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Community Mental Health

Mariam Rahmani, MD

Mariam Rahmani, MD

Kishan Nallapula, MD

Kishan Nallapula, MD

Faculty:

Mariam Rahmani, MD

Kishan Nallapula, MD

Rotations:

Meridian Behavioral Healthcare, Inc.

Camelot Community Care

Sinfonia Family Services

 

 

Meridian Behavioral Healthcare, Inc.

During this rotation residents gain experiences in treating patients in a community mental health setting as part of multidisciplinary treatment team.
This required rotation is in the second year of training, occurring at institution 2 and requires 20% of the resident’s time

Faculty consists of at least one Child Psychiatrist from the Division of Child and Adolescent Psychiatry and the on-site supervision of Dr. Lalita Ramnaraine, courtesy child psychiatrist faculty.

Residents see new and follow up patients for evaluation, diagnosis and treatment in the outpatient setting. Although psychopharmacology is the main treatment modality, resident can recommend individual psychotherapy and request for a therapist be assigned to his/her patient. The resident and the therapists work very closely and many times therapists accompany patients for their appointments with the resident.

Patients treated during this rotation are largely from families of low socioeconomic status. The clinic population consists of about 60% males and 40% females; 45% are Caucasian, 40% African American and 15% Hispanic. Ages range from 4 years up to and including 17 years –the majority are between 5 and 12 years of age. Approximately 50% are treated for disruptive and school behavioral problems, 15% for mood disorders, 10% for developmental disability & pervasive developmental disorders, 5% for psychosis, and 10% for adjustment disorders, i.e., family disruption, death in the family, abuse; . Residents learn pharmacotherapy and behavioral therapy in a multidisciplinary team approach.

Residents provide child psychiatry evaluation and medication management for children and adolescents and work in conjunction with assigned counselors and treatment plans that are school-based, home-based or on-site.

Supervision is provided by the assigned UF courtesy faculty member who is present on-site or by telephonic consultation. This supervision is in addition to the two hours of weekly supervision by assigned supervisors and seminars. Additional faculty members are also available by phone to provide back up if needed.

Following are the goals and objectives for this rotation:

Goal: To provide outpatient care to children and adolescents with psychiatric disorders that is of high quality, with priority on safety and use of interventions with established effectiveness.

Objectives

Knowledge

  • To learn the role of a Child Psychiatrist within a community-based system of care for children and adolescents with serious emotional and behavioral disorders through working as a member of a multidisciplinary team in a community-based mental health system and through interfacing with child protective agencies.
  • To learn ways to increase mental health awareness in underserved populations.
  • To become familiar with commonly encountered assessment and management problems and their possible solutions by community psychiatrists.

Skills

The resident will demonstrate:

  • Proficiency in the assessment and management of emotional and behavioral problems of children, adolescents and their families in rural settings
  • Understanding of the role of a child psychiatrist within a community-based system of care for children with serious emotional and behavioral problems through:
  • Working as a member of a multidisciplinary team in a community-based treatment setting, which includes individual case managers and therapists.
  • interfacing with child protective agencies (emergency, at risk for or in out-of-home placements)
  • Interfacing with school-based services and the foster care program.

Attitudes

The resident will demonstrate:

  • Sensitivity to cultural variation in the assessment and treatment of psychiatric disorders among children and families from various racial and ethnic backgrounds.
  • Respect for the roles of professionals from multiple disciplines in child-serving public agencies.
  • Professionalism by timeliness in appointments, dictations and return of phone calls, and by appropriate physical appearance and demeanor.
  • Commitment to learning how to provide the highest standard of patient care, including the use of the literature to guide treatment and quality parameters to evaluate treatment.

Camelot Community Care

During this rotation residents gain experiences in treating children in the foster care system as part of a multidisciplinary treatment team.

This is a new rotation implemented in 2015 and currently requires 10% of the resident’s time for two weeks per month for 24 months

Faculty consists of one Child Psychiatrist from the Division of Child and Adolescent Psychiatry who is available on-site for supervision.

Residents see new and follow-up patients for evaluation, diagnosis and treatment in the outpatient setting. Although psychopharmacology is the main treatment modality, the resident can recommend individual psychotherapy and request that a therapist be assigned to his/her patient. The resident and the therapists work very closely and many times therapists, case managers and foster parents accompany patients at their appointments with the resident.

Patients treated during this rotation are largely from the foster care system and in DCF custody. Age ranges are from 5 to 17 years, about 60% are male and 40% female, and diagnoses, including comorbidities, are ADHD (29%), depression (21%), PTSD (25%), adjustment disorder (21%), autism (5%), anxiety (5%) and disruptive behaviors. Average length of stay in the foster care system is about 4 months during which the patients receive medication management and therapy. Residents learn pharmacotherapy and behavioral therapy in a multidisciplinary team approach.

Residents provide child psychiatry evaluation and medication management for children and adolescents and work in conjunction with assigned counselors and treatment plans that are school-based, home-based or on-site.

Supervision is provided by the assigned UF faculty member who is present on-site or by telephonic consultation. This supervision is in addition to the two hours of weekly supervision provided by assigned supervisors and seminars. Additional faculty members are also available by phone to provide back up if needed.

Following are the goals and objectives for this rotation:

Goal: To provide outpatient care to children and adolescents with psychiatric disorders that is of high quality, with priority on safety and use of interventions with established effectiveness.

Objectives

Knowledge

  • To learn the role of a Child Psychiatrist within a community-based system of care for children and adolescents with serious emotional and behavioral disorders through working as a member of a multidisciplinary team in a community-based mental health system and through interfacing with child protective agencies.
  • To learn ways to increase mental health awareness in underserved populations.
  • To become familiar with commonly encountered assessment and management problems and their possible solutions by community psychiatrists.

Skills

The resident will demonstrate:

  • Proficiency in the assessment and management of emotional and behavioral problems of children, adolescents and their families in rural settings
  • Understanding of the role of a child psychiatrist within a community-based system of care for children with serious emotional and behavioral problems through:
  • Working as a member of a multidisciplinary team in a community-based treatment setting, which includes individual case managers and therapists.
  • interfacing with child protective agencies (emergency, at risk for or in out-of-home placements)
  • Interfacing with school-based services and the foster care program.

Attitudes

The resident will demonstrate:

  • Sensitivity to cultural variation in the assessment and treatment of psychiatric disorders among children and families from various racial and ethnic backgrounds.
  • Respect for the roles of professionals from multiple disciplines in child-serving public agencies.
  • Professionalism by timeliness in appointments, documentation completion and return of phone calls, and by appropriate physical appearance and demeanor.
  • Commitment to learning how to provide the highest standard of patient care, including the use of the literature to guide treatment and quality parameters to evaluate treatment.

Sinfonia Family Services

During this rotation residents gain experiences in treating children in the community mental health system as part of multidisciplinary treatment team.

A. This is a new rotation implemented in 2016 and currently requires 20% of the resident’s time per week for 12 months.

B. Faculty consists of one Child Psychiatrist from the Division of Child and Adolescent Psychiatry who is available on-site for supervision. Other staff consists of case managers, therapists, mentors, and an LPN.

C. Residents see new and follow-up patients for evaluation, diagnosis and treatment in the outpatient setting. Although psychopharmacology is the main treatment modality for the resident, each patient has an assigned therapist and a mentor who regularly communicate with the resident. Residents meet with the multidisciplinary team in the morning for 2-3 hours to discuss each patient’s case. The patient appointments begin after the multidisciplinary meeting is completed.

D. Sinfonia’s Community Action Team (CAT) is a grant-funded program. It serves individuals between the ages of 10 and 21 years-old who have a mental health diagnosis and have one or more of the following characteristics:

  • At risk for out-of-home placement as demonstrated by repeated failures at less intensive levels of care;
  • Has had two or more periods of hospitalization or repeated failures;
  • Has had involvement with DJJ or multiple episodes involving law enforcement;
  • Has poor academic performance or suspensions.

Patients seen during this rotation are largely referred from the Florida Department of Children and Families and the Florida Department of Juvenile Justice. Age ranges are from 8 to 21 years, about 52% are male and 48% female, about 49% are African American, 35% are Caucasian, 12% are multiracial, and 3% are Hispanic. Diagnoses, including comorbidities, are disruptive behavior disorders (62%), ADHD (45%), depressive disorders (29%), substance use disorders (29%), bipolar spectrum disorders (22%), anxiety disorders (7%) and autism spectrum disorders (7%). The patients remain with the CAT team for an average of 6 to 9 months. Residents learn pharmacotherapy and behavioral therapy in a multidisciplinary team approach.

E. Residents provide child psychiatry evaluation and medication management for children and adolescents and work in conjunction with assigned counselors and treatment plans that are school-based, home-based or on-site.

F. Supervision is provided by the assigned UF faculty member who is present on-site or by telephonic consultation. This supervision is in addition to the two hours of weekly supervision provided by assigned supervisors and seminars. Additional faculty members are also available by phone to provide back up if needed.

G. Following are the goals and objectives for this rotation:

Goal: To provide outpatient care to children and adolescents with psychiatric disorders that is of high quality, with priority on safety and use of interventions with established effectiveness.

Objectives

Knowledge

  • To learn the role of a Child Psychiatrist within a community-based system of care for children and adolescents with serious emotional and behavioral disorders through working as a member of a multidisciplinary team in a community-based mental health system and through interfacing with child protective agencies.
  • To learn ways to increase mental health awareness in underserved populations.
  • To become familiar with commonly encountered assessment and management problems and their possible solutions by community psychiatrists.

Skills

The resident will demonstrate:

  • Proficiency in the assessment and management of emotional and behavioral problems of children, adolescents and their families in rural settings
  • Understanding of the role of a child psychiatrist within a community-based system of care for children with serious emotional and behavioral problems through:
  • Working as a member of a multidisciplinary team in a community-based treatment setting, which includes individual case managers and therapists.
  • interfacing with child protective agencies (emergency, at risk for or in out-of-home placements)
  • Interfacing with school-based services and the foster care program.

Attitudes

The resident will demonstrate:

  • Sensitivity to cultural variation in the assessment and treatment of psychiatric disorders among children and families from various racial and ethnic backgrounds.
  • Respect for the roles of professionals from multiple disciplines in child-serving public agencies.
  • Professionalism by timeliness in appointments, documentation completion and return of phone calls, and by appropriate physical appearance and demeanor.
  • Commitment to learning how to provide the highest standard of patient care, including the use of the literature to guide treatment and quality parameters to evaluate treatment.