• The Postpartum Depression Day Hospital, the nation’s first mother-baby perinatal psychiatric partial hospital devoted exclusively to treating pregnant and newly postpartum women.  It is located at Women & Infants Hospital. The program is designed to keep mothers and their infants together during treatment to foster bonding and attachment, avoid separation of mother and baby, support breastfeeding mothers and directly assess and design interventions focused on the day when impacted by maternal mental illness. This rotation will introduce the fellow to the recognition and treatment of perinatal psychiatric disorders. The fellow will function as a member of our multi-disciplinary treatment team and be expected to participate in daily clinical rounds, conduct first-day admission evaluations and make pharmacological recommendations, co-lead psychotherapy groups, conduct family sessions, conduct short-term individual psychotherapy, provide ongoing medication management and participate in discharge planning. The fellow will receive training in various therapeutic modalities and become familiar with psychopharmacology in pregnant and breastfeeding women.

• Perinatal substance abuse experience is comprised of training in substance use assessment and treatment in outpatient and inpatient settings. Outpatient settings include the Center for Women’s Behavioral Health, where a significant percentage of pregnant as well as post-partum women present with dual diagnosis. Substance use treatment focuses on early recovery, relapse prevention, parenting skills, smoking cessation, domestic violence, and self-care.  The fellow will gain expertise in the pharmacologic management of substance use disorders and dual diagnosis issues in this population. Evidence-based therapeutic approaches in addiction treatment, such motivational interviewing, DBT for substance use and attachment based work will also be discussed. On our Consultation-Liaison Service, the fellow will gain expertise in the treatment of withdrawal from different substances (Opioids, Benzodiazepines and Alcohol). The fellow will gain a broader understanding of opioid dependence and its effects on the baby, by working with the Pediatrics team treating Neonatal Abstinence Syndrome. As a result of this comprehensive experience, the fellow will be comfortable providing care for pregnant or postpartum women with substance abuse disorders and comorbid psychiatric issues.

• Psychiatry Consultation–Liaison Service provides the fellow the opportunity to develop expertise in providing inpatient psychiatric consultation in an OB-GYN hospital setting with multiple clinical services, including postpartum, high-risk obstetrics, gynecologic oncology, gynecology, a 24-hour Obstetric Emergency Department, and an 80-bed NICU. Fellows will provide consultation to both academic and private clinical teams.  The consultation team works closely with the hospital clinical social work department to identify patients in need of psychiatric intervention. Additionally, the fellow will gain experience in clinical bedside teaching and supervision with rotating PGY-2 general psychiatry residents and MS-4 medical students on this service. 
   
• Brexanolone (Zulresso™) is currently the only FDA approved medication for postpartum depression and requires a 60 hour infusion during a hospital admission. Our fellows have the opportunity to gain experience in this hormonal treatment modality. During their year-long fellowship they have the opportunity to evaluate and refer patients for brexanolone infusion and manage their treatment during their hospital admission at Women and Infants Hospital, as well as following the infusion. 
   
• Women’s Partial Hospital Program is a day-hospital program at Butler Hospital that treats women who are chronically suicidal and who meet the criteria for Borderline Personality Disorder. The Women’s Dialectical Behavior Therapy (DBT) program combines individual therapy and group skills training to address the behavioral, emotional and cognitive patterns that underlie their problems in living. The fellow will work closely with the clinical staff at this program to learn about the care and stabilization of this patient population.
   
• Women’s Behavioral Health longitudinal outpatient experience will provide the fellow with a longitudinal experience in the outpatient psychopharmacologic and psychotherapeutic care of pregnant and postpartum women. Additionally, the fellow will gain expertise in pre-conception counseling for women planning a pregnancy. They will also be trained and practice various forms of psychotherapy in this population, including interpersonal therapy, cognitive behavioral therapy and psychodynamic psychotherapy with a focus on attachment issues.

Fellows will have the opportunity to add elective experiences in addition to the core curriculum at the following clinical sites as part of their training experience. Some of those elective experiences are highlighted below:

• Consultation Clinics:  The fellow will have the opportunity to provide outpatient psychiatric consultation to a variety of women’s health populations.  These sites include the Obstetric Medicine Clinic (providing internal medicine care to pregnant women with ongoing medical problems), Gynecologic Oncology (providing care to women with gynecologic and breast cancer), and Reproductive Endocrinology and Infertility.  The fellow, in collaboration with supervisors, will evaluate patients and provide liaison work with women’s health colleagues while simultaneously learning about the intersection of mental health and medical illness.
• Interpersonal Psychotherapy and Perinatal Loss Experience:  The fellow will be able to receive clinical training and supervision in interpersonal psychotherapy, a widely researched and validated treatment for postpartum depression, as well as psychotherapy with patients experiencing perinatal loss.  They will develop a theoretical framework for the understanding of loss that includes pregnancy attachment, parenting tasks, and normal grief.  Psychotherapy supervision will be provided by faculty with specific training and experience in IPT.

Other electives opportunities include:

• Trauma assessment and psychotherapy
• Dialectical behavior therapy in the perinatal patient
• Psychodynamic psychotherapy in the perinatal patient
• Perimenopausal mood disorders

Fellows will participate in focused scholarly activity throughout the duration of the 12-month fellowship under the mentorship of Dr. Cynthia Battle or another women’s mental health expert who serves as a member of the program’s faculty. The specific nature of the scholarly activity will vary depending on the individual fellow’s interests, research background, and future career goals. The two primary goals of this component of the fellowship are: 

1. to promote the fellow’s skills as a critical consumer of the medical and scientific literature relevant to women’s mental health and perinatal psychiatry, and
2. to develop an area of focused expertise on a specific topic related to women’s mental health.

In the initial phase of the fellowship year, the fellow will meet with the research director of the fellowship to develop an individualized plan for their scholarly component, and to identify a primary scholarly advisor. Throughout the course of the year-long training experience, the fellow will have protected time to devote to their scholarly goals (approximately 3-4 hours/ week), including regular supervision from their research advisor. Ultimately, the scholarly activity component of the fellowship is expected to culminate in either an external scholarly presentation (i.e., an abstract presented at a scientific conference, grand rounds presentation) or in an original manuscript to be submitted for publication. Through these scholarly activities, the fellow will hone their skills in evaluating the quality of published research, gain practice in reviewing and coherently synthesizing research, and will produce a final product that demonstrates their expertise in an area of study directly relevant to women’s mental health.