Category Archives: News Stories

Gov. Appoints Mr. Heller To Psychology Board as New Consumer Member

On December 27 the Governor appointed Amitai Heller, of New Orleans, to the Louisiana State Board of Examiners of Psychologists. Heller is an attorney with the Advocacy Center of Louisiana. He will serve as a private citizen and consumer member on the board, a new reform put forward in the 2018 legislative session by Senator Mills.

Mr. Heller works in the legal division of the Advocacy Center, an organization that serves people with disabilities and senior citizens. According to their website, “The Advocacy Center of Louisiana protects, empowers, and advocates for the human and legal rights of people with disabilities and seniors living in Louisiana, in order that they may live an integrated life in the community, free from abuse, neglect and exploitation.”

“The agency was founded pursuant to a federal law establishing protection and advocacy systems in each state and territory in the U.S. The mandate of the protection and advocacy systems is “to pursue legal, administrative, and other appropriate means to ensure the rights of persons with development disabilities in the state.” Since 1977, we have added other populations to our client base including persons with other mental and physical disabilities and senior citizens

Rural Health Focus On Opioid Deaths

The Louisiana Department of Health announced in September 2018 that it had received a Federal grant of more than $24 million toward addressing the opioid epidemic in our state, said Dr. Tiffany Jennings, licensed psychologist in Shreveport, and Louisiana Psychological Association (LPA) Rural Health Coordinator for the American Psychological Association, and chair of the LPA the Rural and TeleHealth Services Committee.

According to the United States Department of Agriculture (USDA) almost 200 people per day died from drug overdose in 2017, more than 72,000 Americans during the year. The overwhelming majority of these overdose deaths involved an opioid. The Centers for Disease Control and Prevention said that the rates of drug overdose deaths are rising in rural areas, surpassing the numbers in urban areas.

“This grant was funded from the Center for Disease Control and Prevention and the US Dept. of Health and Human Services,” said Dr. Jennings. “The money will be used for improving access to treatment, prevention strategies, improving surveillance data and to enable health centers and other agencies to expand integrated services treatment.”

“But we’ve still got a long way to go,” said Jennings. “Mental Health America ranked Louisiana 45th for access to mental health care. In 2016, the Medicaid expansion did provide insurance coverage for more than 430,000 people, it’s difficult to obtain mental health services. Many doctors and agencies will not accept Medicaid due to reimbursement issues and low reimbursement rates. Agencies that do take Medicaid have a waiting list,” she said.

Dr. Jennings has previously served as a neuropsychologist at Overton Brooks Veterans Administration Medical Center in Shreveport and also neuropsychologist for the U.S. Army’s Traumatic Brain Injury Clinic in Fort Polk in Leesville, Louisiana.

As Rural Health Coordinator for APA and LPA, Dr. Jennings has said that one of the goals of her committee is to “develop an ongoing community where those in rural areas, or who serve rural populations, can collaborate with each other.” She said that sharing experiences as to how to set up various telehealth services and also to review current guidelines will be important goals ….”

“Another objective in mind is initiating and continuing the conversation regarding the opioid crisis,” said Dr. Jennings previously. “… it’s a major focus of concern.”

“Telemedicine has been gaining more ground in treatment, particularly for those in rural areas where treatment services may be limited, or non-existent,” she said. “University Health in Shreveport was highlighted in the local media (KTBS.com) highlighting the advantages of telemedicine –such as cost, reduced transportation burden–and that telemedicine can be as effective as traditional in-person treatments,” said Jennings.

This past fall the USDA launched an interactive data tool aimed to help communities build grassroots strategies to stem the opioid epidemic, to help rural leaders make data-driven decisions for their communities.

The USDA invites leaders to see the many ways your community can partner with USDA to meet immediate needs in this fight. According to the USDA, their program resources can help rural communities address many of the deeper, systemic, and long-term issues making these places vulnerable to the opioid crisis in the first place, the agency notes. Their infographic illustrates how USDA can help rural communities respond to the opioid epidemic by addressing some of the root causes.

ASPPB Uses Carrot & Stick for New EPPP2

Members of the Louisiana State Board of Examiners, at their November 30 meeting in Baton Rouge, discussed how the Association of State and Provincial Psychology Boards (ASPPB) has adopted a reward and punishment program for those state boards still resisting adopting the controversial second examination a psychology license, the EPPP2.

Complaints about the new exam had been growing and escalated when officials at ASPPB decided in August 2017 that the new test was to be mandatory. Following that move and resulting controversy, ASPPB backpedaled somewhat and on October 24 notified its members that they would have an option to use the EPPP but without the EPPP2.

However, there are penalties associated. Some members said they view this as an attempt to coerce states into compliance.

According to the October 24 announcement from Dr. Sharon Lightfoot, President of the ASPPB Board of Directors, if Louisiana chooses to decline the use of EPPP2, individuals here will not be allowed to take EPPP2 even if they wish to do so. Also, those test-takers from compliant states will pay $300 as a reward for early adoption of the additional exam, while those from late adopters will pay $450.

“Only applicants who are registered through a jurisdiction that has adopted the Enhanced Exam, and who have passed the knowledge portion of the exam, will be allowed to take the skills portion of the exam,” said Lightfoot.

“January 1, 2020 through December 31, 2021 is designated as an early adoption period. All jurisdictions who decide to adopt the Enhanced EPPP at any point during this time frame will be offered reduced fees for their applicants,” wrote Lightfoot.

In October, LSBEP members Drs. Amy Henke and Greg Gormanous, and Executive Director, Jaime Monic, attended the annual meeting of ASPPB in Salt Lake City, Utah. The EPPP-2 was discussed in depth.

Henke has been critical of the move since she lead opposition and the passage of a Resolution in the Louisiana Psychological Association. Sources say that some consider the ASPPB to be more in the mode of a “sales” organization and that there was little opportunity given for the ASPPB member jurisdictions to voice concerns.

One source said that ASPPB appears to be going around its board members and marketing the new test to internship programs and state legislatures. It was reported that they have also said that student groups support the new test when that is not the case.

Through 2016 and 2017 objections to the EPPP2 mounted, mostly from student and early career psychologist organizations.

In 2016, Dr. Henke, then a Director on the Executive Council of the Louisiana Psychological Association (LPA) and Co-Chair of the LPA Early Career Psychologists Committee in LPA, put forth a Resolution to oppose the EPPP2 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 the new test needs to solve. “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. Henke in 2016.

The Examination for Practice of Professional Psychology (EPPP) is privately owned by the ASPPB, which claims to serve its 64 members, regulatory boards of psychology. In a plan that appears to have been in place for a number of years, the ASPPB has decided to double the content and the price of its main product, the EPPP, from $600 to $1200, plus administration fees.

LSU’s Dr. Frick and Dr. Matson Named World Class Scholars

In two separate reports, Louisiana State University Psychology Professors, Dr. Paul Frick and Dr. Johnny Matson, have been designated as top scholars in comparison to all others worldwide.

In an October report from LSU News, Dr. Paul Frick was noted to be one of only four researchers from LSU who achieved an h-index over 100, based on the Google Scholar Citations database. Only 3,160 scholars worldwide reach this level of significance.

Dr. Johnny Matson, professor of psychology and Distinguished Research Master, was noted for his interdisciplinary achievements, as one of only three LSU researchers who were among the top cited scholars by Clarivate Analytics this year, based on a review of journals indexed in the Web of Science Core Collection 2006-2016. According to LSU News, this measure takes into account the top 1% within each of 21 broad fields, over a specific period of time.

Dr. Paul Frick holds the Roy Crumpler Memorial Chair and is professor of psychology at LSU. His research investigates the many interacting factors that can lead children and adolescents to have serious emotional and behavioral problems, such as aggressive and antisocial behavior.

The h-index measures both productivity and impact of published papers. The score measures the researcher’s total number of papers as well as how many times each paper is cited by other scholars. An h-index over 100 amounts to 100 research papers each cited over 100 times.

“It’s quite an honor to be on this list,” Frick told LSU. “In my research, we have looked at kids with behavioral problems and developed ways of identifying them and treating them. Once your scale or system of how a disease or problem is classified and diagnosed is picked up by entities such as the World Health Organization and the American Psychiatric Association, you tend to get a lot of citations because everyone who uses your measure and has to cite you to justify theirs.”

Dr. Matson was included in the Clarivate Analytics 2018 list of only 6,078 scholars worldwide and one of only 2,020 in the new, interdisciplinary category.

This is the first year that Clarivate Analytics has looked specifically at cross-field citations, “…as frontier areas of research are frequently interdisciplinary, it is even more important to identify scientists and social scientists working and contributing substantially at the CrossField leading edge.”

Dr. Paul Frick is the inaugural recipient of the Roy Crumpler Memorial Chair in Psychology at Louisiana State University, Baton Rouge campus. Frick most recently served as the Department Chair in Psychology at the University of New Orleans.

In 2017, he was named the Editor-in-Chief for the prestigious Journal of Abnormal Child Psychology, the official journal of the International Society for Research in Child and Adolescent Psychopathology (ISRCAP), a multidisciplinary scientific society.

Frick is a leading international authority in child and adolescent diagnosis and behavior and his work focuses on the pathways by which youth develop severe antisocial behavior and aggressiveness. He has published over 180 manuscripts in either edited books or peer-reviewed publications and he is the author of 6 additional books and test manuals. He has been Distinguished Professor and Chair of the Department of Psychology at the University of New Orleans, and was named the recipient of the Robert D. Hare Lifetime Achievement Award by the Society for the Scientific Study of Psychopathy.

Dr. Frick’s research has been funded by the National Institute of Mental Health, Office of Juvenile Justice and Delinquency Prevention, and the John T. and Catherine D. MacArthur Foundation. In 2008, he received the MacArthur Foundation’s Champion for Change in Juvenile Justice Award for the state of Louisiana. He has been the editor of the Journal of Clinical Child and Adolescent Psychology, is past president of the Society for the Scientific Study of Psychopathy. He has an Honorary Doctorate from Orebro University in Orebro, Sweden in recognition of his research contributions in psychology. He is also Professor in the Learning Sciences Institute of Australia at Australian Catholic University.

Dr. Matson is expert in autism, mental disabilities, and severe emotional disorders in children and adolescents, and has produced more than 700 publications and 38 books. Just a few of his titles are the International Handbook of Autism and Pervasive Developmental Disorders, Practitioner’s Guide to Applied Behavior Analysis for Children with Autism Spectrum Disorders, Practitioner’s Guide to Social Behavior and Social Skills in Children, and Assessing Childhood Psychopathology and Developmental Disabilities, and Treating Childhood Psychopathology and Developmental Disabilities.

Matson has served as Editor-in-Chief for Research in Autism Spectrum Disorders (Oxford England), Editor-in- Chief for Research in Developmental Disabilities (Oxford, England), and Associate Editor for Journal of Mental Health Research in Intellectual Disabilities (London).

Through the years he has served on 80 editorial boards, both US and International, including as Editor-in-Chief for Applied Research in Mental Retardation and the Official Journal of the American Association for University Affiliated Programs. He has also served as guest reviewer for over 50 journals, both US and International. And, he has visited as a professor around the world, including Canada, Sweden, and India.

Among his many professional activities, Matson has been a guest expert on ABC’s 20/20, consulted with the Alabama, California, Georgia, Illinois, Iowa, Louisiana, Missouri, Virginia, and the US Departments of Mental Health. He has been a guess expert on CBS Eye-to-Eye and consulted for the DSM III-R Educational Testing Service. He has served on the President’s Committee on Mental Retardation, and consulted to the US States Department of Justice, and the US Department of Education.

“This is really about having a few decent ideas but mostly about having a goal and working and working to reach it,” Dr. Matson said to the Times.

“Maintaining that level of focus over that period of time is not easy,” he said, “at least it wasn’t for me. In my case, largely it has been about getting researchers and clinicians to be made aware of and to have the tools to identify co-morbid challenging behaviors and psychopathology in persons with autism and/or intellectual disabilities,” he said.

“If I have been able to do that, in some small way, then it will mean better care for many persons with developmental disabilities.”

CDC Data Points to Higher Psychological Distress in America

The CDC reported new numbers last month in both deaths by suicide and drug overdoses that point to the worsening psychological well-being of America’s citizens. The CDC Director said the sobering statistics should be a wake up call.

Robert Redfield, M.D., CDC Director, said, “The latest CDC data show that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.”

In its newest report, the CDC notes that the age-adjusted suicide rate increased 33% from 10.5 per 100,000 in 1999 to 14.0 in 2017.

The rate of suicide among females increased from 4.0 per 100,000 in 1999 to 6.1 in 2017, while the rate for males increased from 17.8 to 22.4. Compared with rates in 1999, suicide rates in 2017 were higher for males and females in all age groups from 10 to 74 years, said the CDC.

For 2017, the age-adjusted suicide rate for the most rural counties (20.0) was 1.8 times the rate for the most urban counties (11.1).

The rate for the most rural counties in 2017 (20.0) was 53% higher than the rate in 1999 (13.1).

The age-adjusted suicide rate for the most urban counties in 2017 (11.1 per 100,000) was 16% higher than the rate in 1999 (9.6).

Since 2008, suicide has ranked as the 10th leading cause of death for all ages in the United States. In 2016, suicide became the second leading cause of death for ages 10–34 and the fourth leading cause for ages 35–54.

Another report for 2017 figures from the CDC indicated that there were 70,237 drug overdose deaths in the United States, 9.6% higher than the rate in 2016.

The age-adjusted rate of drug overdose deaths increased from 6.1 per 100,000 standard population in 1999 to 21.7 in 2017. For each year, rates were significantly higher for males than females.

Rates of drug overdose continued to increase. In 2017, the age-adjusted rate of drug overdose deaths was 9.6% higher than the rate in 2016 (21.7 vs 19.8 per 100,000), although the percentage increase was lower than that seen from 2015 to 2016, when the rate rose by 21% (from 16.3 to 19.8 per 100,000).

The rate of drug overdose deaths in 2017 was 3.6 times higher than the rate in 1999. Rates increased for both men (from 8.2 in 1999 to 29.1 in 2017) and women (from 3.9 in 1999 to 14.4 in 2017). In 2017, the highest rates of drug overdose deaths occurred among adults aged 25 to 54 years.

From 1999 to 2017, the greatest increase in drug overdose death rates occurred among adults aged 55 to 64, from 4.2 to 28.0 per 100,000, a more than six-fold increase.

LSBEP to Begin Complaints Processing Procedure Updates

The Louisiana State Board of Examiners of Psychologists (LSBEP) will make changes to their disciplinary policies and procedures, including promulgating new rules and regulations if needed, the Board members announced at their recent Long-Range Planning meeting. The meeting was held November 30 at the Board’s new offices located at 4334 S. Sherwood Forest Blvd., in Baton Rouge.

The new disciplinary procedures are the result of study by a task team, which has been meeting over the past months in confidential discussions to craft these new procedures. Members of the task team are LSBEP Chair, Dr. Jesse Lambert, current LSBEP Executive Director, Ms. Jaime Monic, board attorney for complaints issues, Ms. Courtney Newton, and Louisiana Psychological Association Chair of Professional Affairs, Dr. Kim Van Geffen.

At the November 30 public meeting, Ms. Newton explained to members and attendees about the changes. She said that it was essential for a bifurcated and completely separate process to exist between the investigative element and the hearing element of a disciplinary action, and that the task team worked to create a two-pronged process with a firewall between the two elements.

One of the changes that is being proposed is that whenever a complaint is received and needs to be investigated, a Complaints Committee will be formed. This committee will include the LSBEP attorney, the Board Investigator, who is a private investigator, and a Complaints Coordinator.

In July this year the Board added contracts so that there would be three psychologists available as Complaints Coordinators. The contracts were for Sasha Lambert, PhD (Complaints Coordinator I), Erin Skaff Vandenweghe, PsyD (Complaints Coordinator II), and Mark Vigen, PhD (Complaints Coordinator III). The Board also confirmed Statewide Surveillance as the source for services for Licensed Investigators, in July.

The new complaints process will also include a board member, who is to be part of the investigation process. If the complaint goes to a hearing, the Board member who sits on the Complaints Committee will recuse themselves from the hearing panel.

Previously, the Board had held that no board member could be involved because of the fact that a vote of four of five board members was required for disciplinary actions.

Another of the elements included in the renewed approach is the “Letter of Education.” This has been used before and addresses actions that do not rise to the level of a violation and so are not subject to open records or reporting. This allows the board to recommend further education and avoid a licensee being reported.

The new procedures also allow for confidential process when those with substance abuse problems may be referred for colleague assistance programs, also without always being reported.

The psychology Board is currently involved in litigation involving its complaints procedures and this required closed meetings of the task team during the past year, according to sources.

In February 2017 a psychologist appealed a decision made by the LSBEP. The Judge in the 19th Judicial District Court, Judge Michael Caldwell, vacated the board’s decision, saying that the process “reeked” with due process violations, according to sources.

Next, the LSBEP appealed Caldwell’s decision on two of the issues: 1) That the board’s attorneys were law partners; and 2) the Board’s prosecuting attorney had previously been involved in the psychologist’s child custody case.

The LSBEP won the appeal and now the remaining issues are back in Judge Caldwell’s court.

In another issue, this one regarding time-limits, the Board appears to have confused different requirements during hearings in 2015. One case appears to still be on appeal due to this issue.

State boards have come under the notice of the Louisiana Legislature for process issues and several laws have been passed to address citizens’ complaints. In particular, the state medical board has been in front of the Legislature with citizen’s associations’ complaining about heavy-handed treatments at the board. Louisiana’s board actions increased over the last ten years without a similar increase in lawsuits. (See graph).

Senator Fred Mills advanced several measures and this year passed Act 515, moving boards under the Department of Health, because of what he termed, “…virtually no oversight” at the boards. Act 655 allows citizens to make complaints to the the Legislature committees.

[Editor’s Note: For additional information, see: “The Secret Life of Board Complaints,” in Psychology Times, Vol 6, Nos 10 and 12; “Board May Have Botched Time Limits,” Vol 6 No 10; “Judge Says Psych Board Procedures Unconstitutional,” in Vol.8, No 6; and Appeals Court Reverses Judge Caldwell’s “Reeks” Decision in Cerwonka– LSBEP Dispute,” in Vol 9, No 5.]

Can Louisiana Fully Embrace Integrated Healthcare?

by J Nelson

For decades now, psychological scientists have demonstrated that savings from 30 to 60
percent in medical costs and much better health outcomes are possible if we give up the
biomedical model and embrace the psychological-social-biological framework instead, called
integrated care. But can Louisiana make this change? In this article we review where we are
and where we’re going, and some of the barriers to change that seem to persist.

If the famous axiom is right, and we have to hit bottom to get better, Louisiana should be due
for improvements in its health and healthcare system. Last year U.S. News & World Report
ranked 50th overall with a 45th in healthcare. The rank included a 43rd place in mortality, a
46th in infant mortality, a 50th in obesity, and a 43rd rank in smoking. At the same time,
Louisiana’s costs are high–the Report placing the state at 45th in health care affordability.

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

Yet, healthcare is the largest industry in the country, accounting for almost $3.5 trillion in sales in 2016,according to the National Health Expenditure Data from CMS. More recently, the  industry is now also the nation’s largest employer.

The sheer size and complexity of the healthcare industry would suggest that innovations would  be challenging, but change may be even more unlikely because of the political power yielded by the industry. Last year the pharmaceutical industry, Blue Cross/Blue Shield, the American Hospital Association, and the American Medical Association were the 4th, 5th, 6th, and 7th highest contributors to Congress, and the year before that pharmaceuticals and insurance was 1st and 2nd.

Given this, it is surprising that the American Psychological Association (APA) recently managed to grab a little territory for psychological assessment, now finally considered as a “thinking” valued activity, in the newest Rules. A feat which required behind closed-door negotiations.

Healthcare is a Closed System

The medical-pharmaceutical-hospital-insurance industrial complex has a firm hold on the prices and services in this country, through the “CPT Codes” and the “Relative Value Scale Update  Committee” or RUC. These groups decide what services are allowed and how much they are reimbursed.

Three hundred “Advisors and Experts,” primarily from the American Medical Association’s House of Delegates, representing 109 medical specialties, attempt to influence an “Editorial Panel,” composed of representatives from medical societies, insurance companies and the government.

This panel conducts closed meetings and decides on what healthcare services are paid for, and  which are not, by way of the complex set of codes known as CPT or “Current Procedural Terminology.” CPT is owned by the Center for Medicare and Medicaid Services (CMS), leased to the American Medical Association (AMA), who then copyrights it and strictly controls the development of new codes. The RUC assigns the value to the service, and somehow this is not considered price-fixing or restraint of trade.

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

At a 2015 meeting of the Louisiana Psychological Association, Dr. Tony Puente, now a past-president of APA, was one of the two outsiders allowed to participate in the CPT process. “Essentially,” he said, “the CPT tries to divvy it up in a way that is theoretically and empirically, and diplomatically and politically,  correct.” Participants must sign a strict AMA confidentiality
agreement and declare, “I will not disclose, distribute or publish confidential Information to any party in any manner whatsoever.”

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

An underrepresentation of primary care in this system and an undervaluing of their contribution, has lead to high-cost specialists and a shortage of primary care physicians, according to the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. This has been shown to negatively impact outcomes. In a special issue of the American Psychologist on Primary Care and Psychology, Dr. Susan McDaniel and primary care leader Dr. Frank deGruy reviewed evidence that for each primary care physician added to a social system, “all-cause mortality decreases by 5.3 percent.” Conversely, for every specialist added the mortality rate goes up 2 percent.

Healthcare is a Misnomer

“Health is a misnomer, because most activity involves illness. Health care and medical care are not synonymous,” said Hamilton Moses and co-authors in, “The Anatomy of Health Care in the United States,” in a 2013 article of the Journal of the American Medical Association (JAMA).

Prevention requires tools that are often unfamiliar because educational, behavioral, and social interventions, not usually considered to be part of medicine, may be most effective for many diseases,” Moses wrote.

While medical costs are driven by chronic disease, it is not due to an aging population, even though age is often cited as the cause. The JAMA authors show that about 80 percent of the total health care cost is accounted for by those under 65, and relate to psychological, social and behavioral elements. The CDC estimates that lifestyle factors account for 80 percent of heart disease and stroke, 80 percent of type 2 diabetes, and 40 percent of cancer.

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

For decades now, psychological scientists have known that behavior is the key to costs. In an interview with primary care psychologist, Dr. Michele Larzelere, she explained that psychological scientists have agreed that those using an integrated care model can expect a 30 to 60 percent reduction in medical use costs.

And, unlike medical care which carries a large risk, behavioral treatments have few side effects. The author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, Martin Makary, MD, found that medical error, unrelated to the illness or injury, is the third cause of death nationwide, following only heart disease and cancer deaths.

“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said in a report by The Washington Post. Health is woven into a complex set of social and psychological behaviors, not a single cause. “Socioeconomic status is one of the most powerful predictors of all cause mortality,” says Dr. Chris Leonhard, health psychologist and Professor at the Chicago Professional School at Xavier.

“New Orleans is a startling example of this,” Leonhard said. “Life expectancy at birth in the Tremé where the average household income in 2010 was about $26,000 is 55 years, while in Lakeview, the average 2010 household income $75,000, and life expectancy at birth is 80 years.”

Outdated Treatment Models: The Opioid Crisis Example

A dramatic example of flawed decisions in the medical/pharma industrial complex is the opioid  crisis. Twenty years after a marketing blitz aimed at convincing physicians that opioids were safe and effective, the over-prescribing of this heroine-type drug has catapulted overdose deaths to a rate higher than auto fatalities, HIV or gun deaths.

Louisiana is in the middle of the crisis, with some of the highest opioid prescribing rates in the nation and an escalating death rate from overdose. Last year in a Louisiana House Health and
Welfare Committee hearing, Representative Helena Moreno told members that there are “… more opioids prescribed in Louisiana than are people in this state.”

Despite the flood of legal opioids into the society, the CDC reported no change in pain that would meaningfully drive the prescribing: “…there had not been an overall change in the amount of pain that Americans reported.” The CDC found that there was no long-term benefit for opioids compared to no opioids. However, they did find ample evidence for harm.

In contrast, the CDC did find that psychological and physical treatments for pain were beneficial (“CDC Guideline for Prescribing Opioids for Chronic Pain”). This despite the fact that these non-medical approaches are rarely integrated into treatment programs.

“It is now widely accepted that pain is a biopsychosocial phenomenon,” clinical health psychologist and Past-President of the Southern Pain Society, Dr. Geralyn Datz, told the Times. “For many years the biomedical model of treatment has prevailed as a way to treat pain patients,” Datz said. “This model is based on some very early research about acute pain,” she said. Things are very different now. “We know that chronic pain is a complex and dynamic process, and it involves a person’s thoughts, beliefs, experiences and these all can influence pain for better or worse. In addition, conditions such as depression and anxiety can arise from the presence of pain, and these also can worsen pain through interactions of the brain with the body.”

Louisiana’s Challenges

The intentions to blend psychological factors with traditional healthcare seem sincere in Louisiana. In the Medicaid Annual Report for 2017, the Medicaid Director Jen Steele wrote of her mission to improve quality, patient experience, outcomes and lower costs. And, some progress with Patient Centered Medical Homes has come about.

However, making significant changes may be challenging. Using data from both Medicare and Medicaid use, Louisiana’s costs are above expected in a number of areas. The Kaiser Family Foundation looked at data from 2014 and Medicare spending per enrollee, and found that Louisiana ranked 10th in Medicare spending compared to other states, with New Jersey, Florida, New York, Maryland and Connecticut at the top five.

Data from Dartmouth Atlas of Health Care found that Louisiana has a high average number of inpatient days per beneficiary. In a detailed breakdown from 2012, Dartmouth found that  Louisiana had the highest number of inpatient days per person compared to all other states.
Louisiana averaged 6.0 days per beneficiary while the average across the nation was 4.6 days.

In a group for comparison of multiple chronic conditions Louisiana fell above the 90th percentile again with an average of 20.8 days, while the average was 17 days. For dementia the average number of inpatient days was 30.5, and national average was 22.5.

The Alexandria, Monroe and Shreveport regions are some of the highest areas of hospital usage, based on Medicare data collected by Dartmouth.

Dartmouth found that in 2015, the national average of hospital usage was 254 per 1,000 Medicare enrollees. Louisiana averaged 279.8, and some regions were the highest in the country Alexandria was 335.4, Monroe 325.0, Slidell 320.5, and Shreveport was 294.

Dartmouth researchers note that, “Regional variation in hospital and physician capacity reveals the  irrational distribution of valuable and expensive health care resources. Capacity strongly influences both the quantity and per capita cost of care provided to patients.”

In the Louisiana Medicaid 2017 Annual Report, the top 10 provider types, ranked by payment, were first, hospitals, at $1.3 billion, and second, pharmacy, at $726 million. Dentists were third at $162  million, then mental health rehabilitation at $140 million, nurse practitioners at $115 million, and behavioral health rehabilitation agencies at $114 million. Distinct psychiatric hospitals were next at $76 million and freestanding mental health hospitals at $69.7 million.

In comparison, other providers, which include audiology, chiropractic, personal care attendant, physical and occupational therapy, psychology, social work and other services not covered  otherwise, totaled $917,000.

The need may not be being met, even in this picture. In a 2018-2019 Combined Behavioral
Health Block Grant Plan, published in late 2017, the state noted that the number of persons being served was 3.29% of the estimated prevalence. The estimated number of children/youth with serious emotional disorders was said to be 38,803 and only 1,370 had been served. The prevalence estimate for adults with serious mental illness was 192,019 and only 7,590 had been served.

In the grant report, the state confirmed that it was building its workforce and ability to function in an integrated care environment. The state has indicated progress in developing  integrated care in some ways, looking for its managed care companies to advance the plans.

However, in a list of “Specialized Behavioral Health Services CPT Code” and reimbursements, effective July 2018, the fee structures provide little in the way of reimbursement for health and behavior, or any clear mechanism for integrated services. The “health and behavior” services pay between $12 and $15 and are only listed for a psychiatrist, nurse/physician’s assistant, medical psychologist, and a psychologist. There are none listed for clinical social workers or counselors.

Some codes and fees are listed for psychotherapy. Individual psychotherapy is reimbursed at  69.76 for psychiatrists for 45 minutes, $55.81 for nurse practitioners and physician assistants,
$55.81 for psychologists, and $48.83 for social workers, counselors, and marriage and family
therapists. But this may not translate to integrated care. And group therapy, a valuable therapy mode for many issues, is paid at only $23.23 to $18.58 and there is no reimbursement for the social worker or counselor listed on the current fee schedule.

These arrangements may explain why there are few providers who  chose to participate. Access to care and rates have been a problem nationally, with nearly half of all providers not offering Services to Medicaid patients. Nationwide, Medicaid fees are about 72 percent of Medicare, which is about 80 percent of private pay. Only about 130 psychologists were listed as providers on the 2014 Medicaid rolls, according to a report at that time.

One Representative’s Efforts

During the Louisiana 2016 Regular Legislative Session Representative Barbara Norton from Shreveport put forth a measure, House Bill 1164, to create a task force to study the delivery of
integrated physical and behavioral health services for Medicaid enrollees who suffer with serious mental illness.

Norton brought together an array of associations and state agencies from across disciplines and from across the state to look at ways to improve the care offered by Medicaid.
She told the Times, “This was an opportunity to pull so many people together, at no cost. I met with many of these people who felt as I did, that this would be a great piece of legislation, that they want to help the state of Louisiana and health, and make a real difference.”

The bill passed committee with a 10 to 0 favorable vote. But then, on the House floor, it failed with 51 nays and 33 yeas. Five of those who had supported it in committee switched their votes on the floor and twenty did not vote. Why? Representative Norton thinks it might have been political. “We still feel the Medicaid belongs to President Obama but it belongs to all of us and we’ve not started to understand the significance of these issues.”

Representative Norton tried again in 2017, this time passing a measure as a Concurrent Resolution, asking again for the study of the issue by a comprehensive task force, HCR 55. The
measure passed easily and task force was formed. However, she said that the task force met only twice. The Representative will be calling another meeting in December in Baton Rouge, she said. “It has not been given a fair shake.”

“My goal is to go back with whomever and find out what we can really do for the people because the problems in this area are so serious,” she said. “We’ve not even started to understand the significance of what this should be about and the more we look––the shootings the mental health issues––the more it’s necessary that we reach out to all the people and look at all the facts that there are, and continue to work. Because we’re talking about peoples lives.”

“I understand that sometimes people don’t know the type of leadership it takes but if people want to be on the committee, and care to discuss these real issues, then it’s not the type of thing where a person can call in or send information. We need to discuss ideas and plans,” Norton said.

“I do believe that at the end of the day, with the help of leadership, we may turn some thinking around, and clearly understand why it is so important to look at all these things. I promise you I’m going to work with this until we see some differences, and people see some hope.”

 

Gov. Edwards and First Lady Travel to Israel, Meet with Prime Minister

JERUSALEM, Israel — On October 31, Gov. John Bel Edwards met with Israeli Prime Minister Benjamin Netanyahu as part of a weeklong Louisiana economic development mission in Israel, according to the press release on the same day. Following a photo session, the two discussed Louisiana’s strong relationship with Israel, as well as trade and economic development issues of mutual importance to Israel, the United States and Louisiana.

“This long-awaited meeting is the result of many years of friendship and partnership. On behalf of the people of Louisiana, I was proud to share with Prime Minister Netanyahu that Louisiana stands with Israel, and we will always remain faithful to our staunch ally in the Middle East,” Gov. Edwards said. “Over the years and during this mission, I have come to appreciate how alike our two lands are – similar in industrial strength and similar in economic priorities. But beyond that, Israel and Louisiana are inhabited by warm and welcoming people with a strong desire to succeed and innovate, to leave the legacy of a better way of life to their children and grandchildren. I’m sure this is a source of tremendous pride for Prime Minister Netanyahu, as it is for me. Our delegation has enjoyed learning everything we can about this great nation, and I hope the unique Louisiana culture of innovation that we are sharing in Israel has been equally enjoyed by our hosts.”

Prime Minister Netanyahu has an extensive history of service in the Israeli government and the private sector. He first served as prime minister from 1996 to 1999, and then again from 2009 to the present. He has also held the positions of Minister of Finance, Minister of Foreign Affairs, and Ambassador of Israel to the United Nations. His private sector works includes service with the Boston Consulting Group, and he holds degrees in architecture and business management from MIT. Netanyahu and Edwards are both Army veterans of their nation’s military: Netanyahu served in the Yom Kippur War of 1973. A 1988 graduate of the U.S. Military Academy at West Point, Gov. Edwards commanded a rifle company in the 82nd Airborne Division at Fort Bragg, North Carolina, before completing his military service, graduating from the LSU Law Center and setting up a civil law practice.

Of key interest to Israel and Louisiana on the trip are exploring ways to expand trade and  foreign direct investment activity between the two partners, according to the press release. While substantial, trade between Louisiana and Israel is small in scope compared to overall trade volume with other nations. For instance, Louisiana ranks as the No. 9 exporter to Israel
among U.S. states, with approximately $200 million in exports; that’s a small portion of the over $57 billion in total Louisiana exports. Israel’s more than $60 billion in annual exports includes nearly $22 billion in shipments to the U.S., though Louisiana’s share of Israeli imports is less than $150 million, with fertilizers, mineral and metals among the leading categories.

Talks between Gov. Edwards and Prime Minister Netanyahu are expected to open new avenues of trade and investment growth in commodities where Louisiana is a leader, such as oil and gas; along with applied research areas in which both Israel and Louisiana are emerging, such as water management; and defense and technology related fields where Israel is an innovation leader and Louisiana is an emerging force, such as cybersecurity.

Gov. Edwards also is meeting with key Israeli cabinet officials on the trip, including Deputy Minister Michael Oren in the prime minister’s office; Minster of Energy Yuval Steinitz; and Advisor to the Minister of Energy on International Developments and Foreign Affairs Benjamin Weil.

With Israel playing a central role in global cybersecurity, the delegation met with cybersecurity companies in Israel on Wednesday, with additional exchanges occurring on Monday at the nation’s CyberSpark Industry Initiative in Beersheba and a visit to Twistlock’s Tel Aviv operations planned on Thursday. In April 2018, Twistlock announced the opening of a global solutions engineering center at the LSU Innovation Park in Baton Rouge.

In Israel, cybersecurity exports generate an estimated $6.5 billion in economic activity annually, with Israel attracting $815 million or 16 percent of all global investment in cybersecurity ventures during 2017, second only to the U.S., according to the Israeli innovation partnership Start-Up Nation Central.

Psychologists and Students Present at National Assn of Neuropsychology in NO

The National Academy of Neuropsychology held its 38th Annual Conference in New Orleans at  the Sheraton Hotel, October 17-20, 2018. The theme of the conventional was “Becoming Agents of Change.”

Psychologists from the New Orleans area who presented at the conference included Dr. Kevin Bianchini who spoke on “Pain in the Medicolegal Context.

Dr. Lisa Settles and Dr. Margaret Hauck, along with colleague Dr. Mary Gleason, presented “Early Childhood Brain Development: A Clinical View of Exceptions to Typical Brain
Developmental Trajectories.”

Students presenting included Scott Roye, Alyssa De Vito, and Andrea Smith, all from Louisiana State University, and with co-author Matthew Calamia, PhD, Assistant Professor in Clinical
Psychology, Louisiana State University.

The National Academy of Neuropsychology (NAN) is a non-profit professional membership association for experts in the assessment and treatment of brain injuries and disorders. NAN members are at the forefront of cutting-edge research and rehabilitation in the field of brain behavior relationships.

For her presentation, Lisa D. Settles, PsyD, Assistant Professor of Psychiatry & Pediatrics at Tulane University School of Medicine, Tulane Center for Autism and Related Disorders, reviewed the diagnostic criteria of Autism Spectrum Disorders (ASD), basic neurobiological basis of ASD, specific symptoms of language impairment, social impairment, and RRBs and how the brain contributes to the deficits in youngsters.

Dr. Settles included reviews about issues of social communication delays and restricted, repetitive behaviors. She told the audience about how deficits in ASD are due to connections, activation, structures, and lack in these elements. She said there was difficulty studying young
children using imaging techniques that require stillness and following directions and noted that new information is forthcoming regularly and even weekly.

Margaret Hauck, PhD, neuropsychologist and Assistant Professor of Psychiatry at Tulane University School of Medicine, spoke on “Normal Development,” including cortical development, and explained that different regions follow different patterns. She reviewed how asymmetry appears early on, and how in the third trimester, the cortex is starting to learn. She told the audience how the newborn brain is prepared to experience, and is also prepared by experience. She also included how the greatest plasticity is in early years. She covered memory, encoding, retention, retrieval, autobiographical memory, attention, executive functioning, social and emotional development and other factors.

Dr. Gleason covered the prevalence of adversity in early childhood, the clinical correlates of  adversity and trauma-exposure in very young children, factors related to the presentation of
psychopathology in early childhood, and clinical implications of psychopharmacologic treatments.

She summarized that early childhood development is impacted by adversity and protective  actors in the caregiving environment. Mechanisms of these impacts is complex and includes direct and indirect influences, she explained. Therapy is safest and best supported treatments, while medications may play a role but large gaps in knowledge limit use.

Kevin Bianchini PhD, ABPN, FACPN, presented ” Pain Psychology for neuropsychologists: An Update.” He is a board certified Neuropsychologist and Clinical Psychologist, and is with Jefferson Neurobehavioral Group.

In his presentation, Dr. Bianchini covered the clinical circumstances of pain psychological evaluations, including predicting response to procedures or rehabilitation, understanding difficult-to-explain outcomes, and identifying treatment approaches, including treatment of comorbidities.

He noted that pain-related complaints are extremely common in the general population and  that the presence of pain influences recovery in neuropsychological conditions. He covered
psychosocial factors that influence recovery.

Dr. Bianchini also reviewed how psychometric testing is a valuable component of a consultation to assist the physician in making a more effective treatment plan and that it is useful in the assessment of mental conditions, pain conditions, cognitive functioning, treatment planning, vocational planning & evaluation of treatment effectiveness.

Psychosocial treatment is recommended as an important component in the total management of the patient with chronic pain, he told attendees, and treatments should be implemented as soon as the problem is identified, he explained. Psychosocial treatment may enhance the patient’s ability to participate in pain treatment rehabilitation, manage stress, and increase their problem-solving & self- management skills.

He described the scope of the problem and that pain complaints result in millions of
physician office visits per year and as many as 150 million lost work days. He noted that
the lifetime incidence of low back pain is 11 to 84% and lifetime incidence of neck pain
is 10 to 15%. Back pain is the most common reason for filing a workers compensation claim
and 30-50% of all Workers Compensation claims involve back pain. However, objective
physical findings do not fully explain the breadth and magnitude of disability seen in
many patients with back pain, he noted.

Scott Roye, MA, graduate student at Louisiana State University, presented a research poster, “Associations of Normative and Maladaptive Personality Traits with Self-Reported  Executive
Functioning.” Co-authors are Peter Castagna, MA, from Louisiana State University, and Matthew Calamia, PhD, Assistant Professor and also from Louisiana State University.

In his abstract, Rove noted, “Executive functioning (EF) is a collection of higher order processes designed to facilitate goal-oriented performance. Although commonly studied using performance-based tasks, self-report measures are also useful in assessment given their association with functional impairment. The relationship between self- reports of personality and EF is limited by the use of global EF scores and primarily measures of normative, rather than maladaptive, traits.”

In his study, Roye sought to better understand the relationships between
individual, self-reported EF domains and personality traits among a non-clinical
sample of young adults. Findings replicate prior work emphasizing the relationship of
neuroticism and conscientious/disinhibition to self-reported executive functioning and
extend previous research, Rove wrote.

Alyssa De Vito, MA, also a graduate student at Louisiana State University, presented “Apathy Symptom Severity and Progression Across Empirically-Derived Mild Cognitive Impairment Subtypes.” Her co-author is Matthew Calamia, PhD, Louisiana State University. De Vito examined apathy severity at baseline and its progression over time in empirically derived mild cognitive impairment (MCI) subtypes, she noted.

Using clinical and neuropsychological criteria, amnestic MCI individuals were identified as having more severe apathy symptoms than cognitively normal participants at baseline. However, only clinical criteria identified dysexecutive individuals as having more severe apathy symptoms compared to cognitively normal controls at baseline.

The study demonstrates that apathy severity and progression differ across MCI subtypes. Identification of individuals who may be at risk of developing more severe symptoms is important given apathy’s association with functional impairment, even after controlling for cognitive impairment.

Andrea Smith, an undergraduate senior at Louisiana State University, presented, “White Noise Effects on Cognitive Performance in Those with ADHD: The Moderating Role of Internalizing
Symptoms.” Co-authors are Scott Roye, MA, and Dr. Calamia.

According to her abstract, prior research suggests that white noise played concurrently with a cognitive task may facilitate cognitive performance in those with ADHD, for example, by reduced need to seek out other stimulation. However, much of this work has been done only with children. Additionally, studies of white noise and ADHD have not examined the role of comorbid depressive and anxiety symptoms, which are known to effect cognitive performance in those with ADHD. Smith aimed to address this gap in the literature.

The results indicate that the effects of white noise may uniquely influence cognition among individuals with ADHD, depending upon the presence and severity of their internalizing symptoms, Smith’s review said.

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.