THE ADVENT OF TECHNOLOGY

Technology's Contribution To Health Care Reform:  As President Obama's landmark health care reform legislation, thePatient Protection and Affordable Care Act (PPACA) [P.L. 111-148], is being steadily implemented, the concerns raised from a number of vantage points can be seen as a testament to his vision, as well as to the magnitude of change involved.  Change is always unsettling, especially for those comfortable with the status quo.  One of the underlying objectives of PPACA is to focus the unprecedented advances occurring within the communications and technology fields directly upon the health care environment, as they are already impacting every other segment of our economy.  This can be seen with the significant resources provided for Comparative Clinical Effectiveness Research (i.e., determining objectively what services work, for what symptoms, and under what conditions); ensuring that all providers have ready access to electronic health records, thus providing the capacity to compare outcomes across patients and diagnoses (Health Information Technology (HIT)); and increasing the applicability of telehealth care, so that one's geographical location will no longer be a barrier to receiving quality care.  There can be no question that central to effectively utilizing this technology are critical and complex licensure issues.  Perhaps the underlying question is: Whether our nation looks at providing necessary health care as representing a societal responsibility or an individual patient/provider decision?

            Organized psychology appreciates the importance of being proactive.  In February, the APA Council of Representatives approved the creation of a Telepsychology Task Force, co-chaired by Linda Campbell and Fred Millan, that will be comprised of four APA representatives, four ASPPB representatives, and two APAIT representatives.  One of the issues that the task force will face is inter-jurisdictional practice/licensure mobility.  Their first meeting is scheduled for mid-July. Judy Hall, National Register Executive Officer: "The National Register of Health Service Providers in Psychology (NR) is uniquely positioned to serve as the primary licensure mobility credential for psychologists in the United States, Canada, and beyond.  We are by far the largest credentialing organization for psychologists, with 11,000 members; have standards and credentialing procedures that are well established and are widely approved by licensing boards to expedite licensure mobility.  To date, we have verified credentials to licensure boards for more than 1,300 Registrants.  The NR is ranked by both early career and more senior psychologists as one of the most valuable benefits, both for the here-and-now value and as an insurance policy for those who may apply for additional licenses later in their careers.  For a list of jurisdictions approving the National Register, seewww.nationalregister.org."

            Health Resources and Services Administration (HRSA):  APA's Debra Baker shared with us the report released this Spring by HRSA: "Health Licensing Board Report To Congress."  Requested by the FY'2010 Senate Appropriations bill, the report updated efforts being made on licensure portability and the level of cooperation between health licensing boards, the best models for such cooperation, and the barriers to cross-state licensing arrangements.  HRSA focused on physicians and nurses since in its view these are: "the two professional groups for which there is the most information on alternative approaches to overcoming licensing barriers to cross-state practice."  Utilizing funding from FY' 2006, HRSA created its licensure portability grant program which has subsequently funded projects submitted by the Federation of State Medical Boards (FSMB) and the National Council of State Boards of Nursing (NCSBN), as well as the State of Wisconsin Department of Regulation and Licensing.

            "Licensure portability is seen as one element in the panoply of strategies needed to improve access to quality health care services through the deployment of telehealth and other electronic practice services (e-care or e-health services) in this country.  But licensure portability goes beyond improving the efficiency and effectiveness of electronic practice services.  Overcoming unnecessary licensure barriers to cross-state practice is seen as part of a general strategy to expedite the mobility of health professionals in order to address workforce needs and improve access to health care services, particularly in light of increasing shortages of healthcare professionals.  It is also seen as a way of improving the efficiency of the licensing system in this country so that scarce resources can be better used in the disciplinary and enforcement activities of state boards, rather than in duplicative licensing processes."

            Those involved in the licensing process of both medicine and nursing are seeking ways to simplify the licensing process for those members of their professions who are interested in obtaining licenses in more than one state, although they have taken different strategic approaches to date.  Nursing has developed a far reaching mutual recognition model under which practice across state lines would be allowed, whether physical or electronic, unless the individual practitioner is under discipline or a monitoring agreement that restricts practice across state lines.  This approach requires each state to enter into an interstate compact, called the Nurse Licensure Compact.  This was first implemented on January 1, 2000 by Maryland, Texas, Utah, and Wisconsin.  Currently 24 states participate.

            Medicine has been encouraging states to adopt the model of expedited endorsement.  This is a method of setting criteria to approve the valid license of another state.  The process accepts a license issued in one state that was verified and sets requirements for endorsing a license granted in another state.  Idaho, Iowa,Michigan, Nevada, New Mexico, North Carolina, Oregon, and Rhode Island currently have adopted the expedited endorsement process.

Some state authorities are clearly uncomfortable with accepting the licensing process of another state.  Concerns expressed include: not every state board requires criminal background checks and state boards are ultimately responsible for maintaining public protection within the state.  Control/lack of authority; lack of uniform standards; cost/loss of revenue; fear among unions and state professional associations that this could facilitate strike breaking; a general misunderstanding about the process among practitioners; and the lack of independent evaluations have all been noted as potential barriers.  A number of these concerns can be satisfactorily addressed, especially as the broader provider community becomes more clinically comfortable with the use of advanced technology (HIT) in their daily practices.  To place this evolution in perspective, at the time the Obama Administration began its successful quest for health care reform, their goal was to bring physician HIT utilization up from five percent to 90 percent by 2019 and hospital utilization to 70 percent during the same time frame, with their estimate being that only 1.5 percent of hospitals had a comprehensive electronic system available in all units.

For over a century, health care in theUnited States has primarily been regulated by the states.  Such regulation includes the establishment of licensure requirements and enforcement of standards of practice for health providers.  The licensure authority is administered with the goal of ensuring that health care professionals are academically qualified, competent, and mentally and physically fit to provide the activities covered by the license.  "As the U.S. health system evolves to meet the changing needs of consumers, traditional methods of healthcare delivery are being transformed.  No longer do the patient and the provider need to be in the same location to receive quality health services.  Telehealth (telecommunications and information) technologies are being used to provide healthcare services in a more efficient and effective manner to address the shortages and maldistribution of healthcare professionals that result in lack of access to quality healthcare services, whether due to geographic, economic, or other social factors.  Telehealth services are increasingly becoming part of the mainstream of healthcare.  For these reasons, the number of physicians and the number of other health providers practicing across state boundaries have increased in recent years.  This trend is expected to continue in the foreseeable future."

The purpose of licensing health care professionals is to protect the public from incompetent or impaired practitioners.  A licensure system must be able to administer and enforce its standards.  The basic standards for medical and nursing licensure have become largely uniform across all states.  Physicians and nurses must graduate from nationally approved educational programs and pass national licensure examination.  However, there are significant differences in administrative and filing requirements among the states.

The American Bar Association Health Law Section in its 2008 report proposed a model for allowing the cross-state licensure of physicians, which was approved by the ABA House of Delegates.  The Federal Communications Commission (FCC) released its National Broadband Plan in 2010 urging states to revise licensure requirements to enable "e-care."  Noting that current licensure requirements limited practitioners' ability to treat patients across state lines, which hindered access to care, the FCC urged increased collaboration.  And, if the states failed to develop reasonable licensing policies to facilitate electronic practice over the next 18 months, it recommended that Congress ensure that Medicare and Medicaid beneficiaries are not denied the benefits of "e-care."  Some have already called for the federal government to enact national licensure.  In our view, the states still have time to demonstrate vision.  "You know I feel all right."  Aloha,

Pat DeLeon, former APA President – Division 18 column – June, 2011

 

WHERE HAVE ALL THE FLOWERS GONE?

 The Robert Wood Johnson Foundation (RWJ) is the nation's largest philanthropy devoted solely to the public's health.  Their efforts focus upon improving both the health of everyone in America, and their health care – how it's delivered, how it's paid for, and how well it does for patients and their families.  By investing in improving systems through which individuals receive health care and in fostering environments that promote health and prevent disease and injury, RWJ expects to achieve comprehensive, meaningful, and timely change.  Creating leverage for change is RWJ's greatest asset.  Annually RWJ issues its Anthology, which this year focused upon Improving the Health and Health Care of Vulnerable Populations.  For those colleagues interested in learning about the gradual evolution of our nation's health policy, these publications provide a fascinating glimpse into the vision of the foundation world, where only a few psychologists have ever been involved.  Ruby Takanishi, President of the Foundation for Child Development; Judith Rodin, President of the Rockefeller Foundation; and Anne Peterson, formally of the W.K. Kellogg Foundation, being notable exceptions.

            The Vulnerable Populations portfolio was created in 2003 and has developed a special niche by identifying and supporting innovative programs at the intersection of health and the social factors that influence health – factors such as education, housing, race, class, and income.  As such, it provides a unique opportunity to dramatically change how services are delivered, while at the same time helping individuals, families, and communities make progress towards better health and a healthier society.  Helping real people and moving towards a healthier society are laudable goals which are "possible, but not always easy."

            A concerted effort has been made by RWJ to go beyond supporting creative individual efforts which address national needs, by also nurturing the most promising among them with the hope and expectation that they can become strong enough to "enter the mainstream" of society's expectations.  One example would be RWJ's commitment since the 1970s to fund a range of projects advancing Nurse Practitioners.  The Nurse-Family Partnership program, in which public health nurses visit young, low-income, first-time mothers in their homes, is a RWJ-funded initiative that may be ready to enter the mainstream.  Starting in 1979, support was provided for a new approach to improving the health of babies and their mothers.  In the 31 years since its first grant, RWJ has provided nearly $27 million to build evidence about the effectiveness of this approach and to support its replication.  In 2002, the Edna McConnell Clark Foundation, along with other foundations and corporate funders, supported a major expansion of the program.  President Obama's Patient Protection and Affordable Care Act (PPACA) authorized $1.5 billion for states that adopt home-visitation programs that serve young, low-income mothers.

RWJ's initial nurse practitioner efforts focused upon increasing the access of people living in rural areas and inner cities to non-hospital based care.  These became the forefront of a movement that lead to the widespread acceptance of nurse practitioners as recognized health care professionals.  One might say that the Foundation supported a "disruptive innovations" approach by sponsoring a less costly group of health professionals who could carry out many of the functions performed by a more costly, and often inaccessible group, namely physicians.  The underlying philosophical question remains, however: Why do some initiatives evolve into mainstream concepts while others do not?  Perhaps it is because they are picked up initially by change agents who influence the rest of society until a critical mass of individuals find it is in their best interest to adopt an innovation.  Are there "take-off points" when the accretion of small advances reach the point where change becomes unstoppable?  Or, as APA convention speaker Malcolm Gladwell proposed, by taking one step at a time, does an innovation affect enough people to reach a "tipping point," from which it then naturally races through the population?

            Four elements were highlighted in theAnthology which are seen as necessary to move foundation-funded ideas into the mainstream.  1.) The idea is seen by a substantial portion – or at least an influential portion – of the population as a potential solution to a pressing problem.  2.) The political system is receptive to the adoption of new ideas – especially when legislation is the means of spreading them.  3.) The evidence is strong that an idea is workable and perhaps cost-effective.  And, 4.) Committed advocates keep the idea in the forefront and fight for its widespread adoption.  The RWJ President enumerated five key tools available to philanthropy: Communicating, Convening, Coordinating, Connecting, and Counting (plus a sixth, Cash) – her "Five Cs."  From our experience within the public policy arena over the years, we would especially agree with the view that those who wish to implement significant change must: "Stick with good ideas for a long time.  An inhospitable political climate can suddenly become inviting, as the passage of health care reform in 2010 demonstrates."

            Each of the Vulnerable Population projects has direct application to psychology and the behavioral sciences.  Caring Across Communities explored the need for mental health services among probably the most vulnerable population in our nation, children with mental health problems born to refugees or immigrants.  Generally, this population is not welcome in the medical care system.  If undocumented, they are pretty much precluded from getting care except in public hospitals, free clinics, and community health centers.  They are more likely to live in poverty, be poorly educated, and lack health insurance coverage.  "Despite laws and regulations requiring parity in coverage of mental and physical health services under employer-sponsored health plans, such parity does not in fact exist.  Not to mention the stigma associated with mental illness, which would discourage many people from seeking services for themselves and their children.  Moreover there are all of the cultural barriers, of which language is the most obvious and perhaps the easiest to resolve."

Studies show that one out of every five school children in America is now either the child of an immigrant or an immigrant him or her self.  Problems such as post traumatic stress disorder (PTSD) appear to be particularly prevalent in this population, close to 20% for those immigrants who experienced violence before arriving.  School officials begin to see the effects of PTSD in problems that range from rising individual disciplinary cases to a 25% high school dropout rate for foreign-born pupils nationwide.  North Carolina officials reported 59% of their immigrant children are suffering from symptoms of anxiety, about one-third are dealing with PTSD, and 9% have had thoughts of suicide – while the rates of treatment are appallingly low.  Many refugees and their children have witnessed horrors unimaginable to most Americans.  The parents resettled in the U.S. primarily for their children and yet they face a school system with little understanding of what they or their children have gone through.

            Another impressive initiative, the Alaskan Native Dental Health Aide and Therapist program, is, in our judgment, highly analogous to psychology's prescriptive authority (RxP) quest.  "How to deliver health care services to individuals residing in extremely remote areas?" has long been a challenge for health policy experts.  Professional (and at times social) isolation remains a major challenge for rural America. Alaska is a huge and highly isolated region with what can be considered extraordinary inhospitable weather.  The model proposed by RWJ and others (most notably the Rasmuson and Kellogg Foundations) to address the pressing dental needs of rural Alaska was to provide a limited amount of training to members of the local communities who then could provide basic necessary services to their neighbors (akin to China's barefoot doctors).  The oral health crisis in Alaska has sparked numerous comparisons with the TB epidemic of the 1950s.  Nationwide, tooth decay is the most common chronic childhood disease, interfering with daily activities for an estimated 4 to 5 million children and adolescents annually.  The Indian Health Service (IHS) estimates that untreated lesions exist in 68% of American Indian and Alaskan Native adolescents, compared with 24% of other children in the nation.  One-third of Alaskan Native children report missing some days of school each year due to dental pain.

In 2001 the Alaska Native Tribal Health Corporation, the nation's largest tribal health organization, proposed it's Dental Health Aide Program, based upon the principles underlying community health aides.  At the time there was no appropriate training program in the U.S. since every attempt to introduce such a program had been steadfastly resisted for nearly a century by organized American dentistry.  The World Health Organization (WHO) 2003 report indicated that by that time 42 countries around the world – including Canada, Great Britain, Australia, and New Zealand – had relied for years on such midlevel providers to educate patients, apply sealants, and perform basic dental procedures, from fillings to extractions, and even root canals.  The training for the Alaskan Native providers was conducted in New Zealand.  As the graduates began providing services, the ADA and the Alaska Dental Society filed a joint lawsuit in the state court, accusing the dental therapists of practicing dentistry without a license and mounted a major public relations campaign proclaiming "second class dental care."  In June, 2007 the Alaska Superior Court ruled that the dental health therapists were legal under a federal statue, although we understand that even today there are strict limitations on where they can, in fact, practice.  Organized dentistry's opposition to alternative providers has continued, notwithstanding the dental extender provisions contained in PPACA, as well as increasing financial support from the foundation world.  The underlying policy arguments are: Whether these providers represent an alleged public health hazard?  Or, Are they providing access to quality care?  Not surprisingly, all of the objective evidence supports their continued contribution to the health and well being of the Alaskan Native population and as a result, their probable expansion into the federally qualified community health center network which also continues to report significant difficulty in accessing dental care for their patients.

Throughout the RWJ's impressive history of "making a real difference" there have been at least four reoccurring themes: 1.) Supporting independent quality research to provide an evidence-base that will be widely accepted.  2.) Communications are a key to making research relevant to policy makers and the public.  3.) Answering issues of concern to policy makers.  And, 4.) Policy impact definitely requires a long-term vision.

            This Spring, AARP and RWJ facilitated an impressive Congressional briefing by the House and Senate Nursing Caucuses following up on the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health.  A campaign for action was described with the goal of having Regional Action Coalitions functioning in all 50 states by 2012.  RWJ has already committed $10 million for the campaign which will systematically focus upon building a 21^st century nursing workforce with the skills and knowledge Americans need; increasing the influence of nurses in high levels of health care, policy, business, and community decision making; and removing artificial barriers to nursing being allowed to clinically function to the fullest extent of its training.  Former HHS Secretary Donna Shalala has been actively involved.  Perhaps the most interesting development at the briefing was the public recognition by the President and CEO of the Association of American Medical Colleagues that the time for such change has arrived.  Subsequently, Major General Patricia Horoho was nominated by DoD Secretary Robert Gates to serve as the Surgeon General of the U.S. Army.  When confirmed, she will be the first nurse and first female to serve in that position since the establishment of the Army Medical Corps in 1775.  Times are a-changing.  "When will we ever learn?  When will we ever learn?"  Aloha,

Pat DeLeon, former APA President – Division 42 – June, 2011

 

VISION FOR THE FUTURE – THE IMPORTANCE OF INVOLVEMENT

The Department of Health and Human Services:  In presenting her Fiscal Year 2012 budget, Secretary Sebelius (HHS) expressed her enthusiasm for effectively implementing President Obama's landmarkPatient Protection and Affordable Care Act (PPACA) in a timely fashion.  "In President Obama's State of the Union address he outlined his vision for how the United Statescan win the future by out-educating, out-building and out-innovating the world so that we give every family and business the chance to thrive.  His 2012 budget is the blueprint for putting that vision into action and making the investments that will grow our economy and create jobs.  At the Department of Health and Human Services [HHS] this means giving families and business owners better access to health care and more freedom from rising health costs and insurance abuses.  It means keeping America at the cutting edge of new cures, treatments and health information technology.  It means helping our children get a healthy start in life and preparing them for academic success.  It means promoting prevention and wellness to make it easier for families to make healthy choices.  It means building a health care workforce that is ready for the 21^st century health needs of our country.  And it means attacking waste and fraud throughout our department to increase efficiency, transparency and accountability.  Our 2010 budget does all of this."

            Visionary health psychologist Susan McDaniel and APA Executive Officer Norm Anderson have long been urging our colleagues to become more personally involved in educating society's leaders and the public regarding the importance of the psychosocial-economic-cultural gradient of quality health care, as well as the increasingly emerging scientific and clinical evidence supporting the critical nature of the social determinants of health.  The Secretary clearly has a similar vision.  Her budget redirects and increases funding within the Centers for Disease Control and Prevention (CDC) targeted towards reducing chronic disease.  Rather than splitting funding and making separate grants for heart disease, diabetes, and other chronic diseases, she has proposed one comprehensive grant that will allow States to address chronic disease more effectively.  Similarly, the prevention resources within SAMHSA would be redirected to fund evidence-based interventions and better respond to evolving needs.  States and local communities would benefit from the additional flexibility while funds would still be competed and directed toward proven interventions.

We would rhetorically ask: How many of our colleagues who are primarily in private practice share Division President Glenn Ally's vision and have developed collaborative relationships with their local state or county health authorities?  Glenn, along with two other medical psychologists, works closely with his local Community Mental HealthCenter; other Louisiana medical psychologists in private practice work with their Children's and State Psychiatric Hospitals, not to mention serving on numerous State Boards and Committees/Commissions.  It is only by becoming active community participants and visionary leaders that psychology will ultimately be well positioned to effectively engage in the policy discussions that determine local plans for implementation of PPACA on a collegial and equal basis with other health care disciplines, interested stakeholders, and government and business community leaders.  The President's vision provides the Administration and States with considerable flexibility to develop local strategies for successfully meeting broad-reaching national objectives.  As Jim Quillin keeps reminding us, "All politics are local."

            The HHS Secretary further pointed out that PPACA expands access to affordable coverage to millions of Americans and strengthens consumer protections to ensure individuals have coverage when they most need it.  Focusing upon ensuring access to quality, culturally competent care for vulnerable populations: "The budget includes $3.3 billion for the Health Centers Program, including $1.2 billion in mandatory funding provided through the Affordable Care Act Community Health Center Fund, to expand the capacity of existing health center services and create new access points….  (This) will enable health centers to serve 900,000 new patients and increase access to medical, oral, and behavioral health services to a total of 24 million patients."  Her Innovation Center, in coordination with private sector partners wherever possible, will pursue new approaches that not only will improve quality of care, but also lead to cost savings for Medicare, Medicaid, and CHIP.  We suspect that very few of our colleagues truly appreciate the long term implications for their daily practices of the PPACA established Patient-Centered Outcomes Research Institute which will be funding research and getting relevant, high quality information to patients, clinicians, and policy-makers, so that they can make informed health care decisions.  The Institute of Medicine (IOM) estimates that almost 40% of Americans possess only "basic" or "below-basic" health literacy skills.  Thus, their ability to make informed decisions without concerted assistance will become increasingly difficult as the volume and complexity of data available to them increases.  The Patient-Centered Outcomes Research Trust Fund will fund this independent Institute and related HHS activities.  Approximately $620 million will be allocated during the coming year as investments in core patient-centered health research activities and to disseminate research findings, train the next generation of patient-centered outcome researchers, and improve data capacity.

            The HHS budget also includes $78 million for the Office of the National Coordinator for Health Information Technology to accelerate health information technology (HIT) adoption and promote electronic health records (EHRs) as tools to improve the health of individuals and transform the health care system.  One focus will be assisting health care providers in becoming meaningful users of health information technology.  One of the Secretary's priorities should be of particular interest to APA.  Her budget provides HRSA with $163 million for Health Workforce Diversity programs to improve the diversity of the nation's health workforce and improve care to vulnerable populations.  These funds will support training programs and scholarship opportunities for students from disadvantaged backgrounds who are enrolled in health professions and nursing programs.

            The Department of Defense:  "As this year's Military Nurse Fellow, I was thrilled to attend the Senate Committee on Appropriations defense subcommittee hearing on the DoD Fiscal Year 2012 Health Programs.  During this hearing, Senators heard testimony from the Nurse Corps Chiefs and the Surgeons General from the Army, Air Force, and the Navy.  Not at all surprising was a universal concern voiced by the Senators regarding the behavioral health of our troops and their families.  The Surgeons General and the Nurse Corps Chiefs all mentioned during their testimony that preserving the psychological health of service members and their families is one of the greatest challenges the services face today.  The military is not immune to mental health issues or concerns; behavioral health issues affect military members and their families just as they affect the civilian community, perhaps even more so.

            "Tragically, the wars in Iraq andAfghanistan have produced a group of combat veterans who face a lifelong struggle to cope with the severe physical and psychological traumas of war.  The invisible scars of war cut deep and transcend through military members to their families who are desperately trying to assist their loved ones to cope.  The military health system as a whole strives to provide the very best ongoing healthcare for military members and their families including mental health services and support.  It is clear that early identification of mental health risks through surveillance, education, and training is a key component in helping to mitigate behavioral health and stress related issues.  The Army has developed an approach to strengthen their soldiers' and families' behavioral health and emotional resiliency through a campaign to align various behavioral health programs.  The long term goals of this Comprehensive Behavioral Health System of Care is to protect and restore the psychological health of soldiers and their families and prevent adverse psychological and social outcomes like family violence, DUIs, drug and alcohol addiction, and suicide.

            "Citing that no one is immune to the stresses and strains of life, the Air Force testimony identified that one important aspect of patient-centered preventive care includes preserving the mental health and well-being of service members and improving their resilience.  Initiatives have been developed to support and train front line supervisors to recognize when an individual may be having difficulties.  Counseling services have also been expanded beyond traditional avenues.  Other initiatives aimed at addressing behavioral health and resiliency included utilizing a targeted approach that recognizes different risk groups.  An overarching theme identified was the utilization of 'best practice' programs to help service members become more resilient.  An example of this is teaching the afflicted to realize that seeking help is a sign of strength, not a sign of weakness.

            "The Navy keyed in on the fact that service members and their families are usually mentally and emotionally strong at baseline, but the long conflict (war) and other related deployment challenge this resilience.  Thus, the Navy implemented programs for early detection of stress injuries, which includes focusing on leadership's role in monitoring the health of their people.  Additionally, the programs include providing leaders with tools they may employ when service members are experiencing mild to moderate symptoms and the utilization of multidisciplinary expertise for members more seriously affected.

            "It is evident from the testimony that psychological health issues cut across all walks of life.  Programs that support, prevent, diagnose, mitigate, and treat behavioral health issues are paramount to ensuring the optimal health of our communities, whether civilian or military.  The services are working hard to change the 'culture' and are striving to ensure military members are a healthy, fit and resilient force!" (Lt. Col. Maureen Charles, USAF).

            The Department of Agriculture:  The U.S. Department of Agriculture recently announced a $25 million grant to the Collegeof Agriculture at the University of Hawaii in order to develop obesity prevention strategies among native populations in the Pacific Region, thereby continuing its commitment to meet the rising challenge of obesity in our nation.  The Secretary: "We know that in order to win the future, we have to win the race to educate our children.  That means that our kids must be healthy so they can learn and thrive.  Improving childhood nutrition remains a key priority of the Obama Administration as we work to ensure our kids are ready to out-compete in an increasingly globalized world."  This five year initiative will use a community-based participatory research approach that engages communities to prioritize obesity prevention strategies.  Researchers will work with the communities to develop community needs assessments and establish sustainable nutrition and health-promoting programs.  Specifically, the team will identify specific environmental factors leading to childhood obesity in selected schools and daycare facilities.  Intervention strategies will be attuned to culturally-specific needs and goals, and focus on physical activity, nutritional intake, and the amount of sleep children get each night.  This is a health psychologist's dream.

            The implications of the similar visions expressed by the leadership of these three federal Departments should be quite exciting for psychology, as long as our practitioners, scientists, and educators are actively engaged in shaping the specifics of the implementation strategies as they gradually unfold.  The behavioral sciences have much to contribute to these important national agendas and our visionaries have provided a solid scientifically-based foundation for their success.  Involved we must be.  Aloha,

Pat DeLeon, former APA President – Division 55 – May, 2011