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Best Practices for Sexual Health & Relationship Education

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

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

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

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

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

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

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

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

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Health Professionals Service Program

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

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

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Transgender Bathroom Debate

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

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

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Lessons Learned: The Importance of Clinical Documentation

Lessons Learned: The Importance of Clinical Documentation

By Don Wiger, Ph.D., LP

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Recognizing MPA Members

Sadly, Minnesota lost three distinguished psychologists over the past couple of months.

Bill Percy
Bill was a long time member and leader at MPA. Bill worked at HSI in Washington County (now Canvas Health) and the Range Mental Health Center. Bill was also a long time consulting editor for the Minnesota Psychologist.

Will Grove
Will was long time Professor of Clinical Psychology at the University and was also a volunteer at Walk-In Counseling for many years. 

Adrienne Barnwell
Adrienne had a forty year career in child and pediatric psychology holding lead positions in pediatric psychology at Regions Hospital, and then Gillette Children’s Specialty Health.

In Memoriam: Thomas Paul Carrillo, Ph.D., LP


January 21, 1952 - June 2, 2017

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When You Leave a Clinic: Keep Your Reputation

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

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

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In Memoriam: Sherman E. Nelson, Ph.D.

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

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

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Tribal Politics and the Liberal Psychologist

The day after the 2016 election, psychologists went to work and met with patients, silently questioning who was sitting across from them.  Is this a Trump voter? A Clinton voter? Third party? Did they even vote? Politics of the therapy room became quite personal on November 9, 2016. And we are a big part of the problem.

The majority of psychologists are liberal (Duarte et al., 2014; Heflick, 2011; Inbar & Lammers, 2012; Konnikova, 2014). Graduate school and CE courses on multicultural issues may have helped us understand ethnicity and microaggressions (kind of); however, most of us never really learned to co-mingle with others of different political persuasions and tax brackets. If you voted for Clinton and do not know someone who voted for Trump, you are living in a bubble. I don’t mean your best friend’s uncle that voted for Trump, but someone that you would go out to coffee with or someone you just had over for dinner.  

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New MN DHS Benefit, Behavioral Health Homes: Resources for MA Beneficiaries with Severe and Complex Conditions

Psychologists and other mental health professionals who serve people with more complex and challenging problems may want to refer them to a new DHS service, Behavioral Health Homes. (BHH).  BHH services can increase support and treatment resources for the person, and can help the mental health professional better respond to the person’s needs. 

The Patient Protection and Affordable Care Act (ACA) created a “health home” benefit to help states better coordinate care for Medicaid enrollees with chronic medical conditions. This program focuses on populations that traditionally face serious barriers to accessing medical care, and end up being underserved by our medical and mental health system.  They also have reduced quality of life and increased mortality, and frequently are high utilizers of expensive urgent care services.

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Behavioral Health Outcomes Measures: Problems, Challenges, Solutions

Psychology’s Ambitions

Human suffering, including mental and behavioral health problems, is elusive to define and measure.  Even with relatively objective markers of diagnosed mental illness, consensus is hard to find. People often have more than one diagnosable condition, and the conditions themselves are increasingly understood as dimensional rather than categorical (APA, 2013).  These   conditions also are often embedded in relational and social contexts.  To complicate things even further, they often occur on a spectrum ranging from absent to severe during the course of a care episode, or a lifetime. All of these factors may have a greater or lesser effect on the person’s functioning at different times and under different circumstances.  It is challenging for both patients and providers to sift through all of the data, all of the layers and all of the noise, in order to identify the most important factors that can guide treatment.

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The Importance of Being Earnest - Ethics and Child Abuse Reporting

The fame and glory of being a mandate reporter is not all it’s cracked up to be.  The massive mess and confusion of what and how to report can be daunting, even to the established therapist.  As one author stated, many clinicians feel that; “There is no way to do no harm” (1) when facing a potential child abuse report.  Further, sometimes what is best for the child (a child abuse report) is not what is best for the parent.  In addition, since treating mental illness decreases the risk for child abuse, clinicians certainly don’t want to derail the treatment of mental illness due to the mandated reporting of child abuse.  Nevertheless, therapists are mandated reporters and must report all child abuse regardless of the ramifications. 

The major conundrums fall into one of these four categories: 

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Walk-In Counseling Center Provides Free Mental Health Services Every Weekday

Psst! What’s the best kept secret in town?

It’s this: Any person who needs mental health counseling right away, with no appointment necessary, for free, can get services in Minneapolis and Saint Paul every weekday. Walk-In Counseling Center is the place to go for services provided by mental health professionals during walk-in clinic hours. There are no barriers to service here – no fees, no copays, no sliding scale. Clients can even remain anonymous if they wish.  

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APA's Disaster Response Network Changes its Name to APA's Disaster Resource Network

On January 1, 2016, the Disaster Response Network changed its name to Disaster Resource Network. The advisory committee as well as APA staff believe that the name more accurately reflects the breadth of the program. What follows is that announcement.

Twenty-five years ago, the Disaster Response Network of licensed, disaster-trained psychologists across the United States was created to offer onsite mental health services to Red Cross workers and victims of disaster. Over the years, psychologists have responded to more than a thousand disasters of various types. Their work is frequently featured in APA publications.

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High Intelligence as a Primary Diagnosis and Lens for Intervention with Children and Their Families

When my 18-month-old son was speaking in sentences, our part time nanny asked if she could bring him to one of her graduate classes at the U of MN Institute of Child Development.  Her professor said it was not possible for children to have such advanced language skills.  While I initially found the situation humorous, I realized it meant that child development experts knew very little about precocious kids.  I looked through graduate school textbooks and notes and did not find much information.  I knew what to expect for those on the lower end of the intellectual bell curve, with an IQ of 70 or below, and that it was not ethical for me to work with those clients without proper training. However, I knew little about what it meant to be on the high end of that curve, those with an IQ of 130 or above and yet I worked with very bright kids in my practice every day.   Hence began my quest to understand the gifted population.  That was 12 years ago and what I learned drastically changed the way I saw kids in my practice and what I do to help them.

High Intelligence is Neuroatypical. The ability to read at age three, have academic skills six years above their age level, and wrestle with existential concerns by age four is a result of unique neurological wiring.  Gifted brains have distinct brain structures-- they have double the glial cells, burn glucose more rapidly, and have faster, more efficient connections (1).  They think about things in elaborate creative ways, often looking lost in thought. The cortex thickens more rapidly with the ‘use it’ phase of developing high level circuits starting earlier and lasting longer (2).  There is also a delay in the ‘lose it’ or pruning phase that creates a lag in the development of executive functioning skills for as much as two to four years compared to average peers. Given academic success is largely dependent on ability to organize and get work turned in, this often results in underachievement and a misdiagnosis of ADHD.

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School is Starting and Some Kids Are Dreading it. What Can You Do?

CLINICAL PEARL: Don't say (or write) "Parents should get an IEP for this child who is struggling in school." Instead, say (or write), "Parents should consult with the school staff, a child psychologist, LDA Minnesota, or PACER Center, to assess and design a plan to meet this child's educational needs."

Many of our patients whose schoolwork or attendance is affected by chronic health conditions may benefit from creating a "504 Plan." This is a written agreement for curriculum adaptations, within a regular education program, which ensures the school makes "reasonable accommodations" to meet the child's educational needs, without incurring "undue burden" to the District. A 504 Plan is guided by Section 504 of the Civil Rights Act which says that schools cannot discriminate against a student for needs that reflect a student's physical or mental disabilities. It is NOT "special education" and NOT an "individualized education program (IEP)" but a 504 Plan can be very helpful to students who just need "reasonable accommodations" to succeed with regular classroom instruction.

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Body/Mind Approaches for Treating the Complex Chronic Pain Patient

In 2011, the Institute of Medicine (1) reported that 100 million Americans, or almost one-third of the population, are affected by chronic pain.  Half that number, or 50 million people, experience severe or daily pain, with increased debility and costs to the health care system (2).  Chronic pain is persistent pain, continuing after an injury heals, or emerging in the absence of an apparent injury (3).  And so, a significant minority of our patients experience chronic pain, as well as the impairment in daily functioning, sleep and psychological and social well-being that accompanies it.

The disparaging comment that patients (rightly) dread is, “It’s all in your head,” is no less inaccurate than the more acceptable idea that pain is a strictly body-based phenomenon.  Chronic pain is a body-mind phenomenon, and current research on the theory of Central Sensitization elucidates the mechanisms by which chronic pain emerges (4).  Data supporting Central Sensitization suggests that chronic pain results from three types of changes in the central nervous system:  Sensitization of pain circuits, generalization of pain to non-pain circuits, and failure of inhibitory pathways to dampen pain.  Central Sensitization can occur after a single injury, repeated injury, or even no apparent injury to the body.  Sensitization of central nervous system pain circuits mean that mild or even benign stimuli (e.g., a gust of wind across the cheek of a Trigeminal neuralgia patient) produce pain.  Further, non-pain-related central nervous system circuits (e.g., those that carry temperature signals between brain and body) get “hijacked” into the pain system, generalizing, and thus enhancing, the pain experience.  Finally, central nervous system pathways from brain to body that inhibit pain fail to work effectively, creating another avenue by which pain is intensified. Interestingly, Central Sensitization is being explored as the common underpinning for seemingly diverse conditions such as chronic pain, irritable bowel syndrome, and PTSD. 

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Our Evolving Understanding of Trauma (and its Treatment)

Trauma has been studied by physicians and psychologists alike for decades. Historical events and advancements in the field of psychology have changed our views on how trauma affects a survivor, our recognition of different clinical presentations, and our concept of how to best address varying symptoms in clinical practice. The rate of progress has increased in the last few years as new medical technology has allowed researchers and clinicians to better understand how traumatic experiences can cause long-lasting psychological and physical effects in survivors, in turn advancing the way we approach treatment.

Research beginning in the 19th century began to identify a link between traumatic events and symptoms that could not be easily explained in medical terms. This understanding was later refined by Pierre Janet, French psychologist in the field of dissociation and traumatic memory, who asserted that intense emotions interfere with appropriate or accurate appraisal of and response to an event, leading to sensory experiences, overwhelming emotions, and behaviors that make it feel like the trauma is being re-experienced. This concept became a foundation to our current understanding of trauma. Later, soldiers returning home from World War I displayed new unexplained symptoms related to trauma, which were referred to using terms such as shell fever, mental shock, war shock, shell shock, and war psychoneurosis. Additional phrases such as battle fatigue and combat exhaustion were developed during and after World War II to try to describe the trauma-related syndromes being seen so commonly in combat veterans. It was at this time that Abram Kardiner, American psychoanalyst, began to describe some of the specific symptoms in greater detail such as chronic vigilance and sensitivity to the possibility of threat in his book, The Traumatic Neuroses of War.

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Having the Most Difficult Conversation

By Kristin B. Webb, Psy.D. & Alexis T. Franzese, Ph.D.,
Colleague Assistance Committee Members

The North Carolina Psychologist Vol 65(3), 2013 

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Coordination of Care for Mental Health and Primary Care Services: Concerns, and a Solution

The Patient Protection and Affordable Care Act (PPACA) mandates increased communication between medical providers that has created significant challenges for psychiatrists, psychologists and other mental health professionals (MHPs).   In particular, use of Electronic Health Records (EHRs) raises concerns about the potential unrestricted flow of Protected Health Information (PHI) about mental health services among the patient’s medical professionals.

EHRs are mandated to have interoperability - to be able to transmit PHI from one EHR to another EHR.  Interoperability is currently limited, or aspirational, for most EHRs. As EHR providers overcome technical problems it will be increasingly common for mental health PHI to be available to other medical providers.  For MHPs, this raises significant concerns about who will have access to sensitive mental health PHI, and what they will do with it.  As a result, many MHPs in Minnesota have refused to adopt EHRs.  This raises concerns for physicians about whether they have access to complete information about their patients.

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