Making A Difference: One of the most fulfilling aspects of working within Nursing at the Uniformed Services University of the Health Sciences (USUHS) and the University of Hawaii (with Law and Pharmacy) is the opportunity to pursue interdisciplinary collaboration, which is one of the hallmarks of President Obama's landmark Patient Protection and Affordable Care Act (ACA). One of the very last events of my APA Presidential term was to travel to the State of Washington in December, 2000 to present a well-deserved Presidential Citation to your colleague Colleen Hacker for her outstanding work with the U.S. Women's Olympic Soccer Team, which in my judgment, revolutionized the expectations of our nation's female youth for what they could accomplish in sports, science, and education. They made a lasting impression on my daughter Kate. That evening, I reflected upon the many national accomplishments of WSPA's leaders; for example, Ruth Paige whom I have had the pleasure of serving with on the APA Board of Directors, Barry Anton, and Andy Benjamin. I recalled Al Paige inviting me to Ocean Shores in May, 1981 to talk about the importance of your maintaining the doctoral level standard, notwithstanding internal "political pressures." Former APA Congressional Science Fellow Margy Heldring and Elizabeth Robinson were catalysts for a number of important APA policy issues, including attracting more women into APA's governance.
Recently I had the opportunity to address the leadership of several national pharmacy organizations and learned, once again, that their members from your state have been on the cutting edge of pharmacy's maturation. Today the Doctor of Pharmacy (PharmD) degree is the educational standard and their practitioners are providing comprehensive, patient-centered primary care (comparable to what health psychologists envision), including such preventive services as relaxation techniques, blood pressure evaluations, and anti-smoking educational efforts. Our College of Pharmacy in Hilo conducts well attended community health fairs and is training Hawaii's psychologists in psychopharmacology. The profession of pharmacy has obtained "collaborative practice" medication authority in almost all states and throughout the federal services (i.e., VA, DoD, USPHS, and Bureau of Prisons), often including the ability to initiate, modify, and terminate drug protocols. While pharmacists have been involved with vaccines dating back to the mid-1800s and the distribution of smallpox vaccine, approximately two decades ago pharmacists began routinely immunizing patients in their communities as a standard practice activity. The Washington State Pharmacists Association initiated the first ongoing formalized training of pharmacists in vaccine management in 1994, leading to the American Pharmacists Association's (APhA) nationally recognized training program for their members, in conjunction with the CDC. Today (in contrast to psychology's orientation) organized pharmacy has embraced the utilization of pharmacy technicians, especially with the advent of the impressive advances occurring within the communications and technology fields. Psychology should learn from pharmacy's experiences, including working closely with the pharmaceutical industry to sponsor innovative service delivery models. Within the nursing profession, which also has been steadily expanding its scope of clinical practice over the past several decades, their national leaders have often been from your state. And, various Washington State educational institutions have long maintained an impressive presence throughout Rural America; including on Indian reservations, the Pacific Basin, and the State of Alaska. Providing patient-centered, cost-effective, and demonstrably accountable care has been paramount throughout these efforts. I would love to hear of WSPA's efforts to work collaboratively with your state's federally qualified community health centers (FQHCs).
Novel Models: Former APA President Alan Kazdin recently addressed the need for our nation to develop novel models for delivering quality mental health services. There can no longer be any question that there are significant economic and personal burdens of untreated "mental illness" throughout the nation and the world. Mental health and physical health are inextricably intertwined. Within the U.S. approximately 50% of our population meets the criteria for at least one psychiatric disorder during their lifetime. Many of the barriers for delivering care for physical health issues to large swaths of individuals in need, particularly in developing countries, are recognized to be similar to the barriers of providing mental health care. Alan points out that within the mental health professions the current model of delivering care is expanding; many involve the use of technology and online-versions of treatment drawing upon the Internet and other social media. Similar to pharmacy's recognition, our former President has seriously proposed exploring "task shifting" which is a method of redistributing the tasks of delivering services to a broad range of individuals with less training and fewer academic qualifications than traditional health care workers possess in order to scale up the scope of providing services. The underlying concept is not new having emerged from global health initiatives, particularly in developing countries where the majority of task-shifting applications have focused upon physical health where shortages of human resources and the burden of illness are acute. This approach has recently been expanded to mental health concerns because of its ability to be scaled up to provide services to individuals who otherwise do not have access to care, as well as its adaptability to diverse countries, cultures, and local conditions. Standardized treatments, decentralized delivery models, and simplified treatment protocols are systematically evolving. Perhaps "lessons learned" from the business community's experience with "disruptive technology and disruptive innovations" will become the key. To appreciate the true potential of this approach, psychology's training models of the future must become interdisciplinary in nature and we would suggest, moving beyond those of the traditional health professions.
An Interesting Example of Alan's Vision -- Behavioral Health Technicians: "Recently those of us at USUHS were fortunate to have five enlisted behavioral health technicians (BHTs) speak with the students, faculty, and staff of the Medical and Clinical Psychology Department. The group consisted of Army and Navy personnel, with various assignment and deployment experiences. The main speaker for the group was Army Sergeant First Class (SFC) Jonathan Colon, the Senior Enlisted Leader for the Directorate of Behavioral Health and the senior 68X (Army Behavioral Health Technician) for the Walter Reed National Military Medical Center of Bethesda.
"SFC Colon discussed the primary duties of the BHT within the Army, Navy, and Air Force. For example, the Army BHT assists in providing treatment for patients with behavioral health problems such as substance abuse, sexual assault and domestic violence, social issues, and posttraumatic stress disorder (PTSD). They collect the required data from clients and are responsible for unit training on various behavioral health topics. Under the supervision of a licensed provider (including psychological nurse), the enlisted BHT can conduct initial interviews, perform assessments, provide follow-up care, administer psychological tests, assess patient response to rehabilitation or treatment, co-facilitate group therapy sessions, and perform Combat and Operational Stress Control (COSC) functions.
"The Navy and Air Force BHTs perform very similar functions, but with some distinct differences. For instance, Navy BHTs are initially trained as corpsmen, which means they also have extensive medical training and can assist with emergency patient care if necessary. The Navy is responsible for overseeing the needs of the Marine Corps, as that group is designated under the Department of the Navy. The Air Force BHT job duties include on-call consultation to the Command and clinic management, though the Air Force BHT has a smaller role in conducting therapy sessions.
"Perhaps the most shocking bit of information for the audience was the discovery of how much independent work the BHTs perform while deployed. Due to the lack of licensed mental healthcare providers, these BHTs are left to work alone for weeks or months at a deployed site. They will conduct the initial assessment, create a treatment plan, conduct individual or group therapy, and even make medication recommendations. They work under the auspice of the behavioral health provider assigned to that camp or region through a precept method. The BHT will conduct the work and create the recommendations, then contact the provider by phone for approval or changes, and then implement the finalized plan.
"Another key piece of BHT duty is to act as the liaison between the troops and the commanders, and between the licensed provider and the troops. All licensed providers are military officers, and all BHTs are enlisted. The difference can sometimes be a gulf that is difficult to traverse, and the BHTs are the bridge that connects both sides. Many times, troops will not want to see a licensed provider, but they have an issue they want to discuss. An enlisted BHT, who is in the ranks working, eating, and bunking with these troops, is more likely to find out about the issue and offer assistance. Their presence also reinforces the strength and trust between the troops and the Command structure, as well as helping to eliminate the stigma of being treated in behavioral health. Obviously, the skills and experiences of these BHTs cannot be overemphasized, nor should they be underestimated. They are skills that need to be utilized by the licensed providers of all the military branches, lest we lose them [Steven Brewer]." Interesting times as always. Aloha,
Pat DeLeon, former APA President – WSPA – January, 2013
