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EXECUTIVE ROUNDTABLE OF PRACTICE DIVISIONS
MIDWINTER MEETING
NEW ORLEANS
FRIDAY MARCH l0, 1995
12:30-2:00 P.M.
AGENDA
1. National Conference on the Interface between Public/Institutional Practice and Independent Practice.
Resource Materials: Preliminary Conference proposal Letter from Division 18
Goals of Meeting: Nominate steering committee candidates Clarify goals Consider meaning of joint venture” with CAPP
2. Outcomes Project: Update on CAPP and divisional outcomes projects. Discussion of issues in outcomes research and use of divisional/specialty expertise in providing resource to CAPP and Practice Directorate.
Goals: To develop process for providing guidance and expertise to CAPP/PD.
3. Divisional Congressional Fellow: Update on developments in position description and funding for division sponsored congressional fellow.
Goals:To provide guidance to task force charged with leading this effort and to consider implications for divisions.
4. Task Force on Children in Underserved Populations: Report from the Interdivisional task force chair Louise Holt (appointed January 1995). Resource materials: Announcement with request for members.
Goals: To assist with appointment of members and provide guidance regarding anticipated outcomes of the task force.
5. Task Force on Prescription Privileges: Report on this Interdivisional task force.
Goals: To assist task force in determining important issues and resource materials for divisions and their members.
6. Mental Health Consumer Protection Act: Report on developments in this area.
Goals: Update divisions and begin discussion of how issues should be addressed.
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PRELIMINARY PROPOSAL FOR CONFERENCE TO BE SENT TO DIVISIONS FOR COMMENT
Working Title: National Conference on the Interface between Public and Institutional Psychological Practice and Independent Private Practice: New Models
Convened by: The Executive Roundtable of Practice Divisions Jean A. Carter, Ph.D., and Alan D. Entin, Ph.D., Co-chairs, as a joint venture with CAPP
Dates and Location to be determined Steering Committee to be named
Potential Funding Sources: Practice Divisions, CAPP
Participants: Representatives of all practice divisions
Preliminary Objectives: The primary objectives of the conference are:
1. To bring together diverse groups within the practice community for informed dialogue around a common issue:
2. To provide the groundwork for developing an information base on perspectives, parameters,and implementation of merger and/or integration of practice that is based in the public sector (structure and financed through public institutions), based in other large institutions (structured and financed through institutional support, e.g.,counseling centers) and based in independent private practices:
3. To explore linkages with primary care:
4. To develop resources for practitioners:
5. To elaborate the areas of expertise currently available within the practice community and to outline areas of expertise in need of development.
General Topics: General topics to be addressed include:
1. Competencies and Accountability
Including training for practice and maintaining training opportunities
for students; credentialing; areas of expertise; outcomes; guidelines;
practice parameters: clinical pathways.
2. Legal and Regulatory Concerns
3. Business and Contractual Concerns
Including creating groups; contracting; carve out vs. integration.
4. Scope of Services
Including roles and responsibilities: multidisciplinary relationships
and the use of extenders: development of new models.
PLEASE SEND COMMENTS AND NOMINATIONS FOR THE STEERING COMMITTEE TO JEAN CARTER OR ALAN ENTIN.
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EXECUTIVE ROUNDTABLE OF PRACTICE DIVISIONS
4501 CONNECTICUT AVENUE, N.W.
SUITE 215
WASHINGTON, D.C. 20008
INTERDIVISIONAL TASK FORCE ON CHILDREN IN UNDERSERVED POPULATIONS
At its meeting January 14, 1995, the Executive Roundtable of Practice Divisions established an Interdivisional Task Force on Children in Underserved Populations, to be chaired by Dr. Louise Holt, President of Division 42. The charge of the Task Force is:
1) To define and evaluate the immediate and long-term psychological needs of children in diverse geographical and cultural setting. This may include both urban and rural populations:possibly researching areas including Native American and Native Hawaiian children's services.
2) To identify which psychological services are most needed and begin to prioritize these needs,using available statistics and field observations. To identify high-risk children most in need of care.
3) To begin a process of identifying alternative sources of funding for those children identified as high-risk and in need of immediate psychological services.
NOMINATIONS FOR MEMBERSHIP ON THE TASK FORCE ARE BEING SOUGHT.
PLEASE SEND YOUR NOMINATIONS TO:
Louise Holt, Ph.D.
President, Division of Independent Practice
3900 East Camelback Road, #200
Phoenix, Arizona 85018
Phone: 818 225-9558
Fax: 818 366-3401
Nomination:
Name of Division Representative
Position in Division Address:
Division:
Phone:
Fax:
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CAPP February 3 - 5, 1995
Agenda Item #l0E
PRACTICE DIRECTORATE
ACTION ALERT
MEMORANDUM
To:
State Psychological Associations
From:
Billie Hinnefeld, J.D.
Director, Legal and Regulatory Affairs
Practice Directorate
Date:
January 10, 1995
Subject:
Mental Health Consumer Protection Act
1. The Illinois False Memory Syndrome Society
2. Ohio Parents Falsely Accused
3. Texas Friends of False Memory Syndrome
4. Minnesota Action Committee
5. Florida Friends of FMS
Barden's introduction to the Act states that "The false memory syndrome, or recovery of false memories in therapy would never nave happened and might never have destroyed thousands of family relationships if there had been some effective regulatory controls on the practice of psychotherapy. We propose to set up a fund to finance the development of model legislation...which will
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incorporate such controls."
Following is my analysis of a few of the key problematic provisions of the Act. These points make it clear that the Act is not in the best interest of consumers for a variety of reasons, including limiting of needed services, and an attempt to use a cookbook approach to complex issues. This analysis is not comprehensive, and any actual legislation proposed in a state may differ. I would recommend you contact the APA Practice Directorate regarding any specific actual legislation introduced in your state.
The proposed outline of the Act has six main points:
1. Informed Consent - The Act would mandate that all therapists must have"fully informed consent, in writing, from each patient before initiating any form of therapy." "Informed consent" is then defined as "informing the patient of all known risks and hazards of the therapy, and of alternative treatment and procedures. All informed consent sessions will be audio and/or video taped, and therapists must maintain such tapes...for not less than ten years" (emphasis added).
This language would put an immense legal burden on psychologists and could also hinder the therapy process. The informed consent process is (as in any discussion that takes place within the therapeutic relationship) part of the entiretreatment. For legislation to mandate a particular intervention strategy to be used in everv situation, regardless of the fact that it may actually be damaging to certain clients, prevents the exercise of clinical judgement. For example, the condition of some patients when initiating a therapeutic relationship is such that they may not be able to tolerate the kind of process described here as informed consent. Also, the wholesale requirement of taping an initial session is arbitrary and inappropriate.
2. The second point of the outline states that:
"In the field of psychotherapy,...no controls exist to prevent the introduction of any bogus and/or harmful new approach or to prevent the extension of existing approaches so that they become harmful. The Mental Health Consumer Protection Act would require that no federal or state funding shall be paid for any form of therapy that has not been scientifically proven safe and effective in numerous research investigations. Therapies must meet a "significant agreement" standard before therapists will receive any compensation. (This standard is currently used by the FDA.)"
This part of the Act completely ignores the fact that treatments used by psychologists -based on considerable scientific evidence and research. Furthermore, there is no mention of the numerous safeguards currently built into licensing laws for psychology.
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Licensing laws ensure that those practicing psychology have adequate education and training and require that psychologists only practice within the scope of their competence. Many licensing laws also require continuing education. Licensing boards provide a forum for consumer complaints and a mechanism to ensure that anyone practicing unethically or in a manner harmful to consumers is disciplined or removed from practice. Furthermore, therapy is not a"substance"to be evaluated by a standard such as the one the B uses. There may be differing opinions as to which technique is most beneficial, but that does not in and of itself invalidate the technique.
3. The Act would permit"lawsuits by third parties injured by negligent therapy." All "reasonably foreseeable victims of the willful and/or reckless use of hazardous therapy techniques...shall have a course of action...."
This would mean that any third party who felt that they were somehow injured as a result of what they believe to be negligent therapy of another could file a lawsuit against the therapist. The standard is unreasonably broad,not making clear whether the third party would actually have to suffer damage him- or herself. The Act makes a weak attempt at limiting frivolous complaints by suggesting screening complaints by a three-person panel made up of one citizen,one lawyer and one psychologist. One affirmative vote would be all that was needed to allow pursuit of the case. This would create an enormous "chilling effect" on therapy. Therapists conceivably could be hindered in doing their work by fears of offending relatives and friends of clients. Confidentiality would constantly be threatened, thus interfering with the therapeutic process, if the therapy itself could at any time be the focus of litigation from a third party. No other health profession is the target of such litigation.
4. The fourth point is labeled "banning pseudoscience from the courtroom." This point suggests that no therapy procedure should be used as evidence in court unless it is "validated and accepted by a substantial majority of the scientific community, (not the psvchotheraov community)" (emphasis added).
This point is not elaborated on,so it is not clear which scientific community would be given the authority to validate psychotherapy techniques.
5. The fifth point suggests that "the willful or reckless induction of false accusations of abuse should carry specific criminal penalties. In addition, the fraud associatedwith accepting payments from federal, state or insurance sources for improper procedures needs to be clearly delineated and appropriate penalties installed."
The Act does not define"induction of false accusations of abuse," but the concern would be that any accusation or memory of abuse is considered false by this group. Again, this creates a chilling
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effect on therapy. Since psychologists'malpractice insurance does not cover criminal offenses,threats of such charges could be used as a tool to intimidate providers, since even a false accusation could result in costly legal defense fees.
6. This type interest. of legislation is obviously not in the consumer's best There would be no distinctions as to which professionals are qualified to do what. All would evidently have the same scope of practice. And there is no indication what body would regulate this muiti-professional group. Presumably, professionals of vastly different training and focus would be attempting to make decisions about each others training and practice. Psychologists are currently licensed or certified in all 50 states, and other mental health professions are moving in that direction. To attempt to force them all into one mold and to legitimize non-trained practitioners by licensing them does not benefit the consumer. The sixth point would be to create a Model Licensing Act for all psychotherapists. This would be applicable to any professional offering services as a therapist regardless of their level of credentials.
To assist in persuading legislators to pass the Act, Christopher Barden, author of the outline, suggests: 1) including a description of the"extensive history of fraud in the therapy industry," 2) preparing an extensivediscussion as to the reasons why the "therapy industry" was permitted to receive payments for "medical" treatments,3) noting the lack of scientific research support for the effectiveness of many forms of therapy, 4) preparing an extensive review of alternative coping mechanisms (e.g., religion, family), and 5) explaining why the "therapy community" has been unable and unwilling to police itself -- all of which suggest a lack of understanding about the current state of the profession. Barden also suggests that a legal analysis be done comparing "fraudulent and politicized" psychotherapists to drunk drivers, emphasizing that mandatory controls are needed to protect the public.
It is the Practice Directorate's opinion upon analysis of the provisions
of the proposed Act, that it is detrimental to providers and, more importantly,
does not further the interests of consumers in maintaining access to good
care. If you become aware of the Act or a version of it being proposed
in your state legislature, please contact me at the Practice Directorate
at (202) 336-5886 for assistance.
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