HERE COMES THE SUN

I recently had the opportunity of meeting with graduate students and several faculty members at Purdue University where I obtained my doctorate.  Long time RxP supporters Chuck Faltz and former APA President Jack Wiggins are also Boilermakers, as is APA journal editor extraordinaire Michael Roberts.  My sincerest appreciation to Don Lynam and Chris Agnew for making this visit possible.  It was truly special to be able to visit once again with Cliff Swensen, my major professor.  Two of the messages which I shared with our next generation were that every one of the prescribing psychologists that I have met has been very pleased with their decision to obtain this extra training even though, almost without exception, it was at their own personal expense.  And, that in my judgment, almost all of those colleagues who are adamantly opposed to psychology obtaining this clinical responsibility do not work with those patient populations who would benefit from our expertise – especially in ensuring that appropriate medications and dosages are utilized.  Providing quality care has always been the underlying issue.

Far from being the "public health hazard" that organized psychiatry predicted, our prescribing colleagues in New Mexico, Louisiana, and the federal system have done an outstanding job.  Former APA and Division President Ron Fox notes: "As of December 31, 2013 when I was chair of the APA Insurance Trust, I can attest to the fact that prescribing psychologists do NOT have to pay higher premiums for professional liability insurance as the Trust deemed an increase unnecessary; and, because the Trust policy provides insurance to cover expenses related to licensing board complaints I know that there have been no complaints or actions taken by state licensing boards regarding prescribing abuses by appropriately trained psychologists."  Another visionary former Division President, Bob McGrath, who is spearheading the New Jersey RxP legislative effort, estimates that 1750 colleagues have already completed their advanced psychopharmacology training.  Working at the Uniformed Services University of the Health Sciences (DoD), we would be particularly interested in having those veterans who have completed their RxP training share their experiences with APA's Heather Kelly, who is working on a relevant VA agenda [hkelly@apa.org].

            SAMHSA:  During its deliberations on last year's budget for the Substance Abuse and Mental Health Services Administration (SAMHSA), the Senate Appropriations Committee expressed its concern regarding the current utilization of psychotropic medications for children.  "The Committee has become increasingly concerned about the safe, appropriate, and effective use of psychotropic medications and children, particularly children in foster care settings.  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 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."

            During this year's budget justification, SAMHSA reported: "SAMHSA has taken a significant leadership role to address the safe, effective and appropriate use of psychotropic medication in children and youth.  The agency has collaborated extensively with the Administration on Children and Families (ACF) and the Centers for Medicare & Medicaid Services (CMS) to address this issue for children in foster care; has partnered with professional groups to create more stringent guidelines related to prescribing and medication oversight practices; and has worked closely with parents and youth to improve consumer decision-making with regards to the use of medications.  Below reflect a number of activities and developments that SAMHSA has been engaged in to address the issue.

            "SAMHSA supported the American Academy of Child and Adolescent Psychiatry's (AACAP) development of guidelines on issues that community agencies should address when prescribers are considering the use of psychotropic medications.  Titled, 'A Guide for Community Child Serving Agencies on Psychotropic Medications for Children and Adolescents,' this document provides information to community agencies about safely and effectively prescribing psychotropic medications, describes the phases in treatment when medication could be considered part of an overall treatment plan, and provides information about the use of community based alternatives that child serving systems and agencies should consider in addition to psychotropic medications.  SAMHSA has also collaborated with AACAP to support a Child and Adolescent Psychiatry Fellow at SAMHSA one day a week (20% FTE).  For the past four years each Fellow has undertaken a project to improve psychiatric service delivery, connect with community agencies and organizations, and identify evidence-based treatment strategies.  Perhaps one of the most significant advances SAMHSA has helped to support has been the development of a Youth Advisory Group at AACAP that provides advice, guidance and information about medication use and empowers youth to make their own informed decisions regarding using medications.  One accomplishment supported through this youth group was the development and expansion of the AACAP website as a resource to youth and families.  Via a simple click on the 'families and youth' toolbar on the AACAP homepage, youth and families can obtain a wealth of resources that include a section on how to choose a child and adolescent psychiatrist; 'Facts for Families' on a wide range of topics; a patient education section that provides information about mental health conditions; and an entire section dedicated to youth resources.  Going forward, SAMHSA will be continuing its efforts to address the importance of using psychotropic medications safely and effectively in collaboration with AACP.

            "In addition to the work with AACAP, SAMHSA has also supported efforts by the Center for Health Care Strategies of the Robert Wood Johnson Foundation to provide technical assistance on strategies to improve oversight of psychotropic medication use in foster children.  The technical assistance has included a webinar series, 'Psychotropic Medication Use among Children in Foster Care: Technical Assistance Webinar Series.'  As part of this series, in September of 2013, a webinar was held titled, 'The Use and Financing of Non-Pharmacologic Evidence-Based Practices: Alternatives to Psychotropic Medications.'  Evidence-based psychosocial interventions were identified that may offer a more comprehensive and cost-effective means of addressing behavioral health and social challenges experienced by children and youth in foster care, as well as other child populations with significant behavioral health challenges.  SAMHSA also supported the Center for Health Care Strategies recently released 'Faces of Medicaid Analysis,' which identified areas to improve behavioral health treatment, including the use of psychotropic medications and alternative approaches.

"SAMHSA was also one of the sponsors of an Administration on Children, Youth and Families conference and dialogue about the appropriate use of psychotropic medication for foster children.  SAMHSA provided training to nearly 100 early career child and adolescent psychiatrists on community and public sector psychiatry, systems of care and youth and family engagement.  As part of SAMHSA's ongoing commitment, SAMHSA will maintain its meaningful partnerships with other federal agencies, guilds and organizations to further the important agenda to address psychotropic medication use in America's children and youth."

There can be no question that SAMHSA's efforts to be responsive to the Committee and to the needs of our nation's children, including those placed in foster care, is highly commendable.  We would ask, however: Where is psychology's voice/presence?  We are confident that those colleagues who specialize in serving children and who have completed their RxP training could contribute significantly to addressing this national need.  Yet, one of Hawaii's most rural, and perhaps smallest, federally qualified community health center (FQCHC) on the island of Lanai recently applied for a HRSA behavioral health integration grant which would, among other needed services, provide for part-time child and adolescent psychiatry services utilizing telehealth/telemedicine, at the request of their psychology staff, estimating that approximately 10 patients a year will need these services.  If psychology is unwilling to focus upon national and pressing local priorities, others will; especially as President Obama's Patient Protection and Affordable Care Act (ACA), with its emphasis upon integrated care, is systematically implemented.  Long time health psychology visionary Susan McDaniel reports: "I had a nice surprise last week.  As part of promoting psychology as essential to health, I have done two episodes on the nationally-syndicated PBS show on health called 'Second Opinion.'  The directors are very in tune with a whole person approach to health, and always have a multidisciplinary group of professionals along with a patient, focused on some specific health problem.  I've done one on Grief, and then one 5-minute spot on the show on Teen Depression.  The show heard last week that this episode on Teen Depression won a Telly award (a national award for the best in television programming)."

Meaningful Journeys:  "Reflections of a Peace Corps Volunteer – A Decade Later.  Tempus fugit, time indeed seems to have the habit of proceeding on a logarithmic path.  Could it really be almost a decade since I completed Peace Corps service in Guatemala?  Yes, it is so, time to reflect once again on that experience.  Many questions come to mind.  How did I get there?  What was it like?  What do I tell other people about the Peace Corps?

"I had been retired from 37 years active duty in the U.S. Army.  The last 20 years of my Army career was as an operational psychologist.  For five years I had a great retirement, crewing on sailboats in Hawaii, Mexico and the Caribbean and backpacking in Europe and New Zealand.  I thought about how fortunate I have been in life.  I decided maybe it was a good time to give to others for the many blessings I have received.  I was around when John F. Kennedy founded the Peace Corps.  I greatly admired the idea of the Corps.  I went on line and applied.

"I was in Washington, DC on September 11, 2011, when the terrorists crashed into the Pentagon.  I watched the smoke from the roof of my condo.  Then and there I resolved to do my enlistment in the Peace Corps.  I knew at age sixty-six, the Army would probably not allow me back on active duty.  I decided the best thing I could do for my country and for others was to accept the invitation I had received from the Peace Corps to serve in a Healthy Schools Project in Guatemala.

"Thirty-nine of us gathered in Miami to process and to travel to Guatemala to begin fourteen weeks of training for the Peace Corps.  Of the 39 volunteers, 29 completed the full two year tour.  Each volunteer had to live with a local family during training to learn Spanish and to learn the culture.  I was blessed to live with a wonderful family, with whom I maintain contact.  I have returned to Guatemala to visit them.  The Peace Corps does an excellent job in training volunteers in language, technical skills and cultural interaction.  The Peace Corps nurse clinicians do a superb job in teaching individual preventive care and self-care.  They impressed upon us that you are to a great extent responsible for your own health.  If any of us required definitive care, the Peace Corps ensured the best doctors in Guatemala treated us.  After completing training, we took the Oath of Service from U.S. Ambassador John Hamilton.

"I was fortunate in being assigned to Santiago Atitlan, a Mayan village on the shore of Lake Atitlan.  An awed Aldous Huxley described the Lake as 'too much of a good thing.'  As Lonely Planet states: 'Simply put, Lago de Atitlan is one of the world's most spectacular locales, period.'  The grinding poverty of many of the people is in sharp contrast to the surrounding beauty.  The Mayan people of the Central Highlands probably suffered the most during the tragic 36 year civil war in Guatemala.

"As a psychologist, I really appreciated the behavioral objectives of our Healthy Schools program.  The major objective was to have the children practice good health habits in school on a daily basis.  For example, we strove for at least 80 percent of the students brushing their teeth after the school snack.  And yes, we had to figure out little games to teach the kids how to brush properly.  For some students, it was the first time in their lives that they had a tooth brush.  If a school met the long list of behavioral objectives, it would be certified as a 'Healthy School.'  This certification increased the school's prestige in the community.  In addition, it also helped in obtaining international assistance.  We started out teaching and we trained the teachers in instructing health material.  We encouraged them to adopt experiential learning techniques as opposed to straight lecture.  We conducted workshops, where teachers would create their own material and games.  Another dimension of our job was to work with the parents, local authorities, and nongovernmental organizations (NGOs) to improve sanitary conditions in the schools and in the village.  We ended up with one of the few rural schools in Guatemala that has running potable water, clean bathrooms and even toilet paper.  The kitchen now has a propane stove instead of a wood fire with the dangerous emission of smoke.

"Most days were good.  And then there were the other days.  I remember a day of stumbling over my Spanish words, hoping the children could understand me.  At the same time, I was trying to unobtrusively scratch my flea bites and hoping to control the diarrhea until recess.  That was the day at long last when I could consider myself a real Peace Corps volunteer.  Fortunately days like that were rare.  Most days you were happy to be doing what you were doing.  Living in the village and becoming part of the community was a great experience.  The Mayan people have respect for the family, especially the elderly.  At times, the life of a volunteer could be frustrating, but most of the time it was as they say in Spanish vale la pana, very worthwhile.  In many ways, for someone trained in psychology, a tour in the Peace Corps becomes a living laboratory.  You can see the results of schedules of reinforcement and what modeling and role play can accomplish.  You learn a lot about group dynamics and cross-cultural communications.  And you learn a lot more about others and yourself and what you value.

"This January's Monitor had an excellent article about retirement.  The Peace Corps could be a great experience for any psychologist during retirement.  Also for a young man or woman who just finished their undergraduate work, the Peace Corps could provide the opportunity to serve others and to mature.  One of the best things that happened to me during my tour was that many of the younger volunteers asked me for assistance in planning their future.  Every volunteer, who wanted to return to school for an advanced degree, got accepted into a program.  Most universities are very Peace Corps friendly.  We had an electrical engineer who was in the environmental protection program and who is now a physician.  Another volunteer from the Healthy Schools program went back to law school and specialized in international law.   She is now assisting indigenous people world-wide.  The young volunteers I had the privilege of working with were just what John F. Kennedy had in mind, when he founded the Peace Corps.  My advice about the Peace Corps – if you are thinking about doing it, just do it" [Ernie Lenz].

Retired VA psychologist and now psychology historian and sage fiction writer, Rod Baker: "When you mentioned the person in retirement who said that he thought he still had something to pass on, I remembered one of my favorite stories an elderly gentleman passed on to me was his lament: 'Now that I know all the answers, no one asks me the question.'  Looking forward to seeing you at APA."  It is all right.  Aloha,

Pat DeLeon, former APA President – Division 55 – April, 2014

 

CHALLENGING TIMES – THE IMPACT OF TECHNOLOGY

Psychology, along with the other health professions, is beginning to appreciate the extent to which the unprecedented advances occurring within the communications and technology fields are having an extraordinarily impact upon our nation's health care environment.  It was not that long ago when President G.W. Bush noted: "The health care industry is missing an opportunity….  IT, information technology, hasn't shown up in health care yet.  But it has in one place, in one department… that's the Veterans Department.  Tommy Thompson is the Secretary of the Department of Health and Human Services – a strong advocate about the spread of IT throughout the health care industry….  By introducing information technology, health care will be better, the cost will go down, the quality will go up, and there's no telling whether other benefits will inure to our society….  When we get this implemented, America will remain on the leading edge of technological change.  This is the kind of innovation that's practical and makes sense, that will keep us the leader in the world."  The VA reports that in Fiscal Year 2013, more than 600,000 Veterans received health care utilizing telehealth – accounting for more than 1.7 million episodes of care.  The issue of licensure mobility/portability is critical to this evolution – and it is an area in which theNational Register has demonstrated proactive leadership.

            State Leadership Conference (SLC):  For practitioners, the annual APA Practice Directorate State Leadership Conference (SLC) is one of, if not the, highlights of the year.  At last year's conference, Katherine Nordal described the beginning stages of the implementation of President Obama's Patient Protection and Affordable Care Act (ACA) as: "Really just a mile marker in this marathon we call health reform.  We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us."  This year, Katherine noted: "Our country still doesn't pay nearly enough attention to mental health and substance use treatment.  Health care reform implementation is a work in progress.  And there are hopeful signs, especially related to the goal of increasing the ranks of Americans with health insurance coverage.  As we confront serious problems and the uncertainty of a health care system in flux, psychology continues to demonstrate that we're poised to face those challenges.  The 2014 Medicare fee schedule marked the first time since 2007 that the payment pool allocated for Medicare psychological services increased – psychologists gained the second highest increase in payment allocation among all Medicare provider groups.  The demand for evidence-based practices and use of quality measures related to process and outcome, including behavioral health measures, will grow.  And the increasing use of technology for electronic health record keeping and telepsychology service delivery will continue to evolve.  In a survey last fall, we asked what specific changes members were likely to make in their practice over the next three to five years.  Nearly half indicated they will increase their use of technology….  We achieve good results when psychologists get energized and commit themselves to making positive things happen."

            One of the most intriguing workshops at SLC, chaired by Deborah Baker, was "Developing a Roadmap for Telepsychological Practice."  Already 21 states have affirmatively addressed the issue of insurance reimbursement for telehealth services, with an additional 19 state legislatures currently considering legislation.  The underlying issue of licensure mobility/portability is complex.  For example, does the locus of the patient or provider or both provide the legal authority for licensure board jurisdiction?  Thoughtful views from the APA Insurance Trust (Jana Martin) and the Association of State and Provincial Psychology Licensing Boards (ASPPB) (Fred Millan) were shared – all clearly seeking ways to ensure that psychology will be responsive to the dramatically evolving health care environment.  Will, for example, a special licensure category be established for providing Telepsychology care?  It was refreshing to hear how proactive the joint APA-ASPPB-Insurance Trust taskforce, co-chaired by presenter Linda Campbell, is during its deliberations.  Steve DeMers pointed out that ABPPB has received a special grant from the Health Resources and Services Administration (HRSA) to address the underlying issues.  The National RegisterMobility Program is becoming increasingly timely – now approved or in the process of being approved in 46 jurisdictions in the U.S. and Canada.

            FY 2015 HRSA Budget Request:  The Administration has requested $124.5 million this coming year for the Office of Rural Health Policy.  Established in 1987, this is the focal point for rural health activities within HHS.  Historically, rural communities have struggled with issues related to access to care, recruitment and retention of health care providers, not to mention maintaining the economic viability of hospitals and health care providers in isolated communities.  Today there are nearly 50 million people living in rural America who face challenges in accessing health care.  Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts.  The potential for telehealth providing quality specialty care, professional continuing education activities (addressing provider isolation); and innovative, evidence-based behavioral programmatic activities should be evident.  Interestingly, the Office has historically worked collaboratively with the VA and the Departments of Agriculture, Education, Labor, and Transportation given its holistic approach to ensuring comprehensive care.

            The Office of Rural Health's Telehealth Grants initiative proposes to expand the effective use of telecommunications technologies within rural areas that can link rural health providers with specialists in urban areas, thereby increasing access and the quality of healthcare provided to rural populations.  Telehealth technology also offers important opportunities to improve the coordination of care in rural communities (a priority of the President's AAC) by linking rural health care providers with experts not available locally.  These grants are expected to strengthen the rural health care infrastructure.  This year's budget proposes specific evaluations of the program's impact on the health status of rural residents with chronic conditions, including obesity, and the return on investment for rural grantees and communities.  $13.9 million has been proposed in the coming fiscal year for telehealth activities supporting: 1.) Telehealth network Grant Program grantees (up to 26 grants); 2.) Telehealth Resource Center Grant Program grantees (up to 14 grants); and, 3.) The Licensure Portability Grant Program (2 grants).

            The Federal Trade Commission (FTC):  In March of this year, the FTC issued a policy paper suggesting that state legislators should be "cautious when evaluating proposals to limit the scope of practice of Advanced Practice Registered Nurses (APRNs).  By limiting the range of services APRNs may provide and the extent to which they can practice independently, such proposals may reduce competition that benefits consumers.  Even well-intentioned laws and regulations may impose unnecessary, unintended, or overbroad restrictions on competition, thereby depriving health care consumers of the benefits of vigorous competition."  In the view of the FTC, consumer health and safety are paramount concerns in the regulation of the health professions, and competition is an important mechanism to promote high quality health care.  It is also a means of controlling costs and allocating resources.  When restrictions restrain competition and are not closely tied to legitimate policy goals, they may do more harm than good.  As psychology seeks to expand its clinical influence under the provisions of the ACA, both in its scope of practice (e.g., obtaining prescriptive authority) and actively engaging in the treatment of those with chronic conditions, for example, the recommendations proffered by the FTC become highly relevant.

Recognizing Two Colleagues Whose Leadership Has Made a Real Difference:  On June 13, 2013 Colonel Rebecca Porter became the first clinical psychologist in the U.S. Army to command a Medical Treatment Facility (MTF).  She assumed command of Dunham U.S. Army Health Clinic at Carlisle Barracks, Pennsylvania.  Durham provides primary care to students, faculty, and families at the U.S. Army War College through its Patient Centered Medical Home.  Dunham and its outlying clinics, including the Army Wellness Center, serve a beneficiary population of more than 9,000 active duty military members, retirees, and their families.  Commanding a MFT is not the only "first" for Becky.  She was also the first clinical psychologist to serve as the Army's Director of Psychological Health and Chief of Behavioral Health for the Army Surgeon General (2010-2013), and the first clinical psychologist to serve as a Special Assistant to the Chief of Staff of the Army (2001-2003).  She is a member of the APA and Past-President of Division 19, the Society of Military Psychology.

            "Each and every day of an extraordinary 23 accomplished years, Judy Hall lived and breathed the NationalRegister.  We could not have asked for a more dedicated, intelligent, and caring leader.  Judy kept the Register healthy and on a steady track through two+ decades of profound changes in the health care landscape.  A passionate and tireless advocate for us and professional psychology, she represented the organization in over 300 invited program presentations and 60 interviews on radio, TV, and in print.  For years, Judy has had a central role in formulating national standards for education and training in professional psychology and I sincerely doubt that anyone else in the nation has anywhere near the intimate knowledge that she has of every training program in psychology.  While she has retired from the role of Executive Officer, we have asked Judy to continue with us in a consulting role and are extremely pleased that she has agreed to do so.  Speaking for the Board of Directors – and I believe the 11,000 members of the National Register as well – Judy has our profound thanks for a job well done" [Ray Folen, President/Chair].  Aloha,

Pat DeLeon, former APA President – National Register – March, 2014

 

 

A REAL DIFFERENCE

Having served for nearly four decades on Capitol Hill, I remain impressed by the astute observation of former APA Congressional Science Fellow Neil Kirschner, more than a decade ago, at our annual convention in Toronto: "More often than not, research findings in the legislative arena are only valued if consistent with conclusions based upon the more salient political decision factors.  Thus, within the legislative setting, research data are not used to drive decision-making decisions, but more frequently are used to support decisions made based upon other factors.  As psychologists, we need to be aware of this basic difference between the role of research in science settings and the legislative world.  It makes the role of the researcher who wants to put 'into play' available research results into a public policy deliberation more complex.  Data needs to be introduced, explained, or framed in a manner cognizant of the political exigencies.  Furthermore, it emphasizes the importance of efforts to educate our legislators on the importance and long-term effectiveness of basing decisions on quality research data….  If I've learned anything on the Hill, it is the importance of political advocacy if you desire a change in public policy."

Katherine Nordal, Executive Director of the APA Practice Directorate, issued a similar challenge at last year's State Leadership Conference, reflecting upon President Obama's landmark legislative accomplishment: "The Affordable Care Act [ACA] has survived, and implementation of the largest expansion of the health care safety net will proceed.  But January 1^st is really just a mile marker in this marathon we call health care reform.  We're facing uncharted territory with health care reform, and there's no universal roadmap to guide us.  One of the first steps in positioning for reform is for practitioners to recognize that they bring numerous professional skills and strengths to integrated care setting.  Our practitioners increasingly will need to promote the value and quality they can contribute to emerging models of care.  No one else is fighting the battles for psychology… and don't expect them to.  Health care is a marathon – we're in it for the long haul.  We can't hope to finish the marathon called health care reform if we're not at the starting line."

Those of you who are working in Long-Term Care are to be truly commended.  Many years ago, the late Powell Lawton of the Philadelphia Geriatric Center, who was a visionary in the field of healthy aging, shared his excitement about the potential contributions of the behavioral sciences to the future of our elderly.  Even then, it was clear that our nation was rapidly aging and further, with the advances beginning to occur within the communications and technology fields, that it would be increasingly possible to bring unprecedented social-environmental changes (e.g., stimulation modules) to the lives of our most senior citizens, regardless of where they were residing.  Today, there is considerable discussion at the national level regarding the ever-escalating costs of health care.  The United States spends more on health care than any other industrialized nation, if not twice as much; and yet, our health outcomes are not comparably favorable.  Further, the Institute of Medicine (IOM) reports: "Regions that deliver more services do not appear to achieve better health outcomes than those that deliver less."  "In fact, underuse, misuse, and overuse of various services often put patients in danger."  It is estimated that 50+% of all resource expenditures in hospitals is quality-associated waste (i.e., recovering from preventable foul-ups, building unusable products, providing unnecessary treatments, and simple inefficiency).  Health care systems need to be focused and accountable.

A number of the underlying provisions of the ACA are envisioned as building coordinated, patient-centered systems of care where psychology can contribute significantly to integrated care teams – regardless of the age or disability of the patient.   Historical procedure-oriented reimbursement mechanisms are to be steadily replaced with outcome-oriented metrics.  Cross-provider and cross-diagnostic comparisons are increasingly being called for.  We are optimistic that the critical psychosocial-economic-cultural gradient of "quality" health care will finally be appreciated by other disciplines and most importantly, by those who ultimately make financial decisions.  As Katherine continues to emphasize, the ACA is merely a stage in the evolution of our nation's health care environment.

Unfortunately for psychology, however, our profession is not expressly included in the underlying statute or implementing regulations of either the critical Accountable Care Organization or Patient-Center Medical Home provisions of the law.  Further, although historically Medicaid has been the major source of financial support for long term care services, the profession of psychology has been significantly remiss in not being actively involved.  Accordingly psychology is not recognized in many state Medicaid programs.  If one appreciates that law and business have long been the major professional backgrounds of those elected to Congress and reflect upon Neil's observations, substituting "health care" for "research," one can appreciate that we have a long way to go.  And yet, there can be no question that our clinical expertise can make a real difference in the quality of life of our nation's senior citizens.

Visiting Professor Ann Burgess at the Daniel K. Inouye Graduate School of Nursing, USUHS: "Sexual assault has no barriers to the victim's age or gender.  For example, in the Albert Lea case in Minnesota five teenage nursing assistants were found guilty of sexual harassment and sexual assault of over a dozen male and female Alzheimer residents over a six month period.  Court papers revealed that the nursing assistants were laughing as they talked of poking the breasts and genitalia of elders and taking pictures for online posting.  Family members, after learning of the assaults, said they had noticed changes in behaviors but attributed it to advancing dementia or medication.  This case emphasizes that therapy has no barriers as to age, gender, or mental capacity.  There is the need for caregivers as well as family members to take seriously any patient complaint or behavior that has an oblique or direct sexual content.  In addition, studies show that elder demented patients respond positively to expressive therapies, especially music therapy."  Will those who are working with Long-Term Care families take the next step to ensure that psychology's expertise is appropriately recognized?  Aloha,

Pat DeLeon, former APA President – Psychologists in Long-Term Care – March, 2014

 

EXTRAORDINARY COLLEAGUES

During the final days of my APA Presidency in 2000, I traveled to Washington State to present a Presidential Citation to Colleen Hacker for her outstanding contribution as a role model for our nation's female youth -- inspiring them to excel beyond their wildest dreams.  That evening, Barry Anton's daughter caught him by surprise by agreeing to come to the dinner and sat next to Colleen.  Subsequently, Colleen and I participated at several APA conventions where her message remains very clear: active involvement in sports will make all the difference in a girl's life -- physically, emotionally, and socially.  This past month was Colleen's fifth Olympics as a mental skills coach and her first time at the winter games, working with the U.S. Women's Hockey team.  "Every day it's making new friends and new connections.  It's totally peace and harmony and the world's entire population in support of one another.  The entire world has so much more in common, even with our differences.  We're striving for excellence, we love our families.  We cheer for one another.  All of us say every day, why can't our countries get along the way our athletes and coaches get along?"

            Now it is Barry Anton's turn to serve as APA's 123^rd President.  "APA is home to a diverse and talented group of psychologists who understand that, 'Together we stand.'  APA's effective advocacy efforts ensuring our place in health care delivery in a changing environment, obtaining our fair share of research funding, providing quality education and training for our students, and supporting our ongoing efforts in social justice are some of the issues that I will be working on during my Presidential cycle.  My proposed international summit on psychology and integrated care will help ensure that we bring our best science, our best practices, our best educators and our best trainers together to address the psychological and health needs of an increasing diverse, rapidly changing population."  For me personally, Barry's long time commitment to our nation's children and ensuring that they have ready access to quality psychological care is particularly meaningful.  Children are more than merely "little adults."

            As the nation steadily implements President Obama's Patient Protection and Affordable Care Act (ACA), it is critical that psychology appreciates that the health care environment of tomorrow will be extraordinarily different than what many were trained for.  Integrated and interdisciplinary care is the future.  The unprecedented advances occurring with the communications and technology fields will allow cross-patient and cross-provider comparisons.  Translational science (i.e., bringing new scientific knowledge to clinical practice) has become a high priority for the Administration.  No longer will it be acceptable for new knowledge to take 15-20 years to reach practitioners.

            I had the distinct pleasure of serving with Ruth Paige on the APA Board of Directors during my Presidency.  She was the "behind the scenes" advocate for a number of major policy issues such as ensuring that every state association would have a vote on the Council of Representatives.  Most recently, we have been collaborating on "giving a voice" to the experiences of our senior colleagues who have decided to retire and embark upon new journeys.  Always exciting times.  Aloha,

Pat DeLeon, former APA President – WSPA – March, 2014