TRAILBLAZERS FOR THE FUTURE

Our 121^st Annual APA Convention in Honolulu, Hawaii was truly exciting andprovided a timely glimpse into the future of psychology.  The energy and enthusiasm of the next generation was palpable, as was their appreciation for the critical importance of becoming actively engaged within our nation's healthcare arena.  The community mental health center movement had its beginning with the inspirational vision of President John F. Kennedy; the community health center movement was a feature of President Lyndon Johnson's Great Society, when psychologist John Gardner served as Secretary of the then-Department of Health, Education, and Welfare.  Over the years, almost all training and service delivery programs treated mental health and substance-use as fundamentally separate and distinct from physical health care.  Increasingly, however, enlightened clinicians and health policy experts (including the Institute of Medicine) have called for active integration, with the development of holistic, patient-centered clinical initiatives recognizing the critical importance of the psychosocial-economic-cultural gradient of care.

            The Times They Are A-Changin':  President Obama's signature Patient Protection and Affordable Care Act (ACA) will provide for the largest expansion of mental health and substance-use coverage in a generation, with 32.1 million Americans gaining access to these services, while another 30.4 million currently with some coverage gaining federal parity protection.  Under ACA insurance offered in the new marketplace must cover a core set of "essential health benefits," including mental health and substance-use disorder services.  The coverage for behavioral health services must be generally comparable with coverage for medical and surgical care.  Ken Pope recently shared a similar perspective, noting that in 2009 public and private mental health spending totaled approximately $150 billion, more than double its level in inflation-adjusted terms in 1986.  Perhaps most telling – listening to the Washington Redskins this weekend, two of their former quarterback commentators talked about the efforts of The Purple Heart Foundation to make readily available services for veterans suffering from PTSD and/or considering suicide.  They were talking to a mainstream audience, not to the professional journal readership.

Visionaries:  Oregon's health leaders have long been in the forefront of shaping our nation's evolving healthcare environment.  In 2002 the State requested a Section 1115 Medicaid waiver to develop an effective "safety net" for your most needy citizens, recognizing the need for holistic and "wrap-around" care.  Your 2009-2010 efforts to enact prescriptive authority (RxP) legislation, although not yet successful, places future generations in an enviable position to demonstrate their "value-add" in health care; at the St. Charles Health System Robin Henderson is demonstrating what psychology can contribute.  In 2011 the State established the Oregon Health Insurance Exchange Corporation which is increasingly becoming the implementing vehicle for ACA.  Earlier this summer representatives from the 16 states that have elected to run state exchanges met with officials from the Administration.  According to Hawaii's Coral Andrews, they were very pleasantly surprised to hear President Obama himself join their conference call, requesting a personal briefing on the progress (and tribulations) they were experiencing.  With expected retirements, the next Chairman of the Senate Finance Committee, which has jurisdiction over Medicare and Medicaid (i.e., major components of ACA), will most likely be Senator Ron Wyden, a longtime friend of psychology and professional nursing.  Colleagues James Werth, Jr.; Greg Hinrichsen, and Mary Polce-Lynch served with him as APA Congressional Fellows.  We would suggest, therefore, that those who does not appreciate the President's personal commitment to having all Americans have access to quality healthcare or who hope for Obama Care to be "defunded," simply have not been paying attention to the monumental importance of this national vision.

            Having retired from the U.S. Senate staff after 38+ years with Senator Daniel K. Inouye, I have become quite interested in what "senior colleagues" are doing.  This fall my wife and I will be visiting Oregon simply because we have never been there before together.  Oregon is the home of former APA President and health psychologist extraordinaire Joe Matarazzo.  It was a distinct pleasure to work closely with Joe as a member of the APA Board of Directors and over the years on behalf of health psychology.  Today, whenever I go to the Uniformed Services University of the Health Sciences (USUHS) (DoD) in my part-time capacity as Distinguished Professor, I particularly appreciate his vision in establishing their Department of Medical Psychology.  The local folklore is that four decades ago, while on the founding Board of Regents, Joe successfully convinced each of his fellow Regents to vote to establish the department, losing only the USUHS President's vote.  Oregon's vision has, and will continue to, serve the nation admirably.  Aloha,

Pat DeLeon, former APA President – Oregon Psychological Association – September, 2013

 

 

ONWARDS TO THE FUTURE

  As Steve Ragusea recently pointed out when agreeing to reinvigorate the Florida Psychological Association (FPA) prescriptive authority initiative (RxP), it has been quite a while since one of our state psychological associations successfully enacted RxP legislation.  Over the past decade a number of states have made considerable progress with both Hawaii and Oregon getting as far as having their bill ultimately vetoed by their Governor.  This year Illinois and New Jersey have made considerable progress, each having passed one of the Houses of their respective legislatures, and with both of their efforts remaining alive in their two year legislative cycles.  Patience, persistence, and personal presence will always be the key to ultimate success.  Collectively, how do we encourage our colleagues to keep inching forward at the state level until the next generation of psychologists believes that their profession has "always prescribed," as it has clearly been in the best interests of its patients?  Merely writing e-mails to each other simply does not work.

Prescribing colleagues in the Department of Defense (DoD) and the U.S. Public Health Service (particularly, the Indian Health Service) have clearly demonstrated that psychologists can learn this clinical skill and can apply it admirably.  And, it would be quite helpful in convincing those in administrative and policy positions to expand these important initiatives if our research colleagues would take a closer look at what has been accomplished, including the extent to which behavioral approaches might have been superior to utilizing medication.  For example, research in psychotherapeutic techniques has repeatedly shown Panic Attacks can be successfully treated in less than 10 sessions.  If prescribing psychologists are eliminating the long term costs of anxiolytics and antidepressants by using cognitive behavioral therapy, the monetary savings and reduction in human suffering would be demonstrably substantial.  Bob McGrath, head of the Fairleigh Dickinson psychopharmacology training program, estimates that there are currently 1750 psychologists who have completed their advanced RxP training and with 60 percent of psychotropic medications currently being ordered by primary care providers, there is a pressing societal need.  Incidentally, Bob was just voted Psychologist of the Year by his New Jersey colleagues – a well-deserved honor.

            The Department of Veterans Affairs (VA) is the largest employer of psychologists and Advance Practice Nurses (APNs).  Obtaining RxP authority within the VA would be a major breakthrough for psychology.  The VA serves approximately 49.3 million beneficiaries, constituting 15.5 percent of the nation.  It operates the largest Federal health care delivery system in the country, with 152 hospitals, 107 domiciliary residential rehabilitation treatment programs, 133 nursing homes, 300 Vet Centers, and 821 outpatient clinics.  It is estimated that 6.5 million patients will be treated in the coming year.  The VA has proposed utilizing its federal supremacy authority to establish a system-wide, national nurse practice standard which would allow these practitioners to function to the fullest extent of their training, pursuant to recommendations by the Institute of Medicine (IOM).  Under the leadership of Cathy Rick, then-Chief Nursing Services Officer, the new VHA [Veterans Health Administration] Nursing Handbook, provides APNs with the authority for independent practice, regardless of individual state licensure limitations, unless an individual VA facility limits their scope within that facility.  This visionary document has been "cleared" by the relevant legal authorities who will be reminding hesitant states about the federal government's supremacy powers within federal facilities.  Two underlying values enumerated are that the patient owns and drives their care based on the information available and that nursing interventions are based on the best available evidence and accepted standards of practice.

            Specifically the handbook proposes:  "Clinical nursing practice varies widely among the States.  To ensure safe and appropriate health care to the nation's Veterans, VA has standardized the elements of practice, within VA, for clinical nursing practice other than the prescribing of controlled substances, without regard to individual State Practice Acts.  This ensures a consistent standard of nursing care throughout VA's national health care system….  Under the Federal Controlled Substances Act… a health care practitioner may prescribe controlled substances only if the practitioner's State license authorizes such prescribing.  Accordingly, APRNs, including NPs, may prescribe controlled substances within VA only if they are authorized to do so by their State of licensure or registration and comply with the limitations and restrictions on that prescribing authority.  Where VA establishes elements of nursing practice that are more expansive or otherwise inconsistent with State practice standards, VA's practice standards control.  VA nurses must follow the VA nursing practice standards established in VA rules, regulations, and policies."

            Not surprisingly, medicine (the President-elect of the American Society of Anesthesiologists, who herself possesses a nursing degree and was trained as a nurse anesthetist), has expressed objections, based upon the commonly used "public health hazard" argument.  She said of the proposed policy:  "This document effectively eliminates the gold standard, physician-led, team-based coordinated care in anesthesiology.  The VHA intends this to be the policy for all its hospitals, superseding state law, where currently more than half of states require physician supervision of nurse anesthetists….  (L)ocal chiefs of anesthesiology will no longer have the authority to set policies they deem best for the patients they serve."  The proposal policies "raise significant safety concerns in our sickest population."  "The length and depth of training are dramatically different.  As physician anesthesiologists we trained for 12 to 14 years rather than 5 to 7.  Nursing education and training did not prepare me for the level of care needed in the perioperative environment when seconds matter."  Despite her statement, all of the objective evidence that we have seen over the years indicates that nurse anesthetists are extraordinarily safe, including a recent review of approximately 500,000 cases.  In rural America their services are crucial as they are the primary provider of anesthesia.

We were very pleased to learn that Heather Kelly, who for the past 15 years has addressed legislative and administrative issues for the Science Directorate regarding the importance of psychological research at the VA, NSF, and DoD, has now become the APA point person on their team effort on all military and veteran-related issues, including the clinical portfolio.  Obtaining RxP for interested VA employees will become one of her agendas.  Accordingly, the research that Steve Ragusea has proposed would indeed be most timely, as well as extraordinarily useful to Heather, in countering medicine's ongoing emotional "public health hazard" arguments against the expansion of non-physician scopes of practice and particularly, against RxP.  And, we should remember that obtaining RxP provides clinicians with the authority to modify or stop ineffective medication decisions.  Fred Frese, a longtime advocate for individuals challenged by chronic mental health issues, reports on a 7-year follow-up study published in JAMA-Psychiatry finding that individuals with schizophrenia who are on reduced or no doses of anti-psychotic medications do better than those on medications.  Other research Fred has highlighted suggests that those on antipsychotic medications live 15 to 25 years less than would be normally expected. 

            The Alliance for Health Reform:  One of the most enjoyable aspects of having retired from the U.S. Senate staff after 38+ years is that I have the time (and willing friends) to host a psychology-nursing health policy seminar at the Uniformed Services University of the Health Sciences (USUHS) (DoD).  Each week we invite a colleague who is, or has been, active within the public policy process to discuss their personal journey.  Recently Toni Zeiss addressed the class (generally 7 to 10 students and faculty) about her experience serving as the first woman and first non-physician to be appointed as Chief Consultant for Mental Health Services at the VA Central Office.  At our annual APA convention in Honolulu, President Don Bersoff presented her with a special Lifetime Achievement Award.  A previous guest was twice former VA Secretary Tony Principi.

Ed Howard, another speaker, and I used to work together when he was on the staff of then-Representative Spark Matsunaga, who was elected to the U.S. Senate in 1977.  Ed is currently the Executive Vice President of the bipartisan Alliance for Health Reform, which is chaired by Senators Jay Rockefeller and Roy Blunt.  Ed suggested that our nation's health policy experts might finally be appreciating the importance of mental health care to our nation's overall health care system and our citizens' quality of life.  Interestingly, Ken Pope has shared a similar view noting that in 2009, public and private mental health spending totaled approximately $150 billion, more than double its level in inflation-adjusted terms in 1986.  The Accountable Care Act (ACA) will provide the largest expansion of mental health and substance use disorder coverage in a generation, with 32.1 million Americans gaining access to these services, while another 30.4 million currently with some coverage will gain federal parity protection.

Highlights of the information which Ed presented:  *An estimated 26.2 percent of Americans ages 18 and older – about one in four adults – suffer from a diagnosable mental disorder in a given year.  * In 2008, just over half (58.7 percent) of adults in the U.S. with a serious mental illness received treatment for a mental health problem.  * Approximately 38,000 people committed suicide in 2010.  * Over 8.9 million individuals have co-occurring mental illness and substance use disorders.  Only 7.4 percent of these individuals receive treatment for both disorders, while 55.8 percent receive no treatment at all.  Minorities with mental health disorders have less contact with specialists.  More than half of disabled Medicaid enrollees with psychiatric conditions also had claims for diabetes, cardiovascular disease, or pulmonary disease.  People with mental illnesses and addiction disorders are at much greater risk than the general public for homelessness, poverty, poor nutrition, and lack of health care.

            The All Important "Bigger Picture":  Community Health  --  David Derauf, Executive Director of the Kokua Kalihi Valley (KKV) Community Health Center in Honolulu, Hawaii, recently shared with us the cogent observations of one of his medical colleagues:  "A few months ago, I was sitting across from Dr. Robert Jesse, Principal Deputy Under Secretary for Health in the VA, in a meeting when he asked a provocative question, 'Why is it when we talk about personalized medicine, we only talk about genetics?  Why wouldn't we talk about a patient's social circumstances and how we can 'personalize' medical care for them?'  He is totally right.  In this country, 50 million people are hungry, while 26 million have heart disease and 26 million have diabetes.  Those numbers cannot be mutually exclusive.  Many people with heart disease and diabetes must be hungry at some point each month, which has been shown to result in worse health and higher rates of health care utilization.

"Yet despite this knowledge, we do not typically 'personalize' healthcare to ask patients a simple two-question scale validated by Children's HealthWatch to detect food insecurity, even when we know they are at a higher risk based on their zip code and where they receive their health care.  Think for a second about the inefficiency of a doctor asking a woman to come back to the hospital each month to check her blood pressure when that woman regularly skips meals, worries about paying bills and potentially cuts her pills in half since she can't afford them?  Before we progress to expensive genetic testing to see if a patient processes drugs differently, wouldn't it be more 'personalized' and more effective to screen for a common modifiable factor like hunger, and then make sure eligible patients are getting all the food subsidy programs for which they are eligible?

"In many ways the VHA, the Nation's largest integrated health care system, already 'personalizes' its care in important ways.  It pays for Supportive Services for Veteran Families (SSVF), including help with job training and childcare, and it has begun to bring legal services onsite at VA facilities as part of medical-legal partnerships [such as with the University of Hawaii William S. Richardson School of Law] to address many civil legal needs that interfere with getting and staying healthy.  I look forward to a future when 'personalized medicine' means less high tech care, and more 'patient centered' inter-professional teams addressing the full spectrum of social determinants of health."

A "Retiree's" Journey  –  "A long time ago, ten years ago, I retired from the VA.  And time and technology are passing by me so quickly.  I can see it in my grandchildren, now starting college, who know so much more and can access so many things so quickly – compared to what I was like when I was graduating from high school.  I was typing only 40 words a minute by the time I left high school, compared to two of my grandchildren, one still in high school, who repair computers and design software and create computer systems for their prep-schools.  I stand in complete awe, as I work with Student Veterans, returning home from war, now enrolling in college.  How outstanding they were in combat and now how outstanding they are in college.  Like, what's happening now, as I consult with the Office of the Dean of Students at the University of Texas at Austin, in the Student Veterans Center.  I see first-hand the mastery of so many skills, so that Student Veterans are achieving so much….  Reminds me of my days as a teenager, attending a residential prep-school, adjacent to the UT Austin campus, 1947-1953.  I was awed by World War II combat veterans enrolling in college, worked with them as we nailed up signs for Lyndon Baines Johnson (LBJ) running for the U.S. Senate in the Democratic primaries of 1948.  World War II Student Veterans were awesome then, as OIF/OEF/OND Student Veterans are so now!  Plus, older veterans – Korean and Vietnam era – are retiring and returning to school!  There is so much more we must do to help veterans return to school.

"Sad, now, that political leadership has changed so much in Texas.  LBJ filled his politics with Pro-Life for living, improving education, enhancing health, helping businesses change from war to peace….  Nowadays, though, current Texas politicians are practicing Pro-Death.  Refusing federal dollars for healthcare already paid for by Texas tax-payers; refusing federal dollars for Education already paid for by Texas tax-payers, etc., etc.  It's Pro-Death in Texas and Pro-Life in Massachusetts… and all you have to do is compare the life expectancies in the State of Texas with that of the Commonwealth of Massachusetts.  Citizens are living much longer in Pro-Life Massachusetts than in Pro-Death Texas.  Similarly, it's not just life expectancies being shorter in Texas, it's also Infant Mortality is higher in Texas.  And, it's not only due to lack of healthcare in Texas… some portion of the higher death rate may be associated with greater use and excellent aims in using firearms and weapons here in Texas.  Sad.  But we can not focus on what is Wrong.  We must aspire to doing what is Right… [Walter Penk]."

A Personal Perspective  –  It is important for psychology remember its history as we focus on future agendas.  The Center for the History of Psychology, located at the University of Akron in Akron, Ohio, is a unique institution that cares for, provides access to, and interprets the historical record of psychology and related human sciences.  Under the leadership of David Baker, the Center houses a museum of psychology as well as the Archives of the History of American Psychology and provides a variety of educational programs for the public.  The Center houses and makes available the personal papers of more than 200 psychologists.  The collections include personal and professional correspondence, sound recording and moving images, artifacts, photographs, unpublished papers and presentations, and other kinds of material that tell the story of psychology.  The Center, a 501(c) 3 organization, is supported primarily through gifts from visitors, foundations, and other donors.  The gifts provide support for processing collections, creating exhibits, and providing public programming.  Individuals interested in donating materials should contact Cathy Fay [cfaye@uakron.edu].  Aloha,

Pat DeLeon, former APA President – Division 55 – September, 2013

LAND OF 10.000 LAKES AND EXCEPTIONAL VISION

 Having the 121^st Annual APA Convention in Honolulu, Hawaii was extraordinarily memorable for the 11,400 registrants and HPA.  The vision, vitality, and enthusiasm of the next generation were infectious.  From a health policy perspective, it was especially gratifying to see the extent to which new career psychologists and graduate students were actively embracing the notion of integrated, patient-centered care which is the hallmark of President Obama's landmark Patient Protection and Affordable Care Act (ACA).  Unprecedented change, driven primarily by historically escalating costs and a new appreciation for the potential contribution of the advances occurring in communications technology (i.e., electronic health records, comparative effectiveness research, and telehealth), is rapidly impacting the nation's healthcare environment.  Cynthia Belar described how from the APA Education Directorate's vantage point, psychology's training institutions and internship sites are successfully adapting to the changing demands of the 21^st century.  Personally, one of the most gratifying presentations at the convention was the symposium chaired by Patti Johnson, who has now served in the U.S. Army for over 20 years, addressing the unique psycho-social needs of military families and especially their children.  The nation's protracted conflicts have had a significant impact upon the behavioral health of military children and youth.  Patti's panel discussed a number of innovative programs that were making a real difference.  All of psychology owes President Don Bersoff our gratitude for his vision and passion in developing special Presidential programmatic initiatives focusing upon how psychology can contribute to the nation's responsibility for our Wounded Warriors and their families.

            I currently have the opportunity of serving at the Uniformed Services University of the Health Sciences (USUHS) (DoD) where psychology and nursing have made a special, and in my judgment visionary, commitment to fostering true interdisciplinary training.  "As a graduate student in the clinical psychology doctoral program at USUHS, I study alongside advanced nursing students.  Participating in interdisciplinary classes has taught me that psychology and nursing share similar goals and pursue complementary research questions.  When looking for allies to improve the health care of our warriors and our nation, nurses and psychologists have to look no further than to each other.  And, by collaborating in our formative years, we maximize our impact as team-based healthcare providers (Joanna Sells)."

A Breath of Populism:  During the nearly four decades that I had the honor of working for U.S. Senator Daniel K. Inouye, I found that his colleagues from Minnesota were truly inspirational in their commitment to providing high quality health care for all Americans.  In the early days, right across the corridor was the office of Senator Walter Mondale – a definite friend of psychology.  Senator Hubert Humphrey, who was eventually honored by having the headquarters of the Department of Health and Human Services named after him, was forever actively engaged in numerous policy debates.  Senator David Durenberger, in his Senate Finance Committee capacity, was a visionary in fostering comprehensive bipartisan health care initiatives – perhaps, having seen first-hand the extraordinary accomplishments of the world-renown Mayo Clinic.

The Wellstone Legacy:  Those of us who choose careers in psychology and thereby learn to appreciate the value of the behavioral sciences owe so much to Senator Paul Wellstone, who worked tirelessly across the political aisle with Senator Pete Domenici to enact their far reaching Mental Health Parity legislation.  This effort ultimately led to the critical integration of mental (behavioral) health care into the mainstream of primary care as envisioned in the President's ACA.  Over the years there has been much discussion regarding the unfortunate stigma associated with receiving mental health treatment.  Ken Pope recently shared that change may finally be coming.  Mental health and substance addiction treatment has long been the stepchild of our health care system.  However in 2009, public and private mental health spending totaled approximately $150 billion, more than double its level in inflation-adjusted terms in 1986.  The ACA will provide the largest expansion of mental health and substance use disorder coverage in a generation, with 32.1 million Americans gaining access to these services, while another 30.4 million currently with some coverage will gain federal parity protection.  This Fall, the Military Officers Association of America and the National Defense Industrial Association hosted their 2013 Warrior-Family Symposium "Mental Health: Linking Warriors and Their Families, Government and Society."  The program took a broad look at mental health and the challenges ahead, particularly in a post-war environment.  They addressed: * What is the scope of mental health among our military members, veterans, and their families?  * What are the mental health implications to individuals, government, and society?  And, * What are some of the innovative solutions taking place in the mental health field?  This is a call-to-action on ways that individuals and organizations can affect change to help warriors-families today and tomorrow.  When I arrived on Capitol Hill, on the first day of the infamous Watergate hearings, such a public discussion of mental health issues would have been unheard of.  The efforts of Senator Wellstone and his colleagues have made a real difference.  Mahalo.

RxP – An Evolution:  There were also a number of exciting presentations in Hawaii addressing the maturation of psychology's prescriptive authority (RxP) agenda, which directly relates to the profession demonstrating a "value-add" contribution (citing Katherine Nordal) within integrative healthcare delivery systems.  Bob McGrath, who directs the Fairleigh Dickinson University RxP training program, estimates that 60 percent of the mental health medications prescribed today are ordered by primary care providers who possess considerably less mental/behavioral health training than psychologists or advanced practice mental health nurses.  Illinois's Beth Rom-Rymer coordinated a number of these visionary programs and noted the importance of remembering those who demonstrated vision long before their cause became popular.  "I very much appreciate the emphasis on RxP in our federal systems.  Bob Ax, Randy Taylor, and Kathy McNamara deserve commendation for initiating the conversation about opening up the federal agencies to RxP and keeping these conversations in the forefront of our intentions.  It was Bob and Randy who put out the RFP in 2007 for psychopharm training programs to offer scholarships to psychologists in public service venues who wanted to be RxP trained.  And, then, it was Steve Tulkin who was awarded the opportunity to search for major gifts so that Alliant/CSPP could train these 100 public service psychologists.  Alliant/CSPP has now trained about 50 public service psychologists.  I'm certain that more psychologists will want to be trained when we have additional states and federal agencies hiring RxP psychologists.  As we know, there is a desperate need for RxP in the VA as well as in the prison system."  Over my years of involvement within the public policy process, I have come to appreciate that those with vision and persistence do extraordinarily well in our evolving health care environment.  Aloha,

 

Pat DeLeon, former APA President – Minnesota Psychological Association – September, 2013

TIME FOR ACTION

            State Public Sector Initiatives:  Over the years that we have been involved with the prescriptive authority agenda (RxP), there has been remarkably little discussion regarding the possibility of colleagues working within State prison and mental health systems providing this important clinical service.  Fred Frese, a longtime advocate for psychology's increased involvement with individuals challenged by chronic mental health issues, recently reported on a 7-year follow-up study published in JAMA-Psychiatry finding that individuals with schizophrenia who are on reduced or no doses of anti-psychotic medications do better than those on medications.  Other research Fred has highlighted suggests that those on antipsychotic medications live 15 to 25 years less than would be normally expected.  As is the case with colleagues serving within federal institutions (i.e., the Department of Defense (DoD), Indian Health Service (IHS), and Department of Veterans Affairs (VA)), legislative restrictions on scope of practice issues frequently do not apply to public employees.  We understand from Glenn Ally that since the enactment of their RxP legislation on May 6, 2004, medical psychologists in Louisiana have had an increasing presence within their public mental health system.  Given the impressive and lengthy history of federal colleagues prescribing, we would hope that fostering state-based pilot projects would become a legislative priority for our State Associations.

 

During our recent Hawaii convention, we were very pleased to receive an update from Illinois RxP proponent Beth Rom-Rymer that in Ohio: "While, originally the Ohio RxP bill had been introduced as a small-scale demonstration project focusing upon the needs of the criminal justice system, legislative sponsors have urged us to introduce a full-scale RxP bill.  This bill will be introduced in the 2014 legislative session, with a promise of doing well (Michael Ranney)."  Those familiar with nursing's successful RxP quest over the years will appreciate the pivotal role that a small demonstration project in Ohio (when then-Dean Ron Fox was at Wright State University) evolved into a national success.

 

A New Era for Behavioral Health:  President Obama's Patient Protection and Affordable Care Act (ACA) provides the states with considerable flexibility to implement a program that is tailored to their unique needs and strengths.  Notwithstanding the current political climate, the political/policy experts that I am aware of do not seriously think that the ACA will be repealed or the newest phrase "unfunded."  Unprecedented change has come to our nation's health care system with an emphasis upon integrated, interdisciplinary, patient-centered care, utilizing communications technology to objectively develop data-based "gold standard" protocols.  The Administration has given a high priority to ensuring parity between mental health care and traditional physical health care, demonstrated by mental health and substance abuse services being among the ten "essential benefits" health insurers must provide under the state health exchange provision of ACA, which is to be implemented October 1, 2013.  Aloha,

 

Pat DeLeon, former APA President – Division 31 – September, 2013