PUBLIC PSYCHIATRY FELLOWSHIP
OVERVIEW OF CURRICULUM


    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 — Complete List
 

              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 Congruence Model
  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, Applied Seminar) 

 Guest Speakers

        A series of approximately 30  guest speakers currently active in public psychiatry begins in September and continues for the rest of the Fellowship  year.
 

Field Trips

        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 Island Mental Health Services.
 

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

                Steve Rosenheck
 

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

            Jules 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 TOOL

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.


UNIT V — THE STRUCTURE OF PUBLIC MENTAL  HEALTH SERVICES:  1948 - 2006

Steve Rosenheck

 A:  The Structure of Public Psychiatry in 1948

B:   The 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

           Tony Carino
 

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,  Housing, and the Mentally Ill: An Historical Overview
               


 

UNIT IX  — CURRENT TRENDS IN THE STRUCTURE OF PUBLIC PSYCHIATRY

                    Steve Rosenheck
 

1. Public Mental Health Managed Care
 

A:  The Intellectual Foundations of 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 Advocacy

    Jennifer 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            

                      

UNIT XI: LAW AND PSYCHIATRY

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 Officials

Coercion/leverage                             

UNIT X11: MODELS OF INTEGRATED/COLLABORATIVE CARE FOR BEHAVIORAL HEALTH

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 on developing a strategy for placement activities during the fellowship year. This type of presentation is illustrated towards the end of the summer program by a former Fellow. 

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. A special series of lectures on fiscal management helps the Fellows learn what questions to ask in order to get this information. These presentations are 45 minutes long.  

5) Advocacy (March): Each Fellow presents information about advocacy activities going on at his/her agency. A special series of monthly advocacy lectures helps Fellows learn about 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

                                COMPLETE SYLLABUS

               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, Rockland Psychiatric Center

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 presentations. 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

           Quality Assurance
           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 and Adolescents
            Jennifer Havens, M.D.
            Director, Children's Psychiatric Services, Bellevue Hospital    

            New Developments in Treatment for Substance Abuse
            Herbert Kleber, M.D.
            Professor of  Psychiatry, Columbia University

            The Politics of Evaluation Research
            Robert Rosenheck, M.D.
            Director, New England Program Evaluatiion Center, Veteran's Administration

            Harm Reduction
            Ernest Drucker, Ph.D.
            Professor of Epidemiology, AECOM           
    

            Family Intervention for Child Sexual Abuse (two sessions)
            Fiona True
            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

             The NYS Office of Mental Health (OMH)
             Lloyd Sederer, MD
             Medical Director OMH

            Supported Housing
            Ellen Baxter, MSW
            Director, Broadway Housing Community 

            New Research on Homelessness
            Dennis Cullhane, Ph.D.
            Associate Professor of Psychiatry, University of  Pennsylvania

                       

This syllabus was updated July 12, 2016