Timing may not be everything, but it is critical if consultation about practice issues is going to be most effective.

The practice of psychology is becoming more complex and challenging every day. As legal and ethical standards expand and evolve, psychologists and other health professionals increasingly face issues that require consultation with peers and others. Participating in a regularly-scheduled peer consultation group and seeking timely ethical and legal advice when necessary are key factors in avoiding or at least minimizing practice errors.

Even the best-trained practitioners will encounter ethical and legal issues that they have not previously encountered in their training or practice. As helpful as education, supervision and regular peer consultation are, they are often not enough to enable the practitioner to make appropriate decisions about unfamiliar practice issues. When those issues arise, the best time to seek ethical and legal advice is before making decisions that cannot be “undone” without considerable effort and expense, assuming they can be undone at all. Even if there is no clear answer to the issue, the fact that the practitioner sought consultation ahead of time can signify that she or he attempted to meet the professional standard of care in the circumstances.

I was privileged to have the opportunity to attend the annual APA State Leadership Conference (SLC) in Washington, D.C. as the Early Career Psychologist (ECP) delegate from Minnesota March 14-17, 2015. The theme this year was “Practice Innovation.” The keynote speaker, Jason Hwang, MC, described his idea of disruptive innovation and its impact on the health care field. He provided a different perspective on the changes we have been, and will continue to, experience.

As the ECP delegate, I attended programs that focused on increasing the participation of early career psychologists in their State, Provincial and Territorial Associations (SPTA), particularly in leadership roles. I was able to exchange ideas with other ECP delegates from other states that have experienced similar difficulties.

Most psychologists practice in the seven county metro areas of Minnesota, where approximately half of the state’s five million-plus residents live. The other eighty counties represent the greater land area of the state, where the population is more dispersed and people live in smaller or rural communities with fewer mental health providers and services. The psychologists in rural and greater Minnesota are a hidden and valuable resource who not only provide high-quality behavioral health services to their communities, but in many ways benefit the entire state.

Rural and greater psychologists are quite resourceful, but may face considerable challenges such as longer traveling distances, fewer revenue streams, smaller client base, less mental health and other resources, fewer career options, and less training opportunities. While most of the state has some practitioners, there are nine Minnesota counties with no mental health professionals, and several counties with only one. In such areas, practitioners have to be broadly trained, and have the professional skills necessary to manage extensive and often complicated community relationships.

Concerns such as diversity, poverty, and sexual preference are ever growing issues. As you know, every rural county in the state has diverse groups. There are African Americans and       bi-racial persons living in every county, even in many remote areas. Other rural residents of color include Native Americans, South East Asians, Somali, and Latino cultures. In addition, there are “low profile” gay and lesbian families just trying to have a quiet life without harassment. Some rural persons of color are permanent long-term residents who have lived in the community for generations. Others having arrived in the past 20 years, working low-wage jobs in packing or manufacturing plants, or working as seasonal agricultural workers. Some may be more recent arrivals seeking a new life and others are mobile people who are less invested in the community, and trying to escape their past troubled life in large cities such as Chicago, St. Louis, or Kansas City. The new arrivals often have different behaviors and values, and may not participate in local celebrations. Such persons may burden a small town’s social service resources as the community attempts to accommodate high-need families who may require specialized services.

What is the most accurate violence risk assessment tool on the market today? This is a question asked every day by mental health, correctional, and legal professionals working across the globe. This is particularly the case in the United States, where surveys have estimated that over 80% of forensic psychologists use a structured instrument when conducting risk assessments. But you may be surprised to learn that there are over 400 risk assessment tools currently being used on six continents – all claiming to produce the highest rates of validity and reliability. Recent large-scale research has concluded that there is not a single risk assessment tool that consistently predicts future incidents of violence better than all others. Indeed, the risk assessment tool that is going to be most accurate for you is not the one with the best marketing campaign or even the one with the most studies published related to it. Rather it is the instrument with the strongest goodness-of-fit between how the tool was designed and how you use it. But how do you determine this goodness-of-fit? When deciding upon which violence risk assessment tool to adopt in practice, there are three key factors to take into consideration:

1. Population: Compare your average patient to the sample on which a risk assessment tool was normed, taking into consideration age (child, adolescent, adult), sex, race/ethnicity, nationality, offense history, and diagnostic group. For example, if an instrument was developed in a rural area of Canada on a predominantly Caucasian sample of men with an unclear diagnostic background, that risk assessment tool will likely not perform to its maximum ability in a unit serving predominantly minority female patients in downtown Chicago.
2. Setting: Compare the setting in which you are evaluating the average patient with the setting in which the normative sample was assessed. For example, if an instrument was developed using a group of patients evaluated upon admission to a forensic psychiatric facility, that risk assessment tool will likely not perform to its maximum ability when used by a parole board to make release decisions.
3. Outcome: Compare the outcome for which a risk assessment tool was designed with the outcome you are interested in predicting. For example, if an instrument was developed to evaluate the risk of general recidivism, that risk assessment tool will likely not perform to its maximum ability when used to predict sexual recidivism, specifically. Make sure to pay particularly close attention to the operational definition of the outcome in the risk assessment tool’s manual – instruments differ in terms of whether new arrests, charges, convictions, incarcerations, and/or self-reports of offending are included. Further, some risk assessment tools were developed for the prediction of intra-institutional infractions, whereas others were developed for the prediction of misconduct in the community.

Jerrod Brown, MA, MS, MS, MS, is the Treatment Director for Pathways Counseling Center, Inc. Pathways provides programs and services benefitting individuals impacted by mental illness and addictions. Jerrod is also the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS) and the lead developer and program director of an online graduate degree program in Forensic Mental Health from Concordia University, St. Paul, Minnesota. Jerrod is also currently pursuing his doctorate degree in psychology.

Effective January 1, 2015, Minnesota law required that all healthcare providers in the state adopt and use an interoperable electronic health record system (EHR).  This deadline brought with it controversy among behavioral health providers, many of whom began to advocate for repealing the Minnesota EHR Mandate.  Concerns expressed and shared by many psychologists and other behavioral healthcare providers seemed to converge on issues related to patient privacy and security, costs of EHR adoption particularly for small businesses, and the absence of a choice of whether or not to use EHR.  Dr. Stephen Huey, a Minnesota psychologist, broadly distributed a 25-page document (Huey, 2014) outlining these concerns. This white paper generated support among psychologists toward repealing the EHR Mandate.  Subsequently, Dr. Richard Sethre, another Minnesota psychologist, created and distributed what he described to be an informal survey of behavioral health providers that yielded responses from 567 of the 3783 Licensed Psychologists in Minnesota (Sethre, 2015).

In response to calls from members of the Minnesota Psychological Association (MPA) for a formal position statement on the MN EHR Mandate, the leadership of MPA organized a panel of speakers for the annual convention on the EHR Mandate topic with representatives on both sides of the controversy.  The panel, moderated by Dr. Robin McLeod, President-Elect of MPA, included five speakers:  Dr. Stephen Huey; Dr. Trisha Stark, chair of the MPA legislative committee and EHR Task Force;  Dr. Lee Beecher, a prominent psychiatrist and strong advocate for patient rights;  and, Karen Soderberg and Bob Johnson, both from the Department of Health Information Technology at the Minnesota Department of Health.  An hour of the convention break-out session EHR panel was devoted to an open microphone exchange allowing comments and questions from psychologists in attendance, with members of the MPA leadership present to listen to and take in what members were saying.

Award:  Susan T. Rydell Outstanding Contribution to Psychology Award

Winner:  Trisha Stark, Ph.D., L.P., M.P.A.  


From left to right: Scott Palmer, Trisha Stark, and Scott Slattery

Trisha Stark, Ph.D., L.P., M.P.A., is this year’s recipient of the Susan T. Rydell Outstanding Contribution to Psychology Award.  Dr. Stark was recognized by MPA for her considerable advocacy efforts on behalf of individuals most needing of psychological support by promoting the ongoing strength of our profession.  Recognizing that our own professional complacency does not serve clients well, Dr. Stark has, over the course of the past decade, dared to leave the comfort of our professional village, climb the next mountain on the horizon, and peek over the crest to glimpse what the future portends. A bellweather for psychology during a time of significant change, she has come back from these excursions with news we are not always ready (or don’t want) to hear.  Despite this, she has persisted in educating psychologists and forming collaborative partnerships across the state (e.g., Minnesota Mental Health Workforce Plan) – all to ensure that individuals relying on the availability of psychological services will be represented at the tables where policy and funding are decided.  Dr. Stark’s efforts epitomize the essence of this award.

Award:  Leadership in Diversity Award
Winner:  Jim Ayers, Ph.D., L.P.

As a former computer science major, turned psychologist, I have found myself frequently troubled by misunderstandings regarding the realities, capabilities, and actual limitations of computer technology. These misunderstandings seem to undergird at least some of our community conversations regarding Electronic Health Records.

The complete text is rather long.  I have put in bold some of what I think are the highlights of my points of clarification.  Please do not interpret the bold as “speaking loudly” and rather as hoping to create the Cliff notes (oh my, I think I might have dated myself)

1.  Nothing is stored on the Internet.  The Internet is simply a collection of electronic highways that allow communication between virtual addresses (aka electronic addresses).  Similarly, our highway system provides access to a broad range of physical addresses (e.g., houses, business).

   There are totally public addresses on the Internet – www.cpwmn.com – for example.  Here at CPW, we want people to find us, learn about us, and come to us when they need help.  As such we make our address accessible to a broad audience.There are also password-protected addresses – bank accounts for example.  If one has an online bank account, wherever one can access the Internet he or she can locate the public address for the bank.  After locating the public address, one enters the password-protected aspect that contains her or his personal bank account information.

Mental Health Day on the Hill was held on Thursday, March 12, 2015.  Several MPA members spoke with Minnesota legislators regarding mental health issues.

From left to right: Representative Hornstein, Lindsey Nelson, Lisa Squire with Trisha Stark in the foreground.

“Integration is in response to the fragmentation of health care. As individuals we are not fragmented, we are whole people. The current health care system does not recognize this. Integration is trying to fix a big problem, which is that we have two separate systems that take care of our health. Integration is a game changer for health care.”
Benjamin Miller, Psy.D., A Family Guide: Integrating Mental Health and Pediatric Primary Care

Behavioral health (BH) services are part of general medical services, but typically function in parallel, or even separately, from the rest of the medical field. There are many reasons for this, but there also are many benefits when integrating care. While integrating care may be challenging for professionals, it would provide significant benefits to patients with behavioral concerns—and professionals are likely to benefit as well.

New Year’s Day, 2015.  A new year and new responsibilities.  Waking up to a cup of coffee, reading the newspaper with my wife, HGTV on in the background, and soaking in the relaxation on one of those rare “unscheduled” days that I truly enjoy.  Thinking about my new role as President of the Minnesota Psychological Association (MPA) was not a high priority on my mind on January 1, yet it was something I did think about.  Ah, yes.  January 1, 2015.  I am now MPA’s President.  I want to be a great President for MPA. Being a psychologist is something I am truly proud of, and being the ambassador for psychologists in this State is an honor.  It really is!

Reality check 

The responsibility of representing MPA’s membership became very real.  In 2007 the Minnesota Legislature mandated the Electronic Health Record Technology Statute §62J.495, also known as the 2015 EHR Mandate, which states “[b]y  January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health records system within their hospital system or clinical practice setting.”  Starting my role as MPA President on the same day as the 2015 EHR Mandate?  Was this destiny?  Fate?  A very bad coincidence?  A payback for some wrong that I may or may not have committed in my youth?

1)     What is your background in psychology (e.g., education)?

I have a Ph.D. in Clinical Psychology from Southern Illinois University.

2)      Describe your current occupation and any involvement in the Minnesota Psychological Association if applicable.

“What Every Mental Health Provider Should Know About Cancer Survivorship” was presented at the Minnesota Psychological Association Friday Forum series on March 6, 2015. Drs. Morrison, Ehlers, and Staab focused on three key questions for treating cancer patients and survivors: What do we know?; How can we identify?; and  How can we treat?

Beginning in 2015, the American College of Surgeons (ACoS) Commission on Cancer requires that all comprehensive cancer centers, in order to maintain accreditation, screen for depression and anxiety symptoms, provide mental health referral when needed, and monitor psychosocial symptoms until remission and beyond. As the number of cancer survivors continues to increase in our state, mental health professionals in Minnesota will undoubtedly encounter cancer patients and survivors, regardless of the professional context of their practice or whether cancer is the primary presenting problem.

These are exciting times to be a psychologist!  What a whirlwind these first few months have been as I started my term as President-Elect of MPA.

The year began with a flurry of passionate activity among psychologists as the Minnesota law requiring all healthcare providers to be using an interoperable EHR went into effect.  In an effort to respond and listen, volunteers within MPA organized a panel of speakers for our annual convention on this topic with plenty of time for audience interaction.  What a joy it was to witness such a large gathering of Minnesota psychologists last weekend taking time to give voice to their concerns about the changing healthcare landscape and the impact these changes are having on the way we practice.

Earlier in March, several of the volunteers in leadership positions within MPA attended the State Leadership Conference (SLC) hosted by the American Psychological Association Practice Organization (APAPO) in Washington, DC.  This year’s theme was “Practice Innovation,” and the message I came away with from that experience was stated succinctly by Katherine Nordal, the Executive Director of APAPO:  “Now is not the time for panic; now is the time for action!”   The question she asked in her opening speech is one I believe we all should begin asking ourselves:  How can we as psychologists harness innovation to improve the quality of our services?  I will add this question:  How can we harness innovation to create thriving business models that preserve independent psychology practices?

Electronic Health Records (EHR) seem to be on the minds of most psychologists lately.  As the 1/1/2015 deadline for the Minnesota EHR Mandate arrived, the issue is being forced, and I, like many MPA members, are witnessing what feels like a flurry of email exchanges about the EHR mandate on our listservs.  So many questions, so many worries, so much energy — and so very many opportunities!

As a psychologist in private practice for the past 20+ years, I often find myself working with clients to help them find opportunity in whatever hardship they are facing.  For some clients, the hardships they are facing are tragic, and we work together to find hope within the darkness.  Sometimes, the hardships are about facing radical change to their own life situations because significant others have made choices outside of their control.  Perhaps this is finding hope within the darkness as well; although, often I find myself encouraging clients to actively seek the opportunities that such radical change inevitably presents.

I believe the practice of psychology is now facing radical change.  This radical change has been given to us, not by our own choosing, but by the changes to healthcare services brought on by the Affordable Care Act and HIPAA privacy and security rules.  Minnesota, being the great liberal state that she historically has been, is leading the country in this radical change with the 2015 EHR Mandate.  Minnesota is the first state in the country implementing an EHR mandate that will become a Federal requirement in a few short years.

As the ball dropping in Times Square ushered in 2015, healthcare providers in Minnesota took a collective breath in anticipation of how the new electronic health record (EHR) requirements would be implemented.  Minnesota is clearly the vanguard of this effort nationally, and as such, serves as a proving ground for new healthcare service delivery and communication.  Being part of a national experiment is challenging and exciting; challenging in regard to the unknowns of how new systems and partnerships with fellow healthcare providers will develop; exciting in being part of a process that brings us together as a profession and can shape our future efforts – especially regarding the use of psychological records.

Prior to January 1, we could still sit and ‘wonder’ about what all of these changes would be like.  Presently, we no longer have that luxury – it is here.  As a professional community, we are already beginning to see the need for working together in our common professional and client interests.  The coming years are sure to include the expected (and perhaps unsettling) surges and repulsions of progress as we work to find common ground.

Before moving forward with this process, we, leaders of the Minnesota Psychological Association (MPA), current officers and past presidents, wanted to take a moment to reflect upon and express appreciation for the considerable and substantive efforts by those who have brought us to this point.  Specifically, we proudly recognize the work that the Electronic Healthcare Records (EHR) Task Force has accomplished to date to diligently keep psychologists informed of legal requirements regarding EHR in Minnesota.  We also are confident and in full support of their continued work under the leadership of Dr. Trisha Stark as we seek to fully understand the 2015 Minnesota EHR Mandate and its requirements for implementation in our professional practices as licensed psychologists in Minnesota.  If it were not for the work of the EHR Task Force and of Dr. Trisha Stark specifically, few psychologists would be aware of the Minnesota EHR Mandate.

The 6^th Annual Rural Behavioral Health Practice Conference, “Integrated Care in Rural Practice,” grew significantly in 2014, with 10 organizational partners and over 200 participants from 21 states.  Co-Chairs Willie Garrett, Ed.D. and Scott Palmer, Ph.D., concluded that this growth shows that the conference is filling a national need.  “MPA’s Rural and Greater Minnesota Division has got a great thing going, and we’re pleased that MPA is really supporting it,” Garrett noted.

On Friday, December 5, 2014, Dr. A. David Redish presented at the Minnesota Psychological Association’s First Friday Forum. The title of his presentation was, “The Mind within the Brain: Implications for Psychology and Psychiatry.”  He presented new ideas from his new book titled, The Mind within the Brain: How we make decisions and how those decisions go wrong.  Dr. Redish has provided a summary below.

At the MPA’s First Friday Forum in December, 2014, I presented a new perspective on psychological and psychiatric dysfunction – if we understand the underlying processes of how we interact with the world (including with each other), then we should be able to identify how and where those processes can break down and how better to treat those breakdowns.  These ideas arise from the burgeoning field known as “Computational Psychiatry” which uses information processing (computation) to connect neuroscience (mechanism) with psychology (behavior).   The presentation concentrated on two new ideas – first, the concept of failure mode, and second, a careful identification of the processes underlying decision-making.

The term failure mode comes from engineering and is about identifying the weak links in a system.   For example, when a bridge collapses, we want to know what allowed the bridge to collapse.   If we know that there are weak gusset plates and that the bridge cannot take the weight we expect, then we can strengthen those gusset plates and we can limit the weight on the bridge.   Similarly, a computer virus accesses processes within the operating system of your computer by finding code that can be executed in unexpected ways.   Knowing where the failure modes of a system are allows us to prevent and treat those potential dysfunctions.  But this means that if we want to understand how the human decision-making system can break down (where the failure modes are), then we need to understand how humans make decisions.

1)      What is your background in psychology (e.g., education)?

I am currently an undergraduate student in my junior year at Metropolitan State University studying psychology. I do not have much of a background in psychology beyond the classes that I have taken and research I have participated in with both fellow students and faculty.

2)      Describe your current occupation and any involvement in the Minnesota Psychological Association if applicable.

I believe wholeheartedly that the current attempt by some to reduce all mental health issues to neural chains of events in the brain is totally misdirected. There is plenty of evidence that biological changes in the brain are caused by, as well as have an influence upon, psychological factors such as thoughts, feelings and behaviors.  There is no reason to assume that it is a one-way street: Biological and psychological factors both affect the other.

At the most recent Association of University and College Counseling Center Directors (AUCCCD) conference it was announced that the AUCCCD Diversity Leadership Mentoring Award is now going to be the Harriett Copher Haynes AUCCCD Diversity Leadership Mentoring Award in honor of her contributions to AUCCCD’s ongoing diversity efforts. The Mentoring Award offers mentoring support and funding to attend and present at one AUCCCD conference to a counseling center staff member with at least five years of experience who represents diversity in such areas as race/ethnicity, physical ability or sexual orientation and has had experience advancing a cultural agenda. (University Counseling & Consulting Services Training Director Anshan Eckard was a 2010 recipient of the award.)