RileyDMFT6104-7

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Week 7: Explore a Community Mental Health Center Danae Riley School of Social and Behavioral Sciences, Northcentral University MFT-6104 v2: Family Therapy with Children Dr. Chisato Hotta December 16, 2022

For this assignment I met with Susan Writer who works in Psychoeducation & Public Affairs at Aurora Behavioral Health Care. Their website is: www.aurorasandiego.com , and the facility is located at 11878 Avenue of Industry, San Diego, California 92128. Below are the interview responses. The Interview What are the demographics of the population served at the agency?  This agency offers services to children, adolescents & adults. They have a diverse group of individuals that they serve, and Susan mentioned that they commonly treat active duty service members and their families, first responders, and members of the LGBTQIA+ community. What services are available to children and families?  Aurora offers: o Inpatient psychiatric services (voluntary &/or involuntary) o Inpatient chemical dependency services (detox & rehab) o Outpatient services (Partial hospitalization programs & Intensive outpatient programs) o 24/7 Crisis line and assessment (psychiatric or chemical dependency) o Referral networks o Adjunctive therapies like yoga, art, sports, music, etc. What clinical orientations/ theories are used by staff to provide services at the agency?  For younger children they use an attachment lens and for older adolescent to adult ages they have therapists with a variety of backgrounds but most focus on emotion based

theories. They use Cognitive Behavioral Therapy, Dialectic Behavioral Therapy & Acceptance Commitment Therapies. A primary focus is on learning how to tolerate stress/distress, manage reactivity and regulate emotions. What are common presenting issues?  Common presenting problems for Children & adolescents: Depression, anxiety, self- injurious behaviors, suicidal ideation, & drug or alcohol dependency What are procedures for intake and assessment?  For intake, children and adolescents are either brought in by law enforcement on a 5150 hold due to attempting to hurt themselves or others, or by their parents due to a referral by a therapist or their school, or due to the parents needing help. Older adolescents can also self-admit. The intake line is open 24/7.  The psychosocial assessment is conducted on all patients that come into the facility whether it is voluntary or involuntary. Interestingly enough, during the assessment, some folks agree that they need help and they move from involuntary to voluntary holds within that same sessions which is preferred. The assessment takes 30 min to 1.5 hours based on the severity of symptoms & willingness to communicate with the therapist. After the assessment, the patient will have a consultation with the psychiatrist and discuss recommendations. Programming is Monday through Friday from that point forward.  Room assignment is interesting for children and adolescents. It is a 101 bed facility and 20 of those beds are for children and adolescents. It is a mixed unit but the rooms filled by two patients within one year of their own age. When they come into the facility they are asked if they would be comfortable rooming with a trans kid and if a trans kid comes in they are asked if they prefer to be roomed with a male or female roommate.

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 If it is determined that the patient has any health concerns that cannot be treated at Aurora, they are taken to the local hospital that they partner with and monitor the patients progress until there are ready to come back to the inpatient facility. What are parent and child responses to services?  Depending on the parents acceptance of the disorder the child is faced with or the triggers that may be causing the symptoms, it could be positive or negative. Sometimes parents are overly sensitive and worried and feel that their child is broken, or they don’t actually believe the emotions their child is facing, or maybe they don’t accept the child for who they are based on their gender or sexuality and the services at Aurora accept and celebrate those parts of them. All of these factors play into the parents response.  The children and adolescents have generally strong outcomes if they have the support of their family and financial support inclusive of good insurance. For example, Medical doesn’t cover Partial Hospitalization Programs or Intensive Outpatient Programs so these patients are often moved from an inpatient facility (3-6 days average stay) right back out into the world with one therapy session a week, which rarely works to maintain the stabilization and early phases of therapy conducted in inpatient. These cases end up bringing these patients in over and over again at inpatient, just to be sent right back out to the environment they were not ready to go back to yet on their own. What are challenges the staff/ agency face in providing services?  The prevalence of drug and alcohol use is increasing with kids dealing with immense amounts of pressure, perfectionism, anxiety from social media, ease of obtaining substances, etc. 50-80% of patients are being admitted now with a dual diagnosis inclusive of substance abuse which is skyrocketing from 10 years ago when it was 20%.

o There is a 200% increase in psychosis from high potency cannabis if mental illness/psychosis is in your heritage and most kids don’t have this background knowledge.  It is devastating to not be able to provide the best care to these patients due to their financial means. Medical which all of the foster kids and low income kids have does not provide adequate care and causes these kids to continuously wind up back in these facilities and the kids stop trusting that the therapy itself is working at all. While you are at the agency note any observations about the set-up of the agency space.  The most interesting thing was just the drab environment showing how poorly funded many of these spaces really are. As much holiday cheer as they brought forth with decorations all over and artwork on the walls, the bones of the hospital were a bit rough around the edges. The rooms were decently sized for two beds, but didn’t have much life to them at all. The doors to the bedroom bathrooms were soft and used Velcro to close them so nothing could be used to self-harm.  Everyone seemed friendly and helpful and the woman who I spoke with was clearly a specialist in working with the children, as well as in the unique offerings of this facility as she had worked in numerous roles inclusive of therapy over the last 10 years.

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