An Exciting Vision: Upon occasion, I have been "accused" of being overly optimistic about the future of psychology, especially by senior colleagues who might be emotionally invested in the past. Without question, the health care environment of the 21st century is rapidly changing. However, as long as the field continues to attract "the best and brightest," I am confident that psychology and our colleagues in nursing and pharmacy will do very well. We must appreciate that the vision of our educational leadership is critical to the future.
I am currently serving on the nursing and psychology faculty of the Uniformed Services University of the Health Sciences (USUHS). Since we are located near our nation's Capital, we are fortunate to be able to interact with psychology leaders from across the country, as well as senior APA staff. Former APA Presidents Ron Fox and Don Bersoff have addressed our interdisciplinary health policy class, as well as several Directorate Executive Directors. The students have been invited to a number of APA events, including the annual State Leadership conferences, the recent APA-ABA judicial conference, not to mention being included in ongoing convention activities. A typical initial response to a very last minute expression of interest in the APA Education Leadership Conference: "We would be happy to have some of your students participate. At this point in time we have space limitations or I would try to make this work" (Catherine Grus, Education Directorate). We fully expect that next time it will be possible. Throughout these experiences the palpable enthusiasm of the next generation has been very evident, as has been their interest in shaping their own destiny. USUHS recently announced that our current APA President Nadine Kaslow will be visiting with students and faculty. APA's genuine responsiveness to the interests of our next generation is most impressive – Mahalo, Norman Anderson.
Postdoctoral Opportunities: One of the most exciting developments within the profession has been the establishment of psychology's postdoctoral training initiatives. As we have evolved from being an exclusively mental health focused discipline into a bona fide health care profession, the breath of clinical opportunities for psychological expertise to improve the quality of patients' lives has been exponential. During his APA Presidency, World War II Army veteran Jack Wiggins visited with VA Secretary Tony Principi, a Vietnam veteran, and as a result of that discussion, the Secretary called for the VA to begin a psychology postdoctoral training program. Over the subsequent years, this initiative has steadily expanded, both in numbers and in its clinical focus. Visionary VA senior psychologist Bob Zeiss:
"Health professions education, across disciplines, is a core mission of the Department of Veterans Affairs (VA), with a general goal of providing high quality experiential learning opportunities to develop well educated and well trained health professionals for VA and for the nation. VA's Office of Academic Affiliations (OAA) funds and oversees these training opportunities. During my tenure at OAA (2005-2013) and continuing today (under the leadership of Kenneth Jones, Director of Associated Health Education), the number of funded postdoctoral training positions increased from 52 to 402. Phase III of the five year Mental Health Expansion Initiative will increase those numbers even more for the 2015-2016 academic year.
"Working closely with Mental Health Services and supporting VA's major initiatives to enhance both access to and quality of mental health care in VA, OAA committed to increase the number of trainees in all mental health disciplines. Because of the strength of psychology staff across the nation, psychology as a discipline was particularly poised to develop new internship and postdoctoral programs and enhance existing ones. In recent years, we have increased the focus on developing training opportunities in smaller and rural VA health care settings. These programs provide the same kinds of opportunities as do larger, more traditional programs; they also are intended to generate a cadre of health care professionals eager to remain in and serve in those smaller and more rural settings.
"The focus on postdoctoral training is based on the premise that VA training provides a particularly highly qualified set of candidates from which to recruit future VA staff. Though graduating interns are generally experienced and skilled, the internship does not allow sufficient depth of training to become highly skilled in an emphasis or specialty area. Adding a postdoctoral year to training provides precisely that opportunity. Thus, not only does VA ensure that these new professionals have the skills relevant and necessary for quality care of Veterans, but we are also in a position to determine exactly which developing practitioners have the skills, attitudes, and dedication to VA care that we treasure in our employees."
President Obama's Patient Protection and Affordable Care Act (ACA) envisions the health care environment of tomorrow as providing interdisciplinary data-based care, with a priority on wellness, prevention, and services which are high quality and cost-effective (i.e., the "Triple Aim" – simultaneously improving population health, improving the patient experience of care, and reducing per capita cost). Combined with the Mental Health Parity legislation, the ACA represents the largest expansion of health insurance coverage, particularly for behavioral health, in the history of our nation. And, as Bob indicated, the Administration has demonstrated a concerted effort to engage all health care professions. Mary Dougherty, Director of Nursing Education OAA, reports that the VA supports academic partnerships with Schools of Nursing via the VA Nursing Academic Partnership (VANAP) which funds both baccalaureate and graduate students. The graduate programs are focused on Psychiatric Mental Health Nurse Practitioners (PMHNPs). Both programs require a residency – a post baccalaureate nurse residency or a PMHNP residency. The OAA provides funds for graduate and undergraduate faculty for both schools of nursing and VA, as well as stipends for graduate trainees, post baccalaureate nurse residents, and PMHNP residents. The development of a standard PMHNP competency, curriculum, and accreditation standards are expected outcomes of this program.
Population Focused Health Care: I have recently been appointed to the national advisory committee on Interdisciplinary Community-Based Linkages of the Health Resources and Services Administration (HRSA). The committee is charged with providing advice and recommendations on policy and program development to the Secretary of HHS concerning its various Title VII (Health Professions) training programs and is to submit an annual report to the Secretary and to Congress. Included within its jurisdiction is the Psychology Graduate Education program, as well as the Area Health Education Center, Geriatric Education Center, Quentin N. Burdick Program for Rural Interdisciplinary Training, Allied Health, Mental and Behavioral Health Education and Training initiatives, Education and Training in Pain Care, and the Integration of Quality Improvement and Patient Safety Training into Clinical Education of Health Professionals programs.
One of the challenges facing the nation is addressing the sequela from possessing multiple chronic conditions (MCC). Currently 26% of adults have MCC; 67% of Medicaid beneficiaries with disabilities have three or more conditions. Not surprisingly, as conditions increase, so does the frequency of mortality, poor functional status, hospitalizations, readmissions, and adverse drug events. Sixty-six percent of US health care costs are for individuals with MCC and 93% of Medicare expenditures are for individuals with MCC. For those inpatients 18-44 years of age with more than two chronic conditions, depression is the most prevalent. The HHS Multiple Chronic Conditions Strategic Framework overarching goals include: * Fostering health care and public health system changes; * Maximizing the use of proven self-care management; * Providing better tools and information to workers who deliver care to those with MCC; and, * Facilitating research to fill knowledge gaps. The poor health outcomes of individuals with serious mental illnesses and other behavioral health problems warrants special attention because of the co-occurrences of these conditions with other chronic conditions. This is a priority patient population for which psychology's postdoctoral training would seem most appropriate; including those with specialized training in psychopharmacology.
Ron Rozensky, who served as a former chair of the committee: "It was a great experience representing psychology and having the opportunity to work with the chairs and vice chairs of other advisory committees representing the full range of health care disciplines. We collaborated on writing a letter to Congress during the drafting of the ACA underscoring the importance of the inclusion of interprofessional education, training, and service. Our 10th Report to Congresshighlighted the importance of health behavior as a key component of a truly integrated health care system – what a great honor to chair that report!"
Reflections: I am intrigued by how our senior colleagues respond to retirement. Margy Heldring, former APA Congressional Fellow: "I am nearly full time with the group I founded, Grandmothers Against Gun Violence, after Sandy Hook. It is amazing to build a new organization of 'Women of a Certain Age' and see everyone feel empowered and turn (return!) to activism. What an experience! Psychology seems farther and farther behind me, as I move out and back into policy and politics as a psychologist!" Why, Oh, Why Can't I? Aloha,
Pat DeLeon, former APA President – Division 55 – September, 2014
