron Murphy