Affiliations

Department of Veterans Affairs
Brooklyn Veterans Administration Medical Center (BVAMC)
NY Harbor Health Care System

Residents have a required full-time two-month rotation in their PG-1 year of training at the PRIME Clinic, which is a multidisciplinary outpatient clinic within the Department of Medicine. In addition, residents have a required half time four-month rotation at the Veterans Health Care Clinic (VHCC) during their PGY3 year. Residents may return in their fourth year of training (PGY4) for electives half time up to six months. The BVAMC is a federal government run hospital for veterans of the U.S. Armed Forces. It has 158 medical and surgical beds, 30 psychiatric beds and a full range of outpatient services.

Psychiatric services include acute inpatient treatment, the VHCC, consultation-liaison service, drug and alcohol service, posttraumatic stress disorder clinic and other facilities. Ninety-percent of the VA patients are male ages 21-90’s with the majority over 45. Approximately 50% of the psychiatric population has affective disorders, 30% anxiety disorders, 10% schizophrenic, 5% adjustment disorders and 5% other psychiatric disorders. In the PRIME clinic residents evaluate 5–20 patients per day with the average generally 8-12 medical outpatients. PGY3 residents provide evaluation and assessment of veteran population of outpatients assigned to VHCC. Residents at VHCC participate in such programs as TORCH (The Outreach and Recovery Center for Homeless), IPCC (Intensive Psychiatric Community Care Program), and the mental health clinic. They also learn about vocational resource opportunities, compensated and work therapies and psychosocial clubhouses available to these patients.

Residents assess and treat a wide range of disorders through pharmacotherapy, individual supportive therapy, and group psychotherapy. They also deal with individuals dually diagnosed (majority with drug and concomitant psychiatric disorder) and evaluate them in ongoing treatment and social service support systems. Supervision in PRIME clinic is done by senior residents, and a medical attending and, when necessary, consultants from other subspecialties. In the PG-3 year outpatient clinic rotation, supervision is done on site by a psychiatric attending (Medical Director) as well as a team of social workers and nurses. The BVAMC is located approximately 6 miles from the primary training site. The PGY-1’s spend five days a week full time there and the PGY3’s spend two full days a week at VHCC Outpatient Clinic (approximately 5 miles from primary site). PGY3’s return to the primary site three days a week, two days to see their patients and supervisors in the Ambulatory Clinic at KCHC and one full day at SUNY-Downstate attending seminars (section 4.0 49-63). In addition, they attend a weekly Journal Club at VHCC (59) and attend weekly Ground Rounds at the BVAMC. PGY1’s attend daily conferences in the Department of Medicine at the BVAMC.
The clinical experiences in the PRIME clinic are designed to give residents a broad experience in treating medical outpatients with concomitant psychiatric neurological and other disorders and in providing outpatient care in a multidisciplinary primary care setting. Clinical experiences in the VHCC are designed to give residents a broad experience with types of outpatients not generally seen at KCHC, including patients with PTSD, and veterans with mixed affective states and psychosis. Faculty at the VHCC outpatient includes, 1 full-time psychiatric medical director, 1 part-time geriatric senior psychiatrist, 5 full-time social workers, 1 full- time PA, 1 part time internist and 2 full-time nurses.

The faculty at the BVAMC consists of the 11 full-time psychiatrists, 4 full-time PA’s, 17 full-time psychiatric social workers, 11 full-time nurses. Residents returning to the VA for their fourth year can choose electives in consultation-liaison psychiatry, PTSD, alcohol and substance abuse division, primary care, geriatric psychiatry or research. Electives are arranged on an individual basis.

Project for Psychiatric Outreach to the Homeless (PPOH)
Project for Psychiatric Outreach to the Homeless (PPOH) is a required 12-month rotation (3-4 hours per week) occurring in the PGY-3 year. Residents are assigned to community-based agencies that work with mentally ill homeless or formerly homeless people. These sites have been visited and reviewed by PPOH staff and SUNY Downstate community psychiatrists prior to any resident placements to assure for adequate clinical and educational experience and adequate security and staffing availability. PPOH’s clinical staff consists of 1 full-time psychiatrist (medical director) and 1 full-time social worker (clinical coordinator). Agencies where residents are placed have a multidisciplinary team consisting of social workers, nurses, therapists and case managers. Agencies where residents are placed are approximately 3.8 miles from the primary site of training, and PPOH headquarters is approximately 6.7 miles from the primary site of training.

The majority of educational activities take place on site as residents become integrated into the community agency they are assigned. Formal group meetings take place at PPOH headquarters bi-monthly. Monthly supervision is available on site by the medical director and the clinical coordinator of PPOH. In addition, bi-weekly supervision is set up with a community psychiatrist at SUNY Downstate and KCHC to monitor individual resident’s progress, and experience in a community setting and any additional issues that may arise.

PGY-3 residents are assigned to the following community agencies:

•		ARBOR INN, located at 105 Carlton Avenue, Brooklyn NY 11205, (approximately 3.8 miles from the primary training site) is a transitional shelter for young mothers and their children. Population is predominantly Black and Hispanic and range in age from 18 – 40’s. Children are under 8 years old. PGY-3’s have an opportunity to do brief psychotherapy, groups and outpatient psychopharmacology as well as liaison with other community agencies. Diagnoses seen at Arbor Inn include: affective disorders, anxiety disorders, PTSD, axis II, character disorders, and coexisting substance abuse.
•		MOST HOLY TRINITY Single Room Occupancy-A, located at 157 Graham Avenue, Brooklyn, NY 11206 (approximately 4.8 miles from the primary training site) is a permanent residence for formerly homeless people. Clients are predominantly Hispanic and middle-aged. PGY-3 residents perform psychiatric evaluations, crisis intervention, group therapy, and medication management. Diagnoses at the site include: schizophrenia, bipolar and other affective disorders, OCD, PTSD, axis II disorders and issues regarding substance abuse.
•		OAK HALL, located at 105 Carlton Avenue, Brooklyn, NY 11205, (approximately 3.8 miles from the primary training site) is a permanent residence for formerly homeless individuals. The population is Black and Hispanic, with a greater majority of men than women. PGY-3’s assigned to Oak Hall perform psychiatric evaluations, crisis intervention, medication management and brief psychotherapy. Diagnoses at this site include: schizophrenia, affective disorder, OCD, PTSD, axis II and substance abuse.
•		ST. JOSEPH’S SRO, located at 683 Dean Street, Brooklyn, NY 11238, (approximately 3.0 miles from the primary training site) is a permanent residence for men and women over age 55, with the majority in their 60’s. The population is predominantly Black and Hispanic. PGY-3’s at this site perform psychiatric evaluations, crisis intervention, medication management and brief psychotherapy. Diagnoses at this site include: schizophrenia, bipolar disorders, OCD, PTSD, organic disorders, and some character disorders and substance abuse. Generally, one to two residents are placed at each of the sites listed. Residents may choose to do an elective at a PPOH agency for up to six months in their PGY-4 year.

St. John’s Episcopal Hospital
PGY-1 and 2 residents have a required rotation of three months full-time at this facility. The rotation in the PG-1 year consists of one month of addiction psychiatry and two months of general inpatient psychiatry. The rotation in the PG-2 year consists of three months of geriatric psychiatry and cognitive-behavioral therapy, both running concurrently part-time. Residents return to the primary site one full day a week for the required didactics and outpatient work in the PG-2 year.

St. John’s Hospital is a 300 bed general hospital located at a distance of 16.5 miles from the primary training site. Among the 300 beds, 77 are on psychiatric inpatient units (25 geriatric, 18 acute inpatient, and 34 substance abuse). In addition, there is an outpatient clinic, and a nursing home is attached to this facility. The racial composition of patients on all three units is approximately as follows: 35% Black, 35% White, 20% Hispanic, and 10% other (Russian, Asian).

On the general inpatient unit, there are 18 beds with 100% occupancy rate. The diagnoses include, but are not limited to, major depression, bipolar disorder, schizoaffective disorders, psychotic disorders and mentally impaired substance abusers. The patients range in age from 18 and older with a majority of patients young adults. Treatments include individual, group, activity therapy and milieu therapy. Cognitive-behavioral therapy is used as well. Psychopharmacology and ECT are used. Each resident is primarily responsible for 4-5 patients. All residents receive an individual hour of supervision per week, and one hour of group supervision per week. Additional supervision as needed is provided. The faculty consists of 2 board- certified psychiatrists, 1 activity therapist, 2 social workers and a full complement of nursing staff.

On the addiction inpatient unit, there are 35 beds with approximately 154 admissions per month for detoxification from various drugs including alcohol, heroin, methadone, benzodiazepines, cocaine, and other addicting drugs. The patient population is approximately 65% male, 35% female, 50% Black, 27% White, and 22% Hispanic. Treatment modalities include chemical detoxification, individual, group, behavioral and activity therapy. Twelve-step meetings are held daily on the unit. Residents are primarily responsible for 5 patients and each receives one hour of individual and group supervision per week. The faculty consists of 2 psychiatrists with one certified in addiction psychiatry, 3 board-certified internists, 2 activity therapists, 4 alcohol and substance abuse counselors, and a full complement of nursing staff.

On the geriatric inpatient unit, there are 25 beds with a 100% occupancy rate. The average length of stay is 21 days, with approximately 37 admissions per month. About 60% of patients are male and 30% are female. The racial composition is similar to the one in general inpatient unit. The diagnoses include dementia, schizophrenia, schizoaffective disorders, and mood disorders. Each resident is primarily responsible for 4-5 patients and receives one hour per week of individual and group supervision as well as daily supervision as needed. Faculty consists of 3 board-certified psychiatrists, two of whom have added qualifications in geriatric psychiatry, 2 social workers, 1 activity therapist, and a full complement of nursing staff. Residents follow the director’s rounds in the nursing home to gain additional experience. Residents have opportunity to administer ECT during this rotation.

In the cognitive-behavioral therapy clinic, 55% of patients are male, 45% are female, 25% ages 18-34 years of age, 70% 35-64 years of age and the rest over 65. Racial composition is Black 55%, Hispanic 25% and White 20%. The clinic treats a full range of anxiety; mood, adjustment, psychotic disorders, as well as impulse control and sleep disorders. Residents are assigned one individual patient and one group. They receive one hour of individual and one hour of group supervision per week. The faculty consists of 2 psychologists, one full-time, one part-time, 3-psychology interns part-time, and 1 social worker.