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.)

Our profession is responding to the challenge of a healthcare marketplace that increasingly clamors for more expertise to manage chronic conditions such as pain, IBS, headaches, anxiety and so forth, and demands accountability from practitioners. Sleep health services represent a key set of interventions well within our skill set as applied psychologists and readily adaptable to a variety of treatment settings.

Information about sleep abounds on the web, with numerous opportunities for all psychologists to become versed in the basics of sleep hygiene, insomnia treatment and circadian rhythms. Fellowships and training programs have been established around the country. We are immersed in a global, 24/7/365 world in which work-life boundaries are fluid, and demands are placed on people during what might have been traditional bedtimes. Electronic devices have proliferated, robbing people of sleep, illuminating their retina and stimulating their hypothalamus, all of which disrupts the circadian pacemaker. Nonetheless, we hear advertising messages about the brevity of life and that we should keep alert and conscious as much as possible in the 24-hour day. Have we figured out a way to eliminate the need to eat? I suspect we would have the same luck with sleep. Ironically, the sleep we do achieve may be deleteriously affected by the subtle but omnipresent “light fields” in which all urban dwellers reside. Such dispersed light pollution can suppress melatonin and fool the brain into thinking that we should be awake, active and cogitating. And more and more of us are living in the urban setting, replete with noise, fumes and activity, further impairing our ability to sleep in a consolidated, restorative fashion. It is in this environmental context that we can offer help to clients with insomnia, a widespread behavioral and public health issue in our society.  Please refer to Morin, Bootzin, Buysse, Edinger, Espie & Lichstein, 2006. Well informed psychologists can debunk many of the myths about sleep that bedevil clients and perpetuate their sleeplessness.

There remain pockets of mental health professionals who regard sleep as a clinical issue outside their purview best left to “medical” practitioners. Nonsense. Sleep is a complex set of behaviors which can be readily quantified, as any sleep study data set can attest. Sleep outcomes (e.g., sleep onset latency, reducing nocturnal awakenings, self-rated sleep quality) can be operationally defined in care plans to satisfy the utilization review or treatment audit process. Traditionally, relaxation therapies have been implemented as a way to manage anxiety and thus facilitate sleep. Hypnotherapy has also been invoked. But the sleep function itself is typically bypassed in the everyday work of clinicians. We perform consultations or treatments in traditional wake time periods during the 24-hour clock. Performance fatigue, a ubiquitous problem vexing over-the-road truck drivers, nuclear power plant operators, military sentinels, pilots, ER workers, law enforcement and shift workers, has been studied extensively because of the huge personal and public safety considerations at play. The mindset of our profession was to buy into traditional concepts of psychiatric impairment, where the focus was presumably on daytime functioning and sleep would just be a background process that would take care of itself. Sleep issues do not always remit spontaneously.  We now understand that there is a delicate interrelationship between how one functions during the day and night. The impact is bi-directional. Psychotherapy, behavior management, biofeedback, neuropsychological evaluations and so forth take place when a patient or client is presumably awake and alert, an assumption which may or may not be true. We have learned that the sleep-wake interface is more fluid and semi-permeable than first thought. We have all heard about dramatic cases of sleepwalking, sleepsex and sleepdriving. People have reportedly engaged in criminal behavior but later claim they were not cognizant or mindful of their actions. Micro-sleeping can occur during the middle of the day when a person is grossly sleep deprived. Sleep debt is cumulative, with insidious effects which cannot be rectified by one or two weekend nights of recovery sleep.

Possessing That Critical Global Vision:  One of the most enjoyable experiences of my approximately quarter of a century of involvement within the APA governance was having the opportunity to work closely with Bruce Overmier on the Board of Directors on behalf of all of psychology.  In May of this year, Bruce retired from the University of Minnesota after 49 years of service, a truly amazing accomplishment.  He stated, “I did not stay for the 50^th year as some friends suggested; after all, 50 is just a number.”  It is fascinating to reflect upon the extent to which those elected to the APA Board come to appreciate that they must represent all facets of the field – science, education, and practice – and not merely that “special interest” which might have elected them to the Board.  Although we did not succeed, we worked diligently to bring APS back into APA by ensuring that our national association would be responsive to the unique needs of the scientific community.  Similarly, it is important for those training our next generation of clinicians to appreciate, and be responsive to, the underlying mission of the various federal agencies seeking to improve the quality of life of those subpopulations in which one is particularly interested.  For those concerned about the unique needs of our nation’s children and their families, we would suggest that the Fiscal Year 2015 Budget Justification for the Health Resources and Services Administration (HRSA), and particularly for its Maternal and Child Health program, should be of considerable interest.

The Administration’s Priorities:  The stated objective of the Maternal and Child Health block grant program is to improve the health of all mothers, children, and their families.  These legislated responsibilities reduce health disparities, improve access to health care, and improve the quality of health care.  As one of the nation’s bona fide healthcare professions, psychology must appreciate that it is our responsibility to ensure that the critical psychosocial-economic-cultural element of quality care is affirmatively included.  As the then-President of the Institute of Medicine (IOM) stated in 2006, “Dealing equally with health care for mental, substance-use, and general health conditions requires a fundamental change in how we as a society and health care system think about and respond to these problems and illnesses.  Mental and substance-use problems and illnesses should not be viewed as separate from and unrelated to overall health and general health care.”

Problem: Borderline personality disorder (BPD) is highly prevalent in individuals treated in both psychiatric hospital units and outpatient clinics, and occurs even more frequently among those incarcerated in prisons. Black and colleagues (2007) assessed 220 offenders entering the Iowa prison system and found nearly 30% met criteria for BPD, including 55% of women and 27% of men.  Patients suffering from the disorder present a greater risk for serious behavioral problems at the institution without treatment (Warren et al., 2002). There are few effective, easily implemented, evidence-based treatment programs for BPD in correctional settings.

The STEPPS Program: The 20-week outpatient, cognitive-behavioral, skills-based program is delivered in a group setting with weekly two-hour sessions led by two facilitators who follow a detailed lesson plan. The program is fully manualized, and is designed to be easily delivered in a classroom or seminar setting. Each lesson focuses either on an emotion management or a behavioral skill, and is augmented with homework assignments. STEPPS does not include individual therapy, and is referred to as an “adjunctive” program because it is added to whatever treatment group members are currently receiving (e.g., medications). The program has three main components: (1) Awareness of Illness, (2) Emotion management skills, and (3) Behavior management skills. The term BPD is reframed as Emotional Intensity Disorder (EID) which seems to better reflect the experience of those with BPD. The systems component is implemented with a two-hour session that educates family members, friends, healthcare professionals, and correction workers, about the disorder and the program. The STEPPS program is described in more detail by Blum et al. (2008).

Conclusion: STEPPS was introduced in the Iowa Department of Corrections (IDOC) in 2005, and continues to be used in several prisons; the program has since been extended into community corrections. Secondary data analysis of results in both male and female offenders at eight facilities demonstrated “robust improvement in BPD symptoms, mood, and negative affectivity.” Further, the program significantly reduced both suicidal/self-harm behaviors and disciplinary infractions (Black et al., 2013).  Previous surveys of group participants and therapists showed high acceptance of, and satisfaction with, the program (Blum et al., 2002).

The purpose of the ACA is to curb and control runaway increases in healthcare costs, while improving overall population health. The ACA regulates private health insurance payers as well as expanding access to public health insurance, and setting standards for state-run health insurance systems.

The ACA incorporates parity rules set by the Paul Wellstone and Pete Domenici Mental Health Parity and Addictions Equity Act (passed in October, 2008 and mostly implemented by 2011). “Parity” did not require insurers to pay for mental health care; however, “parity” means that when a group health plan cannot impose treatment limitations or financial requirements for mental health benefits that are stricter than for medical or surgical benefits. The law corrects practices that had been commonplace, such as putting a limit on the number of times an insured person could see a mental health professional or capping the number of days the person could spend in a mental health or substance abuse facility (Erwin, Emmett, & Buchanan, 2012).

The ACA requires state-approved public payers to provide mental health and substance abuse coverage.  Minnesota’s state healthcare exchange, “MNsure,” provides access to insurance for any citizen who is not insured through an employer. MNsure staff help low-income individuals enroll in public assistance programs (Medicaid, Minnesota Care). In addition, MNsure staff help individuals of any income level who do not have health care through an employer. The MNsure “exchange” lists several private insurance agencies called “QHP’s” (qualified health providers) who have contracted with Minnesota to meet the standards set by healthcare reform law. People who enroll with those networks can receive state subsidies, reducing their premiums, based on their income, household size, and where they reside. The ACA says that those payer networks “must maintain a sufficient number and type of providers including those specializing in mental health and substance abuse to assure availability of all services without unreasonable delay” (MNsure, 2012).

There is a growing need for all psychologists to have a basic understanding of the psychology of aging. People 65 years of age and older are the fastest growing segment of the U.S. population and by 2030 will account for 20% of our nation’s people. As discussed in the American Psychologist article, “Aging and Mental Health in the Decade Ahead: What Psychologists Need to Know,” the demand for psychologists with a substantial understanding of later life wellness, cultural, and clinical issues will expand in future years as the older population grows and becomes more diverse (Karel, Gatz, & Smyer, 2012). The recently updated APA Guidelines for Psychological Practice with Older Adults(2013) notes that the demand for psychological services for older adults is expected to rise as Baby Boomers become old, and will continue to increase as cohorts of middle-aged and younger individuals, who are receptive to psychological services, move into old age.

Even if you did not begin practice with the intent of working with older adults, clients do age and their needs often change. Additional issues specific to mid and late life may arise.  Also, age-related issues may arise in work with younger clients (e.g., caring for aging parents, grandchildren being raised by grandparents). Finally, even if you do not work directly with older adults or their families or caregivers, weare all aging. Becoming informed of the science of the psychology of aging will prove useful at a personal level, for ourselves and our families.

In terms of psychological practice with older adults, opportunities abound. The number of psychologists who work with older adults is not keeping up with and will not meet the anticipated need. The decade ahead will require an approximate doubling of the current level of psychologists’ time with older adults. The need for services is particularly anticipated to grow in primary care, dementia and family caregiving services, decision making capacity evaluation, and end-of-life care (Karel, Gatz, & Smyer, 2012). However, only 4.2% of respondents of the 2008 APA Survey of Psychology Health Service Providers reported that geropsychology was their current focus and work (APA Center for Workforce Studies, 2010). This workforce shortage is not limited to psychology. The Institute of Medicine report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands (2012) described the dire need for health providers across professions to address the mental and behavioral health needs of older adults. It found that although the aging population continues to grow in number, diversity, and mental health needs, the geriatric mental health workforce is disconcertingly small and is dwarfed by the pace at which the population is growing.

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

University of Minnesota Twin Cities, CSPP (Counseling and Student Personnel Psychology)

• 1980 M.A. Thesis: Rape Center peer support training model development
• 1999 Ph.D. Dissertation: Type and timing of post pregnancy loss support services and impact on grief outcome.

1984 – Licensed Psychologist

On August 9, I attended the Committee on Women in Psychology (CWP) Network Breakfast Meeting at the American Psychological Association (APA) Annual Convention in Washington, D.C. as a representative of MPA. The CWP is a part of APA and is “committed to ensuring that women receive equity both within psychology and as consumers of psychological services, and that issues pertaining to women are kept at the forefront of psychological research, education, training, and practice.” The Women’s Program Office at APA provides staff support for the CWP.

Meeting Highlights:

What follows is a summary of meeting highlights plus a contribution by MPA Student Member Yolanda Perkins-Volk who also attended the meeting. The meeting was attended by representatives of APA Divisions and State, Provincial, and Territorial Psychological Associations along with CWP members and APA staff.

On September 27, the MPA Governing Council (GC) and Committee Chairs met for a strategic planning retreat, with the specific goal of developing objectives and action plans for 2015.  This work builds on the past two years, which have taken our strategic plan model that was developed in September 2012, and moved MPA forward to a more financially stable and smoothly functioning organization.  As MPA leaders met this year, the focus was on continuing the progress of the past two years while also finding new ways to make MPA even more valuable to all of us.

Our Home

Developing from the notion that MPA is the professional home for all psychologists and psychology students in Minnesota, the strategic model for MPA is that of a house.  The foundation of the house is why MPA exists, and at the 2012 planning retreat we determined that MPA exists to provide “Connection, Protection and Growth” for our members.  The foundation is held together by MPA’s mission statement, “To serve the science of psychology and its applications throughout Minnesota so the interests of public welfare and psychologists are mutually enhanced.”

This past weekend, the leadership of MPA met for our annual strategic retreat to continue to plan the next steps of our professional association’s growth.  This year, one of the topics of discussion was YOU – well, you, and your colleagues who have chosen not to become dues paying members of MPA.

You see, over the past 15 years, psychologists increasingly have decided either not to renew their membership in MPA, or they simply have elected never to join us at all.   What else has happened in the past 15 years?  The number of Licensed Psychologists has grown by about 1000.  The internet has become the primary means of communication.  And, across the country, membership in professional associations has declined steadily.  Professionals in general are just not joining professional associations.

MPA leadership wants to know why, and we need your help.  We are starting with a couple of assumptions.  First, even though MPA offers the same kinds of benefits we’ve always offered, we attribute a significant decline in membership in MPA to a decline in the value of what MPA has to offer psychologists in Minnesota.  The need to connect with peers and colleagues is still there.  The desire to find affordable, competent continuing education hours is still alive and well.  The need to come together to protect the interests of the profession of psychology is more important now than ever before.

Although there has been a significant reduction in tobacco use within the past fifty years, smoking remains high among individuals with mental illnesses. They smoke at rates two to three times higher than the general population. Because of this and other factors like limited access to health care, the average life expectancy for those living with mental illnesses is about twenty-five years less than their peers. One of the most effective ways of reducing this disparity is by focusing on tobacco reduction.

Tobacco use has many harmful effects on health and mental health. Smoking increases how quickly some psychiatric medications are broken down in the body. This can cause an individual to require higher doses of medication and experience more severe side effects. There are a number of benefits to quitting smoking. It can reverse many of the negative effects that cigarettes cause and is associated with an improved mood state as well as a decrease in symptoms of depression and anxiety.

A majority of those who live with mental illnesses and smoke express interest in quitting. By regularly asking about tobacco use and assessing their interest and readiness to quit, mental health providers can assist people in developing a plan for quitting. This may include cessation medication, a quit line, counseling, or a health coach. Providers face a number of demands, but even short discussions with their clients on tobacco use can have a great impact on length and quality of life.

For the last 25 years I have focused my efforts on matching psychologists’ education, training, expertise, and talents to the reimbursement system approved by the federal government’s Medicare system, and to the Current Procedural Terminology. Starting in the late 1980s, I worked for five years on developing health insurance codes in collaboration with the American Psychological Association (APA).  In 1992, when APA received a seat for a formal advisor, I began to represent psychology and APA. During the last six years, I have served on the actual panel. More descriptive information on this panel can be found at the AMA website.

Common Procedural Terminology (CPT), developed almost 50 years ago by surgeons and physicians, is the most widely accepted nomenclature used in the reporting of health services under public and private health insurances. CPT is owned and copyrighted by the American Medical Association (AMA) and licensed by the Center for Medicare & Medicaid Services (CMS). These codes are maintained by the CPT Editorial Panel who meets three times a year to discuss issues associated with new and emerging health care practices, procedures and technologies.  A new CPT code for professional psychological services is developed initially by a Health Care Professional Advisory Committee (also called HCPAC), all non-physicians, then is edited and researched by a selected CPT work group and finally moves to the CPT panel for review and possible approval. These ideas are often vetted simultaneously by a panel of experts convened by APA. This was done for the health and behavior, central nervous system assessment as well as the psychotherapy and applied behavior analysis codes. If successful, this process can take anywhere from two years to twelve years. If not successful, the results may be more clearly visible within two years.

Out of the approximately 8,000 codes, around 60 are possible codes for psychologists to utilize. These codes fall within a few major categories including Psychiatric/Mental Health, Central Nervous System Assessment, and Health and Behavior. Miscellaneous codes also cover things such as preventative measures and telehealth. Psychiatric/Mental health codes were added in the 1970s, testing codes 20 years later and Health and Behavior codes soon thereafter. In between, biofeedback codes were modified as well as expanded and almost all codes currently used were significantly modified and re-valued.

On September 27, MPA will hold its annual Strategic Planning Retreat, bringing together all members of MPA’s Governing Council (which is our board of directors) and all committee chairs.  This is the occasion for reviewing our organization’s long-range strategic plan, the progress on the actions planned for 2014, and developing the action items for 2015.  It is pretty easy to become skeptical about such planning processes because the work to actually implement action steps can be significant, and keeping track of the progress made requires attention to detail, which is time consuming and requires some discipline.  It is not unusual for plans to be created, given little attention, and then new plans made while starting from scratch.

A Significant Success

Thus, it is a noteworthy accomplishment that MPA has stayed focused on our plan and action steps for the past two years, and has continued to “work the plan.”  Our current plan was adopted at the 2012 planning retreat, and has four pillars on which MPA’s strength is based:  leadership and governance; operations and organizational structure; member engagement; and fiscal solvency.  Many, many accomplishments in support of each pillar have been made in the last two years, but perhaps the most measureable has been the improvement in MPA’s financial position, which has improved by approximately $100,000 and moved from a state of significant indebtedness to a positive bottom line.  This was accomplished by lots of attention and hard work from many people leading and following the strategic plan.

Very recently I was reading an exchange of e-mails from the MPA’s Division of Doctoral Level Professional Practice.  The message stated, “As of October 1, 2014 the WHODAS is required when doing a diagnostic assessment for an adult with Medical Assistance.  This is in lieu of the GAF.  See resources at the very bottom of this message.”  Thanks to Trisha Stark, Ph.D. and all others who contributed to this e-mail exchange.

My first thought about the WHODAS was WHOWHAT?  My second thought was “required when doing a diagnostic assessment” very quickly followed up by “OCTOBER 1?”  I won’t share my next thoughts since I need to keep this clean, yet I suspect all of us are very busy people and have implemented a number of practice changes over the past couple of years.   WHOKNOWS, maybe this information came out a long time ago, but the first I became aware of this new mandate was in the e-mail exchange from members of MPA, and then by following up by reading the September 8 issue of the MHCP provider news.  Yes, that’s the September 8 issue and this new mandate goes into effect October 1!  Yikes!

Putting my motivational interviewing skills to good use, on the one hand I could hope that the November elections will make this new mandate go away, and on the other hand, I am aware that as of October 1, the Department of Human Services has the authority to deny payment for any diagnostic assessments that do not include the WHODAS, which is short for the World Health Organization Disability Assessment Schedule 2.0.  If you are reading about this for the first time, I put the links to the MHCP provider news and to the WHODAS at the bottom of this article.  At this time, this mandate applies when a diagnostic assessment is completed on an adult with medical assistance.   As new screening tools become mandates in our practice, I anticipate you will see chatter in the MPA news and listservs.

ABSTRACT

The number of single-parent households in the United States has reached high levels in recent decades. As the extant literature suggests that children raised in single-parent households experience more physical and psychological problems compared to those raised in two-parent households, the implications of homes in which fathers are absent may be important to explore for criminal justice and mental health professionals. The present article aims to examine the extant literature base on father-absent homes, seeking to provide a fair and balanced account of this phenomenon. Specifically, we highlight ten adverse outcomes associated with homes missing a father. Findings suggest that a negative developmental trajectory may result for children lacking a father in the home, albeit further research in this area is warranted.

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

I started out in the mental health field as a chemical dependency counselor in 1976.  I completed an M.A. in Counseling and Psychological Services at St. Mary’s University of MN in 1985.  I was licensed as both a Psychologist and Marriage and Family Therapist in 1989.  I have worked for a number of organizations over the years, including Fairview Riverside Hospital, St. Paul Family Physicians and (the former) Ramsey Clinic.  In 1990-91, I did consultation work for a mission group in Nigeria, West Africa.  I founded Minnesota Renewal Center in 1994.  We are a group of psychologists and therapists who serve the northern St. Paul suburban community, but also specialize in serving ministers, missionaries and military personnel.

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

Sam Scher passed away June 3, 2014 at age 87 having touched the personal and professional lives of many hundreds of people.  This is not a formal obituary, which you can find in the Star Tribune documenting his accomplishments in a detailed article published on June 8, 2014 as Samuel Charles Scher.

My purpose is to provide an appreciative salute to an accomplished psychologist who was a pioneer in promoting the advancement of our profession as a Clinical Psychologist.  When community mental health was actively seeking to meet the needs of persons who typically were not likely to seek professional psychological services, he was at the forefront creating an opportunity through the Walk In Counseling Center, Youth Emergency Services and Bridge for Youth.   He had leadership in those areas as well as in the Minnesota Psychological Association.  While he was active in public mental health, he also was an extraordinary therapist and consultant, and taught at many of the Twin Cities colleges and universities.   He knew the importance of collegial consultation and actively was a leader in high level psychotherapy consultation groups.

In many things I have written for the Minnesota Psychologist over the years, in our old print version through our PDF version and now in our online version, I have talked about getting engaged in MPA—how important, even crucial, member engagement is.  Now I want to return to that topic, but also to look at what comes first before engagement—namely membership.

The desire to support MPA’s mission, “To serve the science of psychology and its applications throughout Minnesota so the interests of public welfare and psychologists are mutually enhanced,” is a great reason to become a member. Similarly, our vision, “to be a thriving community of psychologists that exists for the purpose of genuinely serving the public and the field of psychology,” provides an excellent reason for membership.

The MPA Governing Council (GC), at its strategic planning meeting in the fall of 2012, also identified providing a scientific and professional home that fosters “connection, protection and growth” as a value MPA provides for its members.  We used that value statement as a theme for the 2014 Annual Convention, and we continue to provide that value through the convention, education and training events, legislative advocacy, working with payers, fostering a mentoring program and providing listservs that make connection easier, to mention just a few of the avenues MPA is pursuing.