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Clinical Neuroscience Center (CNSC) is a collection of mental health professionals from many disciplines who have chosen the practice model of teaming together. CNSC is therefore able to offer outpatient clinical services to individuals suffering from a wide range of emotional or neuropsychiatric illness. We have found this type of synergistic combining of clinical skills permits more aggressive, and more effective, overall treatment for our patients. CNSC’s model of intensively collaborative, multidisciplinary care is highly unique, being found in only a handful of clinics nationally, mostly seen only in academic tertiary-care centers. Bringing together knowledge and skills from multiple disciplines, each with its own viewpoint and its own approach, has allowed CNSC teams to diagnose and manage neuropsychiatric illnesses more effectively, and are able to manage conditions of higher severity and complexity than individual clinicians would attempt. This is why CNSC has become a regional referral center, particularly for patients with complex and treatment-resistant mood disorders, and with a particular specialization in the Bipolar Spectrum Disorders. Perhaps similar to an academic center, the broader CNSC model includes a major educational mission which complements the clinical work. A major thrust of CNSC activity involves education: for our patients, for the community at large, for local primary care physicians, but most important of all, for our colleagues. Everyone has something to teach, and everyone has something to learn. It is an absolute requirement for CNSC clinicians that they continually educate themselves and each other. We sponsor weekly lunchtime lectures, which are open to any mental health provider in the community (note: must RSVP). CNSC clinicians also have several confidential clinical case discussions each week. All of these various meetings give us constant opportunities for “sharpening the saw”, and thereby broadening our knowledge base in the critical fields of neurobiology, psychology, neuropsychiatry and psychopharmacology. These fields, those which most affect our clinical work, are undisputedly among the most rapidly expanding fields of scientific medicine. It requires just as much mutual teamwork to keep ourselves sharp as it does to provide cutting edge treatment to our patients. Clearly, the two missions of CNSC go hand in hand.
CNSC combines professionals from a range of mental health disciplines who have chosen to work closely together, collaborating so as to improve patient care. A. Psychiatric physicians, ARNP and nurses deal with the neurobiological, biomedical and pharmacological dimension of patient care. We maintain close working relationships with several neurologists and primary care physicians, as well. B. Psychological issues, as well as
interpersonal and emotional functioning comprise the dimension addressed by
Clinical Psychologists and counselor/psychotherapists. C. For patients who desire to address issues in the spiritual domain, which can be considered the third dimension of the overall treatment process, we are willing to support whatever they need in this area. Although it is important that CNSC remains nonsectarian and open to individuals who prefer not to discuss faith issues, most CNSC clinicians are willing to discuss spiritual issues, if patients so desire. Several CNSC psychotherapists regularly offer spiritually based counseling when patients request it. We are willing to include patients’ outside spiritual counselors, pastors, etc. as part of the treatment team, if they request it, and it is clinically appropriate. An example is our collaboration with the psychotherapists at Emmaus Counseling Center.
CNSC is a voluntary self-association of independent professional practitioners, and therefore is not, in legal terms a “Group” or “Clinic”. We share administrative resources and expenses, but most importantly, we share the commitment to strive for excellence in patient care 1) through multidisciplinary collaboration, and 2) through relentless self-education. We also enjoy working together. Each professional participating in CNSC is a totally independent, private practitioner. Some work at CNSC itself, (located at 303 Bradley Blvd.; Richland, WA 99352). Many have their own offices, elsewhere in the Tri-Cities. Several work part time in other agencies such as the Benton-Franklin County Crisis Response Unit, Nueva Esperanza, or at various long-term care facilities. Although the CNSC treatment model of aggressive, coordinated care has made hospitalization to be a very rare occurrence, if inpatient treatment should be required, Lourdes Counseling Center is utilized.
Call the CNSC office directly: (509) 946-9715. Give the receptionist basic information to start application process. Obtain a set of intake forms either from the office or by downloading from the website: “cnsconline.com”. Fill out these forms and bring them to the CNSC office at 303 Bradley #108, Richland. The office will help with analysis of your health insurance benefits and with pre-authorizations. Note that some health insurance policies require formal referral from your primary care physician. To be a CNSC patient you must have a CNSC psychotherapist: The foundation of your CNSC clinical team is your psychotherapist. As treatment progresses psychotherapy visits may become very infrequent. You are welcome to request a specific psychotherapist by name, but we can also match you up with the psychotherapist best suited for your situation. After CNSC intake assessment clinicians review your application and you have been assigned your psychotherapist, you will be contacted to set up initial appointment with your CNSC psychotherapist, generally within 1-2 working days. Many patients enter CNSC by contacting one of the participating psychotherapists in private practice or at Emmaus Counseling Center (see list). If/when medication management is required, your CNSC participating psychotherapist can initiate the referral, as discussed below.
Whether you are seeking medication management services or not, the first step in assembling a CNSC treatment team is connecting you to the psychotherapist who will be your advocate and “case manager” throughout your treatment relationship with CNSC. You and your therapist will begin meeting in order for you to establish a solid relationship, and in the process, to begin understanding your broader diagnostic picture, as well as to begin learning to handle emotional issues. This initial therapy will allow you to “put down a root system” of skills, knowledge and treatment relationships, that will make it possible to succeed in the more intensive multidisciplinary work yet to follow. Patients who cannot “engage” to form a genuine psychotherapeutic relationship, or who have begun medication management services at CNSC but then drop out of psychotherapy against medical advice, are clearly not ready to take advantage of the CNSC multidisciplinary teamwork approach. Such patients would likely do better elsewhere.
We have absolutely no interest in “stealing” the patients of any other mental health professional in the community. Under no circumstances would CNSC ever insist—or even suggest—that a prospective patient should abandon an ongoing, effective psychotherapy relationship. The CNSC teamwork model, however, requires that all members of the clinical team communicate directly through frequent and detailed collaborative conferences. We all feel strongly that it is important to spend our limited time working with only those clinicians in the community who have demonstrated their willingness to communicate and collaborate. Unfortunately, few psychotherapists are willing to make the commitment of time and energy to join together for team meetings that we at CNSC find so valuable. Not all clinicians in the community are willing to “give” collegially, i.e. to set aside their natural competitiveness in order to share their clinical knowledge and expertise, and to educate each other or the community. CNSC has accumulated a mixture of like-minded clinicians who work well together, and who therefore find it most convenient to refer patients primarily amongst each other. While there is no question that there are many highly-qualified mental health providers in this community, it is often difficult to communicate with them, making teamwork impossible. We feel strongly that phone tag only leads to clinical care that is inadequate and ineffective. Collaborative communication is so important to CNSC clinicians that they are willing to give up time each week to meet together for consultation conferences and educational conferences. Community psychotherapists are welcome to begin attending the lunch meetings, for instance, and to establish communication with CNSC, but thus far only a few are willing to make the commitment to our teamwork model. For these reasons, we feel strongly that if a patient wishes to see any of the psychiatric care providers at CNSC, he/she must be well-engaged in psychotherapy with one of the psychotherapists who has demonstrated himself/herself willing to communicate effectively with us, i.e. those now associated with CNSC. From time to time we will occasionally work with non-CNSC psychotherapists on a trial basis, and at times we will add or subtract therapists from the list.
CNSC clinicians take the multidisciplinary teamwork model very seriously. While many patients (and primary care physicians) wishfully believe that mediations alone will “cure” them, clinical experience demonstrates clearly that success requires that the deeper psychological issues not be neglected. While other psychiatric practitioners may feel comfortable prescribing medications without holistically considering their patient’s entire life picture, all clinicians at CNSC feel very strongly that genuine multidisciplinary teamwork is necessary to give the quality of care we consider our standard. The reputation of CNSC for achieving good clinical results with even very difficult cases is largely the result of the multidisciplinary teamwork model we utilize. If patients absolutely do not wish to work within the type of teamwork we offer, i.e. teamwork that actively integrates psychotherapy, there are numerous other treatment providers available.
Many new patients request, or have been referred by their primary care physicians, medication management services by psychiatric providers at CNSC. We are as eager to treat you as you may be to engage in treatment, but until you and your psychotherapist, in discussion with CNSC medication management providers, conclude that such a referral is clinically appropriate, you will not be accepted for care by any CNSC psychiatric provider. Until formal referral is made by your psychotherapist, and not until after you have actually been seen clinically for an initial evaluation by your CNSC psychiatric provider, you will remain legally the patient of your previous prescriber. Until medication management services are taken on by CNSC, your CNSC psychotherapist, as well as the CNSC psychiatric provider who will presumably be taking your case, will gladly speak to your existing prescriber to help answer his/her questions about psychopharmacology or diagnostic considerations. Once referral for medication management intake has been made, the various CNSC psychiatric providers may differ significantly in the length of time until you can begin treatment. John Evans, ARNP, who consults extensively with Dr. Dye, will frequently pick up patients destined for Dr. Dye, just so their treatment can begin somewhat more quickly. Mr. Evans has patients of his own as well. Sandy Caggiano, RN, who works only with Dr. Dye’s patients, will schedule an information gathering session soon before a new patient sees Dr. Dye, often on the same day, if possible. Dr. Rapport, MD, schedules his own patients, and does his own initial workups. Psychotherapy, as an integral part of the treatment team model, must be an ongoing process as long as you are with CNSC. The intensity and frequency of your psychotherapy visits is a clinical decision that you and your psychotherapist must derive mutually. While there will be more frequent visits initially and during times of crisis, it is also expected that you will eventually evolve into a long-term maintenance phase during which you may need to be seen no more than a few times per year. If you and your therapist, in discussion with the rest of the treatment team, conclude that maintenance-only psychotherapy is clinically appropriate, then medication management services will continue. Patients who do not value the CNSC model, for example by dropping out of psychotherapy, by repeatedly missing appointments, by noncompliance with treatment recommendations, or by neglect of financial commitments, will be allowed to seek services through different psychiatric providers whose practice style may better meet their needs. Termination would only happen after suitable notification.
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