INdiana Systemic Thinking

April 29, 2010

PLA Changes Notice Procedures

The Blogmeister was recently made aware the Indiana Professional Licensing Agency (PLA) was notifying current licensees of the need to renew their licenses via email.  While the PLA is to be congratulated for attempting to save money on postage (they used to mail the reminders), they apparently did not realize many people change email addresses over the two year license period.   End result…  some people did not receive the notice and their licenses expired.  As of the time of this post, they are allowing people to still renew their licenses, but there is an additional fifty dollar fee.  Some people are reporting they received a mailed notice of this policy change, while others are being caught unaware.  The Blogmeister’s advice?  Check your license status ASAP and renew if you are expired.

Spring presents at IAMFT Spring Conference

Janis Abrams Spring presented last Friday (April 23, 2010) at the IAMFT spring conference on the topic of forgiveness.  Spring, who is the author of “After the Affiair” and “How can I forgive you” presented her methods for helping patients work through forgiveness issues regardless of the perceived hurt.  Spring was an excellent speaker who gave a clear and concise lecture of her methods, lacing the talk with plenty of examples.  She also took many questions from the audience of about 120 participants, which included Psychologists, Marriage and Family Therapists, Social Workers, and Mental Health Counselors.

February 19, 2008

Mental Health: Meds, Therapy, or Both?

In a story by the UPI, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services in Washington, said consumers spent 17 billion dollars on Anti-depressants and anti-psychotic drugs.  Accounting for just over 13 percent of the 127 billion U.S. consumers spent on prescription drugs in 2005.

However, in another UPI story today;

In a speech at the annual meeting of the American Association for the Advancement of Science in Boston, Jason Robert of Arizona State University said that while understanding biology is crucial to the understanding of psychosis, “there is more to psychosis than mere biology.”

Robert said claims that genetics and neuroscience will revolutionize medicine and elaborate predictions about new diagnostic tools and new treatments are not being borne out “because they fail to grapple with the complexity of human beings — as brains, bodies, and, embedded in culture, steeped in history, and dynamically creating their own worlds. If we’re really going to have personalized medicine, we have to be focusing not just on the genome, but the person.”

Rather that having a caricature of culture in mind, “what’s really critically important is understanding cultures dynamically, as complex, historic, social and political structures that dramatically influence people’s lives.”

Ignoring all except biology may mean never having the capacity “to actually influence the well-being of the patient,” he said.

Mental health professionals have long known of their patients propensity to want an easy way out of their difficulties by just taking a pill to address their mental health needs.  However, while medication is a wonderful way to feel better and treat the biology of a disorder, almost no one recommends pharmacology alone in the treatment of mental health difficulties.

When I was in school, the prevailing thought about how one develops some of these biologically based disorders was some people are more than likely born with the predisposition to develop these disorders, BUT it was an individual’s life experiences that brought these predispositions out.  Of course, I’m not including things like adjustment disorders (where the environment, social and otherwise, are to blame) or Developmental Disabilities (which are entirely biologically based).

Medication does not address any of the underlying experiences leading to a disorder.  Nor does it help develop new coping mechanisms for situations affecting the disorder.  Americans need to see psychotherapy as they do physical, occupational, speech, and/or other therapies that work in conjunction with medicine.   For example, if one breaks their leg, they would see a physician to set the leg, then begin working with a physical therapist to teach them how to use the newly set leg now and in the future.  They would probably also address what may have happened in the past to cause the fracture.  If Americans used this same rationale with psychiatrists and mental health therapists, we would probably see dramatic “cure” rates for those afflicted with mental health issues.

However, because of stigma, time constraints, or whatever else, we see more people taking medications to feel better about what is going on in their life, which never really seems to change.  Conversely, we also see people who spend years in therapy never getting better either, because, for one reason or another, they don’t want to see a psychiatrist.  However, the people who, in my experience, seem to get better faster and go on to live well adjusted lives are those who employ the services of both professionals.

February 16, 2008

Disability Centers FINALLY Get Funding

Following up on my posts from here and here, the Indiana Family and Social Services Administration has finally decided to give up the 2.5 million last years legislature appropriated to disability agencies.  However, FSSA still bullied the agencies into “agreeing” to some form of “reporting”, which isn’t being explained well.

According to the Fort Wayne News-Sentinel;

FSSA Secretary Mitch Roob said state funding to the centers, once as little as $40,000, has grown to the point where the administration and the Legislature needed assurances that taxpayers were getting their money’s worth.

Hmmmm, I guess we really need to thank Sec. Roob for appointing himself disability appropriations god.  I mean, of course the legislature didn’t think they were getting their money’s worth when they passed the measure, nor did the Governor when he signed the legislation.  Hey, I an idea, lets save a bunch of money and get rid of both the legislature and Governor and let Sec. Roob make all the decisions.  Oh wait, he already is!

February 9, 2008

Inside H.B. 1288: Certified Behavior Analysts

H.B. 1288 requires the state to establish the State Board of Behavior Analysts.  Behavior Analysis, as defined by the bill “means the design, implementation, and evaluation of instructional and environmental modifications to produce socially significant improvements in human behavior through skill acquisition and the reduction of problematic behavior”.  It allows for two levels of Analysts, one requires a Bachelor’s degree, while the other requires a Master’s degree, although the degree can be in any area.  Both certifications require a test and supervised hours.  The requirements mimic the requirements of the Behavior Analyst Certification Board, a non-profit Florida Corporation.

Background

This legislation was first requested at an Indiana Commission on Autism meeting.  Specifically, the commission was asked by Michelle Trivedi, “parent of an autistic child, for the commission to support legislation to be introduced in the 2008 session of the General Assembly that would require board certification for applied behavior analysts.”  The commission heard from Ms. Trivedi, but had many significant questions and did not recommend the legislation be pursued in it’s final report.  However, Rep. Vanessa Summers and Rep. Phil Hinkle, both commission members, introduced the legislation in the 2008 session.

Legislative Progress

Upon introduction, the legislation became very controversial for several reasons.  First, it did not exempt any professionals currently licensed to practice medicine, psychology, mental health counseling, social work, and marriage and family therapy.  Because the definition of what behavior analysis is, it would require all of those professions to become certified as behavior analysts to continue to practice with the licenses they already have.  Thankfully, the authors of the bill agreed to amend the bill to effectively state no-one could use the title Certified Behavior Analyst, unless they are certified.  With this amendment, the concerns of the already licensed professionals were satisfied and they did not oppose the bill in the house.  The bill passed the House last week and is now awaiting a hearing in the Senate Corrections, Criminal, and Civil Matters Committee.

January 30, 2008

Abused Children: Indiana’s Hmurovich

Yesterday a report was released by Prevent Child Abuse America.  It calls for more federal money to be made available for “Federal” foster care support and prevention services.  Sounds good.  Unfortunately, the CEO of the organization is none other than James Hmurovich.  Those who have been around the “welfare” system long enough remember he was in charge of a former incarnation of Family and Children’s Services, where he attempted to do the same thing.   What happened when he was in Indiana is prevention services went up, BUT they were used INSTEAD of foster care services.  The reason?  It is much more cost effective to keep children in their homes than in foster care.  This led to many dangerous situations and the calls for welfare reforms implemented by Governor Daniels.  Looks like Mr. Hmurovich wants to screw up the whole country.  Under his current proposal, he wants to “reward” states for decreasing the number of children in foster care.  Doesn’t look like he learned his lesson from screwing up Indiana.  Here is a summary of what the Indianapolis Star had to say:

January 29, 2008

Mental Health: Fourth Most Expensive Condition to Treat

Wow, I was really surprised when I read this today.  It’s a study estimating the top 10 most expensive health conditions.  It has the usual…heart conditions and cancer are numbers 1 and 3, respectively, but “Mental disorders, including depression”  came in at number 4 with an estimated cost of 56 billion.  I found that hard to believe because Therapists, Psychologists, and Psychiatrists don’t make anything near what a cardiologist or oncologist does.  Then I saw this:

The money paid for visits to doctor’s offices, clinics and emergency departments, hospital stays, home health care and prescription medicines [were included].

Okay, I get it now.  Most of the money in Mental Health care goes to hospitals, emergency departments and prescription medications.  This is due to the public perception they can handle any situation, or take a pill,  and do not seek help early.  When people figure out this strategy is usually ineffective, they usually end up in an emergency room or hospital, where the costs are astronomical.  This “solution” is vastly more expensive than outpatient therapy.  As an aside, most therapists, this one included, do not consider ER and hospital admissions treatment, but crisis management.  With those factors included, the numbers make sense.  If costs for “mental disorders including depression” are ever reduced, a correlating change in perception among the public would also have to occur.  In that regard, Mental Health is no different from any of the other conditions cited, where prevention and early detection is paramount to decreasing costs.

January 25, 2008

Govt. Screw-Ups, Unfair and Inconvenient

Aside from huge tax bills, another thing that gets people madder than heck is when government employees screw-up.  Now everyone is human and we all screw-up from time to time, but when a screw-up ruins someones life or bring to light a hugely unfair system is when people start becoming less and less forgiving.

Look at these two examples, the first if is from the Northwest Indiana Times.  The second, from the Fort Wayne Journal Gazette.

A rural Crown Point man said he learned the hard way Wednesday taxpayers can only depend on themselves to have and hold their property tax deductions.

Norman R. Walters said the county failed to give him credit for his mortgage exemption for the last 13 years, but they still refuse to give him a complete refund.

Dan Repay, tax director for the county auditor’s office, confirmed no taxpayer can be compensated for 13 years of overtaxing.

“The law only lets us go back to correct three years,” Repay said. “I apologize to the gentleman, but I can’t go beyond the law.”

Repay said his office struggles to manage a variety of exemptions on 240,000 separate parcels of land. He said it is ultimately the taxpayers’ responsibility to ensure their exemptions are in order.

The retired steelworker said he has more than an average attachment to his house, sitting on more than an acre in Holiday Creek subdivision southeast of the city limits. He said he has been living there since 1974.

“I built my own home,” Walters said. “I’ve never missed a tax payment, and this last bill went up 26 percent.”

Walters, 66, living on a fixed income, said he began investigating whether to pay off the remainder of his mortgage or keep it and the mortgage exemption — $3,000 subtracted from the property’s assessed value — as a hedge against the rising property taxes.

His investigation led to the discovery he didn’t have a mortgage exemption.

“They told me I hadn’t had one since 1979,” Walters said.

Walters said he couldn’t believe what he was told, so he rummaged through his records and found a receipt, dated 1994, that he had filed for an exemption when he refinanced his home under the administration of former county Auditor Anna Anton.

Walters said he took his 1994 document back to the county complex and was told he is entitled to a refund — but only for the last three tax years, with interest, or about $194.

“It should be four times that amount, and they said I have to pay taxes on my refund,” Walters said. “Look, its not my fault.”

And now the second one:

A Muncie woman says she is trying to make ends meet after the government mixed up her Social Security benefits following her supposed death.

Toni Anderson, 60, said her problems began after her husband, John, died Nov. 8. She went to a local Social Security office to enroll for widow’s benefits and was told that records indicated she, not her husband, had died.

Anderson, who is disabled, already received supplementary security income. The Social Security office secured those benefits for December, she said, but she has not received any more – or widow’s benefits – since that $623 check, which was made out to her husband.

The government also sent a letter to her deceased husband, dated Nov. 16. It begins, “Dear Mr. Anderson: Our condolences on the loss of Mrs. Anderson …”

A Chicago-based regional communications director for the Social Security Administration declined to comment when contacted for a story by The Star Press.

Anderson said the regional official and a manager at the local Social Security office both contacted her this week and said they were working to correct the problem.

“In their eyes, I don’t know whether I’m dead or not still,” Anderson said. “Last I heard, I’m still dead.”

Any wonder why taxpayers are up in arms?

January 24, 2008

Charity Bailey Appealling Release of Records

As most will recall, Charity Bailey, along with Lawrence Green, is accused of beating her daughter, Tajanay Bailey to death back in November.  The case shook the Department of Family Services to it’s core, mostly because Juvenile Court Judge Marilyn Moores ordered the release of records pertaining, not just to TaJanay, but older records of Charity Bailey.  Now, according to the Indianapolis Star, Charity Bailey is appealing that, as well as other decisions, made by Moore.

An attorney representing the mother of TaJanay Bailey has notified the court she will appeal two court decisions releasing juvenile records in the case.

On Jan. 3, juvenile court Judge Marilyn Moores granted The Indianapolis Star’s request to release records in the earlier of two child-welfare cases involving TaJanay. The judge also released the juvenile records of the girl’s mother, Charity Bailey.

TaJanay, 3, died Nov. 27 of apparent abuse. Bailey and her boyfriend, Lawrence Green, both 20, face murder and neglect charges.

Attorney Frances L. Ashton filed a notice last week that Bailey would ask the Indiana Court of Appeals to review Moores’ decision. She also notified the court that she would appeal a Jan. 11 decision by Moores granting The Star’s request for a transcript of the last court hearing before TaJanay’s death.

January 21, 2008

10% Laid Off At Dunn MHC

Calling it a “temporary reduction in force”, Dunn Mental Health Center is saying goodbye to 29 employees, according to the Indianapolis Star.  This accounts for almost 10% of their workforce.  Not wanting to sound partisean, here is the whole story from the Star.  Remember, she said it, I didnt.

Twenty-nine employees of Dunn Center Mental Health in Richmond have been laid off, said CEO Kay Whittington on Sunday.Whittington called the “temporary reduction in force” a result of Gov. Mitch Daniels’ proposed cuts in Medicaid and a bill that could limit how much Medicaid communal health centers may offer.
Dunn Center is comprised of a staff of more than 300.”We have had a temporary reduction in staff across (the) seven counties that we provide services to,” Whittington said.The Dunn Center is a Medicaid provider, and the state government has “dramatically reduced what (the center) can do for Medicaid rehabilitation options,” Whittington said.Gov. Mitch Daniels said in early January a new budget forecast that shows state revenue falling below predictions could lead to some cuts “in some of the entitlement programs like Medicaid.””It all relates to that,” Whittington said.Five of the 29 positions laid off are part-time and the rest are full-time, and Whittington said many of the employees were offered a transfer into other positions.

Whittington said she knows of other communal health centers in the state that have laid off workers.

“We’re all faced with the same thing,” she said. “You can’t wait for the ship to sink.”

Whittington will be available for further details about the situation today, she said.

“We wanted to make sure our staff had the weekend to think about (transferring).”

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