The incentive issue with HHS-appointed therapists

After listening to Dr. Robert Arias talk in Lincoln last night, I've had a realization on the incentive issue concerning therapists contracted for specific services by HHS. Full disclosure - Dr. Arias is the person who was hired by HHS to do two assessments of my daughter while she was a state ward. I think the details are in my timeline, but I'll recap my experience with Dr. Arias here:

• Dr. Arias did the initial assessment of my daughter and indicated that there were signs of ODD (Oppositional Defiant Disorder) that should be assessed. He also indicated in his report that he'd like to see more historical information on my daughter and her family.
• I contacted Dr. Arias' office for a personal appointment in order to share my experiences with my daughter - the history he was looking for - with him. I verified that the case manager had not yet made an appointment for my daughter with Dr. Arias for the second assessment. My appointment was set for the very next day.
• We (Melanie and I) walk into Dr. Arias' office to find both the case manager and my daughter already having a meeting with Dr. Arias. This was an ambush.
• In the course of the 20 minutes or so that we were in his office, Dr. Arias - with my teenage daughter present - makes statements like these: "In most cases like these, I find that the issue is with the parents and not the child"; "This is basically a pissing contest between you and your daughter"; "Why do you want a diagnosis so badly for your daughter?"; "I don't see any evidence of oppositional behavior from your daughter" This last quote followed my daughter saying I was lying about almost every experience I tried to discuss.

What could explain this sort of unethical, unprofessional, and reprehensible behavior from a respected neuropsychologist like Dr. Arias? I believe the answer lies in the incentive model that HHS has set up when it contracts with such professionals. I should note that what I'm about to discuss is conjecture - HHS isn't exactly forthcoming on how they fund people like Dr. Arias when they are contracted for services. Keep in mind as well that in cases like ours, Dr. Arias is not providing therapy, he is simply contracted to do an assessment.

When we questioned Dr. Arias last night at the end of his presentation, he made the joke that you don't make a lot of money working for HHS. That was the comment that got me thinking about the incentives of therapists in similar positions when dealing with HHS. If they aren't making a lot of money, and they aren't treating the child in question, how much incentive do they have to do a thorough job? I would argue very little. This is why in his first assessment he specifically mentioned not having any family history. He is getting paid a flat fee, I assume, to do an assessment so it benefits him to do that assessment as quickly as possible. In his talk last night he touched on this point, that to properly do an assessment for a new patient a thorough history is essential, and it can take quite a bit of time to do so.

But the incentive model in how he gets paid by HHS doesn't permit that. This is at the heart of why such assessments cannot be accurate, caused by not doing the proper histrocial research because HHS won't let the parents anywhere near their appointed professionals when their input and experience would benefit these assessments the most. This explains why we were ambushed during a supposedly private appointment I had made.

We're working on filing a formal ethics complaint against Dr. Arias, and we have already discussed this experience with the head of the psychiatric board for Nebraska who agreed that this story was very disturbing from both an ethical viewpoint and possible legal as well.

But the thought I want to leave you with is this: the financial incentive model set up in the way HHS contracts with therapeutic professionals does not serve the best interests of our children.

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