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 21st 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
