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3 Big needed reforms in Medicaid

1/25/2024

Val's Take

Funding of "Housing" for those needing "Long Term Care"
Repeal of the IMD Rule prohibiting funding of Institutes of Mental Disease
Transitioning to a Public Health Approach to Criminal Justice using Medicaid monies to fund "Therapeutic Secure Placements" as PART of a CONTINUUM OF CARE

This is one of my favorite quotes of Daniel Patrick Moynihan --- I would go beyond this and say it is an endeavor that includes one's own life but expands exponentially and ultimately beyond one's own lifespan.

George Will --- Statecraft as Soulcraft

Prison Health Care is Broken Under the Medicaid Inmate Exclusion Policy

Oregon's 1115 Medicaid Waiver

"Social Determinants of Health" are now often being referred to as "Health Related Social Needs" (HRSN)--- Housing is a BIG HEALTH RELATED SOCIAL NEED.

What CMS seems to be prepared to do beyond their 2015 Guidance --- is to EXTEND the kind of Housing Supports that were provided to people TRANSITIONING FROM THE NURSING HOME --- to other people making significant transitions such as:

from Homelessness to Housing

from Incarceration to Housing

etc.

This is something that I was calling for over 10 years ago --- and it is a "LOGICAL" extension of the work on Nursing Home Transition and there are EQUAL PROTECTION issues.

Obviously, a whole lot of other people saw this, too.

Getting rid of the IMD RULE to build out the High end of the continuum of care

1/24/2024

Opinion

Mayors Coffman, Mobolade and Johnston: Mental health services lacking across Colorado

What’s needed is a historic investment in more inpatient beds and additional inpatient facilities.

Guest Column

January 9, 2024

Val's Take

Colorado Law Enforcement, District Attorneys and Mayors seem to be largely in agreement with regard to the need for more Residential and Inpatient Options.
This has been a really hard issue for the Mental Health Community in Colorado and Nationally and by extension the larger Disability Advocacy Community.
The Medicaid Rule prohibiting the funding of "INSTITUTES of MENTAL DISEASE" has been a disaster.
- The IMD Rule was supposed to serve as an INCENTIVE for the creation of housing and services in the community --
  - BUT YOU KNOW WHAT --- it's been cheaper for STATES not to provide any of the above or not at the scale needed: beds, housing and intensive community services.
  - But those COSTS don't go away --- they are SHIFTED to Cities and Counties. --- That is not just true in Colorado.
    - Further the costs can be horrific.
- The IMD Rule has undergone relaxation over the last few years --- and we probably do just need to get rid of it.
- It would cost the FEDS about $4 Billion Dollars to get rid of the IMD Rule per year, according to a Congressional Budget Office Analysis.
  - This is from Open Minds Executive Briefings-- April 2023

Reference: Medicaid: IMD Exclusion | NAMI: National Alliance on Mental ...

Currently, the law prohibits states from using Medicaid to pay for care provided in “institutions for mental disease” (IMDs), which are psychiatric hospitals or other residential treatment facilities that have more than 16 beds.

The Mayors also recognized the importance of Community Mental Health Services as a STEP DOWN from facilities and to provide a more complete CONTINUUM OF CARE.

That is really a wonderful thing --- because this debate has too often been about Hospitals and Facilities versus Community Care.

The DEVIL IS IN THE DETAILS --- but it is encouraging that so many political and community leaders are calling for greater investments on the HIGH END OF THE CONTINUUM OF CARE.

Genetic Testing, the Standard of Care & Individual Rights to Privacy & Access to Care

12/11/2023

Our societies are called on to Solve Some WICKED PROBLEMS involving Auto-Immune Disease, Cancer, Neuro-Developmental Differences, Psychiatric Disorders & Neurological Diseases

Val's Take/Conjecture

A lot of the problems we're facing are "WICKED PROBLEMS" of our own BIOLOGIES ---
It doesn't breakdown NEATLY into GOOD & BAD -- it's a POSITIVE in some ENVIRONMENTS --- a NEGATIVE in others.
AND WE'VE really got to UNDERSTAND what we're doing on BOTH the LARGE SCALE and the INDIVIDUAL SCALE.
SURVIVAL OF THE FITTEST --- is a pretty BLUNT INSTRUMENT ---
Further --- we all have pretty much the same genes and the greatest diversity is in the IMMUNE SYSTEM.
In the form we're in now --- the HUMAN BEING --- we're ALL OF THE BELOW:
- TOP PREDATOR
- A RATIONAL ANIMAL
- Destroying the Planet ---
- As we COMPETE against each other
It is BOTH an INSPIRING and DEEPLY TROUBLING PICTURE.

I remember a brilliant guy I knew who was also pretty weird and could be a jerk --- said, "I don't think my genes are that special."
- I think that's true.

US vs. THEM THINKING is all around us and in many ways it may be LESS than what it was HISTORICALLY---
- Further, there's a MUSICAL CHAIRS quality to "US vs. THEM THINKING"
- Our "BALANCING ACT" is very much DEPENDENT on PUSHING "SOMEONE" to the BOTTOM
  - In the long run, that's not good for anyone ---
  - BUT it is especially not good in the short term for the person or group(s) -- that get pushed to the BOTTOM.

When it comes to NEURO-DIVERSITY --- at least in some cases what we're talking about is MORE REACTIVE CELLS.

Is that Good or Bad?
Well, it DEPENDS ---
- On the Physical Environment
- On the Diversity in our Microbiomes
  - One of the great insights of the 21st Century is that HUMAN REASONING & FUNCTIONING is DEPENDENT on NON-HUMAN "ACTORS"
- On the Emotional Environment
- On the Social Environment
- A lot of what we think it is to be HUMAN is seen in the EXTREMES with Neuro-Diversity and Maternal Immune Activation.
  - A lot of the INDIVIDUALITY we see among HUMANS is the result of ---
    - GENETIC DIVERSITY in the IMMUNE SYSTEM, and
    - MATERNAL IMMUNE ACTIVATION

Much of what the FREEWILL vs. DETERMINISM DEBATE gets WRONG is it is ROOTED IN THE PAST rather than LOOKING TO THE FUTURE.

We're all just BORN INTO THIS --- and if OUR SOCIETIES --- Don't KNOW or Don't have all the answers --- and they usually don't ---That's often putting a HEAVY BURDEN on the INDIVIDUAL or GROUPS of INDIVIDUALS to FIGURE THINGS OUT.

University of Manchester Professor Daniel Davis

BIOLOGY: Genes & Immunity

According to Davis, the Greatest Diversity of Human Genes is in Our Immune Systems --- and it's Essential we have that Diversity.

How The Black Death Shaped the Evolution of Immunity and Led to a Rise In Auto-Immunity (2022)

Science X: Phys.org, Medical Xpress, Tech Xplore

Neanderthal DNA has Subtle but Significant Impact (2016)

Vanderbilt University

Those impacts can be both positive and negative for mental health.

University of Michigan

The Study of Bipolar Disorder is the Study of Humanity

People with Bipolar Disorder have MORE REACTIVE CELLS.

CONFIDENTIALITY is a BAROMETER of whether we have things FIGURED OUT ---

IF WE'VE GOT THIS --- there's generally not a lot of ANXIETY about DISCUSSING a particular issue ---
IF We don't have this --- there's going to be a lot of anxiety about a particular issue
- If we don't have this and there's a lot of anxiety --- SOME NEURO-DIVERSE PEOPLE are going to start pushing the ENVELOPE ---
  - Because they know IGNORANCE WON'T SOLVE THE ISSUE.
  - They may also know that we need to "SCRUB IDENTIFYING INFORMATION" ---
  - Provide UNIVERSAL ACCESS to the CARE we do have, and
  - SLOWLY COME OUT OF THE NEURO-DIVERSE CLOSET ---
    - For our own Mental Health and that of others.

Rules of Evidence and the mess in Mental Health

10/26/2023

Federal Rule of Evidence 702.

Testimony by Expert Witnesses

A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

(a) the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;

(b) the testimony is based on sufficient facts or data;

(c) the testimony is the product of reliable principles and methods; and

(d) the expert has reliably applied the principles and methods to the facts of the case.

The Issue in 2022 (& Still in 2023)*

Often mental health providers are "reliably applying" the principles and methods to the Defendant.
BUT --- those methods are NOT:
- Based on sufficient facts or data,
- The principles and methods are NOT RELIABLE.

If someone is getting an ANTI-SOCIAL PERSONALITY DISORDER DIAGNOSIS based on criteria from the DSM 5:

That is scientifically suspect.
Now, many of these categories are now being conceptualized as "BLURRED", and
Often related to Neuro-Developmental Differences or Disorders.
- THAT SHOULD MATTER.

Further, it is muddy and messy:

our Legal System is currently not well structured to deal with the FALLOUT ---
- If we raise legitimate questions about the reliability of "ANTI-SOCIAL PERSONALITY DISORDER" in the context of Criminal Justice and the ASSUMPTIONS we're making under MENS REA ---
  - Where does that leave us?

Honestly, we have a system that is about 1/2 way there to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE but doesn't have the PUBLIC HEALTH PRACTITIONERS to SEAL THE DEAL.

*This blog was originally written in 2022 and was on the homepage for over a year.

There are LOGICAL & ETHICAL PROBLEMS associated with trying to use a scientifically invalid diagnostic manual as our DICTIONARY.

Over 600 Research Institutions Find Shared Heritability In Common Disorders of the Brain (2018) --- Contradicting DSM 5 Categories

In 2022 (& 2023)*, the BIG QUESTION is who can live:

In the community, with some supports
In the community, with intensive supports
In a structured placement
In a secure placement.

Further, these questions are NOT somehow divorced from what COMMUNITY INTEGRATION is being provided for people with:

Neuro-Developmental Disorders
Psychiatric Disorders
Brain Injuries, and
Substance Issues that are often related to one or more of the above.

Do we even know what to provide in 2022?

Supportive Housing, and
Supportive Employment

could help a lot of people.

The INTEGRATION MANDATE of Title II of the ADA which also served as the RATIONALE for the US Supreme Court's 1999 Olmstead decision could provide the LEGAL BASIS.

Science Up

“So what this is doing — is it’s starting to kind of shed light on the specific biological pathways that might be shared across these disorders; namely, these specific neurons that are sort of critical and just brain signaling pathways,” Grotzinger said.

With these findings, Grotzinger hopes to be able to identify what the specific genetic risk pathways are so an individual can be diagnosed and treated more efficiently.

The goal is to be able to give an individual one diagnosis and treatment for the disorders they have instead of multiple, if possible.

Currently, an individual cannot be diagnosed with bipolar and schizophrenia disorder.

However, these two disorders have an overlap in their genetic makeup — meaning that an individual can experience symptoms from both disorders.

Grotzinger hopes in the future diagnoses can be made “a little less sort of by the book.”

In addition, there also may be a possibility of treating certain diagnoses with psychotherapy versus prescription medicines.

The research team only analyzed the genetic variation that showed up in at least 1% of the population.

“That really rare stuff might be really important.

And it’s something that we’re just now getting to the point that we can start to look at,” Grotzinger said.

Daily Camera Article --- CU Research

The CURRENT NECESSITY AND Trap of "Confidentiality"

10/17/2023

If We Get Out of Punishment --- and Move to

Safety
Health, and
Problem Solving

[which we are doing as we are able]

We can further "MODIFY" some of the more PROBLEMATIC aspects of the ADVERSARY SYSTEM.

Ironically, that ADVERSARY SYSTEM according to Judge Leifman in Florida is moving to a COLLABORATIVE SYSTEM.

"CONFIDENTIALITY" is a strangely problematic aspect of both Mental Health and Criminal Justice.

The perceived need for "CONFIDENTIALITY" --- is at the ROOT of much Mental Health Stigma.

Now, confidentiality ungirds healthcare as well --- but the perceived NEED FOR CONFIDENTIALITY is often a BAROMETER of whether the SOCIETY "HAS GOT THIS" or Society's understanding is SHAKY.

This is a very complicated dance --- we don't want to subject anyone to PUNISHMENT, EMBARRASSMENT or RIDICULE.

People are coming out of the MENTAL HEALTH CLOSET and our UNDERSTANDINGS and TREATMENTS are getting better.

Coincidence & Remembrance on this Veteran's Day

The World War II Veteran I spoke to wanted to be FORGIVEN by God and as many people as possible.

Further, if one person is struggling with something --- it's pretty likely there are others.

It's not necessary to have identifying information --- BUT some people do want to be seen, provided help as available and their challenges to be treated for what they are --- HEALTH CHALLENGES.

We have created some very expensive systems that are not addressing the underlying problems as well as they might --- and sometimes they are EXACERBATING those problems.

Maria Bamford --- at the Psych Ward
and the strange mix of feelings raised in some patients by professionals who promise they would never tell anyone.

It really gives the message that this is so SHAMEFUL that the patient shouldn't tell either.

Bamford has also said that she openly talks about mental illness in her acts and interviews --- because --
"IT MAKES IT LESS OF A FREAK SHOW."

We're currently not putting people in prison for SUICIDE ---- so Bamford's SUICIDAL IDEATION is NOT THE HARD CASE.

HOMICIDAL IDEATION is the HARD CASE --- BUT we can address that if the person is on the EXTREMES --- IF WE'RE BEING HONEST ---

Incompetent to Proceed and Insanity are already there in US Law and many other Countries.

The harder case is the PERSON with a NEURO-DEVELOPMENTAL DISORDER, no obvious PSYCHOSIS, ramped STRESS & PAIN RESPONSES who seems to be EXACTLY the person the CRIMINAL LAW was meant to address

---WITH OUT OF PROPORTION BAD INTENT & BAD ACTS.

ADHD, Reciprocity, Rejection Sensitive Dysphoria & Differences in Intensity

BUT going deeper than MORE OBVIOUS bad acts and bad intent ---

We can start to move more to PREVENTION by SCREENING for not only problematic mental states but also:

SLEEP DISTURBANCES
PERIODONTAL DISEASE
MIGRAINE
BRAIN INJURY
AUTO-IMMUNE DISORDERS
CANCER
etc.

Stroke & ADHD

DOJ Sues Colorado for Disability Civil Rights Violations

10/10/2023

The US Dept. of Justice is focusing on the INSTITUTIONALIZED NURSING HOME POPULATION with "PHYSICAL DISABILITIES" in Colorado and alleging Colorado is not providing sufficient HOUSING and SERVICES for them in the Community.

From my perspective, Colorado is a very interesting RICH STATE/POOR STATE budget case.

Not all but a lot of DOJ's Disability Rights Cases are filed in POOR STATES --- Colorado is a VERY AFFLUENT STATE with a RESRICTED STATE BUDGET under TABOR and other measures.

I do believe that the ADA and other Federal Law TRUMP TABOR --- but I don't want to start a CIVIL WAR over it.

DOJ doesn't have the resources to file every ADA case out there and they don't --- I think it is significant that they finally filed against COLORADO.

Federal Reports have shown that there are many people with "MENTAL ILLNESS" institutionalized in Nursing Homes.

How people FEEL about that depends on the person.
I am aware of one white young man in SOLITARY with developmental disabilities and mental illness and substance issues in the Denver Jail that came to Colorado because he heard MARIJUANA was legal.
- Mr. Universe, an older black man in his 50s with mental illness who had been homeless since he was 11 ----
  - begged and begged for me to help this young man until I finally relented.
  - GIVEN the options and there weren't many --- the young man wanted to go to the NURSING HOME.
    - But he really did want to go to the nursing home and it was a lot better than SOLITARY in the Denver Jail.
- Mr. Universe is now serving over 20 years in a Colorado prison at least in part because he was tagged with "ANTI-SOCIAL PERSONALITY DISORDER" at CMHIP.
  - I hope the IRONY of that does not escape you --- because it does not escape me.

DOJ ADA Enforcement --- Colorado

See Also

Department of Health and Human Services

      OFFICE OF INSPECTOR GENERAL
      JANUARY 2001 -- OEI-05-99-00700
      YOUNGER NURSING FACILITY
      RESIDENTS WITH MENTAL ILLNESS:
         Preadmission Screening and Resident Review (PASRR) Implementation and Oversight

Especially when it comes to addressing COGNITIVE DISABILITY ---

There's all kinds of COMMONALITY OF INTEREST in more effectively and comprehensively addressing COGNITIVE DISABILITY:

Brain Injury
Mental Illness
Developmental Difference/Disability
Substance Issues that are often related to one or more of the above.

Findings of Fact & Conclusions of Law --- March 2022

Complaint --- Sept 2023

We'd like to see DISABILITY LAW COLORADO, Colorado's federally funded Protection & Advocacy Office for People with Disabilities, investigate Colorado's Compliance with Title II of the ADA and Olmstead in relation to:

Homeless People with Cognitive Disabilities and
Justice-Involved People with Cognitive Disabilities being released from Incarceration.

We'd like that report to be made public as well as delivered to the US Department of Justice.

The ADA, FEDERALISM & DIVIDED GOVERNMENT In Action

8/7/2023

Val's Take

There are MANY, MANY WAYS to address STATE NON-COMPLIANCE with "Olmstead."
I've said this many times --- STATES are OSTENSIBLY ALL FOR IT ---

BUT

The "HOUSING PIECE" of SUPPORTIVE HOUSING is at least PARTIALLY an UNFUNDED MANDATE.

FURTHER, especially with Cognitive Disability

States are very much necessary
- BUT MUNICIPALITIES on the Frontlines of the Homeless Crisis and
- COUNTIES as the Funders of COUNTY JAILS
  - are very much needed as well

The STATES have SUCCESSFULLY COST-SHIFTED a lot of DISABILITY HOUSING RESPONSIBILITIES to the COUNTIES AND MUNICIPALITIES.

I think it is the COUNTIES and MUNICIPALITIES that have an ALIGNED INTEREST in DOING THE DATA COLLECTION.

The challenge is we do need UNIFORM DATA COLLECTION
Maybe the State could fund that through County Health Depts.

"OLMSTEAD" does NOT APPLY to every person with a disability.

It applies to people with Disabilities who are "INSTITUTIONALIZED" or
At risk of "INSTITUTIONALIZATION."

CNN
Cook County Sheriff ---
Jail System Doesn't Make Sense

CSG (The Council of State Governments) Justice Center

Stepping Up: How to Set Targets to Reduce the Number of People with Serious Mental Illness in Jails

Developmental Difference and Mental Health ---Ignorance as a Social Justice Issue

6/7/2023

Sometimes I want to "SHAKE" the Mental Health Profession or the Criminal Justice System so badly -- but it wouldn't do any good . . .

The challenge we really have is of IGNORANCE.

That has changed a lot in my lifetime and the pace of change is quickening because more and more NEURO-DIVERSE people (who are highly motivated) are starting to address their ignorance about these issues.

Further --- THIS ISN'T EASY.

There are some very good reasons why this relationship between Developmental Difference (Maternal Immune Activation) and Psychiatric Disorders is just now being viewed on a "CONTINUUM" by researchers.

Further --- it is NOT JUST NEURAL --- this is often affecting MULTIPLE SYSTEMS OF THE BODY.

Who is Uncle Billy and Who is George?

Composing to Avoid Cacophony --- Understanding Asynchrony

Assessments of Executive Functioning and The Need for Occupational Therapy & Support

5/5/2023

Conjecture

I'm not saying there's NO ROLE for traditional therapy--- because I think there is a VERY IMPORTANT ROLE ---

BUT

We have to get beyond whether someone knew right from wrong to what their EXECUTIVE FUNCTIONING ACTUALLY IS.

Even many RELIGIONS --- say there is a LIMIT TO GUILT ---
- WE NEED TO LET GO OF THAT and FIGURE OUT HOW TO ADDRESS OUR PROBLEMS MORE EFFECTIVELY.

I DO SEE THIS AS A JUSTICE ISSUE.

When we start talking about things like:
- Short Term Memory
- Planning
- Emotional Regulation
- Organization
- for some people Reading

We're NOT talking about how "INTELLIGENT" someone is.

That is really important not only to get to what is ACTUALLY going on --- BUT to build TRUST and also to reduce STRESS for EVERYONE.

There are a lot of extremely "GIFTED and TALENTED" people who have these EXECUTIVE FUNCTIONING CHALLENGES.

I think when we're talking about both CHILDREN and ADULTS it is important to understand someone's level of executive functioning not just in relation to isolated tasks ---

BUT given the "TOTALITY OF THE CIRCUMSTANCES" and DEMANDS of the ENVIRONMENT in which they are living.

Beyond "Try Harder"

2/28/2023

Val's Take

Historically, Humans treat most HEALTH PROBLEMS as Evidence of the DISFAVOR of the God, GODS, FATE or MORAL FAILINGS:

because it wasn't clear to people what was going on;
they were AFRAID --- sometimes needlessly -- but NOT ALWAYS
AND Health PROBLEMS were often demanding:
- CARE from other people --
  - who even if they wanted to help --
    - didn't know HOW.

Addressing complex health problems often takes GENERATIONS OF HUMAN EFFORT to UNTANGLE.

I may think Dr. Palmer doesn't have it perfectly right --- but I do think he is RIGHT --

to get to the CELLULAR LEVEL, and
Start bringing in other SYSTEMS OF THE BODY
- when it comes to understanding Neuro-Developmental and Psychiatric Disorders, Metabolic Disorders, Auto-Immune Diseases, Cancer, Neuro-Degenerative Diseases and AGING.

BUT Dr. Palmer as most of us when we're FRUSTRATED resorts to:
TRY HARDER --- even when it is so clear we need better STRATEGIES than that.

We're really having a HARD TIME coming to terms with the DEVELOPMENTAL ASPECTS of Neuro-Developmental Differences and Psychiatric Disorders.

I'm not saying we can't ultimately get around those DEVELOPMENTAL ASPECTS, but
We tend to UNDER-ESTIMATE what it is really going to take.

That person sitting across from you is NOT YOUR CLONE --

they have STRENGTHS you may not have,
and WEAKNESSES you may not have --- AND
VICE VERSA.

I like Palmer but I don't think he has the BROADER UNDERSTANDING of Stanford's ROBERT SAPOLSKY and the Biological Basis of Behavior and the Implications, including the Justice Implications for that.

Big Think
Professor and Author Robert Sapolsky

I think theFree Will debate is there BUT misguided.

What Sapolsky GETS RIGHT is a COMPREHENSIVE VIEW OF THE BIOLOGICAL BASIS OF BEHAVIOR

"You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain

the childhood experience

the hormone

the gene

or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
. ------Prof. Robert Sapolsky Stanford

The Need for a New Integrated DSM

The Definitional Argument in Mental Health & Criminal Justice Policy

A Strength-Based Approach

Are Mental Illnesses Really Metabolic Disorders?

Dr. Chris Palmer

Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School.

Try Smarter, Not Harder

I think Mental Illnesses are often IDIOSYNCRATIC DYSREGULATIONS of Multiple Systems of the Body that are INTEGRATED.

Further, people with Bipolar Disorder seem to have been BORN WITH MORE REACTIVE CELLS.

Is it all about the Brain and the Central Nervous System, or the Immune System, or Metabolic Processes, or the Endocrine System, or the Microbiome --- or ALL OF THE ABOVE.

It seems to me that Maternal Immune Activation, Shared Genes, Epigenetics and Inflammation acquired during the lifetime are the BIG DRIVERS affecting MULTIPLE INTEGRATED SYSTEMS OF THE BODY.

Further, the Relationship between Neuro-Developmental Disorders and Psychiatric Disorders I think means that LIFESTYLE CHANGES will often help --- BUT MAY OR MAY NOT BE SUFFICIENT.

I think Dr. Palmer has some important, critical insights ---- On the other hand, psychiatry has really had a hard time understanding DEVELOPMENTAL DIFFERENCES for people with an IQ above 70.

I do think there is a certain OVER-REACHING for Dr. Palmer --- BUT I think he is making some legitimate points.

Paul Micallef -- Autism from the Inside

"My strategies tend to be very different than what work for other people.

"THE BEST THING FOR ME IS TO DO WHAT WORKS FOR ME."

If we have some great break-throughs in the treatment of Neuro-Developmental Differences & Psychiatric Disorders --

We should take advantage of them as ethically appropriate.

IN THE MEANTIME:

Saltz' recommendation to spend 80% of the time on STRENGTHS DEVELOPMENT, and
20% on Work-Arounds for Weaknesses

is probably pretty good.

Further, those STRENGTHS & WEAKNESSES are likely falling outside NEURO-TYPICAL RANGES.

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