1 ALBERT EINSTEIN COLLEGE OF MEDICINE of YESHIVA UNIVERSITY/ CHILDREN S HOSPITAL at MONTEFIORE DEPARTMENT OF PEDIATRICS DIVISION OF DEVELOPMENTAL MEDICINE The Division of Developmental Medicine of the Department of Pediatrics at Einstein/Montefiore is the academic home of the Rose F. Kennedy University Center for Excellence in Developmental Disabilities (RFK UCEDD). Funded by a grant from the Administration on Developmental Disabilities of the US Department of Health and Human Services, the UCEDD is one of only 68 such entities in the United States and one of three in New York State. The mission of the UCEDD is to improve the lives of individuals with developmental and other disabilities through clinical service, the training of the next generation of leaders in the field of developmental disabilities, and performing research to find treatments for the conditions that affect our clients. Lives are also improved through active and ongoing advocacy performed by the Division s staff, in partnership with our clients and their families, at the local, regional, state and federal levels. The RFK UCEDD is composed of three subdivisions: The Children s Evaluation and Rehabilitation Center (CERC) is the clinical arm of the UCEDD, providing services to some 7500 children and adults with developmental and related disabilities. The Leadership Education in Neurodevelopmental Disabilities (LEND) project is an integral part of the UCEDD s training program. One of only 44 such programs in the US and funded through a grant from the Maternal and Child Health Bureau (MCHB) of HRSA, the RFK UCEDD s LEND provides short, intermediate and long-term training to more than 1,000 professionals from 19 disciplines each year. Under the direction of John J. Foxe, Ph.D., the UCEDD s Division of Research is the newest addition to our program. In the summer of 2011, the Division of Research formed the centerpiece for the resubmission of the Rose F. Kennedy Intellectual and Developmental Disability Research Center. Funded by the National Institute of Child Health and Human Development of the NIH, the RFK IDDRC is one of only 15 such institutions in the US; it is directed by Steve Walkley DVM; Dr. Foxe is Associate Director of the IDDRC. Taken together, the Division of Developmental Medicine is one of only five institutions in the US that house a UCEDD, LEND project and IDDRC. The Division is directed by Robert Marion, M.D. and is composed of some 35 faculty members from a variety of disciplines, including developmental-behavioral pediatrics, rehab medicine, special care dentistry, psychology, psychiatry, genetics, social work, audiology, ENT, ophthalmology, etc.
2 But although the UCEDD s mission is broad, it is clearly clinical service to our community that is at the forefront of our activities. Again, the clinical arm of the Division is the Children s Evaluation and Rehabilitation Center (CERC), which throughout the Bronx is also known as the Rose Kennedy Center. A description of CERC follows. THE CHILDREN S EVALUATION AND REHABILITATION CENTER: Since its founding in 1956, CERC has provided a broad spectrum of services for infants, children, adolescents, and, despite its name, adults, with conditions that include autism, learning disabilities, cerebral palsy and other developmental disabilities. One of the largest facilities of its kind in the United States, CERC is a voluntary, nonsectarian center whose services are essential components of the care available to individuals in the Bronx and New York metropolitan area with a wide array of developmental disabilities. Every year, CERC s professional staff provides over 58,000 diagnostic, therapeutic and related services to about 7,500 children and their families. Included in this patient population are more than 1,000 individuals seen each year with autism, as well as a large number of children, adolescents and adults with learning disabilities. CERC s staff, composed of more than 150 health-care professionals, includes representative from the following fields: Developmental-Behavioral Pediatricians Pediatric Neurologists Physiatrists (Pediatric Rehabilitation Medicine Specialists) Psychiatrists Ophthalmologists Orthopedic Surgeons Otolaryngologists (Ear, Nose and Throat Specialists) Dentists Psychologists Learning Disabilities Specialists Special Education Instructors Speech and Language Pathologists Social Workers Pediatric Nurse Practitioners Occupational and Physical Therapists Audiologists Nutritionists Geneticists Genetic Counselors These highly trained, well-qualified specialists provide comprehensive diagnostic assessment and treatment through a variety of interdisciplinary and specialized programs. These programs are briefly described on the following pages.
3 Clinical Services Our patients come from a variety of sources. They are referred by physicians, managed care organizations, clinics, schools, community service agencies, other patients or through selfreferral. Residents of New York City covered by Medicaid or other insurance plans are charged on a sliding fee scale based on income and family size. Patients living outside New York City who are not covered by New York State Medicaid are charged full fees. Care at CERC is a family affair. The family plays an important role in the diagnosis and treatment planning process, which is performed as a team effort, using input from the evaluating clinicians and the patient's parents and guardians. Follow-up services, family support, and advocacy (in order to assure that the patient is getting the services he or she needs in the optimal setting) are also available to all clients and their families. Interdisciplinary Units As noted above, the professionals who make up our staff are arranged into specialized programs, or teams. The teams of CERC are described below: Infant and Toddler Team (ITT) Providing a family-based diagnostic assessment of children from birth to 3 years of age who have or are suspected of having developmental delay, the ITT provides evaluations for approximately 275 children each year. The evaluation process begins with a diagnostic screening to elicit the family s concerns and identify problems. It ends with the development of a therapeutic plan tailored to meet the child s needs. The ITT is composed of three other programs: RELATE, which provides services to very young children with autism and autistic spectrum disorder; Baby Team, and the Early Intervention Program, which provides ongoing care to young children with developmental delays. Following the initial evaluation, all children seen at the ITT are provided with a series of recommendations for therapy and/or treatment. In all cases, follow-up services are offered. Early Childhood Center (ECC) The ECC provides therapeutic intervention for toddlers and preschool age children with developmental delays and disabilities who have associated behavioral difficulties. Infants referred to the ECC receive psychotherapeutic supports, developmental therapy, and/or behavioral interventions individually, in groups, and in sessions with their parents or caregiver. Parent groups enhance the guidance, support, information, and advocacy offered to families. Developmental and psychotherapeutic supports are provided to young children in foster care, and guidance is provided to foster parents and child welfare personnel to support children s progress and adjustment. An Infant Mental Health Program provides therapeutic services to infants with developmental and emotional/behavioral problems, and preventive services for infants who are at risk due to problems in their caregiving environments. All services are available in English and Spanish. In 2006, the ECC opened a new program, the Center for Infants, Toddlers and Families, to better serve its patient population. Located in the community around Einstein, the new Center was
4 founded with support from the Robin Hood Foundation, the Women's Division of the Albert Einstein College of Medicine, and New York City. Infant and Preschool Unit (IPU) This multi-disciplinary unit provides diagnostic assessments of children aged 2 years 9 months to 6 years who have questionable or delayed development. As in the Infant Toddler Team, each child referred to the IPU receives an individually planned evaluation designed to assess intellectual and emotional functioning, clarify the medical and/or environmental causes of any disabilities, and determine the child s and family s strengths in coping with these deficits. The population served includes children with autism, Intellectual disability, language disorders, mental health issues, and other disabling conditions. Assessment of parents need for support and child s need for intervention is also provided. Appropriate therapeutic interventions and family supports are arranged for either at CERC, or in the community through referrals. School Age Unit (SAU) This unit provides diagnostic services to school-age children, ages 6-14, with learning difficulties, language delays, hyperactivity and associated behavioral and/or social adjustment problems. Case management and treatment services are offered to provide for continued intervention and family support. Services available include psychoeducational treatment, speech and language therapy, social skills groups, parent and sibling groups, and medication management. When necessary, referrals are made to community treatment centers as well as to appropriate public & private school programs. Adolescent Unit (AU) Provides diagnostic and mental health treatment services to adolescents and young adults ages 12 to 21 who have experienced chronic school failure, due (at least in part) to biologically-based difficulties, the AU provides assistance to adolescents with learning disabilities, limited intelligence and/or attention problems. The specific nature of the adolescent s difficulties and the role they play in his or her psychological adjustment are identified. Treatment usually includes individual or group psychotherapy, family counseling, psychoeducational intervention, speech and language services, and suggestions that enable the adolescent to better cope with his or her environment. Consultation is provided to public school programs and to Montefiore Medical Center s School Health Project for youngsters experiencing chronic school failure. Pediatric Rehabilitation Unit Individuals from birth to 21 years of age with developmental and physical disabilities, usually related to congenital or acquired neuromuscular and musculoskeletal disorders, or to temporary problems of physical function, are evaluated and treated by this unit. Patients seen in the PRU include children with muscular dystrophy, cerebral palsy, and brain injuries. To enable clients to be more self-sufficient, the PRU s multi-disciplinary team designs a comprehensive treatment plan which may include braces, adaptive equipment, seating, transportation devices for use at home and in school, and an array of interventions including physical, occupational, and speech
5 therapy; augmentative communication; feeding therapies; individual and group psychotherapy; and psychosocial services. The Unit also provides consultative services to all other CERC units. Behavior Program The Behavior Program operates once a week and is staffed by interdisciplinary members of the core behavioral teaching faculty. Referrals come from Montefiore primary care clinics, but may also originate from the emergency room, the inpatient unit (as part of continuing management after discharge), the public schools, outside community clinics and private practices. A primary goal of this outpatient resource is to teach the residents and fellows about a range of pediatric behavior problems through their involvement in short term assessment and intervention. Children s Hearing Intervention Program (CHIP) Offering an interdisciplinary approach to the diagnosis and remediation of hearing impairment and other forms of communication disorders for individuals from birth to 21, CHIP provides early identification and diagnosis, newborn and infant auditory screening, otolaryngologic & developmental pediatric examinations, behavioral audiometry, central auditory processing function tests, speech-language evaluation, and psychological/educational assessment. The program stresses that no child is too young for complete auditory assessment. Medical and surgical management of ear, nose and throat disorders are prescribed when indicated. Remediations within the Children s Hearing Intervention Program (CHIP) include auditory training of infants and children, amplification strategies, recommendations and follow-up; speech and language therapy; and educational recommendations. Recently, in collaboration with the Division of Pediatric Otolaryngology at the Children's Hospital at Montefiore, the staff of CHIP has embarked on a project that provides cochlear implantation for children with deafness. The use of cochlear implants has revolutionized the treatment of this condition, provided children born with profound hearing impairment the ability to hear and communicate. Developmental Family Services Unit (DFSU) Providing developmental and psychosocial services for individuals from birth through young adulthood affected with chronic health conditions, and their families, the DFSU helps coordinate services with other programs caring for these children or families. Careful consideration is given to the cultural, language, economic and psychosocial needs of the family. The plan may include recommendations for psychosocial and/or rehabilitation services at CERC and for educational services based in the community. The DFSU conducts psychotherapy for families and children, individual psychotherapy, and psychoeducational treatment services for school-aged children. Academic assessment, educational and vocational planning, and mental health services is also offered. The unit participates in a Bronx consortium that provides diagnostic and treatment services to women, infants, children and youth affected by HIV/AIDS. Fisher Landau Center for the Treatment of Learning Disabilities (FLC) The FLC coordinates all CERC activities in the treatment of learning disabilities in children, adolescents, and adults. The Center also trains a broad range of professionals from health, education, vocational rehabilitation and related fields through fellowships, externships, workshops, conferences and seminars it houses:
6 The Psychoeducational Services Program, which focuses on school-age children and adolescents. Treatment goals include improvements in self-esteem, attitude toward school, academic skills, attention, and the ability of students to manage their school work and complete assignments. Appropriate social interactions are also addressed. Parents receive ongoing support in the behavioral and academic management of their child through follow-up appointments and support groups. The Adult Literacy Program, which provides diagnostic &consultation services to adults with learning disabilities and attention deficit disorders. Psychoeducational treatment and counseling are provided to selected adults 21 years of age and over who have extreme difficulty in reading despite normal intelligence. The Program for Technology and Learning Disabilities, located primarily in the Florence G. Roswell Learning and Technology Center, which employs state-of-the-art approaches to help improve client s reading, math and study skills. Specialized Clinics: The Harold Diner Special Care Dentistry Clinic, a unique facility in the New York metropolitan area, provides comprehensive dental care to patients from early childhood through late adulthood who have developmental disabilities and a variety of chronic medical conditions. A highly skilled staff offers wide-ranging special care dental services which accommodate the unique needs of this population. All of the clinic personnel are trained in the latest behavior management techniques. The facility is also able to offer sedation on an out-patient basis, which makes dental treatment possible for the most apprehensive and behaviorally resistant patient. CERC's Seizure Management Clinic provides care to developmentally disabled children with a seizure disorder. Under the supervision of a pediatric neurologist and the management of developmental pediatricians, anticonvulsant medications are prescribed. The Medication Clinic, directed by a child psychiatrist, provides an initial assessment of children with emotional and behavioral disorders who might benefit from psychopharmacological treatment. If indicated, psychopharmacological treatment is then provided. The behavioral and educational functioning of children taking the prescribed medication is closely monitored by medical and nursing personnel. The Nutrition Clinic provides treatment to children with disabilities who are overweight, underweight, or who have nutrition-related health problems. Directed by a certified nutritionist, individual nutrition counseling is offered to improve the diets of children with eating difficulty or eating-related behavior problems. CERC's Ophthalmology Clinic provides eye examinations, follow-up services and recommends treatments for CERC patients when required. Research Activities In early 2010, Dr. John Foxe was recruited to become CERC s first Director of Research. Our faculty and trainees conduct research in developmental disabilities and mental retardation. Under Dr. Foxe s supervision, a variety of clinical and scientific studies are currently ongoing at
7 CERC. Included among these are clinical investigations in the early diagnosis of autism and other developmentally disabling conditions, hearing problems, genetic and electrophysiologic studies, and the therapeutic effects of various intervention modalities. Other studies are being carried out in the areas of physical rehabilitation, speech, hearing and language development, learning disabilities, developmental dental defects, high risk infant follow-up, social and behavioral adjustment and treatment of hyperactive children, or adolescents, and their families. Technical Assistance and Public Policy The staffs of the RFK UCEDD and CERC provide technical expertise in the formation of public policy to improve services for the developmentally disabled, including early intervention programs in New York State, programs and policies to benefit children with a variety of special needs, children with HIV infections, and health services for developmentally disabled adults. In addition, they have helped create standards for children with special needs in day care, clinical guidelines for early intervention, and improved services for developmentally disabled adolescents. They conducted a major study of financing health care for children with severe disabilities and research in other health-care policy areas. Several of these efforts have led to important changes in the availability of services to children with developmental disabilities. THE CHILDREN S HOSPITAL AT MONTEFIORE (CHAM): The Einstein Department of Pediatrics administrative and teaching activities are centered at The Children s Hospital at Montefiore (CHAM), a state-of- the- art facility that opened in CHAM provides family centered care in a nurturing environment, and is the home of inpatient and outpatient services that interface with training in DB-P. Subspecialty Clinics The department has a full range of pediatric subspecialty clinics, most of which meet on a weekly basis. These include: allergy/immunology, cardiology, dermatology, diabetes, endocrinology, gastroenterology, genetics, hematology, metabolism, nephrology, neurology, pulmonology, pediatric surgery, and urology. Special sessions for children are also held in otolaryngology, ophthalmology, orthopedics, and rehabilitation. Adolescent Clinics A large adolescent program operates at the CHAM and is staffed by members of the Division of Adolescent Medicine. In addition to the usual range of programs there is also a special program for adolescents with HIV infections that provide comprehensive ongoing services as well as counseling and outreach. LlNCS This program provides a medical home to children with complex chronic conditions. It operates as part of the Horizon Floor of the CHAM and works closely with subspecialists who provide the necessary back up for the children's medical management. Staffed by 3 pediatricians and case managers who have special expertise in the care of children with chronic conditions, it provides coordinated care and addresses both the medical and psychosocial needs of these children and their caretakers. It has become a major resource in helping residents and fellows to learn about the coordination of care of children with special health care needs. A great deal of direct teaching as well as individualized consultation on patient care needs occurs through this
8 program. One special new feature is the training of parents to coordinate their own child's special needs. Sleep Study Unit In the summer of 2002, CHAM opened a state-of-the-art sleep center. This unit allows multi-channel monitoring of children during an overnight stay and assessment of their inspiratory effort, ventilation, EEG, EKG and esophageal function simultaneously, while videotaping the child's movements. Up to four patients can be monitored simultaneously and it will provide a unique opportunity to do research on sleep related D-B problems. Epilepsy Unit CHAM also houses an Epilepsy Unit, which has many of the same capabilities as the Sleep Center, but is designed for 12 lead EEG monitoring. It is used to evaluate children with a variety of neurological disorders. Division of Adolescent Medicine The Adolescent Medicine Program has extensive clinical teaching resources and operates a 24-bed adolescent inpatient unit at CHAM that admits patients from age 13 through 20. Division of Community Pediatrics This division runs several programs that are part of both the resident and fellowship training experiences. Two main programs are the Child Protection Program and the Mobile Vans. The former is an interdisciplinary program in a building adjacent to MMC that provides evaluation and follow-up for children suspected of having been abused or neglected. The building was specially designed to enhance the comfort of the children and their families in what can be a difficult and emotionally threatening encounter. Health care personnel work jointly with the investigative arm of the Bronx DA's office and the Child Protective Services, so that children do not have to be subjected to multiple interviews. This is one of only two freestanding programs of its kind in the country. The Division's mobile vans provide health care to homeless children. This prize-winning program is the largest of its, kind and tracks the children and their health care needs. Division of Child Psychiatry AECOM has had a long history of training fellows in child psychiatry. Its post-residency specialist training program has graduated 4% of the child psychiatrists in the United States. Many alumni are in leadership positions within the profession and the training program for child psychiatry fellows continues to be an important mission. The basic philosophy within is to provide comprehensive, thorough, and informed care to patients in the public sector. It offers high quality service to a wide range of patients at CHAM and ambulatory sites and Bronx State Children's Psychiatric Center. Through the years, the D-B services have worked closely with the Division of Child Psychiatry. The Department of Psychiatry also conducts a number of Child Psychiatry Courses for their trainees on normal and deviant psychological development. Our subspecialty residents have and will continue to attend these. CHAM has a strong Consultation Liaison Service, led by an active member of the teaching faculty of our D-B training program. Montefiore School Health Program (MSHP) This program, run under the auspices of the Department of Family and Community Medicine, was established in It is the largest and most comprehensive school-based health care network in the country and is a major community outreach program for children living in the Bronx. The program provides services in 11 School
9 Based Health Centers, covering grades K-12. It uses multi-cultural, interdisciplinary health teams to deliver core primary and preventive medical, mental health and dental services at each of the 11 SBHC. The MSHP plays a leading role in training a wide range of future health professionals in areas of school health. Many local universities send their graduate students to these sites for training. It has a multitude of community partnerships. For a virtual tour of CHAM, please visit Renovation of the Van Etten Building on the Einstein campus is currently underway, and will soon house all clinical and research facilities listed below. CERC's CURRENT LOCATIONS: The Rose F. Kennedy Center: CERC at Van Etten: The Fisher-Landau Center: The Early Childhood Center: 1410 Pelham Parkway South Bronx, New York Phone: (718) Morris Park Avenue Bronx, New York Rousso Building, 1165 Morris Park Avenue, Bronx, NY Phone (718) Seminole Avenue Bronx, New York Phone (718) The Center for Babies, Toddlers and Families: 1225 Morris Park Avenue Bronx, NY Phone: (718) Children s Hospital at Montefiore: 3415 Bainbridge Avenue, Bronx, NY CHAM (2426) c:/mydocuments/fellows/divison of Developmental Medicine descriptioin.2014