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Ethical and Compassionate Care

Valley Psychiatry is a psychiatric practice that is dedicated to caring for residents in nursing homes and long term care facilities. Jay Tillman, M.D. and Maryanne Strindberg, APRN founded Valley Psychiatry in 2005 with the goal of providing the highest possible quality of care for this challenging, complex, and vulnerable population. Over the past eight years Dr. Tillman and Maryanne Strindberg have comprised a team providing care in over thirty different long term care facilities.

The Challenge

Residents of nursing homes are at high risk for suffering undue emotional burden. Many have multiple debilitating medical illnesses. Others endure memory loss that alters their very identity. A further group is affected by both medical and cognitive illness.

These unthinkable circumstances leave residents of a nursing homes vulnerable to both situational and organic mental illness that can be transitory or permanent.

Diagnosis is frequently complicated by multiple factors. Often residents with advanced medical illness or dementia are unable to communicate symptoms or feelings. Former caregivers familiar with the residentís preferences and tendencies may no longer be available. Both the medical illnesses as well as the life saving treatments for them can cause psychiatric symptoms, making accurate diagnosis difficult.

Comprehensive Evaluations

Each resident referred to Valley Psychiatry receives a thorough diagnostic evaluation by both Dr. Tillman and Maryanne Strindberg. Information is obtained from multiple sources including family, other physicians, nurses, nursing aides, physical and recreational therapists, and more. Sometimes the most important clinical data originates from an observation by the non-clinical staff of a facility. It all has to be considered. The residentís medical and past mental health history, if present, including diagnoses, medications, lab work and current physical status is analyzed. Lastly, the resident receives an in-depth interview and mental status exam.

The mental status exam is the psychiatristís equivalent of the internistís physical exam. It is a hierarchical set of questions and observations that are essential for making an accurate diagnosis. Performed by an experienced and expert clinician, it is analogous to the cardiologist listening to the heart with a stethoscope or the neurologist checking reflexes.

This vast amount of information is synthesized and integrated into a concise diagnosis and multidisciplinary treatment plan.

Conservative Treatment

While medication is an important and powerful treatment modality, non-psychopharmacologic options are considered first.

Common but often overlooked causes of mood, anxiety, and behavioral disturbances are examined. Acute or chronic pain, acute medical issues, noise and light levels, constipation, thirst, and hunger can cause behaviors and symptoms that mimic psychiatric illness.

Addressing one or more of these problems, often without the use of any medications, frequently results in the amelioration of most distress. The least invasive treatment modalities, including group, recreational, and psychotherapy are always attempted first.

Practice Philosophy

Valley Psychiatry is a medical practice wholly interested in providing the highest level of care to our current clients. We are not a corporation with a carousel of ever changing clinicians. A facility, family, or resident that has Dr. Tillman and Maryanne Strindberg providing care can rest assured that their provider wonít be relocated or be replaced at the whim of a company that has to answer to scores of other facilities.

Our small size has important advantages. The on-call clinician is either Dr. Tillman or Maryanne Strindberg. Thus 24 hours a day and 365 days a week, residents and staff can be reassured that coverage is provided only by clinicians that are familiar with them. In contrast, large companies rotate call among clinicians who possess no knowledge about the resident or facility. Their clinician may be geographically distant and unable or unwilling to provide on-site care.

Benefitting Your Facility

Our experience working full time in the long term care field has important advantages for our facilities too. Having been through countless state surveys we are keenly aware of where the Department of Healthís ever-changing focus lies. We work with all the other consultants in the facility, especially the pharmacy, and are proactive in addressing potential areas of attention by the Department of Health. Facilities that contract with Valley Psychiatry have never received any psychiatry related deficiencies.

We work hard to maintain the highest degree of communication so that all the needs of the facility are met in the most efficient manner. Large companies have transient and part time employees interested primarily in getting their work done and leaving as soon as possible. Your Valley Psychiatry clinicians are the owners and they are walking into your facility each week, taking the time to develop long term relationships.