Who Are the Clients in the Adult Outpatient Program(s) ?

If you are in training with us, you will see clients in the four different programs that operate under the umbrella of Adult Services. Services in all three programs are funded by a contract with the L. A. County Department of Mental Health (DMH). The clients are funded by Medi-Cal ( California 's Medicaid program).

• Adult Outpatient Program clients represent a broad range of diagnoses and levels of functioning. They include the seriously and chronically mentally ill, including those with psychotic spectrum disorders and the more severe mood disorders. Other clients suffer from a major anxiety disorder or depression. Many clients present with a mixture of symptoms and more than one diagnosis.
• Skills Building Institute clients are treated via a psychoeducational treatment model. Clients can choose from several groups throughout the week designed to increase interpersonal and coping skills of activities of daily living. Specific offerings vary throughout the year but are likely to include topics such as interpersonal communications, problem solving, etiquette, stress management/reduction, money management, hygiene, and healthy living. Several support/process groups offer the clients the opportunity to enhance social skills. Several of our innovative groups have drawn upon feature films, television, and a plethora of literary works, spanning from Mythology to Classical American literature, to teach important life and interpersonal skills.
• Dual Diagnosis Program clients carry diagnoses of both mental illness (of various severities) and substance abuse.
• CalWORKS clients have been on welfare and are required to receive mental health services to reduce the emotional barriers that stand in the way of their entering, or returning to the work force. The clients, usually higher functioning than those in the other two programs, are referred from the L. A. County Department of Personal Social Services (DPSS).

Except in the CalWORKS program, most clients are self-referred, though a small number ofclients are court referred.

The ethnic mix : The clients are primarily Caucasian, including many who are Armenian (Glendale has a large Armenian population). Other Caucasian and non-Caucasian ethnicities (Mexican-American, Korean, etc.) are represented to a lesser extent. To the extent that we have the personnel to do it, we provide services to non-English speaking clients in their native languages.

Program Philosophies

The services offered in the Adult Outpatient Program derive from its philosophy, which is the psychosocial rehabilitation model of working with individuals who suffer from serious and persistent mental illness. This model does not aim for "cure" or remediation of the underlying causes of clients' problems, since in many cases there is a significant biological component to their condition. Instead, the purpose of the work is to help clients make the most of their lives by developing their skills. The work is client-centered in that the focus is on the client's own goals. There is an emphasis on building on client strengths, on integration into the community, and help with practical needs such as obtaining community services such as Social Security Disability Insurance. There is also recognition of the need to work with clients' families: to help them to help the client, and, for themselves, to learn how to live as well as possible with a persistently mentally ill family member.

Dual Diagnosis Program: The philosophy is to treat both aspects of the dual disorders conjointly to substantially improve both conditions and enhance the clients' lives. The goal would be to engage the client to become partners in the recovery process and for them to recognize that sobriety and stability are life- long processes.

CalWORKS : The treatment philosophy is to provide effective programs and treatment in a warm, caring, and professional environment that respects the individual needs of each client, is culturally sensitive, and assists each person to achieve positive results. The goal is to help people move beyond survival to success, as we teach people how to cope with life challenges.

What Services Do We Offer Clients?

 A range of services is available to clients; what services the client receives depends largely upon the individual client's goals and in which program the client is participating.

Intake-evaluation interviews : functional assessment (of strengths, skills, capacities, etc.). A functional assessment is an appraisal of an individual's ability to function personally and in his or her community, including their family. It involves identifying the person's strengths and resources as well as the impairments that limit his or her functioning.

Crisis intervention/case coordination (including referrals for services the program cannot provide, such as longer-term individual psychotherapy. Referrals are also made for social services, housing, etc.) Crisis intervention is oriented primarily toward helping clients mobilize their resources and strengths to deal with the specific crisis situation. Since clients in this program are subject to recurring crises, therapists should expect individual contact with some clients to be episodic rather than continuous. You are also offered the opportunity to shadow staff members who are involved in handling crises and to participate in the process along with them.

Short-term, solution-focused individual therapy. Individual therapy is for the purpose of helping clients solve specific problems, work toward their goals, and develop relapse prevention plans.

Group and conjoint therapy. Group therapy is a major mode of working with the clientele of this program. Some groups are process oriented, while the focus of others is structured, psycho-educational skills building. Still other groups engage the clients in creative activities. There are also groups for symptom management, anxiety reduction and dealing with depression.

Clubhouse. The Adult Outpatient Program clubhouse is distinct from the VMH Arden House Day Rehabilitation Program clubhouse model which is a day rehabilitation program. There are two clubhouses, differentiated by functioning level. Clubhouse programs comprise a number of skills-building activities, group and individual support.

Collateral contacts with family members or other significant support figures in the client's life. Collateral contacts with family members are encouraged as a means of helping the family understand the nature of the client's illness and the client's specific problems in coping. Contacts with the family can be helpful to the issues between the client and family members that stand in the way of the client's rehabilitation.

Psychological testing. Psychological testing may be incorporated into functional assessments of clients. Psychology students and postdoctoral psychologists conduct the psychological assessments.

Medication Services. Most clients in the program are receiving medication services, either as their sole treatment or in conjunction with the psychosocial services they are engaged in. Services include evaluation for medication, prescription and monitoring of medications, and consultation with staff (including trainees and interns) regarding client medications. The medical staff welcomes collaboration with trainees and interns and their input about how clients are responding to their medications. You are also invited to sit in on the psychiatrists' meetings with clients if time is available.

Dual Diagnosis Program

In addition to the services listed below, personnel in this program are responsible for the training and education of the Adult Outpatient Program staff (including trainees and interns) in the diagnosis and treatment of dually diagnosed clients. Clients are accepted into the program only if they indicate some willingness to address substance abuse issues. Clients are referred from intake or when they are already receiving mental health services.

Individual time-limited therapy. The goal of the therapy is to develop and monitor an individualized relapse prevention plan around the client's dual recovery concerns. Aspects of 12-step programs are explored and clients are encouraged to attend Dual Recovery Anonymous groups for additional support.

Group therapy (There are three groups: Early Recovery for those working toward sobriety, Relapse Prevention group, and a women's group).

Prescribing and monitoring of psychotropic medications.

CalWORKS
Clients who qualify for CalWorks services may participate the following services:

• Individual counseling
• Crisis Intervention
• Couples therapy
• Family counseling
• Group therapy
• Medication services

Track II (Consumer Empowerment) Program

An extension of Adult Outpatient Program services, the Track II program offers an array ofconsumer groups aimed at expanding upon individual strengths and fostering self-explorationthrough creative expression. Individuals can choose which activities suit their needs, offer to provide services to others (i.e., if they have a special skill or talent), or help to organize events and activities. The program is available to Adult Outpatient Program clients via referral from their case coordinators.

Writing and Performing

Verdugo staff lead a therapeutic creative writing group that has produced a number of issues of a client-written newsletter, "The Word Pecker" and a professionally printedbook, "Our Stories," for which adult clients each wrote something about their lives. "Our Stories" is published by VMH.

Goals of the Training Program 

• To develop skills in the following areas: psychosocial rehabilitation, plan development; linking clients with outside resources; dia gnosis; functional assessment; crisis intervention; group therapy; and family support and therapy.
• To provide experience with clients who suffer from schizophrenia, bi-polar disorder, major depression, and severe anxiety disorders.
• To teach students the principles of collaboration and consultation in a multidisciplinary team.
• To help trainees and interns gain an understanding of, and experience with, political, legal, ethical, cultural and personal issues as they affect the functioning of professionals in a community mental health center.
• To help trainees and interns, through supervision, to understand themselves, including their strengths and weaknesses as professionals, and to provide guidance and support for their personal and professional development.
• To enhance students' theoretical and applied knowledge and skills through didactic in-service programs and weekly seminars.
• To contribute to students' understanding of professional issues, including the ethical norms and the laws governing their profession.
• To provide students with a variety of competent and ethical professional role models.

Theoretical Orientation

Adult Outpatient Program emphasizes the psychosocial rehabilitation model where the focus is on an individual's strengths instead of their weaknesses and pathology. The goal of this model is to help restore each person's ability for independent living, socialization, and effective life management. Behavioral, cognitive, and other appropriate therapeutic modalities are used when indicated. Supervisors vary in their theoretical orientations and can offer case conceptualization from their respective perspectives.

Dual Diagnosis Program also applies the psychosocial rehabilitation model but supplements it with approaches appropriate for the treatment of substance abuse, including motivational interviewing.

CalWORKS does not use a single theoretical orientation. The emphasis is on using the treatment modality that best fits the presenting problem and the client's goals.

Training Period, Time Commitment, and Vacations

Training Period:

Psychology practicum students and interns : training begins Wednesday, September 3, 2008 and ends Friday, August 21, 2009 .

MFT trainees and interns : the training period is stipulated in individual training contracts.

Social work interns : the training period coincides with the beginning and ending of their respective school years.

Vacation : No more than two weeks of vacation may be taken at any one time, and no vacation may be taken in the last month of training. Supervisors and the program director must approve all vacation requests so that there are a sufficient number of trainee/interns to carry on the program's work at all times.

Required Days, Meetings, and Seminars

Required day : Wednesday

Required hours : 9:00 a.m. - 5:00 p.m.

Required Meeting : Staff meeting: Wednesday, 9:00-9:50 a.m.

Required training : Adult Services Training Seminar : 10:00 - 11:30 a.m.

The seminar presents staff and outside speakers on topics related to working with the seriously mentally ill, including assessment and diagnosis, crisis intervention, group therapy, and community resources.

Required Supervision

All supervision meets at least the basic requirements of the academic institutions from which trainees and interns are drawn. For interns accruing hours for licensing, the supervision at least meets, and usually exceeds, the requirements of the Board of Psychology and the National Register of Health Service Providers in Psychology (for psychology interns) and the Board of Behavioral Science (for MFT interns and trainees and social work interns).

MFT Interns
Individual 1 hour Licensed or registered psychologist. Group 2 hour Licensed MFT, licensed psychologist, or registered psychologist

Psychology Practicum Students
Individual 1 hour Licensed or registered psychologist. Group 1½ hours Licensed or registered psychologist, licensed clinical social worker or licensed MFT

Psychology Interns
Individual 2 hours Licensed psychologists. Group 1 or 1½ hrs. Licensed or registered psychologist.

Social Work Interns
Individual 1 hour LCSW. Group 1 or 1½ hrs. Licensed or registered psychologist.

Supervision groups comprise no more than six members and are devoted entirely to the presentation of cases and the discussion of clinical and professional issues that the cases raise.

Staff Meeting

The 9:00 a.m. Wednesday Adult Outpatient Program meeting deals with administrative matters, clinical issues of interest to the group, and case presentations by trainees/interns.

A Typical Training Week for Trainees/Interns

These hours are the minimum requirement. From time to time it may be necessary to spend additional hours doing paper work, consulting informally with other staff members, and dealing with crises that require face-to-face or telephone contact with the client and consultation with supervisors. Trainees and interns are expected to be flexible in regard to spending additional hours that may be reasonably required from time to time. There is no on-call responsibilityoutside of clinic hours.

Stipend

None of the training positions carries a stipend or any other form of remuneration.

Accreditation

This internship has been approved for internship training by the California Association of Psychology Internship Centers (CAPIC).

Footnotes

1 Direct service activity in a typical week would include:

Psychology and MFT Interns : co-lead 2-3 groups; an intake-evaluation every other week; an average of 6 hours of individual/family contact for enhancing problem solving skills, case coordination, family consultation, crisis intervention, etc.
MFT trainees and psychology practicum students : co-lead 1-2 groups; one intake-evaluation per month; 4-5 contact hours with clients and family members for case coordination, crisis intervention, etc.

2 Two meetings a month are dedicated to case presentations by interns.

Should you have any questions about Adult Services or the training program, you may call Dr. Friedlander at (818) 244-7257.