A New Conceptualization of Community Psychiatry

The Fellowship in Community Psychiatry / Public Health, within the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine, aims to expand traditional definitions of community psychiatry, public mental health, and social psychiatry. Rather than focusing solely on the characteristics of clients with whom community psychiatrists work (such as those with severe and persistent mental illnesses), or the sources of funding for community mental health programs (predominantly public monies), we challenge fellows to consider community psychiatry along the following four dimensions. These dimensions present what may appear to be opposing dichotomies, but which are interlinked in the fellowship.

1. The medical model and the public health model.

We encourage fellows to combine the medical model with the public health model in nontraditional ways in order to become leaders in community psychiatry. From a medical point of view, community psychiatrists treat mental illnesses using a biopsychosocial perspective. The public health approach couples bolstering individuals’ mental health with prevention of mental illness, minimizing the impact mental illness has on one’s quality of life and on society as a whole. The public health perspective also provides a foundation in epidemiology, health behavior theories, and administration / management / policy.

2. Individual treatment and community participation.

We propose that the journey in community mental health is just as important as the destination. We anticipate that informed and involved fellows will embrace the following aspects of this expanded definition of community psychiatry:

• Meeting clients where they are. Whether it is a physical location—like a homeless shelter or a jail ward—or an ideological state of mind, trainees intend to tailor interventions and resource utilization to clients’ needs and expectations.

• Cultural competence. Appropriate and compassionate mental health care begins with the knowledge and appreciation of clients’ individual, familial, cultural, and community experiences.
• Involvement in the community from which clients come. From participation in community events to championing health policies that benefit these communities, client and public advocacy occupy a key position in community mental health.

3. The content and the process of community psychiatry.

Fellows will work with both process and content components of the continuum of mental health care. Content of care (for example, the specific type of psychosocial rehabilitation in which a client participates) is molded by the process that provides that care (how clients access that rehabilitation, who pays for it, what constraints shape the care). Clients of any age, socioeconomic group, diagnosis, or location must maneuver within the system to secure appropriate mental health services. We intend to train community psychiatrists in negotiations of the health care system.

4. Treatment of mental illnesses and promotion of mental health

The fellowship values promotion of mental health and prevention of mental illnesses equally with treatment of mental illnesses. From understanding community resilience through efforts to reduce social stigmatization of mental illnesses to bolstering individuals’ personal recovery, we expect that community psychiatrists will develop a niche in promoting mental health in addition to treating individuals with mental illnesses.

The fellowship also aims to train leaders to reduce fragmentation within the public mental health system, promote recovery (positive adaptation to illness and disability), engage families in the process of recovery, reduce disparities in mental health care, and diminish stigma. It is no coincidence that the Emory University Fellowship in Community Psychiatry / Public Health aims to create its own community. Through clinical care, education, organizational management, political advocacy, and public involvement, we charge members of our academic community to positively impact other communities. The Mission and Vision of the fellowship follow this new conceptualization of community psychiatry, and guide fellows’ experiences to develop into outstanding leaders in community psychiatry.

Fellowship Mission

To train future leaders in community psychiatry

Fellowship Vision

Mental illnesses and substance abuse in adults and children/adolescents are leading causes of disability in the United States and globally. Over half of those with serious mental illnesses do not seek treatment due to social stigma, financial obstacles, fragmentation of services, and the pitfalls of a service system that often neglects the special needs of individuals belonging to racial, ethnic, and other minority groups.

The Emory University Fellowship in Community Psychiatry / Public Health aims to train leaders in community psychiatry, who will then serve as administrators, advocates, clinicians, program developers, and researchers, in the community psychiatry and public mental health arena. The program emphasizes combining the medical model and the public health model, individual treatment and community participation, the content and the process of community psychiatry, and the treatment of mental illnesses and the promotion of mental health.

Fellowship Goals

• To train future leaders in areas central to community psychiatry and public mental health, including advocacy, mental health administration / management / policy, clinical practice, program development, and research.
• To train future leaders in local, regional, national, and international organizations relevant to the practice of psychiatry in community-based settings.
• To promote and maintain excellence in advocacy, administration / management / policy, clinical care, program development, and research for disadvantaged populations including under/uninsured, indigent, and homeless persons.
• To encourage and support the process of interdisciplinary collaboration among various agencies, institutions (both public and private), and health care providers.
• To expand and promote specialized training in community psychiatry and public health by serving as a model definition, curriculum, and training experience for other interested institutions.

Program Description

The Emory University Fellowship in Community Psychiatry / Public Health is a unique two-year training program for psychiatrists dedicated to pursuing a career in community psychiatry. The fellowship provides integrated experiences in community mental health settings at Grady Health System and other designated sites, a course of study leading to a Master of Public Health (M.P.H.) degree, and longitudinal administrative, didactic, and mentoring experiences. Fellows begin the program during their fourth post-graduate year (PGY-4) of psychiatric residency training with an additional year of fellowship (PGY-5), or in two years after residency training (PGY-5 and PGY-6). The following three components of the fellowship occur concurrently:

1. Community mental health activities at Grady Health System:

The first year of the fellowship offers a broad-based community mental health experience, including providing clinical services as well as administration and program development. Typically, these experiences will be structured as four rotations in three-month blocks, and the fellow will spend half of his/her time at these rotation sites during the first year. Possible areas of clinical experience include working with a multi-agency collaborative to provide social services and mental health care to the homeless, following patients involved in a "clubhouse" model day treatment program, and providing care for those with mental illnesses who are incarcerated. Fellows will assist in coordinating care for patients seen in these community settings with more traditional programs already in existence at Grady Health System. Administrative activities may include participation in associated local, state, and national community psychiatry and public health association activities and development of new programs, evaluation tools, or research projects at the fellowship clinical sites.

Prior to the start of the second year of the fellowship, each fellow will meet with his/her mentor to develop a clinical project for the second year in a particular area of interest consistent with the goals of the fellowship. This project will culminate in a special studies project or thesis in collaboration with advisory faculty at the school of public health.

2. Rollins School of Public Health / M.P.H. Degree:

At the Rollins School of Public Health (RSPH) of Emory University , students learn to identify, analyze, and intervene in contemporary public health issues. RSPH is located in Atlanta , “the public health capital of the world," which is home to the Centers for Disease Control and Prevention (CDC), the national home office of the American Cancer Society (ACS), the Carter Center , numerous state and regional health agencies, and the clinical, teaching, and health-related research programs of Emory University 's Woodruff Health Sciences Center . This setting is ideal for hands-on research, collaborations with the world's leading public health agencies, and interdisciplinary work with national and international organizations. Students join the RSPH community from all 50 states and over 40 foreign countries to contribute to the school's mission, which is to acquire, disseminate, and apply knowledge to promote health and prevent disease in human populations.

Fellows are required to complete 42 credits and a required special studies/research thesis on a community mental health issue. The Fellowship provides tuition for 42 credits, and it is expected that Fellows will complete all coursework by June 30 th, two years after matriculation into the Fellowship. In addition to the four regular semesters of coursework available over the course of these two years, Fellows may take classes during up to four short summer sessions during their fellowship. Fellows are required to take any mental health courses offered at RSPH. It is recommended that the applicant apply to either the Behavioral Sciences and Health Education (BSHE) department or Health Policy and Management (HPM) department at RSPH. If the applicant has a special interest in biostatistics, epidemiology, international health, or other areas of public health, alternative curriculum options may be considered. To facilitate registration and processing, Fellows are required to select a major track at RSPH by February 1 st before the July 1 st matriculation into the fellowship. Please visit the RSPH website at: www.sph.emory.edu.

3. Longitudinal administrative, didactic, and mentoring experiences :

• Fellows participate in a longitudinal didactic series that focuses on a variety of topics, including public financing of mental health care, assertive community treatment, crisis intervention services, psychosocial rehabilitation, advocacy, prevention, and other topics that are not specifically included in the Master of Public Health curriculum.
• Fellows conduct site visits to community mental health-related agencies in the Metropolitan Atlanta area.
• Each fellow meets regularly with a selected mentor for career development activities.
• Fellows are strongly encouraged to: (1) prepare for and sit for the American Board of Psychiatry and Neurology board certification examination, (2) join the American Association of Community Psychiatrists, (3) attend the annual symposium sponsored by the Carter Center Mental Health Program, and (4) prepare for and sit for the examination for certification in Psychiatric Administration and Management sponsored by the American Psychiatric Association

Eligibility Requirements

Applicants to the fellowship must have completed at least three years of a psychiatry residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME), and be very interested in pursuing a career in community psychiatry. Applications to both the Emory University Department of Psychiatry and Behavioral Sciences and the Rollins School of Public Health of Emory University are required. These must be submitted as far in advance as possible in order to be considered for entry into the fellowship, which begins in July of each year. See below for information about the application process. Selected applicants will be invited to interview with faculty and staff and to tour the Rollins School of Public Health, Emory School of Medicine Department of Psychiatry and Behavioral Sciences, Grady Health System, and other program sites.

Fellowship Directors

Michael T. Compton, M.D., M.P.H.

Raymond J. Kotwicki, M.D., M.P.H.

Fellowship Faculty

Michael Compton, M.D., M.P.H.
Susan Cookson, M.D., M.P.H.
Benjamin Druss, M.D., M.P.H.
Patrice Harris, M.D.
Karen Hochman, M.D.
Nadine Kaslow, Ph.D.
Carol Koplan, M.D.
Raymond Kotwicki, M.D., M.P.H.
Emile Risby, M.D.
Jon Rubenow, D.O.
Keith Wood, Ph.D.

Fellowship Advisory Committee

Benjamin Druss, M.D., M.P.H.
Nadine J. Kaslow, Ph.D.
Carol Levy, M.S.N., M.P.H.
Steven Levy, M.D.
Keith Wood, Ph.D.

Fellowship Board of Advisors

Thomas Bornemann, Ed.D.
Rep. Pat Gardner
Patrice Harris, M.D.
Walterine Jones
Carol Koplan, M.D.
Richard Levinson, Ph.D.
Dave Lushbaugh
JoNell Usher, Ph.D.
Cynthia Wainscott
William Wardlaw

Salary and Benefits

The salary is the standard Emory University School of Medicine salary for the respective postgraduate year. Customary benefits are provided, as well as tuition for the M.P.H. degree and other educational activities.

Inquiries

Fellowship program inquiries may be directed to:
Michael T. Compton, M.D., M.P.H.
Emory University School of Medicine
Department of Psychiatry and Behavioral Sciences
Grady Memorial Hospital
Department of Psychiatry, Box 26238
80 Jesse Hill Jr. Drive, S.E.
Atlanta , GA 30303
tel: 404-778-1486
fax: 404-616-3241
e-mail: Michael.Compton@emory.edu

OR

Raymond J. Kotwicki, M.D., M.P.H.
Emory University School of Medicine
Department of Psychiatry and Behavioral Sciences
Grady Health System
80 Jesse Hill Jr. Drive, S.E.
Department of Psychiatry, Box 26073
Atlanta , GA 30303
tel: 404-616-9166
fax: 404-616-9684
e-mail: Raymond.Kotwicki@emory.edu

The Application Process

Applications will be accepted from October 1 st through December 1 stof each year. Interviews will be scheduled upon review of application materials, and acceptance for an interview is contingent upon verification of the applicant’s good standing in an ACGME-accredited general psychiatry residency training program. The application packet should include the following information:

1. Current Curriculum Vitae, including all contact information,
2. Contact information for current or past psychiatry residency training program director(s), along with a signed statement allowing the fellowship directors to contact this training director for reference,
3. Two letters of reference that specifically address the candidate’s potential as a successful fellow in the Emory University Fellowship in Community Psychiatry / Public Health, and as a future leader in community psychiatry, and
4. An essay on the applicant’s conceptualization of community psychiatry, reasons for pursuing specialized training in this field, and future career goals.

Fellowship Graduates

Raymond J. Kotwicki, M.D., M.P.H.
Education:
University of Wisconsin – Madison ; Madison , Wisconsin (History of Science)
University of Wisconsin Medical School ; Madison , Wisconsin (Medicine)
Internship in Internal Medicine; Cambridge Health Alliance , Harvard Medical School
Psychiatry Residency Training Program; Boston University School of Medicine
Psychiatry Residency Training Program; Emory University School of Medicine
Rollins School of Public Health of Emory University (Health Policy and Management)

Rotations During the Fellowship:
Task Force for the Homeless: Dr. Kotwicki established a liaison relationship with this large, downtown homeless overflow facility, including group therapy, individual psychotherapy, and psychopharmacologic management. Dr. Kotwicki also participated in health policy advocacy work at the Georgia state capitol and local health boards.

Current Employment / Appointments:
Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences; Medical Director of Community Outreach Services of Grady Health System; Co-Director of Emory University Fellowship in Community Psychiatry / Public Health

A Leader in Community Psychiatry…

• Dr. Kotwicki primarily works with underserved individuals with mental illnesses, including homeless people and individuals belonging to other disenfranchised and underserved communities. The Community Outreach Services Team which Dr. Kotwicki directs visits clients at their homes, under bridges, or at shelters in effort to engage individuals in their recovery programs. Furthermore, teams at the Community Outreach Services of Grady Health System are multidisciplinary and include physicians, nurses, social workers, disability application specialists, and community liaisons who try to inspire trust and confidence among clients and the treatment teams. Dr. Kotwicki’s teams provide mental health care in the community, and invest time, energy, and resources within the communities served.
• Dr. Kotwicki’s clinical responsibilities are inextricably linked to local and state health policy advocacy. He intends to impact health policies and the organizational health care delivery system in a way that encourages appropriate, timely care for all citizens. Clinical experiences provide data with which Dr. Kotwicki lobbies for mental health parity, improved public funding of mental health initiatives, and compassionate care for individuals with mental illnesses. A significant component of Dr. Kotwicki’s position includes legislative and policy advocacy work for which he received training during the course of his fellowship studies to earn the M.P.H. degree.
• Treatment plans for the people for whom Dr. Kotwicki cares include biological interventions, psychological therapies, and social wrap-around services aimed at improving clients’ quality of life.
• As Chairman of the Board of Directors of Positive Impact, Incorporated, the Southeast’s largest and most prestigious mental health service program for individuals infected with and affected by HIV/AIDS, Dr. Kotwicki leads the agency through the economic, political, and stigmatizing landmines of the HIV and AIDS pandemic. If public health prevention of infection with HIV is not realized, Dr. Kotwicki attempts to involve clients’ individual, familial, and community support systems in the treatment of their illnesses.
• Dr. Kotwicki lectures about mental health, mental illness, and sexuality as part of Emory University ’s required undergraduate health education series. In this community venue, Dr. Kotwicki emphasizes de-stigmatization of mental illness, social justice, and respect for individual diversity. The community psychiatry and public health paradigm emphasized in this fellowship culminates in this role within the Emory educational community.

Michael T. Compton, M.D., M.P.H.

Education:
Mary Washington College; Fredericksburg, Virginia (Religion, Biology)
University of Virginia School of Medicine; Charlottesville , Virginia (Medicine)
Psychiatry Residency Training Program; Emory University School of Medicine
Preventive Medicine Residency Training Program; Emory University School of Medicine
Rollins School of Public Health of Emory University (Behavioral Sciences)

Rotations During the Fellowship:
FOCUS Partial Hospitalization Program; Atlanta City Detention Center / Atlanta Community Court (a jail diversion program); Fulton Collaborative Crisis Services System (FCCSS) Mobile Crisis Unit; Metropolitan Atlanta Recovery Residences and St. Jude’s residential recovery programs

Current Employment / Appointments:
Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences; Inpatient Psychiatrist at Grady Memorial Hospital; Co-Director of Emory University Fellowship in Community Psychiatry / Public Health; Assistant Professor, Emory University School of Medicine, Department of Family and Preventive Medicine; Deputy Director of the Emory University Preventive Medicine Residency Training Program

A Leader in Community Psychiatry…

• Dr. Compton primarily works as an inpatient psychiatrist and clinical researcher at Grady Memorial Hospital . This position involves patient care for severely and persistently mentally ill patients as well as teaching of medical students, residents, and psychology interns. Dr. Compton considers himself to be a “community-oriented hospital psychiatrist” and he teaches this community orientation to trainees. This involves focusing on the social circumstances of patients’ decompensation and hospitalization, paying particular attention to enhancing outpatient treatment engagement, and sometimes visiting patients in their community settings (treatment programs, personal care homes, homeless shelters, private homes) following hospital discharge.
• Dr. Compton is involved in a number of research projects that are informed by the community psychiatry / public health approach that he learned during the fellowship. Several of his current research projects deal with the following topics: (1) sociodemographic and clinical predictors of nonadherence with the first scheduled outpatient community mental health follow-up appointment following inpatient psychiatric hospitalization, (2) correlations between potential risk indicators or vulnerability markers in patients with schizophrenia and their first-degree relatives, (3) determinants of and outcomes related to the duration of untreated psychosis (treatment delay) among patients hospitalized for a first-episode of schizophrenia-spectrum disorders, and (4) correlations between level of knowledge about schizophrenia and social distance/stigma.

Monica Taylor-Desir, M.D., M.P.H.

Education:
Yale University; New Haven, Connecticut (Psychobiology)
University of Cincinnati College of Medicine, Cincinnati , Ohio (Medicine)
Psychiatry Residency Training Program; Emory University School of Medicine
Rollins School of Public Health of Emory University (Health Education)

Rotations During the Fellowship:
(1) Mental Health Advocacy Rotation with Patrice Harris, M.D. provided Dr. Taylor-Desir with the opportunity to observe the process of how bills are generated and debated within the state legislature. (2) Rotation at LifeWorks Partial Hospital Program with Lolita Rhone, Ph.D., M.B.A. allowed Dr. Taylor-Desir to practice her clinical skills, supervisory skills, and mentored her in program development and financial planning. (3) Rotation with HeadStart and Dr. Sexson allowed Dr. Taylor-Desir to learn the federal regulations and requirements of HeadStart.

Current Employment / Appointments:
Staff Psychiatrist with the Winslow Indian Health Care Center, Winslow, Arizona

A Leader in Community Psychiatry…
Dr. Taylor-Desir is currently the only full-time psychiatrist for the entire Southwest Region of the Navajo Indian Reservation. She works with many families and treats multiple members of families. The ability to develop interventions for families and assess an entire family has been an important skill in Dr. Taylor-Desir’s practice. Her clinic is currently lobbying local lawmakers to allocate Medicaid funding for transportation for patients to come from the reservation to the mental health clinic. Many of the classes that Dr. Taylor-Desir took at RSPH have helped her to assess the mental health system in which she now works. The courses Dr. Taylor-Desir attended at Rollins School of Public Health have trained her to communicate with community and organization leaders and to go about systematically evaluating the needs and strengths of the mental health services that she provides. Within the first 3 months that she was at the clinic, Dr. Taylor-Desir was asked to evaluate and rewrite the clinic's policy on domestic violence screening. She rewrote the plan and it has been adopted as the screening policy for the entire medical and mental health clinic.

Dr. Taylor-Desir’s clinic is no longer under the federal guise, but is now a private, incorporated clinic that contracts with the Indian Health Service. This means that the clinic’s federal funding has been restricted and it is even more important that the clinic examines and competes for grants for possible new programs and services. Because her clinic primarily serves the Navajo population, Dr. Taylor-Desir must also work within the structure and guidelines of the Navajo Nation, which is a sovereign tribal nation. Mental health screening of the preschoolers and intervention is inadequate at the present time and Dr. Taylor-Desir is challenged to treat many preschoolers in her community despite such limited resources. She recently helped to start a monthly school-based mental health clinic on the reservation. She focuses on parent training and has become comfortable identifying, treating, and working with children with illnesses such as attention-deficit/hyperactivity disorder and oppositional defiant disorder. Dr. Taylor-Desir gives a seminar on attention-deficit/hyperactivity disorder and another on social competence in preschool children for her department’s annual conference on Child Abuse and Domestic Violence. A new adolescent psychiatric unit will be opening on the reservation and she serves on the advisory board. She is doing a community needs assessment project in that role, and her work in curriculum development and evaluation during the fellowship has proven very helpful. Many of Dr. Taylor-Desir’s current roles stem from her training in community mental health and health education during her training in Emory University School of Medicine’s Fellowship in Community Psychiatry / Public Health. In terms of community participation, she has been invited to traditional ceremonies, traditional weddings, a puberty ceremony, and a protection ceremony

Program Evaluation

Ongoing evaluation will be an important aspect of monitoring the success of the fellowship and its trainees. Several levels of evaluation include:

1. Evaluation of the fellowship in attaining its goals
1. The Fellowship Directors will meet at least monthly,
2. The Fellowship Directors will meet semi-yearly with the Fellowship Advisory Committee,
3. The Fellowship Directors will meet yearly with the Fellowship Board of Directors, and
4. The Fellowship Directors will maintain contact with fellowship graduates and track their impact in the field of community psychiatry / public health.
2. Evaluation of the fellows in attaining their training goals
1. Matriculating fellows will develop a training plan with the Fellowship Directors and the designated mentor,
2. Fellowship Directors will meet at least monthly with each fellow,
3. Designated mentors will meet at least monthly with each fellow, and
4. Graduating fellows will review their training plan with the Fellowship Directors and the designated mentor.
3. Evaluation of fellowship rotations, site visits, didactics, and faculty
1. Each rotation site will evaluate the fellow’s performance in terms of relevant knowledge, attitudes, and skills,
2. Fellows will evaluate rotation sites, and
3. Fellows will evaluate the relevance and educational value of each site visit and each didactics presentation.

 

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