The Arizona Psychological Association supports the following statement issued by the American Psychological Association. 

CONTACT
Kim I. Mills
kmills@apa.org
(202) 336-6048

APA DENOUNCES SUPREME COURT DECISION ENDING RIGHT TO CONSIDER RACE IN COLLEGE ADMISSIONS

Court discounted research demonstrating value of diversity in educational institutions

WASHINGTON — The American Psychological Association voiced disappointment in the U.S. Supreme Court’s decision overturning the rights of Harvard University and the University of North Carolina to consider the race of student applicants as a factor in its admissions decisions in order to foster greater diversity.

“The American Psychological Association deeply regrets that the court discounted the substantial body of research demonstrating that exposure to diversity can reduce bias and improve educational outcomes for all students,” said APA CEO Arthur C. Evans Jr., PhD. “Scientific research has also found that exposure to diversity enhances critical thinking and promotes deeper information processing and problem-solving skills, among other benefits. Without purposeful attention to achieving diverse student bodies, our institutions of higher learning are likely to grow even more racially and ethnically polarized.”

APA filed an amicus brief in the cases, Students for Fair Admissions vs. Harvard College and Students for Fair Admissions vs. University of North Carolina. The brief was joined by the Massachusetts and North Carolina Psychological Associations.

“Our institutions of higher education still have a long way to go to achieve meaningful diversity,” said APA President Thema Bryant, PhD. “Eliminating their ability to consider race or ethnicity as a factor in admissions is bound to decrease diversity on our campuses, resulting in poorer educational outcomes for all students.”

APA argued that improving racial-ethnic diversity in higher education remains a compelling need as prejudice and underrepresentation of racial and ethnic minority groups are still present on college campuses today. APA’s arguments were recognized by Justice Ketanji Brown Jackson in her dissent, in which she cited APA’s brief on two issues demonstrated by psychological science: (1) that students of color are more likely to succeed in institutions of higher education when they see others there who look like them and share their experiences; and (2) that diversity helps all students as “students of every race will come to have a greater appreciation and understanding of civic virtue, democratic values, and our country’s commitment to equality.”

“Scientific research has consistently demonstrated that campus diversity relieves many of the negative educational impacts of discrimination and prejudice,” APA said in its brief. “As the influence of discrimination and prejudice is reduced, psychological phenomena inhibiting academic success for minority students become less dominant. And as such phenomena subside, all students are able to engage uninhibited in the academic enterprise.”

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The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA’s membership includes over 146,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives.

The Arizona Psychological Association supports the following statement issued by The Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) of the American Psychological Association. 

Statement Opposing Legislation Targeting Transgender and Gender Diverse People
The Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) of the American Psychological Association

The Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) of the American Psychological Association strongly opposes legislation targeting the health and well-being of transgender and gender diverse (TGD) people. In 2023, anti-transgender legislation has been introduced in the legislatures of 49 of the 50 U.S. states (Trans Legislation Tracker, 2023). Dozens of these bills have already been signed into law (ACLU, 2023; Trans Legislation Tracker, 2023). This onslaught of hundreds of anti-TGD bills is intended to limit or restrict access to gender-affirming care for patients or criminalize providers who provide gender-affirming healthcare (e.g., Mallory et al., 2023; Yurcaba, 2023). Anti-TGD legislation introduced or passed in state legislatures across the United States also limit access for TGD people to public accommodations (e.g., Brasch & Javaid, 2023), restrict participation in educational and extracurricular activities (e.g., Forrest et al., 2023), and prevent the exercise of freedom of expression (e.g., Reagan, 2023).

Restricting Access to Care Contradicts Science and Professional Expertise

There is no scientific or health justification for legislation which restricts access to gender-affirming care. In fact, the medical and mental health professions support gender-affirming care, recognizing the scientific fact that gender identities are diverse and rigid notions of sex and gender are barriers to good healthcare for all patients (e.g., Coleman et al., 2022; American Academy of Pediatrics, 2021; American Medical Association, 2021; American Psychological Association, 2015; American Psychiatric Association, 2020; American Psychological Association, 2021; National Association of Social Workers, 2023). Research has shown that social stigma, prejudice, discrimination, and even violence that TGD people experience, including stigma and discrimination created by anti-transgender laws and policies, creates minority stress processes that are associated with adverse mental and physical health outcomes for TGD people (Horne et al., 2022; Redfield et al., 2023). Instead of helping TGD people, these laws harm them.

These legislative acts are based in anti-TGD stigma and the politicization of gender-affirming healthcare (c.f. Turban et al., 2021; Walch et al., 2020). Arguments supporting these legislative acts recast gender diversity and gender-affirming care as baseless “gender ideology,” “extremism,” and even proof of a conspiracy by medical and mental health professionals to convince people they are TGD and/or abuse children. Proponents of these bills argue that they are protecting TGD people from gender-affirming medical and mental healthcare, which they claim is harmful rather than helpful to TGD people. Similar strategies and rhetoric were used by legislators attempting to restrict lesbian, gay, bisexual, and other sexual minority people from enjoying the right to marry the person they love. Division 44 recognized these arguments as based in stigma, not science, and consequently opposed those attempts then (American Psychological Association, 2011), just as we oppose the current onslaught of attacks on TGD people as based in stigma, not science, now.

Therefore, APA Division 44 affirms the legitimacy of gender affirming care and stands in strong opposition to attempts by local, state, and federal governmental bodies to misinform the public, interfere in the patient-provider relationship, and infringe upon the rights of TGD people and their families to seek and receive appropriate care and accommodations which evidence indicates is supportive of their health.

Restricting Access to Care Undermines Ethical Principles

The recent legislative actions banning gender-affirming care undermine ethical principles that guide psychological practice. Specifically, gender-affirming medical and psychological care has been shown to mitigate the negative effects of gender dysphoria, satisfying the ethical principles of Beneficence and Nonmaleficence. Recent legislative policies threaten providers’ ability to engage in beneficent clinical practice and minimize the harmful effects of gender dysphoria, placing psychologists in a compromising position of abiding by law, or following ethical code of conduct benefiting our patients. It is anticipated that lack of access to gender affirming health, and the increasingly hostile anti-transgender rhetoric which fuels these restrictions, will have dire ramifications for the health of TGD people (Holt et al., 2023), particularly TGD youth (Redfield et al., 2023).

Legislative intrusions into clinical practice that prohibit gender affirming care are inconsistent with the general ethical principle of Integrity. The principle of Integrity states that “Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology” (APA, 2017, p. 3-4). Psychologists who provide truthful, evidence-based information to patients may risk being charged with “aiding and abetting” criminalized medical care. Laws or regulations that cast gender affirming mental health care as “aiding and abetting” could create a conflict between law or governmental regulations and the Ethics Code, which states that “psychologists take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code” (APA, 2017, p. 4; also see Flynn et al., 2021).

Anti-TGD policies are also irreconcilable with the ethical principle of Justice, i.e., the equitable distribution of access to health care (APA, 2017). Geographic disparities in the access to quality medical and mental health care are expected to increase as a result of anti-TGD legislative efforts, further hampering the ability of multiply marginalized and otherwise vulnerable individuals to access needed care (Holt et al., 2023; Truszczynski et al., 2022). Respect for People’s Rights and Dignity affirms “the rights of individuals to privacy, confidentiality, and self-determination,” as well as respect for individual differences including gender identity (APA, 2017, p. 4). Further, psychologists “do not knowingly participate in or condone activities of others based upon…prejudices” (APA, 2017, p. 4). Ethically, therapy clients should have basic rights to self-determination and autonomy, free from the prejudicial views that discourage gender diversity, and access to psychotherapy facilitated by psychologists who understand TGD people (Puckett et al., 2023).

Legislative attacks on TGD youth and adults impair and criminalize ethical psychological practice, placing psychologists at risk of conflicts between governmental law and regulation and professional ethics. Therefore, Division 44 stands in strong opposition to restrictions on access to gender affirming healthcare.

Restricting Access to Sports is Discriminatory

Bills that restrict TGD youth’s access to sports are discriminatory, reduce participation in sports, particularly girls’ sports, and contradict the goals of youth sports. Science finds participation in sports results in positive outcomes, such as better grades, greater homework completion, higher educational and occupational aspirations, and improved self-esteem (Darling et al., 2005; Fredericks & Eccles, 2006; Marsh & Kleitman, 2003; Nelson & Gordon-Larsen, 2006; Ortega et al., 2008; U.S. Department of Health and Human Services, 2008). TGD-inclusive policies increase girls’ sports participation (Center for American Progress, 2021). Excluding TGD children from sports is discriminatory and psychologically harmful to them. Requiring TGD youth to athletically compete on teams based on their sex assigned at birth is the same as banning them from athletic competition entirely (ACLU, 2020). Excluding just some youth from sports runs contrary to the goals of sport. Excluding any subset of youth from sports encourages divisiveness and compromises group cohesion, undermining the benefits all youth deserve from team sports (ACLU, 2020).

All youth should have access to these benefits. Denying TGD youth access to these benefits is discrimination. Thus, Division 44 stands in strong opposition to restrictions on TGD youths’ participation in educational activities including in sports.

Efforts to Ban or Restrict Inclusive School Curricula Cause Harm

Efforts to ban or restrict instruction of topics which touch on the experiences of TGD people, including efforts to remove books from school libraries, compound long-standing problems of invisibility and negative representations that harm TGD students and erode the broader school climate. The latest GLSEN National (2020) survey shows less than 20% of schools taught students about lesbian, gay, bisexual, transgender, or queer (LGBTQ+) history, culture, and people; worse, 17% of schools reinforce negative stereotypes about LGBTQ+ people in their curricula, contributing to the stigma of TGD students. GLSEN (2020) finds that only 21.4% of Black youth are taught positive representations of LGBTQ+ history, culture, or people at school. The stigma that many TGD youth face at school negatively impacts their education, as TGD students in unsupportive school environments experience greater absenteeism, have higher rates of dropout, and have lower GPAs (GLSEN, 2020).

Offering comprehensive, inclusive education reduces stigma and marginalization of LGBTQ+ youth more broadly, including TGD youth, leading to improved school climates. Students at schools with inclusive education reported hearing fewer slurs, lower levels of victimization, felt safer, missed fewer days of school, and had a higher GPA in comparison to students whose schools did not cover LGBTQ+ topics in education (GLSEN, 2020). TGD students whose schools had inclusive curricula also report feeling safer and more accepted (GLSEN, 2020). And, because it is not just TGD youth who are the target of gender-based bullying (for instance, heterosexual students who are not TGD can also be called anti-gay slurs, teased for being too effeminate or masculine, etc.; Fisher et al., 2012; McCarty-Caplan, 2013), inclusive educational environments improve the school climate for all students. Similarly, Snapp et al. (2015) found that LGBTQ+ youth who attend schools which included LGBTQ+ youth in anti-harassment curricula reported lower harassment, less victimization, and felt safer and more supported in their school. And, schools that have implemented inclusive health curricula find that students are subsequently more likely to intervene when witnessing bullying (Baams et al., 2017; Proulx et al., 2019).

Division 44 stands in strong opposition to anti-TGD restrictions on instruction and/or curriculum and calls on policy makers to support inclusive policies.

Anti-TGD Legislation Causes Harm

Anti-TGD legislation and policies have a host of negative impacts on the lives of youth, adults, families, and communities. These policies lead to individuals losing access to medically necessary and appropriate healthcare, being excluded from school curriculum and sports, being disallowed from public bathrooms and changing rooms which match their gender identity, permitting or requiring teachers to use the incorrect name and pronouns for children and adolescents, and other actions. These actions lead to many serious harms including increased mental health symptoms and distress, feelings of marginalization, decreased school engagement, and poorer health (Dubois et al., 2018; Goldberg & Abreu, 2023; Horne et al., 2022; Perez-Brumer et al., 2015; Redfield et al., 2023). Additionally, anti-trans stigma has been identified as a driver of violence experienced by TGD communities (James et al., 2016). In a recent national survey, 86% of TGD youth reported increased distress due to these anti-transgender bills and the debates around them (Trevor Project, 2023). This is particularly concerning because TGD youth were already reporting higher levels of emotional distress and more barriers to accessing care which these latest restrictions, such as gender-affirming care bans and increasingly emboldened and hostile local and societal contexts, will only exacerbate (Abreu et al., 2022; Price-Feeney et al., 2020). Furthermore, transgender and gender diverse people who experience racism and other marginalizing experiences tend to be even more deeply impacted (James et al., 2016; Ryan et al., 2018; Trevor Project, 2022). These anti-TGD bills add stress, infringe upon TGD people’s rights (American Counseling Association, 2023), and further limit the availability of protective resources, putting transgender and gender diverse people at significant risk of harm. Anti-TGD legislation is in sharp contrast to the health-promoting effects of gender-affirming healthcare and other inclusive policies and practices.

Research has clearly demonstrated the safety and effectiveness of gender-affirming care and inclusive policies (Olson et al., 2016; Tordoff et al., 2022; van der Miesen et al., 2020). Public conversations often incorrectly cast gender-affirming care as “new” or “experimental” and therefore do not accurately reflect the careful, rigorous body of research evidence that informs the practice of gender-affirming care (e.g., Swan et al., 2023). Rather than rely on anecdotes, we encourage parents, school staff, community members, and elected officials to refer to evidence-based resources to increase their understanding of transgender people and gender-affirming care.

Conclusion

The Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) of the American Psychological Association stands in strong opposition to the wide range of legislative attacks targeting TGD people’s safety, rights, freedom of expression, and access to care. These legislative attacks increase stigma towards TGD people and LGBTQ+ people more broadly, run contrary to science, and violate ethical principles established in the discipline of psychology.

Click here to view the full statement and accompanying resources. 

The Arizona Psychological Association (AzPA) joins our national colleagues, the American Psychological Association (APA), in expressing our deep concern over the recent U.S. Supreme Court decision to overturn Roe v. Wade.

Our association recognizes that views regarding abortion vary in our society, and that for many these views are a reflection of their personal and/or religious beliefs. As representatives of a profession grounded in science, our concern is not an indication of agreement or disagreement with any particular personal or religious viewpoint, but primarily a reflection of scientific evidence that informs the work we do. This was illustrated in a statement by the American Psychological Association president Frank C. Worrell, PhD, “This ruling ignores not only precedent but science, and will exacerbate the mental health crisis America is already experiencing.”

The evidence that informs our concerns is clear in indicating that restricting access to abortion negatively impacts numerous aspects of an individual’s mental health, physical health, and social/socioeconomic factors. In a longitudinal cohort study, researchers found that women who were denied an abortion reported an increase in anxiety symptoms, lower self-esteem, and lower life satisfaction 1 week after seeking an abortion. In addition to an increase in initial mental health concerns, women who were denied abortions and gave birth reported more health and medical complaints (Foster et al., 2018) over 5 years. Researchers also found a number of detrimental social factors associated with restricted access to abortion. These factors include increase in overall negative financial consequences (e.g. credit and debt problems,) as well as both immediate and longer term household poverty (Foster, et al., 2018, Miller, Wherry & Foster, 2020), all of which can have long term impacts on families and contribute to multigenerational poverty and associated challenges (Duncan, Ziol-Guest, & Kalil, 2010).

The presence of evidence regarding the harm of abortion restriction stands in contrast to the absence of evidence for an often presumed notion among those supporting restricted access to safe abortion. It is argued that engagement in abortion procedures results in increased mental health and physical health issues, however, studies found that abortion does not increase women’s risk of experiencing symptoms of posttraumatic stress, depression, anxiety, or of experiencing lower self-esteem or life-satisfaction (Biggs et al., 2016; Biggs et al., 2017, Rocca et al., 2020.)

While our association’s primary concern is related to the negative impact of restriction in abortion access, we are also deeply concerned about the broad precedent of a legal ruling that serves to restrict individual rights and freedoms and the potential implications of this for the members of our association and the communities we serve. As psychologists, we are aware of the deeply harmful impact of social stigma and policies that marginalize people’s experience related to race, ethnicity, sexual orientation, gender identity or religious belief. We sincerely hope that this ruling does not represent a precedent that would contribute negatively to our communities in this way.

We urge that policies related to reproductive rights and access to safe abortion should not be based on the premise of emotional harm, uncertainty of the decision, or future regret as longitudinal studies have found that women most commonly self-reported feeling relief 5 years post-abortion (Steinberg,2020, Rocca et al. 2020.)

We ask state policymakers and leaders to create and support policies that will increase access to accurate scientific information and education to help individuals make informed decisions about their pregnancies and access to safe medical/mental health care.

We ask the AzPA membership to advocate for reproductive rights and to provide a quality of care in the work that we do that is founded in science.

On behalf of the AzPA Governing Council,

Evelyn Burrell, PsyD
AzPA President

Shirley Yang, PsyD
AzPA Diversity Representative

Confidentiality and Reproductive Health

The Council passed a policy asserting that confidentiality is central to the practice of psychology, and that psychologists should follow the APA Ethics Code when it comes to patient confidentiality surrounding reproductive health. The policy reaffirms “that a psychologist’s allegiance to the Ethics Code, including ethical standards related to patient confidentiality, should be given the utmost attention and significance especially when psychologists are faced with ethical conflicts with a law requiring the disclosure of confidential information regarding sexual and reproductive health, including birth control; fertility treatment; contemplating, seeking, or having had an abortion; and related issues.”

The vote was 148-4, with one abstention. This measure follows on a resolution the Council passed in February 2022 reaffirming APA’s commitment to reproductive justice as a human right, including equal access to legal abortion, affordable contraception, comprehensive sex education and freedom from sexual violence, with a particular emphasis on individuals from marginalized communities.

Click here to view the PDF of this statement and full reference list.

Statement from the Arizona Psychological Association: LGBTQ+ Rights and Advocacy Efforts

Arizona Governor Ducey signed into law SB1165 and SB1138 on March 30th, 2022, which deny gender-affirming surgical care to Transgender individuals before the age of 18 and access to sports for Transgender athletes.

Such legislation is harmful to the children and adults who identify as LGBTQ+. Many states have recently passed similar anti-LGBTQ+ legislation, which denies the basic human rights of individuals and communities that identify as LGBTQ+.

The Arizona Psychological Association (AzPA) strongly opposes the passage of anti-LGBTQ+ legislation, policies, and practices. The negative long-term and societal costs of passing legislation that discriminates against LGBTQ+ individuals are well documented in psychological science and research.

According to the American Psychological Association (APA, 2020):

Anti-LGBTQ+ stigma harms the physical and psychological health of LGBTQ+ people (Bialer & McIntosh, 2016; Burke, 2016; Cahill, 2017; Hatzenbuehler et al., 2009; Newman-Freeman, 2013; Raifman et al., 2018; Singh, & McKleroy, 2011) while equalizing laws and initiatives lead to improvement in LGBTQ+ people's physical and psychological health (Hatzenbuehler & Keyes, 2013; Mattocks et al., 2014; Parco & Levy, 2013; Tran, 2016; Wight, LeBlanc, & Badgett, 2013; Woodford et al., 2018).

Transgender children vary in athletic ability, just as other youth do. There is no evidence to support claims that allowing transgender student athletes to play on the team that fits their gender identity would affect the fairness of the sport or competition (ACLU, 2020).

Stereotype-based information about LGBTQ+ people appearing in discourse around laws, policies, and practices contributes to social stigma (Ball, 2010; Bull & Gallagher, 1996; Conrad, 1983; Douglass, 1997; Dugan, 2005; Eastland, 1996a; 1996b; Fingerhut et al., 2011; Herman, 1997; Keen & Goldberg, 2001; Moats, 2004; Russell & Bohan, 2014; Sarbin, 1996; Witt & McCorkle, 1997) and carries negative effects for LGBTQ+ people (Fingerhut et al., 2011; Russell, 2000; Russell & Richards, 2003).

Research and clinical literature demonstrate that variations in sexual and romantic attractions, feelings, and behavior as well as gender identity and gender expression are normal and positive variations of human sexuality (Bell, Weinberg, & Hammersmith, 1981; Bullough, 1976; Ford & Beach 1951; Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pomeroy, Martin, & Gebhard, 1953) and gender (Bockting, 2008; Coleman et al., 2012; Kuper et al., 2012) and there is no scientific basis for such discrimination based on LGBTQ+ identities. There is ample evidence that an opportunity for adolescents to participate in sports results in positive outcomes, such as better grades, greater homework completion, higher educational and occupational aspirations, and improved self-esteem (Darling et al., 2005; Fredericks & Eccles, 2006; Marsh & Kleitman, 2003; Nelson, & Gordon-Larsen, 2006; Ortega et al., 2008; U.S. Department of Health and Human Services, 2008). Additionally, excluding any subset of gender from sports can encourage divisiveness and compromise group cohesion, undermining the benefits all youth deserve from team sports (ACLU, 2020). All youth should have access to the benefits of sports.

Transgender youth foregoing gender-affirming care can have tragic consequences. Evidence has shown Transgender youth experience disproportionate levels of violence and bullying. Transgender youth are also more likely to feel less safe at school than cisgender youth, that is youth whose gender identity is consistent with their assigned sex at birth (Day et al., 2018).

Access to gender-affirming care has a positive relationship with the mental health of transgender youth and lowers their risk of depression and suicide (Bauer et al., 2015; Green et al., 2021. Transgender youth who have access to gender-affirming medical care experience improvements in mental health and often show mental health comparable to their cisgender peers (Toomey et al., 2022). Additionally, the distress experienced by youth who are provided treatments, but then decide to discontinue them and grow up to be cisgender, is significantly less than that which is experienced by transgender youth when such treatments are delayed (Ashley, 2021).

Decisions about whether to seek gender-affirming care, and what specific services to utilize, must be made between a provider, patient, and the patient’s parents or guardians. Such decisions are relative to the youth’s individual clinical situation. Gender affirming care typically includes steps toward social transition, potentially treatments to temporarily postpone puberty, and in some instances, gender affirming hormone therapy (Coleman et al., 2012). Rather than allow flexibility to account for the varying needs of individuals, SB1138 adopts a “one size fits all” approach by categorically banning the provision of appropriate gender-affirming surgery for minors.

Therefore, the Arizona Psychological Association, ask the federal and state governments to support equal opportunity, fairness, and equal access to care for LGBTQ+ individuals and all minority communities.

We call upon the AzPA membership to advocate for Arizona’s LGBTQ+ and other minority communities by opposing discriminatory legislation such as SB1165 and SB1138.

AzPA asks state policymakers and leaders to join with us in opposing unjust practices and policies in order to promote the well-being of LGBTQ+ communities and all of Arizona’s minority communities.

AzPA asks the citizens of Arizona to join us in urging our leaders to respect and protect the well-being of LGBTQ+ individuals from discriminatory laws, policies, and practices such as SB 1165 and SB 1138.

Evelyn Burrell, Psy.D. 
President
Arizona Psychological Association 

Ashton Dessert
LGBTQ+ Committee Chair
Arizona Psychological Association

Click here to view as a PDF

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Lynda Hughes, Red House Medical Billing

Red House works with clients in transition at every new signing. These are sensitive moments for cashflow. Working in tandem is essential - that means work from the owners of a practice or ops team at a facility. Attempting to establish new billing processes without two-way set up is a recipe for disaster. Claims may be able to get out the door. But the efforts to work denials, maximize digital workflows and payments, and engage with RPA are hobbled.

If you’re managing your own billing, what do you do when someone is retiring or quitting? Or in analysis, you’ve discovered deficiencies in their work? Who is managing website accesses, CAQH and other compliance updates and is it worth a doctor/owner managing it rather than focusing on patient outcomes? For various reasons, changing your billing can be a serious disruption to your cash flow if not properly handled.

In 2022, industry standards in medical billing are electronic and automated. Major carriers have cut back their customer service staff in favor of websites and voice response systems. Staff nowadays are being forced to register for accounts at carrier websites because customer service agents are literally instructed to refuse service unless an answer could not be obtained from the website first. Carriers encourage or require use of direct deposit for payment and electronic remit (ERA) in lieu of paper EOBs.

The problem with all of this? HIPAA. Not just anyone can perform these enrollments. Security is tight, and providers have no choice but to be involved in the process. If you want your new biller to be efficient, you must be ready to participate in getting these chores done. You must not assume your billers can do the work without you. Insurance companies need the assurance and participation of providers and owners to guarantee they are working with authorized third parties.

Some vendors will call to confirm that the person who registered had your permission. Some will mandate that you first create your own account, and then grant access to an associated user account. Some will ask for seemingly sensitive information, such as owner name, dates of birth, or social security number, especially if direct deposit is part of the process. You will hamper your new biller’s efforts right out of the gate if you do not take the time and make the effort to manage the needed enrollments. And that will likely mean a gap in your payments while they struggle to get everything flowing.

The good news? Once it’s done, it’s done. Once an enrollment is completed, they remain fairly maintenance-free unless there is a major change like a new user or a new bank account. New beginnings can be a bit hectic, but if you work as a team with your new biller, the pain will be very temporary. Stay focused on two-way communication and participation in transition and your cash flow will thank you!

Lynda Hughes is a co-founder of Red House Medical Billing. She has been a dynamic entrepreneur in the RCM space since 2003. She is a certified coder and her work has spanned dozens of specialties, states, and facility sizes. She currently oversees all coding and billing operations for Red House. She has been active in AzPA as a sponsor for 5 years!

Jeff Hillam, CEO, Red House Medical Billing

One of the first lessons in practice ownership is Revenue Cycle Literacy. For those who are masters of budgeting, accounting, and finance analysis they learn that the skills of managing a practice’s revenue cycle is altogether distinct.

The revenue cycle for a practice is defined as the sum of all processes that bring in the revenue. These processes include front desk management, accuracy measures, patient communication, billing and coding, payer relationship management, collections, reconciliation, and collaboration between the billing and accounting softwares.

Typical financial health measures might have you looking at your Profit and Loss statement to see how much you’re making, spending, and what’s left over. That data helps you make decisions about where to cut costs, budget growth, and gauge performance. Or you may spend time on your Balance Sheet tracking your assets and debt. In product and service based businesses these financial measures are the bare bones basics. Many of your financial advisors or CPAs may try and help you in your business by relying on these standard reports.

But in a mental health practice you have to know how to read your money through the eyes of billing reports. And you must learn how to process documentation in a way that streamlines these numbers. The most basic items you must be comfortable reading are your Account Receivable (AR) report, EOBs, and payment reports.

Your AR report tells you who owes you money. Your billing software will likely allow you to run AR reports filtered by insurance company, patient, claim, or practitioner. Using the various filters helps you analyze trends and to make decisions about how you work. The AR report tells you how old the money is and who owes it to you. If you see a patient on January first and you do not get paid until March 1, your AR report on February 15 will show a claim that is 45 days old. The AR report is generally broken into several buckets based on age – 0-30 days, 31-60 days, 61-90 days, 91-120 days, and 120+ days. To have Revenue Cycle Literacy you need to know how to use the data in the AR report to make decisions and to take actions and not just see how old an outstanding claim is. Decisions like which insurances you will work with, patients you may need to stop working with, or how to evolve your documentation to avoid costly denials.

An EOB (explanation of benefits) is a statement from the insurance company detailing services allowed, contractual adjustments, denials, and patient responsibility. You need to know how to interpret these documents as they show any denials. Remember a denied line item on an EOB is not always final. Utilize the expertise of your biller (hopefully Red House) to work denied lines that could pay. Revenue is lost in practices who don’t analyze EOBs. You will create your patient statements using EOBs as well. We recommend a streamlined practice where all EOBs are electronic. Electronic EOBs equates to faster velocity of revenue. Your ability to properly and punctually utilize the EOB increases your revenue and creates clean, accurate patient billing.

Lastly is the payment report. You should review this report monthly as a minimum. It shows everything you collected during the month. As you get comfortable maneuvering this report you will find trends in payment speed, reimbursement rates, and completeness. Remember payment reports don’t match your bank statements naturally. This confuses a lot of CPAs and bookkeepers. Payments will post to your bank accountand not be communicated to your billing system electronically for days. You billing system should post (or reconcile) that payment as soon as it comes in. But payments at the fringes of the month can be split across month lines. These reports help you also to double as a revenue report to function in conjunction with other billing reports. It is easier to compare AR and payment reports out of a billing system than to try to use P&L lines to compare with billing system reports. That should not worry you. It is a natural side effect of the purpose of each system.

Once you have mastered the basics, reach out to us to learn about more nuanced and faceted reporting based on code performance, practitioner efficacy, and payor relationship management.

You work hard and deserve to be reimbursed for your valuable services. The best chance of capturing the money owed to you is using these reports to maximize the stages of your revenue cycle. If this article drove only one thing home, it is that if you are managing a practice, you must make the time to become Revenue Cycle Literate.

Click here to view the PDF article

Check out Dr. Stafford's segment on PBS! Click here to view. 

The University of North Texas' Clinical Psychology Ph.D. program has opened up admission for students affected by the Argosy closure. Applications are due on April 15th, with an interview day for those selected sometime in May. If you know of anyone interested in applying please share this information.

Here is a link providing more information:

https://psychology.unt.edu/argosy-closure-response

For information regarding the program, please send any questions to Alana Fondren (alanalharrison@gmail.com) or Dr. Jennifer Callahan (jennifer.callahan@unt.edu).

Frequently Asked Questions Received By APA About Argosy University

APA is deeply concerned about the unfolding situation at Argosy and its impact on students, faculty and staff. We developed this page in response to the most frequent questions we are receiving and in an earnest attempt to support members of our community within our powers.

This page was last updated on March 8, 2019 at 3 p.m. ET.

Given what is being reported in the media regarding Argosy University, is APA taking any action?

APA is taking this matter very seriously. It is affecting the well-being of students, faculty and staff across Argosy's campuses, many of whom are our peers, colleagues, APA members and governance leaders within APA. Argosy is also training a significant portion of the next generation of psychology's providers, educators and others in the workforce, which has impact on the nation's access to healthcare. A team of experts across the organization is meeting regularly, devoting significant resources to supporting our members and stakeholders, and mobilizing our Advocacy team.

Rosie Phillips Davis, PhD, ABPP, APA's president, and Beth Rom-Rhymer, PhD, chair of the Council Leadership Team, said in part on March 7: “Our principal charge is to protect students and the public by promoting consistent quality in the teaching of psychology … We are developing a nimble advocacy strategy … Moreover, we are in constant contact with relevant agencies and other affected accreditors, so that we stay apprised of the rapidly changing terrain … APA does not have authority over the decisions of the psychology programs, the institution, the Department of Education, and the Argosy receiver. We must be careful to maintain our role as an evaluator and policy guide. If Argosy closes, the next step will be to work with Argosy and any programs or institutions, arranging teach-out or transfer plans …. APA is committed to continuing to do all within its scope as an accreditor to facilitate these transitions."

Here is some of what APA has been doing:

• Our APA Advocacy office, in consultation with our Education Directorate and Communications Office, sent a letter on March 1 to Education Secretary Betsy DeVos,urging her to immediately establish a real-time response center to address concerns from affected Argosy students and to provide timely, helpful updates and guidance.
• APA Advocacy staff have contacted key congressional offices seeking to enlist their assistance.
• APA is facilitating members of the Argosy community to take their concerns directly to their elected officials via this online action alert.
• APA is responding to calls and emails from affected students, faculty, and other concerned parties. We established the Psychology Student Action Centerand (202) 336-6014 to listen to members of the Argosy community and direct them to appropriate resources.
• At the direction of a senior Argosy administrator on Feb. 8, access for applicants applying to Argosy University through PSYCAS, APA's centralized application system, was closed. APA requires that schools participating in PSYCAS have institutional accreditation.
• APA is also monitoring the actions taken by the Western Senior College and University Commission (WASC) that Argosy submit detailed teach out plans in compliance with WASC policy and guidelines. WASC maintains a page about Argosy. Also see the ‘terms' section below.

I did not receive my expected federal student loan funds from Argosy. What can I do?

Students who are still waiting on financial aid can make inquiries to their institution, to the agency that regionally accredits Argosy (Western Senior College and University Commission) and/or to the US Department of Education.

What happens with my federal student loans when a school closes before I graduate from it?

There is a process for this called Federal Loan Discharge. Read about general criteria and eligibility and information specific to Dream Center/Argosy. Federal Direct Loans, Perkins Loans, and Federal Family Education Loans (FFEL) are eligible for discharge. It is important to note that the government says, “If you completed or are in the process of completing a comparable program of study at another school through a teach-out, by transferring academic credits or hours from the closed school, or by any other comparable means, you are not eligible for a closed school discharge.” Also, note that private loans are not eligible; you would have to check with your private loan servicer, or possibly the higher education office

in the state where your closed school was located, to see if there are any closed-school discharge options. APA members are entitled to free support with student loans via IonTuition. We recommend using this service after you contact your federal and private loan servicers, as they are likely to have more information.

Can you explain some of the terms I keep hearing?

• Teach-out plan: According to the Department of Education, this is “a written course of action a school that is closing will take to ensure its students are treated fairly with regard to finishing their programs of study. Some plans include written agreements between the closed school and other schools that are still open for teaching.” (Read more about the institutional accreditor's Teach-Out Plans and Agreements Policy.)
• Receiver: A receiver is someone appointed by a government body to take possession and charge of designated assets or property and to administer them in accordance with government or court directives . In this case the receiver was court-appointed.
• Institutional accreditor or regional accreditor: Western Senior College and University Commission accredits Argosy and its campuses as an institution.
• Programmatic accreditor: The APA Commission on Accreditation accredits 10 doctoral programs in psychology at Argosy University. APA does not accredit master's programs.
• Surety bond: An agreement between three parties, in which one (the surety or guarantor) agrees to pay a certain amount to a second (obligee), if and when a third party (principal) does not meet an obligation.

I am a student at an Argosy program. What should I be doing?

Many students and faculty are rightfully distressed by the lack of clarity about what is happening, and what will be the state of enrollment as a student of Argosy in the very near future.

Based on the emails and calls we have received, we understand that some students are finding support in one another via online forums they have created through social media. Some students have told us they are reaching out to local universities about their abilities to transfer credits. Some students are reaching out to members of Congress to start a case file, share their concerns about financial aid and other matters and demand action by the government.

APA set up a response team to hear from concerned students, faculty and other stakeholders. Reach the Psychology Student Action Center via email or by phone at (202) 336-6014, where we will listen to your concerns and direct you to appropriate resources.

APA is also eager to put your message into action. Complete this APA action alert to your member of Congress and ask that they start a case file to assist you.

What should I know about transcripts?

According to WASC Senior College and University Commission, on March 7 “Argosy has indicated that it plans to arrange for student transcripts and records to be made available to students through a third-party service.” Students affected by the possible closure of Argosy may want to contact WSCUC as to how they can obtain copies of their transcripts in the future. The federal government advises that inquiries may also be made to the agency in a particular state that licensed a closed school.

I am worried about my doctoral internship. What can you tell me?

If you are a student already on, or about to go on, a doctoral internship in psychology, and you used the Association of Psychology Postdoctoral and Internship Centers to help you find/match to an internship, APPIC released the following information on March 7: “...[W]hile recommendations may change when more information is available, APPIC would like to provide the following general guidance at present: 

1. "All Argosy students who are currently on internship should continue to move forward toward the successful completion of their internship year. 
2. "All Argosy students who recently matched in Phase I, and those who will match in Phase II or get placed via the APPIC Post-Match Vacancy Service, should continue to move forward with plans for attending and successfully completing their internships.
3. "Internship programs who currently have Argosy students on site, or those who have or will soon be matched to Argosy students, should prepare for those students to attend their internships as planned.
4. "Argosy students who experience a closure of their doctoral program (and a resulting period of uncertainty while a new program is found), a "teach out" situation, a change to a different graduate program, or similar situation are not expected to have their internship placements affected by such a change.
5. "APPIC understands that there will be hardships and unanticipated circumstances that are created by the current situation, and will consider alternative guidance or exceptions to the above on a case-by-case basis, or as needed as the situation evolves. Should any individual affected by these difficult circumstances wish to consult about their specific situation pertaining to the internship Match, please contact  Greg Keilin, APPIC Match Coordinator. Concerned parties or individuals with information about relevant developments are also welcome to contact me [Dr. Mariella Self, Chair, APPIC Board of Directors].” 

What should I know about credentials banking?

APA is hearing from organizations in the psychology community that wish to help doctoral students at Argosy schools “bank” their credentials in the event Argosy closes. According to an article in the APA Monitor on Psychology, "Should you bank your credentials?" credentials banking involves “submitting documentation about your internship, doctoral degree, postdoc and other credentials to a central repository for verification and storage,” and “can offer peace of mind as well as convenience.” There are two organizations offering banking to Argosy students and alums, and both have stepped in to offer assistance at no cost. This service is only available to students in programs that develop students who could later be become licensed psychologists; it is not available to any master’s student, or to any doctoral students outside of clinical, counseling and school psychology. Please visit the Association of State and Provincial Psychology Boards and the National Register of Health Service Psychologists for more information.

Where can I get some general information about what is happening at Argosy?

A number of media outlets have covered this story. If you would like to read some of the coverage, use the following links:

• The Chronicle of Higher Education
• Google News about Argosy University
• Inside Higher Education
• The New York Times
• The Washington Post
• Please also refer to this page for official updates from the institutional accreditor.

What should I make of this situation and those involved?

There has been and undoubtedly will be more coverage in the media about this situation and the various parties involved. It is important that members of the psychology community do all we can to recognize the significant ways that Argosy students and faculty have been affected by the actions and circumstances surrounding their education at Argosy University. Students and faculty are the innocent bystanders to what has been happening. We know that students enrolled in APA-accredited programs at Argosy are being trained by faculty who are preparing them for careers to address critical societal needs for behavioral health services. Accredited programs have been judged to meet standards associated with quality education and training.

Questions about APA Accreditation

What would happen to the program's accreditation status if what we are hearing from many people about Argosy's potential closure is true?

APA accreditation of a doctoral program in clinical, counseling or school psychology rests on the program being open for business and having institutional accreditation. Were one or both of those pieces to disappear, a program would no longer meet the requirements of accreditation by APA. The current accreditation status for all accredited programs is provided by the Office of Program Consultation and Accreditation. Its web page contains an online directory of programs it accredits. Changes in accreditation status, when made, are posted in this directory as soon as possible.

What comes next for a student who is attending a school that is closed or is about to close?

When situations arise that affect an APA-accredited program’s ability to operate, the APA Commission on Accreditation considers the circumstances and works with appropriate regulatory, institutional and other authorities managing the situation in an effort to facilitate the provision of quality education and training in health service psychology for those concerned.

What new information can you tell me about APA's role in teach-out and transfer plans?

The ability to transfer courses is not decided by the American Psychological Association. When an institution closes, the parties involved in approving plans for students to transfer to a new university may include the closing university, the university accepting students, institutional accrediting bodies, relevant state boards of higher education, specialized programmatic accrediting agencies and the U.S. Department of Education. The APA Commission on Accreditation, in collaboration with involved parties, is working to help facilitate high quality transfer arrangements.

What can I do if I think Argosy is not following requirements of the Standards of Accreditation?

The APA Commission on Accreditation has a process by which members of the public may file a complaint if it is believed that an APA-accredited program is not in compliance with accreditation standards (PDF, 58KB). You can download the complaint form (DOC, 24KB). The procedures for handling complaints against accredited programs are intended to deal only with complaints based on purported lack of program consistency with the Standards of Accreditation for Health Service Psychology (SoA). It is not a mechanism for adjudication of disputes between individuals and programs.

Who can I speak with at APA if I have more questions?

Staff in the APA offices on Early Career and Graduate Student Affairs are available to respond to questions during standard business hours. You can reach them via phone at (202) 336-6014 or via email.

Click here to view the APA article.

IMPACT OF PHYSICAL DISCIPLINE OF CHILDREN MAY BE HARMFUL IN THE LONG TERM, ACCORDING TO APA RESOLUTION

Association adopts policy calling for use of alternatives that foster supportive family environment

WASHINGTON - Scientific evidence demonstrates that physical discipline of children by parents and other caregivers can harm children's mental health and possibly increase their propensity toward aggressive behavior, according to a resolution adopted by the American Psychological Association. Instead, alternative forms of discipline that are associated with more positive outcomes for children - such as reasoning, time out, taking away privileges, warnings and ignoring misbehavior - are recommended. 

"Research indicates that physical discipline is not effective in achieving parents' long-term goals of decreasing aggressive and defiant behavior in children or of promoting regulated and socially competent behavior in children," states the Resolution on Physical Discipline of Children By parents. "The research on the adverse outcomes associated with physical discipline indicates that any perceived short-term benefits of physical discipline do not outweigh the detriments of this form of discipline."

The resolution notes that children learn from the behavior modeled by their parents, "and therefore physical discipline may teach undesirable conflict resolution practices," according to research. There is also evidence that physical discipline by caregivers can escalate into physical abuse.

The resolution was adopted by APA's governing Council of Representatives at its meeting Feb. 15. The resolution was drafted by APA's Committee on Children, Youth and Families, whose members relied on an extensive review of the scientific literature. It was reviewed by relevant APA boards and committees before being put to a council vote.

The resolution commits APA to raise public awareness and increase education surrounding the impact of physical discipline on children and the effectiveness of other methods. It calls on APA to promote culturally responsive training and continuing education regarding alternative discipline strategies and their effectiveness. And it directs APA to support funding for research in the United States and other countries on the factors that underlie why some parents support and rely on physical discipline.

"The use of physical punishment on children has been declining in the United States over the past 50 years," said APA President Rosie Phillips Davis, PhD. "We hope that this resolution will make more parents and caregivers aware that other forms of discipline are effective and even more likely to result in the behaviors they want to see in their children."

The resolution was accompanied by a supporting statement citing extensive research into the use and outcomes of physical punishment on children.

"Despite beliefs that physical discipline is an effective way to eliminate undesirable child behavior or to induce child compliance with parents' requests, there is no consistent scientific evidence that physical discipline makes children more or less likely to cease undesirable behavior or engage in desirable behavior in the short term," according to the supporting statement. "Research instead suggests that physical discipline is not better than other discipline methods, nor does it serve to enhance the positive outcomes parents seek, such as conscience development or positive behavior and affect."

Rather, using physical discipline predicts increases in children's behavior problems, even after controlling for race, gender and family socioeconomic status, the supporting statement says.  While cultural and religious differences in attitudes toward and beliefs about physical discipline may contribute to its use, the harmful outcomes are the same, according to the research.

Positive parenting skills - such a modeling orderly, predictable behavior, respectful communication and collaborative conflict resolution - "are more likely to yield desirable behaviors and to foster a more positive and supportive family environment," according to the supporting statement.

The supporting statement noted the limitation surrounding research into physical discipline, noting that it is unethical "to randomly assign children to a condition in which they do or do not receive physical discipline from the moment they are born." However, recent work has used strong research designs using multiple methods and has examined diverse samples. "Thus, findings from these methodologically rigorous studies show that parental physical discipline use can be detrimental, and conversely that other forms of discipline promote positive child behavior over time," it says.

With this resolution, APA joins numerous professional and public health organizations in recommending that parents avoid using physical discipline, including: the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Professional Society on the Abuse of Children, U.S. Centers for Disease Control and Prevention, Association for Child and Adolescent Counseling, National Association of Counsel for Children, National Association of Pediatric Nurse Practitioners, and National Foster Parent Association. In addition, international agreement about the ineffectiveness of physical discipline has resulted in many countries banning the practice in all settings.

The American Psychological Association, In Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 115,700 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.