Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residencies: Case Presentations: Successful National Residency Programs

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WelcomeThe National Cooperative Agreement on

Implementing Postgraduate Nurse Practitioner

& Clinical Psychology ResidenciesPresented by the

the Community Health Center, Inc.

WEBINAR 8: Case Presentations: Successful National Residency Programs

May 11th, 2016

LEARNING COLLABORATIVE APPLICATIONS NOW OPEN!

o Participation in the Learning Collaborative is FREE for health centers.

o 9-month intensive learning collaborative provided by CHCI, it’s Weitzman Institute and partners

o Team Based Care or Post-Graduate Residency Program

How to apply?-Visit www.chc1.com/nca -PDF of the application is available on

our website -Applications due May 20th

http://www.chc1.com/nca

Learning Objectives:

1. Participants will list at least two challenges that current post-graduate residency programs have faced.

2. Participants will identify three factors that successful residency programs have had in common.

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Get the Most Out of Your Zoom Experience• Send your questions using Q&A function in Zoom• Look for our polling questions• Live tweet us at @CHCworkforceNCA and #StartingResidencies and

#HRSAnca • Recording and slides are available after the presentation on our website

within one week• CME approved activity; requires survey completion • Upcoming webinars: Register at www.chc1.com/nca

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http://www.chc1.com/nca

Elizabeth DuBois, MSN, FNP-BC, AAHIVSAssociate Vice President, Medical Affairs

Grace O’Shaughnessy, LMSWProgram Manager, NP Fellowship Program

New York, NY

The beginning

• Primary Care NP Fellowship launched in September 2015o Started with 4 fellows

recruited from across 4 NYC based schools

• Psychiatric Community Health Fellowship will launch in October 2016o Will start with 4-5 fellows

Case for CHN’s NP Fellowship

• Increase in patients seeking care due to ACA, increase in chronic conditions and comorbidities, shortage of primary care physicians

• Prepare new grad NP’s to increase skill level, confidence and decrease turn-over rate

• Integrate a robust NP program into our FQHC

Primary Care NP Fellowship: Breakdown

• 12 months full-time, 35 hours per week, hired by CHN as fellows

• 1.5 days per week building a panel of patients at CHN’s FQHC’s under the guidance of a preceptor

• 1 day per week at CHN’s FQHC’s doing independent practice• 2 days per week specialty rotations at locations around New

York City• 0.5 day per week in didactic presentations• Occasional on-call and Saturday shifts• Procedure Clinic

Primary Care NP Fellowship: Specialty Rotations

• Newborn Nursery• Urgent Care/Emergency Department• Pediatrics (Inpatient and Outpatient),

including Adolescents• HIV and Infectious Diseases

(including STDs) (inpatient and outpatient)

• Orthopedics/Sports Medicine• Dermatology• Psychiatry including substance abuse• Women’s Health (Prenatal) (Inpatient

and Outpatient, including

antepartum, labor and delivery, and postpartum)

• Gastroenterology/Liver Diseases including Hepatitis C

• Transgender• Palliative Care/Chronic Pain

Management• Mini Rotations (Dental,

Ophthalmology, Cardiology, Otorhinolaryngology, Nephrology)

• Procedure Clinic

Inpatient & Outpatient Settings (private practices, hospitals and CBO’s)

Psychiatric NP Fellowship: Breakdown

• 12 months full-time, 35 hours per week, hired by CHN as fellows

• 5 days of seeing patients, under guidance of a preceptor

• 1 hour case conference weekly• Weekly didactics the first 8 weeks• Monthly didactics with expert clinicians • 2-3 specialty rotations of 6-8 days each

Psychiatric NP Fellowship: Specialty Rotations

• Psychiatric Adult Inpatient

• Psychiatric Emergency Department/Urgent Care

• Psychiatric Adolescent (Outpatient and Inpatient)

• Addiction/Substance

Abuse• Seriously Mentally Ill• Neurology/Psychiatry

(Outpatient)• Veterans Care• Integrative primary and

mental health***

Outcomes to Date

• Preceptor feedback: overwhelmingly positive. All preceptors have reported marked improvement

• Specialty rotations – maintained relationships with over 10 external partners

• Didactics – utilized over 10 external providers and over 25 internal providers

• All 4 fellows have been offered permanent positions at CHN

Outcomes to Date

• < Visits to date for Q1 & Q2

• Majority of chronic disease seen: hypertension, asthma, COPD

• Majority of acute illness seen: vaginitis, UTI, contraception management

Outcomes to Date

Applications for 2016 – 2017 Fellowship• Hosted 1 open house and made in-person visits

to several universities on the east coast • Received 50 applications from NYS, North

Carolina, California, Washington, Massachusetts, Connecticut, New Jersey and Alabama

• Expansion to 16 primary care fellows for 2016-2017

NP Fellowship – The Future

• Start the Community Health Psychiatric Fellowship in October 2016

• Collect data and report on the efficacy of the fellowship

• Offer CME/CNE credit for all of our didactic presentations

• Expand to Adult/Geriatric and Pediatric

2015 – 2016 Testimonials• Starting as a new nurse practitioner is an exciting but daunting experience. Being part of this

fellowship has allowed me to venture into practice with support I can’t imagine doing without. Having someone to guide me now is more important than ever.

• By engaging with experienced mentors and multidisciplinary providers within the health care field such as pediatricians, nutritionists, social workers, cardiologists, psychiatrists, HIV specialists, and ophthalmologists I am better equipped to provide informed, empowering, and quality comprehensive patient care.

• I am also grateful to be in an environment that is conducive to learning and encourages new providers: all of the providers that I have interacted with have been willing to answer questions or provide insight whenever we need it. I have never doubted that this is the best way for me to start my career as a Family Nurse Practitioner.

• I've gained insight on how the health care system works and what services are available to patients and overall support for the underprivileged. Didactics supports the rotations we attend and allows the opportunity to engage in dialogue about the cases in practice. Overall, this fellowship experience has been a fantastic learning experience that I would highly recommend to new nurse practitioner graduates.

Grace O’Shaughnessy, LMSWProgram Manager, NP Fellowship Program [email protected], NP Fellowship Program

mailto:[email protected]

Western NC Community Health Services, Inc.

Advanced Practice Clinician Safety Net Residency: A Transition to Practice

Sara W. Mertz, A/GNP, APC Residency Director

S. Todd Wallenius, MD, Medical Director


Asheville, North Carolina

Background• Began September 2014 to address the predicted shortage of

primary care physicians • 12-month intensive immersion in a community health center setting• 4 Foundational Pillars:

– safety net focus – longer patient visits – behavioral health education, support and integration,

and – dedicated precepting time



Safety-Net Focus• Alma Ata Principles

– International declaration to protect and promote the health of all people, underlining the importance of primary care

• Integrated Team Precepts Residents• Culturally Competent Care• Understanding Health Literacy• Affordable, Sustainable Prescribing Practices• Trauma Informed Care• HIV Care• Transgender Health • Time Management



Longer Visits• 1000+ NEW patients per resident per year:

– Preventive Screenings– Treatment Planning– Chronic Disease Management– Urgent Care

• Retain panel of COMPLEX patients• Nurture personal interests

– Procedures– Prenatal/Women’s Health– HIV– Transgender



Behavioral Health• Didactics, Role Modeling, and Point of Care Support

– Relationship• Healthy boundary setting • ACES & Recognizing PTSD • Recognize drug seeking behaviors• Positive psychology• Motivational interviewing

– Diagnostic• Anxiety, Depression & Bipolar Disorder• Personality Disorder• Substance Abuse

– Treatment• Pharmacologic prescribing• Chronic Pain Group



Dedicated Precepting Time• Four dedicated preceptors

– Varying Strengths and Interests– Improve satisfaction and reduce burnout risk

• Time allotted to develop & present didactics

• Uninterrupted time to mentor residents delivering care

• 2014-2015– 3 have completed the residency: – 2 of those remain working at WNCCHS and – 1 is working in the V.A. system

• 2015-2016– 1 ended residency early to fill a vacated full time position – Alternate resident joined at the end of the 1st quarter– Behavioral health team provides peer supervision (support

group)

• High Risk Medication Care Management

• Improved Quality Performance



Outcomes



Future Plans• Seek Accreditation through the National Nurse Practitioner

Residency and Fellowship Training Consortium (NNPRFTC)• Collect & Share Data on Impact of Residency Program on

– Quality– Finding Meaning in Safety Net Medicine

• Program Growth dependent on expanded funding– Hours– Number of Residents per year– Specialty clinics



Contact UsSara Mertz, A/GNP

[email protected] ext 2403

Todd Wallenius, [email protected] ext 2402



Waianae Coast Comprehensive Health Center

Nurse Practitioner Residency Program

Waianae Coast Comprehensive Health CenterWaianae, Hawaii

Lessons Learned

Advance PlanningAPRN CertificationDedicated Residency StaffPreceptor TrainingStaff Training

WCCHCNurse Practitioner Residency

Program2015-2016

Mahalo

Pat McKenzie, APRN

[email protected]

808-697-3480

OUR STORY:POST DOCTORAL PSYCHOLOGY

RESIDENCY PROGRAMElizabeth Bezos, BS, BA – Administrator, Office of Education and Training

Post Doctoral Psychology Residency Program at Citrus Health Network

• CHN Overview

• Opening a Training Program

• Program Structure

• Outcomes

• Future Plans

Citrus Health Network• Founded in 1979 as a Community Mental Health Center.

• Earned designation as an FQHC in 2004 with the addition of primary care services.

• Accreditations / Designations• The Joint Commission

• Behavioral Health Organization & Behavioral Health Medical Home• Ambulatory Health Organization & Primary Care Medical Home

• National Committee for Quality Assurance (NCQA) • Level 3 Patient-Centered Medical Home

• American Psychological Association (APA)• Pre-Doctoral Internship in Psychology• Post-Doctoral Residency in Psychology

• Accreditation Council for Graduate Medical Education (ACGME)• Psychiatry Residency Program

APA Accredited Training Programs• Doctoral Internship Program

• Initial Accreditation in 1998• Currently under re-accreditation process

• Post Doctoral Residency Program• Initial Accreditation in 2004• Re-accredited in 2015

• Psychiatry Residency Program• Institutional Accreditation in 2014• Program Accreditation in 2015

Why open a training program?• 2nd Post Doctoral Residency Program in Florida to be APA –

accredited• The ONLY APA-accredited Post Doctoral program in the nation to

be sponsored by a CMHC.

• Post-Doctoral Residents allowed for a more cost effective workforce

• Satisfied need for well trained providers that were familiar with our community’s need and with our organization’s high standard of care

• Integrated teams required an expert in behavioral health

Program StructureGovernance Structure Key Elements

Board Understand cost/benefit.

CEO Understands & supports clinical learning environment /culture.

Training Director Psychologist with good clinical skills that can design a curriculum, likes to teach & works well in teams. Sees psychologists as treatment team members working collaboratively with the medical staff.

Administrative Educational Leader Has direct access to COO/CEO. Ensures compliance with APA standards; monitors quality of learning environment ; provides staff support to faculty & trainees; effects change as needed, etc.

Committee Structure Parallel to quality improvement structure. Members include key managers & clinical leaders. Provides structure for continuous program evaluation & improvement; Program-Specific Subcommittees

Post Doc Residency Faculty and Trainees

7 Core Faculty Members, 23 Licensed Psychologists center-wide; 10 Resident Placements: Outpatient Psychotherapy, Behavioral Medicine; Crisis Stabilization Units & State Inpatient Psychiatric Program

Program Structure• Direct Client Care • Seminars

• Ethics and Professional Development Seminar• Research Seminar• Psychopharmacology Seminar• CHN’s Integrated Ground Rounds

• Scheduled Supervision Time• Opportunities to Supervise • Evaluations

• In-vivos• Mid Year and Final• Research Symposium

Outcomes• 99 Post Doctoral Residents

trained since 2004

• Settings:• Outpatient Psychotherapy• Behavioral Medicine• Crisis Stabilization Units• State Inpatient Psychiatric

Program• Foster Care Program• Assessment and Emergency

Services

• 34% of graduates that have been employed by CHN immediately after graduation

• 79% of current psychology staff center-wide have trained at CHN

• Most graduates are now licensed• 47% employed in a CMHC; • 30% employed in Independent Practice• 23% employed in Education at the

undergraduate & graduate levels, Private Psychiatric Hospital or VA

Future Plans

• Obtain better graduate data by:• Creating an Alumni Group • Moving towards automated electronic surveys

• Meticulous review of new APA Standards of Accreditation

Questions???

Elizabeth Bezos,Administrator

Office of Education and TrainingCitrus Health Network at

[email protected]

Reminders

Complete our survey!

Learning Collaborative Applications are due on May 31st!

www.chc1.com/NCA

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SpeakersFrom Western North Carolina Community Health ServicesSara Wallenius Mertz MS, RN, A/GNP, Director of Quality Management Todd Wallenius, MD, Medical Director

From Waianae Coast Comprehensive Health Center:Pat McKenzie, MSN, WH-BC, Family Nurse Practitioner, Residency Program Director

From Community Healthcare NetworkGrace O’Shaughnessy, LMSW, Program Manager, NP Fellowship Program

From Citrus Health Network, Inc. Elizabeth Bezos, BS, BA, Administrator, Office of Education and Training

From Community Health Center, Inc.:Margaret Flinter, APRN, PhD, Senior Vice President & Clinical Director Kerry Bamrick, MBA, Senior Program Manager Tim Kearney, PhD, Chief Behavioral Health Officer Diana Paris, MSN, FNP-BC, RN, Nurse Practitioner

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Health & Medicine

Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residencies: Case Presentations: Successful National Residency Programs