Community Mental Health Continuity Clinic at BJC

Rotation Director: Jamie Hook, MD

Rotation Faculty: Jaime Hook, MD, (North East Location), Robert Brady, MD, (Central Location) and Mini Tandon, DO, (South Location)

Number of residents per rotation: 3 divided between North East and Central in the First year; 5 divided between Central and South in the Second year

Length of Rotation: 

  • Length of Rotation in Year 1: 31.2 weeks (three blocks of 10.4 weeks either consecutive or separated). One full day per week.
  • Length of Rotation in Year 2: 52 weeks, one morning or one afternoon per week.

All first years will be oriented to this rotation in the beginning of July.

Goal

The goal of the BJC continuity clinic rotation is longitudinal exposure to the care and outcomes of community children and adolescents, many of which come for very high risk backgrounds.  This rotation allows observation of developmental change and therapeutic change over time. As of July 2011 the second year continuity clinic has a particular focus on preschool/young children. There is an overall goal of increased independence in medical decision making from year 1 to 2 with less reliance on faculty support by year 2.

Objectives

To develop competence in the following areas:

Patient Care

  • Longitudinal treatment of children and their families or children in Foster Care
  • Longitudinal efforts to modify key child risk factors for poor psychiatric outcomes including non-adherence, loss to follow up, and familial or environmental risks including severe parental psychopathology
  • Development of  psychotherapy skills necessary to manage outpatients and their family members and caretakers
  • Longitudinal medication regimens adjustment and changes
  • Ongoing outpatient psychoeducation

Medical Knowledge

The resident will continue to gain medical knowledge through a combination of supervised clinical activities, mandatory divisional didactics, supervised reading of the pertinent CAP or related literature.

  • Understand stability and change in functional impairments associated with various child psychiatric disorders and the ongoing dynamic influence of other risk factors on course, prognosis and outcomes
  • Understand the use of standardized rating scales completed by patients, parents, and/or teachers to document incremental changes in symptoms
  • Longitudinal monitoring of side effects of psychopharmacology especially poly-psychopharmacology
  • Understand appropriate and necessary use of laboratory testing including to safely maintain patients on psychopharmacological regimens
  • Appreciation of adherence and compliance issues

Practice-Based Learning

In addition to supervised clinical activities and self initiated and suggested readings, the resident will participate in supervision including 1:1 supervision by attending faculty and other divisional supervision including individual and team supervision

  • Reflection on longitudinal courses
  • Especially in the second year: management of one’s clinic
  • Appreciation of how BJC patients may or may not differ systematically from patients who have been studied more intensively in child psychiatry research
  • Strengths and limitations of evidence based treatments in understudied populations

Professionalism

The resident will demonstrate sensitivity and compassion to children and adolescents affected by psychopathology and to their families or their caretakers and will continue to develop in relationship with other professionals or professionals in training, including supervisors, colleagues, students and allied professionals.

  • Maintenance and enhancement of therapeutic relationships
  • Maintenance and enhancement of interdisciplinary relationships
  • Increased leadership and autonomy from first to second year of fellowship
  • Accurate and timely completion of medical records
  • Accurate and timely completion of billing for services rendered

Interpersonal/Communication Skills

The resident will longitudinally function effectively as part of the outpatient care team.

  • Continued education of patients and their families and other mental health professionals in compassionate, respectful, culturally sensitive, and effective ways
  • Enhanced respectful and collaborative relationships with clinic staff

System-Based Care

  • As the residents deepen their understanding of the limitation of community mental health care for children and its impact on psychiatric presentations to BJC, it is expected that they will form ideas about possible improvements to systems of care
  • Ongoing team approach for managing outpatients including clinic and outreach therapists

Measurement of Objectives

  • Standard Program evaluations
  • Feedback by other professionals
  • Clinical skills exam

Description of Rotation

The first year residents will rotate one full day a week at either BJC-NE or BJC-C or both and 12 months in their second year rotating one afternoon or morning a week at BJC-S or BJC-C. At each site, they will join a multidisciplinary team dedicated to providing high quality longitudinal community mental health care to children and adolescents in our region.