1. Overview including innovative Peer Advisor Program
2. Academic Seminar — Complete Syllabus
3. Applied Seminar
4. Practicum in Mental Health Administration — Complete Syllabus
5. Guest Speakers —
1. OVERVIEW OF THE CURRICULUM
Peer Advisor Program
The goal of the project is to give Columbia University Public Psychiatry Fellows an opportunity to learn about the lived experience of recovery from mental health and addiction issues outside the conventional bounds of the doctor patient relationship. Being advised by service- users who have worked as peer specialists or other similar capacity will provide fellows with the opportunity to develop a better sense of how recovery principles are enacted and how to incorporate them into their own practice. By utilizing a role-reversal approach that challenges the traditional doctor –patient power dynamic the hope is to lay the groundwork for a truly collaborative relationship to develop between fellows and advisors.
The academic curriculum of the Fellowship in Public Psychiatry is organized as a set of seminar sequences that run throughout the year
The Academic Seminar
This sequence is a series taught by the Fellowship faculty.
Unit I: The Structure Of Public Psychiatry
I: The American Welfare State and Public Mental Health
Unit II: The Role of the Psychiatrist in Community Based Services
Unit III: Introduction to Recovery-oriented Services and Evidence-Based Practices for people with Severe Mental Illness
Unit IV: Management Theory and Practice
Unit V: Introduction to Internal Program Evaluation
Unit VI: The Structure of Public Psychiatry II: The Structure of Public Mental Health Services, 1948-1990
Unit VII: Treatment of Co-Occurring Disorders
Unit VIII: Homelessness and Housing Policy
Unit IX: Current Directions in the Structure of Public Mental Health
Unit X: Public Mental Health Advocacy
Unit XI: Law and Psychiatry
Unit XII: Models of Integrated Care for Behavioral Health
The Applied Seminar
This sequence is made up of presentations by the Fellows. In the Applied Seminar, Fellows use the academic framework above to organize a series of clinical, management and fiscal presentations of their field placement experiences. In addition, each Fellow is expected to design and present an internal program evaluation project examining some aspect of the service system at his/her placement site. These Applied Seminars are a crucial aspect of the Fellowship year, offering Fellows the opportunity to organize, present and evaluate their efforts at implementing the concepts they have learned during the year.
Series 1: Residency Training Program Presentations, Using
Series 2: Field Placement Presentations, Using Congruence Model
Series 3: System-Oriented Clinical Presentations
Series 4: Fiscal Presentations
Series 5: Advocacy
Series 6: Internal Program Evaluation Presentations
Series 7: Final Field Placement Presentations
A more complete
description of these presentations is provided below (Section 3,
A series of approximately
30 guest speakers currently active in public psychiatry begins in
continues for the rest of the Fellowship year.
A sequence of Field
Trips to sites of special interest in New York City includes the
following: Fountain House, AOT Court, Fort Washington Shelter, Sugan Hill Apartments, Rikers
Practicum in Mental Health Administration
The Practicum in Mental
Health Administration consists of a 12 week unit in which conceptual
material is developed in relation to a series of management case
presentations by former Public Psychiatry Fellows. It also
includes a continuous management case presentation by a former Public
Psychiatry Fellow presented at 6-8 week intervals over the course
of the year.
2. THE ACADEMIC SEMINAR OUTLINE
UNIT I: THE AMERICAN WELFARE STATE AND PUBLIC MENTAL HEALTH
A: The Social Security Act: Core of the American Welfare State
B: Centralization/De-centralization in American Government I: The Federal System
C. Medicaid: Eligibility and Benefits
D. Outside the Social Security Act: The Margins of the American Welfare State
E. The American Welfare State and Housing
F. The American Welfare State, Social Stratification and the Clients of Public Mental Health
G. Centralization vs. De-centralization in American Welfare State Structure
UNIT II — THE ROLE OF THE PSYCHIATRIST IN PUBLICLY-FUNDED COMMUNITY SERVICES
The Fellowship Faculty
Introduction to the Four Factor Model of Systems Based Practices
Presentations by alumni serving in leadership roles throughout the year
UNIT III – INTRODUCTION TO
RECOVERY AND EVIDENCE-BASED SERVICES
Ranz, Stephanie LeMelle, Tony Carino and Steve Rosenheck
A: Introduction to Recovery
B: Introduction to Evidedenc-based Services
C: Case Management and Assertive Community Treatment (ACT)
D: Housing First and Supported Housing
F: Individual Placement and Support (IPS) - Supported Employment
G: Integrated Dual Diagnosis Treatment (IDDT)
H: Public Policy regarding Recover-oriented and evidenced based services.
UNIT IV – INTERNAL PROGRAM EVALUATION: A MANAGEMENT
Steve Rosenheck and Stephanie LeMelle
The term "Internal Program Evaluation" delineates this kind of program evaluation from the gold standard of double-blind, randomized research. We are teaching “satisficing” program evaluation (SPE) rather than “optimizing” program evaluation (OPE) i.e. the gold standard. In the language of OPE, SPE are often called pilot studies. Much, if not most, of the psychiatric literature describes OPE, whereas most evaluations of functioning programs are SPE. SPE has its limits regarding its ability to determine if a program being evaluated is the cause of any observed change. Randomized trials are required to exclude all threats to internal validity. One must be diligent about what conclusions one draws from SPE. Nonetheless, SPE is increasingly being required by funding agencies. It is usually an unfounded mandate done by the staff running the program with professional consultation only if available at no extra cost.
SAMHSA now requires grant applications, including proposed pilot studies, to include a logic model of the proposed program. The major objective of a logic model is to describe clearly what are a program’s components and what is the process by which the components interact to achieve the program’s desired goals. It spells out who does what when to whom and outlines the measurements put in place to monitor the program’s outcomes, including demonstrating that the program is functioning as proposed. If the components, the process, and the measurements are not clear, it is not possible to say what caused a change, if one occurred. Whether a program is doing what it purports to do is the first question professional program evaluators ask. They evaluate the program’s evaluability. If things are not being done as designed, they proceed no further.
Although doing a logic model of the program at your field site is not required, doing one would give you a clear picture of the program as it now exists. It can be compared to the original description of the program, and, if changes have occurred, whether the changes were made on the basis of ongoing evaluation. If the program has an MIS (management information system), it is crucial to familiarize yourself with it to understand what data is available to you without your having to collect any yourself. We strongly suggest getting started now. Collecting and analyzing data takes time, especially if you decide to do a pre-post evaluation. You have a good picture of your field placement from having prepared your congruence presentation. A logic model would add a clear picture of the program’s components and their process of interaction, which is essential for undertaking any kind of evaluation and which are not the major focus of the congruence model.
A: The Structure of Public Psychiatry in 1948
Transformationof Service Delivery, 1955-85
C: The State Program Grant Funding Stream
D: The Relationship Between the State Program Grant Funding Stream and Medicaid
E: The Federal Community Mental Health Center Funding Stream, 1963 -1980
F: Future Issues and Directions in the Fiscal and Jurisdictional Structure of Public Mental Health
G: The Structure and Funding of Alcoholism and
Substance Abuse Services
UNIT VI — ALCOHOLISM AND SUBSTANCE ABUSE
Session 1: The Quadrant Model for co-morbid substance use and psychiatric disorders
Session 2: Stages of Change and Stages of Treatment
Session 3. Motivational Interviewing
Session 4: Harm Reduction
Session 5: Relapse Prevention
UNIT VIII — HOUSING, HOMELESSNESS AND HOUSING POLICY
Jules Ranz, Steve Rosenheck
Session 1: Housing Paradigms
Session 2: Housing Categories
Session 3: Housing Costs and The Role of the Psychiatrist in Housing Programs
Session 4: The American Welfare State,
and the Mentally Ill: An Historical Overview
UNIT IX — CURRENT TRENDS IN THE STRUCTURE OF PUBLIC PSYCHIATRY
1. Public Mental Health Managed Care
B: The Historical Ascent of Managed Care
C. Public Mental Health Managed Care in Practice
D: Evaluating Public Mental Health Managed Care
E: Curent Directions in Public Mental Health Services Policy
F: Expanding Insurance Coverage
UNIT X: PUBLIC MENTAL HEALTH ADVOCACY
In honor of Ken Steele, founder NYC Voices and Mental Health Voter Empowerment Project (former speaker in this unit) who died in 2000.
Introduction to Advocacy - Stephanie LeMelle and Steve Rosenheck
Patient Care Advocacy
Sacha Agrawal - University of Toronto
State/Local Level AdvocacyJennifer Parish - Attorney, Urban Justice Center
Jeanette Zelhof - Attorney, Deputy Director, MFY Legal Services
Phil Saperia - Executive Director, Coalition of Voluntary Mental Health Agencies
Harvey Rosenthal - Executive Director, NYS Association for Psychiatric Rehabilitation
Ann Sullivan - Commissioner, NYS Office of Mental Health
National Level Advocay
Laurie Flynn - Former executive director, NAMI
Linda Rosenberg - President and CEO, National Council for Community Behavioral Healthcare
1 Intro- The Relationship between BH and the CJS/Legal systems
2) Historical Review of Law and BH
3) Diversion from the CJS- at all points of the Sequential Intercept points
4) Risk of Violence
5) Criminogenic Risk Responsivity
6) Training CJS OfficialsCoercion/leverage
Intro to Collaborative Care
Models of Collaborative Care
Designing an ideal Collaborative Care Program
3. APPLIED SEMINAR
The Applied Seminar consists of a series of presentations by each Fellow based, except for the first one, on her/his field placement experiences. All presentations are 90 minutes long, except as noted.
1) Residency, Fellowship or Most Recent Job (July): Each Fellow presents the organization of her/his residency or fellowship, using the structure provided by the congruence model. The use of this model is demonstrated in the first week's lecture on the organization of the Fellowship and illustrates the use of the congruence model as a descriptive tool.
2) Field Placement Agencies
(September-October): Each Fellow presents her/his field placement
organization, using the congruence model. These presentations use the
congruence model as both a descriptive and analytic tool. The focus is
developing a strategy for placement activities during the fellowship
type of presentation is illustrated towards the end of the summer
program by a
3) Clinical Presentations (November-December): Each Fellow presents a clinical case that demonstrates how the various components of the field placement agency do or do not work together effectively. The level of conceptualization is the agency rather than the individual, although the interventions discussed may be on individual and/or system levels.
4) Budget (January-February): Each
Fellow presents information about his/her agency's or program's budget.
special series of lectures on fiscal management helps the Fellows learn
questions to ask in order to get this information. These presentations
5) Advocacy (March): Each
Fellow presents information about advocacy activities going on at
agency. A special series of monthly advocacy lectures helps Fellows
the various types of advocacy. These presentations are 30 minutes long.
6) Internal Program Evaluation (April-May): While preparing field placement agency presentations during the summer, each Fellow is encouraged to begin to design an evaluation examining some aspect of the service system at his/her placement. With the help of her/his preceptor, each Fellow is expected to create a preliminary evaluation design by the end of October. By the end of December s/he begins to collect pilot data to demonstrate the feasibility of the design. This pilot data becomes the starting point for the presentation. This presentation is the most demanding of the year and provides invaluable experience in conducting an evaluation from its initial conceptualization and execution to its strategic presentation to relevant stakeholders.
7) Final Field Placement Presentation (June): Returning to the initial field placement presentation, each Fellow uses the congruence model to describe the changes that have taken place in her/his agency over the course of the year, focusing especially on the extent to which s/he has met her/his own individual goals. The analysis includes a discussion as to why these goals were or were not met. If the Fellow plans to stay at the agency, the presentation additionally provides an opportunity to develop a strategy for his/her agency activities for the coming year.
4 . PRACTICUM IN MENTAL HEALTH ADMINISTRATION
Jules Ranz, Stephanie LeMelle and Paul Rosenfield, with Sara Kellermann as discussant
Session 1: The Role of the Manager - Managing Interdisciplinary Teams
Session 2: Organizational Design
Session 3: Diagnosing the Adaptive Challenge
Session 4: Qualities of an Adaptive Organization
Session 5: Designing Effecitve Interventions
Session 6: Acting Politically
Additional sessions on the Role of the Ageny Medical Director, by various alumni:
Mary Barber (1996-97): Clinical Director,
Jorge Petit (1995-96): Regional Senior Vice President for Beacon Health Options - New York Market
Elizabeth Oudens (1999-2000): Associate Behavior Health Medical Director for NY Region, Anthem
Pam Weinberg (1995-96): Medical Director, HARP for NY Region, Anthem
Rosanne Gaylor (1988-89): Executive Director, South Beach Psychiatric Center
Dova Marder (1991-92): Medical Director, HARP for Beacon Health Options/Metro Plus
Ralph Aquila (1990-91): Founder and Director, Residential Community Service, St. Luke's-Roosevelt Hospital Center
Andrew Kolodny (2004-05): Senior VP, Phoenix House
Jeanie Tse (2006-07) Director, Integrated Health, ICL
Maria Yang (2009-10) : Medical Director (Managing Psychiatrist) for King County, Seattle, WA
Vanessa de la Cruz (2005-06): Chief of Psychiatry Mental Health and Substance
Abuse Services Santa
Cruz County Health Services Agency, Santa Cruz, CA
Each year, approximately 30 alumni come back to make
Most of these alumni are program or agency medical directors, as above.
They describe their agencies briefly, and then describe a current or
past management issue. Fellows and faculty give feedback as to how to
deal with the issue presented. Not only do these presentations provide
an opportunity for alumni to receive valuable yearly feedback on their
roles as medical directors, but they also give fellows an opportunity
to meet their predecessors and learn the range of issues with which
they are dealing.
5 . GUEST SPEAKERS
Public Psychiatry as a Career
Francine Cournos, M.D.
Director, Washington Heights Community Service
SSI, Medicaid and other Entitlements
Penny Schwartz, MSW
Mt. Sinai Hospital Resource Entitlement Advocacy Program
Jim Smith, Ph.D.
Consultant on Program Evaluation
A Career as a Public Sector Researcher
Ezra Susser, MD
Director, Dept of Epidemiology, Mailman School of Public Heath, Columbia University
(Voluntary member of Public Psychiatry Fellowship)
Reflections on Place
Mindy Fullilove, M.D.
Associate Professor of Psychiatry, Columbia University
(Voluntary member of Public Psychiatry Fellowship)
Cognitive Behavioral Therapy for Adults with Severe Mental Illness
Page Burkholder, M.D.
(Public Psychiatry Fellow, 1990-01)
Director, Outpatient Services, Kings County Medical Center
Long-Term Outcome in Schizophrenia
C. C. Beels, M.D.
Founding Director, Public Psychiatry Fellowship
Advocacy and Promotion of Public Mental Health Services for Children
Jennifer Havens, M.D.
Director, Children's Psychiatric Services, Bellevue Hospital
Developments in Treatment for Substance Abuse
Herbert Kleber, M.D.
Professor of Psychiatry, Columbia University
Politics of Evaluation Research
Robert Rosenheck, M.D.
Director, New England Program Evaluatiion Center, Veteran's Administration
Ernest Drucker, Ph.D.
Professor of Epidemiology, AECOM
Family Intervention for Child Sexual Abuse (two sessions)
Senior Staff, Child Sexual Abuse Project, Ackerman Institute for Family Therapy
Post-Traumatic Stress Disorder and Women
Paula Panzer, M.D.
(Public Psychiatry Fellow 1992-93, Voluntary faculty)
Deputy Chief Psychiatrist, Adult Trauma Services, Jewish Board of Family and Childrens Services
Office of Mental Health (OMH)
Lloyd Sederer, MD
Medical Director OMH
Ellen Baxter, MSW
Director, Broadway Housing Community
Research on Homelessness
Dennis Cullhane, Ph.D.
Associate Professor of Psychiatry, University of Pennsylvania
This syllabus was updated July 12, 2016