Consultation Services

Mental Health Consultation Services

Dr. Robison values teamwork, consultation, and community partnerships, and recognizes the benefits of consultation with both mental health providers and other organizations. Consultation with mental health providers helps all parties learn, grow, and increase our ability to provide quality, accountable, effective services to our clients. Consultation with other organizations is vital for educating the public about the importance of mental, emotional, and spiritual health; and assists her in bringing services to individuals who may be unlikely to seek out services had they not been exposed to mental healthcare in a non-threatening setting. Below is a brief description of consultation services, which can be tailored to fit the needs of your organization.

Consultation with mental health providers
For a free initial consultation with your mental health agency, contact us.

Quality Improvement Integration
Quality Improvement is a necessary component of any treatment program. Unfortunately, the realities of our day-to-day direct service responsibilities make developing and integrating quality improvement strategies very difficult for providers.

Dr. Robison offers low cost, flexible quality improvement strategies that can be developed, implemented, and/or monitored by us to assist your program with improving current programming, assessing needs within your organization, satisfying your funders, increasing employee and/or client satisfaction, and enhancing your current marketing strategies.

Applying DBT to an existing adolescent mental health or substance use system
Dialectical Behavior Therapy (DBT) is evidence based for adult populations with Borderline Personality Disorder (BPD) symptoms. Because of the strong research supporting DBT, and the tendency for this population to be treatment resistant, complex, and high utilizers of services; funders, referral sources, and regulatory bodies are increasingly requesting the implementation of a DBT model by service providers who treat any individuals with high risk issues related to BPD (i.e. self injurious behaviors, suicidality, multiple hospitalizations). In response, more programs have been modifying DBT in an effort to treat adolescents presenting with these symptoms, and the research community is prioritizing the publication of randomized controlled trials to establish its evidence base with an adolescent population.

In 2004, Dr. Robison formed a weekly outpatient group for adolescents using a modified DBT model. That group continues to run today and since that time, has grown in status and attendance, with referrals from local schools, hospitals, partial hospital programs, and outpatient professionals who are in need of a structured program that offers DBT for this difficult and high risk population. In addition to facilitating groups, Dr. Robison has provided DBT training and consultation groups for residential facilities treating this population, and spearheaded a group charged with revising an existing adolescent residential program model to reflect DBT principles and interventions. Dr. Robison is committed to assisting with the development of DBT programming within adolescent treatment facilities. We currently offer the following services to mental health and substance use providers:

  • DBT training for clinical staff: Anticipating that this is likely to be most beneficial in stages, Dr. Robison offers 4 part training that can be delivered for 2 hours a week for one month, or in longer increments over a shorter period of time for clinicians. For residential facilities, it is recommended that this training be repeated for Direct Care Staff after consultation groups are up and running.
  • Weekly or bi-monthly DBT consultation groups for clinicians: The minimum suggested length and frequency of consultation groups within the original DBT model is 90 minutes twice per month, but can be held weekly or for shorter or longer durations if necessary. In these groups, case presentations, continued training for implementing skills, staff development, team building, communication, coordination of care, increased treatment fidelity, and practice of skills is accomplished.
    • The expectation is that this group will be self sustaining and led by the agency’s internal staff after about 1-2 years, depending upon staffing patterns, turnover, etc. Groups can occur in addition to trainings, or begin after training is completed. Ongoing consultation groups beyond initial start-up can continue with consultation upon request.
  • Program model writing and implementation: Concurrently with staff training and consultation, a written program model should be developed that is consistent with DBT philosophies and interventions. Dr. Robison is available to assist with on or off-site program model revision and implementation planning.

Integrating trauma informed care
The impact of trauma on an individual or family is enormous, requiring providers to modify programming and implement risk management strategies. Particularly in 24-hour care settings, trauma informed care is essential for reducing restraints, employee and client injuries, and premature discharges.
Dr. Robison offers consultation that includes assessing trauma, assessing trauma informed care model implementation, employee supervision and training, and program model development and implementation.

Substance use training, screening, assessment, and service integration consultation
The implications of substance use disorders (SUDs) are vast, including comorbidity with other psychological disorders, legal issues, relationship conflict, homelessness, and high rates of mortality from overdose or secondary accidents or illnesses. Furthermore, from a risk perspective both 24 hour care facilities and community-based programs must be able to proactively minimize the co-occurring disordered client’s propensity for acting out addictive behaviors while in care. An additional challenge is retention, as treatment is 6 times more likely to end prematurely if SUDs are present and not treated (Hall, et al., 1977). The countless risk factors associated with SUDs along with the need to make both mental health and SUD treatment more streamlined, has led government regulators to call for competency in both mental health and SUDs among mental health and substance use providers.

In recent decades, although there has been more and more emphasis placed on early identification and treatment of SUDs, there continues to be too many barriers to service delivery, resulting in treatment gaps that clients cannot afford to experience. For example, according to the Treatment improvement Protocol (TIP series #42) published by the Substance Abuse and Mental Health Service Administration (SAMHSA, 2005), it has been over 30 years since practitioners began to realize that when SUDs present along with other MH disorders, there are “profound and troubling implications for treatment outcomes” (p. 18). Despite this realization regarding the problematic nature of individuals presenting with multiple problems, for years providers have been taught only to provide services within their own scope of practice (Steele & Rechberger, 2002), and many professionals continue to be resistant to being trained in the provision of services outside of their areas of expertise.

In response to this gap between mental health and substance use services, Dr. Robison has developed a comprehensive, step-by-step integrated treatment model that has received accolades by the Pennsylvania Certification Board. This model encompasses all elements of service, from policy development through aftercare and follow-up, and offers a cost effective, practical way for providers to address the needs of co-occurring disordered clients.

Psychological testing
Assessment is an important step in treatment and aftercare planning. Dr. Robison provides psychological services onsite to outpatient clients, and off-site within 24-hour settings per request. The testing battery will be tailored dependent upon the needs of the client and treatment team, but can consist of standardized tests, projective tests, or both. This can include intelligence testing, personality testing, diagnostic tests, achievement and aptitude tests, vocational, and lifeskills testing. All tests used are selected based on strong validity, reliability, and appropriateness to the individual needs of the client. Assessments are done in a timely fashion, with rapid turnaround for scoring and reporting of results and recommendations.

Nursing home, residential, rehabilitation, or hospital mental health service consultation
Dr. Robison offers on-site consultation for 24 hour care facilities related to any clinical, organizational, or quality programming. Clinical consultation such as training, supervision, group, individual, assessment, or program structure is available, utilizing evidence-based clinical practice. Organizational development such as crisis intervention, staff wellness seminars, team building activities, policy development and implementation and pre-employment assessment are available. Finally, quality improvement development, implementation and management activities such as licensing visit preparation and application, client and employee needs assessments, satisfaction surveys, focus groups, and applied research development are just some of the quality improvement strategies that can benefit your program.

Program model development
The rapid changes in our field require us to add new programming, update our existing programming, and keep up with the trends and changes in evidence-based practice. The ever expanding and rapidly changing requirements of mental health programming require us to add, update, and monitor our program models and program model implementation.

Dr. Robison offers consultation around program development, evaluation, updating and implementation, and monitoring. As a program consultant, she can take the burden off of your staff regarding researching, writing, monitoring, and updating your program models, and will continue to be available to you for any future program model needs, notifying you of trends in research applicable to your programming, and assisting with all of your programming needs outside of service delivery.

Aftercare planning
To assist with aftercare planning and reducing individual relapse rates, Dr. Robison offers “Bridge appointments” to clients transitioning from an intensive setting to an outpatient setting. Bridge appointments are completed on-site, within 12-24 hours of the request. They consist of a brief screening and treatment goal and relapse prevention review; focusing on reducing barriers to aftercare.