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					        Department of Psychiatry and Human Behavior
        Gateway Community Mental Health Center – Kent Center – Northern Rhode Island Mental Health Center – South
        Shore Mental Health Center

                                                      Community Psychiatry
                                                      Overview of Rotation
                                                            revised date 2/26/05
The community psychiatry rotations in the Brown Psychiatry Residency are training experiences during which residents
gain knowledge, skills and practice in the care of chronically and/or severely ill psychiatric patients in a mental health center.
The rotation requires a high degree of organization and efficiency, as well as a strong commitment to professionalism. This
latter quality is a core value, which should guide residents in decision-making about which steps to take on behalf their
patients, as well as their own education.
Description of Rotation
This rotation is a half-day weekly assignment that occurs during in the PG3 and PG4 year. Residents, under faculty supervision,
assume primary responsibility for a panel of community-based chronically mentally ill patients in a variety of clinical settings:
inpatient, mobile crisis team, outpatient and free clinic. They function as physician leaders of multidisciplinary teams of skilled
mental health professionals. Residents learn to provide care for the seriously mentally ill in the community setting. They learn the
appropriate indications for hospitalization, alternatives to hospitalization, crisis intervention, case management and rehabilitation of
the chronic and severely ill. Schizophrenia, schizoaffective disorder, bipolar disorder, chronic depressive disorders, substance use
disorders, and personality disorders are the most common diagnoses, with some exposure to anxiety disorders, PTSD and eating

Kent Center
The Kent Center is a community mental health center serving Kent County. The Center sees over 3,000 patients and makes over
100,000 patient contacts yearly. Comprehensive services are available for the acutely and chronically mentally ill. The resident’s time
is on a mobile treatment team which serves 70-73 patients; the resident is assigned 10-15 patients. The rotation consists of one
afternoon per week over the course of 50 weeks.

Northern Rhode Island Mental Health Center
The Northern Rhode Island Mental Health Center is a community mental health center serving the North and Northwestern RI. The
Center sees over 3800 patients and makes over 60,000 patient contacts yearly. Comprehensive services are available for the acutely
and chronically mentally ill. The resident’s time is divided between 3 programs: Emergency Services, Case Management Services,
and General Outpatient Services

South Shore Mental Health Center
The South Shore Mental Health Center is a community mental health center serving Southeastern RI. The Center sees over 3180
patients and makes over 50,000 patient contacts yearly. Comprehensive services are available for the acutely and chronically mentally
ill. The resident’s time is divided between 3 programs: RI Assertive Treatment Team 1; RI Assertive Treatment Team 2; and the
Integrated Adult Services Team.

Name of Rotation                                         Community Psychiatry
Unit Chiefs                                              James Bonnar, MD (Kent Center), Scott Haltzman, MD (Northern Rhode
                                                         Island Mental Health Center), Anthony Thornton, MD (South Shore Mental
                                                         Health Center
Contact Information                                       James Bonnar, MD (Kent Center);
                                                         Scott Haltzman, MD (Northern Rhode Island Mental Health Center);
                                                         Anthony Thornton, MD (South Shore Mental Health Center
Residency Coordinator                                    Rita Misek: 455 6375
Drs, Bonnar, Whalen, Koyfman, Morris, Haltzman, Thornton, Krupp

Topics to be covered are based upon:
 The patients assessed and treated by the residents over the course of the rotation

Principal teaching methods:
     Attending supervision
     Weekly afternoon seminars
Educational materials provided/referred to residents:
 Reading: Each attending and resident is expected to utilize current psychiatric literature regarding assessment and treatment of
    psychiatric patients in the emergency/acute setting.
 Computer-assisted educational materials: All housestaff have access to full-text literature search and retrieval capacity through
    the hospitals’ computer networks. Terminals are located in the emergency room of the hospitals.
 Other: Residents are given articles as part of their weekly afternoon seminar series .

     Evaluation of the resident's successful completion of the above goals will be carried out by the attending.
     Evaluation of the attending's successful completion of the above goals will be carried out by the resident.
     Evaluation of the rotation will be completed as part of the annual resident retreat report.

 The medical director of the mental health center will oversee the educational experience for the residents.
 Supervisors will oversee the care of the patients in the resident’s caseload assigned to that particular supervisor.


     Resident is responsible for evaluation and treatment of for the seriously mentally ill in the community setting assigned to him or
      her under supervision.
     Residents will assess and treat patients in a variety of settings including inpatient, mobile crisis team, outpatient and free clinic.
     Resident is responsible for collecting all relevant information on the patient, including reviewing old medical records.
     Resident is responsible for family and patient communication.
     Resident is responsible for discussing the case with his or her supervisor, other health care professionals involved with the patient
      and the patient’s family, as dictated by the circumstances.
     Resident is responsible for written or dictated evaluations of all patients assessed and followed.
     Resident will submit an online evaluation of the attending upon completion of the rotation.
     Resident must attend weekly educational experiences that are rotation-specific.
     Residents are expected to use their knowledge regarding psychopharmacology, behavioral treatments, system intervention, social
      intervention, forensic intervention and case management.
     Residents are expected to work as leaders within multidisciplinary teams.

Grand Rounds             1st Wednesday of each month, 11:00, Ray Hall, Butler Hospital Campus
Weekly Afternoon
Seminars                  Wednesdays from 1:10 to 4:30 required for all PG3 residents
RCC Clinic               Tuesdays at 1:00 for PG3 and PG4 residents; Thursdays at 1:00 for PG4 residents
Clinical Case Conference 3rd Thursday of each month, 12:00, Ray Hall, Butler Hospital Campus

    Residents should be able to define and discuss the biological, psychological and social contribution factors as they relate to
       the development of the various severe mental illnesses.
    Residents should be able to demonstrate an awareness and understanding of the systems approach to working with the
       mentally ill individuals.
    Residents should understand the structure of the community mental health delivery system in Rhode Island an at their
       clinical assignment site.
    Residents should understand the legal aspects of community mental health care including emergency certification,
       commitment, guardianship and competence.
    Residents should understand the roles fulfilled by members of a multidisciplinary treatment team in the delivery of care to
       severely mentally ill patients.

        Residents should understand the use of psychological agents and their uses with severely mentally ill patients.
        Residents should understand the issues that arise in supervision and collaboration with non-medical staff in the treatment of
        Residents should have a clear understanding of the appropriate uses of the following treatments employed to maximize
         community functioning of severely mentally ill patients.
                                   a.) individual, group and family treatment
                                   b.) social skills and daily living skill training
                                   c.) social and vocational rehabilitative services

        Residents should be able to work cooperatively as an interdisciplinary team member of community-based program for direct
         patient care and develop an appreciation for the contributions of other mental health professionals.
      Residents should be able to perform the following patient management functions with patients:
              1. Diagnostic and psychosocial assessment, treatment planning, recruitment and linking the various resources and
                   components of treatment, monitoring progress and evaluation of treatment outcomes
              2. Residents should be able to perform crisis assessment and be able to determine the most appropriate action,
                   hospitalization or community alternatives.
              3. Residents should be able to perform and effectively integrate the following tasks when appropriate with patients:
                   Supportive psychotherapy, medication maintenance, social skills and daily living skills training and family
      Residents should be able to provide consultation to support networks for the chronically ill patient on a case by case basis
         through contacts with a key person in the patient’s support network and/or through a formal consultation with the program
         that provides service to a population that includes mentally ill clients.
      Residents should be able to rapidly treat patients during a short-term hospitalization and organize effective discharge
         planning emphasizing community maintenance and functional rehabilitation.
      Residents should be able to distinguish culturally determined differences from psychopathology and be competent in the
         evaluation and treat of patients from racial and minority ethnic groups that differ from their own groups.
      Residents should have an appropriate appreciation of the support networks for patients.
      Residents should have an appropriate respect for members of the interdisciplinary mental health team and appropriate respect
         for their opinions.
      Residents should have an appropriate sense of responsibility to the patients, their families and their significant others
         including respect for their welfare and opinions.
      Residents should have a sensitivity and willingness to use a wide variety of opinions and ideas set forth by patients and
         community mental health center staff members.

1. Patient Care                                      Goals and Objectives                                                       Evaluation Method
 Resident must be able Resident will                                                                                    - Residents are evaluated by
                             -    Develop the ability to communicate effectively and demonstrate caring and
    to provide care that is                                                                                              their supervisors who receive
                                  respectful behaviors when interacting with patients and their families.
    compassionate,           -    Learn to gather essential and accurate information about their patients                input from the multi-
    appropriate, and         -    Learn to make informed decisions about diagnostic and therapeutic                      disciplinary staff working with
    effective for the             interventions based on patient information and preferences, up-to-date                 the resident
                                  scientific evidence, and clinical judgment
    treatment of health
                             -    Learn to develop and carry out patient management plan
    problems and the         -    Learn to counsel and educate patients and their families
    promotion of health.     -    Provide health care services aimed at preventing health problems or
                                          maintaining health
                                    -     Work with health care professionals, including those from other disciplines,
                                          to provide patient-focused care
                                    -     Use information technology to support patient care decisions
2. Medical Knowledge                                        Goals and Objectives                                               Evaluation Method
 Residents must               Residents will                                                                              - Feedback of both oral and
                                    -    Demonstrate an investigatory and analytic thinking approach to clinical
    demonstrate                                                                                                            written presentations will be
    knowledge about                 -    Know and apply the basic and clinically supportive sciences which are             provided by supervisors
    established and                      appropriate to their discipline
    evolving biomedical,            -    Learn to generate a differential diagnosis and unique treatment plan for each
                                         patient encounter
    clinical, and cognate
                                    -    Learn to effectively communicate their investigatory and analytic thinking
    (e.g. epidemiological                approach via written notes and presentations to supervisors and other health

    and social-                           care professionals
                                    -     Will keep abreast of new scientific knowledge, which is obtained via
    behavioral) sciences
                                          didactic sessions, Grand Rounds, critical review of scientific literature,
    and the application of                computer and web-based resources
    this knowledge to               -     Will actively participate in seminars
    patient care.

3. Interpersonal and                                         Goals and Objectives                                                 Evaluation Method
Communication Skills
 Residents must be            Residents will                                                                                Residents are evaluated by their
    able to demonstrate                                                                                                      supervisors
                                    -     Create and sustain a therapeutic and ethically sound relationship with
    interpersonal and                     patients
    communication skills            -     Work effectively with others as a member or leader of a health care team or
    that result in effective              other professional group
    information exchange            -     Know and be able to describe the proper boundaries of the
    and teaming with                      physician/patient relationship, and will consistently and
                                          conscientiously avoid any breach of these boundaries.
    patients, their
    patients’ families,             -     Written communications in patient charts will effectively permit subsequent
    and professional                      caregivers to understand the nature of the patient interaction and the goals
    associates.                           and plans for the encounter as well as future encounters when applicable

4. Professionalism                                           Goals and Objectives                                                 Evaluation Method
 Residents must                    Residents will
                                    -    Demonstrate their responsibility to patient care by: (1)Responding to
    demonstrate a                                                                                                            - Attendings will evaluate
                                         communication from patients and health professionals in a timely manner,
    commitment to                        (2) Establishing and communicating back-up arrangements, including how              residents
    carrying out                         to seek emergent and urgent care when necessary, (3) Using medical records          - Feedback from nursing staff,
    professional                         for appropriate documentation of the course of illness and its treatment , (4)      other disciplines
                                         Providing coverage if unavailable, (for example, when out of town or on
                                         vacation), (5) Coordinating care with other members of the medical and/or
    adherence to ethical                 multidisciplinary team, (6) Providing for continuity of care, including
    principles, and                      appropriate consultation, transfer, or referral if necessary
    sensitivity to a                -    Demonstrate ethical behavior, integrity, honesty, compassion, and
                                         confidentiality in the delivery of care, including matters of informed
    diverse patient
                                         consent/assent, professional conduct, and conflict of interest.
    population                      -    Demonstrate respect, sensitivity and responsiveness for and to patients and
                                         their families, and their colleagues as persons, including their ages, cultures,
                                         disabilities, ethnicities, genders, socioeconomic backgrounds, religious
                                         beliefs, political leanings, and sexual orientations.
                                    -    Review their professional conduct and remediate when appropriate.
                                    -    Residents will make reasonable efforts to act as advocates for their patients.
5. Practice-Based                                            Goals and Objectives                                                 Evaluation Method
Learning and
 Residents must be                 -     At the end of this rotation, the resident should be able to identify gaps in       - Day to day knowledge base
                                          knowledge based upon experience, introspective awareness, and feedback
    able to investigate                                                                                                      evaluated by feedback on
                                          for the year. The resident is expected to regularly review both textbook and
    and evaluate their                    primary source literature to maintain up to date understanding of specific         diagnoses, and both
    patient care practices,               topics that have arisen in practice.                                               psychooharmacologic and
    appraise and                    -     The resident should actively seek feedback and advice on practice from             psychotherapeutic treatment
                                          peers, mentors, staff, and patients alike to gain greater objective insight into
    assimilate scientific                                                                                                    approaches
                                          their strengths and weaknesses.
    evidence, and                   -     Obtain and use information about their own population of patients and the
    improve their patient                 larger population from which their patients are drawn.
    care practices.                 -     The resident should be able to obtain scientific literature, appraise quality,
                                          and assimilate data through the use of up to date resources to improve their
                                          practice and care of patients’ health problems.
                                    -     The resident will gain basic skills in literature search methodologies using
                                          standard web-based medical literature search engines such as Ovid, MD
                                          Consult, Pubmed.
                                    -     The resident will have familiarity with a variety of computer and hand-held
                                          computer based resources for looking up medications, dosing, and other
                                          topics of use to the general internist
                                    -     The resident will actively participate in lectures and discussions with peers
                                          and experts on the topics related to the care of their patients.
                                    -     The resident is expected to take a proactive and interactive

                                      approach to enhancing their knowledge. The resident is expected to
                                      “think out loud”, ask for clarification and guidance, and actively
                                      seek input on their practice and knowledge base from their mentors.
                                 -    The resident will facilitate the learning of students and other health
                                      care professionals
6. Systems-Based                                         Goals and Objectives                                             Evaluation Method
 Resident must                  -    The resident will learn to practice cost-effective health care and resource    - Evaluations from supervisors
                                      allocation that does not compromise quality of care
    demonstrate an
    awareness of and             -    The resident will learn how to partner with health care managers and health
    responsiveness to a               care providers to assess, coordinate, and improve health care and know how
                                      these activities can affect system performance
    larger context and
    system of health care        -    The resident will learn how to work other health care providers to develop
    and the ability to                and coordinate a care plan for their patients.
    effectively call on          -    The resident will learn about a variety of insurances and how they affect
    system resources to               patient referrals and prescriptions. They will learn the legal rights of the
                                      uninsured and will work with the appropriate services to assist patients who
    provide care that is of           are under- or un-insured.
    optimal value. By
    the end of their             -    The resident will learn how to interact and advocate effectively with other
                                      physicians, ancillary caregivers, community agencies, landlords, and
    training, residents are           insurance companies etc. via spoken and written communications when it
    expected to have                  effects the health of their patients.
    attained competence
                                 -    The resident will learn about the various community resources available for
    in the following                  patients and will work with case managers and social workers to enable
    goals.                            patients to access these resources

Residents should be mindful of the unique opportunity with which they are presented during this rotation. In caring for sick,
hospitalized patients in a supervised environment, you are being given the chance to study in a protected environment while caring for
patients with the illnesses you are studying. We urge you not to waste this time but rather to embrace your responsibilities and to
study and teach based upon the needs of your patients.


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