Assertive Community Treatment/Corrections

Dorit Saberi, Ph.D., Co-Director of Training; Clinical Director, Full Service Partnership-AMI/ABLE Program

Cheryl Van Der Zaag, Ph.D., Chief, Psychological Services & Director of Training for Community and Correctional Psychology Internship Program

This program is intended to equip fellows with the skills, knowledge, and experience necessary to assume clinical and administrative responsibility within a community-based treatment program and to develop expertise in assessment, treatment planning, evidence-based therapeutic modalities and crisis response for consumers diagnosed with chronic mental illness who are high utilizers of psychiatric emergency and inpatient services and individuals detained in a correctional setting and in transition to the community, state hospital, or state prison.  Services are rendered in two different settings – an Assertive Community Treatment Agency: Alliance for the Mentally Ill – A Better Life Endeavor (AMI/ABLE), and a correctional setting based at Twin Towers Correctional Facility.

Assertive Community Treatment-AMI/ABLE Program

A primary feature of AMI/ABLE is that a multidisciplinary treatment team serves as the single fixed point of responsibility for enrolled clients or program “members.”  The team attends not only to psychiatric symptoms, but also helps members meet their needs in physical health, dental care, co-morbid substance abuse, housing, finances, education, work, social relationships, recreational activity, legal, etc.. This approach to service provision enhances continuity of care and helps insure that clinical decision-making always has the benefit of relatively complete and up-to-date information about the service recipient. Fellows serve as part of the multi-disciplinary team and are mainly responsible for providing assessment, treatment planning, individual and group therapy and crisis services to consumers and to family members.  Fellows receive advanced training in Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT) for borderline personality disorder and Prolonged Exposure (PE) for PTSD.  They also use Motivational Interviewing to enhance treatment collaboration.  Fellows are involved in supervising practicum doctoral students.  In addition, fellows may have the option of being involved in teaching evidence-based treatment to other service providers in the Department of Mental Health.

Correctional Setting

Postdoctoral fellows in the correctional setting are trained in a variety of relevant clinical methods. The unique characteristics of this setting and variability in the length of stay for each inmate-patient demand fast-paced assessment and short-term clinical intervention skills. Each postdoctoral fellow will work within a multi-disciplinary team to determine appropriate care for inmate-patients. Postdoctoral fellows will conduct clinical assessments to determine diagnoses, treatment, and housing needs. Ever present in this setting is the need for risk assessment (e.g., danger to self, danger to others) and crisis intervention. Fellows may gain experience with individuals exhibiting a range of psychological disorders including acute psychosis, suicidality, as well personality and/or behavioral disorders. Issues of secondary gain may come into play as well. The correctional setting will expose fellows to a variety of evidence-based treatment approaches tailored for use with this population.  Fellows will actively participate in the internship training program by providing seminars on various evidence-based practices, as well as supervision from an evidence-based perspective.

Overall, this training in this sub-emphasis will assist in the development of advanced critical thinking; theoretical and empirically-based knowledge; and assessment skills through data collection using detailed clinical interviews, mental status exams, and collateral sources.

Goals and Objectives

The target goal in the ACT/Corrections emphasis is for fellows to successfully complete the program with a minimal level of satisfactory ratings and be able to practice at an independent practitioner level in the areas of:

  • Assessment:  Utilize biopsychosocial assessment and achieve a diagnostic proficiency with severe mental illness diagnoses requiring intervention in outpatient as well as community settings.
  • Intervention Competencies:  1)  Develop comprehensive, individually tailored treatment plan which incorporates psychosocial needs in several life domains; 2) conceptualize and implement treatment based on Evidence Based Practice (DBT, CBT, Prolonged Exposure for PTSD) in the context of integrated care; 3) provide services in nontraditional/community settings while maintaining appropriate boundaries.
  • Consultation Competencies:  1) Consult to consumer’s families and community agencies to promote psychosocial function and stability; 2) utilize advocacy and strength base therapeutic case-management approach to enhance empowerment and agency of consumers.
  • Research Competencies:  Apply diverse methodologies to address psychosocial factors related to diagnosis and treatment of severe mental illness in the context of integrated care.
  • Supervision/Training/Teaching Competencies:  1) Provide supervision in the context of integrated/community service delivery for SMI diagnoses; 2) provide lectures and seminars on Evidence Based Practice with SMI in integrated care model.

Prerequisites

  • Prior experience in the assessment and treatment of persons with severe and persistent mental illness.
  • Previous experience conducting group and individual CBT and DBT.
  • Experience in corrections is preferred but not required.

 Required Clinical Experience

  •  Participate in pertinent AMI/ABLE (Alliance for the Mentally Ill/A Better Life Endeavor) Integrated Services Program meetings: Daily planning meeting, Case Conference, Clinical Team and Administrative Meetings.
  • Serve as primary therapist. The role of case manager involves both office and field-based service delivery. The role of therapist involves providing CBT, DBT and possibly PE to 3 to 4 AMI/ABLE clients.
  • Participate in Dialectic Behavior Therapy program which includes: DBT Extended Track (for co-morbid cognitive deficits) skills group co-leader, DBT skills group for friends and family, individual therapist for 2-3 cases, weekly team consultation meetings, possible trainings and consultations in DBT for Department of Mental Health clinicians in other agencies.
  • Participate in Cognitive Behavioral Therapy Program (individual therapist for 1-2 cases, attend weekly CBT seminar, attend bi-weekly CBT seminar and supervision of supervision seminar).
  • Participate in co-leading a cognitive behavioral therapy-based Symptom Management/Healthy Living group.
  • Supervise 2 AMI/ABLE externs (6-month rotation for each extern)
  • Participate as a member of a multidisciplinary team for unit assigned in the corrections environment
  • Provide group/individual therapy to select patients in need of mental health services
  • Carry a caseload of behaviorally disruptive inmates to address maladaptive behaviors and their consequences which often lead to re-arrest.
  • Prepare and co-present a six-hour supervision series for psychology interns in the correctional setting
  • Fellows who are placed at the Twin Towers Corrections Rotation site participate in didactic seminars focused on clinical practice in the correctional setting
  • Conduct a program evaluation at the corrections site or the ACT site and formally present findings at the end of the training year

 Required Supervision

  •  Meets weekly for 1-hour individual supervision with primary emphasis supervisor who is a psychologist
  • Meets weekly for 1.5 hours in group supervision (team consultation) for DBT with emphasis supervisor
  • Meet bi-weekly for 1 hour in group supervision for CBT with emphasis supervisor
  • Meet quarterly with coordinator of program evaluation – a psychologist.
  • Meets weekly for 1-hour individual supervision with primary correctional sub-emphasis supervisor, a psychologist, for supervision of clinical work.

 Required Courses

  • Cognitive Behavior Therapy Seminar (the fellow assists in teaching the course) 1.5 hours/week
  • CBT Group Supervision Course (1 hour per week)
  • Three day DBT training (24 hours)
  • One day CBASP training (8 hours)
  • One day ACT training (8 hours)
  • Psychology Case Conference (1.5 hrs/week)
  • DBT Team Meeting for Assertive Community Treatment Team (1.5 hrs/week)
  • Supervision of CBT Supervision Course (1hr/week)
  • The fellow may also provide psychoeducational groups for AMI/ABLE members time-limited problem-specific psychotherapy, psychological assessments, and other electives in the Division
  • Corrections Fellows will participate in the following trainings:
    • Seeking Safety
    • Motivational Interviewing as a Brief Intervention for Jail Clinicians
    • Reducing Recidivism in the Jail Environment
    • Weekly didactic seminars relevant to the corrections setting

Elective Courses/Clinical Experiences

  • Fellows may also provide psychoeducational groups for AMI/ABLE members time-limited problem-specific psychotherapy, psychological assessments, and other electives in the Division.
  • Fellows may also provide CBT & DBT training to Los Angeles County Department of Mental Health employees
  • Fellows may provide DBT training modified for the jail setting to DMH staff working for the DMH Adult Justice, Housing, Education, and Employment Service Bureau.

Evaluation of Satisfactory Progress and Outcome

  • Individual supervisory sessions on clinical experiences.
  • Observations of contributions to meetings, rounds, case conferences and group supervision.
  • Monitoring/documentation of data base, intake evaluations, progress notes, assessment reports.
  • In the corrections setting, formal feedback from colleagues from other disciplines regarding ability to work collegially and effectively with multidisciplinary team members and others with whom the fellow consults, e.g. custody (see Consulting Skills Evaluation Form. Ratings of 3 or 4 by end of rotation.
  • In the corrections setting, ratings of the Supervision Series by interns and other attendees (See Didactic Seminar Evaluation Form) . Expected ratings of “good,” “excellent,” “strongly agree” or “agree.”
  • Observation of direct patient care and milieu activity.
  • Observations of group co-leadership.
  • Review of evaluations by supervised psychology externs, mid- and end of year evaluations
  • Formal evaluations at mid- and end-of-year using the Postdoctoral Fellow Evaluation form .