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Misplaced referrals to the Division of Vocational Rehabilitation - DVR; or Vocational Rehabilitation Services - VR; made without "Team Care" support
Neil J. Gillespie
In my opinion
Unfortunately well-meaning organizations make ill-fated referrals to DVR (Division of Vocational Rehabilitation), such as this publication by the Cleft Palate Foundation, but they fail to mandate "Team Care" that would ordinarily be the standard.
In my view, without Team Care, application to DVR is doomed. In my case the two Florida psychologists (see below) were so outraged about providing services for a "cleft palate" (actually a speech disorder, velopharyngeal incompetence), that they missed or overlooked markers of traumatic brain injury.
- Mark Justice, Ph.D. Clinical Psychologist, later identified as Marcus T. Justice, license number PY2327, died in 2004.
- Mark C. Klisch, Ph.D. Clinical Psychologist, license PY3077
Teams are comprised of experienced and qualified professionals from medical, surgical, dental, and allied health disciplines working in an interdisciplinary and coordinated system. The purpose and goal of Teams is to ensure that care is provided in a coordinated and consistent manner with the proper sequencing of evaluations and treatments within the framework of the patient’s overall developmental, medical, and psychological needs. See Parameters, ACPA, Revised 2009
Also see, Team Approval. Commission on Approval of Teams
A paper "A Grammatical Analysis of the MMPI-2" by Florida lawyer Elizabeth J. Kates, Esq. shows issues with the MMPI-2, likely in conflict with Team Care and the ACPA’s Parameters For Evaluation and Treatment of Patients with Cleft Lip/Palate or other CFAs.
Unfortunately it has taken me about 21 years to understand the WRAT-R2 test results.
The Wide Range Achievement Test (WRAT-R2) results reported on or about March 29, 1994 by the Florida Division of Vocational Rehabilitation (DVR) after I sustained traumatic brain injury on August 20, 1988, show a decline of my arithmetic ability (WRAT-R2 grade score 7.4 ) when compared against my actual Grade A: Statistics 101 Spring 1986, earned at the University of Pennsylvania, Wharton School, Evening Division (equivalent WRAT-R2 score 13 ); and successful operation and sale of my car business and property, sold June 29, 1988 for $1.9M.
The DVR WRAT-R2 arithmetic grade score (7.4 ) is an outlier observation point distant from the WRAT-R2 reading grade score (12+ ) and spelling grade score (12B ). The Florida DVR WRAT-R2 arithmetic grade score (7.4 ) is an outlier compared to my actual grade (equivalent WRAT-R2 score 13 ) by almost half.
The WRAT4 was published and sold by PAR Psychological Assessment Resources, Inc. ("PAR") located in Lutz, Florida through July 2015. I contacted PAR about my WRAT-R2 score to no avail. I also recently contacted Florida DVR and learned it out-sources testing now. My doctor was unable to opine on the test because he is a MD and not trained in psychology.
I have degrees in business and psychology. My disabilities impede certain mental functions, but do not significantly impair intellect. While I may be slow, I am not retarded. That is my understanding. I also just realized two of the State’s psychological assessments are missing from its assessment. Florida DVR’s vocational screening states on page one of the report: An unadjusted vocational profile was developed from the job history. In order to confirm or deny these abilities the following information and tests were utilized Medical Information from,
Pamela Kynkor M.S. dated 6/15/93
Jane Scheuerle Ed.D dated 6/2/93
Noreeen Frans M.S. dated 7/2/93
Mutaz Habal M.D. dated 5/5/93
Wide Range Achievement Test
Shipley Institute of Living Scale
General Aptitude Test Battery
United States Employment Service Interest Inventory
Florida DVR’s Vocational Screening failed to disclose psychological assessments done by two of its contracted psychologists,
Dr. Marcus T. Justice and Dr. Mark C. Klisch,
or the results (or lack thereof) from the MMPI, the Minnesota Multiphasic Personality Inventory (MMPI). See DVR's Vocational Screening of me below in PDF, together with my IWRP - Individualized Written Rehabilitation Plan.
Financial_Assistance Cleft Palate Founda[...]
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1994 Vocational Screening by FL DVR+IWRP[...]
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29 page composite, Wikipedia introduction
Wide Range Achievement Test - PAR.pdf
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Testing the Marketplace - Bob and Cathy Smith - PAR
By: Business Observer
April 15, 2010
Company: Psychological Assessment Resources Inc., Lutz.
Industry: Testing resources for professional, educational and corporate
Key: Owns publishing rights to the Self-Directed Search, a popular online career choice tool.
Double-digit unemployment has a way of forcing people to examine what they do for a living and what career changes they should make. For R. Bob Smith III, that means opportunity for his quiet company tucked away near Interstate 275 in Lutz.
Smith and his wife, Cathy, have been operating Psychological Assessment Resources Inc. since 1978 and have built what began as a sideline business into a 60-employee company with annual revenue in the eight-figure range.
One of its top products, the online Self-Directed Search, allows users to click on answers to a battery of questions to help them determine whether the job they have now (or had, if they were recently laid off) is the right fit.
"There are no right or wrong answers with this test," says Smith, a former Veterans Administration psychologist who is now chairman and CEO of PAR. The assessment, designed specifically for individuals without the need for professional counseling, measures six characteristics designed to match the test-taker to the most appropriate occupation and can serve as good reassurance for people happy in their current job or looking to change. Read more
Cleft Palate Foundation Referral to Vocational Rehabilitation
Vocational Rehabilitation Services are designed for persons 16 years of age and older with emotional, mental, physical/medical and/or developmental disabilities that hinder their prospects for employment. Assistance in obtaining local office telephone numbers can be secured by contacting the State Department of Human Resources or the Welfare Office. (PDF, page 2)
The Cleft Palate Foundation, in its publication Information about Treatment for Adults with Cleft Lip and Palate (PDF), wrote,
Are there sources of financial support for adults when they need and desire treatment? Funding through the Children’s Special Health Services (formerly Crippled Children’s Services) stops between 18 and 21 years of age depending upon the regulations of each state. Some adults obtain funding for cleft services through their state Division of Vocational Rehabilitation (or State Rehabilitation Services) if a structural problem causes significant difficulties in areas such as speech related to employment. Sometimes standard medical insurance will pay for part of the treatment, however, many claims are rejected due to "preexisting condition" clauses. The social worker on the Cleft Team can assist in finding sources of funding for needed treatment. (PDF, page 2-3)
I became a client of Florida Division of Vocational Rehabilitation in 1993, as described in my letter to Aleisa McKinlay, Director Florida DVR, February 11, 2014, see below in the next section.
Selections from my
to Aleisa McKinlay, Director
Division of Vocational Rehabilitation
"...It has also come to my attention that "vocational rehabilitation" is not an appropriate substitute for "habilitation" of a congenital speech disorder resulting from a craniofacial disorder, in my case a unilateral cleft lip and palate..."
Habuilitation vs. Rehabilitation
"An important difference between rehabilitation and habilitation services and devices is the fact that habilitation services are provided in order for a person to attain, maintain or prevent deterioration of a skill or function never learned or acquired due to a disabling condition."
"Rehabilitation services and devices, on the other hand, are provided to help a person regain, maintain or prevent deterioration of a skill that has been acquired but then lost or impaired due to illness, injury, or disabling condition."
"Unfortunately persons seeking habilitation of a congenital disorder are often seen as unreasonable and/or displaying a sense of "entitlement" to a benefit not provided to the non-afflicted, who do not need habilitation. This is technically correct: Normal folks do not need habilitation or corrective surgery, and congenitally deformed people want habilitation. Also, some normal folks believe congenitally deformed people were cursed by G-d and not worthy of habilitation, or are deviant and thus undeserving of treatment or full inclusion in society..."
Another issue with VR and craniofacial populations is the lack of Team Care, and reliance on standard tests like the Minnesota Multiphasic Personality Inventory (MMPI-2) by persons not trained in Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies. Also see, Funding Health-Related VR Services: The Potential Impact of the Affordable Care Act on the Use of Private Health Insurance and Medicaid to Pay for Health-Related VR Services. Exective Summary
In my view, the availability and quality of Vocational Rehabilitation services varies significantly by individual states, and in different parts of the United States. That was my personal experience.
Code of Professional Ethics for Rehabili[...]
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with letter Nov-19-1997 to Fla. DVR Consultant
Psychotherapy for CFA, Can We Treat with[...]
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Brain injury suspension for lawyer Dale Thistle
Newport lawyer agrees with his suspension over disability
By Doug Harlow Staff Writer
June 20, 2014
Dale Thistle says he suffered a traumatic brain injury following a car accident in 2011, affecting his ability to handle court cases.
The effects of a brain injury from a November 2011 automobile accident got so bad for Newport lawyer Dale Thistle that he finally reported himself to the state Board of Overseers of the Bar.
That report and other complaints about his work led to Thistle’s indefinite suspension from practice by the Maine Supreme Judicial Court this month. Complaints to the bar included Thistle’s alleged mishandling of a divorce case, real estate litigation that took too long and on a couple of occasions, misspeaking to the judge in the courtroom.
The June 6 order of suspension, based on a recommendation by the Board of Overseers, refers to Thistle, 66, of Skowhegan, as a "disabled attorney" whose injury caused him to violate the rules of professional conduct and as someone who is "a threat to clients, the public and to the administration of justice." Read more
Brain injury suspension for lawyer, 8p c[...]
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By Debra Cassens Weiss
June 25, 2014
A Maine lawyer says he can no longer function effectively as a trial lawyer and he agrees with his indefinite suspension, imposed by a Maine Supreme Judicial Court justice on May 27.
Newport lawyer Dale Thistle, 66, attributes his problems to a traumatic brain injury caused by a November 2011 car accident, CentralMaine.com reports. Complaints made to the bar about his handling of cases "are serious and meritorious and directly stem from my brain injury," he told the publication. "I even self-reported a misfiling in federal court."
Thistle says his intelligence is intact but his ability to perform executive functions is impaired. He suffers from minor seizures and small blackouts. "I couldn’t organize my day-to-day life," he told CentralMaine.com. "I couldn’t stick to the tasks. It’s just the result of the brain injury."
The Bangor Daily News calls Thistle a well-known lawyer in its earlier coverage of the suspension. He represented a former Newport official accused of embezzlement, a 14-year-old girl accused of stabbing her aunt 106 times, and class-action clients who claimed they were illegally strip-searched at the Knox County jail.
Thistle can regain his license if his condition improves, but he’s not optimistic. "I have no plans at the moment," he told CentralMaine.com. "I don’t know what I’m going to do." Read more
Minnesota Multiphasic Personality Inventory - MMPI-2
The Minnesota Multiphasic Personality Inventory, or MMPI-2, "is the most widely used and researched standardized psychometric test of adult personality and psychopathology" according to Wikipedia. The MMPI-2 may be used by VR to assess or screen clients. Is it effective with craniofacial populations?
The MMPI-2 may have useful applications, as explained by retired Phila. Police Captain Ray Lewis, in selecting police recruits.
But a paper "A Grammatical Analysis of the MMPI-2" by Elizabeth J. Kates, Esq. shows issues with the MMPI-2, issues likely in conflict with Team Care and the ACPA’s Parameters For Evaluation and Treatment of Patients with Cleft Lip/Palate or other CFAs.
In June 2014 I contacted Maggie Kjer, PhD of Pearson Clinical, owner of the MMPI-2, with my concerns. Dr. Kjer referred me to the MMPI Pearson Product Manager Deb Ringlewski, who wrote,
The MMPI has a long history of being used in medical settings as part of a comprehensive assessment battery. It is recommended that the extensive professional research literature be reviewed to best address your question...
When I responded "I am not aware of any "professional research literature" that answers my question", Dr. Kier forwarded my comments and questions to the Pearson Clinical legal team.
You have asked questions that are beyond my areas of expertise. I have forwarded your comments and questions to
the Pearson Clinical legal team. See my responses to the questions I can answer below. Other responses will come from the Pearson legal team.
Maggie Kjer, PhD
As of today, the Pearson legal team has not responded.
By Elizabeth J. Kates, Esq, member of The Florida Bar
A Grammatical Analysis of the MMPI-2, By[...]
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Email with Pearson et al, re MMPI-2 June[...]
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Retired Philadelphia Police Captain Ray Lewis gives a quick layman’s explanation of the Minnesota Multiphasic Personality Inventory - MMPI - starts at 0.17 in the video.
My email with Hillary Jones, Team Services Manager, ACPA on July 22, 2014 and her response July 23, 2014
From: "Hillary Jones" <firstname.lastname@example.org>
To: "Neil Gillespie" <email@example.com>
Sent: Wednesday, July 23, 2014 3:58 PM
Subject: RE: Message from: Neil Gillespie - 15296
The American Cleft Palate-Craniofacial Association does not have a position for or against the use of any particular psychological instrument.
Professional ethics and relevant state laws/regulations govern the behavior of each discipline.
Hillary Jones | Team Services Manager
American Cleft Palate-Craniofacial Association
1504 East Franklin Street, Suite 102 | Chapel Hill, NC 27514 USA
www.acpa-cpf.org | firstname.lastname@example.org | 919.933.9044
Mark your calendar for our 72nd Annual Meeting!
April 20-25, 2015 | Westin Mission Hills Resort, Palm Springs, CA
Follow ACPA on Facebook and Twitter
From: Neil Gillespie [mailto:email@example.com]
Sent: Tuesday, July 22, 2014 1:40 PM
To: Hillary Jones
Subject: Re: Message from: Neil Gillespie - 15296
Thank you Ms. Jones, I appreciate your response.
On another matter, does the American Cleft Palate-Craniofacial Association have a position on whether use of MMPI-2, the Minnesota Multiphasic Personality Inventory - 2, by state authorities is a valid screening tool, when used by contracted psychologists, to evaluate adult populations (non-correctional) who are seeking rehabilitation of congenital craniofacial disorders like cleft lip and palate and related speech impairment through the Department of Vocational Rehabilitation (DVR)?
As you know, the ACPA calls for teams of specialists to make this determination. http://www.acpa-cpf.org/team_care/
Wikipedia also reports "A craniofacial team is a multi-disciplinary team (MDT) which provides multidisciplinary consultations, diagnosis, treatment planning and procedures for a range of craniofacial anomalies and syndromes. Craniofacial anomalies or syndromes are defined as congenital conditions other than cleft lip/palate, unless cleft lip/palate is a feature of another condition, anomaly or syndrome."
Recently I contacted Pearson Clinical who markets the MMPI-2, and got this ultimate response:
"Finally, the ACPA-CPF could provide specific information about the use of the test within their interdisciplinary evaluation and treatment model."
Florida attorney Elizabeth J. Kates raised Constitutional questions of law about the MMPI-2, see A Grammatical Analysis of the MMPI-2.
While Ms. Kates’ critique relates to use of the MMPI-2 in family law cases, it may raise similar Constitutional questions of law when the MMPI-2 is used in any governmental setting. At least that is my understanding as a nonlawyer.
Thank you in advance for the courtesy of a response.
Neil J. Gillespie
Email with Hillary Jones RE Message from[...]
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Challenge: Minnesota Multiphasic Personality Inventory
The American Psychological Association (APA), Office of General Counsel submitted an amicus brief in Hudgins v. Moore, 524 S.E.2d 105, Issue: whether the prosecution could use raw MMPI-A test materials, administered to determine the defendant's competency to stand trial, to argue at trial that the defendant admitted to being a liar. Also see Soroka v. Dayton Hudson Corp., dba Target Stores.
When a test turns into a trial
American Bar Association
Things to keep in mind about psychological testing
By Larry R. Seegull and Emily J. Caputo
Volume 15, Number 3 January/February 2006
...A case decided in 2005 in the Seventh Circuit Court of Appeals, Karraker v. Rent-A-Center Inc., demonstrates one of the risks with psychological testing. The Rent-A-Center case held that administering certain psychological tests to employees violates the Americans with Disabilities Act (ADA). Specifically, the court found that the employer's use of the Minnesota Multiphasic Personality Inventory (MMPI) as part of its testing process for managers violated the ADA. The MMPI is a widely researched test for adult psychopathology and can measure such traits as depression, hysteria, paranoia and mania. High scores on the MMPI test can be used by medical professionals in the diagnosis of some psychiatric disorders.
Congress originally enacted the ADA in response to findings in studies and national polls documenting that individuals with disabilities occupy an inferior status in the United States and are severely disadvantaged socially, vocationally, economically and educationally. Congress intended the ADA to provide a national mandate for the elimination of discrimination against individuals with disabilities.
The ADA is relevant to psychological testing in the employment context because the act includes mental impairments in its definition of "disability." The court in the Rent-A-Center case particularly noted that people with psychiatric disabilities have suffered as a result of stereotypes, resulting in an employment rate that is drastically lower than people without disabilities.... read more
The Civil Rights Litigation Clearinghouse
Karraker v. Rent-A-Center Inc., Testing the Limits of the ADA, Personality Tests, and Employer Preemployment Screening
Is the MMPI-2 appropriate for use with people with vision loss? by Christensen, Maurita, Ph.D., CAPELLA UNIVERSITY, 2007, 67p
The MMPI-2 and Vocational Assessment: A Brief Report
Everything You Need to Know about Narcissists, Psychopaths, and Abuse - click on this
The MMPI (Minnesota Multiphasic Personality Inventory), composed by Hathaway (a psychologist) and McKinley (a physician) is the outcome of decades of research into personality disorders. The revised version, the MMPI-2 was published in 1989 but was received cautiously. MMPI-2 changed the scoring method and some of the normative data. It was, therefore, hard to compare it to its much hallowed (and oft validated) predecessor.
The MMPI-2 is made of 567 binary (true or false) items (questions). Each item requires the subject to respond: "This is true (or false) as applied to me". There are no "correct" answers. The test booklet allows the diagnostician to provide a rough assessment of the patient (the "basic scales") based on the first 370 queries (though it is recommended to administer all of 567 of them).
Based on numerous studies, the items are arranged in scales. The responses are compared to answers provided by "control subjects". The scales allow the diagnostician to identify traits and mental health problems based on these comparisons. In other words, there are no answers that are "typical to paranoid or narcissistic or antisocial patients". There are only responses that deviate from an overall statistical pattern and conform to the reaction patterns of other patients with similar scores. The nature of the deviation determines the patient's traits and tendencies - but not his or her diagnosis!
The interpreted outcomes of the MMPI-2 are phrased thus: "The test results place subject X in this group of patients who, statistically-speaking, reacted similarly. The test results also set subject X apart from these groups of people who, statistically-speaking, responded differently". The test results would never say: "Subject X suffers from (this or that) mental health problem".
There are three validity scales and ten clinical ones in the original MMPI-2, but other scholars derived hundreds of additional scales. For instance: to help in diagnosing personality disorders, most diagnosticians use either the MMPI-I with the Morey-Waugh-Blashfield scales in conjunction with the Wiggins content scales - or (more rarely) the MMPI-2 updated to include the Colligan-Morey-Offord scales.
The validity scales indicate whether the patient responded truthfully and accurately or was trying to manipulate the test. They pick up patterns. Some patients want to appear normal (or abnormal) and consistently choose what they believe are the "correct" answers. This kind of behavior triggers the validity scales. These are so sensitive that they can indicate whether the subject lost his or her place on the answer sheet and was responding randomly! The validity scales also alert the diagnostician to problems in reading comprehension and other inconsistencies in response patterns.
The clinical scales are dimensional (though not multiphasic as the test's misleading name implies). They measure hypochondriasis, depression, hysteria, psychopathic deviation, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion. There are also scales for alcoholism, post-traumatic stress disorder, and personality disorders.
The interpretation of the MMPI-2 is now fully computerized. The computer is fed with the patients' age, sex, educational level, and marital status and does the rest. Still, many scholars have criticized the scoring of the MMPI-2.
(From the book "Malignant Self-love: Narcissism Revisited" by Sam Vaknin - Click on this link to purchase the print book, or 16 e-books, or 3 DVDs with 16 hours of video lectures on narcissists, psychopaths, and abuse in relationships: Read more
Thank you Amber for sharing your story. Your insights are excellent.
"Hey there! For this video, I decided to put the makeup away for a bit and speak a little bit about who I am...This video pretty much sums it up if you watch it...Opening up myself to the public is very hard. I usually like to keep these feelings to myself, but how honest would that be to my viewers? read more
Also see Amber's video F.A.U.K.I: How to Handle Bullying 101
and Amber's video Bilateral Cleft Lip & Palate: Nose Surgeries!!!
i had to cut a lot because i filmed for almost 25 mins! thanks guys
I'm just telling some of my story and giving some tips. Thought it could be an informational tool for parents with cleft children. I know there are other Vloggers out
there, they may have some tips for more serious clefts. If you have any questions or comments, don't hesitate to private message me.
Dr. Murray (Missoula, MT)
Dr. Santin (Great Falls, MT)
Dr. Ballweber (Helena, MT)
For those in the Montana area, there are annual Cleft clinics. Contact one of the above for details - their information is available online. For those of other states, my guess is that there are cleft clinics available. Good luck.