LLU&MC Scope Autumn 2000

New BMC leaders appointed

Behavioral Medicine Center begins new millennium under new leadership

Their names and faces are familiar around Loma Linda, and their reputations are well-established. However, each is taking on new responsibilities that will be crucial to the future success of Loma Linda University Behavioral Medicine Center (BMC).

Zareh Sarrafian, MBA œnamed chief executive officer at BMC

Alan B. Soderblom, MBA œnamed vice president for operations at BMC

Edward Field œnamed controller at BMC

Zareh Sarrafian, MBA, joined the BMC staff this past August as new chief executive officer. Previously, he served as vice president for business development for Loma Linda University Adventist Health Sciences Center, as well as president of Adventist Health Behavioral Care, a joint venture between Loma Linda University Medical Center and Adventist Health.

Alan B. Soderblom, MBA, took over responsibilities as vice president for operations at BMC in April. Since 1997, he has served as the organization's director of operations and finance, providing administrative and fiscal management for BMC, as well as overseeing the areas of business development, physician recruitment, and compliance.

As of July, Edward Field has served as controller for BMC. Prior to his appointment, he was assistant controller, a position he has held since 1997. His previous duties included budgeting, general ledger, accounts payable, accounts receivable, and financial statement preparation. His responsibilities also included overseeing the BMC admissions department and patient business office.

William G. C. Murdoch Jr., MD, will continue as medical director for BMC. Dr. Murdoch first joined the organization in 1991 as medical director for youth services. In 1997 he became medical director for the entire BMC. Already, the skills of the new leadership have been put to the test. The Center has undergone a rigorous accreditation survey process and recently learned that the Joint Commission on Accreditation of Health Care Organizations (JCAHO) had granted them accreditation.

A philosophy of 'wholeness'

The staff at Loma Linda University Behavioral Medicine Center provides advanced and inclusive mental health care. Following an interdisciplinary model, BMC team members include psychiatrists, psychologists, nurses, social workers, chaplains, teachers, family counselors, and therapists.

Such a diverse staff ensures flexible and personal treatment for each patient in the least restrictive manner possible. The treatment philosophy is to strengthen, restore, and renew the patient and his or her family.

BMC professionals strive to treat the whole individual, taking into consideration the interrelated biological, psychological, and spiritual aspects of his or her life. Following is a summary of the specific programs offered at BMC.

Seniors psychiatry program

A dedicated inpatient mental health treatment program, the senior psychiatry program assists older adult patients suffering from various acute psychiatric disorders, as well as their families, nursing facilities, and medical professionals by providing assessment and treatment.

Senior clients have their own dedicated unit, staffed by individuals specifically trained to understand and meet the unique challenges associated with this age group. The affiliation with Loma Linda University Medical Center provides clients with access to specialists in all areas of medicine, including neurology, cardiology, and internal medicine.

Members of the treatment team-psychiatrists, nurses, psychologists, social workers, dietitians, and occupational therapists-help clients who are unable to function at home or in a board-and-care facility.

These clients learn to cope with anger, depression, agitation, feelings of hopelessness, and other issues. Behavioral problems associated with Alzheimer's disease are also addressed.

The BMC accepts most insurance plans, including Medicare and private insurance. Free on-site mental health assessments for all BMC programs are available 24 hours a day, seven days a week. A mobile assessment and referral team (MART) will travel to emergency rooms and urgent care centers, nursing facilities, board-and-care facilities, and community agencies.

Adult program

The adult program helps people manage their emotions and learn more effective ways to confront the challenges they face in their daily lives.

Key areas addressed include coping with anger, depression, anxiety, loss, and grief relationship issues.

Some adult clients are inpatients; others receive treatment and support by attending hospital groups and activities on weekdays (between 9:00 a.m. and 3:00 p.m.). A third option is the intensive outpatient program (IOP), offering a highly individualized treatment regimen.

In addition, BMC provides family education support groups once a month.

Child program (ages 3 to 12)

When life becomes chaotic around them, children may "act out"on the feelings they are experiencing. The BMC children's unit staff recognizes children's special needs and provides them with a consistent, structured clinical environment to help them deal with aggressive or self-abusive behaviors, or a tendency to withdraw-behaviors which can no longer be safely managed in the home.

The child intensive outpatient program is designed for children experiencing behavioral problems, family conflicts, and school-related difficulties. It is intended for children who need more than one or two outpatient visits per week with a psychiatrist or therapist, yet who are not appropriate for psychiatric hospitalization.

The entire family is involved in the child IOP with group time for the children by themselves, the parents by themselves, and children and parents together. Treatment is received in a group format, but tailored to meet individual family needs. It is designed for children whose behavior interferes with their ability to be safe, happy, and successful. Underlying issues relating to oppositional and defiant behaviors are explored, and academic and other school-related problems are addressed.

The child IOP offers a safe environment where families can learn the skills needed to create a stable home environment. Through the treatment, the staff educates, supports, and redirects children away from maladaptive behavior patterns, while recognizing the importance of parent education and family involvement in helping and guiding the children.

Two tracks, based on age and maturity, are offered by the child IOP. Children's therapy group gives the children an opportunity to discuss the reasons they have for entering the program. They receive help in the areas of anger management, social skills, conflict resolution, and communication.

One evening a week, parents are given the opportunity to sharpen their own skills in the areas of discipline and communication, as well as learn about family roles, family patterns, and limit-setting. They learn to overcome feelings of frustration, guilt, apathy, and being overwhelmed. Curriculum for this class is based on the book Developing Capable Young People.

Additional support and educational meetings include the multifamily group, where children and their families work together to solve family problems, identify dysfunctional patterns, and improve communication; and school strategies, where children learn techniques to assist them with schoolwork, while improving interactions with peers and teachers.

Also offered are sessions in art therapy, cooperative skills group, and expressive media group, where children use various art media and physical activities as a way to explore and express their feelings.

Team members for the child IOP include a child psychiatrist/medical director, registered nurse, certified art therapist, special education teacher, occupational therapist, clinical social worker, case manager, and family therapist/program director.

Adolescent program (ages 13 to 17)

During adolescence, young people experience rapid physical, social, and emotion changes which can make them susceptible to depression, drug and alcohol abuse, and tendencies toward self-harm.

BMC adolescent program staff members develop individualized approaches for the young people they treat in an effort to restore them to satisfying and healthy lives.

Similar to the child IOP, the adolescent intensive outpatient program is designed for young people experiencing a variety of emotional or behavioral problems, family conflicts, school-related difficulties, and alcohol and/or drug abuse. These individuals are not appropriate for inpatient psychiatric hospitalization, but require more than one to two outpatient visits each week with a psychiatrist or therapist.

Like the child IOP, the whole family is involved in the adolescent IOP. Group times for adolescents by themselves, parents by themselves, and adolescents with their parents are part of the program.

Two tracks are available to meet the specific needs of each patient and his or her family. The chemical dependency track targets adolescents whose use of drugs and/or alcohol interferes with their ability to be safe, happy, and successful. Underlying issues of depression, anxiety, mood swings, and oppositional behavior are explored. The treatment educates, supports, and redirects adolescents away from the use of alcohol and/or drugs.

The mental health track is designed for adolescents experiencing problems with depression, suicidal thoughts, mood swings, attention deficit disorder, anxiety, and impulse control. Those in this track may or may not have minor substance abuse problems.

The young people in the program attend an adolescent therapy group where they examine their own behaviors in an atmosphere of trust and support. They are encouraged to be open and honest about the ways their behavioral problems and chemical dependency have caused serious difficulties in their daily lives.

Adolescents in both tracks take part in an education group, learning specific techniques related to anger management, responsibility, communication and coping skills, conflict resolution, and self-esteem.

Those in the chemical dependency track learn about the serious consequences of substance abuse, relapse prevention techniques, and are introduced to the 12-Step Recovery process.

Two evenings per week, adolescents and their families attend a multi-family therapy group, where they work together to identify family patterns and explore the effects of behavioral problems and substance abuse on the family.

Once a week, parents and family members gather in a parent support group, which provides a supportive and sharing atmosphere. By attending, parents learn better ways to handle frustration, guilt, apathy, and feeling overwhelmed. The families discuss family roles and patterns, communication skills, limit-setting, and substance abuse. Concurrently, the adolescents attend their own support group.

Aftercare programs

Once children, adolescents, and adults complete the more intensive aspects of their individualized treatment programs, an individualized aftercare treatment plan is designed and implemented for them and their family members.

A multidisciplinary team continues to follow the progress of each client and make necessary adjustments as needed.

Emphasis on education

The child and adolescent programs place a great emphasis on keeping up with formal education. Students are supported in their efforts recapture scholastic skills and maintain academic standing. The BMC has its own accredited school with certified teaching staff.

Adult chemical dependency program

Chemical dependency is a progressive disease that can affect the entire family unit. BMC chemical dependency program staff members recognize the varying needs of their clients, and provide a flexible, multi-level treatment to meet these individual needs. Physical restoration is combined with rehabilitation of the mind, body, and spirit. Family treatment takes place during each phase of the program.

The recovery services program provides the highest quality of care consistent with guidelines of the American Society of Addiction Medicine (ASAM). The program has an abstinence orientation and endorses the 12-Step, self-help approach to recovery.

Services include inpatient detoxification, inpatient rehabilitation, outpatient full-day hospital, outpatient partial-day hospital, evening outpatient, continuing care, a chronic pain and medication dependency program, and dual diagnosis.

Staff members are specialists, trained in addiction treatment and offering total patient and family care. Each member of the interdisciplinary team plays a special role in the program. All aspects of each patient's needs are addressed, as well as those of family members affected by the addictive disorder.

The treatment team includes physicians certified by ASAM as addiction medicine specialists, certified chemical dependency counselors, registered nurses, family therapists, a pastoral counselor, psychologists, acupuncturists, and physical therapists.

Chronic pain and medication dependency

A unique specialty offered by BMC recovery services is the treatment of medication dependency associated with chronic pain syndrome.

Pain is different for each person, and chronic pain syndrome can have a profound, negative effect on an individual, forcing major changes in lifestyle.

Chronic pain patients have needs that are different from other chemically dependent individuals. They have a history of real pain, and the drugs they have become addicted to were prescribed for them. These dynamics are important to understand when providing care.

The treatment program includes medical management of pain, detoxification, acupuncture and acupressure, individual and group therapy, biofeedback, physical therapy, Pain and Pills Anonymous, and support for family members.

Loma Linda University Behavioral Medicine Center provides important mental health services to residents of the Inland Empire, as well as a vital training site for medical students and resident physicians.

[Scope, Autumn 2000]