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NEW YORK STATE PSYCHIATRIC INSTITUTE

COLLEGE OF PHYSICIANS AND SURGEONS

COLUMBIA UNIVERSITY - DEPARTMENT OF PSYCHIATRY

FELLOWSHIP IN PUBLIC PSYCHIATRY
 

PROGRAM DESCRIPTION

The Public Psychiatry Fellowship (PPF) of New York State Psychiatric Institute at the Columbia University Medical Center was initiated in 1980 as a public-academic liaison between New York State Office of Mental Health (OMH) and Columbia University. OMH's goal was to facilitate recruitment and retention of high caliber psychiatrists to serve as leaders in the provision of services in the public sector.

The Fellowship is a one year full-time training program for psychiatrists (see information for applicants) who have completed accredited psychiatric residency training and who plan to devote their careers to working with high risk populations in the public sector. Residents whose PGY4 year is entirely elective are also eligible to apply. Fellows spend two days per week in seminars at Psychiatric Institute, learning the major principles and practices of public psychiatry. They spend three days each week applying these concepts at an agency providing comprehensive mental health services in the public sector. Each Fellow meets weekly with a core faculty preceptor who provides crucial guidance in all didactic and field experiences, and with a field placement supervisor who provides clinical and administrative supervision of work at the field site.

Field placement sites are carefully selected to provide a year-long, in-depth experience of how a particular mental health service works and how the psychiatrist as clinician/manager contributes to its effort. The Fellowship has developed a list of community- and hospital-based mental health agencies from which Fellows select a training site. Fellows with special interests can also choose alternative sites. In conjunction with the field site supervisor, each Fellow negotiates a contract to perform certain duties. The duties usually include participation on a clinical team and a combination of direct patient care, supervisory consultation, administration and internal program evaluation. Through these field placements the Fellowship has developed ongoing liaisons with a wide variety of community mental health, municipal, state and not-for-profit agencies. These agencies are consistently eager to recruit our Fellow and alumni. 

Didactic Seminars provide a systematic framework of knowledge to support the field work (see Syllabus). The Academic Seminar is a year long comprehensive overview of major topics in public psychiatry, taught by the core faculty. The topics include: the structure of public psychiatry in the United States, recovery and psychosocial rehabilitation, organizational theory, management methods and strategies for public psychiatry, theory and practice in service delivery for adults with severe and persistent mental illness,  internal program evaluation, fiscal administration, special populations (substance abuser, victims of abuse, people AIDS, the homeless) and managed care in the public sector.

In an Applied Seminar, Fellows use this academic framework 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.

Each week the Fellowship is addressed by a guest speaker currently active in the field of public psychiatry. These talks are coordinated with concurrent topics in the Academic Seminar and cover areas of interest in public policy, delivery of services, specialized clinical work and research.

Finally, there are presentations throughout the year on the Role of the Medical Director. In these presentations, approximately twenty-five alumni who are medical directors of  public sector agencies describe a current management problem. The fellows and faculty help the presenter develop a strategy to deal with this situation. In several instances, the same alumnus returns later in the academic year to report on the outcome, and to present a new problem. 

Approximately once a month Fellows visit a public sector treatment program of special interest (many with national reputations) in the New York area. These include Fountain House, The Dorothy Day Apartments, Clinic, Rikers Island Prison Mental Health Services, Brooklyn Assisted Outpatient Treatment Program and a variety of supportive housing and shelter programs. The field visits are followed by a luncheon discussion evaluating the special significance of that program.
 

Innovative Aspects of Fellowship

In recent years the Fellowship has attained increasing national prominence. Four innovative aspects of the program warrant special mention: (1) uniqueness of curriculum, (2) funding, (3) recruitment into public sector agencies, and (4) ongoing contact with alumni.

(1) Uniqueness of curriculum: The scale and depth of the academic curriculum, expanded and refined over 30 years, is highly unusual in a psychiatric fellowship. It is generally recognized that no other program provides comparable depth of training in public psychiatry.

(2) Funding: Fellowship stipends were originally funded completely by the New York State Office of Mental Health. More recently field placement agencies have increasingly supplemented these funds and now provide two-thirds of total stipends. These new funding sources have allowed the Fellowship to train 10 Fellows a year over the past decade.

(3) Recruitment into public sector agencies: The field placement experiences are conceived more as the first year of a job than as a separate training experience. Fellows receive ongoing supervision in how to create a productive role for themselves within the public agencies in which they are placed. Integration of Fellows into agencies and the eventual transition of many to staff psychiatrists at the end of the year is facilitated by the fact that the agencies provide a large portion of Fellows' stipends. Alumni surveys (see below) reveal that almost half of Fellowship alumni who remain in the New York metropolitan area are currently working at their field placement agencies. The agencies are aware of this impressive retention record and know that Fellows and alumni make valued, long-term contributions to their agencies.

(4) Ongoing contact with alumni: An increasing number of alumni are working in non-traditional settings, often as the first full-time psychiatrist. To counteract the potential problem of professional isolation, Fellowship faculty have fostered the development of a permanent network of alumni through yearly didactic presentations by more than 25 alumni, informal and formal reunions, individual consultations with faculty at career choice points, an e-mail list and this Fellowship web site.
 

The Fellowship is now serving as a national model for fellowship training in public psychiatry

As the oldest, largest and best known program training post-graduate psychiatrists to be public sector leaders, the fellowship is frequently consulted by professionals around the country interested in establishing such programs. The fellowship faculty has been consulted by  new and developing programs at Yale,  Case Western, New York University, University of Pennsylvania, University of Pittsburgh, UT Southwestern (Dallas), UCSF/SFGH, San Diego County Behavioral Health Services/ UCSD and Nassau University Medical Center (NUMC - East Meadow, NY). Four of these programs (at New York University, Case Western, NUMC and UCSF) are being run by PPF alumni. 

 In response, Dr. Ranz, with the fellowship faculty,  has developed seven core elements which they view as essential for such a training program. The felowship's longevity and the career paths of its graduates suggest these Core Elements represent a best practice model for fellowship training in public/community psychiatry. An article describing these elements will be published in Psychiatric Services in mid 2008.

Starting in 2008, Dr. Ranz has run a yearly meeting of all public/community psychiatry fellowship directors at the Institute of Psychiatric Services. Starting in 2009, potential applicants are invited to participate in these discussion, making them particularly lively. By 2011,  there were 14 programs represented at this meeting. 

Research on The Role of The Psychiatrist in The Public Sector

The faculty has undertaken a mission to advance national discourse on the role of the psychiatrist, an issue crucial to the functioning of psychiatrists in the public sector. In the mid 1990s,  the Fellowship  conducted two alumni surveys on the role of the psychiatrist in public sector organizations. The first survey published in Psychiatric Services in May, 1996, revealed that over 90% of alumni were working in public sector agencies, with over 75% holding academic appointments and over 50% having management positions. This survey revealed that alumni of the Fellowship have made a significant impact in the development of numerous innovative community programs at public facilities throughout the region, and have served in leadership positions in the New York metropolitan area and beyond.

The second alumni survey, published in Psychiatric Services in July, 1997, revealed that respondents who are medical directors reported performing a wider variety of tasks and significantly higher job satisfaction than those who are staff psychiatrists. These results have been the focus of several presentations, including a full-day workshop at the Psychiatric Services Institute in October, 1997.

A third article, published in Psychiatric Services in September 1998, examines further the results of the second alumni survey. Despite respondents' belief that clinical collaboration activities most contribute to job satisfaction, it is in fact the performance of administrative tasks that are best correlated with overall job satisfaction. Most of the medical directors in the survey had program, rather than agency, level responsibilities. The role of program medical director can serve as a crucial next step for staff psychiatrists, offering the opportunity to perform administrative tasks.

Fellowship articles:

1. Ranz JM, Rosenheck S, Deakins S: Columbia University's Fellowship in Public Psychiatry. Psychiatric Services 47:512-516, 1996

2. Ranz JM, Eilenberg J, Rosenheck S: The psychiatrist's role as medical director: task distributions and job satisfaction. Psychiatric Services 48:915-20, 1997

3. Ranz JM, Stueve A: The Role of the Psychiatrist as Program Medical Director. Psychiatric Services 49:1203-7, 1998

4. Ranz JM,  Deakins SM. Guest editors for a section: The Role of the Medical Director in Public Mental Health Organizations. Psychiatric Quarterly: 78:169-70, 2007. This section consisted of three articles written by PPF alumni describing their management positions

5. Ranz JM,  Deakins SM. Guest editors for a section: The Role of the Medical Director in Public Mental Health Organizations. Part II. Psychiatric Quarterly: 79:1-2, 2008. This section consisted of a second three articles written by PPF alumni describing their management positions

6. Ranz JM, Mancini AD. Public Psychiatrists' Reports of Their Own Recovery-Oriented Practices Psychiatric Services 2008 59: 100-104

7. Ranz JM,  Deakins SM, LeMelle SM, Rosenheck SD, Kellermann SL: Core Elements of a Public Psychiatry Fellowship. Psychiatric Services 59: 718-720,  2008.

In 2009, Drs Ranz and Deakins initiated a new column in Psychiatry Services, called the The Role of the Public Psychiatrist - Case Studies in Leadership, simulating discussions that take place when alumni present their roles to Fellows. Three articles have been published to date:
Dragatsi D and Deakins SM. Implementing a Metabolic Initiative in a Community Mental Health Clinic. Psychiatric Services 60: 1298-1301, 2009
Tam C.  Developing Collaborative Mental Health Care for Homeless Persons at a Drop-In Center Psychiatric Serv 61: 549-551, 2010
Levin TT, Kelly BJ, Cohen M et al. Using a Psychiatry E-List to Develop a Model for Discussing a Schizophrenia Diagnosis. Psychiatric Services 62: 244-246, 2011

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Surveys of National Psychiatric Organizations

An article published in July 2000 examined the variety of roles filled by psychiatrists functioning as medical directors in community settings, through a survey of all members of the American Association of Community Psychiatrists (AACP). A classification scheme of six types of medical director positions based on level of operation and breadth of supervisory responsibility was created. This classification helps clarify the medical director's role, providing guidance to psychiatrists and agencies negotiating job descriptions for this position (Psychiatric Services 51:930-2, 2000, see full text of article)

The results of the above survey of AACP members, augmented by using the same survey tool among members of the American Association of Psychiatric Administrators (AAPA), resulted in two other peer-reviewed articles. The first (The role of the psychiatrist as medical director: a survey of psychiatric administrators. Administration and Policy in Mental Health 27:299-312, 2000) describes comparisons between the AAPA and the AACP. The second (The role of the psychiatrist: job satisfaction of medical directors and staff psychiatrists. Community Mental Health Journal 37 [6]: 525-539, 2001) describes the results of the above surveys regarding job satisfaction. The findings were consistent with those reported for Public Psychiatry Fellowship alumni, that medical directors experience increased job satisfaction compared to staff psychiatrists. 

A  subsequent survey of members of the AACP, assessing the changes they have experienced over the past five years, was reported in two articles published in 2004 in  Community Mental Health Journal: 40 (5), 479-486, 2004 and 40 (5), 487-494, 2004

Programs Run by Alumni

An extraordinary number of alumni  are currently serving in leadership positions in the New York metropolitan area, throughout NY State, the country and beyond. 
Here is the ever expanding list of management positions currently held by alumni:


NY State Facilities (21 alumni):

Municipal Facilities (13 alumni):

VA Facilities (1 alumna):

Nonprofit Hospitals and Medical Centers (22 alumni)

Community Based Agencies (19 alumni):

A number of alumni have leadership roles in Managed Care Organizations (6)
Four alumni are running other public psychiatry fellowships:

A large number of alumni have leadership positions beyond the New York metropolitan region as follows (28 alumni):

Finally, alumni are providing leadership in other countries (10 alumni):

 

Core Faculty

Jules Ranz , M.D. (Director) has over  forty years experience as clinician-administrator in the public sector. He was Director of Training at the Tremont Crisis Center (an innovative three year social and community psychiatry residency program), Clinical Director of Bronx Psychiatric Center (a state-run inner-city inpatient and outpatient facility), and Director of the Huguenot Center (a comprehensive community service that specialized in systems-oriented care of adults with severe and persistent mental illness).  He is  a member of the Board of Trustees of Project Renewal. He is a Clinical Professor of Psychiatry in the Department of Psychiatry at Columbia University Medical Center. He was the recipient of the APA/NIMH 2013 Vestermark Psychiatry Educator Award.

Stephen Rosenheck, Ph.D., was one of the original founders of the Public Psychiatry Fellowship. A former historian, he specializes in public policy in mental health and has published articles on the history of de-institutionalization. He is currently doing cross national research on government health insurance programs and outpatient mental health care. Mr. Rosenheck also teaches in the Department of Child Psychiatry at Columbia University. He is an Assistant Clinical Professor of Psychiatry (in Social Work) at Columbia University Medical Center.

Sara L. Kellermann, M.D. was Commissioner of the New York City Department of Mental Health, Mental Retardation and Alcoholism Services from 1980 to 1990. In 1987 Dr. Kellermann received the Distinguished Psychiatric Administrator Award from the New York Regional Chapter of the American Association of Psychiatric Administrators. She has published papers on teaching mental health administration, the homeless mentally ill, the mental health aspects of AIDS, and mental health services in the correctional system.

Stephanie LeMelle, MD is Co-Director, Public Psychiatry Education at New York State Psychiatric Institute and Associate Clinical Professor of Psychiatry at Columbia University Physicians and Surgeons. She is the Chairperson of the Board of Directors for Pathways to Housing.  She is currently Vice President of the American Association of Community Psychiatrists, and on the National Advisory Council for SAMHSA. She is also Columbia University Dept of Psychiatry Liaison to Harlem Hospital. She was also a Mac Arthur Foundation Fellow, working on their Network on Mandated Community Treatment. She  is particularly interested in how housing is used as leverage to engage people in psychiatric treatment.

Voluntary Faculty

Ezra Susser, M.D.  is Professor of Epidemiology and Psychiatry and  head of the Department of Epidemiology at the Mailman School of Public Health of Columbia University, and head of the Epidemiology of Brain Disorders Department at the New York State Psychiatric Institute.  His primary research has been on the epidemiology of psychotic disorders.  He has studied the interrelationships between homelessness and psychotic disorders; compared psychotic disorders in low and high income countries;  and related prenatal exposures to the risk of schizophrenia in adulthood. Starting from his early work on homelessness, and later work on HIV, Dr. Susser has also focused on the health of inner city urban populations, and was formerly director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine.  He has published on the development of epidemiology as a discipline:  genetic epidemiology, psychiatric epidemiology, and epidemiology more generally.

Mindy Fullilove, M.D. holds a dual appointment in the Departments of Clinical Psychiatry and Public Health at Columbia University. She has had extensive research experience in the epidemiology of HIV infection in minority communities and in investigating the role of trauma as a co-factor in substance abuse. Previously she served as director of Multicultural Inquiry and Research on AIDS (MIRA), a component of the University of California (San Francisco) Center for AIDS Prevention Studies. Her recent publications are on the long term consequences of urban renewal for African Americans. 

The following voluntary faculty members are all graduates of the Public Psychiatry Fellowship:

Mary Barber, MD is Clinical Director, Rockland Psychiatric Center (RPC), after having served as Director of Community Services at RPC, and previous to that, as Clinical Director, Ulster County Mental Health Department. She was  president of the Association of Gay and Lesbian Psychiatrists  (AGLP) from  2001-5. She is Co-Editor of the Journal of Gay and Lesbian Mental Health (AGLP's journal), co-chair of the Group for Advancement of Psychiatry (GAP) Committee on LGBT Issues, and a distinguished fellow of the APA. She also co-chaired the production team of the documentary, “Abomination:  Homosexuality and the Ex-Gay Movement,” directed and produced by Alicia Salzer, MD, now in distribution by Frameline.

Tony Carino, MD is Associate Medical Director for Psychiatry, Janian Medical Care (formerly PPOH). He is Secretary of the Executive Board and Chair of the Training Committee of the American Association of Community Psychiatrists (AACP). Through AACP he is spearheading an effort to create a certification exam for community psychiatrists.  He is an assistant clinical professor in the Department of Psychiatry at Columbia University College of Physicians and Surgeons.

Dianna Dragatsi, MD is Director of Washington Heights Community Service at New York State Psychiatric Institute and Assistant Clinical Professor of Psychiatry at Columbia University Medical Center. She is also a voluntary clinical supervisor for the Addiction Psychiatry Research  Fellowship of Columbia University.

Juliana Ekong, MD  is National Medical Director for Behavioral Health of Amerigroup and Assistant Clinical Professor of Psychiatry in the Department of Psychiatry at Columbia University Medical Center.

Molly Finnerty, MD.  is Director of Guidelines Initiatives, Division of Strategic Planning, NYS Office of Mental Health. She is APA New York County District Branch Assembly Representative, President, Picnic for Parity, NYS MHA Board Member, NAMI-FACT Board Member. She created NYS OMH PSYCKES, an internet based medication monitoring system that has been implemented through NYS OMH and in many OMH licensed facilities. She has also created MyPSYCKES, a version of PSYCKES for use by consumers.

Andrew Kolodny, MD is Chief Medical Officer, Phoenix House. He has a longstanding interest in mental health and substance abuse policy. He was formerly Chair of Psychiatry at Maimonides Medical Center and prior to that Medical Director for Special Projects in the Office of the Executive Deputy Commissioner for the New York City Department of Health and Mental Hygiene. Dr. Kolodny is a past recipient of the Daniel X. Freedman Congressional Health Policy Award. Dr. Kolodny is a former President of the American Association of Psychiatric Administrators New York Regional Chapter and is presently Chair of the American Psychiatric Association New York County District Branch Public Psychiatry Committee.

Hunter L. McQuistion, MD,   is Director, Division of Integrated Psychiatric Services, Dept of Psych, St. Luke's Roosevelt Hospital Center. Prior to that, he was Chief Medical Officer, Division of Mental Hygeine, NYC Department of Health and Mental Hygeine, and formerly Medical Director, Project Renewal, Inc., a nonprofit agency serving homeless people in New York City.   Dr. McQuistion is an Associate Clinical Professor of Psychiatry at the Mount Sinai School of Medicine.  He is on the Board of Directors of the American Association of Community Psychiatrists, Chair of the APA Committee on Poverty, Homelessness and Psychiatric Disorders,  and on the advisory board of NAMI-NYC Metro, a local affiliate of the National Alliance for the Mentally Ill.

Warren Y.K. Ng, MD  is the Director of the Special Needs Clinic, a family based HIV mental health program at Columbia Universtiy Medical Center of NY Presbyterian Hospital. He is also the director of the mental health services at Incarnation Children's Center and the Family Care Center at Harlem Hospital. He is the President of the New York Council on Child and Adolescent Psychiatry and a delegate to the American Academy of Child and Adolescent Psychiatry. He is Assistant Clinical Professor of Psychiatry in the Department of Psychiatry at Columbia University Medical Center.

Paula Panzer, M.D.,  is Chief of Clinical and Medical Services at the Jewish Board of Family and Children's Services, New York, NY.  She is on the Editorial board of Psychiatric Quarterly and was recently chair of the American Psychiatric Association Scientific Program Committee for the Institute on Psychiatric Services.  She is also former President, New York Regional Chapter, American Association of Psychiatric Administrators (1998-99).

Paul Rosenfield, MD, is Director of the Adult Outpatient Psychiatry Clinic at St. Luke's Roosevelt Hospital Center and Assistant Clinical Professor of Psychiatry at Columbia University's College of Physicians and Surgeons. Previously, he was medical director of the Riverdale Mental Health Association's Personalized Recovery-Oriented Services (PROS) program and assistant unit chief of the Schizophrenia Research Unit at the New York State Psychiatric Institute. His interests include the diagnosis and treatment of schizophrenia, the concept of recovery, the history of psychiatry, and psychiatric education.

Jeanie Tse, MD is the Associate Chief Medical Officer and Director of Integrated Health at the Institute for Community Living, Inc. (ICL), a not-for-profit community behavioral health agency providing a continuum of housing, case management and treatment options to support recovery among people and families living with psychiatric and developmental disabilities. Her main interest lies in "bridging the gap" between academic medicine and disadvantaged communities. She is a Clinical Assistant Professor of Psychiatry at the NYU School of Medicine, serving as a faulty member in the NYU Public Psychiatry Fellowship.



Fellowship Headquarters and Field Placements

The headquarters of the Fellowship is in the Department of Postgraduate Education of New York State Psychiatric Institute. The Institute's library and other educational facilities, as well as the expertise of its internationally recognized professional staff, are readily available to the Fellows.

Through work in field site placements, Fellows have the opportunity to develop themselves as leaders in team-based clinical settings and to explore the approaches that have proven effective in the public sector. These include ACT Teams, clubhouses, day treatment programs, partial hospitalization, and psychiatric rehabilitation. Following is a list of field sites selected by the Fellowship in recent years:

1) Janian Medical Care (formerly PPOH) of the Center for Urban Community Services (CUCS), New York, NY.  PPOH recruits psychiatrists to work on-site at outreach programs, shelters, drop-in centers and transitional and permanent residences for mentally ill homeless persons. Psychiatrists provide evaluations, on-going treatment and staff education, working closely with case managers at these sites as consultants to treatment teams. Each psychiatrist consults with the same program on a weekly basis throughout the year. The Associate Medical Director for Psychiatry and the Assistant Medical Director for PPOH are fellowship graduates.

2) Project Renewal, a not-for profit community based rehabilitation agency providing residential, counseling and social services to homeless adults who are suffering from substance abuse, mental illness and/or AIDS. In recent years Fellows have worked in an SRO residence, alcohol residential treatment programs, men's and women's shelters and a mobile van. The Medical Director for Psychiatry and two Associate Medical Directors are fellowship graduates.

3) ICL  is an award-winning not-for-profit, human service agency offering health care, mental health care, family support, residential assistance, and treatment to almost 10,000 adults, families, and children throughout New York City and Montgomery County, PA. As a national leader in pioneering effective solutions for people with serious mental illness, ICL works every day to help individuals struggling to overcome enormous obstacles.The Associate Chief Medical Officer (VP Integrated Health) is a fellowship graduate.

4) NYS Office of Mental Health Facilities:

Washington Heights Community Service (WHCS) , Audubon and Inwood Clinics, New York, NY . A state-run comprehensive treatment program for the severely and persistently mentally ill living in the inner city. WHCS was founded in the 1970s as a model state-university collaboration using research-based treatment and has continued on that basis for over 20 years.  The director of WHCS is a fellowship graduate.

Rockland Psychiatric Center, Orangeburg, NYis the largest state hospital in New York, treating 400 inpatients and 3500 outpatients and covering seven counties in the lower and mid-Hudson Valley.  In addition to providing intermediate-stay inpatient treatment, including specialty inpatient units for research, deaf adults, DBT, geriatric and forensic patients, RPC operates twelve clinics and two ACT teams and runs an on-campus clubhouse, the Recovery Center, which includes an art studio/gallery.  RPC also has housing in four of the counties it serves, both community residence level and family care homes.  RPC is affiliated with NYU and has connections to the Nathan Kline Institute on campus, one of the two research institutes in New York State.  RPC's Clinical Director, and the  Director of the Recovery Center clubhouse are fellowship graduates.
 
South Beach Psychiatric Center, Staten Island, NY . A model state psychiatric facility, providing comprehensive community and inpatient service to the predominantly middle class borough of Staten Island and a major portion of Brooklyn. The executive director, clinical director and chief of psychiatry are all fellowship graduates.

Manhattan Psychiatric Center, Wards Island, 125th St OPD, NY provide state-of-the art inpatient and outpatient services for the severely and persistently mentally ill living in the inner city. MPC uses research- and evidence-based treatments together with highly innovative computerized neuro-cognitive remediation to address both cognitive and social cognition challenges of clients. Principles of recovery together with extensive peer support programs are at the core of all treatments. Tele-psychiatry and intensive transition interventions support the bridge between in- and outpatient services. Many Fellows have had their field site placement at MPC and continued as staff psychiatrists.

Bronx Psychiatric Center, The Bronx, NY, affiliated with Albert Einstein College of Medicine, providing inpatient and outpatient services, including an ACT team.

Kirby Forensic  Psychiatric Center, Wards Island, NY, a maximum security hospital providing secure treatment and evaluation for the forensic patients and courts of New York City.

5) Maimonides Medical Center Department of Psychiatry, Brooklyn, NY. Maimonides operates one of the nation's first Community Mental Health Centers (CMHC). Built in 1967, the CMHC offers an array of inpatient and outpatient services for adults, children and adolescents. In recent years, the CMHC has transformed itself to meet changing community needs and to respond to changes in the funding and financing of mental health care. Maimonides Medical Center has been collaborating with the New York State Office of Mental Health, the New York State Department of Health and a consortium of mental health organizations in an effort to help redesign the mental health system and to establish a new model of care.

6) Premier HealthCare. A not-for-profit comprehensive ambulatory healthcare system in the YAI Network (www.yai.org) providing a range of medical, mental health, physical rehabilitation, and family support services for people of all ages with developmental disabilities.  Premier is an NCQA recognized Patient Centered Medical Home (a former public psychiatry fellow is leading this initiative), a Mount Sinai affiliate, and has been repeatedly cited as a national model health care agency for our population. Premier has 25 psychiatrists practicing at 5 separate New York City sites.  We provide psychiatric and other training on site and through lectures at most of the major academic hospitals in Manhattan.  Fellows provide direct services and take on meaningful projects to help build the agency.  There are many opportunities to acquire in-service training.

7) Mt. Sinai Health System (including sites at Mt. Sinai, St. Luke's and Roosevelt Hospitals). A comprehensive public sector mental health service system in a prominent medical center on Manhattan's East and West Sides. Opportunities include working in the following programs:,at Mt. Sinai's World Trade Center Program,  at St. Luke's the Child and Adolescent Psychiatric Services, and at Roosevelt, the Addiction Institute of NY and the Residential Community Service (developed and run by another of our graduate). This latter service includes a number of joint ventures with Fountain House, the protyptical clubhouse, and several other supportive residential programs in the neighborhood.

8) Pathways to Housing, Manhattan and Brooklyn teams, NY . Founded in 1992, Pathways to Housing offers scattered site permanent housing to homeless individuals with psychiatric disabilities and addictions. Despite the challenges this population presents, Pathways is unique in what it does not require of its residents: "graduation" from other transitional programs, sobriety, or acceptance of supportive services. The vast majority of clients are moved directly from the streets into permanent, private market housing. The program then uses Assertive Community Treatment (ACT) teams to deliver services to clients in their homes. The ACT teams help clients to meet basic needs, enhance quality of life, increase social skills, and increase employment opportunities.

9) The Bridge Inc. A voluntary agency on Manhattan's Upper West Side providing comprehensive services for adults with severe and persistent mental illness. Services include a continuing day treatment program, prevocational training and a supported work program, nursing and medical support services, group and individual counseling and a number of supportive community residences.

10) BRC  provides outreach to homeless people living on the streets or in the subway, drug treatment, mental health care, comprehensive medical services, vocational services, and supportive communities in which to live. The medical director is a fellowship graduate.

11) New York Presbyterian Hospital Comprehensive Psychiatry Emergency Program (CPEP): The CPEP includes a psychiatry emergency room, extended observation beds and mobile crisis team.

12) Personalized Recovery Oriented Services (PROS): PROS is a comprehensive recovery oriented program for individuals with severe and persistent mental illness. The goal of the program is to integrate treatment, support, and rehabilitation in a manner that facilitates the individual's recovery. Goals for individuals in the program are to: improve functioning, reduce inpatient utilization, reduce emergency services, reduce contact with the criminal justice system, increase employment, attain higher levels of education, and secure preferred housing.There are an increasing number of agencies running PROS.

Alternate Field Sites. In consultation with Fellowship faculty, Fellows may choose an alternate site in a public mental health facility in the Metropolitan New York area. Sites may operate under federal, state, municipal, or non-profit auspices. Fellowship faculty will evaluate proposed sites with regard to their potential for relevant clinical and administrative work, availability of a field site supervisor, training and research opportunities, and value as an educational experience. Final site selection will be made jointly by faculty, the incoming Fellow, and field site supervisors.  

Applications

Candidates for the Fellowship must have completed an accredited residency program in psychiatry or child psychiatry. Residents whose PGY4 year is entirely elective are also eligible to apply. In addition, the candidate must have, or be eligible to obtain, a New York State Medical License prior to entry into the program. Of primary importance in the selection process will be the candidate's demonstrated interest in public mental health issues, especially those concerned with achieving better care for poor and otherwise disadvantaged adults with severe and persistent mental illness. Other factors considered in the selection process include the candidate's interest and ability in a) working as part of an interdisciplinary team, b) psychiatric leadership, c) internal program evaluation and d) other academic endeavors. The selection committee complies with the intent of the Affirmative Action Program and the Americans with Disabilities Act.

Applicants to the Fellowship are helped to find top quality public sector positions which serve as fellowship placements. Alternatively, psychiatrists who already have 3-5 day per week clinical and/or management positions can use the fellowship training program to become more productive in their roles. The agency or hospital salary is supplemented by a stipend  for the 1½ day per week academic curriculum and faculty supervision at New York State Psychiatric Institute.

Fellows receive appointments as Post Doctoral Clinical Fellows in the Department of Psychiatry, College of Physicians and Surgeons of Columbia University. Upon successful completion of the program they are awarded a certificate by Columbia University. The position is a full-time commitment for the academic year (July 1 to June 30), and candidates are expected to comply with that requirement.

The stipend for the academic year starting July 2014 is expected to be at least $88,000 for Fellows at the PGY5 level, and $94,000 for Fellows at the PGY6 level. Approximately 2/3 of that stipend is paid by the field placement agency, and 1/3 by New York State Psychiatric Institute (NYSPI). For those who already have 3-5 day per week positions, the supplementary stipend paid by NYS PI is approximately $28,000 - $29,000 depending on PGY level.

Communication can be sent to the fellowship director:
Jules, M. Ranz, M.D.
Box 111
New York State Psychiatric Institute
1051 Riverside Drive,
New York, New York 10032

Dr. Ranz can also be contacted by telephone (646-774-6334) or e-mail (jmr1@columbia.edu).

This brochure was last updated on July  7, 2014