The Heart and Soul of Change

Posted on March 26, 2013 by Gina Ulery

The Heart and Soul of Change, 2nd Ed, is a new 8-hour book-based CEU course for psychotherapists.

How does psychotherapy work? As research on psychotherapy has accumulated, it has become increasingly clear that common factors like the therapeutic alliance constitute the primary mechanisms for change. This text reviews the empirical research literature, distills the common factors associated with change, and presents them in a clear and straightforward manner for practicing clinicians. Topics include client and therapist factors, the therapeutic alliance, the common factors approach, common factors within psychiatric drug treatment, outcome monitoring (practice-based evidence), and common factors for specific populations (youth psychotherapy, couple and family psychotherapy, and substance abuse/dependence treatment). This CE test is based on the book “The Heart and Soul of Change (2nd Edition): Delivering What Works in Therapy” (2009, 455 pages). The book can be purchased from Amazon.

CE Credit: 8 Hours
Target Audience: Psychologists | Counselors | Social Workers | Marriage & Family Therapists (MFTs)
Learning Level: Advanced
Course Type: Test Only $50

Professional Development Resources is approved as a provider of continuing education by the Association of Social Work Boards (ASWB #1046); the National Board of Certified Counselors (NBCC #5590); the American Psychological Association (APA); the National Association of Alcoholism & Drug Abuse Counselors (NAADAC #000279); the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346); the California Board of Behavioral Sciences (#PCE1625); the Texas Board of Examiners of Marriage & Family Therapists (#114); the South Carolina Board of Professional Counselors and Marriage & Family Therapists (#193); and the Ohio Counselor, Social Worker and Marriage & Family Therapist Board (#RCST100501).

Ethics and Social Media

Posted on February 28, 2013 by Gina Ulery

Ethics and Social Media – New 2-Hour Online CEU Course

Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on Social Networking Services (SNS) like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication? The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy. Course #20-75 | 2013 | 28 pages | 14 posttest questions

The Psychology of Immigration

Posted on February 12, 2013 by Gina Ulery

The Psychology of Immigration in the New Century is a new 4-hour CEU course based on Crossroads: The Psychology of Immigration in the New Century (click link to download free public-access document) published by the American Psychological Association in 2012 (124 pages). Psychologists and other psychotherapists are, and increasingly will be, serving immigrant adults and their children in a variety of settings, including schools, community centers, clinics, and hospitals, and thus should be aware of this complex demographic transformation and consider its implications as citizens, practitioners, researchers, and faculty. This report aims specifically to describe this diverse population and address the psychological experience of immigration, considering factors that impede and facilitate adjustment. The report, which includes the recent theoretical and empirical literature on immigrants, (a) raises awareness about this growing (but poorly understood) population; (b) derives evidence-informed recommendations for the provision of psychological services for the immigrant-origin population; and (c) makes recommendations for the advancement of training, research, and policy efforts for immigrant children, adults, older adults, and families. This report is essential reading for all healthcare providers who work with first and second generation immigrants and diverse groups in the United States. Course #40-34 | 30 posttest questions

CE Credit: 4 Hours
Target Audience: Psychologists, Counselors, Social Workers, MFTs
Learning Level: Introductory

Prevention of Medical Errors

Posted on January 30, 2013 by Gina Ulery

Medical errors continue to be a major issue in today’s health care arena. Yet it’s been over a decade since the eye opening report from the National Academies’ Institute of Medicine Report To Err is Human: Building a Safer Health System (1999): revealed these statistics:

Approximately 50-100,000 Americans die each year from medical errors
Preventable medical errors cause an additional one million injuries to Americans
Medical errors cause more deaths than breast cancer, AIDS or even car accidents
7,000 people die from medication errors alone
Repeat tests, disability, and death due to error cost the US $17-38 billion each year

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Less dramatically publicized – but often equally damaging to clients – are those mistakes that can occur in the practice of behavioral health. Such errors generally fall into the categories of:

Improper diagnosis
Breach of confidentiality
Failure to maintain accurate clinical records
Failure to comply with mandatory abuse reporting laws
Inadequate assessment of potential for violence
Failure to detect medical conditions presenting as psychiatric disorders (or vice-versa)

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Such errors of omission or commission can result in lasting damage to clients just like those that occur in the medical arena. Diagnostic errors lead directly to one of two outcomes: either applying improper – and therefore ineffective and unneeded – treatment, and/or the failure to apply effective treatment. Breaches of privacy and confidentiality can precipitate a cascade of adverse events for clients, often reaching far into not only their personal lives, but even into relationship and occupational spheres.

Mental health professionals are required by several levels of ethical and legal standards to maintain accurate clinical records in order to assure continuity in the course of a client’s treatment. The failure to do so can cause harm resulting from the loss of a clear and coherent course of therapy. Failure to comply with mandatory abuse reporting laws and inadequate assessment of potential for violence lead to obvious dangers to clients and others. Finally, confusing medical conditions with psychiatric ones can lead to damaging – even tragic –consequences for clients due to the failure to offer or refer for appropriate treatment.

Preventing Medical Errors in Behavioral Health, a 2-hour online continuing education course, is intended to increase clinicians’ awareness of the types of errors that can occur within mental health practice, how such errors damage clients, and numerous ways they can be prevented. Its emphasis is on areas within mental health practice that carry the potential for “medical” errors. Examples include improper diagnosis, breach of confidentiality, failure to maintain accurate clinical records, failure to comply with mandatory abuse reporting laws, inadequate assessment of potential for violence, and the failure to detect medical conditions presenting as psychiatric disorders (or vice-versa). It includes detailed plans for error reduction and prevention like root cause analysis, habitual attention to patient safety, and ethical and legal guidelines. The course includes numerous case illustrations to help demonstrate common and not-so-common behavioral health errors and specific practices that can help clinicians become proactive in preventing them. There is a new section on preventing medical errors in the use of technology. *This course satisfies the medical errors requirement for license renewal of Florida Mental Health Counselors, Social Workers & MFTs.

Weighing Patient’s Rights against Psychologist’s Rights

Posted on January 15, 2013 by Gina Ulery

Q: I have a question about the use of e-mails with clients but it may be relevant to larger issues in the therapeutic relationship. Are we allowed to refuse to do certain things that a client requests or must we do everything they want? My usual practice is to let clients know that I communicate by telephone and by voice mail messages; that I don’t communicate by e-mail. The father of a child I am treating is in the middle of a legal separation process and he wants me to “confirm” everything in e-mails the day after each session with my client. He is being very pushy with me and I feel like he’s actually bullying me about this. I know we focus a lot on clients’ rights, but what are my rights (and obligations) in this situation?

A: This is an excellent question that raises a number of important issues that many psychologists may be confronted with over time. A major focus of our profession is the welfare of the consumer of our professional services. The APA Ethics Code (APA, 2002) makes it clear in its General Principles that we seek to help others and minimize the risks of harm, that we fulfill our agreements and act with integrity, that we provide fair and equitable treatment of all and that we act with respect for individual differences.

Specific Ethical Standards address avoiding harm, conflicts of interest and exploitative relationships. Thus, a major emphasis of our profession’s ethics code is on providing high quality professional services that are in the recipient’s best interests, taking clear steps to minimize the risk of exploitation or harm.

But, the situation you describe is less than clear cut. The issue of who your client is must be thoughtfully addressed. Assuming that your client is a minor and could not consent to his or her own treatment, it is likely that the parent is the actual “client,” that is, the one who has provided consent. Since this is a separation/divorce situation this further complicates matters.

Based on what you have said, it appears that thus far there has been no change in the parents’ legal status or rights so they each should be able to consent independently to their child’s treatment and you wouldn’t need consent from both parents. But in these situations it is always best to clarify each individual’s legal status to confirm who has the legal right to consent to a minor child’s treatment.

This situation and your obligations may be viewed under ethical standards 3.10, Informed Consent; 10.01, Informed Consent to Therapy; and 3.07, Third-Party Requests for Services (APA, 2002). All expectations and obligations should be reviewed and clarified from the outset of the professional relationship. For example, Standard 3.07 specifies that:

“When psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained and the fact that there may be limits to confidentiality.” (p. 1065)

While it is important to clarify who the client is, the more basic underlying issue in these situations is to determine and reach an agreement on to whom you owe an obligation and what obligations you owe each individual (Barnett, Behnke, Rosenthal and Koocher, 2007; Fisher, 2009). All this should be discussed and agreed to in the informed consent process at the outset of the professional relationship and revised or updated if substantive changes occur over the course of time that may necessitate this.

What appears to be not so subtly implied in your question is the father’s possible motivations for pressuring you to “put everything in writing.” The use of e-mails as a means of communication can provide him with “proof” or evidence of what has transpired in treatment and could possibly provide him with ammunition for his legal battle. Such issues speak to the difficulties psychologists and other mental health professionals experience when the clinical and legal realms intersect or overlap (Zimmerman et al., 2009).

One issue of great importance to address in the informed consent process is just what your role will be. It is essential to clarify that you will be providing the child with psychotherapy and that you are not conducting a forensic evaluation to be used in legal proceedings. Since the e-mail communications you describe can easily be misused and at a minimum, used out of context, your desire to avoid e-mail communications makes great sense.

Further, exercising your judgment on the appropriateness of composing and sending these e-mails seems very appropriate in keeping with the need to consider your obligations to each party involved.

By Jeffrey E. Barnett, PsyD, ABPP

Excerpt from Ethics & Risk Management: Expert Tips V, a 2-hour online course that addresses a variety of ethics and risk management topics in the form of 14 archived articles from The National Psychologist. Topics include: (1) Is it kosher for a psychotherapist to serve as an expert witness? (2) Weighing patient’s rights against psychologist’s rights (3) Techno breaches could cost practitioners big bucks (4) Custody cases require special training (5) Too many rules – Risk Management (6) Pay me now, pay me later (7) Business of Practice and Ethics (8) Not all nations share APA’s ethics standards (9) Student/professor dating always questionable (10) Therapists need a strong back-up plan (11) Ethics primer addresses core issues (12) Wintering south can create ethics problems (13) Confidentiality in the 21st Century – Risk Management (14) The fiduciary heart of ethics. This course is intended for psychotherapists of all specialties.

Preventing Medical Errors in Behavioral Health – 2013 Update

Posted on January 8, 2013 by Gina Ulery

Preventing Medical Errors in Behavioral Health

By: Leo Christie, PhD; Catherine Christie, PhD; Susan Mitchell, PhD

CE Credit: 2 Hours

Target Audience: Florida-licensed Psychologists, Counselors, Social Workers & MFTs

Learning Level: Intermediate

Course Type: Online

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Preventing Medical Errors in Behavioral Health

This course is intended to increase clinicians’ awareness of the types of errors that can occur within mental health practice, how such errors damage clients, and numerous ways they can be prevented. Its emphasis is on areas within mental health practice that carry the potential for “medical” errors. Examples include improper diagnosis, breach of confidentiality, failure to maintain accurate clinical records, failure to comply with mandatory abuse reporting laws, inadequate assessment of potential for violence, and the failure to detect medical conditions presenting as psychiatric disorders (or vice-versa). It includes detailed plans for error reduction and prevention like root cause analysis, habitual attention to patient safety, and ethical and legal guidelines. The course includes numerous case illustrations to help demonstrate common and not-so-common behavioral health errors and specific practices that can help clinicians become proactive in preventing them. There is a new section on preventing medical errors in the use of technology. *This course satisfies the medical errors requirement for license renewal of Florida mental health professionals. Course #20-70 | 2013 | 31 pages | 15 posttest questions

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Professional Development Resources is approved as a provider of continuing education by the Association of Social Work Boards (ASWB #1046); the National Board of Certified Counselors (NBCC#5590); the American Psychological Association (APA); the National Association of Alcoholism & Drug Abuse Counselors (NAADAC #000279); the Commission on Dietetic Registration (CDR #PR001); the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA #AAUM); the American Occupational Therapy Association (AOTA #3159); and various state licensing boards.

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Florida Social Work, MFT & Mental Health Counselor License Renewal Info

Posted on December 12, 2012 by Gina Ulery

ALL CSW/MFT/MHC licensees and registered intern licenses will expire on March 31, 2013. You may renew your license online beginning January 2013.

30 hours of approved continuing education (CE) are required to renew, including:

Two (2) hour course relating to prevention of medical errors
Three (3) hour course in ethics and boundary issues
Two (2) hours of CE on domestic violence must be completed every third biennial licensure renewal period. These two (2) hours shall be part of the 30 hours otherwise required for each biennial licensure renewal, and may be taken at anytime during the six years preceding the renewal for the biennial in which the credit is due.

Professional Development Resources is approved as a provider of continuing education by the Association of Social Work Boards (ASWB #1046); the National Board of Certified Counselors (NBCC #5590); the American Psychological Association (APA); the National Association of Alcoholism & Drug Abuse Counselors (NAADAC #000279); the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and is CE Broker compliant (all courses are reported to CE Broker within one week of completion).

Florida-licensed social workers, MFTs and mental health counselors can earn all 30 hours required for renewal through online courses offered @ https://www.pdresources.org/.

Anyone licensed in Florida for the first time on November 1, 2010 or after are exempt from obtaining renewal continuing education for the current biennium ending March 31, 2013.

Information obtained from the Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling website on 12/12/2012: http://www.doh.state.fl.us/mqa/491/

Solving ‘Under’ and ‘Over’ Diagnosis in Drugged Children

Posted on December 11, 2012 by Gina Ulery

The number of children/adolescents diagnosed with neurodevelopmental and neuropsychiatric disorders has risen dramatically since the mid-1990s. This has been in tandem with the increased use of psychotropic medications, often multiple agents (“drug cocktails”) as the mainstay of intervention.

Research supports both the “underdiagnosis” and “overdiagnosis” of mental health disorders in children/adolescents, with the exception of the good evidence-based support for medication management in cases of primary attention deficit disorder, which are not associated with significant co-morbidity.

One thing is certain – most children/adolescents with one or more mental health diagnoses who are treated, frequently for extended periods with various “drug cocktails,” are not receiving intensive diagnostic evaluations.

More specifically, “drive-by” assessments in primary care and mental health settings have become an acceptable standard of care while comprehensive psychological/neuropsychological testing and psychoeducational evaluation are clearly the exception.

There are several reasons for the significant underutilization of detailed psycho-diagnostic testing. First, many parents and other consumers of mental health care as well as health care professionals and specialists, regrettably including far too many child psychiatrists, have limited knowledge regarding psychometric assessment.

A second factor is the steadily worsening “pass the buck” phenomena in special education and behavioral health care. Public schools are overwhelmed with the number of students referred for evaluation and most special education departments do not have the staffing or expertise to perform proper assessments in many cases.

Additionally, syndromes such as ADD, which are arguably better conceptualized as psychoeducational conditions than medical illnesses, continue to fall under the purview of medical professionals for diagnosis and treatment, which limits the assessment role played by school departments.

Third, managed care plans remain reluctant to approve authorization for testing conducted by community-based psychologists employed in clinics, hospitals and private practice. Authorization for evaluation of neurodevelopmental conditions – learning disorders and ADD are routinely denied.

When authorizations are approved, the time and payment allotted for the evaluation are typically so limited that psychologists are often given the draconian choice of providing an inadequate and ethically dubious assessment or declining to take the case. Pediatricians, other primary care physicians and medical specialists – notably psychiatrists and neurologists – involved in the assessment and treatment of childhood mental health disorders, have done little to advocate for more adequate authorizations from insurance companies for psychodiagnostic testing.

A collaborative cost-sharing model involving parents, special education departments and community-based clinicians can lead to the timely completion of comprehensive clinical evaluations.

Special education departments could agree to provide assessment within traditional areas of expertise – intelligence and academic skills evaluation, parent and teacher rating scale assessment, socio-emotional testing, speech/language, occupational therapy and physical therapy evaluations.

Community-based psychologists would complete any needed additional evaluation. This could involve administration of neuropsychological tests and, as needed, more in-depth socio-emotional assessment and an evaluation of family functioning.

Fees for record reviews and attendance at psychoeducational planning meetings would be paid to the psychologist by the school department, the family or cost-shared between the two parties.

This model is most clearly indicated for children/adolescents with complicated clinical histories and behavioral symptoms associated with impaired school achievement/functioning. Many of these cases fall within the pervasive developmental disorder, post-traumatic stress disorder, major affective/mood and/or psychotic spectrums.

For a subset of these children, there may be additional questions about risk of self-harm and/or harm to others. These types of cases pose significant challenges for parents and school staff in terms of the completion of an affordable in-depth assessment.

Special education departments, parents and community-based psychologists are strongly encouraged to forge stronger alliances around the issue of how to make top-notch clinical assessments readily available and affordable for children and their families. The medical community is encouraged to step up advocacy and to become more familiar with use of psychometric assessment.

By Jerrold M. Pollak, PhD

Excerpt from Psychotherapy Practice Tips, Part 2

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Professional Development Resources allows you the flexibility to earn CEU credits at your own pace and according to your own schedule, wherever you are. You can explore courses, register, study, take exams and earn your accredited continuing education units all online. And getting started earning CEUs is easy…

Montana Social Workers Continuing Education and License Renewal

Posted on November 14, 2012 by Gina Ulery

Montana-licensed Social Workers have an annual license renewal deadline of December 31st. To renew a license, twenty (20) board approved continuing education hours are required. Twenty (20) hours of continuing education are allowed from home study (online courses). The board accepts ASWB approval of continuing education courses.

The main objective of continuing education credits is to ensure the highest possible standards for the social work profession. All licensees are required to participate in continuing educational opportunities that will build upon existing competence and skill gained from previous educational experiences.

Professional Development Resources is approved as a provider of continuing education for social workers by the Association of Social Work Boards (ASWB Provider #1046, ACE Program). Montana Social Workers may earn all 20 required CE hours online @ www.pdresources.org

Continuing Education Requirements

Montana social workers are required as a condition of renewing a license to complete a minimum of twenty (20) hours of continuing educational activities annually.

Autism Linked to Fever or Flu in Pregnancy

Posted on November 13, 2012 by Gina Ulery

By Joseph Brownstein, MyHealthNewsDaily Contributor

Having a fever or flu in pregnancy may be linked with the development of autism in children, a new study suggests. While researchers are hesitant to draw strong conclusions, the study is at least the second showing such a link.

The researchers followed mothers in Denmark and the nearly 97,000 children they had between 1997 and 2003. During the study, 976 children in the study were diagnosed with autism.

Children were more likely to be diagnosed with autism if their mothers had the flu or developed a prolonged fever during the first or second trimester of pregnancy.

But the topic needs further study before stronger conclusions can be drawn, said study researcher Hjördis Osk Atladottir, of the University of Aarhus.

“Around 99 percent of women experiencing influenza, fever or taking antibiotics during pregnancy do NOT have children with autism,” Atladottir wrote to MyHealthNewsDaily in an email.

Dr. Marshalyn Yeargin-Allsopp, chief of the Centers for Disease Control and Prevention Developmental Disabilities Branch, who was not involved in the study, said, “We’re not recommending clinically that physicians change their management of pregnant women based on these findings.”

One reason for the caution may be that pregnant women who are concerned about lowering their child’s risk of autism would, for the most part, simply need to adhere to existing guidelines, which recommend getting a flu shot, and treating fevers by taking acetaminophen and contacting their physician.

Some researchers were puzzled by the authors’ caution.

“The data indicates that maternal flu infection or an extended fever increases the risk for autism in the offspring — a twofold increase,” said Paul H. Patterson, a biology professor who researches the connections between infection and neurological development at the California Institute of Technology.

Noting that the new finding is consistent with other research, Patterson said, “I’m not clear on why they appear to soft-pedal their results in their conclusions.”

A study published in May from researchers at the University of California, Davis found a similar connection, showing that mothers of children with autism were more likely to have had a prolonged fever in the late first or second trimesters of pregnancy, compared with mothers of children who didn’t have autism.

Irva Hertz-Picciotto, an author of the UC Davis findings, said while the reason that fevers or flu during pregnancy may be linked with autism are unclear, it’s thought that inflammation may have an adverse effect on early brain development.

“I think there’s some growing evidence that perhaps inflammation in the wrong tissue at the wrong time could interfere with normal developmental processes,” Hertz-Picciotto said.

There is also evidence for a link between mothers who have inflammatory conditions such as diabetes and autism in children, but that link, too, has not been conclusively established, she said.

“There is some growing evidence that in neurodevelopment, this could be part of a pathologic process, this could lead to behavioral type syndromes,” Hertz-Picciotto said.

Indeed, researchers are just beginning to develop an understanding of autism’s causes, the experts said.

“We know a lot more than we knew five years ago, but the science is really in its infancy,” said Coleen Boyle, of the CDC.

A CDC-sponsored study, called the Study to Explore Early Development (SEED), is following more than 2,700 children in California, Colorado, Georgia, Maryland, North Carolina and Pennsylvania, with the hope of identifying factors that might influence autism spectrum disorders.

Boyle said that the possible environmental causes of autism can be more challenging to research than the disorder’s genetic causes. For example, data in the new study had to be collected starting in the late 1990s.

“You can just see the time that’s required to collect that kind of information,” Boyle said.

“There’s not a lot of people looking at these environmental factors,” Hertz-Picciotto said. “This is something people should be paying more attention to, because it’s actionable.”

Pass it on:A flu or fever during pregnancy may lead to autism in children.

Source: http://www.myhealthnewsdaily.com/3257-autism-fever-flu-pregnancy-inflammation.html

Professional Development Resources, an accredited provider of online continuing education courses for health professionals, offers a number of courses that address the research, diagnosis and treatment of those on the Autism spectrum.

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