Community Psychiatry

All residents receive experience in consultation to community systems of care, providing consultation under direct supervision from a board certified child and adolescent psychiatrist. Residents collaborate with pediatricians as part of the SmartCare program operated by Vista Hill Foundation. They also have a required first year rotation at Family Health Centers of San Diego, which includes work in a community outpatient psychiatry clinic and spending one afternoon at an integrated site with Pediatrics.

Family Health Centers of San Diego (FHCSD) is a community clinic providing primary care, dental, pediatric services and mental health care to over 155,000 individuals per year in San Diego. FHCSD is accredited by the Joint Commission and certified by the National Committee for Quality Assurance as a Patient Centered Medical Home.  FHCSD delivers high quality care, which is accessible and affordable to members of the community.  FHCSD also plays a key role in increasing access to mental health treatment in the community, providing care to children and adolescents in the primary care setting, as well as to those transitioning out of higher levels of outpatient care.

All first year fellows (both traditional and community tracks) have a required 2.5 month rotation at FHCSD during which they spend two and a half days per week at a mental health clinic, and one afternoon at an integrated site with Pediatrics, for a total of 6 half day sessions per week. At the main clinic, fellows will provide psychiatric assessment, evaluation for psychopharmacology, and ongoing psychopharmacologic management. At the integrated site, they engage in cutting edge evidence based collaborative care treatment of adolescents with mental health challenges in the primary care setting.  They see on average 3-4 patients per half-day and have direct, on-site supervision for every case they see from UCSD clinical faculty and from FHCSD child psychiatrists. Fellows do not have call obligations to Family Health Centers.

The educational experience at FHCSD offers not only a rich clinical rotation and exposure to the community clinic setting, but also an introduction to administrative and organizational issues relevant to public sector behavioral health services. FHCSD is located 15 minutes drive from Rady Children's Hospital.

VHF  (Second year fellows on Community Track):

Vista Hill Foundation (VHF) is a not-for-profit organization with more than sixty years of experience providing psychiatric services to youth and families in San Diego.  VHF operates the innovative SmartCare Integrated Behavioral Health Consultation Program, which leverages televideo and other technologies to deliver psychiatric expertise to primary care providers, and individuals and families struggling with mental illness from across the county. SmartCare serves more than 2,000 individuals annually.  VHF also offers school based mental health services through their Learning Assistance Center programs, which provides mental health services to students with special learning needs and behavioral concerns in multiple school districts across the county.  Additional VHF services include the Bridge Teen Recovery Center, an outpatient program for adolescents struggling with substance abuse, and the Juvenile Court Clinic, which provides intensive transitional psychiatric services for youth referred by the Juvenile Court.  The community track second year fellow has the opportunity to rotate through VHF programs, for 12 hours per week.  In these programs the community track fellow will provide psychiatric assessment, psychopharmacologic management, and multi-disciplinary team supervision, and have opportunity to provide psychiatric consultation to the Juvenile Court and to primary care settings.  Though there is some difference between programs, on average, fellows see 3 to 4 patients per half-day session. The community track second year fellow will receive weekly supervision and mentoring by a board certified child and adolescent psychiatrist who is an experienced national leader in the field of community child/adolescent psychiatry who has direct oversight responsibility for the programs to which the fellow will be assigned. The fellow will also have a program staff psychiatrist providing mentoring and guidance for each clinical rotation. Fellows do not have call obligations to VHF programs. 

The educational experience at VHF offers broad and in-depth exposure to multiple populations and multiple modalities of service provision relevant to community child/adolescent psychiatry with the goal of optimally preparing the fellow for a career in the public sector.  In addition, this rotation trains fellows in cutting edge, evidence based integration services that are unique in San Diego County. VHF is located five minutes drive from Rady Children's Hospital.

SDCC (Second year fellows on Community track):

San Diego Center for Children (SDCC) has provided services for children, adolescents and families in San Diego for nearly 130 years. SDCC is Joint Commission accredited for behavioral healthcare and offers a continuum of mental health programming which includes wrap services, school based services, residential treatment and outpatient psychiatry, reaching over 1000 children per day. The community track second year fellow has the opportunity to rotate in SDCC programs for 12 hours per week to provide psychiatric assessment, CBT therapy sessions, family psychoeducation, and psychopharmacologic management.  During this experience, fellows will work with adolescents and families in a range of settings, including in the outpatient clinic, on the WRAP team, and in the residential treatment center. The community track fellow will see 3 to 4 patients per half-day session. The community track second year fellow receive weekly supervision and mentoring by UCSD faculty as well program staff board certified child and adolescent psychiatrists who provide mentoring and guidance for each program site. Fellows do not have call obligations to SDCC programs.  

The educational experience at SDCC provides the fellow with a unique view into the continuum of care from residential to outpatient treatment. By working with patients in residential treatment, then participating in WRAP designed to help patients and families with the transition from residential back to the community, and lastly, providing care in clinics serving patients who have fully transition out of residential, fellows achieve a greater understanding of the clinical, social, and administrative challenges facing each level of care.  This rotation also plays a role in preparing the fellow for a career in the public sector. SDCC is located five minutes drive from Rady Children's Hospital.


Community Track


The partnership between the Community Track (CPP) of the UCSD Child and Adolescent Psychiatry Fellowship, Family Health Centers of San Diego (FHCSD), San Diego Center for Children (SDCC) and Vista Hill Foundation (VHF), will place Child and Adolescent Fellows at FHCSD, SDCC and VHF sites in addition to Rady and other selective sites. The first phase of the Community Track would start July 2018, with placement of five first-year fellows at FHCSD (Year 1 Curriculum). The second phase, beginning in July 2019, will continue the Year 1 Curriculum (with a new set of fellows), as well as initiate placement of one second year fellow at SDCC and VHF outpatient sites (Year 2 Curriculum). 

 

During Year 1, each first-year fellow rotates through FHCSD, spending ~2.5 months on site, 6 half day sessions per week. The new child mental health clinic at FHCSD in Barrio Logan Area (FCC-2) will be the main clinic with dedicated exam rooms for the UCSD fellow and faculty. FHCSD will dedicate space at its pediatric clinic in either Logan Heights or Diamond Clinic for integrated care model of training. FHCSD will devote two child adolescent psychiatrists to be voluntary faculty with UCSD to help train CPP child adolescent track fellows. Patient volume per half-day will be capped at 3.5. One half-day will be reserved for CPP child/adolescent placement, one half-day will be for UCSD/Rady outpatient clinic, and 2 didactic blocks will be protected.

 

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During year 2, the dedicated second community track fellow will provide outpatient services at a range of clinical sites at SDCC and VHF. These may include Residential program at SDCC, managed MediCal FFS program at SDCC, Merit High School, Substance abuse treatment, Parent Care, or other sites.  The fellow will have 6 half day sessions of outpatient care. This will protect half-day of mandatory Child Adolescent selectives and CPP didactics.

 

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Fellow Expectations and Supervision:

Child and adolescent psychiatry fellows have completed at least 3 years of psychiatry residency, which includes at least two months of approximately 4 days / week of direct patient care for children and adolescents (most commonly on an inpatient unit). First year fellows enter fellowship well versed in safety evaluations, basics of psychopharmacology, psychiatric emergencies, and have carried longitudinal psychotherapy patients.   

 

First-year fellows’ responsibilities include communicating effectively with family and collateral supports, providing psychiatric assessment, diagnosis, treatment planning (including recommendations for medications and psychotherapy), managing psychopharmacology, monitoring medical conditions as appropriate, participating in multidisciplinary teams, and running psycho-educational / CBT/ DBT groups and family meetings. 

 

First-year fellows will review cases on a daily basis with a Board Certified or Board Eligible child and adolescent psychiatrist, who may be a UCSD faculty supervisor, or a staff attending.  Each fellow will be assigned a UCSD faculty member as site caseload supervisor, who will review cases with the fellow at least once per week. 

 

 

 

Second-year fellows are expected to carry approximately 40 outpatients.  Responsibilities include psychiatric assessment, diagnosis, treatment planning (including recommendations for medications and psychotherapy), managing psychopharmacology, monitoring medical conditions as appropriate, participating in multidisciplinary teams. The second-year outpatient caseload is expected to include patients’ facing a range of the most common psychiatric disorders among children and adolescents (anxiety disorders, affective disorders, psychosis, eating disorders, OCD, ADHD)