Author Archives: Susan

CMS Seeks Cuts to Fees of Psychologists; Supervision In place until October 9, the newest of Testing by Nurses, PAs

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Centers for Medicare and Medicaid Services (CMS) are proposing hey new rule impacting the 2021 Medicare physician fee schedule, which will likely result in a 10.6% reduction in payments to psychologists providing services to Medicare beneficiaries, according to the American Psychological Association (APA) Office of Health Care Financing.

APA said that the reductions are proposed in order to offset higher values for next year’s outpatient evaluation and management (E/M) services. E/M services, which are typically a 15 minute, face-to-face with the patient, and decision-making of low complexity.

APA reported that CMS is also proposing to increase the values for some psychotherapy
codes (90791, 90832, 90834, and 90837) but this will not be enough to offset the losses for psychologists.

These payment cuts stem from the agency’s legal requirement to maintain a neutral budget from one year to the next, said APA.

APA is also partnering with a coalition of healthcare providers asking Congress to work
with CMS on a solution that will allow the increases for E/M without cutting payments to
other providers, said officials.

CMS is also proposing that non-physician practitioners (nurse practitioners and physician assistants) be allowed to supervise diagnostic testing including psychological and neuropsychological testing, if the state law and their scope of practice allows.

“APA is adamantly opposed to this proposal and is reaching out to CMS for more information— e.g. circumstances under which such supervision could occur and what types of tests would be involved,” said APA officials.

Legislature Calls Itself into Session

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The Louisiana legislature called themselves into a special session that began on September 28 and which will end by October 27. The September 21 Proclamation lists 70 topics to be addressed, including items for replenishing Louisiana’s Unemployment Trust Fund, addressing COVID-19 recovery efforts, supporting communities impacted by Hurricane Laura, and possible funding of certain devastated school systems.

However, at the top of the list are items about the expanded powers of government under emergency conditions.

The first topic relates to “…legislative procedures, powers, duties, and authority pursuant to the Louisiana Health Emergency Powers Act…” The second item refers to ” … the power and authority of executive branch officers and agencies.”

Gov. Edwards immediately voiced his concerns in a September 21 statement.

“At a time when our state is dealing with the COVID-19 health emergency, hurricanes,
and one severe weather event after another, I am concerned that the Legislature has
again called themselves into a month-long session with an agenda of 70 items. This
session will occur at a time when the public will again be restricted in their access to the
State Capitol and their ability to give needed public input.

“From the beginning of this emergency, I have relied on public health experts and the
White House Coronavirus Task Force to guide Louisiana’s response to this historic
emergency. Further, this response has been in line with the measures taken by our
neighboring states that have unfortunately also been enormously impacted by COVID19.

“Put simply, the measures we have taken in Louisiana are working and we are making
significant progress. However, to abandon these efforts in defiance of the unanimous
advice of the public health experts and the Trump administration would seriously
jeopardize the lives of our people and the gains we have made. Further, it is important
to remember our work in containing COVID19 is far from done, as Louisiana still has the
highest number of per capita infections in the country.

“I am hopeful that the Legislative leadership will significantly narrow the scope and the
duration of this session so that they can do the work they deem necessary, while at the
same time working in a bipartisan and cooperative manner to address our
significant challenges in an honest and transparent manner. Louisianans have come
too far to have all of our effective and lifesaving work upended.”

In a September 28 editorial, The Advocate warned, “As with some of the other
budgetary items on the expansive menu, it’s too soon to say if the body can make
intelligent decisions when so many things, really almost everything, is in flux.

“Further, legislators should remind themselves that interfering with the complex
machinery of emergency declarations means that lawmakers will be taking responsibility upon themselves, individually and as a body, in a situation where there is no pleasant alternative, only a choice among bad options.”

Regarding the special session, proposed measures have been submitted and are being reviewed this month. The Louisiana State Board of Examiners of Psychologists did not submit a new copy of their legislation, which they proposed earlier this year in the
regular session. Sources indicate that the board is working on that legislation for 2021.

Very few bills have to do with psychology since the topics for the session are narrowed
to emergency events. However, House Bill 33 and Senate Bill 12, which are duplicates,
relate to emergency counseling in healthcare facilities.

Present law defines “mental health support personnel” to include psychiatrists, psychologists, social workers, and volunteer crisis counseling groups.

The proposed law provides that the Louisiana Department of Health may include the availability of no-cost or reduced-cost counseling or mental health support services offered by members of the clergy, religious organizations, or other nonprofit organizations when providing information about and referrals to mental health support personnel to address the psychological responses to the public health emergency.

The proposed law requires that, during the COVID-19 public health emergency or any
other contagious or infectious disease for which a state of public health emergency
has been declared, an inpatient healthcare facility provide patient or resident access
to members of the clergy for prayer, mental health support or religious counseling, the sacraments of Holy Communion, Anointing of the Sick, and Last Rites, and other such customary religious services that would normally be offered to patients or residents if the healthcare facility was not subject to a declaration of a state of public health
emergency.

U21 Parishes in FEMA Disaster Area Governor Renews Emergency Status from Hurricane Laura

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Gov. Edwards renewed his State-of-Emergency proclamation on
September 18, authorizing the Governor’s office of Homeland
Security and Emergency Preparedness to continue to undertake all
activities authorized to assist in recovery from Hurricane Laura.

The proclamation prohibits price gouging and allows the Secretary
of the Department of Health to establish protocols and policies for
certain facilities to receive evacuated residents at nursing facilities.
Certain regulations are suspended and schools are allowed to
substitute online instruction.

The proclamation also provides for unemployment compensation
for some of those directly affected by flooding or due to the inability
to get to their worksite in a disaster parish.

The proclamation also authorizes all departments and agencies as
officers of the state to cooperate in actions that may be helpful in
dealing with the effects of this weather event.

On September 13, FEMA approved three additional Louisiana parishes for Individual
Assistance due to Hurricane Laura, bringing the total number of parishes where residents are eligible for aid to 21.

Federal FEMA assistance can include grants for temporary housing and home repairs, low-cost loans for uninsured property loss and other programs to help people and businesses recover from Hurricane Laura.

People who sustained losses in the designated parishes of Acadia, Allen, Beauregard,
Caddo, Calcasieu, Cameron, Grant, Jackson, Jefferson Davis, LaSalle, Lincoln, Morehouse, Natchitoches, Ouachita, Rapides, Sabine, St. Landry Vermilion, Vernon, Winn and Union.

Some additional parishes are still under review.

Individuals can apply for assistance. Register online at http://www.DisasterAssistance.gov or by calling 1-800-621-FEMA.

“People all across Louisiana were impacted when Hurricane Laura brought its strong winds ashore, knocking out power and causing massive destruction,” said the Governor.

Hurricane Laura made landfall in Cameron Parish on Thursday, August 27, with 150 mph sustained winds.

Laura was one of the strongest hurricanes to hit the United States and the worse storm for Louisiana since the 1856 “Last Island Hurricane.”

Twenty-six deaths have been attributed to Hurricane Laura. Property damages have been estimated at approximately $9 billion.

If some you know needs shelter, text LASHELTER to 898-211 for information about where to go or call 211.

Stress Solutions

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Exercise Reduces Stress and
Lengthens Your Life

The first thing that drops out of your schedule when work bears down is exercise.
And, once it is out of your daily routine, it may be days or weeks before you notice
it is missing. I don’t know about you but during this 6-month period of isolation or
quarantine, I have completely loss my exercise routine. It started with our health
clubs closing. Yet, this has been a very stressful period. We need to redouble our
efforts to put exercise back into our schedules.

The importance of aerobic exercise was brought back to mind when I saw this
article in Psychoneuroendocrinology (2018). Dr. Eli Puterman is a professor in the
University of British Columbia’s school of kinesiology and lead author of the
article. The study was focused on showing how aerobic exercise can reduce
stress in family caregivers; however, the results generalize to all of us. In fact, a
much earlier paper on exercise and the length of “telomeres” was done at U. of
California. The bottom line is that Puterman’s study proved that exercising at least
3 times a week for about ½ hour over a 6-month period can slow down cellular
aging, which was measured by telomere length.

Telomeres are regions at the end of chromosomes that are active during cell
division. Simply put, telomeres protect the ends of chromosomes. Telomere
length is one of the most commonly used markers of aging. Telomerase is the
enzyme that adds DNA to the ends of the chromosome. Exercise can induce
apparent telomere growth or lengthening. That translates into longer life and/or a
more healthy and active life.

Dr. Puterman’s study design took a group of 68 men and women who were
inactive and stressed caretakers of a family member with dementia. They
randomly assigned the subjects to a supervised aerobic exercise intervention
group vs a waitlist control group for 24 weeks. The exercise routine was 40
minutes of exercise 3 – 5 times per week or 120 minutes/week of aerobic
exercise. The waitlist control group did not change anything in their usual activity
schedule.

The two groups did not significantly differ in telomerase activity across time, but
they had significantly different telomere length changes across time. Of course,
the exercise group also charted significant body mass index reduction and
increased cardiovascular fitness. Oh, and they reported a significant decrease in
perceived stress levels.

Aerobic exercise is also known as cardio. It includes brisk walking, running,
cycling, hiking, dancing, swimming, and kick boxing. (I added that last to make
sure you were awake.) If your choice of aerobic exercise is walking, you need to
step up the pace and also the length of time you walk. The key is to get your heart
rate up. You should notice your breathing, but you should still be able to carry on
a conversation. An Australian study indicated that walking briskly for 30 minutes
five days a week can improve aerobic fitness. But even walking for 10 minutes
three times a day is as beneficial as walking for 30 minutes one time a day.

Happy Trails to each of you during this Pandemic. Stay healthy.

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Puterman, Eli, Weiss, Jordan, Lin, Jue, et al. Aerobic exercise lengthens telomeres and reduces stress in family caregivers: A randomized controlled trial – Curt Richter Award Paper 2018. (2018). Psychoneuroendocrinology, 98, p.245-252

Stress Solutions

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One Simple FDA Approved,
Non-Drug Therapy
That Reduces Stress AND
Blood Pressure

RESPeRATE is actually the first medical device that has been
clinically proven to lower blood pressure AND stress. And, if
you don’t have high blood pressure, it is still a very effective
and easy to use method to reduce your cortisol levels and
relieve tension due to stress.

What is RESPeRATE? It is a small device that was originally
designed for pilots and other people that needed to reduce their
blood pressure but could not afford to take medication because
of their job or other health issues. This gadget is like a
“breathing coach” because all the work of reducing stress and
blood pressure is done by helping you reduce and calm your
breathing such that you spend 5 to 10 minutes a day (or more)
in slow gentle breathing.

RESPeRATE does the work of matching your breathing and
then gradually slowing it down and lengthening your
respirations until you get into a “therapeutic range.” Once you
reach that range, it keeps you there with a soft chiming to
signal intake of air and exhalation

The kit contains the RESPeRATE device, an elastic belt that
goes around your diaphragm and plugs into the device, and
earphones to allow you to hear the gentle tones that signal the
timing of your breathing. The cost is minimal, and the company
allows for it to be purchased in 3 easy installments.

Many of our patients promise that they will practice breathing
techniques for relaxation, but we all know how easy it is for
such promises to be put off until tomorrow. RESPeRATE helps
with the routine of doing the breathing exercise and it is a
pleasant 10 minutes that can easily become a habit. The same
benefit can be gained by the “doctor” who prescribes the
method.

It is fair to say that breathing is one of the most important
exercises one can do for your health – physical and mental.
The research indicates that daily use for 3 to 4 weeks is all it
takes to significantly reduce blood pressure. The stress
reduction and improved sleep are “side-effects.” Check out the
website for more information on how to order and for
information on the “Clinical Proof.” www.resperate.com

Secret Window

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Secret Window

A Review

by Alvin G. Burstein

With conventional movie theatres still COVID risky, and
having subscribed to a new dish based media provider, I have
a plethora of movie options. A horror flick based on a Stephen
King story and starring Johnny Depp tempted me, despite its
age—it is a 2004 release—and it turned out to be rife with
interesting psychological implications.

Spoiler alert: Facilitating the exploration of those implications
will involve reducing the suspense for the first time viewer, but
then, the film has been around a while, and its implications
reward reflecting on.

The protagonist, played by Depp, is an established writer,
Mort Rainey. He has an agent and has appeared in the iconic
Ellery Queen’s Mystery Magazine. The film opens with a
flashback of his discovery of his wife in flagrante delicto with a
friend. The movie then fast-forwards six months to show
Rainey having left his erring wife in possession of their
connubial home. He is living in a backwoods shack,
manifestly depressed by his impending divorce, wearing a
tattered bathrobe, disheveled and unshaven, unsuccessfully
struggling with writer’s block.

The picture of depression is classic, and its links to oral
conflicts and ambivalence unmistakable. Rainey gorges on
junk food, swills booze out of a bottle, and has fallen off his
no-smoking wagon. Ambivalence is highlighted, and not as a
nice, if inaccurate, term for negative feelings. Rainey misses
his wife and continues to yearn for her at the very same time,
very same moment, that he is enraged by her betrayal. The
quasi-solution to the conflict is redirecting that murderous
anger away from her and towards himself, the basis for his
depression.

As the story unfolds, Rainey is confronted by an amateur
writer, John Shooter, who accuses Rainey of having
plagiarized a novel written by Shooter. Rainey attempts to
brush off his claim, pointing out that his story was published in
EQMM years before Shooter claims to have written his story.

Undeterred, Shooter gives Rainey three days in which to
produce a copy of the magazine containing the original, making
ominous threats that resonate with his name, and with his grim
appearance that includes wearing a broad-brimmed black hat.

Along with his eponymous last name, the black hat is another
heavy-handed hint of impending evil. Good guys wear white
hats, and bad guys….

Unsettled by Shooter’s threats, and more so by the discovery
of his pet dog’s mutilation and murder, Rainey appeals to the
local sheriff and later to a private detective for protection.
Rainey goes to his wife’s home to attempt to find a copy of the
magazine in question, only to find the house destroyed by
arson. The plot continues to darken, Rainey’s private detective,
along with a witness to the Rainey-Shooter confrontation are
found dead, and like the pet dog, mutilated. Rainey receives a
copy of the magazine in question from his agent, whom the P.I.
had contacted, but the critical pages have been cut out.

The crisis mounts. Rainey is back at his shack staring at
Shooter’s hat and begins talking to himself, trying to make
sense of these events. In another heavy-handed development,
there are soon three Rainey’s exchanging views. One of them
puts on Shooter’s hat and—here is the spoiler—it becomes
clear that Rainey suffers from what the psychiatric Diagnostic
and Statistical Manual would call dissociative identity disorder,
and what psychoanalytic theorists would call vertical splitting,
disowned identities. Rainey is also Shooter, Jekyll meeting
Hyde as it were.

In the windup, Rainey’s estranged wife appears, along with her
lover. Rainey, now owning his anger, kills both and buries them
in the field that the secret window overlooks, planting a
cornfield over their graves.

Months later, the sheriff visits a rejuvenated Rainey to remind
him that that he is still a suspect. Rainey grins as he continues
to dine on corn on the cob.

The light-hearted mockery of the ending is a tip of the hat, a
signal not to take the story too seriously. But its highlighting of
psychological issues is both striking and of interest.

The Black Panther

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by Alvin G. Burstein

Once upon a time, centuries ago, in sub-Saharan central Africa, a group of tribes discovered a miraculous source of radioactivity, Vibranium. The competition for control of the lode was resolved when the leader of one of the tribes imbibed a tea concocted from an herb that the mineral had affected, acquiring superpowers. He used those powers to unite the tribes into a kingdom, Wakanda, and to initiate high-tech capabilities, all carefully concealed from the world at large. He called himself The Black Panther.

The Black Panther superhero made his first literary super hero appearance in a Marvel comic book, The Fantastic Four, created by Stan Lee and Jack Kirby in 1964. There is a remarkable synchronicity in his sobriquet. A black panther—and the motto, “Come Out Fighting”—was the icon of the all Black World War I 761st Tank Battalion.

Although Lee has said that there was no intention of referencing any political group in using the sobriquet, The Black Panther Party, founded in the mid 1960’s by Stokely Carmichael and Huey Newton had chosen the same icon. That revolutionary protest party was described by FBI chief J. Edgar Hoover as “the greatest threat to the internal security of the country.”

The current film spin-off is set in contemporary times. Complex tensions beset Wakanda. One of the five tribes, the Jabari, has Luddite objections to technology, seeing it as reflecting weakness. The current king’s brother argues for eschewing concealment and emerging from hiding to support oppressed Blacks world-wide. The Great Powers, Russia and the United States, have gotten scent of a possible African source of atomic power and are competing for access to it.

As the film opens, the Black Panther arrives in the United States to confront his brother about the latter’s scheme to make Vibranium available outside Wakanda. In the confrontation, the brother is killed, and the king returns home. Hoping to avoid stoking the policy disagreements by revealing what has happened, he leaves his brother’s son behind. The nephew ultimately becomes a lethal mercenary, adopting the name Killmonger. He is a brooding presence whose insatiable demand for vengeance makes him like Moby Dick’s Captain Ahab. Like Ahab, his purpose is “an iron rail on which my soul is grooved to run.”

After the King’s death, his son comes home to assume the throne and its super hero mantle. The succession requires him to meet any challenger from the other tribes in combat. Unexpectedly, he is challenged by the chief of the Luddite Jabari tribe. He defeats the challenger but spares his life.

The new Black Panther interacts with a cast of characters that includes a CIA agent, one of the few non-Blacks in this tale; a Dutch mercenary, also White, seeking to steal Vibranium to sell to the highest bidder; and Killmonger, who burns to return to Wakanda and overthrow the new king.

The movie’s initial popularity is deserved. Its plot is vivid and compelling. The action is suspenseful. The characters are fascinating. The cinematography is beautiful and the special effects impressive.

The film is remarkable, too, in cultural terms. The perhaps unintentional echo with the violent anger of the 1960’s Blank Panther protest stirs up uneasiness that could be usefully explored. At the very least, the presentation of a film with predominantly Black actors in complex and varied roles is an unsubtle critique of Hollywood’s failure adequately to reflect cultural diversity. Wakanda’s epitomizing sci-fi high technology calls into question a stereotype of Africans as primitive. That country also has a highly disciplined military elite of women, the Dora Milaje, central to the story. These strong, powerful female figures endorse current cultural shifts toward women as subjects who act rather than as objects to be used. In the film the magnitude of that shift is unfortunately diluted by the fictional country’s strongly patriarchal tradition of authority, especially one validated by mortal combat.

Stress Solutions

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Tapping Reduces Cortisol by 43%

That is what Dr. Peta Stapleton on Bond University in Australia found when she replicated Dawson Church’s 2012 cortisol study. In the original study, Church et al examined salivary cortisol levels in 83 subjects who were randomly assigned to either an emotional freedom technique (EFT) group, a psychotherapy group (SL for Sympathetic Listening) or a no treatment group (NT). The EFT group had a 50-minute session of tapping with a certified EFT coach. The NT group waited 50 minutes in the waiting room and the SL group had a 50-minute session with a licensed therapist. Cortisol was assayed just before and 30 minutes after an intervention. Emotional distress was assessed using the Symptom Assessment-45 to measure the subject’s level of anxiety and depression. The EFT group measured a significant decrease (p<0.03) in mean cortisol level (-24.39%) compared to a decrease of -14.25% in the SI group and -14.44% in the NT group.

Dr. Stapleton replicated the original Church study almost exactly. However, her results were even more dramatic. The EFT group reduced cortisol after 1 hour of EFT by 43%. There were 53 subjects in this study randomly assigned to one of the three groups. The Symptom Assessment-45 was again used to assess psychological distress. Salivary cortisol assessment was performed 30 minutes before the intervention and 30 minutes after.

Cortisol is considered to be an important biological marker of stress. EFT or acupoint stimulation is shown to be an effective method to reduce stress-related cortisol in a person. In an experimental situation, this is “interesting” and often that is all that happens with a reader who has an interest in stress reduction. In a real life situation, however, where someone has a history of not dealing well with stress, finding a short, easy to apply method that reliably reduces the amount of cortisol circulating in their body, the importance cannot be over-stated.

Creating a list of people who have a history of “not dealing well with stress” is an important first step. These are people who for some reason tend to hold the stress producing situation in their minds and continue to think about it, such as people who are more likely to have anxiety disorders like GAD or PTSD. The list should also include people who because of their physical condition, such as being pregnant, do not want to maintain high levels of cortisol in their blood.

An important second step as clinicians is for us to introduce them to various techniques to help them reduce their stress related cortisol. The Tapping Solution is possibly NOT the best technique. That remains to be seen. However, it is surely experimentally proven to reliably reduce cortisol and it is easy to do.

It might make a good tool for your therapy box if you see and treat people with anxiety.

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Stapleton, P., Crighton, G., Sabot, D., and O’Neill, H.M. (2020). Reexamining the effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. Psychol Trauma.doi: 10.1037/tra0000563 (epub ahead of print.)

Church, Dawson, Yount, G., and Brooks, A.J. (2012). The effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. J Nerv Ment Dis., 10, 891-6.

Parasite

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Parasite

A Review

by Alvin G. Burstein

Parasite, a South Korean film, premiered at the 2019 Cannes Film Festival, becoming the first South Korean film to win the Palme d’Or. It went on to win four awards at the 92nd Academy Awards (the Oscars), winning Best Picture, Best Director, Best Original Screenplay, and Best International Feature Film—the first non-English film to win the Best Picture award. Subtitles make it accessible world-wide.

It is a piece of work, hard to describe. A mashup of Beverly Hillbillies, Tobacco Road, and Upstairs/Downstairs. Slapstick humor, teenage romance, gore splatter and trenchant social commentary dazzle.

The title? There are at least three levels of parasitic involvement. The husband of the housekeeper of an elite, sumptuous mansion’s has been hiding from creditors for years in a bunker hidden deep under the house, living on food stolen with his wife’s complicity.

New owners, a couple, their teenage daughter and hyper-active four year old son, are losing the daughter’s college student prepping her for college entrance exams. The tutor persuades an old friend, the son of a dirt-poor, hard-scrabble family to take his gig, using fake credentials.

The new tutor, learning how gullible the rich and naïve parents are, embarks on a scheme to have his sister, pretending to be an art therapist, work with the owner’s son. Hiding their identities, the two conspire to have their parents usurp the roles of the rich family’s chauffeur and housekeeper.

The poor family pretend to be unrelated, and using fictitious credentials, rake in lots of money. The parasites are on easy street.

It is an obvious irony that the wealthy family can be seen as parasitic too. Their way of life depends on the labor of the less fortunate.

When the wealthy family leaves for a weekend at the seashore to celebrate the birthday of the young son, the imposters take over the house, freely feasting on the up-scale goodies that surround them.

Their revelry is interrupted by a visit from the former housekeeper, who persuades them to let her go to the basement for something she has forgotten. They admit her,
and sneaking after her, discover her husband. A battle royal ensues, with fights over a cellphone recording that reveals the interlopers’ scheme. Blood flows freely. The original housekeeper and her husband, badly injured, are left hidden in the basement.

The owners return unexpectedly because of flooding rains, but the interlopers manage to conceal themselves. The mother, in her housekeeper role, remains at their home, while the father and two children sneak out of the mansion, returning to their slum dwelling, only to find it flooded and uninhabitable.

The wealthy family plans a spontaneous, but elaborate birthday party the next day, making a point of inviting the supposed chauffeur the tutor and the art therapist to attend.

The climax of the party is a melee. The original housekeeper’s husband escapes from the basement bunker, stabs the pretended art therapist to death as she presents her student with a birthday cake, and is in turn killed by the supposed housekeeper. The replacement chauffeur kills the wealthy husband but manages to escape to the hidden bunker, taking the place of the original parasite.

In the aftermath, the poor family’s mother and her son are convicted of murder and sentenced to jail. He requires brain surgery to deal with the injuries he received during the melee.

When he is discharged, he learns that the mansion has a new owner and that his father is still hiding in the concealed bunker—doing well as a parasite. He makes plans— unrealistic ones—to make a lot of money and re-unite his family by becoming the owner of the mansion.

It is quite a movie. Did I say “Slap stick humor, teenage romance, gore splatter and trenchant social commentary dazzle?” They really do.

Dr. Bonner Recognized for Psychology in Public Interest

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Dr. Mkay Bonner has been recognized as the 2020 recipient of the Award for Psychology in the Public Interest by the Louisiana Psychological Association,
announced last month by the association officials.

The recognition is given to an individual who has made significant scholarly or
practical contributions to the health and well-being of the general public through their
work in psychology, said officials.

Dr. Bonner is an industrial-organizational psychologist who has worked closely with the police in Northeast Louisiana for decades. She is the Public Safety Psychologist for several police, sheriff, and fire departments. For almost 20 years, she has conducted a variety of evaluations for pre-employment, fitness-for-duty, and officer-involved shootings. Dr. Bonner is also an Associate Professor at the University of Louisiana at Monroe and teaches in the Criminal Justice & Psychology Departments, is a reviewer for the Journal of Police and Criminal Psychology, and authored or co-authored many journal articles and book chapters.

Dr. Bonner and her husband, Assistant Chief of Police at University of Louisiana at Monroe, Dr. Mark Johnson, serve on the Advisory Council of the Northeast Delta Crisis Intervention Team, known as CIT, covering 12 parishes in the northeast part of the state. She and her husband have now trained over 1300 individuals, mostly in the
law enforcement field, through a combination of more than 100 classes, ranging from 4 hour continuing education classes through the 40 hour complete CIT class. Johnson recently finished his EdD in Curriculum and Instruction, specializing in Law Enforcement
training and evaluation.

The nominating psychologist said, “During the events following the tragic death of George Floyd there have been calls for radical police reform, perhaps even wholesale police abolition. Louisiana has a heritage of excessive police behavior and much to overcome. Yet some of us see this as a moment to apply the solutions that Dr. Bonner has been advocating throughout our state and beyond for a long time. We see an opportunity for hope in the midst of our current despair.

“For over 16 years Dr. Bonner has been working quietly, working intensely to provide evidence-based training to prevent police misconduct and to minimize police use of
deadly or inappropriate force. This work has occurred at an organizational and at a tactical level. At an organizational level she and her team have analyzed systemic and
institutional conflicts that result in disparate use of deadly or inappropriate behavior. They have subsequently worked to change specific dysfunctional cultures or systems associated with excessive applications of police use of force and of cultures of racism associated with citizen abuse by first responders. Interventions like this by nature do not get publicized. They are confidential. Who wants their region, their own jurisdiction, their town, most of all their police to be labeled and singled out? But change seems effective and reasonably long term, perhaps a source for a bit of optimism in the present American confusion.”

The nominating psychologist continued, “At a more tactical level Dr. Bonner and her colleagues’ work has developed theory-based training to address common situations involving crisis intervention that police and other first responders frequently encounter. Mental illness is one of these problems. Racism is another. This work is not unique, but I believe it is uniquely effective. There are numerous programs in the country for police and first responders that address race, class, and poverty. Many more attempt to train providers about general mental health issues. But the data shows that they are not particularly effective and don’t do much good over the long term. Perhaps this is because they too often teach generalities rather than train specific skills for high risk situations. They may succeed in raising awareness but do not impart lasting behavioral changes because they do not apply discrete knowledge to risky, emotionally charged situations and back it up with practice and continued training.”

Dr. Bonner is a regular participant and presenter at the Society for Police and Criminal Psychology, an eclectic professional organization that encourages the scientific study of police and criminal psychology and the application of scientific knowledge to problems in criminal justice.

Bonner has also presented at the professional conferences of the Society of Police and Criminal Psychology, the American Psychological Association, and Professional Training Resources, Inc. Examples include, A Successful Rural Mult-jurisdictional CIT Program: A
Quantitative & Qualitative 10 Year Review, presented at the 2017 APA Annual
Conference; “Recruiting and hiring minorities into policing, with international
considerations,” in International Journal of Crime, Law and Social Issues; “The Intersection between law enforcement and persons with a mental illness,” in Crime, Punishment, and the Law; and “Doing more with less: The advantage of reserve officers in law enforcement,” in Innovations in Police Volunteering.

Dr. Bonner has taught multiple courses at the North Delta Regional Police Academy, including courses such as Emotionally Disturbed Persons–Mental Illness, Deescalation, Stress Management, Cultural Diversity, and Police Survival.

The nominating psychologist said, “Dr. Bonner’s and her colleague’s work has been different because it trains police and first responders to think through these necessary specifics. She addresses unusual situations, but situations that might not be unusual to first responders.

“Evidence shows that they reduce the use of deadly and inappropriate police actions by giving participants opportunities to learn and to think through and rehearse. They do not provide miracles, but they help us come closer to where we all want to be as a society.

“She, her husband, a former detective, with a great deal of ‘street credibility,” and colleagues can reach the people, the fellow officers, the paramedics, the fire personnel, the prison guards and correction personnel, that most of us academics just cannot. They can, have, and will continue to be able to address racism, culturalism, classism, and inequalities because they have an authenticity gained through years of experience and a much-earned trust.”

In a recent Times interview about Police Psychology, Dr. Bonner said that not only do psychologists need to stick to their scientific base of facts, but to be truly helpful and comprehensive, psychologists must learn the culture and work environment law-enforcement personnel.

“We must learn and understand the culture and environment that they work in,” she
said. “We cannot leave our office, open a book, lecture to them for two hours on mental illness, and expect it to make a difference. We must spend time with them, go on ride-alongs –at midnight, experience some of their training classes. We must understand them, how to talk to them, the best methods for them to learn…” she said.

“Psychology has much to offer. However, we cannot dabble in research and training with law enforcement,” she warns. “We must be committed and remember our roots of scientific research and competencies. That is how we can make a difference. And, it is an extremely worthwhile endeavor.”
Selection for awards were made by
members of the Louisiana Psychological
Association’s awards committee composed
of Drs. Mike Chafetz, Beth Caillouet
Arredondo, Brian Mizuki, Kim VanGeffen,
and Laurel Franklin. The committee
accepts nominations from the community
at-large.

Dr. Frick Honored for Scientific Achievements

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The state psychological association has named leading international authority, Dr.
Paul Frick, for Contributions in Psychological Science. The 2020 honor is given to an individual who has significantly increased knowledge of psychological concepts by scientific research and dissemination of findings.

Dr. Frick holds the Roy Crumpler Memorial Chair and is professor of psychology at Louisiana State University (LSU). Previously, he was Chair of Psychology at U. of New Orleans. His research investigates the many interacting factors that can lead children
and adolescents to have serious emotional and behavioral problems, such as aggressive and antisocial behavior.

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

Dr. Frick and his colleagues have focused on the importance of “callous–unemotional” traits in children and adolescents.

“We are still working to advance research on callousunemotional traits,” Dr. Frick
told the Times, “especially in light of its addition to both the DSM-5 diagnosis for Conduct Disorder and the ICD-11 diagnoses of Conduct-dissocial and Oppositional defiant disorder,” Dr. Frick said. “In the upcoming September issue of the American Journal of Psychiatry, we have a paper that will be the featured manuscript showing that CU traits predicts gun carrying and gun use in a crime in the four years following the adolescent’s first arrest,” he said.

The study will also be featured in Am. J. of Psychiatry ‘s audio podcasts found at
https://ajp.psychiatryonline.org/audio.

“Also,” Dr. Frick said, “our work to advance clinical assessment of CU traits has also been progressing, with the first papers being published on the reliability and validity of the CAPE 1.1., the Clinical Assessment of Prosocial Emotions, Version 1.1, which
provides clinicians a way to assess the specifier. Finally, an open trial for our early
intervention for young children with CU traits has also recently been published,” he said.

Last year, Dr. Frick and his international co-authors published an article in Nature
Reviews, and pointed out that society pays a heavy price for its failure to diagnose and treat conduct disorders.

Conduct disorder is associated with an exceptionally high costs for individuals and society, noted the authors of the the report. “The health and personal burden of it is seven times greater than that of attention-deficit/hyperactivity disorder, or ADHD, a much more widely known disorder. While it is likely that children diagnosed with ADHD may also show signs of conduct disorder, very few will be diagnosed or receive treatment for it. Conduct disorder is also associated with a greater health burden than
autism.”

“Despite the fact that it is associated with a very high personal, familial, and societal
burden, conduct disorder is under-recognized and frequently goes undiagnosed and untreated. Unfortunately, the longer this goes on, the more difficult it is to treat. It truly
exemplifies the old saying that ‘an ounce of prevention is worth a pound of cure.’ Also, many treatments that are being used in the community have not proven effective,” Frick
previously said to LSU News.

Authors noted that “Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and
is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is
twice as prevalent in males than in females.”

“Callous-Unemotional Traits and Risk of Gun Carrying and Use During Crime,” authored by Emily Robertson, MA, Paul J. Frick, PhD, Toni Walker, MA, Emily Kemp, BS, James Ray,
PhD, Laura Thornton, PhD, Tina Wall Myers, PhD, Laurence Steinberg, and PhD, Elizabeth Cauffman, PhD, can be found in AJP in Advance (doi:10.1176/appi.ajp.2020.19080861)

Authors note, “This study demonstrates the importance of considering callous-unemotional traits in gun violence research both because callous-unemotional traits
increase gun carrying and use in adolescents and because the traits may moderate other key risk factors. Notably, the influence of peer gun carrying and ownership may have been under- estimated in past research for the majority of adolescents by not considering the moderating influence of callous- unemotional traits.”

Another study, “Parent-Child Interaction Therapy Adapted for Preschoolers with Callous-Unemotional Traits: An Open Trial Pilot Study,” is published in Journal of Clinical Child & Adolescent Psychology.

“The Clinical Assessment of Prosocial Emotions (CAPE 1.1): A Multi-Informant Validation
Study,” was recently published in Psychological Assessment. This study examined the validity of the Clinical Assessment of Prosocial Emotions, a newly developed clinician-rating measure of CU traits in children and adolescents.

The “Public Significance Statement” for the research noted, “This study provides empirical support for a new interview-based method for assessing limited prosocial
emotions (e.g., a lack of guilt and empathy) in children with conduct problems (e.g.,
aggressive and disruptive behavior). This is important because existing clinical tools
for assessing limited prosocial emotions have been limited to questionnaires alone despite the important role of clinical interview data in the formulation of psychiatric diagnoses.”

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

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

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

Selection for awards were made by members of the Louisiana Psychological Association’s awards committee composed of Drs. Mike Chafetz, Beth Caillouet
Arredondo, Brian Mizuki, Kim VanGeffen, and Laurel Franklin.

The nominating psychologist said, “Dr. Frick has brought a rich and inspired analysis to
psychology and is one of the great minds in our field. His research exemplifies what it
means to advance psychology for the benefit of the larger society.”

Gov Edwards Signs State Budget

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State Agency Heads Directed to Prepare for Possible Mid-Year Budget Cuts
Gov. Edwards Signs State Budget to Preserve Critical Funding During the Covid-19 Pandemic

Baton Rouge – On July 8, Gov. John Bel Edwards announced that he has signed the
state’s budget for the FY 20-21 operating year, preserving funding for critical health
care, workforce and education services that are needed during the pandemic, especially
as new COVID-19 cases rise again as school systems prepare to return to campus
in the fall, according to the press release from the Governor’s office.

Additionally, the Governor Edwards has ordered cabinet agencies to prepare for possible mid-year budget cuts by sequestering at least 10 percent of their budgets, which he also recommends for the judicial and legislative branches.

He will also issue an executive order to freeze hiring of state employees.

“Right now our budget is in a far better shape than we could have hoped just three
months ago, with funding for critical services in place as we continue to respond to the
COVID-19 pandemic and see case counts as well as hospitalizations rising,” he said.

“I have directed state agencies to prepare for possible mid-year cuts and, we will continue working with the Legislature to make any adjustments that may be necessary this fall,” Gov. Edwards said. “While there are cuts in the budget, federal CARES act funding allowed us to avoid making them even more catastrophic. In addition, we were able to invest CARES act funding into programs for local governments, aid to businesses and direct payments to essential front line workers.”

The Governor also vetoed language that cancelled meritr aises for classified state employees

Gov. Edwards vetoed a provision that impermissibly delayed pay raises for classified state employees and other provisions that sequestered funds appropriated to the executive branch, but not funds appropriated to the legislative and judicial branches.
He also vetoed more than $9 million in
new spending, as well as a provision
contrary to Centers for Medicare and
Medicaid Services guidelines that would
negatively impact the Louisiana
Department of Health and require the
expenditure of more than $10 million of
state general fund plus $32 million of
federal funds.

Cases Rise, Governor Extends Phase Two

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Cases Rise, Governor Extends Phase Two

On July 23, Gov. Edwards signed orders and extending Phase Two and the Statewide Mask Mandate as Louisiana surpassed 100,000 known COVID-19 cases.

State officials put out a graphic highlighting the fact that Louisiana was first in the
nation based on a July 26 high of 3,840 new cases.

The Gov. Edwards signed a renewal of the current proclamation extending Phase Two
in the state, which includes the statewide mask mandate and additional restrictions,
until August 7.

“Today, we are reporting 2,408 new cases, which means that the state has now
surpassed 100,00 total cases. And of course, these are only the cases we know about. There are undoubtedly more,” Gov. Edwards said. “When you hit a milestone like
this one and when you see death totals that are higher than they’ve been in months, as we did yesterday, it’s a reality check.”

“For anyone out there minimizing the seriousness of this situation, you are doing
yourself and this state a terrible disservice. The same is true for anyone questioning the validity of the data that we’re using and releasing every day,” Gov. Edwards said. “COVID-19 is very prevalent throughout our state, and it is more widespread than ever before. We are certainly not where we want to be in Louisiana. I’ve extended Phase 2 with the mask mandate and other restrictions, but we are perilously close to having to make tough decisions that no one wants. This is why we have to follow the mitigation measures that are in place. We have to wear our masks, keep social distance, wash
our hands frequently and stay home when we are feeling sick.”

The statewide mask mandate applies to all 64 parishes in Louisiana. However, parishes with a COVID-19 incidence of fewer than 100 cases per 100,000 people for the most recent two week period for which data is available can choose to opt out of the mandate. Under the state’s policy, parish presidents in parishes with lower incidence rates do not have to opt out and may choose to keep a mask mandate in place.

The Louisiana Department of Health updates its incidence data every other week and at the time of the announcement, no Louisiana parish meets the standard to opt out of the current mask mandate.

The order requires face coverings for everyone ages 8 and older except for the following

Anyone who has a medical condition that prevents the wearing of a face covering
Anyone who is consuming a drink or food
Anyone who is trying to communicate with a person who is hearing impaired
Anyone who is giving a speech for broadcast or to an audience
Anyone temporarily removing his or her face covering for identification purposes
Anyone who is a resident of a parish without a high COVID incidence that has opted out of the masking mandate
Masks are strongly recommended for children
ages 2 to 7.

All bars, including those with food permits from the Louisiana Department of Health, will be closed to on-premises consumption. They can operate for curbside takeout or delivery service only.

The order also limits the size of social gatherings to 50 people indoors. Outdoor
social gatherings are also limited to 50 people if individuals cannot avoid being within six feet of one another.

Experts warn of a mental health crisis due to the impact of Covid-19.

According to a report by ABC News, authored by Alexis Carrington, the impact of Covid-19 could include 20 additional firearm-related suicides per day.

In the July 7 report, the author wrote that a new study has found that there may be a 20 to 30% increase in firearms suicides due to the mental health impact of Covid.

“The uncertainty brought on by the pandemic has been impacting people’s mental health and increasing feelings of anxiety and depression. The pandemic has also led to
increases in gun purchases with an estimated 1.9 million additional guns sold during March and April 2020 compared to the same time period last year. Having access to a firearm in the home triples the risk of death by suicide.”

“The study comes from the research arm of Everytown for Gun Safety, a non profit
organization which advocates for gun control. Rearchers at Everytown looked back at prior crises that led to massive unemployment, including the Great Depression of the 1930s and the Great Recession that ended in 2010.”

Judge Rules Ms. Monic Entitled to Immunity

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The conclusion of a drawn-out legal dispute over a psychologist’s due
process rights concluded with a US District Court judge confirming that the
psychology board, as well as the board’s employee, Ms. Jaime Monic, are both
entitled to immunity under the 11th Amendment, which bars individuals from
suing a state in federal court.

The lawsuit was brought by Dr. Eric Cerwonka who alleged violations of his
Constitutional rights to due process, when his license was suspended without
a hearing and amid other alleged irregularities by the investigations
subcommittee of the Louisiana State Board of Examiners of Psychologists.

A jury trial had been scheduled for June 4, 2020, but Judge Michael Juneau ruled in February on a Motion for Summary Judgment and arguments by Atty. Gen. Jeff
Landry, ending the dispute. A representative from Cerwonka’s legal firm said that there would be no appeal.

The Louisiana State Board of Examiners of Psychologists is the law enforcement and regulatory agency for the practice of psychology.

In August 2017, Dr. Cerwonka filed a lawsuit in the United States District Court Western District of Louisiana Lafayette division. In his complaint, Cerwonka and his attorneys alleged that the board acted on an interim basis before any hearing had taken place, that Cerwonka was denied a proper opportunity to defend himself against specific charges, that an emergency action was taken because he exercised his right to
free speech, and that evidence was manipulated and obtained illegally. Among these and other violations of his rights, he and his attorneys also noted that the prosecuting
attorney for the board had previously represented Cerwonka in a hotly contested custody battle and that the attorney had information that, allegedly, was used in the board’s prosecution.

In January 2018, Cerwonka and his attorneys amended the complaint against the psychology board to include Executive Director Jamie Monic.

In March 2018, Magistrate Judge Carol B. Whitehurst recommended dismissal based on lack of federal jurisdiction, writing, “The Eleventh Amendment bars an individual from
suing a state in federal court unless the state consents or Congress has clearly and validly abrogated the state’s sovereign immunity.”

United States District Judge Robert James agreed, and issued a Judgment on April 18, 2018, stating, “After an independent review of the record, and consideration of the objections filed, this Court concludes that the Magistrate Judge’s report and recommendation is correct and adopts the findings and conclusions therein as its own.”
Therefore, Judge James dismissed the matter in part on the grounds that the state is immune. However, a second aspect of the suit continued, naming the Executive
Director as an individual.

On April 18, 2019, in response to another Motion to Dismiss, Judge Juneau ordered that a Motion to Dismiss was partly granted and partly denied, leaving Ms. Monic as the sole defendant.

In late 2019, Ms. Monic and her attorneys at the state requested a jury trial. Judge Juneau granted the unopposed Motion to reset the Bench Trial to a Jury Trial, and
scheduled the matter for June 4, 2020 in Lafayette.

On December 19, 2019, Atty. Gen. Jeff Landry submitted a Motion for Summary Judgment and memorandum in support of the motion.

Landry wrote, “Plaintiff cannot prove the Jaime Monic acted outside of the scope of her duties. Absent evidence that Ms. Monic acted outside of the scope of her duties, she is clearly entitled to absolute immunity. Alternatively, Ms. Monic is entitled to qualified
immunity as her actions were reasonable actions to assist the Psychology Board is carrying out its duty to protect the public. Plaintiff cannot demonstrate any violation of a clearly established law and therefore, has no claim pursuant to 42 U.S.C. §1983
against Ms. Monic.”

Defending attorneys argued, “… all of the facts alleged arise out of Ms. Monic’s performance of her official duties. It is clear from Ms. Monic’s deposition that Ms. Monic never acted outside her official capacity.”

“Qualified immunity protects public employees and officials from individual capacity suits under 42 U.S.C. §1983 for performance of ‘discretionary duties’ when their
actions are reasonable regarding the rights allegedly violated.” They quoted that, “Qualified immunity protects public officials from suit unless their conduct violates a
clearly established constitutional right.”

Cerwonka’s attorneys argued that the Supreme Court has refused to extend absolute immunity beyond a very limited class. “Absolute immunity extends only to those ‘whose special functions or constitutional states requires complete protection from suit.’
However, ‘state executive officials are not entitled to absolute immunity for their official actions.’

And, they argued that, “In professions requiring specific licenses, ‘the licenses are not to be taken away without procedural due process required by the Fourteenth
Amendment,'” wrote the attorneys.

“An essential principle of due process is that a deprivation of life, liberty, or property be preceded by notice and opportunity for hearing,” said the attorneys for Cerwonka.

Ex. Order Aims to Boost Valid Assessments for Federal Hiring/Selection

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On June 26, the President issued an Order to modernize and reform the hiring
process for federal work candidates.

In the introduction, President Trump wrote, “America’s private employers have
modernized their recruitment practices to better identify and secure talent through
skills- and competency-based hiring. As the modern workforce evolves, the Federal
Government requires a more efficient approach to hiring.

“Employers adopting skills- and competency-based hiring recognize that an overreliance on college degrees excludes capable candidates and undermines labor-market efficiencies. Degree-based hiring is especially likely to exclude qualified candidates for jobs related to emerging technologies and those with weak connections between educational attainment and the skills or competencies required to perform them.

“Moreover, unnecessary obstacles to opportunity disproportionately burden low-income Americans and decrease economic mobility.

“My Administration is committed to modernizing and reforming civil service hiring through improved identification of skills requirements and effective assessments of the skills job seekers possess. We encourage these same practices in the private sector. Modernizing our country’s processes for identifying and hiring talent will provide America a more inclusive and demand- driven labor force.

According to the President, this effort “…directs important, merit-based reforms that will replace degree-based hiring with skills- and competency-based hiring and will hold the civil service to a higher standard — ensuring that the individuals most capable of performing the roles and responsibilities required of a specific position are those hired for that position — that is more in line with the principles on which the merit system rests.

The President is directing the heads of the Office of Personnel Management and
Office of Management and Budget, the Assistant to the President for Domestic
Policy, and the heads of agencies, to review and revise all job classification and
qualification standards for positions within the competitive service, nd that changes
to job classification and qualification standards shall be made available to the
public within 120 days. Reforms include the following:

An agency may prescribe a minimum educational requirement for employment in the Federal competitive service only when a minimum educational qualification is legally required to perform the duties of the position in the State or locality where those
duties are to be performed.

Position descriptions and job postings published by agencies for positions within the competitive service should be based on the specific skills and competencies required to perform those jobs.

Section 3 of the Order addresses “Improving the Use of Assessments in the Federal Hiring Process.”

“(a) In addition to the other requirements of this order, the Director of OPM [Office
of Personnel Management] shall work with the heads of all agencies to ensure that, within 180 days of the date of this order, for positions within the competitive service, agencies assess candidates in a manner that does not rely solely on educational attainment to determine the extent to which candidates possess relevant knowledge, skills, competencies, and abilities. The heads of all agencies shall develop or identify
such assessment practices. (b) In assessing candidates, agencies shall not rely solely on candidates’ self-evaluations of their stated abilities. Applicants must clear other assessment hurdles in order to be certified for consideration. (c) Agencies shall continually evaluate the effectiveness of different assessment strategies to promote and protect the quality and integrity of their hiring processes.

“For purposes of this order: (a) the term “assessment” refers to any valid and reliable method of collecting information on an individual for the purposes of making a decision about qualification, hiring, placement, promotion, referral, or entry into programs leading to advancement;…”

The Order is available at https://www.whitehouse.gov/presidentialactions/executive-order-modernizingreforming-assessment-hiring-federal-jobcandidates/