According to the article, "State proposes rules for gifts to physicians," by M.McAuliffe, The Republican, (December 11th, 2008), Massachusetts wants to hold two public hearings across the state for feedback on proposed legislation to regulate gifts and research practices that physicians receive from pharmaceutical companies. Advocates want gifts to be banned as well as making public knowledge of physicians getting paid for drug research from these companies.
I support this legislation for the following reasons:
1) I agree with the advocates that doctors can be heavily influenced by pharmaceutical salesmen to inappropriately prescribe medications for their clients' symptoms.
For example, I attended one luncheon with one salesman from a drug company that manufactures antidepressants. Normally, I refuse to attend these "bribery meetings," because I don't support the way these drug companies push their medications on physicians. I went for curiosity purposes and to observe this process. While the lunch was good, the salesman's presentation was another story.
The representative educated the physician and the clinicians on how this particular antidepressant works on individuals who have a specific type of anxiety disorder. Charts demonstrated through the company's research studies showed that individuals who took this medication showed a decline in their anxiety symptoms. The last step the salesman did, in which I call the hook, was to try to "push" the physician to prescribe this medication for his clients. His tone and voice went up a notch higher when he asked the physician if and when he would start prescribing this medication to his clients. After careful consideration, the physician kindly thanked him for the information and said he had to get back to work. The physician left the room, and the salesman provided free pens, drug samples, and literature on this medication to his staff.
My observations made me think how physicians can be easily influenced by the "sweet talking" salespeople and the expensive gifts they can provide such as free trips and monetary incentives to support their drugs. Also, I have observed how some of these salespeople will "pester" physicians through on-going telephone calls and numerous visits to their offices to do their presentations. Some will even offer expensive dinners to get the physician to hear their spiels.
It is amazing how much money is spent on heavy advertising and marketing of drugs to physicians as well as through other mediums such as magazines and radio ads. Wouldn't money be better spent on lowering the costs of medications so those individuals can afford to pay for their medications? I would like to see future legislation to make the benefits manager-the negotiator-of drug prices between drug companies and health insurance plans to be a non-profit entity and not a lucrative for-profit enterprise. Also, the public needs to be aware that one of the reasons health insurance plans push mail order prescriptions is due to the benefits manager making a profit from it.
The Department of Public Health will holding a public hearing in Worcester on January 13th. Time and location is unknown. Please contact them for more information at http://www.mass.gov/.
As mental health counselors, what do you think of physicians such as psychiatrists not being allowed to accept gifts and to make public their income made for doing research for these drug companies? Do you think these "bribes" hurt our clients?
Robbin Miller, LMHC
Citizen-Therapist
Facilitator
Wednesday, December 31, 2008
Tuesday, November 25, 2008
Questions to the Massachusetts Children Behavioral Health Initiative
1) Please clarify how an agency or provider can still input the CANS information on the virtual gateway when a parent has declined it, and still be available for viewing by the Departments of Mental and Public Healths and Mass Health.
2) If a clinician works for two different agencies, and is certified to do the CANS, will this individual be able to input CANS info on the virtual gateway with two different passcodes?
3) It is unclear to clinicians like myself who are still unsure about how to score the SED (Serious Emotional Disturbance) score. We were not trained on how to do this process. We were trained only on how to pass the test to be certified.
4) What will be the billing procedures for private practitioners like myself who give a CANS to an individual under 22 years of age? Will we get paid after the first administration of the CANS for subsequent assessments?
5) What happens if a parent declines intensive services for their child whose score qualifies them under SED?
6) What are the reimbursement rates for administrating the CANS?
Thank you,
Robbin Miller,LMHC
Private Practitioner
Facilitator for http://www.therapistsforchange.blogspot.com/
2) If a clinician works for two different agencies, and is certified to do the CANS, will this individual be able to input CANS info on the virtual gateway with two different passcodes?
3) It is unclear to clinicians like myself who are still unsure about how to score the SED (Serious Emotional Disturbance) score. We were not trained on how to do this process. We were trained only on how to pass the test to be certified.
4) What will be the billing procedures for private practitioners like myself who give a CANS to an individual under 22 years of age? Will we get paid after the first administration of the CANS for subsequent assessments?
5) What happens if a parent declines intensive services for their child whose score qualifies them under SED?
6) What are the reimbursement rates for administrating the CANS?
Thank you,
Robbin Miller,LMHC
Private Practitioner
Facilitator for http://www.therapistsforchange.blogspot.com/
Saturday, November 15, 2008
CANS Part III-Some Answers at Last!
Hello!
Finally, I received some answers from a colleague who passed on my questions regarding the use of the CANS (Children Adolescent Needs Strengths) scale to Dr. Jack Simons, Ph.D, Assistant Director, Children's Behavioral Health Interagency Initiatives, from the Massachusetts Executive Office of Health and Human Services. (See the answers highlighted in blue color). My responses are highlighted in brown.
Here are his answers:
What is the CANS?
The CANS forms are available at the CBHI website: www.mass.gov\masshealth\childbehavioralhealth, click on "Information for Providers", click on "CANS Tools". The CANS is designed to provide a standard way of documenting important information from your assessment of the client; at this point the CANS is not being used to produce summary scores or profiles. As we gain experience with the tool, we may be able to use summary scores and statistical prediction rules to help us with service planning, but we are not there yet.
Comments have been made about how the CANS is not a clinical instrument and the category for rating cultural issues are confusing to understand.
Finally, I received some answers from a colleague who passed on my questions regarding the use of the CANS (Children Adolescent Needs Strengths) scale to Dr. Jack Simons, Ph.D, Assistant Director, Children's Behavioral Health Interagency Initiatives, from the Massachusetts Executive Office of Health and Human Services. (See the answers highlighted in blue color). My responses are highlighted in brown.
Here are his answers:
What is the CANS?
The CANS forms are available at the CBHI website: www.mass.gov\masshealth\childbehavioralhealth, click on "Information for Providers", click on "CANS Tools". The CANS is designed to provide a standard way of documenting important information from your assessment of the client; at this point the CANS is not being used to produce summary scores or profiles. As we gain experience with the tool, we may be able to use summary scores and statistical prediction rules to help us with service planning, but we are not there yet.
Comments have been made about how the CANS is not a clinical instrument and the category for rating cultural issues are confusing to understand.
Also, how do I explain to parents what I'm doing and why.
You use the CANS as one way of documenting the info you obtain from the assessment. You don't need to show the CANS form to parents although we hope it will be useful to you in talking with them both during the assessment phase and during the treatment phase. So it is part of your documentation process, and is designed to organize data in a way that will be helpful to you and the parents in planning treatment. It is not a self-report that parents fill out.
Due to the immense information stated for each CANS category, this scale can take more than one hour to explain to parents in which clinicians do not get reimbursed for by insurance companies.
1) What is the threshold scores for determining whether or not a child falls into the Serious Emotional Disturbance category for more intensive services?
The determination of Serious Emotional Disturbance is not based on CANS scores. It is based on a series of questions that appear at the beginning of the CANS form, but are not technically a part of the CANS. (You can see this when you look at the CANS form -- see above on where to find it.)
Clinicians who took the training online or attended a workshop did not learn anything about this Serious Emotional Disturbance(SED) component at the beginning of the CANS form. Where do we find this information on how to determine SED? How can clinicians ethically give this assessment when they were not trained on how to assess for SED?
2) Are parents going to be allowed to sign waivers so providers can score their child's CANS on the virtual gateway?
The Virtual Gateway (VG) CANS application is not required to score the CANS -- that is something the clinician learns to do by taking the CANS training / certification. The CANS is a way of documenting information from the behavioral health assessment. Yes, a parent can decline consent to have the CANS information entered into the VG application. If the parent does not consent to putting the CANS information into the VG application, the clinician documents the CANS on paper and puts it in the record. The clinician uses the CANS either way.
Do we tell parents that the CANS will be used in house instead and put in the client's file?
3) What happens if a parent declines for their child to take the CANS due to the virtual gateway confidentiality issue? -- see previous question. If the parent declines, the clinician will still be expected to enter a limited amount of info (about SED determination) into the VG, but not the CANS itself.
Information posted on the VG can be still accessed by the Departments of Public and Mental Health and Mass Health.
4) How do you score a CANS?
This is covered in the training. Go to https://masscans.ehs.state.ma.us/login.aspx?ReturnUrl=%2fDefault.aspx to register for training.
Some clinicians I spoke with still don't know how to score the CANS including myself? Do we add the points in each category? No scale is given to explain scores.
In summary, there are strengths to the CANS scale but implementation of the this assessment tool is still confusing and more information is still needed. What do you think?
Robbin Miller, LMHC
Citizen-Therapist
Facilitator
Due to the immense information stated for each CANS category, this scale can take more than one hour to explain to parents in which clinicians do not get reimbursed for by insurance companies.
1) What is the threshold scores for determining whether or not a child falls into the Serious Emotional Disturbance category for more intensive services?
The determination of Serious Emotional Disturbance is not based on CANS scores. It is based on a series of questions that appear at the beginning of the CANS form, but are not technically a part of the CANS. (You can see this when you look at the CANS form -- see above on where to find it.)
Clinicians who took the training online or attended a workshop did not learn anything about this Serious Emotional Disturbance(SED) component at the beginning of the CANS form. Where do we find this information on how to determine SED? How can clinicians ethically give this assessment when they were not trained on how to assess for SED?
2) Are parents going to be allowed to sign waivers so providers can score their child's CANS on the virtual gateway?
The Virtual Gateway (VG) CANS application is not required to score the CANS -- that is something the clinician learns to do by taking the CANS training / certification. The CANS is a way of documenting information from the behavioral health assessment. Yes, a parent can decline consent to have the CANS information entered into the VG application. If the parent does not consent to putting the CANS information into the VG application, the clinician documents the CANS on paper and puts it in the record. The clinician uses the CANS either way.
Do we tell parents that the CANS will be used in house instead and put in the client's file?
3) What happens if a parent declines for their child to take the CANS due to the virtual gateway confidentiality issue? -- see previous question. If the parent declines, the clinician will still be expected to enter a limited amount of info (about SED determination) into the VG, but not the CANS itself.
Information posted on the VG can be still accessed by the Departments of Public and Mental Health and Mass Health.
4) How do you score a CANS?
This is covered in the training. Go to https://masscans.ehs.state.ma.us/login.aspx?ReturnUrl=%2fDefault.aspx to register for training.
Some clinicians I spoke with still don't know how to score the CANS including myself? Do we add the points in each category? No scale is given to explain scores.
In summary, there are strengths to the CANS scale but implementation of the this assessment tool is still confusing and more information is still needed. What do you think?
Robbin Miller, LMHC
Citizen-Therapist
Facilitator
Monday, October 27, 2008
Research and Partnerships for Mental Health
The UMass, Dept. of Psychiatry’s Center for Mental Health Services Research printed a new issue brief written by Jodi Adams, MA, Joanne Nicholson, PhD, Susan Maciolek, MPP, Kate Biebel, PhD entitled, “Family Networks Implementation Study: Integrating Rigor and Relevance in Effective Research Partnerships” The new mental health law for children calls for more partnerships between providers/insurance companies to provide quality services for children with mental health needs. Research can be helpful but wasteful and redundant if nothing good comes out of it. Research can touch on certain topics of interest for critical thinking but it is worthless if other pertinent facts are not part of the equation. Read below my views on what I feel needs to be researched for practitioners in the "trenches" that directly impact our clients.
I would like the academic community to research on the outpatient clinical work for families who graduate from the Family Network Programs.For example, families who are involved with DCF tend to have higher no-shows than families not involved with DCF in outpatient counseling sessions. What are the reasons and causes for this high number of no-shows? If it is due to transportation issues, then what can be done about this? If the families are not motivated to want counseling anymore and have to go, then what are agencies supposed to do? I would like to see more reseach on the failure rate of families who just can't get back on their feet after terminating from the Family Networks Program. Maybe policy makers and Talking Heads can look at flagging families from the very beginning in identifying some parents who just incompetent and incapable of raising the child in their homes.
Isn't it ridiculous for DCF to continue take away children from some parents who have histories of drug abuse and domestic abuse and put them in foster care and not put them up for adoption? These parents don't learn anything when their kids are taken away. They tend to just make more children and become more entrenched in the broken child welfare system.
I would also like the academic community to do more research on low income families who attend counseling sessions and on Mass Health and not DCF. Here are some things for them to look at:
The high number of no-shows.
The turnover of clincians leaving the agency for other jobs that are not insurance dependent.
The relationship between families wanting to get on SSI and being committed to the therapy process.
Is their story on the same page as therapists who are there to work with them on their personal issues and not just for the SSI check?
It is amazing funds are being poured into research and not helping these agencies who need assistance to keep afloat. Researchers need to look at those agencies who have reduced staff; services; and have closed some of their other offices due to losing money. Children with mental health needs can't be served as a result.
Robbin MillerAdvocate/Private Practitioner
I would like the academic community to research on the outpatient clinical work for families who graduate from the Family Network Programs.For example, families who are involved with DCF tend to have higher no-shows than families not involved with DCF in outpatient counseling sessions. What are the reasons and causes for this high number of no-shows? If it is due to transportation issues, then what can be done about this? If the families are not motivated to want counseling anymore and have to go, then what are agencies supposed to do? I would like to see more reseach on the failure rate of families who just can't get back on their feet after terminating from the Family Networks Program. Maybe policy makers and Talking Heads can look at flagging families from the very beginning in identifying some parents who just incompetent and incapable of raising the child in their homes.
Isn't it ridiculous for DCF to continue take away children from some parents who have histories of drug abuse and domestic abuse and put them in foster care and not put them up for adoption? These parents don't learn anything when their kids are taken away. They tend to just make more children and become more entrenched in the broken child welfare system.
I would also like the academic community to do more research on low income families who attend counseling sessions and on Mass Health and not DCF. Here are some things for them to look at:
The high number of no-shows.
The turnover of clincians leaving the agency for other jobs that are not insurance dependent.
The relationship between families wanting to get on SSI and being committed to the therapy process.
Is their story on the same page as therapists who are there to work with them on their personal issues and not just for the SSI check?
It is amazing funds are being poured into research and not helping these agencies who need assistance to keep afloat. Researchers need to look at those agencies who have reduced staff; services; and have closed some of their other offices due to losing money. Children with mental health needs can't be served as a result.
Robbin MillerAdvocate/Private Practitioner
Sunday, October 12, 2008
CANS Reflection Part II
As of now as I write this post, I have not received any information on how the CANS (Children and Adolescent Needs Strengths) information will be private and confidential on the "virtual gateway" under the new Children's Mental Health law in Massachusetts. However, I have one tidbit that concerns me. I don't understand why the CANS labels 18-21 years old as "adolescents," when they are in fact, adults. The only possible exception would probably be for those individuals with certain physical, cognitive or psychiatric disabilities who are deemed incompetent by the court and would need decisions to be made for them. I don't know if advocates for these groups would approve such a condescending label for this population.
(Please note, the term, "Jerry's Kid", is offensive for those individuals with muscular dystrophy (MD)over the age of 18 years old. Individuals with MD despise being called this term. There are many people in this population who are fully competent and productive citizens in society).
I am wondering what can be done to advocate that individuals over the age of 18 years be called adults and not "adolescents" under the CANS. Talking Heads needs to know that these adults can decline to take the CANS period! If they are competent and not a danger to themselves or others, nothing can be done to force someone to take the CANS.
What do you think?
Robbin Miller, LMHC
Facilitator
www.therapistsforchange.blogspot.com
(Please note, the term, "Jerry's Kid", is offensive for those individuals with muscular dystrophy (MD)over the age of 18 years old. Individuals with MD despise being called this term. There are many people in this population who are fully competent and productive citizens in society).
I am wondering what can be done to advocate that individuals over the age of 18 years be called adults and not "adolescents" under the CANS. Talking Heads needs to know that these adults can decline to take the CANS period! If they are competent and not a danger to themselves or others, nothing can be done to force someone to take the CANS.
What do you think?
Robbin Miller, LMHC
Facilitator
www.therapistsforchange.blogspot.com
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