Attracting Trainees to Community Psychiatry Through Innovation & Creativity. University Hospitals Case Medical Center Public and Community Psychiatry

Transcription

1 Attracting Trainees to Community Psychiatry Through Innovation & Creativity University Hospitals Case Medical Center Public and Community Psychiatry

2 Cathleen A. Cerny MD Associate Training Director General Psychiatry Residency Staff psychiatrist Centers for Families and Children Kathleen Clegg, MD Director of Public and Community Psychiatry Program Director of Public Academic Liaison (PAL) Program Director of Medical Student Education in Psychiatry Medical Director at Recovery Resources Medical Director of Recovery Resources Patrick Runnels, MD Director of Public and Community Psychiatry Fellowship Medical Director at the Centers for Families and Children

3 Presentation Overview u Public Academic Liaison (PAL) Program u Medical Student Electives u Resident Curriculum and Core Clinical Experience u Public & Community Fellowship u Beyond Training

4 Kathy Clegg, MD

5 Public and Community Psychiatry Program Mission Statement We are committed to the delivery of quality mental health care that fosters hope, recovery and resilience in individuals, families and communities through scholarship, collaboration and leadership.

6 Public and Community Psychiatry Program Core Values u Clinical excellence u Cultural competence u Client centered care u Collaboration u Resilience u Flexibility u Innovation u Compassion u Security u Relationships that build community u Vibrant, optimistic participation u Quality of life u Hope u Integrity u Commitment

7 Public Academic Liaison Program (PAL) - History u Founded in 1990 u Charles Schultz, MD was Chairman of Department of Psychiatry at UH/Case u Dr. Ishiama was Chief Executive Officer of the Cuyahoga County Mental Health Board u Dr. Robert Ronis, current Chairman at UH/Case, recruited to serve as faculty and director of PAL

8 PAL - History u Initial funding of $225K u Initial PAL contract was two years u PGY3 and PGY4 residents spent half day per week on site at a community mental health center identified by the Board

9 Mission of PAL u To provide an organized, faculty supervised experience in interdisciplinary community mental health services for trainees in residency training at University Hospitals, and u To provide needed high quality psychiatric services and a conduit for the recruitment of future psychiatry graduates into the local service system.

10 PAL Today u PGY3 residents each spend a full day a week at a community mental health center u Centers for Families and Children (2 sites) u Connections u Frontline u Recovery Resources u Supervision is provided by UH/Case psychiatry faculty u Budget $721K in 2012 this now provides basis for MEDTAPP matching funds

11 Medical Student Electives in Community Psychiatry u Opportunity to rotate at multiple community centers with several community faculty members u Also can spend time at the Free Clinic u Exposure to addiction and recovery services in Cuyahoga u Can have a specific focus (addiction, women s health, advocacy, forensics)

12 Medical Student Electives in Community Psychiatry u = 3 medical students u = 3 medical students

13 Cathleen Cerny, MD

14 Resident Training in Community Psychiatry u Educational Program ( Didactics ) u Core Clinical Experience u Community Adventure Series u Electives

15 Educational Program u Topics matched to specific training years u Sessions build on prior u Team-based, collaborative care emphasized in sessions u Time for senior level residents to discuss clinical material in case presentation seminars

16 History Recovery Evidenced Based Practices Case Presentations Roles Revisited ACA Redux Lay of the Land Affordable Care Act Mediare, Medicaid, SSI/SSD Roles Integrated Care CPST Talk NP Talk

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18 Core Clinical Experience u Full day clinic for 1 year u Resident Guide to Core Community Clinical Experience u Supervisor Guide to Community Psychiatry Curriculum u Experience begins with general and site-specific orientations u Shadowing

19 Core Clinical Experience u Robust patient load u Supervision is 60 minutes per full day u Supervision is focused on: u Roles u Recovery u Systems Based Practice

20 Community Provider Roles u LeMelle, Clemmey and Ranz Integrating Systems- Based Practice, Community Psychiatry and Recovery into Residency Training Academic Psychiatry (2013) u Diamond, Stein, and Susser Essential and Nonessential Roles for Psychiatrists in Community Mental Health Centers Hospital and Community Psychiatrist (1991)

21 LeMelle, Clemmey and Ranz (2013) u 1. Patient Care Advocate u 2. Team Member u 3. Information Integrator u 4. Resource Manager

22 Diamond, Stein and Susser (1991) u Essential u Medical Expert u Legal or Medical Authority u Non-essential u Assessor u Generalist u Teacher u Scholar

23 A process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential. SAMHSA Administration 2011

24 Systems Based Practice u SPB requires residents demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. - ACGME

25 Systems Based Practice u Work effectively in a variety of health care delivery settings and systems u Coordinate patient care within the health care system u Incorporate considerations of cost and risk/benefit analysis in patient care u Advocate for quality patient care and patient care systems u Work in inter-professional teams to enhance patient safety and improve quality of patient care u Participate in quality improvement

26 ACGME Milestones u Systems based practice 2 Resource Management u Systems based practice 3 Community Based Care u Coordinates care with community mental health agencies, including with case managers u Describes rehabilitation programs and the recovery model u Uses principles of evidenced-based practice and patient centered care in management of chronically ill patients

27 Year-Long Case Study u Chose one patient as a case study u Participate in out-of-the-office activities with patient: u Social Security Office u Grocery Store or Food Bank u PCP Appointment u 12-Step Meeting u Home visit (in conjunction with CPST) u Write-up u Case presentation in educational program

28 Community Adventure Series u Quarterly fieldtrips u Norma Herr Women s Shelter & 2100 Lakeside Men s Shelter u Magnolia Clubhouse u Mobile Crisis u Surprise!

29 Electives u Homeless Mentally Ill PGY3 or 4 u Advocacy PGY2, 3 or 4 u Addiction PGY2, 3 or 4 u The Sampler med students, PGY2

30 Patrick Runnels, MD

31 Fellowship Training u History of Public and Community Psychiatry Fellowship Training u Nationally u CWRU u Core Elements of Fellowship Training 1. Field Placements 2. Didactics 3. Presentations 4. Post Fellowship Mentorship 5. Peer engagement 6. Presentations from leaders

32 Fellowship Training u Structure of Training u ½ day didactics u 45 minutes weekly of individual precepting u Field Placements

33 Beyond Training u 16 of 35 fellowship graduates occupying leadership positions u Medical Directors u Associate medical directors u APN directors u Program directors u 32 out of 35 in public settings at least part time

34 Beyond Training u 28 of 35 remained in Greater Cleveland area u 16 of 27 have remained at their field placement u 14 of 35 have full or part time faculty positions within the department of psychiatry here

35 Picture Credits u u Cleveland photos are from Learning Tree Slide - u Learning Road Sign Slide - u Mind Map Slide - (photo: Tumbler) u Crawl, walk, run, fly Slide - u Hand circle Slide -

36 Picture Credits u Hats Slide - u Road to Recovery Slide - u Love didactics - Slide