Creative Educational Initiatives: Now that I have the opportunity of serving within the academic arena, one of the most personally fulfilling experiences has been being constantly exposed to creative educational endeavors. "At the Uniformed Services University of the Health Sciences (USUHS) DoD students and faculty can participate in Operation Bushmaster which is a two week field exercise for the School of Medicine fourth year students and the Graduate School of Nursing family practitioner and psychiatric mental health students. During this period, the students are put into medical platoons as they learn combat casualty care, care of refugees, and the challenges of providing medical aid to detainees. The students rotate through leadership and medical provider roles where they are evaluated by expert faculty in the areas of leadership, clinical decision making, and the transport of casualties under fire. For over 350 students this year, the exercise culminated with a simulated MASCAL exercise; a simulated attack during a nighttime operation, resulting in mass casualties. The students then drew on their education, training, and experience as they tried to make order out of chaos while triaging, treating, and evacuating patients. The goal of the exercise is for the students to be prepared for being deployed to austere environments to perform any medical support operation. Thus, the students have fulfilled USU's motto, 'Learning to care for those in harm's way.'
"Faculty must be invited to serve as evaluators and/or observer controllers. Most of the faculty selected has been deployed several times to many areas of the world. The trick for faculty during the exercise is to allow the students the latitude to make decisions while being a 'measuring stick' and guide to steer the students in possibly another direction. Each exercise performed by the students has an after action report period where the students perform a self-assessment on how they performed while the faculty provides additional feedback. The faculty has a vested interest in participating in this exercise because they know these students may be serving under or alongside them in medical support operations in the future [Tom Rawlings, GSN]."
Similarly, former HRSA senior staff Dan Kavanaugh: "I am enjoying my second career pursuing my acting interests, continuing to do standardized patient work at USUHS. Since the fall, I have had a 'steady gig' with George Washington University School of Medicine (GWU) that uses theatre to work with physicians and other health care professionals around issues of professionalism and 'burnout.' We have received very high marks from our audience (various specialties at GWU, VA hospital leadership, Society of Anesthesiologists, among others). We are presenting to the American Association of Medical Colleges in the near future. Essentially, we perform a short 25 minute one-act play to look at these issues and then an audience interactive piece which is facilitated by a physician from the GWU School of Behavioral Health Sciences [http://charlessamenowmd.com/medicaltheater/]."
Expanding the RxP Agenda: Bob McGrath (2006 Division President) estimates that there are 1,700 colleagues who have now completed their advanced RxP training. APA's Jan Ciuccio reports that the data on achieving the Recommended Passing Score on the national Psychopharmacology Examination for Psychologists (PEP) includes both first-time takers and repeat-test takers combined. As of November 2012, 289 individuals had taken the PEP and 230 had met the Recommended Passing Score. Thus, approximately 80% of those taking the exam have eventually passed. Bob: "The M.S. Program in Clinical Psychopharmacology at Fairleigh Dickinson University has enrolled a new class every year since its inception in 2000. We have purposely kept our classes small, and will split them if they become too large. Even so, I'm pleased to say that enrollments have actually been growing in recent years. Since the program became one of the first designated by APA as meeting its model curriculum for training in psychopharmacology (designed for state licensing board consideration), recent incoming classes have been almost twice the size of those of 4-5 years ago. It's clear that more and more psychologists recognize the benefits of prescriptive authority in the long term, and enhanced knowledge of psychotropic medications in the immediate future, to their patients and the profession. Though distance based and completely online, we use a traditional academic course model in which activities, readings, and video lectures are completed weekly under the guidance of a course instructor. We have been lucky to retain some faculty members who have been with the program since its very early days, including several exceptional pharmacists and prescribing psychologists. The university has recently established its own School of Pharmacy, so we anticipate even greater collaboration between our program and pharmacists in the future."
During my APA Presidency in 2000, we met several times with pharmacy's national leadership and held our last Board of Directors' dinner meeting at the American Pharmacists Association (APhA) historical building on the National Mall. The newest RxP training program is at the University of Hawaii at Hilo College of Pharmacy which graduated its first two students this past December, one of whom will soon be sitting for the PEP. Those who have been involved with this critical legislative agenda from the beginning will recall Linda Campbell's trailblazing efforts with her colleagues at the University of Georgia School of Pharmacy. With the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA) [P.L. 111-148], pharmacy has been increasingly expanding its primary care role. Back in 2008, 44 states had already recognized pharmacists' collaborative practice authority which allows for the initiation, monitoring, and modification of medication therapy for patients, typically under protocol. What better profession to collaborate with to learn about the fundamentals and intricacies of prescribing?
International Progress: "The Postdoctoral Master of Science program in Clinical Psychopharmacology at the California School of Professional Psychology (CSPP) at Alliant International University will start its 15th cohort in 2013. The program which has also been designated by APA as meeting its model curriculum now includes a course in Molecular Nutrition and RxP. Three psychologists from South Africa will be included in the new group, as well as at least two additional psychologists from Guam (one having already graduated). This group will bring the number of Alliant RxP graduates to close to 500. The program is now delivered through interactive distance education, so students can participate live from their own computers, with no travel necessary. Classes are also recorded and archived so students can watch at a later time. For further information contact me at stulkin@alliant.edu. Additional news is that Dean Morgan Sammons (2009 Division President) and I will be traveling to New Zealand next spring to consult with the New Zealand College of Clinical Psychology and the New Zealand Psychology Board on the development of training programs for prescriptive authority [Steve Tulkin]."
State Level Advances: During the past year, we have been particularly pleased to see an increasing number of state psychological associations pursuing legislative RxP agendas. Rebecca Gordon, one of the RxP lobbyists for the Illinois Psychological Association (IPA): "Illinois has robust discussion on RxP, moves toward passage of bill." On March 6th, IPA's bill for prescriptive authority passed out of the Senate Public Health Committee with a 7-5 vote. This was the first time in Illinois history that the IPA's RxP bill had passed out of a legislative committee. On May 1st, the IPA, together with its lobbying and public relations teams, initiated an extensive statewide grassroots campaign to garner broad-based support for RxP. Under the leadership of IPA President-elect Beth Rom-Rymer (2004 Division President & IPA 2011-2012 President), over 250 IPA psychologists, around the state of Illinois, have been meeting with legislators and the broader mental health care community to educate them on the legislation that would give prescriptive authority for psychotropic medications to psychologists with advanced, specialized training in clinical psychopharmacology. Interest, accompanied by much intense discussion, has been strong with legislators and others in Illinois who are concerned about mental health treatment options. By late November, 38 meetings with legislators and RxP supporters in their districts had been completed with an additional 48 meetings in the works. Whereas five third party statewide organizations have officially endorsed the RxP bill, there have been ongoing discussions with numerous other third party organizations that will yield significant formal endorsements over the next several months. Jana Martin CEO of the APA Insurance Trust and Elaine LeVine (2007 Division President and the first prescribing psychologist in New Mexico) have been actively engaged in many of these discussions. The IPA is looking forward to re-introducing the RxP legislation early in 2013 with the hope that the bill will pass out of both Houses of the State Legislature by May 31st, the date on which the 2013 legislative session ends. Beth and the IPA membership are well aware of the many challenges that face their RxP bill. That Illinois is the home of the American Medical Association is only one of those challenges. We also understand that, as anticipated, the leadership of the Hawaii Psychological Association will again be pursuing RxP legislation at their legislature, following up on their previously vetoed bill. There have recently been changes in the Administration and State House leadership; as well as renewed interest by rural legislators, which we would expect is a direct result of the University of Hawaii at Hilo's graduation of its first psychopharmacology graduates.
Enacting RxP legislation at the state level is extremely important not only for psychology's clients but also for the very future of the profession. In many ways, the President's visionary proposal (ACA) for providing quality health care to all Americans places the primary responsibility for implementation of his overarching schema at the state and local level. Integrated care, interdisciplinary collaboration, wellness and prevention, and effectively utilizing the extraordinary potential inherent in the advances occurring almost daily within the communications and technology fields are critical to the Administration's patient-centered mission. Clinical services are to be data-based and represent gold standard care. Mental health care (i.e., behavioral health) is envisioned as being an important component of primary health care. There will be an unprecedented opportunity to objectively demonstrate the clinical "cost off-set" which former APA President Nick Cummings has discussed for decades. However to thrive as a primary care health provider in such an evolving and unsettled environment, psychology must learn and adapt to the culture of primary care and medicine. This will be a challenge for our traditional training institutions. Change is always unsettling, especially fundamental change. And we have come to appreciate over the years that only a small subset of our profession is comfortable being in uncharted waters. Those colleagues who are on the forefront of the prescriptive authority quest and thereby investing in the future are unique. The majority of practitioners and our training institutions are unfortunately sitting back and waiting for more concrete personal and institutional benefits to evolve.
Lenore Walker: "I have thought about whether or not to write a paragraph about Nova Southeastern University's psychopharmacology program. However, there is not much to say. We are on what we call 'a hiatus' while we re-evaluate the program. Under consideration is the possibility we will re-design it as an on-line program together with some of the other health science practitioners from our health science programs and include students from our doctoral program, particularly the health concentration students but possibly others also. Nothing has been finalized yet but if we really do get one or two more states with prescribing privileges that would make a big difference amongst our administrators. We are also mindful of the national movement towards interprofessional practice so including training psychologists together with other health care practitioners would move us closer to that goal."
Reflecting upon how members of our profession do not appreciate the magnitude of change coming, at the request of the former Dean of the School of Public Health at the University of Hawaii, HPA is attempting to ascertain to what extent Hawaii psychologists are utilizing electronic health records, which is another cornerstone of the ACA. Alex Santiago: "I have been trying to get the information you requested about psychologists using electronic filings. We sent a request over our list serve and I have been in touch with the Department of Health. Very little information is available on this. Many members report using electronic filing for billing, but only a few reported actually using them in their practice for patient records. However, Kate Brown over at Tripler Army Medical Center did indicate that the DoD has used electronic medical records for at least the last 10 years. In Hawaii, this would include Tripler and all outlying military clinics using the AHLTA system and the VA using the JANUS system. At this time the two systems do not communicate with each other although she believes there are plans for the two to ultimately be integrated, including for psychology. I am not sure if anyone has any more information on this, however, I will continue to ask."
Intriguing Developments in Accreditation: Alan Kraut, executive director of the Association for Psychological Science (APS), addressed our USUHS psychology public policy class this fall and described the new Psychological Clinical Science Accreditation System (PCSAS). Over the years Alan has had a very positive impact upon professional practice. For example, APA's first Black Tie event for national politicians was hosted by Alan, honoring U.S. Senator Daniel K. Inouye, in Los Angeles. Increasingly, professional schools have suggested that the current APA accreditation system makes it very difficult for them to offer public policy courses or psychopharmacology. The APS Observer reports that PCSAS was recently recognized after a three year review process (including application, several cycles of accrediting programs, and then review) by the Council for Higher Education Accreditation (CHEA), which is the national nongovernmental gatekeeper of accrediting organizations. This should open the way for graduates of PCSAS-accredited clinical science training programs to work in settings in which graduation from an accredited program is a prerequisite for further training and employment. CHEA is one of two organizations in the nation with the power to recognize national accrediting bodies, the other being the U.S. Department of Education.
Under consideration is adoption by the Department of Veterans Affairs (VA) of the PCSAS standards as the federal statute provides considerable flexibility. Currently the VA only accepts students and hires graduates from APA accredited programs. Antonette Zeiss, who is the first psychologists and first woman to be appointed as chief consultant for mental health services in the VA, has indicated to Alan that's likely to change. She has been leading an internal group that is in the process of revising VA qualification standards, potentially including PCSAS as an acceptable accrediting body for clinical programs. "I think it certainly should happen. I think the only question is just the time it will take." The leadership of PCSAS has indicated that a next step will be to gain acceptance from state licensing boards.
PCSAS was created in late 2007 to promote science-based training and, by extension, to introduce a new culture of scientific clinical psychology. Their underlying objectives, which are highly consistent with the ACA, is to promote superior science-centered education and training in clinical psychology, and to increase the quality and quantity of clinical scientists, thereby contributing to the advancement of public health, and to enhance the scientific knowledge base for mental and behavioral health care. The Director of the National Institute of Mental Health called this recognition "an important step towards allowing this brand of clinical psychology to thrive, and to ultimately benefit the public." Over the years we have come to appreciate that in the long run competition is extraordinarily beneficial to consumers. With the substantial professional school market for accreditation, perhaps this development will result in sufficient flexibility for an expansion of the underlying mission of psychology's training institutions to include societal-oriented courses, such as public policy and psychopharmacology.
An Interesting Proposal: "I am very interested in virtual treatment opportunities. I would start with licensed providers over the age of 65 who want to offer services via a virtual network. This would allow all of us in the 'retirement' community to keep on working in our areas of expertise and not necessarily be confined to geographical borders. If a person is licensed in State A on a doctoral level this should hold for States B, C, etc., if the National Register is the clearing house. We certainly could refine and define the best networking possibilities (Helen Ackerman)." Aloha,
Pat DeLeon, former APA President – Division 55 – January, 2013
