***Most rotations are longitudinal which offers fellows the opportunity to follow the course of disease and recovery in their patients. The OHSU IMPACT team is a block rotation.
|AM||VA OTP/Liver Clinic||VA SATP Continuity Clinic||VA OTP/Primary Care Clinic||VA SATP Continuity Clinic||OTP/HIV-Infectious Disease Clinic|
|PM||OHSU HRBR||OHSU Toxicology Consults||Didactics||Followups/Consults||Hazelden IOP/Detox|
Toxicology Consult Service
Medical Toxicology provides bedside care for patients with poisoning or toxicity at OHSU and Doernbecher Children’s Hospital. Bedside consultations provide an opportunity for fellows to see clinical toxicologic findings, observe cardiac rhythms and electrocardiograms, provide bedside diagnostic and therapeutic care, and provide treatment and antidotes. The consultation service cares for over 250 patients per year, mostly in our adult and pediatric emergency department and intensive care units.
IMPACT Consult Service
IMPACT is OHSU's nationally recognized interdisciplinary inpatient addiction consult service. Fellows will assess a diverse group of hospitalized patients to confirm substance use disorder diagnoses and development and communicate treatment recommendations to the referring service. They will work with an interdisciplinary team including nurses, social workers, counselors, peer recovery specialists, the patient, and their family members to tailor treatment recommendations and link patients to appropriate community-based services in accordance with appropriate ASAM criteria. They will participate in case conferences with addiction medicine faculty.
Harm Reduction and Bridges to Care (HRBR)
HRBR is a low barrier, on demand, addiction treatment clinic at OHSU and partners with OHSU emergency department and Multnomah Country corrections. The clinic primarily initiates and stabilizes patients with opioid use disorder on buprenorphine and then bridges them to community care, however, we also provide treatment for other types of substance use. Fellows see patients with opioid use disorder who walk-in or are referred from community settings.
Substance Abuse Treatment Program (SATP) & Opioid Treatment Program (OTP)
Fellows will perform comprehensive psychiatric assessments on patients in the Portland VA Medical Center’s Substance Abuse Treatment Program (SATP) & Opioid Treatment Program (OTP) in Vancouver, WA. Fellows will also work with SATP’s health psychology team to conduct comprehensive psychiatric/psychological assessments & make treatment recommendations for persons being evaluated for liver transplant. SATP includes an intake team, an Outpatient/Aftercare track and two specialty case management programs (dual recovery program and geriatric substance abuse program).
Residential Recovery Treatment Program (RRTP)
RRTP, also known as Veterans Recovery House, is a two tract 35 bed residential treatment facility that caters to homeless veterans and/or veterans with a substance use disorder. RRTP provides comprehensive medical and psychiatric care which includes pharmacological and non-pharmacological interventions to veterans who often have complex medical issues with co-occurring psychiatric conditions. Additionally, 24 hours/7 days a week nursing care is provided as well as a full compliment of professional services including licensed independent social workers, peer support, recreational therapist, psychologist and chaplain services.
Primary Care Clinics
Fellows rotate in primary care and subspecialty clinics under the supervision of an addiction specialist psychiatrist. They will care for patients with substance use, misuse, or abuse already been seen in the respective clinic but may not identify as having a substance related problem. It provides opportunities for interdisciplinary collaboration in the care of these complex patients. Each clinic will be staffed by an attending psychiatrist, attending from the primary clinic (Internal medicine, hepatology, infectious disease), as well as other trainees including pharmacy residents, medical students, residents and fellows from other subspecialties.
Center for Integrative Pain Care (CIPC)
CIPC is a multidisciplinary clinic consisting of medical specialists in anesthesiology/pain medicine, physical medicine and rehab, psychiatry/addiction psychiatry as well as pain psychologists, pain pharmacist, advanced nurse practitioner, physical therapists, social worker, and acupuncturist. Fellows have an opportunity to participate in evaluation of patients completed conjointly by combination of physicians, psychologist, and pharmacist. Fellows work closely with psychiatrist/addiction psychiatry specialist in conducting comprehensive psychiatric and addictions evaluations, assisting with opioid tapers for patients on high doses of opioids, treating psychiatric co-morbidities, and initiating and following-up with Buprenorphine/Naloxone treatment for opioid use disorder. Interventional pain procedures are done by anesthesiologist/ pain medicine specialists. Fellows also have an opportunity to participate in evidence-based educational, individual and group psychotherapeutic interventions including courses in chronic pain education and pain neuroscience, biofeedback, Acceptance and Commitment Therapy for pain, Mindful Living with chronic pain, and CIPC lecture series for health professionals.
Central City Concern Hooper Detoxification and Stabilization Center
Central City Concern (CCC) is a nonprofit that is both a Federally Qualified Health Center and provider of low-income and transitional housing for individuals struggling with SUDs, mental illness and/or histories of incarceration. This rotation is designed for fellows to further their skills in the assessment and management of adult patients presenting for sub-acute detoxification at a Residential 3.7 Licensed program from alcohol, opioids, benzodiazepines, stimulants and combinations of multiple substances. This patient population experiences a rate of homelessness among its clients exceeding 80% and more than 25% of patients present with SPMI. In addition, this center offers stabilization induction with buprenorphine for the purpose of engaging patients in longitudinal evidence-based treatment for OUD. Time is spent in both residential/inpatient and outpatient settings with emphasis on the diagnosis of addictive disease and withdrawal management of all common substance use disorders among adult patients and a population of pregnant women with opioid use disorder. Outpatient bridge services allow the Fellow with the opportunity for longitudinal follow-up during the first 2-4 weeks post-discharge as patients are navigating the regional treatment continuum.
Hazelden Betty Ford Foundation is a 70 year-old, non-profit substance use disorder treatment organization with 17 treatment locations coast to coast. Hazelden Newberg is a 98 bed facility located in Newberg, Oregon which treats patients 18 and older. Treatment offered includes medically managed withdrawal, residential and day treatment/partial hospitalization. Integrated treatment that attends to co-occurring medical and psychiatric illness is a priority. Highly personalized care and treatment for professionals, those with opioid use disorder and trauma are areas of particular skill and focus. Gender specific programming includes individualized counseling, group therapy, therapeutic programs, fellowship, spiritual work, family engagement, wellness and recreation to promote healthy behaviors to treat the mind, body and spirit.
The program treats individuals from age 18 and up. The team uses a multidisciplinary, comprehensive, integrated substance use and mental health treatment model that is evidence based. In 2020, Hazelden Betty Ford outpatient programs began treating patients with mental health as a the primary or the only illness. Beaverton provides ASAM levels of care 2.5 (PHP) through .5 (Outpatient). Also offered is individual long term therapy and psychiatric services for individuals and referrals for family education and programming specific to kids within the family system. Beaverton averages 170 pts across all outpatient levels of care, 60% of those identify as male and 40% as females. On average about 80% have duel diagnoses; about 60% alcohol use disorder primary.