Overview of the UCSF Public Pyschiatry Fellowship at ZSFG

 OVERVIEW OF THE UCSF PUBLIC PSYCHIATRY FELLOWSHIP AT ZSFG

 

Schedule

Public Psychiatry Wednesday didactics start at 10:10am in ZSFG Room 7E12.

  • 10:10-12pm Capstone Project Supervision (CAP fellow is only available 11:30-12, so has this Monday AM)
  • 1:10-3pm Seminar (lecture 1-2:30, discussion 2:30-3)
  • 3-3:10pm Break
  • 3:10-4pm Group Discussion or Individual Supervision
  • 4:10-5pm Special Topics 

 

Field Placement

Most of your week will be spent at your clinical site. We encourage fellows to make the most of this time by engaging fully with your on-site supervisor. Be inquisitive about your clinical approach to cases: ask your supervisor to talk about his/her clinical experiences at the site and discuss your cases thoroughly. Seek out comments and perspectives from the other psychiatrists. Keep in mind this will be your last opportunity to be a “trainee” and we encourage you to make the most of it! 


Fellowship Supervision

We have different types of fellows dependent on funding source and level of training. Please see the “fellow type” document for important distinctions.

  1. Group Discussion:  Fellows should come in prepared with agenda items that are most pressing. Common items discussed include “special or unusual” clinical or administrative issues that may arise at a fellow’s clinical site, issues with their project, job searches, wellness/burnout, or current events as they relate to public psychiatry. We will spend the first few minutes setting the agenda together. Near the end of each curricular module, the group will review the learning objectives and work together to create a “cheat sheet” with key points and takeaways for the module.
  2. Individual Supervision:  Individual supervision is held every other week for 25 minutes after class (3-4pm). To make the most out of the individual supervision time, fellows are encouraged to provide an agenda at the beginning of supervision. Often, fellows discuss ongoing issues that arise from didactics or other curricular matters, how things are going at their site, capstone project status, and jobs. Twice a year we will do a “supervisor swap” so fellows get to know the other directors.
  3. Site Director Supervision:  All fellows should meet with their site supervisor at least 1 hour a week for clinical supervision. Fellows should discuss their clinical productivity at least monthly with their supervisor.
  4. Research Discussion: The capstone project supervisor and research assistant will meet with the fellows on Wednesday mornings at 10am for project discussion via Zoom or in-person. Because the needs of fellows vary with the stages of the projects, the project supervisor and RA will work to structure upcoming meetings effectively. Fellows are expected to attend each week prepared to discuss their project. Any absences will require faculty approval in advance. The project supervisor and/or RA are available to meet with fellows more often individually throughout the fellowship to discuss the projects as needed.


Wednesday Didactics

The didactics are organized in a module format. Before each module, we will send out an "Overview of the module" with learning objectives and chapter readings via e-mail (also available on CLE). We encourage active learning during our didactics, so please come prepared by completing reading assignments in advance and think about questions to discuss during the talks. The curriculum includes the following modules: 1) Structure of Public Psychiatry; 2) Recovery and Psychosocial Rehabilitation; 3) Advocacy; 4) Homelessness and Substance Use Disorders; 5) Forensic Issues; 6) Management 1 - Funding and Leadership Roles; 7) Integration of Care; 8) Management 2 - Leadership Skills. After each didactic, we will have time to reflect together, and discuss recent articles and/or assigned readings.

 

Please note, weekly didactics do not confer CME credits. 


Fellow Presentations

To gain skills in speaking to small groups, fellows will be asked to prepare and orally present several individual presentations throughout the year (examples on CLE). Scheduled presentations will include:

  1. Logic Model of Field Placement Agency:  Each fellow presents their field placement organization, using the logic model. These presentations use the logic model as both a descriptive and analytic tool. The focus is on understanding the problems with the clinic and developing a quality improvement initiative that could be implemented during the course of the year. This presentation should be 25 minutes including discussion.
  2. Case Presentations:  Fellows are expected to deliver presentations throughout the year that are grounded in a case, but dive deeply into one of the topics for the following modules: 1) Recovery and Psychosocial Rehabilitation, 2) Homelessness and Substance Use Disorders, and 3) Forensic Issues. Fellows are encouraged to look on CLE and/or PubMed/Google Scholar to find evidence supporting their positions/work for certain presentations. These cases typically involve asking fellows to put themselves in the position of a community mental health clinic medical director and use a case example to ground the topic. This presentation should be 5 minutes (followed by 5 minutes of discussion).
  3. Advocacy Plan: This is intended to give fellows some structure and ideas for how to advocate for a policy or change that could improve the mental health or mental health care of the patients/community served by the fellow. With support from faculty and following a structured template that will be provided and discussed beforehand, fellows will each write and present an outline (e.g., aims, background, stakeholders, strategies) of an advocacy plan for the topic of their choosing. Plans will be presented during fellowship didactics, with opportunity for feedback and discussion. This presentation should be 25 minutes including discussion.  
  4. Grant Writing/Responding to an RFP (Request for Proposals):  This is designed to provide fellows an experience in responding to an RFP. With guidance from faculty, fellows will review a Request for Proposal together as a group and talk through the requirements and strategies for completing a proposal. We will read through and discuss together critical concepts of proposal writing and provide a truncated budget template to be used in creating a short “response” to the RFP. The presentation requires fellows to think through a proposed program, writing a brief description of the proposed program and a short justification for funding to support the staffing needed. Fellows will give a brief presentation of their program including a budget to support the program. This presentation should be 25 minutes including discussion.
  5. Budget Presentation: Each fellow will present information about their clinic’s budget, both in terms of revenues as well as expenditures. Half of the presentation should be on the process of getting this fiscal information from your clinic. Examples of budgets will be provided to help the fellows learn what questions to ask in order to get this information from site medical directors (specifically, number of FTEs at their site, indirect costs, benefit costs, revenue, OTPS, etc.). This presentation should be 25 minutes including discussion.
  6. Capstone Project: Each fellow will conduct a capstone project over the course of the year. This project aims to improve the quality of care received by people served in your clinic. The topic should be of interest to both the fellow and the clinic site medical director: a true public-academic partnership. This project needs to be feasible given the available resources (fellow’s time, research assistant’s time, and other resources). To help you do this, each fellow will receive weekly supervision with the project supervisor. This project supervisor has expertise in mental health services research, as do all program directors. As such, in doing your capstone project, you will gain skills in developing strong public-academic partnerships and understand how a scientist might approach a systems-level issue. You will present your capstone project in multiple formats toward the end of the year. 

 

Community Engagement Opportunity (CEO)

We want to encourage fellows to explore longitudinal community-based outreach and engagement with local regional group, based on their interests and goals. This is an optional activity, and fellows can choose their level of engagement over the course of the year. Examples of potential groups/organizations might includue local NAMI chapter, medical student free clinic at MSC South, mentorship programs, city council meetings, cultural centers, etc. This can be a chance to explore new interests or expand on existing pursuits outside of clinical and classroom settings.

 

Enhancing Classroom Learning

San Francisco Health Network-Behavioral Health (SFHN-BH) Medical Directors’ meetings:  These meetings occur on the 4th Wednesday of the month from 8:30-9:30am, either at 1380 Howard Street, Room 515 or on Zoom. There, you can learn about administrative issues faced by medical directors in public mental health settings.

Field Trips:  Fellows will participate as a group in a number of field trips. These trips offer a chance to “get out of the clinic” and are always rated highly by fellows. They provide an excellent opportunity to experience first-hand other parts of the public psychiatry system and help you appreciate how the system works. The ride along portion of our SFPD field trip is encouraged but optional; fellows are expected to attend all other field trips or make other arrangements ahead of time with PPF faculty.

Examples of planned field trips:

1.  Local Public Psychiatry Fellowship clinic sites
2.  ZSFG inpatient unit and Psychiatric Emergency Services (PES)
3.  Steinberg Institute (Sacramento)
4.  SRO “Hotel Rounds,” Supported Housing (The Richardson); SoMa RISE (drug sobering center)
5.  Behavioral Health Court, County Jail, Juvenile Hall, and SFPD Ride Along (optional)
6. San Quentin Correctional Facility

American Psychiatric Association’s Meetings: We encourage attendance at national academic conferences. The APA has two national meetings a year. The main meeting is the APA Annual Meeting in May. We will NOT have PPF didactics that week. The other conference is the Institute for Psychiatric Services in October. You can use education days for non-Wednesday days. 

The fellowship will provide each fellow with funding to cover all costs (registration, travel, hotel, and meals) for attending the APA and potentially other academic meetings (if you receive approval from Faculty). Each fellow is allowed a maximum of $2,500. For SFDPH trainees, this funding is included in your salary. There are restrictions on coverage (e.g., alcohol, triangulated trips). Please refer to the “Reimbursement 101” document and submit your itemized receipts within one week of travel. 


Advocacy:  Many of our fellows are quite interested in the idea of advocacy given their slant towards social justice. The fellowship offers some background and experience in this arena, including didactic sessions, exposure to patient/community groups involved in advocacy, exposure to organized psychiatry, and a training given by staff of the Steinberg Institute (focused on working with the California State legislature). With support from faculty, you will also have the opportunity to complete a presentation on a proposed “advocacy plan” on a topic that is of interest to you and relevant to your patients. Should you choose to participate in outside advocacy efforts, we would love for you to discuss your experience during our group supervision so we can inspire one another throughout the year. Examples may include writing a letter to the editor, presenting at the San Francisco Health Commission, or attending a community meeting. 


Future Employment

We are dedicated to helping fellows obtain rewarding positions in the public mental health system after graduation. Ideally, these should include leadership opportunities. To attain this goal, we encourage:

    • Monthly discussions with individual and field supervisor about job searches
    • Group supervision about jobs
    • Meet with SFHN-BHS and UCSF/ZSFG leadership 
    • Attend the annual NCPS Job Fair (Usually in January, www.ncps.org)


Evaluations

We provide you with feedback throughout the year verbally during presentations and/or supervision and via email. We supplement this with more formal evaluation over MedHub. We also actively improve the program through feedback from you! Therefore, after each module, fellows are asked to complete periodic evaluations in group supervision and via MedHub. These will include evaluation of each lecture and the overall impact of each module. Fellows will also be asked to give more broad feedback about the fellowship twice a year.


UCSF Vacation, Family, and Sick Leave Policy

UCSF-employed PPF fellows have ample vacation over the course of the year (20 days), in addition to education leave (5 days) and sick leave (12 days) if necessary. Please do not take vacation during Boot Camp (the first four didactic weeks) or the last two weeks of June 2024. We also ask that you try to avoid taking vacation during fellow presentation weeks. If possible, please let faculty and your site director know about vacation at least 30 days in advance. Compensated parental leave is four work weeks (20 days) at minimum, though vacation and sick leave may be added to this. 

 

Wellbeing

Your wellbeing is crtically important to us. We are continuing to use a hybrid model for our didactics throughout the year; some weeks will be in person and others will be conducted remotely. Because we won't be together in person each week, we want to encourage fellows to find ways to socialize and promote community (start a group text, go to the park, go ouut to dinner, etc.). With approval of PPF Faculty, we can support this by providing some funding for food. Also, for UCSF-employed fellows, the University of California has contracted with Ginger to provide digital behavioral health services to all residents and fellows (and their dependents 18 and over) in the UC-system who have opted in for UC health insurance. Ginger offers confidential mental healthcare through coaching via text-based chats and self-guided activities, and video-based therapy and psychiatry. Support is available anytime (24 hours a day, seven days a week), for a variety of mental health challenges you may be struggling with - all from the privacy of your smartphone! Ginger has providers from diverse backgounds and gives you the opportunity to specify your preferences. The services provided by Ginger will supplement the resources already in place at UCSF, including the Faculty and Staff Assistance Program (FSAP) and your mental health insurance benefits available through youru insurance plan. As a UC resident or fellow enrolled in a UC insurance plan, this service is free to you and your dependents. You will have unlimited access to the resources in the app and text-based coaching. In addition, you can receive up to 15 free virtual therapy and psychiatry sessions per plan year (July 1 - June 30).


Moonlighting

Current opportunities include ZSFG PES and Laguna Honda Hospital. Note: Obtaining ZSFG medical staff privileges is a lengthy process and should be initiated early in the fellowship year. There are other moonlighting opportunities as well—inquire with faculty for more information.