ALOHA

“WOULDN’T IT BE NICE”

            One of the most satisfying aspects of serving at the Uniformed Services University of the Health Sciences (USUHS) is realizing the extent to which APA, APS, various national nursing organizations, and individual psychology and nursing leaders have been willing to go “that extra mile” for those who are serving our nation and oftentimes putting themselves in “harm’s way.”  Former APA Presidents Don Bersoff and Ron Fox have participated in our health policy seminar, as has APA President Barry Anton.  Nadine Kaslow has addressed a larger psychology colloquium; while Give an Hour Founder and President Barbara Van Dahlen has graciously participated in both venues.

Global Approaches to Integrated Health Care: Translating Science and Best Practices into Patient-Centered Healthcare Delivery:  This Fall, APA President Barry Anton graciously extended invitations to the USUHS community to participate in his two and one-half day working Summit.  Over 400 viewers, representing 36 countries, “streamed live” into the conference; which was held at the APA Capitol View Conference Center.  Video recordings of the summit sessions will soon be made available on the APA web.  Barry’s goal was to facilitate the sharing of best practices and innovations across disciplines, health care professions, health care settings, and countries.  Through the shared understanding of “patient-centered care” he envisions enhanced public expectations (and, in all candor given his long-time interest in the field, appetite) for the integration of health services, bringing together un-likeminded people and shareholders across the health care domain.  On his visionary planning committee was former APA Congressional Science Fellow Brian Smedley and Toni Zeiss, former head of mental health for the Department of Veterans Affairs (VA), both of whom have participated in our health policy seminar.  Two of the noteworthy keynote speakers were Ronalso Holer, MD, from the Pan American Health Organization (PAHO) and Sue Dopson, Ph.D. from the United Kingdom.  APA President-elect Susan McDaniel also actively participated, moderating panels on special populations and international perspectives.

USUHS student-participant views:  “The Summit brought together the pressing issues in healthcare integration.  The attendees demonstrated well-rounded ideas and approaches to healthcare and service delivery.  I learned about many new topics and ways to communicate.  For example, the role of entrepreneurship and business management is becoming increasingly indispensable for any clinician.  The experts expressed the pressing need of updating professional education with integrative science on what exactly ‘health,’ ‘wellness,’ ‘illness,’ and ‘patient-centered care’ mean from various disciplines.  Lastly, the role of the patient in developing and implementing integrated care remains relatively untapped; e.g., training patients and family in health communication, using their consumer choices to influence the market, etc. [Edwin Szeto].”

“The Summit was an incredibly rewarding experience.  While we often speak about the importance of integrated healthcare within the American healthcare system, it was eye-opening to hear from experts from around the globe who provided perspectives on the need for such efforts worldwide.  Not only did we discuss the importance of getting out of our healthcare AND national silos, the conference put this into action by bringing together physicians, economists, nurse practitioners, psychologists, and many others who were national experts in the U.S., the U.K., Latin America, and other countries around the world.  It was spectacular.… Absolutely amazing [Omni Cassidy].”  Psychology’s future will remain very bright, as long as today’s leaders actively engage the next generation in their efforts and thereby share their vision.

Give an Hour:  Also this Fall, Give an Hour celebrated its tenth anniversary having provided over 175,000 hours of free mental health care to our nation’s veterans, service members, and their families.  The four day Celebration of Service included a fireside chat at the Embassy of Canada, as well as a special benefit concert performed by Brian Wilson of the Beach Boys and Paul Dano who played Brian in the outstanding film Love and Mercy – in which a California psychologist was “less than ethical.”  USUHS students and faculty were invited to attend the ceremonies.   If one stays to the very end of the film, long after many in the audience have unfortunately departed, it becomes clear that director Bill Pohlad and Barbara are on a mission to Change the Direction of how our nation views mental health.  Does each of us know “The Five Signs”?  President and Michelle Obama have publicly talked about their importance.

As Barbara has often stated: “We must change our culture if we are to succeed in saving lives and ending suffering.  We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are.”  Today less than half of the veterans (23% to 40%) who are experiencing mental health problems are likely to seek professional mental health care for fear of stigma or other related barriers to care.  Listening to those who have made a difference at the national level, it also becomes quite clear that sustainable change requires commitment at the local, individual-to-individual, level.  At the fireside chat, it was noted that those who serve our nation develop a deep appreciation for the importance of building a community of effort and of seeking to contribute beyond oneself.  It was opined that our nation needs our veterans to once again share their spirit of comradery and to bring home their “lessons learned” to our nation’s cities and rural communities.  As these complex issues are being contemplated, it is particularly timely that Give an Hour announced that they are actively bringing research expertise into their ever-expanding community of partners.  Changing a culture takes time and personal dedication.

Military Construction, Veterans Affairs, and Related Agencies (MilCon):  The day before Veterans Day, the U.S. Senate passed the Fiscal Year 2016 MilCon/VA appropriations bill, recommending $1.0 billion above the President’s budget request, by a vote of 93 to 0.  Addressing the special needs of certain veterans; e.g., the Veterans Justice Outreach (VJO) program, the Senate: “(C)ommends the Department for its efforts to support justice-involved veterans.  According to the Bureau of Justice Statistics, 9.3 percent of people incarcerated in the United States are veterans; 70 percent of these veterans are incarcerated for a nonviolent offense.  The Department reports that 60 percent of incarcerated veterans suffer from substance abuse, 30 percent from a serious mental illness, and 60 percent from a major medical condition.  Almost 50 percent of homeless veterans have interacted with the criminal justice system.  The Department’s VJO specialists provide outreach and case management services to justice-involved veterans to help avoid unnecessary criminalization of mental illness and substance abuse.  VJOs also work directly with local law enforcement and court officials to help identify veteran-specific issues, including Post-Traumatic Stress Disorder [PTSD] and Traumatic Brain Injury [TBI], and they connect eligible veterans with VA treatment programs.”

“Women Veterans – The Committee believes VA must make better progress in addressing the needs of women veterans….  Access to and utilization of VA benefits and services by women veterans remain low, with women often encountering cultural roadblocks in a system that was largely designed to meet the needs of male veterans.  The Committee anticipates the results of an ongoing system-wide review intended to determine what type and number of healthcare workers the system should have to address current and future demand of gender-specific care.”  Changing a culture requires vision and dedication.  “Wouldn’t it be nice?”  Aloha,

Pat DeLeon, former APA President – HPA – December, 2015

 

“WOULDN’T IT BE NICE”

 One of the most satisfying aspects of serving at the Uniformed Services University of the Health Sciences (USUHS) is realizing the extent to which APA, APS, various national nursing organizations, and individual psychology and nursing leaders have been willing to go "that extra mile" for those who are serving our nation and oftentimes putting themselves in "harm's way."  Former APA Presidents Don Bersoff and Ron Fox have participated in our health policy seminar, as has APA President Barry Anton.  Nadine Kaslow has addressed a larger psychology colloquium; while Give an Hour Founder and President Barbara Van Dahlen has graciously participated in both venues.

Global Approaches to Integrated Health Care: Translating Science and Best Practices into Patient-Centered Healthcare Delivery:  This Fall, APA President Barry Anton graciously extended invitations to the USUHS community to participate in his two and one-half day working Summit.  Over 400 viewers, representing 36 countries, "streamed live" into the conference; which was held at the APA Capitol View Conference Center.  Video recordings of the summit sessions will soon be made available on the APA web.  Barry's goal was to facilitate the sharing of best practices and innovations across disciplines, health care professions, health care settings, and countries.  Through the shared understanding of "patient-centered care" he envisions enhanced public expectations (and, in all candor given his long-time interest in the field, appetite) for the integration of health services, bringing together un-likeminded people and shareholders across the health care domain.  On his visionary planning committee was former APA Congressional Science Fellow Brian Smedley and Toni Zeiss, former head of mental health for the Department of Veterans Affairs (VA), both of whom have participated in our health policy seminar.  Two of the noteworthy keynote speakers were Ronalso Holer, MD, from the Pan American Health Organization (PAHO) and Sue Dopson, Ph.D. from the United Kingdom.  APA President-elect Susan McDaniel also actively participated, moderating panels on special populations and international perspectives.

USUHS student-participant views:  "The Summit brought together the pressing issues in healthcare integration.  The attendees demonstrated well-rounded ideas and approaches to healthcare and service delivery.  I learned about many new topics and ways to communicate.  For example, the role of entrepreneurship and business management is becoming increasingly indispensable for any clinician.  The experts expressed the pressing need of updating professional education with integrative science on what exactly 'health,' 'wellness,' 'illness,' and 'patient-centered care' mean from various disciplines.  Lastly, the role of the patient in developing and implementing integrated care remains relatively untapped; e.g., training patients and family in health communication, using their consumer choices to influence the market, etc. [Edwin Szeto]."

"The Summit was an incredibly rewarding experience.  While we often speak about the importance of integrated healthcare within the American healthcare system, it was eye-opening to hear from experts from around the globe who provided perspectives on the need for such efforts worldwide.  Not only did we discuss the importance of getting out of our healthcare AND national silos, the conference put this into action by bringing together physicians, economists, nurse practitioners, psychologists, and many others who were national experts in the U.S., the U.K., Latin America, and other countries around the world.  It was spectacular.… Absolutely amazing [Omni Cassidy]."  Psychology's future will remain very bright, as long as today's leaders actively engage the next generation in their efforts and thereby share their vision.

Give an Hour:  Also this Fall, Give an Hour celebrated its tenth anniversary having provided over 175,000 hours of free mental health care to our nation's veterans, service members, and their families.  The four day Celebration of Service included a fireside chat at the Embassy of Canada, as well as a special benefit concert performed by Brian Wilson of the Beach Boys and Paul Dano who played Brian in the outstanding film Love and Mercy– in which a California psychologist was "less than ethical."  USUHS students and faculty were invited to attend the ceremonies.   If one stays to the very end of the film, long after many in the audience have unfortunately departed, it becomes clear that director Bill Pohlad and Barbara are on a mission to Change the Direction of how our nation views mental health.  Does each of us know "The Five Signs"?  President and Michelle Obama have publicly talked about their importance.

As Barbara has often stated: "We must change our culture if we are to succeed in saving lives and ending suffering.  We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are."  Today less than half of the veterans (23% to 40%) who are experiencing mental health problems are likely to seek professional mental health care for fear of stigma or other related barriers to care.  Listening to those who have made a difference at the national level, it also becomes quite clear that sustainable change requires commitment at the local, individual-to-individual, level.  At the fireside chat, it was noted that those who serve our nation develop a deep appreciation for the importance of building a community of effort and of seeking to contribute beyond oneself.  It was opined that our nation needs our veterans to once again share their spirit of comradery and to bring home their "lessons learned" to our nation's cities and rural communities.  As these complex issues are being contemplated, it is particularly timely that Give an Hour announced that they are actively bringing research expertise into their ever-expanding community of partners.  Changing a culture takes time and personal dedication.

Military Construction, Veterans Affairs, and Related Agencies (MilCon):  The day before Veterans Day, the U.S. Senate passed the Fiscal Year 2016 MilCon/VA appropriations bill, recommending $1.0 billion above the President's budget request, by a vote of 93 to 0.  Addressing the special needs of certain veterans; e.g., the Veterans Justice Outreach (VJO) program, the Senate: "(C)ommends the Department for its efforts to support justice-involved veterans.  According to the Bureau of Justice Statistics, 9.3 percent of people incarcerated in the United States are veterans; 70 percent of these veterans are incarcerated for a nonviolent offense.  The Department reports that 60 percent of incarcerated veterans suffer from substance abuse, 30 percent from a serious mental illness, and 60 percent from a major medical condition.  Almost 50 percent of homeless veterans have interacted with the criminal justice system.  The Department's VJO specialists provide outreach and case management services to justice-involved veterans to help avoid unnecessary criminalization of mental illness and substance abuse.  VJOs also work directly with local law enforcement and court officials to help identify veteran-specific issues, including Post-Traumatic Stress Disorder [PTSD] and Traumatic Brain Injury [TBI], and they connect eligible veterans with VA treatment programs."

"Women Veterans – The Committee believes VA must make better progress in addressing the needs of women veterans….  Access to and utilization of VA benefits and services by women veterans remain low, with women often encountering cultural roadblocks in a system that was largely designed to meet the needs of male veterans.  The Committee anticipates the results of an ongoing system-wide review intended to determine what type and number of healthcare workers the system should have to address current and future demand of gender-specific care."  Changing a culture requires vision and dedication.  "Wouldn't it be nice?"  Aloha,

Pat DeLeon, former APA President – HPA – December, 2015

 

Sent from my iPhone

Division 42 column - November, 2015

INNOVATIVE TRAINING OPPORTUNITIES -- FOR THOSE WITH VISION

Changing Times:  Over a decade ago, in 2003, the Institute of Medicine (IOM) issued its report Informing the Future: Critical Issues in Health.  Most noteworthy: “A person’s behavior and social circumstances have a remarkably strong effect on his or her health.  Taken together, behavioral patterns and social circumstances are estimated to account for more than half of the premature deaths in the United States each year.  Yet medical schools often do not cover these topics, or do so only superficially.  IOM is conducting a study to identify ways to make the behavioral and social sciences an integral part of medical education.”

Several of psychology’s visionary educators are exposing their students to the medical and interprofessional aspects of health care by developing innovative and accredited training experiences, thereby preparing the next generation of practitioners for the unprecedented challenges and opportunities of the coming century.  Gil Newman and Bob McGrath, for example, are placing students within local Federally Qualified Community Health Centers (FQHCs), where they work within primary care, rather than in more traditional co-located specialty mental health services.

The federal health center initiative was created during the Great Society Era of President Lyndon Johnson.  They are located primarily in medically underserved areas and are a core component of the health care delivery system for low-income and minority populations.  In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation’s nearly 1,200 FQHCs operating in 8,500 sites.  The Commonwealth Fund reports that the percentage of FQHCs exhibiting medium or high levels of medical home capacity almost doubled between 2009 and 2013, from 32% to 62%.  Patient-centered Medical Homes and Accountable Care Organizations are a critical component of the Obama Administration’s vision of developing systems of integrated and interprofessional team-based comprehensive care with an emphasis upon prevention.

A Personal Perspective:  At the Uniformed Services University of the Health Sciences (USUHS), Neil Grunberg (along with his medical school colleagues Eric Shoomaker and John McManigle) has effectively integrated leadership skills into the annual Operation Bushmaster training program.  “Every year in October, students from USUHS Schools of Medicine (including the Department of Medical and Clinical Psychology) and Nursing participate in a four-week training exercise known as ‘Operation Bushmaster.’  The first two-weeks of didactic training provide the groundwork for unit cohesion, with a follow-on week of independent study incorporated for mastery of many of the concepts.  During the final week, students ‘deploy’ to a training facility to conduct simulated medical missions and are exposed to many of the same stressors experienced during combat deployments (i.e., lack of sleep, high operational tempo, fatigue, and austere living conditions).  Additionally, Operation Bushmaster provides an atmosphere where inter-professional collaboration transpires and learning the unique perspectives of each discipline is highly encouraged.

“During this field exercise, Psychiatric Mental Health Nurse Practitioner (PMHNP) students and Clinical Psychology students played the roles of patients with mental health illnesses such as psychosis, mania, depression, anxiety, and substance use disorders.  While simulating roles of Battalion Surgeon (senior medical officer) and Combat Stress Control, the graduating medical students and Family Nurse Practitioners (FNP) students assessed and treated mental health ‘patients’ presenting with acute and chronic symptoms.

“This year, PMHNP students joined with Clinical Psychology students to form the Brigade Combat Stress Control (CSC) team.  In this shared role, students evaluated the behavioral health needs of the medical platoons participating in Operation Bushmaster.  The Unit Behavioral Health Needs Assessment Survey (UBHNAS) is a comprehensive survey developed to assess the overall behavioral health status and needs of a military unit.  However, those of us in mental health developed a shortened version of this tool for use during the training exercise.  Our modified UBHNAS assessed the status of each platoon in five critical domains: leadership, leadership cohesion, morale, communication, and training.  Following the assessment students provided direct feedback to the Platoon Leader on methods for improvement and in areas for sustainment within each team.  Additionally, the Brigade Combat Stress Control team offered brief psychological interventions (such as humor, relaxation exercises (i.e., deep breathing), and discussions of resiliency) to platoon members.  On returning from the field, a presentation to Command Leadership was given by the CSC team, where we received feedback on our performance by faculty members [Marlene Arias-Reynoso, Patricia Smith, and Lutisha Jackson, PMHNP students].”  View https://www.youtube.com/watch?v=IWNJ6kdQpqY if interested.

Developments in Illinois:  On June 25, 2014, Illinois joined Guam, New Mexico, and Louisiana in enacting comprehensive prescriptive authority (RxP) legislation.  The Illinois Psychological Association took the innovative approach of opening the Master’s level training in Clinical Psychopharmacology to those who are still at the pre-doctoral level, a far-reaching educational policy position long proposed by former APA President Bob Resnick, Bob Ax, and Gene Shapiro.  Furthermore, because the law requires seven undergraduate science courses, Illinois now has undergraduate psychology students enrolling in “pre-prescribing” specialty curricula.

Beth Rom-Rymer’s report: “It’s been 17 months since the Illinois State Legislature passed our prescriptive authority legislation by overwhelming margins and 16 months since former Governor Pat Quinn signed SB 2187 into law.  We Illinois psychologists have not let any grass grow under our feet.  The process for the approval of our law’s Rules and Regulations is almost complete.  We expect that the effective date for our law will be March 1, 2016.

“Two of the largest state Universities in Illinois – the University of Illinois, Champaign-Urbana and Southern Illinois University, with 33,000 and 13,000 undergraduates, respectively, now have the undergraduate concentration for the ‘pre-prescribing psychologist.’  Some of our Universities are planning a 4+1 academic program that will combine the B.S. in Psychology with the M.S. in Clinical Psychopharmacology.  Those students who earn the combined degrees will then have a very competitive opportunity when they apply for their doctoral programs in psychology.  Several Universities and Professional Schools are working on developing the M.S. curriculum in Clinical Psychopharmacology for their current graduate students as well as for practicing psychologists around the country.

“More than 20 Illinois hospitals and medical centers are creating rotation opportunities for the prescribing psychology trainees.  The number of participating hospitals and medical centers continues to grow and includes Illinois’ most renowned teaching hospitals.  The legal mandate that we must participate in a series of nine medical rotations (e.g., internal medicine, pediatrics, and family medicine) affords prescribing psychology trainees yet another opportunity to form collaborative alliances with physicians by observing first-hand their treatment procedures while functioning as independent members of multidisciplinary treatment teams.  Even our Illinois psychiatrists are more than willing to partner with us to meet the needs of our patients who are desperate for good, accessible mental health care.  Over 90 Illinois practicing psychologists are currently in training, ranging in age from 23-83.  Our oldest trainee, an addictionologist, asserts that her patients will be better served with her being trained as a prescribing psychologist.  We have established strong collaborative relationships with NAMI and various governmental and law enforcement agencies in the state.  In a remarkable development, county mental health boards are raising funds to pay for the training of prescribing psychologists in their jurisdictions.  There is a growing, widespread recognition that prescribing psychologists can transform a broken mental health system.”  Aloha,

Pat DeLeon, former APA President – Division 42 – November, 2015

 

INNOVATIVE TRAINING OPPORTUNITIES -- FOR THOSE WITH VISION

Changing Times:  Over a decade ago, in 2003, the Institute of Medicine (IOM) issued its report Informing the Future: Critical Issues in Health.  Most noteworthy: "A person's behavior and social circumstances have a remarkably strong effect on his or her health.  Taken together, behavioral patterns and social circumstances are estimated to account for more than half of the premature deaths in the United States each year.  Yet medical schools often do not cover these topics, or do so only superficially.  IOM is conducting a study to identify ways to make the behavioral and social sciences an integral part of medical education."

Several of psychology's visionary educators are exposing their students to the medical and interprofessional aspects of health care by developing innovative and accredited training experiences, thereby preparing the next generation of practitioners for the unprecedented challenges and opportunities of the coming century.  Gil Newman and Bob McGrath, for example, are placing students within local Federally Qualified Community Health Centers (FQHCs), where they work within primary care, rather than in more traditional co-located specialty mental health services.

The federal health center initiative was created during the Great Society Era of President Lyndon Johnson.  They are located primarily in medically underserved areas and are a core component of the health care delivery system for low-income and minority populations.  In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation's nearly 1,200 FQHCs operating in 8,500 sites.  The Commonwealth Fund reports that the percentage of FQHCs exhibiting medium or high levels of medical home capacity almost doubled between 2009 and 2013, from 32% to 62%.  Patient-centered Medical Homes and Accountable Care Organizations are a critical component of the Obama Administration's vision of developing systems of integrated and interprofessional team-based comprehensive care with an emphasis upon prevention.

A Personal Perspective:  At the Uniformed Services University of the Health Sciences (USUHS), Neil Grunberg (along with his medical school colleagues Eric Shoomaker and John McManigle) has effectively integrated leadership skills into the annual Operation Bushmaster training program.  "Every year in October, students from USUHS Schools of Medicine (including the Department of Medical and Clinical Psychology) and Nursing participate in a four-week training exercise known as 'Operation Bushmaster.'  The first two-weeks of didactic training provide the groundwork for unit cohesion, with a follow-on week of independent study incorporated for mastery of many of the concepts.  During the final week, students 'deploy' to a training facility to conduct simulated medical missions and are exposed to many of the same stressors experienced during combat deployments (i.e., lack of sleep, high operational tempo, fatigue, and austere living conditions).  Additionally, Operation Bushmaster provides an atmosphere where inter-professional collaboration transpires and learning the unique perspectives of each discipline is highly encouraged.

"During this field exercise, Psychiatric Mental Health Nurse Practitioner (PMHNP) students and Clinical Psychology students played the roles of patients with mental health illnesses such as psychosis, mania, depression, anxiety, and substance use disorders.  While simulating roles of Battalion Surgeon (senior medical officer) and Combat Stress Control, the graduating medical students and Family Nurse Practitioners (FNP) students assessed and treated mental health 'patients' presenting with acute and chronic symptoms.

"This year, PMHNP students joined with Clinical Psychology students to form the Brigade Combat Stress Control (CSC) team.  In this shared role, students evaluated the behavioral health needs of the medical platoons participating in Operation Bushmaster.  The Unit Behavioral Health Needs Assessment Survey (UBHNAS) is a comprehensive survey developed to assess the overall behavioral health status and needs of a military unit.  However, those of us in mental health developed a shortened version of this tool for use during the training exercise.  Our modified UBHNAS assessed the status of each platoon in five critical domains: leadership, leadership cohesion, morale, communication, and training.  Following the assessment students provided direct feedback to the Platoon Leader on methods for improvement and in areas for sustainment within each team.  Additionally, the Brigade Combat Stress Control team offered brief psychological interventions (such as humor, relaxation exercises (i.e., deep breathing), and discussions of resiliency) to platoon members.  On returning from the field, a presentation to Command Leadership was given by the CSC team, where we received feedback on our performance by faculty members [Marlene Arias-Reynoso, Patricia Smith, and Lutisha Jackson, PMHNP students]."  View https://www.youtube.com/watch?v=IWNJ6kdQpqY if interested.

Developments in Illinois:  On June 25, 2014, Illinois joined Guam, New Mexico, and Louisiana in enacting comprehensive prescriptive authority (RxP) legislation.  The Illinois Psychological Association took the innovative approach of opening the Master's level training in Clinical Psychopharmacology to those who are still at the pre-doctoral level, a far-reaching educational policy position long proposed by former APA President Bob Resnick, Bob Ax, and Gene Shapiro.  Furthermore, because the law requires seven undergraduate science courses, Illinois now has undergraduate psychology students enrolling in "pre-prescribing" specialty curricula.

Beth Rom-Rymer's report: "It's been 17 months since the Illinois State Legislature passed our prescriptive authority legislation by overwhelming margins and 16 months since former Governor Pat Quinn signed SB 2187 into law.  We Illinois psychologists have not let any grass grow under our feet.  The process for the approval of our law's Rules and Regulations is almost complete.  We expect that the effective date for our law will be March 1, 2016.

"Two of the largest state Universities in Illinois – the University of Illinois, Champaign-Urbana and Southern Illinois University, with 33,000 and 13,000 undergraduates, respectively, now have the undergraduate concentration for the 'pre-prescribing psychologist.'  Some of our Universities are planning a 4+1 academic program that will combine the B.S. in Psychology with the M.S. in Clinical Psychopharmacology.  Those students who earn the combined degrees will then have a very competitive opportunity when they apply for their doctoral programs in psychology.  Several Universities and Professional Schools are working on developing the M.S. curriculum in Clinical Psychopharmacology for their current graduate students as well as for practicing psychologists around the country.

"More than 20 Illinois hospitals and medical centers are creating rotation opportunities for the prescribing psychology trainees.  The number of participating hospitals and medical centers continues to grow and includes Illinois' most renowned teaching hospitals.  The legal mandate that we must participate in a series of nine medical rotations (e.g., internal medicine, pediatrics, and family medicine) affords prescribing psychology trainees yet another opportunity to form collaborative alliances with physicians by observing first-hand their treatment procedures while functioning as independent members of multidisciplinary treatment teams.  Even our Illinois psychiatrists are more than willing to partner with us to meet the needs of our patients who are desperate for good, accessible mental health care.  Over 90 Illinois practicing psychologists are currently in training, ranging in age from 23-83.  Our oldest trainee, an addictionologist, asserts that her patients will be better served with her being trained as a prescribing psychologist.  We have established strong collaborative relationships with NAMI and various governmental and law enforcement agencies in the state.  In a remarkable development, county mental health boards are raising funds to pay for the training of prescribing psychologists in their jurisdictions.  There is a growing, widespread recognition that prescribing psychologists can transform a broken mental health system."  Aloha,

Pat DeLeon, former APA President – Division 42 – November, 2015

Sent from my iPhone

Division 29 Fall, 2015 column

“FROM OUR EXPERIENCE WE GAIN KNOWLEDGE”

            A Seasoned Perspective, Perhaps:  One of the advantages of becoming “senior” is developing an appreciation for how long fundamental change actually takes.  Today’s insights are often the musings of the past.  In 2003, the Robert Wood Johnson Foundation (RWJ) published one of its anthologies, To Improve Health and Health Care.  RWJ began operating as a national foundation in 1972 and by 2003 had grown into the nation’s fifth-largest foundation, with assets of $8 billion.  Its mission is to improve the health and health care of all Americans.  The then-retiring CEO reflected: “What drew me to medicine was a desire to do good, which came out of a family background steeped in humanism and social justice….  At the Foundation, we’re trying to improve access to care, create better-end-of-life care, reduce smoking, and the like.  The results are hard to measure.  Many factors contribute to the problems we are addressing….  One realization I’ve come to is that we tend to overemphasize strategy and underemphasize execution.  A key component of execution is leadership….  I’ve come to rely less on academics as a stimulus for social change.  It’s much more obvious to me that grassroots movements and the media and politics are very, very critical….  I think one of the unattractive aspects of our country is the relative lack of concern about the less fortunate….  I think we kid ourselves when we think there is one big lever.  Social change is very hard work.  The media – especially TV – has so much power, for better or worse….

“In the health area, we’re becoming more aware that many of the determinants of health lie outside the health care system.  They depend upon personal behavior.  Yet we have a nation that’s becoming more overweight and less physically active, and there’s growing evidence that physical activity may be as important in preventing illness and improving functioning as not smoking.  Trying to change personal behavior, however, is very, very hard.  We’re also beginning to understand that being connected to one another may have an important role in health.”

This Fall during our Uniformed Services University of the Health Sciences (USUHS) health policy seminar, LTG Patricia Horoho, the 43^rd U.S. Army Surgeon General (and the first female and first non-physician SG in its history -- which dates back to July, 1775) expressed a similar view as to the importance of focusing upon the behavioral and psychosocial elements of health care, including sleep, nutrition, and exercise.  Both of these health policy visionaries noted the importance of being willing to take risks and of appreciating the social and political context within which one is operating.  The clinicians of tomorrow must appreciate, and effectively respond to, the ever-changing health care environment of today and that of the future.

LTG. Horoho’ s Congressional testimony: “Long term success in Army Medicine lies in our ability to effectively impact the ‘Lifespace.’  It is in the Lifespace where the choices we make impact our lives and our health.  We understand the patient healthcare encounter to be an average interaction of 20 minutes, approximately five times each year.  Therefore, the average annual amount of time spent with each patient is 100 minutes; this represents a very small fraction of one’s life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families, and Retirees.  We need to reach beyond the physical boundaries of our medical treatment facilities.  In other words, we want to partner with those entrusted to our care during the other 525,500 minutes of the year where people are living their lives and making their health choices.”

During the seminar, she also addressed the critical issue of paying for preventive and behavioral health services.  Under her leadership, the Army has established an accountability metric which focuses upon patient outcome determinations, such as one’s body mass index (BMI), and thereby allows the system to provide “credit” to the health care facility and provider for the broadly defined health services rendered.  This is a highly innovative approach which could well serve as a model for other governmental entities, as well as the private sector, over the next several years.  The bottom line, “The Times They Are A-Changin’” and as a nation we must be responsive to the most up-to-date knowledge learned and not remain blindly wedded to the past, no matter how comfortable that might seem.

Systemic Movement Towards Integrated Systems of Care:  One of the far-reaching philosophical orientations embedded within President Obama’s Patient Protection and Affordable Care Act (ACA) is the development of systems of seamless care, rather than relying upon historic practitioner-oriented, fee-for-service care.  The Patient-Centered Medical Home and the Accountable Care Organization provisions of the law (in neither of which is psychology expressly enumerated in either the statute or implementing regulations) are envisioned as vehicles for providing a wide range of broadly defined health services which are to be delivered by interdisciplinary teams of providers, emphasizing prevention and wellness care, while utilizing cutting-edge technology.  The Commonwealth Fund (CWF) recently released a report noting that the percentage of federally qualified community health centers (FQHCs) exhibiting medium or high levels of medical home capacity almost doubled between 2009 and 2013, from 32% to 62%.  The greatest improvement was reported in patient tracking and care management, although their ability to coordinate care with providers outside of their system, especially with specialists, had reportedly been diminished.

The Obama Administration estimates that since the enactment of the ACA on March 23, 2010, which heavily relies upon Medicaid as its reimbursement mechanism, approximately 16.4 million uninsured people have gained health coverage with over 12.3 million Americans having been added to the Medicaid and CHIP roles.  As Katherine Nordal has consistently stressed during her exciting APA/APAPO annual state leadership conferences, Medicaid remains the single largest payer for mental health services.  FQHCs provide comprehensive primary care, behavioral health services, and dental care to all patients regardless of their ability to pay or their health insurance status.  Created during the Great Society Era of President Lyndon Johnson, they are located primarily in medically underserved areas and are regarded as a core component of the health delivery system for low-income and minority populations.

In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation’s nearly 1,200 FQHCs operating in 8,500 sites.  For example, in Hawaii each of the islands has at least one FQHC; one even offers innovative prescribing psychologist services.  In addition to clinical health services, the center staff provide patients with insurance eligibility and enrollment assistance, case management, language interpretation, and transportation services.  They also provide access to the nonmedical services that many low-income people need, such as nutritious food and supportive housing.  The CWF survey found that a greater percentage of centers that serve as medical homes provide whole-person care, including mental health and dental services, which can improve patients’ overall health status and their ability to take care of themselves.

CWF identified 12 core functions indicative of medical home capability across six domains: patient access and communication, patient tracking and registries, care management, test and referral tracking, quality improvement, and coordination with external providers.  A health center was considered to have high medical home capability if it could perform at least nine of the 12 core functions, medium capability if it performed six to eight functions, and low capability if it performed fewer than six functions.  Between 2009 and 2013, the percentage of centers exhibiting high medical home capability more than tripled.  In 2013, most centers (62%) reported a medium or high level of medical home capacity, whereas in 2009 only 32% did.

Transforming a practice to a medical home can be an arduous and painful process, with the changes required being disorienting and demanding to staff.  Nevertheless, CWF found that 47% of health centers that met the definition of high medical home capability reported improved or much improved provider and staff satisfaction over the past two years, compared with only 39% of those with medium capacity, and 27% of those with low capacity.  Those with high medical home scores also reported improved or much-improved ability to recruit and retain physicians, nurses, and support staff.  This suggests that while high staff turnover may be a barrier to effective transformation, it is not necessarily a symptom of the transformation process itself.

A Grand Vision:  Two of the true pioneers of the psychopharmacology movement, Elaine LeVine and Elaine Foster, have recently joined together to address the challenge of Global Mental Health.  According to the World Health Organization (WHO), half of all countries in the world have less than one psychiatrist per 100,000 people and a third of all countries have no mental health programs at all.  While access and quality of care issues are extremely critical within the United States, they are even more striking in middle- and low-income countries.  Our two colleagues have undertaken to provide expanded training for mental health providers worldwide utilizing the WHO concept of “task shifting.”  Through expanded training for the health care workforce, the goal is to empower less specialized health workers, such as counselors and social workers, to better assist those in need.

In many countries, there are few medical practitioners or doctoral level psychologists available to provide care, and the populations they serve are so vast that they are often not able to provide day-by-day care services to their patients.  Task shifting allows a mental health worker to make recommendations to a primary care provider regarding treatment options, based on augmented training in psychopharmacology, from a psychobiosocial perspective.  The mission of their recently established nonprofit organization, RxP International, is to provide training in psychiatric medications as an adjunct to the many types of therapies that can be used in place of medicine.  Helping midlevel practitioners gain the information and skills necessary is clearly a social justice concern with the focus being on teaching people to better help themselves.

Our colleagues have designed specific teaching modules that can be provided through distance learning and an open communication forum.  These will target the most commonly diagnosed conditions such as anxiety, depression, and psychosis, along with special populations such as the elderly and children.  Their online forum will be actively managed to assist student-providers in sharing their unique experiences and needs from their place in the world.  These personal interactions will provide a better understanding of the mental health needs and interests around the globe.  Their website can be accessed at www.rxpint.org for those who are interested in obtaining APA CE credit, by taking individual courses or pursuing a certificate.

            Unique Perspectives:  One of the most intriguing questions asked at our USUHS seminar was: Whether being the first nurse or the first female selected to serve as Surgeon General was more significant?  From the perspective of a world-wide audience the answer was fascinating.  “And if we get any knowledge, then we gain liberation” [George Harrison].  Aloha,

Pat DeLeon, former APA President – Division 29 – November, 2015

 

“FROM OUR EXPERIENCE WE GAIN KNOWLEDGE”

  A Seasoned Perspective, Perhaps:  One of the advantages of becoming "senior" is developing an appreciation for how long fundamental change actually takes.  Today's insights are often the musings of the past.  In 2003, the Robert Wood Johnson Foundation (RWJ) published one of its anthologies, To Improve Health and Health Care.  RWJ began operating as a national foundation in 1972 and by 2003 had grown into the nation's fifth-largest foundation, with assets of $8 billion.  Its mission is to improve the health and health care of all Americans.  The then-retiring CEO reflected: "What drew me to medicine was a desire to do good, which came out of a family background steeped in humanism and social justice….  At the Foundation, we're trying to improve access to care, create better-end-of-life care, reduce smoking, and the like.  The results are hard to measure.  Many factors contribute to the problems we are addressing….  One realization I've come to is that we tend to overemphasize strategy and underemphasize execution.  A key component of execution is leadership….  I've come to rely less on academics as a stimulus for social change.  It's much more obvious to me that grassroots movements and the media and politics are very, very critical….  I think one of the unattractive aspects of our country is the relative lack of concern about the less fortunate….  I think we kid ourselves when we think there is one big lever.  Social change is very hard work.  The media – especially TV – has so much power, for better or worse….

"In the health area, we're becoming more aware that many of the determinants of health lie outside the health care system.  They depend upon personal behavior.  Yet we have a nation that's becoming more overweight and less physically active, and there's growing evidence that physical activity may be as important in preventing illness and improving functioning as not smoking.  Trying to change personal behavior, however, is very, very hard.  We're also beginning to understand that being connected to one another may have an important role in health."

This Fall during our Uniformed Services University of the Health Sciences (USUHS) health policy seminar, LTG Patricia Horoho, the 43^rd U.S. Army Surgeon General (and the first female and first non-physician SG in its history -- which dates back to July, 1775) expressed a similar view as to the importance of focusing upon the behavioral and psychosocial elements of health care, including sleep, nutrition, and exercise.  Both of these health policy visionaries noted the importance of being willing to take risks and of appreciating the social and political context within which one is operating.  The clinicians of tomorrow must appreciate, and effectively respond to, the ever-changing health care environment of today and that of the future.

LTG. Horoho' s Congressional testimony: "Long term success in Army Medicine lies in our ability to effectively impact the 'Lifespace.'  It is in the Lifespace where the choices we make impact our lives and our health.  We understand the patient healthcare encounter to be an average interaction of 20 minutes, approximately five times each year.  Therefore, the average annual amount of time spent with each patient is 100 minutes; this represents a very small fraction of one's life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families, and Retirees.  We need to reach beyond the physical boundaries of our medical treatment facilities.  In other words, we want to partner with those entrusted to our care during the other 525,500 minutes of the year where people are living their lives and making their health choices."

During the seminar, she also addressed the critical issue of paying for preventive and behavioral health services.  Under her leadership, the Army has established an accountability metric which focuses upon patient outcome determinations, such as one's body mass index (BMI), and thereby allows the system to provide "credit" to the health care facility and provider for the broadly defined health services rendered.  This is a highly innovative approach which could well serve as a model for other governmental entities, as well as the private sector, over the next several years.  The bottom line, "The Times They Are A-Changin'" and as a nation we must be responsive to the most up-to-date knowledge learned and not remain blindly wedded to the past, no matter how comfortable that might seem.

Systemic Movement Towards Integrated Systems of Care:  One of the far-reaching philosophical orientations embedded within President Obama's Patient Protection and Affordable Care Act (ACA) is the development of systems of seamless care, rather than relying upon historic practitioner-oriented, fee-for-service care.  The Patient-Centered Medical Home and the Accountable Care Organization provisions of the law (in neither of which is psychology expressly enumerated in either the statute or implementing regulations) are envisioned as vehicles for providing a wide range of broadly defined health services which are to be delivered by interdisciplinary teams of providers, emphasizing prevention and wellness care, while utilizing cutting-edge technology.  The Commonwealth Fund (CWF) recently released a report noting that the percentage of federally qualified community health centers (FQHCs) exhibiting medium or high levels of medical home capacity almost doubled between 2009 and 2013, from 32% to 62%.  The greatest improvement was reported in patient tracking and care management, although their ability to coordinate care with providers outside of their system, especially with specialists, had reportedly been diminished.

The Obama Administration estimates that since the enactment of the ACA on March 23, 2010, which heavily relies upon Medicaid as its reimbursement mechanism, approximately 16.4 million uninsured people have gained health coverage with over 12.3 million Americans having been added to the Medicaid and CHIP roles.  As Katherine Nordal has consistently stressed during her exciting APA/APAPO annual state leadership conferences, Medicaid remains the single largest payer for mental health services.  FQHCs provide comprehensive primary care, behavioral health services, and dental care to all patients regardless of their ability to pay or their health insurance status.  Created during the Great Society Era of President Lyndon Johnson, they are located primarily in medically underserved areas and are regarded as a core component of the health delivery system for low-income and minority populations.

In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), made 85.6 million visits to the nation's nearly 1,200 FQHCs operating in 8,500 sites.  For example, in Hawaii each of the islands has at least one FQHC; one even offers innovative prescribing psychologist services.  In addition to clinical health services, the center staff provide patients with insurance eligibility and enrollment assistance, case management, language interpretation, and transportation services.  They also provide access to the nonmedical services that many low-income people need, such as nutritious food and supportive housing.  The CWF survey found that a greater percentage of centers that serve as medical homes provide whole-person care, including mental health and dental services, which can improve patients' overall health status and their ability to take care of themselves.

CWF identified 12 core functions indicative of medical home capability across six domains: patient access and communication, patient tracking and registries, care management, test and referral tracking, quality improvement, and coordination with external providers.  A health center was considered to have high medical home capability if it could perform at least nine of the 12 core functions, medium capability if it performed six to eight functions, and low capability if it performed fewer than six functions.  Between 2009 and 2013, the percentage of centers exhibiting high medical home capability more than tripled.  In 2013, most centers (62%) reported a medium or high level of medical home capacity, whereas in 2009 only 32% did.

Transforming a practice to a medical home can be an arduous and painful process, with the changes required being disorienting and demanding to staff.  Nevertheless, CWF found that 47% of health centers that met the definition of high medical home capability reported improved or much improved provider and staff satisfaction over the past two years, compared with only 39% of those with medium capacity, and 27% of those with low capacity.  Those with high medical home scores also reported improved or much-improved ability to recruit and retain physicians, nurses, and support staff.  This suggests that while high staff turnover may be a barrier to effective transformation, it is not necessarily a symptom of the transformation process itself.

A Grand Vision:  Two of the true pioneers of the psychopharmacology movement, Elaine LeVine and Elaine Foster, have recently joined together to address the challenge of Global Mental Health.  According to the World Health Organization (WHO), half of all countries in the world have less than one psychiatrist per 100,000 people and a third of all countries have no mental health programs at all.  While access and quality of care issues are extremely critical within the United States, they are even more striking in middle- and low-income countries.  Our two colleagues have undertaken to provide expanded training for mental health providers worldwide utilizing the WHO concept of "task shifting."  Through expanded training for the health care workforce, the goal is to empower less specialized health workers, such as counselors and social workers, to better assist those in need.

In many countries, there are few medical practitioners or doctoral level psychologists available to provide care, and the populations they serve are so vast that they are often not able to provide day-by-day care services to their patients.  Task shifting allows a mental health worker to make recommendations to a primary care provider regarding treatment options, based on augmented training in psychopharmacology, from a psychobiosocial perspective.  The mission of their recently established nonprofit organization, RxP International, is to provide training in psychiatric medications as an adjunct to the many types of therapies that can be used in place of medicine.  Helping midlevel practitioners gain the information and skills necessary is clearly a social justice concern with the focus being on teaching people to better help themselves.

Our colleagues have designed specific teaching modules that can be provided through distance learning and an open communication forum.  These will target the most commonly diagnosed conditions such as anxiety, depression, and psychosis, along with special populations such as the elderly and children.  Their online forum will be actively managed to assist student-providers in sharing their unique experiences and needs from their place in the world.  These personal interactions will provide a better understanding of the mental health needs and interests around the globe.  Their website can be accessed at www.rxpint.org for those who are interested in obtaining APA CE credit, by taking individual courses or pursuing a certificate.

            Unique Perspectives:  One of the most intriguing questions asked at our USUHS seminar was: Whether being the first nurse or the first female selected to serve as Surgeon General was more significant?  From the perspective of a world-wide audience the answer was fascinating.  "And if we get any knowledge, then we gain liberation" [George Harrison].  Aloha,

Pat DeLeon, former APA President – Division 29 – November, 2015

 

Sent from my iPhone

ALOHA - Division 55 Fall column

SUBSTANTIVE CHANGE TAKES TIME, AND IS EXCITING:

The Fiscal Year 2016 budget for the Centers for Disease Control and Prevention (CDC) proclaims: “Obesity has increased substantially over the past few decades.  An estimated 36% (78.6 million) of adults and 17% (more than 12.7 million) of children have obesity.  Americans with obesity are at higher risk for developing hypertension, high cholesterol, type 2 diabetes, heart disease, and certain cancers especially earlier in life, and for premature death.”  Obesity is projected to result in $147 billion in annual health care costs to the U.S. economy.  Today 61% of military personnel are either overweight or obese.  In May of 2010, the White House Task Force on Childhood Obesity submitted its report to the President entitled Solving the problem of childhood obesity within a generation.  The Task Force reported that overweight and obese children are more likely to become obese adults and estimated that obesity caused 112,000 deaths per year in the United States.  They further proffered that the current generation may be on track to have a shorter lifespan than their parents.  The President of the American Medical Association (AMA) recently described their proactive initiatives in this area at the Uniformed Services University of the Health Sciences (USUHS), having served more than 23 years in the U.S. Navy.  Addressing obesity should be a national priority for all health care professions.

            More than a decade ago, in April, 2004, the then-Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) testified before the U.S. Senate on the relationship between obesity and the environment.  “Environment and behavior intersect in fundamental ways, intersecting with our biology but also with each other.  In no area of public health is this more apparent than with the problem of obesity.  There is a growing body of literature that illustrates the negative physical and mental health effects of unregulated and poor urban, rural, and suburban development and planning.  These studies have documented increased rates of obesity, diabetes, depression, anxiety, and heart disease in these poorly developed areas….

“The NIEHS is designing a program as part of the trans-NIH obesity initiative which is designed to examine how the built environment affects obesity and the effectiveness of changes in community planning, design, and development in reducing the extent of obesity and associated comorbidities.  These intervention research projects will develop tools to characterize and measure individual and population-level indicators of healthful communities – and of residents’ lifestyles and behaviors – that prevent or reduce obesity.”

           From a public policy perspective, the Director’s 2004 public health-oriented testimony was visionary.  This was at a time when psychology was working diligently to convince the leadership of the NIH that the behavioral sciences, and psychology in particular, could significantly contribute to the underlying NIH mission of advancing the health of the nation.  Over the past decade there has been an increasing acceptance of behavioral issues within NIH, even if some of it was a reluctant or grudging acceptance.  Much of the acceptance was fueled by the constant messages from Congressional champions of behavior, expressing their belief that behavior was a critical factor in health.  At the heart of this effort to convince the Congress to support behavioral health research was Alan Kraut, formerly with APA and recently retiring as CEO of the Association for Psychological Science (APS).  For decades, Alan was a most impressive, if not almost constant, presence on Capitol Hill, truly “making a difference.”

            On September 15, 2015, President Obama signed the Executive Order “Using Behavioral Science Insights to Better Serve the American People,” which Ron Wood thoughtfully brought to our attention.  “A growing body of evidence demonstrates that behavioral science insights – research findings from fields such as behavioral economics and psychology about how people make decisions and act on them – can be used to design government policies to better serve the American people.  Where Federal policies have been designed to reflect behavioral science insights, they have substantially improved outcomes for the individuals, families, communities, and businesses those policies serve….  By improving the effectiveness and efficiency of Government, behavioral science insights can support a range of national priorities, including helping workers to find better jobs; enabling Americans to lead longer, healthier lives; improving access to educational opportunities and support for success in school; and accelerating the transition to a low-carbon economy.”

            The President went on to encourage his executive departments and agencies to identify policies, programs, and operations where applying behavioral science insights may yield substantial improvements in public welfare, program outcomes, and program cost effectiveness.  He urged, where possible, rigorously testing and evaluating the impact of behavioral science input and strengthening agency relationships with the research community to better use empirical findings from the behavioral sciences.  [The parallel to RxP with its long history of providing quality care at the federal and state level should be evident to the Division’s membership.]

            Learning From The Past:  One of the most exciting aspects of being personally involved in the public policy process is the constant exposure to individuals who have “made a difference” because of their personal vision, dedication, and commitment to a seemingly “impossible” goal.  Former APA President Nick Cummings was unable to attend this year’s convention in Toronto due to a previous commitment for the inauguration of his newest educational adventure.  Without question, one of Nick’s most lasting contributions to the field has been the establishment of the California School of Professional Psychology (CSPP), now Alliant International University, with their alumni representing nearly half of the practicing psychologists in California.  “In August, the newly provisionally licensed free-standing doctoral graduate college in mental health, the first such in 23 years, began world-wide classes on the internet.  Our daughter Janet heads the Cummings Graduate Institute (CGI) which is the successor to Arizona State University’s (ASU) Nicholas A. Cummings Doctor of Behavioral Health (DBH) program.  After seven highly successful years of turning out DBHs, with a spectacular employment rate in which four graduates are now CEOs of huge healthcare companies, a new ASU administration began moving the program more and more back into academic provincialism.  We successfully recreated our DBH into its free-standing status, and accomplished this within a year rather than the 10 years that had been predicted.  To apply a psychologist, social worker, counselor or nurse must have a master’s degree, be licensed, and have at least seven years of successful practice.  The interest has been enthusiastic, allowing CGI to accept only the best of the best applicants.”

            After returning from Toronto, we had the unique opportunity to hear Capt. (Ret.) Guy D. Gruters, USAF, share his experience with the USUHS community having been a Prisoner Of War in Vietnam for five years and three months, including at the notorious “Hanoi Hilton.”  A graduate of the Air Force Academy, he has been awarded more than 30 combat medals having flown over 400 combat missions during the Vietnam War, and was twice shot down – the second time being captured by the Viet Cong.  As he described the torture he and his colleagues (including U.S. Senator John McCain) underwent -- physical and emotional -- and especially the extraordinarily long periods of isolation, the audience could well appreciate that very few could survive.  “You have heard of being kicked around or slapped around.  I never knew what that meant until prison camp.”  “There were slightly over 3500 aircrew members shot down over North Vietnam in the years 1964 to 1973 who were not rescued.  In 1973, 591 POWs came home from all services and all countries in Southeast Asia of which 472 came home from North Vietnam.  The Russians and North Vietnamese tortured to death or killed in one way or another six out of every seven of us in North Vietnam.”  Belief in God and family were the key to survival.  Ever so humble, after his talk Capt. (Ret.) Gruters had lunch with several faculty and students, including two Doctor of Nursing Practice (DNP) mental health nursing students, and agreed to be interviewed by psychology graduate students for a forthcoming publication.  The importance and relevance of psychology for those who put themselves in “harm’s way” cannot be overstated.  Nick was a WWII paratrooper and since our last Division column, we learned that former APA and Division 55 President Ron Fox served in the National Guard.  Psychology should be proud of its uniformed services heritage.  Our colleagues have served the nation admirably.

            Closing Reflections:  When I reflect upon the vision and inner strength of these dedicated public servants, it gives me pause that today some seem to be trying to “punish” several of our academic colleagues, including destroying their careers, perhaps for example, for publicly accepting the invitation of the Department of Defense to visit Guantanamo Bay, per the Hoffman Report, without the APA governance having found any wrongdoing or malfeasance.  Universities are where ideas are to be critically debated; not where scholars or students are to personally attacked.  Equally important, providing everyone with Due Process – especially if one passionately disagrees with them -- is a fundamental value which psychology should never forsake.  Aloha,

Pat DeLeon, former APA President – Division 55 – October, 2015

 

SUBSTANTIVE CHANGE TAKES TIME, AND IS EXCITING:

The Fiscal Year 2016 budget for the Centers for Disease Control and Prevention (CDC) proclaims: "Obesity has increased substantially over the past few decades.  An estimated 36% (78.6 million) of adults and 17% (more than 12.7 million) of children have obesity.  Americans with obesity are at higher risk for developing hypertension, high cholesterol, type 2 diabetes, heart disease, and certain cancers especially earlier in life, and for premature death."  Obesity is projected to result in $147 billion in annual health care costs to the U.S. economy.  Today 61% of military personnel are either overweight or obese.  In May of 2010, the White House Task Force on Childhood Obesity submitted its report to the President entitled Solving the problem of childhood obesity within a generation.  The Task Force reported that overweight and obese children are more likely to become obese adults and estimated that obesity caused 112,000 deaths per year in the United States.  They further proffered that the current generation may be on track to have a shorter lifespan than their parents.  The President of the American Medical Association (AMA) recently described their proactive initiatives in this area at the Uniformed Services University of the Health Sciences (USUHS), having served more than 23 years in the U.S. Navy.  Addressing obesity should be a national priority for all health care professions.

            More than a decade ago, in April, 2004, the then-Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) testified before the U.S. Senate on the relationship between obesity and the environment.  "Environment and behavior intersect in fundamental ways, intersecting with our biology but also with each other.  In no area of public health is this more apparent than with the problem of obesity.  There is a growing body of literature that illustrates the negative physical and mental health effects of unregulated and poor urban, rural, and suburban development and planning.  These studies have documented increased rates of obesity, diabetes, depression, anxiety, and heart disease in these poorly developed areas….

"The NIEHS is designing a program as part of the trans-NIH obesity initiative which is designed to examine how the built environment affects obesity and the effectiveness of changes in community planning, design, and development in reducing the extent of obesity and associated comorbidities.  These intervention research projects will develop tools to characterize and measure individual and population-level indicators of healthful communities – and of residents' lifestyles and behaviors – that prevent or reduce obesity."

           From a public policy perspective, the Director's 2004 public health-oriented testimony was visionary.  This was at a time when psychology was working diligently to convince the leadership of the NIH that the behavioral sciences, and psychology in particular, could significantly contribute to the underlying NIH mission of advancing the health of the nation.  Over the past decade there has been an increasing acceptance of behavioral issues within NIH, even if some of it was a reluctant or grudging acceptance.  Much of the acceptance was fueled by the constant messages from Congressional champions of behavior, expressing their belief that behavior was a critical factor in health.  At the heart of this effort to convince the Congress to support behavioral health research was Alan Kraut, formerly with APA and recently retiring as CEO of the Association for Psychological Science (APS).  For decades, Alan was a most impressive, if not almost constant, presence on Capitol Hill, truly "making a difference."

            On September 15, 2015, President Obama signed the Executive Order "Using Behavioral Science Insights to Better Serve the American People," which Ron Wood thoughtfully brought to our attention.  "A growing body of evidence demonstrates that behavioral science insights – research findings from fields such as behavioral economics and psychology about how people make decisions and act on them – can be used to design government policies to better serve the American people.  Where Federal policies have been designed to reflect behavioral science insights, they have substantially improved outcomes for the individuals, families, communities, and businesses those policies serve….  By improving the effectiveness and efficiency of Government, behavioral science insights can support a range of national priorities, including helping workers to find better jobs; enabling Americans to lead longer, healthier lives; improving access to educational opportunities and support for success in school; and accelerating the transition to a low-carbon economy."

            The President went on to encourage his executive departments and agencies to identify policies, programs, and operations where applying behavioral science insights may yield substantial improvements in public welfare, program outcomes, and program cost effectiveness.  He urged, where possible, rigorously testing and evaluating the impact of behavioral science input and strengthening agency relationships with the research community to better use empirical findings from the behavioral sciences.  [The parallel to RxP with its long history of providing quality care at the federal and state level should be evident to the Division's membership.]

            Learning From The Past:  One of the most exciting aspects of being personally involved in the public policy process is the constant exposure to individuals who have "made a difference" because of their personal vision, dedication, and commitment to a seemingly "impossible" goal.  Former APA President Nick Cummings was unable to attend this year's convention in Toronto due to a previous commitment for the inauguration of his newest educational adventure.  Without question, one of Nick's most lasting contributions to the field has been the establishment of the California School of Professional Psychology (CSPP), now Alliant International University, with their alumni representing nearly half of the practicing psychologists in California.  "In August, the newly provisionally licensed free-standing doctoral graduate college in mental health, the first such in 23 years, began world-wide classes on the internet.  Our daughter Janet heads the Cummings Graduate Institute (CGI) which is the successor to Arizona State University's (ASU) Nicholas A. Cummings Doctor of Behavioral Health (DBH) program.  After seven highly successful years of turning out DBHs, with a spectacular employment rate in which four graduates are now CEOs of huge healthcare companies, a new ASU administration began moving the program more and more back into academic provincialism.  We successfully recreated our DBH into its free-standing status, and accomplished this within a year rather than the 10 years that had been predicted.  To apply a psychologist, social worker, counselor or nurse must have a master's degree, be licensed, and have at least seven years of successful practice.  The interest has been enthusiastic, allowing CGI to accept only the best of the best applicants."

            After returning from Toronto, we had the unique opportunity to hear Capt. (Ret.) Guy D. Gruters, USAF, share his experience with the USUHS community having been a Prisoner Of War in Vietnam for five years and three months, including at the notorious "Hanoi Hilton."  A graduate of the Air Force Academy, he has been awarded more than 30 combat medals having flown over 400 combat missions during the Vietnam War, and was twice shot down – the second time being captured by the Viet Cong.  As he described the torture he and his colleagues (including U.S. Senator John McCain) underwent -- physical and emotional -- and especially the extraordinarily long periods of isolation, the audience could well appreciate that very few could survive.  "You have heard of being kicked around or slapped around.  I never knew what that meant until prison camp."  "There were slightly over 3500 aircrew members shot down over North Vietnam in the years 1964 to 1973 who were not rescued.  In 1973, 591 POWs came home from all services and all countries in Southeast Asia of which 472 came home from North Vietnam.  The Russians and North Vietnamese tortured to death or killed in one way or another six out of every seven of us in North Vietnam."  Belief in God and family were the key to survival.  Ever so humble, after his talk Capt. (Ret.) Gruters had lunch with several faculty and students, including two Doctor of Nursing Practice (DNP) mental health nursing students, and agreed to be interviewed by psychology graduate students for a forthcoming publication.  The importance and relevance of psychology for those who put themselves in "harm's way" cannot be overstated.  Nick was a WWII paratrooper and since our last Division column, we learned that former APA and Division 55 President Ron Fox served in the National Guard.  Psychology should be proud of its uniformed services heritage.  Our colleagues have served the nation admirably.

            Closing Reflections:  When I reflect upon the vision and inner strength of these dedicated public servants, it gives me pause that today some seem to be trying to "punish" several of our academic colleagues, including destroying their careers, perhaps for example, for publicly accepting the invitation of the Department of Defense to visit Guantanamo Bay, per the Hoffman Report, without the APA governance having found any wrongdoing or malfeasance.  Universities are where ideas are to be critically debated; not where scholars or students are to personally attacked.  Equally important, providing everyone with Due Process – especially if one passionately disagrees with them -- is a fundamental value which psychology should never forsake.  Aloha,

Pat DeLeon, former APA President – Division 55 – October, 2015

 

Sent from my iPhone

Division 18 Fall column

ON THE SHOULDERS OF GIANTS

            Honoring Visionary Colleagues:  During our APA conventions, I enjoy attending the APF/APA Awards ceremonies, reflecting upon the outstanding accomplishments of our colleagues over the years.  In Toronto, Division 18 Fellow Walter Penk received the APF Gold Medal Award for Life Achievement in the Practice of Psychology, recognizing his distinguished career and enduring contributions for advancing professional practice.  His dedication and leadership at various federal and state agencies, as well as in academic settings, has significantly improved the lives of numerous veterans and Wounded Warriors, inspiring resiliency and post-traumatic growth.  Walter was among the first to publish clinical work identifying PTSD, as well as addressing the need to consider issues of diversity among ethnic groups when looking at PTSD.  We were proud that under the Presidency of Femina Varghese, Division 18 honored two members of the Psychological Services editorial team, Lisa Kearney and Phil Magaletta, for their tireless inspirational leadership.  With these visionary mentors, the future for public service psychology looks very bright.

            At the American Psychological Foundation (APF) Toronto reception, former East-West Center Fellow and Visionary Grant recipient Kate Corlew provided an overview of her research addressing risk perception regarding natural disasters and climate change in Hawaii and American Samoa.  “Many communities in the Pacific Islands Region are vulnerable now to the impacts of climate change.  The extent of the impacts varies from place to place, but what remains true is that the impacts do not occur in a vacuum – they accumulate and exacerbate each other and other disaster events and environmental hazards.  My project was based on Maui and American Samoa.  Both sites experience the accumulated effects of disasters and hazards.  Maui has experienced increased rates of extreme drought punctuated by heavy storms (as opposed to the regular rainy and dry seasons).  Secondary impacts from fluctuating between extremes include wildfire and dusty air during drought, and floods and mudslides during storms.  American Samoa has been hit by a number of disasters in the last six years – a devastating tsunami that destroyed villages and killed many people, followed by multiple hurricanes.  American Samoa is experiencing and projected to continue to experience compounding disasters.

            “My research compared the psychological experiences of disaster recovery in the two sites (minor emergency events in Maui and large-scale disasters in American Samoa).  Through a series of surveys, interviews, and community workshops, I explored psychological recovery, risk perception for future disasters and for climate change, and preparedness (emergency kits, plans, etc.) for future disasters.  I found that having experienced a large scale disaster was the best predictor for taking preparedness actions against future disasters.  Surviving a disaster was a better predictor than profession (i.e., disaster and climate change professionals were no more likely than other participants to have an emergency kit and plan in place than anyone else, unless they had personally experienced disasters) and was a better predictor than experiencing small-scale hazards that were inconveniently damaging but not devastating (e.g., a mudslide that blocked roads but did not kill anyone.)

            “During the interviews and community workshops, I gathered stories and advice from community members, disaster and climate change professionals, and community leaders about disaster preparedness education in the focal communities.  Using disaster preparedness guidelines from the American Red Cross and Ready.Gov, I developed community preparedness handbooks for the focal communities.  The handbooks included simple step-by-step guides for preparedness planning, as well as stories from their community about disaster events, hazards, risk, and preparedness.  Over 1,000 handbooks were disseminated for free back into communities (funded by the APF Visionary Grant), including handbooks in English and Samoan to American Samoa.  I have received requests from both sites to hold more workshops.  I am also beginning to develop a similar program of research and community education in Maine, where I am now located.”  APF is in the middle of the Campaign to Transform the Future to increase its grant-making capacity.  Although APF grants approximately $800,000 annually, only 10% of those who apply can be supported.  It is the Foundation’s hope that with this Campaign no worthy graduate student or early career psychologist will go without needed support.  Psychology’s visionaries can make a real difference in the lives of our nation’s citizens.

            Change Can Be Unsettling:  The Senate Appropriations Committee estimates the Department of Veterans Affairs (VA) is responsible for providing care to approximately 48.3 million Americans, or 15% of the nation’s population.  The VA has the nation’s largest integrated healthcare system, consisting of 167 medical centers, 1,018 community-based outpatient clinics, 300 Vet centers, and 135 community-based living centers.  This year the Committee noted: “Congress authorized the employment of licensed professional mental health counselors [LPMHC] and marriage and family therapists [MFT] by VA.  However, the two professions comprise less than 1 percent of the VA behavioral health workforce despite representing 40 percent of the overall [nation’s] independent practice behavioral health workforce….  The Department is directed to report… on the status of hiring additional LPMHC and MFT professionals and detailing how many are currently enrolled and planned to be enrolled in VA’s mental health professional trainee program.”  Further, “The Committee encourages the Department to consider the expanded use of physician assistants [PAs] specializing in psychiatric care to address the mental health provider gap.  PAs provide high quality, cost-effective medical care and are held to the same standard of healthcare delivery as their physician colleagues.”

            I recently had the opportunity to read the thought-provoking book Building School-Based Collaborative Mental Health Teams: A Systems Approach to Student Achievement by Kathleen Laundy.  She is a psychologist who is also a MFT.  It is important for practitioners who are concerned about the future of their profession to understand the experiences of the other behavioral health professions, rather than remaining within isolated professional silos.  Our colleague describes the impressive contributions that MFTs have made within the Connecticut school system and their increasingly successful efforts to develop a national grass-roots support network.  Her case examples are vivid illustrations of how MFTs are making a real difference in individual student lives – which, of course, is the key to political success.

            This is at a time when the Obama Administration is raising fundamental issues regarding the consequences of restrictive licensure for health care professionals, including limitations on licensure mobility and variations in professional scopes of practice within the states.  “Current scope of practice laws for advanced practice registered nurses – nurses such as nurse practitioners (NPs) with master’s degrees or more – vary dramatically by State, both in terms of their substantive content and the level of specificity that they provide.  But State-level evidence suggests that easing scope of practice laws for APRNs represents a viable means of increasing access to certain primary care services.  Research finds that APRNs can provide a broad range of primary care services to patients as effectively as physicians.”  The Administration notes that this trend has expanded to the legal profession with the Supreme Court of Washington State in 2012 adopting a rule creating a new category of legal practitioners – limited license legal technicians (LLLTs).  And, “According to the Pew Health Professions Committee report in 1995, policymakers should endeavor to allow practitioners to offer services to the full extent of their competency and knowledge, even if this means that multiple professions are licensed to offer overlapping services (Occupational Licensing: A Framework for Policymakers).”   Aloha,

Pat DeLeon, former APA President – Division 18 – September, 2015