Although I have long championed a big boost in the federal commitment for early care and education, I have a major concern with the FY 2011 early care and education budget increases President Obama proposed this week. The funding increases the president proposes for FY2011 are, if nothing else, big. They include:

• A $1.6 billion increase in the Child Care and Development Block Grant for a new total of $6.65 billion. That’s the biggest increase that program has seen in decades. Some $800 million of that would not require a state match.
• A $989 million increase for Head Start and Early Head Start, for a new total of $8.2 billion.
• Somewhere in the neighborhood of $9 billion over 10 years for a new Early Learning Challenge Fund (ELCF) that would make competitive grants to states to improve the quality of early learning programs to help children enter kindergarten ready to succeed. (This has not yet passed in the Senate, perhaps because it depends on savings in student loan costs that are being fought by business interests.)
• $450 million for a restructured literacy program the details of which are not yet available.

The President’s commitment to early care and education in tough budget year is admirable. Assuming the Early Learning Challenge Fund passes, we could be looking at a $4 billion expansion of resources in the coming year — and that’s before we take into account the President’s doubling of the child care tax credit! So why am I concerned?

I worry that the new spending will be effective only if it is accompanied by serious reforms. Recent studies find that child care subsidies mostly move children from informal to formal care and have little or no effect on maternal employment. Yet, the quality of subsidized care in the United States is so low that child development may not be improved and might even be harmed. Early Head Start and Head Start produce positive results for children, but are nowhere near good enough. Of course, it doesn’t have to be that way; we can give children better programs.

If child care and Head Start are to receive more money, I would urge it be tied to higher standards, incentives for better performance, and accountability. This is the Obama Administration prescription for education reform (as I read it), and one the ELCF is designed to bring into the birth to five realm. If these new dollars are to be used effectively, the ELCF must be part of the package. And, I would encourage Congress to go even further. Tie new child care and Head Start funds to new requirements for competition, higher standards, accountability. That, combined with rigorous evaluation, can ensure our children truly benefit from these significant new investments.

Steve Barnett, Co-Director, NIEER

If we want to be heard, it sometimes helps to speak the language of our intended audience, many of whom are non-educators. For instance, business talks of productivity. There is a difference, for instance, between apparent and authentic productivity. Although these terms may be anathema to some educators, they can be used in a way that makes sense, particularly when we compare the financial meltdown with the educational meltdown.

Let’s use the lens of the sub-prime crisis to think this through. The profitability of many financial organizations turns out to have been largely apparent but unreal. And others have been profitable but extremely unproductive from the point of view of the community. Profitability and productivity are not the same thing. In fact many of the underlying products and processes were deeply flawed. Securities were not secure, and financial advice was misleading or wrong. So an apparently successful and flourishing system lacked authentic productivity. And the results have been calamitous.

The situation in education is somewhat similar. Society focuses on test scores as indicators of success. But the conceptual blind spot we have as a culture is to assume that test scores, genuine understanding and real world outcomes are directly linked. They are not. The link is indirect.

Putting all our effort into raising scores directly is very much like maximizing profitability at the expense of authentic productivity. The result is to actually undermine education, just as the entire banking enterprise has been undermined.

There is now a great deal of research to support this claim about learning, teaching and results. And this research gels with what great educators know. For instance, when students are taught for deep understanding, the ultimate test is whether they can solve challenging problems, report on their thinking and their processes, and deal with relevant situations in the real world. When they can, they will, in fact, also start to perform better on most tests. Examples can be found in many countries, in public education, in charter schools, in home schooling, and at every level from early childhood education to high school. That is why nations such as Finland can do so much better than on international comparisons than the United States.

What matters is getting the fundamentals right. The net result will be less angst, less pressure, more satisfaction for most stakeholders, and a much more productive system of education.

Title: Giving children a healthy start

Skinny: Assesses the local implementation of national policy from 1999 to 2009 on the health of children from birth to five years of age in England.    It considers local service planning and delivery, including priority setting, and how local bodies can improve service delivery and access for vulnerable groups such as black and minority ethnic (BME) communities, lone and teenage parents.  The impact of government funding on health outcomes for the under-fives; how effectively local bodies manage their resources; and the extent to which they are providing good value for money are also considered.

Publisher: Audit Commission

Size of Publication: 60p

Published: 03/02/2010

Title: Department of Health: Progress in improving stroke care (Executive Summary)

Skinny: National Audit Office Report on the Department of Health’s strategy for stroke care.  It finds that it increased the priority and awareness of the condition and started to improve patients’ care and outcomes.

The strategy has been underpinned by strong national leadership and performance indicators as well as £59 million of central funding over the first two years, £30 million of which was allocated to local authorities specifically to provide support services to stroke patients and their carers. With this clear focus from Ministers and the Department, the NHS is now starting to deliver better care from stroke services, and outcomes for patients are also improving. The NAO estimates that stroke patients’ chances of dying within ten years have reduced from 71 to 67 per cent since 2006.

It identifies that treated in a specialist stroke unit are more likely to survive, have fewer complications and regain their independence, and all relevant hospitals in England now have such a unit, although the services provided and time spent in the unit vary. Stroke patients should be immediately admitted to a specialist stroke unit; however in 2008 only 17 per cent of stroke patients reached the stroke unit within four hours of arrival at hospital. Brain imaging is also very important for stroke patients but many patients are not given a scan quickly enough and access at weekends and evenings is significantly more limited.

It is clear that there is better awareness of the symptoms of stroke, and that it is a medical emergency, following the Department’s ‘Stroke: Act FAST’ advertising campaign, launched in February 2009. The number of calls categorised as being a suspected stroke during April to June 2009 increased by 54 per cent in comparison with the same period in 2008.

However health and social care services are not working as well together as they could. A third of patients are not getting a follow-up appointment within six weeks and only a half of stroke survivors in the NAO’s survey said that they were given advice on further stroke prevention when leaving hospital.

Publisher: NAO

Size of Publication: 48p. (10p.)

Published: 03/02/2010

After coming up with some of the content and structure for a programme, and discussing the need for a stable clinical team with effective skills in group-based CBT and an applied behavioural focus, today I thought I’d add in something about selecting, assessing and follow-up that’s required.

I get absolutely frustrated with reading and hearing about interventions that are either not required to furnish, or don’t consider outcomes – both psychometric questionnaire results (thought to indicate change in the ‘real world’) and real world outcomes.  The art of making sure that what we do makes a difference, and knowing how to do this well seems to be quite lost on many clinicians and it really frustrates me.  I’d find it professionally unsatisfying if I carried out an intervention and never had a clue as to whether it made a difference long after I’d finished seeing the person, so I can’t understand why so many clinicians (a) don’t measure outcomes (b) measure them poorly either through inadequate pre-treatment measures, inappropriate timing of post-treatment measures, or using irrelevant measures (c) measure outcomes using only psychometric questionnaires, or unidimensional measures.

I’ve mentioned outcomes first because part of selecting people for a programme is about taking baseline measures so that you know where you’re starting from, and you can ensure the programme is appropriate for the person’s needs.  Selection also includes identifying the person’s readiness to move towards self managing pain, because if someone’s not ready they can become resistant (just think of all the ways people avoid doing what they don’t want to do! And include yourself), become ‘innoculated’ against the concepts (‘tried that, it didn’t work’), and influence group process negatively.

Just as a surgeon selects people for surgery after careful assessment, and declines surgery for people who are unlikely to benefit from it, so we need to be similarly selective in pain management.  Pain management programmes are not ‘the last resort’ after everything has failed, they are a positive step forward for people who need to and want to take over the management of their own situation.  Like any other self management programme like alcohol and drug rehabilitation, until the person is ready to do what will be very difficult and life-long, it’s unlikely they’ll benefit.

Every participant for a pain management programme needs to be comprehensively, and recently, assessed from a biopsychosocial perspective. Medical issues need to be managed before programmes commence, and the person needs to be reassured that they are safe to begin to do things again – and I’m afraid, this almost always needs to be reassurance from a doctor.  Psychsocial issues influencing the person need to be identified – note the word psychosocial. Without considering the social it’s unlikely the situational and contextual factors that often constrain behaviour change, including things like litigation, family, case management issues and work issues.  These factors influence beliefs, attitudes, behaviours and emotions and it’s critical that the person is seen as one person within a whole network of others.

When screening to establish readiness for pain management, other factors to consider are concurrent activities like vocational management, other investigations and pending treatments, evne things like holidays and training.  Some of the other areas that might make it difficult for someone to participate are communication style, cognitive functioning, learning style, fatigue, activity level, and needs that don’t ‘fit’ with the majority of the programme participants and content or structure.

I’ll post a screening semi-structured interview later today, that I’ve used to help identify whether a participant is ready and appropriate for a group pain management programme.

All participants need to have some baseline measurements taken before a programme.  In fact, there should be one set at comprehensive assessment, and a second set before a programme, another set at completion of the programme, then at least two, but preferably three times after – I think 1, 4 and 9 months later, or thereabouts.  As time progresses, the intervening variables confound outcomes, and the number of respondents also drops, so it can be a challenge to obtain enough responses and for them to reflect programme changes over time.

What to measure and how?  I’ll leave that for another day, suffice to say that questionnaire results are not enough.  Not that they’re unimportant, because they are – but until they have had predictive validity established within the community in which your patients live, they may not reflect much useful information.  Real world actions are far more valid, but are much more difficult to measure accurately – on the other hand, I think I’d like a valid measure that actually measures something important and useful, than to measure something irrelevant but do so incredibly accurately.  Otherwise we could all give participants a blood test for glucose levels and be done with it!

References?  Loads and loads of ‘em.  Where do I start?

The first and probably most comprehensive reference is either of the two editions of Pain Management: Practical applications of the biopsychosocial perspective in clinical and occupational settings by Main, Sullivan & Watson.  The first edition was by Main & Spanswick, it’s a Churchill Livingstone publication under the Elsivier imprint.  The first edition contains almost a ‘recipe’ for how to run this type of programme, while the second edition contains more conceptual material but provides excellent information to support clinical practice.

Further references:

Fordyce, W E (1976). Behavioral methods for chronic pain and illness.  CV Mosby, St Louis, MS.

Turk, D, Meichenbaum, D, Genest, M. (1983). Pain and behavioral medicine: a cognitive-behavioural perspective.  The Guilford Press, New York.

Loeser, J., Sullivan, M. (1995). Disability in the chronic low back pain patient may be iatrogenic. Pain Forum, 4: 114-121

Main, C., Parker, H. (1989). The evaluation and outcome of pain management programmes for chronic low back pain.  In Roland, M., Jenner, J. (Eds.) Back pain: New approaches to rehabilitation and education.  Manchester University Press, Manchester, pp 129-156.

Keefe, F., & van Horn, Y. (1993). Cognitive-behavioral treatment of rheumatoid arthritis pain maintaining treatment gains Arthritis Care & Research, 6 (4), 213-222 DOI: 10.1002/art.1790060408

How many child therapists go into a session believing they will win (as in: their child or young client will manage to come out of the intervention with whatever they needed)?

I ask because the newspapers said that this is how Federer went into his finals match in Australia – believing he would win. Conversely, they make the assumption (because who really knows?) that Murray went in hoping he might win.

There’s something important here. The key words “hoping” and “might” are tentative, exploratory. “Believing” and “would” are much more positive. And they bring up two issues that we all have to bear in mind as we work in counselling or psychotherapy:

1 How much does our having confidence in the young person to solve their own problems affect them?

Do we hold back on the encouragement because we need to honour the “keep yourself out of the way” and “don’t invest too much in a particular outcome” model of working? Do we deprive ourselves of the power of our influence while intending to empower the young person? Surely it is possible to hold both positions without seeming to put a bet on a particular outcome? Can we ever be sure we will win with any client? Should we try and show that faith to the client?

2 When anyone says “hope” or “might”, there is an implicit and unspoken “BUT”.

Some of us term this a tail-ender. Murray may have been thinking: “I hope I might win but Federer’s very good.” Likewise: “Yes, it’s okay…” (BUT); “Fine…” (BUT); “I hope to do that…” (BUT). You can hear them all the time once you start listening for them. And noticing them saves us ploughing on thinking that the young person is with us, or even as positive as their spoken answers suggest. If we hear the tail-enders, we can address them first. That then helps displace the “hope” and “might” with something more certain.

Now, I think these two issues are in most therapists’ minds. But I do know that EFTers (those who use Emotional Freedom Techniques, alone or integrated into their practice) are alert to these all the time.

You see, you can’t really have that “I believe” or “this will be the outcome” attitude unless you deal with the tail-enders as you go. And if we do, then a positive outcome is much more certain. I mean, which gardener would pass over some deadheading while still expecting the plant to blossom for a second time in the season? And we are psychological gardeners of a sort, aren’t we?

To put it in a nutshell: pick off the BUTs and the outcome is certain.

The question of measuring outcomes, defining goals and managing activities can be quite complex and many people have written on this topic. I don’t want to rehash that work or get into a debate about the exact terminology, I don’t think that is important.

What I tell groups I work with is that you do need to be clear on a few key pieces and you can label them however you want.

First – there should be a hierarchy of detail.

• Start at a high-level mission or vision for an organization such as “strengthen the economy by raising the incomes of poor families” [from A Living Wage for Families]. While not a single measure, this sets the overall framework for your organization.
• Then getting into specific goals and objectives
• Next define the specific activities to achieve each goal
• Finally think about the outcomes of your activities – how is this linked back to your mission

Where most organizations get into trouble with communications is that they focus on measuring activities or outputs not outcomes. And in fairness, this is often easier. It is simpler to measure how many kids went through your after-school reading program than it is to measure the impact this had on family cohesiveness. This is the critical piece of tying your measurement back to supporting your mission using simple measures that can be easily captured.

As an example, I worked with a group of high-school students that organized a conference by high-school students and for high-school students. The conference was designed to get kids involved in the community by volunteering, creating non-profits, working on environmental projects, etc. When we talked about measurement, they immediately focused on the low-level details like how many tonnes of carbon were reduced by the various environmental projects. While useful, what is really interesting is what the group is actually doing is building a community of engaged youth leaders. And the tonnes of carbon doesn’t measure that! Instead, I suggested looking at how many kids came back year after year, how many were still engaged with their projects after two years, how many “alumni” returned to the conference to donate their time. These measures start to get at the social and community value being built.

The process of defining measures is often an iterative one, starting with that high-level and dropping down to the details.  You need to remember to use your mission as a check on the measures you choose – do they really communicate the value you are delivering to the community? Or are you simply measuring your activities without linking that to a meaningful impact?



In our sample of already-exercising adults with disabilities, we saw a statistically significant decrease in injuries due to loss of sensation and circulatory problems (swelling of legs or feet and occurrence of blood clots).  In addition, there was a trend toward a decrease in problems with weight control and regulation of eating.  These changes after a relatively short time of exercising are important because they relate to short-term cost changes, but also to long-term effects on health.

• Decrease in problems due to loss of sensation refers to a decrease in the occurrence of skin problems due to loss of sensation, such as skin breakdown, which can be very expensive to manage, with costs ranging from $2,000 to $30,000 per wound.  The cost can go as high as $200,000 if surgical repair and hospitalization is necessary. We saw a decrease of 8% in moderate to severe problems in this area.

• Decrease in circulatory problems relates to a decrease in both swelling in the legs and in the development of blood clots. We saw a decrease of 12% in moderate to severe problems in this area.

• Decrease in problems related to weight control and regulating eating are important because obesity is a common secondary condition for individuals with disabilities, and is related to decreasing independence in transfers and self care and increased problems with blood pressure and diabetes. We saw a decrease of 15% in moderate to severe problems in this area.

• Finally, we saw an overall trend toward a decrease in the severity of secondary conditions, and expect to see a larger change over time. Specifically, we saw a decrease in severity in arthritis, isolation, and problems with access.

This outcomes study of already-exercising adults with disabilities and complex health conditions demonstrates continued gains from regular exercise. The decrease in secondary conditions and in the severity of those secondary conditions translates to real improvements in health for these individuals.  Support for fitness services for individuals with physical disabilities is an effective way to promote health and fitness in a population at risk.

I wanted to share a simple truth that has helped me work on me effectively. If you are looking for chapter and verse, review Romans 7 and 8. In the course of seeing change in my own life, it can sometimes seem like an impossible feat. I’ve learned why….

There are three elements of change:
1. Beliefs                             2. Actions                                     3. Outcomes
We get some outcomes that we don’t like. We’re disappointed in ourselves and feel guilt. So, we go back and work on #2 real hard. Temporary change comes and we begin to feel good about ourselves again…. Until a moment of weakness and we fall back into the same actions and outcomes that we thought we’d never visit again. Now, we feel really guilty and really disappointed and frustrated and perhaps a little hopeless. We try harder and we fail more and we get caught in this whole negative whirlwind of trying and failing and now we’re depressed and we lose the will to keep trying.

There’s a better way. If everything up to this point sounds familiar, I suggest that instead of trying to pull yourself up by your bootstraps again and change your actions, 3,2,3,2,3,2,etc….you take a deep breath and work on #1 a little bit.

What are your core beliefs? Do you believe in God? Do you believe in Jesus, God visiting earth in human flesh? Do you believe that He took the death penalty for your sins and you can be forgiven for the million trips between #2 and #3 and back again? Have you learned who you are in Him? Do you know your authority as a believer? The thing that pleases God is not our works, it is our faith. Take time to call time out every day and get alone with God and work on #1, your beliefs. What you believe will change who you are, your character, your walk with God, and a miracle will happen. Number 2, your actions,  will be changed from the inside out. It will no longer be a performance or an act, but God working in you to will and to do His good pleasure. When this happens #3 will be off the charts and you’ll find it hard to believe yourself, that life could be this good so easy. His yoke is easy and his burden is light. Ask for His help with your life. You don’t have to carry the whole load alone. He will never leave you or forsake you.

Positive feedback in economics explains why some products take off and become the standard, while others don’t.  One example often cited is VHS, which edged it over Betamax (a product with a technical edge) by virtue of having a slight lead in the market.  Because more people had VHS, more VHS cassettes were produced with more choice, making that the choice for those purchasing a system, so more VHS was bought, and so forth.

Another example is a new service being provided by a national charity.  Many local authority commissioners have quickly bought into this service, although it is not yet out of the pilot stage.  I wonder if this is the case of  “everyone else has one, so it must be good”?

Apply this to behaviour at work as well.  If someone gets positive feedback, they believe something worked and will do more of it.  On the other hand, negative feedback, fault finding etc. only tells them what not to do and can lead to risk aversion.

Trouble starts here, as positive feedback can lead to poor decisions – technically we should have ended up with a Betamax standard.  And who remembers when bell-bottomed trousers were the rage (and everyone had them)?

To encourage positive behaviour at work, people set targets.  This would be fine if we knew what would be effective, but the specialised nature of modern work means that the impact of our actions on the whole enterprise is unclear.  Targets are best guesses, which then lock people into behaviour patterns that may be damaging, or parochial and narrow in outlook.  Missed targets can turn potential positive feedback to negative or blaming.

Positive feedback appears to drive a lot of behaviour.  Targets drive a lot of behaviour at work.  How can we know it is effective behaviour until long after the fact, if ever?

President, Congress needs to face duty of health insurance regulation

Meaningful health reform available at little cost

Amidst all the hype, political posturing and rankling over health reform, it seems we have come to a moment of truth.  The President still wants reform, but seems very willing to move on to jobs as his main issue.  The Congress is still engaged, but the Democratic leadership is committed to force feeding their vision down the throat of the American public, which is resisting.  The Republican leadership is more interested in pouting than in making the case publicly and forcefully for their ideas. The past weeks have seen an extraordianary sea change in the movement to Real Health Reform ©.  So then, in light of the changes in the Senate, the willingness of the President and Republicans to exchange ideas, and the statements by the Democratic leadership that they are looking for a way forward, we offer twelve easy, cost efficient ideas to get the ball rolling again.  No 2,000 page bills.  No reams of legalese written by post-pubescent congressional staffers.  No hype.  No political agenda.  Read it and think it over.  Mr. President you could get this page of ideas passed as a bill we bet. You just have to believe.

(1) Eliminate all pre-insurance health related screening.  No pre-existing illness, surgery or health condition can be used to exclude any person from coverage.  DIRECT COST TO TAXPAYER = $ 0

(2) Eliminate ability of any health insurer to drop any subscriber from coverage due to development of illness or injury. DIRECT COST TO TAXPAYER = $ 0

(3) Eliminate any caps on ‘lifetime benefits’ regarding payments by health insurers for costs incurred for approved, legitimate treatment. DIRECT COST TO TAXPAYER = $ 0

(4) Eliminate group rating.  Premiums to be set on total number of persons insured by insurer regardless of group, age, sex etc. DIRECT COST TO TAXPAYER = $ 0

(5) Eliminate waiting periods for coverage under group or individual plans.  When premium is paid, coverage begins. DIRECT COST TO TAXPAYER = $ 0

(6) Eliminate any restriction on national sales of health insurance products (i.e. removal of barriers to interstate sale of health insurance products). DIRECT COST TO TAXPAYER = $ 0

(7) Limit premium increases health insurers are able to make to annually, fixed at cost of health care inflation rate plus 1%. DIRECT COST TO TAXPAYER = $ 0

(8) Standardize health insurance reporting forms for filing of claims by hospitals, surgery centers, doctor’s offices, health clinics etc. DIRECT COST TO TAXPAYER = $ 0

(9) Eliminate ‘timely filing rules’ which are designed to cheat providers out of payment by imposing arbitrary time lines (such as 30-90 days) for a legitimate claim to be filed. DIRECT COST TO TAXPAYER = $ 0

(10) Standardize coverages to that there is full coverage of all medical and surgical conditions, thus eliminating wide variations in coverages from plan to plan. DIRECT COST TO TAXPAYER = $ 0

(11) Allow for expansion of Health Savings Accounts to give consumers choice in regard to premium structure (based off of overall rate as enumerated in #4 above). DIRECT COST TO TAXPAYER = $ 0

(12) Allow for catastrophic coverage options for certain age groups to increase affordability for younger subscribers (based off of overall rate as enumerated in #4 above). DIRECT COST TO TAXPAYER = $ 0

We could go on.  But you get the idea.  Here are 12 (and we have more) basic, easy to understand concepts that could move health insurance reform forward now.  No major government programs.  No direct costs to taxpayers.  No need for increased federal bureaucracy. Seems like this should be an easy, bipartisan, quick method to move health reform forward.  So, are there any takers out there?  Ms. Pelosi, Mr. Reid, are you listening?  Want to get something done for the American people like you say you do.  Mr. Obama, care to lean on the Democratic leadership in Congress a bit?  Republicans, care to get on board for meaningful health reform with little cost to tax payers?  The ball is in your court.  We suggest to you take the field and get moving.  Americans are tired of political games an the unwillingness of either party to practice legitimate oversight of the the health insurance industry.  That is the key to real health reform that we can all believe in . . . obi jo and jomaxx

Health Bill Stalled, Obama Juggles an Altered Agenda – http://www.nytimes.com/2010/01/29/us/politics/29cong.html?scp=1&sq=Health%20Bill%20Stalled,%20Obama%20Juggles%20an%20Altered%20Agenda%20&st=cse

Searching for Some Light Amid the Heat – http://www.nytimes.com/2010/01/30/health/policy/30check.html?scp=1&sq=The%20Struggle%20Over%20Health%20Care&st=cse

While Confident Health Care Will Pass This Year, Democrats Still Search for a Plan – http://www.nytimes.com/2010/01/29/health/policy/29health.html?ref=health

What’s Next for Healthcare Reform? – http://www.thenation.com/doc/20100111/beyerstein

House Democrats Queasy About Health Care Reform Post-Brown – http://www.weeklystandard.com/blogs/house-democrats-queasy-about-health-care-reform-post-brown

GOP officials: no sign of bipartisanship on healthcare reform – http://www.csmonitor.com/USA/Politics/monitor_breakfast/2010/0121/GOP-officials-no-sign-of-bipartisanship-on-healthcare-reform

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“I want to believe in the misdiagnosed but see: he is not altogether well. He escapes to a room in his head like a ship to sea, even as the gulls fly above, imploring: land, land.  I am earth beneath storm, the air inside a snapped reed.  I scream my helpless anger into an empty room.”

- Beth Kephart (A Slant of Sun)

It was eight years ago this month, January 17, 2002,  that we finally got the answer to a question my husband and I had been asking ourselves since Zachary was just 10 months old – Is he “all right?” Back then, being “all right” was the answer we wanted despite all evidence to the contrary.

We had gone the familiar route – hearing tests, assessments for early intervention, numerous trips to doctors and fruitless internet searches. Zach had been “evaluated” from every angle – and now, in the small office of a very nice licensed psychologist we would have our worst fears confirmed, our path forever altered. But, that dreaded diagnosis gave us a place to begin.

Getting in the game is, for many ASD parents, the hardest part. Labels, constructs, pigeon-holes – all are fashioned so that parents can qualify for special therapies, insurance coverage, placements.  Classifying, naming, qualifying that otherworldliness each of our kids possess is left to the professionals – doctors, therapists, educators – even legislators. The toughest job is the navigating;  That is left to us parents and they don’t hand us a road map.

Imagine being dropped on a lonely highway in the middle of nowhere and having only your wits to find your way. That is where most of us start out - thumbless, clueless – hitchhiking along to an undetermined destination.  I believe it is easier for the biblical camel to pass through the eye of a needle than for an ASD parent to enter the kingdom of  Autism. But, times are changing and there is much more available to today’s parents.

This morning, as an experiment, I googled “autism services” for my area of Virginia and the search yielded 27,600 results in .34 seconds – and when I googled “autism services” alone, my computer spat out 6,810,000 in .26 seconds.

Progress? Maybe. But the sheer number of routes are intimidating and most of us aren’t hoping to stay long. We have a “temporary visa” mentality – get in, get out – more of a rescue mission really.

I was definitely hoping to keep my visit short, in fact I felt instructed to do so. When Zach was initially diagnosed his psychological evaluation described his verbal skills with a caveat - that while he was expanding his vocabulary and had the capacity for appropriate interaction, this was typically “fleeting.” His skills at that time represented “an instructional window that if appropriately utilized, is strongly predictive of a good outcome.”

Reading that caused a tremor of panic inside me, because this isn’t the kind of window that stays open, it’s the kind that someone paints shut when you’re not looking. 

For a very long time after “D-Day” we did what we thought we should for Zachary - he ceased being our son during that lost time and became our project. We even bought a sturdy plastic file box where we housed all our war plans.   We pursued every avenue of therapy, diet and medicine with the urgency and fervor of the newly converted.

Some helped, some didn’t. Most didn’t. The only thing we knew for certain was how miserable we all were trying to figure it out. That fleeting window was what we focused on. In the end, Zachary was the only one who could show us how to keep it open. When we quit struggling out of exhaustion, with nothing but our helpless love to give him, he let us follow. He showed us more and more of the person he continues to become today.

The reality of the window is that Zachary will always be on the other side of it. I don’t have the power to pull him back through it, nor does he need me too. But it isn’t shut - I can follow him through it; I can let him show me around. I can relax in this new, exotic land. My guide is from here, he belongs here and there is so much he can teach me if I let him.

Zachary’s salvation is not something I can control, things will unfold as they should, and we will survive. In the words of Mother Teresa We can do no great things, only small things with great love. And that is enough.

Last time I stressed the impact of effective on positive health outcomes, and I identified some specific ones, including higher compliance with treatments, prescriptions, and medical advice; patient satisfaction; trust of providers; lower severity of symptoms; access to and utilization of health resources; and lower morbidity and mortality rates. In particular, I covered some core principles of human communication, all of which I teach in any given semester at the university level. As providers, communication competence reveals how well you listen, how respectful you’ll be, and how much the patient can trust you.

Speaking of trust, patients’ decisions to comply with recommended treatments, procedures, or medical advice has a lot to do with how much they trust your knowledge and the extent to which you have their best interests at heart. In many cases, it depends on your acknowledgement of their perception that any directives you give them are not necessarily absolutes—they’re just options. In the minds of many consumer-minded patients, the decision not to comply with a recommendation is not necessarily disobedience—it’s simply a choice.

It is because communication rests at the core of many medical problems that nonadherence can be so high—up to 50 percent. We first have to understand that all patients run the risk of being noncompliant. For instance, many patients are more compliant right before a visit and much less compliant when they tire of their prescription meds or treatment schedule. Also, some patients aren’t equally compliant with all prescriptions they fill.

A number of communication factors contribute—for better or worse—to levels of patient compliance. One factor that can increase the likelihood of compliance is being understood by one’s patients. This can mean different things. Some patients need the medical jargon to be watered down. Accommodating to a patient’s level of understanding can result in greater levels of trust as well as compliance. Other patients (especially for those whose first language is not English) perceive a cultural or linguistic barrier, and might even prefer doctors who have competency in their primary language. In many cases, competency isn’t even necessary; some patients will appreciate a mere attempt at the language.

Another factor is using clarity with patients who are being prescribed something for the first time. Many patients will not know what questions to ask about a new or unfamiliar medication. The doctor might have to anticipate some of those questions and concerns.

Perhaps the most important factor is the recognition and alleviation of uncertainty. Most humans feel anxiety when experiencing large amounts of uncertainty. Asking about patients’ daily habits, personal circumstances, and what is unknown can help empower them to ask questions and seek information on their own. Equipping them with the proper information—and employing some clever strategies—will encourage higher patient compliance.

Next time . . . patient trust and satisfaction.

Apathy in first episode psychosis patients: One year follow up,  Schizophrenia Research, Vol. 116, Issue 1, January 2010, Pages 20-26Ann Faerden

Abstract:

Introduction

This study describes how the negative subsyndrome of apathy develops over the first year in first episode psychosis (FEP) patients, with an emphasis on the prevalence of enduring apathy and the relationship between apathy, other symptoms and functioning.

Methods

Eighty four FEP patients were assessed both at baseline and after one year with the abridged clinical version of the Apathy Evaluation Scale (AES-C-Apathy). Other symptoms were assessed with the Positive and Negative syndrome scale (PANSS) and functioning with the split version of the Global Assessment of Functioning Scale (GAF-F).

Results

The mean level of AES-C-Apathy decreased from baseline to the one year follow up for the whole group of FEP patients. High levels of apathy at 1 year were best predicted by high levels of apathy at baseline, a long DUP and a diagnosis within the Schizophrenia spectrum. The presence of depression and level of medication only had a minor influence. AES-C-Apathy had a stronger association to GAF-F than other PANSS symptom areas.

Twenty five (30%) FEP patients had high enduring levels of apathy. This group consisted of significantly more males, had a longer duration of untreated psychosis, a greater likelihood of a Schizophrenia spectrum diagnosis, fewer were in remission of positive symptoms and they had significantly poorer functioning at both baseline and follow up.

Conclusion

This study confirms that the negative subsyndrome of apathy is significantly related to poor functioning in FEP. Including negative symptoms and its subsyndromes in early detection strategies are warranted.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The dreaded resume! Every job seeker desperately needs one but no one wants to write one. Why? Because it’s agony. 

The irony is that we fear our resume—the very thing that is our entry ticket to the job we want. Since we resist the things we fear, we put off writing it or suffer major distress when we must. Our concern: “What if my resume isn’t good enough!” 

Our “resumophobia” has three main causes: 

• Frustrating uncertainty about what recruiters/businesses want
• Doubt or confusion about the value of what we’ve done
• Lack of confidence in our ability to write it “right” 

These are legitimate and paralyzing reasons. But we cannot succumb to them. Why? Because—no resume…no interview. No interview…no chance. 

The resume is a rite of passage in nearly every job search. 

There are lots of great books and experts to teach you how to craft a great resume. What I’m offering are insights that will unfreeze your thinking, so you can get started. 

Your resume is packaging. 

It is not a biography, a job description, or a sales pitch. It’s your box! 

The content of a good resume showcases concrete results that you have achieved in other jobs. It contains the products (results) that you created. So when you write your resume, make sure it is about important outcomes you delivered. Not everything you ever did—just the most significant results.

 Your resume is a picture. 

A resume is art and you want the viewer to be absorbed by yours. 

Great artists control the eye of the viewer. Great resumes do that too. The screener’s first scan needs to spot something of interest. That means you need to: 

• Position important facts where the eye falls. 

Don’t make screeners struggle to find what they’re looking for. When they come to your resume, they will scan down the middle. So make sure that their eyes will land on the words, job titles, and achievements they are looking for. Highlight in bold the words that link what you accomplished to the duties listed in the job posting. 

• Create white space so the eye has relief. 

Wading through resumes is visually exhausting. White space is relief so use a font size that isn’t too small. Avoid dense copy since it sends the message that you couldn’t identify your priority accomplishments and don’t know how to write concisely. Use bullets, avoid paragraphs. 

• Include interesting information that keeps the eye reading. 

Everyone brings their own uniqueness to their jobs. Capturing that in a resume differentiates us from other candidates. So be sure to mention a fresh approach you may have taken to a routine work process or to an initiative that you led.

The sections called “interests,” “activities,” and “affiliations” are your big finish. Interesting tidbits there often turn out to be the “big opening” during an interview. 

Your resume is your voice. 

The tone of your written words becomes the sound of your voice. That’s the only glimpse of your personality that the screener will get from your resume. When your words are clean and clear, precise and easy, they create a sense of your nature, your confidence, and your approach to work. 

Please remember: 

• The screener is your audience
• Your purpose is to provide an honest, factual story about your work life 

If resume writing still intimidates you, if you are having a difficult time sorting through all that you have done, or if you have some unfortunate “wrinkles” in your work history, investing in some professional assistance may be in order. 

The bottom line is that it’s always a good idea to have an up-to-date resume on file, especially in these times. Enough said! 

Do you have a specific question about resumes that you’d like discussed? I’m sure you’ll get some help here. 

If you’re a CEO like me, you have high expectations for everyone. I mean really high. If we work this hard, shouldn’t everyone? If we knuckle down and deal with tough problems, shouldn’t others do it with the same gusto? And if we can nail down value points and key indicators like a pneumatic hammer, why does it seem that others are pounding with rocks.

We aren’t the only ones. There are probably lots of people in your organization who feel ‘alone at the top’ of their team. It’s frustrating, but guess what: there’s no where it’s more frustrating than in HR.

Finance has the tools and the data to generate projections. And Operations can give you production metrics. Sales has the top line numbers. Even Purchasing can tell you how much money they’re saving as they upgrade the old coffeepot to the fancy barista station. But HR? Their hard measures are things that keep you up at night, like rising health insurance costs! HR’s other metrics- turnover, onboarding speed, and engagement – never quite seem to ‘measure up’ in terms of business value.

So consider this: all those other executive functions have tools that allow them to analyze needs, identify best options, and demonstrate solution value, while HR has disparate databases, training programs that don’t measure outcomes, personality tests from the middle of the last century, and metrics that neither speed nor simplify management decision making.

Here’s an alternative. Let them you know want them to have the tools they need to prove their business value. Then direct them to The Gabriel Institute and tell them to ask for your old friend Dr. Janice. I’ll take it from there.

Dr. J

P.S. Our solutions cost little, predict how people will perform in teams, build the strength and productivity of your human infrastructure, and deliver measurable business value. Just give HR a little time to learn how to apply them. You WON’T be disappointed.

Good things come to those who wait. Or do they? As someone very close to my heart once said to me, “patience is an overrated virtue”.

 I am a big believer in being master of my own destiny. The trick is not to trample over the wishes of others, or be blinded by my fears, in my haste to charge after my goal.

Today is the anniversary of the day that Susan Boyle first auditioned on Britain’s “You’ve Got Talent” (it was first broadcast on the 11^th April 2009). The fact that she didn’t win has been irrelevant to her success. Her story is remarkable tale of talent and hope.

A frumpy, middle aged woman whom the audience sniggered at on first appearance; achieved the biggest selling album for 2009 in the UK, US, Australia and no doubt many other countries in the world. People love the Susan story; I know I do. I was so intrigued that despite my lack of internet savvy, I visited www.youtube.com for the first time to view the footage of her performance, (this was when I discovered that it www.youtube.com not  www.utube.com!)

I love Susan because she was not afraid to stand up and have people laugh at her. She didn’t care that she was a  middle aged spinster that had never been kissed (she and I have some things in common). That didn’t stop her. She was prepared to risk public ridicule and derision in pursuit of her goal and there are not many of us that have that courage. We prefer to play it safe. Susan is proof that it is never to late to go after your dreams; no matter how improbable success may be. People may laugh and scoff but you can achieve the truly miraculous, if you are prepared to take a chance.

The exhilaration of potential success is well worth the risk of disappointment or failure.  We all get to choose whether we want to be glass half empty, or glass half full types. To a certain extent our perceptions and actions shape our future; be it in the arena of careers, lifestyle choices or relationships. Do we focus on what we most fear, or what we most want?  I know I have a bad habit of letting my self saboteur get in the way of my heart’s desires.

There is nothing like the excitement of getting caught up in the thrill of possibilities. It’s like being a child waking up on Christmas morning. Take relationships, I love that I can still get excited about a first date or a first kiss (I am with you sister Susan), no matter how many times in the past I have been let down. Yet once we move beyond the initial attraction, I find it hard to say what I truly feel in my heart. I am afraid of rejection and I constantly seek reassurance; a tiresome  and exhausting trait.

Maybe at times I need to temper my expectations, as its true the lower the bar the less chance of disappointment.  However I prefer to think about it as detaching from the outcomes. I am not going to give up the adrenaline rush of the deliciousness of possibilities but I would like to be more philosophical when things go awry. 

When people let you down or disappoint you, the most important question to ask isn’t “why did you do that to me?” its “where do we go from here?”   (Note to self : I would actually be better off to keep my mouth completely shut at least until I have my self saboteur under control.)

The more you expect from people the more pressure they are likely to feel and the greater the chance they will disappoint you intentionally, or otherwise. No one wants to feel pressured and no one wants to feel responsible for someone else’s happiness and nor should they.

I am not saying that it is ok for others to treat me disrespectfully or not follow through on their commitments, far from it. However the way I choose to respond, can do far more damage than the initial problem. My angst eventually creating the end result that I most fear, rejection;  as a good friend kindly told me today  “No one wants to hug a porcupine.”

If I just stopped for a second to ask “whats going on for you?” Maybe we could find a more constructive outcome and the concept of a successful relationship wouldn’t seem so elusive.

Enrichment Lesson No 23:  Sometimes it is not all about me.

Professional learning often involves learning new classroom practices. In fact, the term “best practice” has been codified to mean the highest goal from the perspective of some educators. Teaching is certainly performative, and it is certainly important to learn certain teaching moves, especially early in one’s career. The problem with a focus only on what one does as a teacher is that behaviors change quickly. It is easy to adopt a new teaching practice, and just as easy to let it go. (This is similar to a personal habit that one has attempted to change. For instance, many of us have begun a Monday morning with the changed practice of choosing to eat low-calorie food, and then by Tuesday morning we have changed our practice to one of (again) eating junk food!)

On the other hand, shifts in one’s thinking change more slowly than shifts in ones behavior. That is frustrating when there is a need for a quick response to a problem, but it is important when one is a coach and wants to have a sustained effect. When teachers shift their thinking, it takes more time, but that thinking is more likely to “stick.”

What’s more, the thinking aspect of teaching is often more important when making instructional decisions. When teachers merely decide to use different practices, they are often basing those decisions upon mandates, hunches, or the social influence of their colleagues. On the other hand, when teachers shift their thinking, they do so because they have engaged more deeply with information about students (i.e. data, broadly defined), knowledge of the content of instruction, or insights provided by pedagogy. This kind of learning goes deeper and provides a foundation for any changed practices that a teacher may also adopt.

Coaches and administrators often focus on what teachers do, rather than what they think, because behaviors are easier to gauge than thoughts. Understanding the information, knowledge, and insights that are influencing a teacher’s thoughts (and subsequent decisions) requires time spent in conversation. One can do a “walk through” of a classroom in search of practices in a matter of minutes. It isn’t possible to “walk through” a colleague’s brain in the same way!

I urge coaches to:

• Begin coaching with conversation.
• Develop questioning practices that attend to information about students, knowledge of instructional content, and insights about pedagogy.
• Seek to be a learner, along with teacher partners, in deepening understanding and reflection.
• Partner with teachers to understand why a practice might be adopted, when the focus does turn to behaviors.
• Discuss their thinking and decision making with their teacher partners after they have provided demonstration lessons.
• Think carefully about doing observations, particularly to gauge whether they will unduly focus upon doing and ignore thinking.

This is my 100th blog post. I’ve been at this now for about 2 years.

But I’ve been thinking about counting. What are we counting in our leadership? Blog posts? Performance numbers of some kind? Helpful indicators, no doubt, but incomplete.

My daughter is downstairs watching “The Sound of Music.” She’s singing along with her pretty 9 year old voice. She sings often; sometimes so often that we have to ask her to stop so that she can speak to us, or eat.

Why do I bring that up? It’s because unlike other aspects of my leadership, where I’m counting something, trying to bring an outcome to fruition, monitoring progress, I don’t care what the outcome of my daughter’s singing is.

I just want her to enjoy it. And I enjoy it. No agenda, no push for more, no milestones…

And that’s OK. Other things in my life require those from my leadership. My daughter’s singing doesn’t.

It just makes me happy.

And she needs to know that.

What refreshes your leadership? Your life? Where can you be safe from the ever-present demands of measurement? Who needs a hug instead of “feedback”? What are you giving as a leader that isn’t merited because of some kind of measurement?

I’m about to give my daughter encouragement by telling her how her singing makes me feel.

And I’ll probably get a big hug out of the deal, which is a pretty fair bonus.

http://stoshdwalsh.wordpress.com

Early in December, Charity Navigator and Guidestar issued a joint press release saying that “overhead ratios and executive salaries are useless for evaluating a nonprofit’s impact.” They were joined in the press release by the Hewlett Foundation and four other agencies dedicated to assessing and rating nonprofits.

This is a remarkable statement in the current context where conventional wisdom says the savvy donor asks, “How much of my gift goes to program and how much goes to administrative and fundraising costs?”  Its doubly remarkable, however, because the press release comes, in part, from Charity Navigator – the organization that for a decade has been the leading, national proponent of overhead ratios as a reliable guide for effective philanthropy.

What’s the alternative then? Evaluate charities based on their effectiveness, they say.

As Dan Pallotta notes in Uncharitable and in a series on his blog, efficiency measures (overhead ratios) are entirely irrelevant when they are not accompanied by impact measures. Charity Navigator and the others agree with Pallotta and are promising more emphasis on what a nonprofit achieves rather than how it structures its budget.

While largely positive, the announcement merits a bit of skepticism. Most of the rating agencies listed still embrace the goal that motivated Charity Navigator’s original model:  a simple rating system that is a reliable measure of any nonprofit in any context for the purpose of directing donor dollars to high performing nonprofits. There are, however, roughly 700,000 active charitable organizations in the U.S. All of the rating agencies have small staffs and relatively small budgets $1M. In short, their capacity is not adequate to the scale and scope of their intent. Also, the alternate models proposed by some of the agencies – user reviews, expert consensus – seem as flimsy as the efficiency model they are abandoning.

For the most part, though, this is good news. This influential group is redirecting attention to outcome, not input. They are also fostering a recognition that assessing the quality of a nonprofit  is a complex task that requires a careful look at multiple, interrelated factors.

If they succeed in changing conventional wisdom, however, this may pose new challenges for your organization. Your donors and stakeholders may begin to ask about your real impact in your community. You may no longer spend so much time parsing your budget into administrative and program categories, but you might need to focus more attention on evaluation, baselines and measurements.

Do not wait for Charity Navigator to define impact and effectiveness for you. This is a great time to take control of how your organization defines its impact. Spend time developing clear measurements of outcome. Develop program plans and budgets that create straight-line paths to those outcomes and educate your stakeholders on the value they create when they invest their charitable dollars with you.

Health Insurers to Women: Please, Don’t Apply

• Women generally pay more at every level for coverage than men, except at more advanced ages
• Women are ‘penalized’ for being the bearers of children
• Insurers defend these practices saying women use health services more frequently

This is not the first time we have addressed this topic. However, recent events have prompted us to revisit the topic.  Discrimination against women is not new and has not ended.  However, the most blatant area remaining for many is in the area of obtaining health insurance coverage.  A recent request from a female family member prompted some additional updated research.  Appalling, we continue to find demonstrable evidence of the following:

(1) Women generally pay more at every level for coverage than men, except at much more advanced ages.  In some cases, in the prime child bearing years, this amount is as much as double what a man of comparable age would pay

(2) Women are ‘penalized’ for being the bearers of children.  Almost without exception, maternity and newborn coverage is an ‘option’ that is included or excluded randomly based on policies.  Additionally, it is almost cost prohibitive and many otherwise attractive health plans do not offer maternity and newborn coverage at all.  This is true, even when the market is a  young woman, age 20 – 40 who is working and in the midst of the prime child bearing years.

(3) The fact that health insurers publicly post this information on their websites indicates their sense of immunity from any negative feedback.  They in fact defend these practices by saying that women use health services more frequently, especially preventive services, and therefore have higher overall health costs. No doubt, we should penalize anyone who would dare use health services, particularly preventive ones!

Wrong is wrong where we grew up. Discrimination against women in pricing, offering of maternity and newborn coverage, as well as exclusion of health issues that are particular to females should be illegal, plain and simple.  Congress, while voicing concern and objection, is still unable to address even this most obvious issue.  The issue here gets to the heart of health insurance pricing.   Insurance by definition involves the spreading of risk over large numbers of persons, entities or events.  Still, health insurers love to divide and re-divide their policy offerings based on ‘group’ definitions: single, family, employer groups, large groups, small groups, etc.   All are treated separately and rated separately in most cases.  This creates winners and losers across the board.  Furthermore, the ritual of excluding individuals due to higher risk or pre-existing conditions forces many to hold on to jobs to obtain ‘group’ coverage or face loss of all health insurance access. All of this leads to artificial choices by citizens due to lack of choice, access and portability.

Seems like this should be an area where Congress can find agreement.  In 2010 it is a disgrace that young, hard working women, cannot find comparatively priced policies, with maternity and new born coverage, that do not penalize them for being female . . . jomaxx and obi jo

Health Insurers to Women: Please, Don’t Apply – http://www.associatedcontent.com/article/2663251/health_insurers_to_women_please_dont_pg2.html?cat=52

Benefits Summary Personal Choice® PPO – http://www.ibx.com/health_plans/individual/ppo.html?content=/health_plans/ppo/benefits_summary/individual.html&origURL=/health_plans/individual/ppo.html

Women’s Health Policy Facts – http://www.kff.org/womenshealth/upload/1613-09.pdf

Women pay more than men for identical individual insurance policies – http://realhealthreform.wordpress.com/2008/10/31/women-pay-more-than-men-for-identical-individual-insurance-policies/

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