Author Archives: Susan

Stress Solutions

by Susan Andrews, PhD

New Evidence That May Help Prevent the Lasting Effects of Early Life Stress

This was a very new topic 10 years ago. Today, however, it is a research area that is receiving much more activity. In 2012, the American Academy of Pediatrics’ position paper acknowledged that the period of time from conception through early childhood is critical. They include prenatal stress in their definition of toxic stress and say that children exposed to early stressful conditions are more likely to struggle in school, have short tempers, manage stress poorly, and tangle with the law.1

A November 2018 Science Daily article titled, “Studies highlight lasting effects of early life stress on the genome, gut, and brain”, starts with a summary statement: “The new research suggests novel approaches to combat the effects of such stress, such as inhibiting stress hormone production or resetting populations of immune cells in the brain.”

In 2012, many articles existed that spoke to the dangers of high levels of stress in pregnant mothers but at that time, the main measures were cortisol production during stress and an understanding that some women (and men) were less able to reduce the effects of stress on their bodies than others. Longitudinal research done in Avon, England had followed pregnant moms and then their offspring until the children became adolescents. Those studies showed strong correlations between highly/chronically stressed mothers (measured by their own ratings) and the propensity of their children to deal less well with stress.

A subsample of 74 of the Avon children at age 10 years old were asked to collect samples of saliva first thing in the morning and at three other times during the day. The samples were collected for three days. Dr. Thomas O’Connor and the study team examined the children’s levels of cortisol and found that the mothers’ levels of prenatal anxiety, some 10 years earlier, predicted the children’s higher morning and afternoon cortisol levels. In other words, the higher the mother’s cortisol levels when she was pregnant, the higher the child’s cortisol levels 10 years later. This study is cited as providing evidence that prenatal anxiety might have lasting effects on the HPA axis functioning in the child and that the child’s HPA axis is affected by the mother’s high cortisol levels during pregnancy.2

What has been more or less missing was a mechanism that made the link between the pregnant mother’s higher cortisol and the child’s higher cortisol levels 10 years later. It is now emerging that there is not one link but many. For example, stress during pregnancy can alter gut bacteria, which can reduce critical nutrients reaching fetuses brains. Even more exciting is that researchers in Tel Aviv University have used cutting-edge genetic research and brain imaging technologies to produce a personal profile of resilience to stress. Their findings hope to lead to a future blood test that would facilitate preventive measures for people with Low Resilience to stress. This could potentially reduce the damaging health consequences and keep us from passing low stress resilience from generation to generation.

1 Jack P. Shonkoff; Andrew S. Garner; and the Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoptions, and Dependent Care; and Section on Developmental and Behavioral Pediatrics, “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” Pediatrics 129 (2012): e232–46. 
2 Thomas. G O’Connor, Yoav Ben-Shlomo, Jonathan Heron, Jean Golding, Diana Adams, and Vivette Glover, “Prenatal Anxiety Predicts Individual Differences in Cortisol in Pre-Adolescent Children,” Biological Psychiatry 58 (2005): 211–17


Once Upon a Time in Hollywood

by Alvin G. Burstein

“Once upon a time” is a phrase signaling the beginning of a fairy tale. Fairy tales are folk tales that persist in a culture because they embody and illustrate that culture’s values. They function as parables. So the title of this film invites us to look for its moral center.

There is another interesting aspect of director Tarantino’s choice of the title. On one hand, the film is deeply rooted in a particular historical moment, the fifties and sixties. On the other hand, the tale is an odd amalgam of fact and fable. Movie actress Sharon Tate, whose tragic 1969 murder by Manson acolytes riveted the public, is a central figure in the film. But the tale the movie unfolds is an alternate history saga: what if the murderers had gone to a neighboring Beverly Hills mansion instead of that occupied by Tate and her famous husband, Roman Polanski?

That second house is owned by the fictional character Rick Dalton, played by Leonardo DiCaprio. Dalton was the star of a western bounty hunter TV series. He is struggling to upgrade his stereotyped small screen television career into a more rewarding one in big screen movies. An integral part of Dalton’s career is his relationship to his stunt double, Cliff Booth, played by Brad Pitt.

Booth is more than a stunt double. He is Dalton’s factotum, and the film makes much of their relationship, intentionally troubling us with the disparity between their rewards and social status, and the nature of their tie to each other. They need each other, but in ways that transcend convenience and utility. Part of the fairy tale element of this film is its providing an opportunity to make a moral judgment about this pair of characters. The fictional movie star owner of the opulent Beverly Hills mansion next door to Tate and Polanski is less admirable than is his stunt double and body man, an ex-Green Beret who lives in a trailer on a lot behind a drive-in movie screen.

Booth’s “roommate” in his trailer abode is Brandy, a pit bull. In a highly comedic element, Booth feeds his dog Wolf’s Tooth dog food, “Good Food For Mean Dogs.” It comes in two flavors, Rat and Raccoon. Brandy, eager and quivering with hunger, is trained to wait while Booth prepares the dog’s dinner. Not until her owner, at his leisure, gives her the signal, does she lunge slavering to her repast. Brandy later plays a key role in dealing with the misdirected home invasion by Mansonites. She is one of the most admirable characters in the film. The moral point: a creature of simple if urgent impulses, she controls herself out of attachment to Booth. In addition to the contrast between Dalton and Booth, we have a contrast between Dalton and Brandy. Dalton uses Booth and others, Brandy’s devotion is unconditional.

The film is very popular—high ratings from Rotten Tomatoes, grossing over a hundred million dollars at this point. Part of its popularity is its focus on an interesting time and place. Another element of its fascination is its look behind tinsel town glitter. It has the allure of a gossip column, a peek at what goes on behind the doors of the rich and famous. In Freudian terms, a peek into the parents’ bedroom.

New Members Join Psychology Board; Short A Public Member

Two new members, Dr. Gina Gibson (formerly Gina Beverly) of Lafayette and Dr. Michelle Moore of New Orleans, have taken their places on the Louisiana State Board of Examiners of Psychologists. They were appointed July 23, by Governor Edwards.

The consumer member, who was announced twice by the Governor’s Office, Amitai Heller of New Orleans, will not be serving, due to a conflict, noted a source at the board. Because of this, the board is still open for a consumer, public member. The individual must have no connections to psychology.

In a June 20, 2019 press release the Governor’s Office announced that Amitai Heller of New Orleans, was appointed to the Louisiana State Board of Examiners of Psychologists. The Governor’s office has previously announced Heller’s appointment in December 2018 but another undisclosed source said that it was premature and not final. Heller is an attorney with the Advocacy Center.

This leaves the consumer position open, ever since the bill was passed in 2018 to require all regulatory boards to include a public member.
The two new psychologist board members were appointed on July 23, by Governor Edwards. Both were nominated by the Louisiana Psychological Association.

Dr. Gibson is a neuropsychologist with the Department of Veterans Affairs, licensed in 2008. She lists her specialty as Counseling/Clinical Neuropsychology. Her training is from Louisiana Tech University and employment is with Dept. of Veterans Affairs and also private practice. She is a member of the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology.

Dr. Michelle Moore is an associate clinical professor at the LSU Health Science Center. She has served as Clinical Associate Professor of Psychiatry, LSU Health Sciences Center, New Orleans, LA, Department of Psychiatry, Section of Psychology, and Training Director of Clinical Psychology Internship Program. She is a member of the American Psychological Association; Association of Psychologists in Academic Health Centers; Louisiana Psychological Association; Southeastern Psychological Association; and Association of Psychology Postdoctoral and Internship Centers.

How Do You Save A Trillion Dollars?

by Julie Nelson

Imagine that a patient with psychosis is given nutrients. She improves her quality of life to such a degree that she no longer needs yearly hospitalizations, which, along with other expenses, amounted to $500,000 of medical and disability costs over a fiveyear period.

Dr. Bonnie Kaplan, Professor Emerita in the Cumming School of Medicine at the University of Calgary, and expert in the field of nutritional mental health, says this type of prevention might save lives and money. Kaplan publishes widely on the biological basis of developmental disorders and mental health – particularly, the contribution of nutrition to brain development and brain function. She will speak to Louisiana psychologists this November.

In her “Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment,” in International Journal of Mental Health Systems, Kaplan points to dramatic savings for those patients that respond to nutritional interventions.

Nutrition is one of the innovations in illness prevention that has been neglected for decades. Other neglected approaches include behavioral treatments for lifestyle based illnesses, equally as cost-effective.

Prevention requires tools that are often unfamiliar because educational, behavioral, and social interventions, not usually considered to be part of medicine, may be most effective for many diseases,” said Hamilton Moses and co-authors in, “The Anatomy of Health Care in the United States,” in an article of the Journal of the American Medical Association.

While medical costs are driven by chronic disease, these costs are not due to an aging population, even though age is often cited as the cause. Moses shows that about 80 percent of the total health care cost is accounted for by individuals under 65, and relate to psychological, social and behavioral factors. The CDC estimates that three lifestyle factors––poor diet, inactivity, and smoking––account for 80 percent of heart disease and stroke, 80 percent of type 2 diabetes, and 40 percent of cancer.

“Behavioral intervention is the foundation for lifestyle medicine,” writes Dr. John Caccavale, author of Medical Psychology Practice and Policy Perspectives. “Of the top four classes of medical problems in America–– metabolic disorders, respiratory disease, cardiovascular disease, and mental disorders––physicians will have great difficulty demonstrating that they are improving patient health by utilizing medications as a first-line treatment for these classes of disorders,” writes Caccavale.

“I think wellness/prevention are areas where there is tremendous need in primary care,” said primary care psychologist Dr. Michelle Larzalere. But, rarely is this need addressed.

“For both physical and mental health, the need to work on active problems is often so high that wellness/prevention get shorted on attention,” Larzalere said.

“The health habits that most reduce the preventable component of the most prominent causes of morbidity and mortality in the US––for example, refraining from smoking, eating a healthy diet, getting regular exercise, and limiting alcohol consumption––are behaviors that psychologists can really impact positively. Unfortunately, at least in my experience, other needs are so great that it is hard to make time for wellness/prevention initiatives unless there is a specific plan put in place.”

Author of Health Psychology, Dr. Linda Brannon said, “The division of health into mental and physical health is a false dichotomy that we need to get over. I think that many providers address the presenting problem to the extent that they do not look beyond it.”

For decades now, psychological scientists have known that behavior is the key to costs. Larzelere explained that psychological scientists have repeatedly shown that resulting savings by including prevention behaviors can produce savings between 30 and 60 percent in medical use costs.

To put this in perspective, a 10 percent reduction in medical/surgery costs nationwide––by treating the mental or behavioral component––would exceed the entire current national mental health budget, she explained.

She is correct. According to federal agency, The National Health Expenditure Accounts, healthcare spending reached $3.5 trillion in 2017, for both public and private sources. This is $10,739 per person, and accounts for 17.9 percent of the Gross Domestic Product.

A 10% savings, as Larzelere suggests, would result in a savings of $350 billion. The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration estimates treatment spending from all public and private sources to total $280.5 billion in 2020.

Estimating at the low end of the range of expected savings, a conservation goal of 30%, would come to $1 trillion.

Gains in quality of life and productivity would be added on top of that.

Some Current Problems

Is all this spending doing anyone any good?

A pattern of poor health outcomes and high costs reflects the country as a whole. The United States ranks 50th out of 55 industrialized countries in a measure of life expectancy and medical care spending, according to Bloomberg, who concluded the U.S. is the “least-efficient” health-care system in the world.

Louisiana typically falls at the bottom of the states in health ranking. In the most recent report from America’s Health Rankings, an annual analysis of the United Health Foundation, Louisiana ranked No. 50. The state ranked last in both behaviors and community & environment categories, No. 47 in clinical care, and No. 48 in health outcomes.

Louisiana has its challenges. Nearly 21% of the population of the state is at the poverty level or below, when only 12-1/2% of the citizens nationwide fall at this level. Over 41% of the citizens in Louisiana fall at 200% of the poverty level or below, compared to 29.75% nationwide.

Health is woven into a complex set of social and psychological behaviors, not a single cause. “Socioeconomic status is one of the most powerful predictors of all cause mortality,” says Dr. Chris Leonhard, health psychologist and Professor at the Chicago Professional School at Xavier. “New Orleans is a startling example of this,” Leonhard said. “Life expectancy at birth in the Tremé where the average household income in 2010 was about $26,000 is 55 years, while in Lakeview, the average 2010 household income was $75,000, and life expectancy at birth is 80 years.”

But money is flowing. The state paid $10.7 billion on behalf of about 1.9 million Medicaid recipients, according to the Louisiana Department of Health. During the fiscal year 2017– 2018, about 39.6 percent of Louisiana’s citizens were enrolled in the Medicaid program and payments were made on behalf of 1,876,908 recipients.

Using other federal data, this time from Medicare, a concerning picture emerges. According to an analysis by Blake Kruger and Jeremiah Brown, Louisiana spends the most on Medicare beneficiaries per capita than any other state. At the same time, Louisiana reports greater disparities in health status and death rates than other states.

Kruger and Brown investigated the associations between healthcare intensity, healthcare spending, and mortality in Louisiana Medicare beneficiaries. They defined healthcare intensity to be synonymous with the hospital care intensity index, a combination of inpatient days and physicians’ services.

The researchers found no association between healthcare intensity and spending. Nor did they find any association between spending and mortality.

“We also observed no association between health-care spending and age, sex, and race-adjusted mortality,” the researchers wrote. And, when they compared healthcare intensity to age, sex, and race-adjusted mortality, they could find no meaningful associations. Nor did they find that more spending made any difference in survival when adjust for smoking, inactivity, or obesity.

While the lack of an association between healthcare intensity and spending could indicate that outpatient care in Louisiana is becoming more highly utilized, the findings could also reflect that spending more on healthcare in Louisiana does not improve rates of survival or health outcomes for Louisianans.

Healthcare: Designed for You by Special Interests

The sheer size and complexity of the healthcare industry would suggest that innovations like nutrition or lifestyle therapy would be challenging, and new treatments even more unlikely because of the political power yielded by the industry giants. Over the last years the pharmaceutical industry, Blue Cross/Blue Shield, the American Hospital Association, and the American Medical Association were the some of the highest contributors to Congress.

Psychology and other groups have not been able to garner a place at the medical table to push for new methods. California Attorney David Ries of Human Capital Specialists tried to persuade federal Rule makers to include psychologists in the bonus plan for Accountable Care Organizations (ACOs) but failed. He told the Times that the final Rules were very disappointing, and said, “The broad recognition of the importance of behavioral health to overall wellness indicates that ACOs are unlikely to achieve their treatment objectives …”.

These special interests exert themselves not only through direct lobbying, but the medical-pharmaceutical-hospital-insurance industrial complex has a firm hold on the prices and services in this country, through the “CPT Codes” and the “Relative Value Scale Update Committee” or RUC. These groups decide what services are allowed and how much they are reimbursed.

The CPT codes, short for Current Procedural Terminology, control what services are allowed and reimbursed. The codes are created by three hundred “Advisors and Experts,” primarily from the American Medical Association’s House of Delegates, representing medical specialties, who work to influence an “Editorial Panel,” composed of representatives from medical societies, insurance companies and government. This panel conducts secret meetings to decide on which healthcare services are paid for, and which are not.

Dr. Tony Puente, Past-President of APA, was one of the two outsiders allowed to participate in the CPT process. “Essentially,” he said, “the CPT tries to divvy it up in a way that is theoretically and empirically, and diplomatically and politically, correct.” Participants must sign a strict AMA (American Medical Association) confidentiality agreement declaring, “I will not disclose, distribute or publish confidential Information to any party in any manner whatsoever.”

The CPT system is dominated by organized medicine. “Every seat at the table has a vested interest, mostly not supporting your proposed code,” said Dr. Travis Thompson, professor, psychologist, and leader in the Association for Behavior Analysis International. It took him and colleagues three years to muscle through codes for the treatment of autism.

While the CPT approval is a first leg of a long journey, another element of this behindthe-scenes influence is the panel known as AMA/ Specialty Relative Value Scale Update Committee, or RUC. Since 1991 members of the RUC establish the value or price for the CPT codes. Somehow this is not considered price-fixing.

To decide on reimbursement, 28 voting members of the RUC, representing medicine specialties such as anesthesiology, cardiology, neurology, neurosurgery, obstetrics, oncology, psychiatry, and so on, meet and decide how much each service is worth, and how much will be paid.

Control of the CPT and RUC have helped shaped health care toward high technology and high prices, less primary care, and no prevention.

A dramatic example of flawed decisions in the medical/pharma industrial complex is the opioid crisis. Twenty years after a marketing blitz convincing physicians that opioids were safe and effective, now one of the deadliest medical mistakes of modern times.

Despite the flood of legal opioids into the society, the CDC reported no change in pain that would meaningfully have ever driven the prescribing: “…there had not been an overall change in the amount of pain that Americans reported.”

The CDC did find that psychological and physical treatments for pain were beneficial, but these non-medical approaches are rarely integrated into treatment programs. Behavioral approaches were often the more appropriate treatment. “It is now widely accepted that pain is a biopsychosocial phenomenon,” clinical health psychologist and Past-President of the Southern Pain Society, Dr. Geralyn Datz said, and that must be treated as such.

Louisiana Follows the Leaders

Louisiana may have the most to gain from prevention and innovations, but there is a long way to go from where the state is currently.

In the most recent Louisiana Medicaid Annual Report, the top 10 provider types, ranked by payment, were first, hospitals, at $1.3 billion, and second, pharmacy, at $726 million. Dentists were third at $162 million, then mental health rehabilitation at $140 million, nurse practitioners at $115 million, and behavioral health rehabilitation agencies at $114 million. Distinct psychiatric hospitals were next at $76 million and freestanding mental health hospitals at $69.7 million.

In comparison, all other providers, which include chiropractic, personal care attendants, physical and occupational therapy, psychology, social work, and other services, totaled only $917,000.

In a 2018-2019 Combined Behavioral Health Block Grant Plan, published in late 2017, the state noted that the number of persons being served was only 3.29% of the estimated prevalence. The estimated number of children/youth with serious emotional disorders was 38,803 and only 1,370 had been served. The prevalence estimate for adults with serious mental illness was 192,019 and only 7,590 had been served.

Access to care and rates have been a problem nationally, with nearly half of all providers not offering services to Medicaid patients. Nationwide, Medicaid fees are about 72 percent of Medicare, which is about 80 percent of private pay. And this amount comes to an even smaller portion of what some practitioners charge in a fee-for-service setting.

In a list of “Specialized Behavioral Health Services CPT Code” and reimbursements, effective last year, the fee structures provide little in the way of reimbursement for health and behavior, or any clear mechanism for integrated services. The “health and behavior” services pay between $12 and $15 and are only listed for a psychiatrist, nurse/physician’s assistant, medical psychologist, or a psychologist. None were listed for clinical social workers or counselors.

Some codes and fees are listed for psychotherapy. Individual psychotherapy is reimbursed at $69.76 for psychiatrists for 45 minutes, $55.81 for nurse practitioners and physician assistants, $55.81 for psychologists, and $48.83 for social workers, counselors, and marriage and family therapists. And group therapy, a valuable therapy mode for many issues, is paid at only $23.23 to $18.58 and there is no reimbursement for the social worker or counselor listed on the current fee schedule. The low pay may account for why only about 130 psychologists are listed as providers on the current Medicaid rolls, and many of these are agency staff.

These misaligned incentives seem likely to impact those who have the least options to find better care in the private sector.

Finally, physician researcher Dr. Martin Makary has shown that medical error, unrelated to the illness or injury, is the third cause of death nationwide, following only heart disease and cancer deaths.

To conclude, Louisiana spends more than other states while there is no positive relationship between the money spent and health outcomes. Nationwide, the costs are staggering, while many chronic diseases are on the rise. Overall, the system looks to be more like a money-laundering scheme than a set of effective health services.

States like Louisiana with a high percentage of citizens at or near the poverty level, would benefit most from prevention and new, inventive treatments. “A bright new future of understanding, preventing, and treating mental disorders awaits us,” writes Bonnie Kaplan.

But just how long is that wait going to be?

“Panic Button” App Initiative Aims to Improve School Safety

Gov. Edwards joined Louisiana State Police Superintendent Col. Kevin Reeves at Neville High School in Monroe on August 29, to announce that the state is providing funding for all K-12 schools in Louisiana to begin using the RAVE Mobile Safety App that will better alert authorities to emergencies on K-12 campuses.

“Today we are taking a step forward in making our schools safer with technology that will dramatically improve reporting and response times for teachers and other educators who face emergency situations while in their classrooms,” Gov. Edwards said. “While we hope and pray that the safety of our children and their teachers is never compromised, it’s our hope that this technology will assist in protecting our schools.”

Rave Mobile Safety will provide the Rave Panic Button app to all schools that will allow teachers to quickly request immediate assistance from law enforcement or other first responders in the event of a health or safety emergency in their classroom.

This is funded with $4 million included in the state’s FY 20 budget. The app will begin to be deployed to schools across the state this fall.

“The progress that Louisiana is making to improve the safety and security of our students, faculty and staff are the direct results of the vision and leadership of Governor Edwards in creating the Blue Ribbon Commission,” stated Colonel Kevin Reeves, State Police Superintendent. “I am
extremely proud of the work of my fellow Commission members including our parish and local law enforcement partners and the efforts of the men and women of the Louisiana State Police that helped bring this technology to Louisiana.”

“As tragedies at schools have escalated, leaders in education, law enforcement, and emergency response have collaborated to strengthen preparedness and crisis management,” said Louisiana Superintendent of Education John White. “Among those efforts, we have explored the use of new technologies, like the mobile app announced today, that may prove beneficial in quickly and effectively responding to an on-site emergency. Every child and every educator deserves to feel safe in their classrooms, and it’s our duty to put into place every measure to ensure that’s possible.”

The Rave Panic Button is a smart phone app designed to speed emergency response by alerting authorities when there is a medical emergency, a fire, an active shooter or another crisis. When a teacher, administrator or staff member activates the button, it simultaneously places a 911 call to dispatch help while delivering immediate notification of the type and location of the emergency to other school employees and first responders.

This type of coordination further enables schools to respond to emergencies more quickly. The state will cover the cost of the technology for all schools in Louisiana, including charter schools, either as their first line of communications or to work in hand with solutions individual school systems already have in place.

“As a school district, the first and foremost requirement we have is to work to ensure safety for all our students, faculty, and staff,” said Dr. Brent Vidrine, the Superintendent of Monroe City Schools. “This App is one more tool to help our school district be pro-active in working to ensure safer schools for all of our students and adults on campus.”

Gov. Pledges to Close Gaps in Mental Health

Governor Edwards released his Healthy Families Agenda, a plan to make Louisiana a healthier state in his second term.

In a press release August 30, he pledged to close gaps in the mental health system if re-elected. In the release the Gov. said he will build on those first term successes by:

• Keeping the rural hospitals open
• Closing the gaps in the mental health system
• Eliminating Hepatitis C in Louisiana
• Reducing maternal mortality by 20%
• Getting every Louisiana birthing facility to participate in the fight to reduce maternal mortality
• Lowering prescription drug costs
• Continuing the fight against opioid addiction
• Drastically reducing the waiting list for home and community-based health services for older adults
• Continuing to break records for the number of children adopted out of foster care

“Louisiana is much better off today than we were four years ago, in part because our people are healthier. My decision to expand Medicaid has cut our uninsured rate by more than half, created thousands of jobs, and most importantly saved lives. But we have more to do. In my second term we can build on our successes, using innovative approaches to keep our rural hospitals open, lower drug costs, reduce maternal mortality, and fight infectious disease. Let’s keep moving Louisiana forward, to a happier and healthier future,” said Gov. Edwards.

Dr. Coulter, Dr. Reuther to Serve as President, President-Elect for Louisiana Psychological Association

Top: Dr. Alan Coulter at a conference. He is currently serving as President of the LPA. Below: Dr. Erin Reuther presenting. She is the current President-Elect

The Louisiana Psychological Association announced its newly elected officers to their Executive Council, who began serving last month. The 2019–2020 Council are Drs. Alan Coulter (President), Dr. Erin Reuther (President-Elect), and two new Directors, Dr. Christopher Parkinson and Dr. Amanda Raines. Returning officers are Dr. ValaRay Irvin (Secretary), Dr. William Costelloe (Treasurer), Dr. Bridget SonnierHillis (Director) and Dr. Kim VanGeffen (Director).

Dr. Alan Coulter will serve as the 2019– 2020 President. He is the Director of Program Area for the School of Allied Health Professions, Human Development Center, at LSU Health Sciences Center. He is the Director of Educational Innovations for the Human Development Center and LAS*PIC, and the Principal Lead for the TIERS Group. Dr. Coulter served on the President’s Commission on Excellence in Special Education, was a member of the National Monitoring Stakeholders Group, a recipient of Child Advocacy Award from the National Association of School Psychologists, and a past president of the National Association of School Psychologists.

Dr. Erin Reuther will serve as PresidentElect. She is a Pediatric Clinical Psychologist at Children’s Hospital-New Orleans and obtained board certification (ABPP) in Clinical Psychology in 2015. Dr. Reuther earned her doctoral degree from Louisiana State University in Baton Rouge where she focused on research in anxiety and cognitive-behavioral treatment with children and adults. She completed her clinical internship at the University of Florida-Shands Hospital in the child/pediatric track, where she further specialized in exposure with response prevention for OCD, CBT for anxiety, and health psychology working with inpatient and outpatient pediatric and adult clients with medical illnesses including gastroenterology disease, pediatric diabetes, and those preparing for surgery.

For her service, Dr. Reuther will focus on “… communication of all that LPA does to advocate for the profession, including direct coordination and communication with APA and national efforts, interacting with governmental agencies to educate and advocate for the profession, keeping psychologists in Louisiana informed of best practices, and organizing psychologists together.”

Newly elected were Dr. Christopher Parkinson and Dr. Amanda Raines.

Dr. Parkinson is a Clinical Psychologist with an emphasis in Health Psychology from Rosalind Franklin University of Medicine & Science. He completed his internship at the Gulf Coast Veterans Healthcare System and his postdoctoral residency in Health Psychology and Pain at the Southeast Louisiana Veterans Healthcare System. He currently holds a staff position at the SLVHCS as the Palliative Care Psychologist engaged in clinical care, program development, training, and research. He also serves as adjunct clinical instructor within the Department of Psychiatry and Behavioral Sciences of the Tulane University School of Medicine. He is the 2018 recipient of the LPA Early Career award.

Dr. Raines serves as a Clinical Investigator at the Southeast Louisiana Veterans Healthcare System and as Assistant Professor in the Department of Psychiatry at Louisiana State University. Her doctorate is in clinical psychology from Florida State University and her internship and residency was with LSVHCS. Her research focuses on identifying and empirically examining risk and maintenance factors as well as the development of novel interventions that can be used to treat and prevent anxiety and related pathology. She has published over 75 peer-reviewed manuscripts and was the Early Career Psychologist delegate to the 2019 Practice Leadership Conference of the American Psychological Association.

Louisiana is 10th Fastest-Growing Economy in the Nation says Gov. in July 25 Statement

Gov. Edwards released a statement on Louisiana’s record high GDP of $256.45 billion, an annual growth rate of 3.8% in 2019Q1. According to the Bureau of Economic Analysis (BEA), Louisiana has the 10th fastest growing economy in the U.S., the Governor’s Office said on July 25.

“This latest ranking is further proof that Louisiana’s economy continues to grow and move in the right direction,” said Gov. Edwards. “Just this month, we have seen the largest unemployment decline since last year of any state, the lowest it has been in 11 years, personal income is at an all-time high and for the first time in a long time, our state debt is declining.”

“We are continuing to attract new business and industry while retaining and expanding our existing businesses and implementing programs in Louisiana to further strengthen our workforce.”

Louisiana’s GDP is at a new record high: $256.45 billion, compared to $247.2 billion in 2018Q1 and $255.5 billion in 2018Q4.

Non-durable goods manufacturing was the main contributor to growth, contributing 2.09 percentage points.

Retail trade contributed 0.82 percentage points and mining, quarrying, and oil and gas extraction contributed 0.80 percentage points.

In a related story, the Governor’s Office announced that Louisiana has the largest drop in unemployment rates of all states since last year.

Louisiana’s seasonally adjusted unemployment rate in June 2019 is 4.3 percent, which is a .7 of a percentage point decline since June of 2018, the largest such drop for any state.

Louisiana’s unemployment rate is the lowest it has been since January 2008.

La. No Longer “Incarceration Capital of Nation,” Says Gov. $12 Million in Savings

“Louisiana is no longer the incarceration capital of the nation, we have saved over $12 million which is more than double what was projected and are reinvesting those dollars into programs that are helping to reduce recidivism, improve public safety and support crime victims,” Gov. Edwards said in a July 19 press release.

“Everything we have put in place is based on data-driven policies that are successful in other southern states and are now having the same impacts in our state,” Edwards said. “It is still early in this process and there are more lessons to learn and more challenges to meet, but we are taking significant steps toward improving our criminal justice system.”

The comment followed the release of the Justice Reinvestment Reforms 2019 Annual Performance Report, presented to the Legislature in June. The report listed the following:
• Reduced Prison Population: Louisiana’s total prison population has continued to decrease. It has fallen from a peak of 39,867 individuals at the end of 2012 to 32,397 individuals as of the end of 2018. As an immediate result of reduction in nonviolent offenses, Louisiana no longer has the highest imprisonment rate in the nation.
• Sentence Length Down for Nonviolent Offenses: The State has seen significant decreases in sentence length for nonviolent offenses. Drug offenses have seen the largest decrease by the end of 2018 with a drop of 17%, followed by property offenses with an 8.3% decrease. The average sentence length for new felony admissions decreased from 76.6 months to 73.2 months (3.7%).
• Decrease in Use of Habitual Offender Enhancements: The use of Habitual Offender enhancements, which allow for increased penalties for crimes based upon the existence of previous convictions, decreased significantly (74.3%). This reduction is attributed to both prosecutorial and judicial discretion as well as legislative changes which limited the scope of its application.
• Reduction in Probation and Parole Population and Officers’ Average Caseloads: The State has seen a significant decrease in the total supervised population as well as the average caseload of Probation and Parole Officers; from 149 in 2016 to 123 by the end of 2018. The reduction is attributed to new incentives that allow people to earn time off supervision based upon compliance with supervision conditions.

The report can be found at

Psychological science and practice has played an important part in the Governor’s reforms.

Dr. Susan Tucker, the 2019 recipient of the Award for Psychology in the Public Interest, has been a key figure for innovations in the state correctional system. She is Psychologist and Assistant Warden at the Bossier Sheriff’s Office.

Dr. Tucker has focused on treatment and research innovations that reduce recidivism and that are based in the fact that most inmates have a substance abuse problem and few get the right kind of treatment.
She launched the Steve Hoyle Intensive Substance Abuse Program to offer intensive treatment, skill development, educational opportunities, and post release support and care. Her approach has achieved a significant reduction in recidivism, from an expected first year rate of 18 percent to only 3 percent.

Tucker has earned state and national recognition for these achievements, including from the Vera Institute of Justice. Dr. Tucker was also commended by Louisiana legislators for her work and the related cost savings of $15 million by earned “good time credits” through participation and successes in the psychological programs designed by Tucker.