AAMFT California Newsletter, Spring 2014

HEADLINES

Lobby Days in Sacramento and Washington DC
Advocacy Update, Busy Legislative Year Underway
Clinical Corner
Book Review

 

LOBBY DAYS IN SACRAMENTO AND WASHINGTON DC

ACA Implementation in California: Opportunities and Challenges for Mental Health Providers

Olivia Loewy, PhD
AAMFT-CA Executive Director

March was a month of Advocacy Days in both Sacramento and Washington D.C. for AAMFT-CA Division leaders.

SACRAMENTO:  MFT Advocacy Day

On March 4, a group of 20 AAMFT-CA Division members gathered at the Capitol in Sacramento.  A morning program included several informative presentations:

  • Healthcare Reform in CA as it affects
    Mental Health
    David Ford, Legislative Advocate, Noteware Government Relations
  • The Job of the Lobbyist and the Legislative Process
    Fred Noteware, Owner, Noteware Government Relations
  • AAMFT-CA Division Advocacy Agenda
    Benjamin Caldwell, AAMFT-CA Division Advocacy Committee Chair

lobby-days

Following lunch at the historic Frank Fat’s, we split into small groups to conduct visits at the offices of selected state senators and assembly members.

It was the first-ever MFT Advocacy Day in Sacramento and the participants agreed that AAMFT-CA should make this an annual event.  Many thanks to Advocacy Day Planning Committee members:  Jilliana Antoniewicz, Liza Bolanos, Carizma Chapman and Momoko Takeda who coordinated with our lobby firm, Noteware Government Relations, to organize and take care of the careful prep work that made this a truly successful event.  Special thanks to Noteware Government Relations associate, Bless Sheppard.

WASHINGTON D.C.

On March 13 – 16, CA Division President Naveen Jonathan, President Elect Norma Scarborough and Executive Director Olivia Loewy participated in AAMFT Leadership Training and Capitol Hill Lobby Days.  Our meetings at California legislators’ offices were focused on two issues of concern for MFTs:  inclusion of MFTs as providers of Medicare Services and revision of the V.A. hiring regulations.

  • Medicare:  Senate Bill S 562 and identical House companion bill HR 3662 add MFTs (and LPCs) as Medicare Part B clinicians.  For these meetings, AAMFT-CA and CAMFT joined forces to request support of the bills.
  • Veterans Administration:  Our meetings at the offices of selected legislators addressed the obstacles that limit Veterans’ access to mental health services provided by MFTs.  Specifically, we are asking that the V.A. remove the language requiring a licensed MFT to have graduated from a COAMFTE-accredited institution to be eligible for employment.  Our AAMFT Government Affairs staff have worked on securing this change for at least three years and continue to discover new routes that may successfully lead us towards the goal.

AAMFT National Lobby Days have the benefit of including representatives from all 50 states initiating visits to the key legislators who need to be reached.  Our “champions”, of course, do not all come from California.  For instance, HR 3662 was introduced by Representative Gibson from New York as well as Mike Thompson from California.  S’ 562 was introduced by Senators from Oregon and Wyoming.  It is the meetings with constituents that carry the most weight for legislators and we were pleased to be able to “debrief” and compare notes with our counterparts from across the country.

With Healthcare Reform implementation underway, access to care is a major issue at both the state and the federal level.  AAMFT-CA is working in both arenas for inclusion of MFTs to ensure that effective care can be provided to those in need of our services.

AAMFT-CA is the MFT association in California that is focused on providing the information and resources you need to ensure your professional stability in the future. For more information, do not hesitate to contact Olivia Loewy:  olivialoewy@aamftca.org.

Olivia Loewy, PhD is Executive Director of AAMFT-CA.  She can be reached at olivialoewy@aamftca.org

Image source: Courtesy of Olivia Loewy, PhD

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LEGISLATIVE & ADVOCACY UPDATE
Busy Legislative Year Underway

Many Bills Would Directly Impact MFTs

Benjamin E. Caldwell, PsyD
AAMFT-CA Legislative and Advocacy Chair

This is the second year of the Legislature’s two–year cycle, which means legislators are eager to leave a mark before their terms expire, and bills that languished last year have a second chance of being pushed forward. In such a busy year, there are many bills that would impact MFTs. AAMFT-CA has taken positions on nine bills so far, and is actively involved in the development of several others.

Senate Bill 596 would require the state Department of Education to select four high-need schools for a 3-year pilot program testing inclusive practices that integrate mental health, special education, and school climate interventions. We have taken a Support position on this bill.

Senate Bills 924 and 926 would extend the statute of limitations for civil and criminal penalties for child abuse. We have taken a Support position on both measures.

Senate Bill 1046 is an enforcement bill that would give the Department of Managed Health Care the same “teeth” as the Department of Insurance when it comes to penalizing violations of mental health parity. We have taken a Support position on this bill.

Senate Bill 1054 would create a $50 million mentally ill offender crime reduction grant program, half of which would focus on adults and the other half juveniles. We have taken a Support position on this bill.

Senate Bill 1148 would require MFTs to retain treatment records for a minimum of 7 years after the last professional contact (for minors, 7 years after the minor turns 18). There is no specific standard in law now; 10 years is sometimes recommended because that’s the statute of limitations for clients to file claims of sexual misconduct. Records from treatment are a good first defense against such claims. We have taken a “Support if amended” position on this bill, asking CAMFT (the bill’s sponsor) to clarify that would apply to treatment ending on or after January 1, 2015.

Assembly Bill 1993 would require schools to offer counseling services to any student determined to be a victim of bullying or to have committed an act of bullying. We have taken a Support position on this bill.

Assembly Bill 2198 would add suicide training to the continuing education mental health professions must complete in each license renewal cycle. We have taken an “Oppose unless amended” position, as the bill would require duplicative training that we do not believe would achieve the bill’s worthy goals of reducing suicide. The bill’s other component of a task force to develop best practices in suicide prevention is supportable.

Assembly Bill 2213 would update the BBS’s requirements for MFTs coming to California with out-of-state degrees. We have been actively involved with the work of the BBS’s Out of State Education Committee for a year, and this bill is the result of their inclusive work. We have taken a Support position on this bill.

There are other bills of interest that we are also paying close attention to, though we have not yet taken official positions. One such bill (Assembly Bill 1505) aims to change the Child Abuse and Neglect Reporting Act to remove discrimination in the law, furthering the successful effort we made last year on this issue with the BBS.

We welcome your feedback on our advocacy work. You can reach Ben Caldwell directly at bcaldwell@alliant.edu. Further information on each of the bills listed here can be found on the Legislature’s web site at http://leginfo.legislature.ca.gov.

Image source: Courtesy of Ben Caldwell, PhD

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CLINICAL CORNER
Medical Family Therapy: A Brief Introduction

naveen

Jackie Williams Reade, PhD
Director, Medical Family Therapy
Loma Linda University

In a typical initial assessment with a client, we often ask the question: “Do you have any medical conditions?” How do you respond when the client shares that they do have a chronic or acute illness? What do you say? Do you quickly move on to get to the more interesting psychosocial stuff, explore the story behind this medical condition, or wish you knew more about the medical condition so you could ask about it? While this question is present in our intakes to represent our attunement to biopsychosocial (Engel, 1977) factors, we are often not trained in how to assess and intervene when an individual shares their illness, injury, or disability. However, there is often a rich, meaningful world waiting to be explored and understood when clients discuss their medical history with their family therapist.

Medical Family Therapy is an approach to collaboration between mental health and medical care that recognizes that “there are no biological problems without psychosocial implications, and no psychosocial problems without biological implications” (McDaniel, Doherty, & Hepworth, 2014). As Medical Family Therapists (MedFTs), we pursue details of the medical condition, subsequent treatment, and the psychosocial impact on patient and family/community members because we consider illness to be a significant aspect of a person’s life. The diagnosis of an illness, injury, or disability is a stressor for both the patient and their family members who must adjust to symptoms of the condition, stress of treatment, feelings of vulnerability, financial concerns, and changes in family structure, communication, and belief systems (Rolland, 1994). A phrase often used among MedFTs is that illness is not just one of the many stressors that an individual and family is influenced by, but rather illness takes up space as a member of the family and brings dynamic changes to roles, rules, and relationships.

With the knowledge that it is important to consider the impact of a medical illness, the next question is “Where do I start?” The books cited below are foundational texts for MedFT and are well worth a read. In addition, here are a few questions you could ask yourself or your clients to get you thinking about how illness is playing a role in their lives.

  • How has the family had to reorganize itself, or how will it need to do so
    over the course of the medical condition?
  • Is the illness or disability discussed openly? By whom? With whom?
  • What is the current relationship with the medical team? Do all family members trust the medical team’s recommendations and care for the patient?
  • For you, the therapist: Have you examined your personal experience with illness and the impact it may play on how you work with people who have a medical condition?

In asking these questions, we may feel unprepared as we receive answers full of unfamiliar medical terms, diagnoses, and medications. This is normal and perhaps part of the reason we don’t often ask in-depth questions about the medical condition of our clients. However, clients often appreciate the opportunity to educate their mental health therapist on their medical diagnosis and treatment as well as discuss the impact the illness has on their experience and relationships. It is imperative that we consider the role illness plays in the work we do with our clients and provide the much-needed space for patients to explore their relationship with illness and receive the holistic biopsychosocial care they need.

Medical Family Therapy is a growing field and I invite you to find out more about Loma Linda University’s 9-month Medical Family Therapy Certificate and Internship opportunities by visiting our website: http://www.llu.edu/behavioral-health/cfs/medft.page

References

Engel, G. L. (1977). The need for a new medical model. Science, 196, 129-136.

McDaniel, S.H, Doherty WJ, & Hepworth, J. (2014). Medical Family Therapy and Integrated Care, 2nd Edition. Washington DC: American Psychological Association Publications.

Rolland, J. S. (1994). Families, illness, and disability: An integrative treatment model. New York, NY: Basic Books)

Jackie Williams Reade, PhD is currently an Assistant Professor and Director of Medical Family Therapy at Loma Linda University. She graduated from East Carolina University’s doctoral program in Medical Family Therapy and completed a postdoctoral fellowship in pediatric palliative care at Johns Hopkins University. Jackie is interested in furthering the field of Medical Family Therapy and welcomes questions and conversations.

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BOOK REVIEW
On Becoming A Better Therapist

normaAuthor: Barry L. Duncan
American Psychological Association, 2010
Click here to go to Amazon

Reviewed by Cathyrn Leff, LMFT

Barry Duncan is a therapist, trainer and researcher who directs the Heart and Soul of Change Project.  The project focuses on what works in therapy and how to deliver it based on client-based outcome feedback.  This book utilizes the Outcome Rating Scale (ORS), the Session Rating Scale (SRS), and the Child ORS and Child SRS, which he co-developed.

The ORS asks clients to rate how they are doing individually, interpersonally, socially, and overall (general sense of well-being) over the past week.  The SRS scale asks clients to rate their relationship with their therapist (they either felt understood and respected, or they did not), their goals and topics were discussed (whether they worked on their goals or not), the therapist’s approach or method (therapist’s approach was a good fit, or not), and their overall sense of the session (session was right for them or not).  Clients fill out these quick and easy one-page forms for each session.

What I like about Duncan’s book is that he moves away from “the right psychological treatment for the right disorder,” to examining the behaviors and attitudes of therapists.  Duncan requires therapists to monitor their clients’ treatment response and to discuss these responses in sessions.  He also encourages therapists to examine this information over time using a simple Excel file, or other tracking program to become a more effective therapist.   Further, Duncan discusses the substantial evidence that exits, showing that tracking treatment response benefits clients.

A basic understanding of statistics is needed in order to use the scales mentioned above, and the other assessment scales found in the appendix.  Duncan’s writing style is easy on the eyes and his sense of humor engages the reader with an understanding of having worked in the trenches.

What I found helpful to me personally was Duncan emphasized that the therapeutic alliance must be present even while making appointments and collecting fees.  This can be difficult in this new age of therapy being conducted like a business.  Duncan states, “The alliance should always remain the central filter of all your words and actions:  Is what I am saying and doing now building or risking the alliance?”

Essentially, Duncan offers therapists a client-centered, alliance-focused, discovery-oriented, outcome-informed description of how to conduct successful therapy based on research of what works.  Therapists who are lucky enough to stumble across this gem of a book, and embrace its philosophy are sure to become better therapists.

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Thank you to Linda Buck, AAMFT-CA Newsletter editor