The 121st APA annual convention was a tremendous success with approximately 11,400 registrants. HPA President Darryl Salvador's Opening Session Aloha and the accompanying Native Hawaiian dancing and music were extremely well received, especially by our colleagues from the Mainland. Hawaii has much to be proud of. The Hawaii Prepaid Health Care Act, enacted back in 1974, was one of the models for President Obama's landmark Patient Protection and Affordable Care Act (ACA) and accordingly, is expressly "grandfathered," as long as its benefits meet the evolving national standards. A decade later in November, 1984, U.S. Senator Daniel K. Inouye urged the HPA to obtain prescriptive authority in order to better serve their clients, resulting in psychology's first RxP legislative efforts in the nation. The Hawaii Health Connector (Health Insurance Exchange), under the leadership of Coral Andrews, has been focusing upon diversity at all levels of the health care industry, as it prepares to "go live"on October 1st. The implementation of the state based marketplace will complement the existing ecosystem but also contribute directly and indirectly to the development of new business models, new professional structures, and new models of care -- again, in the forefront of the nation. As non-physician providers finally come into their own, a wide range of disciplines will emerge in leadership positions to support the requirements necessary to fully implement ACA. New markets and new approaches will emerge, notwithstanding the considerable pain inherent in substantive change.
Since retiring from the late Senator's staff, I have been pleased to be affiliated with the William S. Richardson School of Law at the University of Hawaii. Under the leadership of Dean Avi Soifer, the School has established new programs in Native Hawaiian Law and Health Policy. Dina Shek administers a most progressive interdisciplinary Medical-Legal Partnership for Children (i.e., legal services clinic) at the federally qualified Kokua Kalihi Valley (KKV) Community Health Center and positive discussions are evolving with the West Oahu Vet Center. Those who are served by these sites have very unique and pressing psychosocial-legal needs as Don Bersoff's APA Presidential programming identified. On a personal note, over the years I have been most impressed by the successful and truly holistic community outreach efforts at KKV. For example, their spacious culturally sensitive food garden targets the life journey of their Polynesian and Pacific Basin clientele, as envisioned by Executive Director David Derauf. "Healing can and needs to take place at so many levels; sometimes the healers heal and sometimes they are healed. Sometimes, when we come together as a community, whether we are doctors, lawyers, psychologists, grandparents, or grandchildren, we find that we can figure these things out together, heal each other and our community." What a wonderful opportunity for meaningful engagement by students in law, psychology, and nursing.
At our APA gathering, Illinois's Beth Rom-Rymer was able to convey the enthusiasm steadily generating within the RxP movement across the nation and internationally. "In Ontario, requests for extending scopes of practice to include prescriptive authority are directed to the Minister of Health. The RxP Committee submitted our request in November, 2012. We have been advised that a ruling on RxP is 'on hold,' pending other requests for legislative change, as the Minister would prefer 'opening up' legislation for more than a single change. We have a number of meetings scheduled with various officials to discuss how prescribing psychologists would benefit a number of Ministry initiatives in an effort to move the process along. It should be noted that the provincial government supports non-physician prescribing and has already granted prescriptive authority to other healthcare professionals, such as nurse practitioners, optometrists, naturopaths, pharmacists, and midwives (Jane Storrie and Diana Velikonja, co-chairs)."
The Congressional Vision: During its deliberations on the FY 2014 budget for the Department of Health and Human Services (HHS), the Senate Appropriations Committee highlighted several items of particular interest to psychology. The level of funding for the Native Hawaiian Health Care Program, which in 2011 served more than 8,400 people, is to remain level at $14.4 million, notwithstanding overall budget reductions. HRSA and SAMHSA are encouraged to continue collaborating in order to develop and replicate community health worker programs that integrate primary care and behavioral health, and provide a report on their efforts for next year's budget. Under the Graduate Psychology Education initiative, thanks to the efforts of APA's Cynthia Belar, support was expressed for the Secretary's initiative to increase the number of psychologists pursuing clinical work with high-need and high-demand populations. These are defined as rural, vulnerable, and/or underserved populations, as well as veterans, military personnel, and their families. "While the Committee commends the emphasis on programs targeting veteran and military personnel population centers, the Committee is concerned that many service members reintegrate into civilian life in communities that are rural and far from military and veteran facilities. As such, the Committee encourages HRSA to maintain a strong commitment to underserved areas generally." Those interested in the legal and RxP agendas should note that: "According to a December 2012 GAO report, an alarming 18 percent of foster children are prescribed psychotropic medications, compared with 4.8 percent of privately insured children. The Committee strongly encourages SAMHSA to establish meaningful partnerships with Medicaid, the foster care program, medical specialty societies, and treatment centers to develop new strategies for treating this vulnerable population. The Committee would like an update in next year's congressional [budget] justification on the steps SAMHSA has taken to promote the most effective and appropriate treatment approaches, including the use of evidence-based psychosocial therapies instead of, or in combination with, psychotropic medications."
Health psychologists and those who contemplate the long term benefits of integrated care should be pleased with the Committee's recognition of the National Institute on Aging for its investment in large-scale longitudinal surveys, including the National Health and Aging Trends Study and the Health and Retirement Study. The Senate Committee particularly applauded the National Academies of Science report "Shorter Lives, Poorer Health," which found that Americans live shorter lives and are in poorer health than people in other high-income countries and that behaviors and social circumstances are major contributing factors. And, as Coral indicated earlier, nurses, in particular, are making significant strides in establishing leadership opportunities as reflected by the Senate's directive that "no less than" $5 million shall be awarded during the coming year to nurse-managed health centers, one of the visionary components of ACA.
The Past Will Return, Eventually: During the 110th Congress Senator Edward Kennedy, Chair of the Health, Education, Labor and Pensions (HELP) Committee favorably reported out of his Committee on October 1, 2007, S.1693, the Wired for Health Care Quality Act, which was a precursor for today's Health Information Technology (HIT) era. At the time there were 11 cosponsors of the bill, eight of whom were Republicans. Senator Hillary Rodman Clinton was one of the Democratic cosponsors. The days of bipartisanship in furtherance of the nation's business will eventually return. In the meantime, Hilo's Judy Steinman reports: "Our first graduate to take the PEP passed on his first try and he just received his credentials to prescribe. Another one of our first cohort is enlisted in the USAF and moving to Arizona. There is a medical psychologist there so she hopefully will be able to complete the program from there. We are graduating all four of our second cohort students this summer. Two are planning to take the PEP and two (civilians) are not planning to take it now because they are going to work in states that do not yet have RxP. One will work in an oncology department so I feel that we are spreading our training into useful areas." Aloha,
Pat DeLeon, former APA President – Hawaii Psychological Association – September, 2013
