Tag: Mental health practice

License to……

Posted on | by SOS Blog | Leave a Comment on License to……

Every two years around this time I am busy completing my Continuing Education Units (CEUs) so I can renew my license as a psychologist. I have done this every biennium since 1980, even though I retired from practice 17 years ago. In Florida, the license is both a practice and title act…to represent myself to the public as a psychologist, I need to be licensed. This was the first year I have even vaguely questioned why I continue to do so.

The decision to renew has usually been an easy one for me to make even though I do not practice and have no plan to return to work as a psychologist. I have a strong identification as a psychologist. I knew since early high school that I wanted a Ph.D. in clinical psychology; I always wanted to practice independently.

Even when we decided to relocate to central Florida and I took the opportunity to close my practice and work with SOS full time, I never considered dropping my license. After all, we have always told you that we provide software by psychologists for psychologists (and all other behavioral health providers). And anyway, who knows what time and politics will bring!

Usually my reading is a way to meet my CEU requirements and keep up with the clinical side of psychology. This year I was surprised; two of the articles I read this weekend were actually quite interesting to me; they were articles on personal or life coaching and Positive Psychology. Both of these areas have roots in the personal growth and Humanistic Psychology movements of the 1970’s, but are 21st century, mainstream ways of implementing growth-oriented interventions.

As the healthcare arena changes over the course of the next few years, it is highly likely that some organizations will seek to provide pure healthcare services. Others will choose to diversify their services in a variety of ways…and even to provide their services in unique fashion. Open Minds recently discussed both telehealth delivery of services and the use of virtual reality interventions to treat certain problems.

What new kinds of therapy has your organization considered? Do you continue to provide the same services you have always performed, or are you on the lookout for ways to diversify? What criteria do you use to decide if a particular service or technique should be added to your bag of tricks?

Please share your comments. We would love to know how you expand the services your organization provides. Just enter your comment in the box below. If you do not see a box, click on the title of the article and scroll down to the comment box. Thanks for reading!

Stress: APA’s 2009 Survey

Posted on | by SOS Blog | 1 Comment on Stress: APA’s 2009 Survey

In early November 2009, the American Psychological Association released the results of their 2009 Stress in America Survey. The executive summary is an excellent way to review the results of the survey in 20 pages. The survey was conducted by Harris Interactive and included 1,568 adults aged 18 and older who reside in the United States. The report also includes the results of a YouthQuery survey conducted among 1,206 youths aged 8-17 years of age. Those who provide mental health services to either or both adults and children should take a look at the outcome of this survey. The data are distressing and worrisome to those of us with interest in the effects of stress on our physical health.

According to the survey, parents think their own stress does not affect their children and that their children are not stessed. It appears that parents do not see the worries and stress-related symptoms of their children accurately; and while three-quarters of young people say they can talk to their parents about things they worry about, they also indicate that worry is a real problem for them. Either they are not telling their parents about their stress or worry, or their parents are not hearing them when they communicate. As a result, children may not be getting the family support they need to manage stress. Parents also seem to underestimate the severity of the stress teens and tweens experience.

42% of adults indicate that their stress has increased in 2009. This is 7% fewer than those reporting an increase in stress during 2008 (49%) but is still almost half of the adults surveyed. While it is somewhat comforting to know that only 42% of adults said that their stress has increased in the past year, it is difficult to tell from this report whether the 49% who reported an increase last year are now experiencing less stress or whether it is merely the same as in 2008. The summary indicates that “this could be a precursor to serious health consequesces related to chronic stress.”

While 44% indicate they exercise or walk to manage their stress, 49% indicate they rely on sedentary means of managing stress. 43% reported eating too much or eating unhealthy foods because of stress. Only 4% indicate that they see a mental health professional to deal with stress.

Money, work and the economy are still the most important sources of stress for adults.

Two-thirds of U.S. adults have been told by a health care provider that they have chronic health condition(s) and 70% have received recommendations for lifestyle and behavior changes….exercise more (48%), lose weight (38%) and eat healthier (36%). Few were offered or received support to make these changes; half did not even get an explanation for the recommendation. Women seem to be bearing the brunt of the stress…or are more likely to report it. They are also more likely to report physical symptoms along with the stress.

The potential physical effects of stress has long been studied by mental health and medical professionals. Back in 1967 Holmes and Rahe developed their Life Changes questionnaire also known at the Social Readjustment Rating Scale. This simple questionnaire has been used in a multitude of studies and scores correlated with the occurrence of serious physical illness within the next year. Let’s hope that those who become ill following these two years of significant stress will have access to the health care services they need.

A 2008 study detailed a physiological explanation, and an article in Gizmag does a nice, brief discussion, of how stress affects the immune system. Under stress, the body produces cortisol to facilitate the “fight or flight” response. Under chronic stress, there is an overabundance of cortisol, so the body remains on alert long after that is necessary and the immune system is affected. The mechanism at work seems to be the shortening of chromosomal end caps called telomeres which produce telomerase, an enzyme that keeps immune cells “young”. Cortisol diminishes the production of telomerase thus shortening the healthy life of protective T lymphocytes.

Of course, there is a perfect opportunity for development of a drug to reduce cortisol or increase telomerase. As specialists in behavioral change, I would think it incumbent upon mental health professionals to be doing more education about stress management rather than waiting for yet another drug to make us healthy. There are certainly online resources to facilitate such education. If only 4% of adults indicate that they consult with a mental health professional to help them manage stress, it would appear that the opportunities in this area are wide open.

What does your organization do to help your clients and your community better manage stress? Do you believe there are ways that behavioral health providers might more effectively attract the severely stressed into treatment? Should the practice of psychotherapy also include community education in stress inoculation techniques? How do you manage your own stress?

Please enter your comments by clicking on the title of this article and making your entry in the box below.

Alphabet Soup: HITSP, CCHIT, ONCHIT, SNOMED CT

Posted on | by SOS Blog | 4 Comments on Alphabet Soup: HITSP, CCHIT, ONCHIT, SNOMED CT

I try to keep informed about Electronic Medical records (EMRs), certification of those products, and funding for them provided through the economic stimulus bill (ARRA). After all, as a developer and vendor of a behavioral health EMR, I really should know some of this stuff. This week, I was struck by the number of acronyms that have come into common parlance in the past six months. I find the amount of information being generated about healthcare information technology (HIT) overwhelming. I am sure it feels even worse to someone who has not been trying to keep up with this information. After all, who can possibly know what all of these shorthands stand for and mean? 

So what would any good technology hound do? Well, of course, I googled ‘Health Information Technology acronyms‘ to see who out there has started to organize this information for the public. To my pleasant surprise, several documents attempt to do just that.

To start with, our federal department of Health and Human Services has a whole web site dedicated to HIT. On the left side of the page, there is a list of tabs. Under Resources there is a page called Acronyms. And that is just what it is. A list of the letters used as the shorthand referents for 112 terms ranging alphabetically from AHIC (American Health Information Community) to WW (Wounded Warrior). You can then cut and paste a name into the Search box on the top right of the page to find documents on the site that reference this “term”. When I do this for American Health Information Community, I get a list of 601 documents linked to this site that refer to AHIC in some fashion. If I do this same search on Google, I get about 129,000,000 hits. Be careful what you search for!

The Rural Health Resource Center, a not-for-profit located in Duluth, Minnesota has a document containing a list of 53 acronyms including brief definitions or descriptions of the terms or organizations listed as well as links to the sites of some of the organizations described.

Likewise, the Department of Health Services of the state of Wisconsin has published a list of acronyms and what they stand for. This list relates to eHealth rather than just health information technology, so it is bound to have some different entries.

A web site created by Pivotal Solution Group called HITECH Answers has their own list of acronyms and definitions. Pivotal Solution Group is a coaching and consultancy organization…a private group as opposed to the government sources listed above.

And finally, the Software and Technology Vendor Association (SATVA), a trade association of behavioral health software vendors to which we belong, has developed a section on their web site to monitor information regarding behavioral health EMR certification. Behavioral Health Certification Watch will be updated as new information is received. 

While some of you have probably clicked on the links above, I think it highly unlikely that you will spend much time reviewing this information. After all, who has the time to go looking into the masses of information that are being created about HIT, certification of products and paying for those products. Most behavioral health organizations are likely to just continue doing what they do until someone finally tells them they must move to an electronic medical record (EMR) by a certain date or they will not get paid for the services they provide. Oh wait, that is what has happened…at least, for Medicare and Medicaid payments.

Is that enough to start movement toward an EMR in your organization? Is your practice beginning to consider the possibilities? What do you believe it will take to move mental health providers into EMRs?

Death and EMRs: Disruptive events?

Posted on | by SOS Blog | Leave a Comment on Death and EMRs: Disruptive events?

The deaths of the past week have set me to thinking. The mother of a friend passed away early in the week followed by the wife of a family friend. Then, news of the death of cultural icon, Michael Jackson, was everywhere.

I come from a family and culture (New Orleans-based) where death is an intrinsic part of life. It very much affects those who are touched most directly by the loss, but it is also integrated into day-to-day life in such a fashion that life moves on with barely a ripple. The deceased is celebrated and mourned in one or multiple events ranging from wake to jazz funeral. Burial in above-ground graves and mausoleums (the water table in New Orleans is very high) caps off the events, and the cemeteries are daily reminders of the short-term nature of life. As with everything else in New Orleans, after death there is a party, but there is real disruption only for those immediately touched by the death. Life goes on.

I married into a family that shares the more traditional views of death held by most of American culture. It is not to be talked about too openly, lest it be invited to approach. And, as for most people in our culture, death is definitely considered to be a disruptive event, dislocating those related to the deceased from the ordinary course of life for an extended period of time. In fact, the disruption is frequently so severe that it is no surprise to those around the survivors that they are forever changed.

The term disruptive technology was introduced by Clayton M. Christensen in 1995 and together with his modification disruptive innovation has become a catch-phrase for technological change that is so radical that it dramatically alters the course of events that follow. If you read any articles about technology, you will come across the terms.

On the way to an event yesterday, we were listening to a podcast of The Week in Technology (TWIT) in which Twitter was discussed as a disruptive technology…disruptive to the field of journalism and to our whole way of communicating and thinking about news events. The techno-nerds who are the mainstay of TWIT are convinced that the immediacy of communication enabled by Twitter is and will continue to radically alter the way in which we receive information, likely becoming the jumping off point for even newer innovations in the realm of communication and information sharing.

I find myself wondering if Electronic Medical Records (EMRs) will not become the same kind of disruptive technology for our current healthcare system. Since EMRs have been around  for a while now, many would argue that they will certainly change healthcare, but do not reach the level of disruptive technology. But when I think about many of our customers in the behavioral health community and the radical changes to their organizations that will be required to move to EMRs and to use them in a meaningful way, I can imagine few more disruptive events.

Some would say that managed care had the potential to be just as disruptive…it certainly changed the way in which private mental health practices have conducted themselves over the last twenty years…but it did not intrinsically change the way in which the provider interacts with the recipient of healthcare services. The consumer may be seen less frequently and for a shorter total length of treatment, the managed care organization may refuse to pay for certain types of care (which the patient can then purchase with their own dollars), but the provider still sees the patient, assesses the problem at hand and provides treatment.

EMRs have the potential for changing that sequence of events. If used in a “meaningful” way, if decision support tools and treatment protocols that are based on scientifically assessed methods (evidence-based treatment) are incorporated into the EMR products and utilized by providers at the point of care in the way envisioned by the framers of HITECH, we will have a new healthcare system….or maybe not.

What do you think? Will widespread adoption of EMR systems be a disruptive innovation for healthcare? Do behavioral health EMRs have the potential to be disruptive technology for the mental health community?

Please add your comment by clicking on the title of this article and typing your thoughts in the comment box at the bottom of the page.

Personal vs. Professional: Social Networking Sites

Posted on | by SOS Blog | 8 Comments on Personal vs. Professional: Social Networking Sites

I checked my email on Sunday night to find two new requests for “friend” status on my Facebook page…one was from a customer, the other was from my mother-in-law. The juxtaposition of requests brought directly home the conflict and confusion that some folks are having about use of the social media sites. Is your use personal or professional? Is it acceptable to mix the two? Would you and your contacts be better served if you have two separate online identities, a personal one and a professional one?

I am a firm believer in synchronicity. I think of Carl Jung and his notion of synchronicity (an acausal connection of events in time) often as I experience the unexpected confluence of events. This weekend was no exception.

  1. On Friday, I had time (for the first time in weeks) to tune in to HubSpot TV, a podcast done by staff members of the Internet Marketing firm whose products and services I use. They mentioned this issue of social media utilization and the possible need to keep one’s “identities” separate. One of their blogs addressed the issue on Friday and the author lays out some considerations.
  2. On Friday evening, my partner, Seth Krieger, suggested that I write a blog on social media and professional vs. personal concerns.
  3. On Sunday I got the Friend requests I mentioned above.
  4. This morning I looked at two print newspapers I receive: The New England Psychologist ran an article featuring input from Thierry Guedj, Ph.D., “Psychologists navigate use of online social networking sites“; and The National Psychologist included John Grohol, Psy.D.’s article “How ‘tweet’ it is: Social networking using Twitter”. Both of these psychologists explore some of the concerns unique to providers in the behavioral health community.

This confluence of events was impossible for me to ignore. I have found myself thinking about these issues often over the past several months. Since I began use of social networking as a way to spread our business presence more broadly on the Internet, the differences between personal and professional presence have been playing around the periphery of my mind.

While I have not seen clients for the last 16 years, I was trained as a psychologist and saw patients in a private practice and in a CD program setting from 1978 to 1993. I am well aware that boundary issues are confronted regularly by psychotherapists charged with providing a safe space in which consumers of their services can deal with issues ranging from relatively minor personal problems to serious chronic mental health issues. Protecting that ‘space’ is part of building trust and of maintaining the privacy of the client.

The sanctity of that space is challenged regularly, sometimes by the spill-over of the therapist’s life into the therapy. Personal illness and family deaths are regular intruders, but many others exist. I hosted a live, call-in television show on psychology topics from 1981 to 1983. Some of my clients were proud of the public education work I was doing; others felt that they lost a part of me that they owned and were not happy to share me with the public. As a feminist psychologist treating lots of women, it was not unusual to cross paths with a client in the ‘real’ world. Prior agreements about how or whether to greet in public aside, face-to-face interaction outside the therapy space was often a cause for discomfort for me and for the client.

Those challenges to privacy are part of the physical community in which we live. Now we add the complication of a virtual world in which massive quantities of information, both personal and professional, are available to anyone who bothers to Google us. Factor into that the fact that we have no idea which information the client has. Each form of social media provides different challenges.

1. blog: A weblog, or blog, can be an excellent way for you to provide useful information to your own clients and to many others who see your blog articles. But if you go out there into the blogosphere and take a look at the material available, you will find that the writing styles are much less formal than other published documents, especially journal articles. Because of that informality, there can be a tendency to slip into personal revelation.

Potential benefits: Great way to become more known in your community, to educate and share valuable information with your clients, and to provide a community service through public education.
Potential risks: Informal style of blogs can lead you to share more personal information than you would usually do in journals or in direct contact with your clients.

2. Facebook: When I started to use Facebook, I intended that use to be purely personal. My nephew’s wife invited me to join first. I resisted. When an age-mate with whom I share a book club and a social sphere invited me, I joined. Facebook has been great fun! I have connected with classmates, friends and family members. As with many people in my age group, my postings are rather tame. They do reveal personal relationships and history. I was a little conflicted when business associates asked for ‘friend’ status, but decided that I do not live a wild and crazy life and there is little about me on Facebook that I am not comfortable sharing with customers and other business associates.

Potential benefits:Facebook is a great way to keep up with new family photos and to stay in more frequent contact with friends and family members who are far away.
Potential risks: If you do live a wild and crazy life and do not want your clients to know that, do not give ‘friend’ status to those clients.

3. LinkedIn: LinkedIn is the only one of the social networking sites I use that is designed for professional purposes. It is professional networking, par excellence. If you want to connect with other colleagues, this is the place to do it. If you are looking for a job, this is certainly the place I would start. There are headhunters who frequent the site looking for the most qualified individuals for their position postings. You can join groups that meet your interests and connect there with other folks who have like concerns. 

Potential benefits: LinkedIn is a great place to network with other professionals. It is designed for peer-to-peer connections.
Potential risks: If your clients/patients are other professionals, you might run into them here and need to make some decisions about who your network should include or exclude.

4. Twitter: Twitter is something else. I am still not sure about Twitter. I use it in a purely professional way. In fact, the name under which I tweet is @SOS_Software. The people I follow are other professionals who have similar interests. Those other folks are great sources of information. The tweets I find most useful are about articles, blogs and news that is relevant to my professional world. Most of the people who follow me are also interested in healthcare and software. Sometimes, I get a follow from someone who seems totally unrelated to anything in which I am interested. I blocked the clearly pornographic Follow that appeared last week.
     The way I use Twitter is totally contrary to the way most young people use it. To folks who are used to text messaging for everything, Twitter is a way to disperse text messages much more broadly. You can let everyone in your network know your status all at one time. To me, this is useless. To many others it is an essential part of staying connected.

Potential benefits: This is an excellent way to disperse a communication to a large group of people at one time. You could use Twitter to communicate educational information to all of your clients at once.
Potential risks: Twitter is like Facebook. Everybody who follows you sees everything. If you intersperse personal messages with your professional ones, everybody who follows you still sees all of it.

What do you think about these social networking sites? Do you use them? Does your organization use them to keep in touch with consumers? What do you see as the potential benefits or glaring weaknesses of being connected 24/7?

One last word of advice: If you decide to jump into the sphere of social networking, decide whether you are going to do so as a professional or for your personal needs. Once you decide, choose your networking sites accordingly. If you want to do both, you might be best served by having two different social networking identities.