Morgan T. Sammons, PhD, ABPP

Sammons 150x188Colleagues, we’re delighted to announce that we just launched our new continuing education website: CE.NationalRegister.org. You can earn more than 100 free CE credits on this site from archived issues of The Register Report. The site also introduces a tremendous new innovation: You now have the capability to electronically bank all of your CE certificates, regardless of where you earned them. You can categorize them and, at your convenience, download status reports of progress towards your CE goals.

We’ve always banked your National Register-earned CE certificates on our website, but now you may simply scan any other CE certificates into the website interface to upload them to a comprehensive electronic file. In other words, you should never have to search for a CE certificate again! Copies of your certificates can be downloaded and printed out should you need to demonstrate compliance with your licensing board or employer. Even better, you can download an Excel report that will tell you exactly how many CEs you have earned, which you can sort by date or type of credits earned (ethics, legal, etc.). The site has been designed to be tablet and mobile-friendly for on-the-go use—vastly simplifying access to what we hope will become your new continuing education home.

We hope all Registrants will take advantage of this benefit, and welcome those members in states like Michigan, New Jersey, Hawaii, and Colorado which just enacted regulations to require all licensees to complete mandatory continuing education.  We plan to send around a brief questionnaire shortly after launch, and we’d appreciate your feedback on the site so we can continue to make improvements.

In the coming weeks this site will also house our Integrated Healthcare Training Series, a collection of videos that contains a wealth of information from leaders in the integrated healthcare field. These videos will be CE eligible. Please check back soon!

The Dog Days of August

August was one of my favorite months when growing up in semi-rural southern Oregon – first there was still no school, then there were peaches from the local orchards, then blackberries picked alongside dusty roads (“don’t pick the ones right by road,” my mother rightfully cautioned us in those ancient times– “they absorb the lead in the car exhaust.”) In that un-air conditioned era, we’d escape the heat by dips in a nearby creek and rolling out sleeping bags on the deck at night. Such choices unfortunately aren’t readily available in sweltering Eastern Seaboard metropolises, and I imagine that many of you, like me, have tried to escape the August heat by taking refuge inside a cool room with a book. It’s an odd coincidence when my summer recreational reading coincides so exactly with my stack of professional journals to plow through, so I thought I’d share some intersects that jumped out at me.

In an attempt to better understand Donald Trump’s appeal to economically disadvantaged white Americans, I picked up a copy of J. D. Vance’s Hillbilly Elegy—the autobiographical narrative of a young man who escaped the poverty of Kentucky and rust-belt Ohio for a law degree at Yale and a nascent career in Silicon Valley. A typical trajectory it is not, and Vance himself was motivated to tell his story by the realization that many like him—born, as he said, with the inherent advantages of belonging to a dominant culture—continued to be sucked into the vortex of drug abuse and domestic violence that marked their collective upbringing. What saved Vance, by his telling, was not only his inherent determination to succeed but the presence, however spotty, of a public support network of public schools, libraries, and other programs that he successfully utilized as an escape ladder.

I simultaneously had the need to update a slide presentation I’ve been working on and in doing so referred back to the Bradley, et al. article on the correlation between social spending and healthcare outcomes I had previously referenced in my June 2016 column (Bradley, E. A., et al [2016], Variation in Healthcare Outcomes…..Health Affairs, 35, 760-768). Bradley and her colleagues documented links between state spending on health-related social services (in particular, nutrition, housing and social support) and lessened burdens associated with obesity, asthma, and mental health indices. They estimated that a 20% shift in spending from healthcare to social support might result in nearly 1 million fewer adults with mental health issues nationwide.

Next on my reading list was a just-published article by Chen and colleagues (Associations of reports of childhood abuse and all-cause mortality in women. JAMA Psychiatry: doi.10.1001/jamapsychiatry.2016.1786). These investigators found that over and above other factors like childhood socioeconomic status, personality traits, or depression, a reported history of either emotional or physical abuse was a unique predictor of early mortality in women. In other words, not only were there associations between adverse childhood experiences and higher physical and psychological morbidity, (an associated documented by Filleti and colleagues almost 20 years ago - Filleti, et al. [1998], Relationships of childhood abuse… to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245-248.) but to mortality in the form of premature death. Significantly, this link was present only in women with childhood abuse histories, not abused men, and equally significantly, the presence of adult mental illness was not a predictor of early death – the childhood abuse played a unique, and devastating role, in all-cause mortality in women.

Vance contextualizes these data in his story, and helps us understand the profoundly debilitating effects of adverse childhood experiences on practically all facets of adulthood—up to and including premature death. The women in his life, flawed as they were, often struggled heroically to survive. Illustrate the scientific data I’ve cited with the personal examples provided by Vance and it becomes clear that the impact of domestic violence and substance abuse is not only a substantial deterrent to social advancement and a predictor of poorer emotional well-being in adults, it is, at least in women in Chen’s survey, a crippling factor associated with premature death. Interestingly, in the concluding chapters of his book, Vance cites the literature on adverse childhood experiences, so there is some hope that these data are entering into public consciousness.

Vance is a self-described conservative, wary of government intervention, and none but the most starry-eyed among us would believe that there are easy external solutions to the profound cultural dis-ease he chronicled. But the data supplied by Bradley and colleagues show a clear link between certain types of public spending and improved physical and mental health outcomes. Coupled with what psychological science has taught us about Adverse Childhood Experiences, it would be foolhardy for policy makers to ignore the potency of these interventions. In turn, the profession has an obligation to continue investigating causality, to better refine our understanding of what public programs yield the greatest long-term good.