In this final webinar of the Training the Next Generation series, we featured successful postgraduate nurse practitioner and psychology residency programs from around the country. Each presenter shared their unique experiences, successes, and failures of implementing these programs at their health centers.

1. 1
Welcome
The National Cooperative Agreement on
Implementing Postgraduate Nurse Practitioner
& Clinical Psychology Residencies
Presented by the
the Community Health Center, Inc.
WEBINAR 8: Case Presentations: Successful National Residency
Programs
May 11th, 2016

2. 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

3. 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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4. 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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5. Elizabeth DuBois, MSN, FNP-BC, AAHIVS
Associate Vice President, Medical Affairs
Grace O’Shaughnessy, LMSW
Program Manager, NP Fellowship Program
New York, NY

6. The beginning
• Primary Care NP
Fellowship launched in
September 2015
o Started with 4 fellows
recruited from across 4
NYC based schools
• Psychiatric Community
Health Fellowship will
launch in October 2016
o Will start with 4-5 fellows

7. 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

8. 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

9. 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)

10. 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

11. 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***

12. 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

13. 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

14. 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

15. 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

16. 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.

17. Grace O’Shaughnessy, LMSW
Program Manager, NP
Fellowship Program
NPFellowship@chnnyc.organa
ger, NP Fellowship Program

18. 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

19. Advanced Practice Clinician Safety Net Residency: A Transition to
Practice
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

20. Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
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

21. Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
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

22. Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
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

23. Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
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

24. • 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
Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
Outcomes

25. Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
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

26. Advanced Practice Clinician Safety Net Residency:
A Transition to Practice
Asheville, North Carolina
Contact Us
Sara Mertz, A/GNP
swallenius@wncchs.org
828-285-0622 ext 2403
Todd Wallenius, MD
twallenius@wncchs.org
828-285-0622 ext 2402

27. Waianae Coast Comprehensive
Health Center
Nurse Practitioner Residency Program
Waianae Coast Comprehensive Health Center
Waianae, Hawaii

28. Lessons Learned
 Advance Planning
 APRN Certification
 Dedicated Residency Staff
 Preceptor Training
 Staff Training

29. WCCHC
Nurse Practitioner Residency Program
2015-2016

30. Mahalo
Pat McKenzie, APRN
Pmckenzie@wcchc.com
808-697-3480

31. OUR STORY:
POST DOCTORAL PSYCHOLOGY
RESIDENCY PROGRAM
Elizabeth Bezos, BS, BA – Administrator, Office of Education and Training

32. Post Doctoral Psychology Residency
Program at Citrus Health Network
• CHN Overview
• Opening a Training Program
• Program Structure
• Outcomes
• Future Plans

33. 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

34. 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

35. 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

36. Program Structure
Governance 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

37. 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

38. 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

39. Future Plans
• Obtain better graduate data by:
• Creating an Alumni Group
• Moving towards automated electronic surveys
• Meticulous review of new APA Standards of Accreditation

40. Questions???
Elizabeth Bezos,
Administrator
Office of Education and Training
Citrus Health Network at
education@citrushealth.com

41. Reminders
Complete our survey!
Learning Collaborative Applications are due on May 31st!
www.chc1.com/NCA
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42. Speakers
From Western North Carolina Community Health Services
Sara 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 Network
Grace 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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