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Friday Forum Recap: Promoting Resilience in Highly Stressed Children

On May 13, 2016, Dr. Abigail Gewirtz presented a Friday Forum Encore on Promoting Resilience in Highly-Stressed Children: Long-term Program Findings. In her presentation, Dr. Gewirtz addressed three key questions: What is resilience in children? What do we know about parenting and its association with child adjustment among families facing traumatic and/or highly stressful events? And, can prevention programs to strengthen parenting improve children’s resilience? A recap of the presentation is provided below.

What is resilience? Children and youth are considered resilient, if they appear to be ‘doing OK’—that is, functioning in the normative range with regard to social, emotional, behavioral, and academic adjustment, despite experiencing adversity (i.e., stressful and/or traumatic living conditions). Several long term studies on resilience have revealed individual, family, and environmental conditions or characteristics that promote resilience. Across multiple studies, the ‘shortlist’ of factors that are associated with children’s resilience includes effective parenting or caregiving. [1]

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The Next Generation of RxP in MN

While many psychologists may have linear career tracks and interests; some others may be driven by unique opportunities and, more importantly, the pressing needs of their community.  

During graduate school, I never thought my career would move through significant paradigm shifts.  The foundation of the scientist-practitioner still holds firm; however, my work in mobile crisis, primary care, and now that attainment of an advanced (MSCP) psychopharmacology degree has awoken a deeper perspective.  And it is this advanced degree, fraught with future obstacles and aspirations, that has been handled with much care, consultation, and, yes, consternation.  But then again, I also never thought I’d be called to duty (Operation Iraqi Freedom III) during graduate school.  So it is here, that my story has parallel processes, in so much that I seem to have been called to duty on another front.

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Current Updates on the Affordable Care Act

As a member of the HCRC, I suggested to our committee chair Michael Sharland, Ph.D., L.P., ABPP, that a summary of the 6/10/16 conference “Ethics and Risk Management in the Age of the Affordable Care Act: Everything You Didn’t Want to Know and Were Afraid to Ask” might be helpful to MPA members who couldn’t attend (take a deep breath, run on sentence).  I thought much of the information provided by that conference is germane to the mission of the HCRC, namely keeping MPA members informed regarding likely changes to psychological practice because of the Accountable Care Act (ACA). 

The 6/10/16 conference was sponsored by MPA and The Trust (formerly known as APAIT).  Daniel O. Taube, J.D., Ph.D., was the presenter.  Every time I start to think of something the HCRC should discuss with MPA members, it feels like there is a moving target or we are herding cats.  Starting to work on this article, I came across a webinar offered 6/30/16 by the website OpenU that also seemed germane to this article. 

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Beltrami PACT Collaborates to Succeed in Implementing the Affordable Care Act

Recently I purchased a plain wooden microwave cart for the lake cabin from IKEA. The item came in a box with several descriptive charts, lots of little pieces and a baffling array of hardware.  I waded into the task trusting the directions and the accuracy of the assembler’s count of screws and bolts. I can say the project was a success and I am reminded how unlike an IKEA package, other things are in life! The directions for implementing the structure that supports participation in the Affordable Care Act have not always been very clear.  In Beltrami County, providers have had a slow start. While other parts of the state have large behavioral and health care organizations that have successfully applied for grants and help, we were largely unaware of the scope of the change. It became obvious to the 11 agency members that we needed to collaborate in order to share the financial benefits associated with the new payment models for Medicare and Medicaid.

The ACA goals also known as the ‘Triple Aims’ of increased health, reduced cost and happier patients are not new ideas any longer, but seemed like lofty goals without a list of tools to be used to attain them. For Beltrami County, our challenges were even greater as our school district is roughly the size of Rhode Island. We also have an isolated, poor population, without central transportation, poor access to services, low wages, high rates of incarceration and crime and suicide as well as high rates of drug and alcohol abuse. In addition, Red Lake Nation, Leech Lake and White Earth Reservations are effected by historical and complex trauma, racism and social exclusion, poverty and high unemployment. In short, the demand for services remains unrelenting and routinely overwhelms the agencies in the area. While mental health providers have had a history of competition and little integration, there has long been the belief that we would likely be better off if agencies collaborated in order to meet the overwhelming needs. The area agencies are often underfunded, with huge demand for services. Perhaps because we are not in competition for business, it made collaboration, despite our history of niche market providers, highly desirable.

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Adlerian Early Recollections: Application to the Client

Frequently, I hear professionals and students discussing Adlerian Early Recollections (ERs) as a tool.  Well, they are not a tool. To stay true to Alfred Adler’s Individual Psychology, we should see Early Recollections as a unique window with a view of one’s pattern of life – a pattern that both a client and a therapist may jointly discover. Because of their strong ties to the ethics and therapeutic fundamentals of Individual Psychology, the significance of ERs can only be understood based on major Individual Psychological assumptions. 

Several of these assumptions, very briefly, are outlined here:     

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CMS wrongfully denying PQRS incentives

Due to the dogged determination and careful attention to detail of Amy Rosett, Ph.D., a solo practitioner from Encino, Calif., the Center for Medicare and Medicaid (CMS) overturned its decision to deny a financial bonus for her 2014 participation in the Physician Quality Reporting System (PQRS).

Last September Rosett failed the Measure Applicability Validation (MAV), the data mining method that evaluates providers’ data submitted under PQRS.

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MPA First Friday Forum: Population-Based Approaches to Managing Anxiety Disorders

Anxiety disorders are the most common mental health condition in the United States, affecting approximately one-third of the population.1 They frequently co-occur with depression, substance, and other anxiety-related conditions. Anxiety disorders are disproportionately associated with a variety of chronic disease risk factors, such as nicotine use, alcohol consumption, and sedentary behaviors, and chronic diseases, such as cardiovascular disease, diabetes, and asthma.2 The public health impact of untreated anxiety disorders is staggering. The adjusted estimated annual economic impact of anxiety disorders is $62 billion through disability, lost wages, and healthcare costs.3 Although highly effective treatments exist for anxiety, only a minority of patients with clinical anxiety receive some form of care. Unfortunately, even among those individuals being actively treated for their anxiety disorder, very few are receiving pharmacotherapy and/or psychotherapy that meet evidence-based practice guidelines.4

Cognitive behavioral therapy (CBT), especially exposure-based interventions, is the most effective treatment for anxiety disorders. 5 CBT is highly acceptable to patients, and typically outperforms evidence-based pharmacotherapy in the longer-term maintenance of treatment gains.6 Although access to CBT remains challenging, large-scale efforts are being made to change health care delivery systems to improve the dissemination of evidence-based treatments.

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From MPA's President Robin McLeod, Ph.D., L.P.: MPA Volunteers - Makin' it Happen in Minnesota!

Welcome to Spring!  The Minnesota Psychological Association’s annual convention is behind us now, and we are looking forward to the coming months.  While writing this essay to you, I learned that the Minnesota legislature passed a bill containing MPA’s proposed Duty-to-Warn language, and Governor Dayton signed it into law!  There is NO ambiguity remaining – psychology supervisors and psychologists-in-training can rest assured that in Duty-to-Warn situations, you are protected with immunity. 

The issue began about this time last year when the Executive Director of the Minnesota Board of Psychology notified MPA that a Duty to Warn case had been overturned on appeal with a ruling indicating that psychology supervisees are not covered with immunity in our current Psychology Practice Act in situations where a Tarasoff warning is required.  In essence, an appeals court had ruled that when receiving information about a credible homicidal threat, supervisees could be sued effectively should they report this information to authorities.  Due to language in the MN Practice Act, this appeals court ruled that only licensed psychologists have immunity is such situations.  MPA leaders were relieved that the Board of Psychology had given us this heads-up, and then sprang into action.   We knew that not only would we need to work to change the language of the law to achieve important clarification in the Practice Act;  we also recognized that we would be serving all psychologists in Minnesota by submitting an Amicus Curiae Brief to the Minnesota Supreme Court, slated to hear this case in 2016.

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From MPA's President-Elect Steve Girardeau, Psy.D., L.P.: Passage of SF2414

With the passage of SF2414, psychologist supervisors are completely covered for their supervisee’s duty to warn under Minnesota’s version of Tarasoff.  What are you talking about you might ask, you thought you were covered already.  As mentioned earlier this year in this newsletter, there was a court case that interpreted the law as it stood as not covering the actions of an unlicensed supervisee and allowed a criminal conviction to be overturned and a civil lawsuit against the supervisee and supervisor to go forward.  This has been argued before the Minnesota Supreme Court with an Amicus Brief filed by MPA and we await the decision of the court.  As we wait we are not idle.  We crafted legislation closing the loophole in the law and have lobbied this law through to the recent passage.

This is what MPA does for you!  We watch for issues and address them as quickly and completely as we can with the resources at our disposal.  This why continued membership is so very important.  In the coming year it seems likely we will have to work on revisions of the Psychology Practice Act to clarify some of the recent confusion in interpretation of that Act. 

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2016 Minnesota Psychological Association's Annual Convention Award Winners

Award:  Susan T. Rydell Outstanding Contribution to Psychology Award (two award winners)

Winners:  Rochelle Brandl, Ph.D., L.P. and Mary Tatum Howard, Ph.D.

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Update from MPA's Health Care Reform Committee (HCRC)

The original intent of this article was to inform MPA’s membership of our promotion from the Health Care Reform Task Force to the Health Care Reform Committee (HCRC), describe the HCRC’s relatively short history, and report current/future goals (but more about that later in this article).

Given recent changes announced by Medicare, however, it seems more prudent to focus providing information gleaned by the HCRC (and other MPA member/committees) regarding such.  Trisha Stark, Ph.D., L.P., provided the following link for the HCRC’s 5/2/16 monthly call-in committee meeting:  http://healthaffairs.org/blog/2016/04/29/breaking-down-the-macra-proposed-rule/   Dr. Stark is chair of MPA’s Electronic Healthcare Records Task Force and an HCRC committee member. 

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From MPA's President-Elect Steve Girardeau, Psy.D., L.P.

Hello to all, my name is Steve Girardeau and I am your president-elect for MPA.  I will serve my presidential year in 2017 beginning my presidency at the same time as the individual we elect to be our next national president.  I offer the observation not because I think my presidency will be as important or impactful for the nation but to connect the processes of the national, state and local elections to our national and state associations. 

In both arenas there has been a great deal of polarization and acrimonious shouting about issues rather than a drive to participate in a rationale discourse on the issues that face us both as a nation and more to the point of this article, as an association.  MPA has weathered a difficult year, the year of EHR implementation, thanks to the strong leadership of Scott Palmer.  The most striking news of 2015 being that quite a few vocal individuals who had not been all that involved in MPA seemed to believe that MPA was a silent partner to the Minnesota Department of Health in the creation and implementation of the EHR mandate.  Having been active in the legislative committee and governing council, and having attended MPA conventions in the years leading up to 2015, I was surprised at their surprise.  MPA had informed the membership of the process as it proceeded, requested feedback, and provided informational content at the conferences in those years.  There was little notice paid and little concern expressed.  It was only after implementation was upon us and there was a direct impact on people’s immediate practice that there was surprise, disappointment and frustration that, “something should have been done.”

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From MPA's President Robin McLeod, Ph.D., L.P.: The Great Minnesota Psychology Get-Together

I always have thought of MPA’s Annual Convention as much like the Minnesota State Fair for psychologists.  Complete with psychology’s version of admission discounts, a Mid-way area, a Grandstand line-up, vendors displaying items of interest to just about anyone, games of skill and chance, and blue ribbon awards. This year’s MPA Annual Convention has something for every Minnesota Psychologist.  We even will have our own version of free entertainment!  Please play along with me as I expand upon this fun analogy.

When you arrive at The Crowne Plaza Minneapolis West Hotel in Plymouth on April 15 & 16, you will check in at the registration table where you will be given a nametag, your pre-purchased ticket to everything at the convention.  If for some reason you haven’t yet purchased a ticket, no worries!  Rhea Sullivan, MPA’s Administrative Director, and one of the convention Visitor Guides, will help you get registered so that you will be ready for two days of action-packed fun!  And, if you are new to MPA, she also will let you know about the huge membership discount available to you only at the convention.  Yes, that’s right.  If you have never been a member of MPA, or if your membership lapsed at least three years ago, you can become a full dues-paying MPA member for a discount of $200.  It’s a bargain only offered during the Great Minnesota Psychology Get-Together!

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Willie B. Garrett Honored as 2016 Award Recipient for Outstanding Career Achievement in Black Psychology

 

Willie B. Garrett was honored on February 5, 2016, as the 2016 award recipient for Outstanding Career Achievement in Black Psychology.  Front row, from left to right: BraVada Garrett-Akiinsanya, Harriett Haynes. Susan Rydell.  Back row, from left to right: Ted Thompson, Pearl Barner, Willie B. Garrett, Shonda Craft, Zach White, Linda Muldoon.

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Essential Advocacy at State Leadership Conference (SLC)

MPA members received the APA Division 31 APAGS Award for an Outstanding State, Provincial, or Territorial Association of the Year at the APA State Leadership Conference in Washington, D.C. Front row, from left to right: BraVada Garrett-Akinsanya, Cynthia (C.J.) Swanlund, Robin McLeod, Sy Gross.  Back row, from left to right: Matthew Syzdek, Daniel Kessler, Yasmine Moideen, Bruce Bobbitt and Willie Garrett.

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New MPA Division: Psychologists in Healthcare Organizations (PHO)

The Minnesota Psychological Association (MPA) is pleased to announce the formation of the new division, Psychologists in Healthcare Organizations (PHO). The PHO division was developed to serve as a resource for psychologists employed in health care settings or interested in working in health care settings, and to assist with the growth and integration of behavioral medicine services into medical practices, clinics, and centers.

The landscape of health care continues to change, and as part of it, delivering effective, yet affordable and safe health care has received greater emphasis. This has been a focus of both government agencies and the private sector alike. Behavioral medicine has attempted, with mixed results, to address this area for years by forging relationships with medical practices. In primary care settings, psychologists screen medical patients for mental health conditions and triage to appropriate mental health care. In neurology groups, psychologists assist with diagnosing patients and making treatment recommendations. In Sleep Centers, psychologists treat insomnia patients, in lieu of prescription sleep medications. Despite these additions, the overall integration of psychologists into medical centers has been slow, uneven, and mostly untapped.

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Marginalized Populations

The social revolution of the 1970s coined the word “marginalized” to describe the experiences of those who live on the fringe of mainstream America.  Such persons are systematically excluded from full participation in the American dream and consequently lack the self-efficacy to improve their life situation.  In the end, society pays the costs when people encounter barriers to achieving their potential.  The term marginalized has expanded from originally referring to minorities and persons from poverty, to include a long list of cultures and populations.  Here is a sample of the most common marginalized groups:

  • GLBT
  • Senior citizens
  • Racial/Cultural minorities
  • Military Combat Veterans
  • Persons of below average intelligence
  • Hearing, visually, and Physically  Challenged Persons
  • Persons with a serious and Persistent Mental Illness (SPMI)
  • Persons with Cognitive Impairments
  • Gamblers and Substance Abusers
  • Autism Spectrum Persons
  • Gifted and Talented Persons
  • Persons with disfigurements
  • Persons Living in Poverty
  • Sex Offenders
  • The Homeless
  • Felons

While this is only a listing of those most commonly referred to as marginalized, there are other individual people who just do not fit into mainstream culture, and suffer the same consequences. Such persons are all around us but virtually invisible…unless they cause problems or disrupt the lifestyles of mainstream persons.

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In Appreciation of Congressman Martin Olav Sabo (February 28, 1938 - March 13, 2016)

The Minnesota Psychological Association recognizes the many years of service to the people of Minnesota with his passing on March 13, 2016. He was an exceptional person and served us with dignity and caring. He was in the U.S. Congress 28 years, 1979-2006, after extensive service in the Minnesota legislature. Congressman Sabo, and his staff, were supportive to the position and visits by Minnesota psychologists sharing his wisdom and time. At one visit during the APA State Leadership Conference he spent more than an hour with two of us, Steve Peltier, Ph.D., L.P. and Sy Gross, Ph.D., L.P., which is  much more time than typical, then or now. We benefitted from his informed ideas about fiscal integrity necessary to seek legislation with his service on the key House Appropriations Committee all of his career in Congress, and Chair of Budget Committee, 1993-94.  He appreciated the challenge faced by psychologists.  His successor in the U.S. Fifth District, Rep. Keith Ellison, has continued being supportive to professional psychology. The Minnesota Psychological Association honors and respects Congressman Martin Olav Sabo.

Written by Sy Gross, Ph.D., L.P., who is the Current Federal Advocacy Coordinator for MPA for the past 12 years, a previous MPA President, and on the Council of Representatives for APA.  His doctoral degree was received from the University of Minnesota Clinical Psychology program and he currently does clinical work at Hennepin County Mental Health Center. His specialization is with persons who are homeless.

Health Professionals Services Program Summary

MISSION

Minnesota’s Health Professionals Services Program protects the public by providing monitoring services to regulated health care professionals whose illnesses may impact their ability to practice safely.

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MNsure and Health Insurance Basics

In late 2015, NAMI Minnesota received another MNsure grant to help people with mental illnesses and their family members obtain health insurance. In addition, NAMI Minnesota is working to educate individuals on how insurance works and how to utilize the benefits offered.  Two fact sheets on health insurance basics have been written, are on our website, and can be sent on request. Presentations are also being offered. Here are some health insurance terms that you or your clients will learn with these fact sheets and at these presentations:

Premium – Monthly amount paid for health insurance plan. This amount must be paid whether or not you actually use your health insurance.

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Diversity Statement

The Minnesota Psychological Association actively encourages the participation of all psychologists regardless of age, creed, race, ethnic background, gender, socio-economic status, region of residence, physical or mental status, political beliefs, religious or spiritual affiliation, and sexual or affectional orientation.Although we are an organization of individuals from diverse cultures and backgrounds, the Minnesota Psychological Association also recognizes our core unifying identities as Psychologists who practice in America. We also recognize that we may hold unintentional attitudes and beliefs that influence our perceptions of and interactions with others. Within this context of unity and self-exploration, we are committed to increasing our sensitivity to all aspects of diversity as well as our knowledge and appreciation of the unique qualities of different cultures and backgrounds.We aspire to becoming alert to aspects of diversity, previously unseen or unacknowledged in our culture. In this spirit, we are committed to collaborating with multicultural groups to combat racism and other forms of prejudice as we seek to promote diversity in our society. To this end, we are dedicated to increasing our multicultural competencies and effectiveness as educators, researchers, administrators, policy makers, and practitioners.