DoSA MMTP

The Albert Einstein College of Medicine Division of Substance Abuse (DoSA) MMTP is a 12 month rotation in the Dual Diagnosis Assessment and Continuity Clinic. Fellows participate in the evaluation of patients with ongoing involvement in the clinic, now requesting psychiatric consultation or seeking psychiatric consultation at the recommendation of the patient's counselor or social worker. The patient population has a variety of co-occurring psychiatric disorders including affective disorders, anxiety, PTSD, and psychotic disorders.

Clinical
Rotations

Fellows also assume, under supervision, ongoing consultation/treatment responsibilities for patients including psychopharmacological management and psychotherapy as indicated.

Support/liasion to clinic counselor and/or social worker staff seeking psychiatric input/supervision as well as support/liasion to clinic non-psychiatrist physicians seeking psychiatric input/supervision are also provided by the fellow.

Clinical supervision is provided by Alexandra Berger, MD and Myreille Polycarpe, MD.

AECOM Division of Substance Abuse (DoSA)
  1. DoSA MMTP - Dual Diagnosis Assessment and Continuity Clinic. Required, 12-month rotation, 0.2 fte.

    Educational Goals and Objectives

    1. the evaluation of patients with ongoing involvement in the clinic, now requesting psychiatric consultation or seeking psychiatric consultation at the recommendation of the patientís counselor or social worker; includes patients with a variety of psychiatric diagnoses
    2. the assumption of ongoing psychiatric consultation/treatment responsibilities for patients who had been previously followed the clinic psychiatric coverage; under supervision
    3. will provide psychotherapy as needed for selected patients
    4. the provision of support/liaison to clinic counselor and/or social worker staff seeking psychiatric input/supervision
    5. the provision of support/liaison to clinic non-psychiatrist physicians seeking psychiatric input/supervision

    As part of the required training for the Addiction Psychiatry Fellowship Program in the Department of Substance Abuse (DoSA), Albert Einstein College of Medicine at Yeshiva University, residents are required to go to weekly continuity clinics. Here are some tasks and goals the resident should be proficient in by the end of their fellowship:

    • Carry a full caseload of patients (20-30) including at least one weekly psychotherapy case, new patient intakes and regular medication management patients. (5-10 patients in a given day, both new evaluations and follow-ups to build a minimum caseload of 20-30 patients)
    • Must be proficient in proper documentation and filling encounter forms. (This includes being legible.)
    • Able to order labs/tests and coordinate patient care with clinic staff and outside providers.
    • Able to order and renew medications for patients that are on DOT.
    • Proficiency in board style interview. Resident should be able to interview patient, do a mental status exam, formulation and assessment/plan and present it to attending physician.
    • To participate and run groups. This includes making presentations and associated paperwork.
    • To attend IDC and other clinic meetings.
    • Residents are encouraged to prepare educational presentations for staff.
    • Resident will be open to constructive feedback from staff and attend weekly supervision sessions with assigned attending physician.
  2. DoSA Melrose-on-Track/Next Steps Drug Free Program. Required, 3-month rotation, 0.6 fte.

    Educational Goals and Objectives

    1. Develop skill with the induction and stabilization of Opioid Maintenance Therapy (OMT), specifically methadone and buprenorphine
      • Understand rationale for and gain experience with dosing for induction
      • Understand rationale for and gain experience with dose adjustments for stabilization, maintenance and detoxification
      • Be aware of common side effects and drug interactions
    2. Be able to complete the initial evaluation (psychiatric, medical, psychosocial and addiction parameters) of new patients to the program [Please note that this includes a basic physical examination and placement of a PPD test.] and to determine level of care for opioid and co-occurring illicit substance uses (e.g., outpatient, medically supervised residential tx, medically managed inpatient tx).
    3. The evaluation of patients already in clinic treatment, now requesting psychiatric consultation or seeking consultation at the recommendation of clinic staff
    4. Next Steps: Evaluation of dual diagnosis patients, the initiation and continuation of psychotropic medications in the treatment of addiction-related, or non-addiction-related psychiatric disorders, and of pharmacological interventions for addictive disorders (e.g. Buprenorphine, antabuse, naltrexone, acamprosate) including for smoking cessation.
    5. Become proficient in facilitating therapy groups for patients in recovery

    Other educational components:

    1. Follow four MMTP admissions, including progress in treatment, by keeping a brief record of key measures (e.g. dose, primary and secondary substance use, admissions to detox, engagement with medical or psychiatric care)
    2. Supervision/feedback with preceptor
    3. Observation with counselor (Addiction Severity Index)
    4. Inservices/Teaching

Supervision is provided by Robert Roose, MD.

Montefiore Hospital Center - North Division
Hospital-based Inpatient Drug and Alcohol Detoxification Unit/Dual Diagnosis Unit
Required, 3-month rotation, 0.6 fte.

Educational Goals and Objectives

Goals

By the end of the rotation, residents will be able to medically detoxify patients from multiple drugs of abuse (e.g., opioids, cocaine, alcohol, benzodiazepines) and engage patients in the process of recovery and motivation for change.

Educational Methods

Pt screening: patients arrive to the unit in several ways. Most patients arrive from the Emergency Room. Residents will become familiar with screening potential Detox patients for appropriateness for Detox admission, with a focus on substance withdrawal symptoms and medical comorbidities. Patients are also transferred from other hospital units and the resident will become familiar with communicating with other MDís and other hospital staff regarding patient screening for Detoxification.

History and Physicals: Residents will become familiar with doing a history and physical on admitted patients. The focus will be on getting a good substance abuse history, including past withdrawal symptoms, amount and type of substances used, periods of clean time, prior treatment, etc. Residents will also become familiar with the stigmata of substance abuse by doing physicals on the unit.

Patient Management and Detox protocols: once patients are admitted to the unit, they are started on a specific detox protocol (Ativan, Librium, clonidine and suboxone). Residents will become familiar with different types of detox modalities and managing the withdrawal syndrome. Residents will also become familiar with managing psychiatric and medical comorbidities as well as biological treatments for alcohol dependence. Residents will work within a team of attending physicians, the physician assistant, nurses and support staff and make clinical decisions regarding patient care. Residents will round on a subset of patients with the attending and will follow up on recommended treatments and lab tests.

Group Therapy: Residents are required to observe or co-lead at least one group per week. Residents are supervised by an experienced group therapist.

12 Step Meetings: Residents are encouraged to attend and observe AA and NA meetings which occur on the unit.

CBT/MI: weekly lecture on cognitive behavioral therapy and motivational interviewing techniques for addiction.

Journal Club: Residents will be responsible for presenting a scholarly article to staff once during the rotation.

Resident Lecture: Residents will be expected to give a lecture on a topic of interest to staff once during the rotation.

Administrative: participate in weekly leadership meeting and monthly psychiatry and cq meetings.

Inservice Education: Residents are required to participate in the inservice education sessions which occur monthly.

Clinical supervision is provided by Noam Fast, MD.

Montefiore Medical Center - The Addiction Psychiatry Consultation Service in Psychosomatic Medicine
Required, 3-month rotation, 0.6 fte.

Clinical Rotation Description

Clinical Rotation Components

  1. Evaluation, consultation, and treatment of:
    1. Patients with primary Substance-related Disorders and their families.
    2. Medical and surgical patients in the emergency department, intensive care units, and general wards of the hospital with acute and chronic Substance-related Disorders, including acute intoxication and overdose.
    3. Psychiatric inpatients with chemical dependencies and co-morbid psychopathology to include a broad range of psychiatric diagnoses, such as affective disorders, psychotic disorders, organic disorders, personality disorders, and anxiety disorders as well as patients suffering from medical conditions commonly associated with Substance-related Disorders such as hepatitis and HIV/AIDS.
    4. Medication dependent patients with chronic medical disorders/conditions (such as patients with chronic pain).
  2. Exposure to patients with Substance-related Disorders related to the following substances:
    1. alcohol
    2. opioids
    3. cocaine and other stimulants
    4. cannabis and hallucinogens
    5. benzodiazepines
    6. other substances of abuse, including sedatives, hypnotics or anxiolytics
    7. miscellaneous/unusual, e.g., nutmeg, designer drugs, organic solvents/inhalants
  3. Rotation should provide residents with experience in evaluating acute and chronic patients in the inpatient setting. There should be an identifiable structured educational experience in neuropsychiatry relevant to the practice of addiction psychiatry that includes both didactic and clinical training methods. The curriculum should emphasize functional assessment, signs and symptoms of neuropsychiatric impairment associated with Substance-related Disorders, and the identification of physical illnesses and iatrogenic factors that can alter mental status and behavior.
  4. The program must provide specific experiences in consultation to acute and chronic medically ill patients with Substance-related Disorders who are being treated on emergency, intensive care, medical and/or surgical services of a general hospital. Supervision of addiction psychiatry residents in their clinical evaluation of such patients, as well as in their consultative role, is essential. The program should provide residents with the opportunity to function at the level of a specialist consultant to primary care physicians and to intensive care specialists.
  5. Experience in working with multidisciplinary teams as a consultant and as a team leader, including the integration of recommendations and decisions from consulting medical specialists and other professionals in related health disciplines.
  6. Experience in working with patients who are participating in self-help programs.
  7. Experience with opiate replacement therapy.
  8. Addiction-related consults are requested by other departments on an ad-hoc basis, so the concept of "caseload" does not easily apply. Addiction Psychiatry Residents receive 4-8 addiction-related consults per week. The resident provides initial consultation and follow-up visits. The resident will make the initial contact with the patient and the referring clinician, and having received supervisory input will be directly providing the consultative input to the requestors.
  9. The Addiction Psychiatry Residents will be given opportunities to develop evidence-based knowledge through exposure to current literature and to formulate and articulate their knowledge through teaching opportunities.

Educational Goals and Objectives

  1. Develop greater skills in obtaining an accurate substance use history and making appropriate substance use disorder diagnosis(es).
  2. Develop skill in recognizing various stages in patientsí readiness to change addictive behavior.
  3. Develop skill in identifying alcohol, opiate, and sedative withdrawal in the medically ill.
  4. Develop skill in assisting the house staff in the management of withdrawal states in the medically ill.
  5. Gain knowledge in the use of benzodiazepines and other appropriate medical interventions in treating alcohol withdrawal.
  6. Gain knowledge in the use of clonidine, methadone, buprenorphine and other medications in treating opiate withdrawal in the medically ill.
  7. Gain knowledge in assessing patients for methadone maintenance and the appropriate use of methadone for detoxification in patients who are not on methadone maintenance.
  8. Gain knowledge in managing acute and protracted sedative withdrawal states.
  9. Gain knowledge in the management of pain in opioid dependent patients.
  10. Gain experience in the liaison work involving difficult to manage patients as it relates to their drug use.
  11. Gain experience with patients who have severe, disabling, chronic addictions and the psychological and social factors which contribute to the chronicity of the addiction. This includes attention to countertransference issues and how it impacts his/her own and other hospital staffsí interaction with the patient.
  12. Gain experience with addressing relapses and various states of recovery.
  13. Learn about the drug treatment resources available in our community and how to make referrals.
  14. Gain experience in educating the nursing and medical house staff about issues related to the management of the addicted medically ill patient.

Clinical supervision is provided by Brenda Chabon, PhD and Samuel O. Sostre, MD.

Sound View Throgs Neck Community Mental Health Center - (SVTN CMHC)
Required, 3-month rotation, 0.6 fte.
(including Adolescent Track, 0.1 fte.)

Clinical Rotation Description

Educational Goals and Objectives (Adult), 0.6 fte.

During the rotation in SVTN MICA program the resident will have ample opportunity to enhance skills in diagnostic assessment, provide individual, group and pharmacologic treatment of individuals with a variety of substance use disorders co-occurring with one or more other serious psychiatric disorders, as well as teach and supervise psychiatry residents and non-medical professionals.

  1. The initial evaluation (psychiatric, medical, psychosocial, and addiction parameters) of patients new to the program.
  2. The evaluation of patients with ongoing involvement in any clinic, new psychiatric consultation at the recommendation of requesting psychiatric consultation or seeking psychiatric consultation at the recommendation of the patientís primary therapist.
  3. The assumption of ongoing psychiatric consultation and treatment responsibilities (with supervision) for patients who have been previously followed in our clinics and have a combined substance abuse history and psychiatric illness.
  4. The provision of support/liaison to clinic counselor and/or social work staff seeking psychiatric input or supervision.
  5. Participation in group therapy in the MICA clinic.

The residentís responsibilities while here include:

  1. Completing three to six combined psychiatric and addiction assessments each week.
  2. Formulating and implementing the treatment plans for each patient assessed, following the patients for the duration of the rotation.
  3. Obtaining random urine and breathalyzer samples for toxicology screens on all patients in the program, logging results and refusals and communicating those to the other relevant care providers.
  4. Participating in substance use groups already established as part of our program as well as initiating and running at least one group that will meet weekly.
  5. Preparing two case conferences with supporting literature to be given to the staff.
  6. Attend daily rounds, weekly clinical team meetings, biweekly in service conferences and MICA staff meetings.
  7. Present and review cases in weekly supervision with the medical director, as well as seek and provide informal supervision with professional staff and trainees as needed.

Educational Goals and Objectives (Adolescent), 0.1 fte.

Goal:

Addiction Resident to become familiar with assessment of youth with substance use problems.

During rotation with child psychiatrist at Turnbull, Addiction Resident will:

At the end of rotation at Turnbull, Addiction Resident will:

Clinical supervision is provided by Elise Richman, M.D. and Myreille Polycarpe, M.D.