New England Psychologist - October 2018

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AN INDEPENDENT VOICE FOR THE REGION’S PSYCHOLOGISTS

VOL. 26, NO. 8

Helping students get back on track, residential schools boast different goals

Behavior analysts must be licensed in Connecticut

By Phyllis Hanlon

By Janine Weisman

esidential, or boarding, schools serve different populations and have different goals. Schools that address behavioral issues in children admit students with a variety of diagnoses.

Those diagnoses include a number of psychological and emotional issues that range from anxiety, mood and eating disorders, attention deficit hyperactive disorder (ADHD) and oppositional defiant dis-

order (ODD) to fire setting, post-traumatic stress disorder (PTSD) and other behavioral problems.

In recent years, more children have presented with a diagnosis on the autism spectrum.

Some agencies have moved away from “...serving kids with social and emotional disturbances to those on the autism spectrum due to the high prevalence rate” of autism, according to Valentina

“Alarmingly, the trend has recently shifted to increased suicidal ideation and behavior.”

David Gleason, Psy.D Massachusetts school consultant

M. Parchin, Ph.D, director of education for the Adelbrook Learning Center in East Hartford, Connecticut. She indicated that as more children are diagnosed, the more services are needed.

In the past, children presented with clinical diagnoses, such as depression, PTSD, learning disabilities, which impact skill development and academic acquisition, Parchin said.

Moreover, therapeutic approaches have changed to address the needs of a child with autism. Parchin explained that schools now use behavioral interventions such as Applied Behavior Analysis (ABA), a technique that teaches the child specific academic, emotional, and social coping skills.

Students receive points or positive feedback when they demonstrate positive behavior.

Board-certified behaviorists at Adelbrook develop individualized intervention plans by determining what will best motivate the student to work harder and achieve success, Continued on Page 10

Despite lack of attention, cults continue on

By Catherine Robertson Souter exting and driving, opioids, vaping: these are the dangers facing young people that rule the media today.

But take a look at a newspaper from 30 years ago and you’ll find a different danger constantly in front of parents’ faces - the prevalence and peril of cults.

These stories don’t seem to grip the nation like they once did. While we still hear

of occasional groups, such as one in New York that has been branding young women, are cults still as rampant?

Yes, they are, according to Eric Sweitzer, M.T.S., Ph.D, a clinical psychologist and director of the Charis Counseling Centers in Massachusetts and Rhode Island.

Sweitzer is also a consulting psychologist for MeadowHaven, a facility in Lakeville, Mass., that provides refuge and treatment for former cult members.

“Cults are on the rise,” he

said, “so it is a conundrum why, in general, the media is not covering them as much as they used to in the days of Jonestown or David Koresh. I think it may be that the definition of cults has broadened and the term can encompass much smaller groups as well which don’t draw as much attention.”

Steven Hassan, M.Ed. LMHC, NCC, founding director of the Freedom of Mind Resource Center in Newton, Mass., has another reason that we may not see as much about cults in the news.

“It was politically incorrect for a time to use the word Continued on Page 9

n July 1, Connecticut became the 30th state in the country to require behavior analysts to obtain a license to practice what has become the bestknown approach to treating children with autism.

Behavior analysts help individuals change behaviors associated with negative consequences to improve outcomes. Being licensed will allow behavior analysts to be reimbursed by insurers. And, it ensures that families, public school districts, the state Department of Developmental Services (DDS), private insurance, and Medicaid providers have a means of regulating the practices of behavior analysts.

Behavior analysts have earned a graduate degree in behavior analysis, education, psychology or a similar degree program, complete extensive coursework and practical experience and pass a BoardCertified Behavior Analyst (BCBA) exam.

Certification is granted by the Behavior Analysis Certification Board (BACB) in Littleton, Colorado.

The Connecticut Department of Public Health (DPH) launched its licensing portal on Feb. 28 to prepare for the law taking effect and had licensed 662 individuals as BCBAs of Sept. 7 with another 62 applications pending.

The list of licensed behavior analysts is available publicly at elicense.ct.gov

Rhode Island was the first New England state to require behavior analysts to obtain a license in 2012 followed by Massachusetts in 2013 and Vermont in 2015.

Maine and New Hampshire do not require a license. New York’s licensure requirement took effect in 2014.

To obtain a license in Connecticut, applicants must provide evidence of BCBA certification to the state’s commissioner of public health and pay a $350 application fee.

Annual renewal costs $175.

Suzanne Letso M.A., BCBA, president of the Behavior Analyst Leadership Council in Milford, Connecticut, a professional trade organization, believes licensure is a form of consumer protection.

“It’s a world-wide problem where without a defensible scope of practice that comes from license, anybody can hang a shingle. You can have little or no training.”

She has had personal experience with this problem.

Shortly before Connecticut’s law went into effect, Letso learned the behaviorist assigned to her 28-year-old son with autism who lives in a group home had a master’s degree in business administration but no behavior analysis training.

“Within an hour of our meeting, she was reassigned to another group home,” Letso said. “She was very sweet. I’m sure she can do a good job on my taxes.”

Continued on Page 11

INSIDE Spurwink offers program to help refugees adapt ..................................Page 7 Latham Centers offers unique program...Page 8 CE listings.................................................Page 13

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New England Psychologist

October 2018

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On Your Feet 10.25x12.75.indd 1

9/14/16 9:52 AM

October 2018

New England Psychologist

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Psychologist Ashley Warhol, Psy.D finds job at Devereux fulfilling As the saying goes, find a job you like and you will never work a day in your life. Psychologists, more than most people, are aware of the need to find meaning in the day to day. For some, however, finding their passion generally takes a long time.

For others, it comes more quickly.

For Ashley Warhol, Psy.D, finding her niche as director of clinical services and internship training at Devereux Advanced Behavioral Health flowed naturally, and quickly, from a predoctoral internship with the organization in 2012.

Following the internship, she was offered a position as a staff clinician, moved up to become assistant director of clinical services and then was promoted to director, all in the past six years.

Along with her day job, Warhol is also an adjunct professor at Becker College, teaching three undergraduate and one graduate class in psychology.

She manages the long days with a hefty dose of passion, she explained in a conversation with New England Psychologist’s Catherine Robertson Souter. She spoke about the work she does with Devereux, a Rutland, Mass.based behavioral health provider of residential and community-based treatment programs and how it fulfills a desire to champion the people who need it most.

Q

What is your day or week like?

A

In general, my position is really meant to over-

see clinical services on a broader scale and to ensure that we are using evidencebased treatment interventions with the youth and adults that we serve.

In a given day I might be working with interns in a training capacity or with staff clinicians on teaching them new evidence-based treatment interventions or helping them maintain fidelity to the models that we use.

We have seven interns currently and anywhere from 20-25 other clinical staff. We take two doctoral interns per year and this year, also have five practicum students.

Q

A

What part of the work speaks to you most?

I’d like to highlight the work we do in teaching all our employees on best practices on working with transgender youth.

We have really ramped up our efforts over the last several years here to utilize best practices and ensure our staff are knowledgeable, educated, and wellversed in creating a safe and affirming environment for our trans students.

We do place youth based on gender identity rather than assigned sex at birth if that is what the student wants and if it is in the student’s best interest for safety.

A lot of what I do in a given day is to educate and advocate on behalf of trans individuals here.

Q

Are you seeing more transgender students?

A

One of the things that we have historically done well here is working with LGBTQ youth but because transgender youth have such unique needs for support and an environment that is inclusive and is respectful, we have ramped up our efforts to ensure we are utilizing best practices for that group.

That is certainly not the only group we work with.

Here at Devereaux we have two main populations.

We have our mental and behavioral health population which is both adolescent males and females ages 13-up into 22.

Our other branch is working with autism spectrum disorders.

We also integrate trauma-informed care and interventions with all of the students we work with.

Regardless of diagnosis, the rates of trauma experiences are relatively high. About 90 percent of the population we serve here has experienced some sort of trauma in their lifetime.

Q

On a personal note, what led you to this career?

A

I always knew I wanted to work with children and adolescents. Child welfare and working with more vulnerable populations is what I was really drawn to.

I am a person who likes to work for the underdog to see if I can make a lasting difference with people who may not have an advocate.

After I finished my rotation and Devereux offered me a full- time staff clinician position, I decided to stay on. Since then, I have had the opportunity to really hone my clinical and administrative skills and slowly move into position I am in now.

I have been fortunate to work for an agency that fosters growth and development. This has been my only job right out of grad school and I haven’t left because of the opportunity and because of the services we provide.

I strongly believe in our mission and believe that we are doing good clinical work here. I wouldn’t do this work if I didn’t feel passionate about it.

Q

What are your goals for the future?

A

I am very passionate about training and education. I do a lot of presenting across Massachusetts working with suicidal youth or with LGBTQ populations. I would really like to be someone who assists other agencies in creating safe and affirming environments for diverse youth, and help them create a culture of acceptance and respect and support.

We are also trying to increase our research efforts here particularly around using evidence-based treatment interventions with different populations.

Right now, we are examining the effectiveness of a DBT clinical program model for our adolescent boys

Q: What is the most cost effective way to recruit psychologists?

A: Place a help wanted ad in...

program. DBT has been historically studied with females and at least up until a couple of years ago, there hadn’t been much research on the use of it in residential treatment for boys.

Q

How do you have time to teach four courses and do a full-time job?

A

A lot of caffeine and not much sleep! Actually, because the courses are in the evening, it really works out. And because it is something I am passionate about, it doesn’t really feel like work. I am able to teach the practitioners of tomorrow about the great work in the field of psychology.

Q

What makes Devereux stand out?

A

If I had to sum it up in one word it would be excellence. From the top down, we are all committed to providing excellent care, intervention, and family support and are always evaluating how to continue that excellence.

Doing the work we are doing and getting stagnant is not an option. We are always looking for ways to say, “Okay, we are doing well. How do we make it better?” NEP Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

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New England Psychologist

IN PERSON

October 2018

EDITORIAL

Embracing the fall

By Alan Bodnar, Ph.D s much as I would like embrace the beauty of autumn with its colorful foliage and bright, clear days, I can never seem to ignore the melancholy chord that this season strikes in my soul and the bittersweet taste of joy diluted by sorrow.

This year I might have made it through, gliding into the season on the wings of anticipated good times with family and friends. But this fall, reminders of losses endured in autumns past and others yet to come were intensified by the widely reported deaths of national figures, most notably, Senator John McCain at the end of August and by more revelations of abuse in the church I love.

The senator’s death had been anticipated for more than a year, ever since we learned that he had been diagnosed with the same kind of brain cancer that took the life of Ted Kennedy in 2009 and Beau Biden, the son of Vice President Joe Biden, in 2015.

McCain was well-known as a former Vietnam prisoner of war who endured torture and five and a half years of captivity before returning home to continue his service to his country, first as a United States Congressman, and then as a senator.

As the Republican Party’s presidential candidate in 2008, he was the model of civility and respect. He engaged his opponent, Barack Obama, around the issues facing the country, never stooping to the kind of name calling and personal attacks that have become the defining theme of the communication issuing daily from the White House.

Watching the televised coverage of McCain’s funeral, I was reminded of something I have been writing about since I began this column 25 years ago, and that is Erik Erikson’s idea of integrity, the crown of a life well lived with all of its faults and blemishes, redeemed nonetheless by a sense of wholeness at the end.

Like the beauty of autumn

in New England, the beauty of a life marked by integrity carries with it the shadow of the absence we feel at its passing. And when that life is lived on a national stage, making a visible imprint on the way we conduct the affairs of government and modeling what it means to be a decent human being, then we are left with a hole in our hearts and a gap in the ranks of our heroes.

Part of Erikson’s genius was to link the developmental achievements of the maturing person with societal structures that support their establishment. The formation of identity in our adolescent years, Erikson tells us, resonates with the ideological outlook of society, supplying the social values that define the good to be sought and the evil to be avoided.

Young people must somehow come to believe, in Erikson’s words, that “the best people will come to rule and rule develops the best in people.” The passing of Senator McCain is the loss of a decent human being, but, more than that, it represents the loss of model of how decency is enacted at our highest levels of government and public life.

When death calls us to the ultimate questions, some of us look to faith for the answers. With more revelations of sexual abuse and cover-up in the church of my faith, another kind of death threatens, a death not of faith, but of trust.

These revelations are not new, but they keep coming, and with each new disclosure, Catholics are horrified at the extent of the corruption and the damage their church has

done to the people, especially the children, it was meant to guide and protect.

Organized religion, according to Erikson, is the societal structure intended to support the young child’s development of basic trust.

He calls it the “institutional safeguard” of trust but adds parenthetically that organized religion is, on occasion, its “greatest enemy.”

Catholics are just beginning to realize how prevalent those occasions have been and to demand long-overdue changes in the way their church operates.

This is not to say that all religions or all the clergy have betrayed the trust of their people; most have not.

My own life in the Catholic church has been enriched immeasurably by good men and women of deep faith, intelligence, and compassion who endure their own form of hurt and betrayal from the shameful actions of some of their peers and superiors.

This fall, the glory of nature is muted by the awareness that two of the key institutions built by and designed to protect our communal strivings are failing us.

Government and religion both seem no longer able to hold our ideals or merit our trust. Yet decency and respect for our shared humanity are bigger than government, and government is bigger than the custodians we elect to carry out its functions.

In a similar way, faith is more than religion, and religion, more than its flawed ministers. Now more than ever, the words of Ghandi urge us to be the change we want to see in the world and to do our part to ensure that our institutions merit our trust and embody our highest ideals.

With all of its foreshadowing of death and decay, the fall foliage is still beautiful.

And we embrace the season because we need beauty even as we need a reminder that it will not last forever and that the time to act is now. NEP Alan Bodnar, Ph.D. is a psychologist formerly at the Worcester Recovery Center and Hospital.

500 million, but the need still grows Psych Central just reached an amazing milestone in our 23 years online. We’ve just passed 500 million visitors who’ve come to our site to learn more about mental illness symptoms and treatments, psychology, personality, parenting, or a relationship issue.

We’re proud of this achievement, but we also realize we have a much longer road to travel.

According to the U.S. Center for Disease Control and Prevention, the annual suicide rate in the United States has increased 24 percent since 1999. During this same time period, the availability of mental health information and support online has increased dramatically.

We went from a few hundred mental health websites in the late 1990s to the millions of online resources that exist today, including thousands of Facebook support groups.

We now have services providing free telephone, texting, and online chat crisis services, and dozens of online therapy sites providing immediate online counseling.

Instead of more information, resources, and online support helping people, it appears that all of these resources have done little to staunch the growth of suicidal behavior.

Some research data even suggest that certain online services – such as social media -- leave people feeling worse off, lonelier, and more depressed.

Our accomplishment, then, is decidedly bittersweet. While it’s amazing we’ve touched so many people’s lives, it’s also telling that we’re still not doing enough to help those most in need.

Not enough people in need seek out treatment with a psychologist or therapist. And affordability of treatment services still remains a problem in many communities throughout the country (including here in New England).

You can help your clients outside of therapy by referring them to trusted online resources, such as Psych Central (or our support groups at forums.psychcentral.com). You can also help on a more personal scale by reaching out to people with whom you’ve lost touch, or to those for whom you have special concern.

Sometimes, all it takes is to know that a single person cares in order to make a difference.

By John M. Grohol, Psy.D.

Publisher:

Editor-in-Chief:

Contributing Writers:

Graphic Designer:

John M. Grohol, Psy.D. Psych Central Susan Gonsalves Alan Bodnar, Ph.D. Phyllis Hanlon Catherine Robertson Souter Margarita Tartakovsky Eileen Weber Janine Weisman Karen H. Woodward

New England Psychologist is published 11 times a year (no August issue) by New England Psychologist, P.O. Box 5464, Bradford, MA 01835. It is mailed at no charge to all CT, ME, MA, NH, RI, and VT licensed psychologists. Distribution of this publication does not constitute an endorsement of products and services. The publisher reserves the right to reject any advertisement or listing considered inappropriate.

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October 2018

New England Psychologist

THE PRACTICAL PRACTICE

BOOK REVIEW

The dilemma: to join a group practice or go solo

By Catherine Robertson Souter t is perhaps the most important question to answer for anyone just starting out in a clinical practice. Does it make sense to take a “safe” position in a group practice or would it be wiser in the long run to set out on your own, rent an office, and start building your brand?

There is, of course, no “right” answer, only many factors to consider. Among them, the administrative benefits of each option, the financial impact, the social impact and the market itself must each be considered before deciding which path to follow.

Of course, it’s also important to take into consideration one’s own goals and personal working style. No use going into private practice if you can’t stand to work alone. Nor does it make sense to join an established group if you value autonomy above all else.

A private practice gives you the freedom to set your own hours (even changing them week to week) define your own vision, make decisions on where to locate, and what insurances you will accept.

With your own name on the letterhead, there can be a sense of pride and ownership you would not have with a group practice.

Joining a group, on the other hand, can mean a wide variety of options are available that would not be otherwise.

Depending on the size and setup, groups may offer health and dental insurance, administrative support with scheduling and billing, shared risk management, IT support and shared costs on computer and other technical equipment, and have more marketing reach.

Being involved in a group practice can reduce isolation and burnout and provide onsite consultation options.

For Evan Greenwald, Ph.D, executive director of the Counseling Center in New Hampshire and Maine, the choice to start a group practice nearly 30 years ago was pretty straightforward. He wanted, he explained, to split

Jeff Zimmerman, Ph.D, ABPP, is in private practice in Connecticut and New York and is also co-founder of the Practice Institute. his time between running a business and doing clinical work.

“At the time I was hoping to eventually not do full-time clinical work,” he said. “It is the balance I wanted.”

Things are different now, though, he explained. Starting a practice is more difficult with managed care plans and more competition. Plus, there is a lot of unpaid time that goes into the setting up phase.

“It is an immense amount of work,” he said.

His advice would be to look at the variety of group practices that exist and compare the options. Some may take care of all billing and administrative tasks while others may merely share office space.

There are many ways to join a group, also - from full to part time to using it as a semi-retirement option.

If setting up your own practice is the goal, however, both solo and group practices would do well to follow some basic guidelines, said Jeff Zimmerman, Ph.D, ABPP, who has a private practice in Connecticut and New York.

He is also co-founder of The Practice Institute, a business and marketing consultancy firm for mental health professionals. Hiring experts, both those with experience in the mental health field and attorneys and accountants, is

5

imperative.

Doing the math on expenses and income shouldn’t be put off and goes hand in hand with creating a solid business plan.

“Most psychologists have made a tremendous financial investment in their careers,” said Zimmerman. “If they were paying me $20,000 as an investment, they wouldn’t sign a check if I didn’t have a business plan. Yet, for ourselves, we don’t require the same care and planning we would of someone else.”

Although it goes against logic, joining a group practice can actually raise costs for the individual psychologists.

“Psychologists typically overestimate the financial benefits of starting a group,” said Michael Goldberg, Ph.D, director of Child and Family Psychological Services in Massachusetts.

“They tend to underestimate the overhead that goes into running a group. I have provided practice management consultations to behavioral health groups and it would shock people to know how little ‘profit’ group leaders tend to earn and how much time they invest into developing practices.”

Overhead costs can be higher but mainly because there is a cost to having someone run a group practice.

They need to make a profit also. But those costs can be offset in part by higher insurance rates negotiated by a larger group.

“Health plans made it very public years ago that they generally prefer to contract with groups and make it much easier for clinicians to join networks through groups,” said Goldberg.

With less hours spent on administrative work and fewer headaches dealing with lease contracts or staffing issues, a therapist can also spend more time in session, making up some of that income loss.

“You could end up making the same or even more money,” said Greenwald.

Setting up a practice, from

Continued on Page 6

Author provides concrete advice, offers approach to assist autistic kids

By Megan Riddle here is a saying that if you have met one person with autism, you have met one person with autism. Each person is unique, with his or her own struggles and strengths. And

In addition, the new edition provides a discussion of the challenges of the Common Core State Standards and how to deal with them. It also has a new section on collaborating within your school to make a more inclusive community.

Understanding the disor-

“Autism Spectrum Disorder in the Inclusive Classroom, 2nd Edition” Barbara Boroson Teaching Strategies; 2 edition (June 1, 2016)

that also means that each presents unique challenges to their classroom teachers.

“Autism Spectrum Disorder in the Inclusive Classroom: How to Reach and Teach Students with ASD, 2nd Edition,”

by Barbara Boroson, provides a guide for teachers to help them meet the needs of children with autism spectrum disorder in their classroom.

Boroson has more than 20 years of experience working in the field of autism spectrum education, including time as a clinician, administrator, and advisor. She has also spoken at numerous national educational conferences.

Her experience extends to the personal, as her son is affected by autism. Her years of experience are apparent throughout the book. Rather than a prescriptive and potentially overwhelming list of “must-dos,” she promotes an approach that focuses “less on implementing strategies and more on looking at our students through this investigative lens.”

This new edition is significantly revised from the original, and now includes the middle school ages as well as more information on classroom technology.

der is the first step to helping these children be successful.

The book starts by offering a background on autism spectrum disorder, providing an understanding of the various components of the disorder and how they can manifest at school.

Boroson also gives an overview of special education for children with autism, including the various early intervention programs for children on the spectrum, such as intensive therapeutic programs like Applied Behavior Analysis (ABA) and Relationship Development Intervention (RDI).

The author breaks the book down into 10 chapters, focusing on a range of topics from how to decrease anxiety to how to facilitate communication and manage disruptive behaviors.

Each chapter expands the reader’s understanding of autism while also providing suggestions and interventions.

For example, in the chapter on anxiety, she offers tips for reducing anxiety through the use of comfort anchors and consistent schedules.

She also provides an

Continued on Page 6

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New England Psychologist

October 2018

GUEST EDITORIAL

To overcome the mental health bias, clinicians must serve as examples

By Elizabeth Lerner Papautsky, Ph.D n the middle of labor with my second child, I had a panic attack. It happened when my epidural kicked in and I realized I couldn’t feel my body. I panicked. After spending hours in excruciating pain of back labor and feeling the sweet sensation of the pain subsiding, I realized I couldn’t move.

I felt the wave of panic washing over me as the nurse repeatedly asked me to move my legs and I could not. “I can’t feel my body” I said, “I’m going to have a panic attack!”

“Ma’am, I see in your chart that you have a history of anxiety. You need to calm down.

It’s not good for the baby to hyperventilate. You’ve been distraught from the moment I walked in” she responded.

What? Calm down? Yes, of course I was distraught when she walked in…I was in labor!

Here’s a healthcare professional in a position of support and medical care provision for

laboring women …and this is the response that I get?

There are several issues at play here. One, is that effective interpersonal skills should be an integral requirement for healthcare providers.

Treating people with consideration goes without saying.

Two, is the bias of mental health. Yes, anxiety appears in my health record. So what?

It appears on many people’s health records. What in the devil’s name is it doing clouding my birth experience?

“We actually we gave you more anesthetic than we normally do because you were in so much pain,” the nurse adds when I try hard to collect myself by forcing my attention away from feeling like I’m locked in a body that weighs a thousand pounds.

The truth comes out. I’m not supposed to feel this way physically and my psychological response is not unreasonable either despite being made to feel like I’m irrational by my L&D nurse.

Spurwink offers program to help refugees adapt

By Eileen Weber ar from home in a foreign country running from violence and war-torn regions, refugees often have signs of emotional trauma. A constant level of stress and fear can show itself through anxiety, depression, and post-traumatic stress disorder (PTSD).

Spurwink Services is doing something to assist those refugees in parts of southern Maine. With the help of a Trauma Systems Therapy for Refugees (TST-R) model from Boston Children’s Hospital, the organization has implemented the ShifaME program that works with children, adolescents, and their families who have been impacted by persecution, resettlement, and acculturation.

Mental health clinicians work side by side with “cultural brokers” who provide

aid in bridging the gaps in language, culture, and health care. The program currently operates in Lewiston, Biddeford, and Portland.

With trauma-focused treatment, clinicians coordinate with the brokers who essentially work as intermediaries.

These brokers come from the same communities as the refugees, so they have first-hand experience in how difficult it can be to assimilate into American life.

“Many of them have come from regions made unstable by terrorism or political torture. Refugees typically come from The Congo, Somalia, Rwanda, Angola, Turkey, Iraq, and Ethiopia,” said Eric Meyer, LCSW, MBA, president and CEO at Spurwink.

“We have to develop their trust. We have to earn it from people who don’t necessarily know us and find a way to get them to accept us.”

Unconscious biases A hefty research literature coupled with anecdotal evidence reports that clinicians are vulnerable to unconscious biases based on a variety of factors including race, socioeconomic status, gender (Stone & Moskowitz, 2011) and mental health.

A 2000 study reveals that physicians are less likely to take patients’ complaints of headaches and abdominal pain seriously if they have prior history of depression.

This study is one in a number with similar findings. It is an incredibly unsettling finding suggesting that patients have a reason to worry that mental health problems appearing on their chart will influence the safety and quality of their subsequent medical care.

This situation may dissuade people from seeking help, which is a significant safety issue in a society where that rates of depression, anxiety, and subsequently, suicide, are already on the rise. I certainly

feel dissuaded.

Is that what happened to me? The nurse was biased to attribute my panic to my history of anxiety rather than a healthy response to a psychologically and physically uncertain situation. Ironically, my history should have elicited the opposite response altogether – one that fosters empathy and support.

In a society where the conversation about mental health is ramping up, our healthcare professionals should serve as examples of responding mindfully to patients regardless of mental health status.

This requires both a formal education and continual training highlighting the need to deliver care that is as considerate of mental health as it is of physical.

As a psychologist and a researcher in patient safety, I am sensitive to the potential of a less than ideal outcome that my nurse’s response could have yielded. Had I continued to panic, my baby may have gone into distress resulting in

approach to figuring out the triggers of anxiety and how to avoid them, including enlisting family members and other members of the child’s educational support team to help identify a child’s strengths, sensitivities, and challenges.

In her chapter entitled “Something for Everyone: Socialization and Self-esteem,” she explores how those on the autism spectrum can benefit from social opportunities in the inclusive classroom.

Throughout the book,

ShifaME, a National Child Traumatic Stress Network initiative is made possible by the Substance Abuse and Mental Health Services Administration.

The program works on a four-tier system of community outreach, skill-based groups within the school system,

Elizabeth Lerner Papautsky, Ph.D is a human factors psychologist who studies decision making in complex environments at the Department of Biomedical & Health Information Sciences at the University of Illinois at Chicago. Based on both personal experiences and research, her passion is patient safety – particularly, ensuring that relevant aspects of the patient story don’t fall through the cracks.

THE PRACTICAL PRACTICE

BOOK REVIEW Continued from Page 5

a C-section, bringing with it additional and unnecessary complexity.

And if a negative outcome had occurred, it would never be traced back to a nurse telling me to “calm down” rather than offering effective guidance on how to do so. Thus, stories that do not result in harm (but could have) remain untold.

Our behaviors and responses impact the individuals around us especially when one is in a position of authority or of care provision. NEP

Boroson is cognizant of how having children with autism spectrum disorder in the classroom can affect those around them, including teachers and other students.

Boronson has created a highly readable book that offers concrete advice while also providing a general philosophy and approach that can be applied broadly to children both on and off the spectrum.

While the focus of this book is for teachers in general classrooms, parents are also likely to find benefit from it.

NEP

Continued from Page 5 the business plan to leases, insurance contracts, staffing, marketing, billing and admin work, can be overwhelming.

It’s not something often taught in graduate school, either. To give mental health practitioners some basic training, the Practice Institute has teamed up with the University of Redlands in California to offer a certificate course in business management. For more information, visit www.redlands.edu/study/ schools-and-centers/CAPE/.

NEP

trauma therapy, and safetyfocused treatment.

During an average 12-week program in the schools, clinicians and brokers meet once a week for an hour with children in grades four through eight.

They usually have around 20 groups of eight kids each.

Continued on Page 7

Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

October 2018

New England Psychologist

7

Youth Villages closes residential program for girls in Mass.

By Janine Weisman residential treatment program for girls with emotional and behavioral problems in Arlington, Massachusetts, shut down in September after a decision by its parent organization to shift focus to community-based services.

That decision impacted 150 staff members at the Germaine Lawrence campus on Claremont Avenue operated by the national private nonprofit Youth Villages. The vast majority of positions are direct care staff, including several master’s level and licensed positions, nursing and maintenance staff.

The program is licensed to serve a maximum of 72 girls between the ages of 12 and 22. But there were only 48 girls on site when Youth Villages announced the pending closure on July 25, down from a high of about 67 last spring, said Matt Stone MSW, executive director of Youth Villages Massachusetts-New Hampshire.

The number decreased to 32 as of mid-August and the

last of the girls were scheduled to be placed by mid-September.

“We had stopped taking girls onto the campus in June,” Stone said. “We had a feeling things were moving in this direction.”

He added: “This was a process where we just determined the resources we have as an organization, the expertise, that we felt like the best way for us to make a contribution in the system of care and help as many children as possible is ... to help families restore their functioning and keep kids home as often as possible.”

Stone said the organization was “working very closely and collaboratively” with the state Department of Children & Families (DCF) to place the remaining girls in suitable settings for their needs.

Youth Villages/Germaine Lawrence entered a three-year contract with DCF beginning July 1, 2017, to provide residential education and group home services for youth in state custody. But it had the ability to terminate its contract with the state at any time,

according to DCF staff.

The state agency said its social workers were supporting the youth residing at the program during the transition to ensure their safety and wellbeing.

“Like any major change in an organization, it’s been a challenging time.”

Matt Stone MSW executive director of Youth Villages Massachusetts-New Hampshire DCF released the following statement about the pending closure: “We are disappointed with Youth Villages’ decision to close its residential treatment and educational services at its Germaine Lawrence campus. Our expectation is that Youth Villages will continue to ensure smooth transitions for all of the youth in their care in collaboration with the state.”

Germaine Lawrence served girls mostly from Massachu-

Spurwink offers program to refugees Continued from Page 6 Sarah Ferriss, DSW, LCSW, ShifaME’s program director, says for these kids, it’s more than just about fitting in their new environment; it’s living in two different worlds.

Many of the children are Muslim. The population the program serves celebrate different holidays, dress differently, and their parents may not speak English. Ferriss said it can be a very isolating experience.

“We see kids that can be tearful throughout the day or always getting into trouble,” she explained. “We hear from the schools that the kids are doing better after 12 weeks.

We’re giving them valuable skills to better function in getting an education.”

While the schools have provided positive feedback, the parents are also in favor of the program. Ferriss noted that, regardless of background or country of origin, most parents want their children to receive an education.

Meyer said this refugee pro-

gram is really the second phase of providing treatment for what he termed “new Mainers.” For the past 20 years, there has been a resettlement program in the state.

Working with the schools in those communities wasn’t

setts, although some have come from Rhode Island and New Hampshire in recent years. Presenting issues have typically ranged from behavioral problems like physical and verbal aggression and tru-

difficult to do as Spurwink already has an existing relationship with about 50 schools throughout Maine.

“We’re also moving into the second generation of new Mainers,” he said. “So, there’s already a cultural infrastruc-

ancy to depression, self-harm and suicidal ideation.

Stone said Youth Villages will have some opportunities for staff in community-based programs but that many will face layoffs. Two job fairs were held in the gym on the campus in August.

“Like any major change in an organization, it’s been a challenging time,” Stone said. “Overall our staff have understood our reasons and have worked through with an

ture here for them to rely on— how to adjust to a very different climate in Maine, find a job, manage housing.”

Ferriss pointed out that, while the cultural brokers help families work with their clinician and get adjusted to life in a new town, they have their own trauma histories. They work with some of the most

amazing amount of grace, and the campus has really been very calm throughout this transition.”

The Germaine Lawrence campus is located on three acres with seven buildings, five of them are two-story dormitories.

Stone said Youth Villages will continue to operate community-based programs. He noted that the next six months will be spent evaluating what to do with the campus. Youth Villages owns six buildings and leases its administration building.

Youth Villages is a national non-profit operating in 12 states with headquarters in Memphis, Tennessee. The organizations started as a merging of two residential treatment facilities but evolved in focus in the late 1980s and 1990s to add communitybased and in-home services.

NEP

Janine Weisman is a journalist based in Newport, Rhode Island, who frequently writes on mental health. Find her on Twitter at @j9weisman.

traumatic families, which can trigger an emotional past.

For the clinicians, it isn’t much easier, she said.

“Clinicians listen to these trauma stories that are super intense day in and day out,” she said. “Children who have seen their parents sexually assaulted or tortured... It’s emotionally exhausting.” NEP

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October 2018

Collaboration results in enrichment program for kids

By Catherine Robertson Souter hortridge Academy, a private co-ed therapeutic boarding school in Milton, New Hampshire, recently announced a unique enrichment program being offered to its students.

As part of a community outreach effort, the school has partnered with Granite State Adaptive Sports, a non-profit organization that provides a variety of physical activities for people with disabilities.

In the program, a select group of students from the school are given an opportunity to work with Granite State’s clients, coaching and guiding them in various sports.

Granite State works with people from age three and up who have physical, cognitive or emotional disabilities as well as those who are visually or hearing impaired. The program offers sessions in adaptive skiing, therapeutic riding, and bike riding.

Students from the school work with Granite State participants, guiding the horses, leading bike tours or teaching simple maneuvers on the snow.

It is a chance, said Mik Oyler, chief operating officer at Shortridge, for the students to give back to the community and to expand their own selfconfidence and interpersonal skills.

“On the spectrum of kids,

our kids probably have the softest profile,” said Oyler.

“These are the kids who tend to be anxious or depressed.

These are not the bullies; they are the ones who were bullied. These are the ones who cope by being withdrawn.

They tend to be engaged in the treatment and motivated to change.”

The school works to provide a more open campus for their students as a step away from full treatment programs and towards a typical residential school.

“In many cases, these are kids who are coming from other programs, from treatment or wilderness programs,” said Oyler. “We try to bring them some balance between the aca-

demic and therapeutic so they don’t feel like they are stuck in treatment forever. We are able to do some amazing programs with them, surfing in the summer, off campus trips, mountain biking, visits to museums or comic book stores.”

In the first winter session last year, the school administrators chose several students to help with the adaptive ski program.

“We were very selective on our end as to who was ready,” said Oyler. “It was looked at as a privilege. The students who did it last year were really committed and almost protective of the program. It generally takes two or three students to champion a new program in order for it to build.”

Latham Centers offers unique program for kids with Prader-Willi Syndrome

By Margarita Tartakovsky, MS ost people have heard of equine therapy, but the term asinotherapy probably would draw many blank stares. Originally developed in Germany, this lesserknown therapy is actually a successful program that uses miniature donkeys.

Since 2009, it’s been an integral part of Latham Centers, a residential care, education, and treatment center for children and adults with PraderWilli Syndrome on Cape Cod. Prader-Willi Syndrome

(PWS) is a complex genetic disorder that affects one in 12,000 to 15,000 births. It is characterized by an insatiable appetite, developmental disabilities, skin picking, and emotional and behavioral problems.

“PWS is a spectrum disorder,” said Patrice Carroll, LCSW, director of PWS services at Latham Centers. “Some kids describe feeling like they never get full, and will overeat if food is around. But they won’t go out of their way to get it.”

Other children will “steal money, run away to get food,

and eat raw or rotten food,” she said.

Some individuals with PWS are of typical intelligence to their peers, attend college, drive, and have long-term relationships, Carroll said.

Others have much lower IQs and need 24-hour support.

However, intelligence isn’t correlated with condition.

Carroll noted that children with average intelligence may have more challenges.

According to Carroll, donkeys work better than horses with students at Latham Centers because the animals are

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Administrators at the school found it gratifying to see their students open up to the Granite State clients.

“We have a video on our Facebook page of one of our kids on the snow with a boy with Down’s Syndrome,” he added. “He had a phenomenal time snowboarding and our kid worked with him to make it a fun event on the snow. He approached it with a fun and loving attitude.”

Over the summer, students joined Granite State for bike riding and equine therapy. At this point, the staff at Shortridge are looking forward to getting back out on the slopes again with a new group of students. NEP

Anne McManus (center) president and CEO, Latham Centers described the asinotherapy program to Mandy Nichols, (left) vice president of the Association of Developmental Disabilities Providers, who was visiting. Also pictured on the right is Latham resident Lauran Baletsa. smaller and calmer. Students who participate in asinotherapy must pass a six-week training on caring for the donkeys and approaching them safely.

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Then, students work with the donkeys weekly, grooming and feeding them and cleaning up their pen for about an hour.

The biggest benefit for students with PWS is the improvement in impulse control, Carroll said. Children with PWS don’t consider the consequences. But “when working with donkeys, students have to think through, ‘If I do this, they’re going to do that.’”

The interaction prompts students to “use the power of their own calmness,” and gain the donkeys’ trust, she said.

If they do something quickly or unexpectedly, the donkeys will lash out, kick, walk away, or yell loudly.

“You can’t force donkeys to do something they don’t want to do,” which fosters greater patience, said Anne McManus, president of Latham Centers.

Continued on Page 9

October 2018

New England Psychologist

Cults continue Continued from Page 1 ‘cult,’” he said. “So, media like the New York Times used the word ‘sects.’ So they haven’t gone away. We just don’t hear the word as often.”

The ICS defines a cult as “an ideological organization, held together by charismatic relationships, and demanding high levels of commitment.”

Hassan, who was once a member of the Unification Church, (nicknamed the

“The top dog is usually male but I have heard of some run by women. They are generally classic narcissistic personalities.”

Eric Sweitzer, M.T.S., Ph.D, clinical psychologist and director, Charis Counseling Centers in Massachusetts and Rhode Island

While it is not clear how many cults exist in the world, the International Cultic Studies Association has more than 4,000 groups listed in its files.

In a 2008 study referenced on the site, of 695 psychologists interviewed 13.1% had direct or familial experience with cults and 33% had treated someone who had been involved in a cult.

“Moonies” in reference to its leader, Sun Myung Moon), has developed a simple model that he uses to help people identify cults.

The BITE chart outlines the main components of a cult: Behavior control, Information control, Time control and Emotional control.

“There is a continuum of groups that can be labelled

as a cult. Any group may use some of the BITE methods,” he said, explaining that not all groups do every aspect but the bottom line is how a person’s ability to make decisions is impacted.

Contrary to popular definition, not all cults are religion-based. Some may be political or financial, racist or personality cults. Today, terrorist groups have also found the internet prime ground for sowing seeds of indoctrination or radicalization.

Locally there are smaller groups that Sweitzer identifies as cults - from one started by a former Marine on the Cape to another run by two brothers in Uxbridge. What’s typical of these, and pretty much all cults, is the personality outline of the cult leader.

“The top dog is usually male but I have heard of some run by women,” said Sweitzer.

“They are generally classic narcissistic personalities.”

Indoctrination techniques are surprisingly similar, he added, as if there is some “master class” on how to run a cult. New members are often “love bombed,” praised and welcomed. As they become more committed, they begin to find themselves reprimanded for minor transgressions and more rules are imposed.

With indoctrinating new people, cults typically target young men and women, although all age groups are affected, and seek out people who are going through a dif-

Latham Centers unique program Continued from Page 8 Asinotherapy is motivating, she said. McManus described a particularly difficult case with a student who wasn’t interested in anything.

“When the donkeys came on the scene, she was delighted.

It was a turning point for her.”

She started getting up, getting dressed and was ready to work.

“It was a stepping stone for other activities.”

Asinotherapy also strengthens students’ self-esteem, confidence, and their ability to empathize and build relationships, Carroll said.

“Over time, you see a certain donkey bonding with a certain child,” she said. The donkey might follow the child around the pen, nudge

them with their nose, and be very vocal and excited to see them.”

Carroll believes people often hyper-focus on the challenges of PWS and discount the positives—a much longer list. Individuals with PWS tend to be extremely engaging, funny, and empathetic, she said.

“We focus on the good list, and we shorten the list of challenges, and the donkey program is one of the ways that’s helped us do that.”

PWS isn’t characterized as an anxiety disorder, but it’s a better way of understanding it, Carroll noted. People with PWS have “high anxiety just about everything.”

Environment is critical. In an anxiety-provoking

environment – unpredictable schedules, many transitions – kids can be aggressive. They’re “compelled to act out because their anxiety takes over.”

“When their anxiety is decreased, kids with PWS can be extremely successful in school, work, and relationships,” Carroll said. This success can happen for kids with the most challenging behaviors, many of whom make friends for the first time in their lives.

“Really, it’s the environment that defines how successful the individual will be,” Carroll said. NEP Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.

9 ficult phase in their personal life.

“As a psychologist, we know that anyone can be drawn into a cult,” said Sweitzer. “But, there are levels of vulnerability. With young people, college kids in their 20s, they are often looking for something bigger than themselves to belong to. Many are disenfranchised to begin with or have come from an unstable or abusive background.”

“They know how to look for people,” he added, sharing a story about a former cult member who was asked to recruit on college campuses. “They started with kids who were flunking out, dropping classes. The recruiting is geared towards these types.”

For a therapist, it can be hard to identify those who have been in, or are in, a cult.

Asking the right questions is a start.

“Identifying is the key thing,” said Hassan. “You can’t just ask if they were in a cult because many people don’t even realize it. Ask them to talk about their relationship to spirituality and how strict a church or religious group they were involved in may have been.’”

The ICS has developed a list of characteristics of cult groups for therapists to understand to be more knowledgeable about cults. For more information, visit http://www. icsahome.com. NEP Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

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New England Psychologist

October 2018

Helping students get back on track, residential schools boast different goals Continued from Page 1 according to Parchin.

Students attend Adelbrook year-round, including an extended seven-week summer program.

In Connecticut, a planning and placement team develops goals and objectives to guide the student during his or her residential stay.

“The same group deter-

particularly those who can effectively manage the behaviors of children on the autism spectrum.

Salaries are so low, individuals can make the same money working at retail stores, she said. “Essentially there is no capacity in the state, even though the prevalence of developmental disorders is increasing.”

Based on her clinical experience, Ostrander reported

“Essentially there is no capacity in the state, even though the prevalence of developmental disorders is increasing.”

Robyn Ostrander, M.D., medical director, division of child and adolescent psychiatry, Maine Behavioral Health Care

mines when the student is ready to participate in the public school educational system,” said Parchin.

Robyn Ostrander, M.D., medical director, division of child and adolescent psychiatry, Maine Behavioral Health Care, spent 11 years in Vermont before coming to Maine in 2016.

She indicated that finding residential treatment in Maine is very difficult compared to Vermont. In addition to geographic challenges, the state struggles to attract and maintain qualified front line staff,

that approximately one-third of children in non-specific residential treatment are on the developmental disorder spectrum.

The other two-thirds have behavioral issues, such as conduct or mood disorders, or ODD. “But the common denominator is multiple disenfranchisement,” she noted.

Children live in poverty, are in state custody, have no natural or family supports and have exhausted all placement options.

Ostrander indicated that such situations can lead to PTSD or a diagnosis of psy-

chosis or bipolar disorder.

Independent boarding schools, residential schools that emphasize a college preparatory curriculum, do not focus on behavioral health issues, but rather emphasize an intense academic curriculum.

However, their students may face a tremendous amount of pressure, often selfimposed but also sometimes coming from external sources such as family or societal expectations, that sometimes translates into depression, anxiety, substance use, eating disorders and more serious behaviors, such as self-harming or suicidality, according to Jamelle Greene, Ph.D. Greene has worked as director of counseling at one such school in Massachusetts.

Greene points out though that the behavioral issues these students face are the same and occur at the same rate as they do for students across the population who don’t attend boarding schools.

Students at these schools are juggling high expectations as well as extracurricular activities. “These kids are working at a high level to maintain lots of interests,” said Greene. Perfectionism often permeates the environment, she added.

Moreover, many international students attend these boarding schools. Greene said that she had to undergo a personal learning curve with this population to figure out that their somatic complaints were communicating mental health issues.

She found that symptoms such as headaches and fainting could reflect depression and anxiety.

The size of counseling centers at these residential schools depends on the size of the school as a whole. Psychologists at these schools typically address mild behavioral issues, but will refer students to an outside therapist for more in-depth treatment, Greene noted.

David Gleason, Psy.D, completed a dissertation in 1993 entitled Learned Helplessness and the Adjustment to Boarding School that detailed his longitudinal study conducted with 105 new students at three different boarding schools.

Diminished self-esteem and increased depression were prevalent over the course of these students’ first semester.

As a group, they experienced greater degrees of “helplessness as they felt were less able to control many features of their new environments.”

Today, Gleason serves as a consultant to a boarding school in Concord, Massachusetts.

As administrative director of student support services at St. Paul’s School during the mid-1990s, Gleason observed that students frequently complained of anxiety and depression.

In subsequent years and at other independent schools, Gleason noticed that high pressure to compete and succeed led many students to substance abuse, eating disorders and cutting/self-injury.

“Alarmingly, the trend has recently shifted to increased suicidal ideation and behavior,” he said.

Gleason now emphasizes that while boarding schools are responsible for maintaining the psychological safety of their students, they are not meant to be mental health clinics.

Instead, schools should provide short-term, crisisoriented counseling services so that students can get back on track and resume their academic functioning – the reason they enrolled in their schools in the first place.

If, however, students need more extensive or longer-term psychotherapy, then schools should provide access to local independent mental health providers, and, if necessary, send students home on a “health leave” to focus on getting the care they need so they can – presumably – return to their school in a healthier state.

Regarding residential schools for children with behavioral issues, Ostrander said that the health care system is not responsive to the “increased burden of illness by increasing capacity.” NEP Phyllis Hanlon has been a regular contributor to New England Psychologist since 1999. As an independent journalist, she has also written for a variety of health, medicine and business consumer and trade publications. She also serves as writer/editor for custom publications.

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11

Behavior analysts must be licensed in Connecticut Continued from Page 1 Letso spent five years trying to get a licensure law passed in Connecticut. She worked with different stakeholder groups and state Rep. Catherine Abercrombie (D-Meriden) to get the state to pass the licensure law last October after it was attached to a budget implementer bill.

Many psychologists already practice behavior modification. But Traci Cipriano, J.D., Ph.D., former director of professional of affairs for the Connecticut Psychological Association (CPA), acknowledged the public need for behavior analysis was beyond what psychologists alone could provide.

CPA worked with the stakeholders and DPH to ensure that the language of the law did not infringe upon the scope of practice of psychologists, Cipriano said.

“When working on the legislation, CPA also sought to ensure that the behavioral analysts’ scope of practice was narrowly defined to reflect their training and education,

and does not include diagnosis, psychological testing, or any sort of psychotherapy,” Cipriano said via email. “The legislation as passed reflects

plinary actions or unresolved complaints pending.

Rafael Gallegos, Psy.D., senior managing partner and clinical director of Applied

“Applied behavior analysis might be a useful tool but it’s not sufficient to address the more complex issues.”

Rafael Gallegos, Psy.D., senior managing partner and clinical director, Applied Behavioral Sciences, LLC, West Hartford

this.”

The new law allows for behavior analysts who practice in another state to apply for a license in Connecticut provided they have no disci-

Behavioral Sciences, LLC in West Hartford said he believed licensure will add a layer of protection for the public. But he was concerned that the public might mistakenly think

a licensed board-certified behavior analyst could handle any behavioral problem.

Complex drivers behind behavior, such as a history of trauma, require clinicians with more training, said Gallegos, whose practice treats many cases that come from DDS and the state Department of Mental Health and Addiction Services.

“Applied behavior analysis might be a useful tool but it’s not sufficient to address the more complex issues,” Gallegos said.

“Doctoral level clinicians have more broad education and training needed to assess and treat complex cases that may require behavior analysis. That said, not all doctoral level psychologists have the training needed in behavior analysis.”

Connecticut has added behavior analysts to the list of professionals with frequent contact with children who are designated as mandated reporters, meaning they are required to report known or suspected incidents of abuse or neglect of any child under

18 or any child under age 21 under state care.

BCBAs are in high demand with current estimates suggesting one in 59 children are diagnosed with autism spectrum disorder.

Applied behavior analysis has been recognized as an effective treatment for autism by the U.S. surgeon general, the American Academy of Pediatrics and the National Institute of Mental Health.

A 2013 study conducted in Alabama and published in Research on Social Work Practice found training programs that taught biological and foster parents’ skills to create safe, positive, and nurturing environments for children were shown to be effective in keeping families together and reducing state costs.

Behavior analysis is also used to improve workplace safety and in dementia treatment and elder care. NEP Janine Weisman is a journalist based in Newport, Rhode Island, who frequently writes on mental health. Find her on Twitter at @j9weisman.

Study identifies barriers to substance abuse treatment

By Susan Gonsalves ccess to treatment for substance use disorders is often a maze that’s difficult to navigate for both providers and patients.

A study in the Journal of Addiction Medicine concluded that issues that contribute to delays in treatment and referrals include patient eligibility, treatment capacity, understanding of options, and communication problems.

Researcher Claire E. Blevins, Ph.D. said that most of the attention is placed on how to get people to want to quit and not enough is put on the road blocks patients face finding services.

Blevins is an assistant professor in the department of psychiatry and human behavior at the Warren Alpert Medical School, Brown University.

“As a provider, navigating the treatment referral process can be time-consuming and confusing,” she said. “My collaborators and I wanted to identify those barriers to care in order to streamline the process.”

Other researchers on the study were Nishi Rawat, a medical doctor and researcher at Johns Hopkins University School of Medicine and Michael Stein, a professor and chair of the health, law, policy, and management department at Boston University.

The researchers garnered input from 59 stakeholders, interviewing individuals in four states and the District of Columbia, including Connecticut and Massachusetts.

The interviewees were individuals who referred patients to substance use treatment such as emergency room physicians, addiction specialists, or other medical providers.

Also interviewed were the people receiving the referrals-substance use treatment facility staff and administrators.

“The big takeaway is that both sides of the referral process want what’s best for their patients and believe there are aspects of the system that get in their way,” Blevins said.

For example, providers felt that there is a lack of transparency regarding treatment capacity, meaning that they

didn’t always know if there are openings for patients.

A lack of communication between the referral source and recipient also means

eligibility for each treatment option and a lack of knowledge or understanding of options by providers.

Blevins said that she hoped

“Recovery is not a universal, cookie-cutter process. Each patient has individual needs.”

Claire Blevins, Ph.D., assistant professor, Warren Alpert Medical School, Brown University

that the source often doesn’t know if the patients actually received the treatment they were seeking.

Other reported difficulties were in determining patient

the information would start an “interdisciplinary dialogue” between mental health professionals.

She said she’d also like to see an improved system of

referral that included a more streamlined database of services.

Other goals include establishment of a set eligibility criteria for admission; clarified terminology and services; the integration of substance use treatment into primary care; and a boost in provider education and training.

Blevins said, “The key is not just to refer to services as quickly as possible, it’s also to refer to appropriate treatment.

Recovery is not a universal, cookie-cutter process. Each patient has individual needs.”

As for the future, Rawat is developing a software platform called Openbeds in order to aid in the referral process.

Blevins and Stein’s other research centers on psychosocial and pharmacological treatment of substance use disorders. NEP Susan Gonsalves has been New England Psychologist’s editor since 2001. Currently based in central Massachusetts, she is also managing editor of Psych Central Pro and a freelance reporter for a daily newspaper.

12

New England Psychologist

October 2018

Benton Center retrofitted to meet the needs of psychiatric patients

By Phyllis Hanlon n 2009, the Rhode Island Department of Children, Youth and Families (DCYF) opened the Roosevelt Benton Center and the Thomas C. Slater Training School (also called the Youth Development Center) as an “intake and assessment center for nonadjudicated youth,” according to Kerri White, MA, Rhode Island’s DCYF communications director.

Last year, Eleanor Slater Hospital acquired and renovated the facility to serve a different population.

White explained that, in conjunction with the Youth Development Center, the $62 million Benton Center was intended to house youth for juvenile detention; some of whom may have diagnosed mental health needs.

Initially, the Benton Center facility operated as a secure correctional detention and assessment facility. All detained youth were immediately enrolled in the Training School’s educational program, which is approved by the Rhode Island Department of Education as an alternative education program and operates year-round.

White said, “The youth at the Training School receive secondary school instruction in core educational fields.”

All youth entering the Benton Center received a full physical and dental exam at the time of admission.

In addition, all youth detained at the Benton Center received a mental health assessment.

“Finally, a clinical social worker was assigned to the unit and a psychiatrist was

available for consultation on both medication management and on-going treatment needs,” White said.

In 2017, the Benton Center closed following reports of staffing, system and equipment issues; all youth were removed and are now housed in separate units at the Youth Development Center, a 96-bed facility where the census of both non-adjudicated and sentenced youth has hovered around 55 for the past eight months, according to White.

As DCYF was vacating the property, Eleanor Slater Hospital was in search of an alternative facility. The Joint Commission had found deficiencies in its unit that housed psychiatric patients, patients who had committed crimes and psychiatric patients who had been civilly committed, according to Brian Daly, MD,

chief medical officer (CMO), Eleanor Slater Hospital and RI Department of Behavioral Healthcare, Development Disabilities and Hospitals (BHDDH).

Building a new hospital was fiscally unfeasible; but renovating the Benton Center made good sense, Daly noted.

At a cost of $7.6 million, just shy of the $8 million budget, the center underwent an extensive overhaul, both on the interior and the exterior.

Daly said that part of the retrofitting process involved adding several security features, such as more electronic sally ports and an 18 to 20-foot double perimeter fence topped by a razor ribbon.

Inside the facility, nurse stations have been situated with better site lines; lighting alarms have been moved to a higher position so they won’t

be broken; patient rooms are ligature resistant; and other safety measures have been implemented.

Daly said the facility has a capacity of 55 with an intensive treatment unit. “Fifty-two patients will occupy the building, which is considered full,” he said. These changes make the facility “more in line with modern psychiatric hospitals.”

He emphasized that the new facility remains “treatment focused.” NEP Phyllis Hanlon has been a regular contributor to New England Psychologist since 1999. As an independent journalist, she has also written for a variety of health, medicine and business consumer and trade publications. She also serves as writer/editor for custom publications.

Trauma-informed care program now a part of JRI

By Eileen Weber n July, the Youth Trauma Program (YTP) at the Fernandes Center for Children & Families of Saint Anne’s Hospital in Fall River, Mass., joined the Justice Resource Institute (JRI), a non-profit organization providing trauma-informed care to families throughout Massachusetts, Rhode Island, and Connecticut.

YTP spent more than three decades providing services for children and families affected by traumatic events.

JRI CEO Andy Pond, MSW, MAT, said in a released statement that the program’s merger with their organization is a

wise move.

“JRI’s focus on traumainformed care and the highly specialized services that we have developed, particularly across the South Coast, make this a smart and timely move for this program and the children and families that it serves,” he said.

“We are taking a program that is already an outstanding resource for the community and strengthening it.”

YTP was founded at Saint Anne’s Hospital about 35 years ago. Ten years ago, it became part of the Steward Health Care System, which is the largest private hospital operator in the U.S. Later, it became part of the

May Institute. Looking for a place that better matched its mission, JRI seemed like a perfect fit.

Because the two organizations are closely aligned in the services they provide, nothing has changed in the YTP program since joining JRI. YTP offers evaluation and counseling services to child and adolescent victims of sexual and physical abuse, neglect, as well as to those who have lost a loved one to homicide or experienced other trauma like violence at home, among peers, or in the community.

All services are free. The program is partially funded by the Victims of Crime Act

(VOCA, other grants and federal funds.

YTP Program Director Jennifer Salem-Russo, LICSW, MSW, described the “polyvictimization” they often see when working with young children.

Many of the children referred to them are immigrants. Coming from violence in their communities only to become a victim of a crime here in the U.S., the trauma experience is often exacerbated, she noted.

A number of children coming in have caregivers who are addicted to opioids.

“The opioid crisis is really impacting these kids,” she said. “Often, it’s not one trau-

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ma. These kids can be victims more than once. We see neglect and sexual abuse, substance abuse, and extreme risk through exposure to strangers coming in and out of the house.”

When the children are really young – two or three years old – they work with the parents, grandparents or even foster care as a “diad unit.” Kids can heal better when they can use their relationship with their caregiver to get through the awful event.

She added that sometimes, children are misdiagnosed as aggressive or having ADHD when trauma is the root problem.

“They are in a state of hyperarousal – always on alert as a way to feel safe,” she explained. “Kids can be impulsive, have a hard time sitting still or regulating their emotions... a hard time focusing. It’s a survival strategy.”

To better serve adolescent clients, YTP is starting a group with teens who have parents with substance abuse disorder this fall. NEP Eileen Weber has been a freelance writer for several years with a master’s degree in journalism and a professional background in publishing.

Based in Fairfield, Conn., she has written numerous articles for magazines, newspapers, and web sites.

October 2018

October Oct. 3-4: Acquired Brain Injury Clinical Continuing Education Certificate. Shrewsbury, MA. 8:30-4:30 pm, $500 BIAMA members, $550 non-members, 13 CEs. This two-day continuing education program is designed to provide participants with a comprehensive overview of major categories of acquired brain injury (ABI), including neoplastic, traumatic, vascular, metabolic and infectious disorders of the central nervous system. Epidemiology, factors affecting outcome, and the potential long-term consequences, focusing on neurobehavioral, neurocognitive and sensorimotor sequelae, will be reviewed. Sponsored by Brain Injury Association of Massachusetts. Contact biama.org/ abitraining2 to register.

Oct. 4: Parent-Child Interaction Therapy (PCIT): An Overview. Warwick, RI. $120, 4 CEs. This workshop will provide a theoretical, empirical, and clinical overview of the Parent-Child Interaction Therapy (PCIT) model. Sponsored by the Rhode Island Psychological Association. Contact 401-732-2400 or ripsych.org

Oct. 5-6: Spiritual Diversity and Psychotherapy: The 2018 Merle Jordan Conference. Boston, MA. $275. Experience two days of rich clinical presentations and stimulating conversations with leading theorists of spiritually integrative psychotherapy, each with deep expertise in the close connection between spirituality and psychotherapy across diverse approaches and traditions. Sponsored by the Albert

New England Psychologist

& Jessie Danielsen Institute at Boston University. Contact www.bu.edu/danielsen/2018merle-jordan-conference/

Oct. 7-13, 14-20, 21-27, 28Nov. 3: What, Where Is Psychoanalysis: Classic Concepts, New Meanings 2018. Newton, MA. $450, 18 CEs. This 4-week course is designed for students, supervisors, teachers, and psychoanalytic practitioners who want a solid foundation in the history of theorizing and technique of psychoanalysis. Sponsored by William James College. Contact www.williamjames.edu/ academics/lifelong/ce/

Oct. 11: Movie + Dialogue Night showing the popular film Call Me By Your Name.

Watertown, MA. 7-10 pm, $55, 3 CEs. In the summer of 1983, in the north of Italy, Elio Perlman, a 17-year-old American, spends his days in his family’s 17th century villa. One day Oliver, a 24-year-old graduate student working on his doctorate, arrives as the annual summer intern. Soon, Elio and Oliver discover a summer that will alter their lives forever. We will discuss the experience of adolescent desire and love from the viewpoint of a time when same-sex relationships were less acceptable than today, recognizing the powerful role of family acceptance of same-sex sexual orientation in promoting young peoples’ well-being.

Sponsored by Therapy Training Boston. Contact 617-9249255 or learn more at: www. therapytrainingboston.com

Oct. 12: Overview of Neurodiagnostic Procedures and Neurological Effects of ABI.

CONTINUING Education New England Psychologist prints as many continuing education conferences as space allows.

Listings with incomplete information will not be printed. CE credits listed are for psychologists. Deadline for submission is the 1st of each month for the following month’s issue. CE Listing correspondence to: New England Psychologist Attn: Continuing Education P.O. Box 5464 Bradford, MA 01835 ce@nepsy.com

Shrewsbury, MA. 8:30-12:30 pm, $150 BIA-MA members, $175 non-members, 3.5 CEs. Participants will learn the pathophysiological mechanisms in acquired brain injury and the common acute neurological sequelae of ABI, including post-concussion syndrome, seizures, hydrocephalus and cognitive disorders. Late neuropsychiatric effects of ABI (e.g., psychosis, mood disorder and personality change) will also be described and discussed. An overview of neurodiagnostic tests (e.g., EEG, CT, MRI, SPECT, PET, fMRI, and DTI) and approaches to interviewing persons with ABI will be presented. Sponsored by Brain Injury Association of Massachusetts. Contact biama.org/ abitraining2 to register.

Oct. 15: Asperger/Autism Network’s Annual Conference with Tony Attwood. Boston, MA. 5.5 CEs. Topics: Special interests and the reason why specific interests occur as part of the Asperger profile; and Independence and Interdependence. Contact www.aane. org/event/tonyattwood2018/ or 617-393-3824

Oct. 20: Before It’s Too Late: Treating Substance Abuse

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and Process Addiction in Couple Therapy. Newton, MA. 9-4:30 pm, $120 (members before 10/3)/$140 (non-members before 10/3), 5.5 CEs. Presented by David Treadway, Ph.D. Sponsored by Psychodynamic Couple and Family Institute of New England (PCFINE).

Contact: www.pcfine.org, pcfine1934@gmail.com or call 781-433-0906.

Oct. 22: Staring Down Panic: Communicating the Elements of Exposure and Response Prevention to Patients Suffering from Anxiety

Disorders. Newton, MA. 4-6 pm, $30, 2 CEs. This program will consist of an overview of the recently published book, Staring Down Panic: Your Guide to Effectively Confronting Anxiety Using Exposure and Response Prevention by Brian D. Ott, Ph.D., followed by a Q&A and a social reception.

Sponsored by William James College. Contact www.williamjames.edu/academics/lifelong/ ce/

Oct. 22-Nov. 18: Intimate Partner Violence 2018. New-

Continued on Page 14

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New England Psychologist

ton, MA + online course. $1100, 28 CEs. This course in Intimate Partner Violence is designed for professionals engaged in providing services to children, adults and families, and the courts who seek to provide or understand best practices of investigation, evaluation, and testimony in matters where domestic violence is alleged. This blended learning course will expose participants to emerging research in interpersonal violence and best practices using available guidelines and standards for evaluation of IPV. Sponsored by The Center of Excellence for Children, Families and the Law at William

James College. Contact www. williamjames.edu/academics/ lifelong/ce/

Oct. 26: Shifting Families Toward Acceptance and Connection: Strategies for Helping When A Youth Comes Out as Transgender or NonBinary. Waltham, MA. 9-4:30 pm, $140, 6 CEs. Considering the vulnerabilities of trans and non-binary youth, it is critical for therapists to have a sophisticated understanding of gender identity/expression. It is also critical to have a solid framework to hold the work and

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support these youth and families. We will start the day with a focus on a deepening understanding of gender, gender identity development and gender dysphoria. Next, a framework for working with families will be discussed which is relevant to providers who see individual youth, parents and families. Sponsored by Therapy Training Boston. Contact 617924-9255 or register at www. therapytrainingboston.com

Oct. 26: Dr. Donald Moss: Heart Rate Variability: Applications to Common Medical and Emotional Disorders.

Montreal, Quebec. 9:30-4:30 pm, $350, 6 BCIA hours. This workshop describes what heart rate variability (HRV) biofeedback is, explores its importance, and introduces potential uses for HRV training. Sponsored by Thought Technology Ltd. Contact bit.ly/2xyb5hO

Oct. 26: What Kids with ADHD Wish You Knew and How You Can Help: Understanding ADHD and Executive Functioning in Children and Teens. Newton, MA. 9-4:30 pm, $150, 6 CEs. This workshop presents the untold voices of children and teens with ADHD as an effective way to assist parents and professionals in thinking differently about the challenges these children face. Dr. Saline explores how listening to and working with the kids diagnosed with ADHD to solve challenges together improves cooperation and success. This presentation

by Sharon Saline, Psy.D. will be both didactic and experiential in nature. Sponsored by William James College. Contact www.williamjames.edu/ academics/lifelong/ce/

October 2018

November Nov. 3: Nurturing Resilience in Children and Families: A Shift from Deficits to Strengths. Newton, MA. 9-4:30 pm, $150, 6 CEs. This conference takes a strengthsbased stance and examines theories, factors, and processes that promote resiliency in children, parents, families and systems. Speakers will provide examples of their work promoting resilience using a strengthsbased approach in various settings with diverse populations.

Sponsored by William James College. Contact www.williamjames.edu/academics/lifelong/ ce/

Nov. 7: Substance Abuse and Acquired Brain Injury (ABI). Shrewsbury, MA. 8:304:30 pm, $250 BIA-MA members, $275 non-members, 6.5 CEs. The clinical criteria for substance abuse disorders and their relationship to the occurrence of acquired brain injury, as well as their neurocognitive impact, will be reviewed and discussed. Participants will learn recommended approaches for recognizing, assessing and treating persons who present with the combined challenges of ABI and substance abuse, including misuse/overuse of prescribed and OTC medications (e.g., analgesics).

Sponsored by Brain Injury Association of Massachusetts.

Contact biama.org/abitraining2 to register.

Nov. 7, 2018 - May 1, 2019: Monthly Master Series in Couple Therapy: Seven More Approaches to Interviewing.

Newton, MA. 7 pm-9:40 pm, $775, 18 CEs. On the first Wednesday of each month, observe and dialogue with seven senior couple therapists about

their ideas about couple therapy (includes live role playing).

Topics include using humor, paradox, and camaraderie to facilitate change; producing deep change quickly; using solution-oriented questions to deepen the conversation; examining your own relational style as a therapist; fostering collaboration in couples work; accessing the couple’s resources for love, compassion, acceptance, and forgiveness; and creating the safety necessary to create an increased depth of understanding. Sponsored by Therapy Training Boston. Contact 617-924-9255 or register at www.therapytrainingboston.com.

Nov. 9: Rise Up! Spirituality, Faith, and Social Justice. Newton, MA. 8:30-5 pm, $130, 6 CEs. This Conference aims to engage agents of social change who are grappling with contemporary social issues that affect vulnerable and oppressed groups in the U.S. It seeks to promote greater awareness of the need for more socially conscious and spiritually sensitive mental health providers who can pursue a social justice agenda.

Sponsored by William James College. Contact www.williamjames.edu/academics/lifelong/ ce/

Nov. 29: Neuropsychological Assessment with Attention to Developmental Trauma and Learning Disorders.

Newton, MA. 8:30-5 pm, $140, 6 CEs. We will cover the use of the WISC-V, BRIEF-2 and BRIEF-A. Co-Sponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College. Contact www. williamjames.edu/academics/ lifelong/ce/

Continued on Page 15

August/September 2018 Nov. 30: Assessment of Youth with the MMPI-A-RF and the R-PAS: Including Aspects of Developmental Trauma and Psychodynamically-informed Cognitive Assessment. Newton, MA. 8:10-5 pm, $155, 7 CEs. Data will be presented demonstrating the validity and reliability of the measures presented as well as their application to the target patient population. CoSponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College. Contact www.williamjames.edu/academics/lifelong/ce/

New England Psychologist

December

15

THE QUICK FIX

Dec. 1: Integrated Assessment of Youth. Newton, MA. 8:30-5 pm, $155, 7 CEs. Case presentations highlighting the role of developmental trauma; including how we measure adulthood and its forensic implications; ethical issues in assessment of youth; and the trajectory of adolescent social and neurological development.

Co-Sponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College.

Contact www.williamjames. edu/academics/lifelong/ce/

For

comprehensive

CE listings check out

NEP

Classifieds Office Space BACK BAY (Boston): Parttime furnished psychotherapy office with stunning Boston views. Shared waiting areas, bathrooms, kitchen & free gym access. Many referrals and optional administrative/ billing support available. Free private practice start-up or expansion business consultation. $176 + /month per 4-hour/week block. Parking for additional fee. Please contact: backbayalliance@gmail. com or 617-230-3002 BEDFORD, MA: Office space PT/FT available. Many referrals and optional admin/ billing support available.

Contact: diane@ bedfordbehavioralhealth.com or 781-275-0099.

FARMINGTON, CT: Furnished office space for sublet. Includes private consultation, testing and waiting rooms. All utilities and housekeeping included. Building has three onsite restaurants and free parking. PT or FT (with minor limitations).

Contact Becky at czlap@ neuropsychologyct.org or 860-803-1136.

HARVARD SQUARE (Cambridge): Furnished

part-time psychotherapy office sublet in Victorian house/ office building. Shared waiting area/bathrooms/kitchen.

Many referrals and optional administrative/billing support available. Free private practice start-up or expansion business consultation. $176 + month per 4-hour/week block. Please contact: harvardsquarealliance@ gmail.com or 617-230-3002

NEWBURYPORT, MA: Great therapist’s office condo for sale. Three therapy rooms, waiting area, bathroom, utility room w/fridge. Private 2nd floor location. Parking in rear. $200k. Contact: Susan Allen at seallen53@gmail.com or 978-462-7107.

NEWTON CENTRE, MA: Attractive, professional office spaces, near T, parking.

Furnished, day/evening/weekend. Wheelchair accessible.

Some offices suitable for groups. Contact: 617-3326755 cea.newton@yahoo.com WELLESLEY/NEWTON LINE, MA: Well-furnished office & waiting room in a professional building with onsite parking. Available Mondays or Fridays $350 a day OR $180 4 hour block per month. Convenient to I-90, I-95, ROUTE 9. Contact: drrobindeutsch@gmail.com

Please check out all of the help wanted ads on Psych Central Professional: pro.psychcentral.com/jobs

Classified Form All classified advertising runs in the next available print edition and on nepsy.com Deadline is 12th of every month (except for Aug./Sept. issue, which is Aug. 1).

For all other advertising deadlines and rates, including Help Wanted and CE ads, please email us at: advertising@nepsy.com.

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Save money by submitting online! http://www.nepsy.com/classifieds/ Please fill out the below form completely and legibly. Payment must accompany ad (make check payable to New England Psychologist) and mail to: Classified Ads, New England Psychologist, PO Box 5464, Bradford, MA 01835.

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New England Psychologist

October 2018

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