[sci hist] A Most Remarkable Week

Sep. 17th, 2017 12:52 am
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(h/t Metafilter)

This link should take you to the audio player for The Moth, cued to a story, "Who Can You Trust", 12 minutes long.

The Moth, if you didn't know, is an organization that supports storytelling – solo spoken word prose – true stories. This story is told by Dr. Mary-Clare King, the discoverer of BRC1. It concerns a most extraordinary week in her life, when pretty much everything went absurdly wrong and right at all once. It is by turns appalling and amazing and touching and throughout hilarious.

It's worth hearing her tell herself before the live audience. But if you prefer transcript, that's here – but even the link is a spoiler.

Recommended.
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I have a recollection of hearing a filk song, I think from a tape, that had a climactic line or repeated like in the refrain, to the effect of "And that's what cities get from trains". I have an impression it was a Leslie Fish song, but I don't know that for sure.

Not having any joy of google. Does anybody recognize it?
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(h/t Metafilter)

I just heard about Senior House. Goddamn.

Also. I hadn't realized that dealing with the administration in his capacity as Senior House's housemaster is what drove Henry Jenkins from MIT. Goddamn.

I am surprisingly angry and sad about this, given that I'm not a SH affiliate.

The shutdown of Senior House would be bad news, by itself. This is appalling:
The questionnaire, the Healthy Minds Survey, was administered by the University of Michigan. Many schools around the country give it to students as a way to pinpoint problems on campus and decide how best to allocate resources. When MIT administered it in 2015, they told students that it was a confidential survey intended to help them. One of the chancellor’s assistants who had lived in Senior House when she was an undergraduate went to Senior House and specifically requested that the residents take it. They did, in large numbers.

What they didn’t know—and what they couldn’t have known from reading the consent form that accompanied it—was that MIT had embedded metadata that allowed the administration to pinpoint the location of those filling out the questionnaire, enabling them to segment the results by dorm. The only question about dorm type in the survey was vague—“What kind of dorm do you live in? Small, large, off campus?”—but by tracking the metadata, Barnhart and the administration were able to see exactly where respondents lived.

It was this data that enabled Barnhart to see what she called a troubling hot spot of drug use. “If it wasn’t a direct violation, it was at least a violation of the spirit of informed consent,” Johnson says.
In light of that...
As Senior House students spread out across campus this year, former advisers worry that they’ll be at even greater risk. They can reach out to MIT’s mental health services if they need it, the chancellor says.
Is there some reason that MIT students should trust MIT Med to keep their information confidential? When MIT just used the confidential results of a "Healthy Minds Survey", which was advertised as a way of seeing where resources were needed, to eliminate resources from vulnerable populations? And the relevant IRB gave it a pass?

(Dear MIT students, and alums concerned about them: it is apparently hypothetically possible for students on the default MIT student health insurance ("extended" plan) to see therapists unaffiliated with MIT, but it has a pretty punative copay:
If you are covered by the MIT Student Extended Plan, and you see a mental health clinician who participates in the Blue Cross Blue Shield (BCBS) PPO, your first 12 visits in a calendar year are covered in full (100%). After that, you will have a $25 copay for each visit.

If you are covered by the MIT Student Extended Plan, and you see a mental health clinician who does NOT participate in the Blue Cross Blue Shield (BCBS) PPO, your first 12 visits in a calendar year are covered at 100 percent of the BCBS allowed amount. After that, your insurance will cover 80 percent of the allowed amount, and you will pay the other 20 percent. For all of your visits, your clinician may bill you for the difference between the BCBS allowed amount and his or her charges. This is something you should discuss with your clinician ahead of time.
I don't know for certain what BCBS's "allowed amount" is, but I know they're paying master's level therapists about $85 per therapy session, so I'm guessing that's it. So if a therapist's regular fee is $100, you'd be paying ($85*0.2)+($100-$85)=$32 per session. A lot of therapists are charging rather more that $100/session these days. At $120/session that's $52/session.

That copay/cost-sharing is absurd. Obviously, many students couldn't possibly afford $25/week copay – specially the most vulnerable ones. So that's a hell of an incentive to seek care from MIT Mental Health and Counseling Service directly: as they proudly state, no copay or other fees to see the therapists that work for MIT.

Less obviously, it's not even vaguely in line with the market right now. I see people who have jobs and pay $10 and $15 copays on other insurances. That students would be charged a $25 copay to see a therapist – in-network! – is incredible. Honestly, students being charged any copay is pretty out of line.

Seriously: MIT students, the people who stock the shelves in the Star Market behind Random have better access to mental health care than you do. That grocery store shelf stocker qualifies for a subsidized Medicaid Expansion plan, which covers at least a therapy session per week, with no copay. Also, their plan has hundreds, if not thousands, of therapists to choose from, none of whom report to your landlord cum diploma-granter-maybe cum civil authority cum boss of your local police.

Also, availing yourself of the option of seeing a non-MIT therapist on your MIT student insurance, even though it's through BCBS, requires a "referral" from MIT Med:
If you are already seeing an outside clinician or have a specific outside clinician in mind, you don’t have to make an appointment at MIT Medical to get a referral. Just call the Mental Health and Counseling Service at 617-253-2916, and ask to speak with someone about getting a referral for your outside treatment.
This may be completely pro forma, but the upshot is that MIT is making it a requirement on you that you notify MIT if you're getting psychotherapy, and that you divulge to them from from whom you are getting it. That someone is in therapy and from whom they get that therapy is highly confidential information, that frankly MIT has no business knowing. You should be able to see a therapist on your student insurance without MIT even knowing about it.

So if you wanted to work for the benefit of students' mental health, there's a great target: demand that MIT's insurance for students provides off-campus, unaffiliated psychotherapy with no copay, cost sharing, or balance billing – or radically less than at present, so MIT students can freely avail themselves of treaters not on MIT payroll; and abolish the need for a referral, because info about your utilization of mental health care is prejudicial, privileged information that can be used against you. But be careful to keep a third-party insurance co in the loop, instead of MIT directly paying therapists; whomever pays the therapist is allowed to snoop in your psychotherapy records.

Or, honestly, given some of the crappy-ass general health care friends of mine have gotten through the Med Center, maybe just agitate for all students to just get a regular BCBS PPO membership instead of having to go to the Med Center, at all. Or given how much BCBS sucks, try to get students into the Medicaid Expansion, so students get a choice of providers. That would be harder.

P.S. Disclosure of conflicts of interest: none – I don't take BCBS, so even if the copay/cost-share/balance-billing were eliminated, and students started flocking to off-campus therapists, I still wouldn't benefit by any of that business, unless somehow you managed to get students into Medicaid Expansion, and then only if students were willing to travel all the way to Medford to see me – I just have it in for MIT Med, and MIT MHCS especially.)
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I now have enough levels in crockpottery to recognize that this recipe, "Chicken Leek and Mushroom Casserole", is absurd as written. For one thing, there's absolutely no reason to include any chicken stock at all, unless one wants a soup as a result, given how much fluid 8 chicken thighs will express; given how much fluid winds up in it, there's no way it would ever come out "creamy", or, for that matter, at all like a "casserole". Yeah, I bet you have to thicken the sauce with cornstarch (ew).

But I really wanted a slowcooker meat dish with leeks, and I wasn't finding much, so I decided to adjust for sanity, double it (because I consider 8 servings a bare minimum for the effort), and give it whirl.

Also, I added canned potatoes to obviate later having to come up with a starch to serve it with.

Results seem pretty good! [personal profile] tn3270 seems very taken with it.

Here's my version:

4.5 lbs of chicken thighs, boneless skinless (could handle another lb)
3 cans (~15oz) whole potatoes
2 leeks (the biggest diameter ones on sale), washed really well and sliced
1 lb sliced button mushrooms
4 tsp minced garlic
4 Tbsp butter
2 tsp thyme
2 tsp rosemary
4 bay leaves
3 Tbsp mustard, dijon
1/2 C cream, heavy
2 Tbsp lemon juice
salt and pepper at the table
slowcooker liner

uses 6qt slowcooker and 4 cup frying pan with lid

0) Melt butter in big frying pan. Sauté the leeks in the butter until they start to soften. Push to sides and add minced garlic; saute abt 90 seconds to golden brown, then mix in with leeks. Add mushrooms, stir a bit to get mushrooms coated with butter, then cover. Cook, stirring occasionally, till leeks are soft and their scent mellows. (Once this is done, this can be refrigerated, if you want to prep this in advance.)

1) Measure the herbs into a mixing bowl. Add mustard, cream, and lemon juice, mix. (This can also be refrigerated, if you want to prep this in advance.

2) Line slowcooker. Open and drain the potatoes, and put in bottom of slowcooker. Put in half the chicken, half the leek-mushroom mixture, the other half the chicken, and the other half the leek-mushroom mixture. Pour the mustard-cream sauce over it.

3) Cook on LOW for 6 to 8 hours. Remove bay leaves before eating.

ETA: Outstanding mysteries:

1) Is powdered rosemary just not a thing? Little rosemary bits isn't the same thing.

2) How much leek is "one leek"? When I got to the store, I had my choice of: a leek the diameter of my wrist, a leek about 2/3s the diameter of that, and lots of leeks the diameter of my two thumbs put together. The original recipe called for "one leek", and I'm like, "What does that even mean in this context?"

3) Is frozen pre-chopped leeks a thing? I love leeks, I do not love chopping leeks. I don't hate it – at least, being cylinders, they're much easier to chop than onions – but there's something to be said for convenience.

4) Even without the added two cups of fluid, it came out with a thin broth. Maybe next time thicken with tapioca. Or maybe reserve the cream for the end, and only add it in the last half hour? Slow cooking cream just seems to break it down.
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0.

So there's this thing called, "GiveAnHour.org". It's (I have recently learned) a non-profit organization which exists to convince psychotherapists to provide pro-bono treatment to servicemembers and military family members.

Now, there's a number of reasons one might raise an eyebrow at this, but lets set that aside to grant at least for now that this is an attempt to address a legitimate need through legitimate means.

The way it usually functions is that volunteer therapists sign up, the org checks their bona fides to make sure they're in proper license status to work in their jurisdiction, and then the therpist get listed in their geographically-based directory that clients can use to find pro-bono therapists.

Well, apparently, they are moved by the plight of Houston to start a Hurricane Harvey relief project. I know about this because my national professional organization, AMHCA, just posted about it on our extranet. Leadership exhorted us to go sign up as volunteers, because GiveAnHour is expresssly and exclusively recruiting licensed mental health professionals as volunteers to provide remote care to people impacted by Hurricane Harvey.

I'm a little perplexed as to how this could work. Texas, as big as it is, does not hold a majority of mental health counselors in our professional org. What with there being 50 states and some-odd other jurisdictions, the vast majority of us AMHCA members are licensed someplace not Texas. We are licensed in our home states (plus a few over-achievers who have multiple state licenses for reasons).

It's not legal – AFAIK – for CMHCs who are not licensed by Texas to practice in Texas. Duh.

This is, in fact, the classic problem with CMHCs being volunteer professional responders to catastrophes. We're not allowed to cross state lines to help. Or rather, we can, but we have to not practice when we get there.

And, yes, we've thought of that: we have to be licensed where the client is, so, no, telecommuting to the disaster doesn't help.

(I have no idea how other medical professions handle this, or if they do.)

So I go poking at the GiveAnHour.org site to see what's up with their Hurricane Harvey volunteer therapist project.

Read more. This and two other eyerollers. )

(no subject)

Sep. 7th, 2017 09:57 pm
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[personal profile] staranise
So, I'm three days in to my new job. It's starting off slow; my first day, almost all I did was read the Policies and Procedures manual. Today I ground through stultifying online trainings like Professional Conduct over Telephone and E-Mail and Maintaining a Respectful Workplace that exist largely so people who behave poorly can't say someone didn't explain common sense to them.

But meanwhile, I've sat in on my supervisor doing a family intake interview, and sat in on case conference, and reviewed the assessment tool they're developing for me to use and made a major revision suggestion which my supervisor said was a very good idea, and the small happy twang of my job my job my job is going off inside my chest. These early days of preparation, of grounding at home office and orientation to the work atmosphere, are important before I dive into clinical work where I will mostly be at my worksites solo, one therapist with a locking wheely-cart against a giant mountain of need. On the other hand, I'm happily anticipating the dive.

TW Money and budgeting

Meanwhile: I was looking for something crunchy and miserable to read at the local library now that The Origins of Totalitarianism is finished (I KNOW, don't look at me like that) and instead, I found All Your Worth by Elizabeth Warren and Amelia Tyagi. Oh, wow. I've been nervously chewing over the idea that I "ought" to have a more structured plan with my money now that I'm going to have some; for the last ten years my plan has been "panic a lot and try not to spend anything, inevitably fail". (It's been nice that my mother had tight money last year; she used to say, "Lis, why don't you go to counselling and get physiotherapy and buy new shoes???" and not understand when I'd explode with stress. Now she says, "Wow, you've been living like a churchmouse for a decade!") Most budget systems give me panic attacks, especially things designed by and for accountants; what works to best for me has felt like a shamefully bastardized system of spreadsheets and looking at my bank balance through my fingers. And now... I wish I'd read this book a long time ago.

The book says right up front, "Most financial advice books are about helping rich people become more rich. This is about helping people who feel panicked and out of control with their money, like they never have enough, to gain stability, peace of mind, and the ability to weather life's ups and downs."

And honestly, if there's anyone I trust not to bullshit me about financial stuff, it's the authors of The Two Income Trap, who fucking KNOW how batshit today's economy is. (My dad and older brother love capitalist self-help books and seminars; dipping into them has always been stress-provoking and unhelpful.)

Their system is really simple, really intuitive, and makes me feel calmer and happier and more in control before I've implemented a single bit of it; I can see how I've been smart about money all along, but am reaching now for some tools to be truly wise with it. I can imagine a long-term strategy. And I'm not trying to wrap my brain around a bunch of terms and concepts that feel like Greek to me. It feels good.

(I'm not sure how it would work with seriously limited incomes, like disability pensions or unemployment stipends; all their examples so far are people with full-time jobs and regular paycheques. I suppose you could take their basic sorting system and adjust the ratios, though.)

First paycheque comes down the pipe in... twenty-six hours. I'm looking forward to it.
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MassHealth, are you still reading? Maybe you could pass this on to DMH?

I am admittedly feeling cranky and dispeptic to begin with. But I got a forwarded email today, advertising 2.5 hours of free Continuing Ed credit – as I've mentioned, one of my favorite phrases is "Free CEUs" – in suicide prevention training sponsored by the Massachusetts Department of Mental Health.

In Worcester.

So I poked around a bit on the relevant websites to see where and when else the DMH was offering trainings.

There are two trainings scheduled so far, both in Worcester.

And that's the point at which my molars started grinding.

Look. I totally get how one might think it's maximally "fair" to hold trainings in the geographic middle of the state.

But it's, like, two hours by car to get to Worcester from: Salem, Gloucester, Newburyport, Fall River, or Pittsfield. I'm not even going to hazard an estimate from the Cape, and we all know Martha's Vinyard and Nantucket don't even count as part of Masschusetts for this sort of thing.

The only people who are going to be willing to do four hours of round-trip driving for a three hour class are those who are super into the topic, which are usually the folks who really don't need a 101-level class like this.

And, DMH, as an aside, there are plenty of us within Rt. 128 who don't have cars. I appreciate that your event is accessible by public transit! But getting to your 9:30am event by public transit takes – I checked on Google Maps – over two hours of transit time and gets you there at 9:01am. Which is to say, I'd have to leave home before 7am, and I'd get home after 2pm, and your 2.5 credit hour course would take over seven hours out of my day. I'm not willing to give up an entire work day to a 2.5hr training[*], even if it is free.

DMH, what are you trying to achieve? Are you actually telling yourselves that you're serving the entire Commonwealth by offering free courses in the middle of the state? Are you telling yourselves you're doing something effective for promoting suicide prevention by dumping a little pile of education in just one part of the state?

Maybe I have this all wrong, and you're actually responding appropriately to some horrible uptick in suicidality in the Worcester area. Or maybe it's been detected that Worcester-area clinicians are comparatively bad at safety planning, and this is a surgical strike to remedy a regional training problem. In which case: good job!

And maybe this is some sort of charity: free CEUs for clinicians out in the hinterlands who don't have access to as many training opportunities as those of us in Boston. Which, well, I suppose that's fine. You could say so somewhere. You could explain this is part of a mission to support clinicians in underserved areas, and then I'd be like, "Oh, okay then".

But if you have – as your website suggests – some sort of state-wide charter to improve suicide prevention, you aren't going to do that – state-wide – by only holding trainings in Worcester. You simply are never going to reach the vast majority of Massachusetts clinicians. Because we are so seriously not showing up for something over an hour and a half away by car, that's only 2.5 credit hours long.

If you are serious about promulgating to the whole of Massachusetts whatever this training promulgates, you're really going to have to hold it in a whole bunch of diverse locations around the state.

Also, DMH, while I have you here, is there some reason I have to hear about these things from word of mouth? I mean, you're a state agency, I'm a state-licensed mental health professional. My professional mailing address is a matter of public record! I understand postage costs money, but I'm pretty sure there are fewer than 10k LMHCs, so for less than $5k you could do a one-time mailing to all of us, notifying us that you have free trainings you're offering us, and how we can get on your email notification list; then just mail the new licensees as they're licensed. Admittedly, you have other professions to care about, too, and it would cost money to mail them, too. But if you're serious about getting clinicians to take your trainings, they have to know about them, and you need to do a better job at notifying them.

Assuming you ever hold them some place they can get to them.

[* Okay, I've done it – but it was a road trip with a friend for kicks and giggles, and it was a much more interesting and specialist topic than this.]

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