Didi Hirsch Community Mental Health Center

1. Didi Hirsch Community Mental Health Center Adult/Older Adult Outpatient Program at Didi Hirsch Sepulveda UCLA Civic Engagement 105SL Program Evaluation By: Bram Conley and Saba Malik

2. What is Didi Hirsch? • With more than 60 years of experience Didi Hirsch provides mental health and substance abuse services in Los Angeles County, regardless of ability to pay. • The 9 sites, located all over the Los Angeles area from Pacoima to Venice to South Los Angeles to the Downtown area, serve nearly 38,000 clients a year.  

3. Mission Statement “Didi Hirsch Community Mental Health Center is committed to empowering our clients to maximize their potential by providing quality behavioral healthcare services to the community and those in need.”

4. Didi Hirsch "In1970, the name of the organization was changed from the Los Angeles Psychiatric Service to Didi Hirsch Community Mental Health Center. Mrs. Hirsch was long time board member of LAPS, a clinical social worker and a staunch advocate for the mentally ill."

5. Treatment Over the Past 65 Years • Through advocacy and education, the agency has made incredible strides in erasing the stigma, shame and ignorance that prevent more than half of all individuals touched by such problems from seeking services.   • Multidisciplinary teams—consisting of social workers, psychologists, psychiatrists, marriage and family therapists and trainees from these professions—serve our community. • Committed to providing culturally competent, client-centered services, the Center’s diverse staff closely mirrors the County’s demographic profile.

6. The Agency’s Services • Case management • Weekly individual or group therapy • Psychiatric evaluation and medication management • Psychological testing

7. The Agency’s Target Population Target population consists of adults that meet the following criteria: • They are medically indigent • They are chronically and persistently mentally ill, and have been diagnosed with a psychotic disorder, major depressive of bipolar disorder. • They have severe functional impairment.

8. Community DemographicCulver City Poverty: Age 18 to 64 (Percent)   0% ~ 48.47%   48.48% ~ 52.98%   52.99% ~ 57.27%   57.28% ~ 62.66%   62.67% ~ 71.55%   71.56% ~ 100%

9. Culver City Demographics • Population: 47,120 (including 11,237 families)‏ • Ethnic Make-up: • 5,208 (11%) African American • 14,390 (31%) Latino • 19,433 (41%) White • Age Groups: • 26,984 (57%) 25-64 year olds • Income less than 100% of poverty level: 6,365 (14%)‏

10. CHIS DataLA County - West Area A significant amount of people who needed mental or emotional help also engaged in binge drinking, supporting the theory that there is a correlation between substance abuse and mental illness. ~18%

11. Program to be Evaluated:Adult and Older Adult Outpatient Program at the Sepulveda site Current Goals and Issues: • The Adult and Older Adult Outpatient Programs strive to assist clients with severe and persistent mental illness in managing the symptoms of their mental illness, gaining skills needed to live independently in the community, preventing hospitalization, and achieving their rehabilitation goals. • While the number of community-based programs for older adults has grown considerably over the past several years, many of these programs do not offer psychotherapy services.

12. What is a Co-occurring Disorder? A co-occurring disorder is defined as: “The simultaneous presence of both mental illness and a substance abuse disorder in a single individual.” (http://www.dmhmrsas.virginia.gov/vasip/default.htm)‏

13. Hendrickson, 2006

14. Clinical Issue to be Addressed • According to the literature, approximately 40-60% of individuals in the mental health client population have a co-occurring substance abuse disorder in addition to a chronic and persistent mental illness (www.samhsa.gov) • The addition of a substance abuse diagnosis is a major impairment to recovery from mental illness and is therefore a challenge to clinicians who are treating this population. (Hendrickson, 2006)

15. Support From Literature • http://ncadi.samhsa.gov • Ekleberry, Sharon C., Edward L. Hendrickson and Marilyn S. Schmal. Treating Co-Occurring Disorders. The Haworth Press: New York, 2004. • Bucciarelli, Carol. Addicted and Mentally Ill. The Haworth Press: New York, 2005. • Hendrickson, Edward L. Designing, Implementing, and Managing Treatment Services for Individuals with Co-Occurring Mental Health and Substance Use Disorders. The Haworth Press: New York, 2006.

16. Research Question “How many clients who were admitted to treatment with both a mental health and substance abuse diagnosis received treatment for both disorders?”

17. Methodology • Qualitative: • Two Clinician focus groups: six clinicians interviewed. • Two Client focus groups: seven clients interviewed in total. • Individual Clinician Survey (9 total, 100% response)‏ • Individual Client Survey (12 total responses)‏ • Quantitative: • Demographic data • Intake data • Institutional data

18. Clinicians: Background • The typical therapist at Didi Hirsch has a masters and is a board registered intern. • They also have between 2 and ½ and 5 years of experience in the mental health field.

19. Clients: Background • Clients were between 30 and 55 years old with a serious mental illness and substance abuse diagnosis

20. Clinicians: Key Findings • Training: • Clinicians vary widely in their background and training • In general there is a need for more training for treating substance abuse issues • There is a need for specific training and supervision in motivtional interviewing, harm reduction techniques and techniques for measuring outcomes for treatment • Stigma: • There are definite barriers to treatment including shame and stigma • Clinicians need to address this by reaching out to the community, and by advocating in order to dissolve the stigma

21. Clinicians: Key Findings Cont. • Staffing: • More clinicians need to be involved in treating substance abuse, not rely on one specialist • It is helpful having a dual diagnosis specialist and groups for dual diagnosis clients • Coordination of Treatment: • Needs to be better coordinated with the psychiatrists, who are often not actively involved in the treatment and may have diverging attitudes regarding substance abuse • Need for Treatment: • Clinicians are estimating 15-20% of dually diagnosed clients are getting treatment, while about 75% of mental health clients need dual diagnosis treatment.

22. Clients: Key Findings • Barriers to receiving Treatment: • getting appropriate medication • becoming stable on medication • managing/decreasing side effects of the medication • having a doctor with a judgemental attitude towards substance abuse. • Effectiveness of Treatment: • One on one therapy was said to be the most helpful • The relationship with a therpaist who was non-judgmental and knowledgeable about substance abuse was said to be highly effective. • Most clients' primary reason for seeking services was mental health • The most effective treatment was seen in clients who identified having a substance abuse problem at intake.

23. Conclusions • There is a significant difference between the clients being treated for a co-occurring disorder and the number of clients that need the treatment. • The number of clients identified and treated was much lower than what was expected. • Overall clients who were treated for a co-occurring disorder were satisfied with the services they received.

24. Policy Recommendations 1. Better coordinate treatment between the psychiatrists and clinicians 2. Improve the training and supervision of clinicians in specified drug treatment, motivational interviewing, and harm reduction 3. Decrease the stigma attached to requesting help for substance abuse 4. Increase the number of clients identified and treated for co-occurring disorders

25. Bram Conley • Director of Adult and Older Adult • Outpatient Services at Didi Hirsch Sepulveda • Saba Malik • UCLA Undergraduate: Neuroscience major, English minor