PGY III COMMUNITY MENTAL HEALTH ROTATION
FOR DARTMOUTH MEDICAL SCHOOL
DEPARTMENT OF PSYCHIATRY TRAINING PROGRAM
(6/00)
West Central Behavioral Health
2 Whipple Place, Suite 202
Lebanon, NH 03766
The Mental Health Center of Greater Manchester
1555 Elm St,
Manchester, NH
03101
A. ROTATION GOALS
To provide the PGY III psychiatry residents in training with the clinical experience and the opportunity to acquire knowledge in the role of the psychiatrist in the provision of mental health services in a community setting.
B. ROTATION SITES
West
Central Behavioral Health
Recovery Center, Lebanon, 85
Mechanic Street, Lebanon
Recovery Center, Claremont, 140
North Street Claremont
The
Mental Health Center of Greater Manchester,
Community Support Services 1555
Elm St, Manchester, NH
a. To train residents in a recovery-oriented community approach to the care of adults with severe mental illness.
b. To expose psychiatry residents to a model of community psychiatry including the necessary close interaction and sharing of responsibilities between MD and other professional care providers.
c. To acquire knowledge and clinical experiences in the diagnostic evaluation and ongoing follow-up of mental health outpatients in the community setting.
d. To provide educational and clinical experience in the care of persistently mentally ill adults in community settings.
e. To provide exposure to the financial aspects of providing psychiatric treatment in a private nonprofit practice model (including 3rd party payers, Medicaid, State benefit screening evaluation, etc.)
f. To expose residents to the role of the psychiatrist in the assessment and treatment of patients with co-occurring psychiatric illness and developmental disabilities.
g. To learn appropriate ways to alter therapeutic techniques to fit individual situations (e.g. when are home visits appropriate, when should we work to increase or decrease client reliance on caregivers).
h. To learn to anticipate difficulties in treatment adherence and learn techniques to minimize these difficulties.
i. To learn to recognize and manage substance abuse difficulties in adults with coexisting mental illness.
j. To learn to efficiently and effectively document clinical activity.
k. To learn community methods of crisis intervention and hospital diversion.
l. To acquire experience in working collaboratively with families.
m. To learn how to enhance and support consumer self help initiatives.
n. To learn how to work effectively with other community resources and systems of care.
o. To gain experience addressing treatment and rehabilitation issues simultaneously.
p. To understand the importance of events in the lives of people with persistent mental illness.
q. To learn ways of supporting competitive employment.
D. LEVEL OF TRAINING
PGY
III residents take this rotation one day per week for the entire third year of
training. Special arrangements can be
made to increase the days/week.
E. DESCRIPTION OF STAFFING
West
Central and HCS-GM staff include psychiatrists, PhD psychologists, program directors,
case managers/social workers/therapists, nursing staff and emergency service
workers.
F. EDUCATIONAL METHOD
Combined model of direct and indirect clinical
exposure combined with supervision and feedback. Contact with non-psychiatric staff will be encouraged.
G. BREADTH OF CLINICAL POPULATION
Adult
(18 and older) outpatients with mental illness. This population includes adults with severe and persistent mental
illness, developmental disabilities and substance abuse disorders and elderly
individuals. Residents choosing to
spend more than one day/week at a site may perform Child and Adolescent and/or
substance abuse requirements at the mental health centers.
H. AVERAGE CASELOADS AND
DESCRIPTION
Residents are expected to have an average of five hours
of direct clinical care per day.
Clinical expectation is based on what will provide residents with good,
engaged clinical experience.
During
the first month they will do no more than one intake evaluation each day. After that they will do no more than two
intake evaluations per day.
I. SUPERVISION
At
least one hour of 'formal' supervision by a staff psychiatrist with additional
open-ended consultation/support throughout the day as needed.
The
supervisors responsibility includes a.) providing clinical supervision, b.)
being available for clinical questions and back up throughout the day, c.)
monitoring the residents experience to ensure that the resident is engaged
productively in the clinic and experiencing an excellent training experience,
d.) reviewing record keeping and Service/Activity logs and e.) generally
helping resident with orientation and problem solving.
J. COURSE EXPECTATIONS
a.
Residents are expected
to participate in the clinic from 8 am to 5 pm at WCBH and 8:30 to 5 PM at
MHC-GM on their CMHC day without returning to the Dartmouth-Hitchcock Medical
Center for conferences, supervision or patients.
b.
Residents are expected
to miss no more than five CMHC days during the year (excluding holidays) for
vacations, bad weather, or conferences.
Residents are asked to inform their supervisor at least one month in
advance if they will be on vacation so that emergency coverage can be
arranged. For unexpected absences or
delays, residents are expected to notify their site and supervisor ASAP so
appointments can be rescheduled.
Residents working more than one day/week are expected to miss no more
that five times the days/week of rotation CMHC days per year up to Dartmouth’s
maximum of 15 vacation days and five conference days/year (ie. 2 d/wk rotation
= 10 days off/year).
c.
Residents are expected
to use their clinic time to: 1) work directly with service consumers; 2) be
available to clinic staff for education, consultation, collaboration; and 3)
receive supervision.
d.
Residents are expected
to prepare and present a minimum of two trainings for the non-medical clinical
staff on medications or other topics of interest.
e.
If on a given day there
is unstructured time, the expectation is that residents will seek out clinical
learning opportunities through the case managers, psychiatrists or other
clinicians. If there is still time then
read psychiatric literature directly related to community mental health.
f.
Residents are expected
to participate in the emergency coverage of their clinic on their clinic day as
outlined by their supervisor.
g.
Residents are expected
to read the following book, Resident's Guide to Treatment of People with
Chronic Mental Illness formulated by the Committee on Psychiatry and the
Community; American Psychiatric Press, Inc.; Washington, DC., London, England,
1993, during the first three months of rotation.
h.
Residents are expected
to participate in the PGY III community psychiatry didactics in the winter of
1999-2000. The expectation is that they
will attend the seminar punctually or call in advance if they will be late or
absent.
i.
By agreement with DHPA,
CMHC patients may not be seen in DHPA offices at the medical center. They are to be seen at WCBH sites, in the
community, on emergency service, in the hospital or in the partial
hospitalization program.
j.
It is the supervising
staffs' expectation that residents will call them or beep them if they have any
significant clinical concern or question in the course of their work. If they are unable to track down their supervisor
they are encouraged to call or beep any psychiatrist at West Central or
Manchester.
k.
Evaluation of residents
will be provided by supervising faculty psychiatrist who will include feedback
from case managers, vocational specialists, nurses, office staff and others.
l.
Although direct care of
consumers is required only on the day residents are present in the clinic they
will be expected to accept phone calls from clinical staff who are working on
the site to provide them with appropriate information to handle crisis situations
on non clinic days. Residents are
expected to handle calls from DHPA patients/staff in a way that does not
interfere with the flow of clinical care during their CMHC days.
K. OTHER INFORMATION
Residents
will meet with other administrative and financial staff to learn about some of
the "mechanical" aspects of community mental health.
Should
a resident experience problems with his/her community rotation he/she should
first bring it up to his/her immediate supervisor. If not resolved Will Torrey will be the contact person at West
Central and Doug Noordsy will be the contact person at The Mental Health Center
of Greater Manchester.
William
Torrey, MD
Medical
Director, West Central Services
Coordinator
of Community Training, Department of Psychiatry, Dartmouth Medical School
Office: 448-0126
Home: 643-1479
Douglas
Noordsy, MD
The
Mental Health Center of Greater Manchester
Associate
Director of Training and Education, Department of Psychiatry, Dartmouth Medical
School
Office: 668-4111 X 5257
Home: 547-6818
COMMUNITY PSYCHIATRY SEMINAR
PGY III DIDACTICS
William C. Torrey, MD
DATE TOPIC INSTRUCTORS
2-3-00 A Recovery-Oriented Approach Will Torrey, MD
to Community Mental
Health Services for Adults with
Severe and Persistent Mental
Illnesses
2-10-00 The Importance of Work Will Torrey, MD
2-17-00 The Skills Psychiatrists Need to Kim Mueser, PhD
Effectively Serve Family Members
2-24-00 Issues in Medication Adherence Will Torrey, MD
3-2-00 Consumer Perspectives George Ross and consumers
3-9-00 Community Psychiatry as a Will Torrey, MD and guests
Career of First Choice.
3-16-00 Family Perspectives on Care George Ross and
local families
3-23-00 A Rehabilitation Approach to Diane Roston, MD
Adults Disabled by PTSD and Wendy Barros, MD
Borderline Personality Disorder Annmarie McDonagh- Coyle, MD
3-30-00 Treatment Approaches to Adults Doug Noordsy, MD
with Severe Mental Disorders and
Substance Abuse Disorders