New Jersey Psychologist Publication of the New Jersey Psychological Association Spring 2012 • Volume 62 • Number 2
Environmental Hazards: Implications for Mental Health & Healthcare
PRSRT STD U.S. POSTAGE PAID TRENTON, NJ PERMIT NO. 114
e Center for Psychotherapy and Psychoanalysis of New Jersey Co-Sponsor: New Jersey Society of Clinical Social Workers Summer 2012 CONfereNCe
Attachment and Sexuality: Emotionally Focused Couple erapy in Action
Susan Johnson, PhD
Sunday, June 24, 2012 • 8:30 am – 4:00 pm
We are born to bond and sexuality is intertwined in our bonding relationships. This workshop will outline EFT, an empirically validated model of couple intervention that focuses on the creation of a secure attachment bond. The evidence is that secure attachment enhances the other two key aspects of love relationships, caregiving and sexuality. This workshop will outline EFT as an attachment intervention. It will then consider how sexuality fits into this perspective and how sexual issues are dealt with in EFT sessions. The day will consist of didactic presentation, discussion, exercises and the viewing of EFT training tapes. Attendees will learn: 1) To understand close relationships from an attachment perspective; 2) To understand EFT as a model of intervention; 3) To link sexuality and attachment, bonding and eroticism; and 4) To describe the way sexual issues are addressed in an experiential attachment oriented therapy.
Location: Lenfell Hall, e Mansion, Fairleigh Dickinson University, Madison, NJ Cost: Faculty, Associates, and Others: $165 at the door/$150 pre-registration by June 10. Candidates: $65/$55; Students with ID: $40 Dr. Sue Johnson is Director of the International Center for Excellence in Emotionally Focused Therapy and Distinguished Research Professor at Alliant University in San Diego, California as well as Professor of Clinical Psychology at the University of Ottawa, Canada. Dr. Johnson’s best known professional books include The Practice of Emotionally Focused Couple Therapy: Creating Connection (2004) and Emotionally Focused Couple Therapy with Trauma Survivors (2002). She trains counselors in EFT worldwide and consults to Veterans Affairs, the US and Canadian military and New York City Fire Department. is program is co-sponsored by the New Jersey Society for Clinical Social Work, which provides leadership and support to clinical social workers in all practice settings. e New Jersey Society for Clinical Social Work has given voice to clinical social workers dealing with the health care industry. e organization provides outstanding continuing education programs and opportunities for collegial contact. www.njscsw.org
Advanced Training Options in Psychotherapy All licensed or license-eligible therapists are invited to apply
The Center for Psychotherapy and Psychoanalysis of New Jersey is dedicated to the training of skillful and effective psychotherapists. Contemporary psychoanalytic psychotherapy is an empirically validated treatment methodology proven to offer the clinician a flexible tool for treatment of a wide variety of patients. Over the last century, psychoanalysis and psychoanalytic training have evolved, integrating the best of psychotherapy approaches including those from infant research, neuroscience, attachment theory, and body-based therapies. Psychoanalytically informed treatment is, at its heart, a process by which people discover the freedom to establish an enduring capacity for satisfying relationships and genuine living. Candidates have the opportunity to form new professional networks to develop both their skills and their practices. Low-cost personal therapy and low-cost supervision are available. Referrals to candidates’ practices are available through our Psychotherapy Clinic.
e One Year Introductory Program
The Introductory Program is a one- year track that includes the first four courses in psychodynamic theory and technique. In these courses you will be exposed to basic psychoanalytic concepts and their relevance to both diagnosis and treatment. In the one year program there is no requirement for a commitment to supervision and personal treatment. It’s a great way to answer your questions about advanced training and how it can improve your practice.
e New Jersey Couples erapy Training Program This eight course program offers a unique multitheoretical approach including a thorough grounding in the theory of couples relationships from family systems and diverse psychoanalytic points of view. Students will have the opportunity to explore the range of contemporary approaches to couples therapy: family systems perspectives, attachment theory, Emotionally-Focused Therapy, Imago Relationship Therapy, Object Relations Therapy, and more, as the student is provided with an opportunity to integrate and incorporate the material into their own work. The goal is to arrive at an eclectic understanding of the couple as an entity, including how each partner has a separate internal world which impacts the whole of the couple. Intensive classroom work and clinical supervision integrate readings with students' own clinical material. Interested candidates can take up to two courses before committing to the full two year program. For further information, go to www.cppnj.org, or contact Daniel Goldberg, PhD at 609-683-8000.
www.njscsw.org • http://blog.cppnj.org • Find us at www.Facebook.com/CPPNJ
New Jersey Psychologist Publication of the New Jersey Psychological Association
Table of Contents 2 Who’s Who in NJPA 2012 3 From the Editor 4 New Members 5 President’s Message 6 Executive Director’s Report 8 Director of Professional Affairs Report 9 Legislative Agenda 10 Psychology and the Law 12 New Jersey Psychological Association of Graduate Students (NJPAGS) 14 Ethics Update 16 Foundation 18 2011 Foundation Contributions 19 Diversity Corner 20 Special Section: Environmental Hazards: Implications for Mental Health & Healthcare 33 What’s New – Psychological Research and Practice 34 Sustaining Members 35 Book Review 37 APA Council Report 38 Appointment Calendar Order form 39 Legal Action Initiative 40 Referral Service 41 Private Practice Manual Order form 42 Classifieds 44 NJPA Membership Directory and Handbook Order form
IMPORTANT DATES ▼ Risk Management Adventures on the Electronic Frontier: Ethics & Risk Management in the Digital Era September 29, 2012
Jeffrey Younggren, PhD, ABPP
2012 Fall Conference October 20, 2012 Renaissance Woodbridge Hotel, Iselin, NJ
Jonathan Shedler, PhD
Cover Art: Submitted by New Jersey artist Barry L. Altman, MD. “Scatterbrain” – mixed media and acrylics. Dr. Altman, a retired Urologist, has had a life-long interest in art and is self-taught.
Who’s Who in NJPA 2012 www.PsychologyNJ.org
New Jersey Psychological Association
Editorial Board Editor: Jack Aylward, EdD Associate Editor: Craig Fabrikant, PhD Herman Huber, PhD Michael Jaffe, PhD Megan Lytle, EdS Gianni Pirelli, PhD Sarah Seung-McFarland, PhD Anthony Tasso, PhD Claire Vernaleken, PhD
NJPA 2012 Executive Board President: Mathias Hagovsky, PhD President-Elect: Sean Evers, PhD Past-President: Sharon Ryan Montgomery, PsyD Treasurer: Kenneth Freundlich, PhD Secretary: Stephanie Coyne, PhD Director of Academic Affairs: Kathleen Torsney, PhD APA Council Representative: Neil Massoth, PhD Members-at-Large: Phyllis Bolling, PhD Jeffrey Kahn, PhD Francine Rosenberg, PsyD Milton Spett, PhD Aaron Welt, PhD Jeannine Zoppi, PhD Parliamentarian: Joseph Coyne, PhD Affiliate Caucus Chair: Jeannine Zoppi, PhD NJPAGS Rep: Krista Dettle, MA Latino/a Psychological Association of NJ Rep: Sylvia Mazzula, PhD ABPsi Rep: Phyllis Bolling, PhD
Central Office Staff Executive Director: Josephine Minardo, PsyD Administrative Director: Jane Selzer Membership & Program: Susan Beatty Communications: Christine Gurriere Administrative Assistant: Keira Boertzel-Smith Director of Professional Affairs: Barry Helfmann, PsyD
NJPA 2012 Committee & Special Interest Group Chairs Committees of the Board:
Diversity: Co-Chairs: Susan McGroarty, PhD; Deirdre Waters, PsyD Finance: Kenneth Freundlich, PhD Governance: Sharon Ryan Montgomery, PsyD Nominations & Leadership Development: Lisa Jacobs, PhD Personnel: Neil Massoth, PhD
Academic & Scientific Affairs: Ilyse O’Desky, PsyD Committee on Continuing Education: Mark Lowenthal, PsyD Committee on Legislative Affairs: Brett Biller, PsyD Conference: Jeffrey Singer, PhD Ethics: Mary Blakeslee, PhD Insurance Committee: Jeffrey Axelbank, PsyD Membership: Anne Farrar-Anton, PhD Publications: Jack Aylward, EdD Public Education: Rosalind Dorlen, PsyD Anti-Bullying Sub-Committee: Jeannine Zoppi, PhD Healthy Workplace Sub-Committee: Cheryl Notari, PhD Media Sub-Committee: Lynn Schiller, PhD Technology Committee: Aaron Welt, PhD
Special Interest Groups:
Early Career Psychologists: Co-Chairs: John Macri, PhD; J. Oni Dakhari, PsyD Forensic: Co-Chairs: Madelyn Milchman, PhD; Eileen Kohutis, PhD Health Psychology: Daniel Gallagher, PhD Neuropsychology: Carol Friedman, PhD NJPAGS: Krista Dettle, MA Co-Advisors: Dawn Gemeinhardt, PhD; Kathleen Torsney, PhD Prescriptive Authority: Co-Chairs: Bruce Banford, PsyD; Joseph Zielinski, PhD Psychology in the Schools: Thomas Massarelli, PhD Sport Psychology: Marshall Mintz, PsyD Trauma Response: Raymond Hanbury, PhD
Task Force Chairs:
Health Care Reform: Robert McGrath, PhD Self-Care Across the Career Spectrum: Neil Massoth, PhD
Addictive Behaviors: Raymond Hanbury, PhD DYFS: Barry Katz, PhD LGBTQ: Jonathan Wall, PsyD
Regional Organization Presidents Bergen: Stephanie Coyne, PhD Essex-Union: Cheryl Futterman, PhD Mercer: Marta Aizenman, PhD Middlesex: Mark Weiner, PsyD Monmouth-Ocean: TBD Morris: Morgan Murray, PhD Somerset/Hunterdon: Jane Simon, PhD South Jersey: Hulon Newsome, PsyD
2012 NJP-PAC Inc. Officers
President: Robert Rosenbaum, EdD Treasurer: Pamela Foley, PhD
2012 NJPA Foundation Officers President: Ilyse O’Desky, PsyD Treasurer: Abigail Rosen Secretary: Toby Kaufman, PhD
Preparation of Manuscripts All manuscripts submitted for publication should follow APA style. Manuscripts should be edited, proofread, and ready for publication. Please prepare your manuscript in a word-processing program compatible with MS Word using Times New Roman font in 12 point type, left flush. Please submit your manuscript via e-mail to NJPA Central Office and to Jack Aylward at e-mail addresses below. Editorial Policy Articles accepted for publication will be copyrighted by the Publisher and the Publisher will have the exclusive right to publish, license, and allow others to license, the article in all languages and in all media; however, authors of articles will have the right, upon written consent of the Publisher, to freely use of their material in books or collections of readings authored by themselves. It is understood that authors will not receive remuneration for any articles submitted to or accepted by the New Jersey Psychologist. Any opinions that appear in material contributed by others are not necessarily those of the Editors, Advisors, or Publisher, nor of the particular organization with which an author is affiliated. Manuscripts should be sent to the Editor: Jack Aylward, EdD E-Mail: firstname.lastname@example.org or NJPA Central Office E-Mail: NJPA@PsychologyNJ.org Published by: New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 973-243-9800 FAX: 973-243-9818 E-Mail: NJPA@PsychologyNJ.org Web: www.PsychologyNJ.org
Deadlines for Submission of Manuscripts ISSUE DATE FALL WINTER SPRING SUMMER
SUBMISSION DEADLINE August 10 November 10 February 10 May 10
New Jersey Psychologist
From the Editor
The Psychology of Class by Jack Aylward, EdD
s most of us have suspected, the polarization of wealth in America, like global warming, seems to be more a matter of statistical certainty than of urban myth. An analysis of US Census data spanning 1985-2010 confirms that within that time period the lower 60% of households have lost four trillion dollars, the majority of which has ascended to the top five percent. In addition, a growing new tier of society takes in more than one million dollars or more each year. Overall, during those past two-and-a-half decades, the poor got a little richer, the rich got a lot richer, and the most rich got phenomenally rich. Several studies that followed this growing schism have uncovered some interesting psychological as well as financial shifts. In general, cross-cultural analyses show that there is a consistent correlation between wealth gap in a country and the general well-being of its citizenry. For instance, the more egalitarian British middle class has lower cancer and diabetes rates than their American counterparts. In Finland and Belgium, where incomes are not as widely spread, school children out perform American students. One interesting finding suggested that social class is not specifically defined by wealth. Rather, it is reflected more in the type of clothes worn, the music listened to, and the school one goes to, factors that seem to influence how people react to each other, at least according to an article in Current Directions in Psychological Science. The authors found, for instance, that those from the lower class depend more on other people, given what is required in eking out a living and in providing for one’s family. As a result, these folks seem to develop higher levels of empathy than found in other classes. In contrast, those of wealthier breeding show less dependency given their financial freedom, thereby allowing them to focus mostly on themselves rather then on others. As such, the idea of nobles oblige, or “trickle down” economics garners little in the way of any research support. What is most surprising is that as the income gap grows it is not only the poor who suffer. It seems that the so-called “diseases of poverty” are closely associated “diseases of affluence” (“Affluenza”) as wealth polarizes. Studies of the rich have found higher incidences of cardiovascular disease, cancer, diabetes, anxiety, and depression in those with the means whereby to seek comfort in over eating and expensive shopping habits. In general, income inequality lowers the life Spring 2012
expectancies across all classes within a society. The bottom line seems to be that unequal societies will remain unhealthy and unhappy ones, independent of how much money is available. Part of this phenomenon is that money does not make one happier beyond a certain threshold. Once you have enough to pay for reasonable expenses and somewhat of a safety buffer, more money doesn’t guarantee personal bliss. Some economists are concerned that many in future generations may have a more difficult time reaching a point at which they can fund such “reasonable expenses.” Given that the current recession has drained many family educational funds, student loan numbers will soon reach one trillion dollars and given current employment statistics, it may be hard to repay this level of debt. For instance, for the class of 2010 graduates, only 56% were working by this spring, compared to 90% of those in the classes of 2006 and 2007. The median starting salary tapped out at $27,000 compared to the $30,000 of those entering the workforce between 2006 and 2008. For the rest, it is difficult to pay back loans when you’re out of work. Unlike other forms of consumer debt, student loans cannot be discharged. Barmak Nassirian of the American Association of College Registrars and Admission Officers was quite blunt on the issue in stating, “You will be hounded for life. They will garnish your wages. They will intercept your tax refunds. You become ineligible for public employment.” They can also dock your social security checks at retirement. Even when the economy picks up, students will continue to be saddled with heavy loan liability. In comparing the ratio between salary and debt size, Kiplinger and his colleagues tried to determine which advanced degrees were worth the academic investment. The five best were: an MD; a master’s in public health; a doctor of pharmacy; an MBA; or a law degree. Psychology, clinical social work, counseling, and marriage and family therapy didn’t make the cut. In fact, 20% of clinical psychology graduates remain unemployed. Historically, unemployment has traditionally had negative psychological consequences. In his book, Why Some Politicians Are More Dangerous Than Others, James Gilligan noted that in all but 14 of the 107 years of American political history he examined, there was a consistent correlation between unemployment figures and a rise in national sui3
cide and homicide numbers. Given the shame and sense of worthlessness accompanying an inability to find work, violence-related deaths increase in conjunction with unemployment figures. And, the psychological damage incurred during recessions of this type lingers on far after the economy has recovered. In this issue of the New Jersey Psychologist, NJPA member Susan Wolf, PhD, has put together a special section dealing with environmental hazards and child development. Susan
currently serves as vice chair of the New Jersey Environmental Federation, New Jersey Chapter of Clean Water Action. She has also agreed to keep our readers aware of issues, problems, and progress in this area in future issues. â?– The views expressed in the editorial are those of the editor, with support of the NJPA editorial board, and do not necessarily reflect the opinions of NJPA leadership or staff.
The Publication Committee of NJPA is seeking out new members interested in joining the editorial board of the New Jersey Psychologist. Responsibilities include quarterly meetings, occasional participation as a liaison editor for special sections, editing input, and working with other committee members in contributing ideas and suggestions for maintaining and advancing the professional image and intellectual integrity of the literary flagship of the New Jersey Psychological Association. For further information, contact either Christine Gurriere at Central Office at NJPAcg@PsychologyNJ.org or editor Jack Aylward at email@example.com
Welcome New Members! Members Sandra Ackerman, PhD Sarah Allen, PhD Tricia Byard, PsyD Francine Conway, PhD Michelle Deering, EdD Thomas Dinzeo, PhD Adriana Dunn, PhD Peter Economou, PhD Suzanne Ernst, PsyD Robin Greene, PhD Lauren Guth, PsyD Joel Ingersoll, PhD Caren Jordan, PhD Deborah Kaplan, PsyD Melissa Katz, PsyD Michelle Lupkin, PhD Silvia Mazzula, PhD Rebecca Olszyk-Kiseli, PsyD Dawn Raffa, PhD Andrea Riskin, PsyD Stacy Rosen, PsyD Sandra Sabatini, EdD, PsyD Joshua Shifrin, PhD John Smith, EdD Mary Jane Snair, PhD
Ronald Striano, PhD Nick Tolchin, PhD Victoria Tomasek, PhD Victoria Wacha, PhD Student Members (NJPAGS) Caroline Axelrod Tamara April-Davis, MS Briana Auman Samantha Brown Giselle Colorado Russell Fleischman Sabina Glab Jessica Heschel, PsyM Karen Hill Richard Khan, MA Amy Kranzler, Michele LaCouture, EdS Maria Pereira-Sosa, MA Allison Winik Senior Membership William Herron, PhD Carol Porter, EdD David Rosenthal, PhD Lucinda Seares-Monica, PsyD
New Jersey Psychologist
by Mathias Hagovsky, PhD Private Practice, Livingston
s I continue deeper into my presidential year, I can assure you with confidence that our Executive Director, Josephine Minardo, continues to challenge us to fine-tune NJPA at every level. This will all be within a spirit of transparency and accountability that can only make us stronger with time. Looking back at 2011 from 2012, I have begun to realize just how much was accomplished during Sharon Ryan Montgomery’s term, the first full year of transition to new leadership, and a year of incredible review, revision, and aspiration. So much had to be done and was done and, in fact, was well done, as it was also flavored by the seasoned assistance of Past-President, Lisa Jacobs. Add our Director of Professional Affairs, Barry Helfmann, the committee chairs, and staff, and it turned out that 2011 was a banner year for all of us at NJPA. As you may also know, NJPA has scored a significant victory in our legal action against the abuses of health insurance providers, and we are greatly encouraged by the recent decision of the judge in our case. Additionally, making clear that she concludes all her cases within 12 months, Judge Klein has put our matter on a fast track, thus forcing Horizon/Magellan to take her decision seriously. In response, Horizon/Magellan appealed her decision (that was then denied by the Appellate Division) and has now brought their petition to the New Jersey Supreme Court seeking a different outcome. Though our attorneys are confident that the two lower court decisions will be affirmed (denying their right to appeal), we may be faced with the rigors of protracted litigation and, of course, the added and ongoing costs. While we have raised a great deal of money through members’ generosity and commitment to this effort, we have spent a great deal as well. Therefore, the time has come for NJPA to make a direct request to all members asking for your continued financial support for this incredibly demanding effort. We have avoided it as long as we can, and now we must ask that every one of us dig a little deeper into our pockets so that we can stay the course, especially now that we have the legal traction we need. Undoubtedly, this is clearly a time to sustain the momentum we have hoped for and have gained, and as president of NJPA, I invite all of you to join me in doing everything we can to keep this Herculean effort alive. Please Spring 2012
make your donation today….and stay tuned! We are keeping members informed more than ever on all the Legal Action updates. As challenging as the legal action has been, I am pleased to report that NJPA continues to move forward on many other fronts, including legislative advocacy and professional development programming. Please visit the NJPA website often to keep abreast of all the association is doing on your behalf and check out the “News & Alerts” section of our homepage that is constantly updated. What you will also find on the website are programs made available through the various affiliates that extend the richness of our membership to one another. I just attended a EUCAP-sponsored presentation on Understanding Latino Culture that I spotted in a Friday Update that was just terrific. If you check your Friday Update, you will see other inviting topics being presented throughout the state including another EUCAP presentation about sex offenders. For those of you who regularly read the Friday Update, you are already aware that this is one of the most impressive electronic communications out there, a veritable “all you need to know” about what is going on at NJPA on a weekly basis. If you are not a regular user, please check it out and see what I mean. This is another way to get involved and stay involved with your colleagues and with those of us who would love you to join us at any level in any venue at any time. Thank you for your continued support. What better way to enhance your professional skills, support other NJPA members, and extend your professional network! ❖
MARK YOUR CALENDAR Risk Management Program September 12, 2012 Woodbridge Hilton Hotel
Adventures on the Electronic Frontier: Ethics & Risk Management in the Digital Era 5
Executive Director’s Report
Making A Difference In Washingtion: NJPA In Action by Josephine S. Minardo, PsyD, Executive Director
n Tuesday, March 13th, as part of APA’s State Leadership Conference (SLC), NJPA leaders went to Capitol Hill in Washington, DC to lobby for three critical federal issues affecting psychologists today—all of them involving Medicare. Three teams, made up of ten NJPA members, met with eight congressional offices, at the conclusion of SLC, to discuss issues that impact our members, and to garner support to move the right legislation through the US Congress. Our committed and fearless members advocated for the following: • Having Congress replace the flawed Medicare Sustainable Growth Rate (SGR) formula and alter the existing favoritism of expensive technology-based specialty services over lower-cost memtal health and primary care to avert psychologists being hit with a devastating reimbursement reduction of 32% scheduled for January 1, 2013. Halting cuts to psychologist payments is crucial to protecting access to Medicare mental health services. Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with further reimbursement cuts. About 28,000 psychologists are Medicare providers but another 3,000, who once participated, have left the program due largely to low reimbursement rates. • Eliminating unnecessary physician supervision requirements in the Medicare program that are hampering psychologists from provid6
ing Medicare patients the full range of services allowable under their state licensure. Congressmen were urged to pass the bill by Sen. Snowe (S. 483) and Rep. Schakowsky (H.R. 831) to include psychologists in the Medicare “physician” definition. Psychologists are key Medicare mental health providers, delivering nearly half of the psychotherapy services to Medicare beneficiaries in the hospital outpatient setting and more than 70% of the psychotherapy services in the hospital inpatient, partial hospital, and residential care settings. Psychologists also provide the vast majority of mental health testing services, many of which are unique to their training and licensure. The Medicare beneficiary population will explode in the coming decades. According to the Substance Abuse & Mental Health Services Administration (SAMHSA), individuals age 65 and older will comprise 20% of the country’s population by 2030. This means increased demand for mental health treatment as the number of older adults with mental disorders, including depression, anxiety, and dementia, grows from 7 to15 million. Psychologists will take on a greater role in working with physicians and other Medicare providers to address co-morbid physical and mental/substance use disorders. • Making psychologists eligible for existing Health Information Technology for Economic and Clinical Health (HITECH) Act incentive payments by passing the Behavioral Health Information Technology Act of 2011 (Senate Bill 539 and a soon-to-be introduced House of Representatives Bill). The legislation would amend the HITECH
Act of 2009 to support mental and behavioral health by enabling psychologists and social workers to qualify for Medicare and Medicaid incentive payments for integrating electronic health records into their practices. It would also extend this eligibility to nationally accredited community mental health centers, residential mental health facilities, outpatient mental health treatment facilities, and substance use facilities. NJPA is grateful to the following members who accompanied me to APA’s State Leadership Conference in Washington, DC, where, for four days, they devoted their time, energy, and resources to educate themselves on the current and emerging trends in state advocacy and healthcare reform, learn from and share experiences with their counterparts from other states across the country, and ultimately, represented you proudly and skillfully with your Congressmen to advocate on your behalf. Mathias Hagovsky, PhD, NJPA President Sean Evers, PhD, NJPA President-Elect Barry Helfmann, PsyD, Director of Professional Affairs Brett Biller, PhD, COLA Chair/APA Federal Advocacy Coordinator Virginia Waters, PhD, COLA Chair-Elect/ APA Federal Advocacy Coordinator Phyllis Bolling, PhD, APA Committee of State Leaders (CSL) Diversity Delegate-Elect Sudha Wadhwani, PhD, Diversity Delegate J. Oni Dakhari, PsyD, Early Career Psychologist (ECP) Delegate Bonnie Markham, PhD, PsyD, APA Treasurer To learn more about the issues mentioned above, visit our “News & Alerts” section on NJPA’s homepage <www.psychologynj.org> and view the “APA Fact Sheets” contained in the article. New Jersey Psychologist
HEALTHCARE REFORM. My report of SLC would not be complete without mentioning Healthcare Reform. After several years of including a variety of educational activities on healthcare reform in SLC programming, APA finally decided it was time for this to, instead, be the focus of the entire conference. With the title “Bringing Psychology to the Table: State Leadership in Health Care Reform” SLC provided its attendees with a wealth of knowledge about how states will be impacted by the federal mandate involved in implementation of healthcare reform and how state psychological associations (and their leaders) can begin to make sure psychologists are included at every level of the decision-making process. There was a consistent theme that psychologists MUST “have a seat at the table” and a frequent reminder by Katherine C. Nordal, PhD, Executive Director of APA’s Practice Directorate that “if you’re not at the table, you’re on the menu.” Psychology cannot afford to be on the menu. With so many other forces at work against us—health insurance companies, regulatory bodies, and even the economy—psychologists must become informed and empowered decisionmakers. We must be regarded as essential stakeholders in Healthcare Reform, no matter what form it takes. As I write this, the US Supreme Court is hearing arguments raised against the constitutionality of portions of the Affordable Care Act (ACA) namely, the
around the creation of the State Health individual mandate that would require Benefit Exchange, and we have strongly all citizens to purchase healthcare insuradvocated that psychologists (and menance or be subject to a fine. And while tal health providers) be involved in the court’s ruling will not be known unshaping whatever form it takes. In part, til sometime in June, and the possibility our voice was heard when, on March of the ACA being repealed, in whole, 15th, both houses passed A2171 and or in part, looms heavily for some, one S1319, the “New Jersey Health Benething is certain—no matter what hapfit Exchange Act,” that called for the pens, the status quo of healthcare in the creation of an advisory committee US cannot continue as it is. Something made up of 15 members including one must change, and psychologists MUST representative from a variety of stakebe part of that conversation. To date, holder groups, including mental health NJPA has made some strides by creatcare providers. While NJPA was very ing a Healthcare Reform Task Force, excited to hear of this, and enthusiastic chaired by Robert McGrath, PhD, who about the potential for a psychologist is also among the select few recruited to serve in this position, the bill does to be part of the APA Practice Organizanot become law until it is signed by the tion Task Force on Healthcare Reform. Governor. Unfortunately, that has not The mission and purpose of this group yet occurred, and will likely not occur, is to 1) educate the membership of the at least until the Supreme Court renassociation as the future of healthcare ders a ruling. Notwithstanding, we feel becomes clearer, 2) advocate with polithat it is a good first step to including cy advisors, legislators, regulators, and psychologists in critical decision-makothers decision-makers in New Jersey ing groups, and we will follow up acto ensure that psychologists are includcordingly, regardless of whatever form ed in all healthcare reform decisions subsequent discussions on healthcare that may impact the profession (i.e. reform in NJ take. As long as we are “have a seat at the table”), 3) provide part of the conversations, we can strive mechanisms for psychologists and proto make a difference and ensure that fessionals to develop new competenpsychologists are heard. I, along with cies relevant to the evolving healthcare what I am certain is many of you, will landscape, and 4) help identify new opState to Leadership beConference closely watching2012 the issue of healthportunities forAPA psychologists redefine care(SLC) reform as it continues themselves or29th diversify their Leadership practices.Conference The theme for the annual State was Bringing Psychologytotounfold the Table:NJPA State Leadership in Health Reform. Leadership Delegation included: has also been partCare of the con- NJPA’s in 2012 the State political discourse, and as the Front row (L to R): NJPA Director of Professional Affairs, Barry Helfmann, PsyD; NJPA Executive Director, Supreme Court makes its Coordinator historical versations taking placePresident-Elect, with stake-Sean Evers, Josephine Minardo, PsyD; NJPA PhD; NJPA Federal Advocacy decision. ❖ Hagovsky, PhD; NJPA Early holders about the implementation of President, (FAC), Virginia Waters, PhD; Back row (L to R) NJPA Mathias Career Delegate, reform Oni Dakhari, PsyD;particularly NJPA COLA Chair/FAC, Brett Biller, PsyD; NJPA Diversity Delegate, Healthcare in NJ, Phyllis Bolling, PhD; NJPA Diversity Delegate, Sudha Wadhwani, PsyD
APA State Leadership Conference 2012 The theme for the 29th annual State Leadership Conference (SLC) was Bringing Psychology to the Table: State Leadership in Health Care Reform. NJPA’s 2012 State Leadership Delegation included: Front row (L to R): NJPA Director of Professional Affairs, Barry Helfmann, PsyD; NJPA Executive Director, Josephine Minardo, PsyD; NJPA President-Elect, Sean Evers, PhD; NJPA Federal Advocacy Coordinator (FAC), Virginia Waters, PhD; Back row (L to R) NJPA President, Mathias Hagovsky, PhD; NJPA Early Career Delegate, Oni Dakhari, PsyD; NJPA COLA Chair/FAC, Brett Biller, PsyD; NJPA Diversity Delegate, Phyllis Bolling, PhD; NJPA Diversity Delegate, Sudha Wadhwani, PsyD
Director of Professional Affairs Report
Managed Care: To Join Or Not by Barry Helfmann, PsyD
aintaining or becoming a panel provider depends on a number of factors. This will be fundamentally affected by the national developments regarding integrated health care. For sure, the role of managed care going forward will be very different from what it has been to date. Some believe that managed care has failed in the final analysis and will eventually cease to exist. Others believe that managed care will take on a more prominent role in health care delivery systems, especially delivery systems that rely more on public assistance. Since we all know the validity in predicting future events, making decisions about joining requires careful thought and a bit of luck. With the onslaught of insurance abuses and intrusions, maintaining privacy has become a real challenge. The requests for treatment plans, telephonic reviews, and justifications for ongoing care are such examples. Third party payors ask for treatment notes or other confidential patient information violating the legal and ethical principles of privacy. This behavior falls under the rubric of the need to meet medical necessity criteria. Failure to provide such information results in authorizations being denied or significant reductions in the frequency of treatment. Ethical and legal guidelines permit breaking confidentiality only if the patient is in imminent danger to self or others, or in cases regarding mandatory report of child abuse. One favorable aspect about joining a network is that it insures, to some degree, a flow of patient referrals that may not be available out-of-network. It also provides some protection against market forces that could negatively affect oneâ€™s patient load, such as contract changes that cost the patient more on an out-of-network basis. There is some belief that insurance companies are friendlier to their panel providers than to those who are not on the panel. Being a panel member also allows in-network psychologists better access to insurance websites. Finally, payment is sent directly to the panel provider less the co-pay. Patients pay much less to go to an in-network psychologist. They often have no deductible and pay a small copayment. This can allow for people to obtain quality care that they previously were unable to afford. 8
The downside to joining a panel is that they are contracted for a set fee that is significantly below what most psychologists charge for their services. Panel providers are precluded from balance billing patients for the difference between contracted rates and what would be the usual office fee. So, out of network psychologists may charge their full fee as long as it is not considered excessive as defined by the New Jersey Board of Psychological Examiners. Many believe that if one signs onto panels then they are helping the managed care company sell their product and concept of care and that it helps keep fees artificially low. The whole concept of freedom of choice and access comes into play here. Many believe that the decisions about treatment should be between the psychologist and patient and not an insurance company that has a profit motive to keep care managed and contained. In addition there is the concept of phantom panels. This means the number of network providers an insurer claims to have may not be accurate. Those who retire, die, or resign are often kept on the panels so it looks more adequate than it is in reality. Also, many psychologists who remain on the panels do not necessarily accept new cases. They remain for a multitude of reasons including keeping in-network status as a safety valve. The decision by a psychologist on whether or not to join a managed care panel rests on a number of factors. First, how do you want to practice? In other words, how managed care friendly are you? Will you be sufficiently comfortable in having decisions affecting your treatment made, or at least influenced by, a third party payor? Are you philosophically attuned with the concept of managed care? Second, can you live comfortably with contracted rates as a trade off for more referrals? Third, do you want and need to set your own fee and control the treatment plan with the patient? Finally, what is your risk tolerance in securing out-of-network patient referrals? In an uncertain future economic climate, what do you believe the future of independent practice will be? Are you able and willing to do the necessary marketing steps to promote your practice? â?– New Jersey Psychologist
The Legislative Agenda
The Legislative Cycle by Brett Biller, PsyD Chair, COLA
s I prepare to write this article for the spring issue, our state legislature is beginning a new two year legislative cycle. Much has changed in both legislative houses as a result of the November elections. We are encouraged that many of the legislators, with whom we have maintained productive relationships, continue to be in a position to affect positive change for the field of psychology and ultimately the well-being of the clients we serve. As is typical at the onset of a new legislative session, there has been minimal movement with many of the bills that we have been involved. As a matter of procedure, any bill that had not been signed into law before the completion of the prior session “dies.” The bill must then be reintroduced and the review process, necessary for enacting a bill into law, begins again. At the onset of the current legislative session, COLA was tracking approximately 80 bills that were pre-filed from the last legislative session. Pre-filing a bill is the process of proposing a bill that had previously been introduced in the prior session. By pre-filing the bill, the process of reviewing the bill begins at the onset of the new legislative session. The review and approval of bills is typically not done expeditiously, therefore pre-filing a bill affords NJPA the greatest duration of time to have the bill reviewed and successfully voted into law. Some of the bills NJPA has pre-filed include A2289 that limits actions against court-appointed psychologists, psychiatrists, social workers, or other licensed mental health professionals in certain family court matters. The bill looks for judiciary review of professional conduct and subsequent approval prior to a legal action or complaint. Other prominent bills that have been pre-filed include sister bills A2419 and S137. These “expansion of scope” bills propose that psychologists, who complete appropriate education and training, be permitted prescription writing privileges. Passage of A2419 and S137 will expand the current scope of psychological practice in areas that research has supported and that are in great need of services, such as pediatrics. COLA is also reviewing bills related to recent initiatives to prevent and address bullying in New Jersey schools. Finally, with regard to changes to current regulations, proposals have been submitted that would eliminate the oral examination component of the licensing procedure. Should the changes to the regulations be approved, candidates seeking licensure in New Jersey will have to successfully complete a written jurisprudence examination subsequent to successful completion of the EPPP. Although the Spring 2012
changes to the regulations have been proposed, they were not approved at the time of this writing. Please also be aware that enactment of the proposed changes would likely not occur until one-year post approval. We are pleased that NJPA continues to maintain positive relationships with many state leaders. As spring approaches and the new legislative session gets underway, COLA is looking to solidify current relationships and to form relationships with legislators with whom we have not previously had the opportunity to do so. NJPA’s ability to form positive and supportive relationships with our state leaders is one of the most effective means to ensure that the needs of psychology are heard and addressed. Toward that end, COLA has been compiling a list of current topics and issues in our state that are of importance to the field of psychology. We have begun to reach out to representatives throughout the state to begin to advocate for the needs of our members. When meeting with the representatives, we will offer different ways in which our membership can be of assistance. For those of you who have had contact with your legislative representatives, you are already aware of the importance of making yourself known and also identifying how you, and/or NJPA can be of service to them and their constituents. COLA will be initiating the process of developing some advocacy points that are important to our members. In addition to the outreach and advocacy efforts maintained by COLA members, we will be interested in hearing from NJPA members who may be interested in reaching out to legislators in their district. COLA is looking to develop an orientation for members who may be interested, but who may be apprehensive or unaware of how to go about doing so. If you have interest in advocating on behalf of psychology in our state, I welcome you to contact me, Josephine, or Jane in the Central Office to further discuss how we can assist you in getting involved. Finally, by the time this article is published, several members of the NJPA executive board and COLA leadership will have returned from the American Psychological Association’s State Leadership Conference in Washington, DC. The title of this year’s conference is “Bringing Psychology to the Table: State Leadership in Healthcare Reform.” During the conference, we will have had the opportunity to meet with our national leaders and advocate for psychology at the national level. We are looking forward to applying the information obtained at the conference to our advocacy efforts in our state. ❖ 9
Psychology and the Law
Correctional Mental Health by Gianni Pirelli, PhD
n this article, I provide an overview of correctional mental healthcare in the United States. As a result of the deinstitutionalization movement (Adams & Ferrandino, 2008; Durham, 1989), correctional facilities have evolved into the primary institutional providers of mental health services in the United States Deinstitutionalization began in 1955 in response to various social forces providing pressure to do so as well the advent of more effective antipsychotic medication (i.e., Thorazine). In 1955, there were 558,239 people diagnosed with severe mental illnesses in America’s public psychiatric hospitals; by 1994, this number was 71,619 that represented a 92% population reduction (Torrey, 1997). Although deinstitutionalization was ostensibly a positive step in public mental healthcare reform, it ultimately led to what some have characterized as the criminalization of mentally disordered people (Abramson, 1972). As such, the nation’s correctional system was faced with an influx of offenders diagnosed with mental illnesses. The vast and steady expansion of correctional mental healthcare over the past four decades has resulted in correctional institutions being referred to as “the last mental hospital[s]” (Gilligan, 2001) and “the de facto state hospitals” (Daniel, 2007). In fact, the Los Angeles County Jail and Rikers Island in New York are currently the largest psychiatric inpatient facilities in the United States, housing 3,400 and 2,800 mentally ill inmates, respectively (Torrey, 1999). Landmark Legal Cases A number of legal cases have set the stage for correctional mental healthcare 10
reform, three of which have been particularly instrumental in this regard (i.e., Bowring v. Godwin, 1977; Cooper v. Pate, 1964; Estelle v. Gamble, 1976). In Cooper, the United States Supreme Court ruled for the first time that state prison inmates have constitutional rights; namely, that they could sue in federal court. In Estelle, an inmate brought suit against the medical director and two officials of the Texas Department of Corrections for not providing adequate treatment of a back injury he suffered while engaging in prison work. The Supreme Court held that “deliberate indifference” by prison personnel to an inmate’s serious illness or injury reflected cruel and unusual punishment as per the Eighth Amendment. In Bowring, the United States Court of Appeals (Fourth Circuit) highlighted the fact that they perceived no underlying distinction between inmates’ rights to receive medical versus psychiatric care. Correctional Mental Health Mentally Ill Inmates. One of the most unique aspects of the inmate population is the representation of all diagnostic categories. Although mania, psychosis, depression, and anxiety have been considered particularly important to screen for in correctional samples (Gebbie et al., 2008), the reality is that many inmates would likely not be receiving mental health services if not incarcerated (e.g., those diagnosed with Cluster A or B Personality Disorders, Impulse Control Disorders, or Paraphilias). In fact, although more than half of state, federal, and jail inmates have diagnosed mental health problems, less than 50% of those with such conditions have ever
received treatment prior to incarceration (James & Glaze, 2006). An additional, distinctive characteristic of the correctional population is the high prevalence of inmates diagnosed with Substance Related Disorders as well as those with trauma histories. Nearly 75% of state prison and jail inmates carry a dual diagnosis, and approximately 30% of inmates with mental health problems report a physical or sexual abuse history as compared to only 10% of inmates without mental health problems (James & Glaze, 2006). In addition, studies have found that inmates are anywhere from two to ten times more likely than those in the general population to have a history of a traumatic brain injury (Gunter, Philibert, & Hollenbeck, 2009). Thus, correctional institutions must be fully equipped, at individual and system-wide levels, to handle people with such complex and diverse clinical presentations. Types of Correctional Mental Health Treatment. Although a major tenet of correctional mental healthcare providers is to ensure the same level of care that is available in the community, the prison atmosphere is quite different than that of the community (Van Marle, 2007). Van Marle (2007) conceptualized mental healthcare in prison as consisting of four levels: basic health care, forensic health care, forensic psychiatric care, and forensic psychiatric treatment. According to Van Marle, basic health care includes routine medical visits, access to nurses, and dentist visits; forensic health care refers to formal treatment planning focused on individual and group programming as well as facilitating communication between inmates and their families; New Jersey Psychologist
Psychology and the Law
forensic psychiatric care includes the prevention of psychiatric deterioration and the prevention and management of disturbed and/or aggressive behavior; and forensic psychiatric treatment refers to a comprehensive approach aimed at reducing the risk of recidivism. Dvoskin and Spiers (2004) conceptualized mental health treatment in prison somewhat differently. They described it as consisting of four aspects: counseling and psychotherapy; consultation; special housing, activities, and behavioral programs; and medication. The Medical School Model. One major way in which a number of states have responded to the increasing need for cutting edge mental healthcare services has been to contract with medical schools. Medical schools have typically been integrated into the correctional system in one of three ways: (i) some states (e.g., Oklahoma, Connecticut, Texas) use medical schools for medical and mental health care; (ii) some (e.g., Georgia) use medical schools for medical care and maintain contracts with private mental health providers for their services; and (iii) some, such as New Jersey, contract with a medical school for mental health services and a private vendor for medical care (Daniel, 2007). Appelbaum, Manning, and Noonan (2002) outlined the benefits of being associated with a medical school that included: increased resources and expertise that should attract competent clinicians, thereby ensuring high quality diagnostic and treatment services; the ability to provide specialty care and the recruitment and training of non-mental health medical professionals; the introduction of an inherent employee feeder system through its training programs (i.e., interns and post-docs); and an overall increase in the attention paid to research, training, and continuing education. â?– References Abramson, M. (1972). The criminalization of mentally disordered behavior. Journal of Hospital & Community Psychiatry, 23, 101-105. Adams, K. & Ferrandino, J. (2008). Managing mentally ill inmates in prisons. Spring 2012
Criminal Justice and Behavior, 35, 913-927. Appelbaum, K. L., Manning, T. D., & Noonan, J. D. (2002). A universitystate-corporation partnership for providing correctional mental health services. Psychiatric Services, 53, 185189. Bowring v. Godwin, 551 F.2d 44, 47 (4th Cir. 1977). Cooper v. Pate, 278 U.S. 546 (1964). Daniel, A. E. (2007). Care of the mentally ill in prisons: Challenges and solutions. Journal of the American Academy of Psychiatry and the Law, 35, 406-410. Durham, M. L. (1989). The impact of deinstitutionalization on the current treatment of the mentally ill. International Journal of Law and Psychiatry, 12, 117-131. Dvoskin, J. A., & Spiers, E. M. (2004). On the role of correctional officers in prison mental health. Psychiatric Quarterly, 75, 41-59. Estelle v. Gamble, 429 U.S. 97 (1976). Gebbie, K. M., Larkin, R. M., Klein, S. J., Wright, L., Satriano, J., Culkin, J. J., & Devore, B. S. (2008). Improving access to mental health services for New York State prison inmates. Journal of Correctional Health Care, 14, 122-135.
Gilligan, J. (2001). The last mental hospital. Psychiatric Quarterly, 72, 45-61. Gunter, T. D., Philibert, R., & Hollenbeck, N. (2009). Medical and psychiatric problems among men and women in a community corrections residential setting. Behavioral Sciences and the Law, 27, 695-711. James, D. J., & Glaze, L. E. (2006). Bureau of Justice Statistics Special Report. <http://bjs.ojp.usdoj.gov/content/ pub/pdf/mhppji.pdf> (retrieved January 19, 2012). Torrey, E. F. (1997). Out of the shadows: Confronting Americaâ€™s mental illness crisis. New York: John Wiley & Sons. Torrey, E. F. (1999, Autumn). Reinventing mental health care, City-Journal. <http://www.city-journal.org/html/ 9_4_a5.html> (retrieved January 19, 2012). Van Marle, H. J. C. (2007). Mental health care in prison: How to manage our care. International Journal of Prisoner Health, 3, 115-123. Please email article ideas to me at firstname.lastname@example.org GIANNI PIRELLI, PhD, is a Staff Clinical Psychologist 3 on a Forensic Unit at Greystone Park Psychiatric Hospital (GPPH) in Morris Plains, New Jersey.
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New Jersey Psychological Association of Graduate Students (NJPAGS)
Building a Foundation of Wellness by Krista Dettle, MA Seton Hall University
elf-care, self-care, self-care...We all talk about it, we all need it, but are we really practicing what we preach? For many, the answer is no, and the question is “why not?” In recent years, adequate self-care has received greater recognition as a core competency of clinical training. Obviously, psychology doctoral training is a professionally formative period. During this time, the opportunity exists for trainees to learn good self-care skills geared towards helping to prevent impairment and to avoid burnout. If good self-care skills are achieved, these skills can assist in maintaining life-long learning, as well as optimal levels of professional and personal functioning across the career span. Furthermore, mental health professionals have an ethical obligation toward self-care in providing quality services to clients. So, what’s stopping us? Enter the NJPA Self-Care Task Force, comprised of ten members representing various career stages, from graduate student to seasoned psychologist. Our first meeting was held on February 3, and many important issues were brought to the table. Among them were stress management, retirement planning, education, burnout, impairment, and staying connected, to name a few. One major question struck a chord with this graduate student…How do we promote active participation in increasing our own wellness? The foundation needs to be built now, at the beginning of our careers. Just as we teach children life skills and values in hopes they will be implement12
ed throughout adulthood, we must learn our wellness skills and values early on, to be maintained and strengthened throughout our careers. At the meeting, Dr. Anthony Tasso noted, “It’s never too early to learn that taking care of yourself emotionally and physically is of paramount importance to a long-term career as a psychologist. Although many graduate students think of self-care as something they need to worry about later in life, this couldn’t be further from the truth. By explicitly incorporating selfcare as a psychologist trainee, such a mindset is more likely to become part of one’s regular personal and professional practices.” Self-care activities are not a luxury and should not be mistaken as selfish or self-centered. Dr. Morris Goodman also noted, “I firmly believe our health and welfare are primarily a function of our connectivity with our community; family, friends, our professional world; as well as the world at large.” In the same vein, professional isolation is a significant risk factor for burnout and impairment. Peer support and supervision, as well as involvement in professional associations (NJPAGS!!) all provide buffers to these detriments and assist in boosting our wellness efforts. As graduate students, it can often feel impossible to strike a balance between our personal lives and our professional demands. Then again, we can also think of wellness in terms of a demand in itself. Dr. Neil Massoth noted, “Self-care is an ethical imperative required by the APA Code of Ethics,” just as any of our other clinical responsibilities are. Partic-
ipation in our own wellness can come in many forms, from small tasks such as taking regular breaks, to more involved challenges as finding time for adequate rest, exercise, healthy diet, and meeting spiritual and social needs. Together, we need to find a way to better inform and reinforce these wellness practices, starting now and continuing throughout our careers. We need to more openly encourage one another, as colleagues and friends, to engage in these activities for ourselves, for our clients, and for future generations of psychologists. ❖
IN MEMORIAM Stanley Horowitz, PhD Member 52 years Letty Pogul, PhD Member 42 years
New Jersey Psychologist
Undergraduate and Graduate Students Awards Undergraduate Student Researcher Award: This award is presented either to an undergraduate psychology major attending a New Jersey college or university who has demonstrated exceptional research potential as determined by his or her academic department. The awardee is invited to present their research as a poster at the NJPA Fall Conference on October 20, 2012 and receives a certificate.
Graduate Student Research Award: This award is presented to a graduate student in psychology who is either attending a New Jersey college or university or interning in a New Jersey institution or an NJPA student affiliate, who has demonstrated exceptional research potential as determined by his or her academic department. This research should have been completed within the last two years. The awardee is invited to present his/her research as a poster at the NJPA Fall Conference on October 20, 2012 and receives a certificate. Applications for either award should provide the following information: • • • • • •
Name, address, telephone numbers and institutional affiliation of the applicant Name, address, telephone numbers, and institutional affiliation of department/faculty sponsor Title of research presentation 100-150 word abstract and/or one page summary of project Resume of applicant Two letters of endorsement from faculty members
The deadline for submission is July 13, 2012 Applications may be made either electronically or by hard copy. Please send completed applications to: Academic and Scientific Affairs Committee New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 973-243-9800 NJPA@PsychologyNJ.org
Ethical Considerations of Supervision and Peer Consultation by Resa Fogel, PhD Psychologist (consultant) for Region V Council for Special Education Private Practice, Montclair/Teaneck
s a psychology intern in the 1980s, I had the amazing opportunity to learn from an array of mental health professionals that included psychologists, social workers, and psychiatrists. Not only were they brilliant, capable, insightful, and caring, they were all eager to impart their knowledge in a sincere and focused manner. I had the benefit of learning from an elderly psychiatrist who had been in the field for many years. I remember a snowy cold and raw afternoon when I stopped in to his office to ask him a question. He politely told me that he only had a few minutes since he had to leave to (drive) “to supervision.” I was concerned for his health and safety and stated that I was sure that any student would understand if he rescheduled. He smiled and replied, “It is not to supervise, it is my supervision, because if you stop learning, you die.” (T. Cherbuliez, personal communication, February 1986). Trained psychologists have first hand knowledge regarding the importance of the supervision process. Psychologists know the importance of learning, of growth, and of being aware of what one knows and what one needs to learn. The APA Ethics Code delineates that a psychologist should never practice beyond the scope of their training. Psychology students, as well as (licensed) psychologists, hone their skills, as needed, via respective avenues of growth. Those avenues could include supervision and peer consultation. Psychology graduate students, as well as unlicensed psychologists, attend supervision, and licensed psychologists often seek consultation via peer consultation groups.
The student/supervisor experience requires the awareness of ethical considerations in the student/supervisor relationship. Educational theory and practice emphasizes that one learns better in an environment that is non-judgmental and where one feels valued and respected. A non-judgmental and comfortable relationship where the supervisee is able to ask questions and also admit what they do not know is essential to an optimal supervisory experience. The supervisor, whom provides an environment where the supervisee feels comfortable and eager to learn, falls in the realm of sound education and psychological practice, as well as in the realm of sound ethics within the supervision experience. The optimal supervisor/supervisee experience requires respect between both members of the dyad. Inherent in that respect is a clear delineation of what the supervisor and supervisee expect from each other. Issues such as timely and frequent feedback are considered within a reciprocal understanding of expectations and requirements. The ethics code (Standard 7.06(a)) states that “In academic and supervisory relationships, psychologists establish timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision” (p.10). The ethics code (Standard 7.06(b)) states that “psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements” (p.10). The supervisor has the authority to evaluate the supervisee, and the ethics code provides guidelines regarding the evaluation process.
The supervisor/supervisee relationship also requires ethical principles be followed when direct service to patients is provided. These include principles such as the requirement to practice within the scope of practice as well as informed consent and confidentiality. Supervisors typically choose their students’ cases to ensure that the case is appropriate for the level of the student’s training and is thus providing services within the scope of one’s training. The student clinician (supervisee) should clearly explain to the patient that s/he is being supervised, and obtain consent for such an arrangement (informed consent). While the ethics code does not specifically delineate the issue of informed consent within the section focusing on supervision, Standard 10.01 includes “when obtaining informed consent to therapy as required in Standard 3.10,.....psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers” (p.14-15). Standard 3.10 states “when psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons…” (p. 6-7). Maintaining confidentiality is vital to sound clinical practice. While the ethics code does not specifically delineate the issue of confidentiality within the section focusing on supervision, standards New Jersey Psychologist
to include, but not limited to, 10.01 (noted above) as well as standards 4.01, 4.02, and 4.04, discuss the importance and limits of confidentiality. The supervisee therefore informs the patient that sessions will be discussed with the supervisor that also includes the patient’s identifying information. The supervisee also informs the patient (client) that the supervisor has access to the patient’s chart and is required to sign all chart notes as well as all correspondence relating to the patient’s treatment. Also discussed explicitly and clearly with the patient is that barring explicit written consent by the patient, both (student) clinician and supervisor are forbidden to discuss the case with others without carefully masking any and all identifying information. Standard 4.05 includes that “psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient …” (p. 8). Ongoing learning, including those of us in practice for many years, is important if not vital to psychological practice. Standard 2.03 of the Ethics Code
discusses the necessity of maintaining one’s competence in order to provide optimal standards of care to the public. Although my supervisor of yore referred to going for his own supervision, he, in a later discussion with me, told me that he has been meeting with the same colleagues, weekly, for many years, and the group is a peer consultation group and not a supervision group. The group meets to discuss cases, patient (client) names are never mentioned and that members of the group consciously and carefully hide all information that might lead the listener to be able to even remotely guess identity. While confidentiality guidelines need to be strictly followed, informed consent is not relevant. Standard 4.06 of the Ethics Code notes that “when consulting with colleagues, psychologists do not disclose confidential information that reasonably could lead to the identification of the client/ patient…..”(p. 8). Similar to the supervisory relationship, peer consultations allow clinicians to raise clinical dilemmas and theoretical questions within a non-judgmental
and positive, caring, and comfortable environment. Unlike supervision, there is no element of evaluation of one member over another, and thus the concept of one being in the role of an authority is nonexistent. As in any relationship, however, communication is paramount, and issues need to be discussed, as well as resolved, ethically and comfortably in order for the peer consultation experience to not only succeed, but also thrive. The supervision, as well as consultation, relationships thrive if built on the foundation of collaboration. The concept of ongoing learning towards goals such as improving clinical abilities and providing optimal care to the public are tantamount in why psychologists seek excellent supervision while in training, and then optimal peer consultation opportunities. ❖ References APA Ethical Principles of Psychologists and Code of Conduct. American Psychologist 2002:57, #12.
JAMES S. WULACH, PhD, JD 28 MILLBURN AVENUE, SUITE 6 SPRINGFIELD, NEW JERSEY 07081 (973) 763-4588 Telephone Consultation Available ATTORNEY AT LAW Legal & Ethical Issues, State Board Matters LICENSED PSYCHOLOGIST #1299 Therapy, Supervision, Testing, Forensic, Custody Author: Law & Mental Health Profs: NJ Former President, NJ Psychological Assn. Certificate, NYU Postdoctoral Program
Enhancing Counseling in Schools with a Team-Based Approach by Danielle Zurawiecki School-Based Youth-Services Program Intern Family Empowerment Program Plainfield High School
hrough the generous support of the New Jersey Psychological Association Foundation (NJPAF), I have been able to experience the benefits of working in a wonderful organization. This story begins in November 2010, almost a year before I began working at the Center for Family, Community, and Social Justice, Inc. A student referred by his guidance counselor was having “academic difficulties.” Further discussion with the guidance counselor revealed the student was not speaking. He was being labeled “mute” and the student began labeling himself a “sociopath.” He was passing his classes; however teachers were being frustrated because whenever they would call on him or he was required to speak, the student would just sit there, eyes cast down. A male member of the Family Empowerment Team (FEP), the Family Systems Specialist (FSS), accepted the referral and immediately spoke with the student, uncertain of what would be revealed. The student eyed the FSS and hesitantly began to speak about himself. He was teaching himself Spanish and Japanese. The two of them made an instant connection since the FSS’s native language was Spanish! Fast forward to January 2012. Over the past year and a half, the FSS had repeatedly attempted to contact the student’s mother, receiving no response. The student would sometimes refuse to have his mother involved, the number was disconnected, or the student would give the wrong number. Despite these challenges, the FSS saw the value in having the student’s family involved and continued to work with him. Upon my joining the FEP team, we discussed the student and his circumstances. Finally, the student agreed to have his mother
included, but first he wanted his grandmother, with whom he felt more support and comfort. A family session was immediately scheduled for the student, his grandmother, the FSS, and me. The meeting revealed the family’s history and the multigenerational stories of strength and survival. The next meeting was set up to include the mother; however, since working only two days per week, I was unable to facilitate this meeting. The FSS and the Community Resource Specialist (CRS) conducted the family session with the student and his mother. While it may appear odd to switch counselors, such a move reveals the importance and trust involved in working as teams. The student continued to speak in the sessions and provided the teams with a greater understanding of why he did not initially speak. It became clear that this was connected to his experiences in his family and the traumatic occurrences that the family shared. The FEP model involves working in tandem, with two counselors in each family session. Typically, this includes the Family Systems Specialist and the CRS, and in joining the team, I became a part of this model. When I first began, I had to learn about the differences between the FSS and CRS. The team members are so intertwined with each other that it was difficult to learn the differences in their roles. But, that’s what is so unique about working under this model: Everyone is essential, working effectively and collaboratively together. I trust the team and know they will work well with the family. This policy also extends to collaborations with other professionals. I was recently in a session with a student who was curious about the rules related to passing
a class. As I was also unfamiliar with such, I asked the student who would be the most appropriate person to ask, and upon her decision, we walked across the hall to her guidance counselor. Furthermore, FEP works with the School-Based Youth Services Program (SBYSP). While this inter-mingling could create potential problems, I found the entire system to be a “well-oiled” machine. We assign referrals based on the presenting problem, have case management meetings together, and complete home visits in pairs. I recently began working with the SBYSP intern. We co-facilitate a girls empowerment and leadership group focused on women’s health, self-esteem, and sexuality. We work together collaborating, communicating, and cooperating throughout the entire process. I believe working with other professionals best reveals how the team approaches families. We see each family as having their own unique history and circumstances with their own strengths. We listen to everyone in the family, hearing their story. We work collaboratively with the family, understanding their strengths and resilience. While it may be difficult to get a family into a session, we persist, always considering how we can work with the student and his/her family, and how the family context impacts each child. The FEP model also utilizes understanding the context of the school and the background of the families and students. At least one member of the team has a background similar to the students and speaks the same language. While I do not speak another language, awareness and appreciation of the context allows me to connect with families despite our different ethnic and cultural New Jersey Psychologist
backgrounds. I understand the importance of recognizing what these families are all about, where they have come from, and where they want to end up. As a team, we receive weekly supervision and monthly training to further enhance our knowledge and skills. We review sessions, role-play, and listen to each other’s stories to gain insight into ourselves as well as into the families with whom we work. The trainings are focused on the importance of listening
to family members and their entire stories. We discuss ways to impact a student’s life in the face of adversity in the schools, at home, and/or in the community. These trainings have helped me focus on the context in which a student lives, rather than focusing only on the individual. Working at the Center for Family, Community, and Social Justice has greatly reinforced the work I want to do. It has helped me realize the benefits
of working in teams, with other professionals, and with families – with all approaches having the end goal of helping students. The experience has also provided me with the opportunity to contemplate my own family and background, an experience that has greatly enlightened my work with families. I am grateful to the NJPA Foundation for the support that made my practicum experience possible. ❖
FOUNDATION AWARDS & SCHOLARSHIPS CRITERIA The applicant must meet at least ONE of the following criteria to be considered: 1. 2. 3.
NJPAGS student affiliate OR Enrolled in a New Jersey University or college master’s or doctoral level psychology program OR Psychology intern at a New Jersey facility.
2012 – NJPA Foundation Awards Application & Requirements The following awards may be given by the NJPA Foundation. As this is a competitive process, the NJPA Foundation reserves the right to provide an award to only those proposals that meet a standard of excellence. Please check the award you will be applying for: Research into Causes and/or Treatment of Social Problems ($2000). Some possible topics include school issues, work problems, health issues, and aggression. __
The NJPA Foundation Scholarship for Research on Diversity Issues ($2000): Awarded to a graduate student in psychology who advances the following goals: (a) Promote scientific understanding of the role of diversity in psychology; (b) Foster the development of sensitive models for delivery of psychological services to diverse populations. Some possible topics include issues related to cultural or ethnic issues, socioeconomic issues, gender issues or work with underserved populations. Dr. Zellig Bach Award for the Study of the Family ($1000). Awarded for the study of behavior related to divorce, teenage pregnancy, adoption, single parents with dependent children, interpersonal abuse, substance abuse, custody, dual careers, childcare, etc. Winifred Starbuck Scott Award ($1000). Awarded to a graduate student in school psychology for completing a distinguished project, usually during internship. To see complete requirements and evaluation criteria, visit the Foundation at <www. PsychologyNJ.org> ALL SUBMISSIONS MUST BE EMAILED Application Deadline: July 16, 2012 New Jersey Psychological Association Foundation 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052 (973) 243-9800 Fax: (973) 243-9818 Email: NJPA@PsychologyNJ.org
Foundation The NJPA Foundation is committed to advancing the psychological health of our New Jersey community by supporting psychological services for children and adults who cannot afford them, by supporting the training of new psychologists, and by disseminating psychological knowledge to the general public. The Foundation’s work would not be possible without the generous donations of our colleagues in NJPA.
“To build a dream, you need a Foundation”
The NJPA Foundation is most grateful to all of the following colleagues who have contributed so substantially to our efforts in 2011. Our heartfelt thanks to all of you. President: Ilyse O’Desky, PsyD Angel $1000 and over Susan Kasper, PhD Richard Klein, EdD John Lagos, PhD Viola Sutherland, PhD Patron $500-$749 Kathryn Adorney, PhD Rosalind Dorlen, PsyD Mathias Hagovsky, PhD Toby Kaufman, PhD Daniel Watter, EdD Everett Belvin Williams, PhD Contributor $250-$499 Jeffrey Axelbank, PsyD Susan Buckley, PsyD Rosemarie Ciccarello, PhD Jane Hochberg, PsyD Kenneth Kline, PhD Alfredo Lowe, PhD Sharon Ryan Montgomery, PsyD Janet Nelson, PhD Kristen Peck, PhD Jeffrey Spector, PsyD Supporter $100-$249 Howard Adelman, PhD Vicki Barnett, PsyD Judith Bernstein, PsyD Jeffrey Bessey, PhD Richard Brewster, PsyD Dorothy Cantor, PsyD Monica Carsky, PhD Kathleen Cullina-Bessey, PsyD Richard Dauber, PhD Patricia DeSear, PhD Jeannette DeVaris, PhD Edward Dougherty, EdD Susan Esquilin, PhD Bud Feder, PhD Donald Franklin, PhD Thomas Frio, PhD Milton Fuentes, PsyD Kenneth Gates, PsyD Larry Gingold, PsyD Elizabeth Goldberg, PhD Ruth Goldston, PhD Allen Hershman, PhD, PsyD Margery Honig, PhD Ellen Hulme, EdD Lisa Jacobs, PhD Sarah Karl, PhD Robert Karlin, PhD Charles Katz, PhD Roberta Katz, PhD Richard Kessler, PhD
Deirdre Kramer, PhD Judith Kramer, PhD Marvin Leibowitz, PhD Neal Leynor, PhD Ruth Lijtmaer, PhD Bonnie LIpeles, PsyD N. John Lombardi, PsyD Mark Lowenthal, PsyD William Boyce Lum, PsyD Marilyn Lyga, PhD Roger Maitland, PhD Neil Massoth, PhD Frank Mazza Nancy McWilliams, PhD Barry Mitchell, PsyD Lynn Mollick, PhD Marsha Morris, PhD Rosemarie Moser, PhD Daniel Moss, PhD Rose Oosting, PhD Julie O’Rourke, PhD Laura Palmer, PhD Nicholas Papouchis, PhD Howard Paul, PhD Francesca Peckman, PsyD Mark Pesner, PhD Lori Pine, PsyD Debra Roelke, PhD Barbara Rosenberg, PhD Elissa Rozov, PhD George Sanders, PhD Komal Saraf, PhD Arline Shaffer, PhD Milton Spett, PhD Ann Stainton, PhD Anthony Tasso, PhD Martha Temple, PsyD Carol Turner, EdD Peggy Van Raalte, PsyD Barbara Von Klemperer, EdD Duncan Walton, PhD William Walsh, PhD Aaron Welt, PhD Nina Williams, PsyD Philip Witt, PhD Stanley Zebrowski, PhD Michael Zito, PhD Friend up to $99 Annette Appleheimer, PsyD Pauline Bergstein, PhD Janet Berson, PhD Carole Beyer, EdD Bernard Bilicki, PsyD Mary Blakeslee, PhD Carol Blum, PsyD Susan Breckwoldt, PhD Adele Brodkin, PhD Robin Cooper-Fleming, PsyD Margaret DeLong, PsyD Angelica Diaz-Martinez, PsyD Nancy Distel , PhD
John Dovel, PhD Michael Feldman, PhD Joan Fiorello, PhD Richard Formica, PhD Eliot Garson, PhD Marc Gironda, PsyD Sandra Grundfest, EdD Osna Haller, PhD Kathy Howley, PhD Ellen Hulme, EdD Susan Huslage, PhD Joy Huston, PhD Monica Indart, PsyD Phyllis Kresch, PsyD Phyllis Lakin, PhD Ilana Lev-El, PsyD Renee Levin, PhD Robert Levine, PhD Gloria Loew, PhD Heather MacLeod, EdD Cornelius Mahoney, PhD Melissa Marano, PsyD Susan Marx, PsyD Robert McGrath, PhD Susan Neigher, PhD James Owen, PsyD Carol Quintana Nancy Razza, PhD Mark Reuter, PhD Katherine Rhoades, PhD Lloyd Ross, PhD Michele Rubin, EdD Peter Schild, EdD Lynn Schiller, PhD Jay Schmulowitz, PhD Zelig Schrager, PhD Paul Schottland, PhD Nancie Senet, PhD Daniel Sugarman, PhD Jacqueline Tropp, PhD Joanne VanNest, PhD Michael Wexler, D Ed Grace Zambelli, PhD Student Lunch Jeffrey Axelbank, PsyD Sheila Bender, PhD Roderick Bennett Janet Berson, PhD Gordon Boals, PhD Stephanie Coyne, PhD Rosalind Dorlen, PsyD Sean Evers, PhD Pamela Foley, PhD Donald Franklin, PhD Daniel Gallagher, PhD Larry Gingold, PsyD Mathias Hagovsky, PhD Raymond Hanbury, PhD Barry Helfmann, PsyD
Jane Hochberg, PsyD Lisa Jacobs, PhD Mary Kelly, PhD Deirdre Kramer, PhD Jack Lagos, PhD Phyllis Lakin, PhD Mark Lowenthal, PsyD Neil Massoth, PhD Susan McGroarty, PhD Norine Mohle, PhD Sharon Ryan Montgomery, PsyD Louis Schlesinger, PhD William Shinefield, PsyD Jeffrey Singer, PhD Laurence Straus, PhD Jonathan Wall, PhD Aaron Welt, PhD Dinner Elinor Bashe, PsyD Philip Bobrove, PhD Cynthia Bratman, PsyD Craig Callan, PsyD Rosalind Dorlen, PsyD Lew Gantwerk, PsyD Marc Geller, PsyD Larry Gingold, PsyD Morris Goodman, PhD Mathias Hagovsky, PhD Osna Haller, PhD Raymond Hanbury, PhD Barry Helfmann, PsyD Lisa Jacobs, PhD Deborah Kaplan, PsyD Eileen Kennedy-Moore, PhD Deirdre Kramer, PhD Jack Lagos, PhD Phyllis Lakin, PhD Judith Margolin, PsyD Charles Mark, PsyD Judith Margolin, PsyD Bonnie Markham, PhD, PsyD Neil Massoth, PhD Wendy Matthews, PhD Stanley Messer, PhD Stanley Moldawsky, PhD Lynn Mollick, PhD Sharon Ryan Montgomery, PsyD Lawrence Perfetti, EdD George Sanders, PhD Kenneth Schneider, PhD Laura Skivone-Fecko, PhD Milton Spett, PhD Patricia Steckler, PhD Daniel Watter, EdD Aaron Welt, PhD Mark White, PhD Nina Williams, PsyD Gail Winbury-Klizas, PsyD James Wulach, PhD, JD Jeannine Zoppi, PhD
New Jersey Psychologist
Greetings from the NJPA Diversity Committee! By Susan McGroarty, PhD and Deirdre Waters, PsyD, Co-chairs
e hope everyone is enjoying the early warm weather and taking advantage of time outside. Similar to many organizations, the Diversity Committee is experiencing structural change and looking forward to new experiences in 2012. After three years of service, our co-chairs, Drs. Phyllis Bolling and Sudha Wadhwani have both decided to transition to other leadership roles. The committee has flourished under their direction in many ways, including organizing outstanding workshops, quarterly contributions to the NJ Psychologist, and expanding the committee’s visibility on the Internet. We are indebted to them for their contributions, expertise in multiculturalism, and overall dedication to the field of psychology. Thankfully, they will remain active in the committee and we will continue to benefit from their wisdom and guidance. As a committee, we discussed new leadership possibilities over the course of several meetings. We, Susan and Deirdre, expressed willingness to step into this role, with the support of Phyllis and Sudha, as well as the other committee members. Because Sleeter’s (1994) writings on white racism and dominance in groups remains relevant today, it was important for us to address any possible concerns of two white women serving as co-chairs. In previous editions of NJ Psychologist, we have both written about our professional experiences in multiculturalism, and while perhaps qualified, reservations on this matter were shared and processed openly. Moving forward, cultural hegemony will be addressed through ongoing consultation and evaluation with our committee members and colleagues. Although academia has highlighted the importance of white involvement in multiculturalism since its conception, in actual practice, roles of leadership often fall upon the shoulders of our peers of color and members of the LGBT community. This process has evolved into a burden for many of our colleagues, at times an unwanted obligation. This conflict was identified by our committee and recognized when considering new leadership. During our tenure as co-chairs, we will continue to explore these topics and welcome your feedback. Other goals include maintaining the current activity level, increasing membership and visibility, and expanding online opportunities for multicultural consultations. Five years ago, Dr. Gwendolyn Puryear Keita published an editorial titled From Imus to ‘I must’ in the Monitor on Psychology (Keita, 2007). In this commentary, Dr. Keita discussed her resolve to learn from public mistakes made related to diverSpring 2012
sity. She emphasized the need to commit to practicing with “vigilant sensitivity,” declining to join in prejudicial activities, and promoting a “culture of inclusion” (p 36). Her message highlights that multicultural competency is an ongoing process that occurs in an environment of support and reinforcement. It is a valuable lesson as we identify our own ‘I musts’ in the New Year. More recently, during an acceptance speech for the Screen Actors Guild (SAG) award for best female actor, Viola Davis said, “I just have to say that the stain of racism and sexism is not just for people of color or women. It’s all of our burden, all of us.” Her words resonate with us: The responsibility belongs to everyone. We are reminded that in our position as psychologists, in the therapy room, in the classroom, and our own individual communities, we can serve as agents for social change. This objective is especially relevant with the recent synagogue bombings and hate threats of LGBT attacks on our state college campuses. Please join us as we work to promote multicultural growth and competency for the members and students of NJPA. We welcome this new challenge. ❖ References Davis, V. (2012). Screen Actors Guild Awards. ABC. 29, January 2012. Keita, G.P. (2007). From Imus to ‘I Must’. Monitor on Psychology, 38(8), 36. Sleeter, C. (1994). White Racism. Multicultural Education, Spring v1 n4, 5-8.
Office Hours by Appointment
Sandra H. Wulach, MD Psychiatry 28 Millburn Ave 75 Oak Street Suite 6 Ridgewood, NJ 07450 Springfield, NJ 07081 Phone: 201-447-1773 Phone: 973-467-1773 Fax: 973-763-2088
Introduction to Special Section
Environmental Hazards - Implications for Mental Health and Health Care By Susan Wolf, PhD, Guest Editor Vice-Chair, New Jersey Environmental Federation, NJ Chapter of Clean Water Action; Private Practice, Cherry Hill Jack Aylward, EdD, Liaison Editor
am thrilled that NJPA is including this special section on the environment. My hope is that it will enlighten our readers and bring to their attention some of the concerns being expressed by epidemiologists, physicians, scientists, and environmental activists. In preparing this section, I have been fortunate to work with dedicated professionals who are devoting their life’s work to environmental research, education, and public advocacy. They have given generously of their time to provide the articles in this section that address important topics of public health and safety. They are clearly knowledgeable in their fields, but as important, they are passionate in their concern about the public welfare. I know that their words will educate and inspire. Surely, the body of evidence of the human contribution to our planet’s imperiled state is growing. As psychologists, we know that awareness is the first step in making change. For instance, many of us are familiar with the pithy, pointed statement “reduce, reuse, and recycle” and make efforts to varying degrees to do so. This statement has become a central and targeted message for the environmental movement and has become one of my personal mantras. It is helpful for psychologists to know what may be impacting the populations with whom they work and what issues may be contributing to mental health and general health issues. This special section was created to inform and to educate the readers about the specific harmful effects of pesticides and herbicides, pollutants, and nuclear energy. Pesticides and herbicides have shown to be deleterious to human development and have been linked to learning and nuerodevelopmental disorders. Their link to cancer has also been well established, specifically to childhood brain cancer and childhood leukemia. (Schettler, Solomon, Valenti & Huddle, 2000). The increase in respiratory problems such as asthma has been contributed to poor air quality (Perera, 2011). Specifically, exposure to pesticides has been correlated to the increase in asthma (Beyond Pesticides, 2011). Nichelle Harriot, a scientist with Beyond Pesticides, provides an article examining the link between neurological disorders and the use of pesticides. Her Washington, DC based
organization works to educate the public about the hazards of pesticide use, addresses alternatives for pesticide management, and seeks to influence policies to address the health and safety of people and the environment. Dr. Robert Laumbach, an occupational health and safety physician at UMDNJ, describes his current study investigating how chronic stress may interact with air pollution and actually worsen asthma. Lynn Thorp, the national campaign coordinator for Clean Water Action, writes about the increase in toxic chemicals since World War II. We are so used to purchasing chemical products that we do not think about their impact on our health, including our neurological systems. This article calls for action to formulate policies that will protect us from hazardous chemicals. It also lists resources about alternative choices for cosmetics, pesticides, building materials, and bisphenol A (BPA). Joe Mangano, executive director of the Radiation and Public Health Project, focuses on the harm to the brain from nuclear reactors and nuclear weapons test. Jenny Vickers, communications coordinator for The New Jersey Environmental Federation, reminds us of the dangers of fracking due to the release of harmful cancer causing chemicals into the groundwater and pollutants into the air, affecting humans and all creatures. I hope these topics open many eyes to the environmental hazards we face and to what we can do about them. This is another way that we, as psychologists, can address the physical and emotional well-being of those we serve. ❖ References Beyond Pesticides/National Coalition Against the Misuse of Pesticides. (2005). Asthma, children and pesticides, pesticides and you, 25(2). Perera, L. (2011). Climate change may be hazardous to your health. Catalyst. Cambridge, MA. Schettler,T., Soloman, G., Valenti, M. & Huddle, A. (2000). Generations at risk: Reproductive health and the environment. Cambridge, Massachusetts: The MIT Press.
New Jersey Psychologist
Special Section: Environmental Hazards
Radiation Exposure From Nuclear Weapons Tests/Nuclear Reactor Emissions and Brain Disorders By Joseph J. Mangano, MPH, MBA Executive Director, Radiation and Public Health Project, Ocean City NJ
hile radiation has been part of life on earth for millions of years, a particular type has been with us for fewer than seven decades. These fission products are found only in nuclear weapons explosions and nuclear reactor operations. This article defines fission products and examines evidence of their effects on the human brain.
1990 and Douple & Jostes, 2005). Landmark findings of radiation-cancer links at low exposures include pelvic X-rays to pregnant women (Stewart, 1958), fallout from atom bomb tests above the Nevada desert (Committee, 1999), and occupational exposures to nuclear weapons plant workers (Alvarez, 2000).
Introduction – Fission Products Defined In the early 1940s, scientists identified a new type of radiation caused by splitting uranium-235 atoms after bombarding them with neutrons. This process, known as fission, generated high heat that was soon used in atomic bombs at Hiroshima and Nagasaki. Later, the process was used to produce electricity in nuclear reactors. In addition to high heat, splitting a uranium-235 atom produces over 100 chemicals, most not found in nature. All are radioactive, and harm humans by killing cells and damaging DNA strands that can lead to cancer, birth defects, and other disorders. Each fission product has a discrete effect on the human body. Iodine-131 seeks out the thyroid gland. Strontium-90 attaches to bone and teeth. Cesium-137 disperses throughout the soft tissues and muscle. Some decay quickly, while others remain for long periods; the half life of Iodine-131 is eight days, while that of Plutonium-239 is 24,400 years. Like all other organs, the brain can be damaged by fission products. Some chemicals that disperse throughout all soft tissues, like Cesium-137, affect it. Other chemicals affect particular portions of the brain. For example, Yttrium-90, a “daughter product” formed when Strontium-90 decays, seeks out the pituitary gland. Damage to the thyroid from Iodine-131 can disrupt mental development, especially in the fetus and infant. The issue of how many humans have been harmed by these radioactive chemicals remains unresolved, but some important principles have emerged. The very young are most susceptible to radiation; harm to children age 2-16 and infants age 0-2 was estimated at three and ten times greater than adults, respectively (US Centers for Disease Control and Protection, 2003). Second, considerable research found that relatively low dose exposures to radiation can harm humans, as confirmed by reports of a blue ribbon panel, that cited hundreds of scientific reports as the basis for their conclusion (Committee,
Atomic Bomb Testing and Harm to Brain The first studies that correlated brain disorders with exposure to fission products were on Japanese atom bomb survivors; rates of many types of cancer (including brain/nervous system) are elevated (Preston et al., 2002). Among young residents of the Marshall Islands who received large doses of fallout from US atom bomb tests during the 1950s, a disproportionate number of cases of severe hypothyroidism were documented and linked with radioactive iodine. This syndrome sharply limits physical and mental growth, and many untreated victims become dwarfs and mentally retarded (Conard et al., 1980). Massive airborne fallout was generated by the 106 American above-ground nuclear weapons tests in the South Pacific, especially the 100 such tests in Nevada; all but five of the 206 tests occurred from 1951-1963. Adding explosions by the Soviet Union during this period yielded explosive power of 40,000 Hiroshima bombs (Norris & Cochran, 1994). While exposure to Americans represented lower levels than the Japanese bomb survivors, health threats motivated President John F. Kennedy and Premier Nikita Khrushchev to sign the 1963 Partial Test Ban Treaty ending large-scale atmospheric tests. Subsequent studies showed that the average concentration of Strontium-90 in US deciduous teeth was 50 times greater for those born in 1963 vs. 1950. After large-scale tests ended, Sr-90 levels in teeth fell by half within five years (Rosenthal, 1969). There is evidence that Americans, especially the young, suffered harm to the brain due to exposure to above-ground test fallout. Table 1 examines the change in brain/central nervous system (CNS) cancer incidence among Connecticut children under age ten in the bomb test era. Table 1 uses five-year birth cohorts from 1945-49 to 1965-69. Cases and populations used to calculate incidence rates were based on five-year periods; for example, the 1945-49 birth cohort used 1945-49 for cases/population 0-4, and 1950-54 for cases/population age 5-9 (US Department of Health and Human Services, 1986).
Special Section: Environmental Hazards
epilepsy, migraines, other headaches, sleep disturbances, organic Incidence, Malignant Brain, and Central Nervous System Cancers, Age 0-9 mental disorders, neurotic/stress/ Before, During, and After Atmospheric Atom Bomb Testing somatoform disorders, emotional By Five-Year Birth Cohort, 1945-49 to 1965-69, Connecticut disorders, and learning disorders (Nyagu et al., 2004). Rising rates Birth Cohort Dxed 0-4 Dxed 5-9 Cases Annual Pop. Rate 100,000 of mental disorders among chilBefore Bomb Testing dren of rescue workers were also 1945-49 1945-49 1950-54 42 182,070 2.307 reported (Matveenko et al., 2005). Finally, rising rates of various During Bomb Testing congenital malformations, many 1950-54 1950-54 1955-59 59 214,483 2.738 affecting the brain and nervous 1955-59 1955-59 1960-64 78 265,524 2.938 system, were documented in the 1960-64 1960-64 1965-69 88 289,904 3.035 Yablokov compilation. Reactor emissions at doses After Bomb Testing lower than Chernobyl have not 1965-69 1976-69 1970-74 70 273,117 2.563 been studied in as much detail, even as the number of US reac% Change in Rate, 1945-49 to 1960-64 Cohort (during testing) +31.6% p<.13 tors soared. United States adult % Change in Rate, 1960-64 to 1965-69 Cohort (after testing) - 15.5% p<.10 brain/CNS cancer incidence has changed little in the past several generations. But brain/CNS cancer rate in children age 0-19 Following the 1945-49 birth cohort that received virtually in nine US states and cities (10% of the population) rose 41% zero fetal/infant exposure to bomb fallout, the brain/CNS canfrom 1973-76 to 1990-93, with little change thereafter. Nearcer incidence rate rose steadily before reaching a peak for ly two-thirds of brain/CNS cancer cases from age 0-19 are the 1960-64 cohort that also was the period with the highest children younger than 10 (National Cancer Institute, 2011). environmental radioactivity. The increase between those two With no scientific consensus on causes of this unexpected incohorts was 31.6% (short of significant at p<.13). Incidence crease, potential factors merit examination. plunged 15.5% (p<.10) for the 1965-69 cohort, who were Since 1975, the number of US reactors jumped from 57 to born after the Test Ban Treaty was signed. Studying long term effects of atom bomb test fallout on 104. All but five of the current reactors are at least 20 years brain/CNS cancer in adults is a far more difficult undertak- old, and parts are aging and corroding (US Nuclear Regulaing than short term effects on young children. Factors such as tory Commission). The percent of time in operation for US in- and out-migration from a geographic area, assessing other reactors has risen from 58% to 90% since 1985 (US Energy potential causes of the disease, and pinpointing the age of Department, 2011).Thus, aging reactors being operated more exposure that raises risk the most, make it highly difficult to often suggests that harmful emissions into the environment conduct meaningful research. However, indications that fetal and bodies may be increasing. A 1990 study by the National Cancer Institute remains exposures increased child brain/CNS cancer suggest that hazthe only national study that examined local cancer rates, inards may also manifest in adults. cluding brain/CNS, before and after startup of 62 US nuclear plants (Jablon et al., 1990). Incidence data for four ConnectiNuclear Reactor Emissions and Harm to Brain The end of large scale atom bomb tests above ground in cut and Iowa plants were also included, and results for brain/ 1963, and the end of all such tests worldwide in 1980, shifted CNS malignancies age 0-9 are given in Table 2. A sharp increase was observed in the local-to-state cancer the origin of environmental fission products from bomb fallincidence ratio for counties where each of the four nuclear out to nuclear reactor emissions. The Chernobyl meltdown in the Ukraine in April 1986 was the most catastrophic of any plants is located. Although the combined increase falls short nuclear reactor accident thus far, even as the toll from the of statistical significance (p<.21) because of the small number 2011 meltdowns at Fukushima has yet to be calculated. One of cases before (26) and after (31) startup, this finding reprerecent report on Chernobyl health effects cited over 5,000 re- sents another suggestion that introducing radioactive fission ports and articles, many in the Slavic language not previously products into the environment raises brain/CNS cancer risk, considered, including studies on brain and other mental dis- most quickly in young children. orders (Yablokov et al., 2009). Reported cancer clusters also provided evidence of a In addition to highly elevated rates of brain/CNS cancer, potential link between reactor emissions and brain/CNS canlocal children irradiated in utero were found to have signifi- cers. In 1996, the Newark (NJ) Star Ledger ran a story about cantly higher rates of various brain and nervous system dis- a cluster of child cancer cases in Ocean County, home of the orders compared to control groups. These conditions include Oyster Creek nuclear reactor â€“ the oldest of 104 in the US.
New Jersey Psychologist
Special Section: Environmental Hazards
disease is difficult, since manifestations of disease often represents a combination Brain/CNS Incidence Rate in Counties Closest to Nuclear Plants of factors. Epidemiological tools such as Before and After Reactor Startup, Connecticut and Iowa, Age 0-9 a case-control study comparing potential factors (such as radiation) for those with Before After County vs. State Rate vs. without a disease, or a longitudinal Nuclear Plant Startup Startup Before After % Ch. Rate cohort study comparing disease rates Haddam Neck CT 1950-67 1968-84 -28% + 4% +32 over time for exposed vs. unexposed subMillstone CT 1950-70 1971-84 -19% + 2% +21 jects can be helpful. However, these Duane Arnold IA 1969-74 1975-84 -48% + 7% +55 tools are limited, as it is virtually impossiFt. Calhoun IA 1969-73 1974-84 + 0% +29% +29 ble to control for all potential confoundTOTAL - 25% + 5% +30 p<.21 ing factors. A number of studies have linked exNotes: Rates adjusted to 1970 US standard population. Counties included are Middlesex, posure to fission products with brain CT (Haddam Neck), New London, CT (Millstone), Benton/Linn, IA (Duane Arnold), Hardiseases. These are important because of rison, IA (Ft. Calhoun). Total local cases are 26 (before startup) and 31 (after startup). the rise in childhood brain/CNS cancers, autism, ADHD, and hypothyroidism – all The outcry moved the US Agency for Toxic Substances and lacking any documented causes. Moreover, the ongoing exDisease Registry to request information from the NJ Departposures to humans by aging and corroding reactors, epitoment of Health and Senior Services. The Department reported mized by the disastrous meltdowns at four Fukushima reactors from 1979-95, the 97 cases of brain/CNS cancer and neurobeginning March 2011, make the topic as relevant as ever. blastoma diagnosed in Ocean County children age 0-19 was Psychologists typically focus on diagnosis and treatment 32% greater than the expected number of 73.4. Rates were esof brain disorders, rather than causes thereof. But increasing pecially high in Dover Township, just eight miles from Oyster knowledge of causes of such disorders would be helpful, since Creek (Division of Environmental and Occupational Health psychologists could share such information with patients, proServices, 1997). moting preventive practices that would lower disease rates. If A six-year follow up study failed to find links between the knowledge that harmful radiation exposure from pelvic X-rays high brain/CNS cancer rates and local environmental toxins, to pregnant women, or unnecessary CT scans to children enincluding emissions from Oyster Creek (Division of Epidemicourages reduction of such scans, knowledge that exposure to ology, Environmental, and Occupational Health, 2003). To fission is harmful would encourage reduction of these expothis date, no cause of the large outbreak of childhood cancers sures, to children and adults. ❖ have been identified by officials, but many local residents still suspect environmental causes – radiation and other toxins Joseph Mangano can be reached at email@example.com. More from local industries - were a factor. about the Radiation and Public Health Project can be learned Awareness of another cluster of child brain/CNS cancer at <www.radiation.org>. was initiated by parents of affected children in St. Lucie County FL in the mid-1990s. The county Health Department found References that from 1981-97, brain/CNS (including neuroblastoma) cas- Alvarez R. (2000). The Risks of Making Nuclear Weapons: A Review of the Health and Mortality Experience of US Dees for county residents age 0-9 was 29, or 38% greater than partment of Energy Workers. Washington DC: The Governthe 21 expected cases. Moreover, 15 of the 29 cases had been ment Accountability Project. diagnosed in the most recent three years (St. Lucie County Committee on the Biological Effects of Ionizing Radiation. Health Department, 1999). Most St. Lucie county residents (1990). Health effects of exposure to low levels of ionizing live less than ten miles from the two St. Lucie nuclear reactors. radiation: BEIR V. Washington DC: National Academy Press. However, the state health department could not document a Committee on Thyroid Screening Related to I-131 Exposure, link between the high rates and any environmental toxin. The Institute of Medicine and Committee on Exposure of the families of two local children suffering with brain cancer filed American People to I-131 from the Nevada Atomic Bomb a legal action against Florida Power and Light (owner of the Tests, National Research Council. (1999). Exposure of the reactors), citing high concentration of Strontium-90 in the American people to Iodine-131 from Nevada nuclear bomb children’s teeth, but the action failed (US Court of Appeals, tests. Washington DC: National Academy Press, p. 72. 11th Circuit, 2008). Conard R.A., Paglia D.E., Larsen D., et al. (1980). Review of
Discussion – Research Findings Limited, but Topic Still Relevant Prior research on harm to the brain caused by fission products has been limited. Isolating radiation as a causal factor in Spring 2012
medical findings in a Marshallese population 26 years after exposure to radioactive fallout. Upton NY: Brookhaven National Laboratory; BNL 51261. Division of Environmental and Occupational Health Services. (1997). Childhood cancer incidence health consultation:
Special Section: Environmental Hazards
A review and analysis of cancer registry data, 1979-1995 for Dover Township (Ocean County) New Jersey. New Jersey Department of Health and Senior Services, September. <http://www.state.nj.us/health/eoh/hhazweb/canswmm. pdf> Accessed on September 27, 2011. Division of Epidemiology, Environmental, and Occupational Health Consumer and Environmental Health Services. (2003). Case-control study of childhood cancers in Dover Township (Ocean County), New Jersey: Volume I: Summary of the final technical report. New Jersey Department of Health and Senior Services. <http://www.state.nj.us/health/eoh/hhazweb/case-control_pff/volume_I/voli.pdf> Accessed on September 27, 2011. Douple, E.V. & Jostes, R. (2005). A summary of BEIR VII. Washington DC: The National Academies. <http://www.health. wyo.gov/media.aspx?medaid=5917> Accessed on September 8, 2011. Jablon, S., Hrubeck, Z., & Boice, Jr., J. (1990). Cancer in populations living near nuclear facilities. National Cancer Institute, NIH Pub. No. 90-874. Washington, DC: US Government Printing Office. Matveenko, E.G., Borovykova, M.P., & Davydov, G.A. (2005). Physical characteristics and primary morbidity in liquidators’ children. International Scientific and Practical Conference. Chernobyl: 20 Years After Social and Economic Problems and Perspectives in Development of the Affected Territories. Materials: Byansk, 176-179 (in Russian).. National Cancer Institute. (2011). SEER Cancer Statistics Review, 1975-2008 (also 1973-1993 volume). Surveillance, Epidemiology, and End Results system, 2011. <www.seer. cancer.gov>. Accessed on September 27, 2011. Norris, R.S. & Cochran, T.B. (1994). United States Nuclear Tests, July 1945 to 31 December 1992. Washington DC: Natural Resources Defense Council. Nyagu, A.K., Loganovsky, K.N., Pott-Born, R. et al. (2004). Effect of prenatal brain irradiation after the Chernobyl accident. International Journal of Radiation Medicine; 6(1-4):91-107 (in Russian).
Barry W. Klein, Psy.D. Psychologist
Child, Adolescent, Adult, Family PDD, Autism, Asperger’s Syndrome, ADHD Behavior Problems, Parenting, School Consultation, Supervision 68 Essex Street Millburn, NJ 07041 973.376.8890 NJ Lic 4204
915 West End Ave. Ste 1A New York, NY 10025 917.692.1281 NY Lic 8960
Preston, D.L., Ron, E., Yonehara, S., et al. (2002). Tumors of the nervous system and pituitary gland associated with atomic bomb radiation exposure. Journal of the National Cancer Institute; 94(20):1555-63. Rosenthal, H.L. (1969). Accumulation of environmental strontium-90 in teeth of children. In proceedings of the Ninth Annual Hanford Biology Symposium at Richland, Washington. May 5-8, 1969. US Atomic Energy Commission, Washington, DC. St. Lucie County Health Department. (1999) St. Lucie Cancer in Children Study Update: Report to the Community. <http://www.stluciecountyhealth.com/epi/cancer.asp>. Accessed on September 27, 2011. Stewart, A., Webb, J., & Hewitt, D. (1958). A survey of childhood malignancies. BMJ;1:1495-1508. US Centers for Disease Control and Prevention. (2003). Prenatal Radiation Exposure: A Fact Sheet for Physicians. <www.bt.cdc.gov/radiation/prenatalphysician.asp> Accessed on August 7, 2009. US Court of Appeals for the 11th Circuit. (2008). Scott Finestone and Rebecca Finestone v. Florida Power and Light Company. No. 06-11132. <http://www.call.uscourts.gov/unpub/ ops/200611132.pdf>. Accessed on September 27, 2011. US Department of Health and Human Services. (1986). Fortyfive Years of Cancer Incidence in Connecticut: 1935-79. NIH Pub. No. 86-2652. Bethesda MD: National Cancer Institute. US Energy Department. <http://www.eia.doe.gov/mer/pdf/ pages/sec8_3.pdf>. Accessed on September 28, 2011. US Nuclear Regulatory Commission. <http://www.nrc.gov>. Accessed on September 28, 2011. Yablokov, A.V., Nesterenko, V.B., & Nesterenko, A.V. (2009). Chernobyl: Consequences of the Catastrophe for People and the Environment. New York: New York Academy of Sciences.
AMY L. ALTENHAUS, PH.D LICENSED PSYCHOLOGIST #1479 80 EAST MAIN STREET FREEHOLD, NJ 07728 732-780-6644
LIFE TRANSITIONS, PARENTING, RELATIONSHIPS, CUSTODY EVALUATIONS NEW: HELPING ADULTS MAKE CAREER CHANGES AND IDENTIFY WHAT GETS IN THE WAY NYU CERTIFICATE IN ADULT CAREER PLANNING AND DEVELOPMENT
New Jersey Psychologist
Special Section: Environmental Hazards
Effects of Stress and Traffic Pollutants on Childhood Asthma in Urban Communities by Robert J. Laumbach MD, MPH Assistant Professor Department of Environmental and Occupational Medicine UMDNJ-Robert Wood Johnson Medical School Environmental and Occupational Health Sciences Institute Piscataway, NJ
he well-established trend of increasing asthma prevalence and morbidity in the US disproportionately affects non-white children living in urban areas and in poverty (Olden & White, 2005). While the extent to which these disparities are due to race and/or poverty is difficult to disentangle, race/ethnic differences in asthma appear to exist independently of socioeconomic status (Wright & Subramanian, 2007). Broad factors proposed to explain health disparities include genetic predisposition; social, behavioral, or cultural differences; access to health care; exposure to environmental toxicants; and stress related to minority and low socioeconomic status (Olden & White, 2005). Combined exposures to the latter two factors, such as increased traffic air pollutants and psychosocial stress, potentially affect many individuals in urban communities.Â Moreover, these risk factors often converge in overly-burdened communities with evident health disparities, including higher rates and severity of asthma. Exposures to diesel exhaust and other traffic-related air pollutants may be one factor increasing risk of asthma and asthma exacerbation in urban communities (Delfino, 2002; Olden & White, 2005). Two recent epidemiological studies suggest that psychosocial stress may interact with traffic air pollution in urban communities. Clougherty and colleagues found an elevated risk of asthma with increase in chronic exposure to nitrogen dioxide, an indicator for traffic pollution, only in children with above-median exposure to violence (Clougherty, et al., 2007). Chen and colleagues reported that chronic psychosocial stress interacted with chronic exposure to nitrogen dioxide to predict peak flow rates, symptoms, and intermediate markers among asthmatic children in Vancouver (Chen, Schreier, Strunk, & Brauer, 2008). Biological mechanisms or modes of action by which stress may interact with air pollution in asthma are not established. Paradoxically, the classic acute stress response, characterized by activation of the hypothalamic-pituitary-adrenocortical (HPA) and sympathetic-adrenal-medullary (SAM) axes, would appear to be protective in asthma. The stress hormones cortisol (HPA axis) and the catecholamines epinephrine and norepinephrine (SAM axis) have well-known anti-inflammatory and bronchodilatory effects, respectively (Chen & Miller, 2007). Activation of Spring 2012
these systems by acute psychological or physical stress (i.e. asthma triggers such as air pollution) should be homeostatic in asthma. In fact, beta-2 agonists and inhaled corticosteroids that act through the same pulmonary receptors as catecholamines and cortisol, respectively, are mainstays of asthma therapy. However, newer evidence suggests that chronic stress can lead to hyporesponsiveness of the HPA and/or SAM axes (Miller, Chen, & Zhou, 2007) that may lead to decreased protective acute stress responses and increased susceptibility to asthma triggers such as air pollutants. Supported by a new four year, $1.25 million USEPA STAR grant, a team of investigators from UMDNJ-Robert Wood Johnson Medical School and the Environmental and Occupational Health Sciences Institute in Piscataway, NJ is working with community members to better understand how chronic psychosocial stress modifies responses to traffic air pollutants among children with asthma in the Ironbound neighborhood of Newark, NJ. The project was developed in partnership with the Ironbound Community Corporation (ICC), the largest provider of social services in this diverse, lower-income neighborhood that struggles with a legacy of environmental contamination. Having gotten its name from the railroad tracks that bordered the neighborhood, today the Ironbound neighborhood is bounded by the Port of Newark and Elizabeth, the busiest seaport on the east coast, Liberty Airport, and Routes 1& 9, 278, and the NJ Turnpike. Residents are concerned about possible links between the high rates of asthma in the community and the diesel exhaust emitted by trucks servicing the seaport and local industry. With assistance from the ICC, the investigators will recruit 40 children, aged 9-14, with mild-to-moderate asthma. They will test the hypotheses that chronic stress interacts with air pollution to cause asthma exacerbation, and that this interaction is mediated by chronic stress-induced attenuation of the protective effects of the HPA and SAM axes. The team will measure each childâ€™s chronic stress using a validated interview, and acute responses to a laboratory stressor. They will measure personal exposures to black carbon, a marker for diesel exhaust, using small, lightweight monitors that the children will wear for several weeks. These real-time 25
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monitors will capture peaks of exposure to diesel exhaust while the children are outdoors. Daily, at-home measurements include symptoms, lung function and levels of nitric oxide in exhaled breath, a marker for airway inflammation. These data will be combined to evaluate how chronic stress modifies associations between worsening asthma and levels of traffic pollutants. â?– References Chen, E., & Miller, G. E. (2007). Stress and inflammation in exacerbations of asthma. Brain, Behavior, and Immunity, 21(8), 993-999. Chen, E., Schreier, H. M. C., Strunk, R. C., & Brauer, M. (2008). Chronic traffic-related air pollution and stress interact to predict biologic and clinical outcomes in asthma. Environmental Health Perspectives, 116(7), 970-975. Clougherty, J. E., Levy, J. I., Kubzansky, L. D., Ryan, P. B., Suglia, S. F., Canner, M. J., et al. (2007). Synergistic effects of
traffic-related air pollution and exposure to violence on urban asthma etiology. Environmental Health Perspectives, 115(8), 1140-1146. Delfino, R. J. (2002). Epidemiologic evidence for asthma and exposure to air toxics: linkages between occupational, indoor, and community air pollution research. Environmental Health Perspectives, 110 Suppl 4, 573-589. Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamicpituitary-adrenocortical axis in humans. Psychological Bulletin, 133(1), 25-45. Olden, K., & White, S. L. (2005). Health-related disparities: influence of environmental factors. Medical Clinics of North America, 89(4), 721-738. Wright, R. J., & Subramanian, S. V. (2007). Advancing a multilevel framework for epidemiologic research on asthma disparities. Chest, 132(5 Suppl), 757S-769S.
PSYCHOLOGIST OF THE YEAR & CITIZEN OF THE YEAR 2012 PSYCHOLOGIST OF THE YEAR NJPA members have the opportunity to recognize and nominate a fellow member who has made an outstanding contribution to the profession of psychology through demonstrated excellence in practice, research, or teaching.
2012 CITIZEN OF THE YEAR The Citizen of the Year is awarded to a non-psychologist who has made significant contributions to the ideals of mental health or social welfare. Nominations should consist of several paragraphs detailing why this individual deserves the honor. Supporting documentation may be enclosed. Recipients will be selected by the NJPA Executive Board based upon how well they meet the criteria of the award. Please take the time to think of someone you admire and/or appreciate that you wish to nominate. The deadline for submissions is June 1, 2012. Entries should be forwarded to: New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 Or email to: NJPA@PsychologyNJ.org
New Jersey Psychologist
Special Section: Environmental Hazards
Neurological Disorders: Exploring the Pesticide Link by Nichelle Harriott, MS Research Associate, Beyond Pesticides
esticides have been the dominant form of pest management in the US since World War II and are used to control insects (insecticides), weeds (herbicides), fungi (fungicides), bacteria (antimicrobials) and other unwanted organisms. Many of the pesticide chemicals utilized by this time were for military use. DDT, used for malarial control overseas during the war, had crossover success as the agent of choice for pest control in the US. It was not until Rachel Carson’s 1962 publication of her famous book, Silent Spring that the public was made aware of the lasting toxic legacy of DDT and other chemicals on human and wildlife alike. As a result of the public outrage and subsequent government regulatory action following Silent Spring, pesticides that are used today are registered by the US Environmental Protection Agency (EPA) that reviews toxicological data to assess risks to human health and the environment. Unfortunately, many dangerous pesticides are introduced to the consumer marketplace in spite of EPA’s regulatory oversight. These include the herbicide atrazine that has been found to contaminate rivers and cause sex reversal in amphibians (Hayes et al., 2009) and Roundup (glyphosate), the popular weed killer used on lawns and crops that has been linked to non-Hodgkin lymphoma (De Roos et al., 2003). Mostly due to political and corporate interferences, as well as numerous flaws in the risk assessment process including the rejection of a precautionary approach, pesticide chemicals are subject to inadequate regulatory standards. Many pesticides have been linked to cancer, hormone disruption, reproductive effects, and even learning and neuro-developmental disorders. Unfortunately many people are not aware that the bug spray used in homes, gardens, or on skin and even the chemicals sprayed on food crops, can cause serious adverse effects. Fortunately, safer alternatives exist to control common pests and include changes in cultural and biological practices like increased sanitation, use of methods to prevent and monitor pest populations, along with a growing availability of ‘greener,’ least-toxic pesticides and organic food. Various cancers, birth defects, neuro-developmental delays, and degenerative disorders, as well as reproductive effects have been linked to pesticide exposures. Those predisposed to asthma and asthmatic attacks can also have their symptoms triggered by pesticide use, especially in homes with poor ventilation. These chemicals can volatilize into ambient air,
leach into ground waters, and run-off from lawns and fields into surface and drinking waters. Exposure to pesticides can come not only though domestic uses of these chemicals in bug sprays, baits, or repellents but also through food and water. Over 800 million pounds of conventional pesticides are used in the US annually (USEPA, 2011), with 80 percent of this used in agriculture, inevitably contaminating food and water supplies. Pesticide residues found in food and water increases chemical body burden as evidenced by frequent detections of multiple pesticide metabolites in blood, urine, breast milk, and even umbilical cord blood. Conversely, mixtures of chemicals in the body or environment can undergo synergistic effects to produce heightened toxicity of each chemical, leading to higher risks of adverse impact (Cao et al., 2011; Christiansen et al., 2009). While the science has not been conclusive, it is widely believed that an individual’s chemical body burden may increase their risk for developing certain chronic diseases. Children are considered to be at greatest risk from pesticide toxicity because the developing brain and other organs are more susceptible to toxicants (Weiss, 2000). The National Academy of Sciences reports that children are more susceptible to chemicals than adults and estimates that 50% of lifetime pesticide exposure occurs during the first five years of life (NRC, 1993). Studies have shown that unborn children exposed to pesticide metabolites in their mother’s womb can develop neurobehavioral deficits along with reproductive effects including reduced sperm count (Anway et al., 2005) and hypospadias (Dugas et al., 2010). Studies show that children living in households where pesticides are routinely used suffer elevated rates of leukemia, brain cancer, and soft tissue sarcoma (Leiss & Savitz, 1995; Buckley et al., 1994). These statistics have led to some restrictions of certain pesticide use in residential settings. One example is chlorpyrifos, a highly neurotoxic organophosphate pesticide that was banned for indoor residential uses in 2000 due to risks posed to children (other uses still remain). Propoxur, a carbamate insecticide used in ant and roach sprays, was banned in 2007 for those indoor uses that result in high risks to children. Recently, certain rat poisons were also banned from homes. Pesticides and Learning/Behavioral Disorders According to the American Academy of Pediatrics, roughly 27
Special Section: Environmental Hazards
one in six children in the US have one or more developmental disability, ranging from a learning disability to a serious behavioral or emotional disorder (Boyle et al., 2011). Emerging science demonstrates that toxic chemicals in the environment that cause developmental and neurological damage in laboratory studies are contributing to the rise of physical and mental effects being found in children. Organophosphates like chlorpyrifos, malathion, and dichlorvos, used in community mosquito spraying programs and in certain baits, are extremely toxic to the nervous system. They are cholinesterase inhibitors and bind irreversibly to the active site of an enzyme essential for normal nerve impulse transmission, inactivating the enzyme that results in various neurological disruptions. Pesticides affecting estrogenic and androgenic hormones can also adversely affect neurodevelopment, causing deficits in cognitive functions in the developing fetus. (Garry, 2004). The thyroid hormone, part of the intricate endocrine system that regulates a number of biological processes in the body, including cell development in the brain (Ghisari & BonefeldJorgensen, 2005), can be disrupted by pesticidal agents. In laboratory studies with mice exposed to chlorpyrifos, learning latency and reduced learning ability were observed in female mice, suggesting that neuro-endocrine reprogramming is triggered by the chemical (Haviland, Butz, & Porter, 2010). Scientists believe that many neurological disorders observed in children, such as attention deficit hyperactivity disorder (ADHD) and autism, may be related to prenatal chemical disruption of the thyroid system (Colborn, 2004; Howdeshell, 2002). A University of California, Berkeley cohort study found that organophosphate exposure in pregnant women and their children was associated with attention related outcomes that were strong at five years and stronger in boys (Marks et al., 2010). In another study examining 119 children, those with higher urinary concentrations of organophosphate metabolites were more likely to be diagnosed as having ADHD, compared with children with undetectable levels (Bouchard, Bouchard, Bellinger, Wright & Weisskopf, 2010). Studies also highlight low-income families, especially African-American and Latino children, as being disproportionately affected by pesticide exposures. For example, highly exposed infants, in a cohort study of inner-city families evaluating chlorpyrifos exposures, were significantly more likely to experience psychomotor development and mental development delays, attention problems, ADHD problems, and pervasive developmental disorder problems at three years of age (Rauh et al., 2006). Similarly, researchers have begun to observe a link between certain pesticide exposures and autism spectrum disorders in children. While the science is preliminary, researchers have observed that residential areas in close proximity to agricultural fields have higher rates of children with autism (Roberts et al., 2007) and have indicated the need for more study. The scientific database has come quite far in documenting the neurological effects pesticides can inflict on young children. These adverse, long-term impacts begin at a critical 28
stage of a child’s neurological development – in the womb. Other effects of exposure include physical and mental retardation, alterations of the cardiovascular system and musculoskeletal defects, alterations of the menstrual cycle, obesity, and failure to develop secondary sex characteristics (Beyond Pesticides, 2011). Pesticides and Neurodegenerative Diseases While serious long-term effects of pesticide exposures can begin in the womb, some effects can manifest much later in life. For many neurological degenerative diseases like Parkinson’s disease (PD), scientists have looked to genetics to explain the phenomena. However, the epidemiological and toxicological evidence have found that genetics cannot be the only defining cause for these disorders. While a number of causative factors have been recognized as inducing PD including vascular insults to the brain, repeated head trauma, and the use of neuroleptic drugs, repeated exposures to pesticides have been implicated, along with specific genepesticide interactions as being significant adverse risk factors that contribute to PD. According to Brown et al., (2006) duration of exposure to pesticides can be a risk factor, with those exposed to pesticides for more than ten or 20 years being associated with an increased risk of developing PD. More often than not, occupational exposures have been found to play a role in PD etiology. The significance of this role is yet to be determined. Nevertheless, positive associations between PD and overall occupational pesticide use, particularly with the insecticide classes, organochlorines and organophosphates, have been established, with associations stronger in men (Moisan et al., 2010; Elbaz et al., 2009). Other data show that regardless of profession the link between pesticide use and the onset of PD is significant. For instance, a 2006 study with over 7,000 participants of varying professions found that individuals exposed to pesticides had a 70% higher incidence of PD than those not exposed (Ascherio et al., 2006). Related data have also reported consistent elevation in the risk of PD with exposure to environmental factors such as rural living and drinking well water, along with farming (Priyadarshi, Khuder, Schaub & Privadarshi, 2001). According to current research, people exposed to chemicals that have a particular affinity to damage proteins in the substantia nigra region of the brain and cause mitochondrial dysfunction or oxidative stress may be at particular risk for developing PD and similar neurological diseases (Tanner et al., 2011). Most studies have focused on the insecticides rotenone and paraquat as well as organophosphate insecticides, but some have found neurotoxic effects from other pesticides, including fungicides and fumigants. Other neurodegenerative diseases like dementia have associations with neurotoxic pesticides. Alzheimer’s disease has been linked to pesticide exposures as well, but the data on this have been conflicting. However, a large Canadian casecontrol study found that occupational exposure to pesticides and fertilizers was associated with risk of Alzheimer’s disease New Jersey Psychologist
Special Section: Environmental Hazards
(Lindsay, 1994). Similarly, in a French study, researchers observed that the relative risks of developing PD and Alzheimer’s disease through occupational exposures were five times higher in men (Baldi et al., 2003) and recently Parrón et al. (2011), after examining a total of 17,429 hospital records collected between 1998 and 2005, found that the prevalence rates and the risk of having Alzheimer’s disease and PD were significantly higher in districts with greater pesticide use as compared to those with lower pesticide use. Although the available data can have methodological limitations, overall it shows that there is a relationship between neurological disorders and pesticides that warrants further exploration. Exposure to pesticides can negatively affect the nervous system, leading to headache, dizziness, weakness, blurred vision, and other short-term symptoms with chronic effects lasting a lifetime. Researchers at the National Institute for Environmental Health Sciences (NIEHS) note that some people may be more sensitive to the effects of pesticide compounds than others, while infants and children appear to be the most vulnerable. It is therefore important, given the data, that clinicians advise and educate patients about prevention of exposure and the use of safer alternatives, especially in populations living in agricultural areas or where household pesticide use is common (Rosas & Eskenazi, 2008). Understanding the role that commonly used pesticide chemicals play in impacting neurological disorders and other types of chronic effects will go a long way in not only changing cultural and biological practices relating to their use, but will also change current reactionary regulatory approaches into precautionary ones. ❖ References Anway, M., Cupp, A.S., Uzumcu, M., & Skinner, M.K. (2005). Epigenetic Transgenerational `1Actions of Endocrine Disruptors and Male Fertility. Science, 308 no. 5727 pp. 1466-1469. Ascherio, A., Chen, H., Weisskopf, M.G., O’Reilly, E., McCullough, M.L., Calle, E.E., et al. (2006). Pesticide exposure and risk for Parkinson’s disease. Annals of Neurology, 60(2):197-203. Baldi, I., Cantagrel, A., Lebailly, P., Tison, F., Dubroca, B., Chrysostome, V., et al. (2003). Association between Parkinson’s disease and exposure to pesticides in southwestern France. Neuroepidemiology, 22(5):305-10. Beyond Pesticides. (2011). Pesticide-Induced Disease Database. Washington DC. <http://www.beyondpesticides.org/ health/index.htm > Bouchard, M., Bouchard, M.F., Bellinger, D.C., Wright, R.O., & Weisskopf, M.G. (2010). Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides. Pediatrics, 125(6); 1270-1277. Boyle, C. A., Boulet, S., Schieve, L.A., Cohen, R.A., Blumberg, S.J., et al. (2011). Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008 Pediatrics, doi: 10.1542/peds. 2010-2989. Spring 2012
Buckley, J.D., Buckley, C.M., Ruccione, K., Sather, H.N., Waskerwitz, M.J., Woods, W.G., et al. (1994). Epidemiological characteristics of Childhood Acute Lymphocytic Leukemia. Leukemia, 8(5):856-864. Brown, T.P., Rumsby, P.C., Capleton, A.C., Ruston, L., & Levy, L.S. (2006). Pesticides and Parkinson’s Disease—Is There a Link? Environmental Health Perspectives, 114(2):156-164. Cao, Z., Shafer, T.J., Crofton, K.M., Gennings, C., & Murrary, T.F. (2011). Additivity of pyrethroid actions on sodium influx in cerebrocortical neurons in primary culture. Environ Health Perspect, 119:1239-1246. Christiansen, S., Scholze, M., Dalgaard, M., Vinggaard, A.M., Axelstad, M., Kortenkamp, A., et al. (2009). Synergistic Disruption of External Male Sex Organ Development by a Mixture of Four Antiandrogens. Environ Health Perspect, 117:1839-1846. Colborn, T. (2004). Neurodevelopment and Endocrine Disruption. Environmental Health Perspectives, 112(9): 944-949. De Roos, A.J., Zahm, S., Cantor, K., Weisenburger, D., Holmes, F., Burmeister, L., et al. (2003). Integrative assessment of multiple pesticides as risk factors for non-Hodgkin’s lymphoma among men. Occup Environ Med, 60(9): E11. Dugas, J., Nienwenhuijsen, M.J., Martinez, D., Iszatt, N., Nelson, P., & Elliott, P. (2009). Use of biocides and insect repellents and risk of hypospadias. Occup Environ Med, 67(3):196-200. Elbaz, A., Clavel, J., Rathouz, P.J., Moisan, F., Galanaud, J.P., Delemotte, B., et al. (2009). Professional exposure to pesticides and Parkinson disease. Ann Neurol, 66(4):494–504. Garry, V.F. (2004). Pesticides and children. Toxicology and Applied Pharmacology, 198(2): p.152-163. Ghisari, M. & Bonefeld-Jorgensen, E.C. (2005). Impact of environmental chemicals on the thyroid hormone function in pituitary rat GH3 cells. Molecular and Cellular Endocrinology, 244(1-2): 31-41. Haviland J.A., Butz D.E., & Porter W.P. (2010). Long-term sex selective hormonal and behavior alterations in mice exposed to low doses of chlorpyrifos in utero. Reprod Toxicol, 29(1):74-9. Hayes, T., Khoury, V., Narayan, A., Nazir, M., Park, A., Brown, T., et al. (2009). Atrazine induces complete feminization and chemical castration in male African clawed frogs (Xenopus laevis). PNAS, 107(10): 4612–4617. Howdeshell, K.L. (2002). A Model of the Development of the Brain as a Construct of the Thyroid System. Environ Health Perspect, 110(S 3): 337-48. Leiss, J. & Savitz, D.A. (1995). Home Pesticide Use and Childhood Cancer: A Case-Control Study. American Journal of Public Health, 85:249-252 Lindsay, J., Laurin, D., Verreault, R., Hebert, R., Helliwell, B., Hill, G.B., et al. (1994). The Canadian study of health and aging: risk factors for Alzheimer’s disease in Canada. Neurology, 44:2073–2080. Marks, A.R., Harley, K., Bradman, A., Kogut, K., Barr, D., Johnson, C., et al. (2010). Organophosphate Pesticide Exposure 29
Special Section: Environmental Hazards and Attention in Young Mexican-American Children: The CHAMACOS Study. Environ Health Perspect, 118:17681774. Moisan, F., Spinosa, J., Dupupet, J.L., Delabre, L., Mazurie, J.L., Goldberg, M., et al. (2010). The relation between type of farming and prevalence of Parkinson’s disease among agricultural workers in five french districts. Movement Disorders, 26(2):271–279. National Research Council (NRC). (1993). Pesticides in the Diets of Infants and Children, National Academy of Sciences. National Academy Press, Washington, DC. 184-185. Parrón, T., Requena, M., Hernández, A.F., & Alarcón, R. (2011). Association between environmental exposure to pesticides and neurodegenerative diseases. Toxicol Appl Pharmacol, 256(3):379-85. Priyadarshi, A., Khuder, S.A., Schaub, E.A., & Privadarshi, S.S.. (2001). Environmental Risk Factors and Parkinson’s Disease: A Metaanalysis. Environ Res, 86(2):122-127
Rauh, V., Garfinkel, R., Perera, F., Andrews, H., Hoepner, L., Barr, D. (2006). Impact of Prenatal Chlorpyrifos Exposure on Neurodevelopment in the First 3 Years of Life Among Inner-City Children. Pediatrics, 118(6) e1845-e1859 Roberts, E.M., English, P.B., Grether, J.K., Windham, G.C., Somberg, L., Wolff, C. (2007). Maternal Residence Near Agricultural Pesticide Applications and Autism Spectrum Disorders among Children in the California Central Valley. Environ Health Perspect, 115:1482-1489. Rosas, L.G. & Eskenazi, B. (2008). Pesticides and child neurodevelopment. Curr Opin Pediatr, 20(2):191-7. Tanner, C.M., et al. (2011). Rotenone, paraquat, and Parkinson’s disease. Environ Health Perspect, 119(6):866-72. USEPA. (2011). 2006-2007 Pesticide Market Estimates. Washington DC. <http://www.epa.gov/opp00001/pestsales/07pest sales/introduction2007.htm> Weiss, B. (2000). Vulnerability of Children and the Developing Brain to Neurotoxic Hazards. Environ Health Perspect, 108, suppl 3:375-381.
2012 Research and Teaching Awards The Distinguished Researcher Award is given to a psychologist who has a distinguished record of research in any area of psychology and holds a full-time academic or scientific position. Awardee receives a certificate and $300. The Distinguished Teacher Award is given to a psychologist who has a distinguished record of teaching in any area of psychology and holds a full-time academic or scientific position. Awardee receives a certificate and $300. The Emerging Researcher Award is given to a psychologist who has made a substantial contribution to research in any area of psychology, is a full-time academician or scientist, and has received a doctoral degree within the past 10 years. Awardee receives a certificate and $100. Nominations should include: • Name and terminal degree of candidate, institutional affiliation • Address and telephone number/email of candidate • 2 copies of a 500-word statement describing the candidate's achievements and contributions • Abstracts of any relevant work • Curriculum vita • Three letters of endorsement including the endorser's credentials
Mail to: Kathleen Torsney, PhD Director, Academic Affairs New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052
Deadline for nominations is July 13, 2012. Self-nominations are encouraged. Nominees need not be members of NJPA. The Committee on Academic and Scientific Affairs reserves the right to make all final determinations on which awardees will be selected.
Master’s Thesis and Doctoral Dissertation Awards The New Jersey Psychological Association’s Academic and Scientific Affairs Committee is seeking nominations for the best Master’s Thesis and Doctoral Dissertation from any specialty within a psychology graduate program in New Jersey. They should be superior in quality, design, and especially, represent a significant contribution to psychology or society as a whole. Each graduate program is asked to nominate one student in each category and forward two copies (photocopies acceptable) of the thesis/dissertation to the New Jersey Psychological Association by June 29, 2012. Please provide contact information for the student as well as the school. Awardees will be honored with a special citation at the NJPA 2012 Fall Conference on October 20, 2012.
Please send two copies directly to: Kathleen Torsney, PhD, Director of Academic Affairs to: NJPA, 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052
New Jersey Psychologist
Special Section: Environmental Hazards
Awash in a Sea of Toxic Chemicals – Moving From Concern to Empowerment by Lynn Thorp, National Campaigns Director Clean Water Action <www.cleanwateraction.org>
here is no shortage of information on the association between toxic chemicals and chronic disease, health problems, and ecological impacts. All of us are exposed to a dizzying array of toxic chemicals in our homes, at work, in what we eat and drink, and in the ambient environment. Many of these chemicals are increasingly associated with health problems that are epidemic in our society. We have all met parents who worry excessively over their children’s exposures, understandable in the face of news about bisphenol A (BPA) in baby bottles and flame-retardants in mattress covers. We also encounter informed people who exhibit something resembling psychic numbing, or at least a jaded approach that somehow it must be impossible to live our modern life without toxic chemicals or someone would have done it. What is needed isn’t increased consumer anxiety nor a laissez-faire attitude, but rather informed understanding and empowerment. We have never known more about the toxic stew that we have created, but we have also never known more about how to get out of it. From the halls of the US Congress to the shopping cart, these solutions are within reach.
What’s the Problem? We’re using an enormous amount of toxic chemicals: Chemical use in the United States has increased dramatically since World War II; we now produce or import 42 billion pounds of chemicals each day and bio-monitoring studies confirm the presence of over 200 synthetic chemicals in our blood and urine. We can link common chemicals to health problems: There is a significant increase in the incidence of certain cancers for which we have evidence of association with toxic chemical exposure. The president’s cancer panel recently reported that while there is much we do not know, we know enough now to act. Commonly used chemicals are linked to impacts on the human brain – for example learning problems - and to nervous system damage – for example dementia and Parkinson’s disease. Chemical exposures are also linked to asthma, reproductive and metabolic problems, and more. Some of the most disturbing new evidence involves epidemics that confound public health professionals. For example, researchers have identified some chemicals as “obesogens,” meaning that they interfere with normal biological processes to encourage the development of fat cells. Given Spring 2012
a nationwide epidemic of obesity among adults and children, such a revelation is inspiring new calls for action. Our policy and legal systems have a tendency to stagnate pending absolute proof of causation. Unfortunately, that is just now how the science around toxic chemicals and health impacts works. We may never find the proverbial “smoking gun,” but one thing is certain: The more we look the more we find about the association between chemicals and health problems, and we cannot afford to wait any longer. Someone always pays: Challenging our current chemical economy is not a question of a costly program that we cannot afford. In fact, what we cannot afford is to keep passing the costs of the rampant use of toxic chemicals on to consumers and communities. The increases in healthcare costs stemming from out-of-control toxic chemical exposure are not being paid for by the chemical manufacturers. Drinking water is a perfect example of the problem of externalized costs. In the coming months, regulators and Public Water Systems (the regulated entities from which 85% of us get our drinking water) will deal with issues ripped from the headlines – perchlorate, lead, and hexavelent chromium. We knew enough decades ago to have prevented a large share of these drinking water contamination problems, and now the burden is right where it does NOT belong – on communities and consumers. Our national policies are woefully out of date and ineffective: The Toxics Substances and Control Act (TSCA) is our primary chemical management law, though there are other important programs including the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), that covers pesticides. Since it was passed in 1976, TSCA has been used to restrict some uses of only five chemicals. For the 60,000 chemicals that were “grandfathered in” when the law passed, full testing has only been conducted on 200. TSCA’s weaknesses include requiring the government to prove a chemical is dangerous rather than requiring chemical manufacturers to prove it is safe, allowing too many “secret” ingredients in chemicals and an inability to be used to control the worst chemicals. What Can We Do About This Problem? Policy – We Can Do Better Our national chemical policy program can be fixed, and there is an unprecedented movement to get this done. Increasing concern about health impacts, new chemical policies in 31
Special Section: Environmental Hazards
the European Union, and other forces have led to the most serious progress on reforming the Toxic Substances Control Act in decades. Bills have been introduced, there is bi-partisan support, hearings are being held, and tough negotiations are underway. Hundreds of organizations from a wide range of advocacy, health, labor, and other perspectives make up the Safe Chemicals Healthy Families coalition, and support a basic set of principles for reform of the law, including: 1) we need to act immediately on the worst toxic chemicals; 2) chemical manufacturers should be responsible for providing information on the chemicals they produce; and 3) some people in our society are especially vulnerable, including children, and pregnant women. Some in our society are also bearing disparate impacts of toxic exposures, including people of color and indigenous people. We need to use the best science available to ensure that our national chemical policies are there to protect all of us, especially the most vulnerable. Reforming TSCA is not the only improvement that is needed, but it is fundamental. There is widespread support for related efforts, such as The Safe Cosmetics Act (H.R.2359) that would increase the ability of the Food and Drug Administration to keep harmful chemicals out of personal care products. You can learn more and get involved in modernizing our national toxic chemicals policies from the Safer Chemicals Healthy Families Coalition at www.saferchemicals.org The Marketplace – Encouraging Innovation Increased public concern about toxic chemicals in products can lead to positive change by chemical users. The Campaign for Safe Cosmetics has worked tirelessly to inform people about toxic chemicals in cosmetics and personal care products, and to win commitments from manufacturers to switch to safer alternatives. Just recently, their efforts led to a commitment by Johnson & Johnson to eliminate formaldehyde-releasing chemicals in the company’s baby products. The Healthy Building Network has helped consumers and green building professionals access the latest science and product information to drive building professionals away from highly toxic materials like polyvinylchloride (PVC) plastic. These and numerous other organizations and projects are demonstrating that alternatives are available and that we can “detox” our economy. The benefits for consumers, workers, and the companies that lead these innovations are immense. Personal Choices While we cannot shop our way out of this problem, there are many resources for those who want to use their buying power to support safer alternatives and to limit exposures for their families, friends, co-workers, and themselves. Some places to start: Cosmetics: The Campaign for Safe Cosmetics provides information on risks from product ingredients, on companies who are moving away from toxic ingredients and on cosmetics laws. <http://safecosmetics.org/> 32
Pesticides: Beyond Pesticides is a good place to start to learn about pesticides issues and how to reduce our use of and exposure to harmful pesticides. <http://www.beyondpesticides.org/> BPA and other cancer-causing chemicals: The Breast Cancer Fund is a resource for information on reducing exposures to bisphenol A (BPA) and other harmful chemicals. <http://www.breastcancerfund.org/> Building Materials: The Healthy Building Network is transforming the market for business materials to advance the best environmental health and social practice. <http://www.healthy building.net/HBN> State and Federal Policy: Clean Water Action and its state offices, including the New Jersey Environmental Federation, are working with allies nationwide to win smarter chemical policies. <http://www.cleanwateraction.org/> and <http://www.cleanwateraction.org/state_focus/njef> ADDITIONAL RESOURCES Designing a Chemically Safer Future, New Solutions: A Journal of Environmental and Occupational Health Policy (Special Issue), Volume 21, Number 3 / 2011. Grün, F & Blumberg, B. (2007) Perturbed nuclear receptor signaling by environmental obesogens as emerging factors in the obesity crisis. Reviews in Endocrinology and Metabolism, 8, 161-171. Leffall, Jr., LaSalle D. & Kripke, Margaret L. Reducing Environmental Cancer Risk: What We Can Do Now, Department of Health and Human Services, National Institutes of Health, President’s Cancer Panel, April 2010. Safer Chemicals Healthy Families, A platform for the reform of the Toxic Substances Control Act, <http://www.saferchemicals.org/about/platform-for-reform.html>. US Government Accountability Office, Chemical Regulation: Options Exist to Improve EPA’s Ability to Assess Health Risks and Manage Its Chemical Review Program (GAO05-458), June 2005. US Environmental Protection Agency, Essential Principles for Reform of Chemicals Management Legislation, <http:// www.epa.gov/opptintr/existingchemicals/pubs/principles. html>.
New Jersey Psychologist
Psychological Research and Practice: A Forum For Discussing and Applying Research To Practice by Sarah Seung-McFarland, PhD St. Peter’s University Hospital, New Brunswick, NJ
he big day is finally here. After years of studying, practicums, internship, supervision, and licensure you are finally ready to see your first client in private practice. You feel pretty secure in the orientation that will guide you. You have a working understanding of your client’s problems and a good sense of the interventions you will use. That is, until you read the latest research on [fill in]. You believe it is your ethical responsibility to incorporate the research into your work, but what factors will you consider to determine whether and how you use the research? Perhaps there isn’t enough evidence to suggest that the research works; or perhaps it’s unclear how to incorporate the research. On the other hand, perhaps it is inconsistent with how you view your clients or their presenting problems. Let us consider another scenario. You are a seasoned professional. You know your clients and their presenting issues well and are quite experienced in performing psychological assessments. You are comfortable with what you know and quite frankly with what you don’t know. Nevertheless, you have read the latest research on [fill in] and are intrigued. But how much of your practice will be impacted by this latest research? Perhaps there are logistical and/or time constraints that prevent you from incorporating the research effectively; perhaps you have tried a few techniques and do not find them helpful; or perhaps you believe the research to be more useful in theory than in practice. Given these hypothetical scenarios, what would be consistent with best practice? And how and when do we translate research findings into practice? Our new column, Psychological Research and Practice, will attempt to address many of these issues. The format will include featured research studies and/or interviews with scientist-practitioners and shared expertise or experiences from our readers. This is in accordance with Standard 2.04 of the APA Ethics Code, Bases for Scientific and Professional Judgments (APA, 2002) that states, “Psychologist’s work is based upon established scientific and professional knowledge of the discipline” (p.1064). All our readers are kindly invited to email their contributions to me at firstname.lastname@example.org. In an effort to provide a framework for this column, it is necessary to have a working understanding of what is meant by best practices. Despite different perspectives on the issue, the idea of best practices is usually synonymous with evidencebased practice in psychology-otherwise known as EBPP. Spring 2012
According to the APA 2005 Presidential Task Force, EBPP is defined as the “integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (American Psychological Association Presidential Task Force, 2006, p. 273). An important consideration is how to be increasingly attuned to the components of EBPP as we render psychological services. According to the APA policy statement, “…clinicians use their best clinical judgment and knowledge of the best available research evidence to develop coherent treatment strategies” (American Psychological Association Presidential Task Force, 2006 p. 275). Notably, there are many disorders for which there is limited research, and the best treatment cannot be identified for every condition. This is where creative exploration plays a role. It is up to psychologists to know when to use a particular treatment or modality, when to modify it, and when to focus on other components of the evidence-based framework (Babione, 2010). Knowledge can also be attained through accumulated clinical experiences transmitted through personal testimony, continuing education, and one’s own personal clinical experience (Altmaier, 2011). In essence, there are different theoretical perspectives and attitudes that impact how we approach the idea of best practices. I look forward to bringing many of these issues to the fore, discussing them, and invite our readers to be part of the process of exploration regarding best practices and applying research to practice. Again, please send your ideas to email@example.com. ❖ References Altmaier, E. M. (2011). Best practices in counseling grief and loss: Finding benefit from trauma. Journal of Mental Health Counseling, 33, 33-45. American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073. APA Presidential Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285. Babione, J. M. (2010). Evidence-Based Practice in Psychology: An ethical framework for graduate education, clinical training, and maintaining professional competence, Ethics & Behavior, 20(6), 443-453. 33
NJPA acknowledges 2012 Sustaining Members By advancing your level of membership to Sustaining Membership status, you have generously demonstrated your additional support of your professional association. We thank you for your commitment and dedication to your organization!
Rika Alper, PhD Amy Altenhaus, PhD Jeffrey Axelbank, PsyD John Aylward, EdD Thomas Barrett, PhD Lara Baskin, PhD Lauren Becker, PhD Leslie Becker-Phelps, PhD Margaret Beekman, PhD Roderick Bennett, PhD Janet Berson, PhD Mary Blakeslee, PhD Philip Bobrove, PhD Richard Brewster, PsyD Daniel Bromberg, PhD Charles Buchbauer, PhD Susan Buckley, PsyD Diane Cabush, PsyD Sidney Cohen, PhD Louise Conley, PhD John Corbisiero, PhD Stephanie Coyne, PhD Kathleen Cullina-Bessey, PsyD Richard Dauber, PhD Deborah Dawson, PsyD John Diepold, PhD Charles Dodgen, PhD Rosalind Dorlen, PsyD Michael Dribbon, PhD Lynn Egan, PsyD Donna English, PhD Susan Esquilin, PhD Anne Evers, PhD Sean Evers, PhD Brian Farran, PhD Janie Feldman, PsyD Ellen Fenster-Kuehl, PhD Resa Fogel, PhD Pamela Foley, PhD Kenneth Freundlich, PhD Thomas Frio, PhD Joseph Ganz, PhD Stephen Garbarini, PsyD David Gelber, PhD
Marc Geller, PsyD Dawn Gemeinhardt, PhD Leslie Gilbert, PhD Debra Gill, PhD Larry Gingold, PsyD Elizabeth Goldberg, PhD Gary Goldberg, PhD Lori Goldblatt, PsyD Wayne Goldman, PhD Lois Goorwitz, PhD Ora Gourarie, PsyD Luise Gray, PsyD Lisa Greenberg, PhD Susan Grossbard, PsyD Lori Grossi Rayner, EdD Mathias Hagovsky, PhD Lawrence Hall, PhD Osna Haller, EdD Raymond Hanbury, PhD Jennifer Hanych, PhD Steven Hartman, PhD Douglas Haymaker, PhD Gladys Hirschorn, PhD Jane Hochberg, PsyD Christine Hudson, PhD Glendessa Insabella, PhD Lisa Jacobs, PhD Thomas Johnson, EdD Nancy Just, PhD Jeffrey Kahn, PhD Robert Karlin, PhD Barry Katz, PhD Charles Katz, PhD Roberta Katz, PhD Toby Kaufman, PhD Kristine Keane, PsyD Richard Kessler, PhD Joel Kleinman, PhD Deirdre Kramer, PhD David Krauss, PhD Stephen Kuwent, PsyD Phyllis Lakin, PhD Robin Lang, PsyD Roman Lemega, PhD
William Linden, PhD Neal Litinger, PhD Rebecca Loomis, PhD Mark Lowenthal, PsyD Marilyn Lyga, PhD Jonathan Mack, PsyD Stanley Mandel, EdD Phyllis Marganoff, EdD Bonnie Markham, PhD, PsyD Neil Massoth, PhD Frank McElroy, PhD John McInerney, PhD Kenneth McNiel, PhD David Mednick, PsyD Marshall Mintz, PsyD Barry Mitchell, PsyD Norine Mohle, PhD Lynn Mollick, PhD Ruth Mollod, PhD Sharon Ryan Montgomery, PsyD Leila Moore, EdD Sandra Morrow, PhD Daniel Moss, PhD Susan Neigher, PhD Cheryl Notari, PhD Rose Oosting, PhD James Owen, PsyD David Panzer, PsyD Francesca Peckman, PsyD Carmen Pelaez, PsyD Mark Pesner, PhD Ann Rasmussen, PsyD John Rathauser, PhD Gina Rayfield, PhD AnnaMarie Resnikoff, PhD Mary Roberts, PhD Debra Roelke, PhD Robert Rosenbaum, EdD Barbara Rosenberg, PhD Lori Rosenberg, PsyD Gina Rudolph, PsyD Anne Rybowski, PhD Carole Salvador, PsyD George Sanders, PhD
Lynn Schiller, PhD Nancie Senet, PhD Eileen Senior, PsyD Arline Shaffer, PhD Brian Shannon, PhD Edmund Shimberg, PhD William Shinefield, PsyD Ronald Silikovitz, PhD Jeffrey Singer, PhD Jeffrey Spector, PsyD Milton Spett, PhD Ann Stainton, PhD Barbara Starr, EdD Jakob Steinberg, PhD Lois Steinberg, PhD Deana Stevens, PsyD Jeffrey Stone, PhD Ben Susswein, PhD Anthony Tasso, PhD H. Augustus Taylor, PhD Tamsen Thorpe, PhD Barbara Tocco, EdD Janine Tremblay, PhD Carol Turner, EdD Elizabeth Vergoz, PhD Claire Vernaleken, PhD Kathleen Waldron, PhD Jonathan Wall, PsyD Beth Watchman, PhD Virginia Waters, PhD Daniel Watter, EdD Mark Weiner, PsyD Ida Welsh, PhD Aaron Welt, PhD Skye Wilson, PhD Gail Winbury-Klizas, PsyD Philip Witt, PhD James Wulach, PhD, JD Michael Zampardi, PhD Stanley Zebrowski, PhD Michael Zito, PhD Jeannine Zoppi, PhD Harold Zullow, PhD Michael Zito, PhD
Show your support and join your colleagues by becoming a Sustaining Member! Receive free enrollment in the Referral Service, a free Membership Directory and Handbook, CE discounts, and special public recognition. 34
New Jersey Psychologist
Anatomy of an Epidemic by Robert Whitaker New York: Crown Publishers Reviewed by Claire Vernaleken PhD
racticing psychologists may be initially skeptical of Anatomy of an Epidemic. Robert Whitaker, neither a health care practitioner nor a researcher, is an award winning writer who has served as a watch dog on the use of pharmacological research and practice that has demonstrated the dangerous 20-year trend between 1974 -1994 of worsened treatment outcomes for people with schizophrenia, depression, ADHD, and bipolar disorder, as well as the surprising finding that schizophrenic individuals from poorer countries demonstrate better outcomes than wealthier countries, with a possible explanation being that individuals in less wealthy countries receive less medications than others. Whitaker explains that the 50-year rise in biologically based treatments beginning with Thorazine and moving towards the SSRIs, should have plausibly led to a reduction of psychopathology and disability from psychiatric conditions. However, this has not been the case. Whitaker highlights the opposite trend: a greater percentage of adults and children being diagnosed with mental disorders over this time span. Whitaker also investigates the development of many pharmacological agents by his review of medical libraries dating back to the 1800s. The author reveals how many commonly used psychotropic medications were “discovered” by happenstance, how medications designed for non-psychiatric purposes soon became a psychiatric staple based on their emotional and behavioral side effects. This means that many of the most widely used “psychotropic” treatments were not specifically developed for the mentally ill. Thorazine, Miltown, and Marsiled, for example, were developed for the treatment of infectious diseases but were discovered to alter mood, behavior, and thinking with such side effects presumable to help psychotic patients. Additionally, Chlorpromazine, a major tranquilizer, acted similarly to a frontal lobotomy while Meprobomate, a minor tranquilizer, blocked emotional responsiveness. The chemical imbalance theory was created from the idea that these drugs altered something and that was sure to mean there was a biological abnormality present. Whitaker examines the limitations of “double blind” methods within psychiatric research by reporting on the typically short-term durations of most clinical trials, usually no more than six weeks, and how many results revealed there were higher rehospitalizations rates for patients taking the drug than within the placebo group. There is also a questionable utility
to “double blind” when both administrator and patient know an active drug is being used rather than placebo, where unlike drugs that do not alter mood or behavior, the patient and doctor will observe drug effects. Why did some patients become more vulnerable to psychosis over the long-term when using these drugs? By the 1970s, there was more evidence to suggest the counterproductive effects of medications in treatment for mental disorders, including depression, bipolar disorder, anxiety disorders, and ADHD than was previously discussed and those treated with drugs seemed to have poorer recovery rates than those treated without medications. Whitaker discusses the use of current cocktails and references data by stating “400,000 children with newly diagnosed bipolar disorder arriving via the ADHD doorway and 500,000 through the antidepressant doorway.” He alluded to the issue of drug side effects and withdrawal symptoms being similar to DSM-IV diagnostic criteria. He reports one study after another where presumably the “chemical imbalance” view of psychopathology is unsupported and proposes that psychotropics may have a negative impact in the context of no clearly defined biological causation or dysfunction. Anatomy of an Epidemic also reports on data linking neurotransmitters to mental illness: serotonin to depression and dopamine to schizophrenia and how studies at major universities and institutes failed to support the notion that 5-HIAA (5-hyrdoxyindole acetic acid), a metabolite of serotonin, would be low in psychiatric individuals and that within groups of psychiatric and non-psychiatric subjects there was wide variability. Similar studies on the role of dopamine failed to support the premise of elevated dopamine levels in schizophrenics and additional research suggested that individuals on long-term psychotropic medications were hypersensitive to dopamine. By the 1980s, the dopamine theory of schizophrenia had been challenged. In 2001, Steve Hyman, now provost of Harvard University, then the Director of NIMH, confirmed that antipsychotics and antidepressants do not normalize brain chemistry, they disturb it. Because of the disturbance of the bodies own normal feedback loops, that is the titration of chemical levels in relation to the body’s production, patients treated with these drugs now had a disturbance in their own capacities to produce or shut down these chemicals. A closing section of the book directly implicates the role of money in mental illness and the ways it stimulates the continued championing of medications in mental illness. “Bipolar 35
disease, once very rare, is now said to inflict 1-2 percent of the adult population and if the ‘intermediate’ bipolar disease is to be counted, 6 percent” Whitaker reports. As this diagnostic expansion happened, pharmaceutical companies and their allies mounted “educational” campaigns making both the illness and medications household names. There is lots of money in mental illness: money not in the form of documented and reliable treatment but in the production of drugs, asserts Whitaker. And if we believe what is unproven, we are wasting valuable time and resources and contributing to suffering.
Anatomy of an Epidemic is sure to transfix the reader. A riveting text challenging commonly held beliefs about biology, mental illness, and the role of medications, there surely will be those within and outside the health care field who question Whitaker’s assertions, potential biases, and his credibility, given he is not a researcher or practitioner. To that, I urge one to read the book, as it is a must-read for mental health professionals. ❖
CALL FOR POSTERS The New Jersey Psychological Association encourages dissemination of research by NJ psychologists to other psychologists in the state. It seeks to encourage development of research by psychologists, whether they are novices or established in research endeavors. NJPA invites data-based research or theoretical presentations on any topic of interest to psychologists to be presented as a poster for its 2012 Fall Conference. Posters may be submitted by graduate or undergraduate student researchers as well as any other academic, applied, or research psychologist. Those submitting do not need to be members of NJPA. However, student research should be endorsed by a faculty member. The deadline for all proposals is July 13, 2012 and should include following information: • Title of proposed presentation • Author’s name, academic degree, address, telephone and email • Institutional affiliation • Faculty sponsor (if the author is a student researcher) with institutional affiliation and contact information • One page abstract including a description of methods and results Poster sessions will be scheduled during the morning at the NJPA Fall Conference on October 20, 2012. Abstracts will be distributed at the conference. Submissions should be sent either electronically or by hard copy to: New Jersey Psychological Association Academic & Scientific Affairs Committee 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052 NJPA@PsychologyNJ.org Inquiries should be directed to: Ilyse O’Desky, PsyD; firstname.lastname@example.org
Share your ideas with us! Do you have an interest in a particular area in the field of psychology and are keeping up with the latest literature and research that you would like to share with your colleagues? We would like to speak to you! Consider sharing your knowledge in a submission for a future “What’s New” article. Exchange your ideas with Herman Huber at email@example.com.
New Jersey Psychologist
APA Council Report
Council of Representatives Meeting Report – February 2012 by Neil A. Massoth, PhD
espite some problems in attracting new members, APA is doing well both financially and in terms of service to members. With recruitment difficulties and the aging of membership (conversion to reduced dues programs), dues revenues are lower. Council approved the 2012 Proposed Budget with a total operational revenue of $105,172,100 and operational expenses of $104,893,900. Council also approved a 2012-2014 Financial Forecast and Net Asset Allocation Plan following review by the Finance Committee and the Board of Directors. Important aspects of the Allocation Plan include: continued reinvestment of net realized gains/losses; continued reinvestment of long-term interest/dividends into the long-term portfolio; and continued paying down of long-term debt per current amortization schedule. APA has a diversified portfolio and has had 10.18% annualized return since 1988. The real estate holdings continue to be an important source of revenue. The APA headquarters building at 750 First Street has an assessed value of $127 million with $67.9 million in outstanding debt. Their building at 10G Street has a $98 million assessed value with $36.4 million in debt. The buildings have not been affected by the current economic environment and remain fully leased. Publications remain a major source of revenue. Publications and Databases contribute approximately $80 million of revenue annually to APA operations while dues are estimated to contribute $11.7 million in 2012. Electronic Licensing Revenues are growing while print products are declining. President Suzanne Bennett Johnson, PhD reported on her three presidential initiatives: the nation’s obesity crisis, how to attract more early career psychologists to APA, and interdisciplinary practice and science. Information regarding the initiatives can be found at: <http://www.apa.org/about/governance/president/index.aspx>. The Council also devoted over a half-day of its 2.5 day meeting to a “mega issues” discussion as part of APA’s Good Governance Project (GGP). The GGP recently concluded an assessment of the APA governance system and brought forward recommendations designed to more fully align the system with what is needed for a 21st century organization. The data indicated that Council wanted to be engaged in discussing strategic issues that have a significant impact on the discipline. In an initial attempt at a trial-run, Council was provided with a background document for its discussion of how technology will impact psychology and APA over the next decade. The discussion centered on such ideas as using social media in public education, how to train psychology faculty in Spring 2012
new technologies, delivering research findings through technology, the role of new technologies in data-sharing, and the creation of psychology apps. Consent items are those items passed without discussion or vote. Any one member of Council can request that an item be removed from the consent agenda. Among the items passed by consent are the following: (1) Division 54 Journal Proposal: Practices and Services Delivery in Pediatric Psychology; (2) Guidelines for Preparing High School Psychology Teachers; (3) revision of APA Guidelines for Ethical Conduct in the Care and Use of Nonhuman Animals in Research; (4) resolution on Combined Biomedical and Behavioral Approaches to Optimize HIV Prevention; and (5) Education and Training Guidelines: A Taxonomy for Education and Training in Professional Psychology. This Taxonomy for Education and Training is, in my opinion, a very significant item with many positive implications. The taxonomy proposes a consistent definition of emphasis, track, specialty, exposure, etc. If properly utilized, the taxonomy should allow consistency in use of terms by training programs, internships, and post-docs, rather than the confusion that currently exists. Take a look at the Taxonomy on the Commission for the Recognition of Specialties and Proficiencies (CRSPPP) web-site. Among the items approved following discussion and vote are: (1) a proposal by APAGS to develop a new journal; (2) amending the association rule and forwarding to the membership for bylaw vote to modify the composition of BEA so that one seat could be held by a high school or community college teacher affiliate member; (3) the addition of $14,000 in the budget to fund one face-to-face meeting of the BEA Task Force on Psychology Major Competencies to facilitate its work in revising the guideline for the undergraduate psychology major; (4) funding to support meeting costs of the APA/ ASPPB/APAIT Joint Task Force for the development of telepsychology guidelines; (5) receipt of the Report of the Presidential Task Force on Immigration; (6) receipt of the Report of the Presidential Task Force on Diversity and Discrimination; (7) extending the contract with the Union of Psychological Science through the anticipated completion of the ICD-10 in 2014; and (8) approving the motion that a member who served as president will not be eligible for present-elect for a period of 10 years beginning after the past presidential year. This will be sent to membership for approval. It should be clear that a major theme of this Council meeting was education and training. I do not wish to imply that this was in any way intended or planned; it should, however, be noted. ❖ 37
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LEGAL ACTION INITIATIVE: LET’S ALL DO OUR PART! Let’s reach our goal of $100,000! NJPA continues to have excellent legal representation on all our initiatives to stop insurance company abuses, but this comes at a significant cost to NJPA. We cannot do this without UNIVERSAL member support and it is essential that we continue to raise funds for this effort. If you have not yet contributed, PLEASE MAKE TODAY THE DAY! If you have already contributed, we sincerely thank you and ask that you consider making an additional pledge. Your contributions can become much more substantial if made via payments over time: most of us do this when directing payments to other causes, so why not take advantage of this easy way to contribute? A pledge of $100 per month for 12 months – a total pledge of $1,200 would be most helpful. Or, if that does not fit into your budget, please consider a pledge of $75, $50, or $25 a month for 12 months. The NJPA website Donation page, <www.PsychologyNJ.org>, gives you the option to make a single contribution, set up recurring payments, or designate a pledge amount (and pay incrementally). Follow our progress by viewing our new “thermometer” that tracks our advancement toward our legal action fund goal. We cannot do this without member support and it is essential that we continue to raise funds for this effort. Contribute today to ensure patients’ rights to privacy be maintained through this landmark case. We thank you in advance for your generous support!
JOIN THE NEWLY EXPANDED NJPA REFERRAL SERVICE! Consumers are looking online for mental health services more than ever these days, and now NJPA can help ensure they find YOU! NJPA’s newly redesigned and enhanced website has already dramatically increased traffic to over 3,000 visitors per month! And our statistics show they visit “Find a Psychologist” (online Referral Service) most often. Available at your fingertips whenever you need, NJPA’s “Find a Psychologist” allows prospective patients and referral sources instant access to your profile to increase your flow of referrals. Your distinct online profile can now include a photo, detailed biographical information, links to promote your own website, and virtually anything else that will make you stand out. DON’T MISS OUT on this opportunity to market your practice and expertise! Remember, insurance carriers do not list your specialty; consumers use the Referral Service to identify participating providers with the specialty, training and/or expertise to meet their specific needs. FOR ONLY $10 PER MONTH, THIS KIND OF ONLINE MARKETING CANNOT BE BEAT!
How does it work? In addition to the online “Find a Psychologist” search, consumers can also call NJPA Central Office anytime during business hours (8:30am – 4:30pm) for more personalized assistance. Our staff conducts a web-based search using the caller’s criteria and provides them with referrals, in addition to information on how to conduct their own web search for providers in the future. Whether online or call-in, the NJPA Referral Service enables consumers to search for psychologists by location and population, specialty, orientation, specialized psychological services, testing/evaluations, special accommodations, and/or insurance accepted. Members with a proficiency in a foreign language are especially encouraged to enroll to meet the increasing consumer demand. Is your practice in Atlantic, Burlington, Cape May, Cumberland, Hudson, Hunterdon, Passaic, Salem, Sussex, or Warren County? Then you could be missing out on potential referrals for your service in these under-populated areas. What are the requirements to join? • Current NJPA membership in good standing • Active New Jersey Licensure with no pending complaints • Professional liability insurance coverage How do I enroll? Beginning May 2012, licensed members can enroll directly online by logging in to the NJPA website <www.psychologynj.org>. Just review the Referral Service instructions and enrollment criteria and complete the attestation to create your listing. Your online referral profile will be published and “live” after payment is processed and you will receive instant notification of the status. Once your listing is published, you have full control over the content and can edit as you wish, at any time, just by logging in. What is the referral enrollment fee? Annual registration for a single listing is only $120! Add an additional office listing for just $25 more. Multi-year packages and discounts also available. Sustaining Members receive free enrollment (additional office/county fees apply). For more information please call the NJPA Central Office 973-243-9800
New Jersey Psychologist
2012 PRIVATE PRACTICE MANUAL Newly Revised and Updated
The fourth edition of NJPA Private Practice Manual [available Fall 2012] is now on sale. The 2012 edition of the Private Practice Manual has been updated to help you practice ethically, legally, and efficiently. This manual reflects current law and regulation, preparation for licensure, and much more. The Manual includes issues pertinent to private practice today and provides strategies, sample forms, as well as resource information. Reserve Your Copy TODAY!
Topics Include: Licensure and Regulations
Overview of written and oral examination Complaints to the Board Psychology Regulations
New and/or expanding areas of practice
Laws and Guidelines Affecting Practice
Child Abuse Reporting Maintaining Records Informed Consent Responding to subpoenas Division of Banking and Insurance Complaint Form
Professional Will Psychological Services to Businesses Addiction Psychology Geropsychology Neuropsychology Sport Psychology Health Psychology Parent Coordination Capacity Evaluations Forensic Psychology
Panel Member: to be or not be Confidentiality and release of information Peer Review
Private Practice: Issues and Models Psychotherapy Guidelines Office Procedures Therapist/Patient Contracts Model Forms for Practice Release of Information Consent to treatment for a minor
Medicare ERISA HIPAA: The Health Insurance Portability and Accountability Act
Use of technology in practice Legal aspects of technology
The Future of the Field
---------------------------------------------------NEW JERSEY PSYCHOLOGICAL ASSOCIATION 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052
NJPA MEMBERS - $55.95 EACH (INCLUDES SHIPPING & HANDLING) TOTAL ENCLOSED________
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Mail to: NJPA 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 973-243-9800 ď‚– Fax 973-243-9818 Order online at www.PsychologyNJ.org 41
Classified Ads The NJ Psychologist accepts advertising of interest to the profession. The minimum rate for Classified Ads is $69 for up to 50 words each, $5 for each additional ten words. For display ad information, visit our website at <www.PsychologyNJ.org> Acceptance of advertising does not imply endorsement by NJPA. Email inquiries to NJPAcg@PsychologyNJ.org ATTN: Christine Gurriere, or call 973-243-9800. The NJ Psychologist is mailed on or about the 10th of February, May, August and November. The journal is mailed as part of a bulk mailing, therefore delivery times may vary with local post offices.
SPACE AVAILABLE MONTCLAIR – ACADEMY SQUARE Perfect for therapists! Brand new office building, great location P/T or F/T, on site parking, and video security. Dr. Keise 732-551-5550 or firstname.lastname@example.org. ❖ MAPLEWOOD/MILLBURN Psychiatry Office Available. 600 square-foot Psychiatry/Psychotherapy office located at 2066 Millburn Ave., Maplewood, NJ. This office is equipped with separate patient entrance (viz., with reception, sitting area) and exit doors as well as office timer. Parking lot in rear of building with plenty of space. Conveniently located off of Route 78 (Millburn exit) and Garden State Parkway in pretty residential neighborhood. $1,150.00/per month includes common area restrooms, utilities, and cleaning. Sublets will be permitted based on approval of the landlord. Contact: David Mahalick at 973-313-1313 or by e-mail at email@example.com. ❖ MILLBURN Newly renovated office for therapist available part-time or full-time on Main Street near downtown Millburn. Share waiting room and restroom with another mental health professional. Office suite is on bus line and three blocks from train line. Office can be used seven days per week and has parking on premises. Call Dr. Robert Kornhaber at 201-906-6788. ❖ PRINCETON Share office suite at Princeton Prof. Park with psychiatrists Jeff Mattes and Mike Leopold. Separate office, share waiting room. Shared facilities available, including phone, receptionist, fax, copier, wireless internet, etc. 609-921-9299 or firstname.lastname@example.org ❖
EMPLOYMENT OPPORTUNITIES PSYCHOTHERAPIST/COUNSELOR (Central New Jersey: Monmouth and Ocean County) GREAT OPPORTUNITY!: For PT/Per Diem/Student/Intern/Extra Income. Experience with Stress-Related Conditions, Bio-feedback/ Relaxation Methods and Head Injuries a plus. Full-Time and LongTerm employment possibility. Excellent working conditions. Email: email@example.com ❖ NEUROPSYCHOLOGIST/EDUCATIONAL PSYCHOLOGIST-TESTING (Central New Jersey) GREAT OPPORTUNITY!: for PT/Per Diem/Student/Intern/Extra Income: Neuropsychological Testing Administration; Experience with Head Injuries/Concussions and Attention Disorders a plus; Experience with Cognitive Rehabilitation/Memory Training/SpeechLanguage Therapy preferred. Full-Time and Long-Term employment possibility. Excellent working conditions. State Licensure/Permit preferred. Email: firstname.lastname@example.org ❖ COGNITIVE REHABILITATION (Central New Jersey: Monmouth and Ocean County) GREAT OPPORTUNITY!: for PT/Per Diem/Student/Intern/Extra Income. Experience with attention, memory, and learning disorders, especially Head Injuries a plus. Full-Time and Long-Term employment possibility. Excellent working conditions. Email: email@example.com ❖ 42
LICENSED PSYCHOLOGIST Well-established group private practice is seeking a part-time, licensed psychologist to conduct psychological and bonding evaluations for guardianship and child abuse cases. On-site training and supervision will be provided. Some therapy cases may be available to experienced psychologists. Associates in Psychological Services, PA <www.apspa. com> was established in 1981. We are a staff of 11, licensed psychologists and professional counselors. Our practice has an excellent reputation with local doctors, lawyers, agencies, and schools. Email resume to firstname.lastname@example.org ❖ LICENSED PSYCHOLOGISTS Growing practice seeking to expand child and adolescent services. In addition, opportunities available for specialists in the treatment of substance use and eating disorders. Part-time positions at our Summit and Cedar Grove offices. Potential for future growth into full-time schedules. Weekend and/or evening hours a requirement. Certification or clinical experience supporting expertise required. Mail: Summit Psychological Services; 86 Summit Avenue; Summit, NJ 07901 Call: 908.273.5558 Fax: 908.273.3355 Attn: Jeffrey Kahn, PhD ❖ NEUROPSYCHOLOGY/CLINICAL PSYCHOLOGY MONMOUTH COUNTY Full/Part Time. Licensed or License Eligible Clinical Psychologists or Therapists. Neuropsychological Assessment, Biofeedback, Sports Psychology and Concussion. Flexible hours within a group private practice setting. Please email CV to NJNP12@comcast.net ❖ LICENSED PSYCHOLOGIST/LICENSED CLINICAL SOCIAL WORKER Scotch Plains – Part-time position is available in a growing private practice setting. Clients, space, materials, and billing provided. Enjoy a flexible schedule and competitive pay. Permit holders considered. For immediate consideration, forward resume to drcarla.sohh@ gmail.com or 908-322-2517 (fax). ❖ LICENSED PSYCHOLOGISTS East Brunswick – At the Rhoades Psychological Group we are seeking licensed psychologists who would like to develop a rewarding and fulfilling full or part-time practice, with the flexibility to create your own schedule. Clients, space and billing provided, panel certification preferred but not required. At RPG our staff can also expedite the certification process with any panel you wish to be affiliated with. For more information call 908-420-6923. ❖ NORTH HALEDON Part-time/full-time position in group practice in free-standing center. Various referral sources available at our convenient location in conjunction with joining insurance networks, makes this a good opportunity for a psychologist who is looking to start-up or relocate his/her business. Terms negotiable. Call 201-788-8090 for more information. ❖
TRAINING AND SUPERVISION
CBT Training/Supervision Group – Congenial group meets in Cranford every other Friday, 10:30 to noon. Didactic material and case discussion focuses on newest approaches. Appropriate for practitioners at all levels of experience with CBT. For additional information, contact Lynn Mollick, PhD. Co-founder, NJ Association of Cognitive Behavioral Therapists and GSAPP Clinical Supervisor. 908-276-3888 or LynnMollick@verizon.net ❖ New Jersey Psychologist
THE NEW NJPA WEBSITE IS HOPPING WITH ACTIVITY! Don’t miss being a part of it… Advertise with NJPA today! A PICTURE IS WORTH 1,000 WORDS: Check out NJPA’s web traffic statistics below. Across only 30 days, there were 3,669 visits (53.18% new visits) and 20,993 page views! Impressive numbers that prove consumers and professionals are turning to NJPA in greater numbers to locate provider information, find referrals, and locate resources. Take advantage of this traffic! Do you have a program or event to promote? Have space to lease or an employment opportunity? Reaching this market is easy and cost effective when you take advantage of new advertising opportunities with NJPA!
Classified Packages 30 day posting Basic (text only) Standard (text plus 1 image) Premium (text plus 2 images)
90 day posting
Programs & Events
$49 $69 $89
Deluxe Basic (text only) $129 Deluxe Standard (text plus 1 image) $179 Deluxe Premium (text plus 2 images) $219
30 day posting
Basic (Text only) $49 Standard (Text plus 1 image) $69 Premium – BEST VALUE! $99 (Text ad, plus Calendar of Events post, plus one-time Friday Update post, and 1 image!)
30 day posting
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Contact Christine Gurriere at NJPAcg@PsychologyNJ.org for more information.
2012-2013 NJPA Membership Directory and Handbook for your home or office!
Name: __________________________________________ Billing Address: _____________________________________ _____________________________________ Phone: _____________________________________
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New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, New Jersey 07052 Fax: 973-243-9818
New Jersey Psychologist
Life’s ➤ Replacing your income ➤ Transferring wealth to heirs ➤ Paying mortgages and loans
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Inflation Safeguard offers additional insurance coverage and the premium will be added to your bill.
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SenioSenior r Care ThCare erapyTherapy CAREER OPPORTUNITY C AR Eprovider E R O P Pof OR T UNIhealth T Y services in over 300 skilled nursing CHE is a leading mental facilities, community-based settings, adult day care, and rehaCHE is a leading provider of mentaladult healthhomes, services inassisted-living over 300 skilled nursing facilities, community-based adult homes, assisted-living settings, adult day care, and bilitation centers. rehabilitation centers.
We are pleased to inform you of openings for New Jersey licensed psychologists to provide to residents in long-term We are pleased to inform you of psychological openings for NJ services and PA licensed care facilities New Jersey. Theinpositions psychologists to provide throughout psychological services to residents long-term can be full or part time. We offer fulfilling asThe well as financially rewarding care facilities throughout Newclinically Jersey and Pennsylvania. positions can positions with a flexible schedule. be full or part time. We offer clinically fulfilling as wellwork as financially rewarding positions with a flexible work schedule.
For further information, please visit www.cheservices.com and forward your CV to F or fu r t h er in email@example.com r m a t ion , p lea se visit www.ch eser vices.com a n d for wa r d you r C V t o n j ca r eer sMember @chBenefit eser vices.cNEW om JERSEY PSYCHOLOGICAL ASSOCIATION
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