Scope Creep: How Does This Impact Clinical / Counseling Psychology

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Jon Snow, Dec 22, 2008.

  1. Jon Snow

    Jon Snow Senior Member
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    MOD NOTE: Okay...I split this out of another thread. I'd like to continue this discussion, but everyone needs to keep in mind the tone and intent of your posts. Please keep it professional. -t4c

    I don't doubt that social workers are encouraged to use evidence-based treatment. What I question is the education with respect to evaluating evidence. I also question this, incidentally, for another recently proliferating group (professional schools of psychology). What constitutes a reasonable degree of evidence before application of a methodology? Further, one can't discount as necessary, breadth of knowledge with respect to diagnosis and treatment. Is one year of school enough? I say one year, because many social work programs focus on social justice for one year. Important for social advocacy, but not for understanding mental illness. My contention is that one year, plus a couple of years of clinical supervision, are not enough to properly evaluate empirical evidence from a theoretical or practical level. The breadth of knowledge is simply not there. I can't imagine cramming everything I needed to know from a theoretical vantage-point into one year. It's barely adequate at 5 (the length of my doctoral program) + a year internship + two years fellowship.


    This is also an issue with respect to assessment. For example, what constitutes an empirically supported assessment scale? What are psychometrics? What is a normative sample? For specific scales, how were they normed, what are the ceilings and floors, how are they most commonly used in clinical practice, what are the strengths and weaknesses of the scale? What medical conditions might cause mental health symptoms? Etc. . .



    I already agreed with this statement, so there's nothing to disagree with :)
    This, as a defense to using EMDR? No, that's unsatisfactory. Too big of a loophole to do whatever you want. As I said, it isn't a clear demarcation. You will find odd viewpoints from a scientific/critical thinking vantage point at all levels. It's an issue of ratio and tools to perform.
     
    #1 Jon Snow, Dec 22, 2008
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  2. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    While JS can be a bit rough around the edges, I do think it is important to be able to discuss these rather controversial issues. I do agree that the scope creep that is happening is a very real area for discussion/debate. I cringe when I see a laundry list of "specialty" areas, that are rarely related.

    It is always a bit of a tightrope walk when discussing these issues, but I usually err on the side of leaving a thread open as long as people can keep it professional (looks at JS :D ).

    So back on topic.....

    What is being done to support SW's expansion into primary areas of therapy/diagnosis/assessment? Curriculum changes, increased req. clinical hours, increased supervision hours? My interactions with SW are similar to Jon's (social advocacy, case management, supportive work), though I don't see where the training gets to the clinician. In the previous mentioned areas they are a great asset, and they have made my life a heck of a lot easier.

    The LCSW is a bit closer to "additional training", but I still think it isn't quite there. Considering what gets crammed into Doctoral training, I can't see how they can adequately get the training to do therapy/assessment/diagnosing AND the administrative/advocacy training. I know some programs offer more of a slant to one or another, but how can that all be done in 2 years, ethically?

    In cases of expansion, the group wanting to expand should PROVE that there is competency, and it shouldn't be up to the current system to PROVE they are not. Unfortunately the MA/MS level lobbies are much more active than the doctoral level, and we are losing on sheer numbers and influence.

    I'd like to have a discussion (Using emperically supported data and related information if at all possible) to talk about these issues.
     
  3. Jon Snow

    Jon Snow Senior Member
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    "When you get a BS you think you know everything. When you get your MS you realize you know nothing. When you get your PhD you still realize you know nothing but it is ok because now you know no one else does either"

    Maybe it goes. . .

    "When you get a BA you think you know everything. When you get your MS, you think you know everything. When you get your PhD you still think you know everything." :)
     
  4. WannaBeDrMe

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    I typed for 25 minutes straight and then, it said "thread closed"... I almost cried a little Christmas tear...

    Good Lord, this blew up today, didn't it?

    JS, while I take tremendous offense to your generalization that LCSW's as a whole are "that incompetent"... your frustrations are not unique to you. Many of my posts and private messages from this forum have detailed why I am transitioning from social work to psychology and have included similar reasoning as your own. However, I feel a bit more qualified to speak about the deficiences of social work practice/training since I have experienced it from the inside.

    Social work, as a profession, is in no way intended to replace nor be compared with doctoral level psychologists. If you are experiencing something different in your state, take it up with your legislators and have your state's mental health policy clarified... Even as clusterfreaked as my state's policy is right now, the definitions of providers are VERY clear. With all of that said, your emphasis on how social workers are not trained as well as psychologists is a personal argument that really means about as much to me as arguing whether or not an apple or a banana tastes better to kitty cats.

    For all of your training, and the fact that your argument is BASED UPON psychologists' greater competence based on your training, where is your evidence? Didn't you even attempt to call someone else out for their lack of evidence? I'm sure there are studies completed demonstrating the patient outcomes following treatment comparing one provider over another... I would research it, but this isn't my argument, it's your's, back it up with the rest of your argument. Show me data that can assert master's level practitioners driving a failboat of assessment/EBP/etc. Until then, it's personal... not professional.

    For someone who repeatedly mentions evaluating evidence, you speak in troubling (and glaring) generalities based on assumptions. Do you have a data breakdown of curriculum for MSW programs in this country? If so, and you can show me that the standard course of study focuses more on social advocacy or whatever over theory or anything else... I'll be more likely to side with your argument. Even if I agree with some of your opinions, they hold little water given the fact that you seem to be pulling them out of the air... which is ok, we are allowed to pull opinions out of the air. Yay air.

    About your googling... I can google just as many psychologist quacks... we could all google quacks all day, that proves nothing and I'm disappointed that you thought that was enough evidence to support your claims. A first year psychology undergrad major might get away with picking and choosing sources to support an opinion but you are supposed to be better... you say yourself in all of these posts that you are better... so, prove it. Stop offering fluff, if this is your argument, bring the facts that would be difficult to dispute without counter-facts.

    My training was atypical for a social worker. All but one (my field supervisor, ACSW), of my successful mentor relationships have been with psychologists/psychiatrists. I get frustrated with the lower skill level of some master's level practitioners in a lot of areas... BUT I do something about it. I constantly lead in-service trainings, offer up my resouces, consult on assessments, etc. My work/research got me noticed by key personnel in the EBP methods you mention. Clearly, their offer to support me as I continue in this vein of research does not support your claim that LCSW's are incompetent when it comes to training/practice/research.

    T4C: I think the main issue here is defining therapy/assessment/diagnosis. If your state's don't do that... that is NOT the social worker's problem... you need to have those areas clearly defined so people are not being reimbursed for services outside their scope of practice. In my state, I am Medicaid reimbursed for providing comprehensive clinical assessments (not meant to be a formal diagnostic assessment, an elaborate psychosocial history with a diagnostic impression) and I can be reimbursed as a member of a TEAM that offers diagnostic assessments. In my state, not even psychologists are supposed to fill that role alone for Medicaid dollars... the diagnostic assessment MUST be signed by 5 team members (all of whom are supposed to collaborate). The truth is, the psychologists get overworked and they farm out the DA's to the master's level clinicians and blindly sign anything that is put out there... how is that the master's level clinician's fault? Or, they don't do DA's at all... assign a diagnosis and move forward... lots are great at assessment but just as many don't take the time or effort to properly assess/determine what's going on... at least in my area.

    As for therapy, I don't do individual therapy other than brief therapy. I have focused the majority of my clinical work on groups. My individual interventions are much more case management/behaviorally based or has been brief interventions and crisis work. My research, however, required me to look more into the empirical side of therapeutic interventions and at least in my small niche, I found no papers speaking directly to the effect of the type/training of practitioner providing the service. Now, my niche is tiny, tiny... so I am guessing that's why I didn't see it but I'm sure it exists in other areas and I'm hoping someone who takes the other side of the argument will come forth with some data. I'd genuinely like to see it since I share a lot of the same concerns.

    As for increased supervision hours, social workers in my state already have more required supervised hours in praticum and post-degree than ANY other master's level practitioner. More than psychologists, more than counselors, and more than art therapists/divinity/etc. I'm not saying we don't need more... but I think the standardization of quality of those hours would be a better use of energy than just making it more hours. My internship was 40 hrs a week for 18 months on a smaller (20-bed) inpatient psychiatric unit where I had 85% time contact with patients/families. Some in my cohort were based at an agency where they averaged 15% face time over the entire duration of their internships. Same with licensing... some of my peers counted the case management crap we had to do toward their 3000 hours... I refused and I absolutely only counted the clinical face hours I had... and when I wasn't getting them at my paid site, I sought them elsewhere...

    If social work could take one thing from doctoral psychology.. it could be the internship process. The fact that internships are expected to provide standard competencies could help... With social work, some internships are competitive, some fellowships are very competitive... but there's still no set guidelines for what should occur... that's individualized between the student, the site, and the school through something called a learning contract. It's created per semester and it seems to be pretty random from what I've heard from other MSW's...

    I'm not sure you guys are understanding the administration/advocacy training part... just like APA ethics... there are NASW ethics... and that code of ethics is based upon this principles... and those are just the underlying guidelines for practice... I never took a class in how to be an advocate... but in my practice classes (since I was in a clinically focused program, I had multiple practice/assessment classes)... we left from a starting point of meeting the client where they are in that moment... almost humanistic in its approach.

    I agree with you wholeheartedly that 2 years is not enough time... and sadly, I've seen that few people go above and beyond to secure additional training. That is NOT, however, representative of incompetence of an entire group of practicing social workers. I'm just as guilty of bashing... I have a spectacular bias against counselors in my state for their lack of training here... it's frustrating to have spent 5 years cleaning up the messes of lesser trained or more arrogant individuals... 1 psychiatrist and 2 psychologists included. People are people and are prone to flaws regardless of their educational background...

    Since my pet peeve in life is pitiful assessment/diagnosis, I don't mind taking a stand and saying that I have serious issue with anyone who sees it as a one time event. I have always learned, since my first tests/measurements class, that it's fluctuating and a living/breathing thing that should evolve as the client evolves. Unfortunately, that's not the nature of mental health in my state right now. To survive, psychologists are no longer individual practitioners, they are assessment monkeys. They might see a client once a year to pop out an assessment and that's it... and in my mind, that's a horrible ethics violation... why agree to diagnose someone based on one event without follow-up? If there's a contract for collaboration, perhaps that's one thing... but collaboration implies ongoing consultation efforts as well... which I haven't seen in my work.

    I disagree with you on the system/competency issue... I think the system should be absolutely required to accurately and clearly define expectations for all of its DHHS practitioners from LPN's to janitors... without those definitions, it's left up to individual judgment... and if you have someone who already sucks... chances are they are not going to have the knowledge level to understand that they should take a step back instead of moving forward.

    So, the conclusion of my 20-minute typed novella is as follows... and as it was before... social workers are no more incomptent, as a group, than other clinical professionals. I don't have data to back it up so i put it out there as an opinion, not as fact. I am seeking a doctoral degree in clinical psychology NOT because social workers are horrible... but b/c that best meets my needs and my abilitiies. There is room in this profession for everyone... if you don't like the direction your field is taking, then learn from us social workers and advocate for your rights... also learn from social workers and try not to step on others as you go after what you want.

    In my state, for the kinks to work out, it's going to take change at every single level. It's going to take the consumers stepping up and raising hell. It's going to take the legislators getting their thumbs out of their asses and re-tooling their failboat. It's going to take psychologists sticking to their own ethics and NOT providing services that they are just going to bitch about later... same for social workers and counselors. I don't believe in kicking kittens... so I don't do it... how freaking hard is that??? Individual responsibility with an awareness for the needs of others... reporting irresponsible and unethical behavior to your licensing board, other licensing boards, and the DHHS immediately after an act occurs, etc, etc, etc.

    Ok, as much as I love procrastination, I think I'm out of high-horse juice now... Peace. PS, no hard feelings JS, I am worried about mental health too... but your argument isn't going to win any prizes... keep it consistent and bring facts if you want to garner support. Otherwise, the people you recruit into your cause are not going to be people capable of change... only those who are unclear/unsteady are influenced by propaganda/rhetoric. Happy holidays.
     
  5. Jon Snow

    Jon Snow Senior Member
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    This type of empirical argument is a fallacy. . .an often repeated one. If we were to take this argument to infinite regress, it would mean no rules until there is empirical support to the contrary. In other words, I, as a psychologist, can perform neurosurgery. The local publix bagger can be a CPA. The hairdresser can be a murder trial defense attornery. . . until empirically proven incompetent. There are so many permutations to consider in this type of outcomes research that it's completely untenable. Instead, we must make logical inferences and decisions based on what we think/know is important as a knowledge-base and skillset for practice, with sprinkles of empricism. Think about outcomes research that asks the patient for example. Patients will attest to almost anything if you sell it well enough. . . *insert holistic medicine nonsense here* *insert religious babble here*. That doesn't make it correct. Also, given the current state of the field, it would be like putting out fires. As soon as proved or suggested that one group is not competent for one thing, they'll just expand to another or alter their training methods (without testing the effect of the alteration) and then say, well you have to test whether we're competent with the new training standards. . . nothing will stop them from practicing except legal intervention and that's a game of money, not logic. Would, for example, optometrists be real happy if psychologists started doing vision evaluations. We did invent their methodologies, afterall? What would be the argument?


    I've only recently considered this particular question. I see some interesting data about theoretical orientations (e.g., most social workers identify themselves as psychoanalytic in approach in one study. . .weird). I also didn't call anyone out for not using empirical arguments per se. What I said was

    In other words, some form of logic or data that can be discussed. I mentioned empirically supported treatments and scientifically reasonable treatments (rebuffing the neuro explanation for EMDR), but that's a very different thing.

    Btw, the quotes I gave for my "quack" example was the first MSW link I clicked after searching MSW Therapist. . .didn't have to sift too hard.


    Oh, and no offense taken or intended. I'll respond more later.
     
    #5 Jon Snow, Dec 22, 2008
    Last edited: Dec 22, 2008
  6. biogirl215

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    I have yet to see an MSW program that spends a whole year focusing on advocacy and have seen many that spend both years focusing on clinical work. Even at my school's MSW program (which is "generalist" but still micro-focused), students are in clinical internships for both years.

    I agree that more training is almost always good (provided it's competent, well-supervised training) but would like to point out that MSW/LCSW's aren't trained or licensed to do assessment (anything beyond, say, a BDI) and that they shouldn't be practicing it, as it's out of scope. Also, LCSW licensure requires about twice as many post-degree hours as Psychologist licensure. Does this "make-up" for internship and so on? No, of course not. But given that LCSWs have a more limited scope of practice (no assessment) and a longer post-degree training period, it does help "level" things somewhat.

    Couldn't they use quantitative assessment scales (all administered by PhD Psychologists ;) ) like they do in most outcome-based research (BDI, Y-BOCS, SENS, etc.)?

    Nope. A defense of grief therapy, not EMDR. Getting to know a lot of my psych professors outside of the classroom (through research, advising, office hours, etc.), I can say that while they all respect/believe in/utilize EBM to some extent, I have yet to meet one who utilizes JUST EBM without bringing in their personal, cultural, religious, and so on experiences in the fray. One even said that he didn't believe in recommending for or against any particular treatment for depression, as he felt that was the client's judgment call, not his... (I, personally, was shocked to hear this--seemed like it should be a matter of clinical judgment--but he cited a study showing that depressed patients improved significantly more when given a treatment modality of their choosing (meds, therapy, or meds/therapy combined) regardless of what the actual modality was...
     
  7. Jon Snow

    Jon Snow Senior Member
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    Ah yes, which gets me to another argument which is actually going to hurt me here. A lot of effect in medicine and psychology is about rapport. . . the therapeutic milieu. When it comes down to it, we don't operate in a vacuum. Personality, presentation, expectancy, culture. . . all play into our ability to relate to and help patients. Without it, it doesn't matter what therapy or theoretical orientation is chosen.
     
  8. Jon Snow

    Jon Snow Senior Member
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    New Yorks LCSW requirement. 12 credit hours?
     
  9. WannaBeDrMe

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    Precisely, they could and they do... program evaluation. Where did I learn that process... hmm, oh yeah, my MSW program. Granted I only had 12 hrs of research classes and a program evaluation project and a thesis so I didn't get that in depth... and I'm not even being a smart ass, there's no way masters level research training compares with doctoral level research training. Still, for what its worth, the tools are offered with the intent that social workers will use the framework to evaluate practice issues... just like everyone else.

    JS, sorry if I misquoted you, I probably saw what I wanted to see during first read through... like I said, I agree with the idea in some form... just not the one I think you are expressing through these posts. I went back to the one of the first posts on the topic which I never even responded to but I feel like it has a few things I can address...

    You admitted problems at your level but seem to be able to separate the good practitioners from the bad practitioners... why is it so difficult for you to tease them apart in social work? Legitimate questions for you, just to better understand your frustration, are as follows...

    1. What types of research experience do you feel makes someone qualified to "understand" theory/practice issues?

    2. What level of theoretical background do you think should be required of a clinician? Do you apply this across the board to psychologists/counselors/social workers/lmft's/speciality therapies (music, art, movement)?

    3. Who do you think social workers get to see? To clarify, what exactly is the process by which you believe social workers are trained, in general?

    As far as the social work requirements in your state, what are the psychology requirements? Yes, masters psychs have to be supervised but if we are being realistic... how many of those supervisory relationships are intensive and how many are just signing off on a log?
     
  10. Neuropsych2be

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    It occurs to me in reading this debate that for doctoral level psychologists, RxP is an example of "scope creep." :) Interestingly, this is a trend across all health care. The coming war ... and folks I think it will be an all out war... in the medical field about the appropriate title, autonomy and clinical role of "doctoral level" nurse practitioners (with the DNP degree) mirrors this concern about "scope creep" in our field. Driving all of this is cost containment. If someone with less education (meaning cheaper) can *seemingly* do a similar job, the the prevaling economic and political forces trump any concerns about quality. My 20 years of professional work with an MS in clinical psych convinced me that the difference between a master's prepared clinician and a Ph.D. prepared psychologist was a couple years of coursework and a dissertation. Now that I am working on my Ph.D. I see how wrongheaded I was. There is an enormous difference between my knowledge base and clinical sophistication as a MS level therapist and my growing skills as a Ph.D. student. The differences are not just quantitative in terms of years of school etc... but qualitative as well. I almost feel as if I am entering another profession! :) In my experience, a doctoral level psychologist *thinks* differently than most MA, MS or MSW prepared therapists, approaches case conceptualization with greater clinical and technical sophistication, has a larger armamentarium of assessment techniques, and is in a better position to utilize empirically supported treatment due to our greater training in advanced research methodology. However, testing this qualitative difference empirically would be an interesting dissertation topic, if it has not been done before :)
     
    #10 Neuropsych2be, Dec 22, 2008
    Last edited: Dec 22, 2008
  11. WannaBeDrMe

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    This is a within my own state comparison of a clinical psychology masters program with a clinical social work masters program. I am saying nothing about the quality of either program nor the quality of students it produces. Just putting two real life examples out there to ponder...

    Pulled it out, too long, pm me for information if you are interested in specifics, I have it saved.

    So, it looks like a clinical psychology 48 hr masters degree with <500 hr practicum will get you an LPA with 4 hrs of supervision a month if you are doing over 31 hours of clinical work per month. Is that right? I'm seriously asking, I have no idea. No independent practice but 4500 supervised hours before moving up to a more independent level of supervision.

    Now for clinical social work... 62 hr masters degree with 1200 hr practicum will get you a PLCSW w/1 hr of supervision for every 30 hrs of clinical work (1 per week if you are working full-time clinical). 3000 total hrs post degree supervised practice to independent practitioner.

    Both have exams, both had comprehensive exams, both had thesis projects, both had classes in theory, etc. I've compared to counselors before but never psychologists, interesting.

    So, based on this (and maybe the specifics I have waiting for ya in pm) would you say that masters level psychologists are also incompetent by your definition? Again, I feel like I have to keep putting disclaimers, but I mean that with sincerity and not mockery...

    As a totally unrelated aside, I just read that NC's advocacy group for masters level psychologists were actually pissed that LPA's were kept out of EMDR trainings b/c they lacked the ability to practice independently. I don't like EMDR so I don't care one way or the other... but I think it's funny that the people upset over being excluded are the ones who share at least 1/3 of your training.
     
    #11 WannaBeDrMe, Dec 22, 2008
    Last edited: Dec 22, 2008
  12. WannaBeDrMe

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    yes, definitely different, no doubt about it... but necessarily better? if so, better by whose standards, the client's, the professional colleagues', the drug companies', etc. I absolutely crave that greater understanding and that's why I'm moving on but I am not willing to concede that remaining a master's level clinician would have damaged anyone beyond repair. (other than myself... ha)

    I love your observation of RxP being pretty much the same bunch of grapes, different fruit basket. Pots and kettles and credentials oh my! I'm going to use this thread as my promise to myself never to bash LPC's again... the fingers wag in many directions.
     
  13. biogirl215

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    I'd to see the information you pulled WannaBeDrMe.

    FWIW, I run a seminar for undergrad. students doing psych internships and had an MA Couseling student and a PhD Clinical Psych student with a previous MA in Counseling come in and talk about their programs, experiences in grad school, etc. They both said that turf wars in the field were somewhat overblown and that there is a ton of crossover between MA-level therapists, LCSW's, and PhD's in clinical practice (and interestingly enough, mentioned that one has to pick up some advocacy/social work-type skills when working with at-risk populations as a clinician). Just throwing that out there...
     
  14. Therapist4Chnge

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    But with RxP there is RESEARCH that supports Clinical Psychology to fill the need effectively.

    Exactly.
     
    #14 Therapist4Chnge, Dec 22, 2008
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  15. Therapist4Chnge

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    I know some states (though not all) have "psychologist" as a protected term that required doctoral training.....so "masters level psychologist" is generally a misnomer.
     
  16. WannaBeDrMe

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    True, sorry to generalize, my state is actually one of those... I'll try to be more respectful in future posts. I know I hate it when social worker gets tossed around to fit every person who ever worked in any helping profession.

    re: the specific information, sending it your way now biogirl, since I'm posting it in pm, I'll also include links to the school's websites in case you want to look at it more, I thought it was really interesting... I've never taken the time to look and see what master's clinical programs were about... there are so few out there it seems...
     
  17. Neuropsych2be

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    Well now that you mention it. Yes there is research to support it. In fact I just coauthored an invited paper on the RxP issue that will be coming out in the Journal of Contemporary Psychotherapy in Jan 2009. :):)
     
  18. Jon Snow

    Jon Snow Senior Member
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    I agree! For what it's worth, I generally don't support RxP for psychologists. Though, I also think this should apply to others as well, e.g., optometrists and the various assortment of midlevels (e.g., nurses, physician's assistants) that have prescription priv. I disagree with that trend. So, it's a tough one for me. On the one hand, I see and believe that physicians are the pharm intervention folks. I bow to their greater knowledge/training/expertise in that regard. But, I do not recognize a similar divide amongst other groups that are able to prescribe. That makes the decision more difficult as we move forward.
     
    #18 Jon Snow, Dec 22, 2008
    Last edited: Dec 22, 2008
  19. Jon Snow

    Jon Snow Senior Member
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    I have no idea. I'm really not too familiar with this stuff. I kind of bipassed the whole masters thing. I'm learning here as we go along.

    Just a nitpick, but there is no such thing as a masters level psychologist (exception: school psychologist, but the school modifier is necessary).


    . . .and I would put them (masters level) on approximately equal footing to social workers in my current understanding of the situation. And, I'm not arguing that social workers are incompetent as a whole, only that some are operating outside of competencies (e.g., diagnosis) and scope creep (I like that term) promotes more and more risks of that kind of situation.
     
  20. Neuropsych2be

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    My MS degree in clinical psychology was 60 hours of graduate work, an empirical thesis, and 1400 hours of practicum! Took me three years full time (groan) and none of my credits transferred into my Ph.D. program because they were too old at > 5 years old.
     
  21. Jon Snow

    Jon Snow Senior Member
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    Terminal masters programs are a different beast, generally not affiliated with doctoral programs. EDITED TO BE LESS STUPID. I'm not sure if it's quite accurate to say 1/3 of PhD/PsyD training. Because the programs are not connected, we're talking a different curriculum, different type of student, different governing bodies and lobbies, and different faculty.

    They are just as much of a scope creep problem as anyone else.
     
    #21 Jon Snow, Dec 22, 2008
    Last edited: Dec 23, 2008
  22. biogirl215

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    Just to play devil's advocate (not the pinball game, though you rock if you got that reference :) ), isn't there a real need for mental health practitioners in general, especially in rural areas? I want to practice in a rural area with an underserved population, and in many of areas where I want to work, there's almost NO practitioners of any type (MA, MSW, PhD, PsyD, MD). Sure, NYC, CO, and Cali are saturated. The rural northwest? Not so much.

    I do agree that research training is ultra-important, and, imo, should be emphasized MORE at all levels, including at some research-weak PsyD programs. No question about that... In fact, I'm applying to PhD programs because I love doing research and see a ton of value in it in regards to clinical training and practice. On the flip side, however, I know grad students in my university's Clinical PhD program who flat-out admit that they are *far* more interested in practice than research and are more than happy to do the minimal requirements of a thesis and dissertation and get out (this, of course, does not represent all the clinical students here... I also know some who are "balanced," and some who are far more interested in research).

    In fact, I think it would probably be a good idea for clinical-track MSW programs to require a degree in psych or substantial post-BA psych education and place more of an emphasis on research.
     
  23. Therapist4Chnge

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    No way this would ever happen....as it would eliminate most of the people going for the degree, as they wouldn't want to jump through those hoops.
     
  24. cara susanna

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    I gotta say, most of the people I know in MSW programs are in them because they hate research, or at least don't like it that much.
     
  25. Neuropsych2be

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    Well if one wishes to argue the equivalency of an LCSW and a Ph.D. in clinical psychology, perhaps we could agree that a Ph.D. or DSW (Doctor of Social Work) degree should be the minimal educational standard for the independent practice of clinical social work :D One issue I see here, after my 20 years experience in mental health is an inferiority complex social work as a profession seems to have vis a vis the other professions. Yet social work is a very very honorable profession with theoretical links to sociology. psychology and anthropology. Perhaps clinical social work should be a doctoral level profession where students conduct empirical dissertation-level research with clinical training on a par with that of psychology psychology e.g. 6000 hours of supervised experience prior to licensure. Certainly with an enlarged research base to inform practice, the dissertation research generated by Ph.D. students in social work could be of immense help to all the professions given their unique perspective. Of course the NASW would never go for the transition to the doctoral level for LCSW's since they have spent so much time advocating for the viewpoint that MS level training as adequate. One problem LCSW's are going to run into are LPC's who typically have equal training as LCSW's (60 hours grad work in counseling or psych and 2000 hours of post-degree supervision) advocating for things such as Medicare reimbursement. But you are right T4C, that prospect would scare off half the student body in social work.
     
    #25 Neuropsych2be, Dec 22, 2008
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  26. biogirl215

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    Actually, I do know of at least one MSW program (Smith), which requires a fairly substantial empirical (clinical) thesis--not the same level as a dissertation, of course, but it's something.

    Don't most states require 3,000 hours for LCSW licensure? That's what I thought, but I could be wrong...

    I've had professors in my social work program argue that this is due, at least in part, to the fact that "social worker" is just now becoming a protected title.

    Could you elaborate on what you mean here, please? Do you think is warranted or not? I'm curious.... :)

    I've never seen anyone argue for equivalancy (and if they did, that would be really, really foolish, imo). All the social workers I've been around have deferred to PhDs in terms of assessment and research (as they should!)--the most I've seen argued for was the idea that they could, with training, be equally competent therapists (including therapeutic assessment and dx). FW(little)IW, I have known some clinical psychologists (professors) to recommend that students who want to do just therapy work (and have little interest in academia) consider MSW programs, as they believed MSW/LCSWs are/were competent clinicians. Just throwing that out there... Like I said, I believe there's real value in doctoral training (I wouldn't be applying otherwise), but I think it's somewhat rash to dismiss LCSWs as incompetent across the board.
     
  27. Neuropsych2be

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    I am just playing out this idea to its logical conclusion with a certain degree of tongue in cheek! I'd never ever ever say that LCSW's are incompetent. They make excellent therapists and advocates for their clients. Can anyone say Virginia Satir?? In fact, clinical psychologists can learn alot from them about advocacy and how to organize. I wish to god that someday the APA sits down with the NASW and actually learns from them how to advocate effectively in terms of public policy because the NASW puts APA to shame! However, the professions are different with a very different skill set. Clinical psychologists are in fact far more than therapists. we (both Ph.D. and Psy.D.'s) are scholars and scientists as well as clinicians. LCSW's are more than therapists, they are advocates for personal and social change and are able to work within systems and against systems to advocate for their clients. What I am saying is that each profession is very distinct with very different strengths and skill sets.
     
  28. Jon Snow

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    I don't understand how these statements are congruent. In my opinion, social workers should not be diagnosing. The risk is too great. I'll give you an example. I was working with a social worker on a case in which the father was a single parent (the child was the patient). The father was going to social work groups and meetings and falling asleep. The social worker kicked him out, told me he thought the father was on drugs, and not making an effort, among other things (I was a graduate student at the time). I watched the guy during various sessions, etc. . . I didn't get the impression he was disingenuous or on drugs. He seemed interested in helping his child. I did notice lethargy and slurred speech on occasion. So, I started asking about medical history. I grew very suspicious and rec'd a neurological evaluation, which he followed up on. Brain tumor. Unfortunately, he died. The social worker was not incompetent. The social worker was not a jerk. They simply didn't know enough to make the medical referral. This kind of tragedy happens with psychologists, psychiatrists, and primary care physicians too. I'm not saying the issue is isolated to social work. Women are diagnosed with hysteria. . . yes, still, but actually have something more serious. People are treated for depression for years when the problem is an under-active thyroid. People are treated for bipolar disorder when they really have fronto-temporal dementia. Again, the problem occurs across disciplines. But, we don't need to set people up for failure. In my opinion, this is an area in which going midlevel. . . expanding scope of practice, is bad for everyone including the social workers.

    The problem for me is social workers are not supervised. They are independent practitioners. Diagnosing mental illness/behavioral presentations requires a lot more than just knowledge of the DSM. I don't see how a license that requires "at least 12 hours" or clinical coursework can possibly be adequate. In my opinion, doctoral level psychology also needs to beef up their biological/neuropsych educations. Accurate diagnosis is important. Beyond the medical co-morbidity issue is a lot of subtlety in determining normal versus abnormal, parsing various conditions, and painting a useful clinical picture (beyond any specific diagnosis). Further, harm can be done by mis-diagnosis.

    I agree, it's rash and unfounded to dismiss LCSWs as incompetent across the board. I think you'll find some clinical psychologists that make that rec (and I'm guilty; I think I've even done it on this board) do it out of cynicism. . . the idea that therapy is not a doctoral level skill and does not require specialized knowledge. It's considered effective (depending on the problem), but not necessarily specific.

    But, it's a discretion issue. You wouldn't send a head banging autistic child to outpatient therapy, ideally. You'd send him to the neurobehavioral unit at Johns Hopkins, or whatever. So, my caveat is, I would send someone that needs to talk through their problems, say for a reactive depression, or something along those lines to a social worker, comfortably (though not if they advertised shamanic soul cleansing therapy). That's supportive therapy. I wouldn't send someone with a specific phobia, PTSD, various personality disorders, OCD, etc. . . to a social worker as a primary therapist. . . and certainly never for diagnosis.
     
    #28 Jon Snow, Dec 23, 2008
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  29. Jon Snow

    Jon Snow Senior Member
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    Yep and taking on diagnosis and "therapeutic assessment" roles dilutes that strength.
     
  30. Therapist4Chnge

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    Agreed. I think the horse is out of the barn on this, but I think there are far too many things that could go wrong to not have supervision. The Dx piece in particular. Many times once a label is written down....it sticks.

    12 hours of pure clinical coursework is a drop in the bucket when it comes to training. Reading Gray's Anatomy (the book) does not make someone competent to effectively diagnose, and the same can be said about the DSM. There are SO many other things that go into a Dx: Cog, neuro, behavioral, projective, objective, etc. Those assessments provide the differentials that can't be had from strictly a clinical interview.

    I didn't know what I didn't know until I started my MS in Pharma. I had to take orgo, A&P, biochem, pathophys, etc. It isn't that I am advocating for all of that, but taking single courses in Pharmacology, Psychobiology, and maybe Neuroanatomy is hardly sufficient nowadays. I think more neuro-based courses need to be required.
     
  31. biogirl215

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    I disagree that LCSW's (and other master's level practitioners) can't acquire the skills to effectively dx and treat psychological disorders. In fact, I would argue that they need to be able to because clients will present with those d/o's or at least symptoms of them. Clients may present with a chief complaint of "anxiety" that is actually OCD or a specific phobia or "sadness" that is actually MDD and/or part of bipolar. A good clinician needs to be able to recognize this and handle it and then make appropriate referrals if necessary (to clinical psychologists for additional testing, MD's for meds or medical rule-outs)

    For example, I work in substance abuse (undergrad intern) where all our clients are mandated for MIPs, dorm write-up's, etc. One of my fellow interns (an MA Counseling student) had a difficult client who she suspected may be bipolar based on his bx in the group. She obviously couldn't dx him without an individual session, but recognizing that possibility changed the way she handled the situation--being trained in diagnosis kept her "antenna up," so to speak, even in a situation where we weren't necessarily expecting to see psychopathology.

    Are all MSW's trained to diagnose and treat disorders? No. But many have had the courses, training, supervision, etc. (and passed a state licensing exam) to allow them to do so. They aren't just getting the MSW curriculum--they're also getting supervision, etc., in the area.

    I agree that medical rule-out's need to be done carefully, and that this is something that needs to be improved, even among clinical psychologists. I think it's a bias of the fields (clinical psych, counseling, lcsw's, etc.) to approach and treat behavioral/emotional issues in a psychological manner, and that this can sometimes "blind" practitioners to the possibility of strictly organic causes (poor wording but hopefully you can follow me) of these issues.
     
  32. Neuropsych2be

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    I just took a look at the MS in pharmacology at Nova. The courses seem far superior to what a typical mid-level NP or PA might get in the sense that the coursework seems very focused. The only concern about such a curriculum is the whole issue of psychotropic drugs interacting with other pathological condition outside the central nervous system. But the curriculum looks impressive. If this is scope creep then it is very nice and very comprehensive scope creep :laugh: I'd love to take a course sequence like that but organic chem and biochem for your typical psychologist with a liberal art background would be challenging to say the least.
     
    #32 Neuropsych2be, Dec 23, 2008
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  33. BohuMSW

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    This thread should (and the closed ones that precede it) should be required reading for prospective clinical social work students. It highlights a few of the joys of being a social worker.

    1)you'll get to work mostly with two types of psychologists. One type will be like Jon Snow, and be openly condescending and dismissive of your abilities. The other type will also generally think you're an idiot, but will be too nice to talk like this around you.

    2)expect plenty of backhanded praise from other disciplines such as "social workers do have excellent skills in providing support and advocacy," i.e. they are good at things any reasonably intelligent person could have figured out how to do without getting a masters degree.

    3)Despite the complaints about social workers assessing and diagnosing, don't expect your psychologist co-workers to be leaping to accept your referrals for testing and assessment.

    4)Do expect your psychologist co-workers to refer every single task that might be related to one's "social" functioning to you. Expect calls asking things like what are the local bus routes home from the clinic, or my favorite "the patient I have been seeing for two years asked me to fill out a form for his work, can you do it?" Or, "my patient with depression is depressed because he is in bankruptcy, could you see him, I only treat his depression?"

    5)Everyone thinks you're an idiot. If you work extra hard, keep up with current literature/research, have a track record of success, take a leadership position, etc. they might rethink that. Now they'll both think you're an idiot and resent you.


    On the other hand there are some valid reasons why people see us this way. A few that come to mind:

    1)we accept anybody. anybody with a pulse can get an MSW. Regardless of what it says in other threads, our programs aren't selective, and they are incredibly easy. Garbage in, garbage out.

    2)Our curriculum is filled with 60's/70's platitudes. Expect liberal indoctrination about how "western" culture is individualistic and shallow, whereas "eastern" cultures live in harmony and joy. Jon Snow is wrong about there being a "social justice year." I'm not sure where he got that, but learning absurd "facts" like "dangerous radicalism almost always rises from the right wing" and "Husserl was the first existentialist" made it into my "human behavior" classes.

    3)our professional organization, the NASW is extremely obnoxious. Expect to hear their views on how you should vote, what you should believe, and I better stop before the black maria arrives at my door to carry me off for re-education.

    I try to not get hung up on this stuff. You learn solid clinical skills in MSW programs that can help a lot of people. I'm sure the same is true for clinical psych. There will always be total tools who get a lot of satisfaction out of hating on each others disciplines sort of like i did in the first part of the post. It's amusing yes, but ultimately pretty stupid. I'm sure I could walk on water, cure severe TBI with my touch, and end world poverty tomorrow, and someone like Dr. snow would still have a "yes but" to disparage social work.

    I think "scope creep" is dangerous, but I don't really think that's what this thread was about at all. It started as a "are social workers incompetent? Why yes they are!!" thread, and changed to a "make a few valid points about scope, then say social workers are incompetent" thread.
     
  34. psychmama

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    As someone who made the difficult decision to start over in a new career as a psychologist in part to escape the obnoxious elitism and smugness of my former profession (lawyer), all I can say is that I'm embarrassed. I do not agree with the tone of most posts on this thread, and it makes me ashamed to call myself a psychologist in training. Maybe it's the fact that I come to this field with more life experience, but the idea that any profession has cornered the market on competence and intelligence is just ridiculous!
     
  35. Jon Snow

    Jon Snow Senior Member
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    I'm not disparaging social work. I'm disparaging scope creep. Btw, that leftist garbage is really obnoxious. But, I digress.


    Sure it is. If we weren't talking about social workers diagnosing and generally doing things beyond scope, no one would be irate. I understand that social work can be a thankless job at times. Often no one is happy with you. But the bonus is, you do make a difference.
    Even my original response in the closed thread had a context attached to it.
     
    #35 Jon Snow, Dec 23, 2008
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  36. Jon Snow

    Jon Snow Senior Member
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    No doubt, who claimed that?
     
  37. psychmama

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    Jon, go ahead and pick apart arguments sentence by sentence. More telling, IMHO at least, is the overall gist and tone of your posts. Your points are sometimes well-taken, for instance about the need for better training of psychologists and the problems with professional schools. Honestly though, are you planning a career in clinical work? Because I have to say that your manner of expression is quite off-putting and sanctimonious.

    I know this is not the well-reasoned, evidence based response you would prefer. It's just a gut reaction from a fellow human. Sheesh!
     
  38. BohuMSW

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    I wouldn't take it too seriously, it's just the internet. Plus, i don't begrudge psychologists some griping. If you complete a doctorate you should be at least entitled to get all "Dey took 'er jobs!!!" now and again with those of us who swooped in with merely a masters. Like snakes in the grass if one is fond of mixing metaphors which i am. I'm also fond of all the psychologists I work with.
     
    #38 BohuMSW, Dec 23, 2008
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  39. psychmama

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    You're right, of course. It's just the internet. I find it scary that the anonymity of the forum allows people to show a side of themselves that I gather they hide rather well in "real life". :)

    Of course, I could be wrong...
     
  40. Jon Snow

    Jon Snow Senior Member
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    Heh. I've seen this style of response before. Notice, I haven't attacked anyone, but I'm sanctimonious and a *implied* poor clinician because of my style of posting on a messageboard and because I support high standards and worry about the product mental health providers represent to the public and other professionals. But instead, this constantly is interpreted as if I'm playing turf war and being elitist. Right, right. This is self-serving. In case you haven't noticed, mental health as a collective enitity has taken major hits in reputation in the public eye because of a lot of the things that I talk about. And yes, I'm pissed about it. I'm pissed that psychology in undergrad is an easy major and that the field (mental health in general) is full of fluff non-thinkers that like to make goofy political statements and have a tendency to pursue any half-baked "theory" with gusto. It's annoying. . . . as if this has anything to do with my ability to establish rapport or show compassion for a patient. . . or anything to do with whether or not I'm a nice guy. Yeah, I care about the field.
     
    #40 Jon Snow, Dec 23, 2008
    Last edited: Jan 5, 2009
  41. psychmama

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    You may be a nice guy. I have no way of telling that except by what you present on these boards. And yes, I can tell you're passionate about the field and want to promote its standing and reputation. I've been around the block a bit, and I would simply point out that (as Grandma used to say) "You catch more flies with honey than you can with vinegar." Like it or not, people will be much more inclined to listen to your arguments if you deliver them with humility and good will. You probably think this makes me a mushy thinker, one of those undisciplined "feel good" types. Maybe I am. I'm also a pragmatist and trained in the art of persuasion (law school and 11 years of practice). Think about it. Reject as you will. It's just my viewpoint.
     
  42. Jon Snow

    Jon Snow Senior Member
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    It's a matter of context what works and what doesn't. I generally agree with you. . . positive is better than negative. But shocking sparks debate. One of my best friends (yes, I have friends) is a very successful trial attorney. Honey doesn't come to mind. Shark does.

    Debate makes people think. If you go back and read what I've said in this thread, nothing I said was presented in a negative tone. Sometimes people aren't going to like an opinion; doesn't matter how you present it. I think people listen to what I have to say.
     
  43. Jon Snow

    Jon Snow Senior Member
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    Probably, that constitutes a good portion of the field and probably accounts for a nice amount of variance for what's wrong with it. :)
     
  44. acidicspecies08

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    Heres a thought, which you can take with a grain of salt since I'm only a junior in undergrad, but could it be that social workers tend to collect more "fluff non-thinkers" due to the shere size of their group? This is kinda my "the bigger the village, the more idiots you get" theory. I bring this up simply because I have heard from a few professors of mine that social workers are the largest providers of menta health services in the country, and as such they porbably have a bigger number of quacks to match their bigger number overall. Just a theory, be gentle with me *cowers from JS*
     
  45. cara susanna

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    Sorry, would you mind listing some examples? I'm curious. Or does this tie in with the complaint that the APA is constantly releasing statements on government policies without providing scientific evidence to back them up?
     
  46. Jon Snow

    Jon Snow Senior Member
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    Hi there! Sure, sure. But, I don't think social work corners the market for fluff non-thinkers. It takes a certain type of person to go into social work (and mental health in general). Some of those qualities are good, a desire to help people, both individually and from a collective sense. . . a sense of fairness, compassion, etc. . . But, in addition to that, you have people that, for whatever reason, aren't particularly concerned about money. Money does drive quality. Plus, there are the admissions standards to consider across different mental health education options, and then curriculum content (how do we equip students/future professionals to evaluate practice options), etc. . .
     
  47. Jon Snow

    Jon Snow Senior Member
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    correct and also the political slant of social work that was earlier mentioned. . .
     
  48. biogirl215

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    Wait. I'm confused here--is the argument that social work (LCSW) has a disproportionate number of "non-thinkers" or that mental health in general (PhD, PsyD, LCSW, MA/MS, MD) has a disproportionate number of "non-thinkers"?

    And maybe I'm reading this wrong, but I really don't see how you can support social workers has clinicians without giving them some of sort of diagnostic scope. Isn't that a necessity for working with clients?

    I agree that LCSW's should have supervision and that all mental health clinicians should have or could benefit from supervision. I think (in my very limited opinion/experience) that there's A LOT of value in supervision.
     
    #48 biogirl215, Dec 23, 2008
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  49. Jon Snow

    Jon Snow Senior Member
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    I don't know. Nurses don't really diagnose across the board. They have their own system for dealing with things. I guess the way I look at it is that social workers are advocates/case managers/supportive therapists (ideally). They need to know enough to recogniize when and to whom a referral should be made. Perhaps this might merit a different diagnostic system with a different set of emphases and actionables.
     
  50. Jon Snow

    Jon Snow Senior Member
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    Both.
     

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