Associate Post Master’s Mental Health Fellowship – Vacaville, Fairfield, Vallejo Psychiatry

Because of the rich ethnic and demographic make-up of our region (our communities are made up of suburban commuters to the large nearby cities of Sacramento, Oakland and San Francisco, and residents of adjacent small rural towns) diversity must always be a primary focus of both training and practice in our service area. We provide a weekly Group Supervision dedicated to diversity issues in treatment, and diversity issues and values are a frequent focus of staff meetings and professional education. We also have an active professional EID committee in the service area that plans regular trainings and experiences. Staff clinicians and trainees are encouraged to develop specialized treatments for underserved and oppressed populations (e.g. African-American Support Group, Women’s Empowerment Group, Support Groups for LGBT Young Adults, and Spanish Language Groups). All of this is in addition to the regional EID training experiences.

Fellows attend a weekly two-hour didactic on evidence-based treatment designed and administered by the Mental Health Training Program, and monthly training workshops on important issues in mental health led by national experts. Fellows also participate in Clinical Specialty or Enhancement  consultation and support in specialized areas of interest (e.g. Trauma therapies, DBT, Gender Health Competency, Bilingual services, Health Psychology). Our Fellows also attend a monthly Forum Speaker series on Equity, Inclusion and Diversity, and are encouraged to attend a monthly EID Consultation Hour. Fellows also have access to the Mental Health Training Program’s Continuing Education Lecture Library, which includes presentations by renowned speakers such as Kristen Neff on Self-Compassion, Bessel van der Kolk on Trauma and PTSD Relief, and Kenneth Hardy on Racially Sensitive Supervision.

Fellows often participate in the ongoing staff development program of the clinics, including staff meetings, regular Feedback Informed Care and Case Consultation meetings associated with Child and other treatment tracks they may be assigned to, and ongoing professional education.

Fellows receive two hours of weekly individual supervision. Fellows also receive two additional hours of weekly group supervision (one on Case Consultation and one on Diversity Issues).

The individual supervisors are responsible for supervising the direct delivery of clinical services and take the lead role in monitoring the Fellow’s progress, providing feedback on strengths and areas in need of further development, ensuring effective and safe patient care, adequate documentation, and evaluating training schedules.

Group supervision includes opportunities for fellows to present and discuss cases. Fellows learn how to address treatment through a cultural framework including ethnicity, language, age, gender and sexual identity. Group supervision allows for vicarious learning, developing case conceptualization skills, practice with professional public clinical presentations, and learning how to give and receive feedback.

Reflecting Kaiser Permanente’s core commitment to mental health and wellness in our communities, each trainee will spend at least 32 hours during their training year on a Community Partnership Project that focuses on improving mental health in the local community beyond our Kaiser Permanente members. Most recently our partnerships have been with the KP Launch Summer Internship for promising high school students in the Bay Area from traditionally underserved communities. Training Objectives include developing skills and partnerships to disseminate psychoeducation and skills associated with improved mental health, fighting mental health stigma, and encouraging more young people to consider careers in mental health themselves.

Two or three of the program’s five fellowship positions are typically assigned to the Adult Track. Adult Track fellows provide outpatient psychotherapy services to adults ranging from age 18 through older adulthood in Kaiser Permanente psychiatry clinics.

The NSA PMF program is characterized by both high expectations and high levels of support. The fellowship is designed to prepare master’s-level clinicians for successful transition into staff provider roles within Kaiser Permanente. Fellows are expected to develop proficiency in evidence-based clinical practice, risk assessment, documentation, professional communication, and efficient management of patient care, while receiving intensive supervision, consultation, and training throughout the fellowship year.

A portion of each fellow’s clinical hours is dedicated to generalist outpatient care. Fellows work with patients presenting with a broad range of concerns, most commonly including depression, anxiety disorders, trauma-related conditions, adjustment difficulties, and other behavioral health concerns. Fellows are assigned clinical caseloads with patients ranging from relatively straightforward outpatient presentations to those with significant psychiatric impairment, complex diagnostic presentations, and elevated clinical risk.
In addition, fellows are assigned to one adult specialty treatment pathway during each of two rotations. Specialty assignments are based on fellow interests, prior preparation, training goals, and clinic availability. Treatment pathway options may include:

• Adult Intensive Outpatient Program (IOP)
• Trauma Treatment Track
• Unified Protocol Treatment Track (“Uplift”)
• Gender Care Program (Regional MHTP Specialty Program)
• Bilingual Treatment Program, Spanish Language (Regional MHTP Specialty Program)

Fellows also co-facilitate one adult treatment group during each rotation. Group offerings may include:

• Anxiety
• Depression
• Dialectical Behavior Therapy (DBT)
• Bipolar Disorders
• Trauma
• Young Adult Support
• African American Support
• Spanish-Language Depression
• Coping Skills

A core component of training involves assessment and management of clinical risk. Fellows are expected to competently evaluate patients who are at risk of harm to themselves or others, assess behavioral health crises, develop appropriate safety plans, and make referrals to Kaiser Permanente and community-based resources when indicated. Fellows are also expected to understand and fulfill mandated reporting responsibilities and to develop proficiency in Kaiser Permanente’s electronic health record and documentation systems.

In addition, fellows learn to conduct structured screening assessments for Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), and to make appropriate referrals for further evaluation and treatment.
Timely documentation is an important component of fellowship training. Fellows are expected to complete documentation for clinical encounters by the end of each workday and submit notes to their supervisors for review.

Patients receiving mental health services within Kaiser Permanente must meet medical necessity criteria for treatment. Consistent with Kaiser Permanente’s episode-of-care model, treatment is focused on helping patients achieve meaningful improvement in functioning through efficient, evidence-based interventions. While the number of sessions varies based on individual clinical need, patients in generalist care are often seen for approximately 6 to 12 sessions. Patients whose functioning does not improve satisfactorily during this interval may require modifications to their treatment plan or referral to a specialized treatment pathway.

Adult track Fellows are expected to learn and utilize evidence-based psychological interventions that have been shown to effectively improve psychiatric functioning in a timely manner. These include, but are not limited to, such interventions as:

• Cognitive Behavioral Therapy (CBT)
• Unified Protocol (UP)
• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavior Therapy (DBT)
• Cognitive Processing Therapy (CPT)
• Prolonged Exposure (PE)
• Interpersonal Psychotherapy (IPT)
• Motivational Interviewing (MI)

A full clinical caseload consists of approximately 20 to 22 patient care hours per week, including intake evaluations, individual psychotherapy appointments, and group treatment. Fellows can generally expect to conduct 2 to 3 intake evaluations and 16 to 18 follow-up appointments per week, in addition to co-facilitating one treatment group.

Two or three of the program’s five fellowship positions are typically assigned to the Child and Adolescent Track. Child and Adolescent Track fellows provide outpatient psychotherapy services to children and adolescents through age 17 in Kaiser Permanente outpatient psychiatry clinics. Based on clinical judgment and patient need, fellows may meet with the child or adolescent individually, with parents or caregivers alone, or with youth and caregivers together.

The NSA PMF program is characterized by both high expectations and high levels of support. The fellowship is designed to prepare master’s-level clinicians for a successful transition into staff provider roles within Kaiser Permanente. Fellows are expected to develop proficiency in evidence-based clinical practice, risk assessment, documentation, professional communication, and efficient management of patient care, while receiving intensive supervision, consultation, and training throughout the fellowship year.

A portion of each fellow’s clinical hours is dedicated to generalist outpatient care. Fellows work with children, adolescents, and families presenting with a broad range of concerns, most commonly including mood disorders, anxiety disorders, trauma- and stressor-related disorders, behavioral concerns, eating disorders, and adjustment difficulties. Fellows are assigned clinical caseloads ranging from relatively straightforward outpatient presentations to youth with significant psychiatric impairment, complex diagnostic presentations, family system challenges, and elevated clinical risk.

Fellows also co-facilitate one child or adolescent treatment group during each rotation. Group offerings may include groups for preschool, elementary-school, middle-school, and high-school-aged patients, as well as multifamily groups addressing anxiety, depression, adjustment to change, eating disorders, trauma, and related concerns.

A core component of training involves assessment and management of clinical risk. Fellows are expected to competently assess safety concerns, evaluate behavioral health crises, develop appropriate safety plans, and make referrals to Kaiser Permanente and community-based resources when indicated. Fellows are also expected to understand and fulfill mandated reporting responsibilities and to develop proficiency in Kaiser Permanente’s electronic health record and documentation systems.

In addition, fellows learn to conduct structured screening assessments for Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), and to make appropriate referrals for further evaluation and treatment.

Timely documentation is an important component of fellowship training. Fellows are expected to complete documentation for clinical encounters by the end of each workday in which the patient was seen and submit notes to their supervisors for review.

Patients receiving mental health services within Kaiser Permanente must meet medical necessity criteria for treatment. Consistent with Kaiser Permanente’s episode-of-care model, treatment is focused on helping patients achieve meaningful improvement in functioning through efficient, evidence-based interventions.

Child and Adolescent Fellows are expected to learn and utilize evidence-based psychological interventions that have been shown to effectively improve psychiatric functioning in a timely manner. These include, but are not limited to:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Behavioral Therapy
• Play Therapy
• Family Therapy
• Modular Approach to Therapy for Children (MATCH)
• Other evidence-based interventions appropriate to the developmental needs of the patient and family

A full clinical caseload consists of approximately 20 to 22 patient care hours per week, including intake evaluations, individual psychotherapy appointments, family appointments, and group treatment. Fellows can generally expect to conduct 2 to 3 intake evaluations and 16 to 18 follow-up appointments per week, in addition to co-facilitating one treatment group.