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Scott Webb: The Comprehensive Assessment Program at Sierra Tucson is designed to provide an inclusive and in-depth psychiatric, psychological and medical assessment. CAP's Intensive Assessment evaluation includes recommendations for. It and referral upon completion and here to tell us more today is Dr. Jasleen Chhatwal. She's the chief medical officer and director of the mood program at Sierra Tucson. This is Let's Talk Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked at number one best addiction treatment centers, 2021 in Arizona by Newsweek I'm Scott Webb.

Dr. Chhatwal, so great to have you back on. Great to hear your voice again today, we're gonna talk about, CAP, the Comprehensive Assessment Program. It's Sierra at Tucson. So let's do that. Describe the program to us. What's it all about?

Dr. Jasleen Chhatwal: God great to be here again. I'd say the Comprehensive Assessment Program is one of our very unique offerings at Sierra Tucson. It is an opportunity for an individual to come in and have a multitude of experts, meet with them and help develop a comprehensive view of the issues that they're struggling with or maybe dealing with. And then also be able to offer up a treatment plan and multiple treatment modalities that may help them get to the place where they can live a fulfilling and meaningful life, which is really what we're always aiming to do for our patients.

Scott Webb: Yeah, that's definitely the dream, the goal, for sure. So when, or why would consider a Comprehensive Assessment?

Dr. Jasleen Chhatwal: Like you mentioned. I think a lot of people could benefit from something that looks like the Comprehensive Assessment Program does here. Usually the people who are best fits for the Comprehensive Assessment Program can be a few different types. One is somebody who may be doing treatment for a while. So they're working on mental health or substance use treatment, and they feel like they've tried various different things and are not quite having traction with treatment, not feeling like treatments, really fitting their needs or progressing them around their goals.

That can be a wonderful time to consider a Comprehensive Assessment Program since it takes you out of that environment, brings you into a setting like ours, where you can meet a multitude of experts like we were saying. And they can help you shift your focus in terms of maybe you need to try a different type of therapy or you need to try different biological treatment modalities. And so that can be one place where you can come for comprehensive assessment and then be able to shape, shift your treatment and go down a slightly different path.

Another person for whom comprehensive assessment can be helpful is if somebody's just starting on their journey for mental health or substance use treatment. And they're not entirely clear about what they're dealing with. So they feel like there's something that's not quite. Right with my life right now, I feel like I could be doing so much better and they know that they're struggling with a mental health issue, but can't quite put a finger on what it is. For those individuals the CAP Program can be wonderful because then it becomes a one-stop shop where they can get all the recommendations and referrals and be able to really know what is a place to put time and energy.

And I always think, time is our most precious resource. So to be able to come for five days and get all these assessments done one after the other, and then to get a comprehensive treatment plan can be very, very meaningful and it can be a fire starter for the treatment process for those individuals. And then finally the third type can also. a referral modality for other clinicians and physicians. So if they're working with a complex patient and they feel like, wow, we're doing some things, which are making an impact and making a difference, but then a lot of the other pieces, they don't quite feel like they know what to do with.

Or they might have tried all the normal things in their toolbox. So that third category can be something that other clinicians might make a referral for because they want additional help. And like I used to tell my students when I worked at the university prior to coming to Sierra Tucson, We never want people to be worrying alone or struggling alone. And so that's one way that we can actually support the clinicians, who are out in the community, doing a bulk of the work that we can support them by doing something like a CAP for their patients, where we can help guide those outside teams into refocusing treatment or being able to maybe expand their view about what else can be done.

Scott Webb: Yeah, it really does seem like a lot of benefits, a lot of good reasons. You mentioned one stop shopping. I love that. Like just come for five days and let's, get it done. Let's do everything. That's awesome. Does someone need to be referred to Sierra Tucson?

Dr. Jasleen Chhatwal: Individuals don't need to be referred by a clinician. It's always helpful if they have an outside clinician. But like I said, given that category of people who are just starting up with mental health treatment, sometimes this can be a quicker way to get into mental health treatment. And then we can use our connections and previous referral sources that we've used to help connect them with ongoing treatment in their community. So essentially they can self refer themselves to Sierra Tucson's CAP Program.

Scott Webb: So doctor, what type of evaluations are conducted and why?

Dr. Jasleen Chhatwal: There are various evaluations that we conduct some of the most basic ones which are done within the first 24 hours include a psychiatric evaluation, a nursing assessment, history and physical exam, and then a biopsy psychosocial or a detailed psychosocial assessment, which is done by a trained therapist. After those initial assessments, we get a greater detailed view of what the person may additionally need. We also do a pre-admission assessment based on which we may have already prepped some of the prior consultations that are needed.

And these can include an addiction, consult nutrition, consult, physical therapy, consultation, pain consultation, transcranial magnetic stimulation evaluation. We'll also be able to offer laboratory testing, which a basic set of tests is done for everybody who arrives. But then we add on tests based on what the person needs. And one of the very interesting pieces of the Comprehensive Assessment Program is a detailed psychological assessment, which is done again, pertinent to the issues that the person is presenting with, and they've been working through or we identify.

And then another one that's very, very interesting to most people is a neurophysiological assessment in which we can do qualitative EEG assessment as well as a HRV assessment. And those are typically found to be very meaningful. All our patients get the naturopathic consultation as well, which is meeting with a naturopathic physician who is able to do a detailed assessment of sort of their mind, body, continuum and assess what types of integrated modalities may be useful for them.

Scott Webb: It does sound really comprehensive and heavy on the testing obviously, and some extensive testing really amazing. Is there also therapy provided?

Dr. Jasleen Chhatwal: Therapy is part of the Comprehensive Assessment Program. But I think when I think about therapy within the CAP, I usually think of it more in terms of getting a bit of a flavor for what types of therapy we might be recommending for the person. So if we notice that they're coming in with fairly extensive developmental trauma, then we'll try and set them up with a session or two of therapy around modalities that would be helpful for that type of issue. If they're, like I said earlier, coming in with something like grief, we may have them meet with our grief therapist and then also do a grief group with us.

So the purpose in those five days is not so much to do immense therapeutic work because it's really not possible in five days, but more so to give the patient and the individual who's coming in a taste of different types of therapies so that they can get a better understanding of what fits with them and speaks to them. I think at the end of the day, the most effective treatments are the ones into which we have buy in and which we believe in. And so that's really the opportunity that we want to provide.

Scott Webb: And you mentioned, a couple times here that it's a five day program. Is that always the timeframe? Is it always five?

Dr. Jasleen Chhatwal: Five days is how it's built out. We've sometimes recommended a slightly longer timeframe if an individual is coming with a fairly complex presentation, the most typical timeframe is from Sunday through Friday. And it just works out well to have the individual here during the work week, because then we can get all these assessments and that's when all the labs and testing sites are open. So if we're sending tests out, it's a little bit easier to get them in a timely manner.

Scott Webb: Yeah. And I'm wondering, and I would love, if you could maybe share a story of how CAP made an impact for one of your patients.

Dr. Jasleen Chhatwal: I think of various patients that I worked with in the CAP program myself, and then also, seeing others come through. But one of the people who really stands out for me was an executive who had come in, they'd been receiving some treatment before and decided that they weren't entirely sure that the way they were doing treatment was sufficient. And I think their clinician was actually the one recommending they come in to do the CAP Program because the clinician felt like the patient wa needed a higher level of care.

And the patient being a busy person really thought taking 30 days of their life to come to treatment was not something they really had buy-in on or felt totally comfortable making that financial as well as time commitment. And so when this person came and I was working with them myself, it really became clear that there were certain things that were not entirely obvious to them in their own treatment that came to the fore. So there was some developmental trauma issues that we were able to uncover and then also able to uncover some process addictions.

And as part of that process in really understanding that there were biologic treatments that we could use for some of the issues they were struggling with and why there was intensive therapeutic work needed in a residential setting. What we were able to achieve in that CAP was really get buy in for some treatment modalities, which they hadn't tried. And because their busyness had not changed. They decided that they would try to complete elements of the program in the outpatient setting. So go back to their home, work with their outside clinicians and try to implement some of the recommendations we had.

And then about six months later, this person decided to come back to Sierra Tucson for 30 days of treatment, because they had felt that in those six months they had been able to make some changes. But not sufficiently where they had found that their life had significantly changed or those issues were no longer a problem. And within those six months, they try to set up their work and other duties in a way that their work, as well as family were better able to sustain while they were away.

And so that was a really wonderful experience to see how somebody could not only take the recommendations they received and be able to develop some insight, but then also have their outpatient team involved and take those recommendations out. And then after making some progress, really realize and come to terms with the fact that they needed the additional time and then returned to us. And sometimes that just really makes you realize how this is a lifelong process. Like we're all trying to grow and improve and change our lives. And so there's not really a timeframe for when this is needed and sometimes it's good to do self care and do treatment in the form of self care before we reach a crisis.

Scott Webb: Yeah, I see what you mean and always good to hear that you're able to work with patients on their timeline and their schedule. And as you say, sometimes they might need to step away a little bit and come back and, that's a great success story and would love to hear also about how you review the results and recommendations with patients?

Dr. Jasleen Chhatwal: That is a wonderful question. I did feel a minute ago that maybe that piece wasn't as clear in our conversation thus far during the timeframe that the person is with us, we in our individual consultations and meetings with them start to share our evaluation findings. As part of that process. Because it is supposed to be collaborative. We're already sharing throughout the week, what we're noticing, what we're finding. But then at the end of those five days, the CAP ends in what is called a round table meeting in which the patient is obviously at the center of it.

The clinicians who have majority, time spent with them or have meaningful consultation findings, will come to the round table. So it's typically the patient, a multitude of our experts here, including the attending psychiatrist and the primary therapist who's working with them. Then we'll also invite the patient's family members or outside clinicians, whoever they're willing to invite. And we usually encourage having the family or close friends and, or the clinician involved because it is helpful to have. another couple levels of support for the patient. And so then we're able to share, we go around the room and one by one share our findings and our recommendations.

And I usually think that round table is the most beautiful portion of the CAP because it's a coming together of expertise, you can sit there and you can see things clicking in for the individual who's there for the cap and. It's a time that the story or the narrative around what I've been struggling with becomes clear for them. And that it's not really something that's faulty or missing in one's self, but really oftentimes some element of skill development or better understanding of one's self developing some insight into why they've been struggling. And so that end product is delivered at that round table.

Scott Webb: It's really awesome. This has been, as it always is with you really educational and helpful today. As we wrap up doctor, what else would you like to share about CAP?

Dr. Jasleen Chhatwal: Scott. I think you've covered all the basic elements of the CAP Program through your questions. To me, the main thing I think I want listeners to walk away with is that the CAP Program or the Comprehensive Assessment Program is a meaningful tool where we don't have to wait for weeks or months to get in with different people, but it can really be that time to come together. And one of the main concerns we usually have in healthcare is how divided it is. And the CAP is really just the opposite of that.

It is a coming together and a collaborative experience, and I really hope it becomes the standard of care in mental healthcare at some point. So we're happy to receive referrals for the CAP and if anybody's considering it and thinking if it's a good fit for them, always happy to talk and help better understand what their needs are.

Scott Webb: Well, as always, I appreciate your expertise and your compassion and I'm with you. It does seem like this should be the standard of care, the gold standard, if you will. So thanks again. You stay well.

Dr. Jasleen Chhatwal: Thank you so much, Scott. Have a wonderful day. Thanks.

Scott Webb: And visit sierratucson.com or call 800-842-4487. Sierra Tucson, we work with most insurance. And if you find this podcast to be helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.