Wow - now that February's FMHCA Annual Conference is behind us it seems like this year is just flying by.  I want to take this moment to thank each of you for your continued membership - FMHCA would not be where we are today without such loyal support! Guess what?

We want to hear from you!

FMHCA has a fabulous newsletter that goes out each month, filled with informative articles that promote and inspire Florida's Mental Health Counselors.  This means you!  We would love to hear your voice and welcome submissions that capture social issues facing our industry, promote solutions, and empower your peers.  FMHCA also welcomes articles highlighting useful tools, best practices, and effective treatment approaches.  Let's work together to help FMHCA remain a top resource for Florida counselors!  Please send ideas and submissions to DocSilvernail@aol.com.

By Corinne Mixon, Florida Statewide Lobbyist for FMHCA

The Florida Mental Health Counselors Association's priority bill has passed through its first committee in the Florida House of Representatives. House Bill 1041, titled Mental Health Counseling Interns, caps internships for clinical social work, marriage and family therapy and mental health counseling interns at five years.

Prior to this bill being filed, a loophole in the law has allowed nearly 1,700 of only 7,300 currently registered interns to continually register for longer than six years. There are currently nearly 200 interns that have been registered since the inception of the law in 1998. Thirty-five percent of the discipline cases that come before the regulatory board result from these long-term interns, many of whom act as though they are fully licensed. This reality is a risk to the people of Florida and must be fixed. Additionally, this bill will ensure that the professional title of Licensed Mental Health Counselor is meaningful and protected.

The FMHCA is proud to help pass this important piece of legislation through its first committee of reference.

Please craft a handwritten note to our 2014 Florida House of Representatives bill sponsor, Rep. Amanda Murphy (D-New Port Richey), to thank her for her hard work in sponsoring this legislation! Her Capitol Address is as follows.

State Representative Amanda Murphy, 1301 The Capitol, 402 South Monroe St., Tallahassee, FL, 32399.

House Bill 1041 must be heard in the Health Care Appropriations subcommittee and the Health and Human Services Committee prior to making its way to the House floor where it will be voted on by all 120 members of the Florida House of Representatives.

The Senate bill, by Sen. Bill Montford (D-Panhandle), SB 1388, will be heard Tuesday, March 25th, in the Children, Families and Elder Affairs Committee. FMHCA hopes that the bill will pass the committee easily and make its way through the Health Policy and Appropriations Committees.

The Agency for Healthcare Research and Quality (AHRQ) welcomes nominations for new members to the U.S. Preventive Services Task Force (Task Force). Each year, the Director of AHRQ appoints new members to serve 4-year terms and replace those who are completing their service. To learn more about the nomination process, how to nominate an individual for consideration, or how to self-nominate, please visit www.ahrq.gov/clinic/tfnominfo.htm. Nominations must be received by Thursday, May 15, 2014 to be considered for appointment with an anticipated start date of January 2015.

Qualified candidates must demonstrate expertise and national leadership in clinical prevention, the critical evaluation of research, and the implementation of evidence-based recommendations in clinical practice. In addition, AHRQ seeks candidates who have experience in public health, the reduction of health disparities, the application of science to health policy, and the communication of findings to health care professionals, policy makers, and the general public.

To maintain balance in the expertise among members, this year, AHRQ is actively seeking the nomination of individuals from the field of family medicine. Individuals nominated prior to May 15, 2013 who continue to have interest in serving on the Task Force should be re-nominated.

The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. More information on the Task Force is available at www.uspreventiveservicestaskforce.org.

AHRQ provides ongoing scientific, administrative, and dissemination support to the Task Force. To learn more about how AHRQ supports the Task Force, please visit http://www.uspreventiveservicestaskforce.org/bulletins/ahrqsupportfact.pdf.

By Lorrie McCann, LMHC, CT

On April 1, 2014, President Obama signed into law an extension to the current Physician Medicare Fee Schedule until March 31, 2015. This legislation was the vehicle AMHCA targeted for an amendment on Medicare Provider Status for LMHC's. Unfortunately the law to extend the current fee schedule for physicians does not include S562/HR.3362, the bills that would mandate LMHC's long sought after provider Medicare status.

This is why is it critical that you contact Florida Senators Nelson and Rubio and your Representatives and urge them to support Medicare Provider Status for LMHC's. Our legislators need to hear from you. The clock is ticking!!

Florida has the highest percentage of people over 65 in the nations. As counselors we know only too well the devastation caused by untreated mental illness and substance abuse.  As counselors we are well trained to serve our legislators constituents. But, without Medicare Provider status we cannot treat this ever growing population.

The Affordable Care Act (Obamacare) seeks to create seamless care entities through Accountable Care Organizations in order to improve outcomes and decrease costs. Insurance companies will likely prefer providers who care treat all their beneficiaries not just those under 65. We are at risk of being left out in the cold. Our education and experience won't count if we're excluded from participation.

Professional Identity and Compliance

By Catherine L. Waltz, PhD, LCSW

Recently during a discussion in a LinkedIn group someone contributed the comments about what folks put behind their names on their cards, e-mail signatures, etc.   I wonder about this all the time.  Even in the FMHCA Discussion Group on LinkedIn people consistently use an acronym that is not allowable according to Florida law and our Rules.  That is, RMHCI. 

There is no such acronym allowed by the law and it continues to frustrate me that more seasoned professionals don't point out those violations to help our new developing professionals to be compliant with the law from the beginning of their 'internship'.  As standard bearers for our profession we shouldn't leave the modelling of professional behavior to Qualified Supervisors.  By the way, many Qualified Supervisors also use the acronym online when referring to Registered Interns.  Our rule 64B4-5.005 Minor Violations, Notice of Noncompliance refer to a standard that states "(j) Failure of a registered intern to use the words 'registered intern" on all promotional materials, including card, brochures, stationery, advertisements and signs, naming the licensee as required by Section 491.0149(2)(b) , F.S." is a "minor violation".  Does the minor nature of the violation allow us and registered interns to ignore the rule?  Yes?  No? 

How about an analogy?  Okay, so if we just go a few MPH over the stated speed limit and "everybody else is doing it" are we breaking the law or not?  We're just as likely to get a speeding ticket if we are stopped by a cop.  Should we wait until the Board takes action to discipline our Registered Interns before we redirect new clinicians and our licensed peers?  I don't think so.  How about spreading the word and improving the profession-wide modelling of professional compliance by engaging your peers in a discussion about this and other violations for which Registered Interns are being disciplined.

by Deb Legge, PhD CRC LMHC

Whether you are building a Private Practice for the first time, or you are looking to "build" your existing Private Practice, it is important to know the opportunities and risks that exist today.  As with almost everything in life, building a Private Practice carries both risks and benefits. 

A huge focus of my work as a Private Practice Mentor is helping my clients reduce their risk and reap every benefit possible. Here are a few tips that might help you as you establish or grow your Private Practice. 

Here are 3 challenges that will require you to reach out for help in order to reduce the potential for risk:

1. Business collaborations are rarely "simple".  Some folks think that because they form a simple partnership (that they not incorporate) just to make things more efficient (like signing a lease, collaborative marketing, or taking a small business loan), they don't need to get the advice and guidance of an attorney.  My experience is that no matter the structure of your collaboration, it is critical to have a partnership agreement that covers things like:  the requirement for your partner to carry life insurance with you as the beneficiary so you can cover the costs should s/he die; how the business will be handled if you do pass away - will your share be left to your business partner or will your family have a stake in the business?; if one of you loses your license to practice, will the partnership go on?, etc.   
2. There are many ways to rent space, and all space is not created equal.  Will you rent an office in an existing office suite?  Will you sublet a couple of days in another practitioner's office?  Will you lease a couple of offices and sublet to others?  Be sure to know the nuances of any agreement you make with regard to space.  Be clear on things like:  Who will carry the office (general) liability? Is there a condition of the lease that allows you to sublease to others?  Is your monthly rent the only bill you will get, or will you get bills for utilities or annual expenses that are not included in the lease?  Are you signing this lease as a business or are you required to sign personally on the lease?   
3. Before you simply change your address with the insurance companies for which you are on panel, know their policies and procedures!  You don't want to change your address only to lose your place on panel because they don't need another provider in the new zip code you'll be practicing from!  Sometimes it is best to add a second location, and then drop the inactive location after some time

Deb Legge, PhD CRC LMHC

DrLegge@InfluentialTherapist.com 

Dr. Legge is known nationally as "The Private Practice Mentor". Her work has been featured by ACA, Counseling Today, AMHCA, ACA-NY, and in her website, InfluentialTherapist.com.   Find out how to Book Yourself Solid� in Private Practice. Schedule your free Laser Coaching Session with Deb Legge: http://www.ScheduleWithDeb.com 

Mythbusting: Tobacco Use Does Not Benefit Persons with Mental Health or Substance Abuse Disorders

by Andr�e Aubrey, MSW, LCSW, CTTS

Did you know that tobacco kills more users than alcohol, HIV/AIDS, illegal drugs, motor vehicle injuries, suicides, and murders COMBINED?  The Center for Disease Control and Prevention (CDC) reports that about 440,000 people die prematurely from a tobacco-related death every year and approximately 200,000 of those deaths are among people who have a mental illness.  Tobacco dependency also is correlated with lower educational attainment, service or blue-collar employment, and lower socio-economic status.   

Although the tobacco use prevalence rate in Florida is an approximate 18%, the prevalence rates for people with psychiatric or substance use disorders is an alarming 45-90%, depending upon the specific diagnosis. These shocking prevalence rates, combined with heavier smoking, enhanced withdrawal symptoms, and fewer lifetime quit attempts in this population significantly exacerbate the health disparities that already exist.   

The myths about the "benefits" of tobacco for people with mental health or substance abuse disorders are rampant.  One of the "benefits" mentioned most often seems to be stress relief.  However, the risks of premature death and disease far outweigh any short-term benefits of tobacco use.   Tobacco kills about half of the people who use it. (World Health Organization)

In addition to the 440,000 people who die prematurely from smoking or exposure to secondhand smoke, another 8.6 million live with a serious illness caused by smoking.

When clients tell you that smoking helps them deal with stress or anxiety, please investigate further.  Nicotine withdrawal is characterized by irritability, frustration, anger, difficulty concentrating, increased appetite, restlessness, depressed mood, and insomnia.   When people smoke a cigarette in response to these symptoms, they interrupt their nicotine withdrawal so they feel better.     

The symptoms of nicotine withdrawal begin approximately 60-90 minutes after smoking or using other tobacco products.   Smoking or chewing tobacco relieves these withdrawal symptoms rapidly, usually within seven to ten seconds, giving the tobacco user a sense of calm and pleasure.  Therefore, the tobacco user feels better, receiving a reward in the form of a brief reprieve from "stress" only to have the "stress" (withdrawal symptoms) return repeatedly throughout the day.   A recent study in the British Journal of Psychiatry found that when people quit, they felt a drop in their anxiety.  The improvement in anxiety was especially true among people with mental health problems who used smoking to cope. (1 )

Mental health counseling has a rich professional history of helping people lead healthier lives, especially people who are oppressed or marginalized.  Mental health counselors must understand the importance of treating tobacco dependency and advocating for improved access to treatment, especially for people with mental health and substance abuse disorders.

Andr�e  Aubrey, MSW, LCSW, CTTS

Director, Area Health Education Center

After Sandy hit New York, Maria felt her civil duty was to volunteer at the shelters. Due to building damage, her practice would be closed for at least a week. She witnessed the devastation, the suffering of those who lost it all, the fear and sadness of the children who couldn't even fathom the dimension of what had just happened.

A few days after experiencing the disaster firsthand, Maria started to wake up abruptly in the middle of the night sweating, the heart galloping like a wild horse in the prairie. It was difficult sometimes to make out reality from nightmares. When she returned to work she was jumpy and irritable, dreading the arrival of her first patient. Her self-confidence seemed gone. Her mind wandered when she tried to listen.

Know what compassion fatigue is about

The above vignette describes symptoms similar to those of PTSD, resulting from the counselor's exposure to traumatic experiences. Her ability to react empathetically was compromised. She might also have experienced a shift in her sense of hope and optimism about the future and the value of their work.

Much is expected from a counselor: to be patient and non-judgmental; to be a compassionate and empathetic listener and often, to put own needs aside. These demands render counselors vulnerable to experiencing burnout and even compassion fatigue.

Not a rare occurrence among healthcare practitioners, Compassion Fatigue (CF) is a relatively new term, coined in 1992 by Carla Joinson, RN. Later on, other authors called the same phenomena "Vicarious traumatization" (Lisa McCann, Laurie Anne Pearlman) or "Secondary traumatic stress" (Charles R. Figley) but the term compassion fatigue held.

In 1995, Figley defined it as "the emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events."

CF can occur due to being exposed to one case or to "cumulative" levels of trauma. A counselor might be affected by listening stories from a client or co-worker, reading case files, hearing court testimonies or watching disturbing news footage.

We are not necessarily aware of how and to what degree witnessing traumatic experiences might affect us. Therefore, we might not be able to recognize the body's warnings that CF is occurring.

Compassion fatigue is different from burnout, a state of physical and emotional exhaustion. CF has a more rapid onset while burnout emerges over time. In CF the person experiences signs similar to those of PTSD including intrusive thoughts, avoidance and hyper arousal but has a faster recovery if recognized and managed early.

Know your neurobiology, explore unresolved issues

In order to prevent CF, counselors should strive to understand how our brains become vigilant and wary and so easily hijacked by alarm, to gain more control over the ancient brain circuitry - the hypothalamic-adrenal axis in charge of the stress response. 

Since unresolved issues make us vulnerable to CF, seriously working through countertransferencial issues will also help counselors build resilience.

Practice mindfulness

Both neurobiology and contemplative practices could contribute to provide us with answers and awareness of the way our brain reacts to feeling threatened. They can help us prevent compassion fatigue and support those patients who as caregivers have been indirectly exposed to trauma.

Mindfulness is demonstrating to be one of the most important tools in stimulating and building up the necessary neural substrate for a mind that has more calm, wisdom and sense of inner strength.

Compassion satisfaction, the pleasure you derive from being able to do your work well, buffers compassion fatigue and becomes an expression of the balance achieved by practicing contemplative disciplines and by focusing on positive rather than on negative aspects of an experience.

Meditation, Tai-Chi, QiGong, yoga, martial arts, journaling and painting are among the contemplative practices that help us foster empathy and communication skills, reducing stress and enhancing our creativity.

Nomination deadline is May 23, 2014. 

Join us in celebrating and recognizing the award winners
at AMHCA's Annual Conference, July 10-12, 2014, in Seattle.

 Each year, AMHCA honors the best and brightest of its membership. 

This is an important time to recognize and join with others to strengthen our personal and professional paths to greater mental health. Each year at AMHCA's Annual Awards Luncheon, our organization honors those individuals and state chapters who have made achievements above and beyond the ordinary. 

Join us at the 2014 Annual Conference to honor inspirational examples of excellence as we celebrate winners of nearly 20 awards.

You are invited to submit nominations for individuals and for large and small state chapters that have made outstanding progress in the last year. Awards categories are described below. All nominees must be AMHCA members, with the exception of nominees for Legislator of the Year. 

The Florida Department of Health, Division of Medical Quality Assurance will now verify a practitioner's continuing education record in the electronic tracking system at the time of renewal.  This program is part of our commitment to expeditiously license health care professionals who meet statutorily mandated standards of competency