Mandersheid: Setting Our Bold Course for 2015

NYAPRS Note: A typically thoughtful piece on today’s Behavioral Healthcare by our friend Ron Manderscheid whose view of key issues in 2015 includes federal mental health legislation, Affordable Care Act court action, Affordable Care Organizations, criminal justice reform imperatives and the key value and role of peer run services.


Setting Our Bold Course for 2015

by Ron Manderscheid, PhD

Behavioral Healthcare December 31, 2014


2015 likely will be a very pivotal year for behavioral healthcare. As you celebrate the arrival of the New Year, prepare yourself to begin a very bold course of action on January 2nd.

As each of us prepares to go out with family and friends to celebrate the arrival of 2015 on New Year’s Eve, I hope that we also will reflect upon our unfinished national agendas from 2014 and then set a very bold course for the New Year. If we do so, I think that we will realize very quickly that the eventualities of 2015 will depend in large measure upon our willingness as a field to take action rather than wait for others to do so.

Read more at:

Ron Manderscheid, PhD

V: 202-942-4296; M: 202-553-1827

The Voice of Local Authorities in the Nation's Capital!


OM: NCQA Reports Drop in MCO Performance on HEDIS BH Measures; Social Measures Must be Included

NYAPRS Note: While post discharge follow up, improvements in diabetes and cardiovascular care and increased and informed use of desired medications are important measures, it is frankly galling that the NCQA’s approach to expanding BH care measures continues to focus only on medically related measures and leaves out the social determinants of health.

Here in New York, our emerging integrated behavioral health and medical managed care initiative will also be evaluating plan performance on measures like housing stability, employment and economic status, decreased criminal justice involvement and increased access to peer support. Improved outcomes in these areas are highly correlated to improved health and decreased use of avoidable inpatient and ER services.

It’s long past time for the NCQA to extend its focus well beyond symptom management measures, especially because these measures are what will drive care for most Americans with mental health conditions.


NCQA Reports Decline In Health Plan Performance On Two Behavioral Health Quality Measures


Newly released National Committee for Quality Assurance (NCQA) health plan data shows an overall performance decline on behavioral health quality measures between 2012 and 2013. Of the two measures for behavioral health quality measured by the NCQA Healthcare Effectiveness Data and Information Set (HEDIS), one showed a decline and the other showed no improvement from the prior year.


The HEDIS performance measures are reported by commercial and Medicare health maintenance organizations (HMO) and preferred provider organizations (PPO) and Medicaid HMOs. For 2012 and 2013, health plans reported on the following behavioral health HEDIS measures:

  • The timeliness of community-based outpatient care post discharge from a psychiatric hospitalization for members age six and older. The measure identifies the percentage of members who received outpatient follow-up within 7 days of discharge and within 30 days of discharge. The measure includes an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner.
  • Provision of follow-up care for children between 6 and 12 years of age diagnosed with attention deficit/hyperactivity disorder (ADHD). The measure identifies the percentage who received a follow-up visit within 30 days of their first prescription of ADHD medication, and the percentage who remained on the medication for at least 210 days, and had at least two follow-up visits with a practitioner in the 9 months subsequent to the Initiation Phase


Of the two measures, health plan quality declined on the seven-day and 30-day timeliness measures for community-based outpatient care post-discharge from a psychiatric hospitalization. Health plan quality was the same for the ADHD follow-up care measures.


The findings were released “The State of Health Care Quality.” Data for the report was submitted by 814 HMOs and 353 PPOs, representing more than 171 million people. About 54% of Americans are enrolled in health plans that report HEDIS performance to NCQA. The HEDIS measures affect multiple aspects of health care quality. Nearly half of the 139 HEDIS measures showed significant, long-term improvement. Eleven measures (8%) reported a decline over the past three to five years. Sixty-four measures (46%) reported performance gains, and another 64 measures showed a mixed result over the past three to five years.


2012 & 2013 Health Plan Performance On Timely Outpatient Care Within 7 Days & 30 Days Following Psychiatric Discharge By Payer & Plan Structure



7-Day Follow-Up

Commercial HMO



Commercial PPO



Medicare HMO



Medicare PPO



Medicaid HMO



30-Day Follow Up

Commercial HMO



Commercial PPO



Medicare HMO



Medicare PPO



Medicaid HMO




2012 & 2013 Health Plan Performance On Follow-Up For Initiation & Continuing Care Appointments For Children Prescribed ADHD Medication, By Payer & Plan Structure




Commercial HMO



Commercial PPO



Medicaid HMO



Continuing & Maintenance

Commercial HMO



Commercial PPO



Medicaid HMO




The NCQA reported that it expects behavioral health measure reporting to more than double from 2013 to 2015. In 2013, the following new behavioral health-focused performance measures were implemented for Medicaid, but no other plan types reported on the measures. The new behavioral health measures include the following:

  • Diabetes monitoring for people on antipsychotics for schizophrenia or bipolar disorder
  • Diabetes monitoring for people with both diabetes and schizophrenia
  • Cardiovascular monitoring people with heart disease and schizophrenia
  • Adherence to antipsychotic medications for people with schizophrenia
  • Using multiple concurrent antipsychotics in children and adolescents
  • Metabolic monitoring for children and adolescents prescribed antipsychotics
  • Using first-line psychosocial care for both children and adolescents taking antipsychotics


The full text of the 2014 “State of Health Care Quality” report can be viewed online December 1, 2014).

OPEN MINDS reported on a the new behavioral health measures in “Seven New HEDIS Medicaid Measures Target Schizophrenia, Bipolar Disorder,” which published June 5, 2012. The article is available at

OPEN MINDS most recently reported on the NCQA quality measures in “Tufts Tops NCQA List Of Top 20 Highest Quality Private Health Plans For 2014,” which published on December 7, 2014. The article is available at


For more information, contact:

  • Andy Reynolds, Media Contact, National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, District of Columbia 20005; 202-955-3500; Fax: 202-955-3599; E-mail:; Website:
  • Apoorva Stull, Media Contact, National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, District of Columbia 20005; 202-955-3518; Fax: 202-955-3599; E-mail:; Website:



CHCS Releases Medicare-Medicaid Integration Toolkit


Advancing access, quality, and cost-effectiveness in publicly financed health care.




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December 22, 2014


Medicare-Medicaid Integration Toolkit


The more than 10 million individuals enrolled in both Medicare and Medicaid (known as Medicare-Medicaid enrollees or dually eligible beneficiaries) are among the nation's highest-need populations. Many Medicare-Medicaid enrollees receive fragmented and uncoordinated care from two distinct programs with separate benefits and enrollment policies. Integrating care and services into a single program or coordinated delivery system is essential to improving the quality of care and lowering costs for this high-need population.


This online toolkit, developed through support from The Commonwealth Fund and The SCAN Foundation, is designed to help states exploring options to integrate care for Medicare-Medicaid enrollees through a variety of vehicles, including financial alignment demonstrations, Dual Eligible Special Needs Plans, managed long-term services and supports programs, etc. The toolkit houses practical resources for: 



    1. Designing Integrated Care Programs
    2. Developing Program Rates
    3. Fostering Administrative Alignment
    4. Working with Health Plans
    5. Engaging Consumers and Providers
    6. Tailoring Integrated Care for Specific Populations; and 
    7. Monitoring Program Oversight and Quality


States, health plans, providers, and stakeholders can use the toolkit to learn more about designing and implementing new models that integrate care and services for dually eligible beneficiaries.


View the Toolkit >>




About CHCS

The Center for Health Care Strategies (CHCS) is a nonprofit organization dedicated to advancing access, quality, and cost effectiveness in publicly financed care. CHCS works with state and federal agencies, health plans, providers, and consumer groups to design programs that better serve high-need and high-cost populations. 




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Copyright © 2014. All Rights Reserved.





US, Finnish Universities Collaborating to Adapt Open Dialogue for US

NYAPRS Note: See newly released overview of the Open Dialogue approach at


Preparing the Open Dialogue Approach for Implementation in the U.S.

Open Dialogue Pic

Check out our newly released first version of The Psychotherapy-Focused Fidelity Chapter entitled "The Key Elements of Dialogic Practice in Open Dialogue: Fidelity Criteria". The intent of this document is to help support the development of an Open Dialogue practice and way of relating in teams that can be used for “self-reflection” by an individual practitioner or whole team participating in Open Dialogue meetings, for supervision and training purposes, and for helping in systematic research.  Please send your comments and feedback to

A multi-disciplinary team at the University of Massachusetts Medical School (UMMS), led by Drs. Douglas Ziedonis (PI) and Mary Olson (Co-I) of the UMMS Department of Psychiatry, is collaborating with Dr. Jaakko Seikkula and his colleagues at the University of Jyväskylä, Finland, to prepare the Finnish “Open Dialogue” for adaptation and implementation in the U.S.

Open Dialogue (OD) is an innovative, language-based, network approach to acute psychiatric crises developed by Jaakko Seikkula, Birgitta Alakare, Jukka Aaltonen and their multi-disciplinary team at Keropudas Hospital in Tornio, Finland. This psychosocial intervention has two components: (1) a community-based, integrated treatment system that engages families and social networks, and (2) a distinct and unique form of dialogues within open psychiatric meetings. The approach has been effective in reducing symptoms of psychosis, leading to fewer and shorter hospitalizations, reduced neuroleptic medication dosage, greater improvements in functioning and improved likelihood of employment (Seikkula et al. 2006).

There is a strong convergence between Open Dialogue and recovery-oriented principles and practices. Both embrace recovery as a genuine process of revival and resiliency, which is grounded in hope, empowerment, and a supportive network. Open Dialogue creates democratic partnerships between professionals and the people they serve to restore productive and meaningful lives. Both the recovery perspective and Open Dialogue are reinforced by the knowledge that people with mental health and addiction problems can and do persevere and play meaningful roles in society.

Research Infrastructure Development Project:

Open Dialogue

Launched in September 2012 and funded by the Foundation For Excellence in Mental Health Care, the UMMS/Finland OD initiative will develop practical tools for clinicians, program leaders, and researchers in the United States – and throughout the world – who hope to further investigate the OD approach.

The collaboration will produce several products to help with adaptation of the Open Dialogue model, including:

1.  A psychotherapy-focused manual and fidelity tool for clinical interactions with individuals and families

2.  A system-focused manual and fidelity tool for assessing program/organizational implementation.

Related links 
Video – Dr. Jaakko Seikkula speaks about Open Dialogue 
Madness Radio: Open Dialogue for Psychosis w/ Mary Olson 
Institute for Dialogic Practice, Haydenville, MA 
Open Dialogical Practices 
National Empowerment Center - Dialogical Recovery from Monological Medicine


Related references 

Aaltonen, J., Seikkula, J., & Lehtinen, K. (2011). Comprehensive open-dialogue approach I: Developing a comprehensive culture of need-adapted approach in a psychiatric public health catchment area the Western Lapland Project. Psychosis, 3, 179 – 191.

Seikkula, J., Aaltonen, J., Alakare, B., & Haarakangas, K. (2006). Five-year experience of first-episode nonaffective psychosis in open-dialogue model. Psychotherapy Research, 16(2), 214-228.

Seikkula, J., Alakare, B., & Aaltonen, J. (2011). The comprehensive open-dialogue approach(II). Long-term stability of acute psychosis outcomes in advanced community care: The Western Lapland Project. Psychosis, 3, 1–13.

Seikkula, J. & Olson, M. (2003). The open dialogue approach: Its poetics and micropolitics. Family Process, 42, 403-418.


Project Team 
Douglas Ziedonis, MD, MPH 
Mary Olson, PhD 
Jaakko Seikkula, PhD 
Jonathan Delman PhD, JD, MPH 
Daniel Fisher, MD, PhD 
Lisa Mistler, MD, MS 
Carl Fulwiler, MD, PhD 

Makenzie Tonelli, BA


For more information on the UMMS Open Dialogue global collaboration project, please contact Makenzie E. Tonelli, Project Coordinator, Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, S7-734, (p) 508-856-8641|(f) 508-856-6621.






C4SI: $40K Grants to Promote Best and Emerging Practices in Peer Services

NYAPRS Note: Please note that capability statements for this grant need to be submitted by February 2.




Bringing Recovery Supports to Scale

Technical Assistance Center Strategy (BRSS TACS)

Funding Opportunity

2015 Peer-Run Organization/Recovery Community Organization Projects to Promote Best And Emerging Practices In Peer Services

In September 2011, the Center for Social Innovation (C4) was contracted by the Substance Abuse and Mental Health Services Administration (SAMHSA) to operate the Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS), which promotes widespread adoption of recovery-oriented supports, services, and systems for people with substance use disorders, mental health conditions, and/or co-occurring disorders. 

To support BRSS TACS’s efforts to promote and support capacity building, implementation and training opportunities for best and emerging practices, C4 is requesting capabilities statements from Peer-Run Organizations/Recovery Community Organizations (PRO/RCOs) to carry out activities to promote best and emerging practices in peer services.



Subcontract Activities

Subcontractors will work within their state, district, territory or tribal jurisdictions to carry out one of the following three types of activities:

  • Promoting the use of best or emerging practices for peer-delivered recovery supports; or
  • Providing virtual training and educational activities; or
  • Planning and developing capacity and/or infrastructure to establish new peer-delivered recovery supports. 

These activities are in support of C4’s efforts to bring recovery-oriented policies, practices, and infrastructure developments to scale.

Subcontract Funds

Up to eight (8) subcontracts in the amount of $40,000 each will be made by the Center for Social Innovation to PRO/RCOs in states, Territories and Tribal Jurisdictions.

BRSS TACS will provide guidance and support on project activities during the six-month subcontract period, including a kickoff call and three teleconferences to share project status, successes and challenges. 




Download the Request for Capabilities Statements for submission instructions and requirements.

Due Date:

Capabilities statements must be received by 5:00pm EST on Monday, February 2, 2015.




Informational Webinar

BRSS TACS staff held an informational webinar on December 22, 2014.

The webinar detailed the capabilities statement submission process for two subcontract opportunities, the 2015 Peer Health Reform Education Efforts and the 2015 BRSS TACS Peer-Run Organization/Recovery Community Organization Projects to Promote Best and Emerging Practices in Peer Services.

Please click the link below to access the archived presentation.

Archived Presentation:


BRSS TACS serves as a coordinated effort to facilitate the adoption and implementation of recovery concepts, policies, practices, and services, leveraging previous and current accomplishments by SAMHSA and other leaders in the behavioral health recovery movement.


Questions about the 2015 Projects to Promote Best and Emerging Practices in Peer Services may be directed to the Center for Social Innovation.  Please send your questions to Rebecca Stouff, by email to, or by phone at (617) 467-6014 ext. 252.



WHAM Summit Attendees Get Free Registration for National Council 2015 Conference

NYAPRS Note: The following comes from the National Council’s Larry Fricks.

Whole Health Action Management — a new science-based program that teaches participants to set and achieve whole health goals through weekly action plans and 8-week support groups. The training prepares persons with mental illness and addiction disorders, employed in behavioral health organizations, to facilitate WHAM groups that help their peers reach whole health, wellness, and resiliency goals through effective self-management. Trainings are offered anywhere in the country for interested organizations and regions.

Given the high incidence of chronic physical health conditions such as diabetes, heart disease and obesity among people with mental illnesses and addictions, WHAM was developed by peers for peers to help them improve chronic health and behavioral health conditions. The training is based on the WHAM curriculum developed by the SAMHSA-HRSA Center for Integrated Health Solutions (run by the National Council) to promote whole health self-management and strengthen the peer workforce’s role in integrated healthcare delivery.


Attend the 2-day preconference WHAM training and summit, and get  complimentary registration for the 2015 National Council Conference in Orlando, FL, April 20-22


The Whole Health Action Management (WHAM) training prepares peer providers to facilitate groups to support individuals in setting and achieving their health goals.

At the 2015 National Council Conference in Orlando, FL, we’re hosting a 2-day WHAM training as well as a special summit for WHAM alumni and training attendees –and we want to be sure that you are there to participate.


That’s why we’re excited to offer those who attend the WHAM training and/or summit a complimentary registration to the 2015 National Council Conference. 

We welcome peer providers to participate in the following two preconference activities:


WHAM Training

The 2-day WHAM training (April 18-19, 2015) is offered at a special rate of $100 per person and includes revised manuals and new training activities. The training ends midday on April 19 so attendees can also participate in the summit. Space for the WHAM training is limited.

WHAM Summit

Get the latest updates on the program – including revised manuals, best practices and innovations from fellow WHAM graduates, and a review of the new WHAM train-the-trainer program at the WHAM Summit April 19, 2015. Register now!

Complimentary registrations are limited; register soon to take advantage of this exclusive offer. Offer limited to WHAM alumni who attend the summit on April 19 and to individuals who attend the 2-day preconference training April 18-19. Contact Hannah Mason at to learn more.

Learn more about the Conference, including information on the preconference WHAM training, on
our website


Congress Passes ABLE Act to Help PWDs to Pursue Work, School & Retirement Goals

NYAPRS Note: The following comes courtesy of NYSPI’s Center of Excellence for Cultural Competence, who writes “Congress recently passed the ABLE (Achieving a Better Life Experience) Act of 2014. The ABLE Act will allow eligible people with psychiatric disabilities (e.g., those receiving SSI or SSDI) to save (exempt from the 2,000 SSI and Medicaid resource limit) contributions from their own income, families or friends for eligible expenses, such as education, housing, transportation, employment training and support, assistive technology, personal support services, health care expenses, financial management and administrative services and others. Annual contributions can be of up to $14,000 and ABLE accounts will be able to have up to $100,000 before affecting SSI eligibility. This is great news for New Yorkers with psychiatric disabilities because ABLE may help many of them achieve their dream of going back to school, live more independently, work, and even retire with a decent income.

As you know, the New York State Psychiatric Institute Center of Excellence for Cultural Competence is collaborating with several organizations, including Baltic Street, AEH., the Mental Health Peer Connection of Western New York Independent Living, and NYAPRS, to assess the financial capability of New Yorkers with psychiatric conditions, and develop a peer-led empowerment intervention in order to improve access of individuals to asset building resources (e.g., mainstream financial services, tax credits, saving programs, work incentives, and other asset building instruments like the one being created by the ABLE legislation).

This new legislation will open the doors of economic empowerment for many of people in our state, and we look forward to help make sure New Yorkers know about it as it becomes available.



Congress Passes ABLE Act: Major Victory for Persons with Disabilities and Their Families


(Washington, D.C. – Dec. 17, 2014) – Last night, the U.S. Senate overwhelmingly passed the Achieving a Better Life Experience (ABLE) Act of 2014 by a vote of 76 to 16. First introduced in 2006, and subsequent sessions of Congress, the ABLE Act will allow people with disabilities (with an age of onset up to 26 years old) and their families the opportunity to create a tax-exempt savings account that can be used for maintaining health, independence and quality of life.

“Today marks a new day in our country’s understanding and support of people with disabilities and their families,” Michael Morris, National Disability Institute (NDI) Executive Director, said. “A major victory for the disability community, ABLE, for the very first time in our country’s policy on disability, recognizes that there are added costs to living with a disability.” He continued. “For far too long, federally imposed asset limits to remain eligible for critical public benefits have served as a roadblock toward greater financial independence for the millions of individuals living with a disability.”

NDI has long championed the ABLE Act as a critical strategy to providing a pathway to a better economic future for all people with disabilities. As the nation’s first nonprofit dedicated to improving the financial health and future of all people with disabilities, the organization has extensively documented and called attention to the daily reality and extra expenses associated with living with a disability, and the challenges of navigating the complex web of government rules to maintain public benefits eligibility.

In recognition of this unprecedented legislation, NDI has created a list of 10 items about ABLE accounts that individuals with disabilities and their families should know:

ABLE Accounts: 10 Things You Must Know

1.     What is an ABLE account?

ABLE Accounts, which are tax-advantaged savings accounts for individuals with disabilities and their families, will be created as a result of the passage of the ABLE Act of 2014. Income earned by the accounts would not be taxed. Contributions to the account made by any person (the account beneficiary, family and friends) would not be tax deductible.  

2.     Why the need for ABLE accounts?

Millions of individuals with disabilities and their families depend on a wide variety of public benefits for income, health care and food and housing assistance. Eligibility for these public benefits (SSI, SNAP, Medicaid) require meeting a means or resource test that limits eligibility to individuals to report more than $2,000 in cash savings, retirement funds and other items of significant value. To remain eligible for these public benefits, an individual must remain poor. For the first time in public policy, the ABLE Act recognizes the extra and significant costs of living with a disability. These include costs, related to raising a child with significant disabilities or a working age adult with disabilities, for accessible housing and transportation, personal assistance services, assistive technology and health care not covered by insurance, Medicaid or Medicare. 

For the first time, eligible individuals and families will be allowed to establish ABLE savings accounts that will not affect their eligibility for SSI, Medicaid and other public benefits. The legislation explains further that an ABLE account will, with private savings, “secure funding for disability-related expenses on behalf of designated beneficiaries with disabilities that will supplement, but not supplant, benefits provided through private insurance, Medicaid, SSI, the beneficiary’s employment and other sources.”  

3.     Am I eligible for an ABLE account?

Passage of legislation is a result of a series of compromises. The final version of the ABLE Act limits eligibility to individuals with significant disabilities with an age of onset of disability before turning 26 years of age. If you meet this criteria and are also receiving benefits already under SSI and/or SSDI, you are automatically eligible to establish an ABLE account. If you are not a recipient of SSI and/or SSDI, but still meet the age of onset disability requirement, you would still be eligible to open an ABLE account if you meet SSI criteria regarding significant functional limitations. The regulations to be written in 2015 by the Treasury Department will have to explain further the standard of proof and required medical documentation. You need not be under the age of 26 to be eligible for an ABLE account. You could be over the age of 26, but must have the documentation of disability that indicates age of onset before the age of 26.

4.     Are there limits to how much money can be put in an ABLE account?

The total annual contributions by all participating individuals, including family and friends, is $14,000. The amount will be adjusted annually for inflation. Under current tax law, $14,000 is the maximum amount that individuals can make as a gift to someone else and not pay taxes (gift tax exclusion). The total limit over time that could be made to an ABLE account will be subject to the individual state and their limit for education-related 529 savings accounts. Many states have set this limit at more than $300,000 per plan. However, for individuals with disabilities who are recipients of SSI and Medicaid, the ABLE Act sets some further limitations. The first $100,000 in ABLE accounts would be exempted from the SSI $2,000 individual resource limit. If and when an ABLE account exceeds $100,000, the beneficiary would be suspended from eligibility for SSI benefits and no longer receive that monthly income. However, the beneficiary would continue to be eligible for Medicaid. States would be able to recoup some expenses through Medicaid upon the death of the beneficiary.

5.     Which expenses are allowed by ABLE accounts?

A “qualified disability expense” means any expense related to the designated beneficiary as a result of living a life with disabilities. These include education, housing, transportation, employment training and support, assistive technology, personal support services, health care expenses, financial management and administrative services and other expenses which will be further described in regulations to be developed in 2015 by the Treasury Department.

6.     Where do I go to open an ABLE account?

Each state is responsible for establishing and operating an ABLE program. If a state should choose not to establish its own program, the state may choose to contract with another state to still offer its eligible individuals with significant disabilities the opportunity to open an ABLE account.

After President Obama signs the ABLE Act, the Secretary of the Department of Treasury will begin to develop regulations that will guide the states in terms of a) the information required to be presented to open an ABLE account; b) the documentation needed to meet the requirements of ABLE account eligibility for a person with a disability; and c) the definition details of “qualified disability expenses” and the documentation that will be needed for tax reporting.

No accounts can be established until the regulations are finalized following a public comment period on proposed rules for program implementation. States will begin to accept applications to establish ABLE accounts before the end of 2015.  

7.     Can I have more than one ABLE account?

No. The ABLE Act limits the opportunity to one ABLE account per eligible individual.

8.     Will states offer options to invest the savings contributed to an ABLE account?

Like state 529 college savings plans, states are likely to offer qualified individuals and families multiple options to establish ABLE accounts with varied investment strategies. Each individual and family will need to project possible future needs and costs over time, and to assess their risk tolerance for possible future investment strategies to grow their savings. Account contributors or designated beneficiaries are limited, by the ABLE Act, to change the way their money is invested in the account up to two times per year.

9.     How many eligible individuals and families might benefit from establishing an ABLE account?

There are 58 million individuals with disabilities in the United States. To meet the definition of significant disability required by the legislation to be eligible to establish an ABLE account, the conservative number would be approximately 10 percent of the larger group, or 5.8 million individuals and families. Further analysis is needed to understand more fully the size of this market and more about their needs for new savings and investment products.

10.   How is an ABLE account different than a special needs or pooled trust?

An ABLE Account will provide more choice and control for the beneficiary and family. Cost of establishing an account will be considerably less than either a Special Needs Trust (SNT) or Pooled Income Trust. With an ABLE account, account owners will have the ability to control their funds and, if circumstances change, still have other options available to them.  Determining which option is the most appropriate will depend upon individual circumstances. For many families, the ABLE account will be a significant and viable option in addition to, rather than instead of, a Trust program.



Sleep for Health and Well-Being

NYAPRS Note: As you rest and restore this holiday season, remember that the benefits of sleep for your mental health, memory, and resiliency to stressful situations cannot be replaced.


There’s More to Sleep than Shuts the Eye: Waking Up to All that Sleep Does for Our Health & Well-Being

Mad in America; James Schroeder, PhD, 12/20/2014


Every day for most people, something mysterious begins to take shape that still defies scientists in these times.  Although the primary reasons for most basic bodily functions, such as eating and moving, have been known for centuries — sleep, or also known as slumbering or snoozing or napping or crashing — still remains an enigma in many ways.  Yet, there is no single activity that we do more in our life.  It is largely controlled by two bodily systems and one earthly one.  One, the circadian rhythms and sleep/wake homeostasis of our body, tells us that the longer it has been since we slept, the more it is time to close our eyes.  And two, the less light that we perceive, the more our brain (largely through the use of melatonin) tells us it is time for bed.  The average person will sleep for 25 years in their lifetime.  Infants typically sleep average between 14-15 hours a night.  Toddlers spend half of their day horizontal.  Even by the time our kids reach school age, we hope that their daily hours of sleep reaches double digits.

Although researchers acknowledge that there is much to learn, what we do know increasingly sends one clear message.  Sleep is vastly more than simply rest and quietness.  It makes sense.  Why would the human body spend a 1/3 of its time doing something unnecessary?  In 2013, an article was published in the journal of Scientific American entitled, Sleeps Role in Obesity, Schizophrenia, Diabetes…Everything  In it, the authors provide an overview of the growing mountain of studies that point to the amazing potential, and significant risks, associated with different sleep patterns.  Studies (e.g., Chase & Pincus, 2011) have long shown that roughly 90% of people diagnosed with anxiety disorders report sleep-reported problems, the latter potentially causing or worsening the former.  We know that ADHD rates are higher in kids with poor sleep.  We know that psychologically healthy kids look a lot like those diagnosed with ADHD when they are chronically sleep deprived (Paavonen et al., 2009).  If you take kids with obstructive sleep apnea and ADHD symptoms and remove their tonsils and adenoids, the improvement in attention is typically much better than using medication. Shortened sleep duration in young kids is associated with a lifelong risk for obesity (Bell & Zimmerman, 2010).  Long-term sleep deprivation mimics psychosis in healthy individuals.  If you have sleep apnea, your risk for depression is fivefold; if you have depression, the risk of apnea is fourfold.

But sleep is not just about warding off disease and disability.  Good sleep is associated with learning better and remembering more.  It appears that our memory is better if we “sleep on it.”  Taking naps after learning tasks results in greater recollection and retrieval than staying awake.  Dreams, long the source of so many conjectures and theories, appear to not necessarily recreate what actually has happened, but create scenarios about events and tasks that likely serve many purposes.  All of us, including athletes, (especially those in intense, ongoing training) often depend on sleep, including recovery naps, to repair the body.  Exercise often improves sleep.  Sleep often improves exercise.  Roughly two-thirds of our growth hormone, which is involved with muscle development, is secreted during sleep.  Sleep helps control when we feel full, and when it is time to eat in order to prepare for the day.  Sleep appears to regulate our blood sugar.  Studies suggest that going to bed earlier can help make a diet more successful. Even the types of foods and drinks we consume can significantly affect our sleep.

As we get deeper into the mystery, we know that not all sleep is created alike.  There are stages of sleep, and patterns of sleep. Very simplistically, there are five primary stages of sleep—stages 1-4 and the Rapid Eye Movement (REM) phase.  Stages 3 and 4 are considered deep, slow-wave sleep.  The average child gets most of his deep sleep in the first three hours of the night (which diminishes as we get older).  That is when issues, such as sleepwalking and sleep terrors, usually occur.  Kids really aren’t awake when this happens and therefore, can’t remember a thing next morning.  On the contrary, REM sleep, usually occurs for children after the 3rd hour and increases as the night goes on.  This is when nightmares typically arise, which may wake the child up and leave memories in the morning.  And somewhere in the night, we all have a “point of singularity”, which nearly coincides with where our body temperature reaches its lowest point.  At this juncture, our core temperature begins to rise, cortisol secretion increases, and the proportion of REM sleep grows.  Unbeknown to us, it is as if our body begins to prepare for another day.

For many, the science of sleep might be liable to, well, put them to sleep.  But the further into the spindles we get, the more astounding and captivating it becomes.  As Dr. Ruben Naimen noted in her book, Hush:  A Book of Bedtime Contemplations, sleep becomes less about something we do, and more about who we are and the rhythms that we feel.  It seems there is a psychophysiological, meta-physical, even spiritual nature to it all.  Yet unfortunately, sleep appears to have become one more marketed commodity.  In past two decades, artificial sleep aids have sharply risen (NCHS, 2013).  Market research between 1998-2006 indicated sleep aid prescriptions for young adults (ages 18-24) had tripled (Russo, et. al, 2008).  They come by many names, on and off label, prescription and over-the-counter, medication and supplement.  But all concoctions used are intended to onset or enhance sleep, or completely sedate the people who use them.  Meanwhile, many researchers suggest that 80-90% of sleep difficulties could be address through cognitive, behavioral, and lifestyle changes.  Recently, the American Academy of Sleep Medicine (AASM) weighed in on this discussion through a document entitled Five Things Physicians and Patients Should Question. Advice #2:   Avoid use of hypnotics as primary therapy for chronic insomnia in adults; instead offer cognitive-behavioral therapy, and reserve medication for adjunctive treatment when necessary.  Advice #3:  Don’t prescribe medication to treat childhood insomnia, which usually arises from parent-child interactions and responds to behavioral intervention.

The great irony is that despite all our attempts to augment sleep, we are slumbering less than we did just a century before.  Twenty percent less.  There are many arguments why.  Maybe our biological systems are evolving.  Maybe our 24/7 culture and the lure of incessant media and bright lights, whether of a mobile screen or the conventional tube, are just too alluring.  Maybe we think we can “beat the system” and get by just fine without adhering to time-honored needs.  Years ago, I got to know a father who swore he didn’t need any more than 4-5 hours of sleep a night.  He was forty pounds overweight, anxious, irritable, divorced, and felt his only child was slowly parting from him.  I challenged his assumptions about his need for sleep, and mused with him what just a couple of more hours a night could do for his quality of life.  I am not sure if he ever saw how more darkness could lead to more light.

And maybe, just maybe, we simply don’t value sleep like we do so many other things.  I cringed a few years ago when I read a blog written by someone about how to truly be a successful professional.  One of the messages was simple:  get used to living with less sleep.  It seemed like a falsity laden with strong undertones that went well beyond the zzz’s.  It echoed of a message we hear elsewhere, which proclaims that whatever we could find outside of ourselves—money, status, power—is well worth sacrificing what we can find within.  Of course, what he forgot to mention was that even if the false promise was true (which it is not), it is only plausible for the few that could make it as he aspired.  Sleep, on the other hand, is given to everyone, even though for some it seems like a nightmare, not a remedy.  As a father, I never knew just how much I loved my sleep until my first kids were born.  There are times when sleep might just be the most important and productive part of my day.

It is time to reclaim the value of the Betty White party, or counting our sheep, and just getting some old- fashioned shut eye.  It is time to stare down the screen and let it know that the bed is calling.  I think we would all be happier, and really not miss a thing.  And better yet, I (and many others) think that when the demands of the day do come calling, striving for optimal sleep will only allow us to be more productive, healthier, more patient, and more loving than before.  And it could all be free.


Hiring, Training, Retaining, Managing Peers: Recorded Web Seminars Available

NYAPRS Note: Follow the links below for the helpful and much-discussed webinars regarding the integration of peer staff in the workplace. These are excellent resources for any manager or administrator, no matter how long peer professionals have been included in your workplace!


Information on the recorded web seminars on “Best Practices for Effectively Integrating Peer Staff into the Workplace.”


This is the first of a two part series on integrating peer staff in the workplace. This first part will focus on who is a peer, what do peer staff do, what peer staff can and should do, how peer staff enhance the therapeutic alliance and specific suggestions for utilizing peer staff.


Link to Part one:


This is the second of a two part series on integrating peer staff in the workplace. This part will focus on what qualifications an employer should look for in a peer staff and teach some of the legal statutes that you can use when posting job announcements and during the interviewing process. Emphasis will also be on how to support peer staff once they've been hired and how to supervise peer staff. A focus on some common supervisory traps and how to avoid them will also be presented.


Link to Part two: