Community Mental Health Continuity Clinic at BJC Rotation
Rotation Director: Robert Brady MD
Rotation Faculty: Robert Brady MD (Central Location) and Mini Tandon DO (South Location) ,
and Jaime Hook MD (North Location)
Number of residents per rotation: 1 at North or Central in the First year; 4 at South in the Second
year
Length of Rotation: 18 months total (6 months in the first year during the Hawthorne rotation and
12 months in the second year). One morning or one afternoon per week.
All first years will be oriented to this rotation in the beginning of July.
Goal
The goal of the BJC continuity clinic rotation is longitudinal exposure to the care and outcomes
of community children and adolescents, many of which come for very high risk backgrounds.
This rotation allows observation of developmental change and therapeutic change over time. As
of July 2011 the second year continuity clinic has a particular focus on preschool/young children.
There is an overall goal of increased independence in medical decision making from year 1 to 2
with less reliance on faculty support by year 2.
Objectives
To develop competence in the following areas
Patient Care
 Longitudinal treatment of children and their families or children in Foster Care
 Longitudinal efforts to modify key child risk factors for poor psychiatric outcomes
including non-adherence, loss to follow up, and familial or environmental risks including
severe parental psychopathology
 Development of psychotherapy skills necessary to manage outpatients and their family
members and caretakers
 Longitudinal medication regimens adjustment and changes
 Ongoing outpatient psychoeducation
Medical Knowledge
The resident will continue to gain medical knowledge through a combination of supervised
clinical activities, mandatory divisional didactics, supervised reading of the pertinent CAP or
related literature.
 Understand stability and change in functional impairments associated with various child
psychiatric disorders and the ongoing dynamic influence of other risk factors on course,
prognosis and outcomes
 Understand the use of standardized rating scales completed by patients, parents, and/or
teachers to document incremental changes in symptoms
 Longitudinal monitoring of side effects of psychopharmacology especially polypsychopharmacology
 Understand appropriate and necessary use of laboratory testing including to safely
maintain patients on psychopharmacological regimens
 Appreciation of adherence and compliance issues
Practice Based Learning
In addition to supervised clinical activities and self initiated and suggested readings, the resident
will participate in supervision including 1:1 supervision by attending faculty and other divisional
supervision including individual and team supervision
 Reflection on longitudinal courses
 Especially in the second year: management of one’s clinic
 Appreciation of how BJC patients may or may not differ systematically from patients
who have been studied more intensively in child psychiatry research
 Strengths and limitations of evidence based treatments in understudied populations
Professionalism
The resident will demonstrate sensitivity and compassion to children and adolescents affected by
psychopathology and to their families or their caretakers and will continue to develop in
relationship with other professionals or professionals in training, including supervisors,
colleagues, students and allied professionals.
 Maintenance and enhancement of therapeutic relationships
 Maintenance and enhancement of interdisciplinary relationships
 Increased leadership and autonomy from first to second year of fellowship
 Accurate and timely completion of medical records
 Accurate and timely completion of billing for services rendered
Interpersonal/Communication Skills
The resident will longitudinally function effectively as part of the outpatient care team.
 Continued education of patients and their families and other mental health professionals
in compassionate, respectful, culturally sensitive, and effective ways
 Enhanced respectful and collaborative relationships with clinic staff
System Based Care
 As the residents deepen their understanding of the limitation of community mental health
care for children and its impact on psychiatric presentations to BJC, it is expected that
they will form ideas about possible improvements to systems of care
 Ongoing team approach for managing outpatients including clinic and outreach therapists
Measurement of Objectives
Standard Program evaluations
Feedback by other professionals
Clinical skills exam
Description of Rotation
The first year residents will spend 6 months in their first year rotating one afternoon or morning a
week at either BJC-N or BJC-C and 12 months in their second year rotating one afternoon or
morning a week at BJC-S. At each site, they will join a multidisciplinary team dedicated to
providing high quality longitudinal community mental health care to children and adolescents in
our region.