ANNUAL REPORT 2018
San Franciscoâ€™s mental health safety net 1
Message to Our Community More than anything, 2018 was a year in which Access Institute strengthened its models of care. For the past 16 years, we’ve prided ourselves on providing all-inclusive mental health care to people with the greatest needs, giving low-income people access to the kind of quality treatment that people with higher incomes receive. What does that look like? It looks like thorough, in-depth assessments using the most up-to-date measures; comprehensive treatment plans customized to an individual’s needs; therapy that addresses deep-seated problems; and medication management integrated with ongoing therapy. It also looks like treatments made more accessible by taking them out into the community, to schools and senior centers. At the same time, we’ve found that many people struggle with difficulties beyond the scope of mental health care. They face problems related to housing, employment, healthcare, legal matters, and other material issues. While these struggles are not caused by mental illness, they definitely impact it, and addressing them requires both psychological and practical support. This year, we created a program to do just that. The Assertive Social Assistance Program (ASAP) is providing case management services integrated with therapy. Similarly, within our In-School Mental Health Program, our therapeutic work with children and families is having a real impact. Children show significant changes in behavior and emotions. We also saw that our work would be enhanced if we did more in the classroom. So we created a new service focused exclusively on mentoring teachers and providing classroom support. Finally, our Psychoanalytic Community Mental Health Training Program provided post-graduate students with mental health training that is uniquely designed to address the problems of today’s society. Thirteen post-graduate fellows engaged in intensive training that combined learning with patient care provided in community settings to a diverse group of individuals and families. I invite you to read about these and other achievements in the following pages.
Bart Magee, Ph.D.
Founder and Executive Director 3
Why We’re Here Rates of depression and anxiety continue to rise in the U.S., especially among our youth. The need for comprehensive mental health care has never been greater. We hear about this every day from the people who call us seeking help. The need is even more acute among the people we serve: people who are primarily lowincome with limited or no insurance coverage, many of whom are struggling with social problems like housing insecurity, employment instability, immigration challenges, and legal problems – all of which are complicated by their mental health struggles.
About Our Clients • 52% are below the poverty level and an additional 41% are low-income • 31% are unemployed • 45% are uninsured and most of the rest had only limited health insurance coverage • 42% are seeking help with depression • 22% primarily struggle with anxiety • 18% are healing from serious psychological trauma • 31% have histories of serious suicidal thinking or past attempts
How We Help
Access Institute offers crisis support, psychotherapy, psychological assessment, psychiatric medication, and intensive case management services at affordable slidingscale rates or for free. This past year, we provided 11,918 hours of services to more than 600 people who have the greatest needs and the least access to care. We value every member of our community and believe that everyone deserves high-quality mental health care. And because we know that the barriers to getting help are not just financial, we provide services in
the community. Through partnerships with seven public elementary schools and two senior centers we provide free, on-site mental health care to at-risk children and seniors. And our treatments work. Among individuals who received at least 26 treatment sessions, 83% of them saw their conditions stabilize or improve significantly. Suicidality significantly decreased in 26% of patients and was successfully managed in another 71%. Only 2% of patients continued to struggle with serious suicidality. 5
Psychoanalytic Community Mental Health Training Program In 2018, Milena Edwards, Psy.D., became Access Instituteâ€™s Director of Training. In her first year leading the program, Dr. Edwards focused her efforts on advancing the programâ€™s mission to train mental health clinicians who are committed to serving marginalized populations. Access Instituteâ€™s training model provides experience-based learning in community settings necessary for the development of culturally-informed practice. We value deep listening and curiosity on the part of our clinicians as we train them to assess and treat a full range of psychological disorders. 6
Last year, 13 postgraduate fellows with doctoral and masters degrees in an array of mental health disciplines provided psychotherapy, psychological assessment, and consultation to hundreds of individuals. In addition to their clinical responsibilities, fellows participated in a rigorous curriculum comprised of over a dozen classes on topics from “Theories of Therapeutic Action” to “Trauma: The Embodied Self and Community Mental Health” to “Genders and Sexualities,” immersing them in contemporary, psychoanalytic thinking about complex clinical presentations. The training curriculum also emphasized a sociallyfocused, “person-centered” model of care that addresses the individual needs of each patient within their sociocultural contexts. One fellow reflected that, “the training curriculum pushes my clinical skills to the next level and I can see the positive impact it has on my clients.”
Dr. Edwards skillfully recruited and retained a faculty of 50 professionals who taught didactic seminars, led case conferences, and provided individual supervision. Our faculty and supervisors devoted over 1,500 hours or $215,000 worth of volunteer service this past year.
“I’m honored to help train the next generation of psychoanalytically informed clinicians. The dedication and commitment of our fellows to address the psychological impact of the social, political, and cultural traumas endured by so many in our community make me proud to work at an organization like Access Institute.” – Dr. Milena Edwards 7
Hayes Valley Clinic At our Hayes Valley Clinic, Access Institute offers lowfee mental health services to people of all ages. Over our 16 year history we have developed a model of care that is intensive, comprehensive, long-term, and serves people who need help recovering from serious psychological difficulties. In 2018, we provided care to hundreds of individuals,
couples, and families who had no other options for accessing care. Unique among community clinics, we donâ€™t have eligibility requirements and donâ€™t impose limits on care. Treatments are tailored to client needs and can be brief and problem focused or in-depth, intensive, and extensive. All services are offered on an affordable sliding-scale.
• Play Therapy for Children Ages 4-12 This includes adjunct sessions with parents and/or caregivers.
• Comprehensive Psychological and Neuropsychological Assessment and Testing Includes assessment for learning differences, cognitive problems, and the full-range of diagnostic and psychological issues. Thorough reports and treatment recommendations are provided.
• Medication Services Medication evaluation and ongoing care. Medication treatment is coordinated with ongoing therapy.
• Clinical Case Management Provided as a stand-alone service or integrated with psychotherapy.
• Psychotherapy Provided for adolescents, adults, couples, and families. A minimum of one weekly session, with additional, more intensive sessions, as needed.
In-School Mental Health Program
Access Instituteâ€™s In-School Mental Health Program serves families who lack the resources necessary to access mental health services. Our therapists work two days per week on-site at each school, providing play therapy to students and consultation to their teachers and families. Therapists are integrated into the schools, working with teachers, principals, and support staff to help them better understand studentsâ€™ emotional and psychological needs and to better support their educational and social development. 10 10
A typical student was a 5th grade boy with depression and anxiety, manifestations of psychological trauma due to witnessing domestic violence. The student was unable to focus on schoolwork, had frequent outbursts, and disruptive behavior. His parents’ contentious divorce meant they were rarely all together and household rules and expectations were dramatically different with each parent. The animosity between them was a constant source of stress and he frequently came to school lashing out verbally or physically. Our therapist focused on creating a safe environment within therapy and facilitated the expression of feelings. In meetings with parents and teachers, our therapist helped them understand his aggression as expressing a need for emotional support and limits. Together, they developed strategies to provide both. Initially play-based, his therapy evolved to talking through coping strategies for anger and fear. He relied on his therapist outside his treatment, too, by checking in when he had a bad morning. His parents learned to ask about behaviors they saw at home, helping his therapist to support him during therapy sessions.
2018 Program Highlights • Services on site at 7 public elementary schools: Grattan, Glen Park, Harvey Milk, Hillcrest, Sanchez, Tenderloin, and John Muir • 51 children and their families served • A total of 2,080 sessions of individual therapy • Classroom observation, teacher and staff consultations totaled 1,200 hours • 81% of families served were living at or below the poverty level • 61% of households were headed by a single parent or parents were separated • 71% of students showed improvements in behavior, grades, class participation, and social skills 11 11
Elder Mental Health Program
at Bayview Adult Day Health Center and Openhouse
In 2018, Access Instituteâ€™s Elder Mental Health Program provided vital mental health services to approximately 198 low-income seniors in the African-American, LGBT, and other marginalized communities in San Francisco. We provided services through partnerships with two communitybased agencies: Bayview Hunters Point Adult Day Health Center (ADHC) and Openhouse â€“ Housing, Community and Services for LGBT Seniors. Our staff was on-site providing developmentally-appropriate, culturally-sensitive mental health care to seniors with medical and psychiatric disabilities and who struggle with problems that include dementia, psychosis, and post-traumatic stress disorder.
Our Elder Mental Health Program thrived under the leadership of our new Director of Elder Services, Anjali George, Ph.D. As a graduate of Access Institute’s Elder Mental Health Program, Dr. George has a deep understanding of the unique needs of our senior community, and a longstanding relationship of trust and successful collaboration with our partner agencies. In addition to providing individual and group therapy to seniors, we enhanced
our support for staff at both sites by developing new inservice trainings. Dementia, severe mental illness, and greif support for elder care professionals were among the topics covered. These trainings have the added benefit of fostering greater collaboration with our team. Nursing and social work staff have been able to turn to us for ongoing support and mentoring around the challenges that arise with patients every day.
“It never ceases to surprise me how much we continue to grow, learn, and strengthen our work so that it becomes tailored to the needs of the elders we serve. Access Institute is remaking mental health care for this community as we address stigma and demonstrate the ways that therapy works to restore dignity through a mutually respectful relationship.” – Dr. Anjali George
Assertive Social Assistance Program (ASAP) Of the more than 600 people we serve every year, approximately 38% are living on the edge psychologically and economically. Their mental health issues are often compounded by a series of traumatic life events (e.g., loss of employment or housing, a life threatening illness or injury, sexual assault, or domestic violence). These challenges are interwoven with, and exacerbate, their mental health problems. Existing social work and case management services in the community are either limited in scope or are not integrated with mental health care.
In 2018, Access Institute responded to the need for integrated social work and mental health services by launching the Assertive Social Assistance Program (ASAP) and welcoming Mary Beth Majoros, LCSW, our Director of Clinical Case Management. Our innovative program is unique to San Francisco – no other organization offers comprehensive mental health services while simultaneously connecting clients to vital social and economic support services. ASAP provides low-fee intensive case management services to clients who require assistance with issues including: • Managing care for health issues (multiple appointments, medication management, or insurance coverage) • Securing government benefits (Social Security Disability Income, Supplemental Security Income, State Disability Insurance, Medicare, or Inhome Support Services) • Eviction or other landlord issues • Job training/returning to work
• Starting/returning to school • Community support groups (e.g., AA, cancer support, new mother groups) • Legal assistance • Substance use treatment and support services • Referrals to low-cost dental or vision care. Access Institute offers ASAP services at our Hayes Valley Clinic on a sliding fee scale.
“This work is especially important today because San Francisco (and the Bay Area) has become an increasingly challenging place to live – both emotionally and practically. People are more often finding they cannot make ends meet. One unexpected life event can have major consequences. ASAP aims to help people take advantage of community resources when they need them, and also to provide a supportive place to discuss and plan their next steps towards stability.” – Mary Beth Majoros, LCSW 15
July 2017 - June 2018 Fiscal Year
Thank you for supporting Access Institute Donations received January 1, 2018 - December 31, 2018
$50,000+ Kaiser Permanente The Laszlo N. Tauber Family Foundation, Inc. Sanat-Hoffman Family Foundation Fund $25,000 - $49,999 GGS Foundation Susan McLaughlin Robin Reed & Lorye George $10,000 - $24,999 Avery-Fuller-Welch Childrenâ€™s Foundation Laura & John Fisher George H. Sandy Foundation Kari Glass & Chad Lester Andrew Goldfarb & Robert Rohr Patrick McNerney & Jennifer Fitch-McNerney The Nick Traina Foundation Laurie & Jeff Ubben Wells Fargo Foundation $5,000 - $9,999 Chris Anderson Alvin Baum & Robert Holgate Jonathan Browning & Mark Heithaus Lisa Chadwick
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STAFF Danni Biondini, LMFT, In-School Therapeutic Consultant Tori Branch, Psy.D., Director of Clinical Services Milena Edwards, Psy.D., Director of Training Gergey Földesi, Psy.D., Testing Specialist Anjali George, Ph.D., Director of Elder Services Azita Ghafourpour, J.D., Director of Development Loong Kwok, Psy.D., Director of Child Services Julie Leavitt, M.D., Staff Psychiatrist Bart Magee, Ph.D., Founder and Executive Director Mary Beth Majoros, LCSW, Director of Clinical Case Management Services Susan Mayer, Business Manager Ben Morsa, Psy.D., In-School Therapist Cristina Reitano, Development Associate Omyda Roundez, Ph.D., Assessment Track Coordinator VOLUNTEER STAFF Laura Fisher, PPS, LPCC, In-School Therapist Sam Tucker, M.D., Psychiatrist POST GRADUATE FELLOWS Yaron Aronowicz, MSW Clara Brandt, Psy.D. Jessica Brown, MA, AMFT José Buenrostro, MA Juliana de Oliveira Campos, Psy.D. Maggie Furey, MSW 22
Jenna Hanson, Psy.D. Albert Hua, Ph.D. Kasia Kanska, Psy.D. Greta Klaber, MA Mary Mykhaylova, MSW Gigi Pagani, Psy.D. Gia Stark, MA, AMFT BOARD OF DIRECTORS Gary Wiss, President Kimberly Taber, Vice-President Nancy Kokolj, Treasurer Mike Wade, Secretary Stephen Best, Ph.D. David Blazevich Kenneth Epstein Carrie Evenden, Psy.D. Kari Glass Andrew Goldfarb Cari Harty ADVISORY BOARD Alvin Baum, LCSW Robin Beers, Ph.D. Jean Wolff Bernstein, Ph.D. Barbara Blasdel, Ph.D. Victor Bonfilio, J.D., Ph.D. Cary Dakin, Ph.D., LMFT Douglas G. Denton Amy Wallerstein Friedman, LCSW Joel Ginsberg, J.D., MBA Francisco Gonzalez, M.D. Sen. Kamala Harris Toni Vaughn Heineman, DMH Phyllis Kempner, Ph.D. Ellen Klutznick, Psy.D., LCSW Michael Krasny, Ph.D. Maureen Murphy, Ph.D. Jean Robertson Joan Sarnat, Ph.D. Louise Schneider, M.D. Lee Slome, Ph.D. Linda Tucker, Psy.D. Harriet Wolfe, M.D.
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