Rationale: Certification will improve the quality of patient care for individuals in community-public settings through supporting recovery oriented providers with knowledge of community psychiatry. Certification also supports the development of the field of Community-Public Psychiatry is it serves to:
  • Increase interest for members in training to pursue careers or training in public and community psychiatry
  • Define essential knowledge and skills of the field
  • Support Public Psychiatry Fellowships and other post residency training programs through external validation process
  • Recognize community psychiatrists with years of providing quality psychiatric services
  • Improve cohesiveness among community psychiatrists through defined professional identity
  • Increased membership in support of the AACP
  • Professionally support community-public psychiatrists through credentialing


(AACP: Guidelines on Public Psychiatry Fellowships)

Guidelines Document

The AACP Community-Public Psychiatry Certification is awarded to individuals who meet the educational, experiential and exam requirements to be certified in community and public psychiatry.

Candidates who meet both Criteria A and B and receive a passing score on the exam are eligible for certification.

Candidates must meet the following two criteria to sit for the exam:
Criteria A:
☐The psychiatrist has completed an ACGME approved residency training program in adult psychiatry.
Criteria B:
☐ Educational Pathway: The psychiatrist has completed a fellowship in Public, Public Service or Community Psychiatry. The fellowship was of at least 12 months in duration, and took place either any time after completing residency training or during PGY4 year of residency training.*
☐ Experiential Pathway: The psychiatrist has worked as a public or community sector psychiatrist for at least five years following the completion of residency training program in adult psychiatry. The public sector professional service can be clinical, administrative, teaching or research based. The candidate must have been working in the public sector for at least 20 hours per week for a total of five years.

*For a list of accepted fellowships, please refer to the AACP website.AACP Fellowships

If you have completed a public psychiatry fellowship that is not on the list, please email Dr. Julie Ranz jmr1@columbia.edu and Dr. Stephanie LeMelle SML35@columbia.edu.

Public sector settings are those that are primarily supported by public (government, philanthropic, grant-based, medicare/Medicaid etc) funding.

The following are the steps for candidates to apply for certification.

1.Review this website. Ensure that you meet eligibility criteria.
2.Complete the 2015 AACP Attestation Document and submit to Frances Bell. A copy of this document is under "Pages and Files" on this website.
3.Once you receive an invoice from Ms Bell, please pay fees necessary for the exam. Pay to register
4.Refer to Table 1: Knowledge Domains and Sources to review topics and sources to prepare for the exam.
5.During the open exam administration time, log in and complete the exam.
6.Submit an email to Frances Bell and Michael Weinberg with your name as the subject of the email communicating that you have completed the exam in the body of the email.

Supplemental Readings:

1. Bertelsen M, Jeppesen P, Petersen L et al. (2008) Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry. Jul;65(7):762-71.
2. Samuels, J.F. and Nestadt, G., “Epidemiology: The Distribution of Mental Disorders in the Community” from Integrated Mental Health Services: Modern Community Psychiatry , Breakey, W.R., Editor, Oxford University Press, New York, 1996.
3. Breakey, W.R., “Prevention” in Integrated Mental Health Services: Modern Community Psychiatry , Breakey, W.R ., (Ed.), Oxford University Press, New York, 1996.
4.Christopher, S. et al , “Building and Maintaining Trust in a Community-Based Participatory Research Partnership.” American J. of Public Health, vol. 98, no. 8, August 2008
Israel, B.A., et. al ., “Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health” Annual Review Public Health, Vol. 19, 1998


1. Asylum Movement
1(a) Thompson JW Trends in the Development of Psychiatric Services, 1884-1994. Hosp and Community Psychiatry. 45(10):987-92. (comprehensive introduction: one of few such in journal literature. Many books available on subject from any library.)

1(b) Campbell RJ. Flashbacks: scenes from psychiatry's revolutions
Bull N Y Acad Med. 1984 Jun;60(5):479-93 (available free via PubMed: general history, with material on asylums)

1(c) Dix D. "I tell what I have seen" -- the reports of asylum reformer Dorothea Dix. Am J Public Health/ 96(4): 622-5, 2006. (reprint of Dix's survey of Mass asylums)

2. Mental Hygiene Movement
2(a) Thompson JW Trends in the Development of Psychiatric Services, 1884-1994. Hosp and Community Psychiatry. 45(10):987-92.

3. Creation of Community Mental Health Centers
3(a) Grob GN. Mad, homeless and unwanted. A history of the care of the chronically mentally ill in America. Psychiatr Clin North Am. 17(3): 541-58.

4. De-institutionalization/ Transinsitutionalization
4(a) Morrisey JP, Goldman HH. Cycles of Reform in Care of the Chronically Mentally Ill. Hosp Community Psychiatry. 35: 785-793, 1984. 4(b) Lamb HR. The new state mental hospital in the community. Psychiatr Serv. 48: 1307-1310, 1997

4(b) Geller JL.The last half-century of psychiatric services as reflected in psychiatric services.
Psychiatr Serv. 2000 Jan;51(1):41-67 (free via PubMed: detailed review paper, also relevant to CMHC movement, above).

4(c) Lesage A, Groden D, Goldner EM, Gelinas D, Arnold LM. Regionalised Tertiary Psychiatric Residential Facilities. Epidemiol Psichiatr Soc. 2008 Jan-Mar;17(1):38-46. (exam of Canadian/Aust/British and Italian use of small scale supportive communities in attempt to completely replace public psychiatric hospitals)

1) AACP Guidelines for Psychiatric Leadership in Organized Delivery Systems for Treatment of Psychiatric and Substance Disorders. Guidelines Document
2) Sowers W.E., MD and Thompson, K.S . (Eds.), “Keystones for Collaboration and Leadership: Issues and Recommendations for the Transformation of Community Psychiatry,”
3) Ranz, J., et al, “The Psychiatrist’s Role as Medical Director: Task Distributions and Job Satisfaction.” Psychiatric Services, vol. 48, no. 7, July 1997
4) Ranz, J. et al, “The Role of the Community Psychiatrist as Medical Director: A Delineation of Job Types.” Psychiatric Services, vol. 51, no. 7, July 2000
5) AACP - Model Job Description Medical Directors Organized Systems of Care see website
6) Corrigan, P.W., and Garman, A.N., “Administrative Update: Transformational and Transactional Leadership Skills for Mental Health Teams” Community Mental Health Journal , Vol. 35, No. 4, August 1999
7) Zuckerman, A.M., “Creating a Vision for the Twenty-First Century Healthcare Organization.” Journal of Healthcare management, vol. 45, no. 5, September/October 2000
8) U’Ren, R., et. al ., “Community Consultation” in Practicing Psychiatry in the Community: A Manual , Jerome W. Vaccaro, MD, and Gordon H. Clark, Jr., MD (Eds.), American Psychiatric Press, Inc., Washington, DC 1996
9) Schwartz, D.A., “A Precis of Administration.” Community Mental Health Journal, vol. 25, no. 3, 1989
10) Duncan, E.A., and Warden, G.L ., “Influential Leadership and Change Environment: The Role Leaders Play in the Growth and Development of the People They Lead.” Journal of Healthcare Management, vol. 44, no. 4, July/August 1999


A. Policy
1) Day SL. Issues in Medicaid policy and system transformation: recommendations from the President's Commission
Psychiatr Serv. 2006 Dec;57(12):1713-8 (Tight review of Medicaid's statutory role in providing mental health services laying out what it covers, what it doesn't, how it's funded, and how it limits service improvement and ways it might be used to amplify positive change)
2) SAMHSA Agency Overview. www.samhsa.gov/About/background.aspx
3) US Dept. of Health & Human Services3) . www.hhs.gov/about/whatwedo __
4) Nadelman, E.A., “Drug Prohibition in the United States: Costs, Consequences, and Alternatives.” Science , vol. 245, 1 September 1989

B. Financing
1)Buck, J.A., “Medicaid, Health Care Financing Trends, and the Future of State-Based Public Mental Health Services,” Psychiatric Services , vol. 54, no. 7, July 2003
2)AACP, “AACP Position Statement: Principles of System Design and Financing for Universal Health and Behavioral Health Care Coverage.”
3)Sharfstein, S.S ., “Medicaid Cutbacks and Block Grants: Crisis or Opportunity for Community Mental Health?” American J. of Psychiatry, vol. 139, no. 4, April 1982
4)Brem er, R.W. et al , “Pay for Performance in Behavioral Health.” Psychiatric Services, vol. 59, no. 12, December 2008
5)Mark, T.L. et al , “Mental Health Treatment Expenditure Trends, 1986-2003.” Psychiatric Services, vol. 58, no. 8, August 2007
6) Dickey, B ., “Are Financial Incentives and Best Practices Compatible?” Psychiatric Services, vol.. 55, no. 2, Feb. 2004

C. Care and Cost Management
1) Ogles, B.M. et al , “Managed Care as a Platform for Cross-System Integration.” J. of Behavioral Health Services & Research, vol. 25, no. 3, Aug. 1998
2) AACP , “LOCUS: Level of Care Utilization System for Psychiatric and Addiction Services, Adult Version 2000.” American Association of Community Psychiatrists, May 30, 2000
3) www.comm.psych.pitt.edu/finds/quality.html , “AACP Position Paper on Standards of Quality Management in Implementing Public Sector Managed Care Systems Introduction.”



1.Assertive Community Treatment
1(a) Stein LI, Test MA. Alternatives to hospital treatment. 1. Conceptual model, treatment program and clinical evaluation. Archives of General Psychiatry. 37.392-397.
1(b) Phillips SD et al. Moving assertive community treatment into standard practice. Psychiatric Services. 52: 771-779, 2001
1(c)Mueser KT, Bond GR, Drake RE et al. Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin. 24:37-74, 1998.

2. Models of Vocational Rehabilitation
2(a)Vocational rehabilitation for people with severe mental illness.
Crowther R, et al. Cochrane Database Syst Rev . 2001;(2):CD003080
(Free via Cochrane: high impact, and while 7 years old its findings are replicated in all the studies listed below)

2(b) Cook JA, Leff S, Blyler CR. Results of a Multisite Randomized Trial of Supported Employment Interventions for Individuals with Severe Mental Illness. Arch Gen Psychiatry. 62: 505-12, 2005. (Core journal: recent, with relatively easy access)

2(c) Bond GR, Drake RE, Becker DR. An Update on Randomized Controlled Trials of Evidence-Based Supported Employment. Psych Rehab J. 31(4) 280-90, Spring 2008. (Meta-analysis; supportive of high fidelity IPS)
(Most detailed and recent: not core journal, not free.

2(d) Twamley EW, Jeste DV, Lehman AF. Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials. J Nerv Ment Dis. 191(8): 515-23, 2003.

2(e) Drake RE, Bond GR. The future of supported employment for people with severe mental illness.
Psychiatr Rehabil J. 2008 Spring;31(4):367-76. (a slightly broader perspective than the preceding article.)

3. Intensive Case Management
Mueser KT, Bond GR, Drake RE, Resniek SG. (1998) Models of Community Care for Severe Mental Illness: A Review of Research on Case Management. Schizophrenia Bulletin. 21 (1): 37-74.

4. Clubhouses
Beard JH, Propst R, Malamud TJ. (1982) The Fountain House Model of Psychiatric Rehabilitation. Psychosocial Rehabilitation Journal. 5 (1): 47-53.

5. Cognitive Remediation
5 (a)McGurk, SR, et al. A meta-analysis of cognitive remediation in schizophrenia
Am J Psychiatry. 2007 Dec;164(12):1791-802.

5 (b)Spaulding WD, Reed D, Sullivan M, et al. (1999) Effects of cognitive treatment in psychiatric rehabilitation. Schizophr Bull 25: 657-676.


1. Twelve-Step Programs
1) Bogenschutz MP. (2007)
12-step approaches for the dually diagnosed: mechanisms of change.
Alcohol Clin Exp Res. Oct;31(10 Suppl):64s-66s.
(3 page summary, written in epigrammatic, declarative style--excellent references)

2. Motivation Enhancement Therapy
2(a) Miller WR. TIP 35:Enhancing Motivation for Change in Substance Abuse Treatment. SAMHSA/CSAT Treatment Improvement Protocols. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302

2(b) DiClemente CC, Nidecker M, Bellack AS. (2008) Motivation and the stages of change among individuals with severe mental illness and substance use disorders. J Subst Abuse Treat 34(1): 25-35.

3. Opiate Dependence
3(a) Connock M, Juarez-Garcia A, Jowett S et al (2007) Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess 11(9): 1-171.

4. Alcohol Dependence
4(a) Anton RF, O'Malley SS, Ciraulo DA et al (2006) Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 295(17): 2003-17

4(b)Pettinati HM, Oslin DW, Kampman KM, Dundon WD, Xie H, Gallis TL, Dackis CA, O'Brien CPA double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. 2010 American Journal of Psychiatry. Jun;167(6):668-75.

5. Contingency Management
5(a) Stitzer ML, Vandrey R. (2008) Contingency management: utility in the treatment of drug abuse disorders. Clin Pharmacol Ther 83(4): 644-7.

6. Integrated Treatment for Co-Ocurring Disorders
6 (a) Ziedonis DM. (2004) Integrated Treatment of Co-Occuring Mental Illness and Addiction: Clinical Intervention, Program, and System Perspectives. CNS Spectr. Dec;9(12):892-904, 925.
6(b)Laudet, A.B. et al , “Addictions Services: Support, Mutual Aid and Recovery from Dual Diagnosis.” Community Mental Health Journal, vol. 36, no. 5, Oct. 2000
6(c) Torrey, W.C ., “The Challenge of Implementing and Sustaining Integrated Dual Disorders Treatment Programs.” Community Mental Health Journal, vol. 38, no. 6, Dec. 2002
6(d) AACP Guidelines on Integrated Care for co occuring addiction and mental health


1. Medical Co-morbidities Common to those with Severe and Persistent Mental Illness
1(a) Newcomber JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. Journal of Clinical Psychiatry. 68(suppl 1): 20-27, 2007.
1(b)Vreeland, B ., “Bridging the Gap Between Mental and Physical Health: A Multidisciplinary Approach.” J. Clinical Psychiatry, vol. 68, 2007
1(c) AACP (American Association of Community Psychiatrists), “Position Paper on Interface and Integration with Primary Care Providers, Approved 10-10-02.”
1(d)Druss, B.G., “Improving Medical Care for Persons with Serious Mental Illness: Challenges and Solutions.” J. Clinical Psychiatry, vol. 68 (suppl 4), 2007

2. Wellness Self Management and Recovery
Mueser KT & Jeste DV. 2008. Clinical Handbook of Schizophrenia.
New York: The Guilford Press. Ch 27: Illness Self Management Training. 268-278.

3. Smoking cessation
3 (a) Baker A, et al. Am J Psychiatry. 2006 Nov;163(11):1934-42.
A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. (Core Journal, free via PubMed)
(Brief overview of the incidence; summary of available tx; RTC of nic replacement and CBT with Mot Interviewing vs Usual Care-->

3 (b) Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? A review of the research
Aust N Z J Psychiatry. 2005 Oct;39(10):866-85.
(detailed review that summarizes its points in an easy to read bullet-style with concrete suggestions based on early studies--themselves concisely summarized. Readable and practical.)

4. Access to Adequate Screening and Medical Care
4(a) Parks J, Svedsen D (eds.). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA, National Association of State Mental Health Program Directors, 2006.

Torrey, W.C., “Community Care of Adults with Developmental Disabilities and Mental Illness.” In Vaccaro, J.V. and Clark, G.H., Jr., Practicing Psychiatry in the Community: A Manual . Wash. DC, American Psychiatric Press, Inc., 1996

(1)United States Center for Mental Health Services: Cultural competence standards in managed care mental health services: Four underserved/underrepresented racial/ethnic groups (Publication No. SMA00-3457). Washington, DC, Substance Abuse and Mental Health Services Administration, 2000. Available at http://mentalhealth.samhsa.gov/publications/allpubs/sma00-3457/default.asp

(2)Accreditation Council for Graduate Medical Education: Residency Review Committee, Guidelines for Psychiatric Residencies, 2007. Available at www.acgme.org/acWebsite/downloads/RRC_progReq/400pr07012007.pdf

(3) Agency for Healthcare Research and Quality: National Healthcare Disparities Report, 2006. Rockville, Md, Agency for Healthcare Research and Quality, 2006. Available at http: www.ahrq.gov/qual/nhdr06/nhdr06.htm

Moffic, H.S., “Cultural Issues in Community Psychiatry” in Practicing Psychiatry in the Community: A Manual , Jerome V. Vaccaro, MD and Gordon H. Clark, Jr., MD (Eds.), American Psychiatric Press, Inc., Washington, DC, 1996
Hughes, C.C., “Culture in Clinical Psychiatry” in Culture, Ethnicity, and Mental Illness . Albert C. Gaw, MD (Ed.), American Psychiatric Press, Inc., Washington, DC 1993
Bell, C., “Treatment Issues for African-American Men” Psychiatric Annals, vol. 26, no. 1, Jan. 1996

1)Wells K, Miranda J, et al. (2004) Bridging Community Intervention and Mental Health Services Research . Am J Psychiatry 161:955-963.
2)Rosenheck, R., “The Delivery of Mental Health Services in the 21st Century: Bringing the Community Back.” Community Mental Health Journal, vol. 36, no. 1, Feb. 2000
3)Chowanec, G.D ., “Continuous Quality Improvement: Conceptual Foundations and Application to mental Health Care,” Hospital and Community Psychiatry , vol. 45, no. 8, August 1994.
4)Srebnik, D. et al , “Development of Outcome Indicators for Monitoring the Quality of Public Mental Health Care, Psychiatric Services, vol. 48, no. 7, July 1997
5)Thornicroft, G. and Bebbington, P., “Quantitative Methods in the Evaluation of Community Mental Health Services.” In Breakey, W.R. (Ed.), Integrated Mental Health Services: Modern Community Psychiatry. New York, Oxford University Press, 1996
6)Hyde, P.S., “A Unique Approach to Designing a Comprehensive Behavioral Health System in New Mexico.” Psychiatric Services, vol. 55, no. 9, Sept. 2004
7)McNamara, C ., “Guidelines and Framework for Designing Basic Logic Model.” Copyright 1997-2008. Http://www.managementhelp.org/np_progs/np_mod/org_frm.htm .
8)Israel, G.D., “Using Logic Models for Program Development.” http://edis.ifas.ufl.edu/WC041 .


1. Psychiatric Rehabilitation
5(a) Hughes RA, Lehman AF, Arthur TE. (1996) Psychiatric Rehabilitation. in Breakey WR (ed.)Integrated Mental Health Services. Oxford University Press.

5(b) AACP PSYCHOSOCIAL REHABILITATION: Issues and Answers for Psychiatry. http://www.comm.psych.pitt.edu/finds/psychosocial.html

2. Recovery
6(a) Deegan, P.E ., “Recovery: The Lived Experience of Rehabilitation,” Psychosocial Rehabilitation Journal , vol. 11, no. 4, April 1988.
6(b) AACP Guidelines for Recovery Oriented Services. Recovery-Oriented Service System: Setting Some System Level Standards,” Psychiatric Rehabilitation Journal , vol. 24, no. 2, Fall 2000. AACP guidelines on ROS
6(d) Davidson, L., et. al ., “Top Ten Concerns About Recovery,” Psychiatric Services, vol. 57, no. 5, May 2006

3. Consumer and Family Perspectives
Deegan, P.E. et al , “A Program to Support Shared Decision making in an Outpatient Psychiatric Clinic.” Psychiatric Services, vol. 59, no. 6, June 2008
Cook, J.A. et al, “A Self-Directed Care Model for Mental Health Recovery.” Psychiatric Services, vol. 59, no. 6, June 2008
Estroff, S.E ., “Medicalizing the Margins: On Being Disgraced, Disordered, and Deserving.” Psychosocial Rehabilitation Journal, vol. VIII, no. 4, April 1985
Leete, E ., “How I Perceive and Manage My Illness.” Schizophrenia Bulletin, vol. 15, no. 2, 1989

4. Collaborative Services and Planning
Adams, J.R. and Drake, R.E ., “Shared Decision-Making and Evidence-Based Practice.” Community Mental Health Journal, vol. 42, no. 1, Feb. 2006
Adams, N. and Grieder, D., “Person-Centered Care” in Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery. Elsevier Academic Press, New York, 2005
Adams, J.R. et al, “Shared Decision-Making Preferences of People with Severe Mental Illness.” Psychiatric Services, vol. 58, no. 9, September 2007

5. Natural & Community Supports
Biegel, D.E. et al, “Facilitators and Barriers to Support Group Participation for Family Caregivers of Adults with Mental Illness.” Community Mental Health Journal, vol. 40, no. 2, April 2004
Grunebaum, H. and Friedman, H., “Building Collaborative Relationships with Families of the Mentally Ill.” Hospital and Community Psychiatry, vol. 39, no. 11, Nov. 1988
Holter, M.C. et al, “Critical Ingredients of Consumer Run Services: Results of a National Survey.” Community Mental Health Journal, vol. 40, no. 1, Feb. 2004
Evans, C.J. and McGaha, A.C ., “A Survey of Mental health Consumers’ and Family Members’ Involvement in Advocacy.” Community Mental Health Journal, vol. 34, no. 6, Dec. 1998


A. Health Care Disparities
Kawachi, I., et. al ., “Health Disparities by Race and Class: Why Both Matter,” Health Affairs , vol. 24, no. 2, March-April, 2005.
Marmot, M ., “Social determinants of health inequalities” Lancet , vol. 365, March 19, 2005
Israel, B.A., et. al ., “Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health” Annual Review Public Health, Vol. 19, 1998

B. Harm Reduction
Wodak, A. and Cooney, A., “Effectiveness of sterile needle and syringe programmes.” The International Journal of Drug Policy, vol. 16S, 2005

C. Violence and Suicide Prevention
Kuther, T.L. and Wallace, S.A ., “Community Violence and Sociomoral Development: An African-American Cultural Perspective.” American J. of Orthopsychiatry, vol. 73, no. 2, 2003
Knox, K.L. et al, “If Suicide is a Public Health Problem, What Are We Doing to Prevent It?” American J. of Public Health, vol. 94, no. 1, Jan. 2004

D. Collaborating with Community Organizations
Goldman, C.R. and Lefley, H.P ., “Working with Advocacy, Support, and Self-Help Groups.” In Practicing Psychiatry in the Community: A Manual , Jerome V. Vaccaro, MD and Gordon H. Clark, Jr., MD, M.Div. (Eds.), American Psychiatric Press, Inc., Washington, DC, 1996
Evans, C.J. and McGaha, A.C ., “A Survey of Mental health Consumers’ and Family Members’ Involvement in Advocacy.” Community Mental Health Journal, vol. 34, no. 6, Dec. 1998


A. Homeless
(1) O'Hara A. Housing for people with mental illness: update of a report to the President's New Freedom Commission. Psychiatric Serv 2007 July 58(7):907-13 (considers barriers to housing the homeless and mentally ill, references various approaches)

(2)Gillig PM, McQuistion HL.(2006) Clinical Guide to the Treatment of The Mentally Ill Homeless Person. Arlington, VA: American Psychiatric Publishing Inc.

-Housing First
(1) Stefancic A, Tsemberis S. Housing First for Long-Term Shelter Dwellers with Psychiatric Disabilities in a Suburban County: A Four-Year Study of Housing Access and Retention. J of Primary Prev, 28(3-4):265-79, July 2007 (Randomized-Control Trial)

(2) Greenwood RM, Schaefer-McDaniel NJ, Winkel G, Tsemberis SJ. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. Am J Community Psychol. 2005 Dec; 36 ( 3-4 ): 223-38 . (Statistically dense--remember Z scores?--and title overstates findings somewhat: still, rare look at topic).

(3) AACP Position Statement on Housing Options for Individuals with severe and persistent mental illness. http://www.comm.psych.pitt.edu/finds/Housing-Revised.pdf

B. Criminal Offenders
McNiel DE, Binder RL. (2007) Effectiveness of a Mental Health Court in Reducing Criminal Recidivism and Violence.
Am J Psychiatry 164:1395-1403, September 2007 (Detailed analysis of such a court in San Francisco: statistically rigorous, but made palatable with POV case example and well written discussion section. Good biblio.) (Core journal)

2) Erickson SK. (2005) A Retrospective Examination of Outpatient Commitment in New York. Behavioral Sci and the Law 23:4, 627-45.
3) Munetz, M.R. and Griffin, P.A., “Use of the Sequential Intercept Model as an Approach to Decriminalization of People with Serious Mental Illness.” Psychiatric Services, vol. 57, no. 4, April 2006

C. Gay/Lesbian/Transgender
1)Barber M. Lesbian, Gay and Bisexual People with Severe Mental Illness. Journal of Gay and Lesbian Mental Health. 2009. 13:133-142.
2)Cochran SD, Mays VM, Sullivan JG. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003 Feb;71(1):53-61
(statistically descriptive, as title suggests: biblio points to more subjective papers)

​D. Substance Use disorders
(see above)

E. Child and Family
(1) Pumariega, A.J. et al, “Community Systems of Care for Children’s Mental Health.” In Psychline, vol. 4, no. 3, 2004
(2) ACCR Child and Family Committee , “Guidelines for Developing Resiliency and Recovery Oriented Behavioral Health Systems for Children and Families.” 2006 www.coalitionforrecovery.org

(3) Martin A, Krieg H, Esposito F, Stubbe D, Cardona L.Reduction of restraint and seclusion through collaborative problem solving: a five-year prospective inpatient study.Psychiatr Serv. 2008 Dec;59(12):1406-12.

F. Rural
(1) Willging CE, Waitzkin H, Nicdao E. Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Services in Rural Settings. Qual Health Res. 2008 Sep;18(9):1231-46.
(instant classic: sets up history of how mental health care funded in rural areas; recent changes in Medicaid; themes central to providers; a proposed model for how changes would impact providers, and a detailed case analysis of what actually is happening in New Mexico. Discussion section is broadly relevant for national debate.)
2)Shore, J.H. and Manson, S.M., “A Developmental Model for Rural Telepsychiatry.” Psychiatric Services, vol. 56, no. 8, August 2005
3) Reed, D. and Merrell, A., “Practice Styles in Rural Psychiatry” in Practicing Psychiatry in the Community: A Manual . Jerome V. Vaccaro, MD and Gordon H. Clark, Jr., MD, M.Div. (Eds.), American Psychiatric Press, Inc., Washington, DC, 1996
4) Vazquez-Barquero, J.L. et al, “The influence of sociocultural factors on the interaction between physical and mental disturbances in a rural community.” Social Psychiatry Psychiatric Epidemiology , vol. 23, 1988

G. Geriatric
Mueser KT & Jeste DV. 2008. Clinical Handbook of Schizophrenia.
New York: The Guilford Press. Ch 38: Older Individuals. 390-398.

H. Institutionalized
(1) Sharfstein SS.(2008) Textbook of Hospital Psychiatry.Arlington, VA: American Psychiatric Publishing Inc.

(2) Dixon L, Goldberg R, Iannone V, Lucksted A, Brown C, Kreyenbuhl J, Fang L, Potts W. Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatr Serv. 2009 Apr;60(4):451-8.
(3) Stahler GJ, Mennis J, Cotlar R, Baron DA. The influence of neighborhood environment on treatment continuity and rehospitalization in dually diagnosed patients discharged from acute inpatient care. Am J Psychiatry. 2009 Nov;166(11):1258-68.

2003 Jul;54(7):999-1005.Association between interruptions in medicaid coverage and use of inpatient psychiatric services.
Harman JS, Manning WG, Lurie N, Christianson JB.
2003 Jul;54(7):999-1005. http://www.ncbi.nlm.nih.gov/pubmed/12851437

1) Psychological First Aid (National Child Traumatic Stress Network/ National Center For PTSD.) Download from: http://www.nctsnet.org/nccts/nav.do?pid=typ_terr_resources_pfa
Brilliant. Includes overview of psychological response for all different age groups, very brief sample questions / scripts for different parts of the evaluation, concise checklists, and discussion of how to address death of loved ones, missing children, injury, those with substance abuse, and much more. Don't be alarmed when page count reads as 197: a quarter of these are blank or title pages, and the bulk of the remainder include lists and columns of descriptors, etc. Can easily be read in an hour.)
Free, extraordinarily useful.

2) Hoffpauir SA, Woodruff LA. Effective mental health response to catastrophic events: lessons learned from Hurricane Katrina. Fam Community Health . 2008 Jan-Mar;31(1):17-22.
(embedded in brief article is a concise summary of MH triage, checklists and recc'd tx goals for various stages of response: overlaps Psych First Aid, but decent intro to the bare bones)

(3)Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder.Lommen MJ, Restifo K.
2009 Dec;45(6):485-96. Epub 2009 Sep 24.



1. Legal/Historical Perspective
Munetz MR, Geller JL. The least restrictive alternative in the postinstitutional era. Hosp Community Psychiatry. 44: 967-973, 1993.

2. Adequacy of Community Resources to Allow for "Least Restrictive" Treatment
2(a) Geller JL, Fisher WH, Wirth-Cauchon JL et al. Second-Generation Deinstitutionalization, I: the impact of Brewster v. Dukakis on State Hospital Case Mix. Am J Psychiatry. 147:982-7, 1990.

2(b) Okin RL. Brewster v. Dukakis: developing community services through use of a consent decree. Am J Psychiatry. 141: 786-789

3. Role of Outpatient Commitment
3(a) Appelbaum PS. Thinking carefully about outpatient commitment. Psychiatr Services. 52(3): 347-50, 2001.
3(b) AACP Involuntary Outpatient Commitment. http://www.comm.psych.pitt.edu/finds/ioc.html

4. Psychiatric Advanced Directives
4(a) Srebnik D, LaFond JQ. Advance directives for mental health treatment.
Psychiatr Serv. 1999 Jul;50(7):919-25. (General introduction to topic by leading experts in field: free via PubMed)

4(b) Law & Psychiatry: psychiatric advanced directives and the treatment of committed patients. Psychiatr Services. 55(7): 751-2, 763, 2004.

4(c) Srebnik D, Russo J. Use of Psychiatric Advanced Directives During Psychiatric Crisis Events. Adm Policy Mental Health. 2008 (July 18) (Epub ahead of print)

4(d)Facilitated Psychiatric AD: A randomized trial of intervention...(Swanson, Jeffrey W et al....Am J Psychiatry 2006; 163:1943-1951)

4(e )Consistency of Psychiatric Crisis Care with AD Instructions (Srebnik, Russo...Pyschiatric Services 9/2007 vol 58 No. 9)

4(f) Effect of Joint crisis plans on use of compulsory treatment in psychiatry: Henderson, C. et al...BMJ 2004; 329; 136 (may be able to download from bmj.com .

4(g) **Campbell LA** , **Kisely SR** . Advance treatment directives for people with severe mental illness. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005963.

B. Use of Coercion
1 Stanhope V et al. The impact of coercion on services from the perspective of mental health care consumers with co-occurring disorders. Psychiatric Services. 2009. 60(2):183-188.

Crook, G.M. and Oei, T.P.S., “Review of Systematic and Quantifiable Methods of Estimating the Needs of a Community for Alcohol Treatment Services” Journal of Substance Abuse Treatment , vol. 15, no. 4, 1998
Hermann, R.C. and Provost, S ., “Interpreting Measurement Data for Quality Improvement: Standards, Means, Norms, and Benchmarks.” Psychiatric Services, vol. 54, no. 5, May 2003
Holcomb, W.R., et al , “Customer Satisfaction and Self-Reported Treatment Outcomes Among Psychiatric Patients.” Psychiatric Services, vol. 49, no. 7, July 1998
Smith, G.R., et al, “Principles for Assessment of Patient Outcomes in Mental Health Care.” Psychiatric Services, vol. 48, no. 8, Aug. 1997
Kramer, T.L. and Smith, G.R., “Behavioral Health Outcomes.” Ch. 13 in Talbott, J.A. and Hale, R.E. (Eds.), Textbook of Administrative Psychiatry . Second Edition. American Psychiatric Press, Inc., Washington, DC, 2001


1. Cognitive-Behavioral Therapy for Psychosis
1(a) Turkington D, Kingdon D, Weiden Pj (2006) Cognitive behavior therapy for schizophrenia. Am J Psychiatry 163: 365-373. 1(b) Valmaggia LR et al (2005) Cognitive-behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. British Journal of Psychiatry 186: 324-330.

2. Motivation Enhancement Therapy
(see above)

3. Family Psychotherapy
3(a) Dixon L, McFarlane WR, Lefley H et al. Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services. 2001 Jul;52(7):903-10.

3(b) Mueser KT, Glynn SM. Family intervention for schizophrenia, in Best Practice: Developing and Promoting Empirically Supprted Interventions. Edited by Dobson KS, Craig KE. Newbury Park, CA. 1998. 157-186.

3(c) McFarlane WF, Lukens E, Link B et al. Multiple family groups and psychoeducation in the treatment of schizophrenia. Archives of General Psychiatry.1995. 52: 679-687.
Cohen, A.N., et. al ., “The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness” Psychiatric Services , vol. 59, no. 1, Jan. 2008
McFarlane, W.R., and Cunningham, K ., “Multiple-Family Groups and Psychoeducation: Creating Therapeutic Social Networks” in Practicing Psychiatry in the Community: A Manual , Jerome W. Vaccaro, MD, and Gordon H. Clark, Jr., MD (Eds.), American Psychiatric Press, Inc., Washington, DC 1996
Heru, A.M ., “Family Psychiatry: From Research to Practice.” American J. of Psychiatry, vol. 163, no. 6, June 2006

4. Supportive Psychotherapy
Stanton AH, Gunderson JG, Knapp PH et al: (1984) Effects of psychotherapy in schizophrenia I: designed implementation of a controlled study. Schizophrenia Bulletin. 10: 520-563.

1. Jared R. Adams, B.S., Robert E. Drake, M.D., Ph.D. and George L. Wolford, Ph.D. Shared Decision-Making Preferences of People With Severe Mental Illness Psychiatr Serv 58:1219-1221, September 2007

1(a) Lieberman JA et al (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. NEJM. 353: 1209-1223. (classic paper on subject; core journal)

1(b) Stroup MS et al. (2007) Effects of antipsychotic medications on psychosocial functioning with chronic schizophrenia: Findings from the NIMH CATIE study. Am J Psychiatry 164: 428-436.

1(c) McEvoy JP et al (2006) Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 163: 600-610.

2(a) Lehman AF, Lieberman JA, Dixon LB et al. (2004) Practice guideline for the treatment of patients with schizophrenia (2nd ed) Am J Psychiatry. 161: 1-56.

2 (b) Garety P, Craig T, et al.
Specialised care for early psychosis: symptoms, social functioning and patient satisfaction
The British Journal of Psychiatry// (2006) 188: 37-45.
(Randomized control trial including tx per usual versus a specialized ACT team with enhanced family / vocational / CBT components, which are described in separate article in more detail. F/up was 18 months with a range of measures included. Good analysis on depth of markers, with useful sources cited. Core journal)

2(c) Lieberman JA, Tollefson G, Tohen M et al. (2003) Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine vs haloperidol. Am J Psychiatry. 160: 1396-1404.

3. Clozapine
McEvoy JP et al (2006) Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 163: 600-610.

CRITERIA FOR SOURCES (Attempts have been made to identify sources which are:)
Evidence Based
Comprehensive Review Articles
Free from Commercial Bias
Accessible to Community and Public Psychiatrists
Classic or Groundbreaking Publications
High Impact

The following process was used in the development of certification process.
1. Engage with key stakeholders and beneficiaries :

  • Consumers and families will identify psychiatrists whose practice is systems based, recovery oriented, family collaborative and evidence based
  • AACP AACP website

  • This process and feedback has been shared with the AACP membership through listserv and meetings
  • AACP: Committee on Scholarship and Training has goal of certification
  • Public Psychiatry Fellowship Directors and Trainees
  • Other post residency training programs (eg PLDP, AACP Mentorship, APA program)
  • Public psychiatry graduates may benefit from validation of education
  • NAMI

2.Facilitate that stakeholders are involved in the plan:
  • Highlight the mutual benefit of certification to stakeholders
  • Emphasize importance of stakeholders input in process of development through team approach
  • Liason closely with AACP: Committee on Scholarship and Training through role of committee as home for developing long term strategies and work group as labor force to carry out plans of committee
  • Facilitate process of communication between the AACP: Committee on Scholarship and Training and work group through formal meetings and informal communication
  • Meet with program directors of public and community psychiatry fellowships.

3. Develop Knowledge Domains for exam content
  • Utilize AACP: Guidelines on Public Psychiatry Fellowships

  • Consider unique content and skills associated with effectiveness in field
  • Identify key source content for material: eg Gillig and McQuistion Clinical Guide to the Treatment of The Mentally Ill Homeless Person, CATIE Studies etc
  • Develop and utilize explicit criteria in identifying sources

4. Develop Pathways for Certification are inclusive for early career psychiatrists and experienced community and public psychiatrists. Criteria include a combination of education, experience and exam score.

  • Graduates of ACGME accredited Residency Programs in Psychiatry
  • Graduates of Formal Community-Public Psychiatry Fellowships
  • Psychiatrists with years of experience serving as psychiatrists in community or public settings.

5. Question item and validation process was created

  • Identify and enlist individuals experienced in exam creation and validation
  • Enlist wider membership for question contribution
  • Exam questions which are rigorous enough to result in valid exam and not overly exclusionary
  • Enlist editors who are experts in community psychiatry to edit and develop exam items

List of Editors of Question Items:

David Pollack
Paula Panzer
Margaret Balfour
Curtis Adams
Michael Flaum
Walter Rush
Russell Lim
Ken Minkov
Peter Chien
Maggie Bennington Davis
Mark Ragins
Beatrice Kovascny
Michael Compton
Jeffrey Geller
Patrick Runnels
Erik Vanderlip
Wes Sowers
Warachel Faison
Charlotte Hutton
Michelle Clark
Suzanne Vogel Scibilia
Stephen Goldfinger
Ryan Bell
Brinda Krishnan
Stephanie LeMelle
Tony Carino
Julie Ranz
Dick Christensen

Ken Thompson

6. An exam pilot was developed to identify empirically valid items for a finalized exam. The pilot exam process and results are as follows:
Methods: The scholarship and training committee of the AACP board of directors contacted experts in the field to write questions in each of 10 domains in community psychiatry. 37 experts developed 259 questions which were revised according to guidelines established in the field of psychometrics as well as for clarity. The exam was then piloted with 73 examinees consisting of 25 experts, 36 early career community psychiatrists, and 12 PGY4 residents who were contacted through AACP and public psychiatry fellowship alumni list serves as well as residency training directors. The test was uploaded on an online platform and made available to examinees through a secure link. Test statistics based on classical test theory were used to determine (1) how well the item discriminated between experts and PGY4 residents as well as high and low achieving early career psychiatrists and (2) the difficulty of the items for the entire sample as well as each group of examinees. The internal structure of the test was evaluated using factor analysis, and internal reliability was assessed with Cronbachs alpha. A passing score was decided upon using the Contrasting Group method (Nedelsy, 1954) to determine the intersecting point between the three groups' performance.
Results: Each item was reviewed to determine its functioning. Items whose difficulty statistic fell at or below chance level (.25) or greater than .90 were eliminated, and items that poorly discriminated between experts and PGY4 residents or within the candidate group were eliminated. Overall 124 items were discarded leaving 135 items. An ANOVA demonstrated the performance of the three groups was different [F (4, 300) = 27.404, p<0.001] with experts and early career psychiatrists performing better than PGY4 residents. The factor analysis did not reveal a discernible internal structure of the test. Reliability was satisfactory (alpha=.88). All of the members of the expert group passed, as did 67% of the early career psychiatrists. In the PGY4 group 33% passed.
Conclusions: These results suggest public psychiatrists have skills and knowledge distinct from novices. It is concerning that the factor analysis did not reveal internal structure to the test in a way that is congruent with the 10 domains in community psychiatry. Test development is inherently iterative and additional field tests are needed with more examinees representing the plurality of psychiatry to fully establish the test's validity.

7. The pilot exam results were reviewed with the board and the AACP scholarship and training committee. Only those empirically valid items were used for the final exam.

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