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• Dr Sandra Fisman MB ;BCh; FRCPC; Masters PLDP, CAP Founder Status

Dr Sandra Fisman MB ;BCh; FRCPC; Masters PLDP, CAP Founder Status

Professor, Senate stream

Consultant Child and Youth Psychiatrist, Child & Adolescent Ambulatory Mental Health Care Program, Children’s Hospital/LHSC

	Med School:	University of Witwatersrand, Johannesburg
	Residency	Queens and Western (UWO)
	Additional Training:	Harvard Macy Leadership Training Program Rotman School of Business Program; Crucial Conversations and Crucial Confrontations training and subsequently taught Crucial Conversations and Crucial Confrontations to hospital senior leaders; Quality Improvement, using 6-Sigma methodology, at GE in Wisconsin 2010/2011, OMA-Schulich York Masters Physician Leadership Program (PLP); recent invitation from OMA president, Dr Rose Zacharias, to participate in 2023/2024 PLP as a teaching faculty.
	Clinical Area of Expertise:	Child and youth psychiatry, CAP psycho-pharmacology, Physician leadership and administration, Narrative therapy method.

Profile

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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 became 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 extended over a decade and established the impact of this stress on maternal mental health and secondarily on the spousal/marital relationship. In addition, with longitudinal follow up of siblings, we found a 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 Hospital/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 was relocated to Children’s Hospital in 2011. It is the central hub for education and training in Child and Youth Psychiatry, integrated with the other affiliated training sites at CPRI and Vanier Children's Service as well as FEMAP. This is of paramount importance to the 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, including telephone consultation 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 during those years 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/Chief of the Department of Psychiatry SSM&D, University of Western Ontario (Western University) and Chief of the London Hospitals Mental Health Services. That decade was 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. It required collaborative work 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 addition the voice of recipients of healthcare is increasingly important.

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 led , consisted of three RNs and a part-time social worker, became 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 had the intended result of building community capacity.

After completing two terms as Chair/Chief for Psychiatry, I re-immersed myself in Child and Adolescent Mental Health. As the Academic Chair of the Division of Child and Adolescent Psychiatry (DCAP) 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. 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 continued as a nucleus member of the Royal College CAP Specialty Committee, representing Ontario Region 3, and was a participant in the design of CBD for CAP Subspecialty. I have continued as Vice-chair of the RCPSC CAP Subspecialty Committee.

I was also committed to moving the Research agenda forward for the DCAP. In terms of my own recent research, I was Principle Co-Investigator in the development of a youth suicide ideation scale: Brief Adolescent Suicide Ideation Scale (BASIS) and we 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 completed a DBT longitudinal outcome study.

Provincially I have been a member of the Associated Medical Services (AMS)Provincial Management Committee (PMC) since 2012 and from 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 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). Following an external review requested by the AMS Board, the focus of the AMS Phoenix Program shifted to the integration of healthcare technology with compassionate care. I was tasked with chairing a Fellowship Transition Work Group to develop Terms of Reference for a Transition Fund. The strategic direction for AMS Phoenix is currently focused on the integration of Compassionate Care and Healthcare Technology. I continue to be an invited panel member for review of applicants to the AMS Fellowship in Compassion and Artificial Intelligence/Digital Technology (most recent call in January 2023).