Category Archives: Features

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

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.

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.

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.

“The Hoffman Report” Defamation Suit Filed Against APA and David Hoffman

On February 16, attorneys for retired Colonels and psychologists Morgan Banks, Debra Dunivin and Larry James, and also two psychologists who are former employees of the American Psychological Association (APA), Drs. Stephen Behnke and Russ Newman, filed a defamation lawsuit against the Chicago attorney David Hoffman, his law firm, and APA, alleging reckless disregard for the truth and false statements in a 2015 report called the Hoffman Report.

Mr. Hoffman was hired by APA in 2014 to review interactions between military psychologists, APA officials, and the Bush administration. Then APA president Dr. Nadine Kaslow sought to resolve ongoing accusations that APA was involved in supporting unethical behavior by military psychologists. The accusations were voiced by human rights activists and psychologists, and had been outlined in several publications, including a book by New York Times’ journalist, James Risen, Pay Any Price.

Hoffman concluded that communications of a 2005 APA members’ task force amounted to “collusion” with military psychologists and therefore with the Department of Defense. A media furor commenced following publication of the Report, splashing the issue of “torture” and APA across national news outlets. APA paid Hoffman $4.1 million for the Report, according to sources.

In the February 16 legal Complaint, a 187-page document filed in the Ohio, Court of Common Pleas, Civil Division, the attorneys for the Plaintiffs allege that the primary conclusions in the Report were not only false, but that Hoffman knew they were false. The complaint states that military psychologists, who had tried to prevent abuses in military interrogations, were painted as having worked to protect possibly abusive procedures. The Complaint alleges reckless disregard for the truth and actual malice in both how the investigation was conducted and in how Hoffman and APA handled matters following the completion and publication of the Report.

The Plaintiffs are represented by James E. Arnold of Columbus, Ohio, who is attorney for all Plaintiffs, attorney and psychologist Dr. Bonny Forrest of San Diego, California, who is attorney for Plaintiffs Banks, Dunivin, James and Newman, and Louis J. Freeh, Former FBI Director, from Washington, DC, who is an attorney for Dr. Behnke.

In the February Complaint, the attorneys describe details alleging how the expansion of the investigation was hidden, how Hoffman over-relied on the accusers and aligned with the accusers’ goals, and that Hoffman failed to consider and follow evidence that contradicted the final conclusions. The Complaint also states that the Report relied on “overstatements,” “misstatements,” and “unsupported inferences.”

The attorneys also allege that APA failed to adequately review the Report, failed to give Plaintiffs an opportunity to respond to allegations, and failed to respond to evidence of the mistakes and errors in the Report.

According to a press release also posted on February 16, Plaintiffs will seek a jury trial, for compensatory and punitive damages for reputational and economic harm.

The Times asked Dr. Forrest what was the reason the conflict had reached this level, and she referred to the joint statement, included in the press release. In that statement, the Plaintiffs write, “We have reached out repeatedly and persistently to APA’s counsel since October 2015 and to Sidley since June 2016 to try to correct the record and repair the damage caused by Hoffman’s false accusations without further damaging the APA. Those efforts have failed, and we now have no avenue left except this lawsuit.”

The press release noted, that Hoffman, “… cherry-picked evidence, ignored contradictory evidence, mischaracterized facts, and failed to follow obvious investigatory leads. Whenever facts might be open to more than one interpretation, he consistently chose the interpretation that portrayed the plaintiffs’ motives in the worst possible light. And, despite acknowledging privately to the APA that he found no evidence of the criminal behavior others alleged, he used terms such as ‘collusion,’ ‘joint enterprise’ and ‘deliberate avoidance’ that are drawn directly from the language of criminal prosecutions.”

“He was hired to write a neutral and objective report but instead assumed guilt and, like a prosecutor, set out to prove it,” commented Dr. Forrest in the press release.

In the 2015 Hoffman Report, Mr. Hoffman wrote that APA staff and officials were “intimately involved” in “behind-the-scenes coordination with the DoD.” Hoffman also concluded that the motivation for this was a “desire to curry favor with the government.” He wrote that because of this relationship with the military psychologists, APA officials essentially acted “to support the implementation by DoD of the interrogation techniques that DoD wanted to implement…”

However, the Plaintiffs’ attorneys state that the Report became a “prosecutorial brief,” and “Hoffman’s primary allegation rests on false statements about military interrogation policies in 2005, the year in which an APA task force was formulating guidelines for psychologists involved in interrogations.”

“Hoffman’s allegations have been proven false by evidence that was in his possession,” noted the attorneys for the Plaintiffs. “Despite that proof, neither Hoffman nor the APA have taken any significant steps to repair the damage he has done to the plaintiffs’ livelihoods and reputations.”

The complaint lists twelve counts: six are all plaintiffs against all defendants, four are all plaintiffs against Hoffman and his law firm, one is Behnke, Dunivin, and James against all defendants, and one is all plaintiffs against APA.

The Plaintiffs’ attorneys wrote, the “…narrative was adopted from long-standing critics of the Plaintiffs and the APA on whom Hoffman relied heavily during his investigation. Their narrative was driven by two goals: banning psychologists from any role in the interrogation process and holding psychologists ‘accountable’ for their alleged complicity in torture. Despite having been rebuffed by the Federal Bureau of Investigation (FBI), for years they had been advocating for criminal prosecutions of the Plaintiffs and others.”

The February 16 Complaint lays out arguments that Hoffman had documents in his possession and that he omitted these in his analysis and text of the Report. These documents, say the attorneys for the Plaintiffs, showed clearly that the military psychologists were working to restrict abusive procedures rather than allow abusive practices. “In fact, the then-existing military policies – some of which the military Plaintiffs helped to draft – were restrictive and were incorporated by reference into the PENS Guidelines. And the PENS participants were fully aware of the history of abusive interrogations, which were discussed in documents circulated at the PENS meetings,” the attorneys write. This evidence, which contradicted the views of the critics, was omitted or distorted, or failed to be followed-up as investigation leads, argue the attorneys in the Complaint.

The Complaint and other documents can be found at http://www.hoffmanreportapa.com/ and at The Modern Psychologist.

Among the examples given in the 187 page–document, the Complaint authors say that Hoffman distorted and omitted key pieces of the history of governmental and DoD policies governing military interrogations. Specifically, they write, he incorrectly emphasizes the outdated policies as the context for the PENS Task Force’s work.

Also, the Report consistently confuses the military policies with the CIA policies, notes the complaint, and ignores the evidence that the two approaches had “dramatically diverged,” omitting policy statements that would have clarified the differences.

And, Hoffman failed “… to describe the role the military Plaintiffs played in writing the regional policies, as well as taking other steps to prevent abuses at the sites to which they were posted.”

In reviewing circumstances, the attorneys write that as the investigation progressed, Hoffman and his team violated norms for conducting such an investigation and APA failed to exercise adequate oversight. “Hoffman obscured the investigation’s scope and the questions he began to pursue, misled the Plaintiffs about its goals, failed to warn them when the investigation had clearly become adverse to their interests, and purposely avoided following leads that would have produced facts that contradicted his narrative.”

“The investigation’s new direction was not disclosed to anyone other than the Accusers and the Special Committee,” the attorneys state. “The Plaintiffs were kept in the dark.”

The complaint alleges that the APA Board published the Report in a hasty manner and without adequate review, saying, “Within 24 hours of receiving the draft Report on June 27, 2015, the Board, on the advice of Hoffman, published it to two of the most vocal and active Accusers …”

The authors of the Complaint state that the board knew of the Accusers’ active engagement with the press during the course of the investigation, and, the Report was leaked to James Risen of The New York Times.

The APA Board immediately voted to post the full Report to the public on the APA website. The APA governing Council had less that 48 hours to review the Report and 6,000– plus pages of exhibits, including information that contradicted the Report’s conclusions, said the authors of the Complaint. “So hasty was the Board’s review and release of the Report that, as many have noted, the APA ignored its own policies that prohibit making deliberations about ethics investigations public.”

The Defendants did not give the Plaintiffs an opportunity to respond to the allegations in the Report, stated the attorneys for the Plaintiffs. For example, Dr. Behnke was immediately terminated without a notice period or without being allowed to meet with the APA board, even though he had been employed for 15 years. Plantiffs Banks, Dunivin, and Newman were “never even notified that the Report was complete or that it was about to be published.” Col. James received an online copy the day before it was released to the Council.

The Complaint lists views from others that pointed to problems in the Report and the process, but that have been ignored by APA.

“In a June 11, 2016, open letter, eight former APA presidents summarized the concerns expressed by four of the APA’s divisions and others as including ‘an apparent failure to properly vet [the Report], failure to protect the rights and reputations of those portrayed negatively, lack of due process for employees who were forced to resign, and more.’”

One of the APA’s largest divisions has passed a vote of no confidence in the Board’s actions, and another has said that the Board’s treatment of those named in the report “without a due process finding of wrongdoing is itself an unprofessional, counterproductive, and potentially unethical action.”

Despite these conflicts, APA re-hired Hoffman to review portions of the information the Plaintiffs provided, a step that ten former chairs of the Ethics Committee have stated that there is a potential conflict in re-hiring Hoffman, said the authors.

The Complaint states, “The false light in which the Plaintiffs Behnke, Dunivin, and James have been placed would be highly offensive to the reasonable person,” and has caused mental anguish, emotional distress, and “severe personal and professional humiliation and injury to their reputations in the community – reputations they have built over many years.”

[See story in Times Vol 6 No 8, “Hoffman Report Rocks Am Psychological Assn” page one.]

“Working diligently” to ease cuts to Higher Ed, says Governor Budget Bleak as Usual

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

What Are You Doing On Mardi Gras?

In late January we asked a variety of community members what they were going to be doing for Fat Tuesday. Below are some of the interesting answers we received.

“On Mardi Gras day, my friends and I have an early breakfast at my house and then we walk downtown. We’ve done this for the last two decades. We go rain or shine!” ––Michael Cunningham, PhD, Tulane Professor in Psychology, African & African Diaspora Studies, and Associate Provost for Graduate Studies and Research, Office of Academic Affairs.

“… I won’t be doing anything for Mardi Gras day itself. I ride in the Krewe of Iris, which is the oldest women’s Krewe in New Orleans. Iris parades the Saturday before Mardi Gras. So, once Iris is over, I take it easy the rest of the time, probably reading my cozy mysteries at home! I also go to parades all day this coming Sunday [Jan. 31]. One of the parades this Sunday is the Krewe of Carrollton, of which I was the Queen in 1973. So, I always like to go to the Carrollton parade. My family had kind of a dynasty in Carrollton. My sister was queen before me and I have a number of cousins who have been queens after me. My father was also the King of Carrollton the year before I was Queen. So between going to Carrollton and Iris, that’s enough Mardi Gras for me. […} … my plans for Mardi Gras day are not very interesting! ––Kim E. VanGeffen, PhD, Past President of Louisiana Psychological Association, 2015 Distinguished Psychologist, New Orleans.

“Nothing for me, except maybe participate in the ‘Mardi Gras Bead Recycling Drive.’ [See following note] I have tons of beads left over from previous Mardi Gras parades that I need to get rid of.” ––Addison Sandell, PhD, Psychologist, Natchitoches.

[NATCHITOCHES – Keep Natchitoches Beautiful is getting into the spirit and asking residents to ‘Throw us something mister!’ On Tuesday, February 9th, Keep Natchitoches Beautiful will hold a Mardi Gras Bead Recycling Drive from 8:00 a.m. to 4:00 p.m. at the Natchitoches Main Street Office located at 781 Front Street.”]

“I’d be happy to give you my Mardi Gras plans as soon as I figure them out!” ––Gerald LaHoste, PhD, Professor, Department of Psychology, University of New Orleans.

“I’m in Israel visiting my mother now and won’t be back ’till later.” ––Denise Sharon, MD, PhD, Assistant Professor at Tulane University School of Medicine, and Clinical Director at Advanced Sleep Center, past President of the Southern Sleep Society.

“I’m seeing clients on Fat Tuesday. Several people have that day off and therefore it makes it easy for them to schedule a session in their otherwise busy routine.” ––Cindy Nardini, MS, LPC, Life Solutions of Alexandria, President’s Award, Louisiana Counseling Association.

“… I may bore your readers to death! My Fat Tuesday likely will consist of catching up on some TV/Netflix, reading a good book, and walking on the treadmill.” ––Donna Thomas, PhD, Department Chair, George and Jean Baldwin Endowed Associate Professor, Department of Psychology and Behavioral Sciences, Louisiana Tech University, Ruston.

“Being born and raised in New Orleans and even now living in Baton Rouge, I’ve been attending Mardi Gras yearly since birth. I have not missed one. My children and I stay at a bed-and-breakfast in uptown New Orleans for the Mardi Gras weekend through Fat Tuesday. Family and friends, many from out of town, meet together for days of food, drink, fun and shenanigans. Each year our crowd seems to get larger. Yes, I am one of those people that are out there by 6 AM. It’s one of the most enjoyable times of the year for me. I am usually dressed in a costume …” [See photo] ––Bryan Gros, PhD, Licensed Psychologist, Past President LPA, Baton Rouge.

“I am afraid that I have no plans for Mardi Gras. It will just be a long weekend at home, probably.” –Rick Stevens, Ph.D., Professor in Psychology, University of Louisiana, Monroe.

“… we are going out of town for Mardi Gras. My wife Catherine just turned 50 this last weekend and we are taking our children to Hawaii for the Mardi Gras break. She is calling this our Hawaii 50 🙂 we usually begin the Mardi Gras break with our children’s Mardi Gras parade at South Downs. Many of the schools are out that week which makes work and childcare a real pain.” –– James Van Hook, III, PhD, ABPP, Licensed Psychologist, Baton Rouge.

“Mark and I are doing what we always do… work. 🙂 So that is rather boring for your readers. We may get a king cake to celebrate with the girls and my mom.” ––Mkay Bonner, PhD, Licensed Industrial-Organizational Psychologist, Bonner Solutions & Services, Monroe.

“I’ll be working. Veterans with PTSD don’t typically participate in Mardi Gras due to large crowds, excessive noise etc. Their hypervigilance is on overload. We will have a Mardi Gras pot luck luncheon for those working in Mental Health that day.” ––Leslie Drew, Clinical Psychologist and PTSD Program Coordinator at Alexandria Veterans Affairs Health Care System, Alexandria.

“My husband (Dr. Michael Apter) and I will be enjoying the festivities from our home in the Fauborg Marigny. On Mardi Gras day, we walk in the Society of Saint Anne parade. Our tribe’s theme is a carefully guarded secret, but here’s a hint: pink leopard print gloves, fake mink, and re-purposed beanie babies. Sounds crazy, but somehow it works!” ––Mitzi Desselles, PhD, Associate Professor, Chester Ellis Endowed Professor, Department of Psychology and Behavioral Sciences, Louisiana Tech University, Ruston.

“I used to march in Krewe of Cosmic Debris every year, but now I costume up early, catch Zulu and Rex, then head into the Frenchman Street frenzy with the artistic locals for the rest of the crazy evening!”
–– Gail Gillespie, Ph.D., Child and Adolescent Psychologist, Director LPA, CE Chair LPA, New Orleans.

“I’m spending the day with sisters, Lynn and Barbara, who live in Slidell. We are celebrating Lynn’s birthday (Feb 3), and being together as Feb 6th would have been my Dad’s birthday. He passed away last year. We’re going to ‘visit’ Dad at the beautiful Veterans Cemetery in Hammond, then we’re going out to lunch and generally having a ‘sister’ day.” –– Katherine Robison, Ph.D., Child Psychologist, Pelts-Kirkhart & Associates, New Orleans.

Reflections on Sandy Hook

An Analysis of the Findings from CCFRP
by Dr. Yael Banai

[Editor’s Note: This article concerns the findings in reports by the Office of the Child Advocate regarding the shootings at Sandy Hook Elementary. The reports were by the State of Connecticut. Dr. Yael Banai is a member of the Louisiana Coalition for Violence Prevention, and a contributing reporter to the Times. Her PhD is in Educational Psychology and she is a Nationally Certified School Psychologist. She is past president of the Louisiana School Psychological Association.]

On the morning of December 14, 2012, armed with two powerful handguns and three rifles, one of which was a Bushmaster AR 15 (a military assault rifle), after having pumped four rounds into his mother’s face as she slept, 20 year old Adam Lanza shot open the locked entrance doors of the Sandy Hook Elementary School in Newton, Connecticut. Responding to the commotion, the school psychologist and the principal ran towards the sound and were shot dead on the spot by the gunman. Lanza proceeded to the first grade classrooms. Before he put one of the pistols in his mouth, he slaughtered 20 defenseless six-year olds and four adults. The entire rampage took 8 minutes.

Directed by the Connecticut Child Fatality Review Panel, the Office of the Child Advocate prepared two reports on the massacre which were published this past November, one of which focuses on a review of the circumstances which led to Lanza’s act of mass murder at Sandy Hook Elementary. The authors chronicle Lanza’s educational and medical histories and observe that all along the way there were “red flags” signaling disaster. However, they are quick to point out that they did not conclude that those factors, either singly or together, added up “to an inevitable arc leading to mass murder… In the end, only he and he alone, bears the responsibility for this monstrous act.”

Among the several “red flags” in Lanza’s history are significant failures of the educational and mental health systems to coordinate their efforts to compose and enact a thoroughgoing, comprehensive set of interventions, both educational and therapeutic, to address Lanza’s significant needs, particularly in terms of social interaction and unmet behavioral and emotional concerns.

Reviewing Lanza’s special education classification and IEP [Individual Education Plan] history, which included services that begun in the “Birth to Three” category in New Hampshire, it appears to this aging school psychologist that the evaluation teams consistently missed correctly classifying this young man. Despite a reported history of early seizure activity, behavioral dyscontrol (repeated temper tantrums including head-banging), a suspected “sensory integration disorder” and significant speech-language deficits which required that his mother act as interpreter for the examiners during his preschool evaluation, Lanza’s earliest classification which continued through to middle school was Speech Language Impairments, for which minimal services of speech and articulation therapies were offered once or sometimes twice a week.

Although Lanza’s difficulties were significant enough for his mother, Nancy, to quit her job to be at home with him full time, it did not seem that she pushed for additional assessment, except when the Connecticut evaluators deemed that his speech difficulties did not interfere with his educational progress and withdrew services. An independent evaluation was sought and speech services were resumed.

However, it should be noted that during this period, Lanza was diagnosed (according to his mother’s report) with a “sensory integration disorder.” He was observed to resist participating in group activities, to speak and interact with peers on a very limited basis, and to engage in “repetitive behaviors.” Somehow the evaluation team apparently did not consider inviting a school psychology consult. No consideration or evaluation of the possible presence of an Autism Spectrum Disorder (which surely would have been signaled at a minimum by the “sensory integration disorder”) was apparent.

What consistently struck me throughout this review was a persistent minimizing of the magnitude of this young man’s difficulties both through mis-classification and restricting his IEP recommendations to speech language and occupational therapy concerns. (Clearly the commission authors thought so too.) Although Lanza appeared to attend elementary school with noted supports in speech and OT (occupation therapy), and participated in the usual age appropriate activities such as soccer, his condition markedly deteriorated in his early adolescent/middle school years to the extent that Mr. Lanza (who was separated and eventually divorced from Mrs. Lanza) requested an evaluation through the Yale Child Study Center.

By far the most comprehensive evaluation to this point, identifying both an Autism Spectrum Disorder as well as Anxiety and Obsessive Compulsive Disorder with possible attendant Depression, the Yale evaluators recommended extensive mental health and special education supports as well as mediations to ease Lanza’s obsessive compulsive symptoms. Presciently, the Yale evaluator noted that should appropriate and extensive therapeutic interventions not be implemented, a deteriorating spiral of functioning was predicted with a poor outcome.

Lamentably, Mrs. Lanza did not accept the Yale conclusions and terminated a brief attempt at medication (Celexa for three days) due to side effects which the consulting psychiatric nurse did not conclude were due to the mild dose of the medication. Mrs. Lanza terminated the relationship with the center and sought consultation with a “community psychiatrist” who ultimately provided her with the necessary documentation for provision of “hospital homebound services” through the school system.

However, as the commission authors noted, these services were woefully inadequate, primarily consisting of speech/language services proffered once per week. Lanza’s classification by that time had morphed into “Other Health Impairments.” Given his diagnoses which may or may not have been shared with the school system (for example, the commissioners noted that the Yale Child Study evaluation was neither referenced in the educational record, nor did it appear in his file) this seems entirely inappropriate on so many accounts. Although it should be pointed out that an IEP is not driven by a classification but rather should be crafted from the child’s listed strengths and needs in the evaluation, a classification does often signal to staff a level of intervention. Clearly, given the information in the commission’s report, Lanza could have been classified both as a student with Autism and Emotional Disturbance. Doing so would have given a clear signal to the school that a significant level of intervention was necessary.

Throughout his life apparently, Mrs. Lanza sought to insulate Adam from the “slings and arrows” of daily life, which had the damaging effect of isolating him from the outside world–and permitted him to indulge in his worst proclivities. As time wagged on, she also tended to treat him as a confidant. As the report notes, it was a dynamic of mutual dependency. Mrs. Lanza’s hypervigilance and micromanaging of his life coupled with the rejection of the psychiatric advice of the Yale Child Study Center had the effect of unwittingly sabotaging opportunities for her son to get better.

Other red flags lay in Lanza’s growing obsession with violence, as exemplified by his writings in middle school. One project, called the Big Book of Granny, chronicled the adventures of a homicidal shotgun toting grandma––who at one point says “lets hurt children”––while at the same time abuses her son and cohort. In the end, the son shoots Granny in the head with a shotgun. In seventh grade, Lanza’s teacher at the private school where he was placed for a year observed that his writings were so graphically violent that “they could not be shared.” Indeed, Lanza returned to public school upon mutual agreement that he withdraw from the private school setting.

Finally, one must wonder what on earth Mrs. Lanza’s thought process was to continue to allow her son access to high powered weaponry. (Apparently, “firearms and target shooting were a pastime for the Lanza family.”) Despite his deteriorating condition and virtual complete withdrawal to his “lair” in the basement with blacked out windows, Lanza had unfettered access to the guns, which included the Bushmaster XM-15, capable of sustained bursts of fire of 45 rounds per minute. After having found a compliant psychiatrist who, contrary to the advice of the Yale Child Study, recommended homebound services, Lanza consumed his days with online gaming (“Call of Duty” seems to have been a favorite as well as “School Shooter”) as well as participating in chatrooms dealing with mass murder.

Completely unaddressed was also Lanza’s Anorexia Nervosa. At the time of his death, at six feet tall, he weighed 112 pounds and was “aneorexic to the point of malnutrition and resultant brain damage.” It seems that even in this Mrs. Lanza was oddly compliant. Pediatric well visits had ceased in late adolescence, shortly after the termination of services with the Yale Center. It would appear that in catering to his disabilities as opposed to obtaining treatment for them, Lanza spent his days indulging his whims, spiraling ever downward into the rage that exploded in the only place (Sandyhook Elementary) he had ever been marginally happy.

For some years now in my practice as a school psychologist, when encountering students with serious behavioral issues, including depression, one question I routinely ask the parents is whether or not they have weapons in the house. In Lanza’s instance I would have immediately thought, given the depression, of the possibility of suicide. As the drama unfolded, not only did he engage in a hideous school shooting, but began his rampage with matricide, also a fairly rare occurrence. And had he at that point, turned the weapon on himself, we would have never heard of him. Lamentably, he only resorted to this eventuality after having decimated 20 first-graders and their teachers. That Nancy Lanza not only allowed but promoted Lanza’s access to military style weapons (or, frankly any weapons) is, in a phrase, an appalling lack of judgment.

The OCA report rightly points out the missed opportunities in this case. To say that there were “red flags” here seemed to me a gross understatement.

Among the documents investigators discovered in the Lanza home, one speaks saliently to this issue. In what possibly was her last act in life, Nancy Lanza had written a check to Adam––a Christmas gift––for the purchase of a handgun. Blind to the last.

Janet and Lee Matthews Showcased in Monitor for AP Foundation Bequest

Louisiana psychologists Dr. Janet Matthews and Dr. Lee Matthews were featured in an article in the December issue of the American Psychological Association’s national magazine, the Monitor.

The couple made a contribution to the American Psychological Foundation. In an interview the Matthews said that what inspired the donation were several factors. “We started making donations to APF to honor friends’ accomplishment, as well as in memory of colleagues who had died.” The couple said that they have no children or siblings, and so it was a natural progression. “It is a way to both acknowledge those psychologists who mentored us and had such a profound impact on our development and success in the profession and to support the growth and vision of both our former and future psychology students.”

Dr. Janet Matthews has been a key figure in the national and state psychology community and long-time professor of psychology at Loyola University in New Orleans. She is now retired and Professor Emerita. She served on the APA Board of Directors and also served as Chair of APA Board of Educational Affairs and as President of Division 31, State, Provincial & Territorial Affairs.

During her career she has served on the Louisiana State Board of Examiners of Psychologists, and as chair. She has published over 70 journal articles and numerous books and book chapters, including Introduction to Clinical Psychology and Your Practicum in Psychology: A Guide for Maximizing Knowledge and Competence. She has served as Associate Editor of Professional Psychology: Research & Practice. She was named as Distinguished Psychologist by the Louisiana Psychological Association (LPA).

Dr. Lee Matthews was also named as Distinguished Psychologist by LPA, in 2014. He is licensed in clinical and clinical neuropsychology and he holds the Diplomat in Clinical Psychology from both the American Board of Professional Psychology and also from the American Board of Assessment Psychology. He is co-owner of Psychological Resources in Kenner, Adjunct Faculty Associate Professor at the LSU Health Science Center in New Orleans, and consults to Children’s Hospital and South Louisiana Medical Associates at Leonard J. Chabert Medical Center in Houma, Louisiana. He has served on and chaired the Louisiana State Board of Examiners of Psychologists.

He is a Fellow of the APA, has authored and co-authored with his wife numerous publications and journal articles served in numerous professional roles, including president of the New Orleans Neuropsychological Society, Secretary/Treasure of the Division of General Psychology in APA, Chair of the Historical Committee for Southwestern Psychological Association, president of the Orleans Psychological Society.

“We can’t predict what areas of research might need funding, but we feel strongly about the importance of personal interaction to stimulate creativity,” they said to the Monitor.

“As a dual-psychologist couple, much of our lives has revolved around the discipline. Psychology has been our profession, our personal identity and the source of friendships that would not otherwise have occurred.”

“We believe that giving money to APF is the best way for us to pay it forward.”

Fifty Chimps Retiring to Chimp Haven in Keithville, Louisiana

Animal Care Director, Kathleen Taylor,
“It’s our opportunity to give back…”

“We have begun the process of bringing the retired NIH-owned chimpanzees to the sanctuary,” said Kathleen Taylor, Director of Animal Care at Chimp Haven. Taylor has a masters in organizational psychology, and a desire to make a better home for chimpanzees who are released from serving the research goals of humans.

The National Chimpanzee Sanctuary, known as Chimp Haven, located in Keithville, Louisiana, will be receiving another 50 chimpanzees from the federal government. These newly “retired” chimpanzees will join the nearly 200 chimps that reside at 13600 Chimpanzee Place, a 200- acre forested reserve just south of Shreveport in the Eddie D. Jones Nature Park.

“This includes not only the 50 who were recently retired,” Taylor said, “but also more than 300 retired in June 2013. We are currently home to more than 190 chimpanzees and over the next few years, with the help of generous donors, look forward to expanding Chimp Haven facilities and infrastructure by adding several new large forested habitats and indoor housing for future retirees.”

Taylor, whose undergraduate is in biological sciences also has a master’s degree in psychology, is a member of the American Psychological Association and the Society of Organizational and Industrial Psychology. On occasion she uses some of what she has learned to help Chimp Haven deal with its growing pains.

Taylor is one of a complex group of professionals that care for the chimps and make sure of the quality of life of the animals. “Our goal here is to make sure we are providing more to the chimpanzees than just the basics,” said Taylor. “They can receive good nutrition and good medical care in other places, but here we look at the chimps to improve their well-being overall. We look at the chimps from a holistic perspective, and try to create opportunities for them to live like a chimp in the wild. This is so important to their well-being.”

The newest group chimpanzees, some of the last held for biomedical research by the National Institute of Health, received their ticket to freedom when the United States Fish & Wildlife Service (W&FS) declared last June that captive chimpanzees deserved the same protection as wild chimpanzees. Chimps living in the wild have been on the endangered species list since 1990.

The W&FS decision was said to be a “hard-fought victory” by animal rights activists. The change began in 2011 when the Institute of Medicine and National Research Council concluded that chimps were not necessary for most biomedical research. In a news briefing in November, the National Institute of Health Director Francis Collins said it was the end of a controversial era of research on chimpanzees.

Chimp Haven was selected in 2002 by NIH to become the National Chimpanzee Sanctuary. Chimps retired to the Haven are protected from any invasive research or any research that requires them to be socially separated from their group.

Chimp Haven founder, Linda Brent, points to the critical value of a humane place for these chimpanzees to retire, many who are older and some who are ill. “This really is the only place in the country that provides naturally forested habitats that are four or five acres large, where the chimpanzees can display the types of behaviors that wild chimpanzees display,” Brent has said. “That is just amazing and it’s worked very well for the chimpanzees here.”

Dr. Raven Jackson, Chimp Haven Attending Veterinarian said, “We meet within our behavioral management team, we meet within our veterinary team, we meet within our animal care team, and we devise plans for the best options for each and every chimpanzee. It takes a group effort to make sure we provide the best life for the chimpanzees here.”

Chimp Haven has a distinguished board of directors including Katherine Leighty, PhD, from Disney’s Animal Kingdom, and Frans De Waal, PhD, from Yerkes National Primate Research Center at Emory University.

The new federal guidelines have given hope to an animal rights group who filed a lawsuit in November to free a 50 year-old chimpanzee from her 40 years of solitary life in a Baton Rouge amusement park.

Members of the Animal Legal Defense Fund are declaring that the solitary existence of the chimpanzee, “Candy,” violates the Endangered Species Act. Candy has been alone for 40 years, a condition the animal rights advocates feel is painful and punishing, and treatment has been condemned by world-renowned primatologist Dr. Jane Goodall and comparative psychologist Dr. Roger Fouts.

If the court finds that Candy deserves her freedom, the staff at Chimp Haven has said they are ready to accept her at Chimp Haven.

Katheen Taylor feels that seeing the chimpanzees express their true social nature is one of the great rewards of her job as Animal Care Director.

“I wanted to personally thank all those who have supported Chimp Haven in the past and those who will give in the future,” she said. “If you have ever seen chimpanzees laugh, play, climb trees, or disappear into the forest just because they can make that choice, you have witnessed the sweet results of Chimp Haven’s staff’s hard work and passion. Providing the care and retirement for these chimpanzees who unwillingly gave their lives for our benefit is true humanity and I am eternally grateful for your support.”

“Over the last 20 years, my understanding and appreciation of humanity has been deepened through exposure to primates.”

“These chimps have served humans for so many years, and unwillingly at that. Now it’s our opportunity to give back to them,” Taylor said.

chimp

A chimpanzee living at Chimp Haven, one of many “retired” from service in biomedical research.
(Photo courtesy of Chimp Haven.)

Dr. Coulter Helps Dispel Misconceptions about Common Core at NASP

In a featured presentation at the National Association of School Psychologists, held in New Orleans last month, Dr. Alan Coulter helped attendees see the misconceptions about the national furor over Common Core, and the role for psychology in helping children who may be left behind in all the various debate.

Coulter is Director for Education Initiatives at the Human Development Center, LSU Health Sciences Center in New Orleans (LSUHSC), Director of the APA-accredited School Psychology Internship, and the Principal Lead for the TIERS Group. TIERS is Teams Intervening Early to Reach all Students.

“The level of misunderstanding by the public of the issues related to Common Core State Standards,” Dr. Coulter explained to the Times, “surpasses almost any other issues –even the difference between a psychiatrist and a psychologist.”

“The federal government did not invent the Common Core State Standards,” he said, despite the fact that many believe this. Common Core State Standards, or CCSS, were developed by The National Governors Association and the National Association of Council of Chief State School Officers, he said. “They developed the CCSS in response to a request of the majority of governors, including Governor Bobby Jindal,” Coulter noted.

“The federal government did not mandate the Common Core. States had options and 45 states simply adopted CCSS,” he said.

A third common misunderstanding is the belief that Common Core is a curriculum. “The CCSS is not curriculum,” explained Coulter. No curriculum materials were mandated by the federal government. There is no national curriculum.”

Panel presenters at the National Association of School Psychologists (NASP) conference also pointed to a fourth misunderstanding––The federal government did not mandate any specific achievement measure. Rather, the federal government funded two efforts by consortia of states to develop a measure of achievement aligned to CCSS, explained Dr. Coulter.

The invited presentation titled, “Bracing for the Common Core Crash: Preventing More Children Left Behind,” included co-presenters Mark R. Shinn, PhD, from National-Louis University, Kimberly Gibbons, from St. Croix River Education District, Minneapolis, MN, Dr. Michelle Shinn, Principal & Executive Director for Student Services, Lake Forest, IL, and Dr. Robert H. Pasternack, former Assistant Secretary for Special Education and Rehabilitative Services, U.S. Department of Education.

Dr. Coulter said, “This event was quite an honor for me and my colleagues.” The national association rarely if ever invites a panel for two years in a row, and this was Coulter’s and his colleagues’ third presentation in as many years. It appears likely that the five will be invited back again.

The panel focused on how Common Core could inadvertently set conditions that could leave more students behind, and pointed out that school psychologists must be aware of risks and ensure advocacy for research-based practices, noted the program authors.

Dr. Coulter is also concerned with assessments. “My issue was one of the need for comparable assessments across states as measures of equitable accountability for results and use of public funds,” Coulter explained. “When 45 states had adopted one of the two newly developed measures, there was a chance of having a broad representation of state performance.”

“However,” he said, “given the growing hysteria about CCSS in states, some had withdrawn to develop their own state specific measures. The result will be a ‘Tower of Babel’ of accountability test scores,” he explained.

“It’s a pity that the politics of hysterical contagion have overridden rational decision-making about responsible accountability,” he said. He explained that Psychology has the expertise and the technology to ensure equitable and meaningful accountability of public school to the public. But, he also feels that Psychology continues to be largely unsuccessful in helping to shape public support for the use of this expertise.

Dr. Coulter said the conference was well attended and reviewed. “The National Association of School Psychologists meeting in New Orleans was one of the organization’s most attended annual meetings. I heard repeated compliments about what a hospitable environment NOLA was for such a meeting. Almost every session I attended, was packed with psychologists interested in expanding their knowledge and skills.”

tucker-and-coulter

Dr. Jim Tucker (L), McKee Chair of Excellence at the School of Education, U. of Tennessee, with Dr. Alan Coulter, Director for Education Initiatives at the Human Development Center, LSU Health Sciences Center, at the recent National Association of School Psychologists last month in New Orleans. (Courtesy photo)

Tulane’s Dr. Barbarin to Work on White House Educational Initiative

Dr. Oscar Barbarin, Psychology Professor and Endowed Chair at Tulane, attended the Advisory Commission on Early Childhood Education as an invited participant on October 20. The Commission is part of the White House Initiative on African American Educational Excellence established by President Obama in a 2012 Executive Order.

The Commission’s goal is to better understand the current status of African-American students and the schools that support them. Members meeting in October discussed the approaches and proven programs that could be of benefit for youngsters and served as an introductory meeting for key experts in the field.

“We were trying to understand the quality of early childhood education and the most important components,” Dr. Barbarin told the Times. Barbarin’s research aims to shed light on the origins of what underlies a disproportionately high rate of poor school adjustment for AfricanAmerican and Latino children, a group he calls “boys of color” or “BOC.”

“Cooperation with peers and social competence are present when the boys enter Pre-K, but when they reach five, after kindergarten, we see a downward trend,” he explained. Barbarin and his team at Tulane are helping to discover the underlying psychology of these and other issues that could improve youngster’s social and educational outcomes.

In one of his longitudinal studies Barbarin found evidence that calls into question the common assumption that boys begin school already dealing with socioemotional issues that hamper their educational success. Instead, Barbarin found evidence that the development of BOC occurs along the same lines as White boys. So, the difficulties these boys experience in adolescence are not evident in Pre-kindergarten.

Barbarin suggests that a more likely explanation for these results and the higher risk for later problems in BOC could be that there is a poor fit in the kindergarten and following grades, between current educational methods and the children’s developmental sensitivities. He concluded that the downward trend in ratings of socio-emotional competence in boys of color was likely related to the educational design and didactic approaches common in kindergarten.

“The programs may not be varied enough,” Barbarin explained. “We need developmentally sensitive practices that take these factors into account,” he said to the Times.

Dr. Barbarin and his work were prominent in the 2013 special issue of the American Journal of Orthopsychiatry focusing on the development of African-American and Latino youngsters. Barbarin wrote the introduction to the special issue, titled “Development of Boys of Color.” He also provided several articles including, “Development of Social-Emotional Competence in Boys of Color: A Cross-Sectional Cohort Analysis from Pre-K to Second Grade,” and “A Longitudinal Examination of Socioemotional Learning in African American and Latino Boys Across the Transition from Pre-K to Kindergarten.”

Dr. Barbarin is one of the national experts looking at the socioemotional development of boys of color and the characteristics related to these youngsters’ overall development. Last month he was one of the experts featured in the lead article for Monitor, the national magazine published by the American Psychological Association.

The headline feature was “Building resilience in black boys.” Barbarin commented to Monitor about his work with BOC. “Part of the puzzle is trying to figure out what happens along the way that creates such disparate outcomes for them,” remarking on the greater risk for African-American boys to exhibit problems in school and social-emotional areas.

In the Monitor report Dr. Barbarin said that one issue is that youngsters may come from homes without the same support for school and school preparation. This can cause some to be behind in language skills and if the children do poorly in their beginning entry to education, it can become a self-fulfilling prophecy, he indicated to the Monitor. He also explained that teaching styles, what he termed “warm demanding” may help teachers when the teacher is struggling with ways to be more constructive with children that are challenging.

Dr. Barbarin is the co-editor of the Handbook of Child Development & Early Education, a 2009 text coauthored with Dr. Barbara H. Wasik. In the Handbook Barbarin points out that early childhood education and developmental science have developed along parallel, rather than perfectly aligned, tracks. He writes that there is need for the two disciplines, education and developmental science, to work more closely to produce innovations to benefit children and BOC.

Also included in the 2013 special issue of the Journal of Orthopsychiatry was “Socioemotional Trajectories in Black Boys Between Kindergarten and the Fifth Grade: The Role of Cognitive Skills and Family in Promoting Resiliency,” authored by Tulane’s Jeffrey Brown, Oscar Barbarin and Kristin Scott.

Kristin Scott, Dr.Barbarin, and Jeffery Brown also authored, “From Higher Order Thinking to Higher Order Behavior: Exploring the Relationship Between Early Cognitive Skills and Social Competence in Black Boys.”

Included in special issue was Tulane professor Dr. Michael Cunningham’s “School- and Community-Based Associations to Hypermasculine Attitudes in African American Adolescent Males,” coauthored with Dena Phillips Swanson and DeMarquis Hayes.

Dr. Barbarin coauthored “Development of SocialEmotional Competence in Boys of Color: A Cross-Sectional Cohort Analysis from Pre-K to Second Grade,” with Iheoma Iruka, Christine Harradine, Donna-Marie Winn, Marvin McKinney and Lorraine Taylor.

Barbarin and Ester Jean-Baptiste authored, “The Relation of Dialogic, Control, and Racial Socialization Practices to Early Academic and Social Competence: Effects of Gender, Ethnicity, and Family Socioeconomic Status.”

The President’s Commission on Early Childhood Education is chaired by Executive Director for the White House Initiative on African American (AA) Educational Excellence, David Johns. The group will work to identify and review research and programs and will be helpful in understanding the current status of African American students and the schools systems that serve them, and develop policies and practices that benefit students’ development and achievements. The White House Initiative on AA Education Excellence is to help AA students receive the education that prepares them for educational success, college completion, and productive careers. According to a previous White House announcement, one specific objective is to increase the percentage of African American children who enter kindergarten ready for success and improve access to highquality learning and development programs.

How Much Do You Know About …?

Editor’s Note: We began looking at how much people know about different topics and decided to engage readers with quizzes on important areas. For this first article we asked two of our Louisiana experts to help us with suicide prevention.

Dr. William Schmitz, Jr., is a psychologist and President of the American Association of Suicidology. His colleague is Dr. April Foreman, Kansas psychologist and expert in suicide prevention, media, and education. Together they agreed to design a short quiz on suicide prevention basics. Here are the 10 questions. Answers are on the next page.

TRUE OR FALSE?
1. If someone denies feeling suicidal, then they are not high
risk for suicide.

2. Simply documenting lack of report of suicidal ideation, or
denial of suicidal ideation is sufficient assessment and
documentation of risk of suicide.

3. If someone reports suicidal ideation, but does not go to the
hospital, then having your patient sign a “No Harm” contract
is the standard of care you should meet.

4. When assessing for risk of suicide you should ask about
and document which of the following: Suicidal Ideation;
Suicide Planning; Intent to act on suicidal thoughts/feelings;
Rehearsal for suicide and self-harm.

5. When assessing suicide risk you should do which of the
following: 1) Assign a level of risk “low-medium-high,” with a
corresponding treatment response, even if someone denies
current suicidal ideation; 2) Prioritize assessing for “distal”
risk factors, such as family history, which are more predictive
than “proximal” risk factors such as agitation and current
stressors; 3) Assign a lower level risk of suicide for patients
who feel they are a burden vs. a higher level of risk patients
who have a history of exposure to life-threatening situations.

6. You should generally only assess for risk of suicide when
someone self-reports suicidal ideation, or if you are made
aware of a history of suicide attempt.

7. No harm contracts are sufficient safety planning, as long
as someone is in outpatient care.

8. When doing a basic 6-step safety plan, you should address
restricting the means of suicide. For most patients this will
mean restriction of access to guns.

9. Means restriction has been proved to be ineffective at
preventing suicide. If you help a patient plan to make it
difficult to get access to one means for killing themselves,
they will just find another means. No harm contracts are
preferred for this reason.

10. Inpatient care is the best standard of care for people
assessed at high risk of suicide.

ANSWERS

1. FALSE: Some studies indicate that the majority of people who die by suicide deny experiencing suicidal ideation at proximal mental health visits. It is more important to assess for overall risk factors, than to just ask about suicide, document it, and move on.

2. FALSE: If you are providing care under an independent license, then you are expected to know how to do a more thorough assessment of risk, and to document that clearly. If you are sued for malpractice, it is relatively easy for an attorney to demonstrate the standard of care for suicide risk assessment, intervention, and documentation, even though research shows that approximately 90% of Psychologists are not able to demonstrate knowledge of this standard.

3. FALSE: No Harm contracts are NOT the standard of care. An empirically based risk assessment and 6 step safety planning process is the accepted standard of care.

4. ALL OF THE ABOVE

5. NUMBER 1. Number 2 is false as both distal and proximal risk factors should be evaluated and addressed. Number 3 is false; as Perceived Burdensomeness, Thwarted Belonging, and Acquired Capability are all considered major risk factors for suicide.

6. FALSE: You should assess for risk of suicide at an initial intake, yearly, following all inpatient admissions, any time distress becomes more acute in the course of treatment, when a patient reports suicidal ideation, and regularly/frequently in the months after a suicide attempt.

7. FALSE: No harm contracts are not considered a standard of care, and have been empirical demonstrated not to significantly reduce risk of death by suicide. If you do a no-harm contract, and do not do the empirically validated 6-step safety plan, you have not met the understood standard of care, and may be in danger of malpractice. Inpatient or outpatient status is irrelevant. Many people in outpatient care remain at high risk for suicide.

8. TRUE: Self-inflicted gunshot wound is by far the most common way that someone dies by suicide–60-80% of cases. You should also ask about plans for suicide and restrict means used in those plan, as well as ask about means from prior attempts, and access to lethal types/quantities of medication.

9. FALSE: Research clearly shows that deaths by suicide significantly reduce after safety planning and means restriction. People who have their suicide plans interrupted by lack of access to lethal means to suicide often do not go on to attempt in other ways.

10. FALSE: When it comes to inpatient vs. outpatient treatment, providers should weigh the pros and cons of each approach and discuss that with high risk patients. Inpatient care is generally best to address acute issues such as immediate inability to keep one’s self alive or need to adjust medications under inpatient supervision. The majority of patients, however, can and should be treated on an outpatient basis using frequent contact with their mental health care team, safety planning, crisis contacts, and involvement of family/friends in safety and treatment planning. A 1-4 day stay in a hospital does not really have much long-term therapeutic benefit for most people with high risk of suicide.

Invisible Forces Behind Health Care

by Julie Nelson

Last month the Department of Health and Hospitals declared that they would integrate behavioral health into medical care for the nearly 1 million on Medicaid in Louisiana.

This is an admirable goal, but not an easy one. Integrative health care––where psychology is combined with physical health care––has been repeatedly shown to lower costs and improve outcomes. But even after decades of evidence, nothing much has changed.

One of the reasons change comes so slow in the US health care system is because of the forces behind what is paid for and how much is paid, the CPT and RUC.

CPT and RUC, short for “Current Procedural Technology” and “The Relative Value Scale Update Committee,” are the behind-the-scenes forces that shape the landscape of health care in the US. It is a system created by organized medicine with government, insurance, and hospitals.

Health care is the largest industry in the country, accounting for 18 percent of the Gross Domestic Product and about $2.8 trillion in sales. At the same time the U.S. trails peer nations in health but leads in costs. Various reasons have been suggested for this conundrum: aging population, high tech solutions, and chronic illness (heart disease, stroke, cancer) are at the top of most lists.

Chronic illness is a big part of the problem. The CDC estimates that three lifestyle factors– –poor diet, inactivity, and smoking––account for 80 percent of heart disease and stroke, 80 percent of type 2 diabetes, and 40 percent of cancer. Psychologists have pointed to the connections between lifestyle and behavior for decades. In an interview with primary care psychologist Dr. Michele Larzelere, she said there is scientific agreement for a 30 to 60 percent reduction in medical use with integrated behavioral health services.

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

Not surprisingly, primary care doctors, the specialty closest to the patient, are carrying water for behavioral health. In a special issue of the American Psychologist on Primary Care and Psychology (May 2014), Dr. Susan McDaniel and primary care leader Dr. Frank deGruy reviewed evidence that for each primary care physician added to a social system, “allcause mortality decreases by 5.3 percent.” Conversely, for every specialist added the mortality rate goes up 2 percent.

Dr. David Carmouche, Chief Medical Director and Senior VP at Blue Cross Blue Shield of Louisiana (BCBS) is working to build primary care back into programs. “Our strategy is to engage providers in communication so that patients develop a trusted relationship with a primary care provider,” Carmouche told the Times.

Still, when a person gets really sick, care becomes expensive. The top 1 percent spends $51,951, the top 5 percent spends $17,401, while the bottom 50 percent spends $850 or less on yearly health care, says Kaiser Health.

In “The Anatomy of Health Care in the United States” (November 2013, JAMA) authors contradict several common assumptions about the rise in costs. While medical costs are driven by chronic disease, they say, it is not due to an aging population. They show that 67 percent of those with chronic illnesses are younger than 65, and when trauma is included, about 80 percent of the total health care cost is accounted for by those under 65.

The authors, a group of physicians and MBAs, write that the common view that higher costs are being driven by the aging population and increased demand for services is wrong. They show that 91 percent of the increase in healthcare costs in the last decade was due to an increase in prices.

Overall, the US health care picture indicates two main issues. Prices are unreasonably high and we aren’t treating the right health problems. Both can be explained by the forces of the CPT/RUC.

At a recent meeting of the Louisiana Psychological Association, Dr. Tony Puente spoke about coming health care changes and CPT codes. Those attending were well familiar with using CPT codes, required to bill for health services. But Puente also spoke briefly about how CPT codes are developed. It turns out to be a system steeped in politics and power.

Officially, “CPT is a set of codes and descriptors for reporting medical services and procedures which provides a common language to accurately describe services in the health care profession,” writes the American Medical Association (AMA). CPT is owned by the Center for Medicare and Medicaid Services (CMS), leased to AMA, who then copyrights it.

CPT codes begin with three hundred “Advisors and Experts” who hammer things out and then attempt to influence the CPT Editorial Panel. The 17-member Panel makes the final decisions on which codes will be approved.

The 300 advisors come primarily from the AMA House of Delegates. They represent 109 medical specialties and they form into about 20 teams to lobby the Panel. The Panel includes 11 physicians from the Medical Societies, two representatives from insurance (Blue Cross Blue Shield and America’s Health Insurance Plans) and someone from the Center for Medicare and Medicaid Services (CMS). Then there are two people from the Health Care Professional Advisory Committee, the only representatives who are nonphysicians.

“Essentially the CPT tries to divvy it up in a way that is theoretically and empirically, and diplomatically and politically, correct.” Dr. Puente said. “That it is a very demanding and a very transparent activity.”

Actually, it is not transparent. Information about CPT negotiations is restricted, meetings are closed and participants have to sign confidentiality agreements and can be barred from future meetings if they disclose any information. No press is allowed.

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

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

“The RUC Advisory Committee was constructed to allow participation by every specialty seated in the AMA House of Delegates, say AMA documents. “The RUC Advisors serve as advocates for their specialty, while RUC members must exercise independent judgment and are not involved in their specialty’s presentations.” But authors do not explain how a physician is to separate from his or her beliefs or biases.

There are 28 voting members on RUC, most who represent medicine specialties such as anesthesiology, cardiology, dermatology, emergency medicine, general surgery, neurology, neurosurgery, obstetrics, oncology, psychiatry, and so on.

The group’s design reflects the composition of the medical profession, rather than reflecting the needs of the consumer. But even within the medical family this led to problems because of an underrepresentation and undervaluing of primary care.In 1992 the Medicare payment for a primary care type office visit was $31 while cataract surgery was $941 and a lumbar spine MRI was $485.

While things have improved somewhat, there has been trouble in paradise. In a report on RUC and Primary Care, AMA Board of Trustees wrote, “The intense RUC review did lead to a divisive debate within medicine …” Trying to calm the waters, they said, “The Board of Trustees believes that organized medicine should work together to support the RUC’s efforts.”

Outcomes of these forces can be seen in how the profession is reshaping itself. The Robert Graham Center for Policy Studies in Family Medicine and Primary Care produced a 2009 report that explained disincentives for medical students to choose a career in primary care over one of the specialties, and why shortages are becoming severe. Figure 10 from the Center’s report, compares the grow of incomes for primary care and specialty physicians.

Control of the CPT and RUC have helped shaped health care toward high tech/high price, services, less primary care, and probably lower quality primary care because these physicians might push toward higher volume to help make up for differences.

Dr. Puente explained to psychologists this past spring that the CMS would set the bar under the ACA, but that decisions would shift from national level to the state level. And they have.

Louisiana Department of Health and Hospitals (DHH) considers family medicine, general internal medicine, and pediatric medicine to be primary care. Fee schedules for Medicaid posted by the DHH indicate that office visits are paid at $25.78 to $40.83. For a more expanded office visit the fee is $49.16 to $70.63. Office visits of high complexity can be paid nearly $200.

But the fee for removing a foreign body from the eye in an out-patient, ambulatory setting ranges from $269.57 to $509.99. Or, for removing an ear lesion the physician can bill $412.84 to $805.45.

At the same time Medicaid fee for a Behavioral Health Counseling Therapy session is $17.02. Mental Health Assessment is $23.65. And, MultiSystemic Therapy is $32.83. While Medication Management is $46.32, a situation to drive providers to medication as the first treatment. Hopefully, the recent announcement to review and build integrated care will help.

The social and political influences stemming from the CPT and RUC systems appear not only to have helped create major barriers for those outside of medicine to make contributions, they has blocked innovation, quality and driven up prices.

“If you can’t describe the process, you don’t know what you’re doing,” wrote Edward Demming about quality. The system we have seems to be one of confusion, rather than insight, of entitlement, rather than performance.

The customer is not empowered and is almost entirely absent from the process that creates services. Considering what we know about conditions that support quality outcomes, any arrangement where the customer and vendor are so distanced from each other is doomed to perform poorly.

La Supreme Court Ruling Points to Need for Specialized Training

Handling of Sexual Abuse Allegations 

By Dr. Alan Taylor

In October the Louisiana Supreme Court ruled on a child custody case that included allegations of child sexual abuse. The court upheld the original trial court’s conclusions, and dismissed the appeals court’s objections, finding them without merit, but not before even more confusion and potential emotional anguish may have occurred.

The case was a strongly contested one where some, well- meaning health professionals became involved, but who did not have the specific knowledge to understand the complications that can be encountered in these cases.
In a guest article for this issue of the Times, Baton Rouge forensic and clinical psychologist, Dr. Alan Taylor, describes the problems in this type of case as “iatrogenic effects of legal and mental health practices.” The lower appeal court’s reversal was due to a lack of understanding that Taylor portrays as: “The first error is an assumption of expertise where it is lacking, and the second error is failure to recognize expertise when it is present.”
Forensic and clinical psychologist Dr. Alicia Pellegrin was the court-appointed expert in the case, and like Taylor, is a member of the Association of Family and Conciliation Courts (AFCC), an organization providing specialized training in this complex area of practice.

Pellegrin said that the case and others like it point to the need for more training and understanding in this demanding sub-specialty. “It is imperative that anyone working in this field have an understanding of child development, including language and cognitive processes,” she said, “child psychopathology, family systems, the legal statutes in the state in which one practices, and an understanding of relevant case law.”

Pellegrin told the Times, “One of our important functions can sometimes be simply to provide education to Judges that can inform their decisions that affect the most vulnerable in our society, our children. Towards that end, one must understand the effects of divorce on children and the particular vulnerabilities that certain children bring to the process. Finally because one or more serious allegations often arise in the context of a custody dispute, an understanding of child sexual abuse, domestic violence, and substance abuse, is critical.”
We present Dr. Taylor’s article in this special report and also cover aspects of the upcoming conference to be held in New Orleans by the Association of Family and Conciliation Courts, a premier provider of training and multidisciplinary thought in this complicated and important sub-discipline in psychology.

A recent Louisiana Supreme Court case (Louisiana Supreme Court case No. 2014- CJ1119) involved a custody battle where allegations of sexual abuse surfaced and caused a great deal of anguish and damage. This case illustrates what I call the iatrogenic effects of legal and mental health practices in custody cases with sexual abuse allegations. Serious mistakes can be made in both the legal and mental health systems that cause great harm to families and set bad precedents for managing these difficult cases. Although this case involved a custody battle, the handling of sexual abuse allegations in general is a volatile topic in all arenas – civil or criminal, public or private.

The first error is an assumption of expertise where it is lacking, and the second error is failure to recognize expertise when it is present.

The issues, problems, and solutions to handling sexual abuse allegations can be the subject of many articles, but this one will concentrate on some conceptual and practical points to ponder.

A Two Part Recipe for Bad Outcomes

1. The illogical assumption that because a person or agency works with a certain population, this makes him/them an expert regarding that population (substance abuse, sexual abuse, or domestic violence)
Coupled with

2. The more disadvantaged and overlooked the population being served, the poorer the training and resources available to the frontline staff who serve them (this is a statement of empathy, not disrespect). A great and unfair burden falls on staff with limited training and experience.

Do not expect expertise from this combination. In settings that deal with the worst human problems, training should focus on collecting data as objectively and clearly as possible at the lower levels, but analyzing and drawing conclusions is a higher-level function that requires professional training and experience. In many cases with sexual abuse allegations, this higher level function is never performed or significantly delayed while misguided efforts to help compound the problems.

A Case Example

To illustrate the forces at work and the complexity of ethical and professional issues, the following and unfortunately “typical” case is offered.
Assume a divorce proceeding involving two parents and a preschool aged child 4 to 5 years old. At a point shortly after the initial separation, allegations are made by the mother on behalf of the child that indicate possible sexual abuse. There is no history of previous allegations being made.

To support these claims, the mother (often advised by her attorney) takes the child to a pediatrician for an exam. The pediatrician sees only the child and the mother and receives all of the background information from the mother. Physical findings are negative. The mother subsequently takes the child to a mental health professional and relates information concerning the child’s behavior and reasons for suspected abuse. The mental health professional obtains information only from the mother and child, but is told about the previous pediatric examination. The physician may also have already made a mandated report which is described by the mother as a “finding” regarding abuse.

The mental health professional does not contact the other parent, who has not been informed of the appointment or the allegations. Based on some behavioral evidence and statements given, the mental health professional may also make a report to child protection authorities, who proceed with an investigation.

The OCS investigation automatically stops any visitation between the suspected parent and child. Pleadings are filed in court to eliminate visitation or have it supervised (often in an ex parte hearing in which information from the evaluations is presented for the first time). The judge “out of an excess of caution” concurs that visitation will be suspended until further evaluation can be completed.

The accused person is not allowed to have contact with the child and, should he become angry and upset with the mother, may find himself under a temporary restraining order. The accused parent may also be denied access to schools or information about the child and may find communication with daycare personnel cut off. This parent is often advised by his attorney to refuse to have any contact with previous evaluators who have seen the mother and/or child, as these people will be considered biased.

An independent custody evaluation may be requested where a petition is made to the court to require all parties to participate. However, the court may instead require that the accused parent undergo a mental health evaluation concerning their emotional stability, propensity for abuse, or fitness to proceed as a parent with visitation. The person performing this evaluation may have no access to the children or the accusing parent.

By this time, an array of as many as five or six mental health professionals may have become involved, none of whom has contemporary and comprehensive information about the history preceding the allegations, events subsequent to the allegations, results of other assessments, or contact with all involved parties. The evaluator may then be called to court to present findings, often as a witness for the particular party they have assessed. The length of this process may take from two to three months to a year or more, during which the accused parent may have little or no opportunity to meet or interact with their child.

If a full court hearing is completed and there are no definitive findings of abuse, the length of time with no contact and the resulting estrangement often necessitates meetings in a therapist’s office or supervised visitation on an infrequent basis to attempt a restoration of the parent/child relationship and progress toward a more normal course of visitation. In some cases, especially if the allegations have been adamantly maintained or supplemented throughout the process, there will be an immediate resumption of fresh allegations once visitation is resumed, setting the stage for another round.

The negative impacts on a child in the preceding section include the following:

1. The child suddenly and often inexplicably loses contact with the accused parent.

2. The child becomes the “litmus test” whose behavior, thoughts, and feelings are intensely scrutinized for any clues that might suggest or support allegations of abuse.

3. A child who reports information may have this information edited and reflected back by their parent, with interpretations or suggestions about what the child remembers or has experienced, along with comments about the intentions of the other parent. The child is exposed to an intense focus on sexual topics and behavior. Multiple evaluations suggest to the child that information of a sexual nature is considered highly important and attended to very closely. Care is often taken to reassure the child that producing and elaborating this material both in language and behavior will bring no negative consequences and indeed may bring praise.

4. Multiple evaluations imply that many adults are interested in and concerned about the sexually charged behavior. The child is led to assume that something “bad” or “wrong” has or was occurring during the time spent with the other parent. Often caretakers and teachers are alerted to observe the child’s behavior and are given background information suggesting reasons why they need to be concerned.

Do’s and Don’ts for Mental Health Professionals

• Whenever receiving an initial referral concerning a child, always ask whether there is an intact family situation. If not, ask what type of custody and visitation arrangements are in place, to be sure there is no underlying agenda.

• If it appears that the information developed from assessment or treatment is quite likely to be used in a forensic setting, immediately make it clear there will be strict rules and conditions agreed to before any services will be provided.

• The best practice is to perform only court-ordered evaluations that allow access to all parents and children. The next best practice would be that both parents be notified and informed of the nature and reason for the services with full access to information and participation by both. With extreme caution: agree to see one party only for a specific purpose, not relating to custody itself, with a clear explanation of the limitations in making any interpretations involving the other parties. Finally, a collaborative approach with other involved professionals is likely to be a good idea.

For Custody Evaluators:

1. Be aware of contamination effects from the number of previous assessments.

2. Do not use questionable or unsubstantiated assessment methods such as dolls.

3. Develop a model and structured approach in terms of interpreting data for relevance and weight (for example, timing of allegations, alternative explanations for normal developmental behavior, possible other potential perpetrators, information from other evaluations, etc.).

4. Remember that there is no expert instrument or procedure that can say whether sexual abuse did or did not take place.

Summary

It takes a brave soul to venture into the arena of high conflict custody battles, as well as any other areas that involve allegations of sexual or physical abuse. These cases are complex and problematic, in that concrete and objective information is scarce, with a considerable amount at stake in terms of emotional and legal consequences. Most judges dread situations in which there is ambiguous evidence and the need to make findings that pose a risk of failure to act on legitimate abuse allegations versus severe damage to parental access to relationships with
children. Attorneys who are advocating for a parent risk failing to act in the best interest of the children. Attorneys should never advise a client to get an evaluation or treatment concerning a child without notifying the other parent and providing an opportunity for them to participate in the
process. There should not be a contest to see who gets to court or the professional’s office
first. Mental health practitioners are presumably guided by children’s best interest, but there are often forces at work that involve multiple roles and becoming manipulated into questionable ethical positions. 

Courts should strongly discourage ex parte or one-sided presentations of “evaluations” or treatment findings where the source of the information is compromised by lack of access to all
information. Appointing an independent practitioner who has full access to all relevant parties, persons, and information is definitely the best practice.

The Louisiana Supreme Court case illustrates the major need for more training and education at all levels (attorneys, judges, and mental health professionals) to avoid the collateral damage done in attempting to work with cases involving sexual abuse
allegations. One of the best available resources would be the Association of Family Conciliation Courts, which has addressed this serious issue over the years in journal articles, training/workshops, and provision of model standards and guidelines for competent and ethical practice. Every national annual conference addresses the problems and developments in this area with reports from leading researchers and practitioners. May 27-29th of this year will afford a golden opportunity for practitioners and educators as the National Conference is held in New Orleans.