Strategic Initiatives: Clinical Systems



Recently, the Austen Riggs Center Board of Trustees and staff undertook a comprehensive strategic planning process that prioritized a number of initiatives designed to expand our role and positively impact the serious mental health issues we face as a society. These include: clinical systems, human development, biopsychosocial advocacy, suicide research, the neuroscience of psychotherapeutic change, and psychodynamic psychopharmacology. This is the first in a series of blogs that will highlight each of these strategic initiatives.

by Margaret Parish, PhD

Margaret Parish, PhD, Director of Patient CareOur strategic planning process begins with our core clinical mission. The Austen Riggs Center exists, first and foremost, as a place where people can bring their troubles, learn about themselves, and discover resources and support for confronting the challenges of their lives.

The Clinical Systems Strategic Initiative has three parts: redesigning the infrastructure that supports our ongoing clinical work, enhancing specific clinical programs, and seeking ways to offer our services to new groups of people.

Clinical system design

Patients come to Riggs seeking help for symptoms that have meaning in a social context, and our work is centrally about understanding. In order to do this effectively, the staff has to work to understand our own experience in our own social contexts – both the ones we create deliberately and the ones we find ourselves inhabiting unwittingly.

The Austen Riggs Center's staff are involved in multidisciplinary treatment teams. During the fall we conducted a study of the ways we use time at Riggs. We learned that some things take more time than we thought, and some things take less time, but in general the clinical staff is busy, engaged in work that we value greatly. In particular, the ample time spent reflecting on the work together in interdisciplinary case conferences, team meetings, and clinical staff meetings is vital to understanding our patients and supporting one another in our work. So while we are in the process of making some adjustments to our meetings, they will be minor. More importantly, we have been thinking about how to support the values underlying our work. Reflecting on the varied experiences of clinicians in different roles doing distinct but interrelated tasks helps us to understand our current social context, and helps us to collaborate with patients in building a community worth living and working in. Some conflicts inevitably arise among people working deeply with others in distress. A certain amount of unstructured time together is important for sustaining working relationships that are strong enough to bear these stresses. Together we face common challenges that override the differences represented by standard categories of diagnosis or credential.

One change we are making to our meeting structure is to institute a dedicated weekly time for staff education. Ongoing learning is essential to maintaining the highest standards of care; it also nourishes and supports the staff, who in turn bring new ideas and the liveliness of ongoing intellectual inquiry into the clinical work. Beginning in the fall of 2017, a new interdisciplinary Grand Rounds Program for all members of the Riggs clinical staff will include a combination of staff presentations of current projects, invited guest speakers, and collaborative reading and study groups.

Enhanced clinical services

The Austen Riggs Center offers fitness instruction to the patients as an integrated approach to health.While a number of our clinical programs are in continual development, in our strategic plan we are highlighting enhancements to two of these. First, we have increased the number of “wellness” offerings, including yoga, qi gong, meditation, interpersonal skills training, nutrition counseling, support for sobriety and smoking cessation, fitness instruction, daily walks, and so on. We are working on developing an integrated approach to health as an actively pursued state, not just a passive absence of illness.

Family work has long been a central component of our treatment, and we are working to encourage and support family involvement as well, beginning at the point of admission. A new family lounge near the lobby in the main office building offers families a private, comfortable place to relax and talk together during the thorough and sometimes lengthy admissions process. We have increased the staff support available to patients and families negotiating with insurance companies for coverage. In addition, we plan to provide additional training and supervision to clinicians working with families. We also are exploring ways to invite family members of different patients to come together for mutual support and learning.

Clinical outreach

The work at Riggs is intense and inward; to balance this, we turn our attention to our connections with others we might serve, learn from, or collaborate with. You will read in subsequent blogs about partnerships we are developing as part of some of the other strategic initiatives. In the clinical arena, we are working with the Brien Center, a local mental health agency, to provide clinical consultation for their therapists with our postdoctoral Fellows in psychiatry and psychology. This partnership started in October, enabling us to offer both a needed service in the local community and a training opportunity to our Fellows.

Finally, we are exploring the possibility of opening an outpatient intensive dynamic assessment service for people who are seeking an in-depth understanding of a set of problems in a relatively brief period of time, without entering into residential treatment. An interdisciplinary team will offer an integrated assessment using clinical interviews, psychological testing, psychiatric evaluation, and family consultation where possible. We aim to do a pilot test of the viability of such a program by offering a few assessments during the first part of 2017.

The Clinical Systems Strategic Initiative is central to the larger strategic plan for the Austen Riggs Center. Please look for additional articles on our other initiatives in the coming months.

Read More

Strategic Initiatives: Biopsychosocial Advocacy

Strategic Initiatives: Human Development

Strategic Initiatives: Suicide Research and Education

Strategic Initiatives: Psychodynamic Psychopharmacology