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.”

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.

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.

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.”

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).]