[Group psychoeducational intervention in relatives of patients suffering from schizophrenia].

The present research paper aims at assessing the effectiveness of a psychoeducational intervention in relatives' groups of patients with schizophrenia or schizoaffective disorder. It examines the possible influence of the intervention on family members as well as on the course of the patient illness. Of a total of 131 relatives, 83 consisted the experimental group and 48 the control group. The relatives of the experimental group were divided into 5 groups and attended 18 psychoeducational sessions. Their patients as well s the patients and the relatives of the control group attended no specific intervention and continued their routine care. The psychoeducational intervention included education about the illness, communication skills training and training in problem-solving. It combined educational and psychotherapeutic techniques. The psychometric tools administered were: The Family Burden Scale, The Family Rituals Scale, The General Health Questionnaire GHQ-28, the Center for Epidemiological studies - Depression Scale (CES-D), the Opinions about Mental Illness Scale OMI, two scales concerning the knowledge about the illness, two questionnaires concerning expectations and feedback about the group process and questionnaires regarding sociodemographic characteristics of the sample and information about the illness. The number of hospitalizations of patients (n=91) during the research year was investigated. An interaction between group and measurement was found. While patient hospitalizations of both research groups did not differ significantly at the year before the study with X2=0.54, p=0.46), they differed when measured a year after the intervention, where patients in the intervention group had statistically significant fewer hospitalizations compared to the patients in the control group (x2=4.58, significant at p=0.032). As to the "compliance" in the medication, two statistical tests were conducted, taking into consideration that "compliance" by patients starting with a "very good" one can't be improved, while by those beginning with poor compliance can't be worsened. In the first investigation, which involved patients with possibility of amelioration or deterioration of "compliance", an improvement of patients (n=12) in the intervention group was recorded. This finding is statistically significant (p=0.0005). The second statistical test included all patients who were giving as an initial reply for the 'compliance' any value below "very good". In the intervention group there were 32 patients, 14 of whom showed improved "compliance" during the research year. This change is statistically significant (p=0.0014). The findings verify that the participation of relatives in psychoeducational groups leads to statistically significant improvement in the course of patient illness, as evident by the reduction in hospitalization rates and the improvement in adherence to pharmacotherapy. The study shows that relatives' psychoeducation constitutes a useful tool in improving the course of illness and empowering the family. The widespread implementation of relatives' psychoeducation in Greece is both necessary and challenging.

Translating Cognitive Behavioral Therapy for Anxious Youth to Rural-Community Settings via Tele-Psychiatry.

This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten different groups from different agencies within Northern Ontario. Each group consisted of four to nine clinicians with child therapy background not specific to CBT (n = 78, 51% social workers, 49% other mental health disciplines). Clinicians were each required to treat an anxious youth under supervision. Changes in clinician knowledge and youth internalizing symptoms were measured. Northern Ontario clinicians showed significant gains on a child CBT-related knowledge test (t (1, 52) = -4.6, p < .001). Although youth treated by these clinicians showed a significant decrease in anxiety symptoms, possible response bias and the lack of a comparison group mandate further studies before generalizing our findings. Nevertheless, training local therapists in anxiety-focused CBT for children via a group supervision based tele-psychiatry model appears to be a feasible and well-received approach to knowledge translation to rural settings.

The evolution of public psychiatry fellowships.

OBJECTIVE: The growth of Public Psychiatry Fellowships (PPFs) has reached a new developmental stage, providing a wide array of academic partnerships and educational opportunities in psychiatric leadership and administration. The authors examine the evolution of these programs and illustrate three distinct models. METHODS: Data from yearly surveys and discussions with PPF directors were used to identify key similarities and areas of divergence as the programs have evolved. RESULTS: The first period of program expansion took place 8-10 years ago when new programs were modeled on the Columbia PPF, and key elements of that program and the American Association of Community Psychiatrists (AACP) guidelines were incorporated broadly. Examples of multiple source (Columbia), single source (Yale and UCSF), and grant-funded programs (Alabama and UCSD) are presented. CONCLUSIONS: A review of the current status of PPFs reveals a diversity of structures and strategies for success, which can be attributed to the range of their funding sources. The advantages and potential disadvantages of those models are outlined with respect to the educational experience and opportunities for growth and sustainability.

Factors impacting the decision to participate in and satisfaction with public/community psychiatry fellowship training.

During yearly meetings of the recently developed network of 15 public/community psychiatry fellowships, it has been noted that programs are having varying degrees of success with regard to recruitment. To understand factors that impact recruitment, a quality improvement survey of fellows and alumni was conducted. Respondents were asked to rate overall satisfaction with their fellowship training as well as perceived benefits and obstacles to participating in a fellowship program, and impact on their careers. A total of 155 (57%) fellows and alumni responded. Factor analysis was used to condense the variables, and a multiple regression explored factors predicting overall fellowship program satisfaction. Factors that represented perceived benefits had higher means than did factors that represent obstacles. Respondents highly valued the extent to which these fellowships enhanced their careers, with regard to job opportunities, academics, networking and leadership.

A community engaged curriculum for public service psychiatry fellowship training.

Transforming the mental health system into a recovery oriented, integrated system of care requires a psychiatric work force that understands the relationship between recovery processes and community living. Fellowship programs in public and community psychiatry contribute to this transformation by educating psychiatrists about recovery, system dynamics, leadership, effective administration and community involvement. This paper describes a novel approach to fellowship programming that accomplishes these aims through an organizational strategy that emphasizes community engagement. After describing the administrative background for the program, we describe how the content curriculum and teaching process focus on the engagement of community members-both service users and service providers-as participating faculty. The faculty includes over 100 consumers, family members, advocacy group representatives, clinicians, and administrators. We present evaluation data obtained from 45 of the 100 community and university faculty who participated in the first 2 years' of the fellowship and conclude with a critique and recommendations for further progress in community engaged fellowship training.

Expanding the playing field: public and community psychiatry fellowship and beyond.

Fellowship training in public and community psychiatry has been shown to both extend career tenure and promote leadership attainment. While starting and sustaining a successful fellowship involves overcoming several hurdles, a successful fellowship can serve as a foundation for developing a viable academic division. Case Western Reserve University has redesigned and expanded its public and community psychiatry fellowship. At the same time, it has retained several fellowship graduates by developing a division of public and community psychiatry with a unique academic identity. This model could serve as a blueprint for other programs looking to establish or expand similar programs.

Community psychiatry tracks for residents: a review of four programs.

Many psychiatry residency graduates end up practicing at least in part in community settings. However, declining funding and other issues prevent many residency programs from offering robust community psychiatry training to all of their residents. Accordingly, some residency programs have developed Community Psychiatry Tracks, with the goal of developing future leaders in public sector psychiatry. We cataloged US psychiatry residency programs offering Community Psychiatry Tracks by reviewing the literature and surveying training directors and members of the American Association of Community Psychiatrists. Authors from each of the four programs found to be actively offering such tracks describe their track curricula, from which we elucidated common and variable elements as well as strengths and weaknesses and then make recommendations for other programs wishing to start a track. A Community Psychiatry Track preliminarily appears to be a well-received way to offer enhanced Community Psychiatry training to interested residents, to recruit medical students to residency programs, to offer opportunities for collaboration between residents and faculty members, and to expand opportunities for scholarly work by residents.

Psychiatry residents' perception of public/community psychiatry fellowship training.

In order to improve recruitment into public/community psychiatry fellowships, a survey was administered to understand psychiatry residents' perception of benefits and obstacles to fellowship training. Using standard statistical methods, the responses of those residents who indicated interest in public/community psychiatry training were compared to those who were not. Residents who were interested in public/community psychiatry fellowships were earlier in their training. These same residents gave higher endorsements to items related to quality, location and flexibility of training program, recommendation of colleagues, opportunities for health policy training and networking as compared to residents who were not interested in pursuing a public/community. Those results attained statistical significance while philosophical approaches including emphasis on recovery and tailoring specific training experiences approached significance. Psychiatric residents appear to start residency training with some interest in public/community psychiatry and this interest can be nurtured if public/community psychiatry is emphasized during training.

Consulting psychiatry within an integrated primary care model.

After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.

Community psychiatry: what should future psychiatrists learn?

Community psychiatry training is required by all adult psychiatry residency training programs. Unlike other core elements of training, the specific content is not clearly articulated, leaving program design and content up to individual programs. At the same time, the meaning of "community psychiatry" is increasingly in the eye of the beholder; traditional structures and systems have lost funding, services are more diffuse, and the traditional medical model is becoming less valued. In this column we describe an approach to training in community psychiatry that is intended to prepare future psychiatrists for the clinical and systems challenges they will undoubtedly face and that achieves this goal through trainees' caring for an especially vulnerable subpopulation--homeless individuals with severe and persistent mental illness. We describe how this model teaches residents to think simultaneously at both the individual and the systems levels and enables them to understand the critical need to use nontraditional treatment approaches in order to provide comprehensive care for this marginalized population. We believe that this clinical and training paradigm can be replicated and might guide other residency training programs in their approach to teaching community psychiatry.

Progress in workforce development since 2000: advanced training opportunities in public and community psychiatry.

A crisis in the behavioral health care workforce has drawn considerable attention from consumers, families, advocates, clinical professionals, and system administrators at local, state, and federal levels in the past decade. Its effects have been felt in the recruitment, retention, and performance of psychiatrists in the public sector, where a focus on biological aspects of illness and efforts to cut costs have made it difficult for public psychiatrists to engage meaningfully in leadership, consultation, prevention, and psychosocial interventions. An array of training opportunities has recently been created to meet the needs of community psychiatrists at various stages of their careers, from psychiatrists just beginning their careers to those who have been working as medical directors for several years. This article describes the development of these initiatives and their impact on public psychiatry in four key areas--training of experienced psychiatrists, ensuring retention of psychiatrists in community programs, providing fellowship training, and creating professional identity and pride. Although these programs constitute only initial steps, opportunities for psychiatrists to obtain advanced training in community psychiatry are much greater now than they were ten years ago. These initiatives will enhance the professional identity of community psychiatrists and provide a solid foundation for future development of public service psychiatry in the behavioral health workforce.

A day in the life of a public psychiatry fellow.

Now in its 29th year, the Public Psychiatry Fellowship of the New York Psychiatric Institute at Columbia Medical Center selects 10 fellows per year for its 1-year program (1). This award-winning fellowship trains future leaders for the public mental health sector. The curriculum (2) employs a combination of a didactic seminar series, management-problem-focused presentations by guest speakers, field trips, and supervision by fellowship faculty to instill the values and skills required for practice and leadership in the public sector. Fellows utilize the framework of the academic curriculum to carry out a series of presentations throughout the year that allow them to organize, implement and evaluate concepts that they learn during the year. The following account, written from bird's eye view, details one fellow's day at his field placement in a State Hospital outpatient clinic setting, with the aim of illustrating how the concepts taught by the fellowship find application in day to day practice.

Child and adolescent psychiatry leadership in public mental health, child welfare, and developmental disabilities agencies.

Child and adolescent psychiatrists are in a unique position to provide administrative and clinical leadership to public agencies. In mental health, services for children and adolescents in early childhood, school, child welfare, and juvenile justice settings, transition-aged youth programs, workforce development, family and youth leadership programs, and use of Medicaid waivers for home- and community-based service system development are described. In child welfare, collaboration between an academic child psychiatry department and a state child welfare department is described. In developmental disabilities, the role of the child and adolescent psychiatrist administrator is described providing administrative leadership, clinical consultation, quality review, and oversight of health and behavioral health plans for persons with developmental disabilities.

Community Systems of Care for Children's Mental Health.

Although the future of the systems of care model continues to evolve, the core values of child psychiatry are well supported and well served in this emerging arena of public children's mental health service delivery. A substantial body of evidence supports the concepts and practices of family-driven care congruent with wraparound principles and practices. Individual and system outcomes data show efficacy for programs that integrate traditional professional services with consumer-centric wraparound approaches, such as mentoring, team decision making, and community-based services and supports. Integrative interagency practice, fostering cross-agency collaboration to address the needs of at-risk populations, has been shown to be central in providing supports for families and youth.

Key features of a unique community psychiatry fellowship: the emory university fellowship in community psychiatry/public health.

The Emory University Fellowship in Community Psychiatry/Public Health is a unique training opportunity whose mission is to train future leaders in the arena of community psychiatry. To complement the recent description of the Public Psychiatry Fellowship of New York State Psychiatric Institute at Columbia University Medical Center, this report describes the key features of Emory's fellowship-its academic curriculum, practicum experiences, site visits and other opportunities for collaboration, and ongoing mentoring and career development. Congruencies between these four key features and the seven core elements of Columbia's fellowship are highlighted, as are several important differences. Such descriptions of innovative training programs in community and public psychiatry are essential in promoting excellence in education, which will translate into vital enhancements in programs, policy, and community-based approaches to mental health services.

Core elements of a public psychiatry fellowship.

As the oldest, largest, and best known program for training psychiatrists to become public-sector leaders, the Columbia University Public Psychiatry Fellowship (PPF) at New York State Psychiatric Institute has frequently been consulted by other departments of psychiatry planning public and community fellowship programs. PPF's faculty has developed seven core elements for such training programs. The fellowship's longevity and the career paths of its graduates suggest that these core elements represent a best-practices model for fellowship training in public-community psychiatry.

Barriers to recovery and recommendations for change: the Pennsylvania Consensus Conference on psychiatry's role.

OBJECTIVE: Recovery has emerged over the past decade as a dominant theme in public mental health care. METHODS: The 2006 Pennsylvania Consensus Conference brought together 24 community psychiatrists to explore the barriers they experienced in promoting recovery and their recommendations for change. RESULTS: Twelve barriers were identified and classified into one of three categories: psychiatry knowledge, roles, and training; the need to transform public mental health systems and services; and environmental barriers to opportunity. Participants made 22 recommendations to address these barriers through changes in policies, programs, and psychiatric knowledge and practice. CONCLUSIONS: The recommendations identify areas for change that can be accomplished through individual psychiatrist action and organized group efforts.