Articles:

Curbing youth violence

By Leah Lancellotta, Erica Ackerman, M.S., Jenny Magram, M.A., and Tom Kennedy, Ph.D.

Pros and cons of PSYPACT

Compiled by the staff of

The National Psychologist

(Below)

Curbing youth violence

By Leah Lancellotta, Erica Ackerman, M.S., Jenny Magram, M.A., and Tom Kennedy, Ph.D.

Although violent crime arrests of children and adolescents have steadily declined since peaking in 1994, there are certain regions experiencing increases in violent criminal behavior among youth, especially those areas known as neighborhood “hot spots.”

Moreover, while youth arrests for robbery and aggravated assault have continued to decline since the mid-1990s, youth arrests for murder have increased since reaching a low point in 2012. Crime tends to be concentrated in micro-places, or hot spots, which often account for 50% of all crimes despite representing only about 5% of a city's street blocks. In these stressful and frequently hostile environments, individuals face financial insecurity, traumatic events, discrimination, and a lack of access to support and services, among other factors that collectively heighten emotional and cognitive distress.

Supporting the concept of behavioral epigenetics, societal stressors play a significant role in the development of specific phenotypic traits that may help youth cope with challenging environments. In response to adverse conditions, epigenetic modifications to genes can alter biological pathways, making their intended functions more susceptible to dysfunction, such as emotion dysregulation, hyperactivity, aggression, and impulsivity.

For example, youth living in high-crime areas may experience changes in DNA methylation, along with other epigenetic alterations related to serotonin receptors and the gene MAO-A. These modifications are associated with elevated rates of sustained aggression. As a result, children growing up in impoverished, crime-ridden, and hostile communities may develop traits that enhance their survival but also increase their risk of exhibiting heightened aggression, violent behavior, and callousness.

Additionally, more children are being raised in single-parent households in these high-crime areas, which is a risk factor associated with violent offenses and reactive aggression. This situation may worsen the impact of certain traits linked to aggression.

Therefore, it is crucial to pay attention to these high-crime areas and the resulting negative epigenetic characteristics that may serve as adaptive survival strategies specific to these regions. This idea aligns with the evolutionary theory of a faster life history strategy, which suggests that youth living in high-crime areas with limited resources, higher mortality rates, inconsistent parental care, and hostile environments tend to prioritize short-term gains while neglecting long-term rewards.

Although youth violent crime rates may overall be declining, the ongoing presence of

violence, the increasing trend in youth murders, and localized rises in certain areas remain

significant concerns. This is especially true given the escalating stressors present in today's

society.

Our understanding of how environmental stressors impact youth behavior indicates that we

might continue to see a rise in violent crime as young people adapt to survive in challenging

environments.

We are just beginning to understand the adaptive function of epigenetic phenotypic expression

underlying the long-term harmful consequences born out of the childhood trauma associated with living in impoverished, hostile, chaotic regions. These adaptive functions may ultimately contribute to an increase in youth engaging in aggressive behaviors and violent crime as a survival strategy in these environments. This underscores the importance of addressing the underlying stressors and fostering healthier coping mechanisms to mitigate the risk of such maladaptive behaviors among young people.

Externalizing behavioral issues are among the most common adjustment difficulties in children, often serving as the primary reason families seek help from child and adolescent mental health services. To address this important concern, psychologists need to assess current interventions and consider innovative solutions. In addition to traditional psychoeducation and various therapeutic approaches, it is essential for psychologists to explore new programs that can effectively intervene with young people.

Implementing targeted interventions for youth in high-risk areas requires a comprehensive approach. This includes community-based support, mentorship programs, and accessible mental health resources to address the unique challenges faced by individuals in these high-stress environments.

Recent research emphasizes the substantial impact of mentorship on young people, underscoring its transformative potential. Findings suggest that fostering a relationship with a single, reliable mentor yields the most favorable outcomes for youth. This underscores the significance of a focused and supportive mentor-mentee connection in positively shaping the developmental paths of young individuals.

In cases where there is a lack of support within the home or the absence of an adult guardian, children and adolescents benefit significantly through a surrogate "role-model figure" to provide the guidance and influence crucial for their well-rounded development. Strong attachment to supportive caregivers, sensitive parenting, and families providing a safe, stable, and well-regulated environment may help lower the risk of youth violence.

Considering this perspective, directing funds toward interventions that provide essential guidance and mentorship in communities where it is most warranted may yield the most significant benefit in reducing the presence of externalizing behaviors, subsequently reducing future criminal involvement.

Leah Lancellotta is a second-year Clinical Psychology Ph.D. student at Nova Southeastern University, focusing on forensic and child psychology, particularly children's testimony in legal settings.

Erica Ackerman, M.S., is currently a third-year Psy.D. student at Nova Southeastern University. She holds a master's degree in clinical psychology from Barry University and has served as the president of the Graduate Association of Students in Psychology (GASP).

Jenny Magram, M.A., is a third-year Psy.D. student at Nova Southeastern University (NSU). She is the Program Manager for NSU’s Master’s in Forensic Psychology program. She obtained her B.S. in clinical psychology from the University of Central Florida.

Tom Kennedy, Ph.D., BFB (corresponding author), is an Associate Professor and the Director of Academic Affairs for the College of Psychology at Nova Southeastern University. He has authored books, book chapters, and articles on juvenile crime, psychopathy, IPV, psychological assessment, bullying, psychophysiology, and research design. His email address is Ktom@nova.edu.

Pros and cons of PSYPACT

Compiled by the staff of
The National Psychologist

The Psychological Interjurisdictional Compact (PSYPACT) has proven to be of immense value, according to Jonathan Perle, Ph.D. While I have been offering telehealth services for many years, a substantial portion of these services was historically confined to patients within my state of licensure. This limitation became problematic as many patients receiving specialized care would relocate during their treatment, compelling me to prematurely terminate their interventions because I was not licensed in their new state of residence. Despite numerous patients expressing a desire to continue working with me, it was impractical, both in terms of time and finances, for me to obtain licenses in each state to which they moved.

Perle continues, “PSYPACT was relatively easy and quick to apply for, and has been simple to maintain year-to-year.” It took about a month to get approval and two weeks to receive my maintenance certificate after completing the online form.
Living in a rural area, I see patients from multiple states who often face challenges attending in-person due to illness, weather, or transportation issues. Video-based services across state lines have been crucial in maintaining continuity of care during the winter months.
Although I need to adjust my methods based on evidence-informed recommendations, such as modifying my office, being more enthusiastic, and changing how I speak, video-based therapy usually works well, and patients enjoy it.
As I frequently receive inquiries about providing services in X state, I find the PSYPACT website, which features a consolidated list/map of PSYPACT-approved locations, to be an easy resource to identify and utilize.

While generally positive, it requires more effort to provide and maintain video-based services compared to in-person sessions. This includes adapting information presentation, troubleshooting issues, and keeping patients, particularly children, engaged.
One of the primary challenges is allocating time to thoroughly review each jurisdiction's laws (e.g., abuse reporting) to ensure compliance with their regulations.

Justin D'Arienzo, Psy.D., was part of the legislative team of Florida psychologists who worked to implement PSYPACT in the state. D'Arienzo already had PSYPACT credentials through a Texas license (a PSYPACT state since 2020) and traveled from Florida to Texas to provide organizational psychological services and see patients virtually in other PSYPACT states via a satellite office in Austin, Texas.

After Florida's PSYPACT law passed in July 2023, I transferred my home state status to Florida, where my main office is in Jacksonville. I've been seeing patients and organizational clients across jurisdictions since November 2022. It's hard to believe it's been over two years.
From a business standpoint, PSYPACT presents both advantages and disadvantages that are interrelated, with the overall impact contingent on one's economic strategy. It has enabled me to access more lucrative markets with a higher concentration of affluent patients, in contrast to Jacksonville, Florida, where I reside.

Due to COVID-19 and the acceptance of virtual meetings, I have had the opportunity to work with several corporations across the U.S. in PSYPACT states to provide employment assessments,

psychological fitness for duty evaluations, and consultation services. This has resulted

in additional opportunities with these companies. Providing high-quality service has led to

a broader reach beyond the home state. Consequently, PSYPACT has significantly increased

the revenue for our practice.

On the other hand, there are some drawbacks. Although it may seem counterintuitive,

PSYPACT has made me feel more isolated. I no longer feel comfortable consulting and

brainstorming with other psychologists across state lines about business ideas. These

psychologists and friends, who once had little impact on our practice, now feel like competitors.
Overall, PSYPACT can benefit patients by potentially reducing rates and providing more care options in various areas. For psychologists, it may lead to improved psychological services as they compete. However, those lacking distinctive approaches or effective branding may find it challenging to succeed in private practice.

Nina Shiffrin Starin, Ph.D., told The National Psychologist, “PSYPACT has been an invaluable tool for both assisting with continuity of care and expanding access to evidence-based treatments.”
She continued, before 2020 a majority of patients I saw were children and younger teens and when they graduated high school, I would have to transfer their care to their college counseling center, which often had long wait lists, only offered brief treatment and frequently did not offer CBT, or try in rare circumstances to find a provider offering evidence-based treatments in walking distance to their campus as most college freshman don't have cars.
As more states have joined PSYPACT, I have been able to continue providing care for patients as they transition to college, graduate school, or new job locations. Currently, many of my patients are college students or young adults, some of whom I treated in their earlier years, while others began treatment more recently but would not otherwise have access to CBT during their college years.
I currently see patients in at least 7 states. Further, PSYPACT has helped make treatment more convenient. While my office is in MD, adjacent to Washington, DC and Virginia, patients no longer need to drive out to the Maryland suburbs to see me.

I am able to maintain continuity of care effectively when patients attend residential summer camps or travel. Previously, I obtained licensure in the District of Columbia to provide treatment during snow days while residing there; my office was in Maryland. The PSYPACT initiative has now eliminated the need to worry about continuing treatment during inclement weather.
My only complaint is, I wish more states would join PSYPACT. When I visit my hometown in upstate New York, despite holding a license in New York, I cannot provide treatment unless patients are in a state where I hold licensure. Many of my patients attend college or camp in Massachusetts. I hope that New York, Massachusetts, and other remaining states will soon participate in PSYPACT

Jonathan Perle, Ph.D., is a licensed psychologist, associate professor, and director of telepsychology at the West Virginia University School of Medicine.

His email address is jonathan.perle@hsc.wvu.edu.

Justin D’Arienzo, Psy.D., ABPP, is a former Navy psychologist; Forensic Division Chair for the Florida Psychological Association; and Chair of the Florida Psychologists Political Action Committee. He is licensed in Florida, Texas, and New Mexico. He is also a second-year student at Fairleigh Dickinson University’s post-doctorate master’s in clinical psychopharmacology.

He may be reached by email at psychologist@drdarienzo.com

Nina Shiffrin Starin, Ph.D., is a licensed psychologist with more than 15 years’ experience. She currently practices in Chevy Chase, Md.

Her email is nshiffrin@alvordbaker.com.