Professor, Child and Adolescent Psychiatry
Sandra Fisman is a professor in the Department of Psychiatry at Western University, and a child and adolescent psychiatrist at the Parkwood Institute (SJHC).
I have been privileged to have enjoyed a long career as a Child and Adolescent Psychiatrist and a Senior Administrative Leader. Beginning as an innovator during postgraduate training in Psychiatry,I was a pioneer in part-time residency training in the 1980s and played an important role in lobbying the Royal College of Physicians and Surgeons of Canada(RCPSC) to create formal guidelines for part-time training which remain operative. This has allowed parents of young children to combine specialty training with raising a young family. This advocacy has continued and extended to promote the retention of faculty in academic medicine across the life span and address issues of work-life balance.
As a Child and Adolescent Psychiatrist,I gave "birth"to several new programs which continue to be an important part of the service system,both in terms of models of care and sustainability. One of these programs was a Community-Based Program for children and youth with Autism Spectrum Disorder. This become a Gold Standard in service provision for these children and their families. Recognizing the inordinate amounts of stress that these families were under,I developed and led a research program,which over a decade established the impact of this stress on maternal mental health,secondarily on the spousal/marital relationship and,longitudinally,the potential effect on sibling relationships and adjustment, relative to other handicaps (in particular Down syndrome)and developmentally average children. This work continues to be cited and led to changes in intervention emphasizing strategies for parent and sibling support.
Another major program development under my stewardship was the development of the acute care Child and Adolescent Inpatient program at Children's Hospital of Western Ontario now Children's /London Health Sciences Centre. The initial seven bed unit and existing outpatient program were expanded under my leadership as Division of Child and Adolescent Psychiatry Chair and Clinical Chief, with the addition of four more Mental Health beds and then a comprehensive Adolescent Eating Disorder Program(four further inpatient beds ,day treatment and outpatient care)and a Mental Health Day Treatment program for children and youth with internalizing disorders. The current Child and Adolescent Mental Health program has been collocated at Victoria Hospital(since 2011).This is the central hub for education and training in Child and Adolescent Psychiatry, integrated with the other affiliated training sites at Parkwood Mental Health,CPRI and Vanier Children's Service. This is of paramount importance to the newly accredited Child and Adolescent Subspecialty Residency.
Among other important clinical innovations was the establishment of a unique 24/7 Child and Adolescent Psychiatry emergency consultation service providing a range of consultation,telephone through face-to-face consultation with acute care admission where indicated,to regional Southwestern Ontario Children's Mental Health Centers. This was sustained over 17 years and continued to be evaluated as both unique and highly valued by the participating community service providers.
Always interested in academic administration and medical leadership,in 2001 I became Chair of the academic Department of Psychiatry at the University of Western Ontario(Western University)and Chief of the London Hospitals Mental Health Services. The past decade has been a time of extensive change with Healthcare Restructuring,hospital bed closures and community service development. Simultaneously healthcare and the role of the physician has,and continues, to undergo transformative change. This calls for strong medical leadership in order to rise to and embrace the wave of change,working collaboratively with partners within and outside of the hospital system and recruiting the right medical human resources to not only meet the challenges of the change process but to also excel both clinically and academically.
In 2006,while Chair /Chief,Working with Dr Gillian Kernaghan,then VP Medical Affairs and Education,I organized a DBT Intensive Training Program with 2 Weeks on-site training by two trainers from the Linehan training center("B-Tech") in Seattle Washington. Several clinical teams at LHSC and then RMHC/SJHC participated in training. The majority of these teams were adult mental health providers but an adolescent team was trained at both LHSC and RMHC/SJHC. Several of the teams embraced the DBT model of care as an effective,evidence-based strategy for affect dysregulation and self-harm behaviours and all had the opportunity for weekly consultation and supervision by one of the trainers:Dr. Lawrence Katz or Kate Comtois. Several of these teams have continued to utilize DBT as a modality. The Adolescent Outreach program at Parkwood/SJHC,which I lead and consult to, consists of three RNs and a part-time social worker,has become the expert resource in Ontario. A very successful outcome for this team was the initiation of DBT Skills Intensive Multifamily Training Groups for teens 13-18 years and their accompanying care provider(generally parent(s).Continuing to work with B-Tech,I led an initiative to bring the same trainers back to London in September 2014,inviting teams from Child and Youth Mental Health agencies across Southwestern Ontario to participate. This has had the intended result of building community capacity.
Since completing two terms as Chair/Chief for Psychiatry,I have re-immersed myself in Child and Adolescent Mental Health. As the Academic Chair of Child and Adolescent Psychiatry from January 2012 to January 2018 my vision was to build a center of excellence with a corresponding CAP Subspecialty Residency training program,supporting excellence in CAP Subspecialty training and nurturing future leaders for the Division. I was also committed to moving the Research agenda forward for the DCAP.
In terms of my own recent research,I have been Principle Co-Investigator in the development of a youth suicide ideation scale:the Brief Adolescent Suicide Ideation Scale (BASIS) and we have developed a 19 item long assessment tool and a 5 item brief screening tool with good predictive validity to assess suicide risk in 12-18 year olds. We are also completing a DBT longitudinal outcome study.
Nationally,I was a member of the RCPSC CAP Subspecialty Examination Board for 5 years and as such was granted Founder Status as a CAP subspecialist. I continue as a nucleus member of the Royal College CAP Specialty Committee,representing Ontario Region 3, and am a participant in the design of CBD for CAP Subspecialty.
Provincially I have been a member of the Associated Medical Services(AMS)Provincial Management Committee(PMC) since 2012 and since January 2014, chaired the AMS Phoenix Fellowship Committee. The goal of this organization has been to recalibrate humanity and compassion into Healthcare through curricula development,patient-provider partnership and workplace culture change. Over 6 years we have funded 40 Physician and Inter-professional Fellows and 20 RNAO fellows. The Phoenix "Project"became a "Program"in 2016 after a successful External Review. The PMC was restructured and expanded as the Provincial Steering Advisory Committee (PSAC). With a recent external review requested by the AMS Board,the focus of the AMS Phoenix Program will shift to the integration of healthcare technology with compassionate care. I have been tasked with chairing a Fellowship Transition Work Group to develop Terms of Reference for a Transition Fund. The strategic direction for AMS Phoenix currently focus' on the integration of Compassionate Care and Healthcare Technology.
I provide rotations for CAP core and sub-specialty trainees as well as medical students,offering a range of experiences across Parkwood,LHSC and community shared mental health. Experiences are available including all CANMEDS roles.
I currently have two book chapters in press which reflect my special interests:
In a book titled "A Handbook of Person Centered Mental Health Care"(Hogrefe Press):Chapter 5 "A Person-Centered Approach to Healthcare Leadership"
A publication by the AMS Phoenix Program (Magill University Press):Chapter 7 "Compassionate Organizations" with co-authors.
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About Sandra Fisman
Sandra Fisman is a professor in the Department of Psychiatry at Western University, and a child and adolescent psychiatrist at the Parkwood Institute (SJHC).
I have been privileged to have enjoyed a long career as a Child and Adolescent Psychiatrist and a Senior Administrative Leader. Beginning as an innovator during postgraduate training in Psychiatry,I was a pioneer in part-time residency training in the 1980s and played an important role in lobbying the Royal College of Physicians and Surgeons of Canada(RCPSC) to create formal guidelines for part-time training which remain operative. This has allowed parents of young children to combine specialty training with raising a young family. This advocacy has continued and extended to promote the retention of faculty in academic medicine across the life span and address issues of work-life balance.
As a Child and Adolescent Psychiatrist,I gave "birth"to several new programs which continue to be an important part of the service system,both in terms of models of care and sustainability. One of these programs was a Community-Based Program for children and youth with Autism Spectrum Disorder. This become a Gold Standard in service provision for these children and their families. Recognizing the inordinate amounts of stress that these families were under,I developed and led a research program,which over a decade established the impact of this stress on maternal mental health,secondarily on the spousal/marital relationship and,longitudinally,the potential effect on sibling relationships and adjustment, relative to other handicaps (in particular Down syndrome)and developmentally average children. This work continues to be cited and led to changes in intervention emphasizing strategies for parent and sibling support.
Another major program development under my stewardship was the development of the acute care Child and Adolescent Inpatient program at Children's Hospital of Western Ontario now Children's /London Health Sciences Centre. The initial seven bed unit and existing outpatient program were expanded under my leadership as Division of Child and Adolescent Psychiatry Chair and Clinical Chief, with the addition of four more Mental Health beds and then a comprehensive Adolescent Eating Disorder Program(four further inpatient beds ,day treatment and outpatient care)and a Mental Health Day Treatment program for children and youth with internalizing disorders. The current Child and Adolescent Mental Health program has been collocated at Victoria Hospital(since 2011).This is the central hub for education and training in Child and Adolescent Psychiatry, integrated with the other affiliated training sites at Parkwood Mental Health,CPRI and Vanier Children's Service. This is of paramount importance to the newly accredited Child and Adolescent Subspecialty Residency.
Among other important clinical innovations was the establishment of a unique 24/7 Child and Adolescent Psychiatry emergency consultation service providing a range of consultation,telephone through face-to-face consultation with acute care admission where indicated,to regional Southwestern Ontario Children's Mental Health Centers. This was sustained over 17 years and continued to be evaluated as both unique and highly valued by the participating community service providers.
Always interested in academic administration and medical leadership,in 2001 I became Chair of the academic Department of Psychiatry at the University of Western Ontario(Western University)and Chief of the London Hospitals Mental Health Services. The past decade has been a time of extensive change with Healthcare Restructuring,hospital bed closures and community service development. Simultaneously healthcare and the role of the physician has,and continues, to undergo transformative change. This calls for strong medical leadership in order to rise to and embrace the wave of change,working collaboratively with partners within and outside of the hospital system and recruiting the right medical human resources to not only meet the challenges of the change process but to also excel both clinically and academically.
In 2006,while Chair /Chief,Working with Dr Gillian Kernaghan,then VP Medical Affairs and Education,I organized a DBT Intensive Training Program with 2 Weeks on-site training by two trainers from the Linehan training center("B-Tech") in Seattle Washington. Several clinical teams at LHSC and then RMHC/SJHC participated in training. The majority of these teams were adult mental health providers but an adolescent team was trained at both LHSC and RMHC/SJHC. Several of the teams embraced the DBT model of care as an effective,evidence-based strategy for affect dysregulation and self-harm behaviours and all had the opportunity for weekly consultation and supervision by one of the trainers:Dr. Lawrence Katz or Kate Comtois. Several of these teams have continued to utilize DBT as a modality. The Adolescent Outreach program at Parkwood/SJHC,which I lead and consult to, consists of three RNs and a part-time social worker,has become the expert resource in Ontario. A very successful outcome for this team was the initiation of DBT Skills Intensive Multifamily Training Groups for teens 13-18 years and their accompanying care provider(generally parent(s).Continuing to work with B-Tech,I led an initiative to bring the same trainers back to London in September 2014,inviting teams from Child and Youth Mental Health agencies across Southwestern Ontario to participate. This has had the intended result of building community capacity.
Since completing two terms as Chair/Chief for Psychiatry,I have re-immersed myself in Child and Adolescent Mental Health. As the Academic Chair of Child and Adolescent Psychiatry from January 2012 to January 2018 my vision was to build a center of excellence with a corresponding CAP Subspecialty Residency training program,supporting excellence in CAP Subspecialty training and nurturing future leaders for the Division. I was also committed to moving the Research agenda forward for the DCAP.
In terms of my own recent research,I have been Principle Co-Investigator in the development of a youth suicide ideation scale:the Brief Adolescent Suicide Ideation Scale (BASIS) and we have developed a 19 item long assessment tool and a 5 item brief screening tool with good predictive validity to assess suicide risk in 12-18 year olds. We are also completing a DBT longitudinal outcome study.
Nationally,I was a member of the RCPSC CAP Subspecialty Examination Board for 5 years and as such was granted Founder Status as a CAP subspecialist. I continue as a nucleus member of the Royal College CAP Specialty Committee,representing Ontario Region 3, and am a participant in the design of CBD for CAP Subspecialty.
Provincially I have been a member of the Associated Medical Services(AMS)Provincial Management Committee(PMC) since 2012 and since January 2014, chaired the AMS Phoenix Fellowship Committee. The goal of this organization has been to recalibrate humanity and compassion into Healthcare through curricula development,patient-provider partnership and workplace culture change. Over 6 years we have funded 40 Physician and Inter-professional Fellows and 20 RNAO fellows. The Phoenix "Project"became a "Program"in 2016 after a successful External Review. The PMC was restructured and expanded as the Provincial Steering Advisory Committee (PSAC). With a recent external review requested by the AMS Board,the focus of the AMS Phoenix Program will shift to the integration of healthcare technology with compassionate care. I have been tasked with chairing a Fellowship Transition Work Group to develop Terms of Reference for a Transition Fund. The strategic direction for AMS Phoenix currently focus' on the integration of Compassionate Care and Healthcare Technology.
I provide rotations for CAP core and sub-specialty trainees as well as medical students,offering a range of experiences across Parkwood,LHSC and community shared mental health. Experiences are available including all CANMEDS roles.
I currently have two book chapters in press which reflect my special interests:
In a book titled "A Handbook of Person Centered Mental Health Care"(Hogrefe Press):Chapter 5 "A Person-Centered Approach to Healthcare Leadership"
A publication by the AMS Phoenix Program (Magill University Press):Chapter 7 "Compassionate Organizations" with co-authors.
| Present | Child and Adolescent Psychiatrist, St. Joseph's Health Care London ‐ Parkwood Institute | |
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| Present | Professor, Western University ‐ Department of Psychiatry | |
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Disciplines
Pediatrics and Psychiatry