Topics for Today. Dr. John Kelly NYASP Conference October 2013

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1 Dr. John Kelly NYASP Conference October 2013 Topics for Today Affordable Care Act and School Psychologists School psychological practice at the EI level Licensure of masters level school psychologists ABA Licensure Community Schools Initiative Framework for Safe and Supportive Schools School Psychologist as a mental health provider 1

2 Medicaid Expansion and School Psychologists The Affordable Care Act provides for the expansion of Medicaid services to millions of previously uncovered children. Children are a priority population for the provision of mental and behavioral health services Schools are identified as priority areas for the provision of services. School psychologists are identified as qualified health providers for these services 2

3 Key Messages Recognizing school psychologists as qualified eligible providers of Medicaid services is good for children and youth. Utilizing qualified school mental health providers currently employed by schools to provide behavioral and mental health services increases the accessibility and cost-effectiveness of services. School psychologists are uniquely qualified to provide behavioral and mental health services in schools. The credentialing requirements for school psychologists are rigorous and comparable to other eligible providers. 3

4 School Psychologists and EI Services Review School psychs are authorized to provide psychological services as long as salaried employees of exempt settings This includes schools and 4410 preschools Some 4410 preschools also offer EI services Therefore, schools psych were able to provide EI services when employed by 4410 programs EI Changes To gain greater fiscal oversight, Cuomo transferred provider agreements from the county to DOH When this change occurred, Provider Agreement was revised In new agreement, school psychs were no longer able to supervise ABA services at EI First indicator that something was wrong 4

5 The answer is discovered... NYSED Office of the Professions has been advising DOH that EI services are considered medical services and not educational, therefore, the school psychology exemption does not apply to EI services Wrong! New York State Educational Law Article 153, section 7601(a) defines the practice of psychology as; The practice of psychology is the observation, description, evaluation, interpretation, and modification of behavior for the purpose of preventing or eliminating symptomatic, maladaptive or undesired behavior; enhancing interpersonal relationships, personal, group or organizational effectiveness and work and/or life adjustment; and improving behavioral health and/or mental health. The practice includes, but is not limited to psychological (including neuropsychological) testing and counseling; psychoanalysis; psychotherapy; the diagnosis and treatment of mental, nervous, emotional, cognitive or behavioral disorders, disabilities, ailments or illnesses, alcoholism, substance abuse, disorders of habit or conduct, the psychological aspects of physical illness, accident, injury or disability, psychological aspects of learning (including learning disorders); and the use of accepted classification systems. The term "diagnosis and treatment" means the appropriate psychological diagnosis and the ordering or providing of treatment according to need. Treatment includes, but is not limited to counseling, psychotherapy, marital or family therapy, psychoanalysis, and other psychological interventions, including verbal, behavioral, or other appropriate means as defined in regulations promulgated by the commissioner. 5

6 Exempt Persons The activities, services, and use of the title of psychologist, or any derivation thereof, on the part of a person in the employ of a federal, state, county or municipal agency, or other political subdivision, or a chartered elementary or secondary school or degreegranting educational institution insofar as such activities and services are a part of the duties of his salaried position. NYSED has offered opinion in the past that as long as a school psychologist is a salaried employee of an exempt setting, they can engage in the full practice defined for psychologists NYSED Changes it s tune... The Office of Professions states that EI settings are NOT school settings, even when they are part of a 4410 program. Therefore, the exemption does not apply Non-licensed school psychologists are currently not eligible to provide EI services 6

7 Licensure of School Psychologists 7

8 Licensure of School Psychologists The definition of school psychological practice includes: Assessment related to education, learning, or adjustment needs Educationally related psychotherapeutic and behavioral approaches to increase school adjustment and academic success Consultation regarding learning problems and adjustment to those problems Development of psycho-educational programming Requirements for licensure (3 E s) Education Masters Degree (at least 60 credits) in psychology Coursework in: (I) BIOLOGICAL, SOCIAL AND CULTURAL BASES OF DEVELOPMENT; (II) PSYCHOPATHOLOGY AND EXCEPTIONALITY IN LEARNING AND BEHAVIOR; (III) ASSESSMENT AND APPRAISAL OF LEARNERS IN HOME AND SCHOOL CONTEXTS; (IV) CONSULTATION AND COLLABORATION IN FAMILY, SCHOOL AND COMMUNITY SYSTEMS; (V) EFFECTIVE INSTRUCTION AND DEVELOPMENT OF COGNITIVE AND ACADEMIC SKILLS; (VI) PREVENTION AND TREATMENT OF BEHAVIORAL AND EMOTIONAL DISORDERS AND DEFICITS; (VII) SCHOOL ORGANIZATION, CURRICULUM, POLICY AND LAW; (VIII) RESEARCH AND PROGRAM EVALUATION; (IX) PROFESSION AND ETHICAL PRACTICE OF PSYCHOLOGY IN SCHOOLS 8

9 Requirements (cont.) Experience 1200 hour internship (at least 600 in school setting) 2400 hours of supervised practice (1200 can include internship) Exam Licensing exam Limitations Cannot treat serious mental illness without consultation with MD to see if medical care is necessary. Schizophrenia Schizo-affective disorder Bi-polar disorder Major Depressive Disorder Panic Disorder OCD Can consult with other MH professionals 9

10 Limitations No RxP No use of invasive procedures No Hospital privileges Can work under a limited permit (supervised practice) for 1 year while acquiring supervised hours, renewable once Certification to work in exempt settings remains. Certified through NYSED OTI Licensed through NYSED OP Part of the State Psychology Board 10

11 ABA Insurance/Licensure Nov 2011, Cuomo signs into law that insurance companies must cover the diagnosis and tx of ASD Services must be provided by certified behavior analyst Goes into effect Nov 1, 2012 PROBLEM: No such thing as a certified behavior analyst in NY! 11

12 Regulations to the Rescue Regulations are the interpretation of the law Oct 2012, emergency regulations proposed by the NYS Insurance Dept of Finance to meet the Nov 1 deadline These regulations were so restrictive that only about 45 professionals in NY could meet the criteria to provide ABA services The proverbial S**T hits the fan! Revised Emergency Regulations ABA Provider means ABA Aide supervised by certified behavior analyst Certified Behavior analyst A Licensed provider A Certified provider What is a certified provider? A SCHOOL PSYCHOLOGISTS!! That s right, school psychologists are identified as qualified providers of ABA services for insurance reimbursement under the new law! 12

13 Don t get too excited With the exception of the licensed provider (psychologist, psychiatrist, clinical s.w.), certified behavior analyst and Aide still do not exist AND Without licensure, school psychs cannot offer services outside exempt settings Enter the ABA Licensure Bill Just released April 29, 2013 Defines Licensed Behavior Analyst and ABA Aides Exemption section defines who can provide ABA services without needing to be a Lic BA or Aide This section exempts those working in the schools, including school psychologists. Passed both Senate and Assembly in June 2013, but has NOT been signed into law by Governor Cuomo 13

14 Community Schools Initiative August 2013, Governor Cuomo announces NYS Community Schools initiative. NYS Community Schools will help give New York students and families a brighter future by transforming our public schools into community institutions that serve the needs of our neighborhoods. The State is empowering schools in distressed communities to give students extra help through health care services, family counseling, and employment assistance, all of which will strengthen our neighborhoods and give students in those areas additional support, both in and out of the classroom. 14

15 Intent transform schools in distressed communities into hubs for a wide range of support services for children and their families including health care, counseling, nutrition and job preparation services. Details Under NYS Community Schools, approximately 30 schools will be selected in the first round to receive grants of up to $500,000 each over three years. These grants will go toward building strong community partnerships that deliver critical academic, health, extra-curricular and social services primarily in the school building. 15

16 Problem with Plan ALL FUNDING TARGETED HERE NYASP Responds Meeting with Governor Cuomo and De Shawn Wright, Gov s Education Czar Allowable use of funds by schools to fund schoolemployed mental health positions Develop effective model of school-community partnership NYASP and Child Mind Institute initiative 16

17 Framework for Safe and Supportive Schools This joint statement provides a framework supported by educators for improving school safety and increasing access to mental health supports for children and youth. 17

18 Key Messages Fully integrate learning supports (e.g., behavioral, mental health, and social services), instruction, and school management within a comprehensive, cohesive approach that facilitates multidisciplinary collaboration. Implement multitiered systems of support (MTSS) that encompass prevention, wellness promotion, and interventions that increase with intensity based on student need, and that promote close school community collaboration. Improve access to school-based mental health supports by ensuring adequate staffing levels in terms of school-employed mental health professionals who are trained to infuse prevention and intervention services into the learning process and to help integrate services provided through school community partnerships into existing school initiatives. Integrate ongoing positive climate and safety efforts with crisis prevention, preparedness, response, and recovery to ensure that crisis training and plans: (a) are relevant to the school context, (b) reinforce learning, (c) make maximum use of existing staff resources, (d) facilitate effective threat assessment, and (e) are consistently reviewed and practiced. Key Messages Balance physical and psychological safety to avoid overly restrictive measures (e.g., armed guards and metal detectors) that can undermine the learning environment and instead combine reasonable physical security measures (e.g., locked doors and monitored public spaces) with efforts to enhance school climate, build trusting relationships, and encourage students and adults to report potential threats. If a school determines the need for armed security, properly trained school resource officers (SROs) are the only school personnel of any type who should be armed. Employ effective, positive school discipline that: (a) functions in concert with efforts to address school safety and climate; (b) is not simply punitive (e.g., zero tolerance); (c) is clear, consistent, and equitable; and (d) reinforces positive behaviors. Using security personnel or SROs primarily as a substitute for effective discipline policies does not contribute to school safety and can perpetuate the school-to-prison pipeline. Consider the context of each school and district and provide services that are most needed, appropriate, and culturally sensitive to a school s unique student populations and learning communities. Acknowledge that sustainable and effective change takes time, and that individual schools will vary in their readiness to implement improvements and should be afforded the time and resources to sustain change over time. 18

19 Advocating for Safe and Successful Schools Be part of the conversation!! Need to balance all the rhetoric related to physical safety measures Share Framework with your administrators and school boards NASP Advocacy Toolkit Release in Spring 2014 School Psychologist as a Mental Health Practitioner Vital for school psychologists to view themselves as providing mental health services Need to get past antiquated adage of we don t provide therapy in schools YOU DO PROVIDE THERAPEUTIC SERVICES IN SCHOOLS!! Service may look different than in a community setting or hospital setting, but school psychs address the mental health needs of children 19

20 If you are not at the table, you are on the menu --Author Unknown 39 Questions? Thank you! John Kelly 20

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