Menlo Park Division: VA-Palo Alto Health Care System
Clinics and Services
The Menlo Park Division, located on 95 beautifully landscaped acres at 795 Willow road near Highway 101, offers a number of outpatient psychiatry, long term care and special programs providing a wide range of health services to veterans. The Menlo Park Division provides comprehensive Mental Health services for veterans. These services include evaluation and treatment through inpatient, outpatient and community-based clinics and programs. Select from the list below or scroll down the page to read descriptions of the various programs.
Menlo Park Division Programs
Inpatient Geriatric Psychiatry (348, MP)
Javid Sheikh M.D., M.B.A;. Director VA Inpatient Psychiatry
Howard Fenn M.D.
R. Chalekere M.D.
Ellen Coman Ph.D.
This ward consists of 20 acute inpatient beds staffed by two full-time geriatric psychiatrists and a full-time geriatric psychologist, with specialty training in Neuropsychiatry. Each resident functions as the primary care provider for approximately half of the ward's patients. High frequency diagnoses include major depression, schizophrenia, bipolar disorder, schizophrenia, schizoaffective disorder and behavioral disturbances associated with dementia. Female as well as male patients are treated on this ward. Residents focus on diagnostic evaluations and using a biopsychosocial approach to treatment, functioning as an integral part of an interdisciplinary team. There is a focus on pharmacologic management as well as short-term supportive psychotherapeutic interventions. In addition, the residents are involved in family interventions, and consult with the psychologist regarding neuropsychological and personality testing. Residents attend a one-hour weekly seminar on Geriatric Psychiatry in addition to a one-hour interviewing course provided by the department. Residents are also expected to attend a lecture on a general topic in psychiatry which occurs once weekly at the Menlo Park VA. Faculty members go over every case daily with the residents and interview patients daily with the resident. The resident follows eight patients who are selected for breadth and variety of experience. Residents are expected to present a case once a month at an interdisciplinary case conference with opportunity for further teaching by other faculty psychiatrists and psychologists.
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National Center for Post Traumatic Stress Disorder
Clinical Laboratory and Education Division (323 A & D, MP)
Steve Lindley M.D., Ph.D.
Supervisors: Kent Drescher, Ph.D.
Robert Jenkins, Ph.D.
Dorene Loew, Ph.D.
Ronald Murphy, Ph.D.
Josef Ruzek, Ph.D.,
Steve Woodward, Ph.D.,
The National Center for Post Traumatic Stress Disorder (NCPTSD) is a congressionally mandated consortium whose goal is to advance understanding of trauma and its consequences. The Clinical Laboratory & Education Division (CLED) at the Palo Alto VAPAHCS, Menlo Park Division is one of five National Center sites. The others are located in Boston (Behavioral Science Division), Honolulu (Pacific), West Haven (Neuroscience Division), and White River Junction, Vermont (Executive Division). The Clinical Laboratory has the largest inpatient milieu of its kind. The Center has an average daily census of approximately 50 veterans, mostly war-zone. Most are veterans of the Vietnam conflict, although veterans of WW II, Korea and the Gulf War are also seen. Since 1993, we also have treated women veterans with active duty sexual assault experiences. The National Center's outreach activities have been extended to other traumatized individuals, (e.g., the 1989 California earthquake survivors and Coast Guard rescue workers, among others).
The 30 bed inpatient program treats PTSD and alcohol addiction/abuse simultaneously, recognizing that alcohol abuse often creates a new set of symptoms that overpower and cover up PTSD symptoms. The program's objectives include reducing the physiologic reactivity and reexperiencing symptoms associated with PTSD and helping the veteran develop coping behaviors that counteract maladaptive coping associated with PTSD and alcohol abuse. Treatment is provided within a therapeutic milieu using psychodynamic, cognitive/behavioral, and developmental methods of treatment across therapy groups and associated activities. Therapy groups and classes include those for conflict resolution, family issues, assertiveness training, autobiography, stress management, relaxation management, and health. Other program activities include discharge planning for housing and employment, and linkage to outpatient treatment , and social supports in the veteran's community.
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Mental Health Clinic (321, MP)
Perrin French M.D.
Joseph Belanoff M.D.
Pat Ashbrook, Ph.D.
Gary Schmidt, Ph.D.
The Mental Health Clinic (MHC) is a full-service outpatient clinic for the Health Care System (HCS) serving individuals with a wide range of psychological, emotional, social, and psychiatric problems. It provides individual and group psychotherapy, family and couples therapy, psychoeducational groups, case management, medication evaluation and follow-up, and liaison/consultation with other programs and staff. Clients are referred to the MHC from various inpatient programs (e.g., psychiatry, addiction treatment, PTSD, medical), other outpatient programs, community programs, or self-referral. Each client is assigned to an interprofessional treatment team who then develops an individualized treatment plan. The MHC also functions as a crisis-intervention center for clients in acute distress. "On call" teams provide triage, evaluation, and limited admission services for the HCS. Clients seen by "on call" team staff generally come to the MHC without a scheduled appointment, and so may be in acute, sub-acute, or stable states. Clients assessed by the "on call" teams may be admitted for inpatient care, referred to outpatient services, or referred to other community services. In addition, the MHC offers specialized services in geropsychiatry, mood disorders, and schizophrenia/other psychoses. From the diagnostic perspective, clients seen in the MHC represent the full range of DSM-IV disorders.
Currently, full-time clinical staff includes 5 full-time psychiatrists, 4 senior psychiatry residents, 1 full-time psychologist, 1 part-time psychologist as well as nurses and social workers. During a resident's six month tenure at MHC she is resposible for a case load of 15 patient hours per weeks, including new patient intakes and ongoing psychopharmacologic and psychotherapeutic management. Residents receive 3 hours of individual and one hour of group supervision per week. Clinic psychotherapy supervisors represent a full gamut of treatment perspectives, including cognitive-behavioral, biological, and psychodynamic, psychoanalytic, interpersonal, feminist, etc. In addition residents receive 3-4 hours didactics per week; one afternoon per week of clozapine clinic and 2-3 months part-time community care.
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Nursing Home Geriatric Consultation/Liaison Psychiatry (Wards 324 A, B, C, D, and Building 331)
James Hawkins M.D.
Elective one-year rotation occurring in the fourth year. Faculty consists of two full-time geriatric psychiatrists and a part-time general psychiatrist plus a team of staff experienced in the long-term care of geriatric psychiatry patients in a teaching nursing home setting. The maximum caseload is twenty patients; the average caseload is fifteen sub-acute and chronic patients. All residents have required individual supervision three times weekly. Residents are expected to present cases at an interdisciplinary case conference with opportunity for further teaching by other faculty psychiatrists and psychologists.
Residents attend a one-hour weekly seminar on Geriatric Psychiatry in addition to two general psychiatry seminars provided at the VA (plus the usual one afternoon per week of seminars sponsored by the department). Residents are also expected to attend formal rounds and to make rounds with their attending on the patients they are following, as well as those being followed by the attending psychiatrists. Faculty members go over every case regularly with the resident and interview patients with the resident. The resident follows between fifteen and twenty patients who are selected for breadth and variety of experience.
High frequency diagnoses include a wide variety of cognitive disorders (including delirium and dementia of the Alzheimer's, vascular and traumatic brain injury types), major depression, schizophrenia, rapid-cycling bipolar disorder, schizoaffective disorder, and behavioral disturbances associated with dementia. A majority of patients have complex psychiatric as well as non-psychiatric medical problems. Female as well as male patients are treated on these wards. Residents focus on comprehensive diagnostic evaluations and use a biopsychosocial approach to treatment, functioning as an integral part of an interdisciplinary team. There is a focus on pharmacologic management as well as short-term supportive psychotherapeutic interventions. In addition, the residents are involved in family interventions, and consult with the members of the interdisciplinary team (including the patients' primary medical physician) regarding all aspects of the patients' care.
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Brief Partial Hospitalization Program
The Brief Partial Hospitalization Program (BPHP) has been in existence since May 1996. It is staffed by a multidisciplinary team from Psychology, Psychiatry, Social Work, Recreation Therapy, Nursing, and Pharmacy services, and trains interns in each of these fields.
Partial hospitalization is defined by its national Association as ''an ambulatory treatment program that includes the major diagnostic, medical, and psychiatric treatment modalities designed for patients with serious mental disorders who require coordinated, intensive, comprehensive, and multidisciplinary treatment not provided in an outpatient clinic setting.'' It has as often been defined as a less restrictive, less expensive alternative to inpatient care. There are highly differing forms of partial hospitals, in terms of length of stay, populations treated, and methods of treatment, the only common feature being that the programs occur during some portion of the day or evening. Functions of partial hospitals have included treating patients otherwise treated on inpatient units ("diversion"), patients in transition from inpatient to outpatient care ("step-down"), and outpatients who may benefit from more intensive care, but don't require inpatient treatment ("step-up").
BPHP functions in each of these ways, within a mandated brief time frame (3-4 weeks). The program runs 5 days a week. Male and female patients carry both Axis I and Axis II diagnoses, and often have concomitant substance abuse, and significant medical, and significant psychosocial problems. A major difference between BPHP and traditional day programs is that BPHP can provide short-term housing for patients temporarily homeless or who live too far away to commute.
Patient needs and goals are quite varied, and include medication evaluation or stabilization; dealing with immediate life crises and stressors; help with adjustment to living situations; help with utilization of outpatient resources and other VA programs (Next Step, Dual Diagnosis, ATS, PTSD, HVRP, etc.); identifying, learning to cope with and change long-standing maladaptive life patterns.
The overall focus of treatment at BPHP is to foster responsible behavior in pursuit of the skills necessary for independent, and mature interdependent, living. Toward that end, patients work to better understand the feelings, thoughts, and behaviors which hinder and help responsible independence and interdependence. They set daily goals in Community Meetings. These goals strive to be specific, realistic, and attainable, and to reflect the patients' primary issues as defined in their Master Treatment Plan. All treatment team members participate in the treatment milieu, intake procedures, and treatment planning.
Patients work both individually and in groups and classes with team members. Each team member serves as a Treatment Coordinator for a certain proportion of patients, and develops their Master Treatment Plan with them. This plan seeks to help the patient make best use of the program, which includes:
- community meeting;
- medication clinic;
- group psychotherapy;
- communication and social skills;
- cognitive skills;
- emotional awareness and distress tolerance;
- internal and external boundaries;
- feelings and values;
- relaxation and stress management;
- general health education;
- symptom management;
- medication education;
- recreation lifestyle development;
- weekend planning;
- creative expression;
- and activities such as gardening, swimming, and bowling.
The intern is a part- or full-time member of the treatment team, and as such participates as a treatment coordinator. Also, co-leading group psychotherapy is a primary responsibility. Otherwise, training opportunities vary according to the intern's needs and interests.
The intern has the opportunity to play a multifaceted role as therapist, case manager, consultant, and teacher, with professionals whose orientations and priorities may differ. Individual supervision will be with the staff psychologist, but additional consultation with other staff is possible. Dr. Linenberg's orientation is broadly psychodynamic and existential, and he has a substantial interest in psychotherapy integration, as well as integration of concepts from the humanities into clinical work.
The general goals of supervision are consistent with the training objectives listed above. They include helping the intern enhance his or her therapeutic style and ability to make therapeutic interventions, while also constructively expanding ways of conceptualizing: patient problems; diagnosis; interpersonal and symbolic meanings of various actions and communications; use of hospitalization and brief treatment; and ways in which psychologists contribute to a pluralistic approach to treatment.
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Dual Diagnosis Program (321-MHC, MP)
Jeffrey Kline, Ph.D.,
Renate Welch, Ph.D.
The Dual Diagnosis program is located on wing C1 of Building 324 at the Menlo Park Division. It is a comprehensive treatment program targeting severely and persistently mentally disordered patients with concomitant substance dependence problems. The program has the capacity to treat patients along a continuum of inpatient and outpatient care according to the needs of the patient. Our multidisciplinary staff offers day programming and individualized outpatient interventions. The services can include assessment, individual psychotherapy, group psychotherapy, psychoeducational classes, relapse prevention skill building, expressive arts, and/or pharmacotherapy. Interns are based primarily in the day program with the option of following patients in ongoing outpatient treatment after their patients complete the day program. Interns serve as a primary provider for a caseload, conduct standard comprehensive assessments for their patients, co-lead group psychotherapy and milieu meetings on a daily basis, teach psychoeducational and relapse prevention classes, and participate in treatment team meetings. The main goal for interns is to become competent as a primary health provider with complex cases by combining case management and psychotherapy. In addition, interns will be familiar with systems issues that interweave in a comprehensive treatment program and will develop a broader and more coherent set of theoretical principles with which to guide their work. Interns spend a minimum of 2 hours per week in individual supervision with either Dr. Kline or Dr. Welch. Interns also spend a total of 1 hour per week in training-focused discussions about the daily group psychotherapy and treatment milieu issues. Supervision focuses on psychodynamically-informed interventions and learning about the implementation of principles of developmental psychopathology, substance abuse treatment, systems theory, and strategic intervention.
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Family Therapy Program (MP)
Douglas Rait, Ph.D., Director
Nancy Koch, R.N.C., B.S.N.
Joan Ross, R.N., M.S.
The Family Therapy Program at the VA Palo Alto Health Care System has an international reputation as a center devoted to the treatment of couples and families, the training of mental health professionals, and the study of family processes. In addition to teaching , The program provides family therapy training for residents, medical students and psychology interns. Family-systems theory represents the major stance from which both clinical data and therapeutic change are considered, and the program's educational curriculum is focused on developing a full range of clinical skills including couples and family assessment, interviewing, intervention, and family-systems consultation. Just as there are numerous models of couples and family therapy, our staff comfortably represent differing theoretical orientations that include structural, strategic, systemic, narrative, experiential, multigenerational, psychoeducational, and sociocultural approaches. Training in this program concentrates first on fundamental systemic assessment and treatment skills that most family therapists draw upon, yet exposure to specific clinical models and techniques is also offered. For additional information about the Family Therapy Program, please contact Douglas Rait, Ph.D. at (650) 493-5000, extension 25573.
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Hospice Care (Nursing Home Care Unit, MP)
Supervisor: Margaret Florsheim, Ph.D.
The purpose of Hospice Care is to provide humane care for terminally-ill patients during end of life. The Psychology intern works with staff at the Hospice Program in the nursing home to support the patient, and he or she works with family and loved ones, as well as the patient, as needed to provide additional services that will enhance quality of life. Individual therapy with caregivers or patients can be offered; Couples' therapy may also be appropriate in some cases. The Hospice team is a well-functioning group of dedicated professionals who value the role of Psychology and include the intern as a full member of the team.
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Homeless Veterans Rehab Program (347, MP)
Thomas Burling, Ph.D., Chief, Domiciliary Service
Joel Rosenthal, Ph.D.
The Homeless Veteran Rehabilitation Program (HVRP) provides comprehensive rehabilitation services for homeless veterans in the Bay Area. Services include an outreach and screening program, a 50-bed residential therapy program, a community-based housing and aftercare program, and a research and training center to promote advances in the understand and treatment of homelessness and addictions.
Both male and female veterans who have been homeless for periods ranging from less than one month to over 10 years are treated thorough HVRP. Approximately 90 percent of inpatients ("residents") have been diagnosed with personality disorders, and a similar percentage carry a diagnosis of substance dependence. About half have at least one other psychiatric diagnosis, including affective (30%), anxiety (15%), and psychotic (5%) disorders. Most incoming HVRP residents, although verbal and intelligent, struggle with restricted repertoires of coping strategies and limited sources of reinforcement.
The treatment approach at HVRP is pragmatic, incorporating cognitive-behavioral techniques into a therapeutic community context. Specifically, cognitive-behavioral skills training provides veterans with new alternatives for dealing with problems, while life in the therapeutic community offers myriad opportunities for trying out new strategies and receiving immediate feedback. Personal responsibility and faith in individuals' capacity for growth are emphasized, and confrontation occurs in a context of overall support. Individual interventions reinforce and supplement group work. Residents move through three phases of treatment during the typical 6-month inpatient stay. To advance from phase to phase, residents must demonstrate increased proficiency in skills and must be practicing those skills in a an expanding range of settings. Graduation from the program occurs with an additional 13 weeks of outpatient treatment. Supportive outpatient therapy is offered to veterans who are unable or unwilling to follow the standard regimen.
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Addiction Treatment Services (137-ATS, MPD)
Lou Moffett, Ph.D.,
Substance use disorders (SUD's) are the most prevalent of all psychiatric disorders. Locally, veterans with SUDs constitute 31% of VA inpatients (50% in inpatient psychiatry, 38% in substance abuse programs, and 12% in medicine) and 11% of all outpatients. These patients present with a wide range of substance use severity and comorbid psychiatric and medical disorders. Most patients use multiple substances, with alcohol, nicotine, cannabis, cocaine, and heroin being the most common. Although alcohol is the most frequently abused substance, only a minority of SUD patients (24%) use alcohol exclusively. Most patients have histories of chronic social and occupational impairment, often criminal histories, and many patients have personality, mood, or anxiety disorders.
Addiction Treatment Services (ATS) provides consultation/evaluation and state-of-the-art inpatient and outpatient treatment to veterans who are addicted to alcohol or other drugs and are ready to relinquish their addiction. ATS consists of four residential inpatient programs, an inpatient detoxification and evaluation program, a day hospital program, a methadone maintenance program and an outpatient clinic. The treatment offered integrates the best aspects of the social self-help and medical models of treatment with therapeutic communities that require a substantial amount of personal responsibility from patients. The outpatient program provides support for continuing abstinence and social rehabilitation of patients discharged from the inpatient programs. These services are closely integrated with other related services such as the Domiciliary, veterans workshop and vocational training programs so as to maximize long term rehabilitation.
ATS Consultation (a) screens patients for substance use treatment, (b) triages patients to outpatient, day treatment, residential, or inpatient care, ( C) coordinates the continuum of care, and (d) confers with other health care staff regarding SUD patients. ATS Consultation Services are staffed by a social worker manager, a psychologist, and nurse, two addiction therapists, a rehabilitation technician, a consulting psychiatrist, and a consulting internist.
ATS Outpatient services include (a) comprehensive assessment, (b) treatment and recovery planning, ( c) outpatient detoxification, (d) an intensive day treatment program, (e) individual counseling, (f) case management (e.g., supervised Antabuse, naltrexone), (g) methadone maintenance, (h) psychoeducation (e.g., 12-step facilitation, coping skills), (I) an evening relapse prevention program, (j) aftercare, and (k) smoking cessation ATS Outpatient (day and evening) are staffed by a psychologist manager, a social worker, three nurses, five addiction therapists, a rehabilitation technician, a part-time recreation therapist, a consulting psychiatrist, and a consulting internist.
The ATS Inpatient Program (a) stabilizes patients in withdrawal, (b) assesses complex patients, and ( c) prepares patients for recovery. The ATS Residential Rehabilitation Program offers intensive coping skills training within a 45-day therapeutic community. ATS Inpatient and Rehabilitation Services are staffed by a nurse manager, ten nurses, five licensed vocational nurses, two psychiatrists, a psychologist, a social worker, a recreational therapist, eight addiction therapists, and four rehabilitation technicians.
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Provides:150-bed Nursing Home Care Unit with and Hospice, Respite and Transitional Care Programs108-bed Intermediate Care Unit with a Dementia Unit, Dementia Respite Program, Two Geropsychiatric Short Stay Programs, Hospital Based Home Care Contracts for Community Nursing Home, Adult Day Health Care and Homemaker/Home Health Aide services.
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100 bed domicile housing the Homeless Veterans and Community Re-entry Programs
Provides patients with independent living skills for transition into the community.
Intensive Psychiatric Community Care Program
Intensive Psychiatric Community Care follows high-risk psychiatric patients in the community to prevent the need for re-hospitalization. Substance use disorders (SUD's) are the most prevalent of all psychiatric disorders. Locally, veterans with SUDs constitute 31% of VA inpatients (50% in inpatient psychiatry, 38% in substance abuse programs, and 12% in medicine) and 11% of all outpatients. These patients present with a wide range of substance use severity and comorbid psychiatric and medical disorders. Most patients use multiple substances, with alcohol, nicotine, cannabis, cocaine, and heroin being the most common. Although alcohol is the most frequently abused substance, only a minority of SUD patients (24%) use alcohol exclusively. Most patients have histories of chronic social and occupational impairment, often criminal histories, and many patients have personality, mood, or anxiety disorders.
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