Treatment Programs

ACUTE PSYCHIATRIC PROGRAM

The Acute Psychiatric Program is a 24-hour, 214-bed licensed program, providing inpatient psychiatric services to inmate-patients referred from prisons throughout the California Department of Corrections and Rehabilitation. The Program consists of five treatment units. These units are specifically designed to provide a means of ongoing psychiatric assessment and treatment of acutely mentally ill inmate-patients within a highly structured and secure environment. The Program operates within a 30 to 60 day length of stay.

The overall goal of the Acute Psychiatric Program is to fully remit, or significantly reduce, the symptoms of a presenting psychiatric illness, while providing education and guidance in developing basic coping skills. The primary goal of the Program is to identify and provide a successful transition to the most appropriate level of care for the inmate-patient, i.e., the Intermediate Treatment Program, CDCR Mental Health Services Delivery System, Atascadero State Hospital, the general prison population, or parole. A particular emphasis is placed on diagnosis and evaluation, including thorough psychiatric and neuropsychological testing, social history evaluation, nursing assessment, rehabilitation therapy assessment, dietary assessment, and observation by the entire interdisciplinary team. Diagnosis and evaluation are ongoing processes that continue throughout the patient's hospitalization.

The bio-psycho-social rehabilitation model guides the Program. This model recognizes the interrelationship of factors that contribute to mental illness, including brain impairment, intra-psychic abnormalities, environmental, situational and social factors. The treatment approach is designed to address each of these areas, through pharmacotherapy, group and individual therapy, and the program's structure and milieu. The theoretical framework for the non-medical treatment interventions is cognitive behavioral. The treatment program focuses on six core concepts, including orientation, self-care skills, socialization, and leisure education.

CORE CONCEPTS

Orientation: The Orientation core concept involves daily treatment activities designed to help orient patients to their surrounding on the unit, to staff and other patients, and to their treatment day. This core concept enables staff to monitor and evaluate the patient's mental status on a daily basis. Brief orientation groups are held each day to address general orientation issues (date, place, time), the day's schedule, current events, and other topics to stimulate discussion and interaction. Inmate-patients who are unable to attend groups are oriented on an individual basis.

Self-Care: Many of the patients in the Acute Psychiatric Program have significant deficits in ability to care for their basic hygiene and grooming needs. The purpose of the Self-Care core concept is for patients to be able to maintain a healthy and socially acceptable level of personal hygiene and cell cleanliness with the greatest possible degree of independence. Each unit has times scheduled throughout the week to assist inmate-patients with hygiene and grooming tasks and cell cleaning. Medication Management and Symptom Awareness: This core concept addresses pharmacological management of the inmate-patient's psychiatric symptoms and assists the inmate-patient in understanding and identifying specific behavioral, cognitive, and affective symptoms relating to their psychiatric illness. Materials adapted from the Social and Independent Living Skills Medication Management module are a primary resource for this group. Coping Skills: This core concept includes one or more structured groups on each unit, addressing both internal (self-management) and external (stressful event) aspects of psychological and social coping. Skills, which may be developed and enhanced, include anger management; practical problem solving, effective communication, stress management, conflict resolution and discharge preparation.

Socialization: This core concept is designed to provide patients with the opportunity to participate in leisure activities and to interact socially in a casual but monitored setting. This component included daily yard-corridor, evening and weekend socialization groups, such as table games, videos, etc.

The Interdisciplinary Treatment Team meets on a daily basis for formal treatment team conference as well as daily shift change/report. At these times, each member of the team is responsible for sharing pertinent
information regarding each inmate-patient, based on their interactions or observations, and /or data gathered from other sources (family contacts, records, psychological testing, etc.). Treatment planning decisions are made as a team, although the psychiatrist/team leader has overall responsibility for treatment decisions. It is important that all team members are involved in and aware of treatment plan changes to ensure that all available information has been considered and to provide for a consistent and cohesive treatment milieu.

INTERMEDIATE TREATMENT PROGRAM

The Intermediate Treatment Program is a 114-bed inpatient psychiatric service within the California Medical Facility, which operates at the ICF (Intermediate Care Facility) level of care. The Program serves male inmate-patients from the Department of Corrections and Rehabilitation who are 18 years of age or older, ambulatory and behaviorally appropriate for housing in a dormitory setting.

Patients at the ICF level of care typically require highly structured inpatient hospitalization with 24-hour supervision due to a major mental disorder, serious to major impairment of functioning in most life areas, recurrent para-suicidal behavior requiring stabilization and elimination of self harm/suicidal behavior, stabilization of psychiatric symptoms or assessment for diagnostic clarification.

In 2007, due to the growing Mental Health treatment needs, Department of Mental Health and California Department of Corrections and Rehabilitation decided to place an additional state of the art 64-bed Intermediate Treatment Program within the California Medical Facility. The ground breaking ceremony was held on June 15, 2010. The projected date of completion is October 25, 2011. The projected date of the first admission will be on December 5, 2011. This expansion will increase both nursing and professional staffing.

Effective treatment is based upon both an experiential and an empirical understanding of the inmate-patient population. Treatment approaches are designed with recognition of shared psychiatric, social and psychological characteristics of the patient population.

Sufficient flexibility is maintained in order to accommodate a wide range of special needs and functioning levels. Implementation of the clinical program is accomplished through an interdisciplinary treatment planning and decision making structure. The professional disciplines of Psychiatry, Psychology, Psychiatric Social Work, Nursing, Dietetics, and Rehabilitation Therapies constitute a multidisciplinary approach to patient evaluation and treatment. An integral and ongoing program evaluation system is maintained in order to provide an accurate and continuing description of the patient population, as well as to measure treatment efficacy. This assures that clinical program components can be maintained in accordance with empirical data.

The program, as an integral part of the continuum of care, recognizes the importance of preadmission status as the starting point for treatment planning. Patients are admitted from the DMH Acute Psychiatric Program, Atascadero State Hospital (ASH) and through the Mental Health Services Delivery System (MHSDS) at CDCR institutions throughout California. The Intermediate Treatment Program strives to maintain effective continuity of care with the above referral sources. Patients generally will have had some level of preliminary and introductory therapy consistent with that provided in the program. The emphasis is on providing the most appropriate treatment plan consistent with individual patient needs.

Discharge planning will continue to address adaptive skill development, environmental contingency management and symptom reduction. The majority of the inmate-patients treated will continue their incarceration in the Department of Corrections and Rehabilitation, and maintenance of therapeutic benefits and maximization of functioning after discharge must occur within that unique environmental context. Therefore, emphasis is on developing skills, which are aimed at maximizing the adaptation of mentally ill individuals living in prison. The program also provides treatment modalities to accommodate the needs of the minority of patients who will likely re-enter the community upon, or shortly after discharge. Therefore, the majority of treatment modalities and approaches are highly specialized.

Upon successful completion of the treatment program, inmate-patients should be psychiatrically stable, have at least a basic understanding of their mental illness, and be capable of assuming a meaningful role in managing their mental illness with use of available supportive resources relevant to their specific living circumstance, and
thereby maintain their optimal functioning level. In addition, they will have acquired and refined a functional repertoire of adaptive coping skills, including emotional management, behavioral control strategies, problem solving skills, and social skills, which will facilitate successful adaptation to their long term living environment.

The typical patient's clinical picture is one of an inadequate, poorly coping, and functionally compromised, vulnerable population with varying degrees of psychotic acuity (the preponderance being at the chronic level). Social skills and social adaptation behaviors are underdeveloped. Chronic impairment in areas of reasoning, decision making, accurate reality perception, and volition are common in this population, as is susceptibility to stress and environmental change. Abilities and rates of adaptation are compromised. Based on these characteristics, the Intermediate Treatment Program provides treatment modalities with the following foci:

A structured environment with adequate clinical staffing levels consistent with an ICF licensing status.
Psychotropic medication adjustment and maintenance.

Psycho educational therapy modalities including Coping Skill Development. These would include therapies facilitating development of an understanding of mental illness, and the symptoms of de-compensation, including precursors and warning signs specific to the individual inmate/patients. It also includes modalities aimed at developing, and supervising implementation of adaptive patterns of social behavior.

Psycho educational modalities focusing on the inmate/patient's capabilities in maintaining psychiatric stabilization and maximizing functioning. This includes understanding the need for medication and possible side effects, and effective use of clinical resources and supportive services available outside an inpatient setting. Therapy focusing on understanding and modifying substance abuse behaviors. Ideally, these incorporate psycho-educational, mutually supportive/directive, and relapse prevention approaches.

Ancillary and supportive therapies aimed at acquiring skills in adaptive living such as those provided by the rehabilitative therapies. These include recreational, art, music, and occupational therapies.

Academic instruction, which includes remedial literacy programs, designed to increase the inmate-patient's reading and writing skills.

Discharge planning. Most inmate/patients will return to the Department of Corrections and Rehabilitation and some will be discharged directly into the community. Discharge planning will need to address both options. This will require therapy and planning at the group as well as the individual level.

The treatment program places an emphasis on skill development as a transition from an acute psychiatric, ICF or EOP setting with increased programming and supervision to improve stabilization, reduce further need for inpatient treatment and promote successful adjustment to the EOP, Correctional Clinical Case Management System (CCCMS), General Population (GP) or parole environment. Patients are integrated with the institutional mainline by taking meals in the mainline cafeteria, going to canteen with the GP population, attending religious services in the appropriate chapels and recreating on the main CMF yard. Medical services are provided via the CMF inpatient and outpatient medical services system.

Substance abuse education and therapy, medication management training, relaxation training, relapse prevention, stress/anger management, ward government, rehabilitative therapies, and therapeutic community meetings teach invaluable problem solving skills. Pre-Release groups and Pre-Parole planning are available to inmate/patients with these needs.