DANGER: HERE BE DRAGONS

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DANGER HERE BE DRAGONS

• DENE BERMAN
• TAPG Adventure Therapy Best Practices, June 2007,
  Durham, NH

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The Lenox Globe Ca. 1503-1507 hic sunt
dracones Located in the New York Public Library
Collection
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Strobnicza Globe Ca. 1512 Depicts the Americas
as Terra Incognita. See the Western Coast of
South America.
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Dragon Associated with Causing Earthquakes
Appears on the nineteenth-century Japanese map
Jishin-no-ben in the library of the University of
British Columbia
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The World of Wilderness Therapy as Once Known
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Outdoor Behavioral Health

• Behavioral Healthcare

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Behavioral Healthcare as an outgrowth of the CMHC
Act of 1963
A National Council for Community Behavioral
Healthcare Publication
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Behavioral Healthcare Organizations now Provide a
Range of Services
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Behavioral Healthcare as a Partner of Primary
Care Medicine
A National Council for Community Behavioral
Healthcare Publication
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Behavioral Healthcare and Medicine
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Behavioral Healthcare Associations Set Standards
of Care
An Association for Ambulatory Behavioral
Healthcare Publication
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Outdoor Behavioral Health

• Behavioral Healthcare
• Outdoor Behavioral Healthcare Industry Cooperative

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Joint Commission on the Accreditation of Health
Care Organizations is now The Joint Commission
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Outdoor Behavioral Health

• Behavioral Healthcare
• Outdoor Behavioral Health Industry Cooperative
• Outdoor Behavioral Healthcare The Joint
  Commission (formerly Joint Commission on the
  Accreditation of Health Care Organizations)

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There have been growing demands from critics
insisting that therapeutic and emotional growth
boarding schools, be regulated through licensing.
One stated presumption is there is no oversight
over these programs because they are unlicensed
and unregulated. There also seems to be the
presumption that with oversight, these programs
will stop the perceived abusive and punitive
methods that are claimed common. Another
presumption is that lack of government or any
other type of oversight is the rule, and that
responsible programs are the exception. Lon
Woodbury, Unlicensed and unregulated? Feb 21,
2007, http//www.strugglingteens.com/artman/publis
h/article_5669.shtml
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I found a case where the judge ruled that because
the guide was not "certified" among other
things, the defendant had enhanced the risks and
assumption of the risk could not be used as a
defenseYes folks if you are not certified in New
York, you are liable. Now it is going to be
harder to defend against lawsuits. Now it will
cost more, with no benefit to run a program. Jim
Moss, Certification, AEELIST, April 12, 2007
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Regulation

• Licensure - Individuals are licensed following
  testing that validates they have acquired the
  basic knowledge required for safe practice.

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Regulation

• Licensure - Individuals are licensed following
  testing that validates they have acquired the
  basic knowledge required for safe practice.
• Certification Like licensure, involves
  individual testing, in this testifying to
  achievement of special competence.

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Regulation

• Licensure - Individuals are licensed following
  testing that validates they have acquired the
  basic knowledge required for safe practice.
• Certification Like licensure, involves
  individual testing, in this testifying to
  achievement of special competence.
• Accreditation - evaluates programs rather than
  individuals and signifies that the program has
  passed a high standard of performance.

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What Would You Expect of a Provider?

• Licensed?
• Professional Associations?
• Evidence-Based Practice?
• Updated CMEs?
• Open Record of Lawsuits?
• Clinic Licensed, Accredited?
• ??????

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A grading system - assess the judgments behind
the recommendations.

• NATIONAL INSTITUTE FOR HEALTH AND CLINICAL
  EXCELLENCE (NICE) SYSTEM IS BASED ON 5 CRITERIA
• Quality of evidence for each outcome
• Relative importance of outcomes
• Quality of evidence across these critical
  outcomes
• Balance of benefits and harms net benefits,
  trade-offs,
• Strength of recommendations
• GRADE Working Group. (2004). Grading quality of
  evidence and strength of recommendation. British
  Medical Journal, 328, 1490-1497

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MEDICARE NATIONAL COVERAGE DETERMINATIONS (NCD)

• A comprehensive summary of safety and
  effectiveness data
• A summary of evidence showing medical benefits
  and target populations
• Reasoning for how coverage will benefit the
  target population.
• Medicare program Revised process for making
  national coverage determinations. 68 Fed. Reg.
  55634 (September 26, 2003).

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When Healthcare is Determined by Insurance
Companies

• Fees set by insurance companies
• Malpractice and lawsuits
• Strict record keeping requirements
• Insurance requirements and payment
• Having a more formal relationship with clients
• Less room for innovation
• Authorization for services is often a matter of
  money and not what is in the patients best
  interests.

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Looking Into the Glass Ball

• The Dragon Eats Creativity

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Looking Into the Glass Ball

• The Dragon Eats Creativity
• The Dragon Requires even More Expertise

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Looking Into the Glass Ball

• The Dragon Eats Creativity
• The Dragon Requires even More Expertise
• Psychopharmacology and the Dragon

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Looking Into the Glass Ball

• The Dragon Eats Creativity
• The Dragon Requires even More Expertise
• Psychopharmacology and the Dragon
• More Staff for the Care and Feeding of the Dragon

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Preparing to Meet the Dragon

• Share our stories

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Psychiatric Continuum of Care

• Outpatient
• WT as an adjunct
• Intensive Outpatient
• WT as more intense structured activities
• Day Treatment
• WT as more intense structured activities
• Partial Hospitalization
• WT as more intense structured activities
• Inpatient Hospital
• WT as more intense structured activities
• Residential
• WT as Expeditions
• At each level, the activities of prior levels are
  also an option

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Preparing to Meet the Dragon

• Share our stories
• Professionalize our field

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NATSAP

• For all new programs and by January 1, 2009 for
  current programs, there must be an Independently
  licensed mental health professionals who has
  oversight of treatment.
• This person must be openly accessible to
  students.

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Preparing to Meet the Dragon

• Share our stories
• Professionalize our field
• Look for allies, not adversaries

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Preparing to Meet the Dragon

• Share our stories
• Professionalize our field
• Look for allies, not adversaries
• Increase our transparency

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Preparing to Meet the Dragon

• Share our stories
• Professionalize our field
• Look for allies, not adversaries
• Increase our transparency
• Do the research

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Preparing to Meet the Dragon

• Share our stories
• Professionalize our field
• Look for allies, not adversaries
• Increase our transparency
• Do the research
• Know who we are not

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Godspeed. Safe Journey.