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Showing posts with label continuing education lmft. Show all posts
Showing posts with label continuing education lmft. Show all posts
November 01, 2010
Mental Health Screenings and Trauma-Related Counseling in Substance Abuse Treatment Facilities
Mental Health Screenings and Trauma-Related Counseling in Substance Abuse Treatment FacilitiesIn Brief •In 2009, more than half (62 percent) of all substance abuse treatment facilities provided brief mental health screenings that could be used to identify clients in need of trauma services; less than half (42 percent) provided full diagnostic mental health assessments
•Facilities that primarily focused on a mix of mental health and substance abuse treatment services were more likely than facilities with other primary focuses to report using trauma counseling "always or often" (30 vs. 16 to 26 percent)
•Facilities that were operated by tribal governments (55 percent) were more likely than facilities that were operated by the Federal Government (37 percent), private for-profit organizations (36 percent), private non-profit organizations (35 percent), or State or local, county, or community governments (32 percent each) to offer domestic violence services
Research shows that the experience of traumatic events and the possible sequelae of posttraumatic stress disorder (PTSD) often co-occur with a substance abuse disorder1 and are present among many substance abuse treatment clients.2 Common types of trauma include being exposed to a natural disaster or violence in combat or noncombat situations and experiencing physical assault or domestic violence. Because of the relationship between substance use and trauma-related mental health problems, it is recommended that substance abuse treatment facilities offer mental health screenings and assessments to determine whether or not a client is suffering from a trauma-related illness3 and/or has been involved in domestic violence.4
This report explores the extent to which mental health screenings, mental health assessments, trauma-related counseling, and domestic violence services are provided in substance abuse treatment facilities. The provision of these services in treatment facilities is captured by the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS).
Mental Health Screenings and Assessments
Mental health screenings and assessments can be used in treatment facilities to identify clients who have been exposed to one or more traumatic events and who have problematic symptoms associated with such exposure. The Center for Substance Abuse Treatment (CSAT) guidelines for best practice with substance abuse treatment clients differentiate between mental health screenings and mental health assessments. Screenings assist in identifying substance abuse clients that show signs of mental health problems by asking questions that elicit a yes or no response; assessments define the nature of the mental health problem and gather more detailed information that may be used to develop treatment plans for clients with co-occurring mental health and substance abuse problems.5
More than half (62 percent) of the 13,513 treatment facilities that responded to N-SSATS provided brief mental health screenings for clients, but less than half (42 percent) provided full diagnostic mental health assessments. Facilities with a primary focus on mental health services, a mix of mental health and substance abuse treatment services, or general health care were more likely than facilities that primarily focused only on substance abuse treatment services to provide mental health screenings or mental health assessments (Figure 1).
Figure 1. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Figure 1 Table. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009 Primary Focus Mental Health Screenings Mental Health Assessments
Substance Abuse Treatment Services 45% 20%
Mental Health Services 94% 89%
Mix of Mental Health and Substance Abuse Treatment Services 90% 76%
General Health Care 85% 75%
Other/Unknown 53% 21%
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Treatment facilities that were operated by the Federal Government (68 percent) were more likely than facilities operated by State governments (52 percent); local, county, or community governments (50 percent); private non-profit organizations (43 percent); tribal governments (40 percent); or private for-profit organizations (36 percent) to provide mental health assessments (Figure 2). Additionally, facilities that were operated by the Federal Government (79 percent) were more likely than those operated by other types of governments or organizations to provide mental health screenings.
It is recommended that substance abuse treatment providers screen all clients in substance abuse treatment for exposure to domestic violence in order to identify batterers and survivors. After substance abuse treatment providers identify those clients who have been involved in domestic violence, the provider may then determine what services the clients may need.4 Domestic violence services may include, for example, specialized counseling, medical services, or legal services.
N-SSATS provides information regarding whether or not treatment facilities offer domestic violence services. In 2009, less than half (35 percent) of treatment facilities offered domestic violence services. Facilities that primarily focused on a mix of mental health and substance abuse treatment services (46 percent) or general health care (44 percent) were more likely than those that focused on mental health services (37 percent) or substance abuse treatment services (30 percent) to offer domestic violence services.
Discussion
Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings and assessments may be used by substance abuse treatment facilities to identify clients who are suffering from mental health problems related to trauma. By first identifying these clients, treatment providers may then develop a comprehensive treatment plan and assist clients with gaining access to trauma-related services. Treatment plans for clients with these co-occurring problems should address their substance abuse and incorporate evidenced-based interventions that aim to reduce the biological, psychological, and behavioral symptoms associated with trauma.6
The data in this report provide a snapshot of the extent to which the treatment system is identifying and providing certain services to clients suffering from co-occurring substance abuse and trauma-related mental health problems. This information may be used to increase public health awareness about substance abuse and trauma-related mental health problems, and inform behavioral health care reform initiatives that increase the treatment system’s capacity to provide needed trauma-related services to substance abuse clients.
End Notes
1 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
2 Nanjavits, L. M. (2002). Clinicians’ views on treating posttraumatic stress disorder and substance use disorder. Journal of Substance Abuse Treatment, 22, 79-85.
3 Center for Substance Abuse Treatment. (1995). Anxiety disorders. In Assessment and treatment of patients with coexisting mental illness and alcohol and other drug abuse (Treatment Improvement Protocol [TIP] Series 9, DHHS Publication No. SMA 95-3061). Rockville, MD: Substance Abuse and Mental Health Services. (Original work published 1994) Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A30236
4 Fazzone, P. A., Holton, J. K., & Reed, B. G. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (1997). Substance abuse treatment and domestic violence (Treatment Improvement Protocol [TIP] Series 25, DHHS Publication No. SMA 97-3163). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A46712
5Sacks, S., & Ries, R. K. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring disorders (Treatment Improvement Protocol [TIP] Series 42, DHHS Publication No. SMA 05-3922). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A74073
6 Shalev, A., Bonne, O., & Eth, S. (1996). Treatment of post traumatic stress disorder: A review. Psychosomatic Medicine, 58, 165-182.
•Facilities that primarily focused on a mix of mental health and substance abuse treatment services were more likely than facilities with other primary focuses to report using trauma counseling "always or often" (30 vs. 16 to 26 percent)
•Facilities that were operated by tribal governments (55 percent) were more likely than facilities that were operated by the Federal Government (37 percent), private for-profit organizations (36 percent), private non-profit organizations (35 percent), or State or local, county, or community governments (32 percent each) to offer domestic violence services
Research shows that the experience of traumatic events and the possible sequelae of posttraumatic stress disorder (PTSD) often co-occur with a substance abuse disorder1 and are present among many substance abuse treatment clients.2 Common types of trauma include being exposed to a natural disaster or violence in combat or noncombat situations and experiencing physical assault or domestic violence. Because of the relationship between substance use and trauma-related mental health problems, it is recommended that substance abuse treatment facilities offer mental health screenings and assessments to determine whether or not a client is suffering from a trauma-related illness3 and/or has been involved in domestic violence.4
This report explores the extent to which mental health screenings, mental health assessments, trauma-related counseling, and domestic violence services are provided in substance abuse treatment facilities. The provision of these services in treatment facilities is captured by the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS).
Mental Health Screenings and Assessments
Mental health screenings and assessments can be used in treatment facilities to identify clients who have been exposed to one or more traumatic events and who have problematic symptoms associated with such exposure. The Center for Substance Abuse Treatment (CSAT) guidelines for best practice with substance abuse treatment clients differentiate between mental health screenings and mental health assessments. Screenings assist in identifying substance abuse clients that show signs of mental health problems by asking questions that elicit a yes or no response; assessments define the nature of the mental health problem and gather more detailed information that may be used to develop treatment plans for clients with co-occurring mental health and substance abuse problems.5
More than half (62 percent) of the 13,513 treatment facilities that responded to N-SSATS provided brief mental health screenings for clients, but less than half (42 percent) provided full diagnostic mental health assessments. Facilities with a primary focus on mental health services, a mix of mental health and substance abuse treatment services, or general health care were more likely than facilities that primarily focused only on substance abuse treatment services to provide mental health screenings or mental health assessments (Figure 1).
Figure 1. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Figure 1 Table. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009 Primary Focus Mental Health Screenings Mental Health Assessments
Substance Abuse Treatment Services 45% 20%
Mental Health Services 94% 89%
Mix of Mental Health and Substance Abuse Treatment Services 90% 76%
General Health Care 85% 75%
Other/Unknown 53% 21%
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Treatment facilities that were operated by the Federal Government (68 percent) were more likely than facilities operated by State governments (52 percent); local, county, or community governments (50 percent); private non-profit organizations (43 percent); tribal governments (40 percent); or private for-profit organizations (36 percent) to provide mental health assessments (Figure 2). Additionally, facilities that were operated by the Federal Government (79 percent) were more likely than those operated by other types of governments or organizations to provide mental health screenings.
It is recommended that substance abuse treatment providers screen all clients in substance abuse treatment for exposure to domestic violence in order to identify batterers and survivors. After substance abuse treatment providers identify those clients who have been involved in domestic violence, the provider may then determine what services the clients may need.4 Domestic violence services may include, for example, specialized counseling, medical services, or legal services.
N-SSATS provides information regarding whether or not treatment facilities offer domestic violence services. In 2009, less than half (35 percent) of treatment facilities offered domestic violence services. Facilities that primarily focused on a mix of mental health and substance abuse treatment services (46 percent) or general health care (44 percent) were more likely than those that focused on mental health services (37 percent) or substance abuse treatment services (30 percent) to offer domestic violence services.
Discussion
Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings and assessments may be used by substance abuse treatment facilities to identify clients who are suffering from mental health problems related to trauma. By first identifying these clients, treatment providers may then develop a comprehensive treatment plan and assist clients with gaining access to trauma-related services. Treatment plans for clients with these co-occurring problems should address their substance abuse and incorporate evidenced-based interventions that aim to reduce the biological, psychological, and behavioral symptoms associated with trauma.6
The data in this report provide a snapshot of the extent to which the treatment system is identifying and providing certain services to clients suffering from co-occurring substance abuse and trauma-related mental health problems. This information may be used to increase public health awareness about substance abuse and trauma-related mental health problems, and inform behavioral health care reform initiatives that increase the treatment system’s capacity to provide needed trauma-related services to substance abuse clients.
End Notes
1 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
2 Nanjavits, L. M. (2002). Clinicians’ views on treating posttraumatic stress disorder and substance use disorder. Journal of Substance Abuse Treatment, 22, 79-85.
3 Center for Substance Abuse Treatment. (1995). Anxiety disorders. In Assessment and treatment of patients with coexisting mental illness and alcohol and other drug abuse (Treatment Improvement Protocol [TIP] Series 9, DHHS Publication No. SMA 95-3061). Rockville, MD: Substance Abuse and Mental Health Services. (Original work published 1994) Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A30236
4 Fazzone, P. A., Holton, J. K., & Reed, B. G. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (1997). Substance abuse treatment and domestic violence (Treatment Improvement Protocol [TIP] Series 25, DHHS Publication No. SMA 97-3163). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A46712
5Sacks, S., & Ries, R. K. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring disorders (Treatment Improvement Protocol [TIP] Series 42, DHHS Publication No. SMA 05-3922). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A74073
6 Shalev, A., Bonne, O., & Eth, S. (1996). Treatment of post traumatic stress disorder: A review. Psychosomatic Medicine, 58, 165-182.
May 11, 2010
Suicide: Consequences
Suicide: Consequences
Cost to Society
•The total lifetime cost of self-inflicted injuries occurring in 2000 was approximately $33 billion. This includes $1 billion for medical treatment and $32 billion for lost productivity (Corso et al. 2007).
Consequences
•Suicide is the 11th leading cause of death among Americans (CDC, 2006).
•Over 33,000 people kill themselves each year (CDC, 2006).
•Approximately 395,000 people with self-inflicted injuries are treated in emergency departments each year (CDC, 2007).
•Many people are exposed to another person's suicide which may affect them psychologically. One estimate was that approximately 7% of the US population knew someone who died of suicide during the past 12 months. (Crosby and Sacks, 2002).
References
Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: National Center for Injury Prevention and Control. Available at: www.cdc.gov/ncipc/wisqars. Last modified 2008 August 26.
Crosby AE, Sacks JJ. Exposure to suicide: Incidence and association with suicidal ideation and behavior – United States, 1994. Suicide and Life-Threatening Behavior 2002; 32:321–328.
Corso PS, Mercy JA, Simon TR, Finkelstein EA, & Miller TR. Medical Costs and Productivity Losses Due to Interpersonal Violence and Self- Directed Violence. American Journal of Preventive Medicine 2007: 32(6): 474–482.
Cost to Society
•The total lifetime cost of self-inflicted injuries occurring in 2000 was approximately $33 billion. This includes $1 billion for medical treatment and $32 billion for lost productivity (Corso et al. 2007).
Consequences
•Suicide is the 11th leading cause of death among Americans (CDC, 2006).
•Over 33,000 people kill themselves each year (CDC, 2006).
•Approximately 395,000 people with self-inflicted injuries are treated in emergency departments each year (CDC, 2007).
•Many people are exposed to another person's suicide which may affect them psychologically. One estimate was that approximately 7% of the US population knew someone who died of suicide during the past 12 months. (Crosby and Sacks, 2002).
References
Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: National Center for Injury Prevention and Control. Available at: www.cdc.gov/ncipc/wisqars. Last modified 2008 August 26.
Crosby AE, Sacks JJ. Exposure to suicide: Incidence and association with suicidal ideation and behavior – United States, 1994. Suicide and Life-Threatening Behavior 2002; 32:321–328.
Corso PS, Mercy JA, Simon TR, Finkelstein EA, & Miller TR. Medical Costs and Productivity Losses Due to Interpersonal Violence and Self- Directed Violence. American Journal of Preventive Medicine 2007: 32(6): 474–482.
April 11, 2010
DISASTER COUNSELING SKILLS
For Mental Health and Human Services Workers
in Major Disasters
DISASTER COUNSELING SKILLS
Disaster counseling involves both listening and guiding. Survivors typically benefit from both talking about their disaster experiences and being assisted with problem-solving and referral to resources. The following section provides "nuts-and-bolts" suggestions for workers.
ESTABLISHING RAPPORT
Survivors respond when workers offer caring eye contact, a calm presence, and are able to listen with their hearts. Rapport refers to the feelings of interest and understanding that develop when genuine concern is shown. Conveying respect and being nonjudgmental are necessary ingredients for building rapport.
ACTIVE LISTENING
Workers listen most effectively when they take in information through their ears, eyes, and "extrasensory radar" to better understand the survivor's situation and needs. Some tips for listening are:
Allow silence - Silence gives the survivor time to reflect and become aware of feelings. Silence can prompt the survivor to elaborate. Simply "being with" the survivor and their experience is supportive.
Attend nonverbally - Eye contact, head nodding, caring facial expressions, and occasional "uh-huhs" let the survivor know that the worker is in tune with them.
Paraphrase - When the worker repeats portions of what the survivor has said, understanding, interest, and empathy are conveyed. Paraphrasing also checks for accuracy, clarifies misunderstandings, and lets the survivor know that he or she is being heard. Good lead-ins are: "So you are saying that . . . " or "I have heard you say that . . . "
Reflect feelings - The worker may notice that the survivor's tone of voice or nonverbal gestures suggests anger, sadness, or fear. Possible responses are, "You sound angry, scared etc., does that fit for you?" This helps the survivor identify and articulate his or her emotions.
Allow expression of emotions - Expressing intense emotions through tears or angry venting is an important part of healing; it often helps the survivor work through feelings so that he or she can better engage in constructive problem-solving. Workers should stay relaxed, breathe, and let the survivor know that it is OK to feel.
SOME DO'S AND DON'T'S
Do say:
These are normal reactions to a disaster.
It is understandable that you feel this way.
You are not going crazy.
It wasn't your fault, you did the best you could.
Things may never be the same, but they will get better, and you will feel better.
Don't say:
It could have been worse.
You can always get another pet/car/house.
It's best if you just stay busy.
I know just how you feel.
You need to get on with your life.
The human desire to try to fix the survivor's painful situation or make the survivor feel better often underlies the preceding "Don't say" list. However, as a result of receiving comments such as these, the survivor may feel discounted, not understood, or more alone. It is best when workers allow survivors their own experiences, feelings, and perspectives.
PROBLEM-SOLVING
Disaster stress often causes disorganized thinking and difficulty with planning. Some survivors react by feeling overwhelmed and become either immobilized or unproductively overactive. Workers can guide survivors through the following problem-solving steps to assist with prioritizing and focusing action.
Identify and define the problem
Describe the problems/challenges you are facing right now.
Selecting one problem is helpful, identify it as the most immediate, and focus on it first. The problem should be relatively solvable, as an immediate success is important in bringing back a sense of control and confidence.
Assess the survivor's functioning and coping
How have you coped with stressful life events in the past?
How are you doing now?
Through observation, asking questions, and reviewing the magnitude of the survivor's problems and losses, the worker develops an impression of the survivor's capacity to address current challenges. Based on this assessment-the worker may make referrals, point out coping strengths, and facilitate the survivor's engagement with social supports. The worker may also seek consultation from medical, psychological, psychiatric, or disaster relief resources.
Evaluate available resources
Who might be able to help you with this problem?
What resources/options might help?
Explore existing sources of assistance and support such as immediate and extended family, friends, church community, health care providers, etc. and how the survivor might obtain their help. Refer the survivor to the appropriate relief agencies and assess if the survivor is able to make the calls and complete the required applications. Assist with accessing resources when necessary.
Develop and implement a plan
What steps will you take to address this problem?
Encourage the survivor to say aloud what he or she plans to do and how. Offer to check-in with the survivor in a few days to see how it is going. If the worker has agreed to perform a task for the survivor, it is very important to follow through. Workers should promise only what they can do, not what they would like to do.
A WORD OF CAUTION
When confronted with a disaster survivor's seemingly overwhelming needs, workers can feel the understandable impulse to help in every way possible. Workers may become over involved and do too much for the survivor. This is usually not in the best interest of the survivor. When survivors are empowered to solve their own problems, they feel more capable, competent, and able to tackle the next challenge. Workers should clearly understand the scope of their role in the disaster relief effort and recognize that empowering survivors is different from doing for them.
CONFIDENTIALITY
A helping person is in a privileged position. Helping a survivor in need infers a sharing of problems, concerns, and anxieties-sometimes with intimate details. This special sharing cannot be done without a sense of trust, built upon mutual respect, and the explicit understanding that all discussions are confidential and private. No case should be discussed elsewhere without the consent of the person being helped (except in an extreme emergency when it is judged that the person will harm himself or others). It is only by maintaining the trust and respect of the survivor that the privilege of helping can continue to be exercised.
in Major Disasters
DISASTER COUNSELING SKILLS
Disaster counseling involves both listening and guiding. Survivors typically benefit from both talking about their disaster experiences and being assisted with problem-solving and referral to resources. The following section provides "nuts-and-bolts" suggestions for workers.
ESTABLISHING RAPPORT
Survivors respond when workers offer caring eye contact, a calm presence, and are able to listen with their hearts. Rapport refers to the feelings of interest and understanding that develop when genuine concern is shown. Conveying respect and being nonjudgmental are necessary ingredients for building rapport.
ACTIVE LISTENING
Workers listen most effectively when they take in information through their ears, eyes, and "extrasensory radar" to better understand the survivor's situation and needs. Some tips for listening are:
Allow silence - Silence gives the survivor time to reflect and become aware of feelings. Silence can prompt the survivor to elaborate. Simply "being with" the survivor and their experience is supportive.
Attend nonverbally - Eye contact, head nodding, caring facial expressions, and occasional "uh-huhs" let the survivor know that the worker is in tune with them.
Paraphrase - When the worker repeats portions of what the survivor has said, understanding, interest, and empathy are conveyed. Paraphrasing also checks for accuracy, clarifies misunderstandings, and lets the survivor know that he or she is being heard. Good lead-ins are: "So you are saying that . . . " or "I have heard you say that . . . "
Reflect feelings - The worker may notice that the survivor's tone of voice or nonverbal gestures suggests anger, sadness, or fear. Possible responses are, "You sound angry, scared etc., does that fit for you?" This helps the survivor identify and articulate his or her emotions.
Allow expression of emotions - Expressing intense emotions through tears or angry venting is an important part of healing; it often helps the survivor work through feelings so that he or she can better engage in constructive problem-solving. Workers should stay relaxed, breathe, and let the survivor know that it is OK to feel.
SOME DO'S AND DON'T'S
Do say:
These are normal reactions to a disaster.
It is understandable that you feel this way.
You are not going crazy.
It wasn't your fault, you did the best you could.
Things may never be the same, but they will get better, and you will feel better.
Don't say:
It could have been worse.
You can always get another pet/car/house.
It's best if you just stay busy.
I know just how you feel.
You need to get on with your life.
The human desire to try to fix the survivor's painful situation or make the survivor feel better often underlies the preceding "Don't say" list. However, as a result of receiving comments such as these, the survivor may feel discounted, not understood, or more alone. It is best when workers allow survivors their own experiences, feelings, and perspectives.
PROBLEM-SOLVING
Disaster stress often causes disorganized thinking and difficulty with planning. Some survivors react by feeling overwhelmed and become either immobilized or unproductively overactive. Workers can guide survivors through the following problem-solving steps to assist with prioritizing and focusing action.
Identify and define the problem
Describe the problems/challenges you are facing right now.
Selecting one problem is helpful, identify it as the most immediate, and focus on it first. The problem should be relatively solvable, as an immediate success is important in bringing back a sense of control and confidence.
Assess the survivor's functioning and coping
How have you coped with stressful life events in the past?
How are you doing now?
Through observation, asking questions, and reviewing the magnitude of the survivor's problems and losses, the worker develops an impression of the survivor's capacity to address current challenges. Based on this assessment-the worker may make referrals, point out coping strengths, and facilitate the survivor's engagement with social supports. The worker may also seek consultation from medical, psychological, psychiatric, or disaster relief resources.
Evaluate available resources
Who might be able to help you with this problem?
What resources/options might help?
Explore existing sources of assistance and support such as immediate and extended family, friends, church community, health care providers, etc. and how the survivor might obtain their help. Refer the survivor to the appropriate relief agencies and assess if the survivor is able to make the calls and complete the required applications. Assist with accessing resources when necessary.
Develop and implement a plan
What steps will you take to address this problem?
Encourage the survivor to say aloud what he or she plans to do and how. Offer to check-in with the survivor in a few days to see how it is going. If the worker has agreed to perform a task for the survivor, it is very important to follow through. Workers should promise only what they can do, not what they would like to do.
A WORD OF CAUTION
When confronted with a disaster survivor's seemingly overwhelming needs, workers can feel the understandable impulse to help in every way possible. Workers may become over involved and do too much for the survivor. This is usually not in the best interest of the survivor. When survivors are empowered to solve their own problems, they feel more capable, competent, and able to tackle the next challenge. Workers should clearly understand the scope of their role in the disaster relief effort and recognize that empowering survivors is different from doing for them.
CONFIDENTIALITY
A helping person is in a privileged position. Helping a survivor in need infers a sharing of problems, concerns, and anxieties-sometimes with intimate details. This special sharing cannot be done without a sense of trust, built upon mutual respect, and the explicit understanding that all discussions are confidential and private. No case should be discussed elsewhere without the consent of the person being helped (except in an extreme emergency when it is judged that the person will harm himself or others). It is only by maintaining the trust and respect of the survivor that the privilege of helping can continue to be exercised.
April 05, 2010
Depression and Mood Disorders
Depression and Mood Disorders
The Prevalence of Major Depression and Mood Disorders in Suicide
Mental Health: A Report of the Surgeon General, states that "major depressive disorders account for about 20 to 35 percent of all deaths by suicide" (p. 244). This estimate is based on a review of psychological autopsies conducted by Angst, Angst, and Stassen (1999). This brief review is intended to address this prevalence estimate. It is important to note that this estimate refers only to the prevalence of major depressive disorder among those who commit suicide, not any other mood disorders (e.g., bipolar I & II, dysthymia, adjustment disorder with depressed mood). Prevalence estimates that include other mood disorders in addition to major depression are much higher.
Major depression in suicide
The lower bound of the 20-35% estimate of the prevalence of major depression in suicide is loosely based on one psychological autopsy study; a study where the reliability of the diagnoses are somewhat questionable. This study (Rich, Young & Fowler, 1986) of 204 subjects identified 15% of suicides as having major depressive disorder. However, an additional 30% were reported as having "atypical depression," defined in this study as having a depressive syndrome that followed the onset of substance use. If this ambiguously defined group were to be considered major depression, the estimate climbs to 45%. A number of other studies suggest that the prevalence of major depression in suicide is somewhat over 30%. The four other available psychological autopsy studies that include samples of suicides from the full age range and reliable diagnoses based on structured interviews (Arato, Demeter, Rihmer & Somogyi, 1988; Dorpat & Ripley, 1960; Foster, Gillespie, McClelland & Patterson, 1999; Henriksson et al., 1993) obtained prevalence estimates of major depression ranging from 30-34% of suicides. In addition, several psychological autopsy studies examining more specific subsamples (e.g., the elderly, adolescents, women) find even higher prevalence estimates. In three psychological autopsy studies of adolescents (Brent et al. 1988; Brent et al., 1999; Shaffer et al., 1996) 41%, 43%, and 32% of adolescent suicides were determined to have had major depression prior to death. Two studies of young adults (Lesage et al. 1994; Runeson, 1989) found a prevalence of 40% and 41%, respectively. A study of 104 women by Asgard (1990) found a 35% rate of major depression. One study of 54 older adults over age 65 found a prevalence of 54%. In summary, the available data suggest that the 20-35% estimate for the prevalence of major depressive disorder in completed suicide is probably somewhat conservative and that a 30-40% prevalence estimate is probably more accurate. This estimate includes both secondary and primary depression. Many of these individuals would also be comorbid with other disorders, especially substance abuse.
Mood disorders in suicide
Prevalence estimates for all mood disorders in suicide (including MDD, Bipolar I & II, dysthymia, and adjustment disorder with depressed mood) are much higher than for major depression alone. These rates are probably closer to 60%, although as noted below, this estimate varies because of inconsistency of the criteria used to define a "mood disorder" across investigations. Four studies examining the full age range of suicides estimate that 36%, 48%, and 66%, and 70% of suicides have some sort of "depressive disorder" or "depression" (Foster et al., 1999; Rich et al., 1986, Henriksson et al., 1993, Barraclough, Bunch, Nelson, & Sainsbury, 1974). Three studies of adolescents found prevalence estimates for "mood disorders" or "affective disorders" of 61%, 63%, and 67% respectively (Shaffer et al., 1996; Brent et al. 1988; Marttunen et al., 1992). Two studies of young adults (Lesage et al., 1994; Runeson, 1989) found estimates of 60% and 64%. A study of 104 women by Asgard (1990) found a 59% rate of "mood disorders." In a review of psychological autopsy studies that examined patterns of psychiatric diagnosis across age groups, Conwell and Brent (1995) concluded that depressive disorders increased with age. Overall estimates for the rates of mood disorders range from 36% to 70% with great interstudy variability. This variability is probably partly a combination of unreliable methods of diagnosis and different definitions of what constitutes a "mood disorder." Despite this variability, a number of studies have found a pattern for increasing mood disorders with aging.
The Prevalence of Major Depression and Mood Disorders in Suicide
Mental Health: A Report of the Surgeon General, states that "major depressive disorders account for about 20 to 35 percent of all deaths by suicide" (p. 244). This estimate is based on a review of psychological autopsies conducted by Angst, Angst, and Stassen (1999). This brief review is intended to address this prevalence estimate. It is important to note that this estimate refers only to the prevalence of major depressive disorder among those who commit suicide, not any other mood disorders (e.g., bipolar I & II, dysthymia, adjustment disorder with depressed mood). Prevalence estimates that include other mood disorders in addition to major depression are much higher.
Major depression in suicide
The lower bound of the 20-35% estimate of the prevalence of major depression in suicide is loosely based on one psychological autopsy study; a study where the reliability of the diagnoses are somewhat questionable. This study (Rich, Young & Fowler, 1986) of 204 subjects identified 15% of suicides as having major depressive disorder. However, an additional 30% were reported as having "atypical depression," defined in this study as having a depressive syndrome that followed the onset of substance use. If this ambiguously defined group were to be considered major depression, the estimate climbs to 45%. A number of other studies suggest that the prevalence of major depression in suicide is somewhat over 30%. The four other available psychological autopsy studies that include samples of suicides from the full age range and reliable diagnoses based on structured interviews (Arato, Demeter, Rihmer & Somogyi, 1988; Dorpat & Ripley, 1960; Foster, Gillespie, McClelland & Patterson, 1999; Henriksson et al., 1993) obtained prevalence estimates of major depression ranging from 30-34% of suicides. In addition, several psychological autopsy studies examining more specific subsamples (e.g., the elderly, adolescents, women) find even higher prevalence estimates. In three psychological autopsy studies of adolescents (Brent et al. 1988; Brent et al., 1999; Shaffer et al., 1996) 41%, 43%, and 32% of adolescent suicides were determined to have had major depression prior to death. Two studies of young adults (Lesage et al. 1994; Runeson, 1989) found a prevalence of 40% and 41%, respectively. A study of 104 women by Asgard (1990) found a 35% rate of major depression. One study of 54 older adults over age 65 found a prevalence of 54%. In summary, the available data suggest that the 20-35% estimate for the prevalence of major depressive disorder in completed suicide is probably somewhat conservative and that a 30-40% prevalence estimate is probably more accurate. This estimate includes both secondary and primary depression. Many of these individuals would also be comorbid with other disorders, especially substance abuse.
Mood disorders in suicide
Prevalence estimates for all mood disorders in suicide (including MDD, Bipolar I & II, dysthymia, and adjustment disorder with depressed mood) are much higher than for major depression alone. These rates are probably closer to 60%, although as noted below, this estimate varies because of inconsistency of the criteria used to define a "mood disorder" across investigations. Four studies examining the full age range of suicides estimate that 36%, 48%, and 66%, and 70% of suicides have some sort of "depressive disorder" or "depression" (Foster et al., 1999; Rich et al., 1986, Henriksson et al., 1993, Barraclough, Bunch, Nelson, & Sainsbury, 1974). Three studies of adolescents found prevalence estimates for "mood disorders" or "affective disorders" of 61%, 63%, and 67% respectively (Shaffer et al., 1996; Brent et al. 1988; Marttunen et al., 1992). Two studies of young adults (Lesage et al., 1994; Runeson, 1989) found estimates of 60% and 64%. A study of 104 women by Asgard (1990) found a 59% rate of "mood disorders." In a review of psychological autopsy studies that examined patterns of psychiatric diagnosis across age groups, Conwell and Brent (1995) concluded that depressive disorders increased with age. Overall estimates for the rates of mood disorders range from 36% to 70% with great interstudy variability. This variability is probably partly a combination of unreliable methods of diagnosis and different definitions of what constitutes a "mood disorder." Despite this variability, a number of studies have found a pattern for increasing mood disorders with aging.
March 19, 2010
California Bills Regarding MFT and LCS Licenses and CAMFT Position
Unpaid Taxes Effect on Licensees
ABX8 8 (Committee on Budget)
This bill, among other provisions, would require the Franchise Tax Board, should an individual licensee fail to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Child Custody and Visitation
AB 612 (Beall)
This bill, as introduced, would have prohibited a court from considering a nonscientific theory in making a determination regarding child custody or visitation with a child. It would also have prohibited a court from considering or receiving into evidence a report, assessment, evaluation, or investigation if it included a nonscientific theory. CAMFT’s position on the bill was “oppose unless amended.” The bill was later amended in a way that we no longer opposed, providing that a child’s expression of significant hostility toward a parent may be admitted as possible corroborating evidence that the parent has abused the child. The amendment prohibited a court from concluding that an accusation of child physical or sexual abuse against a parent is false based solely on the child’s expression of significant hostility toward the parent. But, this amendment was merely a maneuver to get it out of a committee. As soon as the bill progressed, the offensive language was restored and we are once again opposed. This bill is a two-year bill.
Medi-Cal Reimbursement for Same-Day Visits
AB 1445 (Chesbro)
This bill, sponsored by the California Primary Care Association, would provide that a MediCal patient could seek treatment on the same day from more than one health care provider and the providers’ services would be reimbursed. CAMFT is in support of this legislation. This bill is a two-year bill.
MediCal: Alcohol and Drug Screening and Brief Intervention Services
AB 1599 (Beall)
This bill would establish the MediCal Alcohol and Drug Screening and Brief intervention Services Program, which would be administered in consultation with the State Department of Alcohol and Drug Programs. Its purpose would be to increase the state’s ability to make alcohol and drug screening and brief intervention services available to MediCal beneficiaries who are pregnant or of childbearing age. This bill would provide that participating in the program would be voluntary for MediCal beneficiaries. The results of any screening under the program would be confidential. CAMFT is watching this bill at this time.
Parity for Mental Health Care Services
AB 1600 (Beall)
This bill would expand mental health care coverage for certain health care service plans and health insurance issued, amended, or renewed on or after January 1, 2011, to include mental disorders defined in the DSM IV. There has been similar legislation in the two prior years that has been vetoed by the Governor. This legislation goes hand in hand with the Federal Parity law and expands on the existing California parity law that only covers severe mental and emotional disorders of adults and children. CAMFT is in support of this legislation.
Out of State Insurance Carriers
AB 1904 (Villines)
This bill would allow an insurance carrier from out of state to offer, sell, or renew a health care service plan or a health insurance policy in California without holding a license in the state of California . This bill, if successful, would be problematic for MFTs seeking reimbursement from such plans. Due to legislation that CAMFT sponsored in the 80s, out of state insurance companies are required by law to reimburse MFTs. Because they are required, if doing business in California , to abide by California law, which means that they must be licensed to do business in California . We are opposed to this bill, but we are told that the bill is not likely to move forward. There is a companion bill in the Senate as well.
Clinical Social Worker Examinations
AB 2167 (Nava)
This bill would, on and after January 1, 2014, require the Board of Behavioral Sciences to issue a license to each applicant who successfully passes the Social Work National Exam. In other words, if this legislation passes, aspiring clinical social workers would no longer take state-developed examinations, and they would instead take the examination that is used throughout the rest of the country. This change would allow LCSW licentiates in California to compete for federal loan reimbursements, which they are not currently eligible for because of the state specific examinations. CAMFT is watching this bill.
Retired License for Licensees of the BBS
AB 2191 (Emmerson)
This bill would permit persons who are licensed by the BBS to acquire a “retired” license if they choose to. Such a person would not be permitted to engage in any activity for which a license is required. The retired license fee would be nominal at only $40 for the remainder of one’s life. It would be permissible to restore the license to active state, if eligible, by paying the required fees, completing the required mandatory continuing education, and taking the required examinations if more than five years have passed since electing the retired status. If fewer than five years have passed, examinations would not be required. (The bill currently says three years, but the BBS has committed to increase this exception to five years.) CAMFT is watching this legislation. We do have concerns about licensees electing the retired status who may at a later time return to practice. If there is such a possibility of returning to practice, we would encourage the licentiate to elect to have an inactive license during the period of inaction because examinations would not be required upon re-activation.
Repeal of Antiquated Law Regarding Research on Homosexuality
AB 2199 (Lowenthal)
CAMFT has taken a position of support on this legislation that would repeal an antiquated section of law that provided for research regarding the causes and cures of homosexuality.
Child Abuse and Neglect Reporting Act
AB 2380 (Lowenthal)
This bill, among other things, adds further clarification in the Child Abuse and Neglect Reporting Act with regard to the meaning of “reasonable suspicion.” Existing law says that “. . . ‘reasonable suspicion’ means that it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect.” Added to this definition would be the following: “‘Reasonable suspicion’ does not require certain knowledge that child abuse or neglect has occurred nor does it require a specific medical indication of child abuse or neglect; any ‘reasonable suspicion’ is sufficient. ‘Reasonable suspicion’ may be based on any information considered credible by the reporter, including hearsay.” CAMFT is watching this bill at this time.
Continuing Education and other Requirements with regard to Elder and Dependent Adult Abuse and Older Adults
(AB 2435) Lowenthal
CAMFT’s position on this bill is “oppose unless amended.” The bill appears to be intended to affect the professions of marriage and family therapists, clinical social workers, and psychologists, but at this time appears to be solely directed at marriage and family therapists. If such legislation is warranted, we believe it should be equally applied across all of the mental health disciplines. We further object in that there appears to be no intent to affect physicians or other health care professionals and we are curious as to why not. It is also not applicable to professional clinical counselors who will also be regulated by the effective date of the proposed implementation of this legislation.
The bill proposes that elder and dependent adult abuse be added to the seven hour requirement for continuing education in child abuse assessment and reporting. The manner in which the bill proposes to add the requirement to provide for training in elder and dependent adult abuse is confusing and will result in an inability to enforce what is intended. All persons who are already licensed, as well as many who are pursuing licensure, have already fulfilled the requirement to have had training in child abuse assessment and reporting. Placing the new requirement to get training in elder and dependent adult abuse assessment and reporting within this previously existing requirement for training in child abuse and assessment confounds the situation and professionals will not be able to interpret what it is they are supposed to do, i.e., are they to take a new seven hour training that combines the content for both child abuse and elder abuse, or are they to take a three and one-half hour course in elder and dependent adult abuse, which is half of the total requirement?
While we have expressed that we are not necessarily adverse to a requirement for professionals to be knowledgeable about the reporting of elder and dependent adult abuse, as long as equally applied across the professions, this legislation needs to be clear as to what is expected. At this point, it is not. The bill does not address persons who have already taken such courses, or taught such courses, or who have had the content adequately addressed in the content of other courses. This content is typically covered in law and ethics courses and human development courses that cover the lifespan of individuals and families.
The bill proposes changing the name of one (and only one) of the degrees that may qualify for licensure as a marriage and family therapist. Such a change would place a hardship on schools that may have difficulty rapidly changing the title of their degree programs. Adding the term “older adult” without a definition as to what is meant by such a term is also problematic. We would request that this term be removed from the degree title.
The legislation proposes that the 500 required hours of experience for marriage and family therapists in working with couples, families, and children be expanded to include older adults. Again, “older adults” is not defined. Further, while we do not object to required education in working with persons who are aging, we do not want to see the essence and focus of the profession changed. This profession was known as “marriage, family and child counselors” from 1964 until 1999 and then became “marriage and family therapists.” Working with couples, families, and children is at the core of the discipline and of course includes working with persons who are aging, as they too are a part of family systems. We therefore have requested that the focus of these hours not be changed. Additionally, if there were to be such a change in the marriage and family therapist requirements, it should be equally imposed upon the other disciplines and provide greater specificity as to what is intended by the term “older adults.”
Further, persons pursuing the MFT license are currently required to have had ten contact hours of education in working with the elderly and long term care, and those already licensed prior to the effective date of this requirement were required to gain three contact hours in working with the elderly and long term care.
Unpaid Taxes Effect on Licensees
SBX8 8 (Committee on Budget)
This bill like its Assembly companion, among other provisions, would require the Franchise Tax Board, should an individual licensee fails to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Health Care Coverage and Benefits
SB 316 (Alquist)
This bill would have required full service health care service plans and health insurers to expend on health care benefits no less than 85 percent of the fees/premiums collected for policies issued, amended, or renewed on or after January 1, 2011. CAMFT is in support of this legislation. This bill is a two-year bill.
Regulatory Boards
(SB 1111) Negrette McLeod
This is a lengthy and multi-faceted bill that has numerous objectionable provisions. We are generally opposed to the bill and will be working individually and collectively with the other disciplines to modify the objectionable provisions. The purpose of the bill, generally speaking, is to “clean up” enforcement throughout the many Boards, Bureaus, and Committees under the umbrella of the Department of Consumer Affairs. The Department and Administration, rightfully so, are concerned about the excessive amount of time it takes to investigate and prosecute disciplinary actions. These actions, on average, are taking three years to bring to fruition. Of course, both consumers and licensees have an interest in swift resolution of complaints and disciplinary actions. Further, the state’s budget likely exacerbates the delays as a result of cuts within licensing boards, the California Department of Consumer Affairs Division of Investigations (DofI), and the Attorney General’s (AG) office. This bill is seeking to improve efficiency and accountability specifically within the healing arts boards.
One of the changes being sought would require a person who is disciplined to pay to the licensing board the actual costs for the investigation, prosecution, and enforcement of the case. These costs include, but are not limited to, attorneys, expert consultants, witnesses, administrative filing and service fees, and any other fees associated with the prosecution of the case. Currently the licensee, as determined by the administrative law judge, is ordered to pay the “reasonable” costs of the investigation and enforcement of the case. Changing reasonable to actual provides no incentive to the board, the DofI, or the AG’s office to be judicious in how it handles these matters. If they drag cases on for years and years, engage in actions that violate the law or due process rights, and/or needlessly pursue wild goose chases, the licentiate should not be held responsible for such costs. These costs are generally payable 30 days after the effective date of the order and there appears to be no opportunity to challenge the costs as determined.
The bill would give additional authority to the executive officer of the licensing board in many cases. For example, the executive officer would, in some situations, be given the authority to adopt a proposed default decision or adopt a proposed settlement agreement, without such action going to the board. The bill would allow the executive officer of a board, where the licentiate has failed to comply with a request to inspect or copy records, to petition the director to issue a temporary order that the licensee cease all practice and activities that require a license. In such case, the executive officer would be required, to the extent practicable, to provide telephonic, electronic mail, message, or facsimile written notice to the licensee of a hearing on such a petition at least 24 hours prior to the hearing.
The bill seems to confuse confidentiality and privilege. The bill seems to say that the provisions of privileged communications (should be confidentiality when speaking of communications between licensees and their clients) shall not apply to investigations or proceedings conducted by a healing arts board. The board and its agents are expected to maintain confidentiality, but they would have the authority to examine records in the licensee’s office in certain circumstances, apparently without authorization. The psychotherapist-patient privilege belongs to the patient and only the patient should be able to waive the privilege—not a licensing board. The bill provides, “Any document relevant to the business operations of a licensee, and not involving medical records attributable to identifiable patients, may be inspected and copied where relevant to an investigation of a licensee.”
The bill provides that a licensee shall cooperate with the licensing board and sets forth severe financial penalties for those who are deemed to be uncooperative. In such a circumstance, it may not be in the licensee’s best interest to cooperate in order to defend oneself. Such an expectation is unreasonable.
Requirement for Healing Arts Practitioners to Wear Name Tags
(SB 1132) Negrete McLeod
This is a “spot bill” surrounding legislation that has passed in prior years. Existing law requires healing arts practitioners to wear name tags while working that disclose names and license status in at least 18-point type. This requirement is not applicable to health care practitioners working in a practice or an office where a license is prominently displayed. Existing law further provides that if a health care practitioner or a licensed clinical social worker is working in a psychiatric setting or in a setting that is not licensed by the state, the employing entity or agency shall have the discretion to make an exception from the name tag requirement for individual safety or therapeutic reasons. CAMFT is watching this legislation that could become more expansive requiring practitioners to wear name tags.
Restrictions on Advertising and Designations of Licensees
(SB 1150) Negrete McLeod
At this time this bill is not applicable to MFTs, but we are nevertheless watching the bill very closely to see what it will become. The bill, among other things, would require a number of professionals, when advertising, to list the abbreviations for the licenses held immediately after their names. Among other things, the bill would require psychologists to include the designation “Ph.D.” immediately after their names. Of course, the bill is incorrect with regard to psychologists because the supposed required designation is a degree and not a license. The purpose of this legislation may be directed, to some degree, at the potential misleading use of “Dr.” preceding the name of a professional, since such a representation is limited to use by physicians.
ABX8 8 (Committee on Budget)
This bill, among other provisions, would require the Franchise Tax Board, should an individual licensee fail to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Child Custody and Visitation
AB 612 (Beall)
This bill, as introduced, would have prohibited a court from considering a nonscientific theory in making a determination regarding child custody or visitation with a child. It would also have prohibited a court from considering or receiving into evidence a report, assessment, evaluation, or investigation if it included a nonscientific theory. CAMFT’s position on the bill was “oppose unless amended.” The bill was later amended in a way that we no longer opposed, providing that a child’s expression of significant hostility toward a parent may be admitted as possible corroborating evidence that the parent has abused the child. The amendment prohibited a court from concluding that an accusation of child physical or sexual abuse against a parent is false based solely on the child’s expression of significant hostility toward the parent. But, this amendment was merely a maneuver to get it out of a committee. As soon as the bill progressed, the offensive language was restored and we are once again opposed. This bill is a two-year bill.
Medi-Cal Reimbursement for Same-Day Visits
AB 1445 (Chesbro)
This bill, sponsored by the California Primary Care Association, would provide that a MediCal patient could seek treatment on the same day from more than one health care provider and the providers’ services would be reimbursed. CAMFT is in support of this legislation. This bill is a two-year bill.
MediCal: Alcohol and Drug Screening and Brief Intervention Services
AB 1599 (Beall)
This bill would establish the MediCal Alcohol and Drug Screening and Brief intervention Services Program, which would be administered in consultation with the State Department of Alcohol and Drug Programs. Its purpose would be to increase the state’s ability to make alcohol and drug screening and brief intervention services available to MediCal beneficiaries who are pregnant or of childbearing age. This bill would provide that participating in the program would be voluntary for MediCal beneficiaries. The results of any screening under the program would be confidential. CAMFT is watching this bill at this time.
Parity for Mental Health Care Services
AB 1600 (Beall)
This bill would expand mental health care coverage for certain health care service plans and health insurance issued, amended, or renewed on or after January 1, 2011, to include mental disorders defined in the DSM IV. There has been similar legislation in the two prior years that has been vetoed by the Governor. This legislation goes hand in hand with the Federal Parity law and expands on the existing California parity law that only covers severe mental and emotional disorders of adults and children. CAMFT is in support of this legislation.
Out of State Insurance Carriers
AB 1904 (Villines)
This bill would allow an insurance carrier from out of state to offer, sell, or renew a health care service plan or a health insurance policy in California without holding a license in the state of California . This bill, if successful, would be problematic for MFTs seeking reimbursement from such plans. Due to legislation that CAMFT sponsored in the 80s, out of state insurance companies are required by law to reimburse MFTs. Because they are required, if doing business in California , to abide by California law, which means that they must be licensed to do business in California . We are opposed to this bill, but we are told that the bill is not likely to move forward. There is a companion bill in the Senate as well.
Clinical Social Worker Examinations
AB 2167 (Nava)
This bill would, on and after January 1, 2014, require the Board of Behavioral Sciences to issue a license to each applicant who successfully passes the Social Work National Exam. In other words, if this legislation passes, aspiring clinical social workers would no longer take state-developed examinations, and they would instead take the examination that is used throughout the rest of the country. This change would allow LCSW licentiates in California to compete for federal loan reimbursements, which they are not currently eligible for because of the state specific examinations. CAMFT is watching this bill.
Retired License for Licensees of the BBS
AB 2191 (Emmerson)
This bill would permit persons who are licensed by the BBS to acquire a “retired” license if they choose to. Such a person would not be permitted to engage in any activity for which a license is required. The retired license fee would be nominal at only $40 for the remainder of one’s life. It would be permissible to restore the license to active state, if eligible, by paying the required fees, completing the required mandatory continuing education, and taking the required examinations if more than five years have passed since electing the retired status. If fewer than five years have passed, examinations would not be required. (The bill currently says three years, but the BBS has committed to increase this exception to five years.) CAMFT is watching this legislation. We do have concerns about licensees electing the retired status who may at a later time return to practice. If there is such a possibility of returning to practice, we would encourage the licentiate to elect to have an inactive license during the period of inaction because examinations would not be required upon re-activation.
Repeal of Antiquated Law Regarding Research on Homosexuality
AB 2199 (Lowenthal)
CAMFT has taken a position of support on this legislation that would repeal an antiquated section of law that provided for research regarding the causes and cures of homosexuality.
Child Abuse and Neglect Reporting Act
AB 2380 (Lowenthal)
This bill, among other things, adds further clarification in the Child Abuse and Neglect Reporting Act with regard to the meaning of “reasonable suspicion.” Existing law says that “. . . ‘reasonable suspicion’ means that it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect.” Added to this definition would be the following: “‘Reasonable suspicion’ does not require certain knowledge that child abuse or neglect has occurred nor does it require a specific medical indication of child abuse or neglect; any ‘reasonable suspicion’ is sufficient. ‘Reasonable suspicion’ may be based on any information considered credible by the reporter, including hearsay.” CAMFT is watching this bill at this time.
Continuing Education and other Requirements with regard to Elder and Dependent Adult Abuse and Older Adults
(AB 2435) Lowenthal
CAMFT’s position on this bill is “oppose unless amended.” The bill appears to be intended to affect the professions of marriage and family therapists, clinical social workers, and psychologists, but at this time appears to be solely directed at marriage and family therapists. If such legislation is warranted, we believe it should be equally applied across all of the mental health disciplines. We further object in that there appears to be no intent to affect physicians or other health care professionals and we are curious as to why not. It is also not applicable to professional clinical counselors who will also be regulated by the effective date of the proposed implementation of this legislation.
The bill proposes that elder and dependent adult abuse be added to the seven hour requirement for continuing education in child abuse assessment and reporting. The manner in which the bill proposes to add the requirement to provide for training in elder and dependent adult abuse is confusing and will result in an inability to enforce what is intended. All persons who are already licensed, as well as many who are pursuing licensure, have already fulfilled the requirement to have had training in child abuse assessment and reporting. Placing the new requirement to get training in elder and dependent adult abuse assessment and reporting within this previously existing requirement for training in child abuse and assessment confounds the situation and professionals will not be able to interpret what it is they are supposed to do, i.e., are they to take a new seven hour training that combines the content for both child abuse and elder abuse, or are they to take a three and one-half hour course in elder and dependent adult abuse, which is half of the total requirement?
While we have expressed that we are not necessarily adverse to a requirement for professionals to be knowledgeable about the reporting of elder and dependent adult abuse, as long as equally applied across the professions, this legislation needs to be clear as to what is expected. At this point, it is not. The bill does not address persons who have already taken such courses, or taught such courses, or who have had the content adequately addressed in the content of other courses. This content is typically covered in law and ethics courses and human development courses that cover the lifespan of individuals and families.
The bill proposes changing the name of one (and only one) of the degrees that may qualify for licensure as a marriage and family therapist. Such a change would place a hardship on schools that may have difficulty rapidly changing the title of their degree programs. Adding the term “older adult” without a definition as to what is meant by such a term is also problematic. We would request that this term be removed from the degree title.
The legislation proposes that the 500 required hours of experience for marriage and family therapists in working with couples, families, and children be expanded to include older adults. Again, “older adults” is not defined. Further, while we do not object to required education in working with persons who are aging, we do not want to see the essence and focus of the profession changed. This profession was known as “marriage, family and child counselors” from 1964 until 1999 and then became “marriage and family therapists.” Working with couples, families, and children is at the core of the discipline and of course includes working with persons who are aging, as they too are a part of family systems. We therefore have requested that the focus of these hours not be changed. Additionally, if there were to be such a change in the marriage and family therapist requirements, it should be equally imposed upon the other disciplines and provide greater specificity as to what is intended by the term “older adults.”
Further, persons pursuing the MFT license are currently required to have had ten contact hours of education in working with the elderly and long term care, and those already licensed prior to the effective date of this requirement were required to gain three contact hours in working with the elderly and long term care.
Unpaid Taxes Effect on Licensees
SBX8 8 (Committee on Budget)
This bill like its Assembly companion, among other provisions, would require the Franchise Tax Board, should an individual licensee fails to pay taxes, to send a notice of suspension of license. The bill provides that the licensee who fails to satisfy the unpaid taxes by a specified date shall automatically have his/her license suspended. CAMFT has joined with a coalition to oppose this bill.
Health Care Coverage and Benefits
SB 316 (Alquist)
This bill would have required full service health care service plans and health insurers to expend on health care benefits no less than 85 percent of the fees/premiums collected for policies issued, amended, or renewed on or after January 1, 2011. CAMFT is in support of this legislation. This bill is a two-year bill.
Regulatory Boards
(SB 1111) Negrette McLeod
This is a lengthy and multi-faceted bill that has numerous objectionable provisions. We are generally opposed to the bill and will be working individually and collectively with the other disciplines to modify the objectionable provisions. The purpose of the bill, generally speaking, is to “clean up” enforcement throughout the many Boards, Bureaus, and Committees under the umbrella of the Department of Consumer Affairs. The Department and Administration, rightfully so, are concerned about the excessive amount of time it takes to investigate and prosecute disciplinary actions. These actions, on average, are taking three years to bring to fruition. Of course, both consumers and licensees have an interest in swift resolution of complaints and disciplinary actions. Further, the state’s budget likely exacerbates the delays as a result of cuts within licensing boards, the California Department of Consumer Affairs Division of Investigations (DofI), and the Attorney General’s (AG) office. This bill is seeking to improve efficiency and accountability specifically within the healing arts boards.
One of the changes being sought would require a person who is disciplined to pay to the licensing board the actual costs for the investigation, prosecution, and enforcement of the case. These costs include, but are not limited to, attorneys, expert consultants, witnesses, administrative filing and service fees, and any other fees associated with the prosecution of the case. Currently the licensee, as determined by the administrative law judge, is ordered to pay the “reasonable” costs of the investigation and enforcement of the case. Changing reasonable to actual provides no incentive to the board, the DofI, or the AG’s office to be judicious in how it handles these matters. If they drag cases on for years and years, engage in actions that violate the law or due process rights, and/or needlessly pursue wild goose chases, the licentiate should not be held responsible for such costs. These costs are generally payable 30 days after the effective date of the order and there appears to be no opportunity to challenge the costs as determined.
The bill would give additional authority to the executive officer of the licensing board in many cases. For example, the executive officer would, in some situations, be given the authority to adopt a proposed default decision or adopt a proposed settlement agreement, without such action going to the board. The bill would allow the executive officer of a board, where the licentiate has failed to comply with a request to inspect or copy records, to petition the director to issue a temporary order that the licensee cease all practice and activities that require a license. In such case, the executive officer would be required, to the extent practicable, to provide telephonic, electronic mail, message, or facsimile written notice to the licensee of a hearing on such a petition at least 24 hours prior to the hearing.
The bill seems to confuse confidentiality and privilege. The bill seems to say that the provisions of privileged communications (should be confidentiality when speaking of communications between licensees and their clients) shall not apply to investigations or proceedings conducted by a healing arts board. The board and its agents are expected to maintain confidentiality, but they would have the authority to examine records in the licensee’s office in certain circumstances, apparently without authorization. The psychotherapist-patient privilege belongs to the patient and only the patient should be able to waive the privilege—not a licensing board. The bill provides, “Any document relevant to the business operations of a licensee, and not involving medical records attributable to identifiable patients, may be inspected and copied where relevant to an investigation of a licensee.”
The bill provides that a licensee shall cooperate with the licensing board and sets forth severe financial penalties for those who are deemed to be uncooperative. In such a circumstance, it may not be in the licensee’s best interest to cooperate in order to defend oneself. Such an expectation is unreasonable.
Requirement for Healing Arts Practitioners to Wear Name Tags
(SB 1132) Negrete McLeod
This is a “spot bill” surrounding legislation that has passed in prior years. Existing law requires healing arts practitioners to wear name tags while working that disclose names and license status in at least 18-point type. This requirement is not applicable to health care practitioners working in a practice or an office where a license is prominently displayed. Existing law further provides that if a health care practitioner or a licensed clinical social worker is working in a psychiatric setting or in a setting that is not licensed by the state, the employing entity or agency shall have the discretion to make an exception from the name tag requirement for individual safety or therapeutic reasons. CAMFT is watching this legislation that could become more expansive requiring practitioners to wear name tags.
Restrictions on Advertising and Designations of Licensees
(SB 1150) Negrete McLeod
At this time this bill is not applicable to MFTs, but we are nevertheless watching the bill very closely to see what it will become. The bill, among other things, would require a number of professionals, when advertising, to list the abbreviations for the licenses held immediately after their names. Among other things, the bill would require psychologists to include the designation “Ph.D.” immediately after their names. Of course, the bill is incorrect with regard to psychologists because the supposed required designation is a degree and not a license. The purpose of this legislation may be directed, to some degree, at the potential misleading use of “Dr.” preceding the name of a professional, since such a representation is limited to use by physicians.
January 26, 2010
continuing education mft
continuing education mft
For mental health professionals
BBS Accredited Ceus
Courses are focused strictly on mental health CEU requirements. Our founders and course writers include practicing clinical mental health professionals, making our courses relevant to today’s continuing education requirements. Our courses satisfy CEU requirements for the following professions in the following states:
Marriage and Family Therapists (MFT/LMFT/MFTI)
California, Colorado, Florida, Kentucky, Louisiana, Massachusetts, Nevada, Ohio, Oregon, Texas
Clinical Social Worker (CSW/LCSW/ASW)
Arkansas, California, Colorado, Florida, Hawaii, Michigan, Missouri, New York, Oregon
Alcohol and Drug Counselors (CADC I/CADC II)
California
Prevention Specialists (CPS)
California
Clinical Supervisors (CCS)
California
Professional Counselors (LPC/CPC)
Colorado, Hawaii, Kentucky, Louisiana, Missouri, Oregon, Texas
Mental Health Counselor (MHC)
Florida
Continuing education (CEU) courses offered
Aspira Continuing Education’s courses encompass all areas of mental health practice. Whether you are completing CEUs for your certification or maintain your license, our online continuing education courses provide the fastest, lowest cost, most convenient way to fulfill your CEU requirements.
We offer courses in the following subjects:
Aging and Long Term Care CEUs
Alcoholism and Substance Abuse Dependency CEUs
Anger Management CEUs
Anxiety Disorders CEUs
Assessment and Diagnosis CEUs
Bipolar Disorder CEUs
Boundaries CEUs
Boundaries in Marriage CEUs
Child Abuse Assessment and Reporting CEUs
Cognitive Behavioral Therapy CEUs
Conflict Resolution CEUs
Crisis Counseling CEUs
Depressive Disorders CEUs
Family Therapy CEUs
From Panic to Power CEUs
Group Therapy CEUs
HIV and AIDS CEUs
How To Build a Thriving Fee-for-Service Practice CEUs
Human Sexuality CEUs
Law and Ethics CEUs
Managed Care CEUs
Mom's House, Dad's House CEUs
Panic Disorder CEUs
Post Traumatic Stress Disorder CEUs
Psychopharmacology CEUs
Spousal and Partner Abuse CEUs
Step-Wives CEUs
For mental health professionals
BBS Accredited Ceus
Courses are focused strictly on mental health CEU requirements. Our founders and course writers include practicing clinical mental health professionals, making our courses relevant to today’s continuing education requirements. Our courses satisfy CEU requirements for the following professions in the following states:
Marriage and Family Therapists (MFT/LMFT/MFTI)
California, Colorado, Florida, Kentucky, Louisiana, Massachusetts, Nevada, Ohio, Oregon, Texas
Clinical Social Worker (CSW/LCSW/ASW)
Arkansas, California, Colorado, Florida, Hawaii, Michigan, Missouri, New York, Oregon
Alcohol and Drug Counselors (CADC I/CADC II)
California
Prevention Specialists (CPS)
California
Clinical Supervisors (CCS)
California
Professional Counselors (LPC/CPC)
Colorado, Hawaii, Kentucky, Louisiana, Missouri, Oregon, Texas
Mental Health Counselor (MHC)
Florida
Continuing education (CEU) courses offered
Aspira Continuing Education’s courses encompass all areas of mental health practice. Whether you are completing CEUs for your certification or maintain your license, our online continuing education courses provide the fastest, lowest cost, most convenient way to fulfill your CEU requirements.
We offer courses in the following subjects:
Aging and Long Term Care CEUs
Alcoholism and Substance Abuse Dependency CEUs
Anger Management CEUs
Anxiety Disorders CEUs
Assessment and Diagnosis CEUs
Bipolar Disorder CEUs
Boundaries CEUs
Boundaries in Marriage CEUs
Child Abuse Assessment and Reporting CEUs
Cognitive Behavioral Therapy CEUs
Conflict Resolution CEUs
Crisis Counseling CEUs
Depressive Disorders CEUs
Family Therapy CEUs
From Panic to Power CEUs
Group Therapy CEUs
HIV and AIDS CEUs
How To Build a Thriving Fee-for-Service Practice CEUs
Human Sexuality CEUs
Law and Ethics CEUs
Managed Care CEUs
Mom's House, Dad's House CEUs
Panic Disorder CEUs
Post Traumatic Stress Disorder CEUs
Psychopharmacology CEUs
Spousal and Partner Abuse CEUs
Step-Wives CEUs
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