Insult to Injury: U.S. Workers Without Paid Sick Leave Suffer from Mental Distress

Only seven states in the United States have mandatory paid sick leave laws; yet, fifteen states have passed preemptive legislation prohibiting localities from passing sick leave. Despite this resistance, paid sick leave is starting to gain momentum as a social justice issue with important implications for health and wellness. But what are the implications for the mental well-being of Americans without paid sick leave? Little was known about their relationship until now.

Researchers from Florida Atlantic University and Cleveland State University are the first to explore the link between psychological distress and paid sick leave among U.S. workers ages 18-64. Results of their study, published in the American Journal of Orthopsychiatry, illuminate the effects of exacerbated stress on Americans without paid sick leave who are unable to care for themselves or their loved ones without fear of losing wages or their jobs.

The researchers found that workers without paid sick leave benefits reported a statistically significant higher level of psychological distress. They also are 1.45 times more likely to report that their distress symptoms interfere “a lot” with their daily life and activities compared to workers with paid sick leave. Those most vulnerable: young, Hispanic, low-income and poorly educated populations.

“Given the disproportionate access to paid sick leave based on race, ethnicity and income status, coupled with its relationship to health and mental health, paid sick leave must be viewed as a health disparity as well as a social justice issue,” said LeaAnne DeRigne, Ph.D., co-author of the study and an associate professor in the Phyllis and Harvey Sandler School of Social Work within FAU’s College for Design and Social Inquiry. “Even modest increases in psychological distress are noteworthy for both researchers and policy makers since we know that even small increases in stress can impact health.”

The study included 17,897 respondents from the National Health Interview Survey(NHIS), administered by the U.S. government since 1957 to examine a nationally representative sample of U.S. households about health and sociodemographic variables.

“For many Americans, daily life itself can be a source of stress as they struggle to manage numerous responsibilities including health related issues,” said Patricia Stoddard-Dare, Ph.D., lead author of the study and associate professor of social work at Cleveland State University. “Making matters worse, for those who lack paid sick leave, a day away from work can mean lost wages or even fear of losing one’s job. These stressors combined with other sources of stress have the potential to interfere with workplace performance and impact overall mental health.”

The researchers used the Kessler Psychological Distress Scale (K6), considered the gold standard for assessing psychological distress in population-based samples in the U.S. and internationally. With a theoretical range of 0 to 24, higher scores on the K6 represent increased psychological distress and scores above 13 are correlated with having a mental disorder of some type.

Results from the study showed that those with paid sick leave had a lower mean distress score compared to those without paid sick leave, who had significantly higher K6 scores, indicating a higher level of psychological distress. Only 1.4 percent of those with paid sick leave had a K6 score above 12 compared to 3.1 percent of the respondents without paid sick leave.

The most significant control variables indicated an increase in the expected psychological distress score among those who were younger, female, in fair or poor personal health, had at least one chronic health condition, were current smokers or did not average the recommended range of seven to nine hours of sleep per day.

Approximately 40 percent of respondents in the NHIS sample did not have paid sick leave; approximately half of the respondents were female; more than half were married or cohabitating; three-quarters indicated that their highest level of education included at least some college; and 62 percent were non-Hispanic white. The mean age was 41.2 years. Most of the respondents (79.1 percent) worked full-time and 82.7 percent had health insurance coverage. Respondents were in families with a mean size of 2.6 persons and 39.3 percent reported having children in the family. Approximately 32 percent had an annual family income of $35,000 to $50,000, and more than one quarter were below the poverty threshold.

DeRigne and Stoddard-Dare caution that even though there is concern about the potential burden on employers if paid sick leave laws are passed, it is important to be mindful of the overall situation regarding productivity loss and workplace costs associated with mental health symptoms and psychological concerns among U.S. workers. Furthermore, the personal health care consequences of delaying or forgoing needed medical care can lead to more complicated and expensive health conditions. U.S. workers with paid sick leave are more likely to take time off work and self-quarantine when necessary, without the worries of losing their job or income while also not spreading illness to others.

“Results from our research will help employers as they think about strategies to reduce psychological stress in their employees such as implementing or expanding access to paid sick days,” said Stoddard-Dare. “Clinicians also can use these findings to help their patients and clients as can legislators who are actively evaluating the value of mandating paid sick leave.”

HHS Announces Major Initiative to Help Small Practices Prepare for the Quality Payment Program

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Over the last few weeks, the Department of Health and Human Services (HHS) has made several important announcements related to the Quality Payment Program, which has been proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Today, we are announcing $20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer.

These funds will help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.

“Doctors and health care providers in small and rural practices are critical to our goal of building a health care system that works for everyone,” said Secretary Burwell. “Supporting local health care providers with the resources and information necessary for them to provide quality care is a top priority for this administration.”

As required by MACRA, HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality Payment Program at no cost to the clinician or their practice.

“The bipartisan MACRA legislation gave us the tools to improve Medicare and make it modern and sustainable by improving the incentives for and lowering the burden on clinicians,” said Dr. Patrick Conway, acting principal deputy administrator and chief medical officer for the Centers for Medicare & Medicaid Services. “Real change must start from the ground up, and today’s announcement recognizes this reality by  getting doctors the resources they need to provide better, smarter care.”

Organizations receiving the funding would support small practices by helping them think through what they need to be successful under the Quality Payment Program, such as what quality measures and/or electronic health record (EHR) may be appropriate for their practices’ needs. Organizations would also train clinicians about the new clinical practice improvement activities and how these new activities could fit into their practices’ workflow, or help practices evaluate their options for joining an Alternative Payment Model.

“Providing these tools to help physicians and other clinicians in small practices navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients,” said B. Vindell Washington MD, MHCM, FACEP, principal deputy national coordinator. “As with the Office of the National Coordinator for Health IT’s funding for Regional Extension Centers, this assistance will help health care providers leverage health information technology to enhance their practices and the care they deliver.”

Awardees will be announced by November 2016.  HHS encourages all qualified organizations to apply for this funding.

To learn more about today’s announcement and how to apply, please contacthttps://www.fbo.gov/index?s=opportunity&mode=form&id=57766996f8ecd4749cd4b18e60f63a8e&tab=core&_cview=1.

For more information on the Quality Payment Program, please visit:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program.html

7 Things Every Clinician Should Know About Introverts

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It’s not unusual for introverts to run across prejudice, even in the clinical setting. They are encouraged by spouses, bosses, and some therapists to be more “outgoing,” “on,” “cheerful,” and “energetic.” They are told that if they put more effort into what amounts to an extroverted way of being, that they will be happier, enjoy more success at work, and please the people around them.

Susan Cain makes the case in her bestselling Quiet that this bias stems from a culture that is predominated by extroverted ideals coupled with a misunderstanding of what constitutes introversion. As a psychotherapist who’s an introvert, I’ve developed an interest in this topic both personally and professionally. Here are some of the observations I’ve made about my clinical practice.

1. Introversion is normal.

Introversion/extroversion is one of the basic dimensions of personality. A preference for an introverted way of being is normal and includes more time for solitude, not wanting to assert oneself in a self-promotional way at work and other social situations, and a preference for, and even preoccupation with introspection.

Introversion is not synonymous with shyness, depression, or schizoid tendencies. It does, however, overlap with Elaine Aron’s concept of high sensitivity. Introverts are not misanthropes. Most have social skills comparable to extroverts.

Introversion and extroversion exist along a continuum and, according to Myers Briggs Type Indicator (MBTI) data, may be normally distributed. Therefore most people (two out of three) will be within one standard deviation of the mean and will have well expressed introvert and extrovert traits. Because of the need to act extroverted in many work and social situations, people who have an introverted center of gravity may wittingly or unwittingly be acting in extroverted manner. Having a better understanding of what it is to be an introvert can empower people to be more authentic and to practice better self-care.

2. You may be an introvert yourself.

Many helping professionals are introverts. They are drawn to counseling work by an interest in the inner workings of the mind and a preference for significant, one-on-one conversations. Even though the work is meaningful, it can be draining. If you are not predominately an extrovert, you will have to work to restore your energy from doing the work to offset exhaustion. Mindfulness can help with this process of energy restoration

3. There are methodological issues measuring introversion.

The most common research method for measuring introversion doesn’t measure introversion but rather the degree of extraversion that is present. Researchers Peter Hills and Michael Argyle are some of the few researchers to identify the anti-introvert bias present in research. They lament, “The view that extroversion is a preferred state has come to be widely accepted among social psychologists. In consequence, introverts are sometimes represented as withdrawn, isolated or lacking social competence, rather than as individuals who seek independence and autonomy.”

4. The culture is biased against introverts

Psychotherapist Ester Schaler Bucholz in her book The Call of Solitude pointed out, “Health professionals are actually not that different from the average person. Like a relative or companion, they may see the self-possessed introspective person as less malleable, less normal.” They differ in how they feel when those skills are expressed and the situations they prefer to express them within. For example, I prefer an in depth conversation to small talk of the cocktail party variety. My appetite for socialization differs in that I feel a strong need for compensatory solitude after most social forays.

5. You probably have a lot of introverts in your clinical practice

Psychotherapist and introvert advocate Laurie Helgoe discusses in her book Introvert Power that introverts are more introspective and curious about their inner life and therefore more prone to present to treatment. This could create a bias since the depressed or anxious introverts are sitting in your consulting room in greater numbers than extroverts with the same degree of symptoms. They don’t have more psychopathology, just more willingness to address it

6. Mindfulness is a powerful tool for introverts

Introspection has its own set of pitfalls: rumination, obsession, and worry. Introverts can get stuck in their stories and may need help getting out of their heads and into the present moment. As the embodied practice of awareness to this moment, mindfulness is an ideal fit for introverts. Mindfulness meditation practice can help them (and everyone) to better navigate the interior dimensions of the mind to foster creative imagination while mitigating rumination.

7. Introverted ways of being can be helpful for introverts and extroverts alike

As a culture, we have gotten out of balance and squeezed quiet and solitude out of our lives. This, no doubt, contributes to the stressfulness of life. We work longer hours, devote more time to children, and have access to 24/7 information and social media. Mindfulness meditation can help to restore quiet solitude in everyone’s lives. Extroverts can benefit from more quiet; introverts desperately need it.

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