Rotations

Our four clinical sites are:

• University Hospital (UH)
• Veterans Affairs Healthcare System (VA)
• Rutgers University Behavioral Health Care (UBHC)
• Center of Excellence (COE)
  

There are a variety of clinical experiences at each site, ranging from outpatient to inpatient to consultation services. You will have your continuity clinic in the Lighthouse, an outpatient clinic on E-level in the BSHB building in Newark.

University Hospital:

Addiction Consultation Service at UH:

Consultations involving patients with addiction will be assigned to the addiction medicine fellow, who will perform initial and follow-up evaluations and discuss recommendations directly with the primary team. Clinical work will include detoxification, induction of medication-assisted treatment for opioid use disorders, prescribing of anti-craving medications, bedside motivational interviewing and SBIRT, and connection to appropriate aftercare services. The majority of the patients at UH are socioeconomically disadvantaged and have significant psychosocial stressors. There is a high rate of co-occurring psychiatric disorders and many patients suffer from multiple substance use disorders (although opioids are the most predominant substance).  Service Attendings come from diverse specialties including Psychiatry, Internal Medicine, Emergency Medicine and Ob/Gyn.  Our consult fellow will round with residents, students and Community Coordinators; thus this role involves a significant amount of teaching and collaborating with a multidisciplinary team

Lighthouse (Continuity Clinic):

This clinic serves as a year-long continuity clinic and provides a longitudinal outpatient experience for the fellow. This is a low-barrier clinic and insurance is not required. Patients assigned in this clinic will have a broad range of substance use disorders; psychiatric services are available if needed.

Veterans Affairs Health Care System: 

(EO = East Orange campus (green color), Lyons = Lyons campus (orange color). SARTP = Substance Abuse Rehabilitation Program. DCHV =Domiciliary Care for Homeless Veterans. SARTP has both an inpatient residential and outpatient component, and DCHV is inpatient residential. There will be occasional inpatient consultations when the fellow is on-site at EO.)

Inpatient Addiction Services at the VA:

Fellows will rotate on two campuses for an inpatient addiction treatment experience. 

At the Lyons campus, the fellow will spend Monday at the Domiciliary Care for Homeless Veterans (DCHV) under the supervision of Dr. Edward Phinney. Fellows will work specifically with patients with SUD. They will perform intake evaluations and follow-up visits, and gain experience with both buprenorphine and XR-naltrexone prescribing. They will see patients with SUD in a variety of specialized programs on the Lyons campus, such as the residential PTSD program and the residential women's treatment unit. The fellow will co-lead an SUD group with the supervisor.

At the East Orange campus, the fellow will perform evaluations and follow-up visits at the inpatient SARTP (Substance Abuse Rehabilitation Treatment Program), an inpatient rehabilitation program. Some patients on this unit have co-occurring psychiatric disorders, which fellows will manage as well.

The fellow will also perform addiction consultations for the medical/surgical units, mostly to treat patients who are withdrawing and require detoxification from opioids, benzodiazepines and alcohol. 

Outpatient Addiction Services at the VA:

Fellows will spend Thurs/Fri all day and half-day on Tues/Wed at the East Orange campus. They will rotate through the Methadone Clinic and the outpatient SARTP (Substance Abuse Rehabilitation Treatment Program), a partial hospitalization program with individual and group programming for patients with SUD (and some with co-occurring psychiatric disorders).

The fellow will perform intake evaluations and follow-up visits. They will manage methadone/buprenorphine induction, initiation of XR-naltrexone, detoxification for opioids/benzodiazepines/alcohol, address other aspects of SUD, and manage co-occurring psychiatric disorders.  The East Orange VA has a unique Wellness Clinic where complementary and alternative medicine modalities such as acupuncture, massage, and yoga are employed to assist in treating patients. The patients are Veterans, mostly male, and with a range of socioeconomic statuses and ethnicities.

The fellow will also perform consultations to inpatient services while at East Orange (see rotation "Inpatient Addiction Services at the VA" for more information).

Rutgers University Behavioral Healthcare:

(NB = New Brunswick campus (purple), Newark = Newark campus (blue). Amb Detox = Ambulatory Withdrawal Management Program. SATS = Specialized Addiction Treatment Services. PHP = Partial Hospitalization Program. UCHC = University Correctional HealthCare. There will be occasional inpatient consultations when the fellow is on-site at NB.)

UBHC Addiction Services

Fellows will spend Mon/Thurs/Fri at the New Brunswick campus and a half-day on Tues/Wed at the Newark campus.

At the New Brunswick campus, the fellows will rotate through the Ambulatory Withdrawal Management Program in the mornings from approximately 9-11am. This program will provide ambulatory detoxification from opioids (when indicated) and other substances. Fellows will then spend the rest of the day at the SATS program (Specialized Addiction Treatment Services), which is an IOP and OP level program that serves patients with co-occurring SUD and psychiatric disorders. They will perform intake evaluations and follow-up visits, manage anti-craving and maintenance medication for SUDs, and manage psychiatric medications. They will lead or co-lead group therapy sessions and work within a multidisciplinary team. This patient population has a broad range of functioning, with varying diagnoses and varying levels of socioeconomic status and includes pediatric and adolescent patients. Fellows will also perform occasional consultations for initiating buprenorphine on the psychiatric inpatient service at Robert Wood Johnson University Hospital New Brunswick. 

At the Newark campus, the fellows will see patients within the Partial Hospitalization Program (PHP), which runs Monday - Friday from 8:30am – 3:30pm. All patients in this program carry a primary psychiatric diagnosis and the fellow will see patients with co-occurring SUD. They will assess patients regarding their SUD and refer to a higher level of care when appropriate, as well as prescribe anti-craving medications and initiate/manage medication-assisted therapy. 

UCHC Addiction Services

 Fellows will spend one day per week at University Correctional HealthCare (UCHC) during the UBHC rotation. UCHC is a division of UBHC that provides medical and psychiatric care to inmates at correctional facilities. Fellows will have an opportunity to rotate at Northern State Prison in Newark and the Edna Mahan Correctional Facility for Women in Union Township. At both sites, they will focus on treating patients with SUD and working within an interdisciplinary correctional team.

Center of Excellence:

(CARE = Comprehensive Addiction Resources & Education.)

CARE Center

F-Level, Behavioral Health Sciences Building (BHSB), 183 South Orange Ave

The CARE Center (Comprehensive Addiction Resources & Education) is our multidisciplinary clinic focusing on MOUD (Medication for Opioid Use Disorder). Here's a great article about us that was published in USA Today in May 2019! Dr. Gordon is the medical director.  We have a clinic manager, an APN, a social worker, a pharmacist, 4 community coordinators, and 2 secretaries. We accept all patients with opioid use disorder regardless of ability to pay, and we are supported by several grants which enable us to be innovative in our care and to pay for medications for uninsured patients. We focus most on patients with high needs such as those who are unhoused and have significant deficits in their social determinants of health.

Healthy Beginnings (Obstetrics/Gynecology):

This clinic provides combined prenatal care and addiction medicine treatment for pregnant patients with SUDs. The clinic is directed by Drs. Campbell and Roche, who are dual-certified in obstetrics and gynecology and addiction medicine. They will work alongside the fellows and provide direct supervision. The clinic is also supported by a social worker and a certified addiction counselor who work closely with the physicians to provide comprehensive care. Fellows will provide intake assessments and follow-up visits for patients attending the clinic and will utilize pharmacotherapy when appropriate to address SUDs. There will also be occasional inpatient addiction medicine consultations to the labor and delivery, postpartum and gynecology inpatient services at UH.  Fellows may also see patients under the supervision of a third faculty member, Dr Bernadette Cracchiolo, a gynecologic oncologist who is board certified in addiction medicine. 

The Wellness Center (Primary Care):

This is a buprenorphine clinic embedded within the Primary Care Clinic at University Hospital. Referrals come primarily from subspecialty clinics, such as the Healthy Heart Clinic, a federally funded interdisciplinary clinic for patients with congestive heart failure, also located on F level. This clinic serves a disadvantaged inner-city population with high recidivism and poor health literacy. Drs. Gordon, Matassa, and Walsh are internists who run the clinic. You may have the opportunity to teach and oversee Medicine residents and students who are assigned to this clinic.

Restore Center (Infectious Disease):

  
Fellows will rotate through the Infectious Disease (ID) clinic on Thursday mornings at UH. The clinic has multiple attendings who are waivered to prescribe buprenorphine, and they have built up a large cohort of patients with HIV who are maintained on buprenorphine. They have shown impressive reductions in viral loads in their buprenorphine-maintained patients, and they are working on expanding this part of the clinic further by applying for several grants. Fellows will join the multidisciplinary team of social workers, case managers and nurses to help manage these buprenorphine patients and they will evaluate and treat SUD in other patients in the clinic.

In addition, the ID clinic has also begun a program for transgendered patients, and Dr. Dalla Piazza provides hormone therapy for these patients both pre-op and post-op. There is a very high rate of co-occurring SUD in this population, so the fellow will be able to assist in addressing the SUDs specifically.

This clinic is part of UH and serves an inner-city population, most of whom are significantly socioeconomically disadvantaged and who represent a broad range of cultures and ethnicities.  A unique feature of the ID clinic is their special Ryan White funding which allows them to provide excellent care to patients who are unable to obtain insurance or charity care.