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
Saturday, January 24, 2009
Sunday, January 18, 2009
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
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
Sunday, January 11, 2009
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/.
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/.
Friday, January 2, 2009
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
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
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