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/.
Sunday, January 11, 2009
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
Wednesday, December 31, 2008
Regulating Gifts and Research Practices for Physicians from Drug Companies?
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
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
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
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