Community Mental Health Outpatient Rotation at BJC-CAP 1

Rotation Director: Jamie Hook MD

Rotation Faculty: Jaime Hook MD (North East Location) and Robert Brady MD (Central Location), Eric Wittrock DO (several rotations)

Other Supervisors: Carie Dinehart MD, Christina Gesmundo MD

Number of residents per rotation: Two

Length of Rotation: 20.8 weeks (consecutive or in two blocks), 4 chunks of time (mornings or afternoons) per week

Location: BJC Central or BJC North

Goal

The goal of the BJC first year rotation is to provide CAP 1st year residents with an in-depth exposure to the evaluative and treatment modalities used in outpatient community child and adolescent psychiatry. In addition, it is expected that several of the patients will overlap between Hawthorne and BJC systems, thus provided an exposure to the outpatient care of severely ill community children.

Objectives

To develop competence in the following areas:

Patient Care
  • Outpatient evaluation and management of children and their families or children in Foster Care
  • Use of information collected by clinic staff
  • Observing and interpreting family relationships and their relevance to presenting problem including severe environmental deprivation and risk factors’ interplays
  • Incorporation of school information for evaluative purposes
  • Producing an appropriate multi-axial differential diagnosis and dynamic case formulation of psychiatric symptomatology and appreciating the importance of biological, psychological, and socio-cultural aspects of symptoms
  • The use of play in both evaluations and treatment
  • Emerging psychotherapy skills necessary to manage outpatients and their family members and caretakers
  • How to initiate and monitor medications or reevaluate medication regimens initiated by others
  • Outpatient psycho-education
  • Establishment of therapeutic alliance to enhance adherence to treatment and follow up, especially in clinical populations at higher risk for non-compliance
Medical Knowledge

The resident will gain medical knowledge through a combination of supervised clinical activities, readings and on site supervision

  • Appreciate gradient of severity of presentations from epidemiological to clinical outpatient in academic vs. community settings to clinical inpatient
  • Understand the functional impairments associated with various psychiatric disorders and the influence of other risk factors on course, prognosis and outcomes
  • Understand the use of standardized rating scales completed by patients and others
  • Understand side effects of psychopharmacology especially poly-psychopharmacology
  • Understand appropriate and necessary use of laboratory testing
  • Neurological and medical exam integrated into outpatient care as needed
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

  • Familiarity with models of outpatient care sensitive to issues of access to care, health disparities, and the many system issues which impact the quality or availability of services to high risk children
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.

  • Developing intra-professionally by managing adaptively their own emotional reactions to youth psychopathology and to the parents or caretakers of youth with psychopathology
  • Accurate and timely completion of medical records
  • Accurate and timely completion of billing for services rendered
  • Demonstrating a commitment to continued professional development
Interpersonal/Communication Skills

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

  • Talking with and obtaining a history from collateral sources including clinic staff
  • Communication with referring community providers if applicable
  • Education of patients and their families in compassionate, respectful, culturally sensitive, and effective ways
  • Respectful and collaborative relationships with clinic staff
System Based Care
  • Understanding the limitation of community mental health care for children and its impact on psychiatric presentations to BJC
  • Appreciating the role that the BJC system is playing in the mental health care of this community and the attention to quality that is supported and allowed by the BJC system
  • Appreciating the importance of collaborative relationships with all team members
  • A 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 at one of the BJC sites, where they will join a multidisciplinary team dedicated to providing high quality community mental health care to children and adolescents in our region. All first years will be oriented to this rotation in the beginning of July. In addition first years on the rotation will receive site specific orientations under the supervision of faculty and staff.