Stony Brook Medicine

Psychiatry 5-Year Strategic Plan

(2017-2022)

Clinical Services

Education

Research

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Table of Contents

Page

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 3

Clinical Services Strategic Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-18

Education Strategic Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-21

Research Strategic Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-26

Executive Summary

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With the help of every single person working in and around the department of psychiatry over the last four years, we have made tremendous progress in delivering ‘better care for more people’. Specifically, during this time period we increased the number of visits from 38,000 to 62,000, a 60% change! Accompanying this increase in volume has also been an increase in revenue, from $2.6 million to $5.5 million. This year we are on track to have our greatest volume of services provided in all settings. Our research group has done exceedingly well with grant expenditures at $6.5 million, which in this current funding environment, is remarkable. Finally, education continues to be strong with our medical students doing the best on national exams in psychiatry compared to all other disciplines. Our residents have a 100% board pass rate and are getting excellent jobs and fellowships. I have all of you to thank for your tireless, selfless work and dedication to our patients and trainees.

In our new 5 year, strategic plan you will see bold new initiatives that build on this great success. In addition, to make the strategic plan a reality, we have translated the plan into a prioritized ‘action list’ and have started a senior executive leadership group that will meet regularly with the specific intent of assuring that the metrics are met in all domains.

Thank you all for participating in this process. I think you will find the plan exciting and challenging. A special thanks to all the Vice Chairs who coordinated this plan and Dr. Brian Bronson who took the lead.

Sincerely,

Ramin V. Parsey MD/PhDProfessor and Chair of PsychiatryDirector of PET ResearchDean of Clinical Translational Sciences

Stony Brook Medicine

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Clinical Services in Psychiatry5-Year Strategic Plan

(2017-2022)

Summary:

Several events have spurred the development of a new, five-year clinical strategic plan for Psychiatry. This includes the recruitment of several new leaders in key positions; a shared vision among leadership for an integrated plan that aligns the areas of psychiatry, nursing and hospital administration; completion of the last 2013-2016 psychiatry strategic plan; and the establishment of a new strategic plan for the Stony Brook Medicine enterprise, focused on the creation of an integrated, regional network offering superior access, quality of care, and patient satisfaction. In these contexts, Stony Brook Psychiatry is transforming to meet the mental health and substance use service needs of our expanding population and to align with the Stony Brook Medicine plan. We developed the following plan over five months with the inputs listed in appendix I.

Goals:

The five broad goals for Stony Brook Psychiatry, as described in this 5-year strategic plan are as follows:

I. Access: Improve access to care for our regional population, across the continuum of psychiatric and substance use services, with additional attention to referrals from within our network.

II. Quality: Intensify and integrate our approach to quality and safe patient care, patient satisfaction and compliance with regulatory requirements.

III. Revenue: Optimize revenue to sustain and support the growth of mental health and substance use services for our population.

IV. Workforce: Develop a robust, interdisciplinary mental health care and substance use workforce across our growing network that can meet the needs of our target populations.

V. Regional Planning: Participate in regional and county-specific planning efforts through committee participation to identify and improve gaps in services.

Objectives:

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I. Access: Improve access to care for our regional population, across the continuum of psychiatric services, with additional attention to referrals from within our

network.

A. Ambulatory Care:

Despite growth in the number of providers (50 to 64) and patients served by our department over the past three years, the demand for services for newly referred patients remains high, as does the wait times for new patient appointments. Improving access is a central goal, targeting all populations we serve, including children, adolescents and adults with mental health conditions generally, as well as those with the specific conditions of substance-use disorders, autism spectrum disorders, treatment resistant depression, and cognitive disorders. We have cut costs, enhanced rates, set productivity expectations and created incentive programs. To further enhance access to care we will explore additional areas.

We will achieve improved access to care through the following steps:

1. Wait Times: Measure and target improvements in new patient wait times.

2. Utilization: Measure and optimize scheduling efficiency and utilization of available provider time.

a) Prioritize referrals from within our network.

b) Explore the use of a call center as a single point of access for clinical services and research protocols.

3. Staffing: Increase our number of clinicians from a variety of disciplines toserve children and adults.

4. Modalities: Expand the range of non-pharmacologic treatment modalitiesoffered.

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a) Psychotherapy: Evidence-based individual and group psychotherapy and other non-pharmacological services for children and adults. This includes social skills training and other non-pharmacologic support services for children and families with autism-spectrum disorders.

b) TMS: Transcranial magnetic stimulation for treatment resistant major depression, and other treatment resistant psychiatric conditions pending FDA approval.

5. New Programs

a) Alzheimer’s Dementia: Build our regional Center of Excellence for Alzheimer’s Disease (CEAD) and other dementias in collaboration with the Neuroscience Institute and other departments.

b) Integrated Care: Integrate mental health services into hospital article 28 licensed clinics, to improve access to mental

health services for primary care populations including in Family Medicine, Internal Medicine, Obstetrics and

Pediatrics.

c) Novel Therapeutics/Clinics: Explore business models to establish new ambulatory sub-specialty programs, including electro-convulsive therapy and ketamine for treatment refractory depression, and treatment of prodromal schizophrenia, etc.

d) Neurology: Collaborate across the Neurosciences service line to expand outpatient capacity to service those with neuropsychiatric symptoms associated with Epilepsy, Stroke, Movement Disorders, and Traumatic Brain Injury, among others.

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B. Psychiatric Emergencies:

Stony Brook Medicine includes the only Comprehensive Psychiatry Emergency Program (CPEP) in Suffolk County and provides emergency psychiatric service for over 7,000 visits/year. The steady inflow of patients with highly acute conditions, combined with a finite number of psychiatric inpatient beds throughout Suffolk County, predisposes the CPEP to backlogs in patient care and flow. Additionally, the CPEP is the provider of psychiatric consultation to the Stony Brook Medicine Emergency Department (ED), which manages approximately 100,000 patient visits/year. We will improve access to emergency psychiatric care using the following objectives:

1. Wait Times: Improve patient wait times and flow within CPEP.

a) Optimize operations.

b) Support all staff to function at the top of their license.

c) Integrate pre-and post-doctoral psychologists.

d) Collaborate with community hospital affiliates to whom we transfer patients to reduce disposition to discharge times.

2. ED Consultation: Reduce wait times to psychiatric consultation in the Stony Brook Medicine Emergency Department.

3. Extended Observation Beds (EOB): Increase utilization of our EOB for crisis management and acute stabilization by expanding support

services in the EOB beds.

4. Tele-health: Explore Tele-health to increase access to emergency consultation for Southampton Hospital and the South Fork of Long

Island.

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C. Inpatient Psychiatric Hospitalization:

Stony Brook Medicine currently has one 10-bed children’s unit, and one 30-bed inpatient adult psychiatry unit generally close to full occupancy. Because of limits on bed availability, we transfer to outside facilities most adult patients in the CPEP or medical units who require acute inpatient psychiatric care. Limitson adult psychiatric bed availability throughout Suffolk County contribute to delays in transfer and care, and increase length of stay in the CPEP and medical and surgical units.

We aim to improve our bed capacity, flow and coordination of admissionsthrough the following measures:

1. Bed Capacity: Expand the number of inpatient psychiatric beds in our network, through coordination with Eastern Long Island (ELI) hospital, adding 23-inpatient psychiatry beds, to complement our existing 40 beds. Optimize psychiatric staffing at ELI, to allow the unit to function at full capacity.

2. Length of Stay (LOS): Reduce LOS on our inpatient psychiatry units to increase access for new admissions. Focus on and expand

upon the 15-point plan previously established.

3. Flow: Improve flow from the CPEP and our medical/surgical units to our inpatient adult and child psychiatry units at Stony Brook and ELI hospitals.

4. Geriatric Beds: Explore the need for beds dedicated to serving older adults in Suffolk County, particularly due to the aging population on the East End of Long Island.

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D. Substance Use Services:

The opioid epidemic in Suffolk County is taking a major toll on our community. We have participated in a county task force, which made recommendations in 2010, and updated them in 2016. Additionally, we have been active in the New York State Medicaid services reform program (DSRIP), which led to a countywide focus on the identification and coordination of care for persons with substance use disorders. As part of this effort, we recently implemented a screening, brief intervention and referral to treatment program (SBIRT) in our CPEP, ED, all inpatient units and ambulatory primary care settings. In addition, our expected affiliation with Eastern Long Island Hospital will result in the addition to our system of a 10-bed substance detoxification unit and a 20-bed residential rehabilitation unit in Greenport, New York, and an outpatient substance use disorders program in Riverhead, New York.

We will improve access and coordination of care for substance use disorders through the following steps:

1. Services: Expand inpatient and outpatient substance-use services via the affiliation with Eastern Long Island Hospital. Coordinate substance use services between our ED and CPEP, inpatient units, and treatment programs at ELI Hospital through the development of standardized protocols.

2. Leadership: Recruit a director to lead a Division of Addiction Psychiatry in the Department of Psychiatry, to provide clinical expertise and leadership as Stony Brook Medicine assumes an active role as a provider of substance use disorders services in Suffolk County.

3. Pharmacologic Treatments: Expand provider capacity to

prescribe medications used in the treatment of substance use disorders, such as Buprenorphine and Naltrexone. In response to

the New York State Department of Health request, distribute Naloxone kits upon discharge to patients and families who presented to the ED with a heroin overdose or is at elevated risk of such.

4. Institutional Collaboration: Establish an Addiction Services workgroup within Stony Brook Medicine, including clinical departments, west campus stakeholders, Suffolk Care Collaborative (DSRIP) representatives and affiliated hospitals, to ensure cross-departmental awareness, collaboration and evidence-based interventions across departments and levels of care.

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E. Psychiatric Services for Medically Complex Inpatients:

Approximately 30% of persons discharged from Stony Brook Medicine inpatient medical and surgical units have an active, co-morbid psychiatric or substance use disorder, which has been associated with a prolonged hospitalization. Both ELI and Southampton hospitals, with which we anticipate affiliation, ran similar analysis in 2014 for the DSRIP application and resulted in similar findings. Surveys of Stony Brook hospital staff have revealed the perceived need for greater psychological support for medically hospitalized inpatients, more availability of psychiatric consultation after regular working hours, and greater attention to connecting patients to psychiatric and substance use treatments in the community. In 2015, we piloted a hospital medicine integrated care program, which intensified psychiatric staffing and services on two medicine units, while effectively reducing hospital length of stay.

Steps to increase access to care on non-psychiatric hospital services are as follows:

1. Integrated Care: Expand the hospital medicine integrated care program to include the two remaining hospital medicine units.

Consider a similar approach on other units and at affiliated hospitals.

2. Access: Expand the availability of psychiatric consultation outside of regular weekday hours. Explore models of care that utilize

mental health staff from different disciplines practicing at the top of their license.

3. Non-Pharmacologic Interventions: Integrate pre- and post-doctoral psychologists in medical settings to increase our capacity for evaluations and brief non-pharmacologic treatments.

4. Linkage to Community Services: Collaborate with Social Work and Care Management to provide the same quality of psychosocial evaluation and psychiatric/substance use services discharge planning for patients at moderate to high psychiatric risk, regardless of whether the patient has been admitted to a psychiatric or non-psychiatric area of the hospital.

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II. Quality and Safety: Align our medical staff, nursing staff and hospital administration in the shared ownership and improvement of quality and safe patient care, patient satisfaction, and compliance with regulatory requirements across our organization.

A. Safety: Enhance patient safety across our treatment settings, targeting violence, use of seclusion and restraint, suicide, delirium, and falls.

We have initiated patient safety pilot-programs in recent years to reduce the incidence of these events. We will continue to develop these programs with the goal of disseminating best practices across our network. We will promote an institutional culture of safety, and use the SB Safe system as a tool to support for performance improvement.

1. Violence: Ensure patient and staff safety with the following programs:

a) A hospital-wide Crises Intervention Rapid Response team (CIT) for managing hospital-wide disruptive behavior in non-psychiatric areas.

b) Cognitive behavioral therapy based violence prevention pilot on our adult inpatient psychiatry unit.

c) Behavioral modification program on our child psychiatry unit.

d) Reduce hospital-wide restraint and seclusions in conduction with the Department of Nursing.

2. Suicide: The population we serve has an elevated risk of suicide compared to the general population. We are completing a Health Failure

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Mode Effects Analysis (HFMEA) on suicide. We will implement recommendations from this effort, including standardizing the use of best suicide prevention practices across all areas in which we serve high-risk patients.

a) Standardization: Standardize use of best practices for the screening, assessment and prevention of suicide across all areas. Align with recommendations made by the National Strategy for Suicide Prevention, published by the Surgeon General in 2012.

b) Case Management: Collaborate with the hospital to create a dedicated social work suicide prevention coordinator to manage highest risk patients.

c) Depression Screening: Evaluate and monitor the use of the PHQ2/9 to screen for depression and connect patients to treatment. Educate staff to ensure proper use across levels of care.

3. Delirium: Improve upon our current delirium-screening pilot, which aims to improve the recognition and early management of delirium on a medical unit. Disseminate as a best practice across our acute care medical and surgical settings and across affiliated hospitals.

4. Falls: Align with the Stony Brook University Hospital 2017 HFMEA on fall reduction, to reduce falls in our

inpatient and emergency psychiatry areas. Manage utilization of nurse sitters, without increasing the rates of falls, through a Continuous Quality Improvement initiative.

B. Quality: Our quality improvement efforts will focus on the following areas:

1. Documentation: Improve the timing of clinical documentation across areas. Ensure that all encounters billed for have corresponding documentation.

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2. Evidence Based Medicine (EBM): Increase use of EBM and best practices by our clinicians.

a) Evidence based treatment algorithms.

b) Achievement of HEDIS measures, DSRIP metrics and monitoring departmental success with MIPS.

3. Orientation: Streamline new provider orientation to our electronic medical record, and to key policies and procedures.

4. Nursing Bundle: Integrate the Nursing Bundle as outlined in the Department of Nursing to achieve the top decile in care quality within the next three years.

5. Dedicated Quality Arm: Explore with hospital creation of a quality program dedicated to the behavioral health service line.

6. Measurement: Explore, develop and implement quality measures for CMS reporting guidelines in psychiatric in-patient units with emphasis on HBIPS screening for metabolic disorders and alcohol use, and providing the appropriate justification of multiple antipsychotics (Hospital-Based Inpatient Psychiatric Services core measures.

C. Patient Satisfaction: Continue to improve patient satisfaction by monitoring patient’s ratings and providing compassionate and culturally sensitive patient care.

III. Revenue: Increase revenue for sustainability and re-investment in growing mental health and substance use services, while preparing for value-based contracting opportunities such as those promoted through CMS and DSRIP.

A. Inpatient Care:

1. Occupancy Rates: Increase rates across our network:

a) Extended Observation Beds (EOB) in our Comprehensive Psychiatric Emergency Program.

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b) Eastern Long Island Hospital (ELI): Inpatient psychiatry beds and substance-use treatment units. Ensure well-coordinated transfers from our main Emergency Department, CPEP, and Southampton Hospital.

2. LOS: Reduce Hospital Length of Stay:

a) Inpatient psychiatry unit.

b) Internal medicine floors for persons with active comorbid psychiatric and substance use conditions.

3. Contracting: Work with Managed Care Contracting to examine and plan for contracting and rate setting across affiliated hospitals.

4. Documentation: Improve clinical documentation of mental health and substance use disorders on medical services to ensure appropriate coding and stratification of clinical complexity.

B. Ambulatory Care:

1. Professional Fees: Ensure that providers submit bills for all services provided, and that level of procedural coding is appropriate for purposes of both compliance and revenue capture.

2. Payer Rates: Ensure commercial and Medicaid reimbursement rates remain appropriate to cost of doing business through financial analysis and Collaboration with Managed Care Contracting.

3. Explore Business Opportunities:

a) Reimbursement strategies and opportunities through integration model rollout with primary care practices and work with Managed Care Contracting to pursue contracts.

b) Business model with the Stony Brook Captive to capture psychiatric and substance use referrals and integrate behavioral health services.

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c) Collaborative relationships beyond the current structure, i.e. Nursing homes, school districts, main campus health services.

IV. Develop the Workforce: Recruitment challenges to fill open positions have resulted in hiring delays and prolonged vacancies, leaving gaps in clinical services. To improve access to services for the growing population served by our expanding network, we will increase our focus on developing a strong multidisciplinary workforce with the following steps:

A. Recruitment: Foster ongoing efforts to recruit staff from a variety of disciplines, including psychiatrists, psychologists, social workers and nurse practitioners, who can work collectively to meet the demand for behavioral health services across our network. This includes expanding the capacity for mental health and substance use treatments on the Long

Island’s East End, through recruitment efforts and collaboration with Southampton and Eastern Long Island Hospitals.

B. Top of License: Support staff to practice at the highest skill level permitted by their education, training and licensure.

1. Includes staff from the nursing, social work and psychology, and licensed mental health counselors among others.

2. Implement newer models of care to meet the needs of populations, including collaborative care in primary care, and stepped care in a range of settings.

C. Staff Satisfaction: Foster an environment of high professional satisfaction and staff retention.

1. Provide opportunities for professional development and promotion in roles, as well as in academic rank for university faculty.

2. Explore opportunities for staff to work additional hours to increase their earnings while helping to enhance access to services within our network

D. Training: Create a hiring pipeline of graduating trainees from a number of disciplines to assume staff positions in our network.

1. Existing Programs: Expand positions in existing training programs in psychiatry and in psychology.

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2. New Collaborations: Explore potential collaborations with the Stony Brook University Schools of Nursing, Social Welfare, and

Health Technology and Management, to provide additional sub-

specialty training for psychiatric nurse practitioners, social workers, and physician assistants respectively, to enter positions in our network.

V. Regional Planning: Participate in regional and county-specific planning efforts through committee participation to identify and improve gaps in services.

A. Representatives: Work with community providers, as well as county and state representatives to explore and meet the needs of the community through a variety of outreach models.

B. County Forums: Participate in county advisory forums such as the Division of Mental Hygiene sub-committees, to understand community needs and educate those who refer to CPEP.

C. DSRIP: Participate in DSRIP and associated safety-net hospital efforts to understand and meet community needs.

APPENDIX I

Steps undertaken between September 2016 and January 2017 in the Development of the Psychiatry Clinical Strategic Plan:

1. Three strategic planning retreats hosted by the Senior Vice President for the Health Sciences/Dean of School of Medicine to inform Stony Brook Medicine plan.

a) Participation by the Psychiatry Chair, Vice Chair for Clinical Affairs, and Director of Outpatient Services.

2. Review recommendations provided to the Department of Psychiatry in 2015 by Schafer, a behavioral health-consulting firm.

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3. Three meetings of a newly established Psychiatry Executive Leadership Committee, whose initial task was to inform the Psychiatry Clinical Strategic Plan.

a) Participation included the following persons:

i. Chair of Psychiatry; Vice Chairs for Clinical Affairs, Research, and Education; Associate Director of Operations for Neurosciences; Associate Director for Behavioral Services and Psychiatric Nursing; Division Directors for Inpatient Psychiatry, Emergency Psychiatry, Child and Adolescent Psychiatry and Consultation and Liaison Psychiatry; Director and Associate Director for Inpatient Child Psychiatry; Clinical Administrator and Operations Director for Department of Psychiatry; and Nurse Managers for the Comprehensive Psychiatry Emergency Program (CPEP), Adult Inpatient Psychiatry Unit and Child Inpatient Psychiatry Unit.

4. Solicitation of Faculty Input:

a) A Department of Psychiatry faculty meeting dedicated to obtaining faculty input.

b) Electronic mail communications at various stages of plan development to solicit feedback.

5. Individual Planning Meetings between the Vice Chair for Clinical Affairs and the following persons:

a) Chair of Psychiatry

b) Division Directors for Inpatient Psychiatry, Child and Adolescent Psychiatry, Emergency Psychiatry, the Mind Body Clinical

Research Center

c) Leads for Medical Informatics and Programmer/Analyst for Psychiatry.

d) Associate Director of Operations for Neurosciences, and Associate Director for Behavioral Services and Psychiatric Nursing

6. Alignment of the Psychiatry Clinical Strategic Plan with the following plans:

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a) Stony Brook Medicine, Clinical Strategic Plan

b) Stony Brook Neurosciences Institute Strategic Plan

c) Stony Brook Psychiatry Research Strategic Plan

d) Stony Brook Psychiatry Education Strategic Plan

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Stony Brook Medicine

Education in Psychiatry5-Year Strategic Plan

(2017-2022)

Summary :

The mission statements of the Psychiatry Department and Stony Brook Medicine share the important objective of “educating the healthcare professionals of the future.” Yet despite this stated intent, educational goals in the Psychiatry Department have historically received less attention than those associated with clinical and research concerns. Our overall strategic plan for the next 5 years will include clear educational objectives to improve the knowledge base of our medical students, resident/fellow trainees, and faculty alike. The resultant acquisition of knowledge will directly benefit the clinical care of patients and potentially spur clinical questions to guide research. The ability to impart this knowledge (whether at the bedside or in the classroom) is a learned skill and as such, requires several changes for improvement. These include specific training in teaching techniques, continuous tracking of progress as an educator (including student feedback), and instruction in innovative teaching strategies that have worked well both inside and outside the institution.

Goals:

I. Expand the scope of educational programs in Psychiatry for medical students, residents, and fellows.

II. Improve the quality of educational programs in Psychiatry at Stony Brook Medicine.

III. Expand the size and availability of training programs in Psychiatry

Objectives:

I. Expand the scope of educational programs in Psychiatry for medical students, residents, and fellows.

This objective requires increasing both the overall number of educators and the amount of teaching done by individual educators. It will involve methods of increasing motivation and rewards for teaching, as well as coordinating teaching of similar topics for different groups.

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A. Establish an archive of topics of interest and established lectures for individual faculty members that can been be easily accessed for teaching on a topic.

B. Foster teaching of psychiatric topics of interest by members of other departments.

C. Include teaching efforts as part of a redesigned department incentive plan.

D. Establish new teaching awards for faculty (and residents) including the recognition of innovative ideas and the most highly rated classes by students.

E. Create new curriculum for psychiatry residents/fellows in line with ACGME requirements including the addition of population health, mental health issues as part of overall medical health, and quality improvement.

F. Create an expanded and specific neuroscience curriculum for psychiatry residents that spans all post-graduate years.

G. Develop a new curriculum that focuses on evidence-based medicine in Psychiatry with the goal of introducing practices/algorithms that have been determined to have a strong evidence base into our department’s clinical practice.

1. Introduce a PGY-II resident seminar on how best to formulate an answerable clinical question and then find/appraise/apply the evidence. This curriculum would include an introduction to search strategies with Boolean operators and methods for critical appraisal of evidence quality.

2. Initiate evidence-based projects for all PGY-III residents to propose and review a clinical question relevant to their work in Psychiatry.

3. Coordinate which resident projects could potentially be incorporated into clinical practice protocols in conjunction with the Vice-Chair for Clinical Affairs and division directors.

II. Improve the quality of educational programs in Psychiatry at Stony Brook Medicine.

This objective includes methods of monitoring the quality of teaching, by both incorporating innovative teaching techniques to improve that quality and “educating the educators” on how best to make these changes.

A. Create specific metrics that include student ratings/comments about individual instructors and individual seminars. This input will provide course leaders and residency/fellowship directors a better sense of their teaching resources and help determine those educators who would benefit from further education training. More importantly, this feedback will also tell us what programs are already working well (and should therefore be left alone and possibly replicated).

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1. Development and implementation of CBASE teacher evaluation for 3rd year medical school clerks.

2. Development of evaluation on New Innovations (or outside platform) of teachers for psychiatry residents and fellows.

B. Create an educational on-line “portal” for psychiatry residents that contains teaching material (e.g. PowerPoint slides, handouts) for all lectures and resident journal club presentations.

C. Start an annual educational retreat for clinical faculty that would initially include an introduction to student-centered learning techniques.

D. Implement specific training by School of Medicine faculty and any relevant on-line courses that focus on new techniques. This would include a “teaching orientation” for new faculty with limited teaching experiences.

E. Develop interdisciplinary teaching experiences (with RN, NP, and Psychology PhD programs).

F. Include an “educational portfolio” as part of the yearly performance evaluation that can be used as part of the advancement to higher academic rank.

G. Develop an on-line module introducing the department’s focus on evidence-based medicine as part of clinical faculty orientation.

III. Expand the size and availability of training programs in Psychiatry

A. Increase the size of the psychiatry residency program to 30 positions.

B. Develop resident “tracks” that may include further training in research, neurology, neuromodulation, and psychotherapy.

C. Establish new psychiatry fellowships that may include public, emergency, and forensic psychiatry.

D. Focus recruitment and revitalization of our fellowship in geriatric psychiatry.

E. Coordinate training opportunities at our partner hospitals (Southampton Hospital and ELI).

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Stony Brook Medicine

Research in Psychiatry5-Year Strategic Plan

(2017-2022)

Summary:

The department of Psychiatry is at a turning point where investments made in the last few years in the research can now come together to form the basis of a new era of growth. The department has recruited a number of talented new junior and senior investigators achieving a critical mass of investigators, who can engage in collaborations within and cross departments at Stony Brook University and outside. Furthermore, investments in infrastructure can be leveraged to that purpose. We propose over the next 5 years a set of goals that will capitalize on the strengths and address areas of weaknesses. The overall vision is to have a vibrant and transformative research program that will further attract recognition and talent.

Goals:

I. Improve and strengthen existent infrastructure supporting research

II. Build or expand in new areas of research

III. Optimize the links between clinical services and research operation to mutually

benefit both

IV. Increase research funding

V. Collaborations across departments

VI. Increase visibility of the Department and collaborations with outside groups

VII. Teaching research

Objectives:

I. Improve and Strengthen Existent Infrastructure Supporting Research

A. Website

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The department website is a great tool to facilitate research, communication across groups and between departments as well as to the outside world, it should also facilitate recruitment of research participants as well as new trainees and faculty to the Department, and serve other vital functions to the lab: description of Core facilities (EEG for example) or new capabilities (TMS).

Updated website which will offer flexibility for individual researchers and groups to set up their information and update the information as often as needed.

B. Research Cores – Genomics

Enhance the access to Genomics core, to facilitate incorporating genetic research in grantsubmissions.

Collaboration with known experts in the field. Specific recruitment to our department may become more feasible in the future.

C. Research Cores – Imaging

Create core functional MRI processing resources for resting state and task analysis to increase the availability / accessibility of fMRI for researchers without extensive expertise.

Committed computational resources and a programmer/data analyst, with faculty oversight. MRS analysis capabilities would be added; both would be folded under CUBIT.

D. PET

Achieve an operational PET Center within the next 2 years and build a state of the art PET program in the following 3 years.

Creation of a regular meeting, or use of existing research / grant review meetings, to optimize use of MRI scans during PET imaging; i.e., if your study has participants in the scanner for X hours, what is the best use of the MRI time? What tracers are available and what studies can be done/ what grants can be submitted.

E. EEG

Enhance and facilitate use of EEG across different programs.

Collaboration with local and outside EEG experts.

F. TMS

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Setup recently completed.

Expansion of research using TMS by setting up periodic discussions of TMS projects within the research group.

II Build and/or Expand New Areas of Research

A. Schizophrenia

Recent recruitments of Drs. Abi-Dargham, Gil, Slifstein, Weinstein and Van Snellenberg will lead to a new and major emphasis on schizophrenia research in the Department of Psychiatry, which did not exist previously.

To become a magnet for schizophrenia research with enhanced recruitment of patients, research studies, funding, and research staff.

B. Addiction

Enhance research in substance use disorders, with additional recruitments and setting up infrastructure such as self-administration facilities, collaborating on recruitment, sharing research subjects. Expand into areas of cannabis research, nicotine smoking cessation, opiate use, cocaine, in addition to alcohol research. Create a critical mass of researchers interested in substance use.

C. Co-morbid Schizophrenia and Addiction

Made feasible by points IIA and IIB.

D. Women’s Health Issues

This is a new area of research interest, led by Drs. Swain and Mahaffey.

E. Autism

The Child/Adolescent division will increase participation of children with Autism Spectrum Disorders in studies, conducted by Mathew Lerner, PhD and his group in Putnam Hall. Director of Autism will be recruited, and he/she in turn will hire a full-time researcher in Autism within the Department of Psychiatry.

F. Alzheimer’s Disorder

This is a fully funded center, will allow new research opportunities. Imaging is heavily subsidized.

We will recruit an imager or fold the effort into existing imaging groups.

G. Big Data Science

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Some opportunities exist that we will utilize in collaboration with the Bioinformatics department. The Cerner EMR data and data from HealtheIntent can be used to develop predictive algorithms through data analytics with the overall goals of generating datasets for research and allowing research questions to be addressed. Additional databases could be mined : The DSRIP (Delivery System Reform Incentive Payment https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/) program aimed at improving population health and reducing hospitalization through Medicaid redesign, the Suffolk County Collaborative which includes a set of projects related to these missions and many of them include aspects related to behavioral health (https://suffolkcare.org/clinical-summaries). We will set up the appropriate regulatory protections for use of such data sets.

H. Stem Cell Science

Form collaborations with existing preclinical groups or outside groups using this technique within or outside of SBU.

III Optimize the links between clinical services and research operation to mutually benefit both

A. Centralize recruitment

Use of centralized phone response line, brochures, exchange of subjects across groups, hire an FTE to oversee centralization.

B. Programs Beneficial to both Clinical and Research Operations

Set up new programs that can benefit both clinical and research operations: Cognitive Remediation Therapy is therapeutic for patients with schizophrenia and may also allow specific research questions to be answered. Scales for movement disorders or suicidality can be obtained on all patients. With specific approvals, those could be used for research purposes.

C. Child Psychiatry

Continue with behavioral program and study different approaches including use of comfort measures vs. strict limit-setting per psychopathologies and outcomes.

D. Inpatient Research

Maintain a few inpatient beds for research to facilitate studies that require short stays in collaboration with the inpatient unit Chief. Designated trained nursing staff would be needed to work with such patients.

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IV. Increase Research Funding

A. New NIMH Areas of Focus

Be responsive to new NIMH areas of focus. Increase submissions to the Brain initiative funding opportunities, RDoC, precision Medicine, studies of sex differences, to take advantage of new directions in NIMH funding, organize “interest groups” for discussion of RFAs that come out. This could be within the scope of the already existing research seminars.The emphasis on computational Psychiatry is also a new direction announced by the new NIMH Director, Josh Gordon. We will plan meetings with members of the Departments of Applied Math, Computer Sciences, biomed informatics, to see what they are capable of and interested in working on with us, to allow us to submit grants within this area.

B. Rewards for Success

Set up a mechanism to reward success with a bonus system, form a task force to work on the details. This should encourage successful grant submissions and increase funding. Parameters considering funding amount and impact of publications as well as excellence of research mentorship/ collaborations could all be included.

V. Collaborations across Departments

Set up new multidepartment grant submissions; for example, aim to submit a new Conte center for schizophrenia research with Lorna Role.

VI. Increase Visibility of the Department and Collaborations with Outside Groups

NIMH: collaborate with Bob Innis on imaging studies and mentoring of researchers, create new projects with Mount Sinai researchers.

VII. Teaching Research

Submit grants to increase research training for students, fellows and residents. Increase regular interactions with researchers, design feasible studies within the training years of residents. We plan an R25 resubmission. We will also submit over the next 5 years a T32 application for post-doctoral training and one for pre-doctoral graduate students.

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