Attending the annual APA convention has always been an exciting event -- seeing old friends, experiencing the enthusiasm of the next generation, and learning about new challenges. This has definitely become "my gift to myself." This year our 121st gathering was truly special, joining approximately 11,400 colleagues in Honolulu, Hawaii – home of psychology's first prescriptive authority (RxP) legislation. One of the most memorable highlights was attending HPA's welcoming reception with former HPA President June Ching at the beautiful home of another former HPA President Tanya D'Avanzo, overlooking the ocean on the Windward side of Oahu. Hawaii is truly special in so many ways. APA President Don Bersoff, as well as a number of the Board of Directors, was able to attend. Those of us who have decided to pursue careers in psychology are very fortunate – respected by society and possessing "interesting lives." Accordingly, we have a special obligation to "give back to society." Those who were fortunate to attend Don's Opening Ceremony not only were charmed by HPA President Darryl Salvador's Aloha greeting, they also were provided the opportunity to reflect upon how psychologists such as Jon Nachison (Stand Down), Toni Zeiss (VA), and Barbara Van Dahlen (Give an Hour) have lived a meaningful portion of their lives through public service, dedicated to improving the lives of those who have served our nation over the decades; i.e., Wounded Warriors and their families. The inspiring Presidential programmatic initiatives, which were held throughout the convention, focused upon the resilience and the unique and pressing needs of military families, their loved ones, and those continuing to serve the nation with distinction. Over the years, we have learned that the essence of all of the "learned professions" is possessing the vision and the willingness to seek a higher purpose – psychology is no exception.
Since U.S. Senator Daniel K. Inouye called upon HPA to seek prescriptive authority in the fall of 1984, in order to better serve their clients, organized psychology has slowly but steadily advanced this legislative/clinical agenda. In 1989 the Board of Professional Affairs (BPA) held a special retreat on this topic under the chairpersonship of Norma Simon. And in 1995 the APA Council of Representatives formally endorsed obtaining prescriptive authority as APA Policy. As a result of Senator Inouye's leadership during the Fiscal Year 1989 Department of Defense (DoD) Appropriations process, psychologists are prescribing today within DoD and the U.S. Public Health Service, as well as colleagues in Louisiana and New Mexico with John Bolter and Elaine LeVine being the first and first female outside of the federal sector legally prescribing. Few appreciate, however, that both Indiana (1993) and Guam (1998) have also enacted authorization legislation although not implemented to date.
From our global health policy perspective, especially with the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA), we fully expect that those who are comfortable with the present (regardless of their professional discipline and years of training) will soon find themselves obsolete. Psychology and the behavioral sciences have much to offer to our nation's health care delivery system, but only if we collectively get involved in the public policy/political process. As APA's Katherine Nordal graphically described at this year's impressive State Leadership Conference: "We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us. The details of ACA implementation vary from state to state, and so do the key players. Our practitioners increasingly will need to promote the value and quality they can contribute to emerging models of care. I believe that if we are not valued as a health profession, it will detract from our value in other practice arenas as well. No one else is fighting the battles for psychology and don't expect them to. Health care reform is a marathon – we're in it for the long haul. New models of care and changes in health care financing won't take shape overnight. We can't hope to finish the marathon called health care reform if we're not at the starting line. Fortunately, many psychology leaders have embraced our call to action." And a year earlier: "If we're not at the table, it's because we're on the menu. And I quite frankly don't want to be on anybody's plate to be eaten." Katherine also pointed out that psychologists make up only about one-sixth of the behavioral health workforce. Thus, with general practice physicians consistently prescribing 60% of the psychotropic medications, RxP provides a real opportunity to demonstrate "value-add" to the health care systems of the future.
A Visionary RxP Trainer's Perspective: Bob McGrath, who administers the Fairleigh Dickinson University (FDU) RxP training program, reports that: "We were saying 1600 colleagues have already completed their training a year ago. Today I expect we are up to about 1750. The pursuit of prescriptive authority in Illinois and New Jersey has resulted in an unexpected but exciting by-product, which is a dramatic increase in enrollments to the FDU psychopharm masters' program. I'm pleased to say that we are about to start our largest class ever. Even the possibility of passage in a more industrialized state has revealed a continued and even perhaps growing interest in psychopharm training. I continue to believe we can only combat the mismanagement of medication – both its underuse AND overuse – if we can manage it ourselves. I also maintain my belief that RxP should be the #1 advocacy agenda for the profession. While other agenda items such as parity or identification as 'physicians' increase the potential for others to hire psychologists, only RxP enhances the motivation for others to hire psychologists. Unfortunately, for too long a small group of naysayers have dominated the discussion. I think it's time for us to celebrate the remarkable contributions of our prescribing psychologists, including a 20-year history without a single complaint or suit, decoration by multiple branches of the military, and a record of exemplary service in response to some of the great crisis events of recent years." Those interested in the history of RxP would appreciate that Morgan Sammons and John Sexton were the first two DoD prescribing psychologists. The RxP agenda is all about, and always has been primarily about, serving society and making psychological services more readily available for those who would clinically benefit from our expertise. It has further been our observation over the years, as California Psychological Association practice leader Chuck Faltz has emphasized on numerous occasions, when CPA was active in pursuing RxP, the membership became meaningfully engaged and significantly increased their participation, both in numbers and financial contributions. When CPA hit a hiatus, membership involvement slowed down dramatically. At the Uniformed Services University of the Health Sciences (USUHS) (DoD), psychology and nursing are increasingly collaborating on developing integrated and interdisciplinary training modules. Mark Skrade, President of the School of Professional Psychology at Forest Institute, continues to move forward on his vision for a joint PsyD-Advanced Practice Nursing or Physician Assistant dual degree program, with an emphasis on primary care. Graduates of these programs will undoubtedly possess a rich appreciation for the nuances of ACA's integrated care.
New Horizons For Those With Vision: A high personal priority of the NIH Director, the National Center for Advancing Translational Sciences (NCATS) was established at the National Institutes of Health (NIH) on December 23, 2011, with the mission to catalyze innovations aimed at enhancing the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions. By improving the process of translation, NCATS enables scientists in both the public and private sectors to develop drugs, devices, and diagnostics more efficiently for any number of diseases, ultimately accelerating the pace at which they are delivered to the patients who need them. The NCATS budget document ($665.7 million) notes that there have been dramatic advances in our understanding of the molecular pathogenesis of disease in recent years, and by pairing this knowledge with advances in technology and with expert partners, NCATS is on its way to transforming the translational research process into an efficient and collaborative enterprise. By focusing upon commonalities across diseases and organ systems, NCATS complements the work of other NIH institutes and centers as well as that of its pharmaceutical, foundation, and advocacy partners.
To date, NCATS has become a hub of innovation for translational sciences. The Center has launched several major research initiatives, cultivated promising strategic partnerships, and established a presence at the NIH and in the community. The milestones include: guiding an evolution of the national network of clinical and translational research institutions; overseeing an innovative grant program to create new tools for predicting drug toxicity in partnership with the Defense Advanced Research Project Agency (DARPA) and the Food and Drug Administration (FDA); and developing a breakthrough partnership program with eight pharmaceutical companies to find new uses for existing drugs.
NCATS supports the development, demonstration, and dissemination of a broad range of technologies, tools, and resources that facilitate collaborative pre-clinical testing and first-in-human clinical trial implementation. Through its Clinical and Translational Science Awards, NCATS supports institutions across the country in their efforts to improve the quality, validity, generalizability, and efficiency of clinical and translational research. The Research Electronic Data Capture (REDCap) system, a freely available powerful enterprise electronic data capture tool that is easy for investigators to use, provides capability for conducting clinical research studies quickly and securely. Integrated clinical data repositories at supported institutions and policy agreements that allow searches across multiple institutional repositories facilitate clinical trial recruitment and hypothesis generation. These tools are helping amalgamate supported institutions into a national network for observational and interventional trials.
In order for NCATS to meet its mission, the biomedical [and we would add behavioral] workforce must be sufficient in size and equipped with the requisite knowledge and skills for advancing the relatively new discipline of translational science. NCATS supports a dedicated clinical and translational research training pipeline to ensure that our nation has the trained research team members needed to move basic research finding into the clinic. Over 4,100 researchers have been trained so far. These supported training programs incorporate nationally endorsed core competencies required for translational researchers, including the principles and application of translational science, collaborative team science, project management, and entrepreneurship. Training competencies focused on therapeutic development are currently being developed. NCATS is committed to increasing its support for accelerating the bench-to-bedside process. In the coming year, NCATS proposes to greatly expand its successful drug repurposing initiative to encompass up to 100 rare diseases which currently have no treatment. NCATS's highest priority is to advance the discipline of translational research by catalyzing the development of innovative methods and technologies that accelerate the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions. We fully expect that future budget documents will highlight NCATS's yet to be discovered interest in the mental and behavioral health fields.
Retirement Perhaps, For Some: "I appreciate your emails focusing on the major changes in health and different retirement patterns. In my case they go together. I work about half time as a contract psychologist with the Coast Guard Training Base-Petaluma Medical Clinic. The base is an hour and a half north of San Francisco in the wine country and about a half hour from Bodega Bay on the Pacific where my wife and I live. It's a great combination of environments. I have completed my third year at the Coast Guard Clinic collaborating with a Coast Guard Physician(s) and Physician Assistant along with a dozen Health Service Assistants and additional Health Professionals. I determined on starting here to find every psychology way to be helpful to these Coast Guard members and our Coast Guard patients. So I have been able to make use of my broad background seeing patients/clients in universities, country hospital, USAF bases, public health, public agencies, a private in-patient clinic, as well as professional school contexts. As I have worked here in consultation, short and long term psychotherapy roles, as well as in emergency triage situations, I thought how indebted I am to the psychologists from whom I have learned directly and indirectly, those researchers/theorists, and of course practitioners. Then it popped into my mind: 'I belong to a noble profession,' experiencing being proud of being in our profession. We would do well to describe our profession in this way to students and young psychologists. We can get too lost in our disagreements and conflicts. My best, [Rod Nurse]." According to the National Park Service, Dinosaurs were a remarkably successful group of animals. They lived on the Earth for 160 million years. Their world and that of psychology has radically changed. Aloha,
Pat DeLeon, former APA President – Nebraska Psychological Association – September, 2013
