Category Archives: News Stories

Dr. Melissa Dufrene Named Early Career Psychologist

Dr. Melissa Dufrene has been named the 2017 Early Career Psychologist by the Louisiana Psychological Association, announced at the association’s annual convention held in June in New Orleans. Dufrene is a licensed clinical psychologist with numerous community and professional involvements. “I am honored to be recognized,” she said.

Her post-doctoral supervisor, Michael Chafetz, PhD, ABPP, said, “It was indeed a pleasure to learn that Dr. Melissa Dufrene was honored for the Early Career Psychologist award of 2017, as she is clearly deserving.”

“She is a strong and compassionate practitioner who fully understands the application of evidence-based methods to achieve desired clinical outcomes,” Chafetz said, “which she also measures. Before I met her for a post-doctoral position in my clinic, she had strong training, especially in her work in the inpatient OCD unit of Rogers Memorial Hospital in Milwaukee, Wisconsin,” he said.

“In my mind, it is this combination of scholarship and treatment sense that makes her so effective.” In 2014, Dufrene co-authored with Chafetz, “Malingering-by-proxy: Need for child protection and guidance for reporting,” in Child Abuse and Neglect.

Dr. Dufrene currently is a licensed Clinical Psychologist affiliated with the Algiers Neurobehavioral Resource, LLC, where her time is devoted to therapy and psychological evaluations. She leads the clinic’s initiatives surrounding women’s therapy, assessment, and behavioral health needs. In this capacity, she provides services to women patients for issues such as postpartum depression, general anxiety, relationship issues, abuse, and general mental

health.
Her primary areas of interest are anxiety related disorders, PTSD, OCD, depressive disorders, and child behavioral problems.

She has also serves as Adjunct Instructor at the Chicago School of Professional Psychology at Xavier University where she teaches Basic Psychopathology. She has also taught at Delgado Community College and for Instructional Connections. This year she also began working as Gratis Faculty of LSU, where she serves as a supervisor to one of the interns in the program.

She was recently named co-chair of the Early Career Psychologist Committee for the Louisiana Psychological Association. Along with her co-chair and colleague, Dr. Ashley Jefferson, she plans on engaging early career professionals. “We are focusing on increasing the level of involvement of EC’s and students across the state, and addressing pertinent issues in the field,” she said.

Dr. Dufrene serves the broader community in a number of ways. She has served as a member of the Regional Advisory Board for the Alzheimer’s Association where she contributes to community education and support efforts. In 2015 she served as chair of the annual fundraiser event for the association.

She has served as a Partner in Multiple Sclerosis Care, a segment of the National Multiple Sclerosis Society to assist patients in accessing quality care and outreach for those living with MS. She provided training on issues of stress management for those with MS.

She has also served as a Each One Save One Mentor, where she works with at risk-elementary students and with school staff to assist youngsters.

Dr. Dufrene trained at Rogers Memorial Hospital, a nationally recognized residential and behavioral health hospital, treating individuals with serious mental health disorders. At this facility, she worked in the Obsessive-Compulsive Disorder Center, one of only two residential treatment centers in the United States for males and females age 18 and older with obsessive-compulsive disorder and obsessive-compulsive spectrum disorders.

She earned her doctorate in clinical psychology from The School of Professional Psychology at Forest Institute in Springfield, Missouri. Her dissertation was Examination of Executive Functioning Among 9-12 Year Olds with ADHD, Obesity, and Comorbid ADHD/Obesity.

Along with her professional and community service, she has a very busy family life. “And just to keep things interesting,” she said, “my husband and I are expecting baby #2 in December, which will make our two-year old a big brother!”

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Governor Appoints Dr. Leah Crouch to Psychology Board

The Governor has appointed Leah Crouch, PsyD, to serve on the Louisiana State Board of Examiners of Psychologists (LSBEP) according to a Boards & Commission announcement July 21. Dr. Crouch will begin serving the five-year appointment this month, according to sources.

Outgoing chair is Darla Burnett, PhD, MP, who ended her term in June. Currently serving are Drs. Phil Griffin, Koren Boggs, Jesse Lambert, and Amy Henke. Dr. Lambert is the only medical psychologist with Dr. Burnett completing her service.

In February 2017, Dr. Crouch captured 58 percent of the votes cast in the election and Dr. William Schmitz received 42 percent. The Louisiana Psychological Association submitted both Dr. Crouch and Dr. Schmitz to the Governor, with the association’s request that Governor Edwards appoint the top vote getter, according to sources.

Dr. Crouch is owner of River Bends Psychology, a Private Practice located in New Orleans, where she provides psychological services to adult population. She received her PsyD from the University of Denver in 2006 in Clinical Psychology.

She is also with Tulane University, Department of Psychiatry and Behavioral Sciences, where she is a Clinical Assistant Professor and previously an Assistant Professor, and providing services on an adult, acute, inpatient psychiatric unit for those with chronic and severe behavioral illness.

Dr. Crouch has previously worked for the Department of Defense, Department of the Navy, at the Naval Consolidated Brig Chesapeake, providing services at a Joint Regional Correctional Facility, where she helped restore and prepare prisoners for return to duty or re-enter civilian society. She also worked as a psychologist at the Naval Hospital in Beaufort, South Carolina from 2010 to 2012.

In 2009 and 2010 Dr. Crouch provided services in a juvenile correctional center for Louisiana State University, Health Science Center –New Orleans, School of Public Health Juvenile Justice Program.

Dr. William Schmitz, Jr., is a clinical psychologist with the Department of Veteran Affairs and resides in Baton Rouge. He earned his PsyD from Baylor University in 2006.

Dr. Schmitz, previously served as the President of the American Association of Suicidology, and clinical psychologist, and presented in 2015 as the plenary session speaker at conference of the Louisiana Chapter of the National Association of Social Workers.

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LSBEP to Appeal Judge’s Decision

The Louisiana State Board of Examiners of Psychologists (LSBEP) will appeal a recent decision by District Court Judge Michael Caldwell, who ruled that the board’s process violated the Constitutional rights of a psychologist.

On July 27 the Times asked LSBEP Executive Director, Ms. Jaime Monic, if the Board was going to appeal Judge Caldwell’s decision.

Ms. Monic responded the following day, writing, “The Board thoroughly discussed this matter and the Order from the 19th Judicial District Court at a special meeting held on July 7, 2017. With consideration being given to the costs of a new hearing as well as the Administrative Procedures and other statutorily supported procedures that were followed by LSBEP staff, and in consultation with Attorney Amy Groves Lowe, the Board voted to appeal the decision of the 19th JDC.”

On May 2, Judge R. Michael Caldwell of the 19th Judicial District Court in Baton Rouge said that the procedures leading to the suspension of Dr. Eric Cerwonka’s psychology
license included so many Constitutional violations that the decision could not stand, according to Cerwonka’s attorney, Mr. Lane Roy, in a previous interview.

Judge Caldwell agreed to hear additional arguments from the LSBEP attorney, Ms. Amy Lowe. On June 26 Judge Caldwell heard the additional views but stood firm on his initial opinion, this time using the term, “reeks” to describe some of the process, as described by Mr. Roy.

On July 7 the LSBEP met in a special meeting at Children’s Hospital in New Orleans scheduled from 3:35 to 5:00 pm. According to the agenda the members were to have discussed two matters in executive session from 3:35 to 4:30. The agenda listed the two topics for the closed session as: “1. Review qualifications of applicants for prosecuting attorney. 2. Other in-house personnel matters.”

Also according to the published agenda, the members were then to have discussed the following matters from 4:30 to 5 pm in open session:“1. Prosecuting Attorney Contract 2017-18; 2. Complaints Coordinator II Position 2017-18; 3. 201718 Budget Recommendations; and 4. Eric Cerwonka vs. LSBEP, 19th Judicial District Court Decision.”

At the most recent regular board meeting of the Board, held July 28 at the Baton Rouge office of the LSBEP, Dr. Tom Hannie attended and asked about the appeal. Dr. Kim VanGeffen, Professional Affairs Chair for the Louisiana Psychological Association, was also in attendance. Hannie provided the Times with a recording of the discussion.

Dr. Hannie: “I have questions about that case. As I understand it, the lawyer that was running the trial also had represented Cerwonka in a previous case, and the person who was prosecuting, was a member of the same firm. I’m wondering if the attorneys were committing malpractice by not recusing themselves and if y’all have looked at that?”

Dr. Phil Griffin: “We’ve looked at every aspect of it. I, you know…His attorneys, to me, did a pretty damn good job. I was impressed with Cerwonka’s attorneys. And I don’t know, if there’d have seen something awry … that should have brought that up at the trial, in terms of our prosecuting attorney. Those things, those things quite frankly don’t even enter into what all was going on, why the guy was in the hearing in the first place.”

[Many speaking at same time…]

Dr. Amy Henke: “I would encourage anyone who has questions about these hearings, please come. See what you think. They’re open to the public. Julie was there. I encourage LPA, someone from the association, to see what you think. Watch what we watch, and see what you would do.”

Dr. Kim VanGeffen: “… At least as I understand it, it was not so much the hearing itself, but what led up to the hearing.”

Ms. Monic: “Unfortunately, complaint investigations are confidential. There are avenues for reviewing the board’s policies and procedures. The Inspector General could certainly come in and take a look at that case and how it was handled. That wasn’t an option that was pursued and so now we’re in litigation. Whether or not, as an administrative agency, we acted properly administratively, I believe we did.”

[Many speaking]

Dr. Hannie: “I understand that you, you’re shackled, but when I see that the board is going to appeal I look at the cost of appealing, and sometimes when you appeal, you not only pay your legal fees but you pay the other person’s legal fees and it can get outrageous.” He described an unrelated example where an appeal may be costing $100,000 or more.

“In some of these cases they get six figures, paying on an appeal, just paying the other person’s fees, not just their own.”

Dr. Henke: “We worry about costs too, but our number one charge is public safety. We can’t not pursue something, we can’t just say it’s too expensive–– ‘we’re not going to protect the public on this one because it’s too expensive.’ ”

At the May 12 meeting of the LSBEP, following Judge Caldwell’s initial opinion on May 2, the minutes indicate that the board members discussed the alternatives to either appeal the ruling or to conduct a rehearing of the case involving Dr. Cerwonka. The minutes noted:

“Petition for Judicial Review: Eric Cerwonka vs. Louisiana State Board of Examiners of Psychologists: No. C656587 Section 24 – The Board reviewed the Petition for Judicial Review in this matter and the Summary Report provided by Attorney Amy Groves Lowe concerning the Status Conference held on April 21, 2017. The Board approved moving forward with a judicial review before the 19th Judicial District Court in lieu of rehearing.”

Discussion items for that meeting also included the review of Legal Contracts for 2017–2018. The minutes listed the following:

“1. Taylor, Porter, Brooks & Phillips (TPBP) – By motion of Dr. Griffin, the Board unanimously approved an amendment to the July 1, 2016 – June 30, 2019 contract with TPBP to add an additional $12,000, needed for continued legal services.” Taylor Porter is the firm for the Board’s General Council, which includes Mr. Lloyd Lunceford and Ms. Amy Lowe.

The minutes also noted: “2. Breazeale, Sachse & Wilson (BSW) – The consideration of this contract was tabled until July 2017.” BSW is the firm for Prosecuting Attorney, Mr. James Raines.

And the other items were: “3. Roedel, Parsons, Koch, Blanche, Balhoff & McCollister – The consideration of this contract was tabled until July 2017. 4. Other – The Board designated Dr. Amy Henke and Ms. Jaime Monic to conduct interviews for additional legal counsel for the 2017-18 Fiscal Year.” The Roedel firm is the firm for Ms. Deborah Harkins, the attorney often hired for legislative issues.

According to public records the board has had escalating legal fees which stem primarily from charges from the Board Prosecutor, held at one point by Mr. James Raines. Over 2015 to 2016, and into January 2017, Mr. Raines prosecuted 16 cases. Three of these 16 cases amounted to $146,987 of charges from Mr. Raines.

This past legislative session the LSBEP helped pass legislation that removed a oneyear time limit for investigations from the psychology licensing law. The measure also gave the board’s complaints subcommittee the ability to charge fees to psychologists being investigated for activities that do not reach the hearing level.

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

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

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

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

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

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Judge Caldwell Stands Firm on LSBEP Ruling

In an ironic twist of events, the Louisiana State Board of Examiners of Psychologists (LSBEP) has shepherded a bill through the legislature giving them more time to investigate complaints and more authority to charge fees. At the same time a District Court Judge has ruled that the board’s investigation and complaints subcommittee blatantly violated a defendants’ constitutional rights of Due Process.

“It is a huge issue and a major decision,” said Lane Roy, attorney for defendant Dr. Eric Cerwonka, “because it flies in the face of the procedure that we know this board has used time and again.”

The most recent hearing was held on Monday, June 26, with Judge R. Michael Caldwell of the 19th Judicial District Court in Baton Rouge. This latest ruling followed a May 2 review where Caldwell informed both sides that he considered the LSBEP procedures to violate Constitutional rights of the defendant.

On May 2 the LSBEP attorney, Ms. Amy Lowe, urged Judge Caldwell to allow her to present additional arguments and Caldwell agreed.

However, Mr. Roy did not see any meaningful additions presented by Ms. Lowe at the recent June 26 hearing. “She had nothing,” said Mr. Roy. “Zero.”

Mr. Roy also told the Times that Judge Caldwell used the term “reeks” three times at the June 26 hearing to describe his [Caldwell’s] views.

“The Judge ruled in open court and he used the phrase three times–– ‘This matter reeks with denials of Constitutional rights. I don’t care what he did or didn’t do. I can’t put up with this. As a Judge, I can’t,’ reported Mr. Roy. “He [Caldwell] was resolute. He said it was not a close call. That it was basic.”

Mr. Roy also said that the issues ruled on by Judge Caldwell are so basic that there is no possibility that the LSBEP attorneys do not know of these requirements.

“These are good people from good firms,” said Roy. “They all know the laws in these areas. What it tells me, is that they are bold enough to do it anyway.”

“The statute gives the board authority, but how can you have an administrative person, staff workers, who decide, who make decisions that affect the livelihood of people?” said Roy. “It’s the first step in taking the legs out from under the defendant. The defendant is concerned with their livelihood and ability to make a living, and can lose employment, before anyone on the board has even heard their case.”

“They run the costs up so high,” said Roy, “and put them [defendants] under political pressure and economic pressures. In Baton Rouge, where all the boards are, it is a cottage industry for attorneys.”

The Times asked Mr. Roy if he thought that the LSBEP would appeal. “She [Ms. Lowe] said she would appeal. I can’t imagine that this board would appeal, but I’ve been surprised by their decisions before.”

The District Court is not a court of publication explained Roy, but the Appeals Court is. Decisions handed down from the Appeals Court are widely distributed. “If they go to the Court of Appeal, they invite everyone to see their mistakes.”

On May 2, Judge Caldwell mentioned some of what he viewed as Constitutional violations, such as the hearing officer being the law partner of the board attorney and also someone entering Cerwonka’s home illegally to attempt to gather evidence. Another of these issues was that Cerwonka had previously been a client of the LSBEP prosecuting attorney, Mr. James Raines.

Mr. Roy noted in a Pre-Hearing Memorandum, “The prosecuting attorney for the Board had represented Dr. Cerwonka in a hotly contested custody dispute, had obtained much personal information about his then client, and provided information obtained to his Board client, all without authority or consent.”

“The Administrative Law Judge, Lloyd Lunsford, the person who at the hearing made all rulings on questions of law, admissibility of evidence, what was relevant and not relevant, and generally acted as ‘judge’ at the hearing, was and still is the law partner of Amy Lowe, who represented the Board at the hearing and who in fact, is representing the Board in this appeal,” wrote Roy in the memorandum.

Mr. Roy said in an interview with the Times, “It doesn’t mean that the board can’t go back and do it again. They have to do it in the correct way. My opinion is that if they do that, they will not be successful,” he said.

“The interest is not to police the profession, it is some other interest,” said Roy. “Some say it is political, but whatever the interest is, it is not to police the profession.

” The Complaints Committee of the LSBEP is a subcommittee that operates without direct oversight of the board members. The reason for this is so board members will avoid being exposed to information prior to disciplinary votes.

The Policy & Procedures for investigations have been changed dramatically over the last decade, so that once staffed by experienced psychologists and past board members, now there is a Private Investigator and a Prosecutor.

According to public records the board has had escalating legal fees which stem primarily from charges by the Board Prosecutor, held currently by Mr. James Raines. Over 2015 to 2016, and into January 2017, Mr. Raines prosecuted 16 cases. Three of these 16 cases amounted to $146,987 of charges for Mr. Raines.

After seeing the legal charges in this case, Mr. Roy said in a previous interview, “I was shocked at these fees. I’ve never seen these types of fees. It clearly is punitive,” he said. “I’m convinced that they don’t want anybody to appeal.”

Mr. Roy said that he has a good deal of experience with boards and that costs average around $10,000. A previous review of public documents suggested that fees for the Cerwonka case had come to $78,000 for the LSBEP. Mr. Roy noted a total of over $100,000 was closer.

During the recent legislative session, the LSBEP put forth legislation, SB 37 now Act 234, that removed a one-year limit on investigations from the psychology law. The measure also provided for fees to be charged for the investigations subcommittee. The bill was eventually amended so that the subcommittee fees would be capped at $10,000.

The Times asked for comments by the LSBEP after Judge Caldwell’s latest ruling, but has not received comments by publication time. The LSBEP has a policy of no interviews with the press.

[Editor’s Note: See “Judge Says Psych Board Procedures Unconstitutional,” in June issue of the Times. Also see “What’s Behind Door No. SB 37?” in the April Times.]

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LSBEP Publishes Rules for Ethics, Fees, Supervision

The Louisiana State Board of Examiners of Psychologists (LSBEP) published its final version of the new Chapter 13. Ethical Standards of Psychologists,” composed of ten pages of guidelines based largely on the ethics code of the American Psychological Association. The Rules was published in the June issue of the Louisiana Register.

Sections include: Preamble, Resolving Ethical Issues, Competence, Human Relations, Privacy and Confidentiality, Advertising and Other Public Statements, Record Keeping and Fees, Education and Training, Assessment, and Therapy.

The psychology board also published a new Rule for Chapter 6 of the Louisiana Administrative Code (LAC) on Fees. License renewals are increased from $320 to $350 and the Emeritus category will go up from $150 to $175. Reinstatement fees drop from $570 to $550.

Additional changes to Chapter 7 on Supervised Practice Leading toward Licensure, includes “Postdoctoral supervised practice hours can begin accruing after the date on which all requirements for the doctoral degree are met, …” For Licensed Specialists in School Psychology, a change is made to Chapter 33, Definition of Applicant for Licensure as a Specialist in School Psychology. Included is, “5. has completed an internship of at least 1200 hours and nine months in duration, …” with 600 hours in a school setting; .. Also, one year of employment or experience, obtained as part of an acceptable internship may be applied toward required supervision.

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Legislature Wraps Up

Financial issues dominated the legislative session but some bills drew the community’s attention. A measure by the state psychology board aimed to help the regulatory board deal with its mounting legal fees, passed with amendments. An effort by the Counselors to remove the Rx consultation clause moved through after some initial bumps with the psychologists.

Senator Mills’ bill to reform the health boards’ disciplinary hearings and create oversight, bit the dust. One source reported that a board member said, “We killed it.” A new commission was created for prevention of human trafficking and limits were placed on prescriptions for opioids.

In this review we summarize a few of the actions of the 2017 Legislative sessions.

Legislature Finally Passes Budget

Legislators were called to another special session to pass a budget they had failed to negotiate before the regular session, a sign of continuing problems for the state. A $1.2 billion shortfall is expected next July, according to the Advocate.

For now, higher education fared better than expected, and was funded at higher levels than in the last decade. Mental health in Medicaid took a severe cut. State workers, especially the lower paid employees were given a 2 percent increase, amid concerns that employees such as prison guards would not be retained due to low comparative rates.

Governor Edwards warned that the fiscal cliff is coming. He said that if the conservatives would not renew taxes in 2018, it would result in the closing of hospitals and universities, reported the Advocate.

SB 37 (Act 234) Gives LSBEP More Leeway In Investigations

Senate Bill 37 by Senator Martiny, a measure to remove the current one-year time limit for disciplinary investigations at the Louisiana State Board of Examiners of Psychologists and to allow the psychology board to collect fees when psychologists are being investigated by the subcommittee, was signed into law as Act 234 on June 14.

The measure allows for the board to start charging fees for informal hearings, including fees incurred by the board for a disciplinary action that is resolved by settlement, consent decree, or other informal resolution, including its investigator, staff, and legal fees. Previously they were allowed to charge only for formal hearings.

The measure was amended in committee to cap the fees for informal hearings at $10,000.

Previously psychologists enjoyed a one-year limit for the board to bring them to a hearing over a complaint, and in the original version the board would have been exempt from all time limits. However, in the Senate Committee, the measure was amended to conform with the time-limits set out in R.S. 37:21.

At the November 2016 LSBEP Long-Range Planning meeting, the board had said it would work collaboratively with the community to develop administrative Rules, not a new statute, to deal with its problems. In early March, the board sprung the news on the Louisiana Psychological Association (LPA) that it was crafting legislation for the 2017 session.

SB 38 (Act 235) Frees Counselors from Rx Consultation Clause

A measure removing a consultation clause for counselors and marriage & family therapists passed the House floor with 88 yeas and 2 nays on June 1, and returned to the Senate and was approved 33 to 0. The measure was signed by the Governor on June 14.

The bill became law upon signing and relieves those under the Licensed Professional Counselor board of a burden to consult with a professional who prescribes and who is licensed under the state medical board.

The measure hit a snag when psychologists objected to what some viewed as an opening to psychological testing, even though counselors said testing was not part of the bill.

At the June 23 meeting of the House Health & Welfare Committee, author Senator J.P. Morrell told members, “Working with the association of psychologists we came to a compromise in which, working with those groups over a period of time, there was an agreement that the testing provision for a variety of those different conditions would remain with the psychologists and the testing provision would be removed from the practice act.”

“So we removed the language that requires the consultation but we changed the practice act to say that the testing provision should be in the purview of psychologists while the diagnosis and treatment will remain with the mental health counselors and with marriage and family therapists.”

Morrell said that with this change the association of psychologists removed its opposition. The committee reported the bill favorably with an 11 to 0 vote. Then it was passed in the House with 88 yeas and 2 nays.

SB75 Stalled Out in Committee

Senator Fred Mills’ effort to reform and curtail boards’ powers when it comes to disciplinary hearings was stopped in the House Health & Welfare Committee after passing the Senate. At the committee meeting Mills said that there had been some misinformation and he clarified that the measure did not affect the duties or powers of the boards, or the scope of practice that some members of the boards had believed.

He said that the changes are not new ideas. “Forty-four states have Administrative Law Judges for disciplinary hearings,” he said. “We don’t want you to be the sheriff, the DA, and the judge.”

This is a lot less costly Mills said, with the Administrative Law Judge costing on average from $1,500 to $2,000 for a hearing. The measure would have also added a consumer member to those boards that do not currently have one.

“We revised the Ethics laws in 2008 and said that, as a body, we don’t want the sheriff and the DA to be the judge and the executioner,” said Mills. “This bill is for the little man and the little woman. If you have to go in front of a full hearing, you should not go in front of a hearing that are those who’ve been investigating you.”

One source told the Times that board members helped derail the effort.

SB42/Act 181 Creates the Human Trafficking Prevention Commission

The measure creates a 17- member commission with a variety of legal, law enforcement, educational, social and other leaders, and also an Advisory Group, to prevent human trafficking in the state.

Act 162 Limits Service on Medical Board

Amends present law, instead of repealing it, and limits service to three consecutive terms.

SB216/Act 254 PEC Expanded

Prior law authorized any physician, psychiatric mental health nurse practitioner, or psychologist to execute an emergency certificate after an actual examination of a person alleged to be mentally ill or suffering from substance abuse who is determined to be in need of immediate care and treatment in a treatment facility because the person is determined to be dangerous to self or others or to be gravely disabled. Act 254 expands this authority to (1) Physician assistants when acting in accordance with their respective clinical practice guidelines; (2) Nurse practitioners with or without a clinical specialization who act in accordance with a collaborative practice agreement and receive verbal approval from a collaborating physician for executing the certificate.

SB192/Act 82 Limits Prescribing of Opioids

The measure prohibits a medical practitioner from prescribing more than a seven-day supply to an adult for outpatient use or to a minor at any time.

HB341/Act 369 Changes Terminology from Mental Health to Behavioral Health

The measure changes the heading of Title 28 of the La. Revised Statutes of 1950 from “Mental Health” to “Behavioral Health,” and defines “behavioral health” as a term which is used to refer to both mental health and substance use.

HB79 to Act 266

A measure which prohibited the administration of corporal punishment to students with exceptionalities, was signed into law.

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SB 38 Proposed by Counselors and MFTs to Remove Wording Requiring Consult for Medical Board Professionals and Rx

The-Psychology-Times-Vol-8-No-4.pdf

Senator J.P. Morrell has proposed a measure that will remove language requiring that counselors and marriage and family therapists consult and collaborate with physicians, psychiatrists, medical psychologists, advanced practice registered psychiatric nurses, when treating or assessing individuals with “serious mental illness.”
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Dr. Tucker’s Work Honored

Legislators commended the results of the Steve Holye Intensive Substance Abuse Program and other programs created by psychologist and Assistant Warden, Dr. Susan Tucker, in a House Concurrent Resolution (HCR3), signed by the Speaker on February 25.

The HCR3 authors pointed to multi-million 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.

The legislators also noted that, while the programs were effective in shortening sentences of certain offenders, these efforts also helped offenders reintegrate into their families and communities and lower the risk of repeat offenses.

“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. “With successful completion of our intensive treatment program, certain offenders can earn up to one year off their sentence. This is a significant savings to the public,” she said.

Fifteen hundred offenders have graduated from the nine-month program and an additional six hundred have graduated from the six-month program since it was moved to Bossier, after the Forcht Wade Correctional Center was closed due to budget cutbacks in 2012.

The Resolution authors noted that Tucker’s Substance Abuse Program has awarded more than five hundred thousand days of “good time credit” to offenders and saved the state nearly $13,000,000 during the January 2013 to December 2015 time period.

Another group of offenders have earned credits of nearly 50,000 days credit, saving the sate more than $1,000,000. And, those successfully participating in the Family Recovery Program earned 75 days of credit. Over time the program has awarded 55,000 days of credit, a $15,000,000 savings in reduced incarceration time.

“THEREFORE, BE IT RESOLVED,” the authors wrote, “that the Legislature of Louisiana does hereby commend and recognize the Steve Hoyle Intensive Substance Abuse Program for its success in shortening the sentences of certain offenders, while better preparing those offenders to reintegrate into their families and communities without a return to substance abuse and incarceration.”

Tucker has previously explained in an interview what she views as the basis of the program’s success: the innovations, the comprehensive approach, and the evidenced-based methods. “The philosophical approach to our treatment,” Dr. Tucker explained, “includes focusing on the thinking patterns, emotional reactions, and behavioral events that often lead to self–defeating patterns and eventually to criminal activity. We utilize psychological assessment instruments to illuminate areas of concern, including low cognitive ability, personality disorders or features, mood disorders, and thought disorders. We individualize a treatment program for that offender and he works closely with his assigned counselor to meet the goals of that treatment plan.”

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Henke First in LSBEP Election Returns

Dr. Amy Henke has captured 62 percent and Dr. Leah Crouch, 38 percent, of votes from the licensed psychologists casting votes in the election for a seat on the state psychology board, the Louisiana State Board of Examiners of Psychologists (LSBEP).

The position to be filled by either Henke or Crouch is that of outgoing medical psychologist, Dr. Marc Zimmermann, who completes his term this June. The final choice between the two candidates will be made by the Governor.

The election was the first in recent years without a member of the Louisiana Academy of Medical Psychologist (LAMP) seeking a position on the board. The LSBEP has routinely been composed of three medical psychologists in the five members, despite the fact that medical psychologists make up only about 5 percent of all licensed psychologists and are not required to hold a state psychology license.

In the current election, Dr. Henke received 183 votes, Dr. Crouch, 113 votes, and 27 of those casting votes, abstained.

President of the Louisiana Psychological Association, Dr. Lacey Seymour, reported the results to the Office of the Governor in a letter on January 25, obtained from the president.

In the letter, addressed to Ellen Palmintier, Director at Boards and Commissions, Seymour asked that the Governor appoint the individual with the top number of votes. She wrote, “As per our current policy, we respectfully request that the Governor appoint the psychologist who obtained the majority of the votes in the election. Therefore, we urge Governor John Bel Edwards to appoint Dr. Amy Henke.”

By law, the Governor may appoint either nominee on the list provided by LPA.

Sources in the community have said they are curious about the absence of a LAMP member on the list to the governor, which usually results in the appointment of that individual.

Last year an effort was pushed by the LAMP dominated psychology board to remove the wording from the psychology practice law. The law currently gives the Louisiana Psychological Association (LPA) the right to construct the “list” from which the Governor makes appointments.

The effort failed because the Senator sponsoring the bill refused to advance it if there were any conflicts over the substance of the legislation. The LSBEP dropped the effort to delete LPA’s role in the “list.”

LAMP is known to be a political powerhouse. The group donated more money to legislators in 2014 than any other political action committee in healthcare, including the much larger state medical group, for that same year.

Dr. Amy Henke is a clinical psychologist with the Louisiana State University Health Sciences Center and Children’s Hospital in New Orleans. She is a member of APA Divisions for Pediatric Psychology and Health Psychology, and a member and Director for the Louisiana Psychological Association.

Dr. Crouch is a clinical psychologist with membership in the Divisions for Psychologists in Independent Practice, and also for Trauma Psychology. Dr. Crouch is also a member of the Society of Personality Assessment.

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Tulane’s Dr. Bonnie Nastasi Helps Bring Psychology to the Global Community

In 1989 the United Nations held the “Convention on the Rights of the Child,” and called for the promotion of child well-being worldwide, including the physical, psychological, and spiritual. The Convention members said that protection of children was the responsibility of governments and of all adults, and they called on the scientific and professional community to promote learning, development, and the general protection of children across the globe.

Tulane’s Dr. Bonnie Nastasi, Professor in the Department of Psychology, has been at the forefront of this movement for decades. She and her international colleagues have taken up the goal of helping children around the world, much of what began with the “Promoting Psychological Well-Being Globally Project,” a brainchild of school and educational psychologists meeting at a conference of the International School Psychology Association.

From that beginning, a multi-year research project involving 12 countries emerged, in Brazil, Estonia, Greece, India, Italy, Mexico, Romani, Russia, Slovak Republic, Sri Lanka, Tanzania, USA (Boston, Puerto Rico, New Orleans). The work has taken Nastasi from the streets of New Orleans, to the shores of rural Sri Lanka, to the slums of Mumbai, India.

Her work to protect and promote the well-being of children worldwide has spanned the globe and over twenty years. She told the Times, “Doing work in another country, and especially cultures so different from my own has been an amazing experience,” she said, “and has changed the way I think about cultural competence in the US as well.” For example, she explained, the work has helped her “think more deeply about what constitutes culture and how we can best assess and honor the culture of others.”

“Sri Lanka especially feels like my second home,” she said. “I could imagine living there. It is a place I found peace.”

Nastasi and her colleagues have worked to create and develop interventions that address the complex goals of children’s well-being, while at the same time dealing with the issues involved in exporting psychological science developed in the US, to other countries. And, she has authored numerous articles, books, and book chapters on the topic.

In one of her most recent books, Nastasi and colleague Amanda Borja, describe many of the findings and experiences of their global efforts: International Handbook of Psychological Well-Being in Children and Adolescent; Bridging the Gaps Between Theory, Research, and Practice (Springer, 2016).

Also recently published is her co-authored text, Mixed methods research and culture-specific interventions: Program design and evaluation (Sage, 2016). She is working on two edited texts, International handbook on child rights and school psychology, and Handbook of School Psychology in a Global Context, both to be published by Springer.

In a keynote presentation to the Louisiana School Psychological Association this past November, Nastasi explained that the World Health Organization has found that 20 percent of children worldwide suffer from mental health problems and at least 5 percent of these are severe. Access to services ranges from 20 to 80 percent but access is not sufficient in any country, she explained. The risks to children are many––war, ethnic conflicts, poverty, illnesses, lack of education, disasters, Dr. Nastasi told the school psychologists.

At the same time, Nastasi cautioned that research psychologists and psychological practitioners must be careful in “… exporting theories and practices developed in the United States to other cultures and contexts.”

The development of interventions for people across the globe is hampered, Nastasi says, by the tendency for those with the best knowledge to apply existing theories and techniques without fully considering differences in cultures and contexts.

Exporting our knowledge is more challenging than it might seem, she notes. Evidence-based practice is often confused with the search for the ‘one-size-fits-all,’ Nastasi says, and confusion comes with the Western method of randomized controlled trials as the benchmark, which places “emphasis on internal validity at the expense of external validity.”

She and her colleagues set out to resolve some of these issues when they developed the “Participatory Culture Specific Consultation Model” and methods, supporting the development of culture-specific programs for use in the global community.

Nastasi and colleague Asoka Jayasena applied their culture-specific methods in a program to support psychological well-being in youngsters in Sri Lankan school systems, a project spanning almost two decades and which included interventions before and after the 2004 tsunami.

Nastasi and Jayasena illustrated the steps in “An International Partnership Promoting Psychological Well-Being in Sri Lankan Schools,” published in the Journal of Educational and Psychological Consultation in 2014.

Sri Lanka is a small island south of India in the Indian Ocean, with a population of about 20 million. The household income is $231 a month in the provinces where Nastasi and Jayasena worked, with 70 percent rural and high levels of poverty and unemployment.

While government-funded health care was free for the general population, access was severely limited by a shortage of mental health professionals, Nastasi explained. There were only 20 psychiatrists for the 18 million people in 1995 when Nastasi and her group began their work.

With the goal of promoting psychological well-being of the school-age population, the co-consultants engaged in a research–intervention process using participatory culture-specific system consultation.

Each step required careful efforts where the consultants learned the culture, conducted formative research, and formed partnerships with people in the social systems. The researchers developed culture– and context–specific conceptual models, interventions, and assessments for promoting the psychological well-being of the Sri Lankan youngsters.

The collaborative approach included four main phases, Nastasi has explained in various articles. These are a participatory process of consultation, a focus on cultural and contextual specificity, and the use of research to inform and evaluate interventions, “and efforts to promote sustainability and capacity building,” she explained.

In Mumbai, Nastasi and her colleagues developed a culturally constructed model for clinical practice to prevent HIV and sexual disease transmission.

Nastasi and her colleagues attributed much of the program’s success to the capacity for a partnership-based approach.

While extremely rewarding, the work was also at times challenging, she said.

“Especially initially adjusting to the different environment and culture-e.g., the food, the climate,” she said.

“In Mumbai especially, we were conducting work in slum communities—I was overwhelmed initially by the level of poverty, the sanitary conditions, the number of people living on the streets (including children),” she explained, “and by the sheer number of people in the metro area of Mumbai.”

“That took some adjustment,” she said.

“The experience made me wonder,” she said, “if we can ever solve the world’s poverty…” She explained that the scope of need for children, women and families seemed at times, overwhelming.

“The other challenge in Mumbai was the relative status of men and women, even at a professional level. I had not encountered gender discrimination of that magnitude since my early career in academia in the US. That was a huge adjustment, but a female colleague (and later friend) from Mumbai was an enormous help in figuring out how to manage gender relationships professionally.”

The projects in Sri Lanka and Mumbai have concluded, and Dr. Nastasi has moved to new projects, while staying connected.

“I spent 2.5 months of my sabbatical in the Fall 2015 in Sri Lanka—exploring possibilities for the future,” she said. While working with international colleagues on book projects, she also initiated work on another text, this one on supporting the “… psychological well-being of adolescents in the context of ‘Child–Friendly Schools,’ a concept taken on in multiple countries by UNICEF.” This work is to be published in English by Springer first, and then translated to local language for Sri Lanka, she said.

Dr. Nastasi is also working with two charter elementary schools in New Orleans, and directing the work of her doctoral students.

“The most rewarding experiences,” she said, “have been working with colleagues and local participants in research and intervention projects. I have made life-long friends in both places and continue to communicate with them. In both places, I found a place to call home,” she said, and she resides there when she traveled for her work.

“I learned from my interactions with others¬–both colleagues and local participants–and discovered just how similar we all are in terms of our human qualities and struggles, despite cultural differences.”

“The interpersonal aspects plus my own personal growth were the primary rewards,” she said.

Dr. Nastasi is a past-president of APA Division for School Psychology, past-president of the Louisiana School Psychological Association, President-elect of the International School Psychology Association, past co-chair of APA’s Committee on International Relations in Psychology. She is also the current representative to APA Council for Division 16 (School Psychology), among her other achievements.

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Meds Do More Harm than Good? Robert Whitaker Makes His Case To Marriage & Family Therapists

In his keynote presentation to the Louisiana Marriage and Family Therapist Association on February 20, Robert Whitaker pointed to fallacies behind the rampant use of pharmaceuticals as first-line treatment for psychological problems, Cont’d pg 3 drawing on long-term studies, population statistics, and a lack of scientific theory behind the $70 billion global psychiatric drug market. Whitaker, an investigative journalist, is the author of Mad in America and Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.

He laid out three hours of research showing that while short-term benefits give the impression of benefit, the longterm outcomes portray a very different and disturbing picture. In a review of research, experts, critiques of theory, and epidemiological data, Whitaker puts forth a compelling argument that antidepressants do more harm that good, that schizophrenics do better off medication than on, and that children taking stimulates are more likely to progress to chronic illness than if they go without medication.

Whitaker built on his Anatomy of an Epidemic, the first book to lay out an investigation of the long-term outcomes for those taking psychiatric drugs, and to place in a cultural and historical context, and call into question conclusions built primarily on short-term perspectives.

Whitaker told the audience that that psychiatric drugs were designed around a model of “chemical imbalance” in the brain that arose in the 1970s based on the dopamine theory of schizophrenia and serotonin theory of depression. However, evidence never confirmed these theories. As early as 1984, he explained, the National Institute for Mental Health (NIMH) wrote, “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” By 2011 Ronald Pies wrote for a Psychiatric Times review, “In truth, the chemical imbalance notion was always a kind of urban legend, never a theory seriously propounded by well-informed psychiatrists.”

Despite this prescribing increased over time, said Whitaker. At the same time, the drugs cause long-standing changes in the brain, something that has been known for almost 20 years. In 1996 the former director of HIMH, Stephen Hyman, said that psychiatric medications “create perturbations in neurotransmitter functions” and cause “substantial and long– lasting alterations in neural function.”

Whitaker outlined for the attendees how the illusion of benefit happens. One example is that antipsychotics reduce the “target symptoms” by disrupting the way the brain works. And this same effect causes a relapse when the drug is stopped. Physicians see in the short run that symptoms are reduced and that patients relapse if they go off the drug. But the drug creates a new set of problems for the patient compared to the long-term and to those not on the medications.

Looking at population statistics over time, Whitaker showed that in the 1920s, 30s, and 40s, the recovery from depression was high. The majority of those with depression experienced only a single episode. And only 13 percent fell into the chronic area. But by the 1960s and early years of antidepressant use, researchers were seeing a “shortening the intervals” between episodes, and a “change to a more chronic course.” By the 1980s both the National Institute of Mental Health and the American Psychiatric Association had a new view––that depression was recurrent and chronic. By 1997 researchers reported that 50 percent relapsed and only 3 percent went into remission. The longer the patient had been on antidepressant the higher the relapse rate, Whitaker told the audience. By comparing studies for national and international sources, he showed that those not mediated fared as well or better than those receiving the medications. He found much the same pattern with other illnesses, including bipolar illness.

Long-term research on medications with children, such as stimulates for ADHD, are consistent. In the 1990s NIMH looked at long-term improvements for the use of stimulants and found none. William Pelham, from the State University of New York at Buffalo and one of the principal investigators in that study, said, “We need to confess to parents that we’ve found no benefit. None. And we think that with drugs, the benefits should outweigh the risks.”

The routine use of psychotropics has been coming under fire and gaining notice in the psychological and behavioral health communities. In 2013 the Louisiana Psychological Association hosted Dr. Irving Kirsch, author of another line of books on the small clinical benefit of medications. Kirsch stunned the audience at a Tulane conference with facts on science, politics, and the antidepressant drug industry. He showed strong evidence that antidepressants are 75 percent placebo and that FDA approvals are skewed to favor drug companies. Kirsch’s exhaustive research is included in his 2011 book, The Emperor’s New Drugs: Exploding the Anti-depressant Myth.

Coverage of the work of Whitaker and Kirsch and others have stimulated more research and debate, and been picked up by major news outlets.

In a 2010 article in Journal of the American Medical Association (JAMA), researchers followed Kirsch and concluded that antidepressants have minimal use for mild or moderate depression.

The theme went to Newsweek, “Why Antidepressants Are No Better Than Placebos,” and to The New Yorker, “Head Case: Can psychiatry be a science?” The author, Louis Menand, pointed to Kirsch’s book, and also Gary Greenberg’s Manufacturing Depression, to highlight problems in the psychiatric industry. But Richard Friedman, M.D., criticized the research and warned, “Before You Quit Antidepressants…” in the New York Times.

Last year, Mehmet Oz (Dr. Oz) took the antidepressant issue to task on his popular daytime television show, with a hard-hitting special, “The Truth About Antidepressants,” where he said, “Antidepressants don’t work for most patients. They can even make your problems worse.”

Discussion at the February Louisiana Marriage and Family Therapists conference included a straightforward dialogue about the rights of patients and in particular of parents, to obtain a fully informed understanding of the limitations of these medications and a list of the harm.

Dr. Judith G. Miranti, Director of Counseling programs at Xavier University of Louisiana and a Clinical Fellow of the American Association for Marriage and Family Therapy, told the Times that the presentation was enlightening. But, “… morally perplexing to me as a mental health practitioner,” she said.

“Much to my disappointment, I learned from Mr. Whitaker’s research, that there was no evidence to support the long-term positive outcome regarding academic achievement. Instead, the results showed that the conditioned worsened with longer use of the stimulants. This presents for me a moral and ethical dilemma,” she said. “Now I realize before I would ever recommend psychotropic medications to treat certain symptoms/conditions that I would disclose to my clients the short and long terms effects of the medications.”

Tom Moore, marriage and family therapist and Director of the Red River Institute noted the importance for informed consumers.

“Medical practitioners who treat their patients with psychotropic medications run the greatest risk for doing their patients harm,” Moore said, “but are among all mental health providers least likely to inform their patients of the potential ineffectiveness— and harmfulness– of the form of treatment they employ. In light of the wide spread use of drug therapy in this country by so large a number of licensed medical practitioners, this certainly represents a major public health concern that must be addressed by the state regulatory bodies that oversee medical practice.”

Dr. Matt Morris, President of the Louisiana Marriage and Family Therapists Association and Associate Professor of Counseling at Our Lady of Holy Cross College, told the Times that the theme of “therapeutic alternatives to psychotropic medications particularly as a first-line intervention,” was very well received by attendees. “Robert Whitaker and Dr. Jackie Sparks,” Morris said, “were extremely competent presenters who enriched our conference greatly.”

 

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IOM Sides with Psychological Science

In an April 10, 2015 report, Institute of Medicine (IOM) authors sided with psychological science saying that not only should psychological testing be routinely performed in many types of Social Security Disability claims, but that the use of symptom validity testing in particular is needed when there are questions of credibility.

The IOM’s findings are another volley in the now decade-long debate between psychological scientists and policy makers at the Social Security Administration (SSA). The IOM began its review in 2013 after members of Congress and the Office of Inspector General put pressure on the SSA to change its policy. Instead of complying, the agency said it disagreed and would seek out an independent review from the IOM. If the SSA follows the IOM recommendations it could save taxpayers between $20 billion and an estimated $68 billion or more, per year.

At the center of the debate is New Orleans clinical neuropsychologist, Dr. Michael Chafetz, one of a small group of psychological scientists around the country who began to notice disturbing patterns as he went about performing routine disability evaluations as a consulting psychologist. The controversy hinges on the agency’s steadfast resistance to using modern psychometrictools to measure malingering despite the consensus in scientific circles these tools are needed for accuracy. This position also runs counter to other federal agencies and private industry.

On the surface of the issue, the debate has involved the use of symptom validity tests, known as SVTs, in disability evaluations. But underneath, the politically sensitive and disturbing problem of malingering in disability claims is at issue. As psychological science has improved its methods, research with SVTs has shown that up to 40 percent or more of claims include some level of malingering. This can be an especially thorny issue in claims of mental impairment (low IQ), in emotional disorders such as depression, and in some physical claims, such as chronic pain. 

In the IOM report, titled Psychological Testing in the Service of Disability Determination, authors recommend the use of standardized psychological tests, administered and interpreted by psychologists, for mental disorders and whenever somatic complaints are not fully supported by physical test results. They also recommend the use of SVTs when needed for accuracy. Chafetz and colleagues collected archived data to understand the accuracy of their results, also called validity, research that the SSA does not do for itself. But the reception for their efforts has not always been welcoming.

In 2007 Dr. Michael Chafetz and coauthors published the first peer-reviewed research article about malingering in Social Security claims, “Malingering on the Social Security Disability Consultative Examination: A New Rating Scale,” in Archives of Clinical Neuropsychology.

Prior to this, in 2003, Chafetz had shared his research with the local Disability Determinations Service (DDS) for a training workshop, “Malingering on the DDS consultative examination in psychology.” The DDS coordinator congratulated him on his research efforts and thanked him for the workshop, according to internal emails obtained by the Times.

But after publication of the 2007 article, DDS severed their relationship with Chafetz. He had previously performed almost 1,000 disability evaluations for the agency over the years, without complaint. According to emails obtained from DDS, the officials were concerned about the article and study of claimant results, and were in contact with the regional office about what to do about Chafetz. The emails were not specific on the reason for his release. Chafetz has repeatedly declined to comment on this issue, saying that it is private and that the agency had the right to discontinue with him at any time. However, along with colleagues in other areas of the country, Chafetz continued to do basic research, using anonymous claimant data, and in particular, the use of SVTs. The researchers began to see troublingly high “base rates.” As part of a series of research articles, researchers have found base-rates of malingering in social security claims of 41.8 percent. This is higher than the 30 percent that is typically found in legal cases.

Researchers have also demonstrated that malingering is “dose dependent.” There are higher levels of malingering in those seeking the higher benefits or compensation, and also higher levels when the claimant is seeking federal dollars. Chafetz has also described malingering by “proxy,” where children were coached to fake by a parent.

One of SSA’s complaints is that low-IQ individuals, those seeking benefits for intellectual disability, are unfairly labeled as malingering. However, in a study titled, “To Work or Not To Work: Motivation (Not Low IQ) Determines Symptom Validity Test Findings,” Chafetz and colleagues Drs. Erica Prentkowski and Aparna Rao cast doubt on this concern. They compared three groups of low IQ individuals. One group was seeking disability benefits, another group was seeking employment, and a third group was trying to get custody of their children. Only those seeking compensation scored high on malingering. Chafetz and colleagues have published 15 articles on the topic. He has presented his work repeatedly, including at the American Psychological Association and the Louisiana Psychological Association (LPA). Recently Chafetz has authored Intellectual Disability: Criminal and Forensic Issues, published by Oxford Press, which includes many of these issues.

However at one point, officials at DDS sent a letter to all of its consulting psychologists cautioning them about the content of a presentation by Chafetz, hosted by LPA. DDS officials were not willing to provide comment on the matter.

Psychologists have had little success influencing SSA positions. In 2008 the president of the National Academy of Neuropsychology, president of the American Academy of Clinical Neuropsychology (AACN), and others, joined in signing a letter by Chafetz sent to SSA advocating the use of validity tests. According to Chafetz, shortly after that the AACN created a committee on the issues and held a teleconference with SSA to discuss the issues. In 2010, the neuropsychology division of the American Psychological Association also created a task force that then provided guidance on new SSA rules.

By 2012 U.S. Senator Tom Coburn became involved in trying to update procedures at the SSA. Coburn, now retired, is known for his efforts to uncover government waste. In 2011, through the U.S. Senate Permanent Subcommittee on Investigations, committee on Homeland Security and Governmental Affairs, Coburn was studying problems with backlogs in disability appeals. Appeals rose from 12,000 in 1999 to 817,000 in 2012, according to the U.S. Budget Office. The increase had to be processed by Administrative Law Judges (ALJs) who were struggling with extremely high case loads causing years long wait times for decisions.

Coburn’s research found errors rates of 25 percent and insufficient evidence in decisions by ALJs. Some judges approved appeals simply because they did not have time to study the case, according to a report by the Cato Institute. Senator Coburn was referred to Chafetz by an ALJ, Chafetz explained to the Times. And in September 2012, Chafetz provided a special presentation in the public interest for Coburn’s office, through the Louisiana Psychological Association Online Academy.

By January 30, 2013, Coburn wrote to SSA Commissioner, Michael Astrue, asking that the agency fund psychological tests that measure malingering.

“… the agency’s decision stands in stark contrast to current scientific research and findings,” Coburn said and pointed out the support for use of symptom validity tests to identify malingering in psychological evaluations. “In fact, there is broad consensus within the medical community that malingering is a problem and must be addressed,” he wrote.

Coburn noted that there could be $20 billion in a single year of benefits for “malingered mental disorders alone.” He also said, “Translating these base-rates of malingering to benefit payments is alarming.” And, “If one considers that ‘disability,’ which is defined as an inability to work, can be feigned no matter what the illness, then the agency spent approximately $68 billion (or 40 percent of $170 billion in total net benefit payments) in 2011 on disability beneficiaries who were likely malingering.”

Coburn criticized the SSA, saying “… the agency has no idea of its inability to measure the impact of the fraud occurring under its own roof.”

In March 2013, Chairman for the U.S. Committee on Oversight and Government Reform, Darrell Issa, wrote Acting SSA Commissioner Carolyn Colvin. Issa pointed to a number of OIG recommendations that SSA had not implemented. These included improvements to continuing disability reviews, reporting to Congress, conducting of additional work related reviews, revisions to benefit payments, and prosecuting false applications. According to Issa’s letter, the recommendations either had not been implemented or the outcome was unknown. Issa and coauthors also sited Coburn’s findings and the agency’s failure to address “insufficient, contradictory or incomplete evidence,” in disability claims.

In April 2013, Chafetz was asked to present for the Inspector General’s Office (OIG) and by September 2013 the OIG released a report pointing to flaws in SSA’s policy. In “Congressional Response Report: The Social Security Administration’s Policy on Symptom Validity Tests in Determining Disability Claims,” the OIG investigators said that the SSA runs contrary to scientific and medical consensus, other federal agencies such as Veterans Affairs, and standard practice in the private insurance sector, when it refuses to allow the use of SVTs.

The OIG concluded, “While SSA does not allow the purchase of SVTs for its disability determinations, we found that medical literature, national neuropsychological organizations, other Federal agencies, and private disability insurance providers support the use of SVTs in determining disability claims.”

The SSA was still resistant. Their response was authored by a CPA and Financial Manger, Mr. Gary Hatcher.

Mr. Hatcher wrote, “We believe that tests cannot prove malingering, as there are no tests that conclusively determine the presence of inaccurate patient self-reporting. We do not give greater weight to a test than to other symptom validity factors.”

“In addition,” Hatcher wrote, “we plan to seek external expertise on psychological tests from the Institute of Medicine [IOM] to include an examination of published research and studies on SVTs, including those published by Dr. Chafetz. Our goal is to determine the effectiveness and costs of requiring and purchasing SVTs under our disability programs, as well as their applicability to anyone who claims they are disabled.”

Hatcher concluded, “We provided technical comments and listings from medical literature on the shortcomings of SVTs at the staff level.” And, “We have no further comments,” he said.

Last week the Times asked the IOM if there was a committee or other action to address the report findings and the IOM said that while they work closely with SSA, this has not been addressed as yet. As of this date, the Times has not found any public response from the SSA about the April report.

IOM Recommendations

1. The SSA should require psychological testing for “all applicants” when claims relate to either a) mental disorders unaccompanied by cognitive complaints; or b) claims where “somatic symptoms are disproportionate to medical findings.” Statements of validity should be included, which “could include” symptom validity tests.

2. The SSA should require standardized cognitive testing for “all applicants” when claims do not include objective, medical evidence. Again, a statement of validity should be included, and could include performance or symptom validity testing.

3. The SSA should require that testing be performed by “qualified specialists properly trained in the administration and interpretation of standardized psychological tests.” The IOM says the specialist must be licensed or certified to administer and interpret psychological tests.

4. The SSA should conduct research to investigate the “accuracy and consistency of SSA’s disability determinations with and without the use of recommended psychological testing.”

5. The SSA (in collaboration with other agencies) should evaluate the impact of these recommendations on its outcomes, including backlogged cases, time delays, number of appeals, accuracy, and “Effect on state-tostate variation in disability allowance rates…” 6. The SSA and other agencies should support a program of research to “investigate the value of standardized assessment, including psychological testing, in disability determinations.”

[Editor’s Note: The IOM report can be obtained from the Academy of Sciences at IOM website under the section on reports. See Dr. Chafetz’s book reviewed in this month’s Bookshelf. Also see “OIG Shakes Its Finger at SSA,” and “Did SSA Try to Kill the Messenger,” in October 2013 issue of the Times (Vol. 5, No 2).]

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The Chicago School at Xavier Prepares for 1st Class

This September the first class of doctoral students will start at the new PsyD program in clinical psychology offered by The Chicago School of Professional Psychology at Xavier University of Louisiana in New Orleans (XULA). The effort is innovative in a number of ways, including getting a head start on aligning with new standards for “Health Service Psychologists” to be approved later this year by the American Psychological Association. The Xavier based program is also innovative because it will focus on applied clinical psychology specifically for the diverse and multicultural context in south Louisiana, and on “growing PsyD Psychologists here,” explained Dr. Christoph Leonhard, department chair for the new program.

“We developed the program to meet the needs of local social service providers of psychological services and of the community,” he said, “and frankly, to provide culturally competent services by people who understand this community, which is a very unique place in many ways.” The Chicago School of Professional Psychology (TCSPP) program will be admitting about 15 doctoral students this fall. The program is hosted by Xavier, the highly ranked New Orleans institution which is the nation’s only Roman Catholic Historically Black College and University (HBCU). “We have applicants from current students in all the HBCUs in the area,” said Leonhard, “including Southern, Dillard, and certainly Xavier. We also have applicants who have already completed their undergraduate degrees at the local institutions. So far, we only have one applicant without a prior connection to the area.” The Chicago School developed and will manage the curriculum and faculty for the new program, and XULA provides support services and hosts the department on its campus. The PsyD (Doctor of Psychology) degree is the only program of its kind in the state, and the only other clinical psychology training after that at Louisiana State University in Baton Rouge. Clinical neuropsychologist and Assistant Professor in Clinical Psychology in the new program, Dr. Matthew Holcomb, said, “… the PsyD program at Xavier was inspired by the need that southern Louisiana currently has for well trained and qualified clinicians.” He pointed out that from the beginning Leonhard has developed relationships with area agencies for practicum training and externships for the students. “Given that we are a PsyD program, which is invested and emphasizes exposing students to direct clinical work, our students are going to have first-hand experience addressing the multicultural needs of the area, as well as developing an impressive network of professional contacts,” said Holcomb. Holcomb will help train the PsyD students in brain-behavior relationships and assessment practices, his own clinical and research interests being in pediatric neuropsychology.

The program organizers have limited their recruitment to students inside Louisiana. Leonhard hopes to grow PsyD psychologists here, and who will remain here, in order to serve the sometimes unique needs of the Louisiana culture. “Studies indicate that newly graduated psychologists who have to leave the state to get an advanced degree do not return,” said Leonhard. “So the emphasis of this program is to educate and train our own.” To help them reach this goal, Leonhard and his colleagues created an Advisory Committee of local professionals, including two area psychologists, Dr. Janet Matthews and Dr. Michele Larzelere. Dr. Matthews explained that she has met with many of the candidates for faculty and administrators in the new program.

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Dr. Christoph Leonhard, department Chair for the Chicago School of Professional Psychology at Xavier, at his desk. Dr. Leonhard has designed the machine he’s sitting on to help stem the problems for people who have to sit all day at a desk. He has a background in behavioral medicine and health services.

“We have also discussed student recruitment processes, curriculum issues, and overall program philosophy,” Matthews told the Times. “This program is designed specifically to meet community needs,” she said, a topic Matthews knows well, having taught at Loyola for three decades and retiring last year. “With the focus on primary care/integrated care, and cultural diversity issues,” she said, it is ideal for the Greater New Orleans area.” “It has been my experience teaching here for the past 30 years that we have local students who would make solid psychologists but cannot, will not leave the community.” Matthews believes that the new program will allow them to remain in the area, and help assist what she views as an underserved community, in terms of psychological services, she noted. The doctoral students in the TCSPP program at Xavier will complete studies in four models of intervention: Cognitive Behavioral, Psychodynamic, Humanistic Existential, and Systems. The program includes a Research Clerkship model where the students are paired with mentors from the faculty. Three years of practicum and one year internship are included in the 106 total credit hours that will take five years to complete, and while not yet accredited by the American Psychological Association (APA) the program will prepare students to sit for the psychologist licensing exam.

The PsyD program at Xavier will take full advantage of the changes in approach brought about by the Patient Protection and Affordable Care Act (ACA) that requires prevention and a focus on primary care and community health. APA will be shifting its training model later this year in response to ACA, and the Chicago Professional School at Xavier will align with these changes. “To be in compliance with what the ACA calls for, we’re now going to be training health service psychologists– –psychologists that provide health service, mental health being a health service, said Leonhard. “Basically the APA is shifting to a new accreditation model for selfstudies due after September 2016, and they are abandoning the G&P, the Guidelines and Principles,” he said, and there will be “new opportunities for clinical psychologists to be health service providers in interprofessional care teams, including in primary care.” “One of the things that most people don’t know about the Patient and Affordable Care Act is that it mandates interprofessional care teams throughout health care but importantly, in primary care,” he said.

Dr. Michele Larzelere is one of the local psychologists who serve on the Advisory Committee and who sees this benefit: “It’s wonderful that the TCSPP at Xavier University training program will be helping to address the nation-wide need for psychologists with primary care competency.” “Since primary care is an excellent way to reach underserved and minority populations, the PsyD program will also be expanding Xavier’s efforts toward its core mission,” Larzelere said, “and providing a tremendous service to the population of Louisiana.” Leonhard has developed the training design to match both the local needs and the new healthcare law and training directions. “So what we’re doing is setting up this program from the word ‘go’ to be in compliance with the new Standards of Accreditation,” Leonhard said. “There is a lot of emphasis about getting out of the silo early. So for example, we’re talking to the Xavier College of Pharmacy about doing some co-training with the Doctor of Pharmacy students here, in interviewing patients,” he said. “And they actually just got a modern interview lab on campus which is basically like a mock hospital room where you can train people how to interview.”

“We used to train people just in one profession––as psychologists, or as physicians, or as pharmacists or as physical therapists and somehow later on they were supposed to figure out how to be part of a multidisciplinary team,” Leonhard said, “So now the emphasis is on interprofessionalism, where the different professions are co-equal participants in the enterprise to improve the patient’s health.” While there are still a lot of unknowns as to exactly how ACA will unfold, Leonhard believes this will be a good step. “I think key is getting psychologists to be the behavioral health providers in the interprofessional teams, especially board certified psychologists,” he said. But the change in training focus will also include changes in the traditional methods. “For example, I’m just rewriting the Psychometrics course syllabus where the scales that are being used in primary care are very different from the battery type testing that a lot of times psychologists do. Because, it is very quick––its five items, seven items,” said Leonhard. “It’s oftentimes tests and scales that psychologists aren’t really familiar with, that physicians use to assess substance use potential or depression, anxiety disorders. Just on the quick, because when you’re in primary care, it’s very fast.” Dr. Janet Matthews also noted that another advantage of the new program is the focus on evaluation methods and outcomes research methods. “As students move into their practicum sites, they will be trained to help those sites do the type of outcome evaluations that is becoming more of a requirement for funding,” she said. “In this way, their work can influence both the quality of current service and also support future growth”. The new program offers two formal focus area — Clinical Psychology in a Diverse and Multicultural Context and Behavioral Medicine/Health Psychology – which Leonhard and his team at Xavier hope to help meet this growing need and to train psychologists for the healthcare services of the future.

Xavier University of Louisiana serves more than 3,000 students at its location in New Orleans, Louisiana and is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools. Xavier’s Psychology Department, chaired by Dr. Elliott Hammer, will be part of the supporting structure for the program, but is separate in decision-making from the new program. The Chicago School of Professional Psychology is licensed by the Board of Regents of the State of Louisiana. TCSPP owns and provides oversight for the curriculum for the Clinical Psychology PsyD program. Tuition is currently $1,260 per credit hour. While the program is not APA accredited at this time, the curriculum prepares graduates for the psychologist licensing exam and to meet requirements for licensure in Louisiana. For more information see www.TheChicagoSchool.edu/XULA.

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The Unexpectedly Fascinating Research with the Brony Fandom

What’s a Brony? For that matter, what’s a Fandom? Dr. Marsha Redden, long-time Louisiana psychologist, now retired and transplanted to South Carolina where she’s licensed and studying at University of South Carolina– Upstate, has a bit of an idea. Redden and her colleagues have been researching the fan group who call themselves “Bronies,” the unexpected fan group of boys and young men––the average age is 21––who follow the animated television show, My Little Pony: Friendship is Magic. The series, produced by Hasbro, targets the market segment of preadolescent girls and their parents. But the show won critical acclaim and, according to online bloggers, appealed to many of the fans of other animated shows like Pokemon, Robot Unicorn Attack, and Nyan Cat. These young males appreciated the show’s artanimation, music, and story line: a quest against the dark and destructive side of human nature with moral courage, love, and tolerance.

After 2010 these fans began to connect on the Internet and adopted the name Brony (singular) to describe themselves, combining “bro” and “pony,” for boys who like ponies. A polarizing online battle between Bronies and their critics, crystallized the group and the fandom began to thrive.

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Past President of the Louisiana Psychological Association Dr. John Fanning (L) speaks with Brony Fandom researchers from SLU, William Schmidt and Megan Simon. The two work with SLU psychology faculty member Daniel Chadborn in social psychology research and help understand new forms of group identity.

The phenomenon has carried Redden and her colleagues along with it. Redden has appeared in two films and she presented at fan conferences of 10,000 plus, speaking to standing room only audiences. “To our knowledge,” Dr. Redden said, “this is the first time psychologists have studied a fandom from the beginning.” She and colleague Daniel Chadborn, psychology faculty member from Southeastern Louisiana University (SLU), and Drs. Patrick Edwards and Jan Griffin from USC-Upstate, have collected data on 50,000 fans. The research team has looked at the demographics of the Bronies and presented research that has both helped explain the unique fandom, and helped deal with stereotyping. What have they found? Eighty-six percent of the Brony fandom are male, the average age is 21 with a range of 14 to 57, and 70 percent are students and 33 percent employed full or part-time. In sexual orientation, 84 percent describe themselves as heterosexual, 1.7 describe themselves as homosexual, 10.3 as bisexual, and 3.8 as asexual.

As a group, Bronies tend to be higher in Introversion, Agreeableness, and also in Absorption, a trait that seems related to artistic enjoyment and interests. The fandom appears to serve a strong “Social Function” for the Bronies, helping them expand friendship networks, and also a strong “Guidance Function” which helps support and make moral choices. The psychologists’ research has been fully embraced by the Bronies. “In the fandom I am known as ‘Dr. Sci Entific,’ Redden told the Times, “and you haven’t lived until you’ve gotten a standing ovation from 1,000 people or had a line waiting for you to sign autographs.” This is every summer at BronyCon. Redden has even autographed Diagnostic and Statistical Manuals.

While fan clubs have been around forever, the boost that telecommunications have added to overcoming geographical distances has helped to create some large and unique fandoms such as the Bronies. The researchers appear to be the first psychologists who have been able to compare fans and non-fans, and study the evolution of the fans as they grew and matured, explained Redden. “It is also the first time a fandom has been studied in this depth,” she said. “We have data on their demographics, sexuality, religion, hobbies, social behavior, drug behavior, to mention just a few. In all we have over 50,000 respondents in the data pool so you can see that the stats is a giant project.” The database is so big, she said, she’s retaking statistics courses. SLU undergraduate coordinator Daniel Chadborn and his students, William Schmidt and Megan Simon, have produced a host of presentations and presented at APA, the Louisiana Psychological Association, Southeastern Psychological Association, and will present at the upcoming Southwestern Psychological Association (SWPA). Chadborn joined the research group in 2012. “… I was looking into identity and personality types of table top role playing gamers,” he said, when he discovered the Brony reseachers. Chadborn has found it interesting that the “… fandom offers a large motivated population––our second survey took in close to 20,000 survey responses on a 45 plus minute long battery of surveys––and that is first and foremost what we have found supports the idea that fandoms, and especially the Bronies, are a positive group and offers a majority of its members positive benefits.” “It was also interesting to examine a fandom or group that had the potential to expand and last much longer than a few months,” Chadborn said, “and one that we could gather information and track changes from the beginning, rather than 10 plus years down the line or more if you look at groups like the Trekkers/Trekkies.”

He is also interested in the universal purposes of fan and leisure activity involvement. He and students Schmidt and Simon are examining fandom as a whole including focus of identification, fan interactions, size, and the universal traits of fandoms. They will be presenting some of their work at the upcoming Southwestern Psychological Association. Their results suggests that fandoms can offer three functions: a sense of guidance, inspiration, purpose, or sense of uniqueness; a way to share a liked interest; and stress relief. Chadborn, Schmidt and Simon are examining fandom as a whole including focus of identification, fan interactions, size, and the universal traits of fandom. And have concluded that “… regardless of where a fan’s interest lies, the purposes and functions the fandom and interest serve are the same.”

The Brony researchers have been interviewed in two films, distributed internationally and now on Netflix: The Extremely Unexpected Adult Fans of My Little Pony, produced by John De Lancie, and A Brony Tale, produced by Bret Hodge. “There is even a t-shirt, with the logo,” Redden said. The “WWAPD factor” logo and tshirt emerged after Redden commented on the issue of moral guidance and the “What Would a Pony Do” factor. “Many therapists and parents have written to thank us for doing this work because now they know what THEY are dealing with,” said Dr. Redden. To find more information go to www.bronystudy.com and click on the FAQ’s at the top or the Results section.

 

 

 

 

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