Community Health Center, Inc. is proposing to implement postgraduate residency programs for nurse practitioners and clinical psychologists. Residencies would provide intensive clinical training over 12 months to address workforce shortages and reduce burnout. Core elements include precepted clinics, specialty rotations, didactics, and quality improvement training. Residencies aim to develop expert clinicians prepared to lead community health centers. While start-up costs are required, residencies may increase retention, productivity, and recruitment over time, providing a return on investment. Residencies can smooth new providers' transition to independent practice.

1. Building the Case for Implementing Postgraduate
Residency Training Program
December 2nd, 2019

2. Disclosure
• With respect to the following presentation, there has been no relevant
(direct or indirect) financial relationship between the party listed above (or
spouse/partner) and any for-profit company in the past 12 months which
would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenters and
may not reflect official policy of Community Health Center, Inc. and its
Weitzman Institute.
• We are obligated to disclose any products which are off-label, unlabeled,
experimental, and/or under investigation (not FDA approved) and any
limitations on the information hat we present, such as data that are
preliminary or that represent ongoing research, interim analyses, and/or
unsupported opinion.

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4. CHCI Profile:
 Founding year: 1972
 Primary care hubs: 16; 204 sites
 Staff: 1,000
 Patients/year: 100,000
 Visits/year: 550,000
 Specialties: onsite psychiatry, podiatry,
chiropractic
 Specialty access by eConsult to 41 specialties
Elements of Model:
 Fully integrated teams and data
 Integration of key populations
 Data driven performance
 “Wherever You Are” approach
Weitzman Institute:
 Formal Research
 Quality Improvement
 Practice Redesign
 Implementation Science
 Clinical Workforce Development
Locations and Service Sites in Connecticut
Community Health Center, Inc. (CHCI)

5. National Cooperative Agreement
Clinical Workforce Development
Provides free training and technical assistance to health centers across the nation
through national webinars, learning collaboratives, activity sessions, trainings, research,
publications, etc.
©Community Health Center, Inc.

6. Objectives
• Identify the drivers of implementing
postgraduate nurse practitioner and clinical
psychology residencies at your health center
• Describe the process of implementing
postgraduate residency programs
• Recognize the benefits of implementing
postgraduate residency programs

7. Growth and Development of
Postgraduate Residency Training Programs

8. Polling Question
Are you familiar with
postgraduate nurse
practitioner residency
programs?

9. Why Start a Postgraduate Residency Program?
Solve a Problem
• Address the shortage of expert clinicians, particularly for
vulnerable populations
• Give new primary care medical and behavioral health
providers the opportunity for postgraduate residency
training in fully integrated primary care settings
• Support the development of confidence, competence
and mastery in the FQHC setting
• Reduce attrition due to burnout and distress during the
initial postgraduate year
• Provide the depth, breadth, volume, and intensity of
clinical training to a model of care consistent with
PCMH, IOM/FON, and FQHC principles and services
• Prepare the next generation of leadership for FQHCs
For the
common
good
For the good
of clinicians
For the good
of your
organization

10. A Framework for
Postgraduate Residency Programs
• 12 months, full time
employment
• Full integration into all
aspects of the organization
• Continuous training to clinical
complexity and a high
performance model of care
– Team-based inter-
professional collaboration
– Data driven quality
improvement
– Expert use of technology
Clinical-based
practice
experiences
Regularly
scheduled
education
session
System based
learning and
Quality
Improvement
Population
health focus
Leadership and
professional
development

11. Core Elements of a Postgraduate NP Residency
1) Precepted Continuity Clinics; residents develop and manage their own panel of patients with the
exclusive attention of an expert preceptor NP, physician, or PA; primarily new patients
2) Specialty Rotations; Experience in orthopedics, dermatology, women’s health, adult and child psychiatry,
geriatrics, pediatrics, newborn nursery, HIV/Hep C care, and healthcare for the homeless
3) Mentored Clinics; Focused on diversity of chief complaints, efficiency, episodic and acute care working
within a primary care team
4) Didactic Sessions; High volume/complexity/risk/burden topics. Includes participation in Project ECHO
sessions for managing chronic pain, treating HIV, Hepatitis C, and opioid addiction
5) Quality Improvement Training; Training to a high performance QI model, including front line QI
improvement, data driven QI, and leadership development.

12. Psychiatric Nurse Practitioner Residency Program
1. Precepted Continuity Clinics; residents develop their own patient panel of adults and children,
working with dedicated support of an expert preceptor (PMHNP or Psychiatrist)
2. Specialty Rotations; Rotations, of varied length, in several mental health specialty areas including, but
not limited to, medication assisted treatment, group therapy, ED crisis intervention, intensive
outpatient program, LGBTQ+, and interventional treatments (ECT, TMS, acupuncture).
3. Shared Learning Sessions; Focused on special populations with high risk, complexity, and burden,
most commonly effected through the Project ECHO platform. Areas include chronic pain, HIV, HCV,
SUD, LGBTQ, and pediatrics.
4. Supervision; Weekly individual and groups sessions focused on clinical and professional development
of new providers
5. Quality Improvement Training; Training to a high performance QI model, including front line QI
improvement, data driven QI, and leadership development.

13. Polling Question
Do you currently have a
licensed clinical
psychologist on staff at
your organization?

14. Postdoctoral Clinical Psychology Residency
1. Clinical Practice Experiences; independent clinic sessions in integrated practice
settings
2. Supervision; Weekly individual and group supervision sessions designed to
meet state specific licensing requirements
3. Site-Specific Clinical Team Meetings; Participate in team meetings to discuss
clinical case with the integrated care team
4. Weekly Didactic Sessions; Variety of topics including group therapy, medication
management, substance use, child psychology
5. Quality Improvement Training; Training to a high performance QI model,
including front line QI improvement, data driven QI, and leadership
development.

15. Cost Considerations and Sustainability
Program investment must be viewed as a multi-year life cycle project
Year 1 –
Investment
Year 2 – ROI
Retention of residents
Additional benefits
• Smooth transition to full time practice
already trained to your organization’s system
• Increased productivity post residency
• Reduce recruitment costs for external
candidates
• Increased provider satisfaction for staff
involved in the program
• Creates a network of alumni which can
support future recruitment

16. Experiences from Previous Residents
Garrett Matlick
• Class of 2018-2019
• Transition to Practice
Nicole Seagriff
• Class of 2011-2012
• PCP, Preceptor/Faculty
• Leadership Development
• Staffing- Clinical Leader

17. • Recently implemented
program
• Successes and
challenges
• NCA participation

18. The Road to Developing a Postgraduate Residency Program
• Answer the question: What are your drivers for starting a postgraduate program?
• Learn the essential elements of a postgraduate program
• Accrediting standards
• State licensing requirements
• Assess your own resources (physical, human, financial)
• Consider creating an academic partnerships
• Secure board, leadership, and clinical buy-in
• Develop financial and strategic plan including potential partners
• Costs and benefits:
• Direct and indirect costs
• Return on Investment: immediate and longer term
• Benefits beyond the financial return

19. To download the digital version of "Training the Next Generation: Residency and
Fellowship Programs for Nurse Practitioners in Community Health Centers"
https://www.weitzmaninstitute.org/NPResidencyBook

20. Website: www.npresidency.com
www.chc1.com
www.weitzmaninstitute.org
Margaret Flinter, APRN, PhD, c-FNP, FAAN, FAANP
Senior VP and Clinical Director
Email: margaret@chc1.com
Charise Corsino, MA
Program Director, NP Residency Training
Email: charise@chc1.com
Nicole Seagriff, DNP, APRN, FNP-BC
Clinical Program Director
Email: Seagrif@chc1.com
Chelsea McIntosh
Training Director, Postdoctoral Residency Program
Email: McIntoc@chc1.com

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