At the American Board of Vocational Experts (ABVE) Annual Meeting in Scottsdale, Arizona next month, psychologist and vocational expert James A. Athanasou, PhD, will present “The Use of the Earning Capacity Assessment Form™, 2^nd Edition in a Medico-Legal Setting: An Australian Experience.”

The Earning Capacity Assessment Form-2^nd Edition (ECAF-2™) by Michael Shahnasarian, PhD is used to estimate future loss of earning capacity following an injury or accident.  At the ABVE meeting, Dr. Athanasou will provide an introduction to the interpretation of the ECAF-2, along with a critique of its use in an Australian context. Data on Australian accident victims (N=33) from a medico-legal vocational assessment practice are used as a basis for his evaluation.

Dr. Athanasou’s presentation will take place on Saturday, April 13, at 3:00 pm.  Continuing Education Units will be available for conference attendees.

For more information or to register for the conference, visit the ABVE Web site.

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To mark Brain Injury Awareness Month, app is free through the end of March

PAR’s Concussion Recognition and Response (CRR) app, designed to help coaches and parents recognize whether an individual is exhibiting or reporting the signs and symptoms of a concussion, recently received accolades from former NFL quarterback Steve Young.

In addition, to recognize Brain Injury Awareness Month, the CRR app will be available for download free until the end of March.

The CRR app was developed by concussion experts Gerard A. Gioia and Jason Mihalik. It provides instruction during the assessment of an injury, a return-to-play guide, and extensive concussion information.

“As a former NFL player, national spokesperson for the Positive Coaching Alliance, and someone who has personally experienced the significant effects of a concussion, I believe every parent of a young athlete and coaches should be fully aware of the signs and symptoms of a concussion in a young athlete,” Young said. “To help them act and respond to this injury the right way, they need to have proper tools. Based on the great CDC Heads Up work that Dr. Gioia helped to create, the Concussion Recognition & Response App gives parents and coaches a great tool to identify kids with suspected concussions. It also is a great resource of information about concussions and what parents can do to help their child recover from the injury. This app should be a necessary part of every comprehensive youth concussion management and awareness program.”

Young played 14 seasons of professional football, all but two for the San Francisco 49ers. He retired in 1999 with the highest career passer rating among retired players and six NFL passing titles under his belt.

The app is available free through the end of March from the Apple® App Store^SM or Google Play.

Youth concussions are a hot topic in the news, with more and more emphasis being placed on athletes’ safety. Recent research found that even one concussion can result in long-term brain damage. What do you think? Leave a comment and get the conversation started!

Although the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Parity Act) increased access to mental health and substance use services in hospitals, according to new research from the Health Care Cost Institute, individuals continued to pay more out of pocket for substance use admissions than for other types of hospital admissions.

The Parity Act requires large group health plans to make behavioral health coverage rules similar to those that cover medical/surgical benefits. Large group plans were also required to make copays, deductibles, coinsurance, and out-of-pocket maximums for behavioral health care equivalent with the most common medical/surgical treatments.

The report, the first of its kind to look at hospital spending, utilization, prices, and out-of-pocket payments for mental health and substance use admissions, studied people who were 65 and under and had employer-sponsored health insurance. It found that spending on hospital admissions for mental health and substance use grew faster than spending on medical/surgical admissions between 2007 and 2011. Furthermore, patients with mental health conditions paid 10 percent of their hospital bill in 2011 and patients with substance use disorders paid 12 percent of their hospital bill. Medical or surgical patients paid just 4 percent of the total bill in comparison.

According to new research, new mothers are far more likely than others to report mild-to-moderate symptoms of obsessive-compulsive disorder (OCD) after childbirth. The study, published in the March/April issue of the Journal of Reproductive Medicine, found that 11 percent of women reported significant obsessive-compulsive symptoms at two weeks and six months after delivery, compared to the 2 to 3 percent of individuals in the general population diagnosed with OCD.

This, the first large-scale study of post-partum OCD, found that affected mothers reported classic signs of the disease – intrusive thoughts, compulsive behaviors, and fears and rituals related to the baby. Though the survey used self-reported data from 461 moms (329 of which provided information six-months after childbirth), none were clinically diagnosed with OCD. In more than half of the mothers, symptoms of OCD went away after six months.

Researchers posit that being obsessive and compulsive when caring for a newborn may actually be an appropriate psychological development, saying that problems only develop when the symptoms start interfering with the mother’s daily life.

About 70 percent of the women who had OCD symptoms also suffered from depression, supporting the idea that postpartum depression is its own disease, as the anxiety and obsessive symptoms are not typical for a major depressive episode.

Though several sources agree that attention deficit/hyperactivity disorder (ADHD) is is on the rise, new numbers question how much. According to a recent study published in JAMA Pediatrics, diagnoses of ADHD increased 24 percent in Southern California over the past 10 years, bringing to issue previous estimates.

 As part of the study, doctors reviewed the charts of children treated at the Kaiser Permanante Southern California physician’s group from 2001 to 2010 – 842,830 children in all. They found that in 2001, 2.5 percent of children age 5 to 11 were diagnosed with ADHD, but that number increased to 3.1 percent in 2010.

The Centers for Disease Control and Prevention (CDC) estimates that about 9.5 percent of children age 4 to 17 have ADHD. Researchers in the California study believe their estimate gives a more accurate picture of the rate of ADHD in Southern California because they reviewed actual medical records, rather than relying on parents to respond to telephone surveys, which is how the CDC got its number. Furthermore, the majority of ADHD diagnoses in the California study were made by specialists using strict Diagnostic and Statistic Manual of Mental Disorders (DSM-IV) diagnoses. This complicates previous estimates, as new research found that only 38 percent of primary care physicians actually use the DSM-IV for diagnosing ADHD.

New current procedural terminology (CPT) codes went into effect January 1 of this year, marking the first overhaul of the codes used to describe psychotherapy treatment since 1998. The only codes that were revised were the psychotherapy family of codes – codes used to describe testing, health, and behavior remain unchanged.

Reports of the new codes causing major glitches for many providers have started to surface. Many third-party payers, including Medicare and Medicaid, were not updated to recognize the new claim codes, causing delays for payment and denials for service. Though steps are being taken steps to rectify these issues, many providers have not received payment for the work they have done this year.

The American Psychological Association’s coding Web site has had more than 300,000 hits in the past month and has published an extensive list of questions on how to handle this transition and what to do if you are being denied payment. For more information on the new codes, APA has published a special issue.

What has your experience been with the new CPT codes?

A recent study conducted by the American Psychological Association found that the generation known as Millennials, defined as 18- to 33-year-olds in the U.S., reported the highest stress levels along with the most stress-caused ill effects among the four groups surveyed.

On a 10-point scale, Millennials reported an average stress level of 5.4, the same as that reported by individuals in Generation X (ages 34-47 years). However, more than 52 percent of Millennials reported stress-induced sleeplessness, compared to 48 percent of Generation Xers, 37 percent of Boomers (ages 48-66 years) and 25 percent of Matures (67 years and older). In addition, more Millennials and Generation Xers reported anger and irritability due to stress than Boomers or Matures.

Stress is a risk factor for many health conditions, including high blood pressure, headaches, sleeping problems, heart disease, ulcers, and stroke.

It’s not hard to understand why young Americans are on edge. Work was named as a “somewhat or significant stressor for 76 percent of Millennials,” and the U.S. unemployment rate is 7.9 percent. Thirty-nine percent of Millennials have experienced an increase in stress over the past year. And despite efforts to reduce their stress (i.e., 62% have made attempts to decrease their stress levels over the past five years), 25% of Millennials believe they’re not doing enough to manage it.

The good news? Apparently, we experience generally lower levels of stress as we age—Matures’ average stress level was 3.7 out of 10—and we get better at dealing with stress: 50 percent of Matures think they’re doing an excellent or very good job at managing their stress.

What do you think? Does maturity play a big role in handling stress? What can be done to reduce stress in Millennials and in general? Leave a comment and let us know what you think!

The following is a guest blog by PAR author Lisa Firestone, PhD. Dr. Firestone is the director of research and education at the Glendon Association.

Too often, the subject of violence is addressed in our society from a platform of sensationalism, disgust, and trepidation. The reporting of violent events incites two reactions from viewers: horrified fascination or a repelled reflex to turn away. Neither reaction inclines us to seek a better understanding of why violence occurs, nor to ask the question: What makes a human being become violent?

The media’s weighted focus on the effects of violence as opposed to the causes isn’t entirely to blame for our resistance to exploring the roots of violence. Part of our hesitance stems from the fact that violence is a deeply disturbing problem. Violent behavior can be triggered by frustration, anger, or a perceived humiliation. Its purpose can be to retaliate, or intimidate, or exert control. It is only when we have a better understanding of violence that we can begin to make a difference.

Even though there is not one answer to what causes violence, there is something I found in my research that has offered an invaluable insight into what goes on in the mind of someone who is violent. After years of researching, interviewing, and assessing violent individuals, along with my father Dr. Robert Firestone, I began to recognize certain “voices” (negative thought processes) that flood the minds of these individuals influencing them to engage in acts of violence.

These “voices” aren’t experienced as hallucinations but rather are a systematic pattern of negative thoughts against to the self, and hostile and suspicious toward others. We call these destructive thoughts “voices” because many of the people we interviewed reported experiencing them that way.

As I developed The Firestone Assessment of Violent Thoughts (FAVT), to measure the “voices” that incite violence, I was able to identify the thinking that sets the stage for violent and aggressive behavior. This information is not only helpful for predicting violent intent, but also for providing an overall understanding that helps explain all types of violence from the extreme examples that make the headlines to the angry and violent reactions that we sense in ourselves and others.

Voices that contribute to violence include those that support social mistrust. These paranoid, suspicious thoughts encourage people to assume a self-protective and defended posture from a perceived danger. Because the paranoia and misperception makes the threat seem real, people feel justified in acting out violence to protect themselves. The paranoia is supported by negative voices about other people being different, strange and bad. It is easier to hurt someone who is perceived as “not like you.” These voices contribute to a person’s suspicion and mistrust of the world at large. An example of these types of voices is: They are out to get you. Don’t trust them.

Other voices that lead to violence are the ones that support people feeling victimized and persecuted. They advise a person that he/she is the victim of mistreatment by others. These voices promote and support thoughts of being discounted, blamed, or humiliated by other people. An example of these voices is: They are going to make a fool of you. They don’t take you seriously.

Violent people have also reported having self-depreciating voices that make them feel that they are unlovable, and that no one will love or care about them. These voices promote isolation and encourage a person to take care of him/herself. They attack other people and see them as rejecting. All of these voices encourage a person not wanting anything from anyone else. An example of these voices is: You will have to take care of yourself because no one else will. Don’t expect anything from anyone, you will only be disappointed.

Self-aggrandizing voices can be a precursor of violence as well because they promote a view that a person is superior to others and deserves to be treated as such. They support an inflated self-image that functions to compensate for deep-seated self-hatred. When the aggrandized sense of self is threatened, for example by slights or perceived disrespect, a person often reacts violently in an effort to regain the aggrandized self-image. Research that links high self-esteem in adolescents to violence actually measured inflated self-esteem or vanity. An example of these voices is: You are so much better than them. How dare they talk to you like that!!

Overtly aggressive voices also contribute significantly to violence. These voices directly encourage taking violent action. They convince a person that to act out aggressively and violently would be appropriate, or that it would be a welcome release, or even be pleasurable. There is a lack of remorse expressed by the person who is influenced by these types of voices. An example of these voices is: Violence is the way to go. Just smash them; you’ll feel better.

Understanding what is going on in the mind of someone who is violent allows us to better assess the risk for violence and to intervene, protecting both the potential perpetrator and victim. Many risk factors for violence can’t be changed, but a person’s thinking is a risk factor that can be. By monitoring the decrease in a person’s violent thoughts during treatment, we are able to assess their improvement. Moreover, in offering violent people an understanding of the thoughts that underlie their tortured thinking, we are providing them with a means by which to take up arms against the voices that lure them into acts of violence.

 

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When we introduced our two concussion apps, the Concussion Recognition and Response™ (CRR) and the Concussion Assessment & Response™: Sport Version (CARE), it was our hope that they would help as many children as possible to play sports safely. In order to reach a wider audience, we are pleased to announce that we will be reducing the price of the CRR app from $3.99 to 99 cents and the CARE from $9.99 to $4.99.

The CRR app helps parents and coaches to recognize when an individual is exhibiting signs and symptoms of a suspected concussion, helping them to respond quickly in less than five minutes.

The CARE app provides tools for athletic trainers, team physicians, and other qualified health care professionals to assess the likelihood of a concussion and respond appropriately in less than five minutes.

PAR donates 15 percent of the proceeds from the sale of this app to concussion research at the Children’s National Medical Center and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, Chapel Hill.

Visit the App Store or Google Play to download your copy of the app today!

A recent study provides insight into how obsessive compulsive disorder (OCD) develops. Led by Claire Gillan and Trevor Robbins at the University of Cambridge and Sanne de Wit at the University of Amsterdam, the study suggests that compulsive behavior may not be a response to obsessive fears, but instead may be a precursor to those fears (American Journal of Psychiatry, July 2011). That is, compulsions such as repetitive hand-washing may lead to an obsessive fear of germs—rather than the other way around.

“It has long been established that humans have a tendency to ‘fill in the gaps’ when it comes to behavior that cannot otherwise be logically explained,” said Gillan in a recent issue of Cambridge’s Research News. “In the case of OCD, the overwhelming urge to senselessly repeat a behavior might be enough to instill a very real obsessive fear in order to explain it.”

The study, which involved 20 patients suffering from OCD and 20 control subjects, measured patients’ tendency to develop habit-like behavior. Participants were required to learn simple associations among stimuli, behaviors, and outcomes in order to win points on a task. The researchers found that patients suffering from OCD were much more likely to continue to respond with a learned behavior, even when that behavior did not produce the desired outcome; that is, they quickly formed habits, or irresistible urges, to perform a task. These behaviors, initiated and observed in a laboratory setting and in the absence of any related obsessions, suggest that the compulsions themselves may be the critical feature of OCD.

This finding seems to support the approach of exposure and response prevention (ERP) as a treatment for OCD. ERP is a therapy that challenges patients to discontinue compulsive responding and learn that the feared consequence does not occur. Proponents of ERP say that once the compulsion is stopped, the obsession tends to diminish or disappear.

What do you think? What therapies have you found most effective for your clients with OCD? PAR wants to hear from you, so leave a comment and join the conversation!