Category Archives: Features

Dr. Gormanous Sole Candidate for LSBEP

The Louisiana State Board of Examiners of Psychologists (LSBEP) opened self-nominations at their Long Range Planning Meeting held in Baton Rouge on November 17 and found that
Dr. Greg Gormanous was the only qualified candidate for the upcoming election.

Dr. Gormanous is the retired Chair of the Psychology Department at Louisiana State University at Alexandria, and served briefly in June to September 2015 as the LSBEP’s Executive Director.

Gormanous has also previously served on the board twice, the first time in 1981 to 1984 and then from 1986 to 1989

In a message to licensed psychologists the board’s Executive Director Jaime Monic wrote, “ LSBEP’s policy on elections states that the Board will proceed with the election process if at
least one (1) nomination has been submitted. One nomination was received, therefore the Board is proceeding with the election accordingly.”

Licensed psychologists may vote until the election closes on December 22.

Following that the results will be transmitted to the Louisiana Psychological Association who will submit a list to the Governor.

Dr. Gormanous noted several goals of his service on his self-nomination form. “My view for regulating psychology in LA is helping the board become more effective and efficient in protecting consumers of psychological services,” he wrote, “while simultaneously ensuring due process, irrespective of particular staff, board members, issues and personalities.

He noted that his purpose and goals are: “To proactively enhance effectiveness, collegiality
and transparency with administrative, legislative, media, professional, psychological & public stakeholders in order for the LSBEP to ensure statutorily that consumers have access to qualified providers of psychological services and to ensure enforcement of ethical standards of practice to which providers are required to adhere, with appropriate over sight of the Board’s function by the state of Louisiana.

“In both Louisiana and North America, there have been cataclysmic shifts in regulatory  psychology in the last three years. And rapid transformational regulatory changes are on the immediate horizon. Thus, LSBEP is facing & will face additional significant challenges in the next five years.

“1. Revising the “complaint” rules, procedures and practices by focusing on two equally  important objectives: protecting consumers of psychological services AND ensuring due process for all.

“2. Achieving more effective outcomes for the expenditure of legal fees – presumably underway now.

“3. Staying a pace with changes in education and training. For example, other jurisdictions will be moving toward eligibility for candidates to sit for the EPPP 1 after doctoral course work is
completed.

“4. Adjusting to implementation of the competency model (EPPP 1 Knowledge and EPPP 2 Skills) by other jurisdictions and considering what is best for consumers in LA.

“5. Revisiting Generic versus Specialty Credentialing. Does the board stay with its “opportunity for registering…within a limited list of recognized specialties…” or does it implement the health service psychologist (HSP) & general applied psychologist (GAP) categories recognized by APA and ASPPB?

“6. Exploring any ramifications of implementation of the ASPPB’s PEP for LA.”

He also wrote: “A common view in the regulatory community – be it pharmacy, psychology, social work, veterinary medicine, or whatever-is that it takes a year or two for a new board member to figure out her/his role. Past & current experiences as an active member of ASPPB
and FARB & short term services as ED of LSBEP have prepared me to serve.”

Dr. Gormanous is Professor Emeritus of Psychology, LSU Alexandria, and earned his PhD from the University of Southern Mississippi in General Psychology in 1976. He member of
Association of State & Provincial Psychology Boards (ASPPB), the Federation of Associations
of Regulatory Boards, the American Psychological Association, the Society for
Industrial & Organizational Psychology (APA Div. 14), the Society of Consulting Psychology
(APA Div. 13), and the Association for Psychological Science.

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Psychology Laboratory Directors Discuss Research at “Science Café”

Psychological scientists from laboratories around the state shared their work at the first “Science Café,” hosted by the Louisiana Psychological Association this week in New
Orleans. Researchers from the University of New Orleans, Pennington Biomedical and the
University of Louisiana Lafayette discussed current advancements with psychologists
attending the association’s Fall Workshop.

Dr. Elliot Beaton, Assistant Professor in the Department of Psychology at the University
of New Orleans and the director of the Stress, Cognition, and Affective Neuroscience Laboratory, discussed how stress affects brain development and function in children and adolescents at ultra-high risk for later development of serious mental illness.

The goal of Dr. Beaton’s work is to help explain diagnosis, prevention, and mitigation by
understanding early prodromal indicators. He uses functional and structural magnetic
resonance imaging with network connectivity analyses. Dr. Beaton combines this with
behavioral, psychophysiological, hormonal, and immunological stress measures. He was joined by researchers Ashley Sanders, MS, and David Stephenson, MS.

Dr. Christopher Harshaw, Assistant Professor, directs the Mechanisms Underlying Sociality Laboratory at U. of New Orleans. His focus is on understanding the role played by somatic factors in cognition and behavior. Autism Spectrum Disorders frequently exist with a
variety of somatic complaints and issues, including gastrointestinal problems, allergic and immune disorders, as well as thermoregulatory and/or metabolic dysfunction. Dr. Harshaw discussed whether and to what extent such somatic correlates are simply “noise” versus causally related to clinically important facets of dysfunction.

Dr. Robert Newton, Jr., is Associate Professor and director of the Physical Activity & Ethnic Minority Health Lab at Pennington Biomedical. Dr. Newton discussed the effect of
physical activity on African American’s health through the Aerobic Plus Resistance
Training to Increase Insulin Sensitivity in African American Men study. One major goal of
the study is to determine the physiological effects of exercise training in this hard-to-reach
population. African-Americans suffer disproportionately from various health conditions, and
decreased physical activity and increased inactivity levels have been shown to be independent
risk factors for the development of chronic diseases including cardiovascular disease,
diabetes, and obesity. AfricanAmericans spend less time in activity and more time in inactivity than is recommended.

Dr. Valanne MacGyvers is Assistant Professor at the University of Louisiana at Lafayette, where she has taught for 23 years. In her lab Dr. MacGyvers focuses on issues of mindset in achieving excellence, examining the role of mindset in the prediction of academic excellence and in the understanding of psychological problems in adolescents, including depression, anxiety and eating disorders. She discussed current research which examines academic achievement in college and graduate school, measurement development, the role of music in preparing impoverished preschoolers for Kindergarten, understanding the development of empathy, and people’s attitudes about breast feeding in public.

Dr. T. Scott Smith is Assistant  Professor and director of the Louisiana Applied and Developmental Psychological Sciences Laboratory, a laboratory primarily focused on applied
research, or how information may be used to understand the world better or even make adjustments towards our overall  understanding of cognition. One major area of focus is cell phone distraction and how cell phone distraction affects the learning process, not only in the
classroom, but also how applicable distractions may affect driving behaviors and eyewitness
memory.

Dr. Smith also discussed his work on the effects of video game play on aggressive behaviors for children, adolescents, and adults, and how young children process information, specifically reconstruction memory, and how these processes affect their ability to be (in)effective witnesses.

Dr. Charles Taylor, Assistant Professor of mechanical engineering, is founder of the Cajun Artificial Heart Laboratory, a biomedical research lab with high-end computing and
visualization systems as well as a mock circulatory loop for the purpose of testing artificial heart valves. Dr. Taylor is a bioengineering professor and his lab delivers research capabilities
to the artificial internal organ community in the form of robust in vitro systems, with accompanying computational tools, to accelerate medical device development. Dr. Taylor
discussed the theories and principles of artificial organ creation and his on-going projects.

Dr. Taylor and Dr. Scott Smith, from the U. of Louisiana Lafayette Psychology Department, are
collaborating to develop the SMART test or Sensory Motor and Reaction Time Test for persons with blindness and visual impairment.

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More Mental Health, Less Incarceration – Prison Reforms Launched

In an announcement this week, Gov. Edwards said that key parts of the “Justice Reinvestment Initiative,” a package of reform measures passed by the 2017 Legislature, will begin to be implemented. Certain inmates in Louisiana who are currently serving a sentence for non-violent, non-sex offenses, as defined by Louisiana law, will be released an average 60-90 days early. This is an effort to reduce the state’s incarceration rate, the highest in the nation, a pledge the Governor made in taking office.

“Louisiana’s label as having the highest incarceration rate in the nation may be part of our past, but it will not be a part of our future,” said Gov. Edwards.

The package of 10 pieces of legislation is designed to steer less serious offenders away from prison, strengthen alternatives to imprisonment, reduce prison terms for those who can be safely supervised in the community, and remove barriers to successful reentry.

“For more than a year, stakeholders from every walk of life in Louisiana publicly met to
thoroughly review our criminal justice system. Following a model set forth by other Southern,
conservative states, their goal was to make Louisiana a safer place for our children while
being smarter on crime than we have been in the past…” he said.

“Along the way, we will, undoubtedly, find areas where we can improve these changes,” the
Governor said, including “alternatives to incarceration.”

The effort is estimated to save approximately $262 million, with more than $180 million of
those savings being reinvested in programs that reduce the recidivism rate and empower offenders to leave a life of crime.

Louisiana is the latest state to enact such reforms; many others have experienced simultaneous drops in their crime and imprisonment rates. For example, the Texas incarceration rate is down 16% and crime down 30%. In North Caroline incarceration is down 16% and crime down 16%.

The House and Senate votes for S.B. 139 (the bill that includes changes to parole and good time) passed by 26- 11 in the Senate, 75-30 in the House, and then 20-13 in the Senate
concurrence.

This past June, Dr. Raman Singh, Director, Medical and Behavioral Health, Louisiana Department of Public Safety & Corrections, told psychologists at the Louisiana Psychological Association, that the leverage for dramatic changes in the state’s incarceration rate was to institute behavioral health reforms in the Louisiana criminal justice system.

Singh, a medical doctor and cardiologist by training, said, “Louisiana’s incarceration rate
contributes to over-representation of the mentally ill in the criminal justice system.”

Dr. Susan Tucker, clinical psychologist and the Assistant Warden at the Bossier Parish
Medium Security Facility, and President-Elect of LPA, introduced Dr. Singh and explained the
significance of comprehensive psychological programs in the corrections and justice system.
Tucker developed the Steve Hoyle Intensive Substance Abuse Program nationally recognized for excellence.

In 2016 the Louisiana Legislature commended Tucker and her team in a House Concurrent Resolution pointing to multi-million dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed by Tucker.

Singh explained to the audience of psychologists and professors that the reasons for over-incarceration in Louisiana are well-established. Based on a 2016 Louisiana Legislative Auditor’s review Singh said the top reasons were mandatory sentences and habitual offender laws, high rates of local incarceration without treatment programs, and “not addressing issues driving criminal behavior such as substance and mental illness.”

“Incarceration of mentally ill exacerbates symptoms of mental illness. Rarely does incarceration of the mentally ill lead to an improvement in their mental status,” said Singh.

In a related story, in October Attorney General Jeff Landry wrote that taxpayers should be concerned about this “dangerous legislation.” He said that some of those released will
qualify for welfare and that the savings, targeted toward programs to help prisoners with addiction, mental health, and job skills, “…has apparently now morphed…” into more grants rather than taxpayer savings.

Governor Edwards replied that Landry should “Learn the Facts, Stop the Fear Mongering,” in a press release this week.

 

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Inside the Opioid Crisis

by J. Nelson

In an example of flawed decisions in the medical/pharma industrial complex, over-prescribing has catapulted overdose deaths to the top, compared to peak years for auto fatalities, HIV or gun deaths.

“We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths,” writes the Center for Disease Control (CDC).

The National Institute on Drug Abuse says opioid overdoses account for 60% of those deaths.
Researchers from the University of Virginia say these statistics are underreported by 24% for opioids and 22% for heroin overdose deaths, and with particularly large errors in certain states, one being Louisiana.

Overdoses are trending up, not down, by almost 20% for last year. STAT News predicts that
opioids could kill nearly 500,000 people in the next decade.

At the peak of the prescribing frenzy, 2013, doctors wrote nearly 250,000,000  opioid prescriptions––enough for every adult in the United States of have his or her own bottle of pills, reports the CDC.

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

Last year, 20 years after the opioid marketing blitz and prescribing ramp-up began, the
CDC found that there was no long-term benefit for opioids compared to no opiods. However, they did find ample evidence for harm, a fact that the FDA had failed to discover when they approved drugs like OxyContin in the 90s.

Not surprisingly, at least for psychologists, the CDC did find that psychological and physical treatments for pain were beneficial (“CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016,”). This despite the fact that these non-medical approaches are rarely integrated into treatment programs.

Echoing the overprescribing of antidepressants, citizens hoping for genuine healthcare appear to have once again become the unwitting lab rats of a commercial, profit–driven industry, where they and many providers are lulled into quick fixes that ignore long-term consequences and the psychology of the whole person.

Depth of the Problem

Opioids are derived from the same type of compound as heroin, and morphine-like effects for pain relief. The effects also include feelings of relaxation and euphoria. One recreational user described it as “Bliss.” Another as, “Physical––warmth, relaxation. Mental––Joy, boost in self-confidence, loss of anxiety…”.

Schedule I and II drugs have been determined to have a high risk for physical and psychological addiction. Schedule I are illegal and Schedule II are considered to have medical value and so legal by prescription. Heroin is a Schedule I opioid. Drugs like oxycodone, hydrocodone, and methadone are Schedule II opioids.

With continued use, tolerance and dependence result. Increased dosages are needed for the same results. Researchers say that dependency can occur after as few as seven days. Overdose risks go up.

In the 1990s drug manufacturers launched new opioid formulations, assumed to be safe. They expanded markets to non-cancer pain and moderate or temporary pain. Building on a new theme that all pain should be eliminated the opioid market quadrupled from 1999 to 2010, according to the General Accounting Office (GAO).

Physicians for Responsible Opioid Prescribing (PROP) found that the supposed safety of the new formulations in the 1990s was based, not on research, but primarily on a letter to the editor in a medical journal. The sound-bite idea began to circulate in the medical communities and was uncritically accepted as fact, notes PROP researchers.

The risk of addiction is serious. Among new heroin users, approximately 75% report having abused prescription opioids before turning to heroin, notes the CDC. The National Institute on Drug Abuse places the figure at 80%. PROP researchers reported that people get hooked by a prescription and then turn to street heroin.

Heroin use has been increasing among men and women, in all income levels. Those historically low in rates of heroin use––women, the privately insured, and those with higher incomes are seeing the greatest increases, says CDC. While addictions were up overall, those mainly affected were whites, especially those with less education.

In 2015 two Princeton researchers, Anne Case and Angus Deaton, presented findings to the  National Academy of Sciences that drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis, had increased so dramatically that all-cause mortality was up for US
middle-class whites, while declining for Blacks, Hispanics and for those in other countries.

“Over the 15-year period, midlife all-cause mortality fell by more than 200 per 100,000 for black non-Hispanics, and by more than 60 per 100,000 for Hispanics. By contrast, white non-Hispanic mortality rose by 34 per 100,000.”

“This is a disturbing trend,” said Dr. William Schmitz, Jr., Past-President of the American
Suicidology Association The addiction chips away at the person’s hope and adds to the
burdensomeness they experience,” he said. “There is overlap between the accidental overdose and the intentional. The person may think, ‘I’m taking this and if I die, I die and if not, I’ll be here tomorrow.’ What this really speaks to is the increasing need for collaboration in mental and physical health,” he said.

The Problem in Louisiana

Louisiana is in the middle of the crisis, with some of the highest opioid prescribing rates and an escalating death rate from overdose.

In a Louisiana House Health and Welfare Committee hearing this past April, Representative  Helena Moreno told members that there are “… more opioids prescribed in Louisiana than are people in this state.”

In 2007, Louisiana prescribers gave out 110.1 opioid prescriptions per 100 persons, based on numbers from the CDC. Only five others were higher: West Virginia (135.1), Kentucky (130.8), Tennessee (128.8), Alabama (120.3), and Oklahoma at (114.4).

Little change has occurred in recent years. In 2012 the map of southern rural states was the
same, with Louisiana a 112.4 rate, with a slight drop to 108.9 in 2015. The rate again dropped
slightly last year, down to 100.4.

The Louisiana Commission on Preventing Opioid Abuse, looking at internal figures from the state’s Prescription Monitoring Program (PMP), says that the number is even higher. “Over the last six years, since the PMP began monitoring narcotic prescribing behavior, Louisiana has
averaged 122 prescriptions per 100 persons. This rate is 39% percent higher than the national
average (87.44).”

Addictions have rocketed up along with prescriptions. Ed Carlson, CEO Odyssey House
Louisiana, testified at a Senate hearing that, “All of the drug and alcohol treatment programs
throughout the state were overwhelmed with the amount of the people who were seeking
and needing treatment. We currently have waiting lists for all of our programs,” he said.

Louisiana has also experienced a significant increase in overdose deaths, with a 12.4%
increase for 2014 to 2015, according to the CDC.

Another characteristic of the opioid crisis is the inconsistency in prescribers, not accounted
for by the illness level of those being treated.

Prescribing varies widely across the nation from county to county. In 2015, six times more
opioids per resident were dispensed in the highestprescribing counties than in the
lowest-prescribing counties, notes the CDC. Characteristics such as rural versus urban,
income level, and other demographics, explain only about a third of the differences
found in prescribing rates across the country.

In Louisiana, highest parishes include Evangeline (192.1), St. Landry (145.5) Rapides (144),
Richland (139.3), Washington (136), and Tangipahoa (129.5).

Examples from ProPublica, using Medicare Part D information, shows that Hydrocodone Acetaminophen was the first ranked drug prescribed in Louisiana with 812,468 claims.

Highest prescribers were physicians in Pain Medicine and Physical Rehabilitation. The top
prescriber wrote 14,223 prescriptions for opioids. Of his 866 patients, 91% filled at least
one prescription for an opioid. The review by ProPublica rated his patients as less sick than
average.

Another prescriber in Alexandria reported 1,333 patients receiving prescriptions from Medicare Part D and 98% of these filled at least one prescription for an opioid.

True Believers: A Bad Idea Gains Momentum

According to a 2003 report by the GAO, several national pain organizations issued new
guidelines in the mid-1990s, based on their belief that pain was undertreated in non-cancer
pain patients.

In 1995, the American Pain Society, led by Dr. Russell Portenoy, a New York pain doctor, recommended that pain should be treated in a special category. In an investigative
report by the Wall Street Journal (“A Pain-Drug Champion Has Second Thoughts”), said
Portenoy urged the tracking of pain as a “Fifth Vital Sign.”

The idea of a 5th vital sign was adopted by the Joint Commission on Accreditation of Healthcare Organizations, the Veterans Administration, and the Federation of State Medical Boards who provided reassurance to doctors who wanted to more freely prescribe opioids. The Federation drew up recommendations with the help of individuals linked to drug manufacturers, including Purdue Pharma (OxyContin), according to WSJ. The federation received nearly $2 million from opioid makers.

Around the same time, OxyContin was approved by the FDA, but lists no research on the drug.

An explanation by the FDA states: “At the time of approval, FDA believed the controlled-release formulation of OxyContin would result in less abuse potential, since the drug would be absorbed slowly and there would not be an immediate “rush” or high that would promote abuse. In part, FDA based its judgment on the prior marketing history of a similar product, MS
Contin, a controlled-release formulation of morphine approved by FDA and used in the medical community since 1987 without significant reports of abuse and misuse.”

In a Los Angeles Times investigation, based on sealed court documents, the physician who led the agency’s review of the drug, declined to speak with the press. The Times noted that shortly after OxyContin’s approval, the physician left the FDA and in two years was working for Purdue Pharma.

As enthusiasm grew the then Agency for Health Care Policy and Research, part of the national Department of Health, offered reassurance to prescribers about their “exaggerated concerns.”

The GAO noted that providers and hospitals were further required to ensure that patients received pain treatment. The Joint Commission implemented its pain standards for hospital
accreditation in 2001, a guide sponsored by Purdue Pharma.

Reassurances of safety appeared to be based on limited scientific research, a letter to the editor to JAMA, according to PROP and others, and perhaps a small study of 38 individuals.

How could such a gap in scientific decisions occur?

“Most doctors and virtually all patients are unschooled in how meaningfully to compare the
risks of foregoing versus undergoing treatment, and the patient’s frantic desire to ‘do
something now’ often trumps the doctor’s ancient commitment to ‘first, do no harm,’” wrote law professor John Monahan in a special report on statistical illiteracy in medicine, published by the Association for Psychological Science.

Dr. Jason Harman, a decision science expert at LSU, notes, “Doctors have very complex jobs. I know from some of my work on learning in complex systems that accurate and timely feedback is essential for optimal performance in a complex task.”

Some outcomes however have delayed or obscured feedback. In terms of opioids, the
immediate feedback a doctor receives is generally positive––pain is reduced––while
feedback about negative consequences is delayed if it is received at all. This basic
structure of feedback in the environment makes it very understandable to me how
doctors, who have the best intentions, could fall into such an ultimately harmful practice
…”

Marketing Blitz on Doctors’ Psyches

In 1997 Purdue Pharma created a marketing effort that overshadowed anything previously and catapulted sales of OxyContin.

“Purdue directed its sales representatives to focus on the physicians in their sales territories who were high opioid prescribers,” said the GAO. “This group included cancer and pain specialists, primary care physicians, and physicians who were high prescribers of Purdue’s older product, MS Contin. One of Purdue’s goals was to identify primary care physicians who would expand the company’s OxyContin prescribing base. Sales representatives were also directed to call on oncology nurses, consultant pharmacists, hospices, hospitals, and nursing homes.”

By 2003 primary care physicians had grown to constitute nearly half of all OxyContin prescribers, based on data from IMS Health, an information service providing pharmaceutical market research. The GAO report stated that the DEA expressed concern that this resulted in OxyContin’s being promoted to physicians who were not adequately trained in pain
management.

Purdue doubled the total OxyContin sales force by 2000 to nearly 700 and reached up to
94,000 physicians. Bonuses topped at $240,000, on a salary of $55,000.

Purdue expanded its physician speaker bureau, conducted speaker-training conferences,
sponsored pain-related educational programs, and issued OxyContin starter coupons for
patients’ initial prescriptions.

They also sponsored pain-related Web sites, advertising OxyContin in medical journals, and
distributed OxyContin marketing items to health care professionals–fishing hats, stuffed plush toys, coffee mugs with heat-activated messages, music compact discs, luggage tags, and pens containing a pullout conversion chart.

Purdue conducted over 40 national pain management and speaker training conferences,
usually in resort locations, to recruit and train health care practitioners for its national speaker bureau. Over five years, more than 5,000 physicians, pharmacists, and nurses, whose travel, lodging, and meal costs were paid by the company, were engaged. By 2002, Purdue’s speaker bureau list included nearly 2,500 physicians and over 20,000 pain-related educational programs.

“For the first time in marketing any of its products, Purdue used a patient starter coupon program for OxyContin to provide patients with a free limited-time prescription,” and by 2001 34,000 coupons had been redeemed nationally.

Purdue’s market share increased fourfold for cancer pain and tenfold for non-cancer pain by 2002.

Outdated Medical Model of Pain

“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, told the Times.

“For many years the biomedical model of treatment has prevailed as a way to treat pain patients,” Datz said. “This model is based on some very early research about acute pain and basically states that there is a one-to-one correspondence between the extent of injury and the amount of pain experienced. Therefore, large injuries lead to large pains and small injuries lead to small pains,” she said.

Datz explained that this model also assumes that surgery and medications can fix pain. “While
this is sometimes true, this model fails to appreciate what we now know about the central nervous system,” she said.

“We know that chronic pain is a complex and dynamic process, and it involves a person’s
thoughts, beliefs, experiences and these all can influence pain for better or worse. In addition, conditions such as depression and anxiety can arise from the presence of pain, and these also can worsen pain through interactions of the brain with the body.”

“In order to really address chronic pain, we must address the persons reactions to it and teach ways to overcome it, including retraining the brain away from the unpleasant pain signals. This is a psychological process involving education and training and coaching,” Datz said.

“We know that cognitive behavioral treatments create quantifiable changes in the brain, and
that these are distinct to this type of treatment. So these effects are lasting and result in long
term success.”

Dr. Datz says that the “best results are achieved through collaborative care,” but too often, insurance companies make it difficult for patients to have this type of help.

Treating with inappropriate drug therapy, is costly,” said Dr. John Caccavale, author of Medical Psychology Practice and Policy Perspectives. The cost for adverse drug reactions in 2001 was $72 billion to $172 billion while the cost for the drugs was $132 billion. “Actually, it’s now worse,” Caccavale said. “The incidence of hospitalizations from adverse events has risen substantially because of the growing use of medications in all categories.”

Failed Health System

The opioid crisis suggests one more area of poor outcomes for the U.S. healthcare system.
Bloomberg has reported that of 55 countries in a measure of life expectancy and high medical
care spending, the U.S. ranks 50th, dubbing the U.S. the “least-efficient” health- care system in the world. In a comparison of age–adjusted deaths from all causes, the World Health Organization ranks the United States last in similar countries.

Medical care is the largest industry in the U.S., accounting for almost $3 trillion in sales in 2015, according to the National Health Expenditure Data from CMS. At the same time, life expectancy in the U.S. is only 78.9 years, falling behind all other nations except for those such as Jordan, Colombia, and Russia, said Bloomberg.

Likewise, Louisiana ranks 50th of all the states, according to the Louisiana Department of Health and the 2015 Report from America’s Health Rankings.

“Health is a misnomer, because most activity involves illness,” say authors of “The Anatomy of Health Care in the United States” in a 2013, JAMA article. “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,” the authors write.

The system is politically closed to innovation. Three hundred “Advisors and Experts,” primarily from the American Medical Association’s House of Delegates, representing 109 medical specialties, lobby an “Editorial Panel,” composed of representatives from medical societies,
insurance companies and the government, decide on what is paid for, by way of codes.

The “Current Procedural Terminology” or CPT codes, and how much is paid for each service, is decided behind closed doors of the Relative Value Scale Update Committee,” or “RUC,” by those who stand to profit the most.

The system includes the FDA. Dr. Irving Kirsch, Associate Director of the Program for Placebo Studies at Harvard Medical School, has laid out the damning evidence that drug companies and the FDA skew research to approve drugs that have little actual value. The FDA receives 40 percent of its funding from the pharmaceutical companies, Kirsch said.

Add to this the political force of the top spenders for lobbying in Washington: Blue Cross/Blue Shield (3rd), American Hospital Association (4th) the American Medical Association (5th), and the Pharmaceutical Industry (6th).

This closed system is not surprising. In 2002 the 10 drug companies in the Fortune 500 made $35.9 billion in profits, more than all the other 490 companies profits combined.

Legislators in Louisiana are trying. In 2017 there were numerous bills and resolutions put forth to stem the tide of prescribing.

Senators Mizell and White asked for medical societies and hospitals to eliminate pain as the 5th vital sign, in Resolution 21. House Bill 192 led by Representative Moreno and 43 others, put some restrictions on prescribing opioids, became law as Act 82.

Act 88 by Representive Leger and others established the Drug Policy Board’s Advisory Council on Heroin and Opioid Prevention and Education, and Act 76 led by Senator Mills encourages prescribers to use the Prescripton Monitoring Program, where currently only about one third use the system.

The enforcement of these measures will depend on the professional boards. The Department of Health has filed a suit against drug companies.

It will be seen if this can help in the opioid prescribing crisis or the “underlying epidemic” suggested by Case and Deaton that may have contributed what author Christopher Caldwell calls, “American Carnage.”

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Dr. Chafetz Invited Speaker at Swedish Neuropsychological Society in Stockholm, Sweden

Dr. Michael Chafetz, invited speaker for the Swedish Neuropsychlogical Society in Stockholm,
August 22, presented his research and other scientific advancements in the area of disability
assessment and malingering.

He also presented his work at the Karolinsk Institute, Danderyg Hospital, and Rehabilitation
Clinic in Stockholm on August 23.

Chafetz is a board certified clinical neuropsychologist working in independent practice
in New Orleans. His research program has involved validity assessment in low functioning
children and adults being assessed for Social Security Disability, state rehabilitation, and child
protection. He has authored numerous peer-reviewed articles on these topics, challenging
assumptions concerning individuals with intellectual disability.

At the Neuropsychological Society Chafetz’s presentation was titled, “The Long and Short of Malingering in Neuropsychological Assessment: Ethical, Scientific, and Practical Concerns.”

He also presented “Validity Assessment in Public Disability Claims,” at the Karolinsk Institute,
Danderyg Hospital on August 23. Dr. Chafetz covered many ethical and scientific issues for the
Swedish neuropsychologists, including understanding the definitions and background
regarding malingering, biological bases, adaptation and behavioral biology, and the rigorous
development of the field. He also reviewed validity and base rates and important metrics for the neuropsychologists in evidence-based methods.

Dr. Chafetz also covered ethics and boundaries regarding the validity examination in disability and numerous case examples, along with the special case of low IQ, malingered pain-related disability, costs of malingering, andmalingering in children.

Also presenting at the conferences were Muriel Lezak, whose book on Neuropsychological Assessment is required reading in the field, and Grant Iverson, who is a leading researcher on validity and on traumatic brain injury.

The conference was organized by Dr. Christian Oldenburg, President of the Eastern Region of the society. Dr. Oldenburg is a neuropsychologist who, along with his colleagues is working to assist the Swedish disability system.

Dr. Chafetz has consulted for a United States Senator on Social Security policy concerning validity assessment, testified at hearings at the Institute of Medicine, and consulted for the Office of the Inspector General on these issues.

He has presented invited addresses at the American Psychological Association, National
Academy of Neuropsychology, American Academy of Clinical Psychology, several state
psychological associations, the Association of Administrative Law Judges, the Federal Administrative Law Judge Conference, and various bar associations.

In 2015, his book on Intellectual Disability in the forensic arena was published by Oxford University Press.

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Louisiana Dodges Most of Harvey Hurricanes

On August 28, the President approved Gov. Edwards’ Federal Emergency Declaration request
for Beauregard, Calcasieu, Cameron, Jefferson Davis, and Vermillion Parishes and ordered Federal assistance to supplement state, tribal and local response efforts due to the emergency conditions resulting from Tropical Storm Harvey.

But Louisiana appears to have been mostly spared, even though rain gauges showed up to 22 inches in some areas. There was some major flooding in the southwest area, but then mostly moderate flooding or minor elsewhere.

In Texas the rainfall topped records with over four feet of rain being reported and deaths have edged up over 60. Estimated loss in property damage continues to climb and USA Today reporting that the $190 billion loss would make it the most costly natural disaster in modern history.

The property loss, along with the psychological impacts, will be the most significant for many. The average person in the US does not have $500 in savings, and when the flood victims say they’ve “lost everything,” they mean it just that way.

Many from Louisiana rushed to help in Texas, with donations, services, cash and setting up shelters.

Dr. Mark Crosby, who led in recovery for the Watson, Louisiana community, ground zero for the Flood of 2016, told the Times, “We’re sending supplies.”

Crosby said, “The first thing people want is to know someone cares,” he said. “Teams, crews, family and friends coming in to help is important. Next, financial assistance, gift cards, cash. No clothes. No clichés. Someone to listen.”

Houston’s woes follow on the heels of what some in the Baton Rouge area are still attempting to recover from, the Flood of 2016. Like in Harvey, the August ‘16 flood was bizarre rainfall event that was, “…unlike anything we have ever seen before,” Crosby said last year. “The Flood of 2016 will go down in the history books as one of the worse natural disasters in our community, Crosby said. Harvey, however, has rewritten the history books with over 50 inches
of total rainfall being reported.

However, over the last generation, Katrina remains the most expensive and fatal of all the storms. Using data from the National Oceanic and Atmospheric Administration, Moody’s analytics, and New York Times, the website fivethirtyeight.com lists the top five storms:

1. Hurricane Katrina, Aug. 25, 2005. Damages were $160.0 billion and deaths at 1,833. 2. Hurricane Sandy, Oct. 30, 2012. Damages were $70.2 billion and deaths at 159. 3. Hurricane Rita, September 20, 2005. Damages were $23.7 billion and deaths at 119. 4.Hurricane Ike, September 12, 2008. Damages were $34.8 billion and deaths at 112. 5. Hurricane Hugo, September 21, 1989. Damages were $34.8 billion and deaths at 112.

Harvey stands to top Katrina in property damage, but many predict that Houston will recover, driven by its economic stability and business culture. But twelve years later, New Orleans is still not fully recovered. Today, the city is only 80 percent of the population prior to Katrina.

A US attorney for the Eastern District said that many companies left after Katrina and did not return because of the state’s acceptance of corruption. Former Representative Billy Tauzin characterized the state: “Half of Louisiana is under water and the other half is under
indictment.” Following Katrina a Senate seat flipped to Republican and so did the governor’s office. The New Orleans Mayor was sent to jail for bribery charges and the Democratic congressman was also convicted.

Rebuilding, even for Houston will take time. “The problem for so many is rebuilding,” said Crosby, “relocating and restarting their lives as schools try to reopen, as businesses try to salvage their operations and as neighborhoods …” he said. And just as the clean-up starts in Texas and Louisiana, here comes Irma and Jose.

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Dr. Constance Patterson Beloved Leader in Psych Community Dies July 8

 

Constance Kindrick Patterson passed away on July 8 after a battle with renal cancer. She was a leader in the psychology community who touched many lives as colleague, supervisor, mentor and friend. She embraced her community and the people in it with integrity, wisdom and a genuine caring for others and dedication to excellence in the profession.

She served as President of the Louisiana School Psychological Association, as Coordinator of the School Psychology Program and Professor of Practice in the Psychology Department of Tulane University, and as Director in the Executive Council for the Louisiana Psychological Association. She conducted a private practice, supervised interns, and served as an investigator for the state psychology board, as well as many other community roles.

A private tribute and ceremony was held on July 23 in Slidell where family and friends shared stories about Dr. Patterson, “Conni,” and afterward spread her ashes in Moonraker Lake.

Later that day a public gathering was held at one of Conni’s favorite places in Algiers, her adopted community and neighborhood. Friends honored her at The Old Point Bar, located at 545 Patterson Street, Algiers Point, at the curve of the Mississippi River.

Constance Kindrick Patterson, PhD, born in 1952, had a full professional life–she branched out into the social fabric of school psychology and was embraced for her character, values and dedication to excellence.

Tulane colleague Dr. Bonnie Nastasi said, “School psychology in the U.S. is a complex network, with changing relationships and crossed paths. Conni’s presence in my professional life is a great illustration of this. I initially met Conni when she was a doctoral student at Illinois State University and I was a faculty member. I moved on from there, Conni completed her program, and later joined LAS*PIC (located in New Orleans, my hometown) as director of internship program in school psychology and remained in that position until Katrina,” Natasi said. “For several years, she and I were faculty members in the school psychology program at Walden University where she directed field placements. Eventually we both returned to New Orleans and assumed faculty positions in the School Psychology Program at Tulane…”

“Over the years,” Nastasi said, “Conni has been a dear colleague and friend. I have had the utmost respect for her wisdom, professional knowledge and expertise, integrity, and caring spirit.”

Mark Swerdlik, PhD, CoCoordinator, Graduate Programs in School Psychology and Professor of Psychology at Illinois State University, also
knew Conni in many roles. “My relationship with Conni spanned over three decades,” said Dr. Swerdlik, who was her colleague in clinical practice, then her program advisor, internship supervisor and dissertation co-chair when she was a doctoral student at Illinois State University. “…and since 2012 we were university educator colleagues,” he said. “Conni was a wonderful colleague always willing to offer case consultation.”

“I remember being very impressed with her clinical insights,” he said. “Over the years she was coordinator, I recall being impressed with how seamlessly she seemed to be able to mentor interns and then transition to that of colleagues and so many former interns became her close friends.”

Dr. Alan Coulter, Senior Manager at the Human Development Center LSU Health Sciences Center (LSUHSC) also knew Conni as both intern and colleague. “I knew Conni from 1994 until the day she died,” Dr. Coulter said. “I have known her as intern, school psychologist, coordinator of LAS*PIC, graduate educator, independent practitioner, and friend. Conni Patterson was a stalwart professional who embodied the highest ideals of our profession. She was a deeply caring individual who solemnly upheld her commitments especially in the guidance of interns as they expand their knowledge and skills.”

Dr. Constance K. Patterson earned her doctorate in 1999 from the APA Accredited school psychology program at Illinois State University, where she also received her masters and undergraduate. She had earlier begun her career in clinical and worked with children and families.

She completed her School Psychology Internship in 1995 from the Human Development Center, the then LSU Medical Center, and worked as a Certified School Psychologist in Harvey, Louisiana, for the Jefferson Parish Public School System.

Her dissertation was, “Student, Teacher and School Setting Factors Affecting Classification of Students with Emotional/ Behavioral Disorders: A Study of One School System in Louisiana.”

Between 1997 and 2006, she served as Assistant Professor in the Department of Interdisciplinary Human Studies, School of Allied Health Professions LSUHSC and was the CoDirector for the Internship Consortium, then moved to the Quality Assurance Coordinator, for the National Center for Special Education Accountability Monitoring, at the Human Development Center, LSUHSC. By 2004 she had received her license from the state psychology board in School Psychology.

“I seem to also recall,” said Dr. Swerdlik, “that when Conni was searching for a school psychology internship among several sites she was considering the Louisiana School Psychology Internship Consortium,” he said. “She wasn’t sure about this internship as she had not previously lived in New Orleans. As we all know Conni fell in the love with the city and it’s people and they with her and as they say the rest is history.”

In 2006 Conni worked at Unified School District in Tucson, Arizona and also took a position as Assistant Professor in the School of Psychology for Walden University.

By 2011 she turned all of her attention to Louisiana, working for Plaquemines Parish School, and taking a position with Tulane, where she served as Professor of Practice in the Department of Psychology, advancing to Coordinator of the Tulane School Psychology Program.

Conni was an active community member and held a variety of leadership roles. She served as President for the Louisiana School Psychological Association and also as President– Elect, Futures Committee Chair, Membership Chair, Presenter Coordinator, and as Associate Editor and later as Coordinating Editor of the Louisiana School Psychologist.

Some of her other many roles included serving on the Oversight Committee and then on the Advisory Board for the Louisiana Health and Disability Project, on the Advisory Board for the Louisiana Center for Excellence in Autism, and as a School Psychology Focus Group member for the State Department of Education. She served on the Dean’s Committee on Multicultural Issues at LSUHSC and on the Multicultural Training Advisory Committee at the LSU Human Development Center. She was Chair of the Supervision Interest Group for the National Association of School Psychologists.

Conni was a regular speaker and lecturer and spoke on a variety of topics. Her presentations at the National Association of School Psychologists included: “Meeting the challenges of providing internship supervision,” with colleague Dr. George Hebert; “Distance education and field experience;” “Practical strategies for supervision of school psychologists;” and “Generational diversity: Implications for consultation and teamwork,” and she presented research with Drs. Alan Coulter, George Hebert and others, on “Fantasies vs. Job Realities: How interns spend their time.”

Dr. George Hebert, friend and colleague, related that he and Conni were the first psychologists to re-enter the New Orleans Public Schools after Katrina. “… History shall record that she was first,” he said, “because as a Southern gentleman, I held the door open for her.”

Conni also presented at the American Psychological Association including: Has school psychology lost its way? New rules for accountability, a symposium with colleague Dr. Coulter; and Creative training partnerships: Designing internship consortia to support preferred practices, a symposium.

She presented at the annual meeting of the Council of Directors of School Psychology Programs, Traditionalists, Boomers, Xers, and Millenials: School psychological practice across generations and implications for training;” at the American Society of Ophthalmic Nurses, “Meeting the challenge of working across cultures;” and at the Council of Directors of School Psychology Programs.”

She published “Collaborative supervision of internship experiences,” in the Handbook of education, training, and supervision of school psychologists in school and community, with colleague Dr. George Hebert; “Impact of generational diversity in the workplace,” in The Diversity Factor; “School Psychologists as Leaders in a time of change,” in Louisiana School Psychologist; “ Generational diversity: Implications for consultation and teamwork, in Louisiana School Psychologist; and “Working with Gay, Lesbian, Bisexual and Questioning youth: A new training curriculum for school psychologists,” in NASP Communique.

Dr. Carmen Broussard, Professor in Psychology at Nicholls, said, “Conni was available. She was usually in attendance at the state and local level in a number of Dr. Constance Patterson, Beloved Leader continued university and organization events. Her varied experiences in and out of Louisiana led to her thoughtful insight about any matter being discussed,” she said.

“Conni was a friend. She remembered people and she remembered things about them, in a way that made you feel so comfortable. I tried to never miss an opportunity to stop and talk awhile when we crossed paths,” she said. “Conni was a fierce supporter of our profession. She was willing to speak up when needed. She was willing to do some of the work. We owe her many thanks for her service to our organizations and to the many students that she has groomed to carry on.”

Following the announcement of her death, the Louisiana Psychological Association passed a Resolution in her honor, writing: “… Dr. Patterson’s distinguished life includes multiple areas of service and contribution, exhibiting in all she did her dedication to excellence, scholarship, mentoring of others, and the protection and support of the dignity of all people, in all walks of life; …”

One of her interns, Levi Zitting, said, “Her breadth of influence and commitment to quality work in the field was awe inspiring. I hope she can rest in her well deserved peace and that her friends can find comfort.”

Another of her interns, Ms. Connie Morris, said, “She had a way of leading me to answers that helped me develop confidence in my own professional judgment. Even more fortunate for me was the friendship that we shared over the past 20 years,” she said. And, “…we also had several wonderful conversations about life in the abstract and what is truly important in life. During one such conversation, Conni spoke of how meaningful it was to have an impact on the professional development of those who become your peers. For her, it was both an awesome responsibility and a privilege…Truly,” she said, “the privilege was ours.”

“I will miss her terribly,” said Bonnie Nastasi, “but will always cherish the moments of
professional commiseration and casual laughter and companionship. I will miss the opportunity to walk down the hall and visit with her on campus or relax over a glass of wine. Conni’s contributions to the profession will be long remembered and I expect many others will miss her spirit as I will.”

“Everyone that knew her was impressed with her strong character and firm self-control,” said Alan Coulter. “Conni modeled for others that a professional embodies high standards, deep humility, and a good sense of humor…” “Her passion for life and for teaching others was strong and she fought her disease until the last day,” Coulter said. “For Conni, she was intent on being in charge of her own life to the end. There is no way to adequately describe the magnitude of our loss.”

Family and friends composed an obituary including these excerpts:

“Dr. Patterson had a distinguished career during which she mentored more than a hundred professionals and influenced countless others.

“…she carefully shaped training to model effective and ethical practices of interns. Those interns now practice as school psychologists throughout the U.S.

“Dr. Patterson mentored countless school psychologists, teachers, school administrators, and families experiencing challenges. At her passing, many people reached out with stories of how Conni served as an inspirational role model of ethical and family-focused practice. She was an active member of the Algiers Point community in New Orleans supporting the arts, music, and people in need. No one can adequately capture or describe the breadth of her reach and influence on the practice of school psychology and her spirit of reaching out to others.

“During her illness, Conni was supported by her school psychology family and close friends who maintained communication with Conni’s many friends, colleagues, and her family in Virginia. All involved are grateful for mutual support and for Conni’s relief from suffering.

“Conni is survived by her mother, Lorena McCann, her daughter Melanie Hoerner (husband Jerry), her 3 grandchildren, Jared, Caleb and Marley, her sisters, Jean Kindrick, Becky Gibson, Trish Lutz, and Stacey Moffet, and numerous nieces and nephews.

“A memorial school psychology internship fund has been established in her name with the LSU Health Foundation. Donations should be addressed to the Dr. Conni Patterson Scholarship Fund, c/o www.lspaonline.org.”

 

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Behavioral Health Key to Louisiana’s Problems in Corrections says Director

Dr. Raman Singh, Director, Medical and Behavioral Health, Louisiana Department of Public Safety & Corrections, told psychologists last month that the leverage for dramatic changes in the state’s incarceration rate was to institute behavioral health reforms in the Louisiana criminal justice system. The legislature passed laws in its 2017 session to begin the reforms that Governor Edwards said was a top priority, and some of the key changes Singh explained were needed to overhaul the problems Louisiana has in its corrections and justice system.

Singh, a medical doctor and cardiologist by training, spoke to a packed session at the Convention of the Louisiana Psychological Association (LPA) held June 2 and 3 in New Orleans.

“Louisiana’s incarceration rate contributes to over-representation of the mentally ill in the criminal justice system,” Singh told the audience, noting that the United States has the highest per capita incarceration rate in the world and that Louisiana has the highest per capita incarceration rate in the US. Dr. Susan Tucker, clinical psychologist and the Assistant Warden at the Bossier Parish Medium Security Facility, and in-coming President-Elect of LPA, introduced Dr. Singh and explained the significance of comprehensive psychological programs in the corrections and justice system. Tucker developed the Steve Hoyle Intensive Substance Abuse Program which has earned national recognition for excellence. In 2016 the Louisiana Legislature commended Tucker and her team in a House Concurrent Resolution pointing to multi-million dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed by Tucker. Dr. Singh is responsible for the functional supervision of medical and behavioral health staffs who coordinate on-site care for 19,000 offenders assigned to state prisons, for all off-site health care needs for 38,000 DOC offenders and 16,000 local offenders housed in all state prisons and 104 local jails or detention centers. Singh explained to the audience of psychologists and professors that the reasons for over-incarceration in Louisiana is well-established. Based on a 2016 Louisiana Legislative Auditor’s review Singh said the top reasons were mandatory sentences and habitual offender laws, high rates of local incarceration without treatment programs, and “not addressing issues driving criminal behavior such as substance and mental illness.” Singh said that the 599 criminal statute and 164 mandatory minimum sentences contribute to over-incarceration in Louisiana, which are sentences without benefit of probation, parole or suspension. He said that 55 percent of mandatory minimum sentences are for non-violent crimes and that these minimums “shift sentencing discretion from judges to prosecutors.” Another serious factor is the high rates of local incarceration in Louisiana where there is no treatment. Jails and prisons have a disproportionately high number of persons with mental health issues and people with a serious mental illness (SMI), Dr. Singh explained. He noted that of the mentally ill in society, greater than 40 percent have been arrested and the majority of these are brought in for minor offenses. Those with mental illness spend two to five times longer in jail. Singh told the attendees that there was a complex interplay of multiple societal factors stemming from problems in education, stressed family structures, socio-economic challenges and lack of job opportunities. He pointed out that the unemployment rate in the mentally ill adults in Louisiana is 88.3 percent.

And while 16 percent of the DOC prison population has been diagnosed with a SMI, 82 percent are diagnosed with a substance use disorder. “Incarceration of mentally ill exacerbates symptoms of mental illness. Rarely does incarceration of the mentally ill lead to an improvement in their mental status,” said Singh. His vision is to reduce the criminalization of those with mental illness and to resolve the crisis with a comprehensive solutions that provide treatment to those who need it. He promotes the Medicaid expansion and mental health parity. He said that 43 percent of the entire eligible Medicaid Expansion population in Louisiana has a mental health condition, and that offenders with mental illness or substance use disorder can be treated effectively. He wants more outpatient mental health care, more Rapid Stabilization Centers, and emerging models that prevent arrest and incarceration of adults with mental illness, called the Forensic Assertive Community Treatment Programs. To help create alternatives to incarcerating those with mental illness, Dr. Singh said that Forensic Diversion Facilities are needed to help alternative sentencing for offenders with mental health issues and who have committed a minor crime. Expansion of the Mental Health Courts are essential, especially because a majority of offenders are incarcerated for “crimes of survival” such as theft of food or breaking in to find a place to sleep. He wants to strengthen family and communities and help judges divert nonviolent offenders away from jails with better mental health legislation. Dr. Singh serves on the Louisiana Governor’s Drug Policy Board, Louisiana Task Force on Telehealth Access, Louisiana Re Entry Council, Louisiana Medicaid Quality Committee, Louisiana Commission on Preventing Opioid Abuse as well as chairs the Louisiana Commission on HIV/AIDS and Hepatitis C. He has also been appointed by Governor Edwards to be his liaison to the White House Data Driven Justice Initiative project.

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Dr. Salcedo Named LPA Distinguished Psychologist 2017

Dr. Rafael Salcedo, known for his advocacy and comprehensive treatment program for the young victims of human sex trafficking, has been named the 2017 Distinguished Psychologist by the Louisiana Psychological Association. The award was announced last month at the association’s annual conference held in New Orleans.

Dr. Salcedo was honored for his excellence in psychological practice and his dedication to “saving the minds, bodies and souls of little girls,” from the devastation of human traffickers.

Salcedo is a licensed Clinical Psychologist with subspecialties in the area of forensic and neuropsychology, providing services for issues such as competency to stand trial, sanity at the time of crime, and other legal issues. He consults to the court system in Orleans, Jefferson, Lafourche and Terrebonne Parishes, to the Office of Community Services, and has worked with the Department of Children and Family Services for the last 25 years, conducting evaluations of children who are in need of supervision/care.

Dr. Salcedo also chairs the Louisiana Psychological Association (LPA) Committee for Community Psychology & Psychology in the Public Interest.

In 2012, after becoming aware of the depth and tragedy surrounding child sex trafficking, Rafael and wife Beth, a licensed speech-language pathologist, founded the non-profit, advocacy group, the Louisiana Coalition Against Human Trafficking.

The Coalition is a faith-based 501(c)3 nonprofit aiming to alleviate human trafficking in Louisiana through community and government agency awareness, and organization partnerships.

Recognizing the extreme need for genuine, comprehensive treatment for the young victims the couple founded the “Free Indeed Home,” named from John 8:36, “Whom the Son has set free is free indeed.”

Dr. Salcedo volunteers his time and serves as Executive Director and Clinical Coordinator of the Home, the only licensed, therapeutic group home in the state for helping teen girls escape the physical and psychological bonds of sex-trafficking.

The Free Indeed Home is the rescue and restore extension of the Coalition’s efforts. Because of the need for intensive therapy to break the traumatic bonds created by the abuse of the trafficker.

Dr. Salcedo and Beth Salcedo are experts in Complex PTSD, which many, even many in the mental health field, do not fully understand, Salcedo said.

They recently presented an invited address at the Convention of the Louisiana Psychological Association,“ Diagnosing Posttraumatic Stress Disorder, Complex Posttraumatic Stress Disorder, and Other Adolescent Psychiatric Disorders Commonly Encountered in Victims of Sex Trafficking.”

They have also presented at the Summer Symposium, an event presented by Dr. John Simoneaux and Professional Training Resources.

In Complex PTSD, Dr. Salcedo explained, the pathology is similar to the Stockholm Syndrome. “Complex trauma bonding is an entity in itself,” he said. “At the heart of complex PTSD is the phenomenon of trauma bonding.” So, while there is complexity in symptoms, the challenge for treatment is the victim’s attachment to the individual who caused the trauma, he explained.

In a previous interview, Dr. Salcedo said that the Free Indeed Home is a unique setting, for a variety of reasons. The girls’ trauma is very different from typical PTSD. For most forms of PTSD the issues are avoidance of the emotions surrounding the trauma and generalization of symptoms.

“The differences between this type of Complex PTSD and the typical PTSD are huge,” he said. “The victim identifies with and establishes a bond with their tormentor. The girls want to go back to the life. That is why the home is isolated and not in the center of New Orleans. It is the ideal situation if they run, which they do.” He said that 30 percent try and run and staff are not allowed to force them to stay. “All we can do is follow them,” he explained.

This is why the Home located in a beautiful rural and remote setting with large acreage. This helps in treatment when a girl tries to go back to the pimp.

“Most importantly,” Dr. Salcedo said,” it is a safe house. The pimps try and get them back because they are a source of income. They are a reusable commodity,” he said. Unlike with drugs, where the commodity is used up, the girls can produce income over and over, he explained. And that is why there is always the threat of the pimps reacquiring the girls, and how intensive the work can be.

Child sex trafficking is a subset of human trafficking, considered to be the second fastest growing criminal industry in the world. Drug trafficking is first. Current estimates are that 100,000 children in the United States are sex trafficked each year, sold into prostitution, and used for pornography and other commercial sexual acts. The Baton Rouge and New Orleans metropolitan area is one of the top 10 areas in the U.S. for human trafficking.

Dr. Salcedo is a graduate of the Clinical Psychology program at Louisiana State University, having obtained his Doctorate in 1983. He resides in St.Tammany Parish, has been married 27 years, and has three grown children currently in college.

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Psychological Scientists Study Hazards of Distracted Driving

Safe driving

The National Safety Council (NSC) estimates that up to 40,000 people died in auto accidents in 2016, marking a six percent increase from 2015 and a 14 percent increase from 2014. This is the most dramatic increase in 53 years, said Council officials. One of the factors thought to be causing the increase is cell phone use.

An NSC survey of the risky things drivers do while on the highway found that 47 percent of people text, either manually or through voice controls, while driving.

“Our complacency is killing us,” said NSC President Deborah Hersman. “Americans believe there is nothing we can do to stop crashes from happening, but that isn’t true,” Hersman said, as reported by the Safety Council.

Dr. Theodore S. (Scott) Smith from the University of Louisiana Lafayette, and Dr. Melissa Beck, at Louisiana State University, are two of those in the community who are working to uncover the elements of this problem and make a difference.

Dr. Smith is Assistant Professor in the Psychology Department and leads research in his lab, The Louisiana Applied and Developmental Psychological Sciences Laboratory, where he is interested in how cell phone distraction affects the learning process, not only in the classroom, but also how applicable distractions may affect driving behaviors and eyewitness memory. Smith has authored Cell Phone Distraction, Human Factors, and Litigation, published by Judges and Lawyers Publishing and which is becoming a popular resource for legal professionals.

Louisiana State University cognitive psychologist Dr. Melissa Beck is also tracking down the “inattention blindness” that affects us when we are driving. Working with simulators at the Civil Engineering Department, Beck and her associates recently published results of one of her several studies in this area.

For the April issue we take a look at what some of our psychological scientists are trying to do to discover how to make driving less dangerous, and to help stop that one call, that changes a life forever.

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Psychology Board Proposes SB 37

SB 37

The Louisiana State Board of Examiners of Psychologists (LSBEP) is proposing legislation, Senate Bill 37, authored by Senator Daniel Martiny.

The bill would exempt the LSBEP from requirements for time-limits, called “prescriptive” provisions, in the law regarding disciplinary hearings, according to the digest of the bill.

The Psychology Practice Act currently has a clause that limits the board’s disciplinary investigations to one year, from the time that a formal complaint is acknowledged and the investigation begins, to the hearing.

The present wordings, reported by some to have been added by Dr. Jim Quillin, is as follows:

“… no disciplinary proceeding shall be commenced more than one year after the date upon which the board knows or should know of the act or omission upon which the disciplinary action is based.”

If passed, SB 37 would delete this language. The bill also adds to the psychology statue, provisions for fees in disciplinary actions. These activities are managed by the subcommittee called the “Complaints Committee,” which does not contain a board member.

The current statue allows, “A hearing fee may also be charged at the discretion of the board.”

The new language, if passed, would read:

“(4) The board may charge a hearing fee to include reasonable costs and fees incurred by the board for the hearing or proceedings, including its legal fees, stenographer, investigator, staff, and witness fees and any such costs and fees incurred by the board on any judicial review or appeal.

(5) The board may charge an informal resolution fee to include reasonable costs and fees incurred by the board for a disciplinary action that is resolved by settlement, consent decree, or other informal resolution, including its legal fees, stenographer, investigator, staff, and witness fees.

If passed, the board would also add “or informal resolution” to a paragraph for collecting fees for hearings. Included would be legal fees, investigator and staff fees, as well.

Finally, the bill would also allow applicants for a state license to substitute 5 years of license level experience for one of the two years of post-doctoral supervision, currently required.

 

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Budget

Governor Edwards outlined another bleak picture of Louisiana’s finances, telling legislators on Friday that he and his team have to deal with more shortfalls even before they are finished 2016 problems. “I’m asking the Legislature to approve the use of $119.5 out of the Rainy Day Fund, toward the shortfall,” Governor Edwards told the joint meeting on the budget.

“Any plan that does not make use of the Rainy Day Fund would simply be catastrophic and unacceptable to the vast majority of the people of Louisiana,” he said.

Even with the use of the funds, he said there will be “painful cuts to the Department of Health,” and other agencies. He noted his staff was “working diligently” to lessen cuts to higher education. We’re using a “scalpel not a sledgehammer” to solve budget problems. In an Executive Order issued December 15th, and published in the January 20, 2017 issue of the Louisiana Register, Governor Edwards outlined reductions based on a November 2016 projected deficit of $312,665,008 in the State General Fund for the Fiscal Year 2016-2017. The Order noted that to deal with and manage the deficit, departments and agencies are to reduce expenditures from the General Fund. Cuts outlined in the Executive Order included the following: Division of Administration – $ 1,500,000 Office of State Police – $ 5,106,503 Capital Area Human Services District – $ 700,000 Metropolitan Human Services District – $ 787,063 Medical Vendor Payments – $237,963,003 Office of Public Health – $ 1,108,005 Office of Behavioral Health – $ 1,559,019 Office of Revenue – $ 2,996,640 Louisiana State University System – $ 5,577,489 Southern University System – $ 699,715 University of Louisiana System – $ 3,411,230 LA Community and Technical Colleges System – $ 1,853,079

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Meaningful Oversight Task Team Recommends Supervision for Boards

Meaningful Oversight

A task force charged with studying the need for “meaningful oversight” has reported its findings and recommends that the state create an oversight panel to review critical decisions by state boards, in particular those that involve anti-trust concerns.

The group published it report on December 29, 2016, titled, “Meaningful Oversight of State Regulatory Boards: Task Force Recommendations to Acquire State Action Immunity.” Task force chair, Stephen Russo, Esq., Louisiana Department of Health Executive Counsel and task force cochair, Angelique Duhon Freel, Esq., Assistant Attorney General, authored the report.

“The Task Force believes that the best system would utilize a three member panel that would be available to actively supervise decisions of the respective boards that they feel are anti-competitive in nature.”

The authors noted that for most boards the panel could consist of one designee from Louisiana Department of Health, one from the Attorney General, and one from Boards and Commissions.

“This review panel would have the ability to approve, disapprove or modify any decision or policy that was placed before them for anti-trust review.”

According to the report, the group determined that “active market participants,” that is, individuals who activity compete in the marketplace, are needed on boards as subject matter experts. So, then “…development of a structure that provides active supervision is paramount if the legislature wants to cloak certain board decisions with stateaction immunity.”

The authors noted that boards have the power to seek injunctions and to issue cease-and-desist orders. While an injunction is overseen by the court system, a cease-and-desist order is not, and so “would expose the board members to antitrust liability, assuming control by active market participants and lack of active supervision…”

A poll of task members revealed that the cease-and-desist order was fairly rare, said the authors, fewer than five per year being issued in most cases. However, the authors wrote that “…some of the boards may not have a keen understanding on what types of decisions may have anti-trust implications.”

The task force recommendation was, “… the Legislature should explore the possibility of implementing a system that would provide for state-action immunity but still act efficiently without undue delay.”

The authors said that the system should be placed in statue.

According to the authors, the Federal Trade Commission (FTC) offered guidance to the states in October 2015 after a Supreme Court decision found that the state dental board had violated anti-trust laws, North Carolina v. F.T.C.

The January report noted several warnings from the FTC for states designing compliant systems. “A state legislature should empower a regulatory board to restrict competition only when it is necessary to protect against a credible risk of harm, such as health and safety risks to consumers.” And, “A state legislature may, and generally should, prefer that a regulatory board be subject to the requirements of the federal antitrust laws,” said the authors.

And, “The applicability of any state action defense is very fact-specific and contextdependent.”

Dr. Darla Burnett served on the task force for the state psychology board. The task force also included representatives from the Louisiana Behavior Analyst Board, Louisiana Licensed Professional Counselors Board of Examiners, the Louisiana Addictive Disorder Regulatory Authority, Louisiana State Board of Medical Examiners, Louisiana State Board of Nursing, Louisiana State Board of Social Work Examiners, among many others.

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What’s the Matter with the VA?

In the spring of 2014, enough reporters and whistleblowers came together to break through the national consciousness and spark an outrage in citizens and Congress. Schedules and waiting lists had been manipulated at the Phoenix VA. Veterans died while waiting for medical care while executives maintained their bonuses for performance.

“The VA has always been terrible,” said one source who worked in the New Orleans VA more than thirty years ago. “It was fantastic for training, but it was also hit and miss for the veterans. Some received great care, but others did not.”

For years the anecdotal view was that each VA facility had its own culture, some good and some not so good for the veterans. “If you’ve seen one VA, you’ve seen one VA,” is the phrase related by a source. But the Phoenix scandal turned the spotlight on system-wide problems.

The VA’s “Veterans Health Administration” is massive. According to the Government Accounting Office (GAO). The VA system includes 167 VA medical centers and more than 1,000 outpatient facilities that serve about 6.7 million veterans. The VA system is also the largest employer of psychologists, with 4,947 on the rolls for 2015.

According to the GAO, the health system has faced a growing demand by veterans for its health care services, a trend that is expected to continue. From 2011 to 2015, the total number of outpatient medical appointments increased by about 20 percent.

The mental health needs for veterans are serious. This July Military Times reported continuing high rates of suicide among veterans, an average 20 individuals a day. In 2014, the most recent year available data, 7,400 veterans took their own lives, said Military Times.

For this report, we looked into the scandal, examined some of the connections to Louisiana, and asked insiders from three regions of the state about their views. While some of those we talked to offered their names, we choose to protect all identities.

Scandal Breaks at the Phoenix VA

In April 2014 the Arizona Republic broke the story that the Phoenix Veterans Health Administration (VHA) hospital employees had falsified records to make it appear that the 14- day limit for medical care was being met. The goal was connected to executive bonuses.CNN reported that at least 40 Air Force Veterans had died while waiting for care.

Investigations conducted by the VA Office of Inspector General (OIG) and the Justice Department found that schedulers were being pressured to use the false waiting lists in numerous hospitals around the country.

In his report, “Friendly Fire: Death, Delay, and Dismay at the VA,” Senator Tom Coburn’s office said that more than 1,000 veterans may have died over the last decade due to malpractice, fraudulent scheduling practices, insufficient oversight and accountability.

After the Phoenix story broke, other whistleblowers from around the country joined the national picture and other VA facilities were put in the spotlight. On of these was the Overton Brooks VA Medical Center in Shreveport. There, social worker and Army veteran figured out that lists were being manipulated and raised his concerns. Wilkes would later find himself under investigation by the VA’s OIG, and in the middle of a firestorm.

But the OIG did find evidence that employees were using separate spreadsheets outside of the VA’s official scheduling and patient records systems. OIG investigation confirmed that the Mental Health Clinic had created a spreadsheet that identified 2,700 veterans who needed to be assigned a mental health provider. And other investigations around the county pointed to a widespread manipulation of data that covered over veterans’ unmet health needs.

These lists are a “total fiction,” one source said.

Another source from another region explained to the Times, “Oh, we were told to do it. There wasn’t an option. You’d be punished if you didn’t comply.”

“They will retaliate against you immediately,” the source said. “They have a variety of ways to punish anyone who doesn’t conform,” said the source. They put the complaint into a committee so that nothing happens, then they find something to irrelevant to write you up about, the source said. “They can mess with your schedule and cause any number of problems for you.”

The source also explained that management can put pressure on patients to come up with complaints about your work, and then exaggerate the patients’ feedback, using it to discipline you.

After the Phoenix scandal broke, the VA culture also became a focus. In a White House Investigation, the Obama Administration Deputy Chief of Staff, Rob Nabors, called the problems, “significant and chronic,” and the culture “corrosive.”

Defenders of the VA pointed to increases in caseloads: 46 percent in outpatient visits in the last six years. Some report that the increases are linked to the aging Vietnam veterans and the complex challenges with the Iraq and Afghanistan veterans, who suffer from traumatic brain injury, amputations, and PTSD.

Secretary Eric Shinseki, a former Army general, was forced to step down from his Cabinet post. He was replaced by Robert “Bob” McDonald, who vowed to overhaul the department.

One effort was an attempt to give veterans more control.

Veteran’s Choice – A Failed Fix

President Obama and Congress quickly passed the “Veterans Access, Choice and Accountability Act of 2014,” which was designed to allow veterans to go outside of the VA system to obtain health care services when the wait times were too long or when they had to travel long distances to a provider.

It was supposed to be simple. Veterans would have a card that would allow them to access services when needed. But the card was not easy or simple.

Veterans on DisabledVeterans.org commented frankly about the experience.

“I have been waiting since May of 2015 for Healthnet to pay for an MRI that I was authorized to have, now the hospital is coming after me. This program is a joke, I was authorized 26 chiropractic appointments with the same program. My chiropractor now refuses to see me until he gets paid for the 1st 5 appointments.”

Hmm, a joke? Naaa I call it what it is, a cluster f**k! Card says that you have to call before using it, or that the VA will not pay for the doctor or hospital visit. So I guess that means if I am having a heart attack I have to call the VA BEFORE the ambulance?”

“Card says that you have to call in five to seven working days to make the appointment BEFORE the card can be used or again the VA can refuse to pay for it. […] Jeeze who writes this stuff up?”

“Nice scam, Forcing veterans to go back to the VA by not paying the Bills.”

In a May 2016 PBS report, reporter Hari Sreenivasan found that overall, the wait times for the Choice program were worse than the regular system. Veterans could not get the approvals, when they did, the providers could not get paid. Because of the multiple approvals required. Providers would come back to the veterans for payment.

Serious Issues in Mental Health

Mental health also has come into the spotlight again. A 2016 study by Rand and funded by the Department of Defense, reported improvements, but within the report there were also serious, on-going problems in the VA’s approach to mental health for veterans.

Researchers studied over 40,000 active-duty service members diagnosed with PTSD or depression. They found the suicide rate for soldiers in this group was 264 per 100,000, compared to a civilian suicide rate of 13 per 100,000 people.

Only one-third of patients newly diagnosed with PTSD, and less than a quarter of those with depression, were engaged in even minimum levels of psychotherapy and medication management.

One insider said that the report was an effort to “whitewash” the problems in the VA system, and pointed to how the reviewers avoided addressing other serious deficiencies in care. The source said the report glossed over the dramatic issues in scientific support and lack of realistic follow-up, and that the report overlooked inconsistency and inadequacy of how and by whom therapy is provided.

“This is the same type of stuff we have seen; it’s maintained very poor quality of care in the nation’s primary care system and now it is being applied in the analysis of the VA system.”

“The VA is a medical model,” another source said, “and it has always been. Most veterans don’t get the real psychotherapy or psychological help they need.”

Another source said, psychology was “swallowed up,” by the other elements of the system and medical culture.

Whistleblowers

In 2012, a VA emergency-room physician, Dr. Katherine Mitchell, in the Phoenix hospital warned the director that the system was overloaded and dangerous. She was told that she was deficient in communication skills and transferred, according to the Arizona Republic. In 2013 an internal medicine physician Dr. Sam Foote, tried to alert the OIG to the same problems. Two months later Foote retired. After that he collaborated with the Republic.

Germaine Clarno, social worker from the Chicago VA system, told her supervisors about false wait times and when that did not work she went to the press and Congress. Afterward, she was harshly criticized.

In Louisiana, Shea Wilkes, a social worker and disabled Army veteran, and formally an assistant to the director of the Mental Health Division at Overton Brooks VA Medical Center, found himself in the middle of the storm.

As reported on Watchdog.org, Wilkes was seeing quality problems that disturbed him. He noticed that managers were still meeting their goals and discovered the false waiting lists. When Wilkes alerted his superiors, they failed to act and he filed a complaint with the VA OIG.

But then Wilkes found himself a target of the Inspector General’s investigation.

“You know it is going to be hell after you come forward,” he told Tori Richards at Watchdog. “But never in your wildest dreams do you expect the magnitude of what you did to result in what happens after. All this said,” he said. “I would and will do it again if I have to. It gives you such relief to get it off your chest.”

Clarno and Wilkes joined together to create VA Truth Tellers, Clarno saying to the Arizona Republic that “We’ve banded together. We are not giving up.”

And eventually the whistleblowers found an ally in the U.S. Office of Special Counsel (OSC) an independent federal investigative agency to protect whistleblowers. This past February the OSC slammed the VA Inspector General.

“The OIG’s decision to investigate this straw man resulted in inadequate reviews that failed to address the whistleblowers’ legitimate concerns about access to care for mental health patients at Hines and Overton Brooks,” wrote Special Counsel Carolyn Lerner in reports.

“The focus and tone of the IG’s investigations appear to be intended to discredit the whistleblowers by focusing on the word ‘secret,’ rather than reviewing the access to care issues identified by the whistleblowers and in the OSC referrals,” wrote Lerner.

Wilkes and his attorney finally received a call that the VA OIG l had dropped the investigation of Wilkes.

“What they would’ve been investigating him for was accessing a list that wasn’t supposed to exist,” attorney Richard John said to Watchdog. “They had no intention of ever prosecuting him. They did it solely for purpose of intimidation. It has a chilling effect on other people coming forward as witnesses.”

In 2015, this independent OSC received about 3,800 whistleblower complaints from workers in all federal agencies. More than a third came from VA employees.

Special Counsel Lerner warned, “The VA must continue working to make its culture more welcoming to whistleblowers in all of its facilities”

Is the VA Getting Better?

According to an April report in the Washington Post, Debra Draper, GAO’s health investigator, told members of Congress that the system is still hindered by “ambiguous policies, inconsistent processes, inadequate oversight and accountability … “

“And today we have seen at best little progress by the VA in addressing those issues,” she said. “We are very concerned …”

The Special Counsel to President said in February this year, that the OIG failed to consider whether the 2,700 veterans in need of a mental health provider reflected the larger concern about access and mental health provider shortages, or what steps could be taken to remedy these challenges.”

“The OIG’s decision to investigate this straw man resulted in inadequate reviews that failed to address the whistleblowers’ legitimate concerns about access to care for mental health patients at Hines and Overton Brooks,” wrote Special Counsel Carolyn Lerner.

In an April GAO study, delays for a veteran requesting an appointment were still critical. “Sixty of the 180 newly enrolled veterans in GAO’s review had not been seen by providers at the time of the review; nearly half were unable to access primary care…” said the reviewers. Of those 120 who were seen, they waited 22 to 71 days to see a care provider.

After all the dust has settled, it seems that little may have changed for our veterans.

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Thinking Big: The Evolutionary Origins of Spirituality by Matt Rossano, PhD

Dr. Rossano is past Chair, Department of Psychology at Southeastern Louisiana University in Hammond. He is an expert in evolutionary psychology, and author, including Evolutionary Psychology: The Science of Human Behavior and Evolution, and Supernatural Selection: How Religion Evolved.

Why be spiritual? For an evolutionist, the why question always raises issues of ancestral origins and potential adaptive significance. Why did spirituality arise in our ancestors and did it serve some adaptive function? First, one must define terms. Researchers often define spirituality as a sense of meaning resulting from an experience of “losing” the self in “something larger.” Frequently the “something larger” has religious significance; but art, music, natural beauty, and even scientific discovery can prompt spiritual experiences. What seems more important is that the experience is inspirational. It transcends and uplifts us – often motivating us to strive for the betterment of ourselves and our world. So why would our ancestors have started to think this way? Was there any advantage to it?

About 100 miles east of Moscow are the famous Sungir Upper Paleolithic burials. Three bodies were lavishly interred there, bedecked head to toe with necklaces, head bands, waist and arm bands laced through with thousands of carefully crafted beads. Grave goods, such as tools and finely fashioned (and purely decorative) ivory hunting weapons were also buried with the bodies. It has been estimated nearly 10,000 personhours of labor went into this elaborate funeral. Among existing traditional societies, such a send-off is usually indicative of ancestor worship.

Ancestor worship is ubiquitous among traditional societies and Sungir suggests that its evolutionary roots reach back nearly 30,000 years. It assumes that the “something larger” is the tribal community itself, which includes not just the earthly, but the timeless preceding generations now watching from above. Living tribe members understand themselves as players in an ongoing cultural saga whose past is known through myths revealed in fire-side dances and whose future depends on fidelity to traditions and practices passed down to them from their elders.

Sungir gives us an idea of when our ancestors starting thinking spiritually. But why do so? It is notable that nothing comparable to Sungir has been found among any of our hominin cousins. The few possibly intentional burials present among non-sapiens (Neanderthals, for example) are barren of any convincing signs of ritual or afterlife belief. The same is true for cave art. The magnificent murals of Lascaux, Altamira, and Chauvet are exclusively Homo sapiens. Neanderthals rarely ventured into caves and when they did, they left behind no art.

The best explanation we have for this exclusivity is that our ancestors were trying to construct larger, more complex social networks – possibly in response to competition from other hominins such as Neanderthals. To do this, they had to envision an even larger social order. One that both encompassed and transcended the earthly tribes themselves. They had to think big – spiritually big. But thinking wasn’t enough. They had to feel that ‘bigness.’ They had to fire a passionate commitment to that community. They had lose themselves in it. Their art and rituals were strategies for making that spiritual community ‘real’ in an emotionally compelling way. Having inherited these same sentiments, an opportunity arises. Spirituality is everhopeful. If we can agree that we are part of something larger, then maybe we can set aside our differences and work together for a common good.

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