Outpatient Community Mental Health at BJC-BH

Rotation Director: Jamie Hook, MD

Rotation Faculty: Jaime Hook, MD; Robert Brady, MD; Eric Wittrock, DO

Other Supervisors: Carie Dinehart, MD; Eric Wittrock, DO; Brian Bui, DO

Number of Fellows 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-BH Central or BJC-BH North

Goal

The goal of the Outpatient Community Mental health rotation at BJC is to provide first-year fellows with an in-depth exposure to the evaluative and treatment modalities used in the outpatient community of child and adolescent psychiatry. In addition, several of the patients between Hawthorne and BJC systems will overlap, thus providing exposure to the outpatient care of severely ill children in the community.

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 problems 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/caretakers
  • How to initiate and monitor medications or reevaluate medication regimens initiated by others
  • Outpatient psychoeducation
  • 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 fellow will gain medical knowledge through a combination of supervised clinical activities, readings, and on-site supervision

  • Appreciate the gradient of the 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 the course, prognosis, and outcomes
  • Understand the use of standardized rating scales completed by patients and others
  • Understand the side effects of psychopharmacology especially poly-psychopharmacology
  • Understand appropriate and necessary use of laboratory testing
  • Neurological and medical exams integrated into outpatient care as needed
Practice-Based Learning

In addition to supervised clinical activities and self-initiated and suggested readings, the fellow will participate in supervision including 1:1 supervision by the 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 fellow will demonstrate sensitivity and compassion to children, adolescents, and to their families/caretakers affected by psychopathology and will continue to develop relationships with other professionals or professionals in training, including supervisors, colleagues, students, and allied professionals.

  • Developing intra-professionally by managing their own emotional reactions to youth psychopathology and to the parents/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 fellow 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/caretakers 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 examinations

Description of Rotation

The first-year fellows 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-year fellows are oriented to this rotation at the beginning of July. In addition, first-year fellows on the rotation will receive site-specific orientations under the supervision of faculty and staff.