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PROGRESS REPORT
MENTAL HEALTH SERVICES ACT (MHSA) PROJECT
FISCAL YEARS 2008/09 – 2010/11
Title of Project: “County Psychiatrist Training: Best Practices for Medication,
Diagnosis and Treatment of Regional Center Patients with Mental Illness.”
Regional Center: San Gabriel Pomona Regional Center
Regional Center Project Manager: Dr. Stephen Mouton Phone: 909 868-7527
Email address: [email protected]
Reporting Period:
1st Report
(due 12/31/09)
6th Report
(due 6/30/2012)
Activities Phase:
2nd Report
(due 6/30/10)
7th Report
(due 12/31/2012)
3rd Report
(due 12/31/10)
8th Report
(due 6/30/2013)
4th Report X 5th Report
(due 6/30/11)
(due 12/30/11)
Final Report
(7/31/2013)
Development X Implementation X Evaluation X Completion
Activities to Date:
Trainings were conducted on September 14th, October 12th and November 9th. The
three trainings conducted in 2011 were well attended and popular. Many former
attendees of the Best Practices Training from earlier years had passed on registration
information to their colleagues in their clinical settings. Because the training always
involved a small group of Psychiatrists, the training itself encouraged the free flow of
experiences, ideas and a “clubby” feeling among many of the Psychiatrists.
Psychiatrists sharing business cards and information with each other about common
education, previous internships, fellowships and employers were common chatter
among the attendees. Common and “off-label” uses of medications and their personal
experiences with different medications in practice were discussed as it applied to the
clients seen in the training. Recent studies and new unpublished research were shared
informally among colleagues. The impact and potential impact of agency and political
policies affecting the practice and reimbursement of psychiatric services were
discussed. Additionally, the limitations of using different medications at a variety of
dosages and the ordering of specific tests were frequently traded information related to
treatment choices in group discussions. Dr. Craig Wronski, Triple Board Certified, Chief
of Staff at College Hospital led the in-patient training.
The in-patient training included a folder of reference information (posted on the
www.MHSA Grants.com web site.) A standing flip chart overview of the regional center
system was presented to Psychiatrists. Unique aspects of the DDMI wing as California’s
only private psychiatric hospital program exclusively for regional center clients with
mental and behavioral difficulties were compared to typical psychiatric hospitals without
specialty staff and BCBA behavior analysts.
Psychiatrists were toured through the DDMI wings to observe in-patient clients engaged
in groups, unusual behaviors and in a variety of treatment milieus. Later, DDMI wing
staff were brought into the training room to discuss how they handle different client
situations and their unique role within the DDMI wing units. Medical case records were
distributed to the trainees. The in-patient admission and treatment process were
discussed in” round table fashion”. Discussions emphasized initial differential
diagnosis, initial medications / response, course of changes to the meds and client
response / side effects. The broader background dynamics and complications of legal,
family and potential placement complications that affected the treatment choices were
included in the review.
Clients were brought into the training room accompanied by one or more staff members
to talk about their behavor experience prior to entering the DDMI wing and the changes
that have occurred in their behavior since being engaged in the DDMI wing treatment
milieu. Doctors in the training group asked questions pertinent to their history and
medication. Impressions of the client, compared to medical records, were discussed
within the group after the client left the room with DDMI staff.
In each in-patient training session, six clients were brought into the doctor’s lounge
where the bulk of the training occurred. The clients varied in age, sex, functioning level,
mobility and behavior / psychiatric illness. The “live” interaction and compare/contrast
with actual medical records/history helped sharpen the psychiatrists understanding
between the information presented in records, the appearance / perspective / response
of the client and the treatment process/goals related to the successful stabilization and
discharge of the client from the unit.
After lunch, Psychiatrists returned to their cars and drove 45 minutes (28 miles) to San
Gabriel Pomona Regional Center and reconvened in a medium size conference room
which served as a temporary out-patient clinic. Dr. Carlos Muralles, Medical Director of
Alma Family Services led the out-patient training. The out-patient training began with
an overview of developmental disabilities and the unique expression of psychiatric
symptoms by levels of functionality and disability. A brief one-page background of each
of the three clients were presented to the group prior to the appointment. The new outpatient client, accompanied by family members, staff, service coordinator and/or
supervisor attended the initial 30 minute differential diagnosis interview of the client. At
the conclusion of the differential diagnosis interview, the client was connected with the
clinical director of Alma Family Services to continue out-patient treatment. While the
client was out of the room, the Psychiatrists discussed their impression of symptoms,
responses and history of the client presented during the out-patient interview.
In many cases, translators were involved for Spanish, Chinese and Thai speaking
clients. Clients were chosen based on having extraordinary challenges. In some cases,
clients with severe self-injurious behaviors were unable to remain in the interview room
for the full 30 minutes and could be heard running up and down the hallway, sometimes
banging their head against the adjacent walls. Other times, clients would have loud and
repetitive moans or screams that would disrupt the interview process. In some cases,
clients wanted to interact with the psychiatrists and would walk up to them, or push
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apart the tables or take the psychiatrist’s beverage or snacks. Cell phone video
(passed around to the psychiatrists) was provided by one parent of a client who would
head bang in the car while driving, unbuckle himself and grab the steering wheel while
the parent attempted to drive. Some clients were non-verbal and signing or other
communication was used as a form of response to questions by the Medical Director.
The point of choosing high acuity clients, communication impaired and/or low
functioning clients were to demonstrate interview adaptation techniques that could be
used in practice as well as adapted to clients with less difficult behaviors.
Difficulties involved in the out-patient training were directly related to the high acuity of
the clients being seen, resulting in disruption of nearby meetings and other client
interactions occurring on the first floor at the regional center. Despite the difficulties, it
presented the Psychiatrists attending the training an accurate “live” experience with how
to handle high acuity, very difficult, low functioning and impaired communication clients
in an out-patient setting.
15 Psychiatrists attended in clusters from LA County Department of Mental Health,
DMH Downtown Mental Health Center; DMH AV Mental Health Center; Kaiser
Permanante Mental Health Center and Rio Honda Mental Health Clinic.
Pre-Assessment Information included:
*Not all questions received responses; percentages based on total responses per question*
Are you a county employee?
0% No
Are you a county contractor of DMH / DCFS ?
93% No
Do you currently see DMH / DCFS Patients?
0% No
100% Yes
7% Yes
100% Yes
If yes, how many years have you seen regional center patients?
0 % Less than 2 years
50 % 3-5 years
33 % 5-10 years
17 % 10 or more years
Do you currently work in a hospital?
80% No 20% Yes
Would you like to receive a financial stipend for participating in the training? 100% No
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Live Training Evaluation Questions
*Not all questions received responses; percentages based on total responses per question*
Did the training add to your knowledge about medication, treatment and monitoring of
individuals with a developmental disability and mental illness
Outpatient Training
Inpatient Training
Yes 100%
Yes 100%
Were working with “live” patients helpful in applying the techniques learned by seeing
how to interact in an actual DDMI setting?
Outpatient Training
Inpatient Training
Yes 100%
Yes 100%
Would you recommend this training to a colleague interested in working with this
population?
Outpatient Training
Inpatient Training
Yes 100%
Yes 100%
Will this training change the way you diagnose patients with a developmental disability and
mental illness?
Outpatient Training
Inpatient Training
Yes 73% No 27%
Yes 67% No 33%
Will this training change the way you medicate patients with a developmental disability
and mental illness?
Outpatient Training
Inpatient Training
Yes 80% No 20%
Yes 80% No 20%
Average rating of training program with 1 very poor – 5 Excellent
Outpatient Training
Excellent 53% Very Good 40% Good 7%
Inpatient Training
Excellent 73% Very Good 27% Good 0 %
Average rating of Psychiatrist leading the training program
Outpatient
Excellent 60% Very Good 33% Good 7%
Inpatient
Excellent 80% Very Good 10% Good 10%
Additional Comments provided by raters:
“Dr. Wronski was an excellent facilitator”; “Dr. Mouton was informative”; “thoughtfully
presented program”; well organized. “Excellent job”; “Dr. Muralles was excellent”; “patient
interviews could be shorter I think.”; “very good training”; “provide substance abuse disorder
training with mental illness”; “train more often”; “training inclusive”, “handouts helpful”.
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Upcoming Training Events:
Completed. No more training events.
Are anticipated time lines being met?
X Yes
No
Please submit this report, by due date listed above for each reporting period, to:
Department of Developmental Services
Health Development Section
[email protected]
1600 Ninth Street, Rm. 330, MS 3-8
Sacramento, CA 95814
FAX (916) 654-3464
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