Thepriorityistoprovideservicestothoseinneedasearlyaspossibletostrengthenfamilies,boosthealthandwell-being,andavoidmoredifficultandcostlycriseslater

Thus“childwelfare”meanssomethingmuchbroaderinthisstate;withawidearrayofsupports,Coloradoaimstoaddresstherootcausesofcrisisandinstabilitythroughintegratedpreventionandservicedeliveryfocusedonsupportingwholefamilies

TitleIV-EWaiverDemonstrationProject(Waiver).TheColoradoWaiverfocusedonfiveinterventionstobuildonexistingchildwelfarepractice:FamilyEngagement,PermanencyRoundtables,Trauma-InformedAssessment,Trauma-InformedTreatmen

Coloradohasintentionallydesignedabroaddefinitionofcandidacyforplacementpreventionservicesthatpushestoservechildren,youthandfamiliesasearlyaspossibleand,ideally,beforeareportismadetothechildwelfaresystem.

ColoradohasapproachedFamilyFirstimplementationasabroadsystemstransformationeffortthatcutsacrossmultipleofficeswithintheColoradoDepartmentofHumanServices(CDHS),includingtheDivisionofChildWelfare(DCW),OfficeofBehavioralHealth(OBH),OfficeofEarlyChildhood(OEC),andOfficeofEconomicSecurity(OES).Otherstateagencies,includingtheColoradoDepartmentofHealthCarePolicyandFinancing(HCPF)andtheColoradoDepartmentofPublicHealthandEnvironment(CDPHE)havebeenessentialinensuringaholisticapproachtoimplementation

(3) (a) Upon hearing after prior notice to the child’s parent, guardian, or legal custodian, the court may issue temporary orders providing for legal custody, protection, support, medical evaluation or medical treatment, surgical treatment, psychological evaluation or psychological treatment, or dental treatment as it deems in the best interest of any child concerning whom a petition has been filed prior to adjudication or disposition of his case.

(139) “Termination of the parent-child legal relationship”, as used in articles 3 and 5 of this title 19, means the permanent elimination by court order of all parental rights and duties, including residual parental rights and responsibilities, as provided in section 19-3-608

(113) “Qualified residential treatment program” means a licensed and accredited program that has a trauma-informed treatment model that is designed to address the needs, including clinical needs, as appropriate, of children and youth with serious emotional or behavioral disorders or disturbances in accordance with the federal “Family First Prevention Services Act”, 42 U.S.C. sec. 672 (k)(4), and is able to implement the treatment identified for the child or youth by the assessment of the child required in section 19-1-115 (4)(e)(I).

(120) “Responsible person”, as used in part 3 of article 3 of this title 19, means a child’s parent, legal guardian, or custodian or any other person responsible for the child’s health and welfare.

(119) “Residual parental rights and responsibilities” means those rights and responsibilities remaining with the parent after legal custody, guardianship of the person, or both, have been vested in another person, agency, or institution, including but not limited to the responsibility for support, the right to consent to adoption, the right to reasonable parenting time unless restricted by the court, and the right to determine the child’s religious affiliation.

(3) “Adjudicatory hearing” means a hearing to determine whether the allegations of a petition in dependency and neglect are supported by the evidence.(4) “Adjudicatory trial” means a trial to determine whether the allegations of a petition in delinquency are supported by the evidence.

(66) “Foster care” means the placement of a child or youth into the legal custody or legal authority of a county department of human or social services for physical placement of the child or youth in a kinship care placement; supervised independent living placement, as defined in section 19-7-302; or certified or licensed facility, or the physical placement of a juvenile committed to the custody of the state department of human services into a community placement.

68) “Foster care prevention services” means mental health and substance abuse prevention and treatment services, in-home parent skill-based programs, kinship navigator programs, and other programs eligible for reimbursement under the federal “Family First Prevention Services Act” that are trauma-informed, promising, supported or well-supported, and provided to prevent foster care placement.

105) (a) “Parent” means either a natural parent of a child, as may be established pursuant to article 4 of this title 19, or a parent by adoption.(b) “Parent”, as used in sections 19-1-114, 19-2.5-501, and 19-2.5-611, includes a natural parent having sole or joint custody, regardless of whether the parent is designated as the primary residential custodian, or a parent allocated parental responsibilities with respect to a child, or an adoptive parent. For the purposes of section 19-1-114, “parent” does not include a person whose parental rights have been terminated pursuant to the provisions of this title 19 or the parent of an emancipated minor.

(110) “Protective supervision” means a legal status created by court order under which the child is permitted to remain in the child’s home or is placed with a relative or other suitable person and supervision and assistance is provided by the court, department of human services, or other agency designated by the court.

can be a portal to other critical safetynet programs, including

According tothe Urban Institute, TANF programs around the country“usually automatically enroll beneficiaries in SNAP, childcare assistance (if working or in school), and Medicaid.While these programs have different eligibility rules manyare waived for TANF recipients, and the vast majority ofrecipients have income and assets low enough to qualifyunder general program rules.” 11

the Supplemental Nutrition Assistance Program(SNAP)/food stamps,

Why TANF is so importantTANF is oen the only source of financial suppor

TEMPORARYASSISTANCE FORNEEDY FAMILIES

mong our selected states, federal TANF funds were used to supportchild welfare services, such as child abuse hotlines, investigative andlegal services, child protection, and preventive services as well asemergency aid, such as clothing and shelter. Child welfare services aregenerally provided to children and their families to prevent the occurrenceof child abuse or neglect, to help stabilize the family and prevent the needto remove the child from the home if abuse has occurred, and to improvethe home and enable the child to reunite with his or her family if the childhas been removed from the home.

Child Welfare, Emergency Aid,and Other Services

to reunite children with their families

to use such federal funds for families with children

(2) Nothing in this article shall prevent the state department from complying with federal requirements for a program of emergency assistance in order for the state of Colorado

26-5.3-104. Emergency assistance for families with children at imminent risk of being placed out of the home.(1) The executive director of the state department is hereby authorized to include in the state temporary assistance for needy families plan the establishment and implementation of an emergency assistance program for families with children at imminent risk of being placed out of the home. The purpose of the program shall be to meet the needs of the family in crisis due to the imminent risk of out-of-home placement by providing emergency assistance in the form of intake, assessment, counseling, treatment, and other family preservation services that meet the needs of the family which are attributable to the emergency or crisis situation.

Rule 1. Scope of Rules; Definition; Title (a) Scope of Rules. (1) These rules govern procedure in the United States courts of appeals. (2) When these rules provide for filing a motion or other document in the district court, the procedure must comply with the practice of the district court. (b) Definition. In these rules, 'state' 1 includes the District of Columbia and any United States commonwealth or territory. (c) Title. These rules are to be known as the Federal Rules of Appellate Procedure.

(6) Reopening the Time to File an Appeal. The district court may reopen the time to file an appeal for a period of 14 days after the date when its order to reopen is entered, but only if all the following conditions are satisfied: (A) the court finds that the moving party did not receive notice under Federal Rule of Civil Procedure 77(d) of the entry of the judgment or order sought to be appealed within 21 days after entry; (B) the motion is filed within 180 days after the judgment or order is entered or within 14 days after the moving party receives notice under Federal Rule of Civil Procedure 77(d) of the entry, whichever is earlier; and (C) the court finds that no party would be prejudiced.

(ii) regardless of whether its motion is filed before or during the 30 days after the time prescribed by this Rule 4(a) expires, that party shows excusable neglect or good cause.

(A) The district court may extend the time to file a notice of appeal if:

(C) No extension under this Rule 4(a)(5) may exceed 30 days after the prescribed time or 14 days after the date when the order granting the motion is entered, whichever is later.

(5) Motion for Extension of Time.

Colorado Revised Statutes Annotated Title 26. Human Services Code (Arts. 1 — 24)Article 2. Public Assistance (Pts. 1 — 11)Part 3. Food Stamps (§§ 26-2-301 — 26-2-308)26-2-304. Appeals - recoveries - rules.(1) The provisions of section 26-2-127, relating to appeals, and section 26-2-128, relating to recoveries, apply to the food stamp program, except when such sections conflict with federal statute or regulation or when a specific conflict with federal statute or regulation is not clearly present and the state department elects by regulation to follow federal statute or regulation.

SECTION 3. Safety clause. The general assembly hereby finds, determines,and declares that this act is necessary for the immediate preservation of the publicpeace, health, and safety.Approved: June 10, 2010

(2) (a) No later than October 1, 2010, the state department shall create a program or policy that, in compliance with federal law, establishes broad-based categorical eligibility for federal food assistance benefits pursuant to the supplemental nutrition assistance program. (b) At a minimum, the program or policy shall, to the extent authorized pursuant to federal law, eliminate the asset test for eligibility for federal food assistance benefits.

Colorado Revised Statutes Annotated Title 26. Human Services Code (Arts. 1 — 24)Article 2. Public Assistance (Pts. 1 — 11)Part 3. Food Stamps (§§ 26-2-301 — 26-2-308)26-2-305.5. Categorical eligibility - repeal.

You may file your exceptions by filling out this form, by emailing them to cdhs_appeals@state.co.us,

If I believe the initial decision is wrong, what do I do? How do I file exceptions? If you believe the judge based his or her decision on incorrect facts or law, you may file exceptions (objections) to the decision, stating why you disagree with the decision.

About exceptions Exceptions

Documents filed with the Office of Administrative Courts will not be considered by the Office of Appeals unless it is clear that the document constitutes Exceptions to the Initial Decision and all of the following are met: the document is received at the Office of Administrative Courts by the due date for filing Exceptions and the document is received at the Office of Appeals prior to issuance of a Final Agency Decision.

Exceptions can be filed by mailing to 3550 W. Oxford Ave., Denver, CO 80236, by email at cdhs_appeals@state.co.us,

The requirement of this section that notice of the hearing be made by first-class mail is not satisfied when such notice is sent by certified mail,  since the notice will not be delivered by certified mail if the addressee is not present at the time of the attempted delivery. Dodge v. Meyer, 793 P.2d 639 (Colo. App. 1990).

or the denial in whole

shall file with the agency, within twenty days following such decision

applicable department may allow, upon a showing of good cause by the party, for an extension of up to an additional fifteen days to reconsider the final agency action.

after service of the initial decision upon the parties

the administrative law judge or the hearing officer shall prepare and file an initial decision that the agency shall serve upon each party

prompt disposition of petitions

undue delay in connection with such proceeding or action, the court may direct the agency to decide the matter promptly.

gency proceeding or action, with a statement of the grounds therefor

request made

Prompt notice shall be given of the refusal to accept

Every agency shall proceed with reasonable dispatch to conclude any matter presented to it with due regard for the convenience of the parties

A subpoena shall be served in the same manner as a subpoena issued by a district court.

due regard shall be had for the convenience and necessity of the parties

Any person entitled to notice of a hearing shall be given timely notice of the time, place, and nature thereof, the legal authority and jurisdiction under which it is to be held, and the matters of fact and law asserted.

The OOA shall serve a copy of the exceptions on each party by first class mail and byelectronic mail if the party has consented to receiving communications by electronic mail.

Exceptions shall state specific groundsfor reversal, modification, or remand of the initial decision. Exceptions that fail to statespecific grounds for reversal, modification, or remand of the initial decision shall beconsidered as only arguments of general dissatisfaction.

Considering the federal timeliness requirements for SNAP cases, a party may not requestan extension of time to file exceptions unless a party is able to show sufficient goodcause as to why an extension of time should be granted. The determination of goodcause is within the sole discretion of the OOA.

filed such a notice of intent, the party will have fifteen (15) calendar days, plusthree (3) calendar days for mailing from the date the initial decision is mailed to theparties to file its written exceptions with the OOA.

intent to fileexceptions to the decision with the OOA within five (5) calendar days - plus three (3)calendar days for mailing - from the date the initial decision is mailed to the parties

The Office of Appeals shall promptly serve the initial decision upon each party by firstclass mail and shall transmit a copy of the decision to the divisions of the StateDepartment that administer the program(s) pertinent to the appeal

The OOA shall not consider evidence that was not part of the record before theadministrative adjudicator. However, the case may be remanded to the administrativeadjudicator for rehearing if a party establishes in its exceptions that material evidence hasbeen discovered that the party could not with reasonable diligence have produced at thehearing

local office shall initiate action to comply with the final agencydecision within three (3) working days after the effective date.

Motion for Reconsideration of a Final Agency Decision1. A motion for reconsideration of a final agency decision may be granted by the OOA forthe following reasons:a. Upon a showing of good cause for failure to file exceptions to the initial decisionwithin the fifteen (15) calendar day period; or,

Sleep or camp in any city park or greenbelt land at any time between 9:00 p.m. and 6:00 a.m.

Developed recreation areas shall mean and include the Louisville Cemetery and recreational facilities such as the Louisville Recreation Center, multi-purpose athletic fields, baseball fields, softball fields, and golf courses that are owned and managed by the city. Reasonable efforts will be taken by the city to minimize the impact of such areas on open space and natural areas contiguous to open space

Camp means to reside or dwell temporarily in a place, with shelter, and conduct activities of daily living, such as eating or sleeping, in such place. But the term does not include napping or picnicking during the hours of use set forth in section 4.04.050.

Sec. 4.04.050. - Hours of use. Share Link Print Download (docx) Email Compare Share Link to section Print section Download (Docx) of sections Email section Compare versions Unless otherwise posted, lands and bodies of water regulated under section 4.04.010 shall be open daily from one hour prior to sunrise until one hour after sunset.

Medication Prescribing InformationTable of ContentsClinical Standards of Prac0ce: S0mulant Dosages...................................................................1TL;DR:..............................................................................................................................................1References.......................................................................................................................................2Mul0ple Post-Dated Scripts Can Be Wri>en Up to90-day Supply............................................5Quan0ty Limits: No law/rule limits maximum supply; Medicaid pays for 30 days or 100 days if maintenance medica0on for chronic condi0on (Dr’s discre0on to define chronic)...................5Early Refills: Medicaid refills CII currently aTer 50% of prior rx 0me has lapsed by default, or prior to 50% if necessary by phone request;at 85% prior to COVID19, 1x/life0me/drug if lost; immediately if rx is a “dose increase”.....................................................................................6OTC Drugs Paid For: Aspirin and various others labeled “OTC” in the PDL...............................7Paper Scripts Can Be Wri>en for CII Drugs..............................................................................7Pharmacist Authority: CAN dispense alterna0ve dose; CAN dispense a subs0tute (non-psychotropic) drug; CAN dispense emergency refill w/o an rx.................................................7Clinical Standards of Prac0ce: S0mulant DosagesTL;DR:American Academy of Sleep Medicine (formerly American Sleep Disorders Associa5on), Standards of Prac5ce Commi;ee, 1994, 2000, 2007, 2021:•Pa5ents have a wide varia5on in response to s5mulants... therefore, full therapeu5c response in adult pa5ents with narcolepsy can usually be obtained with daily medica5on doses below the recommended maximal doses of:... dextroamphetamine sulfate, 100 mg"Understanding Unapproved Use of Approved Drugs "Off Label", United States Federal Drug Administra;on, 02/05/2018The approved drug labeling for healthcare providers gives key informa5on about the drug that includes:

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

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

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

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

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

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

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

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

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

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

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

Preferred Drug List (PDL)

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

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

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

U. S. Department of JusticeDrug Enforcement Administration

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

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

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

Practice Standards& Regulations: Stimulant Dosingfor Hypersomnias

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

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

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

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

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

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

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

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

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

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

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

4. Dosage

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

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

Treatment aims are to improve daytime alertness with stimulant medication

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

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

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

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

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

Understanding Unapproved Use of Approved Drugs "Off Label"

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

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

udies demonstrated clinically significantimprovements in excessive daytime sleepiness

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

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

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

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

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

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

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

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

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

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

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

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

UNDERSTANDING INTRACTABLE RRD FAMILIES

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

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

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

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

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

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

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

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

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

Don’t necessarily trust your gut

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

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

Collaboration among all treating professionals is called fo

High conflict, entrenched, slow court system

Well intentioned professionals may need to get out of the way

Is the therapist part of the problem?

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

Parents need to be willing to change

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

Child becomes increasingly anxious

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

Refusal of treatment / Previous attempts fortreatment unsuccessf

Chronic parent-child disruptions

No or very infrequent contact between child and RP

Rigid / extreme child reaction to rejected paren

Reconciliation – is rejected

Regret and Remorse – absen

Revision – history is revised to eliminate positiveexperiences

Radical – child’s rejection is extreme and unrelenting

Repetition – of parent’s words

Rigidity – refusal to consider alternate views

Reasons – trivial, frivolous, unelaborated

Reactions – unjustified or disproportionate

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

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

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

Multi-FactorTheory of3DUHQW&KLOG&RQWDFW3UREOHPV3&&3

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

Characteristics of RRD cases

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

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

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

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

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

Dr. Childress agrees with the American Psychiatric Association.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MEMBERS OF PARENTAL ALIENATION STUDY GROUPOctober2022

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

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

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

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

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

treatment of severe cases

most mental health professionals get it wrong

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

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

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

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