Category Archives: News Stories

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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tuker

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.”

henke

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.

bonnie-nastasi

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.

Robert Whitaker, author and investigative journalist, reviewed the evidence
that medications for mental health do more harm than good, speaking at the
recent Louisiana Marriage and Family Therapists Association convention.

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.”

 

Dr. Michael Chafetz has been at the center of
the debate about improving validity in SSA
disability exams. The SSA Inspector General,
members of Congress, and now the Institute of Medicine, support his views.

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.

 

 

 

 

Hoarders

Children of Hoarders

From The Psychology Times, Vol. 3, No. 2

Dr. Chabaud on 20/20

Dr. Suzanne Chabaud, New Orleans clinical psychologist, appeared on the August 5 episode of ABC’s prime time news magazine, 20/20, as part of a special report about children of hoarders and the psychological impact that they must manage as adults.

Dr. Chabaud, an expert on obsessive-compulsive disorders and hoarding-related topics, regularly appears on the A & E television show Hoarders.

Through this work she increased her awareness of the psychological impact on the children coming from these homes, she told the Times.

“These children of hoarders, they walk around with this feeling like ‘I didn’t get the basics on how a person is supposed to live their life,’ “ Dr. Chabaud explained to 20/20 anchor Elizabeth Vargas.

“The effects of a childhood that was hoarded are pervasive and long-lasting,” Chabaud said. “… These children have a burden that lasts a lifetime.”

The 20/20 episode focused on the lives of several adult children of hoarders and a support group, called Children of Hoarders, Inc. Dr. Chabaud serves this group as an expert resource, answering questions, giving help, and reviewing the groups outreach projects, she explained to the Times.

Dr. Chabaud and colleagues at her OCD Institute engage in research about the problems encountered by children of hoarders. In July 2011 she and her colleagues hosted a weekend long seminar for children of hoarders. Twenty-one individuals from around the country spent four days in her research center and worked to develop goals and resources for this population.

“This was an amazing experience,” Dr. Chabaud noted, “and it was the first time most of the attendees ever had a slumber party. We organized focus-groups for outreach, education, research, support, public policy, and media.”

Dr. Chabaud has begun a second phase of research efforts for children of hoarders, including “…an online survey of many aspects of growing up in hoarded homes and establishing an adult life,” she noted. Her group is also working to increase public awareness, and develop local task forces to “ coordinate public officials, community resources and mental health specialists to address the needs of people who are living in hoarded homes.”

In a recent interview with WWL-TV in New Orleans, Dr. Chabaud commented, “Children of hoarders’ lives are deprived in so many ways. It’s not just the unhealthy environment; it’s the emotional contact with a significant adult. It’s the loss of skills for just maintaining their lives, down to bathing, making beds, organizing their belongings.”

“You just can’t put these children in foster homes. There has to be a program to help them through this.”

For more information about Dr. Suzanne Chabaud’s innovative work with children of hoarders, go to her website www.ocdigno.com.

The 20/20 episode can be watched online at:

http://abc.go.com/watch/2020/SH559026/VD55138532/2020-85-children-of-hoarders

International Expert Dr. Paul Frick to Highlight Fall Conference Oct 15

From The Psychology Times, Vol. 3., No. 2

University of New Orleans Department Chair and international expert on disruptive behavior disorders will lead off a conference on Saturday, October 15 at the LSU Cook Alumni Center in Baton Rouge.

Drs. Rita Culross and Marc Zimmermann will present the Ethics portion of the 6-hour continuing education conference, sponsored by the Louisiana Psych-olological Association.

Dr. Frick participated in the American Psychiatric Association’s workgroup for revisions to the DSM-V and was showcased as a highlight at the American Psychological Assoc-iation’s 2010 convention.

Dr. Frick will present “The DSM-V: Overarching Issues and Proposed Changes to Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder,” for the morning session.

He is the editor of the Journal of Clinical Child and Adolescent Psychology, past president of the Society for the Scientific Study of Psychopathy, author of over 160 manuscripts and six books, and a Louisiana licensed psychologist.

LSU’s Dr. Rita Culross, the Jo Ellen Levy Yates Professor, and Dr. Marc Zimmermann, Baton Rouge clinical and medical psychologist, with forensic experience, will present the second half of the day on “Ethics.” Both are currently on the Louisiana State Board of Examiners of Psychologists.

Dr. Culross told the Times that the presentation will cover ethical issues for both early career psychologists and those with greater experience. She noted, “Scenarios reflecting real world examples will be presented and discussed.”

Dr. Zimmermann said that the three hours on ethics topics will help practitioners understand how they need to think through ethical issues. “There is no one answer to any problem in this area,” he told the Times. “So, we are going to teach them how to process information in such a way so that they can defend their decisions.”

The conference will be at the LSU Cook Alumni Center, at 9 am. A free continental breakfast is available at 8 am. Six hours of CEs are available.

Executive Director for LPA told the Times that some of the enjoyable restaurants include The Chimes, Seranno’s, and Louie’s Café. The participants will have ample time to eat with friends and enjoy the university atmosphere on Chimes and State Streets. “If someone is feeling really nostalgic, they might even want to eat at the LSU student union,” she said.

For more information contact Ms. Lowe at 225-766-0185 or online at www.louisianapsychologist.org.

 

 

Self-Nominations For LSBEP To Close This Friday

From The Psychology Times, Vol 3, No 3

Self-nominations are open until Friday, November 4, for a 2012 position on the Louisiana Board of Examiners of Psychologists.

Applications can be obtained from LPA Executive Director, Ms. Gail Lowe. They can be postmarked or faxed by Friday.

If fewer than four psychologists volunteer to serve, the nominations will remain open.

Dr. Tony Young is the current Chair and will be completing his term on June 30, 2012.

APS Observer Notes “Identity Shift” In US Psych Departments

From The Psychology Times, Vol 3, No 3

In a recent lead article for APS magazine Observer, author Eric Jaffe reported on a trend in academic departments to emphasize the scientific nature of psychology in names.

The review pointed to problems in understanding with what psychology does and is. “Sometimes this lack of understanding led people to question psychology’s scientific basis, as was the case with parents who refused to believe their child could major in psychology and also be pre-med. Other times the confusion came from mistaking psychology for psychiatry,” the report noted. The report indicated that the Department of Psychology name also did little to help indicate where research was “heading in the future.”

The article followed the changes of the psychology departments and cited Dartmouth University change to “Department of Psychological and Brain Sciences” in the late 1990s. Other examples were cited such as the department at Duke, now called the “Department of Psychology and Neuroscience.” Chair Harris Cooper at Duke said, “We refer to ourselves as studying behavior from culture to chemistry,” and include “clinical, developmental, social, cognition and cognitive neuroscience, and systems of integrative neuroscience.”

Dr. Noell’s Work in Teacher Effectiveness Being Emulated In Other States

From The Psychology Times, Vol 3, No 3

– S. Booth, Times’ Intern

Last December, The Times talked with Dr. George Noell about his ongoing project, the value-added Teacher Preparation Program Assessment Model. Teacher effectiveness has become an important topic in the national debate because of continued focus at state and national levels for greater accountability and productivity in all areas of government.

Recently we had the chance to chat with Dr. Noell again about the current status of the project, and his innovative work with predictive models on a statewide scale, a program that was discussed at the Board of Regents meeting in September.

Dr. Noell is a school psychology professor at Louisiana State University in Baton Rouge, a licensed school psychologist with clinical experience, and an expert in multivariate statistics.

Louisiana’s teacher preparation program assessment is the product of the combined efforts of Dr. Noell, the Louisiana Board of Regents, the Louisiana Department of Education, and the various teacher preparation institutions around the state.

The purpose of the value- added Teacher Preparation Program Assessment Model is to acquire information about the impact of new teachers in Louisiana on students. Dr. Noell described the program as a “forward looking” effort to strengthen teacher preparation programs so that future graduates of the programs continue to improve from previous years.

Through the investigation of both new teachers in the public school system and the teachers’ institutions from which they got their degrees, Dr. Noell devised a method to assess the quality of training that teachers are receiving. This type of assessment has allowed him and his team to develop a way to objectively score the teacher preparation institutions on the effectiveness of new teachers they recommend for certification.

According to Dr. Noell, the program, which started operating over 4 years ago, is continuously undergoing adjustments and improvements to help the teacher preparation institutions provide the best education that they can to the students in the public school system. Furthermore, Dr. Noell mentioned that although it takes time to see the results of his and his teams’ efforts to improve the quality of teacher preparation, results have improved for programs that made the earliest programmatic revisions based on outcome data.

Dr. Noell told the Times that one of the best decisions that he made on this project was to include and work with the community members who are directly involved in this program, specifically those at the teacher preparation institutions. By talking and working with those at the prep institutions, he said that he feels that his program was able to obtain the “buy in” and support needed to meaningfully impact results.

Although Dr. Noell and the value-added Teacher Preparation Program Assessment Model have received national recognition, including an article in the New York Times, one of the biggest impacts to date is the adoption of programs like this in other states around the nation, he noted. Several states are in the process of implementing their own teacher preparation assessment. Colleagues in Tennessee, Washington and North Carolina have already released parallel reports, while officials in other states are working toward the first release of their teacher assessment program in the near future.

When asked how he felt about his project being replicated in other states, Dr. Noell said that he is nervous. “You want it to be right,” he said, explaining that since the project has reached the national level, he simply wants to ensure that the work is sound and productive. It is especially important because the potential implications at this level are very high, he said.

Despite these concerns, Dr. Noell is optimistic because the work in Louisiana is a collaborative effort across many institutions and colleagues that was cautiously developed over time.

(Suzanne Booth, MA, is an IO graduate student at LSU, and Psychology Times’ Intern.)

Psychologists Emphasize Importance of Sleep

From The Psychology Times, Vol 3, No 3

“From birth to death a normal person spends more time sleeping than doing any other activity,” explained Dr. Denise Sharon, current President of the Southern Sleep Society and Director at the Comprehensive Sleep Medicine Center of the Gulf Coast. “Sleep is a 1/3 of our lives,” she told the Times.

Dr. Sharon’s clinical emphasis is in sleep disorders, a rare specialty for psychologists. She works to help those with obstructive sleep apnea syndrome, restless legs syndrome, narcolepsy, circadian rhythm disorders, insomnia, and other sleep disorders associated with medical or psychiatric disorders.

Dr. Sharon is Associate Professor of Medicine, Sleep Medicine Fellowship Faculty, and Assistant Clinical Professor of Pediatrics, at Tulane University School of Medicine in New Orleans. Sleep is a behavior, she said, and it is an important one for health and safety.

Dr. William Waters, long-time expert in the area of sleep would agree. “The whole country is sleep deprived,” he explained to the Times. “You can’t do sleep deprivation research without feeling a little scared about traveling on the highway at night or early in the morning.”

Dr. Waters developed his interest in sleep during his years as Clinical Director at Louisiana State University throughout the 80s. An ABPP in clinical psychology with a strong psycho- physiological background, Dr. Waters trained psychologists in sleep research and sleep medicine while Director and Full Professor at LSU. His first publication in the area of sleep was also in the 80s. He continues his interest as the Director of the Sleep Disorders Center at Ochsner Clinic in Baton Rouge.

“Sleep deprivation, memory, attention, emotion, cognition … it’s all interlocking,” Dr. Waters said. “For example sleep is really the other side of the attention coin. You can’t actually sleep while attending to something. And you can’t actually attend to something while sleeping. Attention impairs sleep and sleep impairs attention,” he explained.

“There are huge numbers of people who are sleep deprived. And it is a state in which negative emotion tends to prevail, like other strong need deprivation states.”

“It’s not just sleep deprivation,” he said, “but the quality of sleep is very poor for many of those who actually do get enough sleep. For example sleep apnea produces fragmented and light sleep that is not restorative, and causes the same functional decrements that are caused by sleep deprivation, including negative affect.”

According to Harvard Medical investigations have pointed to sleep deprivation as a factor in the 1979 Three Mile Island nuclear accident, the disaster at Chernobyl, and sleep deprivation played a part in the Exxon Valdez oil tanker accident. And the explosion of the space shuttle Challenger revealed critical issues of sleep deprivation.

The Institute of Medicine estimates that between 50,000 and 100,000 deaths are caused each year because of inadequate sleep, and that “drowsy driving” may cause a minimum of 20 percent of all car crashes.

Poor sleep patterns appear connected with a number of chronic illnesses. Researchers are linking inadequate sleep with weight gain and also with a greater risk of diabetes and body mass.

“…And increased morbidity and increased mortality,” noted Dr. Sharon. “If we add intermittent hypoxemia, even mild, to the mix, the result is an inflammatory response that challenges the autoimmune system and contributes to plaque build-up.”

Poor sleep can lead to high stress hormones and research has found that even one night of poor sleep for a person with hypertension can result in elevated blood pressure the next day.

As important as a full night of quality sleep is, the National Sleep Foundation’s 2010 survey, “The Sleep in America Poll,” revealed that 33.7 percent of responders said they did not get the amount of sleep they needed. Only 40 percent said they get a good night’s sleep every night or almost every night.

“Look for an middle-aged, overweight male or female,” said Dr. Waters, “and you are likely to find a problem with quality of sleep because they are likely to have sleep apnea. For psychologists, it is worth noting that sleep apnea will look a lot like depression,” he said.

“The one thing that will reliably destroy sleep is stress,” Dr. Waters told the Times. “No matter what the psychiatrists say, it is all continuous. If you want to take a point on the continuum and call it a disease you can. But stress–the psychophysiological responses–are aimed at getting you to deal with threat,” he said. “And then how likely are you to go to sleep?”

“Keep in mind that negative emotion is a stress response,” he said, “and therefore predictably disrupts sleep, delaying its onset, and making it light and interruptible. In other words, non-restorative.”

Helping a person get the rest and quality night sleep he or she needs was one of the first things that Dr. Sharon enjoyed in this specialty area.

“Coming from psychiatry,” she said, “the first thing I liked about sleep medicine was instant gratification. The majority of our patients [obstructive sleep apnea, narcolepsy, restless leg syndrome] improve immediately after diagnosis and correct treatment with minimal if any side effects.”

She explained a classic example of a bus driver she helped who was struggling with obstructive sleep apnea or OSA. “After diagnosis and a good C-PAP titration,” she said, “he wakes up the next morning and thanks everyone for the best night sleep he has ever had.” “We made the patient happy,” Dr. Sharon said, and we “ensured the safety of tens or hundreds of school kids, other drivers, and pedestrians. Believe me, it’s the best high.”

While Sleep Medicine is considered a medical specialty, psychologists, neuropsychologists, and neurophysiologists had a major role in the development of the field, explained Dr. Sharon.

Dr. Waters told the Times that the field of sleep is perfect for psychologists. “Sleep is the kind of area that clinical psychologists should be doing, it is just made for us,” he said. “We have a whole scientific discipline at our fingertips that is applicable.” He explained that the basic principles of behavior, applied to the treatment of sleep, is a perfect fit.

“Sleep hygiene and stimulus- control therapies are nothing more than applying what we know about sleep related behavior to make the person more likely to sleep,” he said. “Relaxation therapy is what we do to tone down activation. And remember that it is activation, particularly emotional activation, that causes insomnia and reduces the quality of sleep.”

The sleep cycle in most healthy adults begins as the person goes from wakefulness to an orderly set of sleep states. The first cycle is from wakefulness to non-REM sleep, that includes several stages, followed by the first REM period. The two sleep states and the sleep stages continue to alternate throughout the night with an average period of about 90 minutes. A host of difficulties can disrupt the cycle, called fragmentation of the sleep architecture.

“Obviously sleep disorders pose challenges in defining genetics and pathophysiology and developing more and better cures,” said Dr. Sharon, who is currently involved in developing the new edition of the International Classification of Sleep Disorders. She will be reviewing several disorders in the Sleep Related Movement Disorders section for this publication.

“There are many tasks ahead of us,” she noted. “Some relate to education about the importance of sleep to promote adequate development, maintain performance, reduce accidents, morbidity, mortality and overall health costs, as opposed to the on the go 24/7 mentality,” she said. “The importance of ascertaining adequate amounts of sleep in children and teenagers, also, who are among the most sleep-deprived group.”

Researchers at Louisiana Tech in Ruston have a program of research attempting to help unravel some of the complex issues in this area with college students.

“Basically what we’re finding is people that have poor sleep quality tend to consume more food and weigh more over time,” said Dr. Buboltz, Psychology Professor at Louisiana Tech. “Our hope eventually is to give them interventions or strategies to sleep better which would keep them healthier and decrease their weight,” he told the Times.

Dr. Walter Buboltz, Dr. Janelle McDaniel, Rebecca Hoffmann, Eric Robbins, and Barbara Calvert presented “Analysis of food Consumption Behavior and Sleep Patterns in College Students as Measured by Diaries,” at a recent American Psychological Society conference.

The researchers concluded, “College students have a very erratic eating patterns, with some eating regular meals while a large percentage had fairly erratic dietary habits.” And, “Students consumed approximately a whole day’s more of fat during the week than recommended, while at the same time having about a day’s less of calories consumed across the 7 days.”

Dr. Janelle McDaniel, Assistant Professor at LA Tech, com- mented on the study saying, “It’s important to consider the interaction between different factors such as sleep and eating habits when thinking about wellness globally because treating one particular factor may not address underlying conditions.”

“The relationship between sleep and eating habits and food consumption may be more complex than initially believed,” the researchers concluded.

Dr. Buboltz said that the group has “developed an intervention program for college students called the ‘step program’ and it’s basically training students to learn appropriate sleep habits, sleep hygiene and sleep education.”

Sleep hygiene, explained by Dr. Buboltz, is “Doing things that promote sleep, like not drinking coffee past five, not working out at midnight or eating a lot of food before bed, but relaxing before going to sleep.

“What we do is look at the impact of sleep quality and sleep durations, and various outcomes,” Dr. Buboltz said. “We look at how it relates to college adjustment, physical health, mental health, food consumption, and attention.”

Drs. Buboltz and McDainel, and also Lauren Tressler, also presented “Eating Habits and Patterns of College Students: A Preliminary Study, at the American Association of Behavioral and Social Sciences, 14th Annual Meeting in Las Vegas in February this year.

He noted that their goal for these types of studies was “learning about what’s appropriate. Most people don’t know you’re supposed to sleep eight to nine hours a night. Most people don’t know about the amount of caffeine in food. Chocolate is actually worse for caffeine content than Coke! Colleges are bad about having intramural sports events at nine and ten o’clock at night and that prevents them from going to sleep.”

Dr. McDaniel said, “Sleep is a particularly vital factor in college students health.” And for college students even technology can be a crucial element in sleep health. One of the pilot studies that Dr. Buboltz and his team conducted was to examine the relationship between youngsters and their cell phones. “They became little mothers to their cell phones,” he explained. “They became hyper vigilant to answering their cell phones rather than sleeping,” and this can be a habit that can follow one into adulthood.

Future research for the group will be “anything that deals with sleep quality or sleep duration we’re either working with it or planning a study, but we’re mainly focused on its effect on health,” Dr. Buboltz said.

It is a growing and interesting field according to Dr. Denise Sharon. “I got into sleep medicine completely by chance,” she told the Times. She stayed with the field because she enjoyed the “newness” of the area and “the chance to make a difference.”

“When I started I knew everybody or almost,” she said. “The AASM [American Academy of Sleep Medicine] had only about a thousand members … It was easy to get involved and participate and become part of related sleep organizations such as the Southern Sleep Society, which is the oldest regional society.”

Dr. Sharon is now president of the Society. “We are going to have our 34th annual meeting next March,” she said. “The Sleep Research Society, the World Association of Sleep Medicine that tries to promote Sleep Medicine education around the world, the International Restless Legs Syndrome Study Group… It was a welcoming atmosphere to present research, to review papers, to participate in the making, to be recognized for contributions … I easily made numerous friends.”

“Sleep affects major area of life from birth to old age, multi-faceted, new and developing, exciting and friendly colleagues, all but one, treatable conditions with good response. So who in his right mind would not love it?” Dr. Sharon said.

With the overlap between major areas of psychology, psycho- physiology, attention, emotion, Dr. William Waters still finds this area to be perfect for those in psychology and for himself an enjoyable professional activity. “The best clinician you can have is one with an integrated perspective,” he said. And, “It’s fun,” he added “and intellectually satisfying.”

(–Natasha Jordan is a student at ULM, and the Times’ North Louisiana Correspondent)

 

Psychologists Say Sunset Threat Is Real and Serious

From The Psychology Times, Vol 3, No 3

On October 15, Dr. Darlyne Nemeth addressed attendees at the Fall Conference of the Louisiana Psychological Association. She spoke about threats of the Sunset process.

Nemeth asked the attendees to take the Sunset issues seriously, saying that the possibility of losing the licensing law for psychologists was real and that psychologists should consider this a serious threat.

She urged those attending to make a donation to the newly established political action committee, organized by Baton Rouge psychologist and LPA Secretary, Dr. Alicia Pellegrin.

Dr. Pellegrin recently posted a request on the LPA listserve for psychologists to contribute to the PAC, asking for contributions of $200 so that the political action committee could deal with Sunset problems and other political threats to psychology.

Pellegrin also noted in her message that the challenges during the upcoming legislative session are considered to be serious.