Children and Mental Health: Dr. Pathak Explains the Child Programs at PPI

Meenal Pathak, MD

Children and Mental Health: Dr. Pathak Explains the Child Programs at PPI

Meenal Pathak, MD, wears several hats at Pennsylvania Psychiatric Institute (PPI). Dr. Pathak takes care of the child partial hospitalization program, which she has overseen since 2018, she also spends time in the child outpatient clinic, all the while being a Penn State assistant professor, and the president of PPI’s clinical staff.

“My main responsibility is caring for the kids who enter the partial program at PPI. When kids enter our program, I meet them to get their history, revise diagnosis and adjust medications as needed. The duration of our program is usually three weeks, though has sometimes been extended like we saw during COVID times due to patients who needed to be quarantined. Either a nurse practitioner or I see each child once a week during their stay, sometimes doing more check-ins if needed, and they attend group therapy every day. If a child is in crisis, our clinic staff will be the first to address the situation and let the providers know an evaluation is needed to decide if they need to go to the ER or home to their family. I also perform a discharge evaluation before any child is cleared from the program to make sure everything is squared away” explains Dr. Pathak.

Further describing the program, “Since the children do not go to school when going through our program, we have CAIU teachers at PPI. This way kids can continue their schooling while going through the program. We are in touch with their school counselors, provide collaborative care, psychiatry care and approved therapy. We also have a resource coordinator who helps set up aftercare appointments. The partial program can treat up to 45 patients at a time, with enough staffing. However, because of our need for more providers and nurses, our census for what we can currently handle runs closer to 35, which we were doing well with, until Covid hit.”

In March of 2020, all programs moved to telehealth, even the group therapy. Most of the staff was at PPI, but the patients were now at home. Kids were previously pulled from the group for their individual, family or psych evaluation session, but this could not be done with the new online meetings. So, a new plan was needed.

“Our resource coordinator stepped up and took on the responsibility of scheduling appointments for the psychiatrists, calling the families to do so. We had to update our screening practices and Intake forms so that they could be completed online. In July 2020, we started back in-person with a hybrid model, which unfortunately went back to telehealth during the surge in December, fully reintegrating to in-person January of 2021. The transitions were difficult, but our staff and team did well to quickly organize and continue running our programs” notes Dr. Pathak on Covid’s effect on the partial program and outpatient clinic.

“Though our team responded well, we still had our challenges. The severity of mental health worsened during and after Covid. Kids and families were more stressed out. Our inpatient unit has been at capacity for the past two years, so we don’t always have beds available for new patients. Patients coming from the ER would be there for a few days to stabilize before arriving at our inpatient unit. The children were admitted on the Pediatric floor where our consult team sees them and once cleared, they joined the inpatient unit. However, if no beds are available, they then wait on medical floor until we’re able to absorb them into partial program.”

“Similar to what was happening with our adult population, we were also seeing more acute youth patients. We were seeing kids with social anxiety from not leaving home for two years. Our partial hospitalization program helped with surge in mental health crises.”

“The stressors for children are different from adults. When evaluating a child, we consider the family home life, school life, friends, any bulling, stability and if there may be any abuse. Unlike adults, children are dependent on adults to get help for their needs. What we see the most of are diagnoses of PTSD, depression anxiety, autism, social, ADHD behavioral issues referred from aggression and OCDs.”

“When the schools close like due to Covid, or over the summer, some of the patients struggle. Some kids get school-based therapy, so they no longer get those services. Their counselors offer sessions, but the kids need to go to their office or use telemedicine. We found that virtual appointments can sometimes unfortunately hinder connection, as some don’t want to turn their camera on due to anxiety. Because of the difficulty connecting through school-based counseling thorough telehealth, returning to in-person meetings has helped.”

Under the guidance of Dr. Pathak over the past four years, the child partial program has restructured and developed.

“Our day-to-day workflow has changed. We have more streamlined processes for intake, medication administration and screenings. The program now has a nurse practitioner who helps to see patients during the week as well as address any crisis situations that may pop up. And though we have our challenges with nursing enrollment and staffing changes, our team works well to navigate through it.”

Dr. Pathak and her team have noticed that some adolescents struggle with engagement to see the program through. Because of this they are currently in the process of conducting a study on how they can improve compliance of program completion with outcome measures that affect which patients complete the program, and which will fail to complete. She hopes to find significant differences to then improve our parameters (which usually link to social determinants of health like transport, etc.).

“There is a HUGE need right now for mental health services. Our inpatient unit is always full, so having more partial programs available means we can help more people. Looking to the future, I would like to have a complement of telehealth services to help serve those living 2-3 hours away, so we can provide aid to a wider area.”

Through it all, Dr. Pathak stresses her gratitude for her team: “My team has been really great through Covid, and even now. They constantly keep their patients’ interest in mind and try to do the best for them and their families. I know it’s challenging for them, but the staff has been able to identify and address burnout sooner, in order to make sure their mental health is also taken care of.”


To learn more about the Child and Adolescent programs at PPI, click here, or call our Admissions Department at: 717-782-6493 or 866-746-2496.

Setting a New Standard for Psychosis Patients, CAPSTONE Helps Psychosis Patients Live a Normal Life

CAPSTONE Helps Psychosis Patients Live a Normal Life

Setting a New Standard for Psychosis Patients, CAPSTONE Helps Psychosis Patients Live a Normal Life

The word ”psychosis” is a powerful term that sometimes carries a frightening social stigma. But while psychosis is a serious condition, the Pennsylvania Psychiatric Institute’s CAPSTONE program is redefining its treatment and giving patients hope.

”It’s important for people to know that psychosis can be treated,” said Amanda Fooks, LCSW, Clinical Supervisor, CAPSTONE. ”With the right treatment and support, individuals can live a normal life even with active symptoms.”

CAPSTONE is an outpatient program designed to provide comprehensive treatment and support for young adults ages 16 to 30 experiencing early psychosis. ”The program focuses on early psychosis because, like any illness, the earlier you start treating it the better the outcome,” explained Fooks.

Psychosis can present like a break with reality. It can make it difficult for patients to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having unusual and persistent thoughts.

It’s a common misconception that patients experiencing psychosis need to be hospitalized. But a person only needs to go to the hospital if they are unable to keep themselves or other people safe.

”If possible, we want to avoid hospitalization,” said Fooks. ”We want to help them live as normal a life as possible. Hospitalization can be a traumatic experience in and of itself.”

Providing Comprehensive Care

What makes the outpatient CAPSTONE program so effective is the comprehensive nature of the services it offers. The program includes two components. The clinical component includes individual therapy, group therapy, psychiatry, peer support, and family education. The support component includes services like helping patients get a job or return to school and providing case management which helps them get to appointments and manage their mental health.

”This comprehensive care is possible through the close collaboration of three organization,” said Fooks. The Pennsylvania Psychiatric Institute provides the clinical care, and for individuals living in Dauphin County the YWCA of Greater Harrisburg provides the employment and education assistance, and Case Management Unit provides case management support. For individuals living in Cumberland and Perry counties, they would also utilize the YWCA of Greater Harrisburg to utilize supported employment and education and Penn State Holy Spirit for case management support.

”Staff from all three organizations, including psychiatrists, are in constant communication about the patient’s condition,” Fooks said. ”We work very closely together to provide complete care.”

Overall, the program aims to reduce symptoms or help patients managed their symptoms by teaching different skills and coping strategies. But the program is successful because it is centered on the participants.

”People set their own goals,” Fooks noted. ”If they are not working, they might set the goal to enroll in HACC and complete the entire semester. That’s success by their measure.”

For some, the symptoms may never completely go away. But the program recognizes that there is a livable amount of symptoms – which may vary by the person – and that’s the balance the program aims to find for each patient.

If you would like to speak to someone about better managing your stress and anxiety, or to make an appointment, please call (717) 782-6493 for more information.

Who CAPSTONE Helps
Due to grant limitations, CAPSTONE is only available to current residents of Dauphin, Cumberland, and Perry County between the ages of 16 and 30. It is designed for persons experiencing their first episode of psychosis, and requires the individual and their family to participate in services. Even if a person isn’t sure they are experiencing is psychosis, they should contact the Pennsylvania Psychiatric Institute as soon as possible and we can help, whatever the diagnosis.


”It’s important for people to know that psychosis can be treated. With the right treatment and support, patients can live a normal life even with symptoms.”
— Amanda Fooks, LCSW – Clinical Supervisor CAPSTONE

Lilian Comas-Diaz: Researcher for Multicultural Care

Lilian Comas-Diaz, PhD

Lilian Comas-Diaz: Researcher for Multicultural Care

During National Hispanic Heritage Month, September 15-October 15, 2022, we celebrate Latinx leaders who have had a lasting impact on the world of phycology.

The final person we want to highlight this year is Lilian Comas-Diaz, PhD. American psychologist and researcher of multiethnic and multicultural communities, she was the 2019 winner of American Psychological Association (APA) Gold Medal Award for Life Achievement in the Practice of Psychology.

Though born in Chicago, Comas-Diaz would move at six years old to where her parents were originally from in Puerto Rico, living there until her twenties. She felt driven her whole life to be psychologist and after earning her BA and MA from the University of Puerto Rico, she went on to earn her PhD in clinical psychology from the University of Massachusetts, Amherst in 1979.

After graduating, working at the APA in the Office of Ethnic Minority Affairs, she quickly recognized that the field of psychology was not adequately addressing the needs of underserved populations and decided to become an advocate for those communities.

Becoming the APA director of the Ethnicity, Race, and Cultural Affairs Portfolio in 1984, she played a vital role in the founding of Div. 45 of the APA (Society for the Psychological Study of Culture, Ethnicity and Race). She later became Div. 45’s first treasurer and was the first editor-in-chief of its journal, Cultural Diversity and Mental Health.

Outside of writing for the journal, Comas-Díaz has published works related to racial trauma and how to address it from ethnocultural and multicultural standpoints. Her publications include Ethnocultural Psychotherapy (1996), Multicultural Care: A Clinician’s Guide to Cultural Competence (2012), and Multicultural Care in Practice (2013).

In an interview recorded at the 2011 APA Convention in Washington, DC, Lillian Comas-Díaz talks about her book, Multicultural Care: A Clinician’s Guide to Cultural Competence. “Culture is like the air we breathe — it really shapes everything; it permeates all life. Culture shapes the way we get sick, the way we interpret our distress, the way we think we’re going to heal, the way we see our healers. So, it really — if we don’t recognize the elephant in the middle of the consulting room, we would be missing almost 90% of what goes on with clients.”

Further talking about culturally confident clinicians, Diaz-Comas states: “Clinicians need to engage in cultural self-assessment — know thyself. Then they have to commit to an ongoing process of examining the realities of how culturally imbedded we are, we all are, patients and also clinicians. And then an awareness that we don’t know at all, a willingness to not only work with culturally diverse individuals but also to learn from our clients. And last but not least, clinicians, we need to be flexible in our approach when we work with culturally diverse clients.”

“I believe [the importance of being culturally competent with all patients and problems, regardless of cultural or racial backgrounds] is because we are all culturally diverse, every interaction including clinical interactions are cross-cultural in nature. So, if we are culturally competent or we aim to be culturally competent, that’s a way of being a better clinician. In fact, many scholars say that cultural competence is super-ordinate to clinical confidence because it embraces everything. So yes, I do believe that cultural competence is needed with all clients and with all problems.”

As more providers are working towards delivering more culturally competent care, psychologists of color like Comas-Diaz have played essential roles in the difficult transition towards a more inclusive and less ethnocentric field of psychology.

References

First Latina Leader: Dr. Melba Vasquez

Dr. Melba Vasquez

First Latina Leader: Dr. Melba Vasquez

During National Hispanic Heritage Month, September 15-October 15, 2022, we celebrate Latinx leaders who have had a lasting impact on the world of phycology.

Today, we are highlighting the first Latina president of the American Psychological Association (APA), Melba J. T. Vasquez, Ph.D., ABPP.

Dr. Vasquez has authored numerous psychological texts, received awards acknowledging her prowess in the field, co-founded a multi-cultural conference and led to the creation of a new division of the APA, the Society for the Psychological Study of Culture, Ethnicity and Race.

In 2011, Vasquez, prompted by her colleagues, ran for, and was elected the first Latina President of the APA. Previously serving in leadership positions in the Association, she moved into a role previously occupied by only 12 women in the 100-year history of the organization. Her tenure as president focused on educational disparities for poor or ethnic minority students, immigration, preventing discrimination, and social justice.

Her leadership lead to a more inclusive Association and more diverse attendance at their annual convention.

“As APA President, my theme for the 2011 APA convention was social justice, and several of my presidential initiatives were relevant to that theme, and I received feedback that many participants came because of that,” said Vasquez when discussing her time as President. “One mid-career African American psychologist told me that he had attended once before ten years previously and had not connected with the conference, but he was enjoying this conference very much. He said, “this is not my grandfather’s conference!”

In the past, Dr. Vasquez saw a lack of support and inclusion for minorities in the field. “Psychology in general, APA in particular, have a terrible history of racism and other forms of biases,” said Vasquez. “Many in the leadership of the past promoted eugenics and other forms of oppressive, faulty research that was harmful for racial and ethnic minorities in society and among its members.”

In October 2021, the American Psychological Association acknowledged its role in promoting and perpetuating racism in the United States. In issuing its apology, the APA confirmed its commitment to equity, diversity, and inclusion.

“The American Psychological Association failed in its role leading the discipline of psychology, was complicit in contributing to systemic inequities, and hurt many through racism, racial discrimination, and denigration of people of color, thereby falling short on its mission to benefit society and improve lives. APA is profoundly sorry, accepts responsibility for, and owns the actions and inactions of APA itself, the discipline of psychology, and individual psychologists who stood as leaders for the organization and field.” American Psychological Association Council Policy Manual

“The process of arriving at the apology involved reviewing some of the historic racist events and products.” said Dr. Vasquez when commenting on the apology, “Improvements are slowly made, but much work has yet to occur at individual, group and institutional and organizational levels of psychology.”

In 1999, Dr. Vasquez co-founded The National Multicultural Conference and Summit. The conference provided an opportunity for psychological professionals to gather to inform and inspire multicultural theory, research, practice and advocacy. The conference has been held every two years since its inception. In 2024, NMCS will be held in Santa Fe, NM.

With changes from the APA and a visible increase in the presence of Latinx psychologists in academia, conducting research, teaching, and training, and providing services in communities around the United States, Vasquez sees positive change in her field.

For the Spanish-speaking population, linguistically competent care from organizations like the Pennsylvania Psychiatric Institute (PPI) has become a vital part of care.

“The development of structures to provide ongoing services for the Latinx community is very important,” said Vasquez. “We are a varied group; some speak English very well, some are acculturated, but even those more often than not prefer cultural and linguistic compatibility.”

Dr. Vasquez continues to build on her work, spending time promoting leadership development for graduate students, early-career and mid-career psychologists. She does this through informal mentoring and through structured groups like the Leadership Institute for Women in Psychology.

For more information on PPI’s services for the Spanish-speaking population, visit the Hispanic Psychiatric Programs page, or call (717) 782-2120.

Juan Luis Vives: Father of Modern Psychology

“It ought to be the duty of the public officials to take pains to see that men help one another, that no one is oppressed, no one wronged by an unjust condemnation and that the strong come to the assistance of the weak in order that the body of citizens may grow in love day by day and endure forever.”
― Juan Luis Vives

Juan Luis Vives

Juan Luis Vives

During National Hispanic Heritage Month, September 15-October 15, 2022, we celebrate the achievements and contributions of Hispanic champions who have inspired others to succeed.

Today, we are highlighting the father of modern psychology and the grandfather of psychoanalysis, Juan Luis Vives.
Vives lived during a turbulent time in history. Born in 1493, one year after efforts of the Spanish Inquisition intensified due to royal decrees ordering Jews and Muslims to convert to Catholicism. His family would soon come under persecution for their religious beliefs, with his father, grandmother, grandfather and other extended family members executed. In 1509 Vives left Spain for Paris and started his formal academic education, where he was introduced to the Parisian humanist circle. By 1514, he had left Paris and settled in Bruges, where he would spend most of his life, split between the Netherlands and England.

His impact on the world would start to be felt in 1518, with the publishing of “Fabula de homine” (“A Fable about Man”). This piece offered a preview of his developing views on the nature and purpose of humankind. Vives would continue publishing through his death in 1540, with his last work, “De veritate fidei Christianae” (“On the Truth of the Christian Faith”) posthumously in 1543. In physiology, Vivess’ fame rests on the publication of “De anima et vita libri tres” (“Three Books on the Soul and on Life”) in 1538. Within this work, he would discuss the association of ideas, the nature of memory, animal psychology and induction as a method of psychological discovery. Through this publication and his other works, Vives developed his ideas on psychology, leading to the lasting implications in the field we still feel today.

“One of the most distinctive features of Vives’ study of the human soul is the fundamental role that psychological inquiry came to play in his reform program,” writes Lorenzo Casini in the Stanford Encyclopedia of Philosophy. “His use of psychological principles in his writings often surpasses that of previous authors in scope and detail. He applies these principles, for instance, not only to individual conduct and education, but also to professional practice, social reform and practical affairs in general.”

As the first scholar to analyze the psyche directly, his work would go on to influence others, including:

  • Philip Melanchthon, a German theologian, an influential educational system designer.
  • Juan Huarte de San Juan, a Spanish physician and psychologist who established many early works on psychology.
  • Robert Burton an English writer who is best known for his comprehensive book The Anatomy of Melancholoy.
  • René Descartes a French philosopher, scientist and mathematician, who is widely accepted as a leader in the emergence of modern philosophy and science.

 

Juan Luis Vives is still honored today as a notable educator, scholar, philosopher and pioneer in psychology. As recently as 2013, Vives values inspired two Belgian Schools for higher education (KATHO and Katholieke Hogeschool Brugge-Oostende) to choose his name for their merger.

Sources:

The Hispanic Clinic with Dr. Diaz

Ailyn Diaz, M.D.

The Hispanic Clinic with Dr. Diaz

During National Hispanic Heritage Month, September 15-October 15, 2022, we celebrate the achievements and contributions of Hispanic champions who have inspired others to succeed.

To start off, we want to highlight one of our own, Ailyn Diaz, MD, who has been a part of our team since 2015. Dr. Diaz is a child and adolescent psychiatrist at Pennsylvania Psychiatric Institute (PPI) as well as the Director of the Hispanic Clinic.

“The Hispanic Clinic is a specialty service where we can see patients in their native language with bicultural and bilingual therapists. Patients get to see someone with a cultural understanding of what they are going through” explains Dr. Diaz.

“Culturally and linguistically competent care is important. Hispanic women have higher rates of anxiety and the pandemic saw increased rates of suicide in Hispanics.” The relationship and communication between a person and their mental health provider is a key aspect of treatment. It’s important for a person to feel that their identity is understood by their provider to receive the best possible support and care.

The Hispanic Clinic delivers culturally competent psychiatric care and recovery-oriented services to patients in the Latino and Hispanic communities. It distinguishes itself from other PPI services in that all care is delivered/offered in the Spanish language by bicultural and bilingual psychiatrists and therapists. The Hispanic Clinic is inclusive of the Latino and Hispanic communities in Central Pennsylvania with a commitment to collaboration and empowerment through the identification of health disparities, stigma and structural influences.

Dr. Diaz further describes it: “Our clinic helps the Hispanic community with not only mental health and drug and alcohol recovery help and treatment, but also with other things like the ability to obtain services, navigate housing needs, and working with network of providers outside PPI for general treatment. We coordinate with the community, our parent organizations, internal programs, therapists and of course, our patients.”

When it comes to the founding of the Clinic, Dr. Diaz summarizes, “The Hispanic Clinic began in the 1980s by Dr. Montaner and Dr. Morales-Brandt when they were residents at Hershey Medical Center. They saw patients who spoke Spanish, and realized they needed to look at the aspect of culture in treatment. The location of clinic bounced around with the doctors until the Pinnacle Health (now UPMC) and Penn State Health merger in 2009, where it moved to its current location at PPI, where it remains though the founding physicians have either left or retired.”

Though the clinic’s parent organizations changed over the years, it continued to evolve, aiding a community in need, and providing success: “Through this clinic we have been able to help those who were homeless obtain and navigate the system to obtain housing and food, help those who have no insurance, help transgender people with no insurance cross the border in order to see a provider and provide charity care to those in need of specialty medical care” notes Dr. Diaz.

When asked of her goals, Dr. Diaz listed: “One of the great areas of need is a bilingual liaison to help community. I want to continue forming liaisons with community providers. I’d love to expand the clinic, expanding medical care is essential, however, we need a larger team with bicultural and bilingual providers.”

For more information on the Hispanic Clinic, visit our Hispanic Programs page, or call (717) 782-2120.

Vot-ER: Dr. Graziane’s Drive for Civic Health

Dr. Julie Graziane

Vot-ER: Dr. Graziane’s Drive for Civic Health
Julie Graziane, MD, has been an inpatient psychiatrist at Pennsylvania Psychiatric Institute (PPI) for the Mature 50+ unit for five years. Though the Geriatric unit is her home, she also helps to cover the other adult units at PPI. Outside of her love for helping care for her mature patients, she has a side passion for civic engagement.

Dr. Graziane illustrates the situation: “A lot has happened since 2020, and we’re seeing a population with more acute needs. Depression and mental illness decrease the probability of voting, especially as it relates to a marginalized population. However, voting is an important part of the recovery process. It has been found to increase life satisfaction, decrease risky behaviors and increase mental wellbeing.”

“Voting affects policies that affect patients’ lives. With increasing focus on social determinants of health and giving patients a voice in the policies that affect them, voting empowers the patient on an individual level.”

When asked about her interest in this topic, Dr. Graziane responded: “Civic health is academically very interesting for me. It is important to think about when working with patients because it is not only biological illnesses, but also social factors (social determinants of health) that affect patients. A patient’s rights and decisions affect them in the long run, so it is important to consider this in the patient/provider relationship.”

Due to the benefits for patient wellbeing, PPI is offering support to help their patients vote. “Offered to our PA residents, we can help them check their polling place and voter registration. Our hope is to expanded initiatives to encourage voter registration throughout our hospital” explains Dr. Graziane. “We partnered with Vot-ER, a national nonprofit organization that integrates voter registration into the health care delivery system.”

An excerpt from the Vot-ER website further explains their mission:

  • Vot-ER is founded on a core belief that empowered voices and full participation in the democratic process lead to positive health outcomes.
  • More specifically, Vot-ER connects healthcare institutions and providers with the tools, training, and community to register colleagues and patients to vote, bringing providers and patients together to promote civic engagement and create healthier communities across the United States. Vot-ER views hospitals and community health clinics as central touchpoints in communities – much like schools, DMVs, and libraries – where citizens should consider their civic health as well as their physical and mental health.

“PPI has really embraced their identity as a community psychiatric center. With a fair amount of community outreach, and now offering a community psychiatric fellowship, PPI realizes the important role community psychiatrists play in society. We are now taking a broader lens when looking at patients and considering their social determinants of health, which is sometimes just as important as the illness when thinking about recovery.”

Excitedly, Dr. Graziane notes: “My personal goal is to continue to increase civic health at PPI. Civic engagement and voting impact the health of our community. I want it to expand throughout the entire system; getting providers to speak to patients in every department about voting. Providers helping patients register is one more thing they can do to help their patients feel empowered.”