Schedule & Groups

California OnTrack’s Coordinated Specialty Care program is built around a structured weekly schedule of evidence-based groups, individual services, and family supports. Each group is designed to target a specific domain of recovery — from social cognition and resiliency to cognitive remediation, physical health, and family systems. Below is an overview of a typical Monday schedule and the therapeutic groups offered throughout the week.

Typical Monday Schedule

Agency & Expression: Music & Art Therapy

Psychosis can impair the ability to assess and articulate internal emotional states — a difficulty known as alexithymia — which places patients at higher risk of dropping out of treatment when they cannot communicate their needs. Our music and art therapy groups are designed as a first step in shifting this mindset. While patients may struggle to describe confused thoughts and feelings with words, they often retain the ability to communicate meaningfully through music and visual art. The more these patients can express themselves, the more heard and understood they feel, and the more likely they are to remain actively engaged in their own recovery.

Increasing Resiliency: Relapse Prevention

Using both didactic instruction and role-play, clients learn psychoeducation about psychosis and medication management while participating interactively in developing a fully formed Wellness Recovery Action Plan (WRAP). This includes identifying triggers of relapse, tools to avoid or manage these triggers, and a crisis management plan to mitigate harm when relapse occurs. The curriculum promotes recovery by identifying individual strengths and resiliency factors, enhancing illness management, and teaching skills to facilitate functional recovery and maintain personal wellness.

Social Skills Lunch

During mealtime, client social skills are assessed in real time, difficulties are noted by staff, and behaviors are shaped immediately. Mental Health Technicians support clients in utilizing social and resiliency skills to increase emotion regulation and distress tolerance, manage delusions that may interfere with socialization and dining etiquette, and achieve health maintenance goals such as healthful eating and portion control. In short, mealtimes become a social learning laboratory where skills can be assessed and shaped to maximize the likelihood of enduring change.

Social Cognition & Interaction Training (SCIT)

Social Cognition & Interaction Training (SCIT) is an empirically validated, manualized group intervention designed to improve social cognition by focusing on deficits and biases in emotion perception, attributional style, and theory of mind abilities for persons with schizophrenia. In this group, client biases and delusions are mitigated by helping patients generate alternatives to distorted social judgments using proven cognitive and metacognitive techniques. The goal is not to correct distortions perfectly, but to appreciate how various judgments have different social and emotional consequences. California OnTrack is the only program in Southern California to offer this treatment modality.

Mind & Body: Cognitive Remediation

Clients engage in computer-assisted cognitive remediation to address neurocognitive deficits caused by schizophrenia and other thought disorders. The program targets attention, memory, executive function, social cognition, and metacognition — the cognitive processes required for community and social integration. Our cognitive remediation program implements a well-validated, directed but self-paced computer-based program that targets multiple neurocognitive and social-cognitive domains, in concert with high-intensity fitness training shown to accelerate cognitive remediation.

Mind & Body: Physical Fitness & Health Coaching

Sessions are led by a certified personal trainer and individualized based on fitness level. The physical component comprises gravity-based high-intensity exercise targeting 45 minutes of aerobic activity, plus appropriate warm-up and cool-down. The health coaching component addresses developing a sustainable, energy-balanced diet, with additional topics including smoking cessation, accessing primary health care, and sleep hygiene. In those with psychosis, neurocognition improves with vigorous exercise.

Social Skills Training (SST)

Participants are taught and given opportunities to practice the skills required for effective interpersonal communication and interaction, such as recognizing nonverbal cues, conversational skills, and assertiveness. Participants have ample opportunity to role-play various skills and receive targeted feedback from group leaders, preparing for application in the community. Our SST program adheres to five established principles: modeling, reinforcement, shaping, overlearning, and generalization. SST is an accepted evidence-based intervention validated through large-scale clinical trials.

Behavioral Family Therapy (BFT)

Using didactics and role-play, families complete work on motivational enhancement strategies for better communication, recognizing early signs of relapse, and developing a clear staying-well plan. BFT promotes positive communication, problem-solving skills, and stress management within the family. It also introduces family members to the same distress tolerance and communication strategies being taught to clients so that everyone is speaking the same language. Our BFT program is largely based on the RAISE-ETP and NAVIGATE psychosis treatment curricula.

Individual Psychotherapy

Individual sessions allow clients to focus intensively on the topics they need to address most. Early sessions are usually focused on psychoeducation and, where appropriate, learning to process their psychotic episode. Later sessions may be devoted to additional cognitive behavioral therapy for negative emotions, mixed family therapy, or individual case management.

Psychiatry

Psychiatric services are provided by Eric M. Wexler, MD, PhD, and are scheduled as needed throughout the week. Medication management is integrated with the program’s psychosocial interventions and is tailored to each client’s clinical needs and recovery goals.

Additional Therapeutic Groups

Life Skills

Our Life Skills group fosters acquisition and maintenance of independent living skills, which are impaired in psychosis. The program borrows from developmental disabilities clinical practice literature because individuals with psychosis exhibit deficits that clinically overlap with intellectually impaired and autistic populations. Skills training includes home upkeep, health and hygiene, education, employment, and relapse prevention, with large tasks broken down into achievable steps.

Compensatory Cognitive Training (CCT)

CCT, developed through the San Diego VA, trains compensatory strategies that are both internal (e.g., using acronyms or visual imagery) and external (e.g., writing information in a visible place). It is a 12-week, manualized intervention targeting prospective memory, attention and vigilance, learning and memory, and executive functioning — domains selected based on their impairment in schizophrenia-spectrum disorders, relevance for psychosocial functioning, and potential modifiability.

Metacognitive Training for Psychosis (MCT)

Cognitive biases drive the formation of delusions and hallucinations. MCT is a debiasing-focused form of cognitive therapy that produces large and enduring reductions in psychotic symptoms, as demonstrated in numerous clinical trials and validated in meta-analyses. Unlike classical CBT, which focuses on changing individual beliefs, MCT focuses on changing the cognitive biases that foster the development of delusions or hallucinations. It avoids in-depth discussions of delusional content to engage patients who may be unwilling to talk about their psychotic experiences due to suspiciousness, ambivalence, or shame.

Cognitive Behavioral Therapy for Psychosis (CBTp)

CBTp is a well-established intervention for reducing intrusive delusions or hallucinations. While grounded in classical CBT principles, CBTp emphasizes collaborative development of a shared formulation to understand and maintain psychotic symptoms, normalization of the psychotic experience to address stigma, and acceptance of psychotic symptoms with the goal of reducing distress rather than altering symptom occurrence.

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