Innovations 7th Edition - 2024

Bridging Behavioral Health Diverse services and dedicated professionals at RUHS who make them possible

7TH EDITION

FOREWORD Welcome to the Behavioral Health issue of Innovations magazine.

At Riverside University Health System, we believe mental wellness is as vital as physical health. Our services span the entire continuum—from prevention and early intervention to comprehensive inpatient and outpatient care. We provide help at the right time, in the right place and in the right setting.

In this issue, you will find articles highlighting our diverse services and the dedicated professionals who make them possible. You will read about our comprehensive care approach, the importance of integrating behavioral health with primary care and our innovative projects setting new standards in behavioral health services.

A cornerstone of our innovative approach is the Wellness Village in Mead Valley, slated for completion in 2026. This $580 million project will integrate a broad spectrum of services all in one campus to address critical healthcare gaps in Riverside County. The Wellness Village exemplifies our holistic model, combining behavioral and physical wellness, urgent care, supportive housing and social services to foster healing and resilience.

Our crisis response initiatives further demonstrate our commitment to comprehensive care. We support individuals and families during their most vulnerable moments by providing immediate and effective intervention. Our crisis services ensure timely and compassionate care, connecting individuals to ongoing support and services.

We continuously expand our services and think outside the box to innovate wellness solutions. Our goal is to treat behavioral health challenges and eliminate the stigma surrounding them. By fostering an environment of understanding and acceptance, we encourage individuals to seek the help they need without fear of judgment.

As you explore the articles within these pages, I hope you gain a deeper appreciation for the compassionate care that defines RUHS Behavioral Health. Together, we are building a community where mental wellness is valued and supported, empowering every individual to lead a fulfilling life.

Thank you for joining us on this journey of innovation and transformation.

Sincerely, Dr. Matthew Chang Behavioral Health Director Riverside University Health System 2

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CONTENTS

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Sobering Center Offers a Bridge to Recovery

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Supportive Housing: A Pillar of Wellness and Recovery in Riverside County

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Mobile Crisis Vans Revolutionize Care for Vulnerable Resident

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Mobile Unit Responds Round-The-Clock to Behavioral Health Crises

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Mobile app offers stability for people with schizophrenia, psychosis

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Medications for Addiction Treatment Power Recovery

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Geriatric Medicine Improves Quality of Life

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Wellness Village Will Address Physical, Behavioral, and Social Aspects of Health

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Care Pathways: A System of Care for Caregivers and People Living with Dementia

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Addressing Teens’ Social Needs Improves Health Outcomes

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Friday Night Live Builds partnerships for positive and healthy youth development

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Psychology Internship Program Bridges Gap Between Mental and Physical Health

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Psychiatry Training Programs Grow to Meet Patient Needs

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Medical Clinics Offer Psychiatric Services to Provide Whole Person Health Care

MEET THE INNOVATIONS TEAM Edward Bacho, MD Editor in Chief Alex Groves Copy Editor and Writer Robert Youssef Writer David Macamay Design

Ad design by Andrea Putnam

CONTRIBUTORS Sona Ardeshna, MPH Christopher Benitez, MD Marcus Cannon, LFMT Matthew Chang, MD Antonia Ciovica, PhD Jean W. Griffith, MD, MS Wael Hamade, MD, FAAFP, AGSF Brandon Jacobs, MHA Deborah Johnson, LCSW Suzanna Juarez-Williamson, MA Raymond Kramer, MD Jewel Lee Kristin Miller Rhyan Miller, LMFT Susie Morris, MD, MA Jianpeng Wang, MD INNOVATIONS WORKGROUP Edward Bacho, MD Matthew Chang, MD Raul Coimbra, MD, Ph.D, FACS Frank Flowers Jr., MD Ronald Johnson, MD Mahbuba Khan, MD Vikram Kumar, MD, MB Geoffrey Leung, MD, M.Ed Michael Mesisca, DO Adriana Rosato, MD Shunling Tsang, MD, MPH

Visit us at ruhealth.org/resources/innovations RUHEALTH.ORG

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Sobering Center Offers a Bridge to Recovery

By Matthew Chang, MD, Director, RUHS Behavioral Health

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he RUHS Sobering Center is a haven for people in Riverside County who are grappling with substance use. The center offers a safe and supportive environment for those needing immediate assistance and serves as a crucial bridge to recovery.

Unlike traditional detox facilities, which often have restricted hours and require prior appointments, the RUHS Sobering Center provides immediate, walk-in care without the need for a referral. The facility offers short-term safety and long-term recovery support for those who are acutely intoxicated. Guests can stay for 6-10 hours, receiving medical attention, hydration and access to showers and food – all critical steps in beginning a sobriety journey.

The Sobering Center is equipped with 15 reclining chairs and operates 24/7, 365 days a year, ensuring that people can receive help whenever they need it.

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The facility also serves as a transitional space, connecting clients to the next stage of their recovery.

The staff, including nurses, social workers and peer support specialists, works collaboratively to provide personalized care and connect clients with outpatient treatment programs, support groups and other resources to address the root causes of substance use.

Breaking Down Barriers One of the Sobering Center's key strengths is its accessibility, ensuring clients can receive assistance when they need it most. The center also accepts referrals from law enforcement, community partners and other sources.

The Sobering Center's impact extends beyond its walls. It empowers clients to take the next step in their recovery journey. Since its establishment, the Sobering Center has treated 1,443 people and received 2,502 referrals between November 1, 2021, and June 30, 2023. Many who come to the center are connected with outpatient treatment programs, support groups and other resources that can help them maintain their sobriety and rebuild their lives.

A Brighter Future The Sobering Center's success is a testament to the power of collaboration.

Working closely with community partners, law enforcement agencies and other healthcare providers, this collaborative approach not only benefits those who come to the center but also strengthens the entire community's response to substance use by reducing emergency room visits, lowering incarceration rates and providing a network that supports both immediate and long-term recovery needs.

The RUHS Sobering Center is an example of how innovative and compassionate care can make a difference in the lives of people struggling with substance use. By providing a safe haven, breaking down barriers and empowering clients to take the next step, the center is helping to build a brighter future for Riverside County.

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Supportive Housing: A Pillar of Wellness and Recovery in Riverside County

By Marcus Cannon, LMFT, Deputy Director, Forensics, RUHS – Behavioral Health

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huge part of being able to help our vulnerable Riverside County residents struggling with behavioral health challenges is ensuring one of their most essential needs is met: Housing.

Riverside University Health System – Behavioral Health (RUHS-BH), Riverside County Housing and Workforce Solutions and their private partners are focused on making sure that those experiencing or facing homelessness – and particularly those dealing with severe mental illness – are not only placed within supportive housing, but that they receive comprehensive care that includes behavioral health services, substance use treatment and connection to community 6

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resources.

This is an approach that targets the underlying cause of homelessness.

It has been shown to benefit the community by reducing the strain on emergency services and public resources.

Helping RUHS-BH achieve its supportive housing mission is The No Place Like Home (NPLH) program, which dedicates $2 billion in bond proceeds to develop permanent supportive housing for individuals in need of mental health services who are homeless or at risk of homelessness. The program mandates that projects use lowbarrier tenant selection practices, prioritize vulnerable populations and offer flexible, voluntary and individualized supportive services.

More than $82 million in NPLH funding has helped RUHS-BH develop 1,039 apartments in Riverside, Palm Springs and Cathedral City, with 428 units for individuals with behavioral health conditions.

One of the NPLH-funded buildings is the Cathedral Palms Senior Apartments in Cathedral City, developed in partnership with National CORE, a non-profit affordable housing developer.

An existing senior community, The Complex, was rehabilitated to house homeless seniors with mental health issues and features on-site behavioral health services.

Another project is the Vista de La Sierra affordable housing community in Riverside. Developed

RUHS-BH provides an array of services that supports our community through Homeless Housing Opportunities, Partnership & Education (HHOPE). The HHOPE program provides a 24/7 hotline for homeless resources and referrals, homeless street outreach services, emergency housing, transitional housing, rapid rehousing, licensed adult residential facilities and permanent supportive housing services. The program serves more than 3,000 clients and provides more than 300,000 nights of housing annually.

HHOPE

1405 Spruce St., Riverside

951-715-5050

by National CORE, this community provides refuge from soaring rents and includes supportive services tailored to residents’ individual needs.

RUHS-BH also partnered to apply for Homekey funds, managed by California Housing and Community Development (HCD), to create 52 apartments for those who are homeless or at risk of homelessness in Corona.

These apartments opened in 2023.

units in Wildomar, 152 units in Coachella, 23 units in Riverside and 71 units for Seniors in Palm Springs. Of those, 335 units will be reserved for previously homeless individuals.

Supportive housing projects like these provide more than just a roof over one’s head; they offer a lifeline to individuals by breaking the cycle of homelessness and promoting long-term recovery.

More affordable housing communities are on the way, including 97 units in Cathedral City, 55 units in Temecula, 61 units for all ages in Palm Springs, 178 RUHEALTH.ORG

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Mobile Crisis Vans Revolutionize Care for Vulnerable Residents

By Kristin Miller, RUHS Behavioral Health Services Administrator

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behavioral health emergency can be scary and isolating, and driving somewhere for help may not always be an option. That’s why Riverside University Health System brings treatment to those in crisis with the help of its mobile clinics.

The Riverside University Health System – Behavioral Health (RUHS – BH) Mobile Crisis Response team began employing five mobile clinics in September 2023.

The 25-foot vans have medical equipment for monitoring vital signs, a bathroom, refrigerator and other amenities that bring the efficiency of a clinical setting to hardto-reach places such as homeless encampments, or 8

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The Board of Supervisors is committed to meeting the behavioral health needs of Riverside County.

By innovating and seeking new avenues of care, we are making a clear statement: every resident's well-being matters.

— Kevin Jeffries, Riverside County Supervisor

anywhere children and adults may be suffering.

The vans are a much-needed alternative to the crisis team’s county-issued vehicles, which had limited room for equipment and supplies and no space for treatment.

They were funded by a grant from the state Department of Health Care Services.

"These vehicles empower us to provide dignified and compassionate care to

our most vulnerable residents,” said Dr. Matthew Chang, Director, RUHS Behavioral Health. “By bringing our services directly to where they're needed most, we are revolutionizing the way we connect with our residents to offer help."

People in crisis may have a variety of challenges that prevent them from being able to make it to a facility for help. They may distrust traditional systems or may not have the means to transport themselves.

The mobile crisis teams provide assistance to those experiencing panic attacks, substance use issues, psychiatric crises and other challenges. In addition to emergency intervention, the teams offer referrals for services, and access to a sobering center or 24/7 walkin mental health urgent care clinics in Riverside, Perris and Palm Springs.

The RUHS–BH Mobile Crisis Response team answered 1,854 calls for help in fiscal year 2022-2023.

Mobile Unit Responds Round-the-Clock to Behavioral Health Crises

By Christopher Benitez, MD, Medical Director, Outpatient Services, RUHS Behavioral Health Riverside University Health System’s Mobile Crisis Response teams understand the unpredictable nature of behavioral health emergencies, and that’s why they are ready to help residents in need 24 hours a day, 7 days a week.

The multidisciplinary response team includes clinical therapists, case managers, substance use disorder counselors and peer support specialists. They

Assistance from the Mobile Crisis Response Team is available day or night by calling the:

Inland SoCal Crisis Help Line at 951-686-HELP (4357) or the CARES (Community, Access, Referral, Evaluation and Support) Line at 800-499-3008.

“We’re here for Riverside County residents and are available to serve everyone, anywhere, any time in a behavioral health or substance use crisis," — Dr. Matthew Chang, Director of RUHS–Behavioral Health. respond to individuals in crisis wherever they are, including home, school, work or on the street, usually within 30 minutes or less.

The team is dispatched by a call center and responds to a location, assesses the individual, de-escalates the situation and gets them stabilized to reduce the immediate risk of danger and harm.

The intervention has proven to significantly decrease unnecessary emergency department care, psychiatric inpatient RUHEALTH.ORG

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hospitalizations and law enforcement involvement.

The move to round-the-clock mobile response earlier this year is part of RUHS-BH's expansion of services. Other additions include five new crisis response vans to allow for quick and confidential treatment of residents across Riverside County’s 7,200 square miles.

Mobile Crisis Response teams successfully diverted 70 percent of contacts from law enforcement and inpatient admissions in fiscal year 2022-2023, demonstrating their effectiveness in handling crises without traditional enforcement methods.

Those in need of Mobile Crisis Response and other behavioral health services can call 951-686-HELP. Visit https://www. ruhealth.org/crisis-support-system-care to learn more.

RUHS Crisis

Support System of Care • Mobile Crisis Response Team field-based therapists respond quickly to calls.

• Community Behavioral

Assessment Team (CBAT) accompanies law enforcement to calls.

• Community Assessment and Transport Team (CATT) rides with ambulance EMTs.

• Mobile Psychiatric Services • Mobile Crisis Management

Team provides crisis response, ongoing support and case management.

• Behavioral Health Justice

Intervention Services embeds clinical therapists at colleges and universities to support campus public safety and counseling.

• Mental Health Urgent Care

facilities in Riverside, Perris and Palm Springs provide crisis intervention.

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TECHNOLOGY

Mobile app offers stability for people with schizophrenia, psychosis

By Brandon Jacobs, Deputy Director of Quality Management, RUHS - Behavioral Health

Riverside County is the first county in the nation to test A4i as part of a pilot program. Behavioral health specialists as well as patients who have used the app report positive results.

Jason Page counts himself among those who have benefited from using A4i. He appreciates the “Newsfeed” function that connects him to a larger community of patients who also face behavioral health struggles.

So far, 102 app users at 12 clinic sites have participated in the pilot program. During a 2023 showcase led by RUHS – Behavioral Health, healthcare professionals, digital health experts , and others heard about the positive impact the A4i app had on treatment.

The app has also impressed healthcare providers such as Jenny Freeman, a clinical therapist at Riverside New Life, an RUHS program. Freeman recommended the app to a patient with auditory hallucinations and got to see firsthand how that patient was helped by the “reality” feature that distinguishes environmental sounds from auditory hallucinations.

People living with schizophrenia and psychosis can experience extremely vivid and frightening hallucinations, but a new mobile app is helping them determine which noises are real and connecting them with a virtual support network.

App4Independence (A4i) gives people who suffer from hallucinations a valuable coping tool, in addition to traditional treatment methods such as medication and therapy. Some of the app features include:

• A function to help users discern

between auditory hallucinations and real sounds in the environment • Medication reminders • The ability to leave client notes for a mental health provider • A “Newsfeed” that connects users to a community of people with similar challenges

“It makes me realize that other people are going through what I’m going through, or (something) similar, and I’m not the only one.”

– Jason Page, A4i user

Between the app, therapy and medication, the patient is now stable and empowered, Freeman said. The ability for app users to connect with others facing the same struggles is a critical part of the recovery process. “It makes it relatable, and it makes it genuine to them,” she said.

For more information on the App4Independence, visit www. teamruhs.org/behavioral-health/ app-4-independence-a4i-showcase

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Medications for Addiction Treatment Power Recovery

By Raymond Kramer, MD, Ambulatory Primary Care Physician Leader, RUHS Moreno Valley Community Health Center

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edications for Addiction Treatment, or MAT, are a crucial component in helping individuals combat dependence on drugs or alcohol by controlling cravings and managing withdrawal symptoms. Riverside University Health System (RUHS) offers MAT at its Community Health Center (CHC) clinics in Moreno Valley and Palm Springs, at all its Behavioral Health Substance Abuse Prevention and Treatment clinics across Riverside County and in conjunction with the MOMS Perinatal Program for pregnant and parenting women who use substances.

Substance Use Disorders (SUD) include Alcohol Use Disorder (AUD), Opioid Use Disorder (OUD), Stimulant Use Disorder (StUD), Cannabis Use Disorder (CUD), and Nicotine Use Disorder (NUD). These disorders are defined by a loss of control over substance use and continued use despite negative consequences.

Withdrawal syndromes and tolerance are common, but not necessary or sufficient for a diagnosis of SUD. Research shows that the most successful treatment for SUD combines medication with behavioral therapies.

MAT is clinically driven with a focus on individualized patient care, ensuring that each patient receives a treatment plan tailored to their specific needs and circumstances. By combining these approaches, RUHS aims to provide the best possible outcomes for patients struggling with addiction.

At the Moreno Valley CHC, our MAT patients appreciate our efforts to provide a shame-free zone. At every visit, we use a urine test to ensure the treatment is effective

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and to help guide patients on their recovery path, which occurs at a different pace for everyone. The ability for patients to receive these medications at their primary care office is crucial for breaking the barriers of stigma and increasing the chances of long-term recovery.

MAT is an important leg of a “tripod” of treatment for SUD which should also include treatment of other conditions such as hepatitis C, sexually transmitted infections, bipolar illness, depression, anxiety, PTSD and cirrhosis.

We also encourage counseling, reconnection with supportive family and associations, participation in a 12-step program and other psychosocial interventions and recovery activities. This holistic approach ensures that all aspects of a patient's health are addressed, promoting overall wellbeing and recovery.

RUHS utilizes a range of FDA-

approved medications to treat various SUDs, including OUD, AUD, and NUD. These medications help manage cravings and withdrawal symptoms, making it easier for patients to focus on their recovery and engage in behavioral therapies.

For OUD, medications like buprenorphine and naltrexone are used. Buprenorphine reduces cravings and withdrawal symptoms, while naltrexone blocks the effects of opioids, preventing euphoria and reducing the likelihood of relapse.

These treatments are particularly important given the ongoing opioid epidemic and the presence of fentanyl in the street drug market.

For AUD, medications such as naltrexone, acamprosate, and disulfiram are employed to reduce alcohol cravings and support abstinence. Naltrexone helps decrease alcohol consumption, acamprosate stabilizes brain chemistry, and disulfiram acts as

a deterrent by causing unpleasant reactions when alcohol is consumed.

The RUHS MAT program plays a role in empowering patient recovery. By integrating FDAapproved medications with comprehensive behavioral therapies, RUHS provides a holistic and stigma-free treatment environment. The success of this approach is evident in the transformative impact on patients' lives and has been one of the most gratifying experiences of my medical career. As RUHS continues to expand access to these vital services, the commitment to improving the quality of life for individuals affected by SUD remains steadfast. Through innovative and compassionate care, RUHS is addressing the opioid epidemic and supporting long-term recovery for all patients.

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Geriatric Medicine Services Who should be referred?

Patients over 65 may benefit from the services of a geriatric specialist if they are frail, or experience any of the following:

• Multiple health conditions or any

behavioral health condition plus three other chronic physical health conditions

• Taking multiple high-risk medications

• Memory impairment

Geriatric Medicine Improves Quality of Life

By Wael Hamade, MD, Geriatric Medicine Division Chair, RUHS-Medical Center

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n the Geriatric Medicine department at RUHS, our mission is to help older adults lead healthier and more satisfying lives by improving their function and quality of life as much as possible. We achieve this by providing a quality, comprehensive healthcare approach in a compassionate, ethical, and culturally competent manner.

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• Functional decline / inability to

perform activities of daily living

• Behavioral or mood changes, such as depression or anxiety

• Problems with balance or gait • Falls • Incontinence • Unexplained weight loss or appetite disorders

• Deconditioning following hospitalization

• Requiring higher levels of care necessitating transition to alternative living settings

• End of life discussion • Caregiver supports

Geriatric Medicine team

Our aim is to enhance older adults’ quality of life and maintain their independence.

Assesses the risk of elder abuse, self-neglect, and caregiver burden. Video consultation between RUHS Geriatrician and primary care providers.

Alzheimer’s Dementia Care Program: Helps

Caring for geriatric patients is challenging because of the complexity of chronic illnesses complicated by functional and cognitive impairments. Geriatric specialists help choose care strategies that consider not only the medical complexities, but also psychosocial issues, functional and socioeconomic factors.

maximize patient function, independence, dignity and minimize caregiver strain and burnout. CMS Guiding an Improved Dementia Experience (GUIDE) Model: Prevents or delays long-term nursing home care by supporting caregivers and enabling people living with dementia to remain safely in their homes for as long as possible.

Alzheimer’s Association Partnership: Cognition screening and training for healthcare providers.

Geriatric Emergency Department Accreditation:

Countywide Team Addresses Needs of Older Adults

By the American College of Emergency Physicians ACEP, so elderly patient can receive specialized care from geriatric ED staff.

RUHS’ Geriatric Care Team has partnered with the Department of Public Social Services (DPSS), Riverside County Adult Protective Services (APS), In-Home Supportive Services (IHSS) program, and Office on Aging, to support the elderly in Riverside County.

Age Friendly Health System recognition: By the Institute for Healthcare Improvement confirms our unwavering commitment to providing exceptional care and services tailored to the unique needs of our elderly population.

Specialty programs resulting from the partnership include:

Geriatric Home Program: A nurse, physician and social worker visit patients who are unable to come to the clinic for visits.

Geriatric Care Team: Partnership formed with DPSS/APS

and RUHS connect patients with resources and conduct in-home medical needs assessments.

Fall Prevention Program: Comprehensive education campaign provides tools and resources to help reduce the risk of falls.

Elder and Dependent Adult & Neglect Forensic Examination: Guidelines enable the Sexual Assault and Forensic Evaluation Registered Nurse (RN) to perform Forensic Examination for evidence of Elder/ Dependent Adult abuse at RUHS Medical Center SAFE Clinic sites.

Riverside County Elder Abuse Forensic Team: RUHEALTH.ORG

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HIGHLIGHT

Wellness Village Will Address Physical, Behavioral, and Social Aspects of Health The pioneering project in Mead Valley promises hope and healing for children and families

By Deborah Johnson, Director of Innovation/Integration, RUHS Behavioral Health

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Nestled within a serene, 18-acre campus, the RUHS Wellness Village in Mead Valley will stand as a beacon of hope and innovation in healthcare.

Slated for completion in 2026, this $580 million project will revolutionize the way we approach health and wellness by integrating a broad spectrum of services under one roof to address critical healthcare gaps in Riverside County.

The Wellness Village embodies a holistic model of care for all ages, with a range of services such as behavioral and physical wellness, urgent care, supportive housing, residential and outpatient care, education, and social services. This innovative approach provides individuals and families with the right care at the right time in a setting designed to foster healing, resiliency and independence.

The campus will feature green spaces and fragrant gardens to reduce stress and improve well-being.

Sports courts and community meeting spaces encourage fun and friendly personal engagement.

These amenities are complemented by a public market and café designed to promote community interaction.

Cutting-Edge Behavioral Health Services At the heart of the Wellness Village is its focus on behavioral health. The village will house a Children’s Behavioral Health Urgent Care Center and a crisis residential behavioral health center for children under 13 – both a first in Riverside County – and provide accommodations for families while their children are in treatment.

Ground breaking ceremony Photo by Kurt Miller

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The facility will also offer mental health urgent care and crisis residential treatment for adults, as well as substance use disorder treatment.

The goal is to centralize and enhance access to healthcare, so residents and their families no longer have to travel out of the county for essential care. The approach represents a major shift in how we provide healthcare and will serve as a model for the state.

A Hub for Primary and Specialty Care

Future site of Wellness Village

In addition to behavioral health services, the village will offer a comprehensive array of medical services, including dental care, a pharmacy and imaging. The Women, Infants, and Children (WIC) program will be housed within the village, and residents will have access to job training and educational programs aimed at lifelong learning. This integrated approach ensures support for all aspects of well-being.

Specialized programs, including perinatal care and intensive outpatient substance use prevention and treatment, round out a robust offering of services.

Taken together, the village’s programs will ensure that all health needs are met in a cohesive environment. This holistic model of care is designed to address the many and unique needs of individuals and families and promote overall health and wellness.

Interior rendering of 3rd floor lounge

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Interior rendering of 1st floor community space

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Exterior rendering of entry fountain

A Vision for the Future The RUHS Wellness Village is a testament to Riverside County’s commitment to innovative, compassionate healthcare. By seamlessly integrating medical care, behavioral health, and community support, the village sets a new standard for holistic health and wellness.

Exterior rendering of CWEC

Dr. Matthew Chang, Behavioral Health Director for RUHS, fittingly says it best: “This project is unlike anything that’s been done before. The Wellness Village will be a place where people of all ages can access all the health services needed in an environment designed to foster healing, community interaction, and overall wellbeing.”

The Wellness Village is more than just a healthcare facility; it’s a transformative space where care meets compassion, and every individual is embraced on their path to wellness.

Exterior rendering of supportive housing yard

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Care Pathways: A System of Care for Caregivers and People Living with Dementia

By Jewel Lee, Director for the Riverside County Office on Aging

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interventions, using caregiver training sessions as the doorway and anchor to supportive services. Care Pathways is a series of workshops that offers respite resources, enabling a caregiver to access education and group support.

Given that the needs of a home caregiver are multifaceted, the Riverside County Office on Aging has designed holistic approach to offer an array of

Services are available to those who care for a loved one with complex health and wellness concerns.

Along with basic self-care, unique to the program is the recognition of “anticipatory grief”– the feeling of loss while caring for someone with a long-term or degenerative disease. The program explores feelings of anxiety, sadness, and the progressive loss of the “person [they] once knew.” The program also considers the special needs of grandparents raising grandchildren – with special attention to the highly digitized and complex education and child support systems.

ore than one in five Americans provide care to an adult or child with special needs, according to a report by The National Alliance for Caregiving and AARP. The report says the responsibility of caregiving can take a toll. Nearly two-thirds of caregivers consider their situation to be emotionally stressful and 21% of caregivers report feelings of loneliness while providing care. The intense demand of providing care for someone can leave individuals without the energy or time to care for themselves. Various studies estimate 40% to 70% of caregivers have clinically significant symptoms of depression, with up to half meeting the diagnostic criteria for major depression.

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Program Services • Living with dementia • Signs of stress & stress reduction • Communicating in challenging situations • Legal issues related to challenging situations • Managing medications • How to talk to the doctor • Learning from our emotions • Taking charge of your health • Healthy lifestyles • Preventing caregiver burnout • Grieving–Natural Reaction to Loss

Care Pathways also seamlessly flows participants into care management for caregivers, allowing for targeted assessment, planning, and execution of supports from a single point of entry. Finally, the Care Pathways Aftercare component reengages program “graduates” for a two-day caregiver symposium with additional topic-specific workshops, support groups, and follow-up phone calls or electronic contacts.

Access & Flexibility The Office on Aging braids together local and state funding to unify resources into a simplified system that may be accessed by course participants.

The well-established menu of workshops may be regrouped or parceled based on the family’s needs and goals. Although the in-person meetings are traditionally held in a “classroom” setting with a maximum capacity of 15 participants, the course design has flexibility to be offered virtually, with larger capacity and accessibility from any location.

In December 2022, four Care Pathways “basic self-care” courses were successfully re-purposed for a professional caregiver training program through California In-Home Support Services (IHSS). Between July 2023 and April 2024 the program provided 1-hour web courses to 16,644 professional IHSS caregivers across California.

SUCCESS STORY Raul joined Care Pathways after spending seven years as the sole caregiver for his wife, who has dementia and uses a wheelchair. He was referred to the program by a hospital social worker. Despite support provided by the program allowed him to attend sessions away from home, and it was in these sessions that Raul found a support network and camaraderie he didn’t know existed. As a “graduate” of Care Pathways, Raul continued to participate in the After-Care Support Group where he received valuable reminders for caregivers about scheduling and maintaining appointments for themselves. Finally acting on these reminders, he scheduled a wellness check-up. He was caught off-guard when he received a call from his doctor the same day with concerns about his liver. After making some lifestyle changes, Raul positively impacted his health and returned from his doctor with normal results.

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Addressing Teens’ Social Needs Improves Health Outcomes

By Suzanna Juarez-Williamson, MA, Administrative Services Manager and Sona Ardeshna, Research Specialist RUHS Behavioral Health

RUHS

is utilizing an adolescent version of its innovative Whole Person Health Score (WPHS) in high schools to assess socioeconomic factors that impact health – the first such implementation in the country.

Hemet Unified School District (HUSD) approached RUHS in 2019 to develop a student screening tool to help address absenteeism and low engagement. The WPHS evaluates social determinants of health, such as economic stability, education access and quality, and housing, across six domains.

To further support WPHS screening and follow-up response to students with unmet needs, the district and RUHS – Behavioral Health (RUHS-BH) applied for a grant.

Administering the assessment universally to high school students began in 2020 during the COVID lockdown using an electronic means for students to complete the WPHS. Administration continued as students returned to campuses in Fall 2021, with WPHS screening occurring twice during the academic year. Grant-funded RUHS-BH mental health staff were co-located on HUSD high school campuses in that same academic year.

The Adolescent WPHS, developed with resilience in mind, utilized focus groups and a reiterative process to test and refine the new version. The answers, when totaled, produce a letter score for each domain which is further categorized into low risk “green’, moderate risk “yellow” or high risk “red”. The six domains are easily recognized by the acronym “PERSON” which exemplifies the goal of using the WPHS to address the whole person.

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The domains are Physical health, Emotional health, Resources/resilience, Socioeconomics, Ownership, and Nutrition and lifestyle.

Screening across multiple years steadily grew and the completion rate relative to school enrollment varied between 65% and 50%. Active consent was requested from parents at the beginning of each school year.

Grant funding allowed RUHS-BH staff to respond to students scoring in the high risk “red” level of the WPHS while district staff addressed students with moderate risk.

The grant program, named Transforming Our Partnerships for Student Success or TOPSS, paid for a Clinical Therapist, Parent Partner and Transition Age Youth Peer Support Specialist to be embedded on high

The Whole Person Health Score

developed by RUHS measures a person’s health in six dimensions:

• Physical Health (blood pressure, body mass

Across administrations, 26% of WPHS screens had at least one domain identified as high risk, and 47% had more than one domain in the high-risk range.

Figure 1 represents the top three domains with high need scores across administrations. The proportion of students scoring in the high need range decreased over time, contrary to an increasing trend in youth mental health needs.

index, etc.)

• Emotional Health (mental health conditions and social support) • Resource Utilization (how often someone sees their doctor or takes medication, etc.)

• Socioeconomics (finances, housing and food access) • Ownership / Activation (self-management, self-efficiency, etc.)

• Nutrition / Lifestyle (diet, physical activity levels and substance use)

Success Spotlight school campuses. Three TOPSS teams support five high school campuses across HUSD. In addition, a Senior Parent Partner is located at the HUSD Wellness Center, and supports families referred for a variety of challenges, including student non-attendance, basic needs, and resource linkage for housing and medical care.

This novel approach provided the opportunity to proactively identify and respond to students at risk. WPHS screening led to identifying students whose needs were not known prior to the WPHS, some of whom had very complex social needs.

Students and families recently had the opportunity to share their experiences and gratitude to the district and TOPSS staff for their support and lifechanging interventions and resources during a visit by state lawmakers and the Mental Health Services Oversight and Accountability Commission.

TOPSS team

One student affectionately named the ” Prom Queen” highlights the above and beyond efforts of TOPSS team staff.

The Senior Parent Partner met her when she was accessing clothing at the Parent Center. She was behind in credits, and ready to drop out of school because she thought when she turned 18 she would be getting kicked out of her group home.

She thought she needed to drop out of school and get a job to try and find a place to live. When TOPSS staff were able to educate her on the resources available to foster youth past the age of 18 she stayed in school. TOPSS staff assisted with connecting her to those resources. She was able to attend prom with the help of TOPSS staff to get her a dress and shoes. Since then, she attended just about every school dance, received much needed mental health services and support and she walked at her graduation with her class.

—Senior Parent Partner

Recognized by

Riverside County Medical Association

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Friday Night Live Youth Program Promotes Healthy Lifestyle

Program builds partnerships for positive and healthy youth development which engage youth as active leaders and resources in their community

By Rhyan Miller Deputy Director of Forensics and Subtance Abuse Prevention RUHS Behavioral Health

The FNL chapters can vary from traditional school sites to continuation schools, community centers, group homes, and churches—any community-based organization that works with youth grades 4-12.

Riverside County’s program is the largest in the state.

Riverside County’s Friday Night Live (FNL) program builds strong and healthy youth and adult relationships by providing tools and platforms to make real change at home, on their school campuses, and in their communities.

Along with California Friday Night Live Partnership (CFNLP), FNL embraces a multicultural approach that allows young people not only to work with adults but to work with diverse youth county- and statewide.

Mentors play a huge role in FNL as a guiding, supportive force, but it is young people who initiate and lead social change. Founded in 1984, FNL has since developed into an effort that helps steer youth away from alcohol, tobacco and other drugs through resiliency and with the development of preventive strategies including policy change

and community involvement in the process of all projects.

a youth voice to the content of workshops.

FNL promotes a healthy lifestyle, encourages young people to make good choices, and allows youth to advocate for the issues they face in their everyday lives.

Riverside County was one of three pilot counties that operate in alignment with the CFNLP’s standards of practice: • Safe environment, community • Engagement • Skill building • Meaningful relationships • Leadership and advocacy

RUHS-FNL staff host three conferences throughout the year: Advisor Training Institute (ATI), Leaders Energized and Prepared (LEAP) Summit, Active Youth Conference (AYC). The conferences are aimed at building the skills of students and advisors so they can lead effective chapters.

The FNL Youth Ambassadors (FYA), which is unique to Riverside County, is made up of high school students who come together to advocate as a voice of the county. Members of the youth council work alongside FNL staff to assist with event and workshop planning, by providing

FNL also celebrates Red Ribbon Week by providing speakers and holding rallies, campaigns, and social gatherings for the entire month of October. An annual awards ceremony allows FNL to showcase the great work of youth and their chapters and advisors.

Since its founding 40 years ago, the FNL- Prevention Youth Development program strives for a healthier and brighter tomorrow.

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Psychology Internship Program Bridges Gaps Between Mental and Physical Health

By Antonia Ciovica, PhD

A

s the demand for health services continues

component of training for aspiring psychologists. This

to rise, Riverside University Health

innovative program is designed to provide psychology

System, in collaboration with Loma Linda

interns with comprehensive, hands-on experience in

University, supports a cutting-edge health

addressing the complex interplay between mental and

psychology internship program that integrates mental

physical health while at the same time providing much

health services within medical care settings. Clinical

needed services for our community.

psychology internship programs are an essential

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RUHS INNOVATIONS | 2024

The program’s goal is to train the next generation of psychologists to work collaboratively with medical professionals, recognizing that mental and physical health are deeply intertwined. By embedding psychology interns in these medical environments, we hope to provide a more comprehensive and compassionate approach to

medical settings and the importance of a holistic approach to patient care.

In addition to gaining valuable clinical experience, the program places a strong emphasis on mentorship and professional development.

Interns in the program receive mentorship from

patient care.

experienced psychologists who provide guidance

A Model for Training Future Psychologists

mentorship helps interns to develop their skills,

The clinical psychology internship program at RUHS is setting a new standard for training programs nationwide. By integrating mental health services within diverse medical settings, the program is preparing future psychologists to meet the complex needs of patients in a rapidly changing healthcare landscape.

and support throughout their training. This build confidence in their abilities, and navigate the challenges of working in a complex clinical setting.

Benefits to our Community In the ever-evolving landscape of healthcare, the interdisciplinary approach to patient care is becoming increasingly essential. Among the various professionals who contribute to this holistic model, psychologists play an important

One of the unique aspects of this program is its

role. Bridging the gap between physical health

breadth of training across multiple medical

and emotional well-being can bring numerous

specialties. In the rheumatology clinic, for

benefits, enhancing not only patient outcomes but

example, interns help patients cope with chronic

also the overall efficacy and satisfaction of medical

pain and the emotional toll of living with long-

practice and achievement of greater professional

term conditions. In the endocrinology clinic, they

fulfillment for providers. Integrated care offers

address issues related to diabetes management

a multitude of benefits, from improving patient

and the psychological aspects of hormonal

outcomes and streamlining workflow to enhancing

imbalances.

professional satisfaction and reducing healthcare

The cardiology and internal medicine rotations

costs.

expose interns to patients dealing with heart

As the program continues to grow, it promises to

disease and other complex medical conditions,

make a significant impact on the field of clinical

where stress and anxiety often play significant

psychology and the quality of care provided to

roles. Meanwhile, in the oncology and palliative

patients. By offering hands-on experience,

care units, interns support patients and their

mentorship, and a focus on diversity and

families as they navigate the emotional challenges

cultural competence, the program is helping

of serious illness and end-of-life care.

to shape the next generation of mental health

The psychiatry consultation liaison service offers interns the chance to work with patients admitted for various medical reasons but who also require psychiatric evaluation and intervention. This rotation is particularly valuable for understanding

professionals. For aspiring psychologists, this internship offers a unique and invaluable opportunity to develop their skills and make a meaningful difference in the lives of those they serve.

how mental health issues can manifest in

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Psychiatry Training Programs Grow to Meet Patient Needs

Psychiatry Residency Program Expands Training, Treatment Options

By Jean Griffith, MD, MS, Psychiatry Residency Training Director - RUHS Behavioral Health

Riverside University Health System-Behavioral Health (RUHS-BH) has long provided excellent care to the youth, adults and older adults in our community who are affected by mental illness or struggle with substance use. In 2019, Behavioral Health recognized the future needs of our growing community as well as the wealth of educational experience our diverse community would provide and combined these visions to create the Riverside University Health System Psychiatry Residency Program.

The RUHS Psychiatry Residency Program opened its doors in the summer of 2020 with just six resident physicians. Though we have now grown to eight residents per year for four years, we try to stay true to our mission. We utilize the wisdom and experience of our county psychiatrists to train young physicians to become knowledgeable, compassionate, and socially competent psychiatrists in order to provide the highest quality of evidence-based care, all while trying to train and recruit superior clinicians to this community and increase access to care.

From its inception, the Psychiatry Residency Program has staffed the inpatient psychiatric hospital as well as 28

RUHS INNOVATIONS | 2024

the psychiatric emergency services year-round. We have grown to provide treatment services to over 10 different outpatient clinics throughout Riverside County and also provide services to patients struggling with substance use disorders and those with forensic histories.

In 2023, the RUHS Psychiatry Residency Program opened its doors to the Resident Education and Continuity Clinic (RECC) in Riverside. This clinic was designed to give the residents an excellent clinical education and help them learn to utilize innovative treatment modalities. To date in the RECC, residents have provided treatment for nearly 150 patients, and unlike any other clinic Transcranial magnetic stimulation demonstration

New Forensic Psychiatry Fellowship a First in Riverside County

Resident physicians at RECC

in behavioral health, the resident physicians provide therapy as well.

Being in close proximity to the psychiatric hospital and emergency services, many of our patients come from direct discharges, as we are able to provide follow up within one week. We also take referrals from the main hospital and have a clinic dedicated to those hospital discharges and patients who suffer from mental health problems with complex comorbid physical illnesses to provide coordination of care across disciplines. The RECC also provides psychiatric care to the LGBTQ+ community working with the Transgender Health Center while the majority of our referrals are from the CARES (Community Access, Referral, Evaluation and Support) Line.

We offer many unique services to our patients at the RECC. Seeing the growing needs of our community, we have started to offer Medication Addiction Treatment (MAT) outside of our traditional substance clinics.

Utilizing telehealth technology, the resident physicians are able to increase access to care and provide treatment to more remote locations throughout the county. Residents also staff the Mobile Psychiatric Services, MPS, which target patients

who need the most support. As they are stabilized, residents can then transition them into the RECC. This year we will also be offering Transcranial Magnetic Stimulation to treat depression utilizing the MagVenture TMS Machine.

We are so fortunate to have recruited many attending psychiatrists with a range of clinical experiences that will further enrich our education and the healthcare we offer to our patients. As we look to the future, we want to make way for starting an esketamine clinic to treat depression and study the interface of mental health with physical health. We are starting a Forensic Fellowship this year and a Child Fellowship next year. We strive to train physicians who are ready and able to practice anywhere and able to keep pace in the evolving healthcare environment. Above all, we look to support our residents as they form their own professional identity and hope we have bestowed on them the passion to serve this community. Proudly, we have had a 50% retention rate of resident physicians to Riverside County over the past two years and hope this trend of increasing access to high quality care to the people of Riverside County continues for years to come.

By Susie Morris, MD, MA, Program Director and Assistant Chief of Psychiatry, RUHS Medical Center

Beginning in August 2024, RUHS will offer a new fellowship program in forensic psychiatry, the first of its kind in Riverside County.

The program will train graduated psychiatric residents who will rotate through RUHS’s Detention Care Unit, Care Courts, and Patton State Hospital in San Bernardino, among others.

The curriculum will focus on criminal and civil competencies, and fellows will complete forensic assessments of individuals within Riverside County. They will include a summary of written findings and in some cases provide testimony in court.

The one-year, accredited program will provide a valuable service to Riverside County and the patient population we serve. It will offer specialized care to individuals enmeshed in our justice system and facilitate support of other specialty services caring for these same individuals.

Primary goals of the residency include increasing accessibility of competent clinical care, but also, helping to furnish justice for vulnerable populations within our region.

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Community Health Centers Integrate Behavioral Health for More Comprehensive Treatment

By Jianpeng Wang, MD, RUHS - Behavioral Health

Behavioral Health support staff from the Corona Behavioral Health Wellness and Recovery Center discussing consumer case for best services.

R

iverside University Health System improves health outcomes by using an innovative “all-in-one” approach that matches up behavioral health care with primary care in the same clinic. This unique practice at RUHS Community Health Center (CHC) clinics allows a dynamic care team of psychiatrists, clinical therapists and behavioral health specialists to access the same medical record 30

RUHS INNOVATIONS | 2024

system and share test results and treatment plans. The aim is to improve health outcomes by providing comprehensive, stigmafree treatment, especially for underserved populations.

Accessible Treatment The RUHS-Behavioral Health integrated psychiatry program offers in-person and telehealth

options, with clinics located in Riverside, Jurupa Valley, Corona, Moreno Valley, Banning, Perris, Lake Elsinore, Hemet, Palm Springs and Indio. With the help of telehealth, treatment is now accessible to Riverside County residents in areas that previously lacked psychiatric care.

The integrated care psychiatry team evaluates and treats people of all ages for a variety of conditions,

from severe mental illnesses like schizophrenia and bipolar disorder to more common issues such as depression, anxiety, and posttraumatic stress disorder (PTSD).

Patients can access services through various sources, including insurance providers, or even by self-referral. The care team works closely with mental health specialty care programs to ensure that individuals receive the help they need. When individuals complete higher levels of mental health care in specialty programs, they can refer back to the integrated care program for continued support.

This seamless transition ensures ongoing comprehensive care.

Education and Training The integrated psychiatry program serves as a teaching site for residents from UC Riverside, training six to eight psychiatrists each year. The program also provides clinical experience for medical students and those in Physician Assistant (PA) programs, ensuring the development of skilled professionals well-versed in integrated psychiatric care.

Substance Use Prevention and Treatment clinical staff welcoming a consumer at the Corona Wellness and Recovery Center.

The program emphasizes interdisciplinary collaboration and hands-on experience through case conferences, workshops, and seminars covering the latest advancements in psychiatric care and integrated treatment approaches. Through partnerships with academic institutions and healthcare organizations, the integrated psychiatry program also supports research that contributes to the broader field of behavioral healthcare.

Behavioral Health Specialists from the Corona Behavioral Health Wellness and Recovery Center.

About 500 people per week receive comprehensive care from psychiatrists and therapists in the integrated care program

This effort aims to improve the quality of care and increase access to behavioral health services, ensuring that more individuals receive the mental health support they need, particularly in underserved areas.

The RUHS integrated care model bridges the gap between behavioral health and primary care, providing holistic, accessible, and stigma-free treatment. By fostering a collaborative and innovative learning environment, RUHS is not only improving current health outcomes, but also training the next generation of healthcare providers to continue this important work.

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