Outpatient

Rotation Information

There are two outpatient clinics In Exeter and Lindsay, part of the Kaweah Health system. As stated above, Kaweah Health's primary service area covers 219,117 people living in 12 zip codes with the most populous age groups of 25-44 (28%), under 15 (25%), and 45-64 (16%). The area is ethnically diverse: 38% Caucasian, 53% Hispanic, and 3% Asian while gender ratio is 60/40 female/male. The local presence of higher education (48.3%) and median income are lower ($49,100) compared to California (58.6%, $62, 401). The patient population includes those receiving medical, surgical, neurological, pediatric and obstetric/gynecologic services at Kaweah Health and patients referred for outpatient psychiatric consultation from the Family Medicine Residency Program clinic. Caseload is monitored by the medical directors, clinic managers, faculty supervisors and the Program Director to stay within allowed proportions of patients based on age. Core, selective and elective regular clinic and specialty rotations will provide additional outpatient contact experience. In the PGY-4 year, residents are required to continue to follow outpatients for a minimum of ½ day per week (10% time), with supervising psychiatrists, psychologists, marriage family therapy and social work as indicated. Addiction residents participate in specialty Medication Assisted Treatment clinic 1/2 day per week in the Exeter clinic and also 1/2 day a week in the Lindsay clinic. while on their addictions rotations. The clinic assists patients suffering from opiate use disorder and provide residents with experience in treating complex opiate addiction with the assistance of buprenorphine/naloxone and naltrexone. 

Tulare County Mental Health (TCMH) cares for many persistently and chronically-ill patients in the public sector and there is a wide range of community based agencies for ongoing patient care. The goal is to provide high quality care and advocate for the chronically mentally ill, disadvantaged, diverse, and underserved populations in urban and rural settings throughout our region. We aim to inspire residents and prepare them to make a difference by working with those most in need. Patient education is an integral part of patient care, helping patients understand their conditions, effects of medications, stress, insomnia, diet and exercise. Clinical Population: The patient population is acutely-ill and typical of that seen in the Central Valley of California covering a wide variety of socio-economic groups. Tulare County Department of Mental Health provides direct mental health services to 2897 patients with the most populous age groups of 25-44 (41%) and 45-60 (38%). The patient group is ethnically diverse: 49 % Caucasian, 35 % Hispanic, 7 % Asian and 4% African-American while gender ratio is 55/45 female/male. The clinical population includes patients with severe/persistent mental illnesses 76 treated in an outpatient community setting. The primary diagnoses treated include schizophrenia (22%), major depressive disorder (37%), bipolar disorder (7%) and PTSD (7%). Other common co-morbid diagnoses include personality disorders, adjustment disorders, substance-abuse disorders and ADHD. A large proportion of patients are “dual diagnosis,” i.e., they have an Axis I psychiatric disorder plus a co-occurring substance abuse/dependence disorder.

Community psychiatry training occurs in partnership with Tulare County Mental health during the PGY-3 outpatient rotation.  Residents will routinely have contact and interactions with patients’ families, as privacy and other regulations allow. Residents’ education of patients and families will occur during clinic visits and family meetings through treatment planning discussion, medication education, and general treatment counseling. Residents will gain experience with about community resources and will work collaboratively with psychiatrists, psychologists, social workers, marriage family therapy, addiction specialists, case managers, crisis teams and other mental health professionals within and outside of the county mental health system. Finally residents are provided with opportunities for community presentations to the general public and local organizations and local support groups such as NAMI and are involved in the Assertive Community Treatment programs through Tulare County Mental Health. 

Tulare county provides an invaluable learning opportunity for the residents. The Visalia Adult Integrated Clinic is the largest of the county's clinics and provides services to a catchment area of almost 500,000 people and serves the most acute, chronically and severely mentally ill patients in the area. They have vast resources and numerous programs in which residents are able to gain experience and are welcoming and grateful for the care that the residents are able to provide for the community. We have adequate site support and any concerns or requests are handled promptly.