Behavioral Resources And Institute for Neuropsychol the ogical … · 2020-04-20 · BRAINS, PLC 3351 Eagle Run Dr. NE Grand Rapids MI, 49525 616-365-8920 1 BRAINS Express Behavioral

BRAINS, PLC 3351 Eagle Run Dr. NE Grand Rapids MI, 49525 616-365-8920 www.brainspotential.com 1

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Behavioral Resources And Institute for Neuropsychological Services

the

In this Issue:

Featured Education:

Medications: Epidemic or p. 1-4

Intervention

BRAINS Updates: • Occupational Therapy p. 4-5

and Autism

• Michigan Autism Law p. 5-6

• BRAIN CHECK Test p. 6

• BRAINS Foundation p. 7

BRAINS Lakeshore Location: 16986 Robbins Rd, Ste 140 Grand Haven, MI 49417 Individuals Served at BRAINS: Adults, Adolescents, Couples, Family, Pediatrics—Early Childhood

Therapy Services: Neuropsychology, assessment, counseling, social work, couples, groups, Occupational, Physical, Speech Therapies, Neurofeedback, Psychiatry, CITY Program, MAPSS Program: onsite educational therapy and tutoring, auditory processing interventions

Edited by: Michael Wolff, PsyD, ABPdN Rochelle Manor, PhD

MEDICATIONS:

EPIDEMIC OR

INTERVENTION?

Co-author

Michael Wolff, PsyD, ABPdN

Clinical Neuropsychologist

Co-author

Dr. William Walters, DO

Psychiatrist Through the process of healthcare reform, there has been significant attention given to ways of decreasing costs, intervening effectively, and avoiding unnecessary expenses. With this in mind, medications have been scrutinized more closely. A recent article in the Natural News completed by Dr. Hunt and colleagues at Michigan State University, Department of Anthropology, indicated that nearly half of all Americans are currently diagnosed with a chronic condition and 40% of those older than 60 are taking five or more medications. In her research, she had identified that doctors typically prescribe at least two or more major drugs per diagnosed condition.

Unfortunately, this leads to a cascading effect for prescribing, since other

medications are also needed to manage the side effects of the initial prescriptions given. But, even more concerning is that this trend is not only occurring with adults, but also with pediatrics. In fact, children in the foster care system and with early diagnosed conditions such as ADHD are also commonly at risk for increased medication use. The use of psychotropics and psychostimulants has progressively increased between 1996 and 2008 (Zuveks & Vitiello, 2012). Further, the use of psychotropic medications in the child welfare system and to manage aggressive behaviors are being used for off-label purposes. A study completed by Children's Hospital of Philadelphia in 2007 identified 60% of children prescribed antipsychotics were for off-label purposes This concern was supported early by Bazzano et al. (2009) who recognized the trend of off label use with multiple medication classes and urged increasing research in the area.. It is recognized that these medications can increase appetite and potentially lead to obesity.

In August of 2010, Michigan State also completed a separate review of the diagnosis of ADHD. The study focused on the use of the ADHD diagnosis dependent on age and the resultant consequences. The study suggested that children who were

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enrolled in school just prior to cut-off dates and remain the youngest in their class are more commonly diagnosed with ADHD than children who are older in their grade. Their study found that there may be as many as 20% of children who are diagnosed with ADHD that ultimately do not have the diagnosis (ultimately they are misdiagnosed). This results in nearly 900,000 children a year being misdiagnosed. The financial implications of these children being misdiagnosed and then treated with psychostimulant medication was estimated to cost the health care system between $320-500 million dollars a year in unnecessary medication use, (some $80-90 million of it being paid by Medicaid), and this is just in the one medication area.

Ultimately, in 2010, Americans spent more than $16 billion on antipsychotics, $11 billion on antidepressants, and $7 billion for drugs treating attention deficit hyperactivity disorder. The financial cost to health care plans is one benchmark, but more importantly there can be significant health implications as well. As noted above, obesity has a correlation with some medications being used. There can also be stunting of growth, heart-related concerns, implications for liver, suppression of appetite with some medications leading to other potential

metabolic and sleep difficulties for children and adults. Nonetheless, the rate of prescribing multiple medications continues to increase. It is suggested that this is likely related to large pharmaceutical companies incentivizing prescription use, sponsoring financially lucrative research projects, and the change in healthcare utilization. In recent years, medications have been more commonly deemed empirically validated for treatment, because they are more easily studied in relation to outcomes and can be controlled more easily than therapeutic outcomes such as cognitive behavioral therapy. Yet, Dr. Hollon, Professor of Psychology at Vanderbilt University makes the comment, “I would say at least half of the folks who are being treated with antidepressants are not benefiting from the active pharmacological effects of the drugs themselves, but from a placebo effect.”

Clinical reimbursement rates have declined substantially for psychotherapy, which has only further escalated the increase in prescription use. It is not uncommon for psychiatrists and therapists, Master and Doctoral level, to be authorized only a limited number of sessions, which are regulated throughout the year. A client’s care may be limited to 10-20 sessions, from which prescription reviews, individual, family, and group therapy must all be divided. It is becoming even more common that behavioral health policies are being closely regulated and may not even be included in some health insurance formularies, despite mental health parity laws. This growing trend in the United States

is unfortunate in consideration of the fact that the National Health Services in England has adopted a policy where cognitive behavioral therapy is a front-line intervention for the treatment of mild and moderate depression, prior to the use of antidepressants. This is not to suggest that medications cannot be used with positive effect, but not as a initial strategy. DeRubies, Hollon, et. al. (2005) reviewed the use of therapy vs. medications in 240 patients. The research suggested that patients can be effectively treated with cognitive behavioral therapy and were less likely to experience relapse in comparison to patients who were treated by antidepressants alone. Yet, there was recognition that the degree of clinician experience is important. Further, even though we are aware of the increase in diagnostic rates and medication use, major organizations are also expanding age guidelines for treatment. The American Academy of Pediatrics has expanded its guidelines for diagnosis and treatment of ADHD to cover preschoolers through adolscents, whereas historically, ADHD could only be diagnosed to children older than 6 years of age. Now, ADHD, bipolar and schizophrenia are more commonly diagnosed in preschoolers and sometime toddlers. The diagnoses lead to prescriptions, which are encouraged by pharmaceutical companies.

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It has also been acknowledged by Dr. Carlat, Associate Clinical Professor of Psychology at Tufts University, that there is huge financial incentive for psychiatrists to prescribe rather than engage in psychotherapy (Smith, 2005). It was suggested that psychiatrists may be able make two, three, or four times as much money prescribing in comparison to what could be made as a therapist. This results in a vicious cycle of focusing on medication use rather than cognitive behavioral therapy, even though there is increasing evidence that therapeutic interventions can be as effective and have more positive long-term influences. But, it has to be recognized that it has become easier for medications to be prescribed in comparison to the authorizations and oversight needed for therapy. The challenge is not only related to pharmaceutical companies, healthcare reimbursements and ease of prescribing, but there is also a cultural shift that is needed. Teachers, therapists, and families also want “the quick fix.” Therapy and other interventions require time and effort, things often in limited supply in our lives. As a result, interventions are abandoned outside the therapy office, leaving a week of challenges and the perception that therapy is not effective. However, without actively working to change one's life, consistently using strategies outside the therapy hour, and adapt discipline or other skills, change will be less likely to occur. In a fast-moving culture, we tend to want quick short, simple and sweet: this is the perceived influence of medications. This belief makes us more susceptible to what has been termed the placebo effect, where medication may not be providing any positive influence but we forge ahead without actually dealing with our lives.

Yet “dealing” with life may eventually reduce the risk of complicated medical health concerns. Common risks discussed with psychotropic medications include: sleep problems, obesity, diabetes, chronic constipation, appetite suppression depriving the body and brain of necessary nutrients (especially important for children and at risk adults), brain development, growth, headaches and other side effects needing another medication to manage these. Even as I dictate this section recent research is recognizing that psychostimulants can result in sleep latency for some children. An article just released Dr. Gruber, Assistant Professor of Psychology at McGill University in Montréal, recognized moving children's sleep back one hour so that the average child will obtain an additional 27 minutes of sleep can provide significant influence in their lives. Children who received this extra rest were less impulsive, less easily distracted, and less likely to have temper tantrums or cry in comparison to children who did not receive this additional sleep. This article is not suggesting that medications should not be prescribed, in spite of the concerns above. The use of medication has an important role in healthcare and symptom management. Medical and mental health professionals must work closely together to offer the best potential for success. This requires mental health professionals to be proficient in their understanding of medication formularies and to maintain active communication with prescribing physicians. This does not necessarily mean that they need to be practicing side-by-side in the same practice, but rather communication is imperative. The families are also key advocates to

work closely between the medical and mental health professionals. I have great respect for the prescribing physicians working with our clients, and yet the therapeutic and prescriptive skills of a psychiatrist cannot be overlooked. A specialist understanding the dynamics of therapy and medication use can assist with bolstering outcomes.

References:

Bazzan, A, Mangione-Smith, R, Schonlau,

M., Suttorp, M., & Brook, R (2009). Off-Label Prescribing to Children in the United States Outpatient Setting. Academic Pediatrics, 9, 81-88

Children’s Hospital of Philadelphia (2012). Increased Off Label Antipsychotic Drug Use Found Among Children. Retreived: ScienceDaily (October 16, 2012) www.sciencedaily.com/releases/2012/09/120910111700.htm

DeRubeis, R. J., Hollon, S.D., Amsterdam, J.D., Shelton, R. C., Young, P., Salomon, R., O’Reardon, J., Lovett, M., Gladis, M., Brown, L., & Gallop, R. (2005). Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression. Archives of General Psychiatry, 62, 409-416.

Hunt, L. Kreiner, M., & Brody, H. (2012). The changing face of chronic illness

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management in primary care: A qualitative study of underlying influences and unintended outcomes. Annals of Family Medicine, 10, 452-460.

Gruber, R., Cassoff, J., Frenette, S., Wiebe, S., & Carrier, J. (2012). Impact of sleep extension and restriction on children’s emotional lability and impulsivity. Pediatrics, 130, 847-855.

Smith, B. (2012). Inappropriate prescribing. Monitor on Psychology [American Psychological Association], 43, 36-

Zuveks, S. H, & Vitiello, B. (2012).

Stimulant medication use in

children: A 12-year perspective.

American Journal of Psychiatry.

169, 160-166.

PUTTING IT ALL

TOGETHER: OCCUPATIONAL THERAPY’S

PIECE IN THE AUTISM

PUZZLE

Danielle Boog MS, OTR/L

Occupational Therapist

New Michigan legislation regarding the diagnosis and treatment of autism continues to gain traction in the media. Treatment options can be very confusing and overwhelming as families impacted by autism try to figure out what services are available and how to access them. This statewide movement and legislation is designed to allow more access to care and support. It is the responsibility of treatment providers to give families the tools and supports they need to navigate treatment options effectively. When a child is diagnosed with autism, the diagnosis does not just affect the child. Everyone that the child interacts with is also affected, including parents, siblings, teachers, and relatives. Cole is an 8 year old boy in the second grade, and he was recently diagnosed with autism. He often seems very overwhelmed with the world around him, and either is aggressive towards his classmates or shuts down in school. He does not understand sarcasm, which makes it difficult for him to interact with other children his age. He has a hard time understanding expressions and reading body language, which leads to him having difficulty connecting with others, both at school and in the community. At school, he has a hard time when the teacher switches up the schedule for the day, and at recess he likes to either be in charge of the games or he plays on his own. Academically, Cole is barely keeping up with his peers because it takes a lot more time and energy for him to complete his work. He really enjoys computers, and knows very intricate details about how they work and will talk for hours about them. His parents are looking for ways to help Cole function better in school and at home.

An interdisciplinary approach to autism treatment is crucial, and occupational therapy is one facet of treatment that could help Cole. Occupational therapy helps people participate in the activities that they engage in every day. Common occupational therapy interventions include helping children with disabilities, such as autism, participate fully in school and social situations through customized intervention. Interventions focus on an occupational therapist, I strive to provide services that increase the child’s functional skills, as well as offer support to their family. Occupational therapy treatment is broken down into three areas of focus: sensorimotor, psychosocial, and cognitive components.

The sensorimotor component of autism describes how children with autism process sensory information in their world. For example, Cole has a very hard time processing the teacher talking, other kids moving around, and the bright lights in his classroom. Since he has a hard time processing these senses, he gets overwhelmed and does not know how to respond appropriately. This results in him either lashing out at the teacher or other children, or shutting down completely (fight or flight

response). Occupational therapy could help Cole by using techniques that alter how he processes sensory information. If sensory stimuli are being understood


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correctly, then Cole will be better equipped to respond to social situations. Occupational therapy would also work with Cole’s parents to structure his environment to assist him in processing incoming sensory information. This will lead to Cole’s increased ability to interact with the world. The psychosocial component of autism refers to Cole’s ability to interact in social situations. Cole may sometimes appear quiet and reserved, and has difficulty picking up on social cues. Occupational therapy can use social stories, as well as visual cues, to give Cole the skills that he needs to interact more effectively in social situations. These stories will help Cole have a “script” to help him understand the appropriate ways to respond to social cues. Education and strategies will be offered to both Cole and his family to positively affect his ability to interact at home. Strategies can also be provided to Cole’s teachers to assist in the classroom. For example, his teacher may be able to give Cole some warning before she changes the plan of activities for the day. In this way, it would make transitions easier for Cole. By giving Cole tools to use and education to his parents and teachers, it will provide a less stressful situation for everyone involved. Autism may occur in conjunction with other disorders, often with mental retardation or cognitive impairment. Cole’s intelligence is lower, which affects his ability to communicate effectively with others in social situations and perform abstract thinking. This also makes school work difficult. Occupational therapy can help to structure Cole’s ability to problem solve through situations to assist him in

becoming more socially appropriate. Occupational therapy can also provide strategies and tools to his parents in order to structure activities with the intention to foster abstract thinking and communication abilities. Autism affects every aspect of Cole’s life. An occupational therapist was able to work with Cole and his family to target specific areas of difficulty in Cole’s life. Occupational therapy helped Cole function better in his home life as well as in school. This is true for Cole, but it is also true for all of the children that are living with autism. Through occupational therapy, in conjunction with other professions, autism can be treated and children can function more effectively. Occupational therapists are experts in specifically treating the sensorimotor, psychosocial, and cognitive components of autism. The more that professionals work together to provide support to these children and their families, the better these children will be able to function in society. Hopefully, the diagnosis of autism will not be as scary or intimidating in the future because of the supports that are available. References: Hansen, R. & Atchison, B. (2000). Conditions in

Occupational Therapy: Effect on

Occupational Performance, Second

Edition. Baltimore: Lippincott Williams & Wilkins.

Welton, Jude. (2004). Can I tell you about

Asperger Syndrome? A guide for friends and family. Great Britian: Athenaeum Press, Gateshead, Tyne and Wear.

Michigan Autism Law:

How BRAINS fits in

Adrian Lopez

Executive Director

With the recent change in autism benefits offered by insurance providers, many people are left wondering what it all means and how to get the best access for their children. Because of the challenges with diagnosing and treating autism, a set of strict requirements has been placed on which institutions can provide an autism diagnosis for use of insurance benefits applied to applied behavioral analysis (ABA) services and other autism benefits. Many people are asking how BRAINS fits into this picture and what services we have available for autism. To start it is important to understand what an Autism Evaluation Center (AEC) is and how this can help you get access to autism services. An AEC is a multidisciplinary facility that can provide autism diagnosis for access to ABA services reimbursable by insurance. They provide many services for autism but access to AEC’s is a problem, there are only a handful of them in the entire state. As this reality is upon us the fact is that the services that are needed are very difficult to access. BRAINS is adopting all of the principals that are required for a AEC and in fact have had many of these principals at our core since our founding.


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BRAINS is making sure that we are continuing to be on the leading edge of the diagnosis and treatment of autism. This fall we started implementing and testing with the ADOS-2 which is considered the new standard for assessing autism. In addition to our assessment capabilities we also have a team of behavioral experts that work directly alongside of occupational and physical therapist using the most proven and best autism treatments available. This team includes child and adolescent specialists and teen and early adult specialist. Because BRAINS is not an AEC today we cannot diagnose autism to access ABA services reimbursed by insurance or the designated autism benefits associated with an AEC, we can however provide all other services necessary for the diagnosis and treatment of autism. In terms of how to determine what to do, the answer depends on what services you need? In order to get ABA reimbursed by insurance a diagnosis must come from an AEC, unfortunately the access issue exists. If you require comprehensive diagnosis and treatment for autism and other disorders then your best option is to seek a multidisciplinary team oriented facility that can apply proven treatment methods including OT/PT and pediatric behavioral specialists. BRAINS will continue to strive for pioneering successful treatment methods for our patients and this includes autism. We will be posting updates in future editions as we have more information regarding autism benefits and services.

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Metacognition

Use of mental strategies, self awareness and monitoring skills mediated by one’s internal voice while completing specific tasks.

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Fundraising Kick Off:

The Giving Tree Brenda Sipe of Kendall College of Arts and Design of Ferris State University and the BRAINS Foundation, have teamed together to create a magnificent giving tree. The tree is ready to start receiving leaves of giving for our fundraising kick-off. The tree leaves and base plate plaque offer opportunities for various levels of giving. Giving Levels:

Bronze leaf - $100-$249 Silver leaf - $250-$499 Gold leaf - $500-$999 Tree plaque - above $1,000 For each giving level, a leaf with your name or organization will be created and placed on the tree, filling the tree with leaves to acknowledge your generous support. You will also receive a tax deductible receipt for your contribution. The BRAINS Foundation is an IRS Tax Exempt Organization. Non-Profit Tax Identification Number: 37-1545165

www.brainsfoundation.org

BRAINS Foundation

We appreciate you joining

us to support

ongoing services! Services Currently Offered through the BRAINS Foundation: • Neuropsychological Evaluation • Psychological Assessment • Learning Disability Evaluations • Counseling • Behavioral Consultation Additional services are anticipated as funding makes the opportunities possible.

Year in Review The BRAINS Foundation is reaching families with medical or mental health concerns influencing neurocognitive, emotional and/or behavioral abilities who would otherwise not be able to receive the help they need. The families receiving services have had to eliminate anything beyond their primary needs such as meals and housing. Yet by not receiving the current services available, they are at very high risk for discipline problems, learning disorders, dropping out of school, illegal activity, severe mood disorders, or becoming disabled. We are fortunate to be able to help West Michigan. Statistics about Qualifying Individuals: • Average Annual Income for

families served: $13,923.79 • Average # of members in family =

3.39 • Total Collections Resulting from

Family Payments: $2,930.00 Value of Services: • Total Value of BRAINS

Foundation Services to the Community and Those Served as a Result of Sliding Fee Scale: $130,528.00

• Percent of Individuals Receiving No Cost Care: 84.75%

Donations can be mailed or brought to:

The BRAINS Foundation 3351 Eagle Run Drive NE, Ste C Grand Rapids, MI 49525

Documents

Behavioral Resources And Institute for Neuropsychol the ogical … · 2020-04-20 · BRAINS, PLC 3351 Eagle Run Dr. NE Grand Rapids MI, 49525 616-365-8920 1 BRAINS Express Behavioral