the nature and frequency of medicare/medicaid fraud and neutralization techniques among speech,occupational, and physical therapists

ABSTRACT

The current study examines the nature and frequency of Medicare/Medicaid fraud and the techniques of neutralization utilized by a purposeful sample of speech, occupational, and physical therapists working within the context of hospitals, nursing homes, and with home health agencies, in a southern state. Participant observations, surveys, and in-depth interviews were utilized to obtain data for this study. We identified two main fraudulent practices, cutting sessions short while charging for the entire session and charging individual session rates for group therapy sessions. We also identified three techniques of neutralization utilized by the therapists in our study, including: (1) everyone else does it, (2) denial of responsibility, and (3) denial of injury. The implications of our findings are discussed.     

Cognición ambiental

Resumen

Esta investigación revisa el conocimiento espacial humano en los ambientes cotidianos y reales. Los estudios relativos a mapas cognitivos se organizan en cinco categorías empíricas: edad, familiaridad, sexo, clase-cultura y componentes físicos del ambiente. Se discuten las cuestiones metodológicas y conceptuales en los trabajos sobre el conocimiento ambiental, enfatizando los problemas con las metodologías que utilizan el dibujo de mapas cognitivos. En particular se observa una falta de integración entre la investigación cognitiva pertinente y los trabajos de la psicología ambiental sobre mapas cognitivos. Finalmente se discute la aplicación potencial de los trabajos de conocimiento ambiental a la arquitectura, el diseño urbanístico y la educación.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

MAKING ROOM FOR MADNESS IN MENTAL HEALTH: THE IMPORTANCE OF ANALYTICALLY‐INFORMED SUPERVISION OF NURSES AND OTHER MENTAL HEALTH PROFESSIONALS

In this paper, I discuss the importance of psychoanalytically informed supervision and training of nurses and other professionals in mental health settings. Using examples from supervision groups I will illustrate how a psychoanalytic approach to mental health can complement other ways of thinking about practice and management. Psychoanalysis provides a framework for understanding the relationship between the internal world of the patients, the therapeutic relationship and the social system. I will also argue that this understanding helps to develop and maintain therapeutic factors while reducing the risk of damaging behaviour and beliefs.     

Catch 22: the inflammatory nature of insight

I will describe a man I saw in psychoanalytic psychotherapy with a history of serious drug abuse and violent psychotic episodes. At the start of therapy my patient had little capacity to tolerate the anxiety, depression or the inevitable frustrations involved in facing reality. Over time and with the support of the therapy he was able to increase his capacity for self observation noticing the way he withdrew from the world of shared reality into psychotic states of mind in order to avoid painful feelings of rage, humiliation and shame. In the book ‘Catch 22?, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions, while the authorities maintain that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! This insight is deemed to be evidence of the individual’s sanity and consequently their plea of insanity is denied. In this paper, I will show how Mr. A’s developing capacity for reflective functioning lead to a ‘Catch 22’ as the insight he needed as part of the process of recovery threatened to overwhelm him with depressing realities about the extent of his illness.     

Poorer sleep quality is associated with lower emotion-regulation ability in a laboratory paradigm

Theoretical models suggest a positive relationship between sleep quality and individuals' ability to regulate emotion. However, few studies have empirically tested this hypothesised link using standardised laboratory measures of emotion-regulation ability. The present research examined the relationship between sleep quality and the ability to implement a type of emotion regulation that has particularly important implications for psychological health: cognitive reappraisal (cognitively reframing an emotional event so as to dampen its impact). To do so, 156 participants (86 male) reported on their past week's sleep quality. Their ability to implement cognitive reappraisal (CRA) was then measured with a standardised laboratory challenge. Participants with poorer self-reported sleep quality exhibited lower CRA, even after controlling for fourteen potential key confounds (e.g., age, negative affect, mood disorder symptoms, stress). This finding is consistent with the idea that poorer sleep quality impairs individuals' ability to engage in the crucial task of regulating negative emotions.     

Life Meaning Following Combat Among Air Force Security Forces Personnel

An active duty Air Force ground combat unit (n = 189) completed surveys about trauma and combat exposure, mood symptoms, and meaning in life. Two dimensions of deployment-related traumas were assessed: combat (e.g., firing weapons, being fired upon) and aftermath (e.g., seeing dead bodies, injury). Results of regression analyses indicated that Airmen who experienced more intense combat reported less presence of meaning in life, although the significant interaction with gender suggested declines in meaning in life were especially pronounced among males with higher combat intensity. In contrast, more intense aftermath exposure was associated with slightly stronger meaning in life, with no differences by gender. Intensity of combat exposure might differentially affect perceived meaning in life for male versus female combatants.     

Neighborhood Context and Perceptions of Stress Over Time: An Ecological Model of Neighborhood Stressors and Intrapersonal and Interpersonal Resources

We examine the association between neighborhood socio-economic disadvantage and perceived stress during middle and late adolescence among African American youth (N = 665; 51 % female; M = 15.9 years at baseline). In addition, we explored the ways through which neighborhood stressors interacted with an individual’s intra- and interpersonal resources (e.g., coping, social support and substance use), to affect their perceived stress trajectories during adolescence. First, we tested a neighborhood stressors model and found that youth who lived in neighborhoods with greater socioeconomic disadvantage had higher baseline stress and a steeper increase in stress over time. When we included individual-level risk and promotive factors in the model, however, the effect of neighborhood disadvantage on perceived stress was no longer significant, and the stress trajectory was explained by adolescent substance use, social support and perceptions of the neighborhood. Our results support theories of stress and coping, and the importance of proximal intra- and interpersonal factors in either amplifying or mitigating perceptions of stress. We discuss implications of the neighborhood context and how our findings may inform future prevention and intervention related to adolescent stress and development.