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LSBEP Sends Blistering Critique to Psych Boards in US & Canada. ASPPB Rescinds Decision to Make EPPP-2 Mandatory

On August 17, President of the Association of State and Provincial Psychology Boards (ASPPB), Sharon Lightfoot, PhD, announced that the ASPPB Board of Directors voted to rescind their 2017 decision, a decision which would have essentially mandated a second exam for those seeking a license in psychology.

“Based on your input this summer and our own priority-setting,” wrote Lightfoot, “the ASPPB Board of Directors on Sunday August 12, passed a motion to rescind our decision of August 2017 and announced to you in October that made the Enhanced EPPP (including both knowledge and skills portions) as the single licensure exam offered by the ASPPB.”

“We will continue toward launch of the Enhanced EPPP in 2020,” Lightfoot said, “and make it available to states and provinces interested in serving as early adopters. We are lifting the requirement for use of the Enhanced EPPP and are lifting the deadline for implementation.”

Lightfoot’s announcement came after a blistering critique of ASPPB’s methods, sent July 20 on behalf of the Louisiana State Board of Examiners of Psychologists (LSBEP) and signed by Executive Director Jaime Monic. The letter listed numerous criticisms and was addressed to the ASPPB Board of Directors, ASPPB members, and copied to the administrators at state psychology boards across the US and Canada.

“LSBEP does not believe that data exists demonstrating that psychologists are not already held to high standards of competence,” wrote Monic. “The data that exists in terms of complaints and disciplinary actions toward psychologists also does not support the theory that competency problems abound in the field of psychology. In fact, ASPPB’s own data regarding complaint patterns notes that ‘Incompetence’ is not even among the top 10 reasons psychologists were disciplined in 2016 (the most recent year of date reported). Moreover, reported disciplinary action (for any reason) has steadily decreased since 2013.”

“Nationwide, ASPPB reported that only 12 licenses were revoked in both 2015 and 2016,” Monic said. “These numbers are exceedingly low and do not suggests that public safety is in question. Therefore, LSBEP is not convinced that another exam is justified by the current data. Prior to instituting additional barriers to the process of licensure by the LSBEP, clear rationale must be presented for their necessity.”

The letter also noted that there is a strong anti-regulatory climate in the country and that Board members are concerned that additional barriers to practice would draw the attention of Louisiana legislators. They also criticized the idea put forth by the ASPPB that additional testing for psychologists would bring the professional psychology in line with medical training, saying that these two professions are inherently different.

Monic, on behalf of the Board, also pointed out concerns with validity and test construction. “Psychology has long held itself as the profession with the most expertise surrounding test design and construction. We are uniquely qualified to create and implement assessments. We are trained that tests are not used prior to establishing validity and reliability. Changing statutes and rules preemptively before we know that the test is necessary and valid is not prudent and would prevent us from choosing another, perhaps better, exam from another vendor.”

The authors also criticized ASPPB’s role and reminded them that they are not a regulating body and have no jurisdiction in Louisiana, and that the decision is “…an overstep.”

“We are concerned that ASPPB has lost sight of their original mission, which from this board’s understanding was limited to facilitating communication between various member jurisdictions,” Monic and the LSBEP pointed out, and that mandatory decisions on EPPP-2 do not fit this role but rather the role of a vendor providing a product.

The expansion of the current licensing exam, called the EPPP2, has been a source of controversy in Louisiana and for some other state boards.

In 2016, ASPPB CEO, Dr. Stephen DeMers, told the state boards that the ASPPB Board of Directors approved the development and implementation of a second examination to assess competency-based skills. Through 2016 and 2017 the new “skills” test was promoted as a voluntary addition to the Examination for Professional Practice in Psychology (EPPP).

Through 2016 and 2017 objections to the EPPP-2 mounted, mostly from student and early career psychologist organizations. In Louisiana, Dr. Amy Henke, then a Director on the Executive Council of the Louisiana Psychological Association (LPA) and Co-Chair of the LPA Early Career Psychologists Committee, put forth a Resolution to oppose the EPPP-2 for Louisiana. The Resolution passed unanimously.

However, then, in a surprise move, the ASPPB Board voted to make the new test mandatory. In late 2017 Dr. DeMers announced that the EPPP-2 was no longer going to be voluntary and that the price would increase from $600 to $1200 for the two sections.

Issues of need and statistical validity have been concerns for Dr. Henke, the state psychology board, and the state psychological association. She took up the banner for the young doctoral graduates, who will bear the financial and emotional burdens of the proposed new test. Other LPA members began looking closely at the scientific need for the new test and also the methodology.

“There is no evidence that the public is facing some sort of previously unheard of crisis in terms of safety from currently practicing psychologists,” said Henke, who currently serves on the LSBEP.

This past April Dr. DeMers met with LSBEP members and representatives of LPA and others about the objections. After the meeting, Dr. Kim VanGeffen, LPA Past-President and current Chair of the Professional Affairs Committee for LPA, said, “Dr. DeMers acknowledged that, currently, there is not really any research on the validity of the EPPP-2.

“The EPPP2 committee believes that this exam has face validity and content validity,” VanGeffen said. “They are satisfied that these types of validity are acceptable for the EPPP2. There do not seem to be any plans to obtain predictive validity nor does the EPPP2 committee believe that establishing this type of validity is necessary,” she said.

Dr. Marc Zimmermann, past LSBEP board member and Chair of the LPA Medical Psychology Committee, also attended DeMers’ meeting. “I think the idea of measuring a professional’s skills before turning him/her lose on the public is a good idea. I do not think this attempt hits the mark,” Zimmermann said. “When the Board does oral examinations we come closer to this by allowing the
person to provide reasoning for their projected behaviors.”

“He [Dr. DeMers] stated that there is no predictive validity,” said Zimmermann. “He also threw in that none of the national tests had predictive validity. He reported that content validity was the accepted standard because a test with predictive validity could not be constructed.”

“He said several times that they were just a vendor, but they have put themselves in the position of being the only vendor,” said Dr. Zimmermann, and it impressed him that, “… DeMers had the
temerity to try to sell us something that does not meet the standard that psychological tests being published are expected to have.”

In Dr. Lightfoot’s announcement, she wrote, “our goal is to provide the best possible resource to you to evaluate your candidates. All jurisdictions will continue to receive detailed information about the nature, content, validity, and utility of the Enhanced EPPP as that information becomes available during 2020 and beyond.” The ASPPB is a private, nonprofit, 501(c) tax-exempt corporation located in Tyrone, Georgia. The company states its mission is to “Facilitate communication among member jurisdictions about licensure, certification, and mobility of professional psychologists.”

ASPPB’s main income producing product is the national exam for psychologists, which brings in about $5,000,000 in gross sales each year. They have a few other products, such as the Psychology Interjurisdictional Compact (PSYPACT), a service to coordinate psychologists working across state lines. In 2016 they listed assets of $8,954,240.

The “members” are about 65 representatives from regulatory boards from across the United States and Canada. The boards pay dues to be a member of ASPPB.

While many members are government officials, ASPPB does not follow open meetings laws. Deliberations and decisions are private. “If you are not a member or staff of an ASPPB Member Psychology Regulatory Board or an individual member, you are not eligible to access this section of our website,” they write. Their conferences are also members only.

The company it also owns the intellectual property rights to the EPPP and the data generated by the testing program, which they appear to have acquired in or around 2013 from PES.
ASPPB officials said that the change was “mutually beneficial because ASPPB can now provide a simplified agreement that is more specific to the needs of psychology licensure boards. In addition, the renewal of contracts is expected to be more efficient…” And, “Finally, as voting members of ASPPB, each jurisdiction exercises more oversight of this important examination service by contracting directly with ASPPB for examination services.”

Over the last two years, Henke and others have also pointed to multiple hurdles that candidatesalready must clear, including two years of supervision, a written exam, oral exam, background check, and jurisprudence exam. Additionally, the law allows the board to require additional physical and psychological assessments whenever needed, Henke has pointed out.
However, Dr. Emil Rodolfa, involved with test development at ASPPB, has said he questions if these standards are enough, saying that supervisors have “… difficulty providing accurate evaluations of their supervisees to others who may have to evaluate the supervisee’s competency.”

Dr. Henke has said, “I am particularly concerned about ASPPB Rescinds Decision Continued regulatory boards encroaching ownership of training standards. The goal of a regulatory board, in my personal opinion, is to provide the least restrictive amount of guidelines possible in order to protect the safety of the public.”

Dr. Rodolfa disagrees and said, “Licensing boards have a mandate to ensure that the professionals they license are competent. Competence is comprised of the integrated use of knowledge, skills, attitudes and values.”

[Editors Note: The Times has reported on this topic over a number of years. See reports in past issues, Vol 7, No. 6, No. 5, No. 8, and No. 9, and Vol. 8, No. 12, and Vol. 9, No. 5, available on our website.]

Gov. Edwards Resists Attorney General Landry’s Decision on PreExisting Health Coverage Issues

In September the Governor issued a statement, “Attorney General’s Lawsuit threatens health coverage for 849,000 Louisianans with pre-existing conditions.”

The Governor commented that Attorney General Jeff Landry’s unilateral decision to enter the state of Louisiana into a lawsuit that eliminates health care protections for people with pre-existing conditions would deny people coverage.

On September 10, the attorney general appeared on CNN to discuss his effort. During the interview, said the statement, Landry made clear that prior to joining the lawsuit, he did not have a plan in place to ensure insurance companies do not deny coverage for the 849,000 people in Louisiana who could lose health care because they have a pre-existing condition.

“In Louisiana, 849,000 people have a preexisting condition that could lead to an insurance company denying them healthcare if Attorney General Jeff Landry is successful in his latest lawsuit,” said the Governor.

“It’s deeply disturbing that he has committed the state to this effort without consulting anyone and even worse, without having a plan in place to ensure these individuals do not lose their health care. Entering into this lawsuit should not be an impulse decision. It requires thoughtful consideration of the repercussions to the people of Louisiana. After seeing the attorney general’s interview on CNN this morning, it’s clear he did not think this through. Everyone acknowledges the Affordable Care Act (ACA) has flaws, and we should be working together to fix what’s broken. Protecting coverage for people with pre-existing conditions is one area where there is broad, bipartisan support. If successful, this lawsuit would cause chaos within the health care system, and the people of Louisiana would be left to pick up the pieces.”

The attorney general appeared on CNN to discuss the lawsuit. Pressed by a reporter about his plans for the 849,000 people in Louisiana who would lose health care if the court strikes down the pre-existing condition provision, he had no answer, indicating the attorney general had not spoken to anyone for a “Plan B” prior to filing the lawsuit. The interview is available here.

The press release also offered background, including the following:

According to a Kaiser Family Foundation study, approximately 849,000 in Louisiana have a pre-existing condition that could allow an insurance company to deny them health coverage.

A poll conducted by the UNO Survey Research Center in 2014 found that 76 percent of the people of Louisiana supported “requiring health insurance companies to cover anyone, even if they have a pre-existing medical condition.”

NOLA.com|Times Picayune: “The crux of Paxton’s and Landry’s argument is that Congress has repealed the “individual mandate” that required people to carry health insurance or pay a tax penalty, which means that the whole law should be declared unconstitutional. Paxton and Landry argue that the mandate for health insurance companies to cover people with pre-existing conditions cannot work if the individual mandate to carry health insurance will no longer be in place in 2019.

“…But even if he doesn’t succeed at getting Obamacare thrown out, Paxton has asked the court to still strike down the requirement for insurance companies to cover pre-existing medical conditions in the 20 states participating in the lawsuit, including Louisiana.

“…The Texas Attorney General’s office argued both in written briefs and court Wednesday that states — not the federal government — should get to decide whether health insurance companies are
forced to cover people with pre-existing medical conditions.” [NOLA.com|Times Picayune, 9/7/2018]

State to Reinvest Justice Reform Savings to Reduce Recidivism

Gov. Edwards and the Louisiana Department of Public Safety and Corrections (DPS&C) released the first report outlining savings from criminal justice reform measures passed by the legislature in 2017. The savings, according to the report, have exceeded Pew Charitable Trusts’ projections. Savings for fiscal year 2018 totaled $12.2 million, doubling Pew’s original projections of $6.1 million.

“In 2017, Republicans, Democrats and Independents came together to rethink our criminal justice system,” said Gov. Edwards. “We knew what we were doing just wasn’t working and it was costing us more money. By following the lead of other southern, conservative states, we passed a package of 10 bills that will improve public safety and reduce recidivism.”

“This is great news for the state of Louisiana,” said James M. Le Blanc, Secretary, Louisiana Department of Public Safety and Corrections. “Our goal and our mission with criminal justice reform is to reinvest money we would usually pay for incarceration into programs aimed at better preparing our returning citizens and individuals on probation and parole, and to help victims of crime.”

The Justice Reinvestment bills are anticipated to save the state more than $262 million over the next decade, and 70 percent of the savings will be reinvested into programs to reduce recidivism and support victims.

The Department currently intends to use first-year reinvestment funding in support of the following priorities: Increasing programming for state inmates housed at local jails; Enhancing and expanding Regional Reentry Centers; Increasing Probation and Parole staffing and Day Reporting Centers; Launching a Transitional Housing pilot program; Opening a new Reception Center to conduct assessments for new inmates; and Expanding Specialty Courts.

Grants to Community-Based Services: With the goal of ensuring this funding is spent in the most effective and transparent way possible, DPS&C has created a Community Incentive Grant Program and has issued a Request for Proposals (RFP).

The RFP is intended to elicit proposals from qualified community organizations that are interested in enhancing or expanding coordination of reentry services and community supports to increase prison alternatives and reduce recidivism. Funding will be awarded in the fall of 2018.

Grants to Support Victims’ Services: Louisiana Commission on Law Enforcement (LCLE) currently intends to use first-year reinvestment funding in support of the following priorities:

Supplementing the Crime Victims’ Reparations Fund; Establishing a new Family Justice Center in East Baton Rouge Parish; Improving
electronic notifications for victims by developing an electronic system that will interface with all 64 parish clerks of court; and Providing funding to the Louisiana Bureau of Investigations for a dedicated forensics server for their Cybercrimes Unit.

Prior to the passage of the Justice Reinvestment Initiative (JRI) legislation, Louisiana was leading the nation in imprisonment, with a rate nearly double the national average.

Dr. Susan Tucker, psychologist with the DPS&C has been working on programs to reduce incarceration rates. In 2016 legislators pointed to multimillion dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed and delivered by Tucker and her team at the Bossier Sherriff’s Office, Medium Correctional Facility, located between Benton and Plain Dealing, Louisiana. Dr. Tucker has been working on reducing the rates through her comprehensive, innovative, and evidenced-based programs, to improve lives, families and community safety.

“I am very proud of our program and that we accomplish two goals which save taxpayer money but also provide rehabilitation to the substance abuse incarcerated offenders as well as their families,” Dr. Tucker told the Times.

Governor Appoints Dr. Gormanous to Psychology Board

In a July 10 press release the Governor announced that he appointed Greg Gormanous, PhD, of Alexandria, to the Louisiana State Board of Examiners of Psychologists (LSBEP).

Dr. Gormanous will fill the position opened by Dr. Phillip Griffin, who has completed his term. Vice Chair Dr. Jesse Lambert was elected to theChair at last month’s meeting and Dr. Koren Boggs will serve as Vice Chair.

Dr. Gormanous previously served on the board twice, the first time in 1981 to 1984, and then from 1986 to 1989. He is Professor Emeritus of Psychology, LSU Alexandria, and earned his PhD from the University of Southern Mississippi in General Psychology in 1976. He has been a member of Association of State & Provincial Psychology Boards (ASPPB), the Federation of Associations of Regulatory Boards, the American Psychological Association, the Society for Industrial & Organizational Psychology (APA Div. 14), the Society of Consulting Psychology Louisiana is Heading in Right Economic Direction Says Governor Edwards in July (APA Div. 13), and the Association for Psychological Science. He is also a veteran of the United States Army.

Dr. Gormanous was the sole candidate to selfnominate for the current position and was nominated by the Louisiana Psychological Association.

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

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

When applying to serve, he listed six specific issues:

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

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

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

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

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

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

In a 2010 Times feature article (“Close-Up,” Vol. 2. No. 1.) Dr. Gormanous said that his heart was in teaching.

“Teaching is my drug of choice,” he said “I was one of those people who, in the Ericksonian sense, was late in forming my identity. I wanted to be a college professor. It was English, then math, and then I stumbled across psychology. I realized it was the field where I could discover myself, and discover my need to teach. I love to teach and help develop people, and we have students who want to learn and develop, and so it’s been a perfect fit.”

At that time, Dr. Gormanous has remained involved in his community through efforts with the Alexandria Zoo, Business Incubator, the Rapides Parish Primary Health Care Center, the Syra-Meric Club, and the Alexandria Mardi Gras Association, where he started a new parade – Classic Cars & College Cheerleaders. He also started the Krewe of Kolbi Bow-Wow with the Animal Shelter and the Alexandria Zoo. This is a dog Krewe that advocates for pet adoptions. He has been active with the Chamber of Commerce, Rotary Club of Alexandria, and the Convention and Visitors Bureau.

While his heart might be in teaching, his soul is in the blues. A special project, “Psychology of the Blues,” where he applied psychological principles to songs and singers, and how they have been molded into who they’ve become, has captured his imagination for many years.

“Psychology of the Blues” involves four musicians as he explained–Otis
Redding, Steve Cropper, Grady Gaines, and the great B.B. King.

“I’ve had the privilege of knowing, and sort of informally and unofficially traveling with B.B. King since 1983,” he said. In 1983 Dr. Gormanous attended an event memorializing the slain civil rights leader Medgar Evers. “Charles Evers and B.B. King
wanted to keep the spirit of Medgar alive,” he said.

“BB King and his band played free so that music could be the language to bring people together to overcome racism.” He realized then that music was a vehicle to change the world and it inspired him to be involved.

Louisiana Psychological Assn to Host Evolutionary Psychology Legend, Professor Robert Trivers

Times Magazine listed him as one of the 100 Greatest Thinkers of the 20th Century. Richard Dawkins calls him “A uniquely brilliant scientist.” Science named him “One of the most influential evolutionary theorists alive today.”

Stephen Pinker, Professor of Psychology at Harvard and author of How the Mind Works, said, “I consider
Trivers one of the great thinkers in the history of Western thought. It would not be too much of an exaggeration to say that he has provided a scientific explanation for the human condition: the intricately complicated and endlessly fascinating relationships that bind us to one another.”

He is Professor Robert Trivers, the man who pulled back the curtain on key concepts of evolved preferences, and produced a major redirection in social and evolutionary psychology. He will speak at the Louisiana Psychological Association workshop on November 9, in New Orleans.

In a series of brilliant papers beginning in the 1970s, he laid out the evolutionary logic and foundational theory for major areas of human social interaction. His combining of psychology and evolutionary biology opened the door to a better understanding of the deep connections of love, cooperation, competition and the unconscious conflicts that accompany them.

In 1971, with, “The evolution of reciprocal altruism,” Dr. Trivers put the heart back into the psyche: Being moral, good, and fair, had in fact, evolved right alongside our purely selfish traits.

The model is where “friendship, dislike, moralistic aggression, gratitude, trust, suspicion, trustworthiness, aspects of guilt, and some forms of dishonesty and hypocrisy” could be explained as important adaptations to regulate the reciprocalaltruistic system, sensitive to developmental variables and selected to their specific social environment.

Trivers’ theories inspired a staggering amount of research and discussion with bestsellers like E.O. Wilson’s Sociobiology and Richard Dawkins’ The Selfish Gene, and later books like The Adapted Mind, The Red Queen, Born to Rebel, The Origin of Virtue, The Moral Animal, and Evolution of Desire.

As the explosion of research continued, Trivers wrote that some of the ideas had “…almost biblical proportions.” He said, “… you could see how a kind of social heaven and social hell could evolve right here on earth. The social hell was perpetual isolation, perpetual inability to link up with others in a positive way, never being cheated by others to be sure, but at the cost of eternal loneliness. The social heaven was not heavenly in some naïve way, dancing around the mulberry bush together without regard for selfish possibilities. Instead, cooperation required perpetual vigilance to enjoy its fruits, …’”

Together, Trivers’ work helped explain evolved tendencies in romantic relationships between females and males (“Parental Investment and Sexual Selection”) relationships between parents and children, and between siblings (“Parent-offspring conflict”), and how friends deal with friends, acquaintances and strangers (“The evolution of reciprocal altruism”).

In the 1990s, Trivers took another leap and explained an evolutionary logic of self-deception. (“The crash of Flight 90: Doomed by self-deception?” co-authored with Black Panther leader, Huey P. Newton; and “The elements of a scientific theory of self-deception”).

Dr. Trivers has stated that he “… was eager to contribute to building social theory based on natural selection, because a scientific system of social theory must, by logic be based on natural selection, and getting the foundations correct would have important implications for understanding our own psyches and social systems.”

Today, while psychology includes vast amounts of fascinating data and interesting partial theories, it still lacks a foundational, meta-theory, say evolutionary psychologists William Von Hipple and David Buss. In their survey, the two found that almost 90% of social psychologists accept Darwin’s ideas in general, but only about 50% believe that evolved characteristics apply to the human mind and social tendencies.

Trivers himself wrote that he expected his work would be welcomed––he viewed himself to be “on the side of the angels,” he said. Instead, it was labeled “regressive.”

In the past, evolutionary theory may have seemed harsh, and even to be a theory that gives permission for inequality, something psychologists work against. Von Hipple and Buss point to the mistaken idea of “genetic determinism”––the belief that genetic behavior is fixed, and also to the confusion between evolved preferences and actual behaviors in modern humans, as contributing to discomfort with embracing evolution as a metatheory.

Today, a stronger understanding that the expression of these predispositions is plastic, fluid, varying and context-dependent, has worked its way into psychologists’ thinking, along with the acknowledgement that the discipline cannot ignore important science only because it may at times be uncomfortable.

“But Trivers’ ideas are, if such a thing is possible,” said Pinker in an interview with the Edge, an intellectual think tank, “even more important than the countless experiments and field studies they kicked off. They belong in the category of ideas that are obvious once they are explained, yet eluded great minds for ages; simple enough to be stated in a few words, yet with implications we are only beginning to work out,” Pinker said. This may be the case. Trivers Google Scholar citations, now over 44,500, are continuing to increase. Citations for his 10 major papers are much higher now than they were for the first 30 years after publication.

The Louisiana Psychological Association will host the evolutionary theorist at their winter workshop, to be held Friday, November 9, at the Hotel Monteleone in New Orleans.

The one-day event, “Evolutionary Psychology & Ethics,” will address the scientific foundations of self-interest, reciprocal-altruism, cooperation and deception in human relationships, and the evolutionary logic that predicts this complex psychological terrain.

Dr. Trivers will speak on “Ethics and Social Theory: The Evolution of Reciprocal Altruism,” and then on “The Logic of Deceit and Self-Deception.

“I will define natural selection, the basis social traits, then concentrate on altruism and quickly move to reciprocal,” he said, and explain gross and subtle cheating, sense of justice and other traits.

In “The Logic of Deceit and Self-Deception,” he will start with the co-evolutionary struggle between deceiver and deceived, the intrinsic bias in favor of the deceiver, and the invention of self-deception to facilitate deception.

Also presenting and participating as discussants will be Dr. Jack Palmer, from University of Louisiana Monroe, author of Evolutionary Psychology: The Ultimate Origins of Human Behavior.

Dr. Matthew Rossano, from Southeastern Louisiana University, author of Supernatural Selection: How Religion Evolved, will also present.

Dr. Michael Chafetz, known for his extensive work in malingering research, and Dr. Denise Newman, chair of the Louisiana Psychological Association Psychotherapy Interest Area and a psychoanalytic psychologist, and others.

Brilliant and controversial, Robert Trivers has attracted attention for his immensely original thinking and also for his unconventional activities. He currently lives in Jamaica, which he loves, and where he studies body symmetry in elite runners, and where he recently completed an autobiographical memoir––Wild Life: Adventures of an Evolutionary Biologist.

Registration opens August 10 at louisianapsychologicalassociation.org

Munchausen Syndrome by proxy Act 193 Taps into Complex Issues in Effort to Limit Diagnostic Errors

In the 2018 regular session, House Bill No. 145 placed limitations on who may diagnose the disorder known as “Munchausen Syndrome by proxy,” which is known in the DSM-5 as factitious disorder imposed on another or FDIA. The bill, by Representative Kenny Cox, was signed by the Governor and became Act 193.

Formally known as Munchausen syndrome by proxy (MSP), this condition is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. In some cases, illnesses may be actually produced by the caretaker.

Act 193 directs that no physician or other health care provider shall diagnose the condition of factitious disorder imposed on another (formerly “Munchausen syndrome by proxy”) unless he or she meets certain criteria, such as being licensed, qualified by his or her license and training to diagnose, able to provide a certain level of quality in the evaluation, and other stipulations. The new law indicates that the evaluator must review relevant records, history, current clinical conditions, and obtain records from external sources searches schools, childcare providers, and family.

While these quality controls and expectations are standard for psychological evaluation, Representative Cox’s measure suggests that problems have been encountered in the past in this complex area where teasing out the accuracy of claims and symptoms could require a deeper understanding of illness-deception.

The measure was signed by the governor recently and became law as Act 193. However, the real complexities of the matter may still cause issues for those practitioners who are not highly trained to understand nuances and pitfalls regarding illnessdeception.

Dr. Michael Chafetz, a nationally recognized expert when it comes to malingering in forensic and medical
assessments, points to the complexities in understanding these issues.

“Every practitioner who makes a diagnosis has two potential positive outcomes and two potential errors,” said Chafetz. “If the diagnosis is made and is correct, it is a good thing because the patient has the pathology identified and can get appropriate treatment. If the diagnosis is correctly rejected (because no evidence for the pathology could be adduced), it is a good thing because the patient is spared the wrong treatment for pathology that does not exist.”

“The flip side of the positive outcomes involves the errors that are potentially made,” he said. “If the practitioner makes a diagnosis of a condition that the patient does not have, that is a false-positive error. Everyone involved with the case is now acting on false new information about the patient.

“On the other hand, if the practitioner rejects the diagnosis for a condition that the patient does have, that is a false-negative error,” he explained. “This error can be problematic, as no one involved with the case will get on board with the appropriate interventions.”

In decision-making, there is often a trade-off between false-positive and falsenegative errors, and the importance of not making one or the other depends on the relative merits of the outcomes, he explained. “For example, in cancer screening and bomb detection, a false negative error can be more costly than a false-positive error. TSA certainly does not want to miss a bomb, and the radiologist certainly does not want to miss a possible cancer. These false-positive errors may cause some discomfort, but they sure beat the alternatives!”

In Factitious Disorder Imposed on Another, both kinds of errors have realworld consequences. “If the practitioner makes a false-negative error, missing the parental deceptions, the parent does not get diagnosed, which increases the potential for a child to suffer abuse,” Dr. Chafetz said.

“If the practitioner makes a false-positive misdiagnosis of the parent, that parent may face drastic consequences with the possibility of termination of their parental rights.”

He noted that Factitious disorder (FD), like malingering (M), involves deceptive behaviors. In fact, both FD and M are similar in that they both involve deception of others. Malingering involves deception in a medico-legal setting, whereas FD typically occurs in a medical or psychological setting.

The “by-proxy” or “imposed on another” conditions for both disorders are meant to convey that an individual, usually a caretaker, is creating the deception by use of a person under their care.

Dr. Melissa Dufrene and Chafetz have studied these exact issues, in Chafetz, M.D., & Dufrene, M. (2014). Malingering-by-proxy: Need for child protection and guidance for reporting. Child Abuse & Neglect, 38, 17551765.

Both of the by-proxy or imposed conditions can lead to child abuse, he explained. In their guidance article, Chafetz and Dufrene developed guidelines for reporting.

Dr. Chafetz has also discussed these conditions in a physicianeducation article, Chafetz, M.D. (2018). Factitious Disorder Imposed on Another and Malingering by Proxy: Controversies, Recognition, Responsibilities, and Management. American Physician Institute, CMEtoGo, Volume 7, Issue 2.

It is important to recognize that both conditions, M and FD, involve deception of others. Typically, psychological treatments do not take into account the deception, he said.

While Act 193 may help somewhat to make sure qualified professionals are called upon for these complex issues, there could still be a lot of confusion for those that do not have the tools and methods to evaluate these serious issues.

Lawmakers Finally Make a Budget Deal

After a total of seven special sessions since 2016, and three special sessions this year, Governor Edwards and legislators finally wrestled the budget into some type of order by the passage
of an extra .45 percent sales tax, in down to the wire negotiations that ended last week. The move sidesteps drastic cuts to public health and higher education and provides several years
of stability.

The new tax will raise an estimated $463 million to plug holes in the budget hat if left unresolved, had threatened to bring dramatic cuts in health care services and what the Governor called
“a catastrophic cut” to higher education.

The new sales tax, a partial renewal of an expiring one percent sales tax, is said to give the lawmakers some respite from the yearly battles with the budget. The .45 brings the state sales
tax to 4.45.

“The fiscal cliff is now gone and we have predictability ahead of us,” the Governor said after the agreement passed in this year’s third special session.

In the special sessions lawmakers were attempting to deal with the state’s budget crisis when more than $1 billion in taxes would expire on June 30, 2018. The two earlier special sessions
floundered after the House repeatedly rejected increased taxes. The House passed a budget that made dramatic cuts to TOPs, universities and state agencies, and then that was vetoed by
the Governor.

Allowing the new arrangements, this week Moody’s Investors Service changed Louisiana’s rating to “stable.”

Gov. John Bel Edwards said, “Today’s action by Moody’s validates what we’ve been saying about the need for budget stability,” said Gov. Edwards.

“Thanks to the bipartisan compromise achieved during the last special session, Louisiana is no longer on the negative watch list. By working together, for the first time in a long
time, Louisiana’s budget will have the kind of stability and predictability we need to bring new business opportunities to our state and grow our economy. As a result, not only are the
credit rating agencies taking notice, but we are positioned to generate greater savings for our state that will enable us to continue on our path toward prosperity.”

Consumer Member to be Added to Psychology Board New Legislation Brings Change to State Boards

In his effort that has been ongoing for three years, Senator Fred Mills’ measure was signed into law as Act 515, requiring boards such as the state psychology board to make several changes, including adding a consumer member.

Act 515 transfers the healthcare professional licensing agencies, boards, commissions, and like entities to the La. Department of Health (LDH) and deletes repealed and obsolete citations and references.

The new law adds at least one consumer member to each healthcare professional licensing board that did not previously have one and provides standardized eligibility criteria for such
consumer members.

The new law also requires the governor to ensure that his appointments to healthcare professional licensing boards demonstrate diversity with respect to race, gender, ethnicity, and geography.

New law also authorizes all licensing boards and commissions created and provided for in prior law to develop a process to issue a license, permit, or certificate outside the national
examination for those individuals with a disorder which is recognized by the Americans with Disabilities Act.

An effort to take professional associations out of the direct loop for board nominations was amended out of Senator Mills’ measure.

Some of the intent by Senator Mills’ efforts found its way to Act 623, the Occupational Board Compliance Act, authored by Representative Connick. The goal is to help boards use the least
restrictive regulation necessary, in regard to market competition and other factors, in their efforts to protect consumers from present, significant, and substantiated harms that threaten public health and safety.

Act 623 creates the Occupational Licensing Review Commission, comprised of the governor, secretary of state, commissioner of agriculture, commissioner of insurance, and the state treasurer, or
their respective designees, who are responsible for active supervision of state executive branch occupational licensing boards.

In a related measure, Act 655 allows that a person who has a disciplinary action brought against him or her by the La. State Bd. of Dentistry or the La. Auctioneers Licensing Bd. to elect to have the matter moved to the division of administrative law for a disciplinary adjudication by an administrative law judge. The measure also directs boards to develop process for different exams for those with disabilities, and submit quarterly reports to the legislative oversight committee about complaints regarding board actions.

Act 696 Allows Behavioral Health Providers to See Clients at School

Act 696 by Representative Pierre, allows a behavioral health provider to provide behavioral health services to a student at school during school hours if requested by the student’s parent or legal guardian.

The Act defines “Behavioral health provider” as a provider who is licensed by the Louisiana Department of Health or a health profession licensing board including but not limited to a psychiatrist, psychologist, medical psychologist, licensed specialist in school psychology, marriage and family therapist, professional counselor, clinical social worker, or a behavioral health provider organization licensed to provide behavioral health services in Louisiana.

According to the digest of the bill, services include individual psychotherapy, family psychotherapy, psychotropic medication management, community psychiatric support and treatment, and crisis intervention. Also, “Evaluator” shall mean a licensed psychiatrist, psychologist, medical psychologist, licensed specialist in school psychology, professional counselor, marriage and family therapist, or clinical social worker who is certified by the respective board of examiners in Louisiana to provide necessary evaluations and who is not an employee of the public school governing authority or the state Department of Education.

Behavioral health services shall be permitted during school hours if the student’s parent or legal guardian presents a behavioral health evaluation performed by an evaluator chosen by the parent or legal guardian and the evaluation indicates that the services are necessary during school hours to assist the student with behavioral health impairments that the evaluator determines are interfering with the student’s ability to thrive in the educational setting.

The Act says that a behavioral health evaluation presented by the parent or legal guardian of a student shall not be construed as an independent educational evaluation for purposes of determining if a student meets the criteria established for eligibility for special education and related services.

The cost of all behavioral health services provided to a student shall be the sole responsibility of the parent or legal guardian.

The parent or legal guardian of a student receiving services from a behavioral service provider shall be required to execute a “consent to release information form” between the provider and the public school governing authority. And a public school governing authority shall not enter into a contract or an exclusive agreement with a behavioral health provider that prohibits the parent or legal guardian from choosing the behavioral health provider for the student.

Governor Signing Bills Into Laws

The Office of the Governor has been announcing a steady stream of measures being signed into law by Gov. Edwards.

Included in the recent list is the Zero Suicide bill, which authorizes the Louisiana Department of Health to create a program that helps healthcare professionals to prevent suicide. He also signed Act 43, which expands the substance abuse probation program to include treatment for mental health and Act 251 which creates a pretrial diversion program for veterans diagnosed with posttraumatic stress disorder. Act 352 provides for oral and telephonic orders of protections under exceptional circumstances and Act 480 prohibits state agencies from contracting with lobbyists.

Following are some of the measures the Governor signed into law in May:

ACT 38 – SB 275 Authorizes individuals to indicate that part of their refund go to the La. Coalition Against Domestic Violence for education of women who are victims of domestic violence.

ACT 103 – HB 711 Moves the Louisiana Council on the Social Status of Black Men and Boys, to the office of the governor, and changes the name to the La. Council on the Success of Black Men and Boys, which is to be the leading entity that provides and promotes an environment that is conducive to prosperity, success, and excellence for all black men and boys in the state.

ACT 152 – SB 284 Amends the present law regarding Disaster and Emergency Medical Services Committee of the Louisiana State Medical Society, by removing some references to the Medical Society and the Society’s approval of Rules.

ACT 193 – HB 145 Provides limitations on diagnosing of the disorder commonly known as “Munchausen syndrome by proxy”, and on initiation of child welfare proceedings.

ACT 227 – SB 24 Provides relative to social work practice. New law provides that a faculty member who has obtained a master’s degree or license in a field other than social work and who teaches a course in a social work program other than a clinical course, a clinical practicum, or any other course involving the scope of practice of social work at an accredited Louisiana institution of higher education shall not be construed as practicing social work or subject to the licensing of a social worker.

ACT 236 – SB 199 Creates the Advisory Council on Historically Black Colleges and Universities.

ACT 251 – SB 548 Creates a pretrial diversion program for veterans diagnosed with posttraumatic stress disorder. In addition to any existing pretrial diversion program, the district attorney for each judicial district, alone or in conjunction with the district attorney of an adjacent judicial district, may create and administer a special pretrial diversion program for defendants who meet requirements.

ACT 263 – HB 79 Creates the crime of abuse of persons with infirmities through electronic means and provides for criminal penalties and exceptions. The crime is where a person transfers an image that was obtained by any camera, videotape, or other device, of any person with an infirmity. “Person with an infirmity” means a person who suffers from a mental or physical disability, including those associated with advanced age, which renders the person incapable of adequately providing for his personal care.

ACT 270 – HB 524 Requires policies prohibiting sexual harassment and annual training on preventing sexual harassment for public officers and employees.

ACT 271 – HB 735 Establishes a workforce training pilot initiative to serve public assistance recipients in certain regions. Proposed law requires the executive director
of the La. Workforce Commission, the secretary of the Dept. of Children and Family Services, the secretary of the La. Dept. of Health, the state superintendent of education, and the president of
the La. Community and Technical College System, referred to collectively in proposed law as the “state partners”, to collaborate to design and implement a workforce training and education pilot initiative for public assistance recipients.

ACT 273 – HB 394 Establishes the Post-Conviction Veterans Mentor Program and the
procedures by which a veteran is determined to be eligible for the program and the procedures for the veteran’s participation in the program.

ACT 281 – HB 775 Provides relative to the reimbursement of healthcare providers. Provides for payment to a new provider in a contracted network of healthcare providers and authorizes recovery of certain amounts upon denial of an application for credentialing.

ACT 290 – HB 875 Provides relative to health insurance network provider directories. Requires the posting and regular updating of a directory of a health insurance issuer’s network of providers. Requires the directory to be both electronically searchable by
name, specialty, and location and publicly accessible without necessity of providing a password, a user name, or personally identifiable information.

ACT 320 – HB 466 Provides relative to court-appointed special advocates. Grants authority to court appointed special advocate program (CASA) volunteers to access a child’s home and to attend all administrative review hearings and family team meetings related to the case, and provides for the screening of CASA staff members or members of the board of directors.

ACT 324 – HB 539 Provides for an expedited licensing process and associated fees for facilities and providers licensed by the La. Department of Health, including Adult day health care facility; home health agency; hospice; hospital; intermediate care facility for people with developmental disabilities; psychiatric residential treatment facility; therapeutic group home; crisis receiving center; home- and community based service provider; adult residential care provider.

ACT 352 – SB 72 Provides relative to the execution of an order for protective custody and examination. New law provides that a coroner or his staff may apply to the court for an order of protective custody that allows law enforcement to use forced entry to gain access into premises when executing an order of protective custody. New law provides for accompanying documents for an order for protective custody and provides for both oral and telephonic orders of protections under exceptional circumstances.

ACT 353 – SB 99 Extends legislative authority for the Louisiana Behavior Analyst Board. New law changes the year of termination from 2018 to 2028.

ACT 354 – SB 101 Creates the Louisiana Sexual Assault Oversight Commission. New law replaces the current task force with the La. Sexual Assault Oversight Commission (the commission) within the office of the attorney general to develop recommendations for a standardized sexual assault collection kit and protocols for forensic medical examinations to be used statewide.

ACT 359 – SB 147 Provides relative to a defamation claim brought by an alleged
perpetrator of sexual misconduct against the alleged victim. New law provides that a court shall stay proceedings in cases of defamation of character, libel, slander, or damage to reputation brought by an alleged perpetrator of sexual misconduct against the alleged victim. Further provides that the stay shall remain until the completion of all investigations, hearings, or proceedings relating to the allegations of sexual misconduct.

ACT 361 – SB 166 Requires the National Human Trafficking Resource Center hotline information to be posted in additional locations.

ACT 375 – SB 306 Provides relative to Assistive Outpatient Treatment. New laws outlines matters for involuntary outpatient treatment, including: The court shall not order involuntary outpatient treatment unless an examining physician, psychiatric mental health nurse
practitioner, or psychologist develops and provides to the court a proposed written treatment plan, which specifies a provider that has agreed to provide services.

ACT 392 – SB 558 Provides relative to incarcerated women. Requires wardens or sheriffs of a correctional facility to make certain healthcare products available, in housing units and in the medical area, to all women incarcerated in a correctional facility at no cost and in a quantity that is appropriate to the needs of the woman without a medical permit.

ACT 402 – SB 66 Provides relative to admission to treatment facility for mental
illness pursuant to emergency certificate. New law retains prior law but requires physicians executing an emergency certificate to be licensed or permitted by the La. State Board of Medical Examiners.

ACT 409 – SB 207 Extends and provides for the Louisiana Obesity Prevention and
Management Commission.

ACT 412 – SB 291 Provides relative to family violence and domestic abuse as factors to consider in determining visitation and custody. New law retains prior law and provides relative to restriction on visitations for a parent who has subjected a child, stepchild or other household member to a history of family violence or has willingly permitted abuse to his or her children or stepchildren despite the ability to prevent it.

ACT 424 – HB 198 Provides relative to distribution of funding from the Traumatic Head and Spinal Cord Injury Trust Fund. Requires that the Traumatic Head and Spinal Cord Injury Trust Fund is used as a fund of last resort following the exhaustion of Medicare and Medicaid funding.

ACT 431 – HB 440 Expands DPS&C’s substance abuse probation program to include treatment for mental health issues. The program shall provide substance abuse counseling and treatment for defendants, and develop contracts with local governmental entities or the office of behavioral health, training facilities, and service providers.

ACT 450 – HB 148 Provides for implementation of the zero suicide initiative and a state suicide prevention plan. The initiative requires the office of behavioral health to ensure that administrators of all healthcare facilities licensed by LDH and that all healthcare professionals licensed by any Louisiana board or commission have ready access to informational resources and technical assistance necessary for implementation of the zero suicide initiative.

ACT 454 – HB 189 Provides for processes, including public comment, to identify agency rules that may be contrary to law, outdated, unnecessary, overly complex, or burdensome.
Prior law allows any interested person to petition an agency regarding a rule. New law requires the agency to conduct a public hearing for the purpose of comments and to consider fully all submissions.

ACT 458 – HB 488 The mandatory reporting of crimes of sexual abuse of a minor will include female genital mutilation.

ACT 475 – SB 528 Provides relative to physician assistants. New law increases
number of physicians’ assistants that a supervising MD may supervise from four to eight. Physician assistants may apply for prescriptive authority if he/she has 500 hours of clinical training and meets other requirements.

ACT 480 – SB 25 Provides relative to prohibited conduct by state employees and agencies. New law prohibits state government employees from contracting with lobbyists or for lobbying services by use of a contract, memorandum of understanding, cooperative endeavor agreement, or other similar agreement.

ACT 489 – SB 507 In Medicaid managed care organizations, among other requirements, each MCO is to be responsible for ensuring that any provider it contracts with has attained and satisfies all Medicaid provider accreditation requirements and all other applicable state or federal requirements in order to receive reimbursement for providing services to
Medicaid recipients.

ACT 495 – HB 474 Requires additional training for peace officers in domestic violence awareness, including Dynamics of domestic violence, Predominant aggressor determination, communication with hearing impaired, and other topics.

No Deal: Special Session Ends

“Usually the day after session is a day of relaxation after a long few months of hard work and a little late night celebration,” said Keli Williams, with Ourso Consulting.

“Last night was a late night, but there was no celebration. With the last 30 minutes of the special session, which had to end at midnight, the House began taking up the budget bill, HB 1, and the revenue bills, HB 12 and HB 27.”

This special session was the second session and the sixth financial session in the last two years, attempting to deal with the state’s budget crisis when more than $1 billion in taxes are scheduled to expire on June 30. The earlier special session floundered after the house repeatedly rejected increased taxes. At the same time, dramatic cuts in health care services and what the Governor called “could face a catastrophic cut” to higher education had been threatening.

This week the House approved HB 1 but it makes dramatic cuts to TOPS, universities and state agencies, and is similar to the budget that the Governor previously vetoed, explained Williams to the Times.

But the deal collapsed when lawmakers failed to take up the two revenue bills that would have filled the gaps, something the Governor put forth in his hoped for compromise plan.

“HB 12 and HB 27 were both sales tax measures that would have increased the sales tax by 1/2 to 1/3 penny, respectfully, and cleaned some exemptions from the remaining pennies,” said Williams.

“Neither bill was able to gain enough support to pass before midnight,” she said. “With two minutes left, HB 12 was brought up for reconsideration. Rep. Seabaugh went to the microphone to oppose the bill for the purposes of running out the clock, per his own statement at the microphone. A second vote on HB 12 was not taken as time expired.”

As of publication there is no news yet about another special session.

This past weekend the Senate Finance Committee put forth a measure that would begin in July and would cover over $500 million of the state’s $600 million problem.

This is more than the house wanted to cover but not the entire amount that was asked for by Gov. Edwards.

In a May 25 statement Gov. Edward said, “We have a very short window left to fix the fiscal cliff and fund our critical priorities. Right now, the Senate is waiting on bills to come from the House and, with the clock ticking, any day not spent solving this crisis is simply unacceptable to the people of Louisiana. I am here and ready to work, and I’d hoped that the House would do the same. While I’m disappointed that we haven’t made more progress to close the budget gap, the fact that a majority of both the Republican and Democratic caucus members supported renewing a portion of the expiring revenue gives me hope that we can come to an agreement very soon.”

The Republican delegation responded On May 29, “Yesterday, the House of Representatives passed the Republican Spending Reduction Plan that makes sure our critical services like nursing homes and hospitals are funded by renewing one-third of the one-cent sales tax and requires government to reduce it’s spending by 1.3%.”

“The basis for our compromise is that government reduce its spending. Asking state government to cut its spending by 1.3% is not unreasonable. We simply cannot continue to grow the size of government while Louisiana’s GDP is shrinking, businesses are leaving and our population is falling. Again, asking government to reduce its spending by 1.3% is not unreasonable, it’s the most responsible thing we can do.”

In Gov. Edwards’ 2018 Second Special Session opening remarks he said, “The House of Representatives and the Senate passed wildly differing budgets. One completely decimated health care in Louisiana, the other funded health care but decimated higher education and other critical state services like education and public safety, while ignoring that a nearly 25 percent cut to our state agencies would leave thousands of our fellow Louisianans out of work and our agencies unable to do their work.” He asked them to do better.

ASPPB Presents Their Reasoning for EPPP2 At Psychology Board

Steven DeMers, EdD, Chief Executive officer of the Association of State and Provincial Psychology Boards (ASPPB), spoke as a guest at the regular meeting of the Louisiana State Board of Examiners of Psychologists, held Friday, April 20, 2018 at the public library in Baton Rouge.

Along with board members, Drs. Kim VanGeffen, Marc Zimmerman, Alan Coulter and Greg Gormanous also attended the public meeting and ASPPB presentation. Concerns about price, validity and need for the test, were reported by several of those attending.

Dr. DeMers presented information on the expansion of the licensing exam, the Examination for the Professional Practice in Psychology (EPPP) a topic that has garnered criticism from various directions.

ASPPB had announced in late 2017 that its previous plan for an optional, “Step 2” section to the national exam for psychologists was no longer going to be optional. The additional test would now be mandatory and the price will go from the current $600 to $1200.

Kim VanGeffen, Past-President of Louisiana Psychological Association (LPA) and currently Director and Chair of the Professional Affairs Committee for LPA, attended the presentation. She said that Dr. DeMers and others are travelling around the country with their slide show and that, if there were concerns expressed or if problems arise with the beta testing, they might postpone the implementation of this new test.

“Dr. DeMers acknowledged that, currently,” VanGeffen told the Times, “there is not really any research on the validity of the EPPP2, “The EPPP2 committee believes that this exam has face validity and content validity,” she said. “They are satisfied that these types of validity are acceptable for the EPPP2. There do not seem to be any plans to obtain predictive validity nor does the EPPP2 committee believe that establishing this type of validity is necessary,” VanGeffen said.

“I was most impressed with how everyone in attendance who asked questions or offered comments is opposed to this exam due to its cost, concerns about its necessity, and concerns about its validity.”

Asked what if anything concerned her, VanGeffen said, “I am concerned that the EPPP2 will be forced on states. As it stands now, states will be required to use both parts or will not be able to use any of the EPPP. Concern was also expressed that ASPPB has an agenda to eliminate the post doctoral supervision year and oral exams which are required for licensure in some states,” she said.

“ASPPB is planning to do a study to compare how people score on the second part of the EPPP when it is taken prior to the post doctoral supervision year with those people who take the exam after the post doctoral supervision year,” Dr. VanGeffen said. “ASPPB believes that if there is no difference in scores on the EPPP2 whether you take it before or after your post doctoral supervision year, it will bolster their case that the additional year of supervision is not needed.”

““There is, however, another way to view such a potential finding,” she said. “That is, if there is no difference in scores from the two groups, the EPPP2 may not really be assessing competence. It would also seem that ASPPB might better convince states that the EPPP2 is truly assessing competence by doing research comparing test performance of beginning psychologists with psychologists five years out and ten years out in practice.”

Dr. Alan Coulter also attended the public meeting. He said that the LSBEP members appeared skeptical about Louisiana’s need to adopt these changes in order to ensure quality of psychologists serving the public.

“LSBEP members,” he noted, “expressed a need for substantial evidence from ASPPB that any additions to the current examination would add significant value to the state board’s current methodology for determining the fitness of candidates for licensure.”

Dr. VanGeffen echoed this, “Another concern is that the current EPPP may not be of much validity. There is data that the further out someone gets from their graduate school coursework the less likely they are to pass the current EPPP,” she said.

Dr. Marc Zimmermann, past LSBEP board member and Chair of the LPA Medical Psychology Committee, said, “I think the idea of measuring a professional’s skills before turning him/her lose on the public is a good idea. I do not think this attempt hits the mark,” he said. “When the Board does oral examinations we come closer to this by allowing the person to provide reasoning for their projected behaviors.”

“He [Dr. DeMers] stated that there is no predictive validity,” said Zimmermann. “He also threw in that none of the national tests had predictive validity. He reported that content validity was the accepted standard because a test with predictive validity could not be constructed.”

“It seemed to me that it was a c.y.a. and sales effort. He [Dr. DeMers] addressed the questions of why they changed from an optional second part of the EPPP to a mandatory component,” Dr. Zimmermann said.

“He did not say it, but reading between the lines, I think there was resistance to the second part and this is how they plan to implement their will. He said several times that they were just a vendor, but they have put themselves in the position of being the only vendor.”

Through 2016 and 2017 objections to the EPPP Step 2 mounted, mostly from student and early career psychologist organizations.

Last year in Louisiana, Dr. Amy Henke, then a Director on the Executive Council of the Louisiana Psychological Association and Co-Chair of the LPA Early Career Psychologists Committee, put forth a Resolution to oppose the Step 2 for Louisiana, which passed unanimously. Dr. Henke is now serving on the state psychology board.

Objections, from Henke and others, involve technical and scientific issues, but also the criticism that there is no problem that needs to be solved. “There is no evidence that the public is facing some sort of previously unheard of crisis in terms of safety from currently practicing psychologists,” said Dr. Amy Henke for an earlier interview.

Asked why ASPPB came to Louisiana Dr. Zimmermann said, “I think they are on a sales tour and hitting the states that are the squeakiest wheels.”

What impressed him most about the presentation? “That DeMers had the temerity to try to sell us something that does not meet the standard that psychological tests being published are expected to have,” said Dr. Zimmermann.

Appeals Court Reverses Judge Caldwell’s “Reeks” Decision in Cerwonka–LSBEP Dispute

On April 11 the State of Louisiana First Circuit Court of Appeal, reversed Judge Michael Caldwell’s decision that the state psychology board violated Dr. Eric Cerwonka’s rights when the board used attorneys from the same law firm, and when the board’s prosecuting attorney had been previously involved with Cerwonka in a child custody case and fee dispute.

The Appeals Court reversed Caldwell, and sent the matter back to the district court for further proceedings. Costs of the appeal are to be paid by Cerwonka.

Following a January 2017 hearing the Louisiana State Board of Examiners of Psychologists revoked Dr. Cerwonka’s license. He then sought a review in the 19th Judicial District Court. Presiding Judge Mike Caldwell stopped the review and vacated the board’s decision saying that the process “reeked” with due process violations.

Judge Caldwell said that allowing Lloyd Lunceford, a member of the same law firm as the Board’s general counsel, to serve as presiding officer for the administrative proceeding; and allowing James ‘Jim’ Raines, who represented Dr. Cerwonka in a prior child custody matter, which also resulted in a fee dispute, to serve as the Board’s prosecuting attorney, violated Cerwonka’s rights to a fair hearing.

The Appeals Court disagreed. They reviewed the record of the January 2017 hearing and said that despite Ms. Amy Lowe and Mr. Lunceford being from the same law firm, this alone does not constitute a violation.

They cited a U.S. Supreme Court ruling (Withrow v. Larkin, 1975) noting the constitutional framework for analyzing issues involving the combination of investigative and adjudicative functions in state and federal administrative proceedings.

In a case involving a physician’s disciplinary hearing in Wisconsin, the Appeal judges wrote, “Supreme Court recognized that a fair trial in a fair tribunal is a basic requirement of due process and that this requirement applies to administrative agencies which adjudicate, as well as to courts.”

“The Supreme Court went on to state that “[n]ot only is a biased decisionmaker constitutionally unacceptable but ‘our system of law has always endeavored to prevent even the probability of unfairness.”‘

However, the Supreme Court implicitly rejected that structural argument and held that the “combination of investigative and adjudicative functions does not, without more, constitute a due process violation.”

The Appeal judges wrote that the prevailing view is that a party basing a procedural due process claim on an impermissible combination of functions argument must demonstrate that the risk of actual bias is intolerably high, not merely that a combination of functions exists.

After reviewing the record of the hearing, the Appeals court found no evidence that Ms. Lowe had interjected herself unfairly in the proceedings. She did not prosecute or defend, or crossexamine any witnesses. The presiding officer Mr. Lunceford did not decide the merits of the allegations, and while he did rule on the admissibility of evidence, the Court did not see in its review of the record any evidence of unfairness to raise issues of due process.

Regarding Mr. Raines, Judge Caldwell agreed with Dr. Cerwonka’s view that Mr. Raines’ not recusing himself constitutes a due process violation. The Appeals Court disagreed.

The Board’s pleadings note that the issue was first raised during the course of the administrative proceeding, when Dr. Cerwonka argued that Mr. Raines should be recused because he was not impartial as required by LSAC.Cr.P. art. 680. The Appeals Court wrote that the article 680 “provides that a district attorney must be recused when he has a personal interest in the case, is related to the party accused or the party injured, or has been employed or consulted in the case as an attorney for the defendant before his election as district attorney.”

“However, we note that LSAC.Cr.P. art. 680 applies to district attorneys in criminal cases. By contrast, the Administrative Procedure Act applies to the underlying administrative proceeding. It requires only that the adjudicator be impartial and neutral.”

The Appeals Court wrote that Mr. Raines is not required to be a neutral party but an advocate, who has developed the “will to win.”

They wrote, “Dr. Cerwonka contended that Mr. Raines should have been recused because he represented Dr. Cerwonka in a prior custody case in 2006 in which a subsequent fee dispute arose between Raines’ firm and Dr. Cerwonka. Mr. Raines admitted that as a second year associate, he worked under the partner of his law firm and was one of two attorneys who represented Dr. Cerwonka over ten years prior to the initiation of the underlying administrative proceeding. That representation pertained to a custody judgment rendered against Dr. Cerwonka, which was wholly unrelated to the licensing dispute before the Board.”

“Rule 1.9 of the Louisiana Rules of Professional Conduct prohibits an attorney from representing a person or entity that is adverse to a former client in the same or substantially related matter.”

However, the Court said, “Here, there is no possibility that the issues involved in a child custody matter or a collections matter could be considered substantially related to the licensing issue before the Board.

However, Dr. Cerwonka asserts that Mr. Raines used information he possessed from his prior representation against Dr. Cerwonka in the underlying proceeding and that documents from the domestic litigation were used at the examiner’s hearing. Dr. Cerwonka has cited nothing in the record to support these assertions.”

Several Bills Focus on Occupational Regulation

A number of bills are being reviewed by lawmakers that concern the occupational boards, regulations, supervision, and other matters.

Representative Julie Emerson’s bill to review and control occupational licenses was adopted on the House floor and is now HB 748. The bill was heard in committee and reported by substitute in a 14 to 0 favorable vote. It is scheduled for floor debate on April 5.

The proposed law creates the office of supervision of occupational boards “office” within the office of the governor. According to the digest, the measure causes a review of occupational licenses and reports to the legislature and attorney general so to recommend the legislature enact legislation that may do any of the following: (a) Repeal occupational regulations; (b) Convert the occupational regulations to less restrictive regulations as defined in R.S. 37:42; (c) Instruct the relevant licensing board or agency to promulgate revised regulations reflecting the legislature’s decision to use a less restrictive regulation. One aim is to increase economic opportunities, promote competition, and encourage innovation.

SB 494 is pending and would establish the Occupational Licensing Review Act. The measure is proposed by Senator Thompson and similar to HB 748. The proposal creates the office of supervision of occupational boards with the office of the governor and provides for repeal of occupational regulations and less restrictive regulations, similar to HB 748. Proposed law provides for interpretation of statutes and rules Proposed law provides for interpretation of statutes and rules so that occupational regulations shall be construed and applied to increase economic opportunities, promote competition, and encourage innovation; that any ambiguities in occupational regulations shall be construed in favor of working licensees, aspiring licensees, and persons aspiring to work in regulated occupations, and that the scope of practice in occupational regulations is to be construed narrowly so as to avoid its application to
individuals who would be burdened by regulatory requirements that are only partially related to the goods and services they provide.

Senator Fred Mills’ bill to restructure health care boards remains pending in the Senate Health and Welfare Committee.

He has paired down last year’s effort to restructure the health care boards, and is proposing SB40 which contains several of the components of last year’s SB75, including adding a consumer member to each board and removing the professional associations from
the board’s nomination process.

SB40 would transfer the extensive list of boards, commissions and agencies to the Louisiana Department of Health (LDH). Included will be the boards for psychology, counselors, social workers, and the other 22 healthcare boards. These are the boards for dentistry, nursing, optometry, pharmacy, medicine, physical therapy, speech-language, addictive disorders, vocational rehab, behavior analyst and others.

The proposed law adds at least one consumer member to any board that did not previously have one and provides standardized eligibility criteria of consumers to serve on any board.

Present law provides for professional trade associations and other entities to select and submit nominees to the governor for board appointment.

The proposed law opens board nomination eligibility to any member licensed by the board who is interested and eligible. Proposed law requires the board to send notice to its licensees to fill board positions and submit the names of those interested and eligible to serve to the governor for board appointment.

Representative Connick has put forth HB 372 aimed to also address aspects of the anti-trust matters surfaced by a 2015 Supreme Court decision.

The measure would create the Occupational Board Compliance Act. Policies provided in proposed law, are intended to ensure that occupational licensing boards and board members will avoid liability under federal antitrust laws. If passed the law would create the Occupational Licensing Review Commission to be composed of the governor, the secretary of state, and the attorney general or his respective designee. Establishes the governor as the chairman of the commission and the secretary of state as the secretary.

HB 372 would establish the commission’s responsibility for active supervision of state executive branch occupational licensing boards controlled by active market participants to ensure compliance with state policy in the adoption of occupational regulations promulgated by an occupational licensing board, according to the digest.

The present law provides for licensing of behavioral health services providers by the Louisiana Department of Health. The proposed law adds definitions for certified mental health professionals, community psychiatric supportive treatment (CPST), mental health rehabilitation, and psychosocial rehabilitation (PSR) to the definition provisions of present law.

If passed the law would be named the “Behavioral Health Services Provider Licensing Reform Law.” At this point is would focus on qualifications for providers for CPST and PSR for Medicaid reimbursement.

“Proposed law provides that only a certified mental health professional or an individual who is not certified, but who met present law criteria for providing PSR services and did so on a full time basis for a year prior to August 1, 2017, may provide PSR services and be reimbursed by the department for providing the services.

“Proposed law provides that CPST shall be provided by a certified mental health professional with a master’s or doctorate in counseling, social work, or psychology from an accredited university or college.

“Proposed law provides that in order to receive Medicaid reimbursement for CPST or PSR services, the provider agency, certified mental health professional, or other individuals allowed by law, shall have a national provider identification number, be fully accredited by a nationally recognized accrediting organization, be licensed by the department, and be credentialed by the Medicaid managed care organization in which the provider intends to submit claims for services.”

CPST is a face-to-face intervention with the individual present. A minimum of fifty-one percent of CPST contacts must occur in community locations where the person lives, works, attends school, or socializes. “Mental health rehabilitation” means outpatient behavioral health services which are medically necessary to reduce the disability. These services are home- and communitybased and are provided on an as-needed basis. PSR is designed to assist the individual with compensating for or eliminating functional deficits and interpersonal or environmental barriers associated with mental illness.

Suicide Prevention Act Passes House Vote

HB 148 by Representative Reid Falconer, the “Louisiana Suicide Prevention Act,” was reported favorably in a 9 to 0 vote out of committee on March 22 and passed the House this week in an 85 to 0 vote.

The initiative requires the office of behavioral health to ensure that administrators of all healthcare facilities licensed by LDH and that all healthcare professionals licensed by any Louisiana board or commission have ready access to informational resources and technical assistance necessary for implementation of the zero suicide initiative.

The office of behavioral health is to examine and coordinate the use of existing data to identify priority groups of patients, improve the quality of care for persons who are suicidal, and provide a basis for measuring progress in the ongoing operation of the zero suicide initiative.

According to the Legislative Fiscal Office, the proposed law will increase SGF expenditures for the LA Dept. of Health, Office of Behavioral Health by an indeterminable amount. Cost estimates provided by OBH indicate that expenditures are anticipated to total approximately $748,950 in FY 19 with a phaseup of to approximately $792,900 in FY 20 before leveling off at approximately $790,000 in FY 22 and in subsequent years.

OBH reports a need for 2 positions for expanded personnel associated with the initiative. The 2 positions contemplated are a program manager ($123,617 salary and related benefits annually) and a program monitor ($108,015 salary and related benefits annually) for annual total costs of approximately $232,000. Personnel expenditures will be prorated for 9 months in FY 19, which will total $174,000. A majority of the projected recurring expenditure increases ($438,000), will be undertaken by the Human Services Districts and Authorities that will implement the initiative at the local level statewide via interagency transfers from OBH, reported the Fiscal Office.

If passed, the proposal will require a “State Suicide Prevention Plan” to be created and office of behavioral health shall collaborate with criminal justice and health systems, including mental health and behavioral health systems, primary care providers, physical and mental health clinics in educational institutions, colleges and universities, community mental health centers, advocacy groups, emergency medical services professionals, public and private insurers, hospital chaplains, and faith-based organizations to develop and implement all of the following, which shall be included as elements within the state suicide prevention plan.