CRITICAL INVESTMENTS IN OUR NEXT GENERATION

The Institute of Medicine (IOM):  The Board of Children, Youth, and Families of the IOM will establish a Forum on Promoting Children's Cognitive, Affective, and Behavioral Health (C-CAB Health Forum).  This Forum will engage in dialogue and discussion to connect the prevention, treatment, and implementation sciences with settings where children are seen and cared for, including primary health care, schools, preschools and child care, social service and child welfare, juvenile justice, family court, military, and community based organizations, and to create systems that are effective and affordable in addressing children's needs.  A major goal of the Forum is to highlight and address gaps in the science of implementing programs and practices in the service of informing research, policy, and practice.  One necessary component of addressing implementation science is knowledge utilization of the end user or decision maker, which can be at the local, state, or federal level.  The Forum will address gaps in the science of implementation by convening a multi-sectorial group of representatives from academia, federal agencies, professional organizations, and philanthropy in an ongoing way, over three years.  This group of Forum members will decide on two workshop topics per year and work with the Academies staff to design the agendas and invite speakers and guests to participate.  Workshops can be designed to engage the users of research from state and local agencies as well as intermediaries who translate research for legislators and service providers.  Psychologist Kimber Bogard is the staff director for the IOM Board.  Those colleagues familiar with the philosophy behind President Obama's Patient Protection and Affordable Care Act (ACA) will quickly recognize how this IOM initiative nicely parallels the legislation.

            Earlier in the year, the Board issued an insightful report Confronting Commercial Sexual Exploration and Sex Trafficking of Minors in the United States, with psychologist Sharon Lambert serving as a committee member.  Every day in our nation children and adolescents are victims of commercial sexual exploitation and sex trafficking.  The report concluded that efforts to prevent, identify, and respond to this national tragedy are largely under supported, inefficient, uncoordinated, and unevaluated.  They require better collaborative approaches that build upon the capabilities of people and entities from a range of sectors.  In addition, such efforts will need to both confront demand and the individuals who commit and benefit from these crimes.  Supported by the Department of Justice, the report focused primarily on trafficking for purposes of prostitution, exploiting a minor through prostitution and survival sex – which is the exchange of sex or sexual acts for money or something of value.  The Committee based its deliberations on three fundamental principles: * These crimes should be understood as acts of abuse and violence against children and adolescents; *  Minors who are commercially sexually exploited or trafficked for sexual purposes should not be considered criminals; and, *  Identification of victims and survivors as well as any interventions should do no further harm to these unfortunate victims. 

            Numerous factors contribute to the general societal lack of understanding and awareness.  These crimes may be simply overlooked, as they often occur at the margins of society and behind closed doors.  Victims may not come forward.  And, those who routinely interact with victims and survivors may lack awareness or tools to properly identify and assist victims.  Accordingly, there is no reliable estimate of the incidence or prevalence of these crimes and many victims go without help.

The Committee proffered three fundamental recommendations and urged that those are involved and who genuinely care seek to leverage existing resources towards these objectives.  1.) Increasing Awareness – Many professionals and individuals who interact with youth -- such as teachers, health care providers, child welfare professionals, and law enforcement officials – are unaware that these crimes occur and often are ill-equipped in knowledge about how to respond to victims, survivors, and those at risk.  Developing, implementing, and evaluating relevant training activities on how to identify and assist these young victims is necessary.  Public awareness campaigns are needed, with a special focus on increasing awareness among children and adolescents to help them avoid becoming victims.  2.) Strengthening Laws, Improving Understanding, and Prevention -- Minors who are the victims can still be arrested, detained, and given permanent records as offenders.  Instead, they should be redirected from criminal or juvenile justice systems to child welfare systems or other appropriate agencies.  Sadly, individuals guilty of taking advantage of these children have largely escaped accountability.  There is an extremely limited evidence base related to these crimes, particularly related to areas of prevention and intervention, with much variability in quality.  Accordingly, the Committee called for implementing a national research agenda in order to:  * Advance knowledge and understanding of commercial sexual exploitation and sex trafficking of minors in the United States.  * Develop effective, youth-centered, multi-sector interventions designed to prevent minors from becoming victims and to assist victims.  And, * Form strategies and methodologies for evaluating the effectiveness of prevention and intervention laws, policies, and programs.   3.) Collaboration and an Information Sharing Platform is essential – No one sector, discipline, or area of practice can fully understand or respond effectively to the complex problems surrounding commercial sexual exploitation and sex trafficking of minors.  Therefore cooperation is essential.

IOM -- A nation that is unaware of these problems or disengaged from solutions unwittingly contributes to the ongoing abuse of minors.  If acted upon in a coordinated and comprehensive manner, those involved can strengthen the nation's emerging efforts to prevent, identify, and respond to commercial sexual exploitation and sex trafficking of minors.  Myth – Help is readily available for victims and survivors.  Fact – There are far too few services to meet the current needs.  The services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care.

Efforts at the State Level:  "In the Spring of 2012, in response to a request from the Governor's wife, the Anchorage-based Cook Inlet Tribal Council (CITC) President & CEO Gloria O'Neill dedicated staff time to work with service providers from various fields to develop recommendations for state action to address sex trafficking in Alaska.  As a former Congressional staffer and policy analyst for CITC, I was tasked to guide the group.  Federal and local law enforcement and state juvenile justice officials provided technical assistance.  Sex trafficking is an overwhelmingly complex issue that requires multi-sector awareness and response.  According to the literature, vulnerability, often caused by trauma, particularly child abuse and neglect, is a significant risk factor.  Alaska has very high rates of trauma in the general population.  Six trafficking cases have been prosecuted in Alaska; however, concrete action towards prevention, victims' services, and demand reduction have been stymied by the paucity of data and research.  Our group found there was sufficient national and international research and examples of action from other states to guide the development of a basic framework for action in Alaska.  The legislature, which had just strengthened the trafficking statutes and created a temporary task force on the topic, was ripe for input.  Our final product included a background report, a plan of action, and recommended statutory changes.  More than half of our group's recommendations were included in the State Task Force's report to the legislature, and some, such as a comprehensive approach to demand, and new funding for prevention and services were left out.  However, our work effectively framed the issue for policy makers and service providers in Alaska.  Recognizing our work and its impact, FBI staff has nominated CITC for the FBI Director's Community Leadership Award [Lisa Moreno, MSW]."

Because It Was the Right Thing To Do:  Reflections – "I don't remember much about the salary – in the mid-'70s we almost had psychologists paid on the same state schedule as physicians.  I believe the Director of the Department of Health did not really know the difference between psychologists and psychiatrists.  I also recall that his daughter was a psychologist.  At one point he ordered the state hospital to close one of the wards for patients for security.  The hospital did not want to do that.  I later called him to personally say 'thank you' since we were having trouble with the patients sent from the prisons and courts.  Apparently he was very grateful for the support and when the position came open as head of Mental Health he thought of me.  It went fairly well for almost two years when the hospital called me and told me not to renew the contract for one of the psychiatrists.  He was foreign trained and was messing up the medication orders.  So much so that another psychiatrist had to follow him to correct his orders.  I did not recommend the renewal.  A few days later the Director called me in and told me we had to renew the contract.  I told him the problem and explained we couldn't afford to do it.  I found out later that his family had given $20,000 to the Governor's election.  In any case, I told the Director again that the records were clear and my answer was 'no' and that just in case someone tried to change the records, I had taken a copy home with me.  I then walked out of the office and said to myself, 'I think I just resigned.'  I was right and the next week he appointed a psychiatrist to the position.  I was tempted, but never did ask my successor what he did about it.  I assume he renewed the contract.  Jobs like that are too closely related to politics for me.  I went back to my old job until '95 [Joe Blaylock, first psychologist to be appointed as the head of the Mental Health Division of the State of Hawaii]."  Aloha,

 

Pat DeLeon, former APA President – Hawaii Psychological Association – December, 2013

 

TRULY UNCHARTERED WATERS

As the nation's health care leaders anticipate the expanding implementation of President Obama's Patient Protection and Affordable Care Act (ACA), there have been increasing concerns raised at both the state and federal level regarding the availability of qualified health professionals to address the complex behavioral, mental health, and substance-use treatment demands that are expected.  Building upon the current Medicaid system, the 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 will gain federal parity protection.  Under the law, insurance offered in the new marketplace must cover a core set of "essential health benefits," which includes mental health and substance-use disorder services.  As we now move towards integrated systems of care (Accountable Care Organizations (ACOs) and Medical Homes, for example) a critical question surfaces: Does there exist today sufficient numbers of psychologists, doctors of nursing practice (DNPs), and other traditional mental health providers trained to fill this niche, or will other disciplines (such as clinical pharmacists, occupational therapists, or newly evolving behavioral health care providers) expand exponentially into this unchartered arena?  And, are our training programs even aware of the changing behavioral health care environment?

Creative Models:  Since early 2000, visionary and former APA President Nick Cummings has called for the development of an entirely new training model of Behavioral Care Providers, who would work side-by-side with the patient's designated primary care provider.  Today such a program is actively underway at Arizona State University/Mayo Rochester School of Medicine, granting the Doctor of Behavioral Health (DBH) degree and focusing upon the emerging field of integrated behavioral health.  The classes are all online, with individual supervision also online.  There is two-way internet capacity.  The program makes arrangements for field placements in each locale for each student.  They have had absolutely no difficulty in placing students, and over half the placements hired the students, upon their receiving their degree, to create or expand an integrated program in their system.  The Nicholas A. Cummings Doctor of Behavioral Health program has slightly over 300 students, with 19 full-time faculty and 37 part-time faculty.  It is online all over the U.S. with several students being abroad in England, France, Germany, Malaysia, and Dubai.  The students come together in Phoenix twice a year; each time for a week.  Five of the graduates are now CEOs of large health care systems.  Nick's title is appropriately "Founding Sponsor," reporting directly to the University President.  It is perhaps unique in combining evidence-based interventions for integrated behavioral health, behavioral entrepreneurship, and management and accountability for clinical and cost outcomes.  Nick recently received word from China that they now have an affiliation with Jinan University, the largest university in China, which is affiliated with 10 smaller universities in the region.  They will become one of the largest, if not the largest, in the category of U.S. universities applied clinical/management education and training programs in China.

At this year's Illinois Psychological Association (IPA) annual convention, under the Presidency of Beth Rom-Rymer, Keith Baird described his vision for Behavioral Care Providers.  "A consortium of behavioral care providers is forming in Illinois, Behavioral Care Management (BCM), aiming to become a large-scale organizer of behavioral care which will negotiate contracts with ACOs and others.  Our developing network will have psychiatrists, psychologists, social workers, licensed clinical professional counselors, marriage and family therapists, and addiction specialists working collaboratively to deliver a new healthcare product to the marketplace.  We aim to lower health care costs by providing ease of scheduling with our behavioral care providers.  We will offer prevention and wellness services to the 'lives' that we cover, as well as promote access to our ever growing internet library resources.  This is geared to reduce the occurrence of various healthcare problems.  In addition, 40 BCM providers are completing their certification in integrated behavioral care through the University of Massachusetts.  We will offer behavioral care solutions to patients with chronic medical conditions that have a behavioral component, such as type II diabetes, high cholesterol, high blood pressure, obesity, and other stress-related health issues.  We are also working hard to deliver competitive reimbursement rates to our providers for the traditional services of psychotherapy, psychological testing, consultation, and pharmacotherapy."

Interdisciplinary Training:  Although the ACA envisions interdisciplinary, integrative, and collaborative training and service delivery initiatives, at the operational level this is much more difficult to accomplish than one might imagine.  Breaking down historical educational silos takes time and high level administrative commitment.  Educational institutions may have "different tuition rates" for courses taught, for example, in law vs. psychology; and, different disciplines may be on different quarter or semester schedules even within the same health sciences center.  Overcoming such institutional barriers and resistance is definitely a challenge.  However, we can assure you that it is well worth the effort.  Since retiring from the U.S. Senate staff, I have had the pleasure of serving on the faculty of the Uniformed Services University of the Health Sciences (USUHS) of the Department of Defense (DoD) and fostering interdisciplinary training has become a high personal priority.  For ultimately, it will be in the best interest of the next generation of health care providers and their patients (i.e., "educated consumers").

A Personal View:  "I recently had the privilege to participate in a military deployment psychology course.  During this course, the majority of the students were psychologists.  This group dynamic was ideal to be able to communicate and get to know the unique psychologist role along with educating on my role, the psychiatric nurse practitioner.  As a student and professional it is vital to learn the different perspectives our colleagues have on the part psychiatric nurse practitioners play in the mental health arena.  Partaking in this course gave me insight on the need for educating our colleagues on what our scope of practice encompasses.  It also enabled me to put a different lens on and learn about the roles of the whole mental health team including psychiatrists, psychologists, and social workers.

"There were several topics discussed including the deployment experience, cultural considerations in the deployed environment, sexual assault, ethics, traumatic brain injury, provider sustainment, and more.  Each topic was of equal significance and essential to the military mental healthcare field.  A belief that exists embraces psychologists and social workers doing the therapy while the psychiatrists and nurse practitioners prescribe medication.  A part of this course was designed to teach a therapeutic modality, including cognitive behavioral therapy for insomnia and either cognitive processing therapy or prolonged exposure therapy.  This section validated that although nurse practitioners are able to prescribe medications, we are also able to do therapy.  More importantly, we learned how to do these therapies in the deployed environment.

"Another captivating topic discussed during this course was technology in the mental healthcare field.  Technology is constantly evolving and has become integrated in patient care.  As providers, we must stay up to date with technology to deliver the most comprehensive care to our patients.  We learned about virtual worlds to treat disorders such as posttraumatic stress disorder, and mobile apps to guide patients with relaxation techniques and deep breathing exercises.  The lines of which provider was able to deliver the best technological care between different mental health professionals were erased, and together we were taught a treatment option in providing the greatest care for our patients.

"I am looking forward to graduating and working with my mental health colleagues from every path of the academic world.  Being able to participate in a course designed for our fellow psychologists is an imperative step in working as a team.  This team will help provide the best care for those who defend this nation and their families.  We must be able to utilize every specialty and communicate efficiently within our field to deliver healthcare at its finest [Bethany Casper; Capt. USAF]."

            The IOM:  The Institute of Medicine (IOM) was established in 1970 to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public.  Acting under the Congressional charter granted to the National Academy of Sciences in 1863, it serves as an advisor to the federal government and upon its own initiative, identifies critical issues of medical care, research, and education.  This year psychology was extremely well served by the election of APA CEO Norman Anderson to this distinguished body.  This fall, the IOM Board on Children, Youth, and Families convened top experts from multiple disciplines to analyze the best available evidence on critical issues facing children, youth, and families today.  Considered perspectives were elicited from the biological, behavioral, health, and social sciences fields focusing upon the entire lifecycle of our nation's families.  Psychologists Gary Evans, Ann Masten, Pamela Morris, and former Sesame Street CEO David Britt serve on the board.  Kimber Bogard, also a psychologist, serves as staff director.

            Having worked on Capitol Hill for nearly four decades, one of the most intriguing presentations personally was that by the Director of the Washington State Institute for Public Policy, the nonpartisan research arm of the Washington State legislature.  At the request of the legislature, the institute provides detailed cost-benefit analyses on a wide range of public policy areas.  This would include, for example, legislative proposals to reduce crime, improve educational outcomes, reduce child abuse and neglect, improve mental health, and reduce substance abuse.  Express dollar consequences (costs and benefits) were assigned to various proposed preventive efforts, such as encouraging nurse practitioner home visits, over the lifetime of the program and its beneficiaries.  It reminded me of the Office of Technology Assessment (OTA) which from 1972 to 1995 provided a similar non-partisan perspective for the U.S. Congress.  The overarching theme for that segment of the meeting during which the institute director presented focused upon family based preventive interventions which reflected the critical role that the family unit can play as a key mediator for child health outcomes.  The overall panel:  * Examined science that highlights the effect of the family on child health outcomes;  * Assessed how family-based interventions could be brought to scale to sustain positive child health outcomes;  * Considered the implications of benefit-cost analysis of these interventions for public policy;  and, * Explored how the board could advance family focused science and evidence based policy to promote children's' health, safety, and well-being.  One of the underlying questions discussed was: How to "scale-up" those initiatives that were demonstrated to be effective in order to impact the largest possible beneficiary population?  An indication of the national impact the board's deliberations can have was the considerable publicity generated by the release of its subsequent recommendations addressing sports-related concussions in youth, from elementary school through young adulthood, including military personnel and their dependents.

            An Earlier IOM Report:  The critical contribution of interprofessional collaboration to quality care has been known for decades.  In 2004, the IOM released its report entitled Improving Medical Educationfor which psychologists Eugene Emory and Neil Schneiderman served as committee members.  "There are a number of compelling reasons for all physicians to possess knowledge and skill in the behavioral and social sciences.  Perhaps most important is that roughly half of the causes of mortality in the United States are linked to social and behavioral factors [citing HHS reports from 1993 and earlier].  In addition, our nation's population is aging and becoming more culturally diverse.  Both of these trends highlight the need for enhanced physician capabilities in the behavioral and social sciences."  The committee found that there was very little literature on either barriers to the inclusion of the behavioral and social sciences in medical school curricula or strategies that might be employed to overcome such barriers.  However, it was definitely felt that the importance of an institutional commitment to behavioral and social science instruction cannot be overemphasized.  That without a firm belief on the part of the medical school faculty and administration, that this knowledge and skill is an important part of a physician's education and training, their recommendations would be ineffective in producing change.

            The committee further noted that the then current structure of American medical education was adopted in the early 1900s and had not varied greatly since that time.  The basic sciences – anatomy, physiology, biochemistry, and microbiology – were introduced as a scientific foundation on which clinical practice knowledge and skills were built.  In addition, the introduction of clinical science in the context of a university constituted a significant shift from a community practice-based, apprenticeship model of preparation for careers in medicine to one in which clinical medicine was taught by full-time faculty in a university-owned or university-affiliated teaching hospital.  Over the years, however, shifts have occurred within the basic structure of medical education, including those related to learning techniques.  Today, one hears more and more, for example, about the movement from passive learning through lectures to more active learning utilizing problem-based curriculum and most recently, the increasing utilization of technologically oriented simulation models.

            Exciting Journeys:  "GOLEM HAUNTS HARVARD – There's nothing like a high school or college reunion to focus attention on the reality of aging.  I recently attended the 40^th reunion of the Harvard and Radcliffe Class of 1973.  Name badges were critical to identifying classmates whose 20 year old faces had morphed into those of older adults in the foothills of traditionally defined 'old age.'  Unease about the march of time was evident in aging-related joking by classmates about memory and diminished loss of physical vigor.  A class discussion about research on aging was well-attended and provoked informal discussions about what each of us might do to make our later years personally, financially, and socially meaningful.  As a geropsychologist with 35 years in the field of aging, I shared my own personal and professional perspectives on aging with my classmates that emphasized the resilience of most older adults in contending with late life challenges.

"Skepticism from my classmates about what was seen as an overly rosy view of getting older was not unexpected.  Social expectancy research well demonstrates that most individuals acquire negative expectations about the aged and aging throughout their lifetimes.  Negative expectations about old age can be self-fulfilling prophecies.  As a psychology undergraduate, I remember reading Robert Rosenthal's Pygmalion in the Classroom in which he documented that simply by telling teachers that they should expect good performance from a class of students, those students, in fact, subsequently evidenced good performance.  The 'golem effect' is that low expectations lead to low performance.  It would be sad if my classmates – who are among the best and brightest of their generation – lived their later years under the shadow of golem and deprived themselves of the satisfactions that the later years can bring" [Greg Hinrichsen, APA Congressional Science Fellow (2007-2008) served with U.S. Senator Ron Wyden].  Rod Hammond, former Director of the Division of Violence Prevention, Centers for Disease Control and Prevention (CDC), was recently elected to the Berkeley Lake, Georgia, City Council – "I am failing the retirement thing! (Smile)."  Aloha,

Pat DeLeon, former APA President – Division 42 – November, 2013

 

THE FUTURE DEPENDS UPON WHERE ONE STANDS

  The enthusiasm for the future which was so palpable among the Early Career attendees at our recent Honolulu convention was similarly evident within that subset of the approximately 325 participants this Fall at the Illinois Psychological Association (IPA) annual convention, "Advocating for Psychology and Our Community: The Time is Now."  There can be little question that the enactment of President Obama's landmark Patient Protection and Affordable Care Act (ACA) will bring unprecedented change to our nation's health care environment.  The law envisions educated consumers (i.e., patients) taking responsibility for their own health care, including capitalizing upon the advances occurring almost daily within the communications and technology fields.  We will gradually transform from a fundamentally illness-oriented approach to one which places a priority upon prevention, wellness, and data-based care that emphasizes holistic, interdisciplinary, and integrated services.  Educational institutions will have to carefully consider whether they are really exposing their students to healthcare information and experiences (e.g., nutrition, exercise, resilience, etc.) or are they merely reinforcing an illness-oriented status quo that is comfortable.

Building upon the current Medicaid system, the 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 will gain federal parity protection.  Under the law, insurance offered in the new marketplace must cover a core set of "essential health benefits," which includes mental health and substance-use disorder services.  Within this overarching federal framework, the implementation process now moves to the individual state level.  Historically, unfortunately, organized psychology has been less than enthusiastic about serving the Medicaid and Medicare beneficiary populations.  Change is always unsettling and takes time, often far longer than one might initially expect, especially fundamental change.  Today's practitioners will undoubtedly experience significant "pain" as the projected changes are steadily implemented.  The next generation, however, will thrive – as long as the field of psychology remains relevant and continues to attract "the best and brightest."  The ACA provides significant challenges and for those with vision, exciting opportunities.  Especially, we would suggest, for those with an underlying commitment for serving society.

IPA's Call to Action:  "Why am I such a strong proponent of advocacy for ourselves, as psychologists?  Because if we don't advocate for ourselves, who will?  We advocate for ourselves because we identify ourselves in the world as psychologists.  We as individuals feel more empowered when we stand up, publicly, and declare that psychologists can make a difference in the world: with our patients, in the business and corporate world, in community agencies, in the criminal justice and civil litigation system, in government, in medicine.  How do we advocate for ourselves?  We develop a statement of purpose and a rationale.  We talk to friends and colleagues and we sign up a core group of interested people, who will hopefully become a group of highly enthusiastic, fervently committed, deeply engaged, inner circle people!  We figure out a plan for implementation.  Why should we advocate for others?  Because we are not solitary figures in our world.  We depend on others and others depend on us.  Because we are compassionate in the face of suffering.  We advocate for others because, as we strengthen others, we strengthen ourselves.  Today, we help others.  Tomorrow, others help us.  Insularity is suffocating.  Personal gain only is short-sighted and limiting.  We live in an interdependent world where there is knowledge and richness in diversity and pallor in sameness.  Why must we advocate, now, for our community and our profession?  There is no time to lose.  Our national healthcare system is at a critical juncture.  Hundreds of thousands of new patients will join the state Medicaid rolls as of January 1^st.  Approximately 250,000 of them will be diagnosed with a mental illness.  Our mental health system is not equipped to care for these new patients.  We, as psychologists, can make a difference and it is up to us to be at the forefront of change in the ways in which mental health care is delivered in our state.  Obtaining prescriptive authority is a critical step.  Either we rise to meet the challenge of our society's healthcare crisis or we run the risk of getting swept away by the incoming tide of change.  There is no other time but now [IPA President Beth Rom-Rymer]."

The Illinois Psychological Association prescriptive authority legislation (RxP), after considerable open and public debate, passed their Senate by a vote of 37-10-4.  Their chief Senate Sponsor is Don Harmon, the President Pro-Tem of the Senate.  With their lobbyists, IPA's leadership made the critical strategic decision to spend the next 12 months educating psychologists and legislators around the state on RxP issues, rather than immediately press for a House vote.  Theirs is a two year legislative session.  As always, "we live in interesting times."

            The Educator's Voice:  "We don't hear nearly as much about RxP in APA as we once did.  I think the combination of a long lull in getting bills passed, combined with continuing criticism of RxP by what turns out to be a pretty tiny group, has taken some of the wind out of the sails.  Sometimes these days when we're talking about planning for the future of the profession, RxP feels to me a little bit like your crazy Uncle Alfred.  Everybody knows it's still around and going strong, but you're not supposed to mention it in polite company.  It's too bad, because instead we should be celebrating the accomplishments of our prescribing psychologists.  We have several who have been decorated by the military.  We have brethren who have joined the Indian Health Service (IHS) for the opportunity to work in truly disadvantaged communities.  We have prescribers in Federally Qualified Community Health Centers and in Cancer Care Centers, and who have been deployed to help in major disasters.  We should be proud of our 20+ year record as a prescribing profession, not making believe it's not there [Bob McGrath, Director of the Fairleigh Dickinson University Clinical Psychopharmacology and Integrated Primary Care programs]."

A Voice from The Past:  "Volunteering is a wonderful vehicle for professional and community service.  In retirement, the opportunities abound.  Volunteering has afforded me many opportunities to find satisfaction and fulfillment in giving back to others.  My experience volunteering in the community during my 'retirement' has given me a wonderfully fulfilling life outside of psychology.  In Columbia, South Carolina, I deliver Meals on Wheels, exercise special needs dogs at Howlmore Animal Sanctuary, and teach line dancing.  I have also coordinated group service opportunities through my church to persons who are homeless.  I was recently honored to be the first 'runner up' for a national volunteer award given by the Meals on Wheels Association of America.  I endorse Marian Wright Edelman's belief that 'Service is the rent we pay for living.'  It has made retirement 'golden' for me, and many others [Mike Sullivan, former NYSPA President and APA State Advocacy guru for 13 years]."  Aloha,

 

Pat DeLeon, former APA President – NYSPA – November, 2013