Postdoctoral Psychology at Kaiser Permanente
South Sacramento and Roseville
DEPARTMENT OF PSYCHIATRY
8247 EAST STOCKTON BLVD
SACRAMENTO, CALIFORNIA 95828
The Central Valley Consortium consists of two programs, South Sacramento and Roseville. The South Sacramento Program has three postdoctoral residency positions in the Outpatient Program: Two are full-time temporary positions in the Adult Outpatient Program, and one is a full-time temporary position in the Child & Adolescent Outpatient Program. The Roseville Program has two full-time temporary positions in the Adult Outpatient Program. Residencies are limited to one year: all residents are required to complete 40 hours of training per week over a 12-month period, during which they accrue a total of 2000 training hours. In each position, the resident has some input on the structure and focus for the training year, especially in identifying competency goals.
MISSION AND TRAINING MODEL
The mission of Kaiser Permanente Medical Centers (KPMC) is to provide integrated, efficient, high-quality, evidence-based health care while supporting innovation and continuous quality improvement. The mission of the Central Valley Program Postdoctoral Training Program is to provide residents with advanced training within this highly integrated, multidisciplinary healthcare system, in order to prepare them for dynamic roles as practicing psychologists in the healthcare system of the future. Residents train in collaboration with, and with guidance from, psychologists and physicians.
The Central Valley Postdoctoral Training Program subscribes to the Practitioner-Scholar model of training. This model emphasizes the development of professional skills among practitioners who utilize the field's scientific knowledge (Evidence-Based Treatment) in their professional practice. The program is committed to training professional psychologists who are life-long learners dedicated to engaging in continuous education, scientific inquiry, and scholarly endeavors.
THE SETTING
Sacramento
The greater Sacramento area (city/county) has a population of one and a half million people. The area is located at the confluence of the Sacramento and American rivers, in the Sacramento valley, an easy day trip from the ocean, San Francisco, or the Sierra Nevada Mountains. Outdoor activities are popular, esp. from April to November, when the weather is warm and dry. Cost of living is moderate for California communities.
Sacramento is the heart of California’s Central Valley and also the state capitol. One postdoctoral resident specializing in Adult Psychiatry train at the South Sacramento satellite office. This facility is located just south of downtown Sacramento and adjacent to one of the fastest growing cities in the country, Elk Grove. There is a satellite clinic in Elk Grove that offers both medical and psychiatric services. Elk Grove is known for its affordable new housing, proximity to downtown Sacramento and welcoming family atmosphere. The postdoctoral residents specializing in child psychiatry and the second Adult Psychiatry resident train at the Elk Grove clinic. Both sites are located about 2 hours from the Pacific Ocean, San Francisco, and Napa/Sonoma wine country, and only 90 minutes from the Sierra Nevada Mountains and Lake Tahoe. Roseville is a small city about 16 miles east of Sacramento.
Patient Population
We have 180,000 members covered in our area; the Kaiser programs in Sacramento cover approximately 30% of the residents of the county. The diversity of the south area is reflected in our patient population: Caucasian = 42%; Hispanic = 23%; Asian = 21%; African-American = 13%; Native-American = 1%.
The Staff
South Sacramento
Most of the staff in the department are full time. Currently, the South Sacramento/Elk Grove Departments of Psychiatry include 22 psychologists, 38 social workers, and 15 psychiatrists. A triage team performs telephone and face-to-face screening and assigns patients to regular or urgent intake appointments.
Roseville
The professional staff consists of over 120 mental health practitioners located on four different sites throughout Sacramento (Sacramento, Roseville, Folsom and Ranch Cordova Campuses). Staff include psychologists, psychiatrists, nurse practioners, licensed psychiatric social workers, marriage and family therapists, and psychiatric nurses. A team of triage staff members provides front line access for patients through telephone and face to face contacts on each campus, and we provide triage at the Emergency Room in Sacramento and Roseville.
Services
South Sacramento/Elk Grove
The departments of Psychiatry at South Sacramento and Elk Grove offer outpatient therapy to adults, couples, families, and children. The therapy coverage for most Kaiser members is focused, brief treatment, although patients with severe and chronic problems have access to ongoing services. Treatment for many diagnostic groups is informed by Best Practice guidelines, developed and periodically updated by regional work groups. Patients are encouraged to participate in classes and groups that are offered for most problem areas. A treatment “package” often includes a combination of individual, group, classes, and possibly medication. Intensive Outpatient (“day treatment”), Alcohol and Drug treatment, Eating Disorders, and Dialectic Behavior Programs provide more intensive, focused options for treatment.
Roseville
The Department of Psychiatry provides individual, group, psychological and neuropsychological testing, and psycho-educational programs such as stress reduction, couples communication and other classes. It also includes an Intensive Outpatient Program (IOP) that provides services to recently hospitalized individuals or people who would otherwise be at risk for hospitalization. We run approximately 30 different groups, from Dialetic Behavioral Therapy to Job Stress. The members of the staff represent a variety of theoretical orientations.
BACKGROUND AND HISTORY
In Northern California, postdoctoral residency programs have been an integral part of KPMC’s larger vision. Beginning in the late 1960s, KPMC began hiring large numbers of psychologists, as a result of the influence of Nicholas Cumming, Ph.D., who was a Kaiser psychologist early in his career. Subsequently, KPMC initiated several postdoctoral programs. During the last twenty years, there has been a major movement to standardize KPMC’s mental health delivery system. Under the leadership of Robin Dea, M.D., Chair of the Northern California Regional Chiefs of Psychiatry, mental health treatment services have tripled in size. Dr. Dea prompted the development of new treatment guidelines and integrated care. Along with this organizational maturation and integration of psychological services, the postdoctoral residency program grew in size, with increased support by KPMC.
Under the leadership of Lloyd Linford, PhD., we have made a commitment to evidenced-based treatments. To this end, departments throughout the region send specialists to meet regularly to develop Best Practice guidelines based on the most current research for major psychological disorders, such as: Depressive Disorders, Anxiety Disorders, and Eating Disorders. These guidelines are published in manuals which every department is expected to use in order to provide comprehensive and appropriate treatment. The Best Practices literature is made available to all residents and is considered part of overall curriculum of the residency program.
The Central Valley Consortium functions within the largest HMO in the United States. Each medical center provides a full range of services to thousands of patients. Health care, as envisioned by KPMC, is an integrated system. Providers from specialty areas such as pediatrics, internal medicine, neurology and psychology work together in a collaborative manner to provide integrated treatment. The postdoctoral residents train within this collaborative system and are seen as an integral part of the overall healthcare delivery system. Each medical center has psychologists working in various departments including Psychiatry, Chronic Pain, Chemical Dependency, and Behavioral Medicine.
PROGRAM FACULTY
The program faculty includes licensed psychologists and board certified psychiatrists who lead seminars and conduct individual and group supervision. Training is overseen by the postdoctoral residency training director, with additional administrative guidance provided by the Northern California Director of Training.
The postdoctoral residency training director develops residents’ schedules which include supervision for the primary and delegated supervisors, group supervision for psych assessment, case conferences, staff meetings, etc. The training director also assigns each resident to department programs/groups that meet the resident’s particular interests and training goals. In addition, the training director is responsible for data collection/documentation and record keeping of residents in their program, program design, development, and evaluation. The training director meets with supervisors once a week to discuss residents, program coordination, disseminate information, etc.
The training director also meets with the Northern California Director of Training on a regular basis to problem solve and ensure standardization of training. Topics of discussion include: program development/evaluation/maintenance of records/recruitment, keeping up-to-date with regional standards, BOP, APPIC, and APA.
THE TRAINING PROGRAM
General Principles
The postdoctoral program is intended to lay the foundation for clinical competence sufficient for independent functioning in the practice of clinical psychology and for a well-founded professional identity. In addition, residents get direct and indirect instruction on how to function in a multi-disciplinary team.
In practice, the resident is expected to handle evaluations and treatment for a wide range of outpatient problems, with guidance and supervision from a primary supervisor and secondary supervisors. Most residents have contact with more than 100 outpatients over the training year and have experience co-leading or leading groups and psycho-educational classes.
Goals, Objectives, and Competencies
Supervision
Coordination of supervision, schedules, training assignments, and administration issues is the responsibility of the Postdoctoral Residency Training Director. The “primary supervisor” is responsible for the supervision of the resident’s clinical work. Each resident works under the primary supervisor’s license. Each patient who is seen by the resident is informed at the time of telephone contact, and then before being seen, in writing, of the professional status of the resident. The primary supervisor provides at least two hours of face-to-face supervision a week and is available by telephone throughout the work week. One hour of group supervision is provided by the training director. Additional supervisors and/or a weekly case conference add up to an hour of supervision for every ten hours worked.
Seminars
Residents attend weekly two-hour training seminars where psychologists and other staff present on topics relevant to clinical practice. On a regular basis, the residents travel to the Bay Area for an afternoon workshop on such topics as ethics, Best Practices for chemical dependency, and professional development.
Evaluations
The training directors and primary supervisors are responsible for completing the resident’s Competency Quarterly Progress Reports in collaboration with the rest of the training staff. All efforts are made to provide ongoing feedback to residents throughout the year. Residents also have an opportunity to evaluate this program twice a year.
Grievance Procedure
At the time of orientation, residents complete a supervision agreement contract which sets out expectations and terms of continuance and termination. This serves as a reference for any disagreements that may arise. Residents are encouraged to work out conflicts with supervisors with the supervisor. Problems in interactions with staff may be discussed with the primary supervisor and the Training Director, and, if necessary, the Department Chief.
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