Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0141Developing and Maintaining Links between ServiceDisciplines: the Program for OrganizingInterdisciplinary Self-education (POISE)John A. TonerColumbia University Stroud Center, New York, USAThe need for effective and systematic education of geriatricspecialists in the field of psychiatry has been widely recognized 1 .Current shortages of general and child psychiatrists are graduallybeing surpassed by the shortages of geriatric psychiatrists 2 . Thefield of geriatric psychiatry education began to expand onlyrecently, and this expansion was a direct result of funding ofpostgraduate specialty training programs in geriatric mentalhealth by the National Institute of Mental Health 3 .Another major development in the field of psychiatry that hasled to increased interest in, and expansion of, geriatric psychiatrytraining programs has been the evolution of subspecialization ingeriatric psychiatry through Added Qualifications (Board Examinations)and the accreditation of geriatric psychiatry residency/fellowship programs. However, as the specialty field of geriatricpsychiatry has evolved, it has become more apparent than everthat general practitioners, rather than geriatric psychiatrists, willprovide the bulk of care to mentally ill older people. Althoughguidelines for developing curricula in geriatric psychiatry havebeen developed 1,3 , these guidelines focus primarily on the clinicalskills necessary for the psychiatrist or general practitioner to treatgeriatric patients, and not on the leadership skills necessary for thepsychiatrist or general practitioner to facilitate and lead theinterdisciplinary healthcare team. The curriculum guidelines alsoneglect to emphasize the role of the geriatric psychiatrist as the keylink between service disciplines on the mental healthcare team.For some time, the interdisciplinary healthcare team approachhas been well established in specialty areas, such as rehabilitation,surgery and dentistry; however, the fields of psychiatry and andgeneral medicine, specifically geriatric psychiatry, have been slowto realize the important role of the geriatric psychiatrist as part ofthe mental healthcare team approach to care of the geriatricpatient. The field has been even slower to recognize the centralrole the geriatric psychiatrist can and should play in facilitatingcohesive team function and linking treatment goals of differentservice disciplines. The purpose of this chapter is to describe amodel interdisciplinary team leadership training program, whichexists within the curriculum of a geriatric psychiatry fellowshipprogram sponsored by the New York State Office of MentalHealth. This model program is unique in that it focuses ontraining geriatric psychiatrists in the skills required to develop,lead and maintain interdisciplinary treatment teams in inpatientand outpatient settings.Schmitt et al. 4 indicate that the term ‘‘interdisciplinary teams’’in healthcare settings has a variety of meanings, depending onusage. Thus, it is important to establish criteria that define theterm. For the purpose of this chapter, we have adopted the criteriaset out by Schmitt and her colleagues 5 . These criteria require at aminimum that the healthcare team: (a) includes a variety ofdisciplines in the care of the same patient; (b) encompasses adiversity of dissimilar knowledge and skills required to treat thepatient; (c) plans care by establishing an integrated set of goalsshared by the providers of that care; and (d) shares informationand coordinates their services through a systematic communicationprocess.PROGRAM BACKGROUNDThe interdisciplinary team training program described in thischapter is the outcome of 15 years of work devoted to thedevelopment of a durable, cost-effective method of linking andcoordinating mental health services within the institutionalsetting. The program evolved, in part, from an educationalphilosophy that focuses on a participative model of selfeducation.The assumption is that the healthcare staff of aninstitution already have the technical skills required to function intheir particular position, but need to enhance their understandingof how their roles in their particular discipline relate to the roles ofother team members from different disciplines, and how the teamas a whole relates to other staff and teams. A system by which thestaff can work collaboratively to deliver effective treatment topatients is regarded as essential.This concept was first applied in assessment training programsand subsequent related studies involving mental healthcare teamsat state psychiatric centers in New York 6–8 . The results of theseevaluation studies and the favorable response of staff to theinterdisciplinary mental healthcare team leadership training 9–11 ledto a request by the Deputy Commissioner of the New York StateOffice of Mental Health to adapt the program for implementationin other psychiatric centers throughout New York State. Insubsequent discussions, it was determined that the training wouldbe most successful and relevant if it was conducted with the keymember of the mental healthcare team who most often isresponsible for team leadership, namely the psychiatrist. In thisway, a culture of learning would be established and the psychiatristtrainees would then go on to work on interdisciplinary treatmentteams elsewhere, and bring with them to their new work setting thisculture of learning. Thus, the psychiatrist trainees wouldPrinciples and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd