*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 two-week block rotation scheduled in each half of the year.
|AM||VA OTP/Primary Care Clinic||VA SATP Continuity Clinic||VA OTP/Primary Care Clinic||VA SATP Continuity Clinic||OTP/HIV-Infectious Disease Clinic|
|AM||FORA||VA Continuity Clinic||FORA||Kaiser||FORA|
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 assess substance use disorders then develop 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 buprenorphine and stabilizes patients with opioid use disorder and then bridges them to community care, but also provides 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 and provide longitudinal care for 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 recovery program). SATP partners with the VA's PAVE (Preventing Amputation in Veterans Everywhere) program to provide enhanced tobacco cessation for veterans at risk of amputation. Fellows in VA's OTP will train in initiating, titrating, and maintaining methadone for the treatment of opioid use disorder, along with treatment of multiple commonly comorbid conditions in this population.
Residential Recovery Treatment Program (RRTP)
RRTP, also known as Veterans Recovery House, is a two track 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 complement of professional services including licensed independent social workers, peer support, recreational therapist, vocational counselors, psychologists and chaplain services. Addressing and ending homelessness among veterans is a major mission for the RRTP.
Primary Care Clinics
Fellows rotate in primary care and subspecialty clinics under the supervision of an addiction psychiatrist. They will care for patients with substance use, misuse, or addiction already being treated 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 or complex persistent opioid dependence. 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.
Addiction Psychiatry fellows will be imbedded in Recovery Pathways at Kaiser Permanente’s Interstate clinic. Recovery Pathways is a team-based level 1 outpatient care model to wrap-around services for patients with co-occurring mental health and substance use disorder. Patients are typically in the program for 12-16 weeks receiving case management, counseling, group, and psychiatric care as well as peer support. Psychiatrists on this team typically collaborate with these clinicians for high acuity physical health needs which would support the fellow in learning the integrated care model. Fellows will also attend IOP groups in addiction medicine.
Fellows will also rotate at the Brookside Center for Residential Addiction Treatment which is situated within the Kaiser Sunnyside Hospital (on the first floor), providing both withdrawal management and residential treatment services for patients with substance use disorders. There is a multidisciplinary team consisting of nurses, therapists, milieu counselors and unit specialists.
Fellows will gain exposure to the therapeutic aspects of residential treatment and practice medical oversight of residential and detoxification patients.
Fora Health Treatment & Recovery
Fellows will join Fora Health staff in medically managed detoxification and continuing care in Oregon’s largest residential dual diagnosis SUDS treatment facility. They will participate in the development and implementation of treatment plans to address complex medical, psychiatric, and addiction related comorbidities. They will participate/lead individual and group therapy sessions and link patients to other required services. They will participate in counseling sessions and co-facilitation of educational sessions on topics such as the use of naloxone, which is prescribed on discharge, and the chronic disease model of addiction.
Unity Center for Behavioral Health
Fellows will rotate at the Child and Adolescent Inpatient Psychiatric Unit at the Unity Center for Behavioral Health. There will be participation in the interdisciplinary teams meeting for all patients on the unit. Fellows will evaluate and co-manage treatment of adolescent patients with dual diagnosis; as well as lead an adolescent group session, providing psychoeducation on substance use disorders and mental health challenges. There is also an opportunity to provide individual motivational interviewing sessions with those adolescents in need of additional substance use disorder support.