In these remarks, my final set as President-Elect, I use the opportunity to take a brief look back at the past year and offer some information about what we aim to accomplish this coming year.   As in the past remarks, I will offer some depth on a particular aspect of the organization and mention current issues.  The topic for review in this issue is how MPA is governed and how this relates to the work done by the various parts of the organization.  This discussion leads to a review of the various MPA committees that do the lion’s share of the day-to-day work of the Association.  The focus on committee functions will be a recurring topic of my Presidential remarks in 2018.

MPA Governance and Operations - How We Do What We Do.  As I spent time this past year planning for 2018, it became clear to me that despite many years in MPA governance I did not have a complete sense of how the organization operates.  Starting in the Spring of this past year, I started to attend as many committee meetings as I could in order to understand the operations of each of the committees.  In the process, it became clear to me that we have a large and energetic group of people working hard to achieve our goals and live up to the mission of the organization.  MPA also has a formal governance structure of psychologists and psychologists-in-training who oversee the organization and chart its direction.   It is important to understand what the governance group does and what the committees do.

This is the third in a series of five articles about lessons that I have learned in the school of experience and hard knocks, rather than in graduate school.  The first dealt with the ethical considerations when you leave a practice.  The second focused on the necessity of proper documentation and the potential consequences of not properly documenting mental health services.  This article describes the importance of writing treatment plans in which clients’ progress can be measured and evaluated in clear, not vague, terms.

My training:  In graduate school I was taught that treatment plans were a description of the intended services to be provided to a client (i.e., the plan for treatment).  The information was to include the diagnosis, the type of therapy (e.g. individual or group), the mode of therapy (or school of thought), the number of expected sessions, a list of problem areas to be addressed in the counseling, the goals and objectives for client change, plus a list of client’s strengths and areas of concern. We were taught to have at least three goals and at least three objectives for each goal.

The Health Professionals Service Program (HPSP) is designed to protect the public, as well as to help licensed health care professionals practice safely.  Conditions that may be eligible include physical health conditions, mental health conditions, and substance use disorders or combinations thereof.

What do you, as a psychologist need to know?  If you are concerned about a colleague who is not acting like themselves, is struggling either suddenly or having an episodic set of performance difficulties at work with technical items, impaired clinical decision making, or poor impulse control, you may be interested in engaging with the HPSP.  These performance difficulties are of more concern especially paired with tardiness, erratic behaviors of other types, or perhaps charting, email or phone messages that are of great concern.  You could fulfill your ethical obligation, if you decide you need to make a report, by reporting that professional to HPSP rather than to the licensing board of that professional.  If said behavior is due to a health condition and HPSP has jurisdiction, this could allow the person to get evaluation, proper treatment for whatever condition or conditions are present, and the monitoring necessary to ensure safe practice.  If HPSP has to turn the person or case over to the proper board, they surely will; however, it helps with proper triage of conditions to allow HPSP to provide this very important service.

The school systems across Minnesota play an important role in the lives of the families that reside in each district. Sex education curriculum taught in Minnesota schools is likely the only type of relationship and sexual health learning that a student receives before moving on to the emerging adulthood stage of life. Research shows that when students do not have up-to-date and inclusive education, they are not as likely to succeed across a variety of outcomes as students who do receive comprehensive education that engages the school and the family (Frisco, 2008; Grossman, Tracy, Charmaraman, Ceder, & Erkut, 2014). Currently, the standards for sex education in Minnesota do not meet the needs of students and families, and ultimately put Minnesota students at a disadvantage as they start their careers or continue to higher education. Each district across the state must revise their curriculum standards to ensure that all students in Minnesota receive the best education that promotes relationship and sexual health.

The Minnesota school system plays a vital role in the health and wellbeing of its students, while overseeing their academic development. Teachers, staff, and administration all have a vested interest in ensuring that they see each student reach their potential and appreciate the many paths students take into adulthood. Primary and secondary education has made great advances in reaching the potential of each student to succeed. Research and training has provided teachers and administration the ability to design and implement new approaches to curriculum and diverse applications of teaching (Grossman et al., 2014). The future of education requires the continued collaborative effort that administrators and teachers have engaged in to promote student learning, their health, and their current and future relationships. Without comprehensive and inclusive sex education, Minnesota students are at a higher risk of STI’s, unplanned pregnancy, risky sexual behavior, and a host of relationship issues across their lifespan (e.g., intimate partner violence, divorce, and issues that translate into social and workplace relationships).

In Minnesota, the only requirements for sex education are that a sex education curriculum must be taught, it must be comprehensive, technically accurate, and updated. However, the statute also mandates that the curriculum must help students refrain from sexual activity until marriage (MINN. STAT. 121A.23, 2017). Minnesota allows for each school district to interpret this law in their own way, and provides parents the ability to remove their children from sex education courses with no consequence to students’ academic progress. This is problematic for Minnesota students because abstinence-only education has not shown effectiveness and is contradictory to comprehensive sex education. The statute indicates the need for technically correct (but not medically correct) sex education, and allows for schools to exclude sex education directed towards sexual & gender minority students. This means that schools do not need to teach up-to-date information on sexual health (i.e., school districts are free to withhold important information related to sexual health).

Abstinence-only sex education programs are widely used across the United States (including Minnesota) and receive more funding than any other type of sex education program. Abstinence-only sex education curriculums can be a highly polarizing topic for families and their school districts. However, there is mounting evidence that abstinence-only education is detrimental to all students, regardless of their family background (Kohler, Manhart, & Lafferty, 2008; Santelli et al., 2006). Abstinence-only education has been shown to increase the students’ knowledge of abstinence, beliefs about waiting until marriage, and intention to remain abstinent after receiving this education. However, the age at first sexual intercourse, condom use, and rate of STIs are not consistent with the aims of these programs for the students who receive this type of learning (Denny & Young, 2006; Kohler et al., 2008). Researchers across medical, public health, law, psychology, and social science have now begun to discuss abstinence-only and other non-comprehensive sex education programs for students as a human rights issues. This stems from the mounting evidence that comprehensive sex education protects students at the time of their education and throughout their lives (Santelli et al., 2006).

The pregnancy rate for adolescent females in Minnesota ages 15-19 was 20.4 pregnancies per 1,000 people and the actual birth rate was 15.5 per 1,000 people in 2014, which means that each day in Minnesota in 2014 10 girls become pregnant and 7 gave birth (Farris & McKye, 2016). Although this is below the national average (24.2 births per 1,000 people), certain areas of Minnesota are experiencing teen birth rates as high as 58.2 births per 1,000 people (Farris & McKye, 2016, Office of Adolescent Health, 2016). STI’s in Minnesota among adolescents increased by 15% in 2016 (Farris & Burt, 2017). Further, the rates of pregnancy and STD/I’s for racial & ethnic adolescents in Minnesota are triple those of white students. Sexual & gender minority adolescents in Minnesota are also at a greater risk for STI’s, pregnancy, and risky sexual behavior (Farris & McKye, 2016; Farris & Burt, 2017). Racial and ethnic minority students are much more likely to go to public schools where there might be a lack of comprehensive and medically accurate sex education programs, as opposed to a white student that is more likely to go to a private, charter, or magnet school where they may have adopted comprehensive and inclusive sex education. Sexual & gender minority students are faced with receiving no relevant sex education across the state, leaving them vulnerable to a host of negative experiences and outcomes as they navigate sexual relationships without proper education on their sexual health.

The issue between technically correct sex education and medically correct information is the ability for individual districts to tailor their sex education programs to leave out pieces of information when teaching students. One example would be an abstinence-only curriculum teaching abstinence as the only 100% effective way to intentionally avoid an unplanned pregnancy, and leaving out education regarding appropriate condom use and other forms of sexual health practices in order to prevent increased sexual activity. However, the vast majority of health professionals argue that leaving out the information regarding condoms, STI vaccination options, and alternatives to intercourse is actually detrimental to the students. Comprehensive sex education has actually been found effective in preventing teen pregnancy, while abstinence-only programs show no effectiveness (Kohler et al., 2008). Kohler, Manhart, & Lafferty (2008) also found that comprehensive sex education does not increase sexual activity nor STI’s in students who received this education.

The goal of sex education is to provide students with information about puberty, pregnancy prevention, HIV/AIDS and STI prevention, consent, and appropriate birth control/contraceptive/prophylactic use. This parlays into student understanding of themselves and how to engage in healthy relationships. The state of Minnesota has a duty to do what is best for their students’ health and well-being, and is an opportune place to do so. Implementing a new standard of sex education requirements for schools across the state would significantly increase the positive outcomes for these students and provide a safer and healthier Minnesota. Because each school district has some autonomy over their curriculum, mandating comprehensive and inclusive sexual health and relationship education is vital in protecting students who are unable to advocate for themselves in most areas of their lives. This is also particularly important for the marginalized groups that live across the state. Implementing new standards for practice in the classroom would work to decrease the enormous health disparities Minnesota is working to reduce.

Many curriculums have been developed to provide a safe and effective way of teaching sex education. One example is the Our Whole Lives curriculum, which is a comprehensive and inclusive sex education program that gives the students a well-rounded education on sexual health and relationships. The unique aspect of this program is the incorporation of the parental system in the process. This curriculum engages parents and children in conversations about sexual health, which has been found to be another effective way of increasing positive outcomes and decreasing health risks for adolescents (Aspy et al., 2007; Campero, Walker, Atienzo, & Gutierrez, 2011). The University of MN produces some of the best teachers and educational researchers from around the world. Collaboration between teachers, researchers, and policy makers could help Minnesota become a leader in sexual health education for students, and help promote the overall well-being of the many families that live and work throughout the state.

Hello for the final time as President of MPA. It has been my honor to serve you all in the past year. I will continue on as the immediate past president, member of the legislative committee, and in a new role (related but not a part of MPA) as Treasurer of the official MPA Political Action Committee (PAC). More on that later.

This has been a big year for MPA with a lot of important actions by your professional association. A quick and incomplete list includes a reorganization and revitalization of the leadership structure of the organization. This will lead to a greater ability to respond in a quicker and more consistent fashion over longer periods of time. We also have strongly responded to sanctions by the Board of Psychology on supervisors and academics with advocacy and passing changes to the Psychology Practice Act. Leadership of MPA has also attended all public board meetings to address general and specific concerns as members of our profession. Also, we sponsored and passed legislation reducing the requirements for, and timing of, diagnostic assessments for Medicaid clients. This last item and the Practice Act were completed through the hard work of Trisha Stark, the Legislative Committee Chair, and the Executive Committee (EC) of MPA. While others reported the change, MPA through its legislative committee and EC made it happen.

So often, people have preconceived notions about what it means to be transgender.  For the longest time, media portrayed transgender individuals as freakish or deviant.  Images of men dressed in women’s clothing with bad wigs and clown-like make-up littered television and movie screens.  It was not uncommon to see transgender people being depicted as street walkers, serial killers, or pedophiles.  As a result, negative stereotypes and misinformation plagued the transgender community.

I am not transgender, nor do I claim to know the plight of all transgender individuals.  However, as a PhD candidate with a concentration in Industrial/Organization Psychology, I have a professional interest of transgender people in the workforce.

Mental health professionals are not supposed to lose a friend or family member to suicide. We are supposed to know the signs, respond appropriately, and prevent it. Despite the fact that about 20% of therapists will lose a client to suicide during their life of practice, we rarely talk about it. However, I have to report the sad news that I did just that. Literally a month after I completed the Mental Health First Aide certification and within a year of presenting a professional workshop on suicide prevention, my good friend died by suicide. She had been my friend for 35 years.

I can truly say she was the most loving and optimistic person I knew. She was married and had an adult daughter whom she loved deeply. Her marriage, although it had the usual bumps, was well on its way to a second wind. She was a person whom I often put forth as a role model of how to manage the illness of depression in a successful manner. She ate healthy food, exercised regularly, completed a course on mindfulness, and took her medication. She never had an incidence of self-harm. She had no previous suicide attempts and had never said a word that would indicate that she was thinking of suicide or death.

So when I first responded to this news, I went through all the normal reactions: shock, sadness, and anger. I talked about not suspecting a thing. I talked about seeing her two weeks before her death and thinking everything was great. She had plans for the future and she had things she was looking forward to. She had none of the signs (previous attempts, history of self-harm, lack of future thinking, comments about death or suicide) that we, as mental health professionals, are told to look for.

But I couldn’t let it go. The same thoughts woke me up in the morning and I wrestled with them before bed each night. What had I missed? What could I have done differently? Finally, I had to face the truth. There had been signs of trouble. I did not see them as threats. Sometimes I felt irritated by them. Other times, I felt slightly embarrassed for her. I know this is codependent but I am being completely honest here. I did not call it out directly or sneakily worm those concerns into our conversations. As much as I want to deny it, me - a mental health professional, was shamed into denial of mental health problems.

What did I see? Well for one thing, she had crying spells without cause. She was hanging into specific regrets over long past events that did not happen the way she believed they did. She shared feelings indicating a sense of being disconnected. She was worried about being forgetful. She was not sleeping well. Yet, I was silent. I did not point out my observations to her or her family. I did not suggest action or take any action myself.
I keep reviewing the steps she must have taken as she made her plan to die. I continue to deny that this could really have been her desire. She would never have wanted to hurt me, her family, or her friends. I have struggled daily to understand. The only way I can put her suicide together with the person she was, is to think of her behaviors that day as a brain attack.

I know I am not responsible for her death; I am not that codependent. However, was it possible to have intervened in some way? Was I as good of a friend to her as she was to me? It is certainly true that if I had intervened, she could have died by suicide anyway, or possibly sooner. The road to anxiety is paved with possibilities. And obviously, there is no going back. But mostly, I just want to scream at myself and the world: the brain is just another organ that gets sick. It gets sick like a kidney or a lung. Sadly we, as a society, have no way of managing that.

Going forward, I have made these promises to myself. I will always talk openly about mental health regardless of how uncomfortable it is. I have made it clear to my friends and family that I want complete honesty if they have questions about my mental health or cognitive function. I will speak up if I see changes in cognition among friends and family. I will ask the hard questions whenever I see any potential for suicide, including indications cited in the interpersonal theory of suicide. I will renew my faith in the power of connection with others to bridge these gaps in comfort. I will learn to get more comfortable with the fact that all of our organs can suffer from imperfection, change, and age.

Libby Bergman, LICSW, was one of three co-founders of the Family Enhancement Center and has served as the Executive Director since 2000. Libby has worked with youth and families for over 25 years. Libby was the recipient of the 2011 Children’s Law Center of Minnesota’s Heroes for Children Award. She was honored again in 2013 with the University of Minnesota School of Social Work Alumna of the Year.

Horn, P. J. (1994). Therapists' psychological adaptation to client suicide. Psychotherapy: Theory, Research, Practice, Training, 31(1), 190-195.

Jordan, J. R. (2001). Is Suicide Bereavement Different? A Reassessment of the Literature. Suicide and Life-Threatening Behavior 31(1), 91-102.

McAdams, C. R., III; Foster, V. A. (April, 2000). Journal of Mental Health Counseling, 107-121.

Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575-600.

These are my first remarks in my role as President-Elect, and serve as a prelude to my year as President beginning January 1, 2018. I plan to use this forum to keep MPA members informed both about what the organization is doing and how it is doing it. My comments will appear on the website approximately every other month, and at times more frequently as is warranted. In each of my reports to you, I will provide some depth on a particular aspect of MPA and how it works. In today’s comments, I give my sense of what we are about, what we focus on, and what we believe. I also briefly mention some pressing matters regarding reimbursement for services and briefly discuss our annual meeting set to occur in April of 2018. I close by again introducing you to the Harrington Company, our new Association Management Company (AMC), and to our new Executive Director, Michelle Herr.

What are we about? Unlike a business, a practice, or an academic setting, our association is a group of psychologists who choose to affiliate through being members. Our purpose is to support both the field of psychology and the profession of psychology. Most of our members are professional licensed psychologists; it is important to promote the development of professional psychology and to protect our profession when needed. We also are part of a larger group of psychologists who embrace the broad aspirations of our field. This means we will speak out on broader issues that are important for all of us. Our recent statement on the tragic events in Charlottesville, Virginia, is an example of our underlying beliefs and commitment to freedom from violence, discrimination, and support for free and respectful speech. We want our tent to be large and broad and provide a warm welcome to all psychologists - especially those who come from differing cultural backgrounds. We desire to be a diverse, inclusive, and respectful group that strives to assist, as feasible, in reducing unequal and inherent disparities in our various communities. These beliefs are a fundamental part of MPA’s core values.

This is a challenging time for our profession. We face challenges on a day-to-day basis with our clients, and recently we have found ourselves facing significant challenges with insurance companies. First came challenges with the transition of BCBSMN to Magellan. MPA has helped to address some of those concerns through the efforts of our Payer Committee, and those efforts will continue. Unfortunately, unannounced rate reductions began on July 1st, followed by an explanatory letter from BCBSMN, which led to even greater levels of confusion, anger, and fear for many providers. MPA participated in a community meeting sponsored by NAMI last week and helped to facilitate a meeting with BCBSMN executives on 9/11/17, which included representatives from NAMI and other organizations.

From that meeting, BCBSMN acknowledged they had not communicated effectively and had not taken the concerns and needs of providers into account in their recent decisions. The other participants expressed a great many concerns related to their planned changes and how those decisions would impact providers in the short, medium, and long term. In an hour long meeting, it became apparent the rate changes have been rolled back as stated in the letter sent to MPA members last week. The overpayment correction remains in place, as it was a clear departure above the rate in contracts. Be that as it may, BCBSMN indicated it is their intention to work with providers on how to collect the overpayment in a manner that will not be detrimental to the practices impacted. It is MPA’s intention to continue to advocate for no return of overpayments, as doing so would be too great a hardship for providers.

Lessons Learned: The Importance of Clinical Documentation

By Don Wiger, Ph.D., LP

Hello from the Student Division. We are excited to give an update covering the last year’s events. First, I would like to start by introducing myself. My name is Bronwyn Neeser and I am a third year PsyD student at Saint Mary’s University of Minnesota. I was elected co-chair of the Student Division my first year in the program. My predecessor, C.J. Swanlund, left very large shoes to fill but am glad that I took on the challenge. I took my first year to learn what MPA is all about, how the association works, and what it can offer students.

Needless to say, I am honored to serve on the General Council. The way in which the council strives to have open and honest communication with the board and members--offering information, opportunities, and news--is impressive. I obtained a co-chair, Erika Brink, in January of 2017. She is also a third year PsyD Student at Saint Mary’s University of Minnesota. Together, we decided that a mission statement and a revamp of goals would benefit the Student Division. Although we missed the opportunity to represent the division at the Annual MPA Convention, we look forward to participating in 2018.

New Member Spotlight - Heidi Bausch

1) What is your background in psychology (e.g., education)

January 21, 1952 - June 2, 2017

It has been a pleasure working as a psychologist, in Minnesota, since the early 90s. During that time, I have learned many lessons that were not taught to me in graduate school. Some simply take common sense to figure out, while others are the result of falling down a few times. Here, I present a lesson never taught to me in grad school.

What happened? My first position as a psychologist was at a very large clinic in the Twin Cities. I was so proud to be hired by a place so well known. During my interview, I met the owner, manager, and several therapists. They certainly knew how to recruit. When I showed up for work a few days later, the only people there were the owner, one of the clerical staff, and a couple therapists. There were papers all over the floor, as if the place had been vandalized. I was told that one of their lead therapists, and others, had spent the night in the clinic copying clients’ charts. They had secretly told each of their clients they were opening a new clinic. The owner of my new clinic knew nothing about it. My new clinic eventually went out of business. To me, it was very sad for the owner, and quite greedy, or disheartening, for the therapists to take the business away from the clinic that spent much in time and money to obtain these referrals.

On April 14, 2017, Minnesota Public Radio reported that a group of parents in Virginia, MN had dropped a lawsuit against their school district. They had been trying to prevent students from using bathrooms appropriate to their gender identity. A few weeks earlier, the North Carolina legislature had overturned their own law that had stated that students must use the bathroom appropriate to the sex listed on their birth certificates. Money had prevailed over bigotry, the state having lost a great deal of money from corporations withdrawing business from North Carolina because of that law.  

Nicole’s earlier struggle for equality was heard by Maine Supreme Court in January, 2014. Becoming Nicole takes us to the late 90s when Wyatt, an identical twin who had identified as female from age two, encountered harassment when he used the girls’ restroom. His school, which had been supportive of him until a multiple stall bathroom for fifth graders raised this issue for the first time, failed to support him. Many years later, by the time a lawsuit against the school had been resolved, a boy who had bullied Nicole/Wyatt, wondered whether her identical twin was disappointed about losing a brother. Jonas never was, and once said to Nicole, “I never had a brother. You were always a sister to me.”

Award:  Susan T. Rydell Outstanding Contribution to Psychology Award
Recipient:  Steven P. Gilbert, Ph.D., ABPP, LP

 
From left to right: Steven P. Gilbert and Duane Ollendick

The mission of the Rural and Greater Minnesota Division of the Minnesota Psychological Association is to enhance rural practice through advocacy, representation, and education. Rural psychological practice is highly rewarding as practitioners have a significant impact on their own communities and the state. Psychologists working in small communities are part of the first responders for critical incidents, emergencies, and the emotional well-being of rural residents. Rural psychologists often observe the direct impact of behavioral health services on their communities, while helping to maintain a productive rural workforce. It is this workforce that provides the agricultural and manufacturing resources that support larger cities in the state and nationally.

Recent Rural & Greater Minnesota Division activities include the on-going planning of the Rural Behavioral Health Conference by Coordinator Dr. Kay Slama, and co-chairs Dr. Scott Palmer and Dr. Willie Garrett. The conference is web-based and offers all practitioners rural-specific training. The conference is inexpensive and high value, with national speakers, for up to 7.5 CEs. Past training topics have included integrated behavioral healthcare ethics, substance abuse, GLBT, diversity and cultural minorities, suicide interventions, the Affordable Care Act, school based interventions, and military deployment and reintegration. Rural students and educators also present poster session research. Attendees cross seven time zones and offer diverse perspectives on rural practice. The next Rural Behavioral Health Conference is October 6, 2017.   

A very happy spring to all my fellow Minnesota Psychologists.

A lot has happened since I last checked in with you all.

Born the youngest of six children in Northeast Minneapolis in 1928, Dr. Sherman E. Nelson died in February of this year. Sherm was the therapist’s therapist.  In 1966, I met him while he was treating another graduate student. Over the years, he treated many. He was a professor in the clinical psychology program at the U of M and taught and mentored many until his retirement in 2000.

He was the youngest in his doctoral class in 1952, and went to work at the Minneapolis VA Hospital.  After three years, Sherm became the second local psychologist to go into private practice.  His career was spent at the Minneapolis Clinic of Psychiatry and Neurology, where he headed the psychology department.  His wife, Denise Lillian Nelson, is also a psychologist as is one of his daughters, Liane Nelson.