Understanding the Future of Integrated Services for Psychologists James Windell, Editor The afternoon session will be devoted to how all that T he way care will be delivered in the very was discussed in the morning session is playing out near future, and the way providers will be in Michigan. The initial afternoon presentation will reimbursed for their work, is changing -- be given by Lynda Zeller, Deputy Director of the whether we like it or not,” declares Louis Post, Ph.D., Michigan Department of Community Health. Ms. Chair of MPA’s Insurance Committee. Zeller will share her thoughts regarding the ACA and With that in mind, MPA has scheduled a conference the delivery of mental health and substance abuse on Friday, November 7, 2014 entitled The Future of treatment in Michigan. Psychological Services in the Era of Integrated Care. Following Ms. Zeller will be Dr. Thomas Simmer, An all-day conference beginning at 8:30 am, the M.D., Senior VP for Health Care Value & Provider conference will be held at The Henry Center, Affiliation, Chief Medical Officer, Blue Cross Blue Michigan State University, 3535 Forest Rd, Lansing, Shield of Michigan. Dr. Simmer’s presentation will Michigan. address these issues from a private sector perspective, Dr. Katherine Nordal, the Executive Director for including how the Physician Group Incentive Professional Practice of the American Psychological program has evolved, the nature of the integrated care Association will be the first morning speaker. She models which have evolved within the PGIP, the will address how the impact of the Affordable Care role of psychologists within the PGIP, and his vision Act (ACA) and the movement toward the integration as to where the provision of treatment and of of health care services is playing out in terms of psychological services is heading. policy and application at the national level. She will “This conference is a must for any psychologist in also discuss how the delivery of mental health private practice who participates with insurers and for services will be affected by the ACA and the those psychologists working in the public sectors,” different models for the delivery of integrated care. Dr. Post emphasizes. Dr. Nordal’s presentation will focus on Health Care “Our intent is to provide attendees with an Reform in 2014 and the implications for professional understanding of what is going on, how it might practice. affect their livelihood, and the opportunities that are The second morning speaker will be Dr. Benjamin present for them,” Post said. “For psychologists who Miller, Director of the office of Integrated Healthcare are in private practice, a lack of clear understanding Research & Policy at the Department of Family as to what is occurring, and how to respond, can end Medicine, University of Colorado, Denver. Dr. Miller up literally taking money out of their pockets.” will talk about the integration of behavioral health CE credits will be available upon completion of the and primary care, and he will particularly focus on all workshop, and registration can be handled online at the reasons why we must integrate to get to better the MPA website through November 5, 2014. health outcomes, decrease cost, and enhance our patient’s experience. To comment on this article, email James Windell at [email protected] 1 The Michigan Psychologist – 3rd Quarter 2014 If I become disabled and can’t work, who will pay the bills? Take care of yourself and your family with Trust Income Protection Trust LifeStyle Plans Feature: (disability income) Insurance. (cid:43) “Your own occupation” definition of disability Think about how many people you care for… in (cid:43) Monthly benefits up to $10,000 your business, in your community, and especially (cid:43) Choice of benefit payment periods at home. 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The speakers of multitude of organizations, foundations, and non- this day-long workshop were immensely profits have addressed this issue for decades, but for knowledgeable and engaging. The morning speaker, the first time in this country there may be an Dr. Jessica Henderson Daniel, provided an historical, opportunity to make significant strides in alleviating social, political, and economic exploration into this injustice with the Affordable Care Act (ACA). African-American ethnic identity, with special The ACA mandates parity which requires insurance emphasis on adolescent development. Dr. Julie plans in the Marketplace to cover mental health and Hakim-Larsen took attendees through a rich journey substance use disorders on par with other health into Arab-American cultural diversity and provided concerns. Additionally, most plans are prevented tangible treatment recommendations for working from denying benefits due to pre-existing conditions. with this population. Those attending the workshop Preventive care, such as screening for depression and were as diverse as the material shared. For those anxiety, are incorporated in plan benefits. The ACA interested, the resources provided by the speakers is incredibly young in its inception which makes it will be available on the Committee web page. difficult to anticipate the long term effects of this As is the case for most workshops, the audience was policy. However, for some time, psychologists and a self-selected group. Due to professional interests other mental health professionals have been informed and/or practice matters, attendees take special interest that the nature of health care is forever changing in in establishing and maintaining multicultural this country. Combine this reality with the data on competence. Clearly, multicultural competency increasing diversity in this country, and it is clear that evolved far beyond a simplistic understanding of the work of psychologists is being reshaped by new mutually exclusive diversity categories some time practice environments. ago. Practicing clinicians are now challenged with Even the nature of supervision is being affected. assessing, understanding, and applying data regarding With each generation, the beliefs around race, the patient’s intersecting identities into their practice, ethnicity, gender, sexual orientation, class, etc. have regardless of theoretical orientation. This is no small taken on new meaning. Training relationships require task given the rapid increase and complexity of that the supervisor and supervisee find a common “diversity” within the U.S. language to meaningful engage in dialogue around Another issue of diversity that permeates throughout client needs. Therefore, it is just as imperative to the U.S. is mental health disparity. These disparities stay abreast of findings related to culture/diversity as have always existed because of the differential access it is to follow developments in neuroscience as it to health care, which is an artifact of class in this applies to the treatment of trauma. Members are country. Interestingly, during the workshop Dr. encouraged to read the October, 2014 issue of Larsen shared that a number of Arab-American American Psychologist. Articles include “Critical adolescents must sacrifice their education in order to Cultural Awareness: Contributions to a Globalizing help provide income for the family. This practice is Psychology”, “The Cultural Lens Approach to also quite common in the African-, Hispanic-, and Evaluating Cultural Validity of Psychological European-American communities based on this Theory,” and Feminism and Psychology: Critiques of author’s own clinical caseload. While there are likely Methods and Epistemology.” Psychologists would 3 The Michigan Psychologist – 3rd Quarter 2014 do well to not overestimate their levels of Lastly, MPA is pleased to bring another important multicultural competence. The human species is far workshop to its members. On November 7, 2014, Dr. too complex to take this stance. Katherine Nordal, along with several other experts, will discuss the Affordable Care Act and Integrated MPA continuously works to make sure that psychologists have a seat at the table. Let us work Care. Although the practice settings and environments are changing for psychologists, we together to make sure that the following important message is shared with policy makers. Psychologists continue to provide excellent, comprehensive care for the clients that rely on us for their well-being. Let’s are uniquely qualified to incorporate multiculturalism into our assessment and treatment practices relying honor the trust they have placed in us and do all that we can to remain on the cutting edge of theory and on psychological science to inform the field practice in mental health. regarding the implications of individual and group differences and similarities. This is one of the most To comment on this column, contact important aspects of our training and practice that set Tamara McKay, Ph.D. at [email protected] us apart from other mental health disciplines. EXECUTIVE DIRECTOR’S REPORT Executive Director Leaving with Confidence in MPA’s Future Cheval Breggins, MBA – Executive Director Many of you have heard that I am resigning as the MPA Executive Director and will serve as the Executive Director for the Florida Psychological Association. I truly am humbled to have had the opportunity to be the MPA Executive Director and the opportunity to work with such outstanding association members. I want to thank the Board of Directors, Committee volunteers, Association members and staff for their support and dedication. Many of the accomplishments during my tenure were highlighted in prior newsletters. You should know that the MPA Board members have worked tirelessly, and their efforts and contributions have been outstanding. The Board is embarking on an important, thought-provoking, and challenging facilitated strategic planning process. As a result, I continued to learn and try new ideas for a profession that is evolving, and hopefully for the better. To those of you that I had the opportunity to work with closely, I commend you for your achievements and hope that you continue to succeed through your life journeys. I could mention individuals by name and groups, but in the end the message would still be: I have truly enjoyed my time as the MPA Executive Director, and have been well supported with the work and outcomes we have achieved. I hope that you give the next Executive Director just as much, and even more, support to him or her. I leave with great confidence knowing that MPA is capable of overcoming any hurdles that will come up. MPA has managed to assemble a very competent and practical Board and staff that will continue to provide excellent support to the membership. This provides me with a sense of pride and gratitude that is indescribable. As I continue in my career as an Executive Director, I would like to leave you with an anonymous quote: “Do not follow where the path may lead. Go instead where there is no path and leave a trail.” I wish you all the very best. I welcome your input, questions and concerns about MPA; you can contact me at [email protected] or call me at 517-391-0182. 4 The Michigan Psychologist – 3rd Quarter 2014 Stacey Gedeon, Psy.D. is Honored with Award for Exemplary Services by James Windell, Editor Stacey Gedeon, Psy.D., was one of two staff MidMichigan Community Health Services provides members from the MidMichigan Community Health quality, comprehensive, affordable health care to Services honored for exemplary services at the residents of Roscommon and Gladwin counties. It is Michigan Primary Care Association’s (MPCA) 35th one of Michigan’s 38 Health Center organizations annual awards ceremony held August 5, 2014. that together operate 240 sites across the state, providing care to more than 600,000 patients each The MPCA. the non-profit year regardless of insurance status or income. association representing Michigan Health Centers are part of a nationwide Michigan Health Centers, network of Health Centers that serve the primary recognized Dr. Gedeon, medical, dental, and behavioral health care needs of Director of Behavioral more than 22 million individuals in over 9,000 Health & Integrated Primary locations across the U.S. Care at MidMichigan Community Health Services, The award is given to a Michigan Health Center as the 2014 Clinician of the clinician who exemplifies leadership, dedication, and Year. MidMichigan Community Health Services in commitment to providing quality health care to located in Houghten Lake, Michigan. Michigan residents, however, the award has never been given to a psychologist previously. Each year MPCA honors a Michigan Health Center clinician for commitment to providing quality health “I felt incredibly honored and appreciative to have care to Michigan residents. received such an award,” Gedeon said. “Being the first psychologist to receive this award holds special “Dr. Gedeon is most deserving of the 2014 Clinician significance to me, as it emphasizes the importance of the Year Award,” said Kim Sibilsky, CEO of of having psychologists embedded in the primary Michigan Primary Care Association, in presenting the care team." award. “She has been a catalyst for integrating primary and behavioral care at MidMichigan To comment on this article: Community Health Services and across the state with Contact James Windell: [email protected] the goal of improving patient health.” To contact Stacey Gedeon, email her at Sibilsky went on to say that integration increases [email protected] access to health care, improves the quality and cost effectiveness of care, and effects health outcomes. “We honor Dr. Gedeon for her dedication to implementing this model of care that is impacting the lives of so many,” Sibilsky concluded. 5 The Michigan Psychologist – 3rd Quarter 2014 Appropriate Behavioral Health Care and Communication Between Providers Contributes to Better Overall Patient Health By Carol Ellstein, Ph.D. Increasing emphasis on behavioral health has health and psychological functioning of two patients prompted many primary care physicians to ask how with complex presentations. collaboration with mental health specialists and other • Annie (pseudonym) is a woman in her mid-50s with allied health professionals benefits their patients. I’m Type 2 diabetes, obesity, migraine headaches, a licensed psychologist in northern Michigan who has medication-resistant depression, generalized pain, collaborated onsite for almost six years with primary sleep disturbance, energy deficits, and a rare care providers (PCPs) in an independent family autoimmune disease. medicine practice. My first contribution was to discover a history of The collaboration begins when a PCP refers a patient hypomanic episodes in addition to depression. After to me for mental health treatment, behavioral health consulting with me, the PCP referred her to a consultation, and/or psychodiagnostic assistance. psychiatrist, who prescribed a mood stabilizer, with Sometimes I’m asked to provide a second opinion. good results. Other times, a patient self-refers. Once in a while, Next, Annie and I developed a three-tier activity I’m asked to conduct a same-day consultation, which routine that corresponds to her energy level on any leads to a discussion between the patient, provider, given day. We also located an online food tracking and me for planning purposes. system and created a behavioral health regimen for My psychological interventions range from sleep hygiene. behavioral health consultations for specific medical Annie’s chiropractor introduced her to essential oils issues (e.g., techniques for pain management) to a that, according to Annie, eliminated her migraine full course of specialty mental health treatment (e.g., headaches and substantially decreased her overall anxiety or trauma). The patient gives consent for the physical pain. She now works closely with an medical provider and me to share information. aromatherapy practitioner. I maintain two sets of records: a complete set of Annie’s medication use has decreased substantially; written notes that is stored in a locked file cabinet, most notably, she reports that she is now completely and a brief session summary and plan that is written free of pain medications. Annie manages her sleep into the electronic health record. Unless the PCP and disturbance with behavioral strategies and sleep- I catch each other for impromptu consultations, the inducing essential oils. Although Annie suffers an EHR is the primary mechanism through which we occasional setback, she generally reports significant communicate. My notes are omitted from outside improvements in mood, energy and overall sense of record requests unless the patient specifically wellbeing. consents to include them. Office staff schedules my • Barbara (pseudonym) is a woman in her late 60s appointments, obtain treatment authorizations and with uncontrolled type 2 diabetes, congestive heart bill insurers and patients for my services. failure, pain, occasional suicidal ideation, numerous Here are two examples of how specialty mental medical hospitalizations, routinely missed office health and behavioral health services, in concert with other providers, have helped to improve the physical 6 The Michigan Psychologist – 3rd Quarter 2014 appointments, a long-standing diagnosis of bipolar along with a decrease in hospitalizations overall, and disorder, and an unhappy marriage. no hospitalizations for diabetic crises. Her PCP referred Barbara to me as a last resort My inclusion in the treatment team has contributed to before dismissing her from the practice due to each woman gaining a level of physical comfort and noncompliance with medical treatment. Based on psychological wellbeing within a one to two-year conversations with Barbara and her PCP, our initial period that would likely have been impossible to goals were to increase Barbara’s compliance with achieve otherwise. treatment protocols and to elicit active involvement in her own health care. Carol Ellstein, Ph.D., maintains a psychology After almost two years of intense teamwork between practice in Indian River, MI. She also serves as the Barbara, her PCP, the practice unit’s diabetes on-site clinical psychologist and behavioral health educator, and me, along with routine follow-ups with specialist for Little Traverse Primary Care, a BCBSM outside medical specialists, we have seen significant Patient-Centered Medical Home with offices in Harbor Springs, Alanson and Cheboygan MI. You can improvement in treatment compliance, mood, reach Dr. Ellstein with questions or comments at responsibility for self care, and marital satisfaction, [email protected] MPA President Tamara McKay with recent Conference speaker Jessica Henderson Daniel with conference speaker Jessica Henderson Daniel. MPA Board Member Josephine Johnson. Position Available: Neuropsychologist Full time position available for Neuropsychologist to join thriving private practice in Bingham Farms, MI. Position requires primarily neuropsychological evaluation, although there is some opportunity for provision of individual psychotherapy with adults with traumatic brain injury, dementia, vascular disorders, movement disorders and other neurological conditions. Candidates should have substantial experience in neuropsychological evaluation and should be fully licensed or eligible for full license in the State of Michigan. Competitive salary and benefits. Qualified individuals are welcome to submit a CV, letter of interest and at least one sample report with all identifying information deleted to Renee Applebaum, Ph.D. at the following email address: [email protected]. Any potential candidates would also be asked to provide 3 letters of recommendation. 7 The Michigan Psychologist – 3rd Quarter 2014 BOOK REVIEW: ALSO FOR PSYCHOLOGISTS Review of Blood Will Out Walter Kirn - Liverwright, 2014. Reviewed by Jack P. Haynes, Ph.D. As a psychologist particularly interested in murderer, a person who misled the author about personality disorders, and of that group being almost everything. particularly interested in antisocial personalities, The dynamics of this psychopath are described, and often labeled psychopaths, Walter Kirn’s recent book the author eventually realized that he had been taken Blood Will Out was a title of interest. It did not in and manipulated over about ten years. Kirn talks disappoint. It was much more than good summer about how their relationship was established, how he reading. essentially bonded with Gerhartsreiter, how the con The book has a noir-ish title and the cover does have man was able to manipulate him and others, and how a blood stain. But the book is more than a well- the real person was revealed, including his major written true crime story. It also is about fraudulent crime. identity, improbable friendship, and about conflicts in Some of the most interesting passages reference the a friendship with perceived striking social class inquiry by Kirn of the unmasked “Rockefeller” while differences. The book is the true story of the the con man was incarcerated awaiting trial in 2013 friendship of the author with Clark Rockefeller, a for a 1985 murder. How the author came to be duped scion of the Rockefeller family and a huge and how their relationship was maintained make for namedropper, except that the subject of the book fascinating and at times harsh and uncomfortable turned out to be no Rockefeller at all, but was reading. revealed to be a fraud, a con man named Christian To comment on this article, contact Jack P. Haynes, Gerhartsreiter, who also was discovered to be a Ph.D. at [email protected] Recent MPA conference speaker Jessica Henderson Conference speakers Julie Hakim-Larson and Daniel with WSU Professor Christopher Trentacosta Jessica Henderson Daniel. (who also helped co-sponsor the event). 8 The Michigan Psychologist – 3rd Quarter 2014 Charles Clark, Ph.D.: A Remembrance Jack P. Haynes, Ph.D. Dr. Charles Robert Clark, known to many as Charlie, concise, and direct. But things never were the same was a long time friend of mine, a fellow forensic after Beth died so early, about ten years ago. psychologist, and a highly respected colleague. Charlie and Beth had been a team -- both bright and Charlie, age 66, died suddenly and unexpectedly, in articulate, but with Beth more outgoing, expressive, Ann Arbor on September 22, 2014. energetic and warm, while Charlie was more Charlie and I met in 1982, when each of us was a cerebral, witty, and imposing. The team had been relatively newly minted psychologist. Charlie, Larry broken up. Charlie withdrew, and several of us took Cowan, and Rod Howard were the founding him out to dinner monthly. He was appreciative, but members of the Michigan Society of Forensic Charlie was not the same -- less intense, less Psychology. I became member number 6, and we all enthusiastic, more contemplative. took turns as president of MSFP during the next ten However, after years of mourning the loss of Beth, years. Charlie recently allowed himself to develop a Charlie’s training and experience were impressive, to meaningful relationship with a woman in Ann Arbor. be sure. First, there was his work with John Exner of Also, in the last years -- who knew these would be Rorschach fame at Long Island University, and after the last years -- Charlie enjoyed spending time with that, experience and connections at St. Elizabeth’s his grandchildren through his son, Peter, who had Hospital in Washington, D.C. recently moved to his house in Ann Arbor, as had Beth’s mother. Charlie was head of the Psychology Department at the Center for Forensic Psychiatry, then went into Charlie was proud of both his children, Peter and private practice. He was a President of MPA and Laura. He spoke of them with strong commitment active in leadership of the American Board of and clear appreciation. In some ways Beth lived on Forensic Psychology, as well as being the APA through them. That was important to Charlie, and it is Ethics Chair. important and offers some consolation to those of us who knew and appreciated Charlie and Beth. We at MPA were fortunate that he was involved with the MPA Ethics Committee. Charlie and Beth, his Contributions in memory of Charlie can be made to wife who was also an outstanding psychologist, The Nichols Arboretum in Ann Arbor. together wrote a handbook of relevant laws for Michigan psychologists. To comment, contact Jack P. Haynes, Ph.D. at Later in his career, Charlie and I occasionally worked [email protected]. together on cases, and we referred cases to each other. He loved working in his home library, especially in later years, and especially on reports. Charlie was a low key fellow, very bright, erudite, and articulate, and his reports often were parsimonious because Charlie himself was strong, 9 The Michigan Psychologist – 3rd Quarter 2014 Notes of a Psychology Watcher What Killed Robin Williams? Not Depression, Manic-Depression Steven J. Ceresnie, Ph.D. The comedic genius Robin Williams put a belt youngsters and adults, while lining the pockets of around his neck and took his life on August 11, 2014 pharmaceutical companies and boosting the incomes at age 63. Most media reports concluded that of quick-fix 15-minute appointment docs who pass depression, alcohol, and drugs were the lethal mix out medication before they understand the patient. that killed him. Mental life is always complicated and can be altered But depression is a set of symptoms that can occur in from each of these four perspectives (McHugh & a variety of diseases. The disease that most likely Slavney, 1998). For example, Robin William’s life killed Robin Williams was bipolar disorder (manic- was altered by what he “had” -- the mental disease depressive illness), an “episodic recurrent of bipolar disorder; what he "was" -- personality traits pathological mood disturbance that ranges from such as hyperthymia; what he “did " -- behaviors extreme elation or mania to severe depression, and is such as drug and alcohol abuse; and what he usually accompanied by disturbances in thinking and “encountered" -- an often absent father, three behavior, and often by psychotic features such as marriages, and the recent cancellation of a new TV delusions and hallucinations” (Craddock and Sklar, series. 2013). Some people have mild to moderate manic symptoms There are no diagnostic tests for this disorder that has all the time. Williams had that kind of mind --- his two subtypes: bipolar l (have at least one full manic associations were faster than a speeding bullet, his episode), and bipolar II (have only milder hypomanic wit had no equal, his personality was “hyperthymic” episodes). Bipolar disorder type I and II affect about – extroverted, funny, high-energy, hard-working and 2% of the world population (Geddes and Miklowitz, successful. He had access to the stuff of dreams, 2013). doing jazz improvisations with words to create visual images, tickling the depths of our unconscious minds. The mean delay between the illness onset of bipolar disorder and diagnosis is 5 – 10 years (Phillips & Williams was described by those who knew him as Groucho on steroids -- a man fueled by a high Kupfer, 2013). The major reason for this surprising voltage mind that was always going. delay is the difficulty differentiating bipolar I and II from unipolar depression. Misdiagnosis of the illness Some clinicians have claimed that bipolar disorder is as recurrent unipolar depression occurs in 60% of a gift. They draw connections between bipolar patients seeking treatment for depression (Phillips & disorder and creativity. Nancy Andreasen, who first Kupfer, 2013). obtained a Ph.D. in English Literature and then No doubt Williams’ years of cocaine and alcohol became a psychiatrist, is the author of “The Creative Brain: The Neuroscience of Genius.” Andreasen abuse contributed to his death. Even cocaine use did not escape Williams’ ability to turn tragedy into uses the case-study method and introspective descriptions of creative individuals to study the comedy. He once quipped that cocaine is God’s way of telling you you’re making too much money. creative process (Andreasen, 2005). Kay Jamison, a psychologist who talks about her own bipolar Depression is the most acceptable diagnosis for disorder, has outlined connections between creativity Williams based on media reports. Clinicians and and madness in famous artists, musicians, and so on consumers often downplay, dismiss, and trivialize in her book “Touched with Fire: Manic-Depressive bipolar disorder. Many clinicians say we are over- Illness and the Artistic Temperament” (Jamison, diagnosing bipolar disorder, especially in children 1993). and adolescents, leading to dangerously drugging 10 The Michigan Psychologist – 3rd Quarter 2014