MN Psychologist Online

From MPA's President Steve Girardeau, Psy.D., LP: You asked for it, and we will provide it!

A new year has begun and with it my increased responsibilities to MPA.  I say increased, rather than new responsibilities because it is my belief that we have a responsibility to give back to the profession that we have chosen and to be a part of protecting and building psychology’s place in the future of health care.   To that end I have served on the MPA Legislative Committee, the Governing Council, the Executive Committee and now serve you all as president.

In that time, I have come to realize that in many ways MPA has lost its way.  It has moved away from our natural role of a professional association, with responsibilities as a “guild” for the profession.  This became especially clear in our survey of members last year which identified “protection” as the most important responsibility for the association.  We heard that message and have acted.

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Integration of Behavioral Health in Population-Based Approaches to Caring for Patients in Primary Care (Based on the presentation given at the MPA Annual Convention April 2016)

In May 2008, the Minnesota legislature adopted health care reform legislation that allows primary care clinics in Minnesota to become certified as Health Care Homes (HCH).  The HCH program provides “an approach to primary care in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life for individuals with chronic or complex health conditions (Minnesota Department of Health, Health Care Homes).”  The goals for HCH are based on the “Triple Aim” put forth by the Institute for Health Care Improvement.  These aims are 1) improving patients’ experience of care, 2) improving health from a population perspective, all while 3) reducing the cost of health care (Institute for Health Care Improvement).

This shifted the perspective of many primary care clinics, as clinics tended to focus on patients who showed up asking for care.  These aims ask clinics to proactively reach beyond their clinic walls and provide evidence-based care for patients in a systematic manner.  Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”  At the core of population management is defining a group of patients (e.g., those on chronic opioids, patients with elevated PHQ-9 scores, patients with diabetes with blood pressures over a set point, etc.) and using available data to actively follow and review patients to ensure the condition is being optimally managed in relation to available evidence-based guidelines for treatment.

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Tribal Politics and the Liberal Psychologist

The day after the 2016 election, psychologists went to work and met with patients, silently questioning who was sitting across from them.  Is this a Trump voter? A Clinton voter? Third party? Did they even vote? Politics of the therapy room became quite personal on November 9, 2016. And we are a big part of the problem.

The majority of psychologists are liberal (Duarte et al., 2014; Heflick, 2011; Inbar & Lammers, 2012; Konnikova, 2014). Graduate school and CE courses on multicultural issues may have helped us understand ethnicity and microaggressions (kind of); however, most of us never really learned to co-mingle with others of different political persuasions and tax brackets. If you voted for Clinton and do not know someone who voted for Trump, you are living in a bubble. I don’t mean your best friend’s uncle that voted for Trump, but someone that you would go out to coffee with or someone you just had over for dinner.  

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New MN DHS Benefit, Behavioral Health Homes: Resources for MA Beneficiaries with Severe and Complex Conditions

Psychologists and other mental health professionals who serve people with more complex and challenging problems may want to refer them to a new DHS service, Behavioral Health Homes. (BHH).  BHH services can increase support and treatment resources for the person, and can help the mental health professional better respond to the person’s needs. 

The Patient Protection and Affordable Care Act (ACA) created a “health home” benefit to help states better coordinate care for Medicaid enrollees with chronic medical conditions. This program focuses on populations that traditionally face serious barriers to accessing medical care, and end up being underserved by our medical and mental health system.  They also have reduced quality of life and increased mortality, and frequently are high utilizers of expensive urgent care services.

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Behavioral Health Outcomes Measures: Problems, Challenges, Solutions

Psychology’s Ambitions

Human suffering, including mental and behavioral health problems, is elusive to define and measure.  Even with relatively objective markers of diagnosed mental illness, consensus is hard to find. People often have more than one diagnosable condition, and the conditions themselves are increasingly understood as dimensional rather than categorical (APA, 2013).  These   conditions also are often embedded in relational and social contexts.  To complicate things even further, they often occur on a spectrum ranging from absent to severe during the course of a care episode, or a lifetime. All of these factors may have a greater or lesser effect on the person’s functioning at different times and under different circumstances.  It is challenging for both patients and providers to sift through all of the data, all of the layers and all of the noise, in order to identify the most important factors that can guide treatment.

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New Member Spotlight: Amy R. Steiner, Psy.D., LP

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

2002 B.A. in Psychology from Butler University (Indianapolis, IN)

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Culturally-Sensitive Diagnostic Interviewing Protocol for Somali Immigrants and Refugees

Dr. Dasherline Cox Johnson presented her dissertation research on Culturally-Sensitive Diagnostic Interviewing Protocol for Somali Immigrants and Refugees at the Minnesota Psychological Association’s 80th Annual Convention on April 16, 2016 and at the 2nd Annual Mental Health Summit on June 17 in Minneapolis and St. Paul respectively, with the following objectives: 1. Demonstrate cultural-specific understanding of Somali mental health, 2. Recognize relevant issues related to Somali mental health, and 3. Apply cultural competent practice to mental health assessment of Somali clients.

Methodology: The researcher conducted semi-structured, in-depth interviews with eight mental health providers from five local agencies with at least two years of experience working with Somalis. A qualitative method of snowball sampling was conducted to identify research participants. Questions addressed challenges of working with Somalis within the current mental health system and how clinicians handle or resolve them. An inductive content analysis was used to analyze the interviews and to inform the development of a culturally sensitive diagnostic interviewing protocol.

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MPA First Friday Forum: Formulating Diagnostic Impressions and Pitfalls of Self-Report

Catherine A. Carlson, Psy.D., LP

There is undetected psychosis and feigning in mental health settings. Some people lie about symptoms and impairments. Those who feign or malinger (feigning for secondary gain), typically emphasize and endorse psychotic symptoms or cognitive impairments for manipulative reasons. The most common motivation for malingering in non-forensic settings is money. Social Security Disability (SSDI) provides a monthly income. When feigning or malingering, dramatic acting and portrayals of purported symptoms are often part of the ruse. These are far from academy award winning performances given the frequent inconsistencies with bona fide mental illnesses. Some mimic portrayals of mental illness in movies, which are rarely accurate. I find much less drama when examining those with genuine disorders. Other people self-report (malinger) extreme anxiety to get benzodiazepines, a controlled substance that has high potential for abuse. I have rarely seen people feign a non-psychotic Major Depression. For some, the feigning itself is intrinsically reinforcing. Psychological needs related to attention and control are met by deceiving and manipulating others. If this behavior is habitual, and there is no evidence of feigning for secondary gain, a diagnosis of Factitious Disorder needs to be carefully considered. Then there are those with undetected and untreated psychosis, a particularly guarded subgroup, who generally deny psychotic symptoms they have experienced. When they voluntarily seek treatment, chief complaints usually consist of extreme anxiety (including panic attacks), ‘overwhelming stress,’ and/or self-diagnosed Posttraumatic Stress Disorder. They are willing to report anxiety but usually too guarded to disclose the underlying paranoid psychosis (including hallucinations) that is generating the intense anxiety.  They do not seek out treatment for ‘psychosis’ because they have limited to no insight into this condition. They know they are anxious (terrified is probably more accurate) but do not recognize the fears stem from irrational or delusional thought processes. People with non-psychotic depression seek out treatment for depression. Those with guarded psychotic illnesses seek treatment for anxiety not psychosis.

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Online Rural Conference Brings CEs to Rural Behavioral Health Professionals

“Critical Issues in Rural Practice” was the subject of the 8th Annual Rural Behavioral Health Practice Conference on Friday, October 21.  The conference was webcast to individuals and group webcast sites across the United States.  Minnesota sites were at Mankato, Marshall, UM-Morris, St. Cloud, and Willmar.

The conference was very well received by participants, with comments such as:  “This has been an absolutely wonderful day/experience.”  “The presentations were excellent and very relevant to our practice.”  A group webcast coordinator said, “Thanks again for a great conference, and we look forward to hosting again next year!”

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The Importance of Being Earnest - Ethics and Child Abuse Reporting

The fame and glory of being a mandate reporter is not all it’s cracked up to be.  The massive mess and confusion of what and how to report can be daunting, even to the established therapist.  As one author stated, many clinicians feel that; “There is no way to do no harm” (1) when facing a potential child abuse report.  Further, sometimes what is best for the child (a child abuse report) is not what is best for the parent.  In addition, since treating mental illness decreases the risk for child abuse, clinicians certainly don’t want to derail the treatment of mental illness due to the mandated reporting of child abuse.  Nevertheless, therapists are mandated reporters and must report all child abuse regardless of the ramifications. 

The major conundrums fall into one of these four categories: 

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Walk-In Counseling Center Provides Free Mental Health Services Every Weekday

Psst! What’s the best kept secret in town?

It’s this: Any person who needs mental health counseling right away, with no appointment necessary, for free, can get services in Minneapolis and Saint Paul every weekday. Walk-In Counseling Center is the place to go for services provided by mental health professionals during walk-in clinic hours. There are no barriers to service here – no fees, no copays, no sliding scale. Clients can even remain anonymous if they wish.  

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APA's Disaster Response Network Changes its Name to APA's Disaster Resource Network

On January 1, 2016, the Disaster Response Network changed its name to Disaster Resource Network. The advisory committee as well as APA staff believe that the name more accurately reflects the breadth of the program. What follows is that announcement.

Twenty-five years ago, the Disaster Response Network of licensed, disaster-trained psychologists across the United States was created to offer onsite mental health services to Red Cross workers and victims of disaster. Over the years, psychologists have responded to more than a thousand disasters of various types. Their work is frequently featured in APA publications.

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High Intelligence as a Primary Diagnosis and Lens for Intervention with Children and Their Families

When my 18-month-old son was speaking in sentences, our part time nanny asked if she could bring him to one of her graduate classes at the U of MN Institute of Child Development.  Her professor said it was not possible for children to have such advanced language skills.  While I initially found the situation humorous, I realized it meant that child development experts knew very little about precocious kids.  I looked through graduate school textbooks and notes and did not find much information.  I knew what to expect for those on the lower end of the intellectual bell curve, with an IQ of 70 or below, and that it was not ethical for me to work with those clients without proper training. However, I knew little about what it meant to be on the high end of that curve, those with an IQ of 130 or above and yet I worked with very bright kids in my practice every day.   Hence began my quest to understand the gifted population.  That was 12 years ago and what I learned drastically changed the way I saw kids in my practice and what I do to help them.

High Intelligence is Neuroatypical. The ability to read at age three, have academic skills six years above their age level, and wrestle with existential concerns by age four is a result of unique neurological wiring.  Gifted brains have distinct brain structures-- they have double the glial cells, burn glucose more rapidly, and have faster, more efficient connections (1).  They think about things in elaborate creative ways, often looking lost in thought. The cortex thickens more rapidly with the ‘use it’ phase of developing high level circuits starting earlier and lasting longer (2).  There is also a delay in the ‘lose it’ or pruning phase that creates a lag in the development of executive functioning skills for as much as two to four years compared to average peers. Given academic success is largely dependent on ability to organize and get work turned in, this often results in underachievement and a misdiagnosis of ADHD.

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New Member Spotlight: Heather Johnson, Psy.D., LP

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

I have both a Masters and a doctoral degree in Counseling Psychology from the University of St. Thomas.  My undergraduate degree was in French and Philosophy. I didn’t come to my love of psychology until after my undergraduate education.

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From MPA's President Robin McLeod, Ph.D., LP: APAPO - The Voice of Psychologists in D.C.

Hang around me long enough, and you learn that I am a complete and total APA Practice Organization (APAPO) geek.  As Alan Nessman (Senior Special Counsel at the American Psychological Association) once said to me, “You drank the Kool-Aid, Robin!”  That’s right…I am a true believer in the mission of APAPO, which is “…to advance, protect and defend the professional practice of psychology.”  You read that right!  APA exists to promote the interests of psychology.  APAPO exists to promote the interests of psychologists

In the early years of my professional career as a psychologist, like many early career psychologists, I was very focused on building my practice at the same time that I was building a family life.  I didn't look beyond my own small world in those years.  Honestly, and somewhat humbly, I have to say that I really didn't even realize that there was so much more going on in the world of professional practice; that is how turned inward that I was in those early years.  Realizing, however, that it was important to belong to our professional associations during those years, I continued to pay annual dues to both APA and MPA.  I recall thinking that someday I would get involved in these organizations, but at the time chose to focus on what was immediately in front of me.  With hindsight, I often wish that someone would have tried to shake me up a little and help me realize that the practice of psychology goes far beyond the small business I was trying to build.  I think if someone I respected had sat me down and explained that all of what I was building really was even possible because of the political advocacy that comes from our professional associations, specifically from APAPO and MPA, I might have looked up long enough to have realized that if I could not contribute my time, I could at least contribute money towards those efforts.

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From MPA's President-Elect Steve Girardeau, Psy.D., LP: Creating Our Identity as Psychologists

Fall is here. It is a time of change, of preparation for the end of a year and the beginnings of anticipation of the year to come.  This past weekend we completed our strategic planning meeting for my presidential year 2017.  It began with Robin McLeod, our current president, reviewing what has been accomplished and will be accomplished in 2016.  There was much to be proud of in that review, but I leave that review to her.

In planning for 2017, the current leadership team met to discuss the directions that MPA will go in the coming year.  That leadership team included the Executive Committee (EC), the Governing Council (GC) and the representatives of all the divisions of MPA as well as committee chairs/co-chairs.  The majority of that team (the EC, GC and Division Chairs/Co-Chairs) was formed was by people volunteering to take on roles as members of each of those bodies through an election process.  Our election process is set to begin in the coming weeks.  I would encourage all to consider being a part of the process.

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MPA First Friday Forum: Supporting Families During Pregnancy Following a Perinatal Loss

The loss of a baby during pregnancy is estimated to be around 30% of all pregnancies and is almost always unexpected and sudden, thus is a traumatizing experience for the mother and her partner.  Regardless of the cause of the death, it is impossible to have another experience of pregnancy without stimulating memories of the painful past loss. As parents enter a new pregnancy rather than unresolved grief, parents experience a new layer of grief; for their deceased baby and fear that the new unborn child might also die.

Bereaved parents report common themes around their loss experience. These include viewing the loss as a major life event possibly even traumatic in nature, a sense of isolation and loneliness due to the stigma and silence around pregnancy loss, invalidation from family and friends who intentionally or unintentionally diminish their loss in some way as well as lack of support from family and friends. These themes remain as parents move into a subsequent pregnancy with additional themes including an increase in anxiety about the outcome of the subsequent pregnancy, conflicted emotions around how to grieve for one baby while trying to be hopeful for another, and lack of trust in a ‘good outcome’ for this pregnancy. For the pregnant mother, this can present as lack of trust in one’s own body to keep this next baby safe.

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Social Justice and Ethics: Dilemmas and Opportunities for Psychologists

Before we decided to send this topic for consideration for the MPA 81st Annual Convention we had conversations about the events that were happening around the country related to police brutality and killings of unarmed African Americans, the riots, and the protests. We wondered why voices of psychologists were missing from the commentaries in the media; both on local and national TV, and in print media. We wondered about the psychological impact of the traumatic events in Ferguson, Baltimore, Minneapolis and others to the communities and the country as a whole. We wondered how traumatizing it was for young children and adults to see the body of Michael Brown lying on their streets for hours. We wondered how it was possible for all, except psychologists to frequent newsrooms to comment, analyze, and condemn these acts. We wondered what was stopping psychologists from having a strong presence on the microphones to explain, teach, or even warn about long-term effects of trauma that were unfolding before our eyes. Then we decided to delve into psychology literature on Ethics and Social Justice, and the APA Ethical Guidelines. To say the least, there is ample work that has been done on this topic.  We looked at the history of psychology and social injustice, social justice, and through discussions explored ideas on the role of the psychologist and dilemmas on ethics and legal issues in media presence.

APA’s Multicultural Guidelines (2010)
“Psychologists are in a position to provide leadership as agents of prosocial change, advocacy, and social justice, thereby promoting societal understanding, affirmation, and appreciation of multiculturalism against the damaging effects of individual, institutional, and societal racism, prejudice, and all forms of oppression based on stereotyping and discrimination” (p. 382).

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Working with Native American Patients & Clients - The 3 C's

On April 15, 2016, Dr. Antony Stately (Ojibwe) and Jennifer Waltman (Lakota), a doctorate of psychology student, presented at the MPA Annual Convention on Working With Native American Patients & Clients. The presentation addressed the 3 C’s of integrating Indigenous consideration into your practice:  Context (Understanding the story); Comfort (Building it); Communication (Tools & Techniques for Indigenous relationship building). A recap of the presentation is provided below applying information from both research and applied experience working in the community and intended for generalization.

Context. Understanding historical trauma (HT) for Native Americans is key to conceptualizing the significant stigma related to issues of mental health and the greatest health disparity in Minnesota.  Native Americans commonly use humor to disguise trauma. Humor conversely provides strength to explore distress that may contribute to misdiagnosis and confusion for many non-Native healthcare providers. 

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School is Starting and Some Kids Are Dreading it. What Can You Do?

CLINICAL PEARL: Don't say (or write) "Parents should get an IEP for this child who is struggling in school." Instead, say (or write), "Parents should consult with the school staff, a child psychologist, LDA Minnesota, or PACER Center, to assess and design a plan to meet this child's educational needs."

Many of our patients whose schoolwork or attendance is affected by chronic health conditions may benefit from creating a "504 Plan." This is a written agreement for curriculum adaptations, within a regular education program, which ensures the school makes "reasonable accommodations" to meet the child's educational needs, without incurring "undue burden" to the District. A 504 Plan is guided by Section 504 of the Civil Rights Act which says that schools cannot discriminate against a student for needs that reflect a student's physical or mental disabilities. It is NOT "special education" and NOT an "individualized education program (IEP)" but a 504 Plan can be very helpful to students who just need "reasonable accommodations" to succeed with regular classroom instruction.

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