MN Psychologist Online

Motivational Interviewing

I really enjoy learning and have challenged myself to learn something I consider substantial every year.  When I was in the first semester of my freshman year in college, it was learning how to learn.  When I completed graduate school, it was learning to read for fun.  One year, it was learning how to sail big sailboats and another year it was scuba diving.  When I turned 50, it was riding a motorcycle, not as a mid-life crisis but as a mid-life adventure.  I really look forward to learning the rest of my life.

If there is one thing I wish I knew when I was an early career psychologist and a young husband and father, I think it would have been Motivational Interviewing (MI), a skill or approach developed by distinguished psychologists, William Miller, Ph.D. and Stephen Rollnick, Ph.D.  MI as an approach is infused with respect and compassion for the clients we get to know and the people we talk with in our everyday life.  According to Miller and Rollnick, MI is done “for” and “with” a person and it is not something done by an expert to a passive recipient, like a master to a disciple. (Miller & Rollnick, 2013, p.15).

Even better, I would have learned this approach in graduate school as I would have been much better equipped to manage my first videotaped, supervised therapy appointment that involved an angry, 14 year-old adolescent who told me she was “forced” to come in by her parents and she would not be talking during the appointment.  Well, her commitment to not talk was a 10 on a 10 point scale, and I found out later in supervision that the videotape didn’t catch my heart racing and my fight or flight response kicking into high gear.  I suspect we have all had those experiences in our offices where we would like to push the pause button and head to Maui.

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MPA Student Division Launches Mentorship Program

In collaboration with the Membership Committee and New Psychologist Network, the Student Division launched the MPA Mentorship Program on Saturday, April 12 at the Annual Convention. Designed as part of the “Student & New Psychologists track” for the convention, the goal of the Mentorship Program Launch was to provide students and new psychologists (“mentees”) with the opportunity to establish mentoring relationships with experienced psychologists (“mentors”) working in various specialties.  The concept was born out of the strategic retreat in the fall of 2013, when MPA leaders discussed the association’s goals for the following year.  These goals broadly included connection, protection, and growth – the theme of the 2014 Annual Convention.

The strategic retreat buzzed with energy as MPA leaders discussed the benefits of establishing connections across generations and the accompanying challenges for connecting individuals with different interests, needs, and preferred modes of communication.  As always, the membership committee was interested in developing innovative ways for protecting and growing the association, and instead of asking potential members “what can MPA do for you,” the question evolved into “what can you do with MPA?”  The latter question promoted a high level of member engagement, and the leaders continued to discuss ways of tapping into the impressive human capital of MPA.  Eventually, the idea of connecting individuals across professional developmental stages in the spirit of protecting and growing the community of psychologists emerged in the shape of a mentorship program.

The Mentorship Program Launch was a successful event at the convention, as over twenty students and new psychologists gathered to connect with eleven mentors from multiple disciplines.  The mentors worked in a variety of treatment settings, including university counseling centers, private practices, community mental health clinics, hospitals, among other settings.  Also, the mentors reported expertise in working with specific populations, including children and families of individuals with Autism Spectrum Disorders, LGBT populations, homeless individuals, college students, individuals with sexual concerns, children and adults with AD/HD, among other populations.  Several experienced psychologists expressed interest in sharing their valuable time, insights, and unique expertise with a new or future psychologist, but were unable to attend the session, and they were asked to provide their information for a “mentorship database.”   If mentees have interests beyond the specialties represented at the convention or were unable to attend the session, they may contact the Student Division to access contact information of additional mentors within the database.

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APA Adopts a More Efficient Governance System

From the APA Governance Affairs Office

Over the past several years, the APA Council has been working on developing a more nimble, efficient and responsive governing system, as part of the APA Good Governance Project (GGP).  This project was an outgrowth of the strategic plan focused on optimizing organizational effectiveness. APA’s existing governance system is a 1950s model built for a world where twice annual meetings was sufficient for conducting the business of the association. The new model, proposed after a thorough assessment with input from many different groups, has three primary goals: nimbleness, strategic alignment across the organization and increased member engagement. Under this model, members will have a more direct voice in the decision-making process and more opportunities for service.

In February 2014, Council voted to begin a three-year trial delegation of authority to the Board of Directors for: financial and budgetary matters; oversight of the CEO; alignment of the budget with the Strategic Plan; and internally focused policy development.  The Board composition changes with 6 member–at-large seats now open to election from and by the general membership, the addition of a public member and the guarantee that both a student and early career psychologist voice will be present. Two seats are reserved for members of the Council Leadership Team, to ensure a bridge between the two bodies.

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Minnesota Board of Psychology Complaint Resolution Process and Interactive Ethics Module

This was the presentation of the Minnesota Board of Psychology (Board) at the Minnesota Psychological Association (MPA) 2014 Convention on Friday, April 11, 2014 by the following Board members and staff: Dr. Scott A. Fischer, (Vice Chair) Ph.D., LP, Dr. Jeffrey L. Leichter, Ph.D., LP (Chair), Angelina M. Barnes, Esq. (Executive Director), Scott W. Payne (Compliance Director), and Joshua Bramley (Compliance Specialist).

Complaint Resolution Process

The Board’s Complaint Resolution process begins with the receipt of a written complaint. The complaint is reviewed to ensure it is jurisdictional; whether the Board has the power to preside over the complaint.  The Board has jurisdiction over matters only to the extent granted to it by state statute (see Minn. Stat. sec. 148.905).  A question regarding jurisdiction asks whether there is power over the person, the subject matter, or the geographic location.  For the Board, this equates to power over applicants and licensees of the Board, the practice of psychology, and/or the State of Minnesota.

Complaints are acknowledged by written notice to the complainant within 14 days after the receipt of a complaint (see Minn. Stat. sec. 214.103, subd. 1a[a]).   The Board is required to “notify a licensee within 60 calendar days after receiving a complaint against a licensee” unless such notice would “compromise the board’s investigation and that such notice cannot reasonably be accomplished within this time” (see Minn. Stat. sec. 214. subd. 1a[b] and [d]).

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2014 Minnesota Psychological Association’s Annual Convention Award Winners

Award:  Susan T. Rydell Outstanding Contribution to Psychology Award
Winner:  Bruce Bobbitt, Ph.D., L.P.

Bruce Bobbitt, Ph.D., L.P. is this year’s recipient of the Susan T. Rydell Outstanding Contribution to Psychology Award.  The Susan T. Rydell Outstanding Contribution to Psychology Award recognizes an MPA member who has made distinguished contributions to the field and discipline of psychology in the State of Minnesota. Dr. Bobbitt received his Ph.D. in Child Psychology from the University of Minnesota.  He is currently employed as the Vice President of Quality Management and Improvement for Optum Behavioral Health Solutions.  Dr. Bobbitt has served the Minnesota Psychological Association in countless ways over many years.  He served as a member of MPA’s Governing Council for 14 years, and as treasurer for 5 years.  Dr. Bobbitt served as MPA’s representative to the American Psychological Association’s Council of Representatives from 1990 to 1995.  Dr. Bobbitt frequently provided presentations to MPA members at its annual convention and in other education venues.  Dr. Bobbitt played a key role in the discussion leading to changes in the academic preparation for licensure as a psychologist in Minnesota.  This was a long, contentious discussion that was resolved in large measure through his work.  Dr. Bobbitt was awarded the Karl F. Heiser Presidential Award for Advocacy on Behalf of Professional Psychology from the American Psychological Association (APA) for his leadership.

Nationally, Dr. Bobbitt has also made significant contributions.  He has served as a consulting editor for the journal Professional Psychology: Research and Practice from 1994-2006 and 2012 to the present.  He served on the Behavioral Health Advisory Panel for the National Committee for Quality Assurance from 2003-2007 and currently started serving again in 2012 to present.  He was an invited participant and discussant for APA’s Practice Summit held in April 2009 in San Antonio, Texas.  Dr. Bobbitt has also been an invited workshop and plenary speaker for the AOA State Leadership Conference.  He has authored a number of articles on psychology policy, especially quality improvement, in peer reviewed journals.  Dr. Bobbitt has been a frequent invited speaker for state and national groups regarding quality, health reform, and the emergence of new payment models in psychology.  In addition, Dr. Bobbitt has served his community in a number of volunteer capacities.  He served on the Board of Directors for Walk-In Counseling center from 2000-2011 and acted as Board Chair from 2005-2011. Dr. Bobbitt also served on the Board of Directors of the Budget for Runaway Youth from 1986-1992 and led as Board Chair from 1990-1991.  Beyond his many distinguished achievements in the service of psychology, Dr. Bobbitt is a personal champion for psychology in Minnesota, holding high standards for MPA and its members. 

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From MPA's President Steve Vincent, Ph.D., L.P.: Continuing a Theme: Connection, Protection and Growth for MPA Members

As you may have recognized from previous pieces I have written for the Minnesota Psychologist Online, I have been thinking a lot about “Connection, Protection and Growth.”  This was the theme for MPA’s annual convention this year, taken from our strategic plan as the statement of what MPA offers members.  Most readers will readily see that this statement leads to a next set of important questions about how we bring these terms—connection, protection and growth—to life.  How do we operationalize them?

One Success Story

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The Zeitgeist from the Eyes of Your President-Elect

When I was an undergraduate psychology major at St. Olaf College, I clearly remember learning a strange sounding word, zeitgeist, defined by Merriam-Webster’s Dictionary as “the general beliefs, ideas, and spirit of a time and place.”  A Ph.D. and 28 years as a psychologist later, this word resonates with me once again.

Zeitgeist:  Reflecting on the spirit of the times, I have heard many psychologists describe this time as a scary yet exciting place for psychologists engaged in the science of psychology and its application.  For psychologists in a therapy or assessment practice, the times are a bit scary because psychologists have seen steady erosion in reimbursement rates over more than a decade.  The times are concerning because the decline in Medicare and Medicaid payment rates is leading psychologists to leave these programs and become highly selective in who they provide care.  Challenging because psychologists in Minnesota are faced with mandates to implement expensive electronic health records (EHR) or to submit outcome measures to a web portal so the results can be shared with the general public.  Yikes, should we all treat anxiety disorders with a more predictable treatment response?

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New Member Spotlight: Mary Garafalo

1)     What is your background in psychology (e.g., education)?

My interest in psychology began in high school when I enrolled in AP Psychology as a senior.  As I made my way through the curriculum, something just clicked and I knew that this was the field for me.  After high school, I continued to study psychology throughout college at the University of Minnesota where I enrolled in courses such as Social Psychology, Cultural Psychology, and the Psychology of Human Sexuality.  Each specific course provided the opportunity for me to expand my psychological knowledge while reinforcing my passion for the field.

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ADHD and Sleep-Related Disturbances: A General Introduction

Sleep-related disturbances are common among children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD; Mick, Biederman, Jetton, & Faraone, 2000).  Recent estimates suggest that approximately one-third of children diagnosed with ADHD experience moderate to severe sleep problems (Sung, Hiscock, Sciberras, & Efron, 2008).  These problems include difficulties initiating sleep, delayed sleep onset, bedtime resistance, maintaining sleep, restlessness during sleep, and chronic tiredness upon awakening from sleep (Corkum, 2001; Lecendreux & Córtese, 2007; Owens, et al., 2009). The causes of sleep-related disturbances range from environmental (e.g., family, neighborhood, school) to psychological (e.g., depression and anxiety) to biological (e.g., obesity and diabetes).  They also frequently result in co-morbidities such as Restless Leg Syndrome, Sleep Disordered Breathing, and/or Periodic Limb Movement Disorder (Chervin, et al., 2002; Córtese, et al., 2005; Konofal, 2008).

Although there appears to be a fairly clear connection between sleep-related disturbances and ADHD, the reasons for this co-morbidity is largely unknown. Research has shown that even subtle changes in the sleep patterns of children diagnosed with ADHD potentially impacts cognitive and psychological development in children (Kirov et al., 2012). Hence, understanding the nature of the co-morbidity between sleep problems and ADHD and the adoption of interventions based on this understanding may improve these children’s quality of life. For example, when it is possible to create a connection between disordered sleep and the effects of stimulant medication used to treat ADHD, medical professionals, educators, and family members may be able to intervene more quickly and more effectively (Cortese et al., 2012).

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In Memoriam: Dorothy Loeffler, Ph.D., ABPP

Dr. Dorothy Loeffler, a past president of the Minnesota Psychological Association (1979-1981), passed away on June 16, 2013.  She earned her Ph.D. in educational psychology (1965) at the University of Minnesota and was employed there at University Counseling and Consulting Services where she worked as a psychologist and Director of Training until her retirement in 1995.  Dr. Loeffler was an adjunct professor in the Department of Educational Psychology.  A highly respected professional, she mentored many young psychologists and modeled how to share energy and expertise.  Dr. Loeffler generously gave her time and energy to make sure that students received the best counseling training and developed excellent research skills.  She demonstrated the responsibility of the profession to support women in their development when she was the founding “mother” of Minnesota Women in Psychology and the creator of the course, “Women a Sense of Identity.”  Dr. Loeffler, an ABPP in psychology, actively served on the national level as a member and fellow in the American Psychological Association (Divisions 37, 31, & 35) and member of Division 20 – Student Personnel Psychology Program.

From MPA's President Steve Vincent, Ph.D., L.P.: A Celebratory Round Trip

A Psychology Celebration in Washington, D.C.

Having recently returned from APA’s State Leadership Conference (SLC) in Washington, D.C., I am again proud of both psychology and Minnesota.  Each year at SLC there are two awards ceremonies which honor, respectively, 1) winners of Psychology Healthy Workplace Awards [PHWA], and 2) individuals and state associations that have made significant contributions to advancing psychology through advocacy.  Minnesota produced winners for each of these ceremonies.

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New Member Spotlight: Justin King

1)      What is your background in psychology (e.g., education)?

I did my undergraduate studies at Gustavus Adolphus College in which I received my B.A. in Psychology.  Afterwards, I attended the Minnesota School of Professional Psychology.  I graduated in 2012 with my doctorate in clinical psychology and became licensed in October of 2013.

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Communities Invested in African American Youth: Strengthening Relationships among Children, Caregivers, and Teachers

On Friday, February 7, 2014, Dr. Willie Winston III and Dr. Sonya S. Brady co-presented at the Minnesota Psychological Association’s First Friday Forum. The title of their presentation was Communities Invested in African American Youth: Strengthening Relationships among Children, Caregivers, and Teachers. The presentation described results from a five-year research partnership between the Minnesota Association of Black Psychologists (ABPsi) and the University of Minnesota School of Public Health, funded by the University of Minnesota Medical School, Program in Health Disparities Research. Minnesota’s ABPsi chapter is a non-profit organization focused on enhancing the well-being of African Americans through social change programs and positive approaches to research. Formative research was conducted in two stages with a partnering elementary school in St. Paul, Minnesota including: (1) Focus groups of 16 African American children and their caregivers to discuss the most important issues affecting the well-being and future success of young people in the African American community; and (2) structured interviews of 46 African American children and caregivers to begin testing a conceptual model informed by empirical literature and clinical experiences of Minnesota ABPsi members. The model posits that externalizing behavior among disadvantaged African American youth may be a response to stressors within the home, school, and community. Inadequate resources may lead professionals to focus solely on children’s behavior, without also addressing underlying affective symptoms, such as depression, related attitudes, and low academic investment. Youth assets and resources for resilience fostered by parents, teachers, and community members may protect youth from negative outcomes. Further, advocacy on the part of caring adults may reduce the likelihood that mental health referrals, diagnoses, and treatments are exclusively focused on behavior.

Dr. Winston and Dr. Brady presented data in support of their conceptual model. Key interview findings discussed with the First Friday Forum audience included the following: (1) When children experience many stressors or have poor relationship quality with their caregiver, children report more symptoms of depression, anxiety, anger, aggression, and rule breaking; (2) When caregivers feel more supported by others in their social networks, children feel more supported by their caregiver; (3) When children feel more supported by teachers, they exhibit fewer externalizing symptoms, are more academically invested, and perform better academically; (4) When African American boys engage in greater levels of problem-focused coping, they perform better academically and have higher standardized test scores; and (5) Different facets of African American identity are associated with academic investment and performance among boys and girls. Key focus group findings discussed with the First Friday Forum audience included the following: (1) It is sometimes difficult for caregivers to acknowledge information suggesting that children are struggling with behavior because this may reflect poorly on the caregiver; (2) children hesitate to trust professionals with their problems, particularly those involving events at home; (3) words such as “depression” and “anxiety” are not used in the African American community, despite the need for help in coping with feelings; (4) teachers and parents need to work together to help children reach their full potential; (5) African American families address racism and discrimination in different ways. Collectively, findings demonstrate a need to strengthen relationships among African American children, caregivers, and teachers. In addition, it is essential that mental health practitioners and other professionals improve the conceptualization and treatment of behavioral problems among youth who experience adversity.

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Creative Minds - Fascinating Journeys

When many of us think of the contributions of Minnesota psychology, the MMPI immediately comes to mind, as it well should — dating back to 1943.  The personal journey of MMPI expert, and now Professor Emeritus, James Butcher exploring Watercolors as a late-life adventure, and the extraordinarily impressive APA governance service of his University of Minnesota colleagues Bruce Overmier and Jo-Ida Hansen, seem equally significant however.  As editor of Psychological Services, I had the pleasure of working closely with Shelia Brandt on behalf of the profession’s public service members.  Having worked on Capitol Hill for nearly four decades, I was very pleased to learn of her growing interest in becoming involved in the public policy process.  This year she is serving as a Humphrey School of Public Affairs Fellow.  Those fortunate to attend the annual Practice Directorate State Leadership Conferences (SLC), which in my judgment are one of the highlights of the APA year, have recently been exposed to the vision and dedication of another explorer, Art Evans, Commissioner of the Department of Behavioral Health and Intellectual Disability Services for the City of Philadelphia.

Arthur C. Evans, Jr. is a psychologist and frontline policymaker who oversees a one billion dollar behavioral healthcare system in Philadelphia.  Growing up in Florida in the 1970s, the unlikely journey that brought the son of a school teacher and an Air Force electronics technician to his current position was somewhat circuitous.  After graduating as a music major at a local community college, his psychology teacher asked him what he planned to do next.  He admitted he didn’t know, but, while he enjoyed the field a great deal, he did not want to major in psychology, because he thought it would take him too long to complete school through to a doctorate.  That brief conversation altered the course of his life as his teacher encouraged him to pursue his real interest and identified a couple of colleges that he could attend, including Florida Atlantic University (FAU) where he would matriculate with a bachelors and master’s degree in experimental psychology.  At FAU he received rigorous training in research, including a year of full time work experience through a co-op at the United States Army Aeromedical Research Laboratory.  He credits this strong scientific foundation to a core belief; that the answers to many of the complex problems that society faces may lie in psychological research.  But, he has observed, the dots between the researchers and those trying to resolve the problems often remain unconnected.

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In Memoriam: Donald H. Blocher, Ph.D.

On November 9, 2013, Donald H. Blocher of Hugo, MN, a highly influential psychologist and my former graduate program advisor, passed away. Don died at the age of 85; he is survived by his wife, Betty, his three children, John (Carolyn), Susan and Mark, and a grandson, Matthew.

A 1959 doctoral graduate of the University of Minnesota, Don had a distinguished career as a scholar and educator in counseling psychology.  Upon the completion of his graduate degree (which was done under the guidance of Dr. Gilbert Wrenn), he took a position at the university where he stayed until 1975—leaving to take a position at the University of Western Ontario.  In 1977 he joined the faculty at the University of Albany where he stayed until he retired in 1991.  He then returned to Minnesota.

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When I first visited Hawaii in 1974, a year before I started graduate school, I was told that “aloha” meant several things:  hello, goodbye, and I love you. A few decades have come and gone since then. I finished graduate school, worked in several roles as a psychologist, and in 2008 was elected to serve as your APA Representative. As I now write my final APA Representative communiqué, I do so from the perspective of having attended my last Council of Representatives (COR) meeting in Hawaii.  It is therefore fitting that this aloha column means both hello and goodbye.  I would also have to say that as love fests go, it has truly been a blast serving you in this capacity.

In regard to COR meetings, the 2013 (COR) meeting in Waikiki wasn’t exactly a barnburner as we like to say in the Midwest.  It was important for the internal workings of APA in that it primarily focused on our Good Governance Project, a multi-year endeavor to help us become more streamlined and effective as a Council.  The work we did leading up to and being in Hawaii will reflect itself in a different composition of the Council in years to come.  I expect that you will hear more about those developments from MPA’s newly elected 2014 council representative BraVada Garrett-Akinsanya, Ph.D.

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From MPA's President Steve Vincent, Ph.D., L.P.: Making Connections

Starting the New Year

As I start the year as president of MPA for 2014, I am struck by the many opportunities for linkages and connections around us.  At MPA’s annual strategic planning meeting in the fall of 2012, participants at the meeting discussed what MPA offers to its members. The conclusion: MPA offers members the chance for connection, protection and growth through our membership and association with each other.

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Mental Health Workforce Development Steering Committee

This committee was created by the Minnesota Legislature in the 2013 session to address needs for mental health workers across the spectrum of providers. Currently all of Minnesota except the Twin Cities and southeastern Minnesota (Mayo) are considered mental health provider shortage areas. The project is being managed by HealthForce Minnesota, the Minnesota Department of Health, and the Minnesota Department of Economic and Educational Development. The steering committee will be doing some advanced research to prepare for a summit or meeting of stakeholders that will be held on May 28, 2014 at Hennepin Technical College. The steering committee is comprised of representatives of professions, the Minnesota Department of Health, the Minnesota Department of Human Services, higher education programs specific to mental health, and private and public higher education representatives.

Several previous efforts have looked at workforce issues in mental health, including an MMHAG group in 2008, through a mental health needs assessment, and as part of the governor’s task force on health reform. The needs consistently highlighted were prescribers, especially for children and adolescents, mental health professionals that can provide supervision to mental health practitioners and those seeking licensure, culturally specific providers for underserved populations, and all providers in greater Minnesota. The primary approach to addressing shortages has been to offer tuition reimbursement and loan repayment. While there has been some use of these programs, they have not proved to be an effective tool. Additional slots have been added to the psychiatry residency program at the University of Minnesota and this has led to an increase in psychiatric providers. Efforts to ease the process of using foreign-trained psychiatrists has also been effective. Some primary care physicians have used the prescribing consultation service administered through the Department of Human Services for the care of children and adolescents to assist in providing services to this population in a primary care environment. In the 2013 legislative session, training programs in psychology and social work were added to the list of those able to access Medical Education and Research Costs (MERC) funding. Monies available for training through the Affordable Care Act do not appear to have been accessed by Minnesota training programs. It is too early to assess the impact of this extension of MERC funding.

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e-Health Advisory Committee Activities

The Minnesota e-Health Advisory Committee has been meeting for more than ten years. The committee membership is delineated in Statute, and only this year has behavioral health representation been added as an “alternate” non-voting position. MPA is honored to represent the needs and concerns of the mental health community.  The inclusion of behavioral health reflects the growing recognition of its importance in health reform. Minnesota is unique in having a mandate, passed in 2008, requiring all providers to have electronic health records by January 2015. Unlike the federal mandate, Minnesota includes behavioral health, social services, post-acute care, and public health, recognizing the need to capture a comprehensive view of patients. The e-Health Advisory Committee has worked in partnership with the Minnesota Department of Health to develop tools and standards to guide health providers in the acquisition and implementation of electronic health records. This work has been enhanced by a State Innovation Model grant awarded to Minnesota by the Centers for Medicare and Medicaid Services. Funds obtained will be used to develop and test the Minnesota Accountable Health Model. Expanding what is included in an electronic health record is an important aspect of the grant.

This year, Minnesota’s e-Health Advisory Committee made the decision to focus on three particular areas regarding the electronic exchange of health information. Three work groups were formed including Health Information Exchange Oversight, Standards and Interoperability, and Privacy and Security.

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The Mental Health Legislative Network

MPA has long participated in the Mental Health Legislative Network (MHLN). It is a group of thirty provider and advocacy organizations that support each other’s work, and legislatively address issues related to mental health. The purpose of the group is to advance the understanding of and services to people with mental illness. The view is that as a group more impact can be had. It is the group that organizes Mental Health Day at the capitol each year. Often representatives from the Department of Human Services are in attendance, and occasionally legislators will attend. The MHLN meets weekly when the Minnesota Legislature is in session, and monthly when not in session. It is hosted by either the Mental Health America-Minnesota or NAMI-MN organizations. Their support includes testifying for one another’s bills when needed, as long as they fit with the members’ viewpoint. The MHLN does occasionally act as a unit to write letters of common concern to the Commissioner of the Department of Human Services, payer organizations, the Governor, legislators, and members of Congress.

Participation in the MHLN has been a great support for MPA. They have joined with us on concerns with payers in the past, testified for our bills, and generally provided a greater probability of bill passage. They were especially helpful in dealing with legislation that sought to allow physician assistants to be paid as mental health professionals.