12-280-125. Substitution of prescribed drugs and biological products authorized - when - conditions.(1) (a) A pharmacist filling a prescription order for a specific drug by brand or proprietary name may substitute an equivalent drug product if the substituted drug product is the same generic drug type and, in the pharmacist’s professional judgment, the substituted drug product is therapeutically equivalent, is interchangeable with the prescribed drug, and is permitted to be moved in interstate commerce. A pharmacist making a substitution shall assume the same responsibility for selecting the dispensed drug product as he or she would incur in filling a prescription for a drug product prescribed by a generic name; except that the pharmacist is charged with notice and knowledge of the FDA list of approved drug substances and manufacturers that is published periodically.

12-280-125.3. Pharmacists’ authority - minor prescription adaptions.(1) Except as provided in subsection (3) of this section, a pharmacist who is acting in good faith and is using professional judgment and exercising reasonable care may make the following minor adaptions to an order if the pharmacist has the informed consent of the patient for whom the prescription was provided:(a) A change in the prescribed dosage form or directions for use of the prescription drug if the change achieves the intent of the prescribing practitioner;(b) A change in the prescribed quantity of the prescription drug if the prescribed quantity is not a package size commercially available from the manufacturer;(c) An extension of the quantity of a maintenance drug for the limited quantity necessary to achieve medication refill synchronization for the patient; and(d) Completion of missing information on the order if there is sufficient evidence to support the change.(2) A pharmacist who adapts an order in accordance with subsection (1) of this section shall document the adaption and the justification for the change in the patient’s pharmacy record with the original prescription and shall notify the prescribing practitioner of the adaption.(3) A pharmacist shall not adapt an order if the prescribing practitioner has written “do not adapt” on the prescription or has otherwise communicated to the pharmacist that the prescription must not be adapted.

Dispensing an Emergency Supply of a Chronic Maintenance Drug Without a Prescription

Early RefillsPharmacies are able to override early refills at the point-of-sale (POS) after 50% of medication day supply has lapsed sincelast fill for reasons related to COVID-19. Use DUE response codes with reason for service code ‘ER’ at the POS to receive apaid claim. This override is not available for use by mail order pharmacies.If a member requires a refill before 50% of the day supply has lapsed, a POS override is not available. Please contact theMagellan Help Desk at 1-800-424-5725 for a one-time refill authorization

Lost/Stolen/Damaged/Vacation Prescriptions The Department does not pay for early refills when needed for a vacation supply. The Health First Colorado program will cover lost, stolen, or damaged medications once per lifetime for each member. Pharmacies must call for overrides for lost, stolen, or damaged prescriptions. If a member calls the call center, the member will be directed to have the pharmacy call for the override. Stolen prescriptions will no longer require a copy of the police report to be submitted to the Department before approval will be granted. The replacement request and verification must be submitted to the Department within 60 days of the last refill of the medication.

Refill Too Soon Policy For DEA Schedule 2 through 5 drugs, 85 percent of the days' supply of the last fill must lapse before a drug can be filled again. For non-scheduled drugs, 75 percent of the days' supply of the last fill must lapse before a drug can be filled again. A 7.5 percent tolerance is allowed between fills for Synagis. If the appropriate numbers of days have not lapsed, the claim will be denied as a refill-too-soon unless there has been a change in the dosing. For non-mail order transactions, there is a maximum 20-day accumulation allowed every rolling 180 days. If a Medicaid member enters or leaves a nursing facility, the member may require a refill-too-soon override in order to receive his or her drugs. A PAR must be submitted by contacting the Pharmacy Benefit Manager Support Center.

Health First Colorado Pharmacy Benefits Frequently Asked Questions Are over-the-counter (OTC) medications covered?Insulin and aspirin are covered without a prior authorization. All other over-the-counter (OTC) medications require a prior authorization before approval unless an OTC is a preferred product on the Preferred Drug List (PDL).

Can I get my medication early?Early refills are covered when there is an increase in dosage or if a client is going into or leaving a nursing home. Clients may receive up to a 100 day supply of maintenance medications and up to a 30 day supply of non-maintenance medications. If you run out of medication, contact your doctor and discuss adjusting your prescription to your current needs.

Please note that DEA does not assign a numerical limit to the amount of schedule II controlledsubstance to be prescribed. Instead, DEA recognizes that these are medical decisions within theprescribing practitioner’s sound medical discretion, as guided by any limitations imposed by thestate medical board and state law

8.800.14 PRESCRIPTION QUANTITIES8.800.14.A For chronic conditions requiring maintenance drugs, the maximum dispensing quantities for new and refill prescriptions shall be a 100-day supply. For all other drugs, the maximum dispensing quantities for new and refill prescriptions shall be a 30-day supply. The Department may set or change minimum or maximum dispensing quantities of certain drugs

DEPARTMENT OF HEALTH CARE POLICY AND FINANCINGMedical Services BoardMEDICAL ASSISTANCE –SECTION 8.80010 CCR 2505-10 8.800

Preferred Drug List (PDL)

practitioner must signand date the multiple prescriptions as of the date issued, (21 CFR 1306.05(a)); and, write on eachseparate prescription the earliest date on which the prescription can be filled (21 CFR1306.12(b)(ii)).

ursuant to 21CFR 1306.12(b) “an individual practitioner may issue multiple prescriptions authorizing the patientto receive a total of up to a 90-day supply of a schedule II controlled substance, subject to specificconditions are met

This does not prohibit thepractitioner from issuing one prescription for a 90-day supply if allowed by state law and regulationthat otherwise comport with 21 CFR 1306.04(a)

U. S. Department of JusticeDrug Enforcement Administration

The prescriber reasonably determines that the patient would be unable to obtain controlled substances prescribed electronically in a timely manner and that the delay would adversely affect the patient’s medical condition.

12-30-111. Electronic prescribing of controlled substances - exceptions - rules - definitions

Electronic prescribing of controlled substances: What physicians and practices need to know

Practice Standards& Regulations: Stimulant Dosingfor Hypersomnias

c. Amphetamine, methamphetamine, dextroamphetamine, andmethylphenidate are effective for treatment of daytime sleepinessdue to narcolepsy [4.1.1.1] (Guideline).This recommendation is unchanged from the previous recom-mendation. These medications have a long history of effective usein clinical practice

Practice Parameters for the Treatment of Narcolepsy and other Hypersomnias ofCentral OriginAn American Academy of Sleep Medicine Report

FIG. I. Relative efficacy of stimulant drugs commonly used to treat narcolepsy. The lighter shading denotes baseline sleep latencies on either MSLT or MWT, expressed in terms of percent of normal levels (13.4 minutes for the MSLT and 18.9 minutes for the MWT), and the darker shading denotes values observed at the highest dose of each drug evaluated. See text for methods. Abbreviations: PEM, pemoline; MOD, modafinil; DEX, dextroamphetamine; MAM, methamphetamine; MPD, methylphenidate.

ASDA Standards of Practice Narcolepsy and Its Treatment With Stimulants Merrill M. Mitler, Michael S. Aldrich, George F. Koob and Vincent P. Zarcone

7. Side effects Most patients with narcolepsy can be effectively treated with stimulants without developing significant side effects.

ASDA Standards of Practice Practice Parameters for the Use of Stimulants in the Treatment of Narcolepsy

11. Follow-up (a) A patient stabilized on stimulant medication should be seen by a physician at least once per year, and preferably once every 6 months, to assess the de-velopment of medication side effects

Little evidence suggests that stimulants in therapeu-tic doses cause a significant increase in blood pressure in normo-or hypertensive paiients~

6. Abuse (a) Patients with narcolepsy are no more likely to become drug abusers or to use stimulant medications illicitly than any other group of patients treated with stimulants [5.5]

(b) Full therapeutic response in adult patients with narcolepsy can usually be obtained with daily medi-cation doses below the recommended maximal doses of: pemoline, 150 mg; methylphenidate hydrochloride, 100 mg; dextroamphetamine sulfate, 100 mg;

Patients have a wide variation in response to stim-ulants and in the incidence of side effects; therefore,

4. Dosage

(b) Methamphetamine hydrochloride generally pro-duces the most improvement in alertness and has the most rapid onset of action. Dextroamphetamine sulfate and methylphenidate hydrochloride are only slightly less effective.

2. Treatment objectives and indications (a) The objective of treatment with stimulants should be to alleviate daytime sleepiness, thereby allowing the fullest possible return of normal function for patients at work, at school and at home [1.0]. (b) Stimulants are most effective at producing im-provement in fatigue and sleepiness in boring and in-active situations;

Treatment aims are to improve daytime alertness with stimulant medication

The American Sleep Disorders Association (ASDA) ex-pects these guidelines to have an impact on profes-sional behavior

This report provides the first clinical guidelines on the appropriate use of stimulants in the treatment of narcolepsy.

Unapproved use of an approved drug is often called “off-label” use. This term can mean that the drug is:

From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient.

The approved drug labeling for healthcare providers gives key information about the drug that includes:

Understanding Unapproved Use of Approved Drugs "Off Label"

The ultimate judgment regarding the suitability of any specific recommendation must be made by the clinician and the patient

differentchoices may be appropriate for different patients. The clinician must help each patientdetermine if the suggested course of action is clinically appropriate and consistent withhis or her values and preferences.

udies demonstrated clinically significantimprovements in excessive daytime sleepiness

Recommendation 6: We suggest that clinicians usedextroamphetamine (vs no treatment) for the treatmentof narcolepsy in adults.

Treatment of central disorders of hypersomnolence: an American Academyof Sleep Medicine clinical practice guideline

“The biggest implication of this change is that we were not able to make any recommendation for some interventions that have been widely used in clinical practice and were recommended in the 2007 guideline

“The prior set of treatment recommendations was published in 2007,” says Lynn Marie Trotti, MD, MSc, an associate professor of neurology at Emory University School of Medicine in Atlanta. Trotti is on the board of directors at the AASM and co-authored the new hypersomnolence recommendations

New AASM recommendations released in August 2021 on medications to treat these disorders

It’s been more than a decade since the American Academy of Sleep Medicine (AASM) last issued guidelines for the treatment of central disorders of hypersomnolence

A new American Academy of Sleep Medicine clinical practice guideline details “strong” and “conditional” recommendations for the treatment of central disorders of hypersomnolence in adults and children.

Stimulant and Related Medications: U.S. Food and Drug Administration-Approved Indications and Dosages forUse in AdultsThe therapeutic dosing recommendations for stimulant and related medications are based on U.S. Food and Drug Administration (FDA)-approvedproduct labeling. Nevertheless, the dosing regimen is adjusted according to a patient’s individual response to pharmacotherapy.

Risks of High-Dose Stimulants in the Treatment of Disorders of Excessive Somnolence: A Case-Control Study

Practice Parameters for the Treatment of Narcolepsy: An Update for 2000

A secure attachment is now seen asanchored in both the emotional closeness within the parent–child relationship, as well as in thechild’s comfort venturing beyond that realm to explore the larger world, as facilitated by the parentwho supports and encourages separation-individuation (for discussions of attachment theory andresearch, see Main, Hesse, & Hesse, 2011; Marvin, Cooper, Hoffman, & Powell, 2002

child may otherwise appear to be independent and com-petent, even an academic and social “star.”

UNDERSTANDING INTRACTABLE RRD FAMILIES

WHEN A CHILD REJECTS A PARENT: WORKING WITHTHE INTRACTABLE RESIST/REFUSE DYNAMICMarjorie Gans Walters and Steven Friedlander

Johnston, J. & Sullivan, M. (2020). Parental Alienation: In Search of Common Ground Fora More Differentiated Theory. Family Court Review, 58(2), 270–292.

Fidler, B. J., Deutsch, R. M., & Polak, S. (2019). “How am I supposed to treat these cases?”Working with families struggling with entrenched parent–child contact problems. InL. Greenberg, B. Fidler, & M. Saini (Eds.), Evidence-informed interventions forcourt-involved families (pp. 227–259). New York, NY: Oxford University Press

Fidler, B., & Bala, N. (2020). Concepts, controversies and conundrums of alienation:Lessons learned in a decade and reflections on challenges ahead. Family CourtReview, 58(2), 576-603

Deutsch, R., Drozd, L., & Saini, M. (2021). Trauma as a Potential Distractor or Illuminatorin Exploring Resist/Refuse Dynamics, Association of Family and ConciliationCourts, annual convention, Boston, June 7, 2021.Deutsch, R., Drozd, L., & Ajoku, C. (2020). Trauma-informed interventions in parent-childcontact cases. In B. Fidler & N. Bala (Eds), Parent-child contact problems:Concepts, controversies & conundrums. Family Court Review, 58(2), 470-487.Drozd, L., Saini, M., & Deutsch, R. M. (2018). Assessment and intervention in resist/refusecases: A trauma-informed approach. [Presentation] Presentation at AFCC 55thAnnual Conference, Washington, DC

Team consists of:• Judge• Attorneys• Therapists• Family Member• Optional• Alternative decision-maker (PC or Case Manager?)• Guardian ad Litem• Counsel for MinorsMixing roles.............blurred boundaries.........multiple hats forone person may cause problems

Evidence-InformedInterventions (EIIs) to address parent–child contact problems

Assessment is part of the intervention; order interventionearly, rather than late

Conventional wisdom passed down from judge to judge may work in“average parenting case,” but not here

Don’t necessarily trust your gut

Swift decisions on little evidence – too often gut responses are basedupon personal experience and maybe clouded by emotions

he Perfect StormSuch cases often involve personality disorders, high parentalconflict, and complex systems involvement, in what [Drs.Abigail Judge and Peggie Ward] call ‘the perfect storm.’In these circumstances, clinicians, attorneys, and judgesfrequently become players in the family drama, so it isimportant for all professionals to assess whether they arebeing manipulated by one or both parents and actuallymaking a bad situation worse.Because systems-based perspective and a teamapproach are essential in working with families in highconflict, scrupulous attention to inter-team dynamics iscritical to preventing parallel divisive dynamics amongprofessionals.From OVERCOMING PARENT-CHILD CONTACT PROBLEMS edited by Abigail Judge andRobin Deutsch; Oxford (2017); Introduction page 3. Introduction by Drozd and Bala

Collaboration among all treating professionals is called fo

High conflict, entrenched, slow court system

Well intentioned professionals may need to get out of the way

Is the therapist part of the problem?

A Child’s Voice is critical to hear (and not necessarily is a child havingchoice in their best interest

Parents need to be willing to change

“Don’t Treat the Trauma without (a finding of) Trauma:Treatment without a finding of trauma perpetuatesdysfunction.• Evidence-based or evidence-informed trauma treatment isthe treatment of choice

Child becomes increasingly anxious

Therapist reporting back to court when there isnoncompliance with parenting plan, orders ortreatment agreement

Refusal of treatment / Previous attempts fortreatment unsuccessf

Chronic parent-child disruptions

No or very infrequent contact between child and RP

Rigid / extreme child reaction to rejected paren

Reconciliation – is rejected

Regret and Remorse – absen

Revision – history is revised to eliminate positiveexperiences

Radical – child’s rejection is extreme and unrelenting

Repetition – of parent’s words

Rigidity – refusal to consider alternate views

Reasons – trivial, frivolous, unelaborated

Reactions – unjustified or disproportionate

Domestic Abuse in the Context of RRD cases•Screening•Criteria that may disqualify a case from “family systemapproach”•Current & active coercive-control dynamics (with or withoutphysical violence)•Legitimate safety risks•Active substance abuse•Certain types of mental health diagnoses

Keys to the Castle in RRD Work• Treating only the child and treating the rejected parent and child doNOT work.• The Favored Parent holds at least one of the keys. They must buy in.• Catching the family as early as possible is another key. Entrenchedpatterns are very very difficult (not going to say impossible) to break.• Known measures of success or even small steps of progress arecritical.• Transparency, modified confidentiality, & accountability are keys.• “Contact” (between each parent and the child) involves more thanphysical custody.• The greatest potential (& often the most challenging work) rests in thecoparent relationship

SOLUTIONS:The Whole Family must be Involved•Treatment of choice is SYSTEMIC FAMILYTHERAPY

Multi-FactorTheory of3DUHQW&KLOG&RQWDFW3UREOHPV3&&3

What’s the Research Say?2020 Survey of Resist and/or Refuse Dynamics• Collaboration between National Council of Juvenile andFamily Court Judges (NCJFCJ) and the Association of Familyand Conciliation Courts (AFCC) in 2020• Represents the largest sample of responses on this topic.Over 500 pages of comments were submitted by participants.• Aim – to ‘take the temperature’ of the professional cultures.• Most participants indicated receiving no more than 4 hours oftraining on resist/refuse dynamics• Most (+85%) were unaware of tools available to differentiaterealistic estrangement from alienating behavior by a parent15Saini, 2021Knowns1516Saini, 2021Knowns16

Characteristics of RRD cases

The Solution, continuedWhat failsTime is the enemy and thus..........Therapists, attorneys, and the court may be part of the problem in RRDwork.BiasesConstructive advocacy vs. zealous advocacyMixing up clinical and forensic rolesBeing too helpful: Dual rolesCaution: The voice of the child

What worksEarly and earlier interventions.The Team Approach: When therapists, attorneys, and the court are on ateamAccountability.Keeping costs down.Tools in the Toolbox.One Size Really Does Not Fit All: The Importance of Incorporating CulturallyRelevant Adaptations in Reunification Therapy (April Harris-Britt, DianePaces-Wiles, Noa Wax, 17 September 2021, Family Court Review.Reunification Therapy research is significantly limited as it pertains to thechallenges of treating and assisting such families from diverse culturalbackgrounds.Suggestions are offered for enhancing Evidence-Informed Interventions(EIIs) to address parent–child contact problems within diversepopulations by incorporating culturally specific interventions to increaseparenting skills, reduce parent and child distress, and repair attachmentsthrough therapeutic experiences66

Washington State PsychologicalAssociationAlaska Psychological Association2021 NW Psychological Fall ConventionOctober 15-17, 2021

The therapies that will be coming here once we get them here will be DBT first, “informed” by EFT.

Parents will want Dialectic Behavior Therapy (DBT; Linehan) adapted to the family courts, informed by Emotionally Focused Therapy (EFT; Johnson).

Dr. Childress agrees with the American Psychiatric Association.

As a licensed clinical psychologist, I have active duty to warn and duty to protect obligations relative to the Gardnerian PAS “experts”. In two separate matters in which I am personally involved, I have an identifiable victim in imminent danger directly as a result of the reckless, unethical, and irresponsible actions of Dr. Bernet, Dr. Lorandos, Ms. Gottlieb, and Dr. Harman.

The Gardnerian PAS “experts” reject the diagnostic guidance of the American Psychiatric Association and they reject the ethical guidance of the American Psychological Association. They are unwise and reckless, and they are practicing substantially outside the boundaries of their professional competence.

Natalie J. Valentino, M.S.W., a social worker in Denver, Colorado, has experienced parental alienation inher own family. She has worked for law firms and a legal services office, and she has experiencein child protection, therapeutic foster care, and adoptions. Ms. Valentino participates regularlyin the Colorado Parental Alienation Support Group. Email: natalie.valentino7@gmail.com

Jonathan M. Ogline, Esq., is an attorney in Westminster, Colorado, who specializes in the representa-tion of fathers in divorce and child custody disputes. He had a case involving severe parental al-ienation, in which another PASG member was brought in to serve as an expert witness on thetopic. Email: jon@brettwmartin.com

David Littman, M.A. J.D., a family law attorney in Denver, Colorado, is a former chair of the Family LawSection of the Colorado Bar Association. He is a member of the Colorado Supreme Court Stand-ing Committee on Family Issues. Mr. Littman currently serves as a child and family investigator, amediator, and an arbitrator, whose cases often deal with parental alienation.Website: www.littmanfamilylaw.com. Email: david@littmanfamilylaw.com

Phillip Hendrix, M.A., M.B.A., is a counselor, family mediator, parent educator, parenting coordinator,and forensic specialist in Castle Rock, Colorado. Educated in psychology and business and exten-sively trained and experienced in cases involving parental alienation and other forms of childabuse and domestic violence, he has served in court-appointed roles and as expert witness. Ascoach and advocate, Mr. Hendrix leads the Colorado Parental Alienation Support Group and Col-orado Children’s Center to assist children caught in the middle.Website: www.covenantcounselors.com. Email: phillip@covenantcounselors.com

Susan Heitler, Ph.D., is a private practice clinical psychologist in Denver, Colorado, who specializes intreatment of anxiety, depression, marriage difficulties, and parental alienation. She has pub-lished From Conflict to Resolution, The Power of Two, and several other books. Also, Dr. Heitlerblogs on psychologytoday.com, where her articles have had over 13 million total reads. Dr. Heit-ler’s overview website provides links to the multiple resources she has authored for therapistsand the general public. Email: drheitler@gmail.com.

Lisa Baker, B.A. (Psychology), M.M. (Jazz Guitar), is a musician/guitarist/songwriter who lives near Chi-cago, Illinois. Ms. Baker has experienced parental alienation in her own family, as she is alien-ated from an adult daughter and grandson. She has been writing songs about parental aliena-tion and is guesting on radio programs to bring awareness for the greater good.Email: lisaanitabaker@live.com

William Bernet, M.D., a forensic child psychiatrist, is professor emeritus at Vanderbilt University Schoolof Medicine, Nashville, Tennessee. Dr. Bernet was the editor of Parental Alienation, DSM-5, andICD-11 and the co-editor of Parental Alienation – Science and Law. He was the founder and firstpresident of Parental Alienation Study Group. Email: william.bernet@vumc.org

J. Michael Bone, Ph.D., a clinical and forensic consultant in Winter Park, Florida, specializes in the prob-lem of parental alienation. Dr. Bone is co-author of The Essentials of Parental Alienation Syn-drome (PAS): It’s Real, It’s Here and It Hurts, a concise overview of parental alienation. His web-site is www.jmichaelbone.com. Email: michael@michaelbone.com

Albert V. Evans, an attorney in Denver, Colorado, has been practicing law for more than 40 years. Overthe years, he has learned a lot about sociopathy and also parental alienation. He has observedparental alienation dynamics in some of his family law cases.Email: evansalbertv@qwestoffice.net.

Sharon S. Feder, M.S. (Psychological Counseling) is a psychotherapist in Englewood, Colorado. Shelearned about parental alienation from PASG member Phillip Hendrix. Ms. Feder works withfamilies and individuals who have gone through a divorce – providing individual, family, and re-integration therapy. She works as a parenting coordinator/decision maker, parent coach/co-par-enting educator, and therapeutic supervised parenting time supervisor. She has been qualifiedin courts in the Denver Metro area as an expert in reintegration therapy and parental alienation.Email: SharonSFeder@msn.com

Jennifer J. Harman, Ph.D., an associate professor of social and health psychology at Colorado State Uni-versity, Fort Collins, Colorado, has focused her research on power and intimate relationshipsand, more recently, on how social and cultural institutions impact parental alienation. Dr. Har-man co-authored Parents Acting Badly: How Institutions and Societies Promote the Alienation ofChildren from Their Loving Families. Dr. Harman and Dr. Zeynep Biringen established the Colo-rado Parental Alienation Project, which is at www.facebook.com/parentalalienationproject.Email: jennifer.harman@colostate.edu

Scott J. Goldstone, J.D., is an attorney practicing in Northern Colorado with offices in Erie and Greeley,Colorado. He provides the following services: mediation, legal representation of parents in di-vorce and custody disputes, and legal consultation. Website: www.peekgoldstone.com.Email: scott@peekgoldstone.com

Jane Fong, Ph.D., a clinical psychologist in Colorado Springs, Colorad

Zeynep Biringen, Ph.D., a professor in the Department of Human Development and Family Studies atColorado State University, Fort Collins, Colorado, conducts research on emotional availability inparent–child relationships, attachment, and prevention programming. Dr. Biringen and Dr. Jen-nifer J. Harman co-authored Parents Acting Badly: How Institutions and Societies Promote theAlienation of Children from Their Loving Families and established the Colorado Parental Aliena-tion Project, which is at www.facebook.com/parentalalienationproject.Email: zeynep.biringen@colostate.edu.

MEMBERS OF PARENTAL ALIENATION STUDY GROUPOctober2022

Beware Communities worldwide all need more therapists who can knowledgeably assess and treat alienation. At the same time, therapists need serious study and specific training to work effectively with these poignant, challenging, yet highly rewarding cases.

When the child is hostile to a parent, what are the parent's immediate response options? The Baker and Fine article referenced above offers much wisdom.

do not dare to allow themselves to enjoy the targeted parent.

essential in severe alienation in order to free children from loyalty conflicts that would prevent a successful reunification.

Treatment of severe alienation Pioneering alienation therapist Linda Gottlieb emphasizes that severe alienation—when an alienator blocks designated parenting-plan time, withholds school or medical information—requires court orders:

treatment of severe cases

most mental health professionals get it wrong

Targeted parents may present as anxious, depressed, and angry. At the same time, beneath these desperate situational reactions generally lies psychological health. Alienating parents, by contrast, generally often calm, cool, and charming and therefore look more attractive. They lie convincingly. Alienator and child appear credible by telling similar stories. THE BASICS What Is Parental Alienation? Find a therapist near me

When a child's negative reaction stems from verbal, phyiscal or sexual abuse, children still want a relationship with the abusive parent. In addition however, accusations that a targeted parent has been abusive need to be assessed thoroughly to be certain that these kinds of abuse are not occurring, and if so, addressed directly. In contrast, when a child's negative reaction stems from the abuse of alienation, the child becomes resistant, increasingly hostile, and eventually rejects altogether the targeted parent.

A former part time Magistrate in Denver and Jefferson Counties, he has special insight into the inner working of the courtroom process. David’s background in psychology and mental health counseling assists him in working with your complex family issues.  He has recognized competency in dealing with extremely difficult matters, including those involving sexual abuse, alienation, substance abuse and mental illness. His concern for the unique issues military families face during their service has prompted his interest in working with these families. David’s pro bono work earned him the Foster Parent Association of Colorado Advocate of the Year Award, as well as recognition by the Colorado Supreme Court.  He is a past Chairman of Colorado CASA Board and a strong supporter and participant with Metro Volunteer Lawyers.

Jennifer Harman, Ph.D. Fort Collins, Colorado jennifer.harman@colostate.edu

Phillip Hendrix, M.A., M.B.A., Treasurer Castle Rock, Colorado info@covenantcounselors.com

Parental Alienation

Phillip Hendrix, M.A., M.B.A. A family mediator, parent educator, child custody evaluator, and parenting coordinator in Castle Rock, Colorado, Mr. Hendrix makes presenattions, educates others, and leads a large in-person support group, the Colorado Parental Alienation Support Group. His website: http://www.covenantcounselors.com.

Cara E. Koch, D.Min. Dr. Cara E. Koch, who lives in Colorado Springs, Colorado, recently published a book, From Heartbreak to Healing: Resolving Parental Alienation. Dr. Koch has experienced parental alienation in her own family. She hopes to participate in the effort to increase public awareness and gain support for recognizing, treating, and stopping parental alienation. Her website: https://carakoch.com.

Jennifer J. Harman, Ph.D., and Zeynep Biringen, Ph.D. Professors at Colorado State University, Fort Collins, Colorado, they published Parents Acting Badly: How Institutions and Societies Promote the Alienation of Children from Their Loving Families. Dr. Harman and Dr. Biringen also established the Colorado Parental Alienation Project, which is at http://www.facebook.com/parentalalienationproject.

Zeynep Biringen, Ph.D. A professor in the Department of Human Development and Family Studies at Colorado State University, Fort Collins, Colorado. Dr. Biringen and Dr. Jennifer J. Harman co-authored Parents Acting Badly: How Institutions and Societies Promote the Alienation of Children from Their Loving Families and established the Colorado Parental Alienation Project, which is at http://www.facebook.com/parentalalienationproject.

Michael Bone and Brian Ludmer, in particular, have written on this issue.  Note especially that lawyers without strong experience in this area will be highly likely to lose your case.  Experience in other areas of law is insufficient for lawyers to win alienation cases.

How alienation is best treated psychologically.  Individual therapy alone for the alienated child not only will be unlikely to resolve the alienation; it is likely to reinforce the pattern. Alienated children must be treated in joint sessions with the targeted parent.  The alienating parent must be in treatment as well to learn to recognize and stop his/her alienating behaviors.  Treatment addressed toward helping the parents resolve the issues that motivate the alienation also can help. Court intervention is generally essential in more severe alienation cases where time allotted to the targeted parent in the court-approved parenting plan is being blocked. In the case of severe alienation, urgency is an issue.  Earlier intervention prevents worsening and increases the likelihood of successful treatment for all cases.

Dr. Heitler, please feel welcome to email her at drheitler@gmail.com.  PLEASE NOTE THAT DR. HEITLER NO LONG HAS A DENVER OFFICE.

an attractive woman

Patience is a necessity

traumatized

unable to find one he believed understood his experience well enough

education

drive doubt away.

report any doubts or negative thoughts to Jacob

Put forth a closed sense of logic; allow no real input or criticism.

replace it with the leader’s own vision

metaphorically snap.

Control the person’s time and, if possible, physical environment.

six years

Five years

were forbidden contact with family

was more concerned about

I’m not a stupid man. I’m not, really. And I just can’t seem to figure out what went wrong.”

neither seemed to understand what he’d gone through.

I hoped to explain to him how cults operate. Once he understood the powerful techniques of persuasion that were used against him, perhaps at least some of the guilt and foolishness he might be feeling over his cultic involvement would decrease.

DSM-5(3)Childpsychologicalabuse(995.51),whichincludes“harming/ abandoning...peopleorthingsthatthechildcaresabout.”DSM-5, pg. 716,719(5thed. 2013); WilliamBernet,et. al. , ChildAffectedbyParentalRelationshipDistress55J. oftheAm. Acad. ofChildandAdolescentPsychiatry571-579(2016)

DSM-5(2)Parent-childrelationalproblem(V61.20),whichincludes“negativeattributionsoftheother’sintentions,hostilitytowardorscapegoatingoftheother,andunwarrantedfeelingsofestrangement.”DSM-5, pg. 715,719(5thed. 2013); WilliamBernet,et. al. , ChildAffectedbyParentalRelationshipDistress55J. oftheAm. Acad. ofChildandAdolescentPsychiatry571-579(2016)

DSM-5DSM-5 hasTHREEspecificdiagnosesunderwhichParentalAlienationmayfall,albeitbydifferentnames:(1)Childaffectedbyparentalrelationshipdistress(CAPRD)(V61.29),which“shouldbeusedwhenthefocusofclinicalattentionis thenegativeeffectsofparentalrelationshipdiscord(e.g., highlevelsofconflict,distress,ordisparagement)ona childinthefamily,includingeffectsonthechild’smentalorothermedicaldisorders.”DSM-5, pg. 716,719(5thed. 2013); WilliamBernet,et. al. , ChildAffectedbyParentalRelationshipDistress55J. oftheAm. Acad. ofChildandAdolescentPsychiatry571-579(2016

SEVERE: thepreferredparentis obsessedwiththedesiretodestroythechild’srelationshipwiththeotherparent; thebehaviordoesnotrespondtotypicaloutpatientcounseling

and passes the DaubertgatekeepingExpert testimony on parental alienation “aided the court by providing a counterintuitiveexplanation as to the dynamics...present in [the] situation.”Expert testimony met the threshold level of reliability ~ DaubertstandardSupreme Judicial Court of Maine(Bergin v Bergin, __ A.3d __ (2019)) (2019 WL 3788326

The phenomenon of PA is “well known”...-“Thephenomenaofparentalalienationarewellrecognizedinternationallyand,s a d l y,arefrequentlyallegedorencounteredincustodyandvisitationlitigation....Thespecificterm‘parentalalienation’doesnotyetappearasa psychiatricdiagnosisintheofficialclassificationoftheAmericanPsychiatricAssociation,althoughitsfeaturescommonlymaybesubsumedunderoneormoreotherdiagnosticcategories...”McClainv. McClain, 539S. W.3d 170,182(2017)(CourtofAppealsofTennessee

Dr. Amy Baker et al. (2011), Brief Report on Parental Alienation SurveySurveyconductedat2010meetingoftheAssociationofFamilyandConciliationCourts(AFCC).300attendeescompletedsurveyregardingPA.98%endorsed,“Doyouthinkthatsomechildrenaremanipulatedbyoneparenttoirrationallyandunjustifiablyrejecttheotherparent?”

Severe PA: remove the children from abusive hom

Long-term Effects of Parental Alienation BehavioralEffects◦Childshunsalienatedparentforyearsora life-time◦ChildrepeatsalienatingbehaviorsinlateradultrelationshipsCognitiveEffects◦Childfailstodevelopcriticalthinking◦ChildexperiencesrelationshipsasallgoodorallbadEmotionalEffects◦Chronicdepressionoverlossoflovedparent◦Chronicguiltoverparticipatinginrejectionofparent

Short-term Effects of Parental Alienation Child escapes battleground between parentsChild resolves cognitive dissonanceChild becomes enmeshed with preferred parentChild loses relationship with rejected parent

What is the difference betweenalienation and estrangement?ALIENATION= childrejectsa parentwithouta goodreason. Thechild’srejectionis faroutofproportiontoanythingtherejectedparenthasdone.ESTRANGEMENT=childrejectsa parentfora goodreason,suchashistoryofabuseorneglect.

World Health OrganizationQE52.0:Caregiver-childrelationshipproblem= “substantialandsustaineddissatisfactionwithinacaregiver-childrelationshipassociatedwithsignificantdisturbanceinfunctioning.”INDEXTERMS◦Parent-childrelationshipproblem◦Parentalalienation◦Parentalestrangemen

Bernet, W. et al. (2018), An Objective Measure of Splitting in Parental Alienation: The Parental Acceptance-Rejection Questionnaire(PARQ

Craig Childress (2015), An Attachment-Based Model of Parental Alienation: FoundationsConceptofattachment-basedparentalalienation

2020 EditionParental Alienation: The Legal Landscape

Proposal for Parental Alienation Relational Problemto be Included in“Other Conditions That May Be a Focus of Clinical Attention”in DSM-5-TRSubmitted to DSM-5-TR Steering CommitteeNovember xx, 2022Submitted by William Bernet, M.D., and Amy J. L. Baker, Ph.D.

Protecting Your Clients in Parental Alienation Cases When the Courts Don’t

Winning Parental Alienation Cases: A Roadmap for Family Lawyers

rentalAlienation:WHATFAMILYLAWYERSNEEDTOKNOW

Prevalence of adults who are the targets of parental alienating behaviors and their impact

The child’ssense of disconnection and inauthentic realityare reinforced when alienated parents repeat their false narratives to third partiesas part of their alienationcampaign

Losses Experienced by Children Alienated from a ParentJennifer J. Harman, Mandy L. Matthewson, Amy J.L. Baker

What did we find? Of the more than 200 empirical studies we reviewed, 40% were published since 2016. This means that many of the reviews published before 2016—such as the ones critics rely on to argue that parental alienation research is in its “infancy”—are hopelessly outdated. Our study leaves no doubt that parental alienation is a valid concept supported by a robust and well-developed scientific literature. This literature sports several hallmarks of a maturing scientific field. First, the number of studies is increasing each year. Second, the type of studies increasingly favors quantitative (e.g., statistical analysis) over qualitative (e.g., descriptive) methods. Third, the studies increasingly test hypotheses and situate the design and results in a theoretical and explanatory framework.

Developmental Psychology and the Scientific Status of Parental AlienationJennifer J. Harman 1 , Richard A. Warshak 2 , Demosthenes Lorandos 3 , and Matthew J. Florian 41 Department of Psychology, Colorado State University2 Independent Practice, Richardson, Texas, United States3 Psychlaw.net, Ann Arbor, Michigan, United States4 Eris Enterprise, LLC, Fort Collins, Colorado, United State

Parental Alienation andAmerican Family Courts:Common Fallacies and PitfallsPRESENTED BY: ASHISH JOSHI

criteria proposed by Judge Richard Dollinger are related to scientific and clinical issues that provide the basis for expert testimony in cases where PA is alleged.

Up until recently, there were no legal criteria for defining parental alienation. Now we have some guidance from New York State. The recently decided NYS AD case of JF v. DF (NY Law Journal, 12/27/18; filed 12/06/18) provides legal criteria for identifying parental alienation (PA) based on tort law. These criteria are intended to differentiate parental alienation from more conventional examples of poor parenting, such as missed phone calls or the occasional vulgarity or snide remark about the other parent.

The Five-Factor Model for the Diagnosis of Parental AlienationAuthor links open overlay panelWilliam Bernet MD a, Laurence L. Greenhill MD b

Five-Factor ModelThe Five-Factor Model (FFM) is a method for diagnosing PA byunderstanding and identifying the components of this mental condition. TheFFM includes the following criteria:¢ Factor One: the child manifests contact resistance or refusal, i.e.,avoids a relationship with one of the parents.¢ Factor Two: the presence of a prior positive relationship betweenthe child and the now rejected parent.* Factor Three: the absence of abuse, neglect, or seriously deficientparenting on the part of the now rejected parent.¢ Factor Four; the use of multiple alienating behaviors on the partof the favored parent.* Factor Five: the child exhibits many of the eight behavioralmanifestations of alienation.

Although the actual words “parental alienation” are not in DSM-5 or ICD-11, the concept of PA is found in those diagnostic manuals. In the DSM-5,there are three diagnoses that can be used when PA has been identified in achild or a family. For example, a new diagnosis in DSM-5, child affected byparental relationship distress, can be used in cases involving PA, which wasexplained in an article by Bernet, Wamboldt, and Narrow (2016). Otherdiagnoses in DSM-5—that ts, parent-child relational problem and childpsychological abuse—may also be used in cases involving PA. Likewise, withregard to ICD-11, the diagnosis of caregiver—child relationship problem canbe used in cases involving PA.

PA-detractors seem to think that somewhere thereis arule or a commandment to that effect, but there is no such rule. There aremany examples of medical and psychiatric ailments being routinely diagnosedbefore those conditions were officially included in diagnostic nomenclature.For example, Tourette’s syndrome was described and identified in 1885, longbefore it was officially included in DSM-III in 1980. Human immunodeficiencyvirus (HIV) and autoimmune deficiency syndrome (AIDS) were described,identified, and diagnosed in the early 1980s, years before they found their wayinto ICD-9 (1991).

Conclusions:Indoctrinating a child to hate or fear a parent without a goodreason is a form of child psychological abuse. Clinicians should use theDSM-5diagnosis of child psychological abuse when an alienating parent is deter-mined to cause parental alienation in his or her children. Child protectionpersonnel should investigate cases of parental alienation as instances of childpsychological abuse

dies showthat when courts remove severely alienated children from the influence ofthe alienating parent and order an appropriate intervention, at least 90%of the children are restored to a satisfactory relationship with bothparents

Social Worker or Counselor has different levels of training and may practice independently or under alicensed supervisor. It is important to ask when making an appointment if the social worker or counselorhas specific child and family training

Effective residential treatment programs provide:

Involvement of the child's family or support system. Model residential programs encourage and provide opportunities for family therapy and contact

Psychiatric care coordinated by a child and adolescent psychiatrist or psychiatric prescriber.

An Individualized Treatment Plan that puts into place interventions that help the child or adolescent attain these goals.

who have not responded to outpatient treatments

Residential treatment programs provide intensive help for youth with serious emotional and behavior problems. While receiving residential treatment, children temporarily live outside of their homes and in a facility where they can be supervised and monitored by trained staff.

AACAPOFFICIALACTION

Comply with the training requirements mandate

derstand the Colorado Children’s Code, §§ 19-1-101 to19-7-103,C.R.S. Volume 7 CDHS Rules and Regulations for Child Welfare Services, 12 Code Colo. Regs. 2509-1 –2509-8, this Chief Justice Directive, the Indian Child Welfare Act, 25 U.S.C. §§ 1901 to 1963 and other relevant State and Federal law