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! TOUR THROUGH RECENT DEVELOPMENTS AT 40! IS A BIT LIKE STROLLING THROUGH AN AMUSEMENT PARK 3OMETIMES IT S PRETTY EXHILARATING LIKE RIDING THE 4EXAS 'IANT !T OTHER TIMES ONE FEELS TRAPPED IN SOME PERPETUAL UNPLEASANT AMBUSH LIKE A COMBI NATION OF BUMPER CARS AND THE HAUNTED HOUSE
)T S GREAT TO BE A PSYCHOLOGIST IN 4EXAS 7ANT PROOF 7E RE JUST COMING OUT OF A GREAT 40! #ONVENTION IN (OUSTON 7OW ) HOPE YOU WERE THERE 4HIS WAS THE BEST AT TENDED CONVENTION WE VE EVER HELD IN (OUS TON AND IT WAS A RESOUNDING SUCCESS -ANY CONVENTION GOERS WERE OVERHEARD TO REMARK THAT THE PROGRAM PRESENTATIONS WERE EXCEP TIONALLY GOOD THIS YEAR BREADTH QUALITY AND RELEVANCE TO PRACTICE ALL CAME IN FOR PRAISE 4HE OFFERINGS SPANNED HEALTH PSYCHOLOGY PHARMACOLOGY FORENSIC PROBLEMS SUPERVI SION THE BUSINESS OF PRIVATE PRACTICE AND ETHICS )NNOVATIVE NEW PRACTICES WERE DIS CUSSED AND THERE WERE SEVERAL PRESENTATIONS ON THE CLINICAL DEMANDS OF SPECIlC POPULA TIONS COUPLES THE ELDERLY SPECIlC MEDICAL PROBLEMS ABUSE VICTIMS 4WO THREADS RAN THROUGH THE PROGRAM EMPIRICISM AND SO CIAL AWARENESS ! NUMBER OF OUR COLLEAGUES SHARED THEIR CONCERNS ABOUT THE VULNERABLE AND UNDERSERVED POPULATIONS AND MANY PRESENTATIONS EMPHASIZED A STRONG RESEARCH FOUNDATION )N ADDITION THERE WERE SEVERAL EXCELLENT POSTER SESSIONS FEATURING GRADUATE STUDENT RESEARCH BRINGING YOUNG FACES TO 40! 4HE (OUSTON CONVENTION SHOWCASED EXCELLENCE IN ACTION FROM PSYCHOLOGY AND PSYCHOLOGISTS 0AT %LLIS 0H$ AND THE PRO GRAM COMMITTEE HAVE CERTAINLY RAISED THE BAR #IRCLE THE OF .OVEMBER AND lND OUT IF NEXT YEAR S MEETING IN $ALLAS CAN TOP THE MARK
ALMOST YEARS AGO AND THE ACTIVE PLANNING AND LOBBYING ON BEHALF OF PSYCHOLOGY STARTED OVER THREE YEARS AGO 4HERE WERE MANY THREATS TO COLLAPSE THE 4EXAS 3TATE "OARD OF %XAMIN ERS OF 0SYCHOLOGISTS INTO SOME OTHER BOARD OR TO GUT THE 43"%0 S RESOURCES 40! SUCCEED ED IN PERSUADING THE LEGISLATURE TO PRESERVE THE 43"%0 AS AN AUTONOMOUS AGENCY FOR AN OTHER TWELVE YEARS 4HIS WAS GREAT NEWS AND THERE WAS A DELIGHTFUL SHORT lLM PRESENTED AT THE CONFERENCE FEATURING INTERVIEWS WITH SOME OF THE PRINCIPLE PLAYERS WHO WERE CEN TRAL TO 40! S EFFORTS 7E ARE INDEED FORTUNATE TO HAVE SUCH HARD WORKING COLLEAGUES
NEW APPROACHES TO TREATING MENTAL ILLNESS &INALLY DON T MISS THE ETHICS PIECE BY $RS %MILY 3UTTER AND * 2AY (AYS 4HE LEGAL ETHICAL AND PRACTICAL DILEMMAS THEY RAISE ARE UNUSUAL AND VERY INTRIGUING
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)T IS PRETTY CLEAR THAT MENTAL HEALTH IS SUFFERING DISPROPORTIONATELY IN THE NATIONAL HEALTH CARE DEBACLE AND WITHIN THE MENTAL HEALTH INDUSTRY PSYCHOLOGY IS CERTAINLY EM BATTLED 7HEN THEY ARE NOT BEING REDUCED BY lAT MANAGED CARE FEES ARE DECLINING AGAINST INmATION CREATING DOWNWARD PRESSURE ON 3EVERAL OF THOSE COLLEAGUES ROTATED ON INCOMES BUT THAT IS OLD NEWS 0SYCHOLOGICAL AND OFF SEVERAL GOVERNANCE POSITIONS DURING TESTING IS IN MANY INSTANCES GROSSLY UNDER THE CONVENTION 3EE $R -ELBA 6ASQUEZ S VALUED AND PSYCHOTHERAPY BENElTS SUFFER PRESIDENTIAL COLUMN FOR AN ACKNOWLEDGE ARBITRARY AND IRRATIONAL LIMITATION MENT OF THESE lNE FOLKS 3HE ALSO DISCUSSES THE IMMIGRATION CONFERENCE THAT !0! WILL %VERYBODY HAS A HORROR STORY BUT LET ME BE CONDUCTING IN &EBRUARY IN 3AN !NTONIO SHARE A FRESH NEW INSULT ! POTENTIAL CLIENT -ELBA REPLACES $R 0AUL "URNEY WHO IS HAS BEEN ORDERED BY THE COURT TO OBTAIN ROTATING OFF AS 40! PRESIDENT 0AUL S ENTHU A PSYCHOLOGICAL EVALUATION PURSUANT TO A SIASM AND ABILITY TO SEE THE BIG PICTURE HAVE CRIMINAL AND CIVIL CASE 7E DISCUSSED THE BOTH GUIDED AND FUELED MANY OF 40! S SUC NEED TO OBTAIN RELEVANT DOCUMENTATION %2 CESSES 4HANKS 0AUL AND POLICE REPORTS ETC AND THE NEED FOR PSY CHOLOGICAL TESTING AND A THOROUGH INTERVIEW ! PERENNIAL FEATURE OF THE 40! CONFER 4HE CLIENT WAS AGREED TO THE PROCEDURES BUT ENCE IS THE RECOGNITION OF THOSE PEOPLE WHO BALKED ON THE PRICE )T SEEMS THAT A PUBLIC RECEIVED AWARDS FROM 40! FOR THEIR EFFORTS AGENCY OFFERED THE CLIENT A PSYCHOLOGICAL ON BEHALF OF PSYCHOLOGY 4HAT MAKES THIS EVALUATION FOR lFTY BUCKS ) M GUESSING THAT THE !WARDS )SSUE AND YOU LL lND HEREIN A THIS AGENCY ADMINISTERS SOME SORT OF CHECKLIST DESCRIPTION OF THE EXEMPLARY PEOPLE WHOSE WITHOUT REALIZING THE LIABILITY THAT ATTACHES TO WORK WAS ACKNOWLEDGED IN (OUSTON !LSO A PSYCHOLOGICAL EVALUATION )T S DISTURBING )T 4HE CONVENTION WAS OUR lRST GET TOGETHER IN THIS ISSUE YOU WILL lND A VERY INTERESTING REVISITS THE PROBLEM OF THE QUALITY OF SERVICES SINCE THE SUCCESSFUL COMPLETION OF 3UNSET 7E ARTICLE BY $R ,ANE /GDEN ABOUT DRAMATIC DELIVERED BY EXEMPT AGENCIES -ORE ALARM BEGAN BUDGETING FOR THIS LEGISLATIVE STRUGGLE CUTTING EDGE IDEAS THAT REPRESENT GENUINELY ING IT BESPEAKS A DEGRADATION OF OUR PUBLIC
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IMAGE EVIDENTLY SOME PEOPLE MAY NOT REALLY AND WE HAVE DEMONSTRATED OUR WILLINGNESS EXPECT MUCH FROM A PSYCHOLOGICAL EVALUATION DO THE WORK 7ITHOUT THE NEEDED POLICY AND FUNDING CHANGES THE PUBLIC IS SHORTCHANGED AND BY EXTENSION FROM PSYCHOLOGISTS FROM HAVING THE BEST QUALITY CARE /UR PROBLEMS ARE NOT LIMITED TO GUILD 4HE PROBLEMS NOTED ABOVE ARE CHRONIC ISSUES 4HE PROBLEMS OF MENTAL ILLNESS ARE EXACERBATED BY THE PROBLEMS OF POVERTY 4HIS BUT THERE IS AN ACUTE EXACERBATION OF THE ISSUE S ARTICLE ON 0SYCHOLOGY IN THE 0UBLIC LONGSTANDING CONmICT BETWEEN LICENSED )NTEREST BY $RS /LLIE 3EAY #HARLES -C PSYCHOLOGISTS AND MASTER S LEVEL PSYCHOLOG $ONALD !LISON 7ILSON AND 3ELIA 3ERVIN ICAL ASSOCIATES ! PROPOSAL HAS BEEN MADE 'UERERRO ,ย PEZ DISCUSSES THE RELATIONSHIP TO THE 43"%0 THAT WOULD GRANT INDEPEN BETWEEN POVERTY AND MENTAL HEALTH !S THE DENT LICENSURE TO ,0!S 4HIS WOULD EVIS AUTHORS NOTE POVERTY REPRESENTS A MAJOR CERATE THE DOCTORAL STATUS OF PSYCHOLOGISTS STRESSOR EXACERBATING PSYCHOLOGICAL PROBLEMS IN 4EXAS )N HIS COLUMN IN THIS ISSUE 40! S OF THE POOR AND BECAUSE OF EVER MORE LIMITED %XECUTIVE $IRECTOR $AVID 7HITE DESCRIBES RESOURCES THE POOR ARE UNLIKELY TO RECEIVE THE THE MOST RECENT SALVOS IN THIS RECURRENT AND LEVEL OF CARE THEY REQUIRE &URTHER THEY RE VEXATIOUS THREAT TO OUR PROFESSIONAL IDEN MIND US THAT SHRINKING RESOURCES HIGH STRESS TITY 4HE SUCCESSFUL RESOLUTION OF THE 3UNSET AND INCREASINGLY RESTRICTIVE GOVERNMENTAL PROCESS WILL BE IRRELEVANT IF WE DON T PREVAIL REGULATIONS ALL CONTRIBUTE TO BURN OUT AMONG AGAINST THIS CHALLENGE THOSE MENTAL HEALTH PROFESSIONALS WHO HAVE 7HAT DO WE DO NOW 0SYCHOLOGY HAS DEDICATED PART OF THEIR CAREERS TO WORKING ENORMOUS POTENTIAL TO ACT FOR THE GREATER WITH IMPOVERISHED POPULATIONS GOOD BUT THE PUBLIC NEEDS TO KNOW WHAT 4HESE ARE POLICY AND RESOURCE ISSUES $R GOOD PSYCHOLOGISTS ARE ALL ABOUT 7E OBVI *ERRY 'RAMMER AND $ENISE "RADY OF THE OUSLY CAN T REST ON OUR LAURELS OR OUR PO 4EXAS MENTAL (EALTH !SSOCIATION PROVIDE US TENTIAL /UR COLLEAGUES WILL BE DOING THE WITH AN EXCELLENT UPDATE ON THE FATE OF MEN RESEARCH THAT DElNES POLICY AND PRACTICE TAL HEALTH FUNDING ISSUES IN 4EXAS 4HE NEWS ACROSS MENTAL HEALTH MEDICAL CARE FOREN IS NOT ALL BAD BUT OVERALL THE PICTURE IS DIS SIC MATTERS THE FAMILY THE WORKPLACE AND COURAGING *ERRY AND $ENISE DOCUMENT THE THE COMMUNITY !FlRMING OUR PROFESSIONAL RELATIVELY SORRY CONDITION OF MENTAL HEALTH IDENTITY IS CRITICAL TO ENSURING THAT THE BEST CARE IN 4EXAS COMPARED TO OTHER STATES AND IDEAS ARE HEARD BY DECISIONS MAKERS IN BOTH DISCUSS THE POLICY CHANGES THAT NEED TO OC THE PUBLIC AND PRIVATE SECTORS AND THE CUR TO IMPROVE ACCESS AND QUALITY OF MENTAL 4EXAS 0SYCHOLOGICAL !SSOCIATION IS THE BEST HEALTH SERVICES 0SYCHOLOGISTS KNOW HOW TO MOST DEDICATED ADVOCATE FOR OUR PROFESSION HELP THE MENTALLY ILL WE KNOW WHAT WORKS IN !USTIN
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40! NEEDS TO BE A STRONG ORGANIZATION BUT INDIVIDUAL PSYCHOLOGISTS NEED TO BE STRONG ADVOCATES FOR OUR PROFESSIONAL IDEN TITY 4HOSE AWARD RECIPIENTS ARE ALL ADVOCATES FOR PSYCHOLOGY 9OU CAN BE TOO ) HOPE YOU lND THIS ISSUE OF THE 4EXAS 0SYCHOLOGIST IS STIM ULATING AND ) HOPE YOU LOOK FOR WAYS YOU CAN ACT TO PROMOTE OUR PROFESSION -OST OF ALL 3(/7 4()3 )335% 4/ #/,,%!'5%3 '%4 4(%- 4/ */). 40! #HEERS "RIAN #/ %$)4/2 "RIAN ( 3TAGNER 0H$ IS A #LINICAL !SSOCI ATE 0ROFESSOR IN THE 0SYCHOLOGY $EPARTMENT AT 4EXAS ! - AND IS THE FOUNDING DIRECTOR OF !SSOCIATES FOR !PPLIED 0SYCHOLOGY IN "RYAN #OLLEGE 3TATION (E IS A FORMER CHAIR OF THE 43"%0 AND FORMER %THICS #HAIR AND CUR RENT "OARD -EMBER OF 40! #ONTACT HIM AT BHS PSYC TAMU EDU #/ %$)4/2 $ONNA 3 $AVENPORT 0H$ IS AN !SSOCI ATE 0ROFESSOR IN THE #OUNSELING 0SYCHOL OGY PROGRAM AT 4EXAS ! - WHERE HER RESEARCH AREAS INCLUDE ETHICS AND MULTICULTURAL ISSUES )N ADDITION TO HER TEACHING AND INDEPENDENT PRACTICE SHE IS THE FOUNDING DIRECTOR OF THE ,IFELONG ,EARN ING )NSTITUTE AT 4EXAS ! - #ONTACT HER AT DDAVENPORT COE TAMU EDU
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)T IS WITH HONOR THAT ) WRITE MY lRST 0RESIDENTIAL #OLUMN FOR THE 4EXAS 0SYCHOLOGIST ) WILL SHARE SOME ISSUES EVENTS AND THOUGHTS
!PPRECIATIONS ) WANT TO THANK 0AST 0RESIDENT 0AUL "UR NEY 0H$ FOR HIS INSPIRATIONAL AND DEDICATED CONTRIBUTIONS AS 0RESIDENT OF 40! FOR AS WELL AS OUTGOING "OARD OF 4RUSTEES MEM BERS 2ICHARD &ULBRIGHT 0H$ 2OBERTA .UTT 0H$ AND $EAN 0ARET 0H$ 7E ARE VERY LUCKY TO HAVE SUCH AN OUTSTANDING EX PERIENCED AND EFFECTIVE 40! STAFF INCLUDING $AVID 7HITE #!% AS %XECUTIVE $IRECTOR 3HERRY 2EISMAN AS $IRECTOR OF #ONVEN TION .ON $UES "OB -C0HERSON 0H$ AS $IRECTOR OF 0ROFESSIONAL !FFAIRS ,INDELL "ROWN -EMBERSHIP $IRECTOR AND ,YNDA +EEN %XECUTIVE !SSISTANT ) WOULD ALSO LIKE TO CONGRATULATE AND WELCOME OUR NEW OFlCER 2ON #OHORN 0H$ 0RESIDENT %LECT $ESIGNATE AND OUR NEW BOARD OF 4RUSTEES -EMBERS 6ERLIS 3ETNE 0H$ "RIAN 3TAG NER 0H$ AND 4OM 6AN (OOSE 0H$ OUR NEW "OARD OF 4RUSTEES MEMBERS ) WOULD ALSO LIKE TO EXPRESS APPRECIATION TO ,ANE /GDEN 0H$ FOR HAVING SERVED AS &EDERAL !DVOCACY #OORDINATOR HE WILL BE REPLACED BY /LLIE 3EAY 0H$ AND 3HERRY 2E ISMAN WILL CONTINUE IN HER ROLE AS OUR SECOND &!# ) WOULD ALSO LIKE TO THANK 2ICK -C 'RAW 0H$ FOR HIS MANY YEARS AS THE "USINESS OF 0RACTICE .ETWORK 2EPRESENTATIVE HE WILL BE REPLACED BY *ERRY 'RAMMER 0H$ #ATHERINE -ATHEWS 0H$ COORDINATED A VERY SUCCESSFUL SILENT AUCTION TO RAISE FUNDS AS 0RESIDENT OF THE 4EXAS 0SYCHOLOGICAL &OUNDATION 3HE WILL BE REPLACED BY %LIZABETH 2ICHESON 0H$ AND THE 0RESIDENT %LECT OF THE 40& IS 3HEILA *EN KINS 0H$ 0ATRICK %LLIS 0H$ HAS SERVED AS THE VERY ABLE 0RESIDENT OF 039 0!# AND WILL ÈÊ
BE REPLACED BY -IMI 7RIGHT 0H$ /UR $I SASTER 2ESPONSE .ETWORK #OORDINATORS *UDITH !NDREWS 0H$ AND 2ITA *USTICE 0H$ WHO WORKED SO HARD IN THE AFTERMATH OF (URRICANES +ATRINA AND 2ITA HAVE AGREED TO CONTINUE IN THEIR ROLES /UR #OMMUNICATIONS #OMMITTE #HAIRS %D $AVIDSON 0H$ AND 3UZANNE -OUTON /DUM 0H$ COORDINATED A GREAT EFFORT TO REMIND LEGISLATORS OF OUR PRESENCE BY DELIVERING SMALL REGULAR GIFTS TO EACH ONE DUR ING THE LEGISLATIVE SESSION AND IS CONTINUING IN THIS ROLE 3TUDENT INVOLVEMENT IN 40! IS CRU CIAL GIVEN THAT OUR STUDENTS ARE THE FUTURE OF OUR PSYCHOLOGICAL COMMUNITY !MY / .EILL WAS A VERY PRESENT AND ACTIVE REPRESENTATIVE OF STUDENTS AS AN EX OFlCIO MEMBER OF THE "OARD OF 4RUSTEES WE WELCOME $EBORAH (ORN AS THE NEW STUDENT REPRESENTATIVE ) AM ALSO DELIGHTED THAT $ONNA $AVEN PORT 0H$ AND "RIAN 3TAGNER 0H$ ARE CO EDITORS OF OUR 4EXAS 0SYCHOLOGIST AND ) LOOK FORWARD TO THEIR SCHOLARLY AND CREATIVE IM PRINT ON THIS JOURNAL 4HANKS ALSO TO ALL THE CHAIRS AND ACTIVE MEMBERS OF OUR $IVISIONS AND 3PECIAL )NTEREST 'ROUPS 7ITHOUT THE ENERGY COMMITMENT AND VISION OF OUR ACTIVE MEMBERS 40! WOULD NOT HAVE THE VIBRANCY AND EFFECTIVENESS THAT IT DOES
-AINTAIN $OCTORATE AS THE -INIMAL 2EQUIREMENT TO BE A 0SYCHOLOGIST *UST AS WE ARE OUT OF A VERY SUCCESSFUL 3UNSET ,EGISLATIVE YEAR THE ,ICENSED 0SY CHOLOGICAL !SSOCIATES HAVE PROPOSED NEW RULES TO THE 4EXAS 3TATE "OARD OF %XAMIN ERS OF 0SYCHOLOGISTS 43"%0 TO ATTEMPT TO
GAIN INDEPENDENT PRACTICE OF PSYCHOLOGY /N .OVEMBER SEVERAL 40! OFlCERS AND MEMBERS PROVIDED PUBLIC COMMENT TO TESTIFY ON BEHALF OF THE PROFESSION OF PSY CHOLOGY !S YOU KNOW 4EXAS 0SYCHOLOGICAL !SSOCIATION MAINTAINS THAT THE DOCTORATE IS THE MINIMAL REQUIREMENT FOR THE INDEPEN DENT PRACTICE OF PSYCHOLOGY 4HE !MERICAN 0SYCHOLOGICAL !SSOCIATION AND VIRTUALLY EVERY STATE IN THE NATION DO SO AS WELL )N ADDITION WE STRONGLY OPPOSE THE 43"%0 DEALING WITH THE CURRENT RULES PERTAINING TO THE PRACTICE OF PSYCHOLOGICAL ASSOCIATES AS WE BELIEVE THAT THE 3TATE ,EGISLATURE SHOULD DEAL WITH SCOPE OF PRACTICE AND TITLE CHANGE ISSUES ,0!S ARGUE THAT THEY CANNOT PRACTICE INDEPENDENTLY YET THEY ARE ABLE TO OBTAIN OTHER CREDENTIALS RECOGNIZED BY EMPLOYERS AND THIRD PARTY PAYORS SUCH AS ,ICENSED 0ROFESSIONAL #OUNSELORS ,0#S ,ICENSED -ARRIAGE AND &AMILY 4HERAPISTS ,-&4S AND ,ICENSED #HEMICAL $EPENDENCY #OUN SELORS ,#$#S 3OME HOLD DUAL LICENSURE AS ,ICENSED 3PECIALISTS IN 3CHOOL 0SYCHOLOGY ,330 TO PRACTICE IN THE SCHOOLS )T WOULD BE A DISSERVICE TO CONFUSE THE PUBLIC BY PRETENDING THAT THERE ARE NOT VASTLY DIFFER ENT EDUCATIONAL AND LICENSING REQUIREMENTS BETWEEN ,0!S AND 0SYCHOLOGISTS /UR 40! %XECUTIVE #OMMITTEE "OARD OF 4RUSTEES AND STAFF ARE WORKING HARD TO PREVENT THIS CHANGE AND HAVE SENT A #ALL FOR !CTION TO THE MEMBERSHIP 7E WILL CONTINUE TO NEED LONG TERM SUPPORT AS WE CONTINUE TO PROMOTE OUR STRATEGIES %XECUTIVE $IRECTOR $AVID 7HITE #!% ADDRESSES THESE ISSUES IN MORE DEPTH IN HIS COLUMN IN THIS ISSUE OF THE 4EXAS 0SYCHOLOGIST ÊÊÊÊÊ7 / ,ÊÓääÈÊ
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3UMMIT ON )MMIGRATION /NE OF THE GOALS OF MY PRESIDENTIAL YEAR IS TO HIGHLIGHT DIVERSITY IN PSYCHOLOGY !S SUCH 4EXAS 0SYCHOLOGICAL !SSOCIATION IS COSPONSORING WITH SEVERAL $IVISIONS OF THE !MERICAN 0SYCHOLOGICAL !SSOCIATION %XPERT 3UMMIT ON )MMIGRATION h'LOBAL 2EALITIES )NTERSECTIONS AND 4RANSITIONSv ON &EBRUARY IN 3AN !NTONIO 9OU ARE ALL INVITED TO ATTEND THIS ONE DAY CONFERENCE 4HROUGH HIS hFOCUS ON FAM ILYv PLATFORM !0! 0RESIDENT %LECT $R +OOCHER PLANS TO SPOTLIGHT THREE AREAS THAT SPAN ALL OF PSYCHOLOGY S CONSTITUENCIES
$EPARTMENT OF 3OCIOLOGY AT THE 5NIVERSITY OF !LBANY 35.9 HAD OVERALL RESPONSIBILITY FOR THE .ATIONAL 2ESEARCH #OUNCIL REPORT TITLED &ROM 'ENERATION TO 'ENERATION 4HE (EALTH AND 7ELL "EING OF #HILDREN IN )MMI GRANT &AMILIES AND #HILDREN OF )MMIGRANTS (EALTH !DJUSTMENT AND 0UBLIC !SSISTANCE $R #AROLA 3UAREZ /ROZCO #O $IREC TOR OF )MMIGRATION 3TUDIES AT .95 AND CO AUTHOR OF #HILDREN OF )MMIGRATION AND 4RANSFORMATIONS -IGRATION &AMILY ,IFE AND !CHIEVEMENT -OTIVATION !MONG ,ATINO !DO LESCENTS 3HE IS ALSO THE CO EDITOR OF THE AWARD
!0! 0RESIDENT %LECT $R +OOCHER PLANS TO SPOTLIGHT THREE AREAS THAT SPAN ALL OF PSYCHOLOGY S CONSTITUENCIES ONE OF WHICH IS $IVERSITY IN 0SYCHOLOGY ONE OF WHICH IS $IVERSITY IN 0SYCHOLOGY h/UR SOCIETY IS BECOMING DIVERSE IN WAYS THAT COULDN T HAVE BEEN IMAGINED YEARS AGO v SAYS +OOCHER NOTING THAT NOT ONLY ARE MINORITY POPULATIONS GROWING BUT SO ARE TRANSRACIAL MARRIAGES AND INTERNATIONAL ADOPTIONS h0SYCHOLOGY HAS THE POTENTIAL TO HELP TO MOVE !MERICA IN GREATER AC CEPTANCE OF MULTICULTURALISM v #ONlRMED PLENARY SPEAKERS INCLUDE $R -ARY 0IPHER #LINICAL 0SYCHOLO GIST AND AN !DJUNCT #LINICAL 0ROFESSOR AT THE 5NIVERSTY OF .EBRASKA 3HE IS ALSO .9 4IMES BESTSELLING AUTHOR OF 2EVIVING /PHE LIA AND )N THE -IDDLE OF %VERYWHERE IN WHICH SHE hUNITES REFUGEES PEOPLE WHO mED SOME OF THE MOST REPRESSIVE REGIMES IN THE WORLD WITH ALL OF USxv
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#ONTINUING %DUCATION CREDIT IS PROVID ED BY THE 3OCIETY OF #OUNSELING 0SYCHOL OGY $IVISION APPROVED BY !0! TO OF FER CONTINUING EDUCATION FOR PSYCHOLOGISTS $IVISION MAINTAINS RESPONSIBILITY FOR THE #% PROGRAM !DDITIONAL INFORMATION INCLUDING REGISTRATION CAN BE FOUND AT HTTP WWW REISMAN WHITE COM AND CLICK $R $ONALD * (ERNANDEZ 0ROFESSOR IN THE ON THE #ONFERENCE 2EGISTRATIONS LINK
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3OCIAL *USTICE 4ASK &ORCE AND 0SYCHOLOGY IN THE 0UBLIC )NTEREST 4HE INTERESTS OF 40! MEMBERSHIP AND 4EXAS PSYCHOLOGISTS ARE BROAD AND ) AM VERY INTERESTED IN SUPPORTING THE CONTINUING EF FORTS TO BUILD OUR ,EGISLATIVE INmUENCE TO PROMOTE PRESCRIPTION PRIVILEGES AND TO MAKE OUR ASSOCIATION ONE THAT APPEALS TO A WIDE VARIETY OF INTERESTS AMONG US ) AM CONTINUOUSLY MOTIVATED TO hMAKE THE CIRCLE WIDERv TO INCLUDE MORE DIVERSITY INTO THE PSYCHOLOGICAL COMMUNITY OF THIS STATE !S SUCH ) HAVE APPOINTED A 3OCIAL *USTICE 4ASK &ORCE TO EXPLORE AND REPORT THE KNOWL EDGE BASE ABOUT ISSUES RELATED TO VARIOUS MARGINALIZED GROUPS IN SOCIETY INCLUDING ETHNIC MINORITY PERSONS WOMEN THE AGED PERSONS WITH DISABILITIES IMMIGRANTS GAY LESBIAN BISEXUAL TRANSGENDERED PERSONS AND THE POOR /NE ACTIVITY OF THE 4ASK &ORCE IS TO PROVIDE REGULAR ARTICLES TO THE 4EXAS 0SYCHOLOGIST IN THE COLUMN h0SYCHOLOGY IN THE 0UBLIC )NTEREST v &ORMER 40! 0RESIDENT 2ICK -C'RAW 0H$ SERVES AS #HAIR OF THIS 4ASK &ORCE /THER MEMBERS INCLUDE $RS #HARLES -C$ONALD $EAN 0ARET /LLIE 3EAY 3ELIA 3ERVIN ,OPEZ .ATHAN 3MITH { $AVID 7EIGLE AND !LISON 7ILSON 4HE 4EXAS 0SYCHOLOGIST INCLUDES ARTICLES THAT SUPPORT THE PROFESSIONAL PRACTICE OF PSYCHOLOGY THE EDUCATION AND TRAINING OF PSYCHOLOGY THE SCIENCE OF PSYCHOLOGY AS WELL AS THE PUBLIC INTEREST OF PSYCHOLOGY h0SYCHOL OGY IN THE 0UBLIC )NTERESTv IS A COLUMN THAT HAS BEEN DEVELOPED IN ORDER TO COMMUNICATE SOME OF THE EXCITING PSYCHOLOGICAL RESEARCH AND KNOWLEDGE THAT INFORMS US ABOUT ISSUES RELEVANT TO MARGINALIZED GROUPS IN SOCIETY $OING SO ALLOWS FOR US TO CONVEY KEY INFOR MATION TO THE MEMBERSHIP AS A MEANS OF PRO MOTING HUMAN WELFARE AN IMPORTANT PART OF 40! S MISSION "ECAUSE SOME OF THE TOPICS MAY BE CONTROVERSIAL IN NATURE WE PROVIDE A DISCLAIMER INDICATING THAT THE POSITIONS IN THE ARTICLES ARE NOT INTENDED TO REPRESENT OF lCIAL 40! POLICY UNLESS SUCH POLICY HAS BEEN ENDORSED BY THE "OARD OF 4RUSTEES / ร
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LEASE DON T POP THE CHAMPAGNE BOTTLE YET !S A MATTER OF FACT YOU MIGHT WANT TO KEEP IT ON ICE FOR A WHILE LONGER 4HE SUCCESS AND CELEBRATION THAT THE 4EXAS 0SYCHOLOGICAL !SSOCIATION EXPERIENCED WITH THE PASSAGE OF THE 4EXAS 3TATE "OARD OF %XAMINERS OF 0SYCHOLOGISTS SUNSET LEGISLATION (" HAS BEEN SHORT LIVED AT LEAST FOR NOW !S EACH OF YOU KNOW 43"%0 HAS BEEN RE AUTHORIZED BY THE STATE LEGISLATURE TO REGULATE PSYCHOLOGISTS AS AN INDEPENDENT BOARD FOR THE NEXT YEARS A FEAT THAT REQUIRED A TREMENDOUS AMOUNT OF 40! S TIME AND RESOURCES 7ITH THE BEGINNING OF THIS YEAR RENEWAL STARTING IN 3EPTEMBER THE lRST DILEMMA THAT THE 43"%0 WAS GREETED WITH WAS THE RE QUEST FROM 4EXAS !SSOCIATION OF 0SYCHOLOGICAL !SSOCIATES TO CHANGE RULES ALLOWING LICENSED PSYCHOLOGICAL ASSOCIATES TO PRACTICE INDEPEN DENTLY $URING THE RECENT PASSAGE OF (" THE 0SYCHOLOGICAL !SSOCIATE !DVISORY #OM MITTEE 0!!# WAS ELIMINATED 4HE PURPOSE OF THE 0!!# WAS TO RECOMMEND RULES TO THE 43"%0 RELATED TO THE SUPERVISION REQUIREMENTS FOR 0! S IN CATEGORIES THOSE WITH FEWER THAN YEARS EXPERIENCE AND THOSE WITH MORE THAN YEARS EXPERIENCE 7ITH THE ELIMINATION OF THIS 0!!# 4!0! HAS hSPUNv THIS INTO A LEGAL ISSUE AND HAS INTERPRETED THE NEW LAW AS THE ABILITY TO PRACTICE ).$%0%.$%.4,9 WITHOUT THE SU PERVISION OF PSYCHOLOGIST )N ESSENCE THEY ARE LOOKING AT PRACTICE PARITY WITH PSYCHOLOGISTS 4HIS WOULD EFFECTIVELY ERODE PSYCHOLOGY S IDEN TITY AS A DOCTORAL LEVEL PROFESSION IN THE PUBLIC MIND WITH DISASTROUS RESULTS FOR OURSELVES AND FOR THE PUBLIC
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4EXAS 0SYCHOLOGICAL !SSOCIATION /F lCERS MEMBERS AND STAFF ATTENDED A MEET ING OF THE 43"%0 ON .OVEMBER TO ADDRESS CONCERNS ABOUT PROPOSED RULES !T THIS MEETING 40! WAS $%.)%$ THE OPPORTUNITY TO BE LISTED ON THE AGENDA TO RESPOND TO THESE ISSUES DESPITE THE FACT THAT IN THE PREVIOUS 43"%0 MEETING *ULY 4!0! WAS ACCORDED SUCH A PRIVILEGE AS THEY PRESENTED THEIR PROPOSED RULES !S A RESULT 40! OFlCERS WERE FORCED TO RESPOND IN THE hPUBLIC COMMENTSv SECTION OF THE .OVEM BER MEETING !LLOWING PUBLIC COMMENT IS MANDATED BY STATE LAW TO ALLOW hTHE PUBLICv A VOICE IN EVERY GOVERNMENT MEETING 40! ARGUED THAT 3UNSET !DVISORY #OMMISSION WAS CLEAR IN ITS ORIGINAL CHARGE THAT SCOPE OF PRACTICE ISSUES WOULD NOT BE ENTERTAINED DURING THE LEGISLATIVE SESSION AND THEREFORE THE INTENT OF (" WAS NOT A VEHICLE TO DEAL WITH SCOPE OF PRACTICE ISSUES 4HE RULES OF PRACTICE FOR 4EXAS PSYCHOLOGISTS CLEARLY STATE THAT SUPERVISION IS REQUIRED FOR PSYCHOLOGICAL ASSOCIATES "OARD 2ULE H ,ICENSED PSYCHOLOGICAL ASSOCIATES AND PROVISIONALLY LICENSED PSYCHOLOGISTS MUST BE UNDER THE SU PERVISION OF A LICENSED PSYCHOLOGISTS AND MAY NOT ENGAGE IN INDEPENDENT PRACTICE 4HIS RULE OR PREVIOUS VERSIONS HAS BEEN IN PLACE FOR DECADES IN RECOGNITION OF THE DOCTORAL STANDARD FOR INDEPENDENT PRAC TICE AS A PSYCHOLOGIST )N SHORT WITH POS SIBLE RULE CHANGES FROM 43"%0 WE FACE A BATTLE WITH THOSE ATTEMPTING TO LOWER THE EDUCATIONAL AND EXPERIENCE REQUIREMENTS FOR BECOMING A PSYCHOLOGIST
7E PRESENTED THE FOLLOWING ARGUMENTS TO THE 3TATE "OARD s 4HE ESTABLISHMENT OF THE 43"%0 WAS FORMALLY PROPOSED TO THE LEGISLATURE BY THE 4EXAS 0SYCHOLOGICAL !SSOCIATION IN ACCORDANCE TO UNIFORM NATIONAL STAN DARDS SPECIFICALLY DESIGNED TO PROTECT THE PUBLIC BY ENSURING THAT THE BROAD SCOPE OF PSYCHOLOGICAL SERVICES WOULD BE RENDERED DIRECTLY BY OR SUPERVISED BY QUALIFIED PSYCHOLOGISTS WHO WOULD ADHERE TO ESTABLISHED PROFESSIONAL STAN DARDS OF PRACTICE s 4HE !MERICAN 0SYCHOLOGICAL !SSOCIATION HAS A LONG AFlRMED THE DOCTORATE AS THE MINIMUM EDUCATIONAL REQUIREMENT FOR ENTRY INTO INDEPENDENT PRACTICE AS A PSYCHOLOGIST s 4HE 4EXAS LICENSING REQUIREMENTS FOR PSY CHOLOGISTS ARE DIRECTLY LINKED TO ACADEM IC TRAINING ACCREDITATION STANDARDS FOR MALLY APPROVED BY THE NATIONAL #OUNCIL FOR (IGHER %DUCATION !CCREDITATION s %DUCATIONAL AND LICENSING REQUIREMENTS DIFFER VASTLY BETWEEN LICENSED PSYCHO LOGICAL ASSOCIATES LICENSED SPECIALISTS IN SCHOOL PSYCHOLOGY AND PSYCHOLOGISTS s $URING THE SUNSET PROCESS THE 3UNSET #OMMISSION STAFF STATED THAT hx CUR RENT RULE LANGUAGE IS CLEAR AND UNAM BIGUOUS AS TO THE SPECIlC FUNCTIONS OF THE LICENSED PSYCHOLOGISTS AND PSYCHO LOGICAL ASSOCIATES v )N ADDITION 2EP 3OLOMON AND THE 3UNSET #OMMISSION EXPLICITLY STATED THAT SUNSET BILLS WERE ./4 ).4%.$%$ TO DEAL WITH SCOPE OF PRACTICE ISSUES
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0SYCHOLOGIST ^ YEARS OF ORGANIZED GRADUATE STUDY AS PER !0! STANDARDS
%DUCATION $ISSERTATION BASED ON ORIGINAL RESEARCH
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YEAR OF PRE DOCTORAL INTERNSHIP
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YEAR OF POSTDOCTORAL SUPERVISION
s 4HERE ARE UNIVERSITIES IN 4EXAS PREPAR ING PSYCHOLOGISTS 4HESE PROGRAMS MEET !0! ACCREDITATION STANDARDS 4HE FACULTY WHO TEACH IN THESE PROGRAMS ARE LICENSED PSYCHOLOGISTS s 3OME PSYCHOLOGICAL ASSOCIATES MAY POS SESS APPROPRIATE TRAINING FOR ELIGIBILITY AS ,ICENSED 0ROFESSIONAL #OUNSELORS ,0# ,ICENSED -ARRIAGE AND &AMILY THERAPISTS ,-&4 OR ,ICENSED #HEMICAL $EPEN DENCY #OUNSELORS ,#$# s 'OVERNMENT -EDICARE AND MANAGED CARE GUIDELINES SPECIFY THAT PSYCHOLOGICAL SERVICES MUST BE PROVIDED BY A DOCTORAL PSYCHOLOGIST 3COPE OF PRACTICE E G INDEPENDENT PRACTICE AND TITLE CHANGES E G ELIMINATING !SSOCIATE FROM TITLE WILL NOT OTHERWISE QUALIFY MASTER LEVEL PERSONS FOR REIMBURSEMENT
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^ YEARS OF ORGANIZED GRADUATE STUDY AS PER !0! AND .!30 STANDARDS
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ÌiÃÊvÀ Ê ÕÀÊÀi>`iÀÃ\ ,AST ISSUE S INAUGURAL PIECE ON 0SYCHOLOGY IN THE 0UBLIC )NTEREST DEALT WITH THE BALLOT ISSUE TO AMEND THE 4EXAS #ONSTITUTION TO PROHIBIT GAY MARRIAGE 7E RECEIVED SEVERAL INFORMAL COMMENTS ON THE 0UBLIC )NTEREST 4ASK &ORCE )N ADDITION WE HEARD FROM 2ICHARD (OLT ,YNNE 3HEPHERD AND -IGUEL 9BARRA 4HEY NOTED THAT .ATHAN 'RANT 3MITH S ORIGINAL ARTICLE DIDN T MENTION AN IMPORTANT POLICY ISSUE )N THEIR WORDS 7E ARE SCIENTIST PRACTITIONERS WHO BASE OUR PROFESSIONAL ACTIONS UPON SCIENTIl C EVIDENCE AND THE 0SYCHOLOGIST S #ODE OF %THICS !T THE NATIONAL CONVENTION THE !0! #OUNCIL OF 2EPRESENTATIVES ADOPTED A RESOLUTION SUPPORTING CIVIL MARRIAGE FOR SAME SEX COUPLES AND OPPOSING DISCRIMINATION AGAINST SAME SEX PARENTS 4HE VOTE WAS UNANIMOUS )N DOING SO THE NATIONAL COUNCIL RECOGNIZED THE OVERWHELMING SCIENTIl C EVIDENCE THAT SAME SEX COUPLES ARE NO LESS PSYCHOLOGICALLY HEALTHY OR LESS COMPETENT AS PARENTS THAN ARE HETEROSEXUAL COUPLES AND PSYCHOLOGY S ETHICAL MANDATE TO CONTRIBUTE TO THE PUBLIC GOOD BY TAKING A CLEARLY FORMULATED STANCE REGARDING THIS IMPORTANT PUBLIC POLICY ISSUE
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)NTRODUCTION
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HE MASSIVE DESTRUCTION OF THE 'ULF #OAST AND THE WHOLE SCALE EVACUATION OF .EW /RLEANS IN THE AFTERMATH OF (URRICANE +ATRINA HAVE BROUGHT INTO SHARP FOCUS THE NOT ONLY THAT A NATURAL DISASTER CAN OVERWHELM THE ABILITY TO PROVIDE BASIC HUMAN SERVICES BUT THE VULNERABILITY OF THE MORE FRAGILE SECTORS OF OUR SOCIETY BOTH DURING AND AFTER SUCH A DISASTER /NE OF THE MORE TRAGIC EXAMPLES WAS THE PLIGHT OF THE POOR WHO HAD FEW IF ANY OPTIONS FOR SURVIVAL ! PARTICULARLY FRAGILE SUBSET OF THAT GROUP IS THE MEDICALLY AND OR MENTALLY ILL WHO ARE DEPENDENT ON A SUPPORTIVE HEALTH CARE SYSTEM TO MAINTAIN THE ABILITY TO FUNCTION AT SOME LEVEL OF INDEPENDENCE IN DAILY LIFE )N THIS ARTICLE THE AUTHORS EXAMINE THE LINK BETWEEN POVERTY AND MENTAL ILLNESS AND SUGGEST WAYS IN WHICH PUBLIC POLICY AND PERSONAL PERSPECTIVES INmUENCE OUR PROFESSIONAL RESPONSE 4HE OBJECTIVE IS BOTH TO ENCOURAGE MORE OPEN DISCUSSION ON THESE ISSUES AND TO CHALLENGE OUR PROFESSION TO BECOME MORE ACTIVE IN RESPONDING TO THE NEEDS 7 / ,ÊÓääÈÊ
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7HO !RE THE 0OOR )N OF THE POPULATION OF THE 5NITED 3TATES WAS CLASSIlED AS AT OR BE LOW POVERTY LEVEL AND 4EXAS EXCEEDED THAT NATIONAL RATE WITH OF ITS POPULATION LIVING IN POVERTY 5 3 #ENSUS "UREAU 4ABLE 0/6 0OVERTY IS DISPROPORTIONATE AMONG PERSONS WHO ARE "LACK AND (ISPANIC AS COMPARED TO 7HITES 5 3 #ENSUS "UREAU 4ABLE " )N FACT RATES OF POVERTY ARE GREATEST FOR
FAMILIES HAVING A SINGLE FEMALE HEAD OF HOUSE HOLD IN PARTICULARLY IF THE FAMILY IS BLACK OR (ISPANIC IN WHICH CASE THE COMBINED RATE SOARS TO JUST UNDER 5 3 #ENSUS "UREAU 4ABLES " AND " %LDERLY POPULATIONS SHOW SIMILAR TRENDS WITH OF ALL RACES LIVING IN POVERTY OF 7HITES OF "LACKS AND OF (ISPANIC PERSONS AT OR BELOW THE POVERTY LINE 5 3 #ENSUS "UREAU 4ABLE "
AL 4HERE ARE AT LEAST TWO COMPETING EXPLANATIONS FOR THIS STATE OF AFFAIRS )N THE SOCIAL CAUSATION HYPOTHESIS STRESSORS IN VOLVED IN BEING POOR ARE BELIEVED TO RESULT IN INCREASED LEVELS OF MENTAL DISORDERS WHILE THE DOWNWARD DRIFT OR SOCIAL SELECTION HYPOTH ESIS DESCRIBES THE PROCESS BY WHICH THOSE WITH MENTAL ILLNESSES LOSE STATUS AND MOVE TO THE POOREST AND LOWEST LEVELS OF SOCIETY BECAUSE THEY ARE UNABLE TO FUNCTION EFFECTIVELY WITHIN HIGHER LEVELS AND BECAUSE OF THE STIGMA AS
SOCIATED WITH THEIR MENTAL ILLNESS $ICKEY "LUMBERG $OHRENWEND ET AL (UDSON
4HE LITERATURE ON STRESS AND COPING SPE CIlCALLY THE TRANSACTIONAL MODEL OF ,AZARUS AND &OLKMAN WOULD APPEAR TO SUP PORT THESE EXPLANATIONS 4HIS MODEL NOTED THAT THE PRESENCE OF LIFE STRESSORS MODERATES COPING RESPONSES AND DEPLETES RESOURCES AND CAN RESULT IN ANXIETY AND OR DEPRESSION 0ERSONS WITH LOWER SOCIOECONOMIC STATUS )N ADDITION #OPING 3ELF %FlCACY 4HEORY 3%3 HAVE CONSISTENTLY BEEN FOUND TO HAVE "ENIGHT ET AL SUGGESTS THAT THE HIGHER RATES OF PSYCHIATRIC DISORDERS (UDSON IMPACT OF LOSS OF RESOURCES ON STRESS RELATED ,EE #URRAN 3URGEON 'ENER TO TRAUMA IS MEDIATED THROUGH INDIVIDUAL S ยฃร ร
BELIEFS IN THEIR ABILITY TO COPE 3OCIAL SUP PORT IS A FACTOR IN REDUCING TRAUMA RELATED STRESS BY BOLSTERING FEELINGS OF SELF EFlCACY "ENIGHT ET AL 0EOPLE WHO HAVE BEEN SEPARATED FROM FAMILIAR OTHERS AS IN DISASTERS MAY FEEL A LACK OF SOCIAL SUPPORT WHICH AFFECTS THEIR COGNITIVE APPRAISAL ABOUT THEIR OWN CAPABILITY TO HANDLE DEVASTATING EVENTS AND WHEN COMMUNITY MEMBERS ARE SEPARATED THERE MAY BE A REDUCTION IN THE COLLECTIVE COPING ABILITIES OF THE INDIVIDUALS AND THE GROUP "ANDURA 3O PEOPLE WHO HAVE TO DEAL WITH SEVERAL SOURCES OF LIFE STRESS AT THE SAME TIME E G POVERTY HOMELESSNESS UNEMPLOYMENT ETC WILL HAVE FEWER RESOURCES TO DEAL WITH A NEW STRESSOR E G NATURAL DISASTER ETC THAN OTHERS WHO HAVE FEWER STRESSORS )NDEED THE CAUSES OF MANY MENTAL DISORDERS MAY BE MORE STRONGLY RELATED TO ADVERSITY IN THE ENVIRONMENT THAN COMPARABLE CHRONIC PHYSICAL HEALTH DISORDERS HEART DISEASE CANCER WHICH MAY BE CAUSED BY SUCH NARROW AND MODIlABLE RISK FACTORS AS SMOKING AND DIET +ESSLER #OSTELLO 2IES -ERIKANGAS 5STUN 4HE STRESS OF ECONOMIC HARDSHIP AND ITS RESULTING NEGATIVE EFFECTS ON PSYCHOLOGICAL WELL BEING HAVE BEEN FOUND TO PERSIST FROM CHILDHOOD THROUGH ADOLESCENCE ADULTHOOD AND INTO LATE ADULTHOOD %VANS 'ONNELLA -ARCYNYSZYN 'ENTILE 3ALPEKAR 3OBOLEWSKI !MATO )N A STUDY OF CHILDREN THROUGHOUT THE 5NITED 3TATES THOSE CHILDREN IN HOUSEHOLDS AT OR BELOW POVERTY LEVEL HAD A HIGHER PROPORTION OF MENTAL AND EMOTIONAL DISABILITIES THAN ANY OTHER SOCIOECO NOMIC GROUP SUCH THAT POVERTY ALONE CAN BE SEEN AS A POWERFUL RISK FACTOR FOR MENTAL DIS ORDERS IN CHILDHOOD #OLPE #HILDREN WITH PSYCHIATRIC DISORDERS TERMINATE THEIR EDU CATION PREMATURELY WITH VERY FEW COMPLETING HIGH SCHOOL OR COLLEGE THUS ADVERSELY AFFECTING THEIR OWN LATER LIFE COURSES AND AFFECTING SO CIETY IN TERMS OF LACK OF CONTRIBUTIONS TO THE WORKFORCE AND THE COMMUNITY AS WELL AS PLAC ING DEMANDS ON SOCIAL SERVICES +ESSLER &OSTER 3AUNDERS 3TANG ร ร ร ร ร 7 / ,ร ร รครคร ร
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FACED BY MENTAL HEALTH PROFESSIONALS INTER ESTED IN WORKING WITH LOW INCOME ADULTS AND FAMILIES INCLUDE GOVERNMENT REGULA TIONS AND RESTRICTIONS INCLUDING THE LACK OF FUNDING FOR STATE AND FEDERAL MENTAL HEALTH INITIATIVES .!2-( AND RECENT CUTS TO MENTAL HEALTH SERVICES ! RECENT ILLUSTRA TION OF FUNDING CUTS IN 4EXAS OCCURRED WHEN THE TH ,EGISLATIVE 3ESSION MADE CHANGES IN -EDICAID .AMELY -EDICAID COVERAGE WAS DISCONTINUED FOR CERTAIN MENTAL HEALTH SER VICES PROVIDED BY PSYCHOLOGISTS AND OTHERS )N PARTICULAR THE -EDICAID 0ROVIDER -ANUAL 4EXAS -EDICAID (EALTHCARE 0ARTNERSHIP INDICATED AFTER THAT LEGISLATIVE SESSION THAT h/UTPATIENT BEHAVIORAL HEALTH SERVICES BY A PSYCHOLOGIST FOR CLIENTS YEARS OF AGE AND OLDER ARE NOT A BENElT OF THE 4EXAS -EDICAID 0ROGRAM UNLESS PERFORMED IN AN &1(# FEDERALLY QUALIlED HEALTH CENTER SET TINGv 4-(0 P !S A RESULT OF THESE CHANGES PROVIDING SERVICES FOR LOW IN COME ADULTS IN 4EXAS BECAME EVEN MORE CHAL LENGING FOR NOT ONLY THE RECIPIENT WANTING TO ACCESS QUALITY CARE BUT ALSO THE PRACTITIONER INTERESTED IN PROVIDING THAT CARE $ESPITE THE FACT THAT THE TH ,EGISLATURE REINSTATED THESE SERVICES LOCATING FUNDING TO PAY FOR THEM WAS DELAYED UNTIL $ECEMBER
/THER ASPECTS TO CONSIDER ARE PRACTITIONERS ATTITUDES TOWARDS PROVIDING SERVICES TO LOW IN COME POPULATION AND THE OBSTACLES COMMONLY FACED BY THOSE WHO ARE INTERESTED IN WORKING WITH THE POOR OR ARE ALREADY DOING SO (IS TORICALLY ATTITUDES TOWARDS THE POOR HAVE BEEN OVERWHELMINGLY NEGATIVE IN THE 5NITED 3TATES #OZZARELLI 7ILKINSON 4AGLER "ULL OCK )N PARTICULAR PERCEPTIONS OF THE POOR TEND TO REmECT ATTITUDES AND STEREOTYPES THAT ATTRIBUTE POVERTY TO PERSONAL FAILINGS RATH ER THAN SOCIOECONOMIC STRUCTURES OR SYSTEMS 1UADAGNO 3TEREOTYPED BELIEFS ABOUT LOW INCOME PEOPLE ARE WIDESPREAD AND SERVE TO MAINTAIN NEGATIVE ATTITUDES AND ATTRIBUTIONS SUCH THAT THERE IS A hDISTANCING FROM THE POORv BY THOSE IN THE MIDDLE AND UPPER CLASSES ,OTT ,OTT "ULLOCK 7ILLIAMS ,IMBERT 2EASONS FOR THESE lNDINGS HAVE BEEN ATTRIBUTED TO PEOPLE HAVING A HIGH JUST WORLD BELIEF A BELIEF THAT THE WORLD IS A JUST PLACE AND THAT PEOPLE GET WHAT THEY DESERVE #ORYN /THERS HAVE SUGGESTED !MERICANS FAVOR THE USE OF INDIVIDUALISTIC INTERNAL ATTRIBUTIONS TO EXPLAIN POVERTY BECAUSE IT IMPLIES AN ELE MENT OF INDIVIDUAL CONTROL &OR EXAMPLE CIT ING A PERSON S hLOW MORALITYv OR hLAZINESSv TO EXPLAIN WHY AN INDIVIDUAL OR FAMILY IS LIVING IN POVERTY "ULLOCK ET AL #OZZARELLI ET AL (OW $OES 4REATING THE 0OOR ,IKEWISE ATTRIBUTIONS FOR POVERTY HAVE !FFECT 5S !S A 3OCIETY ALSO BEEN CORRELATED WITH SOCIO DEMOGRAPHIC 4HE LACK OF ADEQUATE MENTAL HEALTH SERVIC VARIATIONS I E AGE GENDER ETHNICITY ETC ES FOR PERSONS IN IMPOVERISHED MINORITIES HAS BEEN WELL ESTABLISHED 4HE 3URGEON 'ENERAL S !LTHOUGH THE ATTITUDES OF MENTAL HEALTH REPORT OF FOUND THAT MINORITIES HAVE PROFESSIONALS PROVIDING SERVICES TO LOW IN LESS ACCESS TO MENTAL HEALTH SERVICES AND ARE COME ADULTS AND FAMILIES HAVE NOT BEEN FOR LESS LIKELY TO RECEIVE NEEDED SERVICES )N AD MALLY EXAMINED STUDIES HAVE FOUND A HIGHER DITION THE SERVICES PROVIDED ARE OFTEN LESSER RATE OF BURN OUT FOR THERAPISTS WORKING IN QUALITY TREATMENT THAN IS RECEIVED BY MAJOR GOVERNMENT FUNDED COMMUNITY MENTAL ITY POPULATIONS 4HE REPORT CONCLUDES THAT HEALTH CLINICS AND LOW INCOME RURAL SETTINGS THESE DISPARITIES PLACE A GREATER BURDEN ON THE 0ROSSER ET AL +EE *OHNSON (UNT POOR RESULTING IN hGREATER LEVELS OF DISABILITY 4HE MOST COMMON REASONS ATTRIBUTED IN TERMS OF LOST WORKDAYS AND LIMITATIONS IN TO HIGH BURN OUT INCLUDE EMOTIONAL EXHAUS DAILY ACTIVITIESv $EPARTMENT OF (EALTH AND TION LACK OF SOCIAL SUPPORT FROM COLLEAGUES (UMAN 3ERVICES 4HE REPORT FURTHER AND STRESS ASSOCIATED WITH INDIVIDUALS WHO CONCLUDES THAT h"ECAUSE OF DISPARITIES IN HAVE MULTIPLE CONDITIONS /THER OBSTACLES MENTAL HEALTH SERVICES A DISPROPORTIONATE 7 / ,ร ร รครคร ร
NUMBER OF MINORITIES WITH MENTAL ILLNESSES DO NOT FULLY BENElT FROM OR CONTRIBUTE TO THE OPPORTUNITIES AND PROSPERITY OF OUR SOCI ETY v (UDSON IN A STUDY ON THE LINK BETWEEN SOCIOECONOMIC STATUS AND MENTAL ILLNESS CONCLUDED THAT THE POORER A PERSON S SOCIOECONOMIC CONDITIONS THE GREATER THE RISK OF A MENTAL ILLNESS AND PSYCHIATRIC HOSPITAL IZATION 4HIS RESEARCH DID NOT SUPPORT A DI RECT CAUSE EFFECT RELATIONSHIP BETWEEN POVERTY AND MENTAL ILLNESS AND PERHAPS IT IS WELL THAT IT DID NOT BECAUSE SUCH A CONNECTION COULD SERVE TO ADD TO THE ALREADY PRESENT STIGMA ATTACHED TO BEING POOR AND HAVING A MENTAL ILLNESS IN OUR CULTURE /BVIOUSLY THE INADEQUACY OF OUR MENTAL HEALTH SERVICE SYSTEM HAS PROFOUND SOCIAL AND PERSONAL CONSEQUENCES FOR THE POOR "UT THE DELETERIOUS EFFECTS ALSO HAVE AN IMPACT ON OUR SOCIETY IN GENERAL THROUGH THE ADDED COSTS OF LOST LIVES DISRUPTED FAMILIES AND GREATER COSTS IN GENERAL MEDICAL SERVICES AND THE CRIMINAL JUSTICE SYSTEM )NVESTING IN A MEN TAL HEALTH SYSTEM THAT ADDRESSES THE NEEDS OF THIS POPULATION HAS THE POTENTIAL TO IMPROVE NOT ONLY THE LIVES OF THOSE DIRECTLY AFFECTED BUT OUR SOCIETY AS A WHOLE &OR EXAMPLE AN INTERESTING lNDING IN (UDSON S STUDY WAS THAT PATIENTS HOSPITALIZATION EX PERIENCES OFTEN SERVED TO REENGAGE THEM IN EMPLOYMENT ACTIVITIES AND THAT PATIENTS WHO RECEIVED CARE COULD MOVE UP ECONOMICALLY &ROM A PERSONAL POINT OF VIEW THE RECLAIMING OF ONE S ECONOMIC POTENTIAL IS A DRAMATIC LIFE CHANGING EVENT &OR SOCIETY THE CUMULATIVE EFFECT OF THESE CHANGED LIVES INCREASES THE POTENTIAL CONTRIBUTION TO OUR CULTURE &UR THERMORE #ORRIGAN IN REVIEWING THE EFFECT OF STIGMA ON THE UTILIZATION OF MENTAL HEALTH CARE CITES RESEARCH THAT SUPPORTED THE POSITION THAT THE SUCCESSFUL TREATMENT OF A DISEASE MAY HELP TO ERADICATE THE ACCOMPANY ING STIGMA OF THAT DISEASE 3INCE POVERTY AND MENTAL ILLNESS ARE IN SOME WAY LINKED ONE CAN CONCLUDE THAT ANY EFFORT IN IMPROVING ONE WILL HAVE A POSITIVE EFFECT ON THE OTHER AS WELL AS THE STIGMA ATTACHED TO BOTH ยฃร
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4HE STUDY EVALUATES BOTH THE ECONOMIC FOCUSED ON EMPLOYMENT EARNINGS AND WORKER PRODUCTIVITY AND lSCAL FOCUSED ON GOVERNMENT TAX REVENUES IMPACT OF 4EXAS POLICY AND FUNDING DECISIONS 7HAT HAS EMERGED FROM THIS COMPREHENSIVE ANALYSIS ARE lNDINGS AND RECOMMENDATIONS THAT IF IMPLEMENTED WILL GO A LONG WAY TOWARD HELPING MOVE 4EXAS TO THE TOP OF THE COM PARATIVE RANKINGS RATHER THAN THE BOTTOM 4HE GROUNDBREAKING REPORT h4URNING THE #ORNER 4OWARD "ALANCE AND 2EFORM IN 4EXAS -ENTAL (EALTH 3ERVICESv CAN BE FOUND IN ITS ENTIRETY AT WWW MHATEXAS ORG
3OME OF THE KEY lNDINGS INCLUDE
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MENTAL HEALTH SPENDING ACCORDING TO THE .ATIONAL !SSOCIATION OF 3TATE -ENTAL (EALTH 0ROGRAM $IRECTORS .!3-(0$ WWW NRI INC ORG
)N THE CASE OF MENTAL HEALTH CARE IT S h4HANK GOODNESS FOR .EW -EXICO AND !RKANSAS v n THE ONLY STATES RANKED LOWER THAN 4EXAS IN IN TERMS OF PER CAPITA
4HIS LACK OF FUNDING AS WELL AS OTHER UNSOUND PUBLIC POLICY DECISIONS MADE BY STATE LEADERS HAS HAD HUGE lSCAL AND ECO NOMIC CONSEQUENCES FOR THE ENTIRE STATE 4HE -ENTAL (EALTH !SSOCIATION IN 4EXAS -(!4 RECENTLY COMMISSIONED A STUDY CONDUCTED BY -'4 OF !MERICA )NC AND ITS PARTNERS 480 )NC AND 2( #ONSULT ING TO EVALUATE AND QUANTIFY THE IMPACT OF CURRENT AND PAST PUBLIC MENTAL HEALTH POLICY AND FUNDING DECISIONS
HERE S AN EXPRESSION FREQUENTLY HEARD AMONG PROFESSIONALS AND AD VOCATES IN THE lELD OF HEALTH CARE EDUCATION CHILD CARE OR OTHER SOCIAL SERVICES h4HANK GOODNESS FOR -ISSISSIPPI v /R !LA BAMA /R /KLAHOMA )T IS ONLY WHEN ONE OR MORE OF THESE USUALLY 3OUTHERN STATES IS AT THE BOTTOM OF A NATIONAL RANKING OF STATES HEALTH AND HUMAN SERVICE OR EDUCA TION SPENDING THAT 4EXAS CAN AVOID BEING VERY LAST
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4EXAS PUBLIC MENTAL HEALTH SYSTEM HAS BEEN CHRONICALLY UNDER FUNDED 4EXAS OPENED ITS lRST MENTAL HOSPITAL THE 3TATE ,UNATIC !SYLUM IN !USTIN IN )N LESS THAN A DECADE THE ASYLUM S SUPERINTENDENT BEGAN COMPLAINING OF OVERCROWDING AND UNDER FUNDING 3ADLY COMPLAINTS LODGED BY STATE HOSPITAL SUPERINTENDENTS IN THE LATE S CAN STILL BE HEARD AT THE 3TATE #APITOL TODAY #HRONIC UNDER FUNDING PUSHES PEOPLE WITH MENTAL ILLNESS INTO PRISONS JAILS OR OVERCROWDED EMERGENCY ROOMS OR ON TO THE STREETS OF OUR COMMUNITIES 0ATIENTS IN NEED OF IMMEDIATE HOSPITALIZATION ARE BEING TRANSPORTED TO FACILITIES FAR FROM HOME WHEN LOCAL HOSPITALS ARE FULL )N lSCAL 4EXAS SPENT PER CLIENT ON MENTAL HEALTH SERVICES PLACING US TH IN THE NATION .!3-(0$ INCLUDES THE $ISTRICT OF #OLUMBIA IN ITS RANKINGS FOR A TOTAL OF RANKINGS 4EXAS PER ร ร ร ร ร 7 / ,ร ร รครคร ร
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IMPOSED BY PRIVATE INSURANCE PLANS HAVE ALL COMBINED TO INCREASE THE LIKELIHOOD THAT PERSONS WITH MENTAL ILLNESS WILL WIND UP IN THE CRIMINAL JUSTICE SYSTEM /BVIOUSLY PEOPLE WITH MENTAL ILLNESS ARE NOT INHERENTLY MORE CRIME PRONE OR VIOLENT THAN OTHER IN DIVIDUALS FOR SOME HOWEVER A LACK OF ACCESS )N FACT 4EXAS HAS CONSISTENTLY RANKED IN TO TREATMENT AND MEDICATIONS INCREASES THE THE BOTTOM PERCENT OF STATES FOR PER CAPITA LIKELIHOOD OF THEIR ENGAGING IN BEHAVIOR THAT MENTAL HEALTH SPENDING IN ALL PROGRAM AREAS BREAKS THE LAW EXCEPT FOR RESEARCH 4ODAY THE CRIMINAL JUSTICE SYSTEM IS THE -ENTAL ILLNESS COSTS THE STATE AND LO DE FACTO PROVIDER OF LAST RESORT FOR INDIVIDU CAL TAXPAYERS BILLION IN 4HE ALS WITH UNTREATED MENTAL ILLNESS 4HE FEDERAL TOTAL ECONOMIC COST OF MENTAL ILLNESS IN 4EXAS GOVERNMENT "UREAU OF *USTICE 3TATISTICS ES DURING WAS BILLION A lGURE THAT TIMATES THAT PERSONS WITH UNTREATED MENTAL INCLUDES BILLION IN LOST INCOME DUE ILLNESSES COMPOSE ABOUT PERCENT OF THE TO TO REDUCED WORKFORCE PARTICIPATION BILLION FOR MORTALITY COSTS AND MORE THAN MILLION FOR LOST INCOME DUE TO FAMILY CARE GIVING CAPITA SPENDING WAS A MERE PERCENT OF THE NATIONAL AVERAGE !ND AFTER ADJUSTING FOR INmATION WE SPENT NEARLY PERCENT LESS ON MENTAL HEALTH IN lSCAL THAN WE DID TWO DECADES EARLIER IN 4EXAS LOST GROUND AT A HIGHER RATE THAN MOST OTHER STATES
4HE TOTAL lSCAL IMPACT TO STATE AND LOCAL GOVERNMENTS OF MENTAL ILLNESS IN 4EXAS DUR ING WAS BILLION INCLUDING MILLION IN UNREALIZED STATE REVENUE AND MILLION IN UNREALIZED LOCAL GOVERN MENT REVENUE 4HE CHRONIC UNDER FUNDING OF 4EXAS MENTAL HEALTH SYSTEM SHIFTS UNFUNDED MANDATES TO LOCAL GOVERNMENT ESPECIALLY IN CRIMINAL JUSTICE )N GENERAL CUTS IN MENTAL HEALTH CARE FUNDING CREATE UNINTENDED ECONOMIC CON SEQUENCES &OR THOSE WITH SEVERE MENTAL ILLNESS INADEQUATE TREATMENT CAN LEAD TO AN INCREASE IN INDIRECT PUBLIC COSTS RELATED TO CRIME AND CRIMINAL JUSTICE HOMELESSNESS AND UNCOMPENSATED HEALTH CARE !LTHOUGH DATA IS UNAVAILABLE TO CONSISTENTLY MEASURE THE DIRECT IMPACT OF STATE FUNDING CUTS ON LOCAL GOVERN MENT ANECDOTAL EVIDENCE CLEARLY SUGGESTS THAT LOCAL GOVERNMENTS PICK UP THE BURDEN OF STATE CUTBACKS
OTHER INMATES 3O IN ADDITION TO BEING IN AN ENVIRONMENT NOT CONDUCIVE TO RECOVERY INDIVIDUALS WITH MENTAL ILLNESSES ARE REMAIN ING IN THOSE ENVIRONMENTS LONGER )N THE AREA OF YOUTH AND THE JUVENILE JUSTICE SYSTEM THE 4EXAS 9OUTH #OMMISSION REPORTS THAT IN THE LAST TEN YEARS THE PROPOR TION OF YOUTH WITH SERIOUS MENTAL HEALTH PROBLEMS AT TIME OF COMMITMENT TO 49# HAS INCREASED FROM PERCENT TO PERCENT /FFENDERS WITH MENTAL ILLNESS COST MORE TO DETAIN AND HOUSE IN JAILS THAN THE GEN ERAL POPULATION 4HEY OFTEN REQUIRE SEPARATE HOUSING AND MORE MEDICAL AND PSYCHOLOGI CAL TREATMENT THAN OTHER OFFENDERS 4HEY ARE
4HE TOTAL FISCAL IMPACT TO STATE AND LOCAL GOVERNMENTS OF MENTAL ILLNESS IN 4EXAS DURING WAS BILLION
TAL 5 3 JAIL AND PRISON POPULATION )N 4EXAS IN THIS WOULD MEAN THAT OVER INDIVIDUALS IN 4EXAS JAILS AND APPROXIMATELY OFFENDERS IN THE STATE PRISON SYSTEM HAVE MENTAL ILLNESS (OW MANY OF THESE IN DIVIDUALS WERE INCARCERATED PRIMARILY BECAUSE OF BEHAVIOR THAT GREW FROM AN UNTREATED MENTAL ILLNESS IS IMPOSSIBLE TO DETERMINE
MORE LIKELY TO BE DISRUPTIVE REQUIRING GREATER STAFF RESOURCES !ND AS NOTED ABOVE THEY TYPICALLY SPEND MORE TIME IN JAIL THAN OTHER OFFENDERS FOR THE SAME CRIME )T IS COST EFFECTIVE THEREFORE TO KEEP THESE OFFENDERS OUT OF THE CRIMINAL JUSTICE SYSTEM WHENEVER POSSIBLE AND TO PROVIDE THEM WITH COMMUNITY BASED SERVICES INSTEAD #OMMU NITYnBASED MENTAL HEALTH PROGRAMS ALSO ARE A MORE EFFECTIVE WAY TO OFFER AN INTEGRATED ARRAY OF MENTAL HEALTH SUBSTANCE ABUSE AND OTHER SUPPORT SERVICES AND ULTIMATELY BREAK THE CYCLE OF CRIMINAL BEHAVIOR
4O FURTHER COMPOUND THE PROBLEM A "UREAU OF *USTICE 3TATISTIC REPORT FOUND THAT MENTALLY ILL STATE PRISON INMATES WERE SENTENCED TO SERVE AN AVERAGE OF MONTHS IN PRISON OR ABOUT MONTHS LONGER THAN OTHER OFFENDERS /N AVERAGE VIOLENT OFFENDERS WITH A MENTAL ILLNESS WERE #OST SHIFTING TO PROTECTIVE SERVICE SENTENCED TO MONTHS MONTHS LONGER SYSTEM $EINSTITUTIONALIZATION INADEQUATE COM THAN OTHER VIOLENT INMATES AND PROPERTY OF 4HE FOSTER CARE SYSTEM HAS ALSO BECOME MUNITY MENTAL HEALTH PROGRAMS AND LIMITS FENDERS MONTHS MONTHS LONGER THAN A MENTAL HEALTH CARE PROVIDER OF LAST RESORT 7 / ,ร ร รครคร ร
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FOR SOME 4EXAS CHILDREN WITH EMOTIONAL DISORDERS 4HE $EPARTMENT OF &AMILY AND 0ROTECTIVE 3ERVICES $&03 RECORDED CHILD ABUSE OR NEGLECT CASES IN lSCAL 4HE AGENCY TRACKS A hREFUSAL TO ACCEPT PAREN TAL RESPONSIBILITY CATEGORY v WHICH INCLUDES SITUATIONS IN WHICH PARENTS RELINQUISH CUS TODY TO THE STATE TO OBTAIN OTHERWISE UNAVAIL ABLE MENTAL HEALTH CARE FOR THEIR CHILDREN 4HERE WERE OF THESE CASES RECORDED IN lSCAL 3OME OF THESE FAMILIES HAVE PRI VATE INSURANCE THAT DOES NOT ADEQUATELY COVER THEIR CHILDREN S NEEDS $&03 HAS ESTIMATED
SINGLE AGENCY INCORPORATING EVIDENCE BASED -ORE RECENTLY ( " FROM THE TH PRACTICES INTO THE DELIVERY OF MENTAL HEALTH 4EXAS ,EGISLATIVE SESSION COMBINED SERVICES USING BEHAVIORAL MANAGED CARE AND MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES INTO ONE AGENCY THE 4EXAS $EPARTMENT OF OTHER INNOVATIONS 3TATE (EALTH 3ERVICES AND MANDATED A 4EXAS HAS MADE SOME PROGRESS IN THESE DISEASE MANAGEMENT MODEL OF SERVICE FOR AREAS 3INCE 4EXAS HAS HAD THE 4EXAS THOSE THAT ARE ELIGIBLE #OMBINING MENTAL #OUNCIL ON /FFENDERS WITH -ENTAL )MPAIR BEHAVIORAL HEALTH PROGRAMS WITH GENERAL MENTS RECENTLY EXPANDED AND RENAMED PUBLIC HEALTH PROGRAMS AT THE TOP LEVEL OF THE 4EXAS #ORRECTIONAL /FlCE ON /FFEND GOVERNMENT IS GENERALLY VIEWED AS A POSITIVE ERS WITH -EDICAL OR -ENTAL )MPAIRMENTS STEP TOWARD MENTAL HEALTH BEING SEEN BY THE 4#//--) 4#//--) PROVIDES A PUBLIC AS AN ISSUE OF OVERALL HEALTH WHICH CAN FORMAL STRUCTURE THROUGH WHICH CRIMINAL HELP REMOVE THE STIGMA OF MENTAL ILLNESS AND ENCOURAGE MORE PREVENTATIVE CARE (OWEVER MUCH REMAINS TO BE DONE BE FORE 4EXANS WITH MENTAL ILLNESS ARE ABLE TO TAKE ADVANTAGE OF THE PROMISES OF THIS NEW STRUCTURE AND SERVICE DELIVERY MODEL 4HE ,EGISLATURE HAS NOT PROVIDED ENOUGH FUND ING TO ADEQUATELY SUPPORT THE RECOMMENDED SERVICE PACKAGES FOR h2ESILIENCY $ISEASE -ANAGEMENT AND 4EXAS CRITERIA FOR WHO CAN PARTICIPATE IN THE PROGRAM ARE PARTICULARLY RESTRICTIVE ( " NARROWED THE CRITERIA GOVERNING WHO IS ELIGIBLE FOR PRIORITY MENTAL HEALTH SERVICES FROM ONE BASED ON SEVERITY OF FUNCTIONING TO ONE THAT PRIORITIZES ONLY THOSE WITH BIPOLAR DISORDER SCHIZOPHRENIA OR CLINI CALLY SEVERE DEPRESSION WITH FEW EXCEPTIONS
THAT FAMILIES RELINQUISHED CUSTODY OF CHILDREN IN TO OBTAIN MENTAL HEALTH SER VICES 4HIS NUMBER SADLY IS ABOUT AVERAGE FOR ANY RECENT YEAR
3OME PROGRESS MANY CHALLENGES )N RECENT YEARS MANY STATE MENTAL HEALTH SYSTEMS HAVE IMPLEMENTED POLICY INITIA TIVES TO CONTROL COSTS AND IMPROVE PATIENT OUTCOMES 0OPULAR REFORMS INCLUDE CLOSING DOWN STATE HOSPITALS AND SHIFTING RESOURCES TO THE COMMUNITY CO LOCATING MENTAL HEALTH AND SUBSTANCE ABUSE AGENCIES IN A ยฃnร
JUSTICE AND HEALTH AND HUMAN SERVICES ORGA NIZATIONS CAN COMMUNICATE AND COORDINATE POLICY AND PROGRAM DECISIONS CONCERNING OFFENDERS WITH SPECIAL NEEDS 4HESE INCLUDE PERSONS WITH SERIOUS MENTAL ILLNESS MENTAL RETARDATION SERIOUS MEDICAL CONDITIONS AND PHYSICAL DISABILITIES AS WELL AS THE ELDERLY 4#//--) OPERATES SEVERAL SPECIALIZED OF FENDER PROGRAMS INVOLVING A NUMBER OF STATE AGENCIES AND HAS CONTRACTS WITH LOCAL MENTAL HEALTH AUTHORITIES TO OBTAIN OUTPATIENT SER VICES FOR OFFENDERS WITH MENTAL ILLNESS LIVING IN THE COMMUNITY
/NLY ABOUT HALF OF 4EXAS ADULTS WITH MENTAL ILLNESS AND FEWER THAN PERCENT OF CHILDREN WITH EMOTIONAL DISTURBANCE WERE EL IGIBLE FOR PUBLICLY FUNDED SERVICES BEFORE THE CHANGES TO THE ELIGIBILITY CRITERIA AND ONLY A QUARTER OF THOSE ACTUALLY RECEIVED SERVICES !N ESTIMATED 4EXANS WITH MENTAL ILLNESS BECAME INELIGIBLE FOR MOST PUBLIC MENTAL HEALTH SERVICES ONCE THE STATE S PRIORITY CRITE RIA WERE CHANGED
2ECOMMENDATIONS h4URNING THE #ORNERv MADE A NUMBER OF RECOMMENDATIONS FOR FUNDING AND POLICY CHANGES THAT COULD HELP BRING 4EXAS INTO THE ST CENTURY OF MENTAL HEALTH CARE 3EVERAL OF THESE RECOMMENDATIONS THE -ENTAL (EALTH ร ร ร ร ร 7 / ,ร ร รครคร ร
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!SSOCIATION IN 4EXAS AND OTHER ADVOCATES WERE ABLE TO SEE EFFECTUATED DURING THE TH ,EGISLATIVE 3ESSION AND AFTERWARDS &OR EXAMPLE MENTAL HEALTH BENElTS WERE RESTORED TO THE #HILDREN S (EALTH )NSURANCE 0ROGRAM SOME OF THE MENTAL HEALTH AND SUB STANCE ABUSE FUNDING CUTS FROM WERE RESTORED ONE JAIL DIVERSION PROGRAM RECEIVED hPILOTv FUNDING AND RECENT RULES PUBLISHED BY THE (EALTH AND (UMAN 3ERVICES #OM MISSION WILL RESTORE THE ABILITY OF -EDICAID CLIENTS TO RECEIVE COUNSELING SERVICES FROM LICENSED PSYCHOLOGISTS LICENSED MASTER SOCIAL WORKERS LICENSED MARRIAGE AND FAMILY THERA PISTS AND LICENSED PROFESSIONAL COUNSELORS
)NVESTING IN JAIL DIVERSION PROGRAMS 4HESE PROGRAMS WHICH DIVERT OFFENDERS WITH MENTAL ILLNESS TO COMMUNITY BASED TREATMENT RATHER THAN INCARCERATION ARE INCREASINGLY CRITICAL IN REDUCING PRISON AND JAIL OVERCROWDING AND IMPROVING OVERALL PUBLIC SAFETY ! NUMBER OF LOCAL GOVERNMENTS HAVE INITIATED SUCH PROGRAMS BUT THE STATE HAS MADE ONLY MODEST INVESTMENTS IN THEM &EDERAL AND STATE LAWMAKERS SHOULD CONSIDER PROVIDING MATCHING GRANTS TO JURISDICTIONS WITH SUCH PROGRAMS
ING OPPORTUNITIES TO MAKE THE SYSTEM MORE EFFECTIVE AND EFlCIENT
#ONSIDERING WAYS TO INCREASE -EDIC AID FUNDING OF MENTAL HEALTH SERVICES ! REVIEW OF SEVERAL STATES COMPARABLE TO 4EXAS FOUND THAT THEY HAVE ALL BEEN MORE SUCCESS FUL THAN 4EXAS IN FUNDING THEIR MENTAL HEALTH SYSTEMS WITH -EDICAID DOLLARS "ECAUSE THE FEDERAL GOVERNMENT MATCHES -EDICAID FUND ING BOOSTING THE USE OF THESE DOLLARS ALLOWS THE STATE TO STRETCH LIMITED TAXPAYER RESOURCES AND SERVE MORE 4EXANS IN NEED )N PARTICULAR SHOULD CONSIDER DEVELOPING #REATING PURCHASING COOPERATIVES POLICYMAKERS 5NDER SUCH A SCHEME hINTERDEPARTMENTAL -EDICAID WAIVERS TO FUND HOME AND COM BEHAVIORAL HEALTH PURCHASING COLLABORATIVESv MUNITY BASED SERVICES FOR 4EXANS WHO ARE (OWEVER MANY OF THE POLICY CHANGES WOULD CONTRACT WITH A SINGLE STATEWIDE EN CURRENTLY UNDER YEARS OF AGE AND OVER RECOMMENDED HAVE YET TO OCCUR
4HESE GAPS INCLUDE 2ESTORING THE $EPARTMENT OF 3TATE (EALTH 3ERVICES hTARGETv PRIORITY POPULA TION TO ONE BASED ON NEED RATHER THAN ON DIAGNOSIS 4HE STATE S RESTRICTIONS ON WHO HAVE PRIORITY FOR PUBLICLY FUNDED MENTAL HEALTH SERVICES SERIOUSLY LIMITS ACCESS TO SER VICES FOR 4EXANS WITH MENTAL HEALTH NEEDS ,OCAL AGENCIES ESPECIALLY EMERGENCY ROOMS AND JAILS ARE ALREADY REPORTING A SHARP IN CREASE IN PATIENTS WITH MENTAL ILLNESS THAT HAVE NOWHERE ELSE TO TURN 4HE IMPACT OF HURRICANE +ATRINA AND 2ITA ON THE PUBLIC MENTAL HEALTH SYSTEM WILL ALSO SURELY BE IN NEED OF STUDY
4EXAS COULD IMPROVE ACCESS TO CARE IN THE PRIVATE SYSTEM BY REQUIRING HEALTH INSURANCE PLANS TO INCLUDE EQUAL COVERAGE FOR MENTAL HEALTH CARE AND TREATMENT
TITY TO MANAGE PUBLIC MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAMS INCLUDING THOSE lNANCED BY -EDICAID +EY GOALS OF THIS RE FORM INCLUDE REDUCING ADMINISTRATIVE COSTS AND FREEING UP DOLLARS TO INCREASE PROVIDER RE 2EMOVING RESTRICTIONS ON THE USE OF IMBURSEMENT RATES AS WELL AS MOVING TOWARD CUTTING EDGE PSYCHOTROPIC DRUGS 4HE SAV REQUIRING THAT ALL DOLLARS SPENT ON MENTAL INGS PRODUCED BY A PREFERRED DRUG LIST 0$, HEALTH CARE BE USED TO PURCHASE SERVICES AND ARE SHORT TERM AND WILL BE MORE THAN OFFSET TREATMENTS WITH SOLID OR EMERGING EVIDENCE BY OTHER EXPENSES INCLUDING THE COST OF IN BASED POSITIVE OUTCOMES CREASED HOSPITALIZATIONS !CCORDING TO A #ONSOLIDATING REPORTING FOR MENTAL STUDY PUBLISHED IN THE .EW %NGLAND *OURNAL OF -EDICINE LIMITING ACCESS TO EFFECTIVE PSY HEALTH EXPENDITURES &EW OF THE STATE AGEN CHOTROPIC MEDICATIONS CAN INCREASE OVERALL CIES THAT PROVIDE MENTAL HEALTH SERVICES AS AN COSTS FOLD DUE TO INCREASED HOSPITALIZA ADJUNCT TO THEIR PRIMARY MISSIONS TRACK THEIR TION COSTS 4EXAS IMPLEMENTED A 0$, FOR EXPENDITURES IN THIS AREA 7ITHOUT A COM -EDICAID EXPENDITURES THAT INCLUDES SEVERAL PREHENSIVE ACCOUNTING OF ALL MENTAL HEALTH EXPENDITURES 4EXAS IS ALMOST CERTAINLY MISS PSYCHOTROPIC MEDICATIONS 7 / ,ร ร รครคร ร
TO REDUCE OUT OF HOME PLACEMENTS
4HE 2OAD !HEAD 4HERE ARE MANY OPPORTUNITIES TO IMPROVE ACCESS TO MENTAL HEALTH CARE IN THE STATE OF 4EXAS !LONG WITH INCREASED APPROPRIATIONS TO STATE AGENCIES THAT PROVIDE PUBLIC MENTAL HEALTH CARE AND POLICY CHANGES MENTIONED ABOVE 4EXAS COULD IMPROVE ACCESS TO CARE IN THE PRIVATE SYSTEM BY REQUIRING HEALTH INSURANCE PLANS TO INCLUDE EQUAL COVERAGE FOR MENTAL HEALTH CARE AND TREATMENT IN THE PLANS THEY SELL TO INDIVIDUALS OR GROUPS 4HE -EN TAL (EALTH !SSOCIATION IN 4EXAS LOOKS FORWARD TO CONTINUING TO WORK WITH 4EXAS PSYCHOLO GISTS AND OTHER PROFESSIONALS ON PUBLIC POLICY INITIATIVES TO IMPROVE THE MENTAL HEALTH OF ALL 4EXANS / ยฃย
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3ENATOR .ELSON DID A TREMENDOUS JOB IN PASSING 3" WHICH CONTINUES THE WORK THE STATE PROVIDES TO PROTECT THE CHILDREN AND ADULTS WHO ARE NOT ABLE TO CARE FOR THEMSELVES ALLOWING PSYCHOLOGISTS TO ASSIST THE ELDERLY AND DISABLED WHO MIGHT BE SUFFERING FROM ABUSE OR NEGLECT 3ENATOR .ELSON IS A FORMER PUBLIC SCHOOL TEACHER WHO REPRESENTS 3ENATE $ISTRICT WHICH INCLUDES PORTIONS OF 4ARRANT AND $ENTON COUN TIES 3HE JOINED THE 3ENATE IN AFTER TWO SUCCESSFUL TERMS ON THE 3TATE "OARD OF %DUCATION IN WHICH SHE LED THE lGHT TO CORRECT MORE THAN FACTUAL ERRORS IN OUR PUBLIC SCHOOL TEXTBOOKS 3ENATOR .ELSON SERVES AS #HAIRMAN OF THE (EALTH (UMAN 3ERVICES #OMMITTEE ! STRONG ADVOCATE FOR PATIENTS 3ENATOR .ELSON AUTHORED 4EXAS lRST COMPREHENSIVE MEDICAL PRIVACY LAW FOUGHT FOR (-/ REFORM SPONSORED REFORMS TO OUR MEDICAL LIABILITY SYSTEM AND AUTHORED THE hPROMPT PAYv LAW TO IMPROVE THE HEALTH CARE BILLING SYSTEM 3HE WAS NAMED RECIPIENT OF THE PRESTIGIOUS .ATHAN $AVIS !WARD FROM THE !MERICAN -EDICAL !SSOCIATION #ITIZEN OF THE 9EAR BY 3ENIOR 3ERVICES OF 4ARRANT #OUNTY AND THE 4EXAS "EST -EDICINE !WARD FROM THE 4EXAS -EDICAL !SSOCIATION
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$R +OBOS IS CURRENTLY THE $IRECTOR OF THE #OUNSELING 3ERVICE AND A 0ROFESSOR IN THE 0SY CHIATRY $EPARTMENT AT THE 5NIVERSITY OF 4EXAS (EALTH 3CIENCE #ENTER AT 3AN !NTONIO AND IS ENGAGED IN A WIDE SPECTRUM OF ACTIVITIES TO BENElT THE PSYCHOLOGICAL COMMUNITY (E HAS BEEN VERY ACTIVE IN IMPACTING THE PSYCHOLOGICAL COMMUNITY AT THE LOCAL AS WELL AS AT THE NATIONAL LEVEL HOLDING OFlCES IN THE "EXAR #OUNTY 0SYCHOLOGICAL !SSOCIATION 4EXAS 0SYCHOLOGICAL !S SOCIATION AND THE !MERICAN 0SYCHOLOGICAL !SSOCIATION $R +OBOS IS TRULY A PIONEER IN OUR lELD AS HE HAS PLAYED A ROLE IN ESTABLISHING NUMEROUS ORGANIZATIONS AND RULES WHICH CONTINUE TO SUPPORT OUR PROFESSION $URING HIS TIME AS THE ,EGISLATIVE #HAIR AND 0RESIDENT OF 40! HE HELPED TO ESTABLISH THE &REEDOM OF #HOICE ,EGISLATION TO ENABLE PSYCHOLOGISTS TO RECEIVE PAY MENT FOR THEIR SERVICES (E ALSO ENDORSED AND ASSISTED IN THE IMPLEMENTATION OF THE ORAL EXAM FOR LICENSURE FOR THE 4EXAS 3TATE "OARD OF %XAMINERS OF 0SYCHOLOGISTS !T THE NATIONAL LEVEL HE HELPED TO ESTABLISH $IVISION 'ROUP 0SYCHOLOGY AND 'ROUP 0SYCHOTHERAPY AND 'ROUP AS A SPECIALTY OF THE !MERICAN "OARD OF 0ROFESSIONAL 0SYCHOLOGY $R +OBOS ALSO CONTINUES TO WORK VIGOROUSLY TO MONITOR OUR PROFESSION (E HAS SERVED ON THE !0! #OUNCIL OF 2EPRESENTATIVES AND THE !0! #OMMITTEE ON !CCREDITATION (E IS CURRENTLY A 4REASURER AND A MEMBER OF THE "OARD OF 4RUSTEES OF THE !MERICAN "OARD OF 0ROFESSIONAL 0SYCHOLOGY )N ADDITION TO ALL OF HIS ACTIVITIES AT THE LOCAL AND NATIONAL LEVEL HE CONTINUES TO WORK EXTENSIVELY WITH RESIDENTS (E SUPERVISES AND TEACHES BOTH PSYCHIATRY AND PSYCHOLOGY RESIDENTS &URTHERMORE HE GOES BEYOND WHAT IS REQUIRED IN HIS JOB AND MENTORS PSYCHOLOGISTS THROUGHOUT THEIR CAREERS GIVING GUIDANCE AND SUPPORT REGARDING VARIOUS PROFESSIONAL ISSUES ร รคร
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$R #UNNINGHAM WORKED TIRELESSLY WITH THE 4EXAS 3ENATE #RIMINAL *USTICE #OMMITTEE TO IMPLEMENT THE hLIFE WITHOUT PAROLEv PROVISION IN THE DEATH PENALTY STATUTE (E HAS DONE EXTENSIVE RESEARCH ON THE PRISON BEHAVIOR OF LIFE WITHOUT PAROLE INMATES IN OTHER STATES AS WELL AS EVALUATING THE SUCCESS OF MAINSTREAMING DEATH SENTENCED INMATES ELIMINATING $EATH 2OW $R #UNNINGHAM IS A RECOGNIZED EXPERT IN VIOLENCE RISK ASSESSMENT AT CAPITAL SENTENCING AND HAS GREATLY IMPROVED THE STANDARDS OF ASSESSMENTS OF FUTURE DANGEROUSNESS THROUGH HIS RESEARCH ANALYSIS AND PUBLISHED ARTICLES "OARD CERTIlED IN &ORENSIC 0SYCHOLOGY HE HAS BEEN CALLED TO TESTIFY IN DOZENS OF CAPITAL SENTENCING CASES ON THE FEDERAL LEVEL AS WELL AS IN STATE COURTS ,ICENSED IN STATES $R #UNNINGHAM HAS WORKED TO PROMOTE PROFESSIONAL PRACTICE MOBILITY CO AUTHORING A h-ODEL 2ULE 2EGARDING THE 4EMPORARY &ORENSIC 0RACTICE OF 0SY CHOLOGY v PROPOSED FOR STATE LICENSING BOARDS ON A NATIONWIDE BASIS $R #UNNINGHAM RECEIVED THE *OHN !UGUSTUS !WARD &OR /UTSTANDING #ONTRIBUTIONS 4O 4HE 0ROFESSION /F 3ENTENCING !DVOCACY FROM THE .ATIONAL !SSOCIATION OF 3ENTENCING !DVOCATES AND HAS BEEN SELECTED TO RECEIVE THE !0! !WARD FOR $ISTINGUISHED #ONTRIBUTIONS TO 2ESEARCH IN 0UBLIC 0OLICY NEXT !UGUST
"ÕÌÃÌ> ` }Ê*ÕL VÊ ÌÀ LÕÌ ÊÌ Ê*ÃÞV }ÞÊ Ü>À` iÌÃÞÊ-V Ü>ÀÌâ]Ê -7 "ETSY 3CHWARTZ IS THE EXECUTIVE DIRECTOR OF THE -ENTAL (EALTH !SSOCIATION OF 'REATER (OUSTON AND AS SUCH HAS BEEN VITAL TO MANY MAJOR MENTAL HEALTH SYSTEM REFORMS 4HROUGH HER CREATION AND LEADERSHIP OF COMMUNITY BASED COALITIONS SHE EFFECTED MANY CHANGES IN THE WAY (ARRIS #OUNTY TREATS THE MENTALLY ILL !MONG THESE CHANGES ARE A NEW LAW ENFORCEMENT SYSTEM FOR RESPONDING TO ADULTS WITH MENTAL ILLNESS NEW MENTAL HEALTH PROGRAMS IN THE (ARRIS #OUNTY COURT SYSTEM A PRIMARY MENTAL HEALTH PROGRAM IN THE (OUSTON )NDEPENDENT 3CHOOL $ISTRICT AND AN INTEGRATED PROGRAM DESIGNED TO KEEP YOUTHS WITH SERIOUS EMOTIONAL DISTUR BANCES OUT OF THE (ARRIS #OUNTY *UVENILE *USTICE SYSTEM )N ADDITION SHE WAS CENTRAL TO A NEW INTERAGENCY PLAN FOR CRISIS CARE IN THE COMMUNITY MENTAL HEALTH CENTER -S 3CHWARTZ HAS BEEN OUTSPOKEN IN HER ADVOCACY OF MENTAL HEALTH ISSUES THROUGH REGULAR MEDIA INTERVIEWS AT ALL LEVELS AS WELL AS SPEAKING AT CONFERENCES TRAINING SESSIONS AND PUBLIC EVENTS LOCALLY AND NATIONALLY 3HE IS ONE OF ONLY FOUR -(! LEADERS FROM THROUGHOUT THE NATIONAL CHOSEN TO ADVISE .-(! REGULARLY ON PROGRAM ORGANIZATION ADVOCACY AND FUND DEVELOPMENT STRATEGIES 3HE IS PAST PRESIDENT OF #OALITION OF THE (OMELESS AND VICE CHAIR OF THE -ENTAL (EALTH .EEDS #OUNCIL 3HE HAS RECEIVED THE (OUSTON !DVOCATES FOR -ENTALLY )LL #HILDREN ,EADERSHIP !WARD THE 'OLDEN (ARVEST !WARD FROM THE !SIAN !MERICAN &AMILY #OUNSELING #ENTER AND A 7OMAN ON THE -OVE !WARD FROM 4EXAS %XECUTIVE 7OMEN
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$R $UFFY GRADUATED CUM LAUDE WHILE RECEIVING HIS THEOLOGY DEGREE FROM !NGELICUM 5NI VERSITY IN 2OME )TALY IN (E WAS ORDAINED A 2OMAN #ATHOLIC PRIEST WAS INVOLVED IN PARISH MINISTRY MISSIONS AND RETREATS AND WAS A CHAPLAIN TO THE 53 !RMY AND !IR &ORCE IN 'ERMANY !FTER HIS CAREER IN THEOLOGY HE RECEIVED HIS 0H$ IN #OUNSELING 0SYCHOLOGY FROM THE 5NIVERSITY OF 4EXAS AT !USTIN IN (E IS A DIPLOMATE IN #OUNSELING 0SYCHOLOGY FROM THE !MERICAN "OARD OF 0ROFESSIONAL 0SYCHOLOGY (E IS CURRENTLY A 0ROFESSOR IN THE #OUNSELING 0SYCHOLOGY 0ROGRAM AT THE $EPARTMENT OF %DUCATIONAL 0SYCHOLOGY AT 4EXAS ! - 5NIVER SITY (E HAS SERVED ON MANY 40! COMMITTEES AND TASK FORCES AND SERVED AS 40! S 0RESIDENT IN (E HAS OVER THIRTY YEARS EXPERIENCE WITH ADULT AND CHILD PSYCHOTHERAPY AND HAS CONDUCT ED EXTENSIVE CLINICAL ASSESSMENT OF CHILDREN AND ADULTS AT 4EMPLE 3TREET #HILD 'UIDANCE #LINIC AND 3T *OHN OF 'OD #HILD 'UIDANCE #LINIC AND 0SYCHIATRIC (OSPITAL IN $UBLIN )RELAND (E HAS PRESENTED OVER WORKSHOPS FOR STATE NATIONAL AND INTERNATIONAL AUDIENCES (E HAS ALSO BECOME ONE OF THE NATION S LEADERS IN 'ERONTOLOGY AND SERVES AS A CONSULTANT TO #OLLEGE OF -EDICINE AT 4EXAS ! - 5NIVERSITY 'REENLEAF (OSPITAL AND 6! (OSPITAL IN 4EMPLE ON DEVELOPMENT OF GERIATRIC TRAINING (E ALSO DEVELOPED 0ROJECT /!3)3 FOR TRAINING PARAPROFESSIONAL MENTAL HEALTH WORKERS FOR NURSING HOMES IN "RYAN #OLLEGE 3TATION (E IS ON THE %DITORIAL "OARDS OF #LINICAL 'ERONTOLOGIST 4HE 4EXAS *OURNAL ON !GING 4HE 3OUTHWESTERN 4HE *OURNAL OF !GING IN THE 3OUTHWEST AND AD !D (OC REVIEWER FOR THE )NTERNATIONAL *OURNAL OF !GING AND (UMAN $EVELOPMENT 0SYCHOLOGY AND !GING AND 4HE 'ERONTOLOGIST
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$ONNA $AVENPORT S CONTRIBUTIONS TO EDUCATION ARE FELT BY 0SYCHOLOGY STUDENTS NATION WIDE 4HE BOOK SHE CO AUTHORED !N INTRODUCTION TO PSYCHOTHERAPY #OMMON CLINICAL WISDOM IS THE MOST WIDELY USED TEXTBOOK FOR TRAINING PRACTICUM LEVEL STUDENTS IN COUNSELING 3HE ADDED A CHAPTER ON MULTICULTURAL COUNSELING TO THE SECOND EDITION 3HE ALSO AUTHORED A BOOK ON ANTICIPATORY GRIEF WHICH IS USED AS A TEXT IN $EATH AND $YING COURSES NATIONWIDE )N THE CLASSROOM $R $AVENPORT S INNOVATIVE TEACHING METHODS CHALLENGE STUDENTS TO LEARN AND GROW 3HE HAS DEVELOPED NEW COURSES ON TOPICS SUCH AS DEATH AND BEREAVEMENT GENDER ISSUES AND ADVANCED PSYCHOTHERAPEUTIC SKILLS AS THE NEED AROSE 3HE ROUTINELY HAS A WAITING LIST OF STUDENTS WHO WISH TO TAKE HER COURSES AND HER FORMER STUDENTS CONTINUE TO FEEL THE IMPACT OF HER TEACHING THROUGHOUT THEIR PROFESSIONAL CAREERS $R $AVENPORT IS THE &OUNDING $IRECTOR OF THE ,IFELONG ,EARNING #ENTER AT 4EXAS ! - CHAIR OF THE 3TUDENT 2ESEARCH !WARD #OMMITTEE FOR THE 4EXAS 0SYCHOLOGICAL &OUNDATION ORAL EXAMINER FOR 43"%0 AND CO EDITOR OF THE 4EXAS 0SYCHOLOGIST TO MENTION ONLY A FEW OF HER CURRENT COMMITMENTS 3HE WAS NAMED $EATH %DUCATOR OF THE 9EAR IN BY THE !SSOCIATION FOR $EATH %DUCATION AND #OUNSELING AND RECEIVED THE 4EXAS ! - 7OMEN S #ENTER &ACULTY !WARD IN ÓÓÊ
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$R 2ITA *USTICE IS A CLINICAL PSYCHOLOGIST WHO AS BEEN IN PRIVATE PRACTICE IN (OUSTON FOR MORE THAN YEARS 7ITH HER HUSBAND PSYCHOLOGIST "LAIR *USTICE SHE CO AUTHORED TWO PIO NEERING BOOKS ON CHILD ABUSE AND INCEST 4HE !BUSING &AMILY AND 4HE "ROKEN 4ABOO 3EX IN THE &AMILY &ROM THE BEGINNING OF HER CAREER SHE HAS KEPT THE BODY AS WELL AS THE MIND AND EMOTIONS AN IMPORTANT FOCUS IN HER PSYCHOTHERAPEUTIC WORK 4HAT INTEREST LED TO HER AUTHOR ING !LIVE AND 7ELL ! 7ORKBOOK FOR 2ECOVERING 9OUR "ODY AND SERVING THE LAST SEVEN YEARS ON THE %XECUTIVE #OMMITTEE AND "OARD FOR THE 5 3 !SSOCIATION OF "ODY 0SYCHOTHERAPY !N ON LINE NEWSLETTER % (EALING THAT SHE AND $R "LAIR *USTICE WRITE APPEARS MONTHLY IN THE 5NIVERSITY OF 4EXAS (EALTH 3CIENCE #ENTER AT (OUSTON (EALTH ,EADER AND REACHES MORE THAN READERS (ER WORK ON DISASTER RESPONSE INCLUDES HER CO CHAIRING THE 40! $ISASTER 2ESPONSE .ET WORK AND HELPING TO FORM THE #ITY OF (OUSTON /FlCE OF %MERGENCY -ANAGEMENT -ENTAL (EALTH #RISIS 2ESPONSE 4EAM )N BOTH THOSE CAPACITIES SHE HELPED COORDINATE THE MENTAL HEALTH EFFORTS FOR THE +ATRINA REFUGEES AT THE 'EORGE 2 "ROWN #ONVENTION #ENTER AND CONTINUES TO BE PART OF THE PLANNING EFFORT TO DELIVER MENTAL HEALTH CARE TO THE REFUGEES AND VOLUNTEERS IN THE #ITY OF (OUSTON
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#O CHAIR OF 40! S $ISASTER 2ESPONSE .ETWORK $R !NDREWS IS ACTIVE IN CRISIS AND DISASTER MENTAL HEALTH INTERVENTION IN CONJUNCTION WITH (0! 40! THE !MERICAN 2ED #ROSS AND THE .ATIONAL /RGANIZATION FOR 6ICTIMS !SSISTANCE 3HE HELPED KEEP 40! MEMBERS INFORMED ON WHERE THEY MIGHT BE ABLE TO HELP DURING THE RECENT HURRICANE CRISES $R !NDREWS IS IN PRIVATE PRACTICE CONDUCTING PSYCHOLOGICAL ASSESSMENTS AND PROVIDING DIAGNOSES AND PSYCHOTHERAPY FOR CHILDREN ADOLESCENTS AND ADULTS 7ITH AN EXTENSIVE BACK GROUND IN CHILD BEHAVIOR MANAGEMENT AND VIOLENCE PREVENTION SHE CONDUCTS SEMINARS AND PROVIDES TRAINING TO PARENTS TEACHERS AND SCHOOL COUNSELORS ON THESE TOPICS AND ON !$($ SUBSTANCE ABUSE AND DEPRESSION IN ADOLESCENTS (ER WORK EARNED HER THE 6IOLENCE 0RE VENTION )NITIATIVE S /UTSTANDING !CTIVIST !WARD FROM THE (OUSTON 0SYCHOLOGICAL !SSOCIATION AS WELL AS THEIR 0RESIDENT S !WARD
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INFORMATION ABOUT TWO OF THESE DEVELOP MENTS EITHER OF WHICH MIGHT CONCEIVABLY BECOME EXTREMELY IMPORTANT IN THE FUTURE 4HESE ARE EXCITING TIMES IN WHICH TO BE A PSYCHOLOGIST NOW MORE THAN EVER WE MAY BE STANDING ON THE THRESHOLD OF AN INCREASED ABILITY TO UNDERSTAND AND TREAT EMOTIONAL PAIN !LTERNATELY WE MAY LOOK BACK lVE YEARS FROM NOW AT THIS ARTICLE AND SEE AN EIGHT TRACK PLAYER A ROTARY ENGINE OR ALUMI NUM WIRING %VEN IF THE FUTURE SHOWS THESE INNOVATIONS NOT TO BE SIGNIlCANT THE READY AVAILABILITY OF INFORMATION ON THE INTERNET AND THE FREQUENCY WITH WHICH OUR PATIENTS ASK QUESTIONS ABOUT THE LATEST RUMORS OF MEDICAL BREAKTHROUGHS MAKES IT INCUMBENT ON US TO STAY AHEAD OF THE CURVE ABOUT PO TENTIAL ADVANCES
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ROGRESS COMES AT DIFFERENT PACES 3OMETIMES IT IS SLOW AND INCREMENTAL WITH EACH SMALL STEP INTRICATELY CON NECTED TO THOSE OCCURRING JUST PREVIOUSLY !N EXAMPLE OF THIS WOULD BE AN INDIVIDUAL CHILD LEARNING TO READ BY lRST IDENTIFYING LET TERS THEN SOUNDS OR PHONEMES THEN WHOLE WORDS THEN BEGINNING TO PUT THESE WORDS SEAMLESSLY TOGETHER INTO MEANINGFUL PHRASES OR SENTENCES !T OTHER TIMES PROGRESS OCCURS IN DYNAMIC BURSTS OR QUANTUM LEAPS WITH THE INTRODUCTION OF A REVOLUTIONARY NEW THOUGHT OR DEVELOPMENT WHICH RADICALLY AND QUICKLY ALTERS THE LANDSCAPE !N EXAMPLE WOULD BE THE INVENTION OF THE MOVABLE TYPE PRINTING
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PRESS WHICH QUICKLY LED TO AN EXPLOSION IN LITERACY AND UNPRECEDENTED DISBURSEMENT OF AVAILABLE KNOWLEDGE /NE NEVER KNOWS THE IMPACT OF A NEW IDEA OR TECHNOLOGY UNTIL THE PASSAGE OF SOME TIME ALLOWS FOR PERSPECTIVE TO DEVELOP 4HERE ARE SEVERAL SIGNIlCANT ENTIRELY NEW TYPES OF TREATMENT TECHNOLOGIES FOR TREATING PSYCHOLOGICAL PROBLEMS ON THE HORIZON NEW PARADIGMS REALLY %ACH REmECTS A MA JOR SHIFT IN THE APPROACH TO AMELIORATING A DISORDER AND EACH IS OUTSIDE THE PARAMETERS OF CURRENTLY PRACTICED PSYCHOTHERAPY OR PHARMACOTHERAPY 4HIS DISCUSSION AIMS TO PROVIDE PSYCHOLOGISTS WITH UP TO THE MINUTE
)N *ULY OF THE &$! APPROVED 6.3 VAGUS NERVE STIMULATION 4HERAPY 4- PRO DUCED BY #YBERONICS )NC OF (OUSTON 48 FOR THE TREATMENT OF CHRONIC OR TREATMENT RESISTANT DEPRESSION .OTE THAT THIS IS NOW APPROVED AND PSYCHOLOGISTS ARE ALREADY BE GINNING TO SEE IN OUR OFlCES THE lRST PATIENTS WHO HAVE THESE DEVICES IN PLACE 4HIS IS NOT A MAYBE OR SOME DAY DEAL BUT CURRENTLY AVAIL ABLE THERAPY 4HE SPECIlC &$! MANDATED LANGUAGE IS
h4HE 6.3 4HERAPY 3YSTEM IS INDICATED FOR THE ADJUNCTIVE LONG TERM TREATMENT OF CHRONIC OR RECURRENT DEPRESSION FOR PATIENTS YEARS OF AGE OR OLDER WHO ARE EXPERIENCING A MAJOR DEPRESSIVE EPISODE AND HAVE NOT HAD AN ADEQUATE RESPONSE TO FOUR OR MORE ADEQUATE ANTIDEPRESSANT TREATMENTS v ร ร ร ร ร 7 / ,ร ร รครคร ร
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)N THE SAME DEVICE WAS APPROVED FOR THE TREATMENT OF SEIZURE ACTIVITY AND THUS THERE ARE WELL OVER INDI VIDUALS WITH 6.3 IMPLANTS ALREADY IN THE POPULATION 4HE UTILIZATION OF THIS TECH NOLOGY FOR TREATMENT RESISTANT DEPRESSION IS JUST BEGINNING AND THERE ARE NUMEROUS QUESTIONS STILL TO BE ANSWERED
7HAT )S )T 4HE 6.3 4HERAPY 3YSTEM IS COM PRISED OF TWO COMPONENTS WHICH MUST BE SURGICALLY AND PERMANENTLY IMPLANTED 4HE &$! AUTHORIZATION EXPLAINS h4HIS DEVICE IS A PERMANENT IM PLANT )T IS ONLY TO BE USED IN PATIENTS WITH SEVERE DEPRESSION WHO ARE UNRESPONSIVE TO STAN DARD PSYCHIATRIC MANAGEMENT )T SHOULD ONLY BE PRESCRIBED AND MONITORED BY PHYSICIANS WHO HAVE SPECIFIC TRAINING AND EXPERTISE IN THE MANAGEMENT OF TREATMENT RESISTANT DEPRESSION AND THE USE OF THIS DEVICE )T SHOULD ONLY BE IMPLANTED BY PHYSICIANS WHO ARE TRAINED IN SURGERY OF THE CAROTID SHEATH AND HAVE RECEIVED SPECIFIC TRAINING IN THE IMPLANTATION OF THIS DEVICE v ! h0ULSE 'ENERATORv WHICH IS X X INCHES AND WEIGHS OUNCE IS PLACED INTO THE LEFT CHEST AREA 4HIS COMPONENT HOLDS A BATTERY YEAR LIFE AND DELIVERS MILD ELECTRICAL PULSES AT PROGRAMMABLE TIME AND POTENCY LEVELS 4HE SECOND PIECE IS THE "IPOLAR ,EAD WHICH RUNS SUBCUTANE OUSLY FROM THE GENERATOR TO THE LEFT NECK AREA WHERE IT WRAPS AROUND THE VAGUS NERVE )T IS ESSENTIALLY A MM DIAMETER WIRE OF SOME CENTIMETERS IN LENGTH 4HE INSTALLATION IS PERFORMED UNDER GEN ERAL ANESTHESIA AS AN OUTPATIENT PROCEDURE AND CONSISTS OF TWO INCISIONS LEFT UPPER CHEST FOR THE GENERATOR AND LEFT NECK AREA IN SKIN CREASE FOR THE LEAD 7 / ,ร ร รครคร ร
(OW $OES )T 7ORK 4HE VAGUS NERVE ONE OF THE TEN CRA NIAL NERVES AND ,ATIN FOR hWANDERINGv HAS A COMPLEX AND DIVERSE PATTERN OF DISTRIBUTION )T IS INVOLVED IN THE REGULATION OF AUTONOMIC NERVOUS SYSTEM RESPONSE HAVING PROJECTIONS INTO THE AMYGDALA AND OTHER LIMBIC AREAS !DDITIONALLY IT hWANDERSv INTO THE 2APHE .UCLEUS AND ,OCUS #OERULEUS SOURCES OF SE ROTONIN AND NOREPINEPHRINE SUPPLIES WHICH ARE IMPLICATED IN DEPRESSION AND ANXIETY DISORDERS 4HE 6.3 DIRECTLY STIMULATES THIS NERVE 3TIMULATION BY SOME AS YET UNDElNED MECHANISM SEEMS TO REGULATE FUNCTION IN THE AREAS OF CORTICAL PROJECTION WHICH ARE DYSREGULATED IN MOOD DISORDERS /BSERVED SIGNIlCANT IMPROVEMENT IN DEPRESSIVE SYMP TOMS OF PATIENTS TREATED FOR EPILEPSY WITH THE DEVICE AND THE FACT THAT ANTICONVULSANTS HAVE SOME THERAPEUTIC VALUE IN MOOD DISORDERS ENCOURAGED INVESTIGATION OF ITS EFlCACY FOR THE DIRECT TREATMENT OF DEPRESSION .OTE THAT THIS IS AN hADJUNCTIVEv TREATMENT WHICH MAY ACT BY POTENTIATING THE EFFECTIVENESS OF OTHER TREATMENTS MEDICATIONS .OTE ALSO THAT PHARMACOLOGICAL THERAPIES FOR DEPRESSION CURRENTLY STATE ON PACKAGE LABELS THAT hTHE EXACT MECHANISM OF ACTION IS NOT KNOWN v 7E HAVE OBSERVED THAT THIS UNKNOWN MECHANISM DILEMMA SEEMS TO BOTHER THOSE TRAINED AS 0H$ S MORE THAN THOSE OF OTHER SPECIALTIES WHO ARE PERHAPS MORE USED TO IT OR LESS CONCERNED WITH DATA THAN PERCEIVED EFFECTIVENESS /NCE IMPLANTED THE STIMULATOR MUST BE hADJUSTEDv AND MONITORED IN THE PSYCHIATRIST S OFlCE WITH THE HELP OF A HAND HELD PROGRAM MING WAND ABOUT THE SIZE OF A PALM PILOT 0ARAMETERS ARE OUTPUT CURRENT PULSE WIDTH SIGNAL FREQUENCY AND ON TIME OFF TIME
)S )T %FlCACIOUS AND 3AFE 5NFORTUNATELY THERE ARE NOT A TREMEN DOUS AMOUNT OF DATA YET AVAILABLE ABOUT THIS DEVICE )NDEED COMPARATIVE EFlCACY WITH OTHER ANTIDEPRESSANT TREATMENTS IS DIFlCULT TO ASSESS FOR SEVERAL REASONS 4HESE
INCLUDE THE FACTS THAT 6.3 INVOLVES PA TIENTS WITH CHRONIC OR TREATMENT RESISTANT DEPRESSION NOT TYPICALLY INCLUDED IN OTHER ANTIDEPRESSANT STUDIES THAT OTHER ADJUNC TIVE TREATMENTS OF VARIOUS TYPES ARE ALSO IN PLACE SIMULTANEOUSLY AND THAT hPLACEBOv RESPONSE IS VERY HARD TO DElNE UTILIZING AN IMPLANT 4O SUMMARIZE THE DATA THAT ARE CURRENTLY AVAILABLE DO SUGGEST THAT PERHAPS TO OF PATIENTS SHOW SOME CLINICALLY SIGNIlCANT RESPONSE WITH AROUND HALF THAT MANY EVENTUALLY ACHIEVING REMISSION )T IS IMPORTANT TO NOTE THAT CLINICAL BENElT SEEMS TO CONTINUE TO ACCRUE OVER TIME WITH MANY PATIENTS SHOWING STILL INCREASING IM PROVEMENT YEARS AFTER IMPLANT !S PART OF &$! APPROVAL #YBERONICS WILL BE CON DUCTING A PATIENT POST MARKET DOSING STUDY AND A PATIENT YEAR OUTCOME REGISTRY &URTHER INFORMATION IS AVAILABLE AT WWW CYBERONICS COM WHERE YOU CAN WATCH A REPLAY OF A PRESENTATION BY DOC TORS WHO WERE INVOLVED IN A NUMBER OF CLINICAL STUDIES 3AFETY ISSUES INCLUDE THOSE RELATED TO THE IMPLANT SURGERY AND TO THE LONG TERM USE OF THE DEVICE 0ATIENTS MAY BE ABLE TO FEEL THE PRESENCE OF THE PULSE GENERATOR BUT IT IS NOT CONSIDERED TO BE UNCOMFORTABLE 0HYSICAL ACTIVITY MUST BE REDUCED FOR DAYS AFTER THE PROCEDURE AND THE DEVICE ISN T TURNED ON UNTIL AT LEAST DAYS POST OP )MPLANT COMPLICATIONS ARE RARE WITH INFECTION AND HOARSENESS TEMPORARY VOCAL CORD PARALYSIS 4HERE HAS BEEN A ASYSTOLE BUT NO MORTALITYย ASYSTOLE HAS OCCURRED DURING SURGERY WHEN THE DEVICE IS TURNED ON TO A HIGH SETTING AS A TEST PRIOR TO CLOS ING THE WOUND )N ALL CASES NORMAL HEART FUNCTION RETURNED SPONTANEOUSLY WHEN THE DEVICE WAS TURNED OFF -OST ADVERSE EVENTS ASSOCIATED WITH THERAPY ARE STIMULATION RELATED TRANSIENT AND TEND TO OCCUR ONLY DURING ACTUAL STIMULATION CYCLES !LMOST ALWAYS THESE DIMINISH OVER TIME CAN BE DIMINISHED OR ELIMINATED BY ADJUSTING PARAMETER SET TINGS AND CAN BE TEMPORARILY ELIMINATED ร x
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BY USE OF AN EXTERNAL MAGNET GIVEN TO PATIENTS TO SIMPLY TURN OFF THE DEVICE AT WILL #OMMON EVENTS USUALLY ONLY WHILE THE DEVICE IS STIMULATING INCLUDE HOARSE NESS VOICE ALTERATION COUGH THROAT PAIN SHORTNESS OF BREATH AND A PRICKLING FEEL ING IN THE SKIN
)S )T 2EALLY 2EADY 4O "E 5SED 4HE RELATIVELY LOW RISK PROFILE AND THE LEVEL OF DESPERATION FOR HELP FREQUENTLY FELT BY THOSE WITH CHRONIC OR TREATMENT RESISTANT DEPRESSION SUGGEST THAT FURTHER INTEREST IN AND INVESTIGATION OF THIS DEVICE IS WARRANTED (OWEVER THERE ARE SEVERAL RATHER SIGNIFICANT QUESTIONS REMAINING TO BE ANSWERED &IRST OF ALL ESSENTIALLY NO DATA EXIST ON WHAT SETTINGS ARE MOST EFFECTIVE 4HE MANUFACTURER SUGGESTS YOU JUST ADJUST TO TOLERANCE BUT THERE IS LITTLE KNOWN ABOUT WHICH OF THE PARAMETERS IS MOST IMPORTANT OR CRITICAL 3ECOND THIS IS AN EXPENSIVE TREATMENT PROGRAM AND THE RESPONSE OF INSURERS IS JUST NOW BEING DETERMINED #YBERONICS CLEARLY HAS A VESTED INTEREST IN WORKING WITH INSURANCE COMPANIES AND WITH REFERRAL SOURCES TO GET COVER AGE FOR THIS DEVICE AND TO THAT END WILL TAKE OVER THE PROCESS OF FOLLOW UP ONCE APPROPRIATE PATIENTS HAVE BEEN REFERRED &INALLY MORE EXTENSIVE DATA ON THE IM PACT OF THIS TREATMENT ARE SORELY NEEDED #ERTAINLY THIS WILL EMERGE WITH TIME BUT CURRENT PATIENTS ARE TRULY PIONEERS IN A NEW AREA "ECAUSE BY DEFINITION WE HAVE LITTLE TO OFFER FOLKS WITH TREATMENT RESISTANT DEPRESSION ANY TREATMENT WHICH PURPORTS TO HELP IS WORTH A SECOND LOOK AND RIGOROUS INVESTIGATION 4HE NETWORK OF TRAINED PROVIDERS IS JUST NOW BEING FULLY SET UP 3HOULD YOU HAVE A PATIENT YOU THINK MIGHT BE A CANDIDATE FOR THIS TREATMENT YOU CAN CALL THE 6.3 4HERAPY #ALL #ENTER AT 4HERE YOU CAN BE DIRECTED TO THE REPRESENTATIVE COVERING YOUR TERRITORY WHO WILL KNOW OF QUALIFIED PSYCHIATRISTS NEARBY ร ร ร
42!.3#2!.)!, -!'.%4)# 34)-5,!4)/. 4HOUGH NOT APPROVED IN THIS COUN TRY FOR USE ON THE CORTEX ANOTHER INTER ESTING TECHNOLOGY IS DEVELOPING WHICH INVOLVES MAGNETIC STIMULATION OF THE BRAIN THROUGH THE SKULL FROM OUTSIDE 4HE BASIC IDEA IS THAT AN EXTERNAL ELEC TRICAL FIELD CAN ALTER CELLULAR MEMBRANE POTENTIALS CAUSING DEPOLARIZATION AND ACTIVATION OF EXCITABLE TISSUE 4HESE CHANGED FIRING PATTERNS OFFER SOME HOPE OF EXPRESSING THEMSELVES AS RELIEF FROM PSYCHOLOGICAL DISTRESS 7HEN ONE ALTERS THE BRAIN S ELECTRICAL SIGNALS WHICH SERVE AS INTERCELLULAR COMMU NICATION IT FOLLOWS THAT THE MESSAGES BEING SENT MIGHT ALSO BE ALTERED 4HE HOPE IS THAT THIS PROCESS CAN BE BETTER UNDERSTOOD AND THAT THE 4-3 TECHNOL OGY WILL BE ABLE TO SELECTIVELY TARGET AND APPROPRIATELY MANIPULATE CIRCUITS TO PROVIDE SYMPTOM RELIEF 4HAT IS THOUGHT TO BE THE ESSENCE OF THE THERAPEUTIC EFFECT OF %#4 WHICH IS CURRENTLY USED AS A SORT OF LAST RESORT TREATMENT FOR SEVERE INTRACTABLE DEPRES SION %#4 UTILIZES ELECTRICITY TO CAUSE THE BRAIN TO SEIZE BUT IS NOT ABLE TO BE FOCUSED OR DIRECTED TO SPECIFIC AREAS 4-3 SEEKS TO PROVIDE A SIMILAR EFFECT BUT WITH MORE SPECIFICITY AND PRECI SION !DVANTAGES ARE THAT THE LOSS OF MEMORY INVASIVENESS AND CONCOMITANT DANGER ASSOCIATED WITH %#4 AS SIDE EF FECTS ARE ELIMINATED 3AFETY PROFILES WITH THE TECHNOLOGY ARE GOOD AND SIDE EFFECTS MINIMAL ESPECIALLY IF THE STAN DARD OF COMPARISON IS %#4 0ART OF THE PROBLEM IS THE LACK OF KNOWLEDGE ABOUT WHAT TYPE AND LEVEL OF STIMULATION ARE OPTIMAL 4HERE IS SOME APPARENTLY SLIGHT RISK OF INDUCING A SEIZURE AND THIS CLEARLY DEMANDS MORE STUDY AND CARE IN APPLICATION 4-3 DEVICES HAVE BEEN IN SOME USE SINCE AND THERE ARE MORE THAN BEING UTILIZED 4HE 4-3 DEVICE CONSISTS OF A PULSE
GENERATOR MACHINE AND A HAND HELD COIL WHICH IS ABOUT THE SIZE OF A PING PONG PADDLE 4HE GENERATOR PRODUCES PULSES OF ELECTROMAGNETIC ENERGY AT AN ADJUST ABLE UP TO CYCLES PER SECOND RATE 4HE COIL IS HELD NEAR THE SKULL ACTUAL CONTACT IS NOT NECESSARY AND THE MAG NETIC ENERGY PASSES THROUGH THE SKIN AND BONE INTO THE SOFT TISSUES BELOW $IFFERENT SETTINGS CAUSE DIFFERENT IM PACTS AND SPECIFIC PROTOCOLS AS TO IDEAL PULSE RATES AND TARGETS ARE BEING EXPERI MENTED UPON 2EPETITIVE RAPID PULSE TREATMENT IS REFERRED TO AS vR4-3v )T APPEARS THAT LOW FREQUENCIES (Z TEND TO INHIBIT ACTIVITY IN EXPOSED AREAS WHILE HIGHER FREQUENCIES SEEM TO STIMULATE THESE AREAS 7HY THIS SHOULD BE SO IS UNKNOWN )F YOU CHUCKLED OR SCOFFED AT THE LACK OF EFFECTIVENESS DATA ON THE VA GUS NERVE STIMULATOR THIS TECHNOLOGY MAY PUSH YOUR INCREDULITY TO THE NEXT LEVEL .EVERTHELESS IT DOES APPEAR THAT SOME SUFFERERS GET SYMPTOM RELIEF FROM DEPRESSION AND EVEN PERHAPS THE AUDI TORY HALLUCINATIONS OF SCHIZOPHRENIA 3PECIFICALLY HIGH FREQUENCY R4-3 TO THE LEFT PREFRONTAL CORTEX HAS BEEN AS SOCIATED WITH DECREASED LEVELS OF DE PRESSION ! GOOD STARTING POINT FOR THE INTERESTED READER IS WWW PSYCOM NET DEPRESSION CENTRAL TRANSCRANIAL HTML OR WWW BIOMAG HUS FI TMS 7HERE THIS ULTIMATELY WILL LEAD IS QUITE UNCERTAIN AND THE TECHNOLOGY IS LARGELY EXPERI MENTAL AT THIS POINT BUT IT DOES REPRE SENT A NEW TREATMENT PARADIGM THAT IS GARNERING SERIOUS ATTENTION
0(!2-!#/4(%2!09 &2/.4)%23 4HE TRADITIONAL PHARMACEUTICAL PARA DIGM IS NOT WITHOUT ITS RADICAL NEW IDEAS /NE OF THE CUTTING EDGE IDEAS IS THE USE OF DIRECT PROTEIN BASED MEDICATIONS BUT THAT S ANOTHER STORY THAT WE LL HAVE TO KEEP UP WITH / ร ร ร ร ร 7 / ,ร ร รครคร ร
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$ILEMMA 0AUL 0UREHEART A LICENSED PSYCHOLOGIST IS EMPLOYED BY THE COUNSELING CENTER OF A 4EXAS UNIVERSITY /NE OF HIS PATIENTS 3AMARA EL (AFEZ IS A YEAR OLD STUDENT AT THE UNIVERSITY WHOM HE HAS SEEN IN COUNSELING FOR A WHILE TO REDUCE HER EXTREME ANXIETY 3AMARA S INITIAL RETICENCE WITH 0AUL IS BEGINNING TO ABATE (ER FAMILY INCLUDING A TWIN BROTH ER REMAINS IN THE -IDDLE %AST 'IVEN HER SEPARATION FROM HER FAMILY LACK OF SOCIAL SUPPORT AND THE UNREST IN HER HOMETOWN CONTRIBUTE TO HER ANXIETY 4HE ONLY SUPPORT SHE HAS IS FROM A GROUP OF STUDENTS WHO ATTEND DAILY PRAYERS ON CAMPUS ,ATE IN THE SEMESTER 0AUL IS APPROACHED BY TWO OFlCIAL LOOKING hSUITSv WHO IDENTIFY THEMSELVES AS &") AGENTS AND INFORM 0AUL THAT HE MUST ALLOW THEM ACCESS TO 3AMARA S EMAIL COMMUNICA TIONS AND OTHER RECORDS RELATED TO HIS TREATMENT OF HER 7HEN 0AUL RESISTS THE AGENT IN CHARGE EXPLAINS THAT HER FAMILY MAY BE INVOLVED IN FUNDING TERRORIST ACTIVITIES AND THAT UNDER THE 53! 0ATRIOT !CT 0AUL MUST HAND OVER 3AMARA S RECORDS 4HEY PRODUCE A hNATIONAL SECURITY LETTERv THAT PURPORTEDLY ALLOWS INVESTIGATORS TO DEMAND RECORDS AND TO PROHIBIT 0AUL FROM DISCLOSING THE REQUEST TO THE OWNER OF THE RECORD ÓnÊ
!NALYSIS !S WITH ANY DILEMMA 0AUL HAS COMPETING INTERESTS TO CONSIDER (E NEEDS TO EXAMINE HIS RIGHTS AND RESPONSIBILITIES DU TIES AND OBLIGATIONS TO THE PARTIES IN THIS ISSUE /NE MAJOR INTEREST FOR 0AUL IS RESPECTING HIS PATIENT S RIGHT TO PRIVACY THE OTHER MAJOR INTEREST IS ASSISTING IN THE SECURITY OF THE COUNTRY BY RESPECTING THE LAW OF THE LAND IN THIS CASE THE 53! 0ATRIOT !CT 0AUL ALSO HAS AN INTEREST IN BEING FREE OF GOVERN MENT INTRUSION INTO HIS RECORDS OF TREATMENT AND WHETHER OR NOT THAT REQUEST OF HIS RECORDS MEETS THE CONSTITUTIONAL STANDARDS FOR SEARCH BY THE GOVERNMENT (E ALSO HAS AN INTEREST IN KEEPING 3AMARA INFORMED OF THE USE TO WHICH HIS RECORDS OF HER TREATMENT ARE PUT )S IT FAIR OF THE GOVERNMENT TO OBTAIN THE RECORDS WITHOUT 3AMARA S CONSENT OR KNOWLEDGE 2ESOURCES 0AUL S INITIAL REACTION IS TO lND OUT WHAT HE CAN AND CANNOT DO )N REVIEWING THE ETHICAL AND LEGAL RESOURCES AVAILABLE TO HIM 0AUL CONVENIENTLY TURNED TO THE )NTERNET TO ACCESS RELEVANT DOC UMENTS (E CONSULTED THE FOLLOWING WHICH HE FELT TO BE THE RELEVANT BUT NOT NECESSARILY AN EXHAUSTIVE LIST OF RESOURCES ÊÊÊÊÊ7 / ,ÊÓääÈÊ
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) %THICAL 2ESOURCES ! !MERICAN 0SYCHOLOGICAL !SSOCIATION #ODE OF %THICS WWW APA ORG ETHICS !0! n MINIMIZE INTRUSIONS ON PRIVACY INCLUDE ONLY GERMANE INFORMATION !0! n DISCLOSE CONlDENTIAL INFORMATION ONLY AS ALLOWED BY LAW " 4EXAS 3TATE "OARD OF %XAMINERS OF 0SYCHOLOGISTS WWW TSBEP STATE TX US 43"%0 n DElNITION CONTENTS OF RECORDS 43"%0 C n RELEASE INFORMATION WITH CLIENT CONSENT COURT ORDER OR BY LAW )) ,EGAL RESOURCES ! 4EXAS ,AWS WWW CAPITOL STATE TX US THEN CLICK ON 4EXAS STATUTES IN THE LEFT COLUMN UNDER 2ESEARCH 48 (EALTH 3AFETY #ODE AND n EX CEPTIONS TO CONlDENTIALITY 53! 0ATRIOT !CT 3EC THAT PROVIDES FOR DISCLOSURE OF RECORDS THAT MAY RELATE TO INTERNATIONAL TERRORISM OR CLANDESTINE INTELLIGENCE ACTIVITIES " .ATIONAL ,AWS AND COURT CASES &AMILY %DUCATIONAL 2IGHTS AND 0RIVACY !CT THAT PROVIDES FOR PRIVACY OF STUDENT S RECORDS IN EDUCATIONAL SETTINGS *AFFEE V 2EDMOND 5 3 THE 3UPREME #OURT CASE THAT PROVIDES PRIVACY IN &EDERAL CASES FOR PSYCHOTHERAPY RECORDS #ONSTITUTION OF THE 5NITED 3TATES "ILL OF 2IGHTS !MENDMENT )6 WHICH PROVIDES AMONG OTHER THINGS PROTECTION AGAINST UNREASONABLE SEARCHES AND SEIZURE BY THE GOVERNMENT $ISCUSSION #OULD THIS SCENARIO HAPPEN /UR SOCIETY IS INCREAS INGLY CONCERNED WITH SECURITY AND PROTECTION FROM TERRORISM (OME LAND 3ECURITY AND THE 53! 0ATRIOT !CT ARE BUT TWO EXAMPLES OF THE PERCEIVED NEED TO ACCESS AND USE RELEVANT INFORMATION TO THWART TER RORISM 7HILE PROTECTION IS IMPERATIVE HISTORY SUGGESTS GOVERNMEN TAL POWERS CAN SOMETIMES BE ABUSED )N THIS SCENARIO 0AUL WEIGHS THE VALUE OF ACCESSING 3AMARA S RECORDS VERSUS THE HARM SUCH RELEASE OF RECORDS MAY CAUSE TO HIS TREATMENT OF 3AMARA OR DIRECTLY TO 3AMARA OR HER FAMILY IF THE INFORMATION IS USED INAPPROPRIATELY 0AUL IS AWARE OF THE EXCEPTIONS TO CONlDENTIALITY UNDER THE 4EXAS (EALTH AND 3AFETY #ODE %VEN IF HIS RECORDS OF HER TREATMENT CON TAINED INFORMATION ABOUT CRIMINAL BEHAVIOR ON THE PART OF 3AMARA OR HER FAMILY SUCH INFORMATION IS LIKELY STILL PROTECTED 4HE 4EXAS LAW DOES NOT REQUIRE THE DISCLOSURE OF A CLIENT S CRIMINAL BEHAVIOR PER SE UNLESS IT INVOLVES CHILD 4EXAS &AMILY #ODE 3EC OR ELDER ABUSE 4EXAS (UMAN 2ESOURCES #ODE 3EC (OWEVER THERE ARE EXCEP 7 / ,ร ร รครคร ร
TIONS IN THE LAW WHERE RECORDS MAY BE RELEASED UNDER CERTAIN CIRCUM STANCES SUCH AS IMMINENT DANGER TO SELF OR OTHERS A LICENSE REVOCA TION ACTION CERTAIN JUDICIAL OR ADMINISTRATIVE PROCEEDINGS OR FORENSIC EXAMINATIONS TO MENTION JUST A FEW )N 0AUL S OPINION NOTHING IN 3AMARA S BEHAVIOR MEETS THE EXCEPTIONS TO CONlDENTIALITY OUTLINED IN THE LAW NOR DOES IT APPEAR THAT THE &AMILY %DUCATIONAL 2IGHTS AND 0RIVACY !CT &%20! THE NATIONAL LAW THAT PROTECTS STUDENTS RECORDS AUTHORIZE SUCH RELEASE OF INFORMATION 0AUL ALSO KNOWS THAT RECORDS OF PSYCHOTHERAPY ARE HELD TO BE PRIVATE AND ARE PROTECTED FROM DISCLO SURE IN FEDERAL CASES UNDER THE 3UPREME #OURT DECISION IN *AFFE V 2EDMOND 4HE 'OVERNMENT S REQUEST FOR RECORDS SEEMS CLEARLY IN CONmICT WITH THAT DECISION 0AUL ALSO BELIEVES THAT THE #ONSTITUTIONAL PROVISION AGAINST UNREASONABLE SEARCHES IS IMPORTANT TO CONSIDER 3O FAR AS HE KNOWS THE GOVERNMENT HAS NO PROBABLE CAUSE TO SUSPECT THAT 3AMARA IS INVOLVED IN ANY ILLEGAL ACTIVITY RELATED TO TERRORISM OR CLAN DESTINE INTELLIGENCE GATHERING IT SEEMS TO HIM THAT SHE IS JUST TRYING TO GET HER BACHELOR S DEGREE
(OMELAND 3ECURITY AND THE 53! 0ATRIOT !CT ARE BUT TWO EXAMPLES OF THE PERCEIVED NEED TO ACCESS AND USE RELEVANT INFORMATION TO THWART TERRORISM 0AUL READS THE 53! 0ATRIOT !CT AND lNDS THAT AN .3, IS ISSUED AFTER A REVIEW OF THE REASONS FOR THE REQUEST !S FOR NOT TELLING 3AMARA THAT HER RECORDS ARE BEING SOUGHT BY THE GOVERNMENT 0AUL S FURTHER CAREFUL READING INDICATES THAT WHILE THE !CT CLEARLY STATES THAT NO PER SON SHALL DISCLOSE THAT THE &") SOUGHT THE RECORDS THERE IS NO PENALTY SPECIlED IN THE !CT IF HE TELLS 3AMARA OF THEIR VISIT AND ITS PURPOSE 0AUL GUESSES THAT S WHAT HAPPENS WHEN LEGISLATION IS WRITTEN IN THE HEAT OF THE MOMENT "ECAUSE OF THE NEWNESS OF THE 53! 0ATRIOT !CT 0AUL PLANS TO CONTACT AN ATTORNEY AS ONE OF HIS RESOURCES PRESUM ABLY THE ATTORNEY FOR HIS UNIVERSITY USING APPROPRIATE ADMINISTRATIVE CHANNELS OF COURSE %THICALLY 0AUL IS ATTEMPTING TO COMPLY WITH EXISTING LAW AND LICENSING "OARD 2ULES THAT REQUIRE SUCH COMPLIANCE BUT HE IS ALSO TRYING TO ACT IN THE BEST INTERESTS OF HIS CLIENT !0! 0RINCIPLE ! ร ย
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)N THIS CASE WE HOPE HE FOLLOWED THE !0! ETHICAL STANDARD IN ONLY INCLUDING INFORMATION IN 3AMARA S RECORD THAT IS GERMANE TO HER TREATMENT )F SHE REVEALED INFORMATION ABOUT CRIMINAL ACTIVITY IN HER FAMILY PRESUMABLY THAT WOULD HAVE BEEN CHARTED AS hRELATES ANXIETY ARISING FROM FAMILY DYNAMICSv OR hWORKING WITH TECHNIQUES TO REDUCE ANXIETY OVER CONmICT WITH AUTHORITY lGURESv OR SOME SUCH )N THIS
! PSYCHOLOGIST CAN BE REQUIRED TO RELEASE THE RECORDS OF A CLIENT UNDER THE 53! 0ATRIOT !CT WAY EVEN IF 0AUL IS REQUIRED TO RELEASE THE RECORD IT CONTAINS ONLY INFORMATION DIRECTLY RELATING TO TREATMENT 4HE OLD DAYS OF hPROCESS NOTESv RECORDING VERBATIM REMARKS OF THE CLIENT AS WELL AS THE PROVID ER S THOUGHTS OR THEORIES OR OBSERVATIONS ARE BEING REPLACED BY A NEW STANDARD OF PLACING IN RECORDS ONLY ESSENTIAL RELEVANT INFORMATION THAT ALLOWS FOR CONTINUITY OF CARE FOR THE CLIENT 3UCH RECORD CON TENTS ARE DElNED IN 0SYCHOLOGY "OARD 2ULE CITED ABOVE AND INCLUDE THE CLIENT S IDENTITY DATES OF SERVICE TYPES OF SERVICE
INFORMED CONSENTS FEES ASSESSMENT REPORTS TREATMENT PLANS GOALS CONSULTATIONS SESSION NOTES RELEASE FORMS AND RECORDS OBTAINED FROM OTHER SOURCES )N RESEARCHING THIS DILEMMA THE SENIOR AUTHOR CONTACTED THE 5 3 !TTORNEY S /FlCE IN (OUSTON 4HAT OFlCE INDICATED THAT A hNATIONAL SECURITY LETTERv .3, TO OBTAIN MENTAL HEALTH RECORDS WOULD LIKELY BE EMPLOYED IF THE CLIENT IN QUESTION HAD ACCESS TO CLASSIlED INFORMATION AND THERE WAS A SUSPICION THAT SUCH INFORMATION WAS BEING GIVEN TO ENEMIES OF THIS COUNTRY 4HE 5 3 !TTORNEY S /FlCE ALSO INDICATED THAT A MENTAL HEALTH PROVIDER WOULD BE COMPLETELY WITHIN HIS HER RIGHTS TO ASK FOR A COURT ORDER BEFORE RELEASING THE RECORDS 3UCH A PROCESS IS APPARENTLY QUITE STANDARD WHEN AN .3, FOR MEDICAL PSYCHOLOGICAL RECORDS IS INVOLVED #ONCLUSION #OULD A PSYCHOLOGIST BE REQUIRED TO RELEASE THE RE CORDS OF A CLIENT UPON RECEIPT OF A hNATIONAL SECURITY LETTERv UNDER THE 53! 0ATRIOT !CT AND THEN RESTRICTED FROM INFORMING THE CLIENT OF SUCH RELEASE 9ES BUT NOT LIKELY UNLESS SOMEONE LIKE 2OBERT (ANSEN SPY FOR 2USSIA WAS THE CLIENT AND PART OF THE INVESTIGATION OF HIS ACTIVI TIES INCLUDED SEEKING TREATMENT RECORDS THOUGHT BY THE GOVERNMENT TO BE PERTINENT (OWEVER PSYCHOLOGISTS NEED TO BE AWARE OF THIS NEW LAW S POWERS IN OBTAINING INFORMATION !S IN THE CASE OF SUBPOENAS OR COURT ORDERS IT IS ALWAYS WISE TO CONSULT AN ATTORNEY BEFORE RELEAS ING RECORDS &URTHER IT IS ALWAYS PRUDENT TO PLACE IN A CLIENT S RECORDS ONLY INFORMATION GERMANE TO THE CLIENT S CONTINUITY OF CARE PROTECT ING PRIVACY AS MUCH AS POSSIBLE /
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American Psychological Association Expert Summit on Immigration: Global Realities: Intersections and Transitions Through his “focus on family” platform, APA President-Elect Dr. Gerry Koocher plans to spotlight three areas that span all of psychology’s constituencies, one of which is Diversity in Psychology. “Our society is becoming diverse in ways that couldn’t have been imagined 20 years ago,” says Koocher, noting that not only are minority populations growing, but so are transracial marriages and international adoptions. “Psychology has the potential to help to move America in greater acceptance of multiculturalism.” Please complete the form below in order to register for the Expert Summit on Immigration to be held in San Antonio, Texas, February 2, 2006. Date: Thursday, February 2, 2006 Registration: Regular and On-Site Rate: $150 Location: St. Anthony- A Wyndham Historic Hotel, 300 East Travis, San Antonio, Texas, 78202 (210) 227-4392
Confirmed Plenary Speakers: Dr. Mary Pipher: Clinical Psychologist and Adjunct Clinical Professor at the University of Nebraska; NY Times bestselling author of Reviving Ophelia and In the Middle of Everywhere in which she “unites refugees, people who have fled some of the most repressive regimes in the world, with all of us...” Dr. Donald J. Hernandez: Professor in the Department of Sociology at the University at Albany (SUNY); had overall responsibility for the National Research Council report, titled From Generation to Generation: The Health and Well-Being of Children in Immigrant Families and Children of Immigrants: Health, Adjustment, and Public Assistance Dr. Carola Suarez-Orozco: Co-Director of Immigration Studies at NYU and co-author of Children of Immigration and Transformations: Migration, Family Life, and Achievement Motivation Among Latino Adolescents. She is also the co-editor of the award-winning six volume series entitled Interdisciplinary Perspectives on the New Immigration. Summit Co-Chairs: Toy Caldwell-Colbert, PhD – President of Div 45 Cynthia de las Fuentes, PhD - President of Div 35 Continuing Education: Society of Counseling Psychology (Division 17) is approved by the American Psychological Association to offer continuing education for psychologists. Society of Counseling Psychology (Division 17) maintains responsibility for the CE program. Your official namebadge will be printed using the information submitted on the form below. Please take care to enter your name as you wish it to appear on your official registration.
For additional information, schedule and registration information go to www.reisman-white.com click on the Conference Registrations link.
Save the dates for these Texas Psychological Association
Continuing Education Events
Professional Education Conference
2006 Annual Convention
May 5-6, 2006
November 16-18, 2006
Austin, Texas
Dallas, Texas
Doubletree Hotel
Westin Galleria
6505 IH-35N
13340 Dallas Parkway
(discounted rate of $99 for reservations made before 4/14/06)
(discounted rate of $129 for reservations made before 10/27/06)
Discounted parking
3 full days of continuing education credit available
9 hours continuing education hours, including 3 hours ethics as required by TSBEP
Additional information coming to www.texaspsyc.org soon!
PRESORTED STANDARD U.S. POSTAGE PAID AUSTIN, TX PERMIT #1149