Training Sites
Training Sites
Below are the details of the main rotation sites for the fellowship program. This list does not include elective opportunities in San Antonio as those sites are considered optional rotations and would vary based on the fellow’s interests.
UT Health San Antonio (UTHSA) is the sponsor site and the primary central location for the program, where the fellows will have an office location to finish working on evaluations. UTHSA is also a primary rotation site for doing court ordered evaluations on Monday.
On Tuesday, the fellows will have supplemental didactics discussing various forensic topics and group case rounds. In addition, the fellows will dedicate time to pursuing scholarly and quality improvement projects. Lastly, they will have a landmark forensic case seminar. The fellows will teach residents and medical students about forensic psychiatry throughout the program. The fellows will each have one hour for individual preceptorship during the week which can vary based on the fellows’ schedule and are typically during the Monday court ordered evaluations. For one half day weekly on Friday morning, the fellows will attend virtual Texas-wide case rounds and didactics.
CHCS is the local mental health authority for Bexar County (San Antonio) and has many programs that interact with the legal system. These include court-ordered treatment for NGRI aquitees, Out-patient Competency Restoration (OCR), Jail-Based Competency Restoration (JBCR), pretrial defendants who present for treatment, and patients in the mental health or substance use specialty courts.
At CHCS, the fellow will learn how to perform Certification of Medical Examinations (CME’s) for individuals on court ordered treatment. Often these evaluations will need testimony before the Magistrate Judge. This is the same court who oversees incompetent defendants and will provide ample exposure and practice to testimony. It is expected that the fellow be sworn in as an expert in psychiatry in this county before completing the fellowship.
In addition, the fellow may also preform competency evaluations for defendants in the OCR and JBCR programs.
At Hill Country MHDD Centers they are the local mental health authority for a wide catchment area to the north of Bexar County. With 22 locations, including 15 mental health clinics we serve a population of approximately 816,000 within a 22,714 square mile area.
The fellow will perform virtual evaluations for a variety of purposes to include, Assisted Outpatient Treatment (AOT), Court-ordered medication over objection, and may have additional competency cases at Jail-based competency programs in the surrounding area.
The forensic psychiatry fellows receive training regarding the clinical management of detainees in a jail setting at the Bexar County Adult Detention Center (BCADC). For six months, the fellows will provide longitudinal treatment to detainees one half-day per week. The treatment will include new intakes to the detention center and psychiatric patients in the general population. The fellow will continue to follow the patients on whom they perform an initial psychiatric evaluation.
Fellows will provide medication management for inmates who are referred for psychiatric evaluations. The fellows will have indirect supervision initially in order to orient the fellows into the jail system. By the end of the rotation, the fellows will demonstrate progression in their clinical skills to have the supervisor provide oversight for the fellow working in a correctional facility.
At the JDC the fellow will evaluate juvenile defendants for their competency to proceed. The fellow will work alongside psychologists to learn about different psychological testing given to juvenile defendants.
If the fellow has completed a child and adolescent psychiatry (CAP) fellowship prior to the start of this program, the Jail Psychiatric Services treatment rotation will be changed from the BCADC to the JDC. The fellow will also perform more child and adolescent forensic cases within the juvenile justice system that include minors under the age of 14.
The forensic psychiatry fellows will provide forensic consultation and evaluations of forensic patients admitted to San Antonio State Hospital (SASH) one day every other week for 12 months. Fellows will be assigned competency to stand trial evaluations, criminal responsibility evaluations, will learn the use of psychological and neuropsychological instruments in forensic evaluations. Fellows will learn to administer, score, interpret and summarize relevant tests and assessment instruments to assess malingering, violence risk assessments, and future sexual recidivism. The fellows will also provide consultation and participate in a clinical review to determine treatment over objection. The fellows will provide consultation to forensic hospital treatment teams to provide risk assessment and treatment recommendations to manage barriers to release.
The forensic psychiatry fellows will provide forensic consultation and evaluations of forensic patients admitted to Kerrville State Hospital (KSH) one day every other week for 12 months.
Fellows will be assigned will learn the use of psychological and neuropsychological instruments in forensic evaluations. Fellows will learn to administer, score, interpret and summarize relevant tests and assessment instruments to assess malingering, violence risk assessments, and future sexual recidivism. The fellows will have the unique experience with the risk assessments for NGRI community transition and evaluations for maximum security patients.
The fellows will rotate with faculty currently practicing forensic psychiatry in a private practice setting. They will spend two-hours every week to observe and participate in private practice cases. They will alternate between currently practicing forensic psychiatrists who have active civil cases. Fellows will be provided mentorship in the transition to independent forensic practice. Fellows will discuss active cases and observe depositions or testimony as they occur. Fellows will prepare parallel reports and discuss essential elements of a well-supported opinion for commonly encountered civil forensic issues. Evaluations may include topics such as: personal injury litigation, psychiatric disability determinations, psychiatric malpractice, guardianship, and testamentary capacity.
The fellows will have the opportunity to audit a law school course at St. Mary’s during their fellowship. They will also participate in teaching student lawyers on a psychology of persuasion enrichment course.