1.     Overview

    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 ACADEMIC CURRICULUM

    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: Psychosocial Rehabilitation I:  Introduction to Psychosocial Rehabilitation and Recovery-oriented Practices for   the Severely and Persistently  Mentally Ill
    Unit IV: Introduction to Managerial Program Evaluation
    Unit V:  The Structure of Public Psychiatry II: The Structure of Public Mental Health Services, 1948-1990
    Unit VI:  Alcoholism and Substance Abuse
    Unit VII: Psychosocial Rehabilitation II:  Topics in Psychosocial Rehabilitation and Recovery-oriented Practices for  the  SPMI
    Unit VIII:  Homelessness and Housing Policy
    Unit IX:  Current Directions in the Structure of Public Mental Health
    Unit X:  Public Mental Health Advocacy
 

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:  Internal Program Evaluation Presentations
  Series 6: 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, Family Court, Third Street TC (Project Renewal), Lincoln Hospital Acupuncture Program, St. Francis Residence, Dorothy Day  Residence, 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

                                COMPLETE SYLLABUS

New! Many of the articles in the syllabus have been scanned by Denise Leung, Public Psychiatry Fellow 2007-08. Click on the link embedded in the number of the article  to access these articles.

UNIT I:  THE AMERICAN WELFARE STATE AND PUBLIC MENTAL HEALTH

                Steve Rosenheck
 

A:      The Social Security Act: Core of the American Welfare State

Readings:
[1.1] Rimlinger, G. Welfare Policy and Industrialization in Europe,  America, and Russia,  JohnWiley, 1972,   pp. 193-236.
[1.2a] Stevens, R., Stevens, R. Welfare Medicine in America, Free Press,  1974, pp. 45-6.
[1.2b] Newman, H.Medicare and Medicaid; The Annals of the American Academy of Political Science 339:194-229, 1972.
[1.3] Berkowitz, E.,Disabled Policy, Cambridge University Press, 1987,p.85. 
[1.4] Iglehart, J. Medicaid Turns to Prepaid Managed Care. New England Journal of  Medicine 308, 1983,  pp.976-80
[1.5] "Major Welfare Reforms Enacted in 1996",  The Social Security Bulletin 59: 60-63, 1996.
[1.6] Rosenbaum, S. The Children’s Hour: The State Children’s Health Insurance Plan. Health Affairs 17(1): 75-89, 1998.
[1.7] What “deficit reduction” means for people with mental Disabilities. NAMI-NYS News, April 2006.

B:     Centralization/De-centralization in American Government  I: The Federal System

Readings: 
[2.1] Morgan, J., Connery, R. Shared Responsibilities in the Federal System.  In: The  Administration of Mental Health Services (Ed. Feldman) Charles C.Thomas, 1980, 242-246.
[2.2] Peck, J and Swartz T. Six Profiles of the Changing Face of Fiscal Federalism: An Overview. In The Changing  Face of Fiscal Federalism, M. E. Sharpe, 1992, 3-4.

Readings: See 1.2a, 1.2b, 1.4, 1.6, 1.8 above.

Reading:
[3] Woodbury, R., Social Insurance: An Economic Analysis, New York, 1917, pp. 2-4, 19-20.

Readings:
[4]  Terry, D. To Avoid Deficit, Michigan Ends Welfare to Some Adults,  The New York Times , October 4, 1991.
[5a] Kaiser Commission on Medicaid and the Uninsured, The Uninsured, A Primer, 2004
[5b] Regenstein M., Huang, M., Stresses to the Safety Net: The Public Hospital Perspective.
Kaiser Commission on Medicaid and the Uninsured, 2005.
[6a] Foscarinis, M. The Federal Response: The Stewart B McKinney Homeless Assistance Act. In J. Baumohl,(Ed,), Homelessness in America (pp. 161-70) Washington,D.C.:Oryx Press, 1996.

Readings:
[9] Peterson, P., The Urban Underclass and the Poverty Paradox,in (C. Jencks P. Peterson, Eds.) The Urban Underclass, The Brookings Institution, 1991,  pp.4-8.
[10] Smeeding, T, Rainwater, L,  Burtless, G, Poverty in the United States and Other Western Countries,  Focus 21, 2001, pp 50-54
[11] Weir, M., Orloff, A.,Skocpol, T., Understanding American Social Politics. In The Politics of Social Policy in the United States, Princeton University Press, 1988, pp. 3-27.

Readings:
[12] Hunter, D., Vienonen, M. & Wlodarczyk (1998). Optimal Balance of Centralized and Decentralized Management. In R. Saltman, J. Figueras, ( Eds.)  Critical Challenges for Health Care Reform in Europe (308-25). Philadelphia: Open University  Press.
[13] Salamon, L., Partners in Public Service: Government-Nonprofit Relation in the Modern Welfare State,  Baltimore: Johns Hopkins, 1955, pp.53-4

                                            The Fellowship Faculty

Session 1:  Roles, Role Conflict and Role Transitio

Reading:
(1) Allen, Vernon L., and van deVliert, Evert, ed., “A Role Theoretical Perspective on Transitional Processes” in Role Transitions, Explorations and Explanations, pp. 3-18.

Readings:
(2a) Diamond, Ronald J., M.D., Stein, Leonard I., M.D., and Susser, Ezra, M.D., M.P.H., “Essential and Nonessential Roles for Psychiatrists in Community Mental Health Centers”, Hospital and Community Psychiatry, February 1991, Vol. 42, No. 2, p.187-189.
(2b) AACP Guidelines for Psychiatric Leadership in Organized Delivery Systems for Treatment of Psychiatric and Substance Disorders

Readings:
(3a) Ranz,  J.M., McQuistion, H.L. & Stueve, A: The role of the community psychiatrist as medical director: a delineation of job types. Psychiatric  Services 51:930-32,  2000.

UNIT III – INTRODUCTION TO PSYCHOSOCIAL REHABILITATION

            Jules Ranz and Sue Deakins

Session 1 : Overview and Assertive Community Treatment (ACT)

Readings:
Overview: 
(1a) Bachrach, L . Psychosocial rehabilitation and psychiatry: what are the boundaries? Canadian Journal of Psychiatry 41: 28-35,  1996.
(1b) Hughes RA, Lehman, AF, Arthur TE: Psychiatric Rehabilitation, in  in Integrated Mental Health Services (ed. Breakey WR), Oxford University Press, New York, 1996, pp. 286-300).
(1c)  Lamb, HR. A Century and a Half of Psychiatric Rehabilitation in the United  States. Hospital and Community Psychiatry 45: 1015-20, 1994.

ACT: 
(2a) Stein, L. & Test, M.  A program for difficult-to-treat patients. New Directions in  Mental Health 26: 29-39, 1985.
(2b) Bond GR, Drake RE, Mueser KR and Latimer E: Assertive community treatment for people with severe mental illness: critical ingredients and impact on patients. Dis Manage Health Outcomes 9(3) 141-159, 2001.
(2c) Deci PA, Santos AB, Hiott WD.  Dissemination of assertive community treatment  programs.  Psychiatric Services 46:676-8, 1995.
(2d) Phillips, SB, Burns, BJ, Edgar, E., et.al. Moving Assertive Community Treatment into Standard Practice, Psychiatric Services 52, 771-79, 2001.

Session 2:  ACT  Replications, Adaptations and Evaluations.

Readings:
(2e) Mueser KT, Bond GR, Drake RE, Resnick SG: Models of community care for  severe mental illness - a review of research on case management. Schizophrenia Bulletin 24(1):37-74, 1998.  
(2f) Wolff, N, Helmniak, T, Diamond, R. Estimated Societal Costs  of Assertive Community Treatment Mental Health Care. Psychiatric Services 46: 898-906, 1995
(2g) Salyers, MP, Risnick SG, Bond GB:: Fidelity of New York State Assertive Community Treatment Programs; NYS OMH Report, 8/3/00

Session 3:   Pathways to Housing and Case Management

Readings:
(3a) Gulcur L, Stefancic A, Shinn M, Tsemberis S and Fischer SN: Housing, Hospitalization, and Cost Outcome for Homeless Individuals with Psychiatric Disabilities Participating in Continuum of Care and Housing First Programmes. Journal of Community & Applied Social Psychology 13:171-86, 2003
(3b) Tsemberis S, Eisenberg RF: Supported housing for street-dwelling homeless individuals with psychiatric disabilities;  Psychiatric Services 51:487-493, 2000
(3c) Bedell JR, Cohen NL and Sullivan A: Case management – the current best practices and the next generation of innovation. Community Mental Health Journal: 36  (2): 179-194, 2000.

 Session 4:  Fountain House

Readings: 
(4a.) Beard, J.,Propst,R.,Malamud, D.,The  Fountain House Model of  Psychiatric Rehabilitation PsychsocialRehabilitation Journal, 1:47?53, 1982.
(4b) Macias, C, Barreira P, Alden, M.,  Boyd, J. The ICCD Benchmark for Clubhouses: A Practical Approach to Quality Improvement in Psychiatric Rehabilitation. Psychiatric Services 52: 207-13, 2001.
(4c) Propst R: The standards for clubhouse programs: why and how they were developed. Psychosocial Rehabilitation Journal 16:25-30, 1992
(4d) Macias C: MA Employment Intervention Demonstration Project - “An experimental comparison of PACT and Clubhouse”, April 2001
 

Reading:
(5a) Becker, D., Drake, R., A Working Life for People with Severe Mental Illness; selected chapters and  Vocational Profile and Supported Employment  Fidelity Scale, Oxford Univ Press 2003
(5b) Salyers M, Becker D, Drake R, Torrey W and Wyzik P.  A Ten-Year Follow-Up of a Supported Employment Program. Psychiatric Services 2004 55:302-308.

Readings:
(6a) Jacobson, N, Greenley D: What Is Recovery? A Conceptual Model and Explication. Psychiatr Serv, Apr 2001; 52: 482 – 485.
(6b) Ranz J and Mancini A. Public Psychiatrists' Report of Their Own Recovery-Oriented Practices, Psychiatric Services (draft accepted for publication)

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.

The module will examine various types of evaluation i.e. quantitative and qualitative, the  threats to internal validity and the logic module.  We will look at the logic module of a proposed program and then look at a program and create a logic model  for it.

                                                                                                                    
Session 4: Qualitative Evaluation Methods

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

Session 1:   Introduction

Readings: 
[14] Review Summary # 1
[12] Hunter, D., Vienonen, M. & Wlodarczyk (1998). Optimal Balance of Centralized and Decentralized Management. In R. Saltman, J. Figueras, ( Eds.)  Critical Challenges for Health Care Reform in Europe (308-25). Philadelphia: Open University  Press.

Session 2:  The Structure of Public Psychiatry in 1948

Readings:
[15] Lebensohn, Z., General Hospital Psychiatry USA: Retrospect and  Prospect, Comprehensive Psychiatry  21:  500-503, 1980 .

 

Session 4: The State Program Grant  Funding Stream

Readings:
[18] Hunt , R., Forstenzer, H.  The New York State Community Mental Health  Services Act:     
 Its Birth and  Early Development.  American Journal of Psychiatry, 113:680-685, 1957.  
[19] Frank, R., Gaynor,  State  Government Choice of Organizational Structure for Local Mental Health Systems, Advances in  Health Economics and Health Services Research 14: 181-96, 1996.
[20a] Forstenzer, H. Problems in Relating  Community  Programs to State Hospitals, American Journal of Public Health 51, 1152-59, 1961.
[20b]  Cameron, J., Ideology and Policy Termination: Restructuring California's Mental Health System. Public    
Policy 26:560-62.  (Note that Cameron article is in same file as Forstenzer article).
[21a] NYS CSS Report
[23a] NYS OMH Budget 1993-94

            Readings:
            [24a] Fossett, J. (1993). Medicaid and Health Reform: The Case of New York. Health Affairs,  Fall,  pp. 84-94
            [24b]. Buck, J. Spending for State Mental Health Care, Psychiatric Services 52: 1294, 2001
            [25]  OMH Weekly (1991) New outpatient programs are being tailored to meet different needs. April, pp.3, 4,  15
            [26] Edwards, B. & Smith, V (2007). Insights and Opportunities: Medicaid Directors Identify Mental Health Issues. 
            Psychiatric Services 58:1032-34

Readings: 
[21] Grob , G. The Mad Among Us,  The Free Press, 1994, pp.249-65.
[22a] Message from the President of the United States Relative to Mental Illness and  Mental Retar dation, 88th Cong., 1st Session, Feb. 5, 1963, H.R. Document 58.
[22b] Cameron, J. (1989). A National Community Mental Health Program. In D. Rochefort, (ed.). Handbook of Mental Health Policy in the United States (pp.121-42). Greenwood Press: Westport, Conn.
[22e] Gronfein. W. (1985). Incentives and Intentions in Mental Health Policy: A Comparison of the Medicaid and Community Mental Health Programs. Journal of Health and Social Behavior26: 192-206.

[Optional]  Pardes, H., The demise of a major innovation: Carter’s 1980 Community Mental Health Systems Act in Reagan’s hands. In I. Marks & R. Scott, Eds., Mental Health Care Delivery (pp.189-200), Cambridge University Press, 1990.

Session 7:  Future Issues and Directions in the Fiscal and Jurisdictional Structure of Public Mental Health

Session 8: The Structure and Funding of Alcoholism and Substance Abuse Services

 Readings: 
 [30] Broadening the Base of  Treatment for Alcohol Problems, Washington D.C.: National  Academy Press, 1990,  pp. 405-27
 [31] Lewis, J., Congressional Rites of Passage for the Rights of Alcoholics, Alcohol Health and Research World 12:23-24, 1980
 [32] Courtwright, D  A Century of  American Narcotics Policy, in Treating Drug Problems  vol  II , ed. D.  Gerson. & H. Harwood,   Washington, D.C.: National Academcy Press, 1992, pp. 1-63              
[33] New York State Office of Alochol and Substance Abuse Services [OASAS] (2007) History of OASAS.  

UNIT VI —  ALCOHOLISM AND SUBSTANCE ABUSE

            Sue Deakins
 

Session 1:  The Quadrant Model for co-morbid substance use and psychiatric disorders

       Readings:

1.     Mueser, Kim T. et al, “Co-morbid Substance Use Disorders and Psychiatric Disorders” in Rethinking Substance Abuse, ed. Miller, William R. and Carroll, Kathleen M., pp.115-127, 132.  Those of you in child psychiatry may be interested in pp. 127-131 as well.

2.     “Origins of the Quadrant Model for Persons with Co-occurring Disorders”, Letter to the Editor and Reply, Psychiatric Services, December 2007, Vol. 58, No. 12, pp. 1607-1608.

3.     McGovern, Mark P., Ph.D. et al, “Co-occurring Psychiatric and Substance Use Disorders: A Multistate Feasibility Study of the Quadrant Model”, Psychiatric Services, July 2007, Vol. 58, No.7, pp. 949-954.  To my knowledge this is the first study of the Quadrant Model.

4.     Mueser, Kim T., “Principles of Integrated Treatment” in Integrated Treatment for Dual Disorders, pp. 16-25 (up to Motivation-based Treatment).

5.     Drake, Robert E. et al., “Ten-Year Recovery Outcomes for Clients with Co-Occurring Schizophrenia and Substance Use Disorders”, Schizophrenia Bulletin, vol. 32, no. 3, pp. 464-473, 2006.  To my knowledge this is the only long term follow-up study on this population.  IDDT was the treatment modality

        8. Miller, William R., “Motivational Factors in Addictive Behaviors” in Rethinking   Substance Abuse, ed. Miller, William R. and Carroll, Kathleen M., pp.134-150.

        10. Mueser, Kim T.,  “Motivational Interviewing”, in Integrated Treatment for Dual Disorders, pp.108-120.

        11. DiDlemente, Carlo C., “Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders”, Journal of Substance Abuse Treatment 34, (2008) 25-35.

Readings:

12. Marlatt, G. Alan, and Tapert, Susan F., “Harm Reduction: Reducing the Risks of    Addictive Behaviours”, p.243-272.

13. Marlatt, G. Alan, and Witkiewitz, “Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment”, Addictive Behaviours, 27 (2002), p. 867-886.

Session 5: Relapse Prevention

Readings:

14. Witkiewitz, Katie and Marlatt, G. Alan, “Relapse Prevention for Alcohol and Drug Problems”, American Psychologist, Vol. 59, No.4, p.224-235. 

15.   Connors, Gerard J. et al., “Relapse”, in Substance Abuse Treatment and the Stages of Change, p.194-212.

  16. Brownell, Kelly D. et al., “Understanding and Preventing Relapse”, American Psychologist, Vol. 41, No. 7, p765-782.

17. Drake, Robert E., et al, “A systematic review of psychosocial research on psychosocial interventions for people with coo-occurring sever mental and substance use disorders”, Journal of Substance Abuse Treatment 34 (2008) 123-138.

 18. Brunette, Mary F., et al, “A review of research on residential programs  for people with severe mental illness and co-occurring substance use disorders”, Drug and Alcohol Review (December 2004), 23, 471-481.
 

19. Petry, Nancy M., “A comprehensive guide to the application of contingency management procedures in clinical settings”, Drug and Alcohol Dependence 58 (2000) 9-25.

24.Assessment Instruments and Other Forms

25. Dual-Disorder Treatment Fidelity Scale

UNIT VII  —  TOPICS IN PSYCHOSOCIAL REHABILITATION

        The Fellowship Faculty
 

Session 1: The Anthony Model of Psychiatric Rehabilitation
                Tony Salerno, PhD, Director of Psychiatric Rehabilitation, Rockland Psychiatric Center

           Reading:
           Farkas MD, Anthony WA, Cohen MR, Psychiatric Rehabilitation: the approach and it's programs. In Farkas and Anthony (Eds) Pryschiatric Rehabilitation Programs: Putting theory into practice. Baltimore: Johns Hopkins University Press, 1989
 
Session 2: The Family Perspective on Severe Mental Illness

            Martin Willick, MD

Session 3: The Drake Model: ACT and Supported Employment
                Sue Deakins

Readings:
Becker, D., Drake, R., Individual Placement and  Support: A Community Mental Health Center Approach To Vocational Rehabilitation, Community Mental Health  Journal 30:193-205, 1994. 
Drake, R., et. al., Day Treatment Versus Supported Employment for Persons with Severe Mental Illness: A Replication Study. Psychiatric Services 47: 1125-27, 1996. 
Drake, R., et al., The New  Hampshire Study of  Supported Employment for People with Severe Mental Illness.  Journal of Consulting and Clinical Psychology 64: 391-99, 1996.

Session 4: Adaptation of the Liberman Model: Money Management Module
              
          Stephanie Lemelle, MD (Public Psychiatry Fellow, 1997-98)
 

Session 5:  Psychiatric Rehabilitation: The Client's Experience of Work
                 
            Dianna Dragatsi (Public Psychiatry Fellow 2003-04) and clients from the Washington Heights Community Service
 

Session 6:  Family Psychoeducation for Schizophrenia I
           
            Sue Deakins and Bonnie Horen

Readings: 
Dixon , L., et. al. Service to Families of Adulsts with Schizophrenia: From Treatment Recommendations to Dissemination. Psychiatric Services 50: 233-38, 199.
Dixon , L., Lehman, A. Family Interventions for Schizophrenia.  Schizophrenia Bulletin 21: 631-43, 1995.

Session 7:  Family Psychoeducation for Schizophrenia II
           
        Sue Deakins and Bonnie Horen

Readings:
Macfarlane, W., et.al.. Multiple Family Groups and Family Psychoeducation in the Treatment of Schizophrenia. Archives of General Psychiatry 52:pp. 679-87, 1995;
Anderson, C., Reiss, D., Hogarty, G. Schizophrenia in the Family. New York: Guilford Press,  1986, pp.26-70

UNIT VIII  — HOUSING, HOMELESSNESS AND HOUSING POLICY

               Jules Ranz, Steve Rosenheck and Hunter McQuistion

Session 1: Housing Paradigms

Readings:
(1a) Lehman AF, Newman SJ: Housing, in Integrated Mental Health Services (ed. Breakey WR), Oxford University Press, New York, 1996;  
(1b) Hopper K, Barrow SM: Two genealogies of supported housing and their implications for outcome assessment. Psychiatric Services 54: 50-54, 2003;
(1c) McHugo GJ, Bebout RR, Harris M et al: A randomized trial of integrated vs parallel housing services for adults with severe mental illness. Schizophrenia Bulletin 30 (4): 969-982, 2004.
(1d) Siegel CE, Samuels J, Tang DI, et al:  Tenant Outcomes in Supported Housing and Community Residences in New York City.  Psychiatr Serv, Jul 2006; 57: 982 - 991.

(2a) Lipton FR, Siegel C, Hannigan A, Samuels J, Baker, S: Tenure in supportive housing for homeless persons with severe mental illness. Psychiatric Services 51: 479-86, 2000;
(2b) Supportive Housing Options - NYC; prepared by the Center for Urban Community Services;
(2c) Newman SJ: Housing attributes and serious mental illness: implications for research and practice. Psychiatric Services 52: 1309-17, 2001

Session 3: The Role of the Psychiatrist in Housing Programs

        Reading:
        (3) Diamond RJ: The psychiatrist’s role in supported housing. Hosp & Com Psych 44: 461-464, 1993

Session 4: The Client Viewpoint On Housing

    Dianna Dragatsi  (Public Psychiatry Fellow 2003-04) and a panel of clients from the Washington Heights Community Service
 

Session 5:  The  American Welfare State,  Housing, and the Mentally Ill: An Historical Overview
                    Steve Rosenheck

Readings:
(5a) Dolbeare, C., General  Considerations on Housing Policy, in  Jim Baumohl, ed. Homelessness in America. Washington D.C.:Oryx Press, 1996. 
(5b) Foscarinis, M. , The Federal Response: The Stewart B  McKinney  Homeless Assistance Act   In   J. Baumohl,(Ed,), Homelessness in  America  (pp. 161-70) Washington,  D.C.:Oryx Press, 1996.

Session 6:  The Causes of Homelessness

Reading: 
(6) Koegel, P., Burnam, N., Baumhol, J.  The Causes of Homelessness. In Jim Baumohld (ed.) Homelessness in America (pp.161-70). Washington D.C.: Oryx Press, 1996.

Session 7:   The Evolution of New York City Policy on the Homeless
                    

Readings: TBA

Session 8:  The New York City Department of Homeless Services: History and Structure
  
        Dova Marder, Medical Director, NYC DHS  (Public Psychiatry Fellow, 1992-93)
 

Session 9:  A National Perspective on Services for the Homeless Mentally Ill  

Reading:
(9) Cohen, C. & Thompson, K., Homeless Mentally Ill or Mentally Ill Homeless, American Journal of Psychiatry  149:816-23, 1992.

UNIT IX  — CURRENT TRENDS IN THE STRUCTURE OF PUBLIC PSYCHIATRY

                    Steve Rosenheck
 

1. Public Mental Health Managed Care
 

Session 1: Introduction

Readings:  
Holahan, J., Zuckerman, S.,  Evans, A., & Rangarajan, S., Medicaid Managed Care in  Thirteen States, Health  Affairs vol .17, no. 3, 1998, pp. 43-63. [Optional]

Session 2:  The Intellectual Foundations of Managed Care

Readings: 
Mayer, T., Mayer, G.  HMO’s: Origins and Development,  New England Journal of Medicine, 312, 1996, pp. 590-94.
Enthoven, A. The History and Principles of  Managed Competition.  Health Affairs 12 (Suppl.), 1993, pp. 24-7
Enthoven, A.,  Health Plan, Addison-Wesley, 1980, Chapters 4-5 

Session 3:  The Historical Ascent of Managed Care

Readings: 
Starr, P., The Social Transformation of American Medicine,  New York: Basic Books, 1982, pp.
Bodenheimer, T., Sullivan, K. How large employers are shaping the healthcare marketplace. The New England Journal of Medicine  338, 1998, pp. 1003-7 

Session 4:.  Public Mental Health Managed Care in Practice

Readings: 
Hurley, R., Freund, D., Paul, J., Managed Care In Medicaid, Health Administration Press, 1993,, p.1
Cutler, D., Bentson, B., & Winthrop, K.  Mental Health in the Oregon Health Plan: Fragmentation or Integration. Administration and Policy in Mental Health 25, 1998, pp. 308-10.
Busch, S. Carving Out Mental Health Benefits to Medicaid Beneficiaries: A Shift Towards  Managed Care. Administration and Policy in Mental Health, 24, 1997, pp. 301-21 

Session 5:  Evaluating Public Mental Health Managed Care

Readings: 
Reinhardt, U.,  Rationing Health Care: What It Is, What It Is Not, and Why  We Cannot Avoid  It,  in  Altman & Reinhardt (Eds.),  Strategic Choices For a Changing Health Care  System, Health Administration Press, 1996, pp. 67 –78; 
Croze, C. Managed Behavioral Healthcare in the Public Sector. Administration and Policy in Mental Health 28, 2000, pp. 23-36 [40]

Session 6: . Curent Directions  in Public Mental Health Services Policy

Reading: 
Mazade, N., Glover, R., Hutchings, G.  Environmental Scan 2000: Issues Facing State Mental Health Agencies. Administration andolicy in Mental Health , 27, 2000, pp. 167-81[41]

Readings: Expanding Coverage: Issues and Options, Health Affairs 2001, pg. 8; Pear, R. (2001, February 26). Governors Offer ‘Radical’ Revsion of Medicaid Plan. The New  York Times, pp. A1, A12;  Miller, M. (2000, December 28). What Tax Cuts Can Buy for Health. The New York Times;   Pear, R. (2000, November 20). Ex-Enemies On Insurance Offer a Plan. The New York Times.

UNIT X: PUBLIC MENTAL HEALTH ADVOCACY (Twelve sessions)

In honor of Ken Steele, founder NYC Voices and Mental Health Voter Empowerment Project (former speaker in this unit) who died in 2000.

        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 with case presentations by Alumni
                  Sara Kellermann -  Discussant

Note:    Most readings are from Managing Organizations, ed., Nadler, Tushman, Hatvany (NTH).  Little Brown, 1982. Some
additional readings are from The Handbook of Mental Health Administration (HMHA), ed. Austin and Hershey; Jossey-Bass,
1982; The Handbook of  Leadership  (HoL), ed. Bass, The Free Press, 1990
 

Case Presentation 1:  The Inwood Clinie of  Washington Heights Community Service                   

            Dianna Dragatsi - Director, Inwood Clinic (Public Psychiatry Fellow 2003-04)

Case Presentation 2:  The Family Care Center, Dept of Psychiatry, Harlem Hospital

                Warren Ng, Medical Director of Behavioral Health, FCC, (Public Psychiatry Fellow, 1998-99)   

Session 1:  The Role of the Manager - Managing Interdisciplinary Teams

Readings:
HMHA chapters 9 (pp. 170-177) and 10, Facilitating Productive Staff Meetings; 
Chapter 3, Organizational Theory, in Textbook of Administrative Psychiatry, ed. Talbott);
NTH chapter 18, Leaders: Their Behavior and Development (pages 239-42); 
Silver M, Akerson, D, and Marcos, L; Preferred management styles among psychiatrist-administrators, Hospital and Community Psychiatry, 1990, 41:321-3; 
Bass & Stogdill’s chapter 23, pp 474-94

Case Presentation 3: The ADEPT Day Program

        Anna Skiandos, Unit Chief, Acute Detox Unit, Addiction Institute of NY, St. Luke's Roosevelt Hospital Center

Session 2: Organizational Design I - Information, Control and Coordination

Readings: NTH chapter 23

Case Presentation 4:  Project Renewal

       Elizabeth Oudens, Director of Psychiatry, Project Renewal (Public Psychiatry Fellow 1999-2000)        
 

Session 3:  Organizational Design II —

Readings: NTH chapters 22, 27

Case Presentation 5:  A Medicaid Managed Care Company

        Juliana Ekong, Behavioral Health Medical Director, Care Plus Health Plan (Public Psychiatry Fellow 2000-01)       
 

Session 4:   Organizational Change

Readings:  NTH chapters 33, 34 (pp.456-59), 35 (pp. 462-67).  Other sections of chapters 34 and 35 are optional

Case Presentation 6 –  Young Adult Institute (YAI)

    Peter Della Bella, Director of Psychiatry, YAI            

Session 5:  The Political Perspective - Organizational Conflict  and Group Decision-Making

Readings: NTH chapters 16, 20; HMHA, Ch. 8.

Session 6:  Summary of Management Course and Cases
 

Session 7:  Boundary Spanning - Dealing with Governing  Boards, Financial Resources and Certifying Agencies
                Sara Kellermann

Reading: Re-read HMHA chapter 8;  Talbott,  Textbook of Psychiatric Administration, chapter 7, pages 196-204

Additional sessions on the Role of the Ageny Medical Director, by various alumni:

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.

            Public Psychiatry as a Career
            Francine Cournos, M.D.
            Director, Washington Heights Community Service

            SSI and other Entitlements
            Penny Schwartz, MSW
            Mt. Sinai Hospital Department of Psychiatry

           Quality Assurance
           Jim Smith, Ph.D.
           Director of Program Evaluation, Veterans Integrated Service Network IV

            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)

            Boundary-Spanning and Fund Raising
            Ed Geffner, LLB
            President and Chief Executive Officer, Project Renewal

            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

            Mentoring Young Psychiatrists
            Jennifer Havens, M.D.
            Director, Children's Psychiatric Services, New York Presbyterian Hospital

            The Epidemiology of  Psychiatric/Substance Abuse Comorbidity
            Rik Rosenthal,  M.D.
            Chairman, Department of Psychiatry,  St. Luke's Roosevelt Medical Center

            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           

            Budgeting Mental Health Service
            Bryan McGreal, M.D.
            (Public Psychiatry Fellow, 1993-94)
            Medical Director, Bowery Residents' Committee

            Assisted Outpatient Treatment in Practice
            David Tractenberg, M.D.
            Director, Brooklyn/Staten Island Assisted Outpatient Treatment Program

            Family Intervention for Child Sexual Abuse (two sessions)
            Fiona True
            Senior Staff, Child Sexual Abuse Project, Ackerman Institute for Family Therapy

             Coercion in Mental Health Services
             Stephanie Lemelle (Public Psychiatry Fellow 1997-98)
             Member, McArthur Foundation's Network on Mandated Community Treatment

            Post-Traumatic Stress Disorder and Women  (three sessions)
            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 

            Pathways to Housing
            Sam Tsemberis, PhD
            Director

            The Organization of Services for the Homeless in New York City
            Dova Marder, M.D.
            (Public Psychiatry Fellow, ’91-’92)
             Assistant  Director for Psychiatry, New York City Department of the Homeless

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

            Lisa Green, LLB
            Director, Office of Housing Services
            NYC DMH

This syllabus was updated March 24, 2009