The AAMFT Blog

Michigan Enrolls MFTs as Medicaid Providers

Congratulations to the Michigan Division on successfully persuading the state Medicaid agency to enroll LMFTs as Medicaid providers. In October 2015, the Division announced that the Medicaid agency would start enrolling MFTs as direct service providers effective in 2016. In February, the department announced its proposed policy change that would include LMFTs as Medicaid providers, effective July 2016. AAMFT submitted comments to the department in support of this proposed policy change. On June 2, AAMFT received a notice from the Michigan Department of Health and Human Services that LMFTs will be able to enroll as Medicaid providers, effective July 1, 2016.

In a letter to Michigan members, President John A. Becker said: 

The board of the Michigan Division of AAMFT is pleased to announce Medicaid Inclusion. In order to provide greater access to care for behavioral health services, the Michigan Department of Health and Human Services (MDHHS) will begin enrolling marriage and family therapists as Medicaid providers, enabling them to be directly reimbursed by Medicaid for behavioral health services provided to beneficiaries. As of July 1, 2016, fully-licensed marriage and family therapists will no longer bill for rendered services under their delegating/supervising physician’s National Provider Identifier (NPI) and must be uniquely identified on all claims.

Please note this advancement of our profession, particularly to state organizations, community mental health organizations, clinics, physicians, psychiatrists, and private practice marriage and family therapist.

Thank you to all members who invested into this advancement.

Join AAMFT's network of advocates to advance policy interests of the profession through the Family TEAM.

Connect with Your Children this Summer

By Dr. Carolyn Greene, VA Mental Health Services

With school out and warm weather, summertime can be a great time for kids; but it can be anything but a vacation for parents. It can be stressful having your kids home more, balancing your schedules and keeping the entire family happy – and entertained.

The Department of Veterans Affairs (VA) developed Parenting for Service Members and Veterans (Parenting) help parents reconnect with their children and strengthen their families. While Parenting is useful and applicable all year, use the extra time your kids have during the summer as a time to (re) connect. Parenting offers tools and resources for parents with children of all ages – from newborns to teenagers.

Parenting is one of three courses in the VA Online Self-Help Resource Center. All courses are completely confidential, free and available online 24/7. No log in and no registration required. You can take the course at the pace and place of your choosing.

This course is different from other self-help resources because it focuses on the parents’ needs, not just on those of the children. Parenting has several modules and you can choose what interests you and/or what is relevant. Modules feature practical advice and interactive multi-media, including:

• Videos of real military families discussing their challenges and how they overcame them
• Quizzes to better understand your parenting style
• Tools to help you improve your work-life balance
• Information on the specific behaviors and emotions children display at different ages
• How to incorporate much-needed “me-time” into your day

The Resource Center also features Anger & Irritability Management Skills and Moving Forward, courses that teach ways to reduce stress and anger and solve problems to help you overcome challenging situations.

Enjoy summer and make the most of your time with your family; visit www.veterantraining.va.gov/parenting/

AAMFT’s Family TEAM Advocates on Capitol Hill for MFTs in Medicare

During the week of June 6, several AAMFT members visited Capitol Hill to lobby Congress to allow LMFTs to be covered by Medicare. As part of the Family TEAM, AAMFT members flew in from Louisiana, Michigan, New York, North Dakota, and Texas to lobby members of the U.S. House of Representatives who serve on the House Energy and Commerce Committee. The visit was strategically timed as the Energy and Commerce Committee was planning to debate and amend legislation (HR 2646), the Helping Families in Mental Health Crisis Act, which makes several significant changes that impact mental health.  AAMFT members urged this committee to amend HR 2646 to include MFTs and LPCs as Medicare providers.

During the effort, AAMFT members visited the offices of Rep. Fred Upton (MI), Chair of the House Energy and Commerce Committee, as well as the offices of four other members of this committee: Rep. Michael Burgess (TX), Rep. Steve Scalise (LA), Rep. Chris Collins (NY), and Rep. Kevin Cramer (ND). In addition, AAMFT members from Louisiana also visited the office of Senator Bill Cassidy. Senator Cassidy and Senator Chris Murphy (CT) are sponsoring a Senate mental health bill, S. 2680, which is similar to HR 2646.

"Accompanied by Ben Johnson, my visit to Capitol Hill to meet with senior staff from Congressman Scalise's office and Senator Cassidy's office was a meaningful experience. With input and support from the AAMFT lobbyist, I believe we made a positive impact. The staff we spoke with were engaged and interested in our perspective relative to the need for MFTs to be included in the medicare legislation. I was able to provide a historical perspective relative to the growth of AAMFT and the impact that MFTs have in the delivery of health care services. This was a very important visit as I believe it is critical for our voice to be both heard and seen." John Shalett, MSW, LCSW-BACS, LMFT-S, Lousiana

In addition to these visits, AAMFT initiated a grassroots campaign urging AAMFT members who are constituents of a member of the House Energy and Commerce Committee to contact and urge their Member of Congress to support an amendment to HR 2646 that would allow MFTs to become Medicare providers. This grassroots campaign, which was initiated on June 7, resulted in at least 240 emails plus telephone calls to members of this committee.

On June 15, the House Energy and Commerce Committee did debate HR 2646, the mental health legislation. It was voted out of committee by a vote of 53 to 0. Unfortunately, the Medicare language was not added to this bill since the committee decided not to make any major changes to this legislation. However, there might be an opportunity to amend this legislation when it is sent to the full House of Representatives for a vote, which could occur as early as July. AAMFT will also continue advocating that the Senate include the MFTs in Medicare language in its mental health legislation. 

These recent Hill visits and phone calls have succeeded in increasing support for MFTs in Medicare on Capitol Hill and the Family TEAM continues to advocate for MFT inclusion. AAMFT members can continue to urge Congress to support S. 1830, Seniors Mental Health Access Improvement Act of 2015, and HR 2759, the Mental Health Access Improvement Act. These two bills would allow Marriage and Family Therapists to be covered by Medicare. Please reach out to your Senator or Congressperson today and urge them to support MFTs in Medicare. We have prepared scripts that you can use by clicking here and you can find your Congressperson here.

How to be a Helpful Therapist in the Aftermath of the Orlando Shootings

They were LGBTQ+. They were Latinx. Yet those relevant identities are being erased as we collectively talk about the horrific shootings in Orlando last weekend. While at the same time the media response increasingly seeps in anti-Islamic rhetoric. As therapists, what are we to do?

AAMFT issued in a response statement they want “to start a necessary dialogue around the absolute need for all to feel safe in our society.” While well intended, there are those who cannot feel safe in a culture where we are not only gunned down, but our identities are erased. Where many people live in states where it is still legal to be fired from your job or kicked out of your housing because of your identity. Where presidential candidates tout their plans to revoke your marriage license, and accuse you of being a pervert for wanting to safely use the restroom, and want to build a wall between the U.S. and your country of origin. Where you turn on the news and hear that Mexican men are criminals and rapists, statements made for political gain but not in truth. Where a night out dancing with friends in a seemingly safe space can end in death. Where your faith is misconstrued and blamed for atrocities and as a result your place of worship threatened.

All cannot feel safe in our society.

We need more than tweets and Facebooks posts offering “thoughts and prayers”. We need action. As family therapists and trained systems thinkers, we have a responsibility to be engaged in systemic change to reduce widespread racism and homophobia and Islamophobia. If you are thinking to yourself this isn’t about racism or homophobia or Islamophobia, if you are thinking I just want to know how to help clients in my office, then this message is especially for you. Discrimination and vilification of groups of people is connected at all levels of the system; discrimination at the macro level is connected to depression and suicide at the micro level. Consider this, since the introduction of the transgender bathroom bill in North Carolina, calls to the Trans Lifeline suicide hotline have doubled. We need only to turn back to our grad school intro to theory course books to understand this phenomenon.

Yes, we must be prepared to work directly in therapy with clients who experience hardship, and we also must be engaged in social change to reduce such hardships. We need to show up. At community cultural events. At pride events. At events that support communities of color. To march. To donate blood. To hand out water. We need to shut up and listen to the people most effected. We need to check our privilege and realize that if these events are optional for us, then we have a responsibility to stand with marginalized groups.

Then we need to speak up. At the dinner table. At church. In the classroom. By calling our elected officials. When we witness injustice. As therapists, our work and our ongoing education extends far beyond the therapy room and the conference workshop. We must be in communities listening to the voices of people of color and of LGBTQ+ people, particularly communities where identities intersect as queer people of color are most likely to be the targets of violence and discrimination. Then we work with these communities for change. You will learn more about how to be a helpful therapist in these spaces than anywhere else.

Kristen Benson, PhD, LMFT is an Associate Professor of Human Development and Family Science and core faculty in the Couple and Family Therapy doctoral program at North Dakota State University. She is an AAMFT Clinical Fellow and an AAMFT Approved Supervisor. She chairs the AAMFT Queer Affirmative Caucus.

 

 

Crisis Resources

When tragedies occur, even if we are not directly affected, there is a systemic impact that can affect anyone. Many of our members have shared that speaking with their clients in recent days, they have found they are struggling with processing Sunday’s shooting at Pulse nightclub or explaining the news of recent weeks to their children. The resources below have been created by member MFTs or compiled by AAMFT to help support this process.

Tips for Parenting During Times of Crisis

• Model calm and control. Reassure children that they are safe and so are the other important adults in their lives.
• Make time to talk with your children about crisis events. Take some time and determine what you wish to say. This is especially true since new information will unfold each day. Provide brief, accurate, and age appropriate information. Don’t dwell on the scale or scope of the tragedy, particularly with young children.
• Keep your explanations developmentally appropriate. Early elementary school children need brief, simple information that should be balanced with reassurances that their lives will not change. Upper elementary school children will be more vocal in asking questions about their safety and what is being done. They may need assistance separating reality from fantasy.
• Understand what your child is asking. Difficult questions that children ask may be spurred by curiosity or feelings. Rather than plunging into an immediate answer, learn what motivates the question. Ask, “What made you think of that?” or “What ideas do you have?” Once the meaning of a question is known, it is easier to answer effectively.
feelings.
• There may be questions we cannot answer. Rather than invent a response, it is more helpful to say “I don’t know,” or “I’ll try to find out.”
• Acknowledge, validate, and accept your child’s feelings. He or she may be feeling confused, frightened, or even excited. Listen calmly and reassuringly as they express their thoughts and feelings.
• Limit the amount of your child’s television viewing of these events. If they must watch, watch with them for a brief time; then turn the set off. Young children should not be allowed to watch tv coverage of the event, as they are too young to process what they are seeing and hearing.
• Maintain a “normal” routine. To the extent possible stick to your family’s normal routine for dinner, homework, chores, bedtime, etc. Children feel secure when routines are calmly followed.
• Spend extra time reading or playing quiet games with your children before bed without the television or news radio on. These activities are calming, foster a sense of closeness and security, and reinforce a sense of normalcy.

Many MFTs in the Orlando area are volunteering free services to those in the community who are struggling. To find a therapist, you can utilize our directory here: Find a Therapist. Additionally, these services are available: 

• Free services in the Orlando area including counseling for the LGBTQ and Latinx community
• The Center, serving the LGBTQ community, is open and offering grief counseling in English and Spanish. It is located at 945 N. Mills Ave. in Orlando. You also can call its hotline at 407-228-1446 or text your zip code to 898-211 to connect
• The Heart of Florida United Way 24-7 crisis line: 2-1-1
• Victim Service Center of Central Florida hotline: 407-497-6701
• UCF students can receive free counseling on campus at Counseling and Psychological Services from 8 a.m. to 5 p.m. Contact the office at 407-823-2811.

Past Family Therapy Magazine articles of interest:

• Spinning Fear
• Fear and the Family
• The Neuroscience of Fear
• Put the Oxygen Mask on Yourself First- Self Care when Working with the Traumatized 

Overreaching Texas Medical Association Limits Access to Care: Marriage and Family Therapists Fight to Maintain Diagnosis Ability

On Monday, the Texas MFT licensure board and TAMFT filed for a rehearing with the state supreme court. The motion requests a reconsideration of the recent denial of TAMFT’s petition for review. In the meantime, Texas, and our profession, needs your voice.

As providers, we frequently work with clients to advocate for their needs – whether with a partner, their family, or in their community. Now, we must advocate for our own needs, and for our profession’s. As a group smaller and younger than other mental health professions, we’re getting picked on. But, as a concerned colleague recently asked me, “don’t they know it’s a house of cards? Once we go, don’t the counselors and psychologists see we’ll all go?”

Consider our need to speak out systemic advocacy: we must advocate for our ability to practice as we always have and are qualified to do, and demand our mental health colleagues with alternate licenses do the same, in order to ensure that we’re still around to help clients in need of our care. We must work together, as advocates for self, other, and group, to change attitudes and policies that contribute to a dire mental health crisis, in Texas and elsewhere. For a profession with grass roots origins, solidarity and a unified voice will be critical.

Following the notice that the Texas Supreme Court had denied TAMFT’s petition for review, I stewed. I was frustrated, and felt unappreciated; isolated, in a world where I’m outnumbered by every other kind of mental health provider. But, a colleague shared a reframe I needed: “What are the options? Stay frustrated, feel like we can do nothing? I can’t stay there; that becomes hopelessness. I choose to speak louder.” As I’ve recommended to clients many times before, I decided to write my frustration out of my system. At the end, I had a piece that expressed my frustration with the Texas Medical Association, discussing the mental health crisis in Texas, and the need to continue to allow MFTs in the state to do what we are qualified to do. I submitted it to the Dallas Morning News as an OpEd, expecting to hear nothing, but able to sleep. Next day, it was published.

If you’ve never written an OpEd, now’s the time. You do not need to have ever done something like this before to be successful – but, we must try. It’s time to advocate for the profession and for those in need of our care broadly, on bigger stages than many of us are used to. Use your voice. Loudly, and often. Talk to friends, family, colleagues, mental health providers in other disciplines, and medical providers about what we do. Tell them 1 in 5 adults has a mental illness, fewer than half get the care they need. Sign up for AAMFT’s Family TEAM. Be ready and willing to volunteer to advocate, and respond quickly when called. Donate to TAMFT's political action committee, Family PAC, or AAMFT's Practice Protection Fund. Participate in social media, and use Twitter to connect with MFTs and a broader audience. More importantly, fight hopelessness, and combat threats to our profession and the growth of a worsening mental health crisis, by doing anything to walk the walk.

Material below previously published in Dallas Morning News, as How Texas is Creating a Mental Health Care Crisis (June 13th, 2016):

The state of Texas is experiencing a health care workforce crisis, and the most severe shortage is in mental health. So why, then, has the Texas Medical Association taken legal action to ensure that marriage and family therapists in Texas may no longer diagnose and treat mental health disorders?

Marriage and family therapists (MFTs) have effectively and efficiently been diagnosing and treating mental health disorders in Texas for years. In 2008, the Texas State Board of Examiners of Marriage and Family Therapists sought to edit the state regulatory code to more clearly indicate the profession’s ability to independently diagnose. Then, in a grand overreach, but for what appears to be typical for the organization (they have done similarly with chiropractors, podiatrists, and dentists), the Texas Medical Association sued the board to prevent diagnosis as part of the scope of practice of MFTs in the state.

 

Orlando: A Queer Voice

Late Sunday morning, I opened Facebook on my phone as a way to pass some time. I expected to see a few pictures of friends’ babies, some rants about the upcoming election, and photos from the various gay prides my friends are attending around the country. Instead, I learned about the rising death toll in Orlando. I read through the postings of my queer friends, many of whom were reeling in sadness, anger, and fear. My initial reaction was to detach. I thought, oh god, not more violence. I can’t deal with this right now. I don’t want to deal with this right now. And I put my phone away. It didn’t feel real and, for some reason, it didn’t yet feel personal.

On Monday morning, I still hadn’t spoken about it. I was still detached. At the gym, I heard another member discussing the club, Pulse, with her trainer. Shut up, I thought, I’m here to escape. I put on my headphones, turned the music up, and used my anger to get through the rest of the workout.

On Monday afternoon, I showed up to my department’s on-campus clinic for an evening of supervising students with the realization that my students, some of whom identify as queer, may be dealing with their own reactions and might not be prepared to provide therapy to others. I realized that some of our clients might be processing their own feelings. I steeled myself in preparation for their vulnerability. After all, I was responsible for all of their well-being. It wasn’t time for me to be vulnerable yet.

On Monday night, I lay in bed and opened the only social media application that felt safe—one that shows you your own postings from the same day at any point in the past. So, I did not expect to see anything about what happened early Sunday morning. I watched a video I had taken five years’ prior at a Robyn concert. As I watched her perform one of her most popular songs, “Dancing on My Own”, I was brought back to 2011 and the countless times I had sung that song at the top of my lungs in my favorite gay bar. Those joyful memories quickly turned to sadness and fear at the thought of all of that being taken away. I imagined someone attacking that bar on one of those nights and I could no longer detach from my feelings. It became personal and I finally became vulnerable.

You see, this was the same gay bar where I spent many nights dancing with best friends, new friends, and strangers. The same gay bar where I waited for the results of the 2012 presidential election. The same gay bar where I asked out another girl for the first time. The same gay bar where I finally felt visible as me—as queer.

The visibility of identities is crucial at a time like this—a time when people are being threatened, attacked, and killed for their membership in a marginalized and stigmatized group. When policies, the media, and our conversations do not explicitly include LGBTQ people, we make them invisible. And this invisibility allows homophobia to persist.

Many of us in the LGBTQ community can choose to hide. We can keep our heads down and be quiet about who we are. It certainly would feel safer—but only temporarily. Over time, our invisibility has and will further our own marginalization. By speaking up, by showing our pride, by making ourselves visible, we validate our identities and our own existence. We make it safe for those who are afraid to be themselves.

Many LGBTQ people are making themselves visible—through social media, vigils, marches, and through continued attendance at pride events. Search online for vigils in your area. Go to www.gaypridecalendar.com to find a gay pride in your area. And most importantly, check out these hashtags on any social media platform to see how LGBTQ people are fighting homophobia and making themselves visible: #gaysbreaktheinternet #twomenkissing #loveislove #lovewins #pride

Dr. Erica Hartwell is a LMFT and an Assistant Professor in the Department of Marriage and Family Therapy at Fairfield University in Connecticut. She has been a member of AAMFT and the AAMFT Queer Affirmative Caucus for 8 years. Her teaching and scholarship focus on issues of social justice, equity, and inclusion.

MFT Voice on Orlando

The music shut off and security was herding everyone out. It was closing time downtown at Wall Street. My girlfriends and I said our goodbyes after a carefree night of dancing in honor of the upcoming marriage of two dear friends. We were celebrating love. I got in my car and drove home to my husband who I awoke from his sleep on the couch. After a brief rundown on the evening’s shenanigans, we said “I love you” and went to sleep.

I woke up Sunday morning to messages on my phone. Social media asking me to mark myself as safe, emails and texts asking for a response, phone calls from love ones afar needing reassurance. The revelation of what happened hit. Just 1.5 miles away from where we were that night and early morning, at the same time, tragedy struck. Hatred and fear struck. What can be said that has not already? Our hearts ache to comprehend how yet another mass shooting against our own brothers and sisters could be happening, in our city or in any city. Our souls are weeping for those who did not get to say goodbye or I love you. For those whose carefree night was taken from them. For those who do not get to hear the voice on the other end of the line saying, “I’m alive.”

As I continued to read the news and social media keeping abreast of details pertaining to the tragedy, one thing is certain. United we stand. Members of the community finding ways to help and colleagues running out to provide support and counseling until all hours of the night. FAMFT’s own president-elect slept in a mobile unit after providing hours of service in the community until past 11:00 PM, only to awake and continue. A document circulating with over 450 (at that moment) names and contact information of mental health professionals, including our best local MFTs, offering free services to anyone in need. At my place of employment, practitioners volunteered in droves to provide 24 hour crisis and grief counseling anywhere that was needed both in the community and to fellow staff. This is a mere glimpse at the solidarity that has sprung.

While I reflect on the pain and tears fill my eyes at how this atrocious act could even come to fruition, I think of Dr. Viktor Frankl: “Everything can be taken from a man but one thing: the last of the human freedoms-to choose one’s attitude in any given set of circumstances, to choose one’s own way.” It is clear that despite what others try to inflict upon us and the temptation to turn against each other, our community, a symbol of diversity, has made a choice. “I grasped the meaning of the greatest secret that human poetry and human thought and belief have to impart. The salvation of man is through love and in love.” Well said Dr. Frankl. We are Orlando Strong and we choose to continue celebrating Love.

Free services for the Orlando area

The Center, serving the LGBTQ community, is open and offering grief counseling in English and Spanish. It is located at 945 N. Mills Ave. in Orlando. You also can call its hotline at 407-228-1446 or text your zip code to 898-211 to connect.

Heart of Florida United Way has a 24-7 crisis line at 2-1-1, and the Victim Service Center of Central Florida has a hotline at 407-497-6701. UCF students can receive free counseling on campus at Counseling and Psychological Services from 8 a.m. to 5 p.m. Contact the office at 407-823-2811.

Melissa Tran is a LMFT who has worked at the Orlando VA for five years. She serves on the FAMFT board and is the contributor for the FAMFT Twitter and Facebook. She is recently married.  

Support for the Orlando Community

On behalf of the AAMFT Board of Directors and Staff, our thoughts are with those in Orlando who were impacted by this weekend’s tragic mass shooting, particularly those coping with the loss of a loved one and those injured. Our thanks to the first responders, including many dedicated trauma and support therapists, who are providing vital aid to those coping with the outcomes of Sunday’s attack. If you or someone you love is in need of immediate support, we encourage to contact a licensed marriage and family therapist in your area.

As relational therapists, we recognize the long-term adverse effects that events like these can have on not only those who were immediately impacted but on our families, loved ones, and communities. And as an organization that highly positions diversity and inclusion in our core values, we stand opposed to any actions that marginalize and harm our diverse communities. Over the coming days as more details of this tragedy emerge, we share our support and voice with the many coming together to start a necessary dialogue around the absolute need for all to feel safe in our society.

MFTs, as highly trained experts, you are able to offer unique insight and voice to this tragedy. We encourage those of you wanting to share your thoughts to submit a perspective piece to the AAMFT blog. Email your draft to us at [email protected].