The Power of Using Cable Access Television

In 2005, my colleage and I released a 30 minute video entitled, "Promoting Olmstead:The Need for Community Based Services for Persons with Disabilities." This video showed individuals who were either in danger of being in a nursing home or have been rescued due to having services in the community to keep them at home. I sold 50 videos at $ 30.00 a piece and won a national award from the Alliance for Community Media for producing this video with my esteemed colleague. Community leaders purchased this film and advocated to their state legislators to push the need for community based services.The video took 60 hours to edit due to multiple clips being filmed. It was well worth the effort.I want to offer you the opportunty to learn how to produce your own show on cable TV in your town.

Please view my upcoming teleconference at www.robbinmiller.vpweb.com for more information.
A five minute clip of this video can be viewed at www.youtube.com/millerchat.

Robbin Miller, LMHC

Grassroots Advocacy in Action

REDD, Rights, Equality for the Dignity of the Disabled, in which I am a member of this group, is running a grassroots advocacy effort to recruit paratransit riders with disabilities to talk about their transporation issues to a local legal aid entity.

Here are the questions that are being posted in local flyers:

Did a van or cab pass you by then charge you for a no show?

Did a driver fail to call out your stop or bus route when approaching or stopped at a bus stop?

Did you file a complaint; get no response or satisfaction from the *WRTA?

Were you left stranded when the wheelchair lift failed?

Did the WRTA or *PBSI ban you from using the service due to the weight of you and/or your wheelchair?

Do you need help getting out of your front door to reach the curb and does this lack of service prevent you from using paratransit?

(*Worcester Regional Transit Authority and *Para Brokerage Service Inc).

REDD will be doing presentations at Public Housing Complexes; Neighborhood Community Centers; Religious Groups; and with Individuals to educate them on the above issues and to have their voices heard.

It is very concerning that the above issues are happening to persons with disabilities and the bus company has not been proactive in resolving these issues. These issues have been going on since 2002 and one of their typical responses have been "We will correct it and make sure it does not happen again." The administrators and drivers lack empathy when it comes to riders with a mobility impairments being told that "they can't come on the bus due to the lift (on a fixed route) being broken." How humilitating it is for these riders to be denied equal access and steered to use paratransit service instead.

Please note that paratransit service has specific eligibility requirements under the Americans with Disabilities Act to access this service for riders with disabilities who are not able to use the fixed bus route service. Paratransit service requires a one day notice with a 20 minute window of time to pick up a rider to an appointment. The fares are higher and the time slots given for pick-up and drop-off can be up to a hour before a rider's appointment.

Last month, the Chair of REDD appeared on my TV show, Miller Chat to talk about these issues and to recruit people to have their voices heard. Cable Access Television is one avenue to get the word of on important issues affecting people in your community.

I welcome your comments.

Robbin Miller, LMHC
Facilitator
http://www.robbinmiller.vpweb.com/.

P.S. A one hour teleconference will be given on January 15th from 1-2 PM on learning how to produce your own TV show. More information is posted on the above website.

Are Mental Health Professionals Providing Quality Customer Service?

As the new year approaches upon us, I am wondering if the mental health profession for both social workers,mental health counselors,and psychologists can evaluate how we deliver quality customer service to our clients. The medical profession has taken a positive stand in teaching medical students how to provide quality customer service to their patients through one to one interactions in patient-doctor experiential training programs during their third and fourth year of medical school. I don't recall getting similar training when I went to counseling school for masters and post-masters degrees in the 1990's. In fact, I received no training whatsoever on how to provide quality customer service to my clients. I was just told to be "polite and politically correct" when counseling my clients at my internship and clinical training sites by my supervisors.

Furthermore, doctors who belong to certain organizations in their professions can receive continuing education credits for taking webinars and/or attend presentations on how to improve their skills in customer service with their clients.

I call on the National Association of Social Workers; American Counseling Association; American Mental Health Counselor Associations; and Americal Psychologist Association to evaluate whether offering customer service webinar/courses (for credit) would be an investment in training mental health professionals to provide quality customer service to their clients.

As a mental health professional who has been practicing since 1996, some of the biggest complaints I have heard from clients are that some counselors don't call back their clients; don't show up for their appointments with them; and only see their clients for thirty minute sessions and bill their insurance provider for an hour session to get a higher rate of payment.

I look forward to receiving your comments.

Robbin Miller, LMHC
Facilitator

Effect of 9c Cuts on Massachusetts Residents

Governor Deval Patrick announced the latest cuts for Mass Health that affect persons with disabilities and elders as reported by http://www.dpcma.org/: My comments are inserted in bold for some of the cuts:

1) Reducing day habilitation services by 5 hours per week, per recipient
2)Rolling back day habilitation rates to pre-February 2008 rates

3)Reducing Adult Dental Care, eliminating restorative care; allowing only emergency, preventative and x-rays

Comment:

This cut is ridiculous. If people can't get dentures paid for Mass Health, how will they eat solid foods? Elders and persons with severe disabilities are in danger of starving to death. Why should they have to resort to having their foods pureed if they can't afford dentures to eat solid foods? Not a sound healthcare policy by the Governor. There will be an increase in emergency room visits due to people getting infections in their teeth for poor dental care. A big cost to taxpayers.

4)Eliminating podiatry for all but diabetics

As mentioned above, not a sound healthcare policy. There will be an increase in ER visits due to Mass Health not paying for preventive foot care.

5)Eliminating PCA supports for severely disabled people needing less than 14 hours of service per week

Unfortunately, individuals who had less than 14 hours a month for PCA care are in danger of going to a nursing home due to cuts in homecare. Families will now have to do more to help their loved ones stay out of nursing homes and/or going to the ER for lack of personal care. More stress on the family and caregivers will result in potential neglect and physical abuse on these clients.

6)Reducing Adult Foster Care rates

I have mixed feelings due to one for profit entity making a 20% profit after operational costs are covered. Why can't these entities be non-profit and put the profit back into needed services for those clients to remain living at home?

7)In addition, there will be co-pays for some office visits and on presecription medications.

Hooray! Finally, these residents will have to pay something for their services. I am aware that some of them will not pay due to poor money management strategies. These individuals needs better skills in money management to pay for their co-pays for services. I have no sympathy for some individuals who blow their money on lottery tickets and on other foolish ways on the public dole.

In summary,these changes will be implemented over the course of the five months through April 2010. Some will require regulatory changes that include public hearing. Others may require legislative changes but let's be real - the legislature is not about to dirty it's hands in any way other than passing quickly on whatever the Governor proposes

Final Comment:I am aware that Mass Health will reduce their rates to providers who have to ask for co-pays from their clients. Potential layoffs can occur if providers are not able to provide the bare bone services they are currently providing for this population

What do you think?

Robbin Miller, LMHC
Facilitator

Promoting Disabilities as a Cultural Competence Part II.

Below I copied and pasted a Mass Health Provider (I did not put the actual name down) for Mental Health Services in Massachusetts on their policy for Cultural Competence:

What is Cultural Competence?

Cultural competence is the ability to work effectively with people from different ethnic,
cultural, political, economic, and religious backgrounds. This Mass Health Provider for mental health is committed to cultural competency and aims to improve the
access and quality of care received by our diverse group of Members.

This Mass Health Provider trains staff and providers so they are able to provide services with sensitivity, understanding, and respect for the Member's culture.

This Mass Health Provider is committed to a culturally competent program and aims to
establish services that reflect:
• Staff knowledgeable in the primary languages and cultural backgrounds represented
by Members;
• Sensitivity of staff members toward the cultural differences of Members;
• Programs that respect and reflect community values and are created by the
participation of community groups; and
• Involvement of Members in decision-making of policies and procedures.

Comments:

The above does not address Disability Sensitivity as a cultural competence. Why not? How would the proposal to use "unique physical characteristics" as suggested as a possible use for all individuals with these characteristics fit in as a cultural competence?

Please comment.

Thank you,

Robbin Miller, LMHC
Facilitator

House passes Healthcare Reform: What do you think?

On November 7th at 11:15, the House of Representatives by a slim victory of 220 to 215 votes passed the bill for Healthcare Reform our country. The bill now goes to the Senate for a fierce battle over what stays and goes to improve healthcare reform for our citizens. I was appalled by the lack of disrespect both sides of the aisle had for each other in voicing their disagreements with each other. What happened to civility?

I watched part of the debate on Saturday night and learned how the liberal Democrats chose to forego the abortion issue of using federal funds to pay for it so they can get the votes from their fellow conserative Democrats. Despite the conversary to get the bill passed, it had to be done to move it forward to the Senate in a timely manner.

I agree with some of the concerns the Republican Minority Whip raised during this debate regarding the following issues:

1) Increase in taxes to pay for it.
2) Another layer of government beaurcracy to manage it
3) Seniors losing their choice for enrolling in medicare advantage programs
4) Malpractice insurance and liability for doctors have not been discussed yet

I also agree with the benefits put forth by the Democrats with some reservations:

1) The donute hole for seniors enrolled in the medicare program would be eliminated and discounts of medications would be available. However, are the discounted drugs generic or brand medications?
2) Americans can keep their current health plans. However, will employers find a way to force people to go on the government's plan to decrease their costs to run their businesses?
3) Medical errors in hospitals still need to be addressed. Yes, I agree with the the Democrats that increase errors can lead to increase malpractice and liability claims for doctors and hospitals.
4) The End of Life counseling by doctors is voluntary and not mandatory. This issue needs further clarification.

What bothers me the most is the issue regarding mental health care. How will healthcare reform impact this care? Is the new mental health parity starting in January 2010, the answer to resolving all the concerns and issues that will no longer need to be addressed in healthcare reform?

What do you think? Regarding abortions, I would like healthcare reform promote more adoptions as an alternative and a viable choice for women.

Robbin Miller, LMHC
Facilitator

Reps. Rooney and McMahon Introduces CARES Act to Allow for LMHC TRICARE

Press Release from the American Mental Health Counselor Association:

Independence 10/16/09 Alexandria, VA- October 16, 2009-

AMHCA commends Reps. Tom Rooney (R-Fl), a member of the U.S. House of Representatives Armed Services Committee, and Michael McMahon (D-NY), a member of the Foreign Affairs Committee, for today introducing legislation that would strip TRICARE of its licensed mental health counselor “supervision and referral” requirement, thus giving TRICARE beneficiaries immediate access to licensed mental health counselors. This legislation, appropriately titled the CARES Act, “The Counselor Accessibility Reform and Expansion for Soldiers Act,” would permit TRICARE beneficiaries the same direct access to licensed mental health counselors currently available to numerous beneficiaries of private insurance plans. Disturbing statistics about recurring incidents of post traumatic stress syndrome in soldiers returning from Iraq and Afghanistan inspired Reps. Rooney and McMahon to introduce the CARES Act. Rep. Rooney says, “An important part of properly treating PTSD and other mental health problems facing our soldiers is to ensure them access to professional counselors.” Rep. McMahon identifies “face to face counseling with mental health professionals” as the means to ensuring America’s men and women of the Armed Forces “adequate, efficient mental health services.”

Before the genesis of the CARES Act, Congress tasked the Institutes of Medicine (IOM) to convene a panel and hold several meetings to make a recommendation to Congress as to whether to retain or strip TRICARE of its current “supervision and referral” requirement for licensed mental health counselors. The IOM panel has not yet issued a recommendation to Congress, and it is not expected to for several months.

AMHCA is committed to working with Reps. Rooney and McMahon, in addition to responding to the needs of the IOM TRICARE panel, to see the elimination of TRICARE’s current “supervision and referral” requirement for licensed mental health counselors.

Contact AMHCA Director of Legislative Affairs, Julie A. Clements, J.D., at jclements@amhca.org for more information

Please send letter to Congress:

Letter to Congressional Delegation

October 15, 2009

Dear Congress man/woman:

Daily headlines capture the attention of readers about declining state revenues, severe cutbacks in local aid, layoffs in state and municipal workforces, and reduced consumer spending. The headlines and the stories give only occasional play that the state’s fiscal condition has had on the safety nets low-income people rely upon for survival.

We are writing to you to ask you to put a continuation of the federal stimulus funding on the front burner for 2010 and 2011. The U.S. economy’s health cannot recover if fifty state economies continue to restrict spending and reduce growth.

Moreover, the important factor is what happens to people if state economies continue to bleed money, jobs, and services:

Home care services for elders and people with disabilities have been restricted, putting many at risk of going into a nursing home, which have a guaranteed stream of Medicaid funding.

People with disabilities relying on personal care services have their time allocations for toileting, bathing, and dressing cut to satisfy a bureaucratic need to reduce spending.
The service networks built over thirty years to provide non-institutionalized care for people with developmental and intellectual disabilities are broken in key areas, ones that are the linkages that underpin the whole service network: transportation, family support services, and vocational training.

The $1 billion of Federal Medicaid Assistance Percentage monies the Commonwealth applied to the FY10 state budget went a long way to stave off deep spending cuts. However, with the Massachusetts economy still shrinking, the devastation of deep budget cuts is coming within weeks as decreased tax revenues persist.

Renewing and expanding the FMAP stimulus funding is vital and has immediate advantages over construction and other projects. The money can be put to work almost immediately. The multiplier effect of Medicaid spending has been amply documented by leading economists. Finally, it is spent satisfying our national and state goals of “common wealth”.

A representative of our coalition will be calling you shortly to address this issue in person. We trust you will find our message appropriate to carry through the halls of Congress

Signed

Sponsored by www.dpcma.org.

A Challenge for the Mental Health Profession: Disability History Awareness Month

On October 15th, 2009, at 2 PM at the State House in Boston, the celebration of Disability History Awareness Month will be proclaimed.

Below is the following Law:

AN ACT DESIGNATING DISABILITY HISTORY MONTH.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
D) Chapter 6 of the General Laws, is hereby amended by inserting after section 15K the following section:-
Section 15L. The governor shall annually issue a proclamation setting apart the month of October as Disability History Month to increase awareness and understanding of the contributions made by persons with disabilities. Appropriate state agencies and cities and towns and public schools, colleges and universities shall establish programs designed to educate and promote these objectives.
E) Approved August 26,

Congrats to the Youth with Disabilities Leadership group who lobbied their legislators to pass this bill.

I now ask how the Social Work and Mental Health fields will promote Disability History Awareness Month in the graduate curriculums on the college and university levels and in our profession.

I have been advocating for years that my training course on "Disability Sensitivity Awareness" for mental health and social work professions be approved for CEUs. I have not had any takers due to being told "there is no interest for this training."

OK, colleagues, what can we do to honor Disability History Awareness Month in our professions?

Please let me know.

Robbin Miller, LMHC
Facilitator
www.robbinmiller.vpweb.com

Promoting Critical Consciousness in the Counseling Profession

The fourth anniversary of Hurricane Katrina in New Orleans brought together Americans to assist with the clean up of the devastation with their fellow citizens and to greatly promote the need for cultural competence including disability sensitivity for disaster preparedness staff including mental health counselors.

Goodman and West-Olantunji's article "Applying Critical Competence Consciousness: Culturally Competent Disaster Response Outcomes," (2009), states the lack of cultural competence training for disaster preparedness staff. One solution that these authors suggest is to train students (as an example) for "Critical Consciousness." This concept involves students working collaboratively with individuals and leaders in their communities to increase their awareness of their own personal biases and understanding of the complex issues at hand, which therefore can lead to empowerment and social justice for these groups. However, the article did not include disability sensitivity training as a component of cultural competence when working with persons with disabilities in their communities.

What can be done on the state and local levels to promote disability sensitivity training for students in graduate counseling programs and for those currently practicing as counselors?

In Massachusetts, as an example, there are various advocacy groups and service providers working collaboratively together to promote disability sensitivity for emergency responders in cities and towns across the Commonwealth. Here are a few resources:


1) Involvement with Committee Work:

Interested students/counselors can contact their local Independent Living Centers to find out how to get involved with the city and/or town committees on Emergency Preparedness. Serving on a local or state committee will increase your awareness on how difficult it can be to service all individuals' needs due to budget and fiscal constraints. Both Boston Center for Independent Living and Metrowest Independent Living Centers have taken leadership roles in being very vocal in promoting equal access for persons with disabilities.

2) Report:

On the state level, a report published in September 2008 entitled, "Recommendations from the Massachusetts Task Force on Emergency Preparedness and People Requiring Additional Assistance" concluded that the Commonwealth needed to remove barriers that prevent all individuals from accessing emergency products and services (p.iii) on the local and state levels. This report provides a complete list of recommendations to remove specific barriers in several areas in helping individuals requiring additional assistance during an emergency. This report can be accessed at http://www.dpcma.org/. The Disability Policy Consortium is an organization of volunteer advocates dedicated to lobbying for legislation on the state level that benefit persons with disabilities across the Commonwealth. DPC is very active and vocal in promoting the civil rights for persons with disabilities.

3) Public Hearing for Olmstead Initiatives


For those interested in learning more about the Commonwealth's plan to promote community base alternatives as opposed to living nursing homes for persons with disabilities, there will be three hearings in October across the state for people to attend:

October 23: Holyoke Community College 1 - 4 PM

October 28: Worcester Public Library 1 - 4 PM

October 30: Gardner Auditorium, State House 1 - 4 PM

4) Attendance at Grassroots advocacy meetings:

REDD, Rights, Equality for the Dignity of the Disabled, is an informal group of volunteers with/out disabilities who meet once a month on Saturdays in Worcester from September-June. Since its inception in 1996, REDD has accomplished major projects such as the extension of the platform at Union Station for persons with disabilities to board the trains with their families and friends and getting accessible taxicab service in Worcester that is available 24/7 in 2005. The latter took ten years to implement due to politics with City Hall. For more information, please contact the author of this blog. REDD's two major priorities are Transportation and Emergency Preparedness.

Resources:

Goodman, R.D, and West-Olatunji, C.A. (2009). Applying critical consciousness:Culturally competent disaster response outcomes. Journal of Counseling and Development, 87, 458-465.

http://www.bcil.org/

http://www.mwcil.org/

http://www.worcesteractivist.org/.

Robbin Miller, LMHC Facilitator

Counselors and Clients: Can't We All Get Along?

The Worcester District Medical Society published their recent magazine (July/August 2009 edition) entitled, "Worcester Medicine-Health Professionals and Patients: Can't We All Get Along," (Part 2) that printed several articles on different topics pertaining to the doctor/patient relationship.

One particular article entitled, "Understanding Humiliation" by the Dr. Aaron Lazare, MD, talked about how diagnostic labels such as hypertension, heart failure, psychiatric disorder, just to name a few, can be demeaning and decrease a patient's sense of dignity. Some of the patients he interviewed responded to his question, "How did the situation that brought you here (hospital or clinic) make your feel?" Some of their responses were: "like an animal," "like a welfare patient," "like I did not matter," "like a person without any rights," and "like a nobody."(P.11). Further, some patients also felt degraded when their doctors criticized their behaviors such as excessive drinking, weight gain, etc.

Dr. Lazare's attributed some possible reasons on why doctors and medical students may respond to their patients these ways:

* Not enough time with them(patients)
* Their (Patients) unreasonable expectations and demands
* Doctors/Medical Students feeling inadequate as a result of their own personal issues of perfectionism and dealing with overwhelming knowledge of information they need to know in their jobs
* Fear of malpractice suits

How can doctors learn to be more self-compassionate people with their patients?

Dr. Lazare teaches doctors about the emotional impact of humiliation on their patients as well as for themselves. Dr. Lazare's talks about the importance of offering an apology when appropriate and admitting to making a mistake to your patients. This solution makes patients feel that their doctors care about them by increasing their trust in them and being able to be more open with their doctors.

What can counselors take from the above information: I look at this opportunity as threefold:

1) Counselors can become more self-aware of how we treat our clients when we are feeling pressured on our jobs. For example, if you work in a family clinic, you are required to fill out treatment plans and quarterly reports in order to be paid by insurance companies. Other examples include taking on more clients to make a "liveable" income and responding to emergencies that can take all day to resolve, that is, if it is solvable. For those in private practice, the pressure can be to recruit and to retain prospective clients to stay in business. Other issues are trying to balance some of your clients' unreasonable and high demands for therapy outcomes due to their investment and time in seeing you. We need to be cognizant if we offend our clients in anyway and offer offer an apology
when appropriate.

2) Counselors need to be sensitive to how they process their clients' diagnoses with them. Sometimes, counselors can forget that the client is a person first before the diagnosis. Counselors also need to empower our clients to not be stuck with the "labels" but to see it as a small part of themselves that they need to manage on an ongoing basis.

3) Counselors can teach their clients that they have the right to be treated with respect and dignity at the hospital and in the doctors' offices. Counselors can refer them to the appropriate resources that can help them resolve their complaints if they choose to file one. Counselors can also work with them on their feelings of humiliation they experienced and to teach them coping skills to decrease their symptoms. However, if some of your clients act inappropriately in these places, you need to work with them on how to be more patient and to act in a dignified manner with an imperfect healthcare system.

I would like to see articles on teaching counselors similar communication and customer services skills that medical students and physicians receive in hospital settings.

What do you think?

Robbin Miller, LMHC
Facilitator
http://www.robbinmiller.vpweb.com/.

Controversial Health Insurance Reform Forum

I had the opportunity to be invited by Congressman McGovern's office to attend the Health Insurance Reform Forum at the University at Massachusetts Medical School today, 8/4/09 from 330-5 PM. Besides getting a lost due to poor logistics on finding the appropriate amphitheater and being appalled by the lack of adequate handicap accessibility for persons with disabilities, this forum achieved some of its goals in explaining the nuts and bolts on the proposed health insurance reform that is currently sitting in Congress.

The room was full and standing room only. Fortunately, I followed a few people to the platform level where I was able to hear the speakers and not see them. Later on, I was told to go to the fourth floor amphitheater where I was able to sit in an air conditioned room and see the speakers on the screen.

Some of the participants in the audience were loud, rude and disrespectful toward both Congressmen Richard Neil (from Springfield) and James McGovern and to each other. An UMass official told the audience that if those participants did not clamp down and stop their heckling, that both Congressmen would be escorted from the room and the forum would end.

After the brief 15 minute fray, things quieted down and both speakers were able to present their support of health insurance reform. Here are some of the points on why they both support changes:

1) The current system of health care is broken
2) The status quo is not working
3) 16% of Gross Domestic Product(GDP goes to healthcare costs; by 2040, health insurance costs will be 50% of the GDP. If this becomes the cost, the federal government will have difficulties paying for education and other costs that are important for Americans to have.
4) Drug costs are increasing exorbitantly.
5) The donut hole in Medicare is unaffordable for many seniors and for persons with disabilities

Here are some points that were clarified and supported by both speakers for health insurance reform:

1) The current Bush medicare "donut hole" for seniors would be changed. Currently, the Department of Health and Human Services (HHS) is forbidden under federal law to negotiate drug prices with drug companies. If bill is passed and would be effective in 2013, HHS would be able to negotiate for lower drug costs.

2) The myth or misunderstanding that patients would be mandated to have "End of Life Care" discussions with their doctors is false. Both speakers emphasized that these discussions are voluntary and the doctors will be able to get reimbursed for their time with their patients. It was noted that End of Life care is very expensive in particular for a young 25 old male (as an example) who gets into a motorcycle accident and has no health insurance to cover his costs. This position sort of makes sense to me as I understand why "the morphine" is sometimes pushed with hospice patients to get them of their misery. If they on Medicaid, it is cheaper to end their life sooner, as a cost-saving mechanism for the government. I also understand that this issue is controversial and very taxing and emotional for some family members to deal with.

3) If you have your insurance plan and like it, you can keep it. A participant yelled out, "How long?" Both speakers emphasized that nothing would change for them if they like their health insurance plans.

4) Incentives would be given for doctors to enter the primary care field as there is a current shortage of them throughout the country. The same is for increased recruitment of nurses for the same current economic conditions.

5) Increase emphasis will be on promoting and using evidence based practices to reduce costs and increase quality for patient care. An Independent Board of physicians and experts would conduct studies to evaluate the cost effectiveness of using evidence based practices that are not influenced by drug companies and special interest groups.

6) Overall, the gist of health insurance reform is to promote prevention, to increase responsibility on the individuals to purchase health insurance, and to improve the quality of care using cost-effectiveness evidence-based practices in reducing costs to the government and to taxpayers. To do nothing as both speakers stress, will result in higher taxes for Americans and maintain the status quo.

What do you think?


Robbin Miller, LMHC
Citizen-Therapist
www.robbinmiller.vpweb.com

Calling a Person with a Disability an Inspiration:Is this an inappropriate comment?

As an advocate, I am not comfortable when the general media calls a person with a disability "a story of inspiration" and " accomplishing a heroic feat." These terms in my opinion are offensive and actually put down a person with a disability. A friend of mine who has a mobility impairment said that a person with a disability is either looked at as a "hero" or "as shit" by the community. She said an individual with a disability needs to be looked in the "middle" as a person just like anyone else who does not have a disability.

How about if articles labeled a person without a disability as a TAB-Temporarily Abled-Person when writing about their issues in the general media? How would the community respond to this?

Many healthcare professions also believe that motivating their clients to arise above their disabilities by performing "extradordinary" feats will make them feel better. This is wishful thinking and can actually cause more harm than good. What about if this person does not accomplish this "feat' than what?

I have been actively advocating that "Disabilities" become part of the "Committee on Healthcare Disparities" for minority groups in Massachusetts. At press time, I don't if this legislation was pass to include "Disabilities" as part of this committee.

What do you think?

Robbin Miller, LMHC
Facilitator
http://www.robbinmiller.vpweb.com/

Promoting Your Private Practice

If it is true, we are in a deep recession, I ask my fellow colleagues on what they are doing to stay afloat and to grow their business?

Some new ideas emanating from the profession are the following marketing tips:

1) Take advantage of the internet in promoting your business. Form an Yahoo or Google group to attract clients. Also, being involved with a social network group like Facebook and Twitter may help promote your business.

2) Participate in committee work for social causes in your local communities to get your name out there.

3) Write articles on different topics pertaining to psychosocial issues affecting the general community in journals; blogs; magazine, etc. for potential clients to hear about your work.

4) Attend networking events with colleagues and business owners from different professions.

5) Offer free workshops to "enroll" potential clients.

What other ideas are you currently doing to build your practice?

How about the new concept of offering online counseling? A potential market that can be tapped into quite soon.

Robbin Miller, LMHC
Facilitator
http://www.robbinmiller.vpweb.com/

Obama's Proposal for Health Insurance Reform: What do You Think?

President Obama made his speech to the nation tonight stating that health insurance reform will provide health care to every American who needs it. Obama said that the public health insurance program will create competition with the private sector commercial insurance companies for the American people to choose from. Obama also said that the deficit would decrease from 7.3 trillion dollars to 7.1 trillion dollars when health insurance reform is passed. As stated earlier this week in several newreports, hospitals have agreed to take cuts in reimbursements for providing free care to individuals who don't health insurance. How will this impact you in terms of preminums being increased to pay for these costs to hospitals? Will America's healthcare insurance reform be like Canada where the healthcare is rationed with long waiting lists to get medical appointments and procedures done for their citizens?

One Republican congressman said that President Obama's plan will ration healthcare due to a new Governmental Bureacracy being formed. This individual also said that his constituents in this North Central state do not want the government taking away their healthcare.

What do you think? Are American people afraid of the changes in how health insurance will be paid for and decided for you by our government?


Robbin Miller, LMHC
Facilitator

New Mental Health Law Parity

Effective July 1, 2009
Massachusetts Mental Health Parity Law

1. What is the Massachusetts Mental Health Parity Law?
The Massachusetts Mental Health Parity Law requires insurers who offer mental health benefits to cover the diagnosis and treatment of certain mental disorders to the same extent that they cover the diagnosis and treatment of physical disorders. The law makes it illegal for some health insurers to place stricter annual or lifetime dollar or unit of service limitations on coverage of qualifying mental disorders that differ from the limitations on coverage of physical conditions. The law also provides for minimum outpatient and inpatient benefits for those disorders not required to be treated the same as physical ailments.

2. What mental disorders must be given unlimited medically necessary treatment?

The Mental Health Parity Law provides parity for these disorders:“Biologically-based” mental disorders· Schizophrenia· Schizoaffective disorder· Major depressive disorder· Bipolar disorder· Paranoia and other psychotic disorders· Obsessive-compulsive disorder· Panic disorder· Delirium and dementia· Affective disorders· Any other "biologically-based" mental disorders appearing in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (the "DSM") that are scientifically recognized and approved by the Commissioner of Mental Health in consultation with the Commissioner of Insurance Rape-related mental or emotional disorders ·

Mental or emotional disorders in victims of rape, or assault with intent to commit rape, to the extent the costs of diagnosis and treatment exceed the maximum compensation awarded to victims under the Massachusetts law regarding compensation to victims of violent crime. There are special provisions for children. NOTE: Showing the insurance company that the service you want is “medically necessary” is a must, even when the disorder or treatment is covered by the parity law.

3. What special rights do children have?

For children under the 19, the law provides additional safeguards with respect to "non-biologically-based " mental, behavioral, or emotional disorders. These are in addition to the protections for "biologically-based" disorders. Specifically, the law requires health plans to provide coverage to children: For non-biologically-based mental, behavioral, or emotional disorders that substantially interfere with or substantially limit functioning and social interactions, where: The child’s primary care physician, pediatrician, or a licensed mental health professional has made the referral for diagnosis and treatment of the disorder, and has documented the substantial interference or limitation,or ·

The substantial interference or limitation is evidenced by conduct, including, but not limited to (1) an inability to attend school, (2) the need for hospitalization, or (3) a pattern of conduct or behavior that poses a serious danger to self or others. ·

If a child turns 19 while undergoing treatment, the health plan must continue to provide this coverage until the course of treatment is completed and while the benefits contract covering the adolescent remains in effect. The plan is allowed to charge a premium for these extended benefits, if the child's eligibility for coverage would otherwise end at 19.

4. Does the law cover treatment for alcoholism or other chemical dependency?

Massachusetts law requires that coverage of alcoholism and/or chemical dependency treatment include 30 days inpatient care and $500 worth of outpatient benefits. However, when treatment for these problems occurs in conjunction with treatment for mental disorders, the patient is entitled to broader coverage.

5. What is the minimum coverage for disorders that are not on the list of covered disorders?

For mental disorders that are not on the list of disorders eligible for parity, insurers must provide medically necessary coverage during each 12 month period for a minimum of 60 days inpatient treatment and 24 outpatient visits. Carriers cannot impose other limitations or cost-sharing (such as copayments) on treatment for these mental disorders, unless the same requirements apply to physical conditions. Medication visits and neuropsychological testing are not subject to these limits, and must be covered on the same terms as medical services.

6. What health plans must comply with the MHPL?

The Mental Health Parity Law applies to all of these health plans:· Group Insurance Commission ("GIC") plans for government employees and retirees·Plans issued by Massachusetts-licensed commercial health insurers· Blue Cross and Blue Shield of Massachusetts plans·Plans issued by Massachusetts-licensed HMOs· Small group health plans regulated by Massachusetts insurance authorities·Non-group health plans·Student health insurance plans (for higher educational institutions) The following plans do not have to comply with this law:·Self-insured employer group health plans.An employer is self-insured when, instead of paying an insurance company or HMO to cover the health care costs of its employees, the employer itself covers these costs. For more information about your rights in a self-insured plan, call the Department of Labor (regional office) at 617-565-9600 or visit www.dol.gov <http://www.dol.gov/> , or the Attorney General's Insurance Hotline at 1-888-830-6277.·

7. Does the parity law cover outpatient as well as inpatient services?

Yes. The law states that a full range of inpatient, intermediate, and outpatient services shall be available for the treatment of mental disorders, so that treatment may take place in the least restrictive clinically appropriate setting.

8. What is not covered by the parity law?·

Insurers are not required to cover mental health services for persons incarcerated in jail, prison, Department of Youth Services facilities, or other correctional settings. Insurers are not required to pay for those “educational services” that a school must provide as part of its special education program. Note: If there is a medical component to a special education plan, the insurer still should pay for those services which are medically necessary. Insurers are not required to cover services provided by the Department of Mental Health.

If you have questions about the Mental Health Parity Law or you need help getting your insurer to pay for mental health services, please contact: Mental Health Legal Advisors Committee(617) 338-2345 or (800) 342-9092ext. 29
Posted by olddockeller at 12:03 AM

Submitted by Robbin Miller, LMHC

Please support the following House Bills:

Please email the following two Chairs of the State House Judiciary Committee to ask them to release these bills from their committee in a timely manner:

Chairman Eugene L. O'Flaherty
State House, Room 136
Boston, MA 01233
617-722-2396

Chairwoman Cynthia Stone Creem
State House Room 416-B
Boston, MA 02133
617-722-1639

House Bill 3529: An Act Relative to the Safety of the Children in the Commonwealth;

House Bill 3528: An Act Relative to Protecting Children from Exploitation; and

House Bill 3527: An Act Relative to Sex Offender Registration

Thank you,

Robbin Miller
Blog Facilitator

Ethics Reform for the Mental Health Profession

The State of Massachusetts is implementing ethics reform in how it handles pensions, benefits, etc for their state employees and politicians.

What do you think of the Mental Health and Social Work professionals looking at ethics reform on how some clinicians choose to bill for services that are not honest.

For example, some clinicians will bill an insurance company an hour for an individual session when they only saw the client for 15 or 30 minutes. Their rationale is that they have to make productivity or being laid off or demoted to fee for service status. Furthermore, if an agency conducts a customer service call to their clients, their clients will vouch that they saw their clinicians for hourly appointments and not for a 30 minute or for a 15 minute appointement.

What do you think?

Robbin Miller, LMHC

A Case for Social Justice:

Below is an article in today's Worcester Telegram and Gazette talking about a women who I personally know who was denied access to a public bus due to an operable lift. This issue of inoperable lifts have been going on for years where the bus company always apologizes but offers no compensation for these riders who are left out in the "cold." I have called on my advocates and the Office on Civil Rights and Disabilities in Worcester to address this problem as a civil rights issue. What do you think?

Robbin Miller, LMHC
Facilitator

Woman is left behind
WRTA fails rider with walker twice in one day
By Lee Hammel TELEGRAM & GAZETTE STAFFlhammel@telegram.com

3 comments Add a comment

WORCESTER — As the No. 8 bus pulled away from Jean Bourgeois and her walker on Franklin Street on Wednesday afternoon, there was a sense of déjÀ vu. It wasn't just in the mind of the 84-year-old resident of Seabury Heights. It's something that she said happened repeatedly last summer. Five times in a month last summer, she said, lifts on Worcester Regional Transit Authority buses failed to operate, and the buses left without the driver offering to call RTA Transit Services to provide her an alternative. Last summer, RTA Transit Services, which operates the transit authority's buses, said the problem was twofold. The aging fleet of buses had finicky wheelchair lifts that sometimes broke down the same day they were fixed, and there were too few mechanics to do anything about it. It left the company with no choice but to violate not only company policy, but Federal Transit Authority requirements on how often buses can leave the garage with inoperable lifts, according to John F. Carney, general manager of the bus contractor. But by Aug. 30 the company hired another mechanic and put eight new buses on the road, retiring the worst vehicles. “After Aug 30, if the lift's not working, the bus won't go out,” he vowed last summer. Yet this week Mrs. Bourgeois was unable to get on not one, but two WRTA buses in a single day because the lifts did not work. Mr. Carney said the company knew that one of them wasn't working before it left the garage. Despite his promise last year, he said Thursday “When push comes to shove, we do” operate buses with malfunctioning lifts because “we have to make service.” The first time, about 1:40 p.m. Wednesday, the lift did not work on the No. 30 bus to Wal-Mart in West Boylston, Mrs. Bourgeois said, so she waited for the 2 p.m. bus. She and her companion, Panteles Demis, returned to Main Street opposite City Hall to transfer to the Route 8 bus that leaves from the Franklin Street side of City Hall for Seabury Heights, 240 Belmont St. There, trouble resumed when the lift could not be operated on the 4 p.m. bus. The driver of the 1:40 p.m. bus, who took over at City Hall for the employee who drove the bus earlier in the day, could not locate the key necessary to operate the lift, Mr. Carney said. He acknowledged that the lift on the 4 p.m. No. 8 also was inoperable. But he said that he was informed that the driver at least followed procedure. That would have meant calling a starter, requesting a backup van, and offering the customer a choice between waiting for the backup or walking back to Main Street to catch the No. 24 bus to Seabury Heights, which Mr. Carney said would have been quicker for the customer. Because the No. 24 driver knew that a passenger had been inconvenienced by the No. 8 bus, he delayed leaving City Hall for five minutes after he should have left, Mr. Carney said, but Mrs. Bourgeois did not show.

That's because Mrs. Bourgeois said she'd had enough. Contrary to the policy Mr. Carney outlined, Mrs. Bourgeois said the bus driver said he was told by the company that no backup van was available and he instructed her to walk back to Main Street to catch the No. 24 bus. Mr. Demis confirmed he does not recall hearing the driver offer an alternative to walking back to Main Street. She did not walk back to Main Street because “I'm handicapped. I hurt, and I just walked down there, and I get worn out.” One of the reasons she hurts, she said, is “I'm still recovering from the bus accident” — when an RTA bus driver had to slam on his brakes to avoid an accident last summer. “I took off like a missile” — out of her seat and into a pole on the bus. At the time, she had nearly recovered from back surgery, and said that 11 months after the accident “my back kills me” and “my head doesn't feel good.” Mr. Carney said there were times last year that seven or eight buses a day without operable wheelchair lifts were on the road. “Now if I have one or two on the list, that's a lot.” The day Mrs. Bourgeois encountered both of them, the company picked up, without incident, 24 other passengers needing the lifts, the general manager said. Christopher W. Bruce, head of Amalgamated Transit Union Local 22, who was critical of the company's record with wheelchair lifts last summer, said, “I believe it's much better than it was.” Mr. Carney said of Mrs. Bourgeois, “I can do nothing but apologize. We'll try to do better.”

Boston Globe supports Disabilities as a Disparity

The Boston Globe
Editorial
June 9, 2009

What 'access' really means
PUBLIC HEALTH officials have long recognized - and tried to eliminate - the sharp disparities in health among racial and ethnic minorities. But there is another group as well that ranks well below average on many measures of health: people with disabilities. When the state launched its universal access to healthcare law in 2006, it created a council to monitor and correct health disparities. The Legislature should pass a bill that would have the council address the barriers to good health faced by people with disabilities, as well as other minorities.
According to a report released this spring by the Disability Policy Consortium, adults with disabilities have four times the average risk of developing diabetes and a 20 percent higher risk of obesity. The diagnosis of cancer in a late stage is 41 percent more common among people with disabilities than in the population at large.
The report shows that it is not enough for health facilities to comply with the physical access and other requirements of the Americans with Disabilities Act. People with disabilities face other obstacles in getting the medical attention and education they need. The report deplores health programs and systems "that lack the cultural competency to provide appropriate healthcare services and education to people with disabilities."
Insurance coverage for nearly 98 percent of the population is an impressive achievement by the state, but the persistence of disparities in health outcomes and at-risk behaviors indicates that a strictly medical model for providing care is insufficient. Public and private health providers have to address the needs of people with disabilities from the broader social perspectives that they have already begun to use with racial and ethnic minorities.
© Copyright 2009 Globe Newspaper Company.
Click here to download the report, Disabilites and Disparities.

Testimony to the Joint Committee on Public Health
June 1st, 2009

My name is Robbin Miller. I am a healthcare advocate for persons with disabilities. I am supporting Senate Bill 858 to include “Disparities” as part of the work the Health Disparities Council conducts in promoting policy making for ethnic and minority groups.
I have one story to demonstrate on how attitudinal barriers in the healthcare profession can discriminate against persons with disabilities.

Sheba is a 40 year old thin build woman who has Multiple Sclerosis (MS). Sheba told me that one day she went to Boston to get x-rays of her back at an outpatient facility for her doctor who specializes in MS treatments and research. The technician directed Sheba to follow her to the room that would take her x-rays. The technician asked why Sheba did not bring her personal care attendant (PCA) to assist her on the table. Sheba said she was told that she did not have to bring her PCA due to the technician that would assist her instead. Sheba told me that the technician made an angry face at her and said something under her breath. As the technician proceeded to assist Sheba on the table (from her manual wheelchair), Sheba heard the technician moaned several times on how heavy she was and that she needed to lose some weight. Sheba was horrified by these remarks and did not know what to say.

Sheba was afraid to be assertive with this technician for fear of being left on the table with no one to assist her back in her wheelchair. Sheba said she will never go back to this facility due to the verbal abuse she encountered with this technician.
The technician’s actions are unacceptable in mistreating Sheba as a human being. Healthcare facilities that perform outpatient medical services will benefit from receiving disability sensitive training like they do for working with ethnic and minority groups. They will learn how to interact appropriately with persons with disabilities in a professional manner.

I summarize my testimony in asking the Joint Committee on Public Health to support Senate Bill 858 to include “Disabilities” as part of the work that Health Care Disparities Council conducts for ethnic and minority groups. As an advocate, I have offered many healthcare facilities an opportunity to receive a program on “Disability Sensitivity Training” when interacting with persons with disabilities. Unfortunately, their gatekeepers feel that Disability is not a cultural competence. Disability leaders want to let members know of this committee that disability is a culture that needs to be respected equally along with minority and ethnic groups that this council serves.
Respectfully submitted,

Robbin Miller
Advocate

Testimony to Support House Bill 3586

Dear Members of the Mental Health and Substance Abuse Committee:

I am a Licensed Mental Health Counselor. I present my testimony based upon my professional experiences counseling families in an outpatient clinical setting.
I support House Bill 3586, An Act Relative to the Coordination of Children's Mental Health Care that will be heard this Wednesday, May 27th at the State House in Boston. This proposed bill will require commercial insurers to pay for collateral contacts for children with mental health needs. Collateral contacts refer to scheduled, in-person or telephonic consultations between a therapist and other individuals in a child’s life (parents, teachers, pediatricians, guidance counselors, etc) who can help withcoordination of care and help the therapist better understand how the child is responding to the treatment.

Currently, Mass Health pays for collateral contacts. As a clinician, I have found collaborating with the above professionals very helpful in coordinating the best care for these children who were involved with a variety of providers. For example, this past year, I attended a meeting at an inpatient residential facility for boys, ages 5 years old and up. My client who is a tween, between eight to twelve years old, was admitted for a ten day evaluation for acting out in school. The staff psychologist invited me to a meeting with his teachers and with parents to discuss an action plan to discharge this client back into his community and to live at home with services in place. If it wasn’t for Network Health paying for my time to attend this one hour meeting, the client’s action plan would have been incomplete for servicing his mental health needs. A residential facility can not discharge a child unless his/her action plan includes provisions for counseling services in the community.

Unfortunately, for those children on commercial insurances, I have declined attending meetings with their schools due to not being reimbursed for my time. For example, last month (April 2008), I declined attending a team meeting at my client’s school due to her commercial insurer not paying for my time. Please note that due to an ethical responsibility to service my client’s mental health needs, I did speak to the school personnel via telephone for less than twenty minutes. However, the client’s behavior did not improve in school and I was not able to attend further meetings in school. As a result, the parents decided to seek counseling services in school and terminated their child’s mental health services with me at the clinic.

Children are children no matter what health insurance provider covers their mental health needs. In spirit of the Children’s Behavioral Initiative to cover collateral contacts for children on Mass Health, I ask this committee to please support House Bill 3586, An Act Relevant to the Coordination of Children’s Mental Health Care.

I have asked parents on commercial insurances to please contact their legislators to support the above bill that will provide quality services for their children's mental health needs.

Respectfully submitted,

Robbin Miller, LMHC
Facilitator for www.therapistsforchange.blogspot.com

Is Raising Taxes the Answer to Avoiding Cuts to Core Services?

Health Care For All's Healthy Blog (May 15th, 2009) published this information on their website, http://www.hcfama.org/, in justifying why raising taxes is a good idea for the Commonwealth of Massachusetts. I support raising taxes and major reform on how our state spends taxpayers' funds for core services and infrastructure projects. I also believe that our welfare and SSI systems needs to be scrutinized as abuse is quite rampant by many residents.

Unfortunately, some residents believe that being on welfare and getting a SSI check for their child's diagnoses is the answer to supporting their families and continuing to practice unhealthy behaviors in their homes and in their communities. What do you think?

Robbin Miller, LMHC
Facilitator

Here is the information from Healthcare for All's Healthy Blog:

"Economic theory and historical experience both show that raising taxes during a downturn—particularly taxes that affect only higher-income families—is generally better for a state’s economy, and better for its citizens, than sharp budget cuts.

The reasons are simple. Almost every dollar that states and localities spend on aid for the needy, salaries of public employees, and other vital services enters the local economy immediately. So if states cut their spending in these areas, overall demand suffers at a time when demand is already too low and support services are most needed.

The alternative—raising taxes—also reduces spending, but by less than budget cuts of comparable size. And by targeting these taxes appropriately, their negative effects can be minimized.…Keeping budget cuts to a minimum can also benefit the states in another way. Well-designed investments in education, health care, transportation, the environment, and other areas strengthen the economy over the long term. States with educated, healthy workforces, strong infrastructure, and a high quality of life will be best positioned to benefit from the economic recovery.

In short, we believe that maintaining many of the services provided by state governments is critical to an economic recovery, and that cutting those services would harm those who are most in need. "

Speak Now for Kids

Below is my testimony I submitted to www.speaknowforkids.org.

Children's Mental Health Law:


To Congress:

Please modify the inequitable system on how mental health clinicians are reimbursed for their time in counseling children in outpatient clinics. Currently, mental health clinicians with masters degree and above and with/out licensure are underpaid; not reimbursed for clients on Medicaid; and have to endure unfair and stringent productivity requirements to be paid on a salary as opposed to fee for service. In Massachusetts, the new Children's Mental Health Law under the Rosie D vs. Romney suit, does address the mental health needs of children with severe emotional disturbances but fails to put improve the quality of services for children who need outpatient services that don't have serious emotional disturbances.

Respectfully submitted:

Robbin Miller, LMHC
Citizen-Therapist

Community Organizing

Yesterday, May 5th, 2009, advocacy groups, advocates, and agencies serving persons with disabilities packed Worcester City Hall to attend a City Council meeting to have their voices heard. The City of Worcester has eliminated two positions in the Office of Disabilities due to budget cuts and have merged their services with the Office of Human Rights. Advocates are outraged as this office has no staff person trained on disability issues to service their complaints and their issues under the American with Disabilities Act(ADA).

One of the City Councilors called on the City to seriously consider their decision to eliminate the operations of the Office on Disabilities and to think about how the needs of Disability Community will be met under the Office on Human Rights. Only one advocate was allowed to speak on this issue due to a heavy plate of agenda items that the Council had to finish before another meeting took place afterwards. The advocate spoke with disgust on how the City did not notify the above parties that the Office on Disabilities would be eliminated. The advocate felt that the City could have done a better job in communicating their intentions to close this office and to ask for feedback from the community on how the disability community's needs would be impacted.

To further add to advocates' frustration, The City Manager has not communicated with one disability agency to meet with them to discuss the above issues including who will serve as the ADA Coordinator for the City of Worcester.

As a member of a disability advocacy group who attended yesterday's meeting, I emailed all the City Councilors a few weeks ago to ask them to return the clerk who was laid off to work with the Office of Human Rights in an expert capacity on ADA issues for the disability community. Unfortunately, the City did not reinstate this clerk's position to this office.

The advocates, disability agencies and advocacy groups have to continue to strategize to have their voices heard. I will keep you posted as we move along.

Robbin Miller, LMHC
Facilitator

The Seniors Mental Health Access Improvement Act of 2009

This information was sent by the American Mental Health Counselors Association. Please email or send a letter to your congressional representative and senator regarding the below information:

April____, 2009
The Honorable___________House/Senate Office BuildingWashington, DC 20510RE:

Please Co-Sponsor S. 671/H.R. 1693:

The Seniors Mental Health Access Improvement Act of 2009.

Dear Senator/Representative:

I am writing to strongly urge you to co-sponsor S. 671/H.R. 1693, The Seniors Mental Health Access Improvement Act, which would establish Medicare coverage for licensed professional mental health counselors. With the exception of a recent federal law that finally equalized outpatient co-payments for mental health and medical/surgical services, the baseline Medicare mental health benefit has not been updated in almost 20 years. This inaction has consequences.

Improve Access in Rural Areas and among Underserved Minority Populations:

Approximately 77 million older adults live in 3,000 mental health professional shortage areas. Yet over 50% of rural counties have no practicing psychologists, psychiatrists or social workers. It is shocking to note that fully two thirds of rural residents with mental illness symptoms receive no treatment at all. As a direct result of this lack of access, older Americans with chronic medical conditions and major depression (nearly 2 million senior citizens nationwide) have significantly higher rates of disability than those with either condition alone. Similarly, in a report entitled "Mental Health: Culture, Race and Ethnicity," the United State Surgeon General noted that "striking disparities in access, quality and availability of mental health services exist for racial and ethnic minority Americans." A critical result of this disparity is that minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental disorders.

Making Medicare a Better Purchaser of Mental Health Care:

Inpatient psychiatric hospital utilization by elderly Medicare recipients is extraordinarily high—particularly when compared to psychiatric hospitalization rates for patients covered by Medicaid, VA, TRICARE and private health insurance. To the extent that fully one third of these expensive inpatient placements are caused by clinical depression and addiction disorders, it is strikingly clear that additional community-based mental health services provided by licensed professional mental health counselors will reduce unneeded hospitalizations.

The bottom line is: lack of access to mental health care is increasing both the burden of disability on our senior citizens and minority communities as well as the financial burden on the Medicare program. Please Co-sponsor H.R. 1693/ S. 671.

Sincerely,

Should Mandatory Continuing Education Requirements be reformed?

Attorney Richard S. Leslie, JD, wrote an opinion piece entitled "Mandatory Continuing Education-Does It Work" in the Risk Management section of the April 2009 edition of the Advocate Newsletter (published by the American Mental Health Counselors Association) about whether or not mandatory continuing education requirements for mental health counselors really decrease "the number and severity of disciplinary actions against licensees? (P.10). Attorney Leslie writes that if a study was done by each licensing board in each state, for example in Massachusetts, the results would indicate that the mandate does not decrease the number or severity of cases for disciplinary actions.

In fact, disciplinary actions taken by state licensing boards tend to be true violations of their state laws for example, insurance fraud, sexual relationships with clients, and failure to report child abuse. Attorney Leslie states these illegal acts are not related to a continuing education issue.

Attorney Leslie writes as he spoke to an "renowned expert" (P.10) about changing the system on mandatory continuing education requirements. The suggestion would be for mental health counselors to be tested every five years on specific topics designated by their licensing board. If the counselor fails the exam, his/her license would be reissued. However, the individual would be required to take continuing education training to increase his/her knowledge of a specific topic area that was not passed on the exam.

What do you think? I do not support taking a test every five years to measure certain areas of knowledge by the state licensing board. Taking an exam of this nature, requires many hours of studying that I would find inconvenient and not fun. I rather take the required thirty hours of continuing education units (CEUs) that is mandated by the licensing board every two years in which I can freely choose what trainings to take on my own time. I agree with Attorney Leslie that continuing education may not stop a counselor for committing an alleged illegal act under state laws. No mandated test or continuing education training will prevent a counselor that lacks immoral character from committing a crime.

I recommend that counseling graduate programs implement a mandated course on "Ethics and Professionalism" that will be able to weed out those students who don't belong in the program. Also, employers could implement a mandatory ethics training program once a year during their staff meetings to keep counselors updated and refreshed on new issues that may arise on the job.

Robbin Miller, LMHC
Facilitator
www.therapistsforchange.blogspot.com

A Sad Time for Childrens' Mental Health

In the past few months, several family clinics throughout the state have closed their doors due to not receiving the increase in Mass Health rates to service childrens' mental health needs. As a result, there will be limited services and openings for low income children who need outpatient therapy as well as for medication management. Please note that the Rosie D mandate will fund intensive services for children diagnosed with serious emotional disturbrances(SED). However, those children who are not diagnosed with SED, will have a difficult time finding outpatient therapists and psychiatry for their mental health needs.

What can you do:

Please contact your state legislator at 617-722-2000 to voice your concerns about the lack of adequate reimbursements to fund family counseling centers for children with mental health needs that need outpatient and medication management services.

Medicare Mental Health Counseling Coverage Bill Introduced!

Dear Colleagues:

Please contact your congressmen and senator to support that licensed marriage, family and mental health counselors be covered under medicare .

Please see below the press release by AMCHA this morning:

Congressional Background Information Legislation has been introduced in both the House and Senate to establish Medicare coverage of licensed professional counselors. On March 23rd, Senators Blanche Lincoln (D-AR) and John Barrasso (R-WY) introduced S. 671, the "Seniors Mental Health Access Improvement Act of 2009." The next day, Representative Bart Gordon (D-TN) introduced H.R. 1693, identical legislation with the same title. The legislation would also establish coverage of licensed marriage and family therapists. AMHCA and ACA worked closely with Senators Lincoln and Barrasso, and with Congressman Gordon, on the development and preparation of the legislation.

We Need Cosponsors! Mental health counselors are strongly encouraged to call, write, or e-mail their Senators to ask them to cosponsor S. 671, and their Representative to ask for cosponsorship of H.R. 1693. The more cosponsors we have for S. 671 and H.R. 1693, the more likely we are to gain their inclusion in the larger Medicare legislation to be approved by Congress.

Follow this effective method to reach your senators and representatives:
Call 202-224-3121 (the main Capitol switchboard).
Ask to be connected to the office of a specific senator or representative.
Once connected, ask to speak with the health legislative assistant.
Ask his or her boss to co-sponsor the bills referenced in this message.

We Are at a Critical Crossroads!Yes, Congress has actively considered legislation providing Medicare reimbursement to LPCs for several years now. But THIS year, in THIS session, Congress will be considering legislation to reform America’s health care system. Plus, Congress will pass Medicare legislation this year, in order to prevent a scheduled 20% pay cut for physicians under the program from taking effect on January 1, 2010. We need mental health counselor coverage to be part of this Medicare package—and this represents a prime opportunity to achieve our long sought goals.
Please take a moment to call or e-mail your Representative and Senators and ask them to cosponsor the "Seniors Mental Health Access Improvement Act of 2009" (H.R. 1693 / S. 671).This legislation will improve Medicare beneficiaries’ access to outpatient mental health care in a cost-effective manner, by establishing coverage of highly-qualified LPCs.

For more information, contact Al Guida, AMHCA's lobbyist, at 202-331-1120, or e-mail him with any questions. Act now!


Submitted by,

Robbin Miller, LMHC
Facilitator

Will Viritual Reality replace the Brick and Mortar of Counseling?

Michael Ventura's article, "Screenworld" (Psychotherapy Network, Jan/Feb 2009) talked about the differences and impact of cyberspace on the traditional brick and mortar style of counseling.

It is true that more and more people are using the internet for a variety of reasons. Some people find comfort in engaging in social networks such as facebook and myspace as a way of connecting with each other and meeting new people. Others enjoy participating in a variety of interactive computer games that can be discerning, particulary, for children and teens engaging in violent and competitive games with each other. The internet can also provide valuable educational opportunities for adults to take college classes online and to click on to other websites that can provide informal learning opportunities based upon an individual's interest area.

The question is "Will counseling lose its effectiveness for people wanting to meet their counselor in person? In an office setting, a client gets the three dimensional view of interacting with their counselor as opposed to the one dimensional view in cyberspace. While the former can provide a warm environment by its smells, its touch, its sight, its taste, and personal connection from a caring professional, how can counselors make the latter similar and inviting?

Maybe a little bit of both is the answer as the client and the counselor can benefit and compromise from each domain. However, one greatest challenge facing the profession is the lack of insurance reimbursements for seeing clients through cyberspace. How many clients are willing to privately pay to engage in treatment over the internet? I am glad though that the profession has developed ethics and guidelines for internet therapy.

What do you think? Can you imagine conducting therapy through facebook and myspace? What will become of the profession in the next few years and decade?

Robbin Miller, LMHC
Facilitator
http://www.therapistsforchange.blogspot.com/

Support GHEA coverage for Licensed Mental Health Counselors

To all mental health professionals, please write to the following individual regarding their company's policies to reimburse licensed mental health counselors for counseling services under the Federal Employee Health Employment Program. Below is a suggested letter to be sent. Please feel free to add your own ideas or facts to GEHA. Please note that ideas and some wording for this letter was taken from a template that the American Mental Health Counselors Association sent to their members in the monthly newsletter, The Advocate, February 2009 edition.

Government Employee Health Association, Inc.
PO Box 4665
Independence, MO 64051

Dear GEHA:

I am writing as a licensed mental health counselor in Massachusetts concerning the Government Employees Health Association (GEHA) refusal to reimburse the services of licensed mental health counselors under the Federal Employee Health Employment Program (FEHEP). I am requesting that GHEA modify its policies to include covering the services of mental health counselors in all your plans you currently offer. Below are three main points on why it important for GEHA to revise its policies:


1) Mental health counselors are professionals with at least a master's, advanced masters, or doctoral degree in counseling or a related discipline and are licensed in 49 states. Mental health counselors can independently diagnose and treat mental and emotional disorders and practice in a variety of settings including community mental health centers, hospitals, managed behavioral health organizations, drug abuse treatment centers, employee assistance plans, and in private practice.

2) Clinical training for mental health counselors are comparable to training for other professions you currently reimburse, yet our rates are lower than our colleagues in the psychiatry, psychology, and social work professions. Mental health professionals provide cost-effective services and typically employ a short-term treatment perspective.

3) GHEA can obtain access to a network of quality mental health providers at affordable rates, helping to keep insurance rates down for the federal government and its employees.

I appreciate your consideration and look forward to a positive response.

Sincerely,

Robbin Miller, LMHC
Licensed Mental Health Counselor
Facilitator
www.therapistsforchange.blogspot.com

Support Disabilities and Disparities in Health Care

I was invited as the Secretary for REDD (Rights, Equality for the Dignity of the Disabled) group to provide a testimony about our group's priorities to area state legislators at the Easter Seals Office in Worcester. For those who do not what REDD is or does, REDD is a group of volunteer advocates with/out disabilities dedicated to supporting and fighting for the civil rights for persons with disabilities in Central Massachusetts. Since REDD's inceptions in 1996, some of our accomplishments include getting accessible taxicabs in Worcester and extending the length of the platform at Union Station, so persons with disabilities would have access to more than two cars in boarding on and off the trains.

After I spoke about REDD's two priorities:Transportation and Emergency Preparedness, I changed hats as a private resident to speak about the proposed bill called "Disabilities and Disparities in Health Care," sponsored by Senator Richard Moore. The rationale for the bill is stated below. As a licensed mental health clinician, I support this bill as our profession needs to learn how to work and to counsel persons with disabilities. I said that the mental health profession is operating from the 1950's mode in how some clinicians inappropriately talk to this community. If Disabilities is included as a "minority group" with other ethnic groups, then the profession will learn more about this culture's health and behavioral needs on an equal footing along with these groups. I pushed for the profession to learn sensitivity training in how they counsel this community as it is badly needed and ignored.

The Disability Policy Consortium, a private entity that lobbies for specific causes across all disabilities, will be coming out with their own study on several health indicators such as "Smoking,"and "Behavioral Risk Factors," affecting these populations this year.

Bill: Disabilities and Disparities in Healthcare as posted on http://www.dpcma.org/. This bill is part of the Disability Policy Consortium's 2009-2010's Legislative Agenda:

Health Disparities Council

SECTION 1. Section 16O of Chapter 6A of the General Laws, 1as appearing in the 2006 Official Edition, is hereby amended by adding after “HIV/AIDS”in line 8, the following: “disabilities”

Health Care Quality and Cost Council

SECTION 2. Section 16K of Chapter 6A of the General Laws is further amended by deleting 57 subsections (h) and (i) and replacing them with the following new language:
(h) The council, in consultation with its advisory committee, shall develop annual health care cost containment goals. The goals shall be designed to promote affordable, high-quality, safe, effective, timely, efficient, equitable and patient centered health care. The council shall also establish goals that are intended to reduce health care disparities in racial, ethnic and disabled communities.

Contact: Shawn (SEN)" Shawn.Collins@state.ma.us

RATIONALE
While “Universal Health Care” has been the rallying cry of advocates for healthcare reform in Massachusetts, a quieter, but no less important focus has been on health care disparities. The Commonwealth of Massachusetts landmark healthcare reform legislation and the creation of the “Commonwealth Connector” extending health insurance to hundreds of thousand of more citizens has sharpened the national debate on Universal Health Care. Data on racial and cultural disparities along with advocacy on behalf of those who have clearly been racially, ethnically and culturally discriminated against by the previous healthcare and insurance system, helped to lay the foundation for healthcare reform.

The discussion of health care disparities has been limited to primarily to ethnicity, and race, issues that highlighted the efforts at healthcare reform.

The purpose of this paper is to show that the categories used to measure and discuss disparity in healthcare must be expanded to include people with disabilities.

It is the conclusion of the DPC that the discussion on disparities in health care must be changed to include people with disabilities. If, on the other hand, policy advocates choose to continue to focus solely on ethnic and racial factors, the title of the debate should be changed from “health care disparities” to “racism in the health care system."

Robbin Miller, LMHC
Facilitator

Are Children being Overmedicated? What do you think?

Here are fews paragraphs from today's article from the Milford Post by Dr. Azerrad:
http://www.milforddailynews.com/opinion/x1162817640/Azerrad-Too-young-for-adult-medicine


"By prescribing strong medicines instead of teaching children new choices using proven behavioral methods, we short-circuit a child's learning process and, even worse, lay the tracks for a lifetime habit of responding to challenge and disappointment with avoidance, denial and chemical dependency. Growing up is not a condition. Childhood is not a disease. Children act up and defy authority and they need adults to teach them how to manage difficult feelings and handle disappointment appropriately.There are ways for parents to do this that are quite effective and don't involve drugs, but they do involve parents being teachers. Our preschool children are far too young to defend themselves.It's up to parents to "say no to drugs" and teach their children that life is meant to be learned and experienced - it's not just a pill to be swallowed."

I agree with Dr.Azzard's view that most children's behaviors are rambunction, and are part of normal development. Also, I have seen a few kids whose behaviors are in the bi-polar range that do warrant medication but parents can learn parenting skills to manage these behaviors as well as applying similar techniques to manage their children's behaviors that don't need medication.Too often, over the years, I know of, and had some parents who play the medication card to apply for SSI. They have the mindset that because their child is behaving rambunctiously and they are having difficulties managing their behaviors, they learn from others in their environment how to apply for this "paycheck" to avoid working. I am appalled how some parents still refuse to apply the skills they learned in parenting classes or through FST programs after they are awarded a "SSI" check. The motivation goes down to "zero" in terms of continuing counseling with their clinician. What needs to be done to resolve this problem?

A study needs to be done to correlate SSI applications with the first counseling appointments throughout the state. Clinics need to be more assertive in asking if parents are coming to counseling and medication appointments to get a SSI check only. If this is the case, then clinics need to be more proactive in educating the families that getting SSI only, does not solve their child's behavioral problems. Massachusetts is behind the times in thinking parenting is a "right" due to the DNA, not true. If laws were passed to require parenting classes and psychological evaluations for at-risk parents,like they are for adoptive parents, then maybe the statistics for children taking medications for behavior would decline.

Robbin Miller, LMHC
Citizen-Therapist
Faciltiator

One Failure of the new Children's Mental Health Law in Massachusetts

Does anyone remember seeing the movie, "Stuart Little," where the alley cats said sarcastically to the house cat, "A pet cat for a mouse." "How can that be?" In the real animal world, it is usually the cat that have the "pet mouses" and not vice versa. How does this example apply to the mental health field for children?Mass Behavioral Health Partnership (MBHP) issued Alert # 55 (December 22nd 2008) stating new changes in how they will authorize Outpatient Mental Health Services for Adults and Children.

As a FYI, adults, 19 years of age and older will get 12 units authorized for a 180 day period (six months), while children and adolescents, 18 years old and under will get 14 units authorized for a 180 day period (six months). However, if a child or adult needs additional sessions within this time period for example, weekly visits due to the severity of a client's mental health symptoms, MBHP now requires the clinician to have a telephonic meeting with them to scrutinize the updated treatment plan that is submitted to them for review.

This new procedure is highly insulting for a clinician to "beg" for more services from not only from MBHP but also from other health insurance providers who will be following the same protocol as well. I am aware of the economic climate to control costs in a shaky economy in the healthcare arena. However, it is the clinicians training and expertise in children's mental law that needs to be respected and not undermined by insurers.

While the new children' mental health law will have services in place for mobile crisis interventions and at home therapy interventions for families, it fails to advocate for improved outpatient services for children. It is the clinicians that know how long it will take to treat their clients' symptoms and not the insurers. If a child does not receive additional sessions within the authorized time period, the child will be at risk for hospitalization or residential treatment that will cost the insurance companies more money to pay for. Last but not least..this stricter requirement to "beg" for more sessions from "the big mouse" will not help retain and/or recruit clinicians to service children with mental health needs.

Robbin MillerCitizen-Therapist
Facilitator
http://www.therapistsforchange.blogspot.com/.

Whose Story Is It?

Dr. David Kruegar from Mentorpath, http://www.mentorpath.com/, writes about how individuals create their own plots and storylines from their beliefs and assumptions that they hold. These belief systems and assumptions are developed from their needs and ideals that people have build over time. I am beginning to understand more why some clients choose to terminate early and/or choose not to show up again after a few counseling sessions. It can be simply that their goals for counseling based upon their individual belief systems are not in mesh with how the therapy process works in mental health counseling.

What can be the client's story?

For example, some clients are motivated to attend counseling and medication appointments just to apply for SSI (Social Security to avoid going to work. They have learned through talking with others that if their child or themselves are feeling a certain way or behaving differently, they can act accordingly to fool their therapist into thinking they can earn their SSI check. Their possible beliefs are that they are entitled to get SSI because it is owed to them due to welfare reform that resulted in certain work requirements, and receiving only one check given to them no matter how many children they have.

What is our story?

Clinicians, have created our own stories based upon our training to treat our clients' s symptoms. We have expectations on how the therapy process should be and what is reimbursable by insurance companies. Is it possible that some clinicians can be duped into believing that their clients are truly experiencing their symptoms and want to learn new coping skills using diverse treatment modalities? In some cases, clients are smarter in creating their stories based upon their needs to support their children or themselves the "easy way", and living their ideal way"to have their cake and eat it too." As a consequence, once clients get their SSI check plus retroactive pay (after appealing their SSI denial over time), they are never again to be seen as "they disappear into the blue yonder" of the universe.

What can be done to change our story to retain our clients to be motivated to work on their goals? Answer: Part II will be posted soon.

Robbin Miller, LMHC
Facilitator
www.therapistsforchange.blogspot.com