Second year fellows continue the general, continuity clinic started in first year.  They typically continue with the caseload they developed over the first year, and may add patients as they become more comfortable and capable of managing a busy clinic schedule.  As in the first year, fellows are expected to carry at least one therapy case at a time, though many fellows choose to take on more cases.  They continue weekly supervision, though with a new supervisor.  The focus of psychotherapy in the second year is broader and may include family therapy, psychodynamic therapy, CBT, and aspects of play therapy. 

This rotation serves to complement the educational experience of the fellowship with a deeper focus on early childhood development and neurodevelopmental disorders, including developmental delays, autism spectrum disorder, and its comorbidities. This is a largely observation based rotation which takes place at Fraser Minneapolis, a nationally recognised provider of autism and early childhood mental health services.  Fellows have the opportunity to observe diagnostic assessments, including the ADOS, and feedback sessions with families.  They are also able to observe both children with various neurodevelopmental disorders and mental health concerns, as well as neurotypical children, in group settings group settings in order to make observational peer comparisons with typical and atypically developing children. 

Each week, for a portion of the year, fellows attend Family Consult Clinic with a psychology faculty member.  In this unique clinic, the lead psychologist, all participating fellows, and the family are present in the room.  This allows fellows to not only observe the family dynamics and the interventions of the psychologist, but to provide input as they become more comfortable with family interventions.  There is time for discussion of cases built into the clinic block.  Previous fellows have consistently reported this is a very high yield learning experience that increases comfort working with families and expands knowledge of dynamics and development.  This clinic also provides a valuable service, allowing fellows to refer patients and their families who are in need of family assessment or intervention. 

This rotation provides an opportunity to learn more about higher level schools and the services they offer, while gaining experience as a consultant.  The children in these level 4 schools have not been able to succeed in mainstream schools and need additional support due to neurodevelopmental disorders, mental illness, or other emotional and behavioral issues. Fellows spend a half day per week in the school, working with teachers, administrators, and support staff to optimize the interventions various children recieve.  In a consultant role, fellows must work to share their medical knowledge and style of thinking and formulating cases with the school staff.  The capacity to formulate a differential diagnosis, to include pertinent data in support of their formulation, and to then evolve a plan of treatment is not a common part of school teachers' experience and understanding of behavior.  This rotation also gives fellows a better understanding of the importance of collaborating with schools in psychiatry practice, they services they can offer, and their limitations.

This subspecialty clinic provides comprehensive evaluation for children and adolescents with anxiety disorders, who are often referred due to treatment resistance or diagnostic uncertainty.  Being able to understand complex differential diagnoses and interactions of biology and environment is an inherent part of this learning experience. The fellow leads the evaluation, which often includes gathering extensive collateral information and referring for neuropsychological testing.  Fellows learn to use tools such as the BASC (Behavior Assessment System for Children) and MASC (Multidimensional Anxiety Scale for Children) as part of their comprehensive assessment.  Fellows also attend the weekly Anxiety Round Table, a multidisciplinary case conference, which previous fellows have found to be an excellent learning experience. 

This rotation takes place in-person in the busy community clinic at Hennepin Healthcare in downtown Minneapolis. There are a mix of patients - some in-person and some virtual. On a rare occasion a fellow may need to do the entire clinic virtually. There is a higher percentage of patients at HCMC who use interpreter services.  I have not yet needed an interpreter for a visit, but I've been taught that they also join the zoom session from a remote location.  Note templates are available from Dr. Wermager.

In this clinic, fellows develop expertise in the assessment and development of a plan of care for children and adolescents with complex, treatment resistant, or difficult to diagnose mood disorders.  Fellows take special care to understand the risk and protective factors for each child and family, and how these play a role in the development of mood disorders in each child’s lifetime. There is also focus on differential diagnosis and formulation in these complex cases.  Fellows participate in a multidisciplinary assessment team which includes social work, psychology, and pharmacy.  They then typically continue to follow these patients for medication management, which provides the opportunity to continue to revise case formulations and to provide ongoing care to these patients and their families.  This clinic also includes a case conference with all members of the adolescent and young adult teams each week, during which new evaluations are discussed. 

In this clinic, fellows deliver care for patients with psychotic symptoms, a diagnostically challenging patient population which requires keeping in mind that various medical illnesses and developmental delays can mimic early onset psychotic disorders. This rotation is primarily spent performing assessments, work up and medication intervention for this patient population in the psychiatry clinic.  Fellows also have the opportunity to work with a faculty psychologist who completes evaluations of patients presenting with concerns for early psychotic disorders.  This unique opportunity provides fellows a chance to observe the triage process and neuropsychological testing, and to contribute to diagnostic clarification as part of a multidisciplinary team.  Fellows also take part in a weekly conference during which cases and relevant literature are discussed.