Philadelphia Connections Psychiatry Initiative:

Seminar Series on Community Psychiatry in Philadelphia:

Curriculum Proposal

Focus:

· History and context of changes in Philadelphia and Pennsylvania public sector behavioral health care since 1950, focusing on role of psychiatry

· Current structure of public sector behavioral health care in Philadelphia and the role of psychiatry

· Clinical, economic, and cultural characteristics of Philadelphia public sector patient population

· Problems and promise in the Philadelphia Behavioral Health System (BHS) and psychiatry's current and potential role

· What characterizes psychiatric practice in a Philadelphia community setting that is different from other settings and other populations?

· Topic areas that are not likely to be covered in other parts of the residents' curriculum

Goals:

· Provide exposure and background to practice in and structure of Philadelphia BHS

· Create interest in the practice of community psychiatry

· Understand uniqueness of community psychiatry and Philadelphia BHS

· Increase awareness of career options within community psychiatry

Method:

4-6 presentations to a particular school's psychiatry residents. Discussions with each participating school would help determine scheduling issues, target PGY residents, and any special topics of emphasis.

CORE CURRICULUM TOPICS

I. Overview of Community Psychiatry in the Philadelphia Behavioral Health System (1 session)

Objectives:

At the conclusion of session, residents will be able to:

- Relate the evolution of the system from hospital based to community based system

- Articulate the basic vision of system and factors helping and hindering accomplishment of vision

- Explain major structures and relationships existing in the Philadelphia BHS including but not limited to inpatient resources, CBH, and community providers

- Describe typical function and expectation of psychiatrist at CMHC

- List significant differences and similarities between presentation and treatment of clients in the community and those seen in inpatient unit

II. Walk a Mile in My Shoes: Consumer and Family Perspective and Advocacy

(1-2 sessions)

Objectives:

At the conclusion of session, residents will be able to:

- Articulate an understanding of at least two significant issues/problems facing consumers and families dealing with a long term mental illness

- List some goals of and resources for family advocacy in Philadelphia

- Recognize the elements of a positive relationship between family, consumer, and psychiatrist

- Determine the impact of cultural and ethnic issues on psychiatry practice

- Describe the major functions and impact of CST

III. Best Practices and Special Programs in Philadelphia

(1-2 sessions)

Objectives:

At the conclusion of session, residents will be able to:

Describe major function and impact of several unique and noteworthy programs, including but not limited to:

- Case Management emphasis

- Residential facilities including LTSR

- Emergency and Crisis approaches

- Alcohol and Drug abuse treatments

- Issues and resources for Children’s Mental Health

- Articulate issues and elements of practice topic of special interest to their School

IV. Roles, Careers, and Professional Issues in Community Psychiatry

Objectives:

At the conclusion of session, residents will be able to:

- Articulate the vision for psychiatry practice in the BHS and the factors helping and hindering accomplishment of this vision

- Explain several Psychiatric practice issues in PBHS including but not limited to:

Medication,

Special populations and concerns,

Risk management,

Managed care

- Describe several critical relationships for the psychiatrist to develop in PBHS including but not limited to:

Legal and law enforcement system

Social service system including child welfare

Inpatient resources

Professional societies and affiliations

- Describe the PGY4 Administrative Rotation available at CBH

Suggested Readings: (From NEOUCOM Curriculum)

1. Peszke MA: The chronically mentally ill, residency training and

psychiatry.(Editorial) American Journal of Psychiatry, 146:1249-1250, 1989.

2. Nielsen AC III, Stein L, Talbott JA, Lamb HR, Osser DN, Glazer

WM: Encouraging psychiatrists to work with chronic patients: opportunities and limitations of psychiatric residency education. Hospital and Community Psychiatry, 32: 767-775, 1981.

3. Grob, GN: The severely and chronically mentally ill in America: a historical perspective. In Soreff SM (editor): Handbook for the treatment of the seriously mentally ill. Hogrefe and Huber Publishers, Seattle, 1996.

4.Community Mental Health Centers- The Dream. In: Madness in the Streets by RJ Isaac and VC Armat Chapter 3. pp 67- 85, Free Press, New York, 1990

5 How No One Planned Deinstitutionalization: It Would Have Happened Anyway. In : Out of Bedlam: The Truth About Deinstitutionalization. Ann Braden Johnson. Basic Books, 1990

6. Appelbaum PS: Crazy in the streets. Commentary Magazine. May 1987 (pages 34-39.)

7. Minkoff K. Beyond Deinstitutionalization: A new ideology for the postinstitutional era. H & CP 38: 945-950, 1987.

8. Lamb HR: Deinstitutionalization at the crossroads. Hospital and Community Psychiatry, 39: 941-945, 1988. 1. Bachrach LL: Psychosocial rehabilitation and psychiatry in the care of long-term patients. American Journal of Psychiatry 149: 1455-1463, 1992.

9. Munetz MR, Birnbaum A, Wyzik PF: An integretive ideology to guide community

based multidisciplinary care of severely mentally ill patients. Hospital & Community

Psychiatry, 44: 551 - 555, 1993.

10. Anonymous: How I've managed chronic mental illness. Schizophrenia Bulletin

15:635-640, 1989.

11. Bernheim KF, Lehman AF: Working with Families of the Mentally Ill. Chapter 2.

The Family's Plight. W. W. Norton & Company, New York, 1985, pps. 18-34.

12. Lamb HR, Oliphant E: Schizophrenia through the eyes of families. Hospital &

Community Psychiatry 12: 803-806, 1978.

13. Kanter J: Case management with longterm patients: a comprehensive

approach. In Soreff SM (editor): Handbook for the treatment of the seriously

mentally ill. Hogrefe and Huber Publishers, Seattle, 1996.

14. Knoedler W: The continuous treatment team model: role of the psychiatrist

Psychiatric Annals. 19: 35-40, 1989.

15. Cutler DL, Bloom JD, Shore JH: Training psychiatrists to work with community

support systems for chronically mentally ill persons. American Journal of

Psychiatry. 138: 98-101, 1981.

16. Guidelines for psychiatric practice in community mental health centers.

American Psychiatric Association, 1988.

17. Lefley HP: Thinking about recovery: paradigms and pitfalls. Innovations &

Research 3:19 - 23, 1994.

18. Minkoff K, Stern R: Paradoxes faced by residents being trained in the

psychosocial treatment of people with chronic schizophrenia. Hospital &

Community Psychiatry 36: 859-864.

19. Harding CM, Zubin J, Strauss JS: Chronicity in schizophrenia: Revisited. British

Journal of Psychiatry 161 (suppl. 18) 27-37, 1992.

20. Blaska B: The myriad medication mistakes in psychiatry: a consumer's view.

Hospital & Community Psychiatry 41: 993-997, 1992.

21. Practicing Psychiatry in the Community: A Manual by Jerome Vaccaro, M.D.

and Gordon H. Clark, Jr.,M.D., M.Div., APA Press, 1996.